Forget Everything You Know About Diets and Healthy Eating

CellScience now has an explanation for why many of us try out the latest diet only to find that it is not working. A study published in the journal Cell this week, has demonstrated that different people’s bodies respond to eating the same meal very differently – which means that a diet that may work wonders for one person may not have the same impact on another. A key component used in creating balanced diet plans like Atkins, Zone or South Beach called the glycemic index, developed decades ago as a measure of how certain foods impact blood sugar level, was assumed to be a fixed number. But it’s not. It turns out that it varies widely depending on the individual.

The researchers studied 800 volunteers and collected data through health questionnaires, body measurements, blood tests, glucose monitoring and stool samples. They also had the participants input lifestyle and food intake information into a mobile app that ended up collecting information on a total of 46,898 meals. They found that not only does age and body mass index impact blood glucose level after meals but that different individuals showed vastly different response to the same food even though their own responses remained the same day to day.

The Beginnings of Personalized Dieting and Nutrition

The researchers said these findings show that tailoring meal plans to individuals’ biology may be the future of dieting and that the study yielded many surprises for individuals. For example, a middle-aged woman in the study tried and failed many diets. Tests revealed that her blood sugar levels spiked after eating tomatoes – indicating it is a poor diet choice for her since blood sugar has been associated with cardiovascular problems, obesity and diabetes – but since she didn’t know this, she was eating them as part of her healthy diet plans several times a week.

The authors collected extensive phenotypic data from these individuals, which were then used to train a machine-learning algorithm that could accurately predict glycemic response to various meals. This study is an important proof-of-principle for the utility of tailoring nutritional and/or pharmaceutical interventions to each individual. Precise predictions of glycemic response could represent a powerful tool to optimize dosing of insulin (or dietary interventions) in type 1 or even type 2 diabetics to avoid hypoglycemic episodes and more.  According to the lead author, the work “really enlightened us on how inaccurate we all were about one of the most basic concepts of our existence, which is how we eat and how we integrate nutrition into our daily life.”

Source: Cell

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Diabetes Screening Inadequate in Mentally Ill

JAMA-IMNew research shows that despite long-standing recommendations that severely mentally ill patients who take antipsychotics undergo annual screening for diabetes and other metabolic disorders, only 30% receive such screening. A recent research letter in JAMA Internal Medicine described a retrospective cohort study that analyzed diabetes screening prevalence and predictors of screening among adults in the California public mental health care system with severe mental illness taking antipsychotic medications.

The study cohort included adults with a diagnosis of severe mental illness who received a prescription for an antipsychotic medication at least once during each of the study periods. Of 50,915 patients in the study, only 15,315 (30.1%) received diabetes-specific screening. A total of 15,832 (31.1%) received no form of glucose screening at all during the year-long period. The rates for those who received no glucose screening were similar regardless of age (38.4% for patients aged 18 – 27 years; 31.9% for patients aged 28 – 47 years; 26.9% for those aged 48 – 67 years; and 40.9% for those aged 68 years and older). The study noted that contact with primary care improved diabetes screening rates. Patients with severe mental illnesses who had at least one primary care visit in addition to receiving mental health services were more than twice as likely to be screened than those who did not have a primary care visit (35.6% vs 19.8%).

An editorial that accompanied the new study, Mitchell M Katz, MD pointed out that “To improve care for persons with serious mental illness, it will be necessary to break down the silos that separate the mental health and physical health care systems. Integrated care (care provided by a team of physical and mental health clinicians)—or at least colocated care (care provided by physical and mental health clinicians in the same place)—offers the promise of improving the physical health of individuals with mental illness, as well as the mental health of those seeking physical health services.

Mangurian  C, Newcomer  JW, Vittinghoff  E,  et al.  Diabetes screening among underserved adults with severe mental illness who take antipsychotic medications [published online November 9, 2015]. JAMA Intern Med. doi:10.1001/jamainternmed.2015.6098.

Katz, MH. Improving the Health of Persons With Serious Mental Illness. JAMA Intern Med. Published online November 09, 2015. doi:10.1001/jamainternmed.2015.6159

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Diagnostic Method for Alzheimer’s from Sweden Becomes International Standard

gu2Researchers at Gothenburg University have developed a reference method for standardized measurements that diagnose Alzheimer’s disease decades before symptoms appear. The method has now formally been classified as the international reference method, which means that it will be used as the standard in Alzheimer’s diagnostics worldwide.
Beta amyloid protein is commonly found in the brain. While the protein’s normal function is not completely understood, it is believed that it participates in the formation and removal of synapses, which is essential in enabling the brain to form new memories. In healthy people, beta amyloid is quickly transported out to the spinal fluid and blood. But in individuals with Alzheimer’s disease, the beta amyloids remain in the brain, where they clump together and begin to damage the synapses, which leads to nerve cell death.

This process can begin in middle age and continue unnoticed for decades until the nerve cells are so damaged that symptoms take the form of a memory disorder and impaired cognitive abilities. At that point, the disease is felt to be too advanced to be treated, so intensive worldwide research is underway to find methods that diagnose Alzheimer’s sooner. After decades of research, Henrik Zetterberg and Kaj Blennow at Sahlgrenska Academy, Gothenburg University, were able to develop a method that measures the exact amount of beta amyloid in spinal fluid and diagnose Alzheimer’s ten to thirty years before the disease becomes symptomatic.

The Gothenburg researchers’ pioneering studies have gained wide international recognition since the measurement method they developed was approved as the international reference method by the Joint Committee for Traceability in Laboratory Medicine (JCTLM), whose goal is to promote and provide guidance on equivalent, internationally recognized and accepted measurements within laboratory medicine. The new method will be used as the norm for standardizing beta amyloid measurements around the world.

Source: University of Gothenberg

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National Depression Screening Day

October 8th is National Depression Screening Day
This year commemorates the 25th Annual National Depression Screening Day

Screenings in schools

Mental health professionals are using screenings as a way to identify potential physical and mental health conditions. Just as a blood pressure screen helps to detect warning signs, a mental health screening provides a quick and effective way to recognize students who are at risk for treatable mental health disorders.

Screening at work

Early detection, assessment, and treatment can have a significant impact on the lives of those who experience mental health issues. Not only can this prevent mental health problems from worsening, but it can also improve worker productivity and decrease the cost of providing health insurance.

Community Screening

Many community organizations are offering free screening for depression and other mental health issues

More informaton

Mental Health Screening

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Shared Decision Making Tool for Antidepressant Choices

mayologoThe choice of antidepressant in primary care can directly affect outcomes and quality of care for patients with depression. Faculty at the Mayo Clinic developed the Depression Medication Choice (DMC) encounter decision aid, designed to help patients and clinicians consider the available antidepressants and the extent to which they improved depression and other issues important to patients.

A tool to help patients with depression make informed decisions about appropriate antidepressants improves the antidepressant decision-making process without extending the length of primary care visits, according to a report in JAMA Internal Medicine. The tool, developed by researchers at the Mayo Clinic in Rochester, Minn., is called Depression Medication Choice (DMC). DMC consists of a series of cards that present general information about antidepressant efficacy and highlight various features of antidepressants—for instance, effects on sleep, sexual issues, and weight gain. The cards are used by the patient with the clinician during the primary care visit.

Mayo researchers conducted a cluster randomized trial of adults with moderate to severe depression considering treatment with an antidepressant. Primary care practices in 10 rural, suburban, and urban primary care practices across Minnesota and Wisconsin were randomly allocated to treatment of depression with or without use of the DMC decision aid. Compared with usual care, use of DMC significantly improved patients’ decisional comfort, knowledge, satisfaction, and involvement. It also improved clinicians’ decisional comfort. There were no differences in encounter duration, medication adherence, or improvement of depression control between study arms.

Source: JAMA Internal Medicine

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Americans Say They View Mental and Physical Health As Equally Important

A recent Harris Poll survey about attitudes toward mental health was conducted on behalf of the Anxiety and Depression Associations of America, American Foundation for Suicide Prevention and the National Alliance for Suicide Prevention. Over 2,000 US adults over 18 responded. Results revealed that “ majority (65%) of U.S. adults has seen a primary care physician within the past 12 months, yet only 12% have seen a mental health counselor or therapist. Despite this, about 9 in 10 adults (89%) feel that mental health and physical health are equally important for their own overall health. However, more than half (56%) say that, in our current healthcare system, physical health is treated as more important than mental health, and less than one-third (28%) feel that mental and physical health are treated equally. It is not surprising then that the overwhelming majority (92%) of adults feel that health services that address mental health, such as treatment for depression and suicide prevention, are fundamental to overall health and should be part of any basic health care plan.”

While nearly two in five adults (38%) believe that seeing a mental health professional is a sign of strength, more than four in ten (43%) believe it is something that most people can’t afford. Similarly, three in ten feel it is not accessible for most people (31%) or something people do not know where to find (30%). The most common diagnoses were depression (21%) and anxiety/panic disorder (20%). While only a third of adults have ever been diagnosed, nearly half (47%) admit that they have thought they may have had a mental health condition at some point. Nearly a third (31%) presumed they had anxiety/panic disorder (31%), while more than a quarter (28%) considered that they may have depression.

  • Among adults who have been employed in the past 12 months, more than 1 in 10 have missed work days because they were too anxious (14%) or too depressed (16%) to go to work.
  • Nearly two in five (38%) adults have ever received treatment for a mental health condition. Talk therapy (29%) is the most commonly used treatment resource, followed by prescription medication (25%).

Source: American Foundation for Suicide Prevention Website

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Revised Practice Guidelines for the Psychiatric Evaluation of Adults

The AmePractGuiderican Psychiatric Association has released the third edition of the Practice Guidelines for the Psychiatric Evaluation of Adults. These guidelines are different from previous versions in that they represent the first APA guidance developed using a new process that addresses standards set forth in a 2011 Institute of Medicine (IOM) report titled “Clinical Practice Guidelines We can Trust.”

In line with the IOM recommendations, this new edition of the practice guidelines was developed following an extensive review of the literature as well as input from around 800 experts in the field. The most noticeable change in the third edition of the Practice Guidelines for the Psychiatric Evaluation of Adults is the way it is organized. Rather than resembling a manual, these new guidelines are divided into nine separate guideline “modules” that are connected by the overarching theme of psychiatric evaluation. These are the nine guidelines:

Review of Psychiatric Symptoms, Trauma History, and Psychiatric Treatment History
Substance Use Assessment
Suicide Risk Assessment
Assessment of Risk for Aggressive Behaviors
Assessment of Cultural Factors
Assessment of Medical Health
Quantitative Assessment
Involvement of the Patient in Treatment Decisions
Documentation of the Psychiatric Evaluation

In situations where there may be less expert consensus, the guidelines offered “suggestions” instead of recommendations. When writing out the recommendations, care was taken to avoid unclear words like “consider” which can be hard to implement and may vary in interpretation. There is a section in each of the modules on implementation that discusses barriers to carrying out the recommendations and adjustments for patient preferences. As new science informs the evaluation process, the iterative design of the practice guidelines will allow them to be reviewed and updated as needed.

Source: Psych News

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Primary Care Providers Should Screen For Depression: US Task Force

USPSThis week the U.S. Preventive Services Task Force posted a draft recommendation statement and draft evidence review on screening for depression in adults. Both are available for review and public comment from July 28 through August 24, 2015. In this proposal, the Task Force broadens its 2009 recommendation that adults should be screened in doctors’ offices if staff-assisted depression care is available.

The USPSTF recommends screening in all adults regardless of risk factors. There are a number of factors that are associated with an increased risk of depression. “Among general adult populations, prevalence rates vary by sex, age, race/ethnicity, education, marital status, geographic location, and employment. Women, young and middle-aged adults, and nonwhite individuals have higher rates of depression than their counterparts, as do persons who are undereducated, previously married, and unemployed. Other groups at increased risk of developing depression include persons with chronic illnesses (e.g., cancer or cardiovascular disease), other mental health disorders (including substance misuse), and a family history of psychiatric disorders.”

Risk factors for depression during pregnancy and postpartum should be reviewed and include “prenatal depression, poor self-esteem, childcare stress, prenatal anxiety, life stress, decreased social support, single/unpartnered relationship status, history of depression, difficult infant temperament, maternity “blues,” lower socioeconomic status, and unintended pregnancy.” Older adults also can present a number of risk factors for depression including “disability and poor health status related to medical illness–complicated grief, chronic sleep disturbance, loneliness, and a personal history of depression. However, the presence or absence of risk factors alone cannot distinguish patients with depression from patients without depression.”

The Task Force recommend measurement-based screening tools such as
the “Patient Health Questionnaire (PHQ), Hospital Anxiety and Depression Scales in adults, the Geriatric Depression Scale in older adults, and the Edinburgh Postnatal Depression Scale (EPDS) in postpartum and pregnant women. “All positive screening tests should trigger additional assessment that considers severity of depression and comorbid psychological problems (e.g., anxiety, panic attacks, or substance abuse), alternate diagnoses, and medical conditions.”

Treatments for depression include antidepressant medications, psychotherapy or both, according to the recommendation.

U.S. Preventive Services Task Force on Depression in Adults in Primary Care

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National Academy of Medicine Establishes Standards for Psychosocial Treatments

A new reppsychosocialreptort by the National Academy of Medicine, titled, “Psychosocial Interventions for Mental and Substance Use Disorders: A Framework for Establishing Evidence-Based Standards” highlights the need to strengthen evidence on the effectiveness of psychosocial interventions, and to develop guidelines and quality measures for implementing these interventions in professional practice.

Two important pieces of legislation aim to improve the delivery of and access to treatments for mental health and substance use disorders, the Mental Health Parity and Addiction Act, and the Affordable Care Act (ACA). These two important pieces of legislation set the stage for establishing standards for psychosocial treatment.

Approximately 20% of the U.S. population, are affected by mental health and substance use disorders and frequently occur together. The comorbidity of these disorders with physical disorders is also common. Psychosocial interventions for mental and substance use disorders include psychotherapies, community-based treatments, vocational rehabilitation, peer support services, and integrated care interventions. The treatment modalities include: individual, group and virtual settings, and may be administered as stand-alone treatments or combined with other interventions such as medications.

NAM-framework The NAM report proposes an iterative process that engages consumers at every step. The framework highlights the need to: (1) support research to strengthen the evidence base on the efficacy and effectiveness of psychosocial interventions; (2) identify the key elements that lead to improved health outcomes; (3) conduct systematic reviews to inform clinical guidelines that incorporate these key elements; (4) develop quality measures of the structures, process, and outcomes of interventions; and (5) establish methods for successfully implementing, sustaining, and improving psychosocial interventions in regular practice

Source:  Institute of Medicine

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Atypical Antipsychotic Shows Promise for New MDD Subtype

New to the diagnosis of major depressive disorder as of DSM-5 is the specifier “with mixed features.” According to DSM-5, “specifiers provide an opportunity to define a more homogeneous subgrouping of individuals with the disorder who share certain features (e.g., major depressive disorder, with mixed features) and to convey information that is relevant to the management of the individual’s disorder.”

A study presented at the American Society of Clinical Psychopharmacology (ASCP) 2015 Annual Meeting, demonstrated that patients with MDD presenting with mixed (subthreshold hypomanic) features showed significantly greater improvement when treated with lurasidone vs placebo, as evidenced by scores on the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Clinical Global Impression–Severity (CGI-S) scale. This is the first randomized placebo-controlled, prospective study to evaluate this group of patients (n=109) who present with subthreshold manic or hypomanic features or irritability during a depressive episode and do not meet the criteria for bipolar disorder. It is estimated that 20% to 40% of patients with MDD may have mixed features.

The 6-week study presented by Trisha Suppes, MD, PhD, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, excluded any patients with a history of manic episodes or any mixed manic episodes. Treatment with lurasidone was demonstrated with significantly greater improvement compared with placebo from week 2 through 6 on both the depression and severity scales.

Medscape Medical News

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