One of the world’s most popular and trusted assessments of cognitive impairment is now available as a convenient app for smartphones and tablets. Like the paper-and-pencil version, the app can be used to screen for cognitive impairment, to select patients for clinical trials research in dementia treatment, or to track patients’ progress over time.

The MMSE/MMSE-2 app includes a brief instructional video that walks users through the features of the app. In addition to the original MMSE, both standard and brief versions of the MMSE-2 are available, enabling health care providers to choose the version that will suit each client. Scoring is done automatically, and patient records can be uploaded directly to an electronic medical records (EMR) system or e-mailed to appropriate personnel. Equivalent, alternate forms of the MMSE-2 decrease the possibility of practice effects that can occur over serial examinations. The app also includes norms for the MMSE and the MMSE-2, by age and education level.

The MMSE/MMSE-2 app is available to qualified health care professionals from the Apple® App StoreSM (for the iPhone® or iPad®) and from Google Play (for Android™ devices). The app is free—users pay only for administrations, which start at $1.25 each.

 
Editor’s Note: Last week, we blogged about non-medical prescription drug use (NMPDU) and a study that linked it to depression in college students. This week, we follow up with one of the study’s coauthors, Dr. Amanda Divin, from Western Illinois University. In the study, Dr. Divin found that young women were more likely to abuse painkillers than young men. We wanted to learn more.

PAR: Why might females be more likely than males to use painkillers if they were feeling hopeless, sad, depressed, or suicidal?

Dr. Divin: Well, there are lots of reasons. First, the properties of opioid painkillers are that they block pain reception in the brain but also increase release of dopamine in the brain which results in euphoria. So the pharmacological properties of painkillers make them attractive to people who may be feeling the blahs of depression or other depressive symptoms.

Second, research indicates that females have greater exposure to prescription drugs with addictive potential (e.g., opioid painkillers and anti-anxiety drugs) and are more likely to be prescribed a drug than males. If you look at the literature, and even empirical evidence, it's very common for a woman to go to a doctor complaining of symptoms, and she is given a prescription for a painkiller or sedative, whereas a male may be given different advice or treatment.

Third, women are more likely to suffer from depression. Their physiology also makes them more likely to become addicted to painkillers (females actually need a lower dose of opioids than males do to experience the same amount of painkilling effects).

If you put all those things together, it almost seems like common sense that females are more likely to self-medicate. I do want to point out, however, there have been other studies which have found the opposite—that it’s males [who are more likely to self-medicate]. There is still a lot of research and replication that needs to be done.

PAR: Why did you decide to conduct this study? How did it affect you personally?

Dr. Divin: I'm a professor, so I work with college students every day. It’s not at all uncommon that a student will come talk to me about their problems. It’s very common that prescription drug use or depression/suicidal thoughts are among those problems. In talking with my colleague Keith Zullig [from West Virginia University], who has done a lot of research on prescription drugs, we decided this was an area that really needed to be investigated. This study personally affected me in a couple of ways: I read just about every single article that had ever been printed regarding prescription drug use—and wow, did this open my eyes to what a commonplace, everyday sort of thing NMPDU is, how easy it is to acquire prescription drugs, and just how socially acceptable it has become. Both the NMPDU and suicide literature also opened my eyes to the stress college students are under nowadays and how stress, depression, and NMPDU are all connected. I will say some of the scariest things I learned from doing this research are about the very dangerous side effects and risks that prescription drugs carry.

PAR: What advice would you give to college students using non-medical prescription drugs?

Dr. Divin: My best advice would include a few things:

(1) If you're feeling depressed, the solution isn’t going to be found in a pill bottle. NMPDU only offers a temporary solution to a very real and pervasive problem. The best thing to do is go see a professional. On most college campuses, seeing a doctor or mental health professional is free! In the final analysis, you are just temporally postponing the problem and possibly creating others in the process.

(2) Prescription drugs carry very real and dangerous side effects. Just because they were approved by the FDA doesn't mean you’re not going to have an adverse or deadly reaction.

(3) If you are currently taking several different prescription drugs non-medically, be very careful of the possible drug interactions.

(4) There is no shame in admitting you have a problem and need help.

 

This interview was conducted by Grace Gardner, a recent graduate from the University of South Florida and an editorial assistant in the Production Department at PAR.
The Centers for Disease Control and Prevention (CDC) is calling painkiller use in the U.S. a “public health epidemic.”

A new study found that non-medical drug abuse is linked to depression and suicide in college students. Keith Zullig, PhD, from West Virginia University and Amanda Divin, PhD, from Western Illinois University conducted a study analyzing non-medical drug use among college students and its relationship to symptoms of depression.

Zullig and Divin analyzed data from the 2008 American College Health Association National College Health Assessment (ACHA-NCHA). ANCHA-NCHA asked 26,000 randomly selected college students from 40 campuses in the U.S about their non-medical drug use including painkillers, stimulants, sedatives, and antidepressants, along with their overall mental health in the last year.

The study, entitled “The Association between Non-medical Prescription Drug Use, Depressive Symptoms, and Suicidality among College Students” appears in the August 2012 issue of Addictive Behaviors: An International Journal. Authors reported that 13 percent of respondents who felt hopeless, sad, depressed, or were considered suicidal were using non-medical prescription drugs. The results were especially apparent in college females who reported painkiller use. Authors suggest that these findings are the result of college students self-medicating to mask their psychological distress.

“Because prescription drugs are tested by the U.S. Food and Drug Administration and prescribed by a doctor, most people perceive them as ‘safe’ and don't see the harm in sharing with friends or family if they have a few extra pills left over,” Divin said in a news story  from Western Illinois University. “Unfortunately, all drugs potentially have dangerous side effects. As our study demonstrates, use of prescription drugs—particularly painkillers like Vicodin and Oxycontin—is related to depressive symptoms and suicidal thoughts and behaviors in college students. This is why use of such drugs need[s] to be monitored by a doctor and why mental health outreach on college campuses is particularly important.”

The U.S. Department of Education’s Higher Education Center for Alcohol, Drug Abuse, and Violence Prevention says, “Before choosing a prevention strategy, you must start with assessment—the same as you would when addressing high-risk alcohol abuse or violence on campus.” The Center’s suggestions included surveys such as the NCHA, environmental scanning, including physical and online social networking environments, and increased faculty-student contact and mentoring.

What do you think? Should colleges do more to address non-medical prescription drug abuse as part of mental health and suicide prevention programs for their students? We would love to hear from you and keep the conversation going!

Editor’s note: This week, PAR is pleased to welcome guest blogger Grace Gardner. A recent graduate of the University of South Florida with a B.A. in Mass Communication, Grace is working as an editorial assistant this summer in the production department at PAR.

 
The Sports Legacy Institute (SLI) is a non-profit organization focused on solving the concussion crisis by supporting education and research on the causes and effects of concussions and by helping to shape subsequent policy.   SLI’s mission is “to advance the study, treatment, and prevention of brain trauma in athletes and other at-risk groups.” SLI is one of PAR’s valued partners, sharing our commitment to creating connections and changing lives.

This month, SLI announced the launch of the California Concussion Coalition, and PAR was a proud sponsor of kick-off events in Los Angeles and Oakland. The goal of the coalition is “to provide student athletes in the community with the best-in-class resources available to protect them from concussions in sports.” Special guests at the August 20 kick-off event in LA included former NFL players Jim Brown, Michael Haynes, Jerry Simmons, and Shelby Jordan, as well as professional wrestler Rob Van Dam.

Concussion prevention is very important to us at PAR, and we are delighted to be working with an organization like the SLI, which supports education and research that will help protect young athletes from serious brain injury.  In terms of best-in-class resources, our concussion apps, including the award-winning CRR (for parents and coaches) and the CARE (for health care professionals), provide a simple and cost-effective way to help users quickly assess the likelihood of a concussion and take appropriate action. PAR donates 15% of the proceeds from the sale of each concussion app to support concussion research at the Children’s National Medical Center and the Matthew A. Gfeller Sport-Related Traumatic Brain Injury Research Center at the University of North Carolina, Chapel Hill.

Have you had a chance to download one of our concussion apps? If not, click on the links above or find us at the Apple® App StoreSM or Google Play. And let us know what you think—PAR wants to hear from you, so leave a comment and join the conversation!
A recent study published in the Archives of General Psychiatry found a relationship between gestational age and various psychiatric disorders in adults. The results suggest that a concrete relationship exists between a shorter gestational period and the onset of mental illness later in life.

The study analyzed data from the medical records of 1.3 million adults born in Sweden between 1973 and 1985. Researchers analyzed multiple pregnancy outcomes including gestational age at birth, birth weight, and Apgar score; they then compared this data with information about psychiatric hospitalization in adulthood and diagnoses of bipolar disorder, depressive disorder, eating disorders, and drug/alcohol dependency.

A smaller gestational weight was associated with alcohol and drug dependency in adulthood, whereas a low Apgar score suggested an association with depressive disorder. Most strikingly, people born very premature (i.e., 32 weeks gestation) were:

  • 2.5 times more likely to have a non-affective psychosis;

  • 2.9 times more likely to have a depressive disorder; and

  • 7.4 times more likely to have bipolar disorder.


Lead author Dr. Chiara Nosarti, from the Institute of Psychiatry at King’s College London, told the BBC, “I don’t think parents should be worried, but we know that preterm birth confers an increased vulnerability to a variety of psychiatric conditions and perhaps parents should be aware of this and monitor early signs of later more serious problems.”

Although Nosarti and her coauthors acknowledge that previous studies have found associations between preterm birth and the onset of psychiatric disorders in childhood as well as adult onset schizophrenia, they assert that this study is the first to find an association between preterm birth and adult onset of both depressive disorder and bipolar affective disorder.

“We found a very strong link between premature birth and a range of psychiatric disorders,” said Nosarti in a King’s College press release. “Since we considered only the most severe cases that resulted in hospitalization, it may be that in real terms this link is even stronger. However, it is important to remember that even with the increased risk, these disorders still only affect 1-6% of the population.”

What do you think? Should parents of premature infants be alerted to their children’s increased risk for mental illness later in life? PAR wants to hear from you, so leave a comment and join the conversation!

Editor’s note: This week, PAR is pleased to welcome guest blogger Grace Gardner. A recent graduate of the University of South Florida with a B.A. in Mass Communication, Grace is working as an editorial assistant this summer in the production department at PAR.
The old playground rhyme got it wrong. Although sticks and stones do break bones, words can have devastating consequences as well. And when those words come from a child’s parent or caregiver, the repercussions for the child’s psychological and emotional health can be long lasting.

A recent clinical report from the American Academy of Pediatrics (Pediatrics, July 20, 2012) describes the behaviors of emotionally abusive parents/caregivers and outlines the risks to children who are subjected to this abuse. Lead author Roberta Hibbard, MD, director of child protection programs at Indiana University and Riley Hospital for Children in Indianapolis, asserts that the emotional maltreatment of children deserves the same level of attention that physical and sexual abuse is given.

Hibbard and her coauthors describe the different forms that psychological abuse of children can take, including:

  • spurning, that is, belittling or ridiculing the child in public;

  • terrorizing, or exposing the child to dangerous or chaotic situations;

  • isolating, or shutting the child out of interactions or relationships;

  • exploiting or corrupting the child; and

  • neglecting the child’s health or education.


According to the report, emotional abuse by a parent/caregiver may be verbal or nonverbal, active or passive, and with or without intent to harm. But regardless of the form or intent, these behaviors are harmful to a child’s cognitive, social, emotional, and even physical development. “Psychological maltreatment has been linked with disorders of attachment, developmental and educational problems, socialization problems, disruptive behavior, and later psychopathology,” says Hibbard.

In her July 30 article, “Childhood Mental Abuse Under the Radar?,” MedPage Today staff writer Nancy Walsh summarizes the AAP report and describes some of the challenges for mental health care providers in identifying and treating emotional abuse. “Although it can be difficult to determine the actual prevalence of psychological and emotional maltreatment of children, an estimated 4% of men reported having experienced some form of this abuse as children, as did 8% to 9% of women,” says Walsh. “The problem most often is found in families with high levels of conflict, and where substance abuse, violence, and parental mental health difficulties such as depression exist.”

Support for parents and early intervention may be the key to reducing these numbers, according to the AAP report. “Prevention before occurrence will require both the use of universal interventions aimed at promoting the type of parenting that is now recognized to be necessary for optimal child development, alongside the use of targeted interventions directed at improving parental sensitivity to a child’s cues during infancy and later parent-child interactions,” says Hibbard. “Intervention should, first and foremost, focus on a thorough assessment and ensuring the child’s safety. Potentially effective treatments include cognitive behavioral parenting programs and other psychotherapeutic interventions.”

What do you think? What can be done to increase awareness about the emotional maltreatment of children and to support parents who may be at risk for these behaviors? PAR wants to hear from you, so leave a comment and join the conversation!
The Department of Veterans Affairs is working to address the growing problem of suicide among members of the military, using technology to strengthen communication between active-duty troops or veterans and the mental health professionals who can help them. VA Secretary Eric Shinseki says that the VA will be making greater use of videoconferences between doctors and their patients, according to a June story from the Associated Press.

Suicides this year among active-duty military personnel now outnumber battle deaths, according to Pentagon statistics (New York Times, June 8). Between January 1 and June 8, 2012, there were 154 suicides—an average of one per day and an 18 percent increase over the number of suicides during the same period in 2011.

The VA is planning to use videoconferencing to eliminate some of the barriers that prevent members of the military from seeking help for feelings of distress or suicidal thoughts. Videoconferencing can reduce the amount of time patients spend traveling, making it more convenient to meet with a health care provider. Shinseki said that members of today’s military are comfortable with online chats, and working with them in this way can help reduce some of the stigma that patients feel about their mental health concerns. ‘‘Shame keeps too many veterans from seeking help,’’ Shinseki said.

The VA is also stepping up its use of electronic health records, according to the AP story. In recent months, Congress has criticized Shinseki about the length of time that some veterans have had to wait before receiving a full mental health evaluation from the VA. By integrating electronic health records among departments, the VA hopes to expedite treatment for veterans who need immediate attention.

VA officials estimate that up to two-thirds of all veterans who commit suicide have never asked for the VA’s help, a reality that Shinseki called frustrating and disheartening. “We know when we diagnose and treat, veterans get better,” he told the audience at a recent veterans suicide prevention conference, “but we can’t influence and help those we don’t see” (Stars and Stripes digital edition).

What do you think? Is videoconferencing a viable option for improving the responsiveness of mental health services for active-duty personnel or veterans? Do you use technology to communicate with clients—military or otherwise—in your practice? PAR wants to hear from you, so leave a comment and join the conversation!


PAR is proud to announce that the following 14 PAR authors will be presenting at APA this year. We encourage you attend their sessions and to visit our booth to meet our staff, pick up a complimentary doorhanger, and receive 15% off plus free shipping and handling on all purchases made during APA 2012.


Kevin D. Arnold
2212


Phillip J. Brantley
3293


Lisa Firestone
1174, 3051


Gerard Gioia
2210


Christopher Hopwood
4060


Randy Kamphaus
1150, 2127, 2163, 4104


Alan Kaufman
3211


Mark McMinn
1096, 1307, 2073, 2316, 3099, 3248


Jonathan Mueller
4132


Randal Salekin 
1013, 1141, 4130, 4135


Peter Sheras
 2271, 3047, 4131


Glenn Smith
3073


Robert Stern
2210


Irv Weiner
1066

Although more common in teens and young women, eating disorders are affecting a growing number of older women, according to a new study published in the International Journal of Eating Disorders. The research, led by Cynthia Bulik, a professor of psychiatry and director of the Eating Disorders Program at the University of North Carolina, surveyed 1,849 women aged 50 years and older from across the U.S. The survey included questions about eating disorder symptoms, dieting and body checking behaviors, and weight and shape concerns. Among the sometimes surprising results, 13 percent of those surveyed reported eating disorder symptoms such as excessive dieting, binge eating, and purging; 62 percent said that their weight or shape has a negative impact on their lives.

“The disorders have serious physical as well as emotional consequences,” said Bulik in a June 21 interview with USA Today. “Part of my goal is to make this an issue all doctors need to be aware of regardless of a woman’s age. Many think eating disorders end at age 25. They exist at every age, we're finding.”

Although eating disorders have a serious negative impact on health at any age, the problems are compounded in older women, whose immune systems can be weaker and whose bone density is often lower. Bulik often sees severe osteoporosis, gastroesophageal reflux disease, and cardiovascular health issues linked to eating disorders in older patients (American Medical Association online newsletter, July 9).

One of the country’s first residential treatment centers for eating disorders, the Renfrew Center reports a 42 percent increase over the last 10 years in the number of women aged 35 years and older seeking treatment at its clinics. Some of the center’s older patients have struggled with eating disorders or other weight issues for many years, while others developed an eating disorder for the first time later in life.

“We ask the question, what are the triggers to mid- and late-life eating disorders?” Bulik said in the USA Today interview. “They’re talking about divorce, loss, children leaving home, children coming home, being in the sandwich generation when you’re taking care of children and your parents…. Food can be seen as a way to regulate mood during these times.”

Some attribute part of the increase in eating disorders among older women to more frequent diagnoses based on doctors’ greater awareness of the issue. But whatever the cause, it’s clear that eating disorders are not limited to the young—and older women are seeking help more often as they struggle with weight and shape concerns.

What do you think? Have you noticed an increase in the number of older clients with symptoms of eating disorders? PAR wants to hear from you, so leave a comment and join the conversation!

 
Concussions are in the headlines once again as awareness grows about a possible link between concussions and the permanent brain damage associated with Alzheimer’s disease and dementia. The issue has far-reaching implications, including for one of the country’s most venerated institutions: the National Football League.

A major complaint filed last month against the NFL involving more than 2,400 former professional football players alleges that the NFL was not only aware of links between head injuries (such as concussions) and permanent brain injuries, but that they attempted to hide the information from players and the public. According to a June 30 AP report, “At issue is whether the NFL knew if there were links between football-related head trauma and permanent brain injuries and failed to take appropriate action.” Attorneys for retired players accuse the NFL of “negligence and intentional misconduct in its response to the headaches, dizziness, and dementia that their clients have reported.”

The league has denied the charges, stating, “The NFL has long made player safety a priority and continues to do so. Any allegation that the NFL sought to mislead players has no merit. It stands in contrast to the league’s many actions to better protect players and advance the science and medical understanding of the management and treatment of concussions” (Huffington Post, June 7).

According to a 2009 study commissioned by the NFL and conducted by the University of Michigan’s Institute for Social Research, former professional football players report being diagnosed with Alzheimer’s, dementia, and other mental impairments at many times the national average. Although the study was based on interviews and self-reporting rather than on independent diagnoses, the results suggest an alarming rate of memory-related problems.

Amid the swirl of headlines, allegations, and denials, one thing is clear: concussion is a brain injury that must be taken seriously by those who work with athletes at every level. With this goal in mind, PAR has been working closely with researchers at the Matthew Gfeller Sport-related Traumatic Brain Injury Research Center at the University of North Carolina, Chapel Hill, to develop tools that can help coaches, athletic trainers, and parents recognize the signs and symptoms of a concussion and respond appropriately. The Concussion Recognition & Response™ app (for parents and coaches) and the Concussion Assessment & Response™ app (for athletic trainers, team physicians, and other medical professionals) are the result of this collaboration.

Are attitudes toward concussion changing in your community? Is the recent media coverage helping to raise awareness about brain injuries? PAR wants to hear from you, so leave a comment and join the conversation!