FDA panel cautiously OKs antipsychotic drugs for kids

Three widely used antipsychotic medications appear safe and effective overall in treating children and teenagers with schizophrenia or bipolar disorder, a U.S. advisory panel said on Wednesday.

The Food and Drug Administration's panel of outside experts backed wider use of the pills -- Eli Lilly and Co's Zyprexa, AstraZeneca's Seroquel and Pfizer's Geodon -- but expressed concern over long-term effects the medications may have in younger patients.

The drugs are already approved for adults and are given to youngsters at a doctor's discretion, reaching $10 billion in combined annual sales. FDA approval would allow the drugmakers to market them specifically for children and teenagers.

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I must say that as a double certified and triple-board eligible neuropsychiatrist, we should all have significant concerns with prescribing these 'major tranquilizers' to anyone, especially those whose brain isnt even finished myelinating. These medications can be life-saving and very appropriate for certain individuals in certain cases - but the fact remains that we have very little long term data on kids and that these are medications that cause significant metabolic changes in our bodies and brains; they should NEVER be prescribed lightly. Our healthcare system in our country is NOT setup to allow Psychiatrists enough time to take into account all of the general medical considerations for these patients and be reimbursed for doing such things, therefore they will be tempted to cut corners (not weighing the patients at each visit, or taking full vital signs, or tracking growth on growth charts, etc) -- let alone the poor GPs which can and do perform these things but get on average 8 min and 3 problems per patient or else it has to be a different visit, etc.

We must NEVER take lightly changing someone's body chemistry/metabolism let alone their BRAIN chemistry and metabolism - and yet we have parts of our country that for lack of other better incentives to have physicians move into the state or graduates from their medical schools go into psychiatry, will short-change patients by having a psychologist take a course in medications and begin to prescribe medicines to adults AND CHILDREN in their states!

For those of us who are conscientious about the enormous physiological data to consider (hormonal, immune, neurological and behavioral) when prescribing these medications, it baffles the mind that someone would even ethically DARE to do this without the proper training or patient-specific data and ability to scientifically/medically interpret that data on a patient-to-patient basis.

Notice in the news article cited above that there is no clear/quick OK-DOKEY for Risperdal - as this is one of the worst ones for changing (indirectly) peoples hormones. Unfortunately it is prescribed often (I myself wrote out several prescriptions today to maintain patients on doses I have inherited them on while I work them up). Again, for some patients, after weighing the risks vs benefits and with proper medical monitoring and metabolic/hormonal screening, it will be life-saving and beneficial--but people flock to our clinic because unfortunately many places rarely even weigh their patients, let alone do blood-work or routine physiological follow-up.

I once heard an 'old' general psychiatrist tell me that "I never met a personality without a body" -- meaning that the mind lives in the soma or body (yeah, the brain is part of our body-I'm biased, I think its the most important part). Without some measures of how your body is doing (to include your brain and its functions) we cannot tell how your mind can be/should be working.

These are powerful medicines and can help, but they should not be prescribed flippantly nor nonchalantly-- A LOT of forthought, medical workup and medical follow-up needs to be added and our healthcare system currently is not set up to support that, with general psychiatrists, fully licensed in their respective states to practice medicine, not being credentialed by certain insurance companies to bill for general medical procedures--so things like blood work or ekg's or eeg's slipping through the cracks or no incentive (actually dis-incentives) to weigh their patients or take blood pressures, heights, calculate BMI's and TRACK ALL OF THOSE THINGS THAT THE MEDICINES THEY ARE PRESCRIBING CAN CHANGE FOR THE WORSE; or the GP who IS credentialed to bill for these things, but has their own set of dis-incentives to actually talk to the patient, and spend the time necessary to do the other piece that psychiatrists as trained physicians CAN DO.

In our country, we have allowed ourselves as patients and physicians, to be split apart - physicians, dult licensed by the state medical boards, not being credentialed by the insurance company to BILL for services is a financial thing, not a medical thing. This sets up dis-incentives for doctors to 'do the right thing' -- which, even when I went to meedical school, was to get the "VITAL" signs. Not just because of vital as in vita (life) but as in these are 'vital' to know about someone.

We must not allow insurance and pharma or any other strong political group to continue to get in the way of the doctor patient relationship-- we need to provide sound, preventive-medicine/wellness-type care in a "do no harm" environment that is open to scientifically-sound integrative medicine centers of care.

In the most technologically advanced democracy that this world has ever seen, it is inconceivable that we even have these dichotomies of care and schisms between those patients who have the luxury of 'concierge-tyoe services and doctors (take the time, do the work up no matter what is needed and without haveing to jump through hoops for 'pre-certification' by a bean-counter whose job is to bar you from getting the test/procedure in the name of good resource management-- not good medicine--and get the medicine/treatment/procedure you actually do need).

Have your doctor TAKE THE TIME to do the medical/lab workup necessary; get to know you; look up prior experiences with meds/labs; and to follow you going forward with labs, ekg's, hormone panels,etc.

Fracture risk doubled after obesity surgery

The dramatic and sustained increase in bone turnover that occurs following surgery for obesity, or "bariatric surgery," translates into a significantly increased risk of fractures, especially in the hands and feet, according to a study presented today at The Endocrine Society's annual meeting in Washington, DC.

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Sleep deprivation tied to weight gain-

Failure to get a full night's sleep can lead to weight gain or compromise the beneficial effects of a reduced calorie diet on total body fat, according to presentations at SLEEP 2009, the annual meeting of the Associated Professional Sleep Societies, underway this week in Seattle.

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Weight training may enhance quality of life for some back-pain patients, researchers say.

USA Today (6/10, Lloyd) reports that, according to a study presented at a sports medicine meeting, "weight training and improving overall body strength could help" people manage "nagging back pain." Researchers from Canada's University of Alberta found that "weightlifting enhanced quality of life for back-pain patients by as much as 28 percent," with "more frequent training" leading "to better results." For the study, the team examined "240 men and women who had had no back surgery, damaged vertebrae, or nerve root problems. All had chronic, non-specific lower-back pain as a result of injury to soft tissue in the lower back." For the "first three weeks of the 16-week study, participants worked out with low levels of weight and fewer repetitions to prevent further injury." During "the last 13 weeks," participants undertook "a heavier, more demanding program" in order "to develop strength." The authors emphasized that "the benefit comes from bench presses for the chest, lateral pull-downs for strengthening the back, and leg presses," all three of which "were correlated with pain reduction."

Study indicates levels of depression may be higher in adolescents having later bedtimes.

Following a USA Today story, NBC Nightly News (6/9, story 10, 2:10, Williams) reported that a study presented at a sleep conference "shows the importance of" teenagers "getting enough sleep." Science correspondent Robert Bazell explained, "This latest study from Columbia University surveyed more than 15,000 teens and found that levels of depression and thoughts of suicide are higher in kids who have later bedtimes on school nights."

        In the Los Angeles Times (6/9) Booster Shots blog, Shari Roan added that adolescents "with parental-mandated bedtimes of midnight or later were 25 percent more likely to suffer from depression and 20 percent more likely to have suicidal thoughts. The study supports the idea that inadequate sleep could lead to depression," according to lead author, James Gangwisch, PhD.

        According to HealthDay (6/9), Jonathan Pletcher, MD, "an adolescent medicine specialist from Children's Hospital of Pittsburgh," who was not involved in the study, pointed out, "There's a bi-directional relationship between depression and sleep." He added, "Teens who get less sleep may be more anxious and more likely to feel badly." Dr. Pletcher explained that "besides increasing the risk for depression and suicidal thoughts, a lack of sleep can affect a child's focus and learning," and may make teens "more impulsive." Meanwhile, Gangwisch noted that "a dearth of sleep is also associated with obesity and type 2 diabetes."

Breastfeeding lowers risk of MS relapse: U.S. study-- the interlinkages of the immune system, the hormonal system (endocrine) are many and complex...and those are the few we know about and can kinda understand.

Read the following article regarding the change in the disease in women who breast feed and suffer from Multiple Sclerosis.

http://www.reuters.com/article/healthNews/idUSTRE5575OK20090608

Healthy diet may boost men's fertility-Everything from good insulin secretion and glucose control to the amount of micronutrients (i.e. folic acid) are of immense importance for fertility. Read the following article for more:http://www.reuters.com/article/healthNews/idUSTRE5575AW20090608

Adult type 1 diabetics have higher depression rates-The links between depression and diabetes have been well documented for a long time. This new study continues that trend; diabetes is a metabolic disorder that affects all cells of the body- especially the in the most sensitive organ of the body (the brain).http://www.reuters.com/article/healthNews/idUSTRE5574T120090608

We physicians and allied health professionals at the Springboro Medical Wellness & Neuropsychiatric Center, always have your wellness in Mind TM

We expressly believe that, together, we can be The difference between living and BEING TM so that there can be the healing of body and MINDS.TM

The Springboro Medical Wellness & Neuropsychiatric Center is a specialized practice dealing exclusively in the union of Integrative Medicine, Psychosomatic Medicine, and Age Management Medicine; all highly vested in preventive medicine.

Integrative Medicine is a growing field of medicine in which the patient and providers work together to develop a diagnostic and therapeutic program that draws on a variety of traditions, expertise and modalities to address an individual’s needs; specifically, it is an approach to medical evaluation and treatment that intentionally uses conventional medical treatments alongside other practices (eg. nutritional supplements, herbal remedies, massage, acupuncture, energy work, etc.) for maximum patient benefit. Protocols developed in this framework, may include one or more modalities of treatment (on and off-label), diagnostic testing (conventional and otherwise), naturopathic and allopathic/pharmaceutical therapies, as well as, referrals to other allied health professional and healing practitioners.

Psychosomatic Medicine integrates interdisciplinary evaluation and management involving diverse specialties including but not limited to endocrinology, immunology, psychiatry, psychology, neurology, surgery, gynecology, pain management, pediatrics, dermatology and psycho-neuro-endocrine-immunology. Clinical situations where psychological processes act as a major factor affecting medical outcome and affecting medical compliance and/or surgical results (i.e. Asthma, Diabetes, Alzheimer's, PANDAS, Menstrual Irregularities) are areas where Psychosomatic Medicine has competence and has demonstrated expertise and effectiveness in the medical literature.

Age Management Medicine is defined as preventive medicine focused on regaining and maintaining optimal health and vigor. This medical specialty incorporates well-known and accepted markers of disease-risk into proactive patient management and uses hormone modulation for the endocrinologically "normal" by identifying hormone levels that yield superior health outcomes. Example: for most hormones, this is simply the upper 33% of the normal range for a patient's age. The exceptions are insulin and cortisol that should be modulated to the lower 33% of the normal range.

These combined medical specialty practices/disciplines recognize that successful therapies/outcomes necessitate a healthy lifestyle including optimal low glycemic index nutrition, reduction in maladaptive behaviors & behavioral changes, appropriate hydration, control of addictive behaviors, appropriate nutrient supplementation, and the absolute need for physical exercise; they focus on the synergy of all these elements in order to enhance vitality and extend our health span and optimal mental and physical functioning. While we may or may not be able to increase longevity, prevent premature disability and death we aggressively strive to and are able to significantly enhance quality of life.