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Autumn 2004, Vol 8 No 1

the front cover of a crosscurrents magazine- the main image is a vase with bold coloured flowers

 

Research Update            

By: Hema Zbogar

 

Cocaine-exposed children benefit from healthy home environment

Babies born to mothers who used cocaine heavily during pregnancy do not have lower IQ scores than other children, although they may have problems with specific skills. Researchers at Case Western Reserve University in Cleveland, Ohio, tracked 190 cocaine-exposed children and 186 non-exposed children from birth until age four. The researchers found that both groups had similar IQ scores at age four, but the cocaine-exposed children performed worse on tasks involving visual-spatial skills, as well as on general knowledge and arithmetic tests. However, cocaine-exposed children placed in foster care or adoptive homes appeared to overcome those problems. Adoptive and foster parents tended to be better educated and had a more stimulating home environment than parents or relatives of cocaine-exposed children. Previous studies have found developmental problems among such children, but few have taken into account the child’s home environment. The authors conclude that a positive home environment may compensate for some of the negative effects of prenatal cocaine exposure. They suggest that early environmental intervention may prevent developmental disabilities among some cocaine-exposed children.

 

Journal of the American Medical Association, May 24, 2004, v. 291: 2448–2456. Lynn T. Singer et al., Department of General Medical Sciences and Pediatrics, Case Western Reserved University, Cleveland, Ohio.

 

Moderate alcohol use may be safe after heart attack

Drinking up to 10 alcoholic beverages per week does not increase the risk of heart failure among individuals who have had a heart attack, say researchers at the University of Texas in Houston. Researchers assessed the outcomes of 2,231 participants in the Survival and Ventricular Enlargement Trial, a study of individuals who had experienced a heart attack and were at risk for heart failure. Based on their alcohol use, participants were classified as non-drinkers, light-to-moderate drinkers (up to 10 drinks per week) or heavy drinkers (more than 10 drinks per week). There was no evidence that light-to-moderate drinking increased risk of heart failure, but heavy alcohol use did. The results are in line with ear-lier studies that have found that moderate alcohol use is not harmful, but that heavy drinking may be linked to coronary heart disease. How-ever, the authors caution that a larger number of participants is needed to confirm the association between drinking and heart failure risk.

Journal of the American College of Cardiology, June 2004, v. 43: 2015–2021. David Aguilar et al., University of Texas Health Science Center, Houston, Division of Cardiology, Houston, Texas.

 

Food additives linked to ADHD symptoms

Food additives may be associated with symptoms of attention-deficit/hyperactivity disorder (ADHD), according to researchers at the University of Southampton in the United Kingdom. The study was conducted over a four-week period on 277 three-year-olds. All children underwent baseline testing for hyperactivity. During the first week, all children were put on a diet free of artificial colourings and preservatives. During the next three weeks, the children were given either a drink containing artificial colourings and the preservative sodium benzoate or a placebo mixture. Parents, who were blind to which drink their children were getting, kept a daily journal of their children’s behaviour. Parents of children taking the additive drink reported that their children were more active, inattentive and short-tempered than parents whose children received the placebo. The number of children identified as hyperactive fell to six per cent from 15 per cent with the change in diet. Children who had been diagnosed as hyperactive at baseline were not found to be more affected by the additives than children without the diagnosis. However, the differences between the additive and placebo group were not observed on formal tests by researchers. The authors recommend further studies using general population samples and extending the study to older age groups.

 

Archives of Diseases in Childhood, June 2004, v. 89: 506–511. B. Bateman et al., Infection, Inflammation and Repair Division, University of Southampton, United Kingdom.

 

Alternative and conventional medicine need more communication, collaboration

Among people turning to complementary and alternative medicine (CAM) for mental health issues, co-occurring treatment by conventional medical providers is common, but communication or co-ordination of care is rare, according to researchers at the Center for Health Studies in Seattle, Washington. A sample of acupuncturists, chiropractors, massage therapists and naturopathic physicians in four states reported on 8,933 consecutive visits, including demographic characteristics, presenting complaints, referral source, treatments provided, disposition and other sources of care for the problem. The proportion of visits for a mental health problem ranged from seven to 11 per cent for all but chiropractors, for whom mental health problems accounted for one per cent of visits. The CAM provider discussed care with a conventional medical provider in six to 20 per cent of cases and was aware of concomitant conventional medical care in an additional 10 to 30 per cent. Only one to five per cent of CAM users were subsequently referred to conventional providers. The authors call for increased communication and co-ordination of care and for more training in mental health for CAM providers.

 

General Hospital Psychiatry, June 2004, v. 26: 171–177. Gregory E. Simon et al., Center for Health Studies, Group Health Cooperative, Seattle, Washington.

 

Mental illness under-treated globally

Mental illnesses, including anxiety disorders and depression, are common and under-treated in many developed and developing countries, according to the World Health Organization Mental Health Survey Consortium. The study was based on a face-to-face, two-hour survey in the homes of 60,463 adults in 14 countries: Belgium, China, Colombia, France, Germany, Italy, Japan, Lebanon, Mexico, the Netherlands, Nigeria, Spain, Ukraine and the United States. The study found that mental illness affected more than 10 per cent of respondents in more than half the countries surveyed. Rates of illness ranged from 26 per cent in the United States to five per cent in Nigeria. In developed countries, between 36 and 50 per cent of people with serious symptoms were untreated. In developing nations, that rate was between 76 and 85 per cent. The researchers caution that the prevalence of mental illness may be underestimated because the survey used subjective data, and questions about certain disorders were not asked in all countries. In all countries, a substantial proportion of people with less severe cases received treatment, suggesting a “misallocation of treatment resources.” The authors call for better health care systems and training, stating that reasons for under-treatment include lack of access to health care and lack of insurance coverage for mental health treatment in some countries.

 

Journal of the American Medical Association, June 2004, v. 291: 2581–2590. The WHO World Mental Health Survey Consortium.

 

Concurrent disorders prevalent among needle exchange program users

Psychiatric and substance use comorbidity is common among users of syringe exchange programs, according to a study at Johns Hopkins University in Baltimore, Maryland. Participants were 422 male and female intravenous opioid users who accessed a community needle exchange program in Baltimore. Participants were over age 18, with an average age of 38. Researchers administered the Structured Clinical Interview for the DSM-IV for Axis I disorders and antisocial personality disorder (APD). Major depression was the most common current (6%) and lifetime (21%) psychiatric disorder. APD was diagnosed among 37 per cent of participants. More than 50 per cent were diagnosed with at least one psychiatric disorder or APD. In addition to opioid dependence, cocaine dependence was the most common current (68%) and lifetime (78%) substance use disorder, followed by alcohol (68%, 33%) and cannabis dependence (51%, 8%). Participants reported an average of one current and more than three lifetime substance use disorders in addition to opioid dependence. Presence of a psychiatric disorder was associated with increased prevalence of a substance use disorder for all drug classes. The authors conclude that the high comorbidity rates suggest that needle exchange programs can enhance their harm reduction efforts by referring participants to programs that treat substance use and psychiatric disorders.

 

Drug and Alcohol Dependence, May 2004, v. 74: 115–122. Michael Kidorf et al., Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.

 

PTSD common after orthopaedic trauma

About half of people with an orthopaedic traumatic injury develop post-traumatic stress disorder (PTSD), according to researchers at the University of Texas in Dallas. Researchers administered the Revised Civilian Mississippi Scale for Posttraumatic Stress Disorder Questionnaire to 580 individuals with orthopaedic trauma. Demographic and injury data were also collected. The study found that 51 per cent of participants met the criteria for PTSD. The best individual predictor of PTSD was a positive response to the item “The emotional problems caused by the injury have been more difficult than the physical problems,” although the item was only a fair predictor of the presence of PTSD. The prevalence of PTSD was higher among individuals injured in motor vehicle–pedestrian collisions (65%) or in motor-vehicle collisions (57%) than among those injured in a fall (43%). Participants with PTSD had significantly higher injury severity scores and a longer duration since the injury than those without PTSD. However, these variables alone could not identify participants with PTSD. The researchers are planning a multi-centre prospective randomized trial comparing the rate of PTSD, depression and anxiety among orthopaedic trauma clients who get cognitive behavioural therapy to a similar group that gets the current standard of care, which is no psychological treatment.

 

Journal of Bone and Joint Surgery June 2004, v. 86: 1115–1121. Adam J. Starr et al., Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.