Stress Linked To Immune System Problems

How Stress Can Make You Sick, Sydney Researchers Explain

Garvan Institute scientists have discovered how a hormone, known as neuropeptide Y (NPY), can prevent our immune system functioning properly, paving the way for two new major opportunities for therapeutic intervention.

“Most of us expect to come down with a cold or other illness when we are under pressure, but until now we have mostly had circumstantial evidence for a link between the brain and the immune system”, says lead Garvan researcher Associate Professor Fabienne Mackay.

“During periods of stress, nerves release a lot of NPY and it gets into the bloodstream, where it directly impacts on the cells in the immune system that look out for and destroy pathogens (bacteria and viruses) in the body,” explains Mackay.

This significant discovery came about through a collaboration between Mackay's immunology group and scientists in the Neurobiology programme at the Garvan Institute of Medical Research, Sydney, Australia.

Associate Professor Herbert Herzog who heads the Neurobiology programme says, “Elite athletes are particularly prone to illness, possibly because of the extreme physical and emotional stressors associated with competition. But our research is relevant to everyone because there is no escaping stress - be it in the workplace or at home. Employment surveys show many workers feel there is more job-related stress today than even a couple of years ago”.

Absenteeism, around 30% of which can be attributed to own ill health or physical disibility , costs well over $10 billion Australian dollars a year , so now more than ever employers should be thinking about how to reduce stress in the hope that their workforce will be healthier.

The Garvan Institute study centres on two key events that enable our bodies to recognise foreign substances and control invaders. When we encounter a pathogen (bacteria and viruses), the immune ‘sentry' cells that are on guard duty retain and interrogate the suspects. Their activation is made possible by NPY. These cells then return to the lymph nodes, which are found all over the body, with information about the foreign invaders. The lymph nodes are where decisions about defense are made.

In the case of bacteria and viruses, TH1 cells are part of the attack team that is sent out on the ‘search and destroy' mission. But when their job is done they need to be turned ‘off' and the immune system reset. The same hormone, NPY, that activates the sentry cells now prompts the TH1 cells to slow down and die.

Mackay adds that: “Under normal conditions, circulating immune cells produce small amounts of NPY, which enables the immune cells on sentry duty and the TH1 immune cells to operate - it's a yin and yang kind of situation. But too much NPY means that the TH1 attack is prevented despite the foreign invaders being identified - and this is what happens during stress”,

Understanding the connection between NPY and the immune system offers two new major opportunities for therapeutic intervention. The first is to design new drugs to stimulate immune system defences in people exposed to high levels of stress, such as in a bereavement situation, and in immuno-compromised individuals. The second is to exploit this Th1 inhibitory mechanism to prevent immune responses getting out of control as in various inflammatory and autoimmune diseases such as Crohn's disease, rheumatoid arthritis, multiple sclerosis, type I diabetes and lupus.

ABOUT GARVAN

The Garvan Institute of Medical Research was founded in 1963 by the Sisters of Charity. Initially a small research department of St Vincent's Hospital in Sydney, it is now one of Australia's largest medical research institutions with over three hundred scientists, students and support staff.

Associate Professor Fabienne Mackay is a Principal Research Fellow in the Arthritis and Inflammation Research Program at the Garvan Institute and a Conjoint Associate Professor, Faculty of Medicine, University of NSW and University of Sydney. She is also a Wellcome Trust Senior Research Fellow.

Associate Professor Herbert Herzog is a Principal Research Fellow and the Director of the Neurobiology Program at the Garvan Institute. He is also a National Health and Medical Senior Research Fellow; an Adjunct Associate Professor at the Faculty of Medicine, University of New South Wales; and an Associate Professor for Biochemistry, Department of Biochemistry, Free University of Berlin.

This research is being published in the Journal of Experimental Medicine, Volume 202, No. 11, December 5, 2005, pp1-13.

http://www.garvan.org.au

1 Robert Half International, 2005
2 Australian Bureau of Statistics, cat no. 6342.0, Nov 2003, page 4
3 Based on an absence rate equating to 2% 2004 GDP, as detailed in http://www.racp.edu.au/afom/absenteeism.pdf

Biological Basis for Anxiety - fascinating

Fleeting Images of Fearful Faces Reveal Neurocircuitry of Unconscious Anxiety

Researchers at Columbia University Medical Center have found that fleeting images of fearful faces - images that appear and disappear so quickly that they escape conscious awareness - produce unconscious anxiety that can be detected in the brain with the latest neuroimaging machines.

It's one of the first times that neuroimaging has captured the brain's processing of unconscious emotion.

Using a high-resolution version of functional magnetic resonance imaging (fMRI) the researchers observed a structure in the brain important for emotional processing - the amygdala - lights up with activity when people unconsciously detected the fearful faces.

Although the study was conducted in people who had no anxiety disorders, the researchers says that the findings should also apply to people with anxiety disorders.

“Psychologists have suggested that people with anxiety disorders are very sensitive to subliminal threats and are picking up stimuli the rest of us do not perceive,” says Dr. Joy Hirsch, professor of neuroradiology and psychology and director of the fMRI Research Center at Columbia University Medical Center, where the study was conducted. “Our findings now demonstrate a biological basis for that unconscious emotional vigilance.”

Dr. Hirsch adds that the finding makes a profound prediction: “If a treatment for anxiety works, we should see the unconscious activity in the input end of the amygdala go down. In future studies, we want to use brain imaging to test the effectiveness of psychotherapeutic and pharmacological treatments for anxiety disorders.”

The study was led by Drs. Hirsch; Eric Kandel, Senior Investigator at the Howard Hughes Institute, and Director of the Kavli Institute for Brain Science at Columbia University Medical Center; Rene Hen, professor of pharmacology; and graduate students Amit Etkin and Kristen Klemenhagen. Their research appears in the Dec. 16 issue of Neuron.

About the Study

In the study, the researchers presented images of fearful facial expressions, which are powerful signals of danger in all cultures, to 17 different subjects. None of the 17 volunteers had any anxiety disorders, but their underlying anxiety varied from the 6th to the 85th percentile of undergraduate norms, as measured by a well-validated questionnaire.

“These are the type of normal differences that would be apparent if these people got stuck in an elevator,” Dr. Hirsch says. “Some of them would go to sleep; some would climb the walls.”

While the subjects were looking at a computer, the researchers displayed an image of a fearful face onto the monitor for 33 milliseconds, immediately followed by a similar neutral face. The fearful face appeared and disappeared so quickly that the subjects had no conscious awareness of it.

But the fMRI scans clearly revealed that the brain had registered the face and reacted, even though the subjects denied seeing it. These scans show that the unconsciously perceived face activates the input end of the amygdala, along with regions in the cortex that are involved with attention and vision.

Brain activity varies with level of anxiety

The researchers also noticed that the amount of brain activity varied from person to person, depending on their scores on the anxiety quiz.

The amygdalas of anxious people was far more active than the amygdalas of less anxious people. And anxious subjects showed more activity in the attention and vision regions of the cortex, which manifested itself in faster and more accurate answers when the subjects were asked questions about the neutral face.

“What we think we've identified is a circuit in the brain that's responsible for enhancing the processing of unconsciously detected threats in anxious people,” says Amit Etkin, the study's first author. “An anxious person devotes more attention and visual processing to analyze the threat. A less anxious person uses the circuit to a lesser degree because they don't perceive the face as much as a threat.”

Unconscious vs. conscious processing of fearful faces

In contrast to unconscious processing of fearful faces, the researchers found that when subjects looked at the fearful faces for 200 milliseconds, long enough for conscious recognition, a completely different brain circuit was used to process the information. And the activity in that circuit did not vary according to the subject's level of anxiety.

“Our study shows that there's a very important role for unconscious emotions in anxiety,” Etkin says.

Columbia University Medical Center provides international leadership in basic, pre-clinical and clinical research, medical education, and health care. The medical center trains future leaders in health care and includes the dedicated work of many physicians, scientists, nurses, dentists, and other health professionals at the College of Physicians & Surgeons, the School of Dental & Oral Surgery, the School of Nursing, the Mailman School of Public Health, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. With a strong history of some of the most important advances and discoveries in health care, its researchers are leading the development of novel therapies and advances to address a wide range of health conditions

Contact: Karen Zipern
kz2110@columbia.edu
212-305-9746
Columbia University College of Physicians and Surgeons

Great Mental Health Is All About Persistence

"Nothing in the world can take the place of Persistence. Talent will not; nothing is more common than unsuccessful men with talent. Genius will not; unrewarded genius is almost a proverb. Education will not; the world is full of educated derelicts. Persistence and determination alone are omnipotent. The slogan 'Press On' has solved and always will solve the problems of the human race."

Calvin Coolidge

Understand Autism and Problem-Solving

Autism problems explained in new research

New research from Melbourne's Howard Florey Institute helps to explain why children with autism spectrum disorders (autism) have problem-solving difficulties.

Using functional magnetic resonance imaging technology (fMRI) the Florey scientists have shown that children with autism have less activation in the deep parts of the brain responsible for executive function (attention, reasoning and problem solving).

Research leader Dr Ross Cunnington said autism was known to have a biological cause, but this neuroimaging research clearly showed the dysfunction in the brain that accounted for why children with autism have problems with their executive function.

"Discovering why children with autism have impaired executive function may help develop better therapies to improve their ability to pay attention and solve problems," Dr Cunnington said.

Specifically, we found that activity in the caudate nucleus, a critical part of circuits that link the prefrontal cortex of the brain, is reduced in boys with autism."

"These findings have important implications, since prefrontal brain circuits play a critical role in maintaining and focusing attention, planning and setting goals, and keeping goals in memory during problem-solving and decision-making."

"Our neuroimaging findings showing dysfunction in these prefrontal brain circuits now explain why children with autism have problems with learning and problem-solving," he said.

Dr Cunnington along with PhD student, Tim Silk, have also been studying children with attention deficit hyperactivity disorder (ADHD) and have found similarities in the impairment of specific executive function in children with ADHD and autism.

The autism study was conducted with boys aged 11 to 18 years who had autism or Asperger's disorder, as well teenage boys without the condition.

Autism affects one in 100 Australians and is lifelong condition that affects the way a person communicates and relates to other people. People affected by autism typically display major impairments in social interaction, communication and behaviour (restricted interests and repetitive behaviours).

The majority of people with autism also have an intellectual disability. Those with Asperger's disorder are typically of average or above average intelligence and may have relatively good communication skills but specific learning difficulties.

The Florey scientists collaborated with scientists from Monash University, the Brain Research Institute and Texas Tech University in the USA. The results of this research are soon to be published in American Journal of Psychiatry.

The Howard Florey Institute is Australia's leading brain research centre. Its scientists undertake clinical and applied research that can be developed into treatments to combat brain disorders, and new medical practices. Their discoveries will improve the lives of those directly, and indirectly, affected by brain and mind disorders in Australia, and around the world. The Florey's research areas cover a variety of brain and mind disorders including Parkinson's disease, stroke, motor neuron disease, addiction, epilepsy, multiple sclerosis, muscular dystrophy, autism and dementia.

Merrin Rafferty
Research Australia
http://www.researchaustralia.com.au

Pot Use Doubles Fatal Car Crashes

Cannabis Almost Doubles Risk Of Fatal Crashes

Driving under the influence of cannabis almost doubles the risk of a fatal road crash, finds a study published online by the BMJ today. However its share in fatal crashes is significantly lower than those involving alcohol.

The study took place in France and involved 10,748 drivers who were involved in fatal crashes from October 2001 to September 2003. All drivers underwent compulsory tests for drugs and alcohol.

A total of 681 drivers tested positive for cannabis (7%) and 2096 for alcohol (21.4%), including 285 for both (2.9%). Men were more often involved in crashes than women, and were also more often positive for both cannabis and alcohol, as were the youngest drivers, and users of mopeds and motorcycles.

The risk of being responsible for a fatal crash increased as the blood concentration of cannabis increased (known as a dose effect). The odds increased from 1.9 at a concentration of 0-1 ng/ml to 3.1 at or above 5 ng/ml. These effects were adjusted for alcohol and remained significant when also adjusted for other factors.

These results give credence to a causal relationship between cannabis and crashes, say the authors.

Samples show that the prevalence of cannabis (2.9%) within the driving population is similar to that for alcohol (2.7%) at or above 0.5 g/l, they add. However, in France, its share in fatal crashes is significantly lower than that associated with alcohol (2.5% compared with 29% for alcohol).

Pre-existing Anxiety Disorder and Suicide

Pre-existing anxiety disorder raises risk of a subsequent onset of suicidal thoughts and suicide attempts

A pre-existing anxiety disorder significantly increases the risk of a subsequent onset of suicidal thoughts and suicide attempts, according to a study in the November issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

Suicidal thoughts and suicide attempts are strong risk factors for completed suicides, according to background information in the article. Mood disorders such as depression, substance abuse disorders and schizophrenia are well established risk factors for suicidal thoughts and suicide attempts but, the authors suggest, because anxiety disorders often co-exist with these mental disorders, the impact of anxiety disorders on risk for suicidal thoughts and suicide attempts has been difficult to assess.

Jitender Sareen, M.D., F.R.C.P.C., of the University of Manitoba, Winnipeg, and colleagues analyzed data from interviews of a random sampling of people from the Netherlands to determine whether anxiety disorders are risk factors for subsequent suicidal thoughts or attempts. In two follow up assessments, one year and three years following the baseline interview, the researchers examined whether anxiety disorders at baseline were associated with incidence of suicidal thoughts or suicide attempts.

At the first (one-year) and second (three-year) follow-up periods, there were 41 and 44 new cases of suicidal ideation, respectively (total of 85 new cases at either assessment), and 24 and 15 news cases of suicide attempts, respectively, (total of 39 new cases). After adjusting for other mental disorders and other social factors, the researchers found that presence of anxiety disorder more than doubled the risk of suicidal thoughts or attempts for the 7,076 participants in the baseline interview. For the 4,796 people who participated in all three interviews, the presence of anxiety disorders at baseline more than doubled the risk of subsequent suicidal thoughts and more than tripled the risk of subsequent suicide attempts. "Further analysis demonstrated that the presence of any anxiety disorder in combination with a mood disorder was associated with a higher likelihood of suicide attempts in comparison with a mood disorder alone," the authors report.

"This is the first study to demonstrate that a pre-existing anxiety disorder is an independent risk factor for subsequent onset of suicidal ideation [thoughts] and attempts," the authors conclude. "Moreover, the data clearly demonstrate that co-morbid anxiety disorders amplify the risk of suicide attempts in persons with mood disorders. Clinicians and policymakers need to be aware of these findings, and further research is required to delineate whether treatment of anxiety disorders reduces the risk of subsequent suicidal behavior."

(Arch Gen Psychiatry. 2005;62:1249-1257)

The Netherlands Ministry of Health, Welfare, and Sports (the Hague) provided financial support to conduct the survey. Preparation of this article was supported by a grants from the Institute of Neurosciences, Mental Health and Addiction, Canadian Institutes of Health Research, Ottawa; the Canadian Institutes of Health Research; and the Manitoba Health Research Council, Winnipeg.

Patch Works For ADHD Kids

Positive study results for methylphenidate transdermal system

Shire announced at the US Psychiatric and Mental Health Congress in Las Vegas, Nevada, that its investigational methylphenidate transdermal system (MTS) demonstrated statistically significant reductions in the symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) and was generally well tolerated in patients aged 6 to 12 in two clinical trials.

"Children who have ADHD must cope with symptoms throughout the day and in a number of environments, including in the classroom, during extra-curricular activities, or while at home," explained Frank Lopez, MD, developmental pediatrician at the Children's Developmental Center, Maitland, Florida. "While oral methylphenidate has long been a first-line treatment for patients with ADHD symptoms, if approved, this transdermal patch formulation would provide parents and health care professionals the first and only non-oral medication for children with ADHD."

The MTS patch was developed by Noven Pharmaceuticals, Inc. and combines the active ingredient of methylphenidate with transdermal technology. This transdermal deliveryäNoven's patented DOT Matrix system was designed to provide continuous medication release throughout the day. The transdermal system releases medication that passes through the skin and directly into the blood stream. The patch is water-resistant.

Data from phase II and phase III clinical trials presented this week in Las Vegas demonstrated statistically significant improvements in the primary and secondary endpoints analyzed for children treated with MTS compared to children treated with placebo.

The phase II analog classroom study included 79 children with ADHD. The patch was worn for nine hours, and efficacy was assessed throughout the day for twelve hours. MTS demonstrated statistically significant improvement over placebo on the measures tested. Behavior, which was measured using the Swanson, Kotkin, Agler, M-Flynn, and Pelham -Deportment (SKAMP-D) scale, was improved with MTS overall (mean score 3.2 for MTS versus 8.0 for placebo) and at all time points throughout the day (P < 0.001).

Children taking MTS also completed more math problems correctly on the Permanent Product Measure of Performance (PERMP) scale than did those taking placebo (110 versus 81, respectively).

In the phase III naturalistic trial with 270 participants, investigators found that MTS worn for nine hours reduced the children's overall symptoms of ADHD, compared to a placebo (P < 0.0001), as measured by scores on the ADHD Rating Scale (ADHD-RS). By the study's end, mean ADHD-RS scores declined -24.2 points (56%) from baseline for children treated with MTS versus a decline of -9.9 (24%) for those treated with placebo (P < 0.0001). ADHD-RS assesses 18 individual symptoms of ADHD as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision(TM), a publication of the American Psychiatric Association.

In both studies, MTS was generally well tolerated during both the dose optimization and double-blind phases. Adverse events typically were mild to moderate, resolved with continued therapy and were consistent with known effects of methylphenidate. The most common adverse events reported by patients who received MTS in clinical trials were: nausea, vomiting, nasopharyngitis, weight decreased, anorexia, decreased appetite, affect lability, insomnia, tic, and nasal congestion.

Shire and Noven provided funds for both studies.

Noven and Shire are seeking approval for MTS and the application is currently under review by the FDA. The trade name DAYTRANA(TM) has been proposed to the FDA and is currently under review.

About MTS

MTS is not intended to be administered to patients with: marked anxiety, tension or agitation; allergies to methylphenidate or other ingredients in MTS; skin sensitivities to soaps, lotions, cosmetics or adhesives; eczema, psoriasis, dermatitis or sensitive skin syndrome. MTS has not been studied in children under 6 years of age. Patients will be advised to avoid direct external heat to the patch application site. MTS will need to be stored in a safe place, out of the reach of children.

Methylphenidate should not be administered to patients with:
glaucoma; tics, Tourette's syndrome or a family history of Tourette's syndrome; current or recent use of Monoamine Oxidase Inhibitors (MAOIs). Chronic abuse of methylphenidate may lead to dependence and careful supervision following withdrawal from abuse is warranted. Methylphenidate should not be given to patients with a history of drug dependence or alcoholism. Methylphenidate should not be used for the prevention or treatment of severe depression or normal fatigue states. Growth should be monitored in patients treated with methylphenidate. Use with caution in patients with psychosis, history of seizures or EEG abnormalities, hypertension, and history of drug dependence or alcoholism. Rare cases of visual disturbances have been reported with methylphenidate use. Hematologic monitoring is advised during prolonged therapy.

About ADHD

ADHD affects approximately 7.8 percent of all school-age children, more than 4 million in the United States. ADHD is considered the most commonly diagnosed psychiatric disorder in children and adolescents. ADHD is a neurological brain disorder that manifests as a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequent and severe than is typically observed in individuals at a comparable age and maturity. If untreated, ADHD can acutely affect a child's life, leading to problems with family members, friends, sports, after-school activities and academics.

Shire Pharmaceuticals Group plc

Shire's strategic goal is to become the leading specialty pharmaceutical company that focuses on meeting the needs of the specialist physician. Shire focuses its business on central nervous system (CNS), gastrointestinal (GI), general products (GP) and human genetic therapies (HGT) - all being areas in which Shire has a commercial presence. The structure is sufficiently flexible to allow Shire to target new therapeutic areas to the extent opportunities arise through acquisitions. Shire believes that a carefully selected portfolio of products with a strategically aligned and relatively small-scale sales force will deliver strong results.

Shire's focused strategy is to develop and market products for specialty physicians. This approach aims to deliver increased returns and lower risks. Shire's in-licensing and merger and acquisition efforts are focused on products in niche markets with strong intellectual property protection either in the US or Europe.

For further information on Shire, please visit the Company's website: http://www.shire.com

"SAFE HARBOR" STATEMENT UNDER THE PRIVATE SECURITIES LITIGATION REFORM ACT OF 1995

Statements included herein that are not historical facts are forward-looking statements. Such forward-looking statements involve a number of risks and uncertainties and are subject to change at any time. In the event such risks or uncertainties materialize, Shire's results could be materially affected. The risks and uncertainties include, but are not limited to, risks associated with: the inherent uncertainty of pharmaceutical research, product development, manufacturing and commercialization; the impact of competitive products, including, but not limited to, the impact of those on Shire's Attention Deficit and Hyperactivity Disorder (ADHD) franchise; patents, including, but not limited to, legal challenges relating to Shire's ADHD franchise; government regulation and approval, including, but not limited to, the expected product approval dates of DAYTRANA (MTS/METHYPATCH) (ADHD), SPD503 (ADHD), SPD465 (ADHD), MESAVANCE (SPD476) (ulcerative colitis), I2S (iduronate-2-sulfatase) (Hunter syndrome), and NRP104 (ADHD), including its scheduling classification by the Drug Enforcement Administration in the United States; Shire's ability to benefit from its acquisition of Transkaryotic Therapies, Inc.; Shire's ability to secure new products for commercialization and/or development; and other risks and uncertainties detailed from time to time in Shire's filings with the Securities and Exchange Commission, including its Annual Report on Form 10-K for the year to December 31, 2004.


Matthew Cabrey
484-595-8248B
Media Relations
Brian Piper
484-595-8252
Investor Relations
Shire Pharmaceuticals Group
http://www.shire.com/shire/index.jsp

Good! They Are Having Doctors Screen for Depression & Anxiety!

Internists to Screen for Depression and Anxiety

The American College of Physicians (ACP), the national organization of doctors of internal medicine, is encouraging members to screen patients for anxiety and depression as part of a national mental health screening effort on October 6.

ACP is partnering with Screening for Mental Health (SMH) on behalf of the 2005 NDSD Mental Health Screening program, also known as National Depression Screening Day. ACP and SMH are providing more than 3,000 ACP members with an NDSD Primary Care kit for use in screening patients for mood and anxiety disorders.

The screening kits include a 10-point depression screening form that can be completed by patients in the waiting room and placed in their files for review. The kits also include clinical guidance for physicians.

Although October 6 has been designated as the screening day, physicians can hold screening days at other times. Physicians or other health professionals who want to order downloadable screening materials can browse online.

ACP has co-sponsored the NDSD Primary Care Outreach program since 1998. Participating ACP members have reported that the screening program was helpful in identifying patients with mood and anxiety disorders who might otherwise have gone undetected.

The American College of Physicians has resources for its members and others on its Web sites www.acponline.org and doctorsforadults.com. An ACP patient education brochure on depression can be downloaded here. ACP also has a booklet, “Celebrating Life: A Guide to Depression for African Americans,” that accompanies a video program of the same name. The booklet can be downloaded here, and the video is available for a $2 shipping fee here, or by contacting ACP Customer Service at 800-523-1546, ext. 2600, or 215-351-2600.

Members of the American College of Physicians have access to updated Web-based clinical decision-making tools and links to patient information on depression and other mood disorders via PIER, the Physician's Information and Education Resource. An ACP Key Diseases Series book, “Depression,” edited by James L. Levenson, MD, is available at ACPOnline or by contacting ACP Customer Service at the above numbers.

ACP (Doctors of Internal Medicine. Doctors for Adults.®) is the largest medical-specialty organization and second-largest physician group in the United States. Membership includes more than 119,000 internists, related subspecialists, medical students, residents and fellows. Internists specialize in the prevention, detection and treatment of illnesses in adults.

The American College of Physicians (acponline.org) was founded in 1915 to promote the science and practice of medicine. In 1998 it merged with the American Society of Internal Medicine, which was established in 1956 to study economic aspects of medicine. ACP works to enhance the quality and effectiveness of health care by fostering excellence and professionalism in the practice of medicine.

http://www.acponline.org

Bipolar Parents Have Creative Children

Bipolar disorder parents have more creative children

Researchers at the Stanford University School of Medicine have shown for the first time that a sample of children who either have or are at high risk for bipolar disorder score higher on a creativity index than healthy children. The findings add to existing evidence that a link exists between mood disorders and creativity.

The small study, published in the November issue of the Journal of Psychiatric Research, compared creativity test scores of children of healthy parents with the scores of children of bipolar parents. Children with the bipolar parents - even those who were not bipolar themselves - scored higher than the healthy children.

"I think it's fascinating," said Kiki Chang, MD, assistant professor of psychiatry and behavioral sciences and co-author of the paper. "There is a reason that many people who have bipolar disorder become very successful, and these findings address the positive aspects of having this illness."

Many scientists believe that a relationship exists between creativity and bipolar disorder, which was formerly called manic-depressive illness and is marked by dramatic shifts in a person's mood, energy and ability to function. Numerous studies have examined this link; several have shown that artists and writers may have two to three times more incidences of psychosis, mood disorders or suicide when compared with people in less creative professions.

Terence Ketter, MD, professor of psychiatry and behavioral sciences and a study co-author, said he became interested in the link between mental illness and creativity after noticing that patients who came through the bipolar clinic, despite having problems, were extraordinarily bright, motivated people who "tended to lead interesting lives." He began a scholarly pursuit of this link and in 2002 published a study that showed healthy artists were more similar in personality to individuals with bipolar disorder (the majority of whom were on medication) than to healthy people in the general population.

Some researchers believe that bipolar disorder or mania, a defining symptom of the disease, causes creative activity. Ketter said he believes that bipolar patients' creativity stems from their mobilizing energy that results from negative emotion to initiate some sort of solution to their problems. "In this case, discontent is the mother of invention," he said.

The researchers point out that creativity and bipolar may have important genetic components that are transmitted together inter-generationally. There have only been limited studies investigating this; the Stanford study is the first to specifically examine creativity in the offspring of bipolar parents.

During the study, the researchers looked at creative characteristics in 40 bipolar patients and 40 offspring, comparing them with 18 healthy adults and 18 healthy offspring. The children in the study ranged in age from 10 to 18. Half of the children of bipolar patients also had bipolar disorder; the other half had attention deficit hyperactivity disorder or ADHD, which appears to be an early sign of bipolar disorder in offspring of parents with the condition. The majority of participants with bipolar or ADHD were on medication.

The researchers included children with ADHD so they could study creativity before the onset of full bipolar disorder. "We wanted to see whether having a manic episode is necessary for this sort of creativity," said Chang, who also directs the Pediatric Bipolar Disorders Program at Lucile Packard Children's Hospital.

Study participants were given psychiatric evaluations and then completed the Barron-Welsh Art Scale, or BWAS, a test that seeks to provide an objective measure of creativity. The scoring is based on "like" and "dislike" responses to figures of varying complexity and symmetry; past studies suggest that creative people tend to dislike the simple and symmetric symbols.

The researchers found that the bipolar parents had 120 percent higher BWAS "dislike" scores than the healthy parents. The children with bipolar and the children with ADHD had, respectively, 107 and 91 percent higher BWAS dislike scores than the healthy children.

"The results of this study support an association between bipolar disease and creativity and contribute to a better understanding of possible mechanisms of transmission of creativity in families with genetic susceptibility for bipolar disease," the researchers wrote in their paper.

The researchers had hypothesized that the scores of children with ADHD would differ significantly from the scores of bipolar children so they were surprised when the scores did not. Chang said this indicates that mania is not what is fueling the creativity. "The kids with ADHD who hadn't been manic yet still had very high levels of creativity," he said.

The researchers also found a link between the length of a bipolar child's illness and creativity: the longer a child was sick or manic, the lower the BWAS dislike score. It makes sense, Chang said, that this illness could, over time, erode one's creativity. "After awhile you aren't able to function and you can't access your creativity," he explained.

BWAS dislike scores tend to decrease with age even in healthy individuals, so more research is needed, Ketter said. Further studies are also needed to assess the role of genetic and environmental factors in creativity and bipolar, he added. The team plans to next examine whether the degree of creativity in parents correlates with the degree of creativity in their children.

This study was funded by the Heinz C. Prechter Fund for Manic Depression, a NAR-SAD Young Investigators Award, a Klingenstein Third Generation Foundation Fellowship and the National Institutes of Health.

Stanford University Medical Center integrates research, medical education and patient care at its three institutions - Stanford University School of Medicine, Stanford Hospital & Clinics and Lucile Packard Children's Hospital at Stanford. For more information, please visit the Web site of the medical center's Office of Communication & Public Affairs at mednews.stanford.edu.

Michelle Brandt
mbrandt@stanford.edu
650-723-0272
Stanford University Medical Center
med-www.stanford.edu/MedCenter/MedSchool

New Warning - Paxil

New Warning Issued on Paxil
By Amanda GardnerHealthDay Reporter

WEDNESDAY, Sept. 28 (HealthDay News) -- U.S. health officials have issued a warning about possible birth defects in infants born to women who take the antidepressant Paxil during the first trimester of pregnancy.

A study sponsored by GlaxoSmithKline, the drug's maker, suggested that infants born to women taking Paxil were at about double the risk of birth defects compared with women taking other antidepressants. The most common defects were cardiovascular. The risks were about 50 percent higher than they were in the general population.

GlaxoSmithKline, which first alerted the U.S. Food and Drug Administration of the problems around Sept. 6, anticipates labeling changes to the drug, said company spokeswoman Mary Ann Rhyne.

"We've also taken this information to regulatory bodies around the world to voluntarily add this to the label," she said. "That discussion, as I understand it, is how to handle it."

Glaxo has also sent a letter to physicians alerting them to the findings.

Dr. Mary Jo O'Sullivan, a professor of obstetrics and gynecology at the University of Miami School of Medicine, said the findings do raise some concerns. "One cannot deny with absolute certainty that there's nothing related to Paxil and an increased risk of malformations, but we dont have a truly controlled population," she said.

"One has to be cautious and if there's a way to get a patient off Paxil prior to pregnancy and substitute another drug, then that would be the ideal way to go," O'Sullivan advised. "But just because she's on Paxil does not necessarily mean that her risk of congenital malformation is overwhelming. This needs more work."

Paxil (paroxetine) belongs to a group of drugs called selective serotonin reuptake inhibitors (SSRIs), which first hit the market in 1988 and are widely used today to treat depression, anxiety and other mood and behavioral disorders in adults as well as children.

This class of popular drugs has been the subject of much recent controversy.

In February, Spanish researchers reported that babies born to women taking SSRIs during pregnancy may experience neonatal withdrawal syndrome in the first few days of life. The association seemed to be highest among women using Paxil.

And last year, reports of suicidal thinking among adolescents using SSRIs led to the FDA ordering a "black box" warning be placed on SSRI labels. There has also been concern that SSRIs triggers manic behavior in 10- to 14-year-olds.

The data on SSRIs and birth defects is inconclusive, with some studies showing a higher risk and other research showing no increased problem.

GlaxoSmithKline undertook this study because a British pregnancy registry turned up a possible signal for cardiovascular defects in women using bupropion (Wellbutrin) and Paxil.

For this study, the researchers relied on a database affiliated with UnitedHealthcare, a national managed-care plan covering the Northeast, Southeast, Midwest and Western United States. They focused on women taking bupropion in the first trimester of pregnancy and compared them with infants born to women who took bupropion before or after the first trimester, as well as women taking other antidepressants during the first trimester.

When all analyses were completed, there appeared to be no increased risk associated with bupropion. A secondary analysis to investigate the risk associated with other antidepressants, including Paxil, was carried out at the request of the FDA.

That analysis found about double the risk of general birth defects in Paxil compared to other antidepressants, when taken in the first trimester. The prevalence of birth defects as a whole among infants born to women in this group was 4 percent, or 43.6 per 1,000 births.

The risk for cardiovascular defects was slightly more than double. The more common of these were ventricular septal defects, where one or more holes are present in the muscular wall separating the right and left ventricles of the heart. This is the most common congenital heart defect.

The overall rate of birth defects in the general population is about 3 percent, and the rate of heart defects about 1 percent. The overall rate among infants of women taking Paxil in the first trimester was about 4 percent and, for women taking other antidepressants during this time, about 2 percent. "I wished I had an explanation," Rhyne said of the discrepancy.

Researchers still do not know if the relationship is a causal one and there is, in general, a paucity of research on the subject. Data from the Swedish Birth Registry, for instance, found no increased risk of major malformations associated with SSRIs. But other small studies have found risks.

"There's not a whole lot of detail there," Rhyne said. "We're trying to drill down on information that we have to see exactly what is going on."

And for women who are on Paxil or considering taking it, GlaxoSmithKline said it is sticking by previous recommendations.

"This medicine already has a pregnancy precaution. That means that physicians should be talking with patients about potential benefits and potential risks and we recommend that this study be a part of that discussion," Rhyne said. "The label already has a category C pregnancy caution, which means no adequate, well-controlled studies have been done to determine the effect on the fetus. This is a medicine doctors should already be talking with patients about."

"Like everything else, it's a risk-and-benefit ratio," O'Sullivan said.

Mood Disorders Misdiagnosed in Blacks?

Mood Disorders Often Misdiagnosed in Blacks

FRIDAY, Aug. 26 (HealthDay News) -- Researchers are planning to find out why black Americans seeking help for depression and other mood disorders are often misdiagnosed with schizophrenia.
A team of University of Cincinnati investigators will lead a four-year national study to determine why these misdiagnoses occur and whether they lead to the excessive use of antipsychotic drugs among blacks.
"Research has already shown that African-American patients are being improperly diagnosed, but we need to find out why," said Dr. Stephen Strakowski, the study's lead investigator.
Previous studies have suggested that misdiagnosis occurs when doctors overemphasize certain symptoms often associated with schizophrenia, while overlooking the symptoms of mood disorders.
The researchers will also look into whether Hispanics also experience an excess number of these types of misdiagnoses as well.
The study is funded by a $10 million grant from the National Institute of Mental Health and will include researchers from five other universities across the country.

ADHD - Did We Create It?

Evolution Of Hyperactivity, Impulsivity, And Cognitive DiversityThe evolutionary status of ADHD is central to assessments of whether modern society created it, and is important in understanding its neurobiology and treatment. ADHD's association with a positively selected gene raises the possibility that ADHD itself is selected for. But previous suggestions of evolutionary benefits of ADHD have either been factually incorrect, or have not explained why, if it is useful, it remains confined to a minority. We present simulations showing that unpredictability, a key feature of ADHD, impairs individuals, but optimises foraging by the group. This is because risks are borne mainly by the individual, but the entire group benefits from behavioural and genetic experimentation. This 'group exploration' view accounts for the prevalence, sex & age distribution, severity distribution, and heterogeneity of ADHD. by Dr JOH Williams and Prof E TaylorTim Watsontim.watson@royalsoc.ac.ukRoyal Societyhttp://www.royalsoc.ac.uk

Fountain of Youth in A Card Deck

Anti-aging secrets are in the cards


A new set of trading cards from SAGE Crossroads offers a fun look at the brains behind the latest theories on aging and immortality. The series profiles the 48 most accomplished, cutting-edge, and controversial scientists in the field of aging research.

"Trading cards are a fun and easy way to introduce the public to the people who are shaping aging science, research, and policy," says Daniel Perry, Exectuive Director, Alliance for Aging Research. "They highlight the important work that these experts are doing and show the diversity of projects underway around the world." The cards are available on-line at www.SAGECrossroads.net and will soon be available in print. Visitors to the website can email a favorite card to a friend or colleague or nominate experts for inclusion on future cards. Each trading card includes information about a featured scientist, such as research specialties and goals, key findings, publications, and predictions.

Some of the most popular trading cards in the series feature experts like

-- Aubrey de Grey, a "prophet of longevity" who believes that aging is curable,

-- Rudy Tanzi, a Boston researcher who is breaking ground in the study of Alzheimer's disease, and

-- Richard Miller, a geneticist working to breed research mice with physiology more similar to humans' in order to better understand the mechanisms of aging.

SAGE Crossroads is the premier online resource for emerging issues related to human aging. Its aim is to bring together viewpoints from the entire spectrum of aging and health communities and provide a forum for interaction and elevated discussion. Launched in 2003 by the Alliance for Aging Research and the American Association for the Advancement of Science (publishers of Science Magazine), www.SAGECrossroads.net provides an opportunity for policy makers, journalists, scientists and the public to get together and explore the rapidly developing field of aging research.

Debbie Zeldow
dzeldow@agingresearch.org
Alliance for Aging Research
http://agingresearch.org

Effects of Stress on Brain

Researchers use imaging technique to visualize effects of stress on human brain - Method tracks water molecules in blood

The holiday season is notorious for the emotional stress it evokes. Now, researchers at the University of Pennsylvania School of Medicine have come up with a non-invasive way to see the effects of psychological stress in an area of the brain linked to anxiety and depression. This research has important implications for how practitioners treat the numerous long-term health consequences of chronic stress.

In the study, which is reported in the Nov.21 online edition of the Proceedings of the National Academy of Sciences, researchers used functional magnetic resonance imaging (fMRI) to detect an increase in blood flow to the prefrontal cortex in individuals subjected to stress. Further, the increase remained even when the stressor was removed, suggesting the effects of stress are more persistent than once thought.

Whereas most previous fMRI studies have relied on indirect measures of cerebral blood flow, the Penn team, led by John A. Detre, measured blood flow directly, using a technique called arterial spin labeling. The technique is non-invasive, relying on magnetically "tagging" the water molecules in subjects' blood.

This research is supported by the National Science Foundation, the National Institutes of Health, and the U.S. Air Force.

NSF-PR 05-203

The National Science Foundation (NSF) is an independent federal agency that supports fundamental research and education across all fields of science and engineering, with an annual budget of nearly $5.47 billion. NSF funds reach all 50 states through grants to nearly 2,000 universities and institutions. Each year, NSF receives about 40,000 competitive requests for funding, and makes about 11,000 new funding awards. The NSF also awards over $200 million in professional and service contracts yearly.

Receive official NSF news electronically through the e-mail delivery and notification system, MyNSF (formerly the Custom News Service). To subscribe, visit nsf.gov/mynsf and fill in the information under "new users".

Mitch Waldrop
mwaldrop@nsf.gov
National Science Foundation
http://www.nsf.gov

Olivia Fermano
olivia.fermano@uphs.upenn.edu
University of Pennsylvania
http://www.uphs.upenn.edu

Stress Free With Sweet Snacks?

Sweet snacks could be best medicine for stress


Researchers from the University of Cincinnati (UC) have found that eating or drinking sweets may decrease the production of the stress-related hormone glucocorticoid--which has been linked to obesity and decreased immune response.

"Glucocorticoids are produced when psychological or physical stressors activate a part of the brain called the 'stress axis,'" said Yvonne Ulrich-Lai, PhD, a postdoctoral fellow in the department of psychiatry. "These hormones help an individual survive and recover from stress, but have been linked to increased abdominal obesity and decreased immune function when produced in large amounts.

"Finding another way to affect the body's response to stress and limit glucocorticoid production could alleviate some of these dangerous health effects."

The laboratory findings were presented during a poster session Tuesday, Nov. 15, at the annual Society for Neuroscience meeting in Washington, D.C.

Dr. Ulrich-Lai and a team of researchers from the department of psychiatry showed that when laboratory rats chose to eat or drink sweet snacks their bodies produced lower levels of glucocorticoid.

She said that sweets--especially those made from sugar, not artificial sweetener--might do the trick.

"The sweets we are talking about are not the low-calorie, sugar-substitute variety," said Dr. Ulrich-Lai. "We actually found that sugar snacks, not artificially sweetened snacks, are better 'self-medications' for the two most common types of stress--psychological and physical."

Psychological stress could involve things such as public speaking, being threatened, or coping with the death of a loved one. Examples of physical stress are injury, illness, or prolonged exposure to cold.

During the study, researchers gave adult male rats free access to food and water and also offered them a small amount of sugar drink, artificially sweetened drink, or water twice a day. After two weeks, the rats were given a physical and psychological stress challenge. Following both types of stress, rats that had consumed the sugar drink had lower glucocorticoid levels than those that drank the water. Those drinking the artificially sweetened drink showed only slightly reduced glucocorticoid levels.

Dr. Ulrich-Lai noted that although her team was not studying the health effects of the sweetened drinks, they did not notice a body-weight increase in the rats consuming the sugar drinks.

James Herman, PhD, co-author, professor and stress neurobiologist in the department of psychiatry, said the next step will be to determine how these sweetened drinks are decreasing glucocorticoid production.

"We need to find out if there are certain parts of the brain that control the response to stress, then determine if the function of these brain regions are changed by sugar snacking," he said.

Co-authors also included Dennis Choi and Michelle Ostrander, PhD, both of UC's psychiatry department.

Dama Kimmon
dama.kimmon@uc.edu
University of Cincinnati
http://www.uc.edu/news

Stress, Deprivation and Overeating

Mix stress, deprivation and tempting foods and you get overeating


Two studies in the October issue of Behavioral Neuroscience show that when animals are stressed, deprived and exposed to tempting food, they overeat, with different degrees of interaction. The powerful interplay between internal and external factors helps explain why dieters rebound and even one cookie can trigger a binge if someone's predisposed to binge.

The findings also implicate the brain's opioid, or reward, system in regulating overeating, especially when the food is extra-tempting - and not only in under-fed animals. This knowledge may help even non-stressed people to avoid overeating, keep their weight down and improve their health. Behavioral Neuroscience is published by the American Psychological Association (APA).

A study by M. Flavia Barbano, PhD, and Martine Cador, PhD, at the University of Bordeaux 2 in France, separated the distinct roles in consumption played by food deprivation and the "yum" factor, establishing that the interplay between internal and external factors regulates food intake, at least in mammals. Although much has been learned about human overeating, it is easier to untangle and verify the different variables involved in controlled animal studies.

Working with laboratory rats, the researchers tested three aspects of eating behavior: motivation (how bad did they want it), anticipation (how excited were they in advance), and intake (how much did they eat), all relative to homeostasis (satiety or deprivation) and food type (ordinary lab chow or "highly palatable" chocolate breakfast cereal, as verified by a pre-test of different foods).

For motivation, the researchers measured how fast 16 rats - who either had eaten freely or been put on a diet -- ran down an alley to a bowl of either chow or Choc and Crisp, a German-brand cereal. The animals ran faster when they were either food-deprived or presented with the chocolate cereal. However, when the food-sated animals were presented with Choc and Crisp, they ran just as fast as the hungrier rats.

The authors also measured anticipation in 32 rats by comparing activity levels when placed in individual cages where they would get either chow or cereal. First, the authors got the rats used to unpredictable feeding times; then for 10 days fed them a half hour after they went into the cage. Whether they expected chow or cereal, the food-restricted rats were more active, rearing up a lot more. Regardless of food type, only the deprived rats were more active, so the researchers concluded that anticipatory activity depends not on food type but on whether the animal has had enough to eat (homeostatic state).

As for actual intake, when presented with the Choc and Crisp, the food-sated group ate almost as much as the food-deprived group. But when presented with lab chow, they ate very little. Barbano and Cador concluded that highly palatable food motivates an animal to eat more than it really needs. When food type and satiety interact, attractiveness overrides satiety -- a phenomenon known to anyone who has ever stood in a buffet line.

In another key study, neuroscience psychologist Mary Boggiano, PhD, and her colleagues at the University of Alabama at Birmingham focused on the regulatory role of the brain's opioid system. Opioids or endorphins (the brain's "feel good chemicals") play a key role in our liking of food. Yet external substances such as heroin and morphine mimic endorphins by binding to the same receptors in the brain, produce a sense of reward (among other functions). The researchers compared how binge-eating rats versus non-binge eating rats responded to drugs that either turn on opioid receptors (butorphanol, which treats pain) or block them (naloxone, which treats heroin addiction).

From the rats' responses to these drugs, Boggiano and her colleagues inferred how stress and dieting change the brain's opioid control of eating. The binge eating occurred after rats experienced both foot shock (stress) and cyclic caloric restriction (dieting). Either caloric restriction or stress alone were not enough to produce changes in food intake, but stressed and underfed rats ate twice the normal amount of Oreo® cookies, which rats find rewarding. In other words, animals subjected to both stressors became binge eaters, confirming how strongly these outside factors interact to change eating behavior.

The findings also implicated opioids in the neurochemistry of binge eating. The highly rewarding butorphanol enhanced the binge eating; the reward-blocker naloxone suppressed how much the stress/deprived rats ate, to the level of the control rats. The authors say this pattern of findings in rats who were sated at the time of testing strengthens the evidence that reward, more than metabolic need, drives binge eating. Boggiano and her colleagues speculate that sensitized opioid-receptor signaling may be necessary to initiate binge eating. In the rats, stress and reduced calories seemed to sensitize those receptors to the presence of highly palatable food, in this case cookies. This, they write, "may underlie the common clinical observation that just a bite of highly palatable (often forbidden) food triggers binges and makes it difficult to abstain from binge eating."

The researchers speculate that the deprived and stressed rats may have been in a "hedonic deprivation state," essentially craving something good and rewarding. The research underscores how what is viewed as an unhealthy behavior (indulging in palatable foods, which are cheap, convenient and often high in fat and sugar) may have its roots in the need to survive. It suggests that binge eating is an adaptive response to abnormal environmental conditions. Boggiano cites other scientists' findings that among healthy people without eating disorders, dieting is the biggest predictor of stress-induced overeating.

In light of their findings, she says, "Highly palatable food can mimic opioid drugs by releasing opioids or activating sensitized receptors, so imagine so imagine what it can do in a human with a history of dieting. If only rat chow is available, even rats with a history of dieting when stressed rats don't binge -- but when they get a little bite of cookie first, they do." As a result, she says when treating bulimics and binge eaters, it may not be a good idea to introduce palatable (junk) food too early in therapy.

However, she thinks that binge eaters' sensitized opioid receptors should return to normal as long as they stay away from very-low-calorie diets and from trigger foods for a long time, perhaps relative to the amount of time they've had the disorder. In the meantime, scientists could perhaps develop a safe opioid blocker that could help binge eaters fight off food cravings. However, Boggiano believes that the main key is not drugs but behavioral change around food, recognizing stressors and avoiding restrictive diets.

"Binge eating is normal," she says. "It's your brain's best way to respond to expected starvation. It's restrictive dieting and stressing so much about your body weight and shape that is abnormal."

Articles both appear in Behavioral Neuroscience 2005, Vol. 119, No. 5:

1. "Various Aspects of Feeding Behavior Can Be Partially Dissociated in the Rat by the Incentive Properties of Food and the Physiological State;" M. Flavia Barbano, PhD, and Martine Cador, PhD, Laboratoire de Neuropsychobiologie des Désadaptations, Centre National de la Recherche Scientifique, Unite Mixte de Recherche 5531, Universite Victor Segalen Bordeaux 2, Bordeaux, France.

(Full text of the article is available from the APA Public Affairs Office and at: Feeding Behavior:
apa.org/journals/releases/bne11951244.pdf)

2."Combined Dieting and Stress Evoke Exaggerated Responses to Opioids in Binge-Eating Rats;" Mary M. Boggiano, PhD, Paula C. Chandler, M.A., Jason B. Viana, B.S., Kimberly D. Oswald, B.S., Christine R. Maldonado, B.S., and Pamela K. Wauford, B.S.; University of Alabama at Birmingham.

(Full text of the article is available from the APA Public Affairs Office and at Dieting and Stress:
apa.org/journals/releases/bne11951207.pdf)

The American Psychological Association (APA), in Washington, DC, is the largest scientific and professional organization representing psychology in the United States and is the world's largest association of psychologists. APA's membership includes more than 150,000 researchers, educators, clinicians, consultants and students. Through its divisions in 53 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting human welfare.

Landmark Study on Domestic Violence

Landmark study on domestic violence, WHO


The first-ever World Health Organization (WHO) study on domestic violence reveals that intimate partner violence is the most common form of violence in women's lives - much more so than assault or rape by strangers or acquaintances. The study reports on the enormous toll physical and sexual violence by husbands and partners has on the health and well-being of women around the world and the extent to which partner violence is still largely hidden.

"This study shows that women are more at risk from violence at home than in the street and this has serious repercussions for women's health," said Dr LEE Jong-wook, Director-General of WHO at the study release in Geneva. "The study also shows how important it is to shine a spotlight on domestic violence globally and treat it as a major public health issue."

The study is based on interviews with more than 24 000 women from rural and urban areas in 10 countries: Bangladesh, Brazil, Ethiopia, Japan, Namibia, Peru, Samoa, Serbia and Montenegro, Thailand, and the United Republic of Tanzania. The Women's Health and Domestic Violence Against Women study makes recommendations and calls for action by policy makers and the public health sector to address the human and health costs, including by integrating violence prevention programming into a range of social programmes.

The study finds that one quarter to one half of all women who had been physically assaulted by their partners said that they had suffered physical injuries as a direct result. The abused women were also twice as likely as non-abused women to have poor health and physical and mental problems, even if the violence occurred years before. This includes suicidal thoughts and attempts, mental distress, and physical symptoms like pain, dizziness and vaginal discharge. The study was carried out in collaboration with the London School of Hygiene and Tropical Medicine, PATH and national research institutions and women's organizations in the participating countries.

“The degree to which the health consequences of partner violence in the WHO study are consistent across sites, both within and between countries, is striking,” noted Dr Charlotte Watts, from the London School of Hygiene and Tropical Medicine, a member of the core research team for the study. "Partner violence appears to have a similar impact on women's health and well-being regardless of where she lives, the prevalence of violence in her setting, or her cultural or economic background."

Domestic violence is known to affect women's sexual and reproductive health and may contribute to increased risk of sexually transmitted infections, including HIV. In this study, women who were in physically or sexually abusive relationships were more likely to report that their partner had multiple sexual partners and had refused to use a condom than women in non violent relationships. Women who reported physical or sexual violence by a partner were also more likely to report having had at least one induced abortion or miscarriage than those who did not report violence.

Although pregnancy is often thought of as a time when women should be protected, in most study locations, between 4% and 12% of women who had been pregnant reported being beaten during pregnancy. More than 90% of these women had been abused by the father of the unborn child and between one quarter and one half of them had been kicked or punched in the abdomen.

For policy makers, the greatest challenge is that abuse remains hidden. At least 20% of women reporting physical violence in the study had never told anyone before being interviewed. Despite the health consequences, very few women reported seeking help from formal services like health and police, or from individuals in positions of authority, preferring instead to reach out to friends, neighbours and family members. Those who did seek formal support tended to be the most severely abused.

“This is the first ever study conducted in Thailand on this issue and has made us better understand the extent of violence that women experience in our country," noted Dr. Churnrurtai Kanchanachitra from Mahidol University, and a member of the study team in Thailand. "The findings helped us to develop the national plan for the elimination of violence against women and children."

The report recommends a range of vital interventions to change attitudes and challenge the inequities and social norms that perpetuate abuse. It further recommends integrating violence prevention programming into ongoing initiatives aimed at children, youth, HIV/AIDS, and sexual and reproductive health. Health service providers should be trained to identify women experiencing violence and to respond appropriately. Prenatal care, family planning or post abortion care are potential entry points to provide care, support, and referral to other services. Schools need to be safe places, support systems for victims must be strengthened and prevention programmes put in place. Raising awareness of the problem among the general public is critical. . "Domestic violence can be prevented and governments and communities need to mobilize to fight this widespread public health problem," said WHO's Dr Claudia Garcia Moreno, Study Coordinator. "WHO will continue to raise awareness about violence and the important role that public health can play to address its causes and consequences. Globally, we need to stop the violence from happening in the first place, and to provide help and support to women who are in abusive relationships."

WHO's Global Campaign for the Prevention of Violence supports governments to develop comprehensive violence prevention programmes to address domestic violence alongside other types of violence.

Some quotes from women interviewed for the study

-- "I suffered for a long time and swallowed all my pain. That's why I am constantly visiting doctors and using medicines. No one should do this." Woman interviewed in Serbia and Montenegro.

-- "He got this gun, I don't know from who… And he would tell the girls: "I'm going to kill your mother… The day will break and your mother will be dead right here…" I would sleep in a locked bedroom and with a dog inside the room with me. My dog. So he would not kill me". Woman interviewed in Brazil.

-- "He hit me in the belly and made me miscarry two babies - identical or fraternal twins, I don't know. I went to the Loayza hospital with heavy bleeding and they cleaned me up." Woman interviewed in urban Peru.

How physical and sexual violence was measured:

For physical violence, women were asked whether a current or former partner had ever: slapped her, or thrown something at her that could hurt her ; pushed or shoved her ; hit her with a fist or something else that could hurt ; kicked, dragged or beaten her up ; choked or burnt her on purpose ; threatened her with , or actually used a gun, knife or other weapon against her.

Sexual violence was defined by the following three behaviours: Being physically forced to have a sexual intercourse against her will ; having sexual intercourse because she was afraid of what her partner might do ; being forced to do something sexual she found degrading or humiliating.

http://www.who.int

Insomnia - Sleep

Is good sleep a new 'vital sign'?

Sleeplessness affects too many Americans - and it doesn't go away as we age. Results of a new survey being revealed at the International Longevity Center's Sleep and Healthy Aging Scientific Consensus Conference will shed new light on what's keeping older adults awake at night and the lengths they're going to in order to cope.

The nation's top medical experts will convene at the conference to discuss an overlooked issue in the medical community - sleep and healthy aging. The conference will address such questions as:

-- Should sleep be considered a new "vital sign" for older adults?

-- How does lack of sleep add to the physical and emotional burden of being a caregiver?

-- What is the relationship between exercise and sleep in older adults?

-- How does sleep affect older adults' quality of life?

Media are invited to participate in a one-hour preview that will highlight the new survey results and select presentations from the conference.

Host
Robert N. Butler, M.D., President and CEO, ILC-USA Additional presenters also will be available for interviews.

WHEN & WHERE?

Thursday, November 3, 2005 9:00-10:00am Harvard Club, 27 W. 44th St., NYC Or via teleconference at 888-632-5950 (outside the US: 713-481-1320)

Megan McIntyre
Communications Manager
International Longevity Center- USA
meganm@ilcusa.org

Adam Pawluk
adam.pawluk@ketchum.com
646-935-4135
Ketchum
ketchumcomms.co.uk

The Sleep and Healthy Aging Scientific Consensus Conference is sponsored by the International Longevity Center-USA and made possible by an unrestricted educational grant from Takeda Pharmaceuticals North America, Inc.