glass of alcohol

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Several medications can help people with alcohol use disorders maintain abstinence or reduce drinking, according to research from the University of North Carolina at Chapel Hill.

The work, published today in the Journal of the American Medical Association (JAMA) and funded by the Agency for Healthcare Research and Quality (AHRQ), provides additional options for clinicians to effectively address this global concern.

Although alcohol use disorders are associated with many health problems, including cancers, stroke and depression, fewer than one-third of people with the disorders receive any treatment and less than 10 percent receive medications to help reduce alcohol consumption.

“There are many studies that have tried to show whether certain medications can help with alcohol use disorders, but it is a lot of information to digest and many providers do not know what works or doesn’t work,” said Daniel Jonas, lead author of the study and professor in the department of medicine and the Cecil G. Sheps Center for Health Services Research. ”When you synthesize all the evidence, it shows pretty clearly that some medications do work.”

Jonas led a team from the RTI-UNC Evidence-based Practice Center to review published studies examining the use of drugs to treat alcohol use disorders. The researchers conducted a systematic review of 122 randomized controlled trials and one cohort study. They then graded the strength of the evidence on the impact of drugs on alcohol consumption.

They found that two drugs, acamprosate (brand name Campral) and oral naltrexone (brand name Revia), have the best evidence supporting their benefits. Both drugs reduced return to drinking and improved other drinking outcomes. Among medications used off-label (i.e., those not FDA approved for alcohol use disorders), moderate evidence showed improvement in some drinking outcomes for topiramate and nalmefene.

“The health implications of preventing return to drinking and reducing alcohol consumption are substantial,” said Jonas. ”Modeling studies have shown that such improvements would result in significant reductions in alcohol-attributable mortality, costs from health care, arrests and motor vehicle accidents.”

“This work expands upon the growing evidence that medications can play a valuable role in the treatment of alcohol use disorders,” said James Garbutt, professor of psychiatry and scientist at UNC’s Bowles Center for Alcohol Studies and senior author on the paper. “We are hopeful that this information will encourage clinicians to strongly consider these medications and that individuals will gain awareness that there are medications that can help them to stop or significantly reduce their alcohol use.”

The study was developed by the AHRQ-funded RTI-UNC Evidence-based Practice Center is a collaboration between RTI International and the University of North Carolina at Chapel Hill. Jonas co-directs the center with Meera Viswanathan at RTI. The review is an update of the first product of the center, which was published in 1999 in JAMA. Since 1999, there has been more than a tenfold increase in the number of individuals studied in controlled clinical trials of naltrexone and acamprosate, and many trials of medications that are not FDA-approved.

University of North Carolina at Chapel Hill

Sleepless Mature Man

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If counting sheep can’t help you sleep, you could try thinking of an elephant, French toast and scuba diving.

Simon Fraser University researcher Luc Beaudoin has created mySleepButton, a first-of-its-kind app that harnesses the power of the imagination to help users nod off.

Distributed by Apple as a free iTunes download, the app incorporates concepts from cognitive science, a multidisciplinary study of the mind and its processes. It works by preventing sleep-interfering thoughts and activating a mechanism that could help trigger sleep.

Based on the “cognitive shuffle” technique developed by Beaudoin, an SFU adjunct education professor, the app works by prompting users to imagine various objects or scenes in rapid succession.

“For example, one moment, users may be directed to think of a baby, then next a football game, then beans, a ball, London, and so on,” he says.

The method is based on the uniquely incoherent nature of sleep onset “mentation,” a term used by Beaudoin that refers to all kinds of mental activity.

“As you fall asleep, you tend to entertain various detached thoughts and images. The app gets users to think in a manner that, like sleep onset, is both visual and random,” explains Beaudoin.

In a nutshell, it’s a case of ‘fake it until you make it.’

“Brain areas involved in controlling sleep detect that sense-making has been suspended. This basically gives them an implicit license to continue the transition to sleep,” he adds.

Executive functions—brain functions like planning, worrying and problem solving that are vital for helping us make sense of the world during waking hours—can delay sleep when they don’t switch off at bed time.

By prompting users to interpret and visualize words, mySleepButton can help deactivate these executive functions. “While you’re thinking about random objects or scenes, you can’t think about your mortgage, an important meeting or an impending divorce,” says Beaudoin.

“That’s because, to a certain extent, we all have one track minds. It’s very hard to think about multiple distinct things at the same time.”

Beaudoin, an associate member of SFU’s cognitive science program, says the app could also help increase cognitive productivity.

“Quality of work decreases when people are sleep-deprived and getting adequate sleep is very important for cognitive performance,” he says.

The app has potential applications for industries that employ scientific knowledge workers, such as software and aviation, or for employees on variable schedules who need to be alert, such as transportation workers.

The application is also a valuable research tool for sleep science and cognitive science, says Beaudoin, who authored the book Cognitive Productivity. Data collected from consenting users could be used in scientific studies or feed directly into further development of the app.

Simon Fraser University

Simon Fraser University is consistently ranked among Canada’s top comprehensive universities and is one of the top 50 universities in the world under 50 years old. With campuses in Vancouver, Burnaby and Surrey, B.C., SFU engages actively with the community in its research and teaching, delivers almost 150 programs to more than 30,000 students, and has more than 125,000 alumni in 130 countries.

by Norma Desmond

Image: Norma Desmond

The incidence of autism spectrum disorders is rising in the United States, and the latest estimates reveal one in 68 American children is affected.In 2012, the rate of incidence was one in 88.

 
New findings released March 27 in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report, include data collected by University of Alabama at Birmingham researchers who lead the Alabama Autism Surveillance project, a part of the CDC’s Autism and Developmental Disabilities Monitoring Network.

Autism spectrum disorders are a group of developmental disabilities that can cause significant social, communication and behavioral challenges. The ADDM Network data help the CDC direct research into potential risk factors and help communities direct outreach efforts to those who need it most.

“We are confident that some of this increase is due to increased awareness and access to services; however, those issues don’t explain all of the increase,” Martha Wingate, Dr.PH, director of the AASP and associate professor in the UAB School of Public Health, said of the data, which were collected at 11 ADDM sites during the 2010 surveillance year.

“Our study focuses on providing an estimate of children affected to help with policy development and planning for medical providers and schools, but other researchers are working hard to figure out why there is an increase,” Wingate said. “Some studies are looking at paternal age, preterm birth and other factors; but there is not one cause.”

In Alabama, the number of 8-year-olds identified was one in 175 children, compared with one in 303 in 2002. Wingate says this is lower than at some other ADDM sites, but it’s still an increase of more than 70 percent.

The study also found approximately one in 42 boys and one in 189 girls living in the ADDM Network communities were identified as having ASD. Non-Hispanic white children were approximately 30 percent more likely to be identified with ASD than were non-Hispanic black children, and they were almost 50 percent more likely to be identified with ASD than were Hispanic children.

“Our biggest focus continues to be on recognizing the signs and symptoms of autism spectrum disorders and other developmental disabilities and getting children access to services early,” Wingate said. “The CDC’s “Learn the Signs. Act Early.” campaign is focused on educating providers and parents about the importance of recognizing developmental delays and getting children into the appropriate services.”

© Istockphoto

© Istockphoto

In a large population-based cohort study, researchers have found a link between poor cardiovascular fitness and low cognitive performance at age 18 and the later onset of dementia. The study’s lead researcher was Jenny Nyberg, Ph.D., of Sweden’s University of Gothenburg. Results appear in the new issue of Brain.

The study included more than 1 million Swedish men. At age 18, they underwent mental and physical exams as part of their military conscription. These men were then followed up for up to 42 years to see which ones developed early-onset dementia. The researchers then used the data to see whether there was an association between cardiovascular and cognitive fitness at age 18 and early-onset dementia.

The researchers found that such an association did exist. Both low cardiovascular and cognitive performance in early adulthood were associated with an increased risk for future early-onset dementia, but the highest risks were observed for individuals who had poor performance in both areas.

“This technically well-executed study is among the first to link cardiovascular fitness and cognitive functioning at a young age with early-onset dementia,” Kostas Lyketsos, M.D., chair of psychiatry at Johns Hopkins Bayview Medical Center and a geriatric psychiatrist, told Psychiatric News. “As the study is observational, high confidence in a causal link is not possible. However, the findings are consistent with other research linking cardiovascular health or disease and cognitive functioning or reserve with late-onset dementia decades later. Much research is needed to translate this finding into a specifically actionable preventative intervention. For now, active efforts to maintain cardiovascular and cognitive fitness through the lifespan, starting at a young age, offer some promise of preventing or delaying the onset of dementia at mid- or later life.”

Another large study identified still other risk factors for early-onset dementia. See the Psychiatric News article, “Early-Onset Dementia Linked to Alcohol Abuse, Other Factors.” In addition, extensive information about dementia can be found in American Psychiatric Publishing’s Clinical Manual of Alzheimer Disease and Other Dementias.

Source: American Psychiatric Association