SWEDEN: Stress, Depression Linked to Accelerated Aging

NEW YORK, NY / Medscape News Today / Psychiatry / March 1, 2012

By Fran Lowry

Shortened telomere length, which is known to be associated with aging, is also associated with depression and hypocortisolism, new research shows.

These findings confirm earlier research showing shorter telomere length in depressed patients in comparison with nondepressed individuals from the general population, according to lead author Mikael Wikgren, PhD, from Umeå University in Sweden.

Dr. Mikael Wikgren 

"It also goes on to suggest that this difference is related to a dysregulated stress response, which is a stress response pattern which has been tied to chronic stress," he told Medscape Medical News. "This, in turn, underlines the important role stress regulation plays in depressive illness, and, in view of telomere length being considered a marker of biological aging, suggests that stress accelerates aging."

The study is published in the February 15 issue of Biological Psychiatry.

Established Link

Dr. Wikgren's earlier work established that telomere length was associated with depression. In the current study, he and his group sought to investigate how telomere length related to biological and psychological measures of stress and whether these were related to the shorter telomere length seen in depressed patients.

The researchers measured telomere length in the leukocytes of 91 study participants who had recurrent major depressive disorder and 451 control participants. The mean age of the study participants was 59 years. Most of the depressed patients had suffered from depression for an average of 28 years.

The participants also underwent a dexamethasone suppression test to assess the reactivity of the hypothalamic-pituitary-adrenal (HPA) axis, which is a very important regulator of the stress response, most known for regulating cortisol.

Participants also filled out psychometric self-report questionnaires.

High Stress, Low Cortisol

As expected, telomere length was significantly shorter among depressed patients compared with control participants (P = .001).

Telomere length was also shorter in both depressed and control participants who showed low cortisol levels on the dexamethasone suppression test. However, it was shortest in the depressed patients.

This hypocortisolemic state was associated with a family history of affective disorders among the depressed patients and with high C-reactive protein levels among the control participants.

The researchers also found that telomere length was inversely associated with higher levels of stress as measured with the perceived stress questionnaire.

"Hypocortisolism has been found in patients with chronic fatigue syndrome, post-traumatic stress disorder, burnout, fibromyalgia, irritable bowel syndrome, disorders which share symptoms of fatigue, pain, and increased stress sensitivity," Dr. Wikgren said.

Traditionally, too much cortisol has been thought to be harmful, but more and more research is showing that the opposite is true, he added. "When you experience chronic stress, cortisol levels go down. A hyporesponsive HPA axis evolves over time when under stress, so an initially hyperreactive HPA axis gradually evolves into a hyporesponsive HPA axis."

Beyond Emotional Distress

Commenting on this research for Medscape Medical News, John H. Krystal, MD, the Robert L. McNeil Jr Professor of Translational Research and Chair of the Department of Psychiatry at Yale University School of Medicine, New Haven, Connecticut, said the current findings provide further evidence that stress and psychiatric disorders may have profound effects on health that go beyond emotional distress and functional impairment.

Dr. John Krystal

"We are learning a great deal about the functions of telomeres in processes like cellular aging and cancer," Dr. Krystal, who is also the editor of Biological Psychiatry, said.

"From this perspective, the importance of helping people to identify these life problems and to get effective treatment for them may be an important part of preserving their overall medical health. In other words, the average doctor routinely measures blood pressure, EKG, and glucose levels, but if we want to protect against some health problems, we may also need to measure depression and to assure that depressed people obtain the treatment they need."

This research was funded by the Swedish Research Council, Umeå University, and the County Councils of Västerbotten and Norrbotten, Sweden. Dr. Wikgren and Dr. Krystal have disclosed no relevant financial relationships.

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USA: Delirium in the Elderly - When It's Time to Call 911

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NEW YORK, NY / The Huffington Post /  Living / May 10, 2011

By Kathryn Haslanger

Delirium is quite common among people over the age of 65, and while it can be life-threatening, it is often preventable.

We all hear stories of the difficulties people have when caring for their elderly family members. But once in a while I hear a story that I feel needs especially to be shared because even the most informed and well-intentioned caregivers may be unaware of the subtle signs that may indicate a very dangerous condition. Such is the case with delirium -- an acute mental disorder that presents as disorientation and can come on very quickly -- within hours or days.

Delirium is quite common among people over the age of 65, and while it can be life-threatening, or lead to adverse events culminating in the loss of independence or an increased risk of chronic illness, delirium is often preventable. Recognizing and responding to the signs of delirium in its earliest stages is an important skill for the family caregiver to develop.

Illustrative photo by courtesy of
How Long Do Delirium Tremors Last ?

Clara is the 86-year-old mother of my close friend, Margie. An energetic woman who has lived on her own for many years, Clara has always been upbeat and optimistic, even in the face of the diabetes she's had to manage for the last several years. My friend Margie stops by to visit her mother every morning before work, but, other than dropping off a few of Clara's favorite magazines and showing her fascinating new uses for her new computer, there's not much she needs in the way of assistance. Getting Clara's coffee and breakfast ready each day is more of a comfort for Margie than a necessity for Clara.

Recently, Clara was scheduled for a home visit by a nurse from the Visiting Nurse Service of New York (VNSNY) to have a weekly diabetes coaching session and blood sugar monitoring. These were typically pleasant and uncomplicated visits in which the nurse would review the patient's self-checked blood sugar measurements and talk about healthier food choices if she found moderate spikes in blood sugar. The week before, Clara and the nurse had had a lively discussion, talking about the news of the day and the latest activities of President Obama.

However, when the nurse arrived last week, something was clearly wrong. Margie was still at Clara's house at 11:00 in the morning, and, upon entering the apartment, the nurse could see the stress in Margie's eyes. "I don't know what's wrong," said Margie, clearly distraught. "Mom is complaining about the breakfast I made, though she's not being very specific. She is extremely irritable, but I'm not exactly sure why. In fact, after complaining all morning, now she won't even talk to me." Margie felt bad that she had upset her mother, but didn't know what to do.

The home care nurse checked Clara's temperature, blood pressure and blood sugar, all of which were normal. However, the nurse agreed with Margie that the patient was markedly different on this day. The nurse started asking Clara pointed questions, and observed that Clara was not able to give the date or say what she had eaten for breakfast that morning.

Hearing Margie's report that Clara had been in her usual cheerful state the day before, the nurse made a call to Aneil Shirke, M.D., Ph.D., a psychiatric consultant in the VNSNY Behavioral Health program.

Upon hearing the symptoms of sudden disorientation, irritability and non-communicativeness, as well as the nurse's report that Clara's daughter "has never seen her this way," Dr. Shirke recommended a call to 911. "Any physical or behavioral condition that comes on in just 24 hours is a true medical emergency and needs to be evaluated in an emergency room," stated Dr. Shirke. He went on to say that many family caregivers hesitate to call 911 because they don't want to be a bother, especially when symptoms are not specific. But he stressed that "a family caregiver's intuition is very important; they may fear they've done something to upset a person, when more commonly the patient is experiencing delirium."

In the emergency room, Clara received a standard blood workup, chest x-ray and brain scan, and within a short time, it was clear that she was suffering from dehydration. She was given intravenous fluids and released later in the day, with instructions on how to remain hydrated.

Dehydration is one of the most common causes of delirium in the elderly (other common causes are infections and medications). Dehydration is especially a problem in the summer, when many older people, in an attempt to save money, turn off their air conditioners, or, due to reduced sensations of thirst, forget to drink regularly. "Unfortunately, many of the body's checks and balance systems, which work so well in middle age, become less sensitive in the elderly," stated Dr. Shirke. "Someone may become dehydrated to a dangerous level without any real outward physical symptoms." An attentive family caregiver, taking seriously that a family member is "not herself" and seeking prompt medical attention, can truly save a life.

After a brief, re-hydrating stay in the hospital, and some extra attention at home, Margie's mother was back to her old self. Clara was fortunate that she had home care in place because experienced health professionals know to take signs of delirium seriously and coordinate prompt medical attention. Yet it is also important that caregivers educate themselves about the major factors that predispose an elder care patient to the onset of delirium. Your family member is especially at risk for delirium if he or she suffers from:

• Cognitive Impairment
• Immobility
• Visual Impairment
• Hearing Impairment
• Sleep Deprivation
• Dehydration
• Alcohol abuse

Since delirium can have such dire consequences, and is often hard to treat when it gets severe, it is best to try to prevent it whenever possible. As the caregiver, there are things you can do to help prevent delirium for your family member in the hospital or at home, including:

• Go for walks together: Even down the hall! Some physical exercise three times a day is optimal.
• Be careful with sleeping medications: Wean your family memberer off of them if possible (with the doctor's approval). Try good, old-fashioned remedies such as a warm glass of milk, back rubs and playing soothing music.
• Play games: Word games, bingo, guessing games -- anything that gets the brain actively engaged and orients a person to their surroundings.
• Discuss current events: Watch the news together and share current stories from the extended family's lives.
• Foster independence: Can your family member button his/her own shirt? Then encourage it, no matter how long it takes. Find ways to re-introduce your caregiving charge to the daily activities he/she has always enjoyed (cooking, mending, tinkering, etc).

Dr. Shirke gives the following mnemonic to remember the most common causes of delirium:

D Dehydration
E Electrolyte imbalance
L Liver failure
I Ischemia or hypoxia (insufficient blood flow and oxygenation)
R Renal failure
I Impaction of stool
U Urinary tract or other infection
M Medications, especially psychotropics

Source: http://eldercareabcblog.com/how-caregivers-can-help-prevent-delirium/

Kathryn Haslanger is Senior VP for Community Benefit and External Affairs for VNSNY.

Copyright © 2011 TheHuffingtonPost.com, Inc.

UK: Growing up about growing old

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LONDON / BBC News / Health / April 21, 2011

By Dr Julian Hughes

Many elderly people are happy and healthy

The increasing number of elderly people in society tends to be seen as a problem. But in this week's Scrubbing Up column, old age psychiatrist Dr Julian Hughes argues we should actually see the over-60s as a bonus.

The prospect of getting old has never seemed alluring. And even if this is changing with the important advocacy of people like Dame Joan Bakewell, the ageing population is still seen as a problem. The problem of ageing for the individual appears as anything from wrinkles to memory problems; whilst the problem for ageing societies is seen as economic.


Increasingly, however, evidence is emerging that ageing is less of a problem than people, often younger, think it might be. For a start, even if age does bring aches, it also seems - according to studies all over the world - to bring happiness.


A large study by Newcastle University, for instance, has shown that 85-year-olds, despite having significant levels of disease and impairment, are very positive about their health and are able to function well.


Even at the level of the economy, pointing the finger at older people turns out to be unfair. The rest of society has to spend money on its older people, for sure, but the traffic is two-way, especially if (what are called) intergenerational transfers are measured broadly.


Putting it bluntly, older people are giving more to their offspring by and large than the other way around.


The big (older) society


If we look at volunteering, we discover that the big society is already here, and has been for years. But it is largely dominated by older people.


From the Women's Royal Voluntary Service, working in our hospitals and communities, to the volunteers working at National Trust properties or the voluntary work of faith-based charities, volunteers are more likely to be naturally silver. This is active citizenship, but also active ageing.

 

Who wishes to live a life that is brutal and short?
asks Dr. Julian Hughes

Remaining active, of course, is good for you, both mentally and physically. But, some will say, albeit we can paint an optimistic picture, isn't it the case that the diseases of old age will catch up with us eventually? Well, they might. It is certainly true that living longer brings with it an increasing risk of age-associated conditions, from arthritis to stroke disease. However, we have to remember that longevity is a success.
Who wishes to live a life that is brutal and short? And if most people at 85 are enjoying their lives, why would we wish not to enjoy this possibility too?After all, one aspiration of gerontology, the science of ageing, is that the morbidity curve can be squared off. In other words, rather than the ends of our lives involving an inevitably slow decline, instead, after a relatively healthy old age, we'll die quickly. Indeed, given the link between so many diseases and ageing, it makes sense to argue (somewhat radically) that if we could understand ageing itself (as we are increasingly doing), we might then have a better chance with cancer, heart disease, dementia, and so on.

The real challenge, however, is to do with making sense of our lives. If we're going to live longer, which we are, what's it for? Biomedical science and technology will help us to age. The purpose of ageing, however, what gives life meaning, is a matter for the arts, social sciences and humanities.

Dr Julian Hughes (right) is Consultant in old age psychiatry, Northumbria Healthcare NHS Trust and Newcastle University.

BBC © 2011

AUSTRALIA: Brain damage may explain elderly living in squalor

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MELBOURNE, Victoria / The Age / National News / September 26, 2010

By Stephen Cauchi

ELDERLY people living in squalor - a problem so widespread it prompted a National Squalor Conference last year - could be caused by brain damage, according to Caulfield Hospital researchers.

Steve McFarlane of Caulfield's Aged Psychiatry Service said a team of researchers were embarking on a study to test the theory that damage to the frontal lobe may be responsible.

''I think the keys to squalor lie in a part of the brain called the frontal lobe, which is to do with planning, organisation, judgment, social awareness,'' Professor McFarlane said. ''If we look hard enough we'll find these deficits and hopefully be able to do something about them.

''Sometimes there's direct evidence. I came across one lady recently who had had a frontal lobe lobotomy and was living in squalor. There are people who have had other frontal lobe insults like a stroke or head injuries and they end up living in squalor.''

Professor McFarlane said there was a range of theories on why people lived in squalor, including dementia, obsessive compulsive disorder, personality disorders and depression, but little proof.

''On a casual inspection, these people are really normal,'' said Professor McFarlane. ''They have no psychiatric diagnosis.

''[Researchers] look for depression and can't find it … When [people's living conditions] are pointed out to them, they can't even acknowledge that it is a filthy environment,'' he says. ''Simply cracking the whip and telling them to clean up won't work.''

Known as ''senile squalor'' - typified by houses filled with piles of rubbish and hoarded items and often with filthy toilets and kitchens - the condition affects between one-in-2000 and one-in-700 people over 65, he said.

Professor McFarlane, the team's lead investigator, hopes to study the frontal lobes of 50 people suffering senile squalor over the next two years using a PET (positron emission tomography) scanner or similar imaging device.

If the frontal lobe theory was proved, then drugs - probably similar to those used to treat Alzheimer's - could be used to treat the condition, he said.

Copyright © 2010 Fairfax Media

USA: Lasting Pleasures, Robbed by Drug Abuse

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NEW YORK, NY / The New York Times / Health / Views / August 31, 2010

By RICHARD A. FRIEDMAN, M.D.

Of all the things that people do, few are as puzzling to psychiatrists as compulsive drug use.

Sure, all drugs of abuse feel good — at least initially. But for most people, the euphoria doesn’t last. A patient of mine is all too typical.

“I know this will sound strange,” he said, as I recall, “but cocaine doesn’t get me high any more and still I can’t stop.”

When he first started using the drug, in his early 30s, my patient would go for days on a binge, hardly eating or drinking. The high was better than anything, even sex.

Within several months, though, he had lost the euphoria — followed by his job. Only when his wife threatened to leave him did he finally seek treatment.

When I met him, he told me that he would lose everything if he could not stop using cocaine. Well, I asked, what did he like about this drug, if it cost him so much and no longer made him feel good? He stared at me blankly. He had no clue.

Neither did most psychiatrists, until recently.

We understand the initial allure of recreational drugs pretty well. Whether it is cocaine, alcohol, opiates, you name it, drugs rapidly activate the brain’s reward system — a primitive neural circuit buried beneath the cortex — and release dopamine. This neurotransmitter, which is central to pleasure and desire, sends a message to the brain: This is an important experience that is worth remembering.

We would not have gotten very far as a species without this brain system to motivate us to seek out rewards like food and a nice mate. The trouble is that while such natural reinforcers activate the reward system, mind-altering drugs do it much more powerfully, causing a far greater dopamine release.

In other words, drugs have a competitive advantage over these natural rewards and can hijack the brain’s reward system.

Even so, the acute pleasure fades when the neurons in the reward circuit get used to all that dopamine. Eventually, as with my patient, even higher and higher doses cease to feel good as users try in vain to recapture the initial high.

So what explains compulsive drug use, especially when it brings the user to the brink of personal ruin?

I got a clue from my patient’s recent relapse. After nearly six months of abstinence, he found himself inexplicably craving cocaine on the way home from work.

It happened that he had run into an old friend just outside his office with whom he had used drugs years earlier. Although he did not consciously associate the friend and the drugs, his brain had not forgotten, and the meeting touched off the urge to use again.

In short, recreational drugs like cocaine don’t just usurp the brain’s reward circuit; they have powerful effects on learning and memory.

Many brain imaging studies, using positron emission tomography, show that cues like viewing drug paraphernalia are enough by themselves to activate memory circuits and unleash drug craving. Where you are and what you are doing when you use a drug like cocaine is inextricably linked with the high. And these associations are stored not just in your conscious memory, but also in memory circuits outside your awareness.

This kind of pathologic learning lies at the heart of compulsive drug use. Long after someone has apparently kicked the habit, long after withdrawal symptoms subside, the individual is vulnerable to these deeply encoded unconscious associations that can set off a craving, seemingly out of the blue.

I could not rewire my patient’s brain. But at least I could try to help him reconfigure his environment by avoiding cues that might provoke cocaine craving. I had him make an inventory of all the people and places he associated with his drug use — and then had him steer clear of as many as he could. Lucky for him that he never used drugs at home.

His problems did not end there, however. Although he has been cocaine-free for nearly two years, he feels life is lackluster and little excites him. And that experience is consistent with recent evidence that the effects of drugs like cocaine can endure long after use has ended.

Dr. Nora D. Volkow, a psychiatrist who is director of the National Institute on Drug Abuse, has shown using PET scans that methamphetamine-dependent subjects have about 25 percent fewer dopamine transporters in critical brain regions compared with normal volunteers. Since the transporters ferry dopamine in and out of neurons, this decrease means less dopamine release and a less responsive reward circuit.

Alarmingly, this reduction in dopamine transporters was present in subjects who had not used methamphetamine for at least 11 months, suggesting that the effect was long-lasting — perhaps even permanent.

Though my patient had not used methamphetamine, cocaine has similar effects in the brain. With years of abuse, he could have lost enough dopamine transporters that his own reward circuit would become dulled to everyday pleasures. After all, to most brains a fine dinner with friends or a beautiful sunset is no match for the euphoria of cocaine.

We do not yet know whether the loss of dopamine transporters is permanent or eventually reversible. But why take the chance and endure a dulled life? The plain truth is that drug-induced pleasure is a cruel illusion: it never lasts.

Dr. Richard A. Friedman is a professor of psychiatry at Weill Cornell Medical College.

Copyright 2010 The New York Times Company

IRELAND: Over 800 patients in ‘outdated’ psychiatric facilities

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DUBLIN, Ireland / The Irish Examiner / Health / Politics / June 7, 2010

Over 800 patients in ‘outdated’ psychiatric facilities

By Jennifer Hough

MORE than 800 mental health patients are still housed in psychiatric hospitals labelled as "Dickensian deplorable and appalling" despite repeated Government promises to shut them down.

John Moloney, Minister For Mental Health

Documents released to the Irish Examiner under the Freedom of Information Act reveal that some patients have been locked away for over 10 years, with many others needing intensive care for the rest of their lives. The documents also reveal concerns from healthcare professionals that "significant" capital investment is needed in several regions to move people with complex needs into more suitable facilities.

Last January, Minister for Mental Health John Moloney announced "closure plans" had been developed for 13 of the 19 remaining hospitals, branded "outmoded, outdated and grossly unsuitable" in a 2008 report.

He also claimed about €50 million a year will be available over the next three years, from the sale of buildings and land, to reinvest in community mental health facilities.

However, more than a year later, while most of the hospitals report that "reconfiguration" of services is under way, FOI documents reveal there are only six closure plans down on paper, one of which is a short email. The six are: St Brendan’s, Grangegorman,  St Ita’s, Potrane, St Brigid’s, Ardee, St Davnet’s, Monaghan, St Brigid’s, Ballinasloe and St Finan’s, Killarney.

According to the healthcare professionals who wrote one closure plan, some patients’ needs will not be met by relocation to nursing home care. "It will therefore be the responsibility of the mental health services to provide for their future care, quite possibly for the rest of their lives." A closure plan for St Finan’s states those who remain consist of older adults whose mental health requirements are overshadowed by physical frailty.

They have lived in the institution for some time, live in secure accommodation and are difficult to place in less restrictive environments, the document states.

In one secure unit seven women and five men all in their 40s have been living in the hospital for more than five years, and eight of those for more than 10 years.

In 2006, an expert group on mental health policy, called for the closure of St Brigid’s Psychiatric Hospital in Ardee, Co Louth. The closure plan for the hospital warns that although the service is "acutely aware" of the need to transform services, it estimates the cost at €51m. It also highlights the very specific needs of elderly people with a mental illness.

In relation to another hospital, St Senan’s in Co Wexford, Mr Moloney clearly stated a closure plan has been developed, but according to FOI documents, closure of St Senan’s is "dependent on a decision in relation to acute bed provision and capital investment". About 80 patients still remain in the hospital.

The closure plan for St Davnet’s says those who remain and were admitted in the past five years have "complex and challenging needs" and there are no suitable facilities elsewhere. According to the document, a new unit will require a "major capital investment".

© Examiner Publications (Cork) Limited

UK: NHS cuts ‘threaten talking therapies for psychiatric patients’

. LONDON, England / The Times Life & Style / Health / April 19, 2010 By David Rose, Health Correspondent Half a million people with serious mental illness could lose access to counselling and other services as the NHS struggles to make unprecedented efficiency savings, campaigners warn. Despite manifesto pledges from the three main political parties to increase access to “talking therapies” in the health service, Monitor, the independent regulator for NHS Foundation Trusts, has written to all the organisations that it oversees, asking them to plan for deeper cuts than previously forecast from next month. The suggested cuts of 5 per cent are equivalent to a spending reduction of an extra £50 million across the 40 Mental Health Foundation Trusts in England, according to Rethink, the mental health charity. RETHINK on Facebook It warned that mental health services were considered a “soft target” for cuts, and that up to 500,000 patients with illnesses such as schizophrenia and bipolar disorder could suffer if clinics and day centres closed or staff posts were lost. Related Links > ‘I fear going back on the waiting list’ > Dr Mark: The real risks of mental illness Labour has promised to recruit more than 8,000 new psychological therapists if it wins the election, while the Conservatives and Liberal Democrats also say that they will increase access to counselling services. But experts say that any political promises could ring hollow as the NHS overall is challenged with making £20 billion of efficiency savings over the next four years. Paul Jenkins, the chief executive of Rethink, said that mental health services had previously suffered when the NHS went into deficit four years ago. A lack of support could put patients at risk to themselves and others, he added. “We know from the past what happens with people who have severe mental illness when financial pressures begin to bite. Cutbacks are made from teams working in the community, and instead of people getting the regular contact with services and support they need they become more isolated and enter the ‘revolving-door’ cycle of going in and out of hospital. “It could be harder for people developing new problems to be picked up and for those getting towards crisis to have access interventions to deal with that.” Up to one in four of the population suffers from a mental health problem at some point in their lives. However, NHS patients with depression or anxiety disorders often wait months to see a trained professional for counselling or cognitive behavioural therapy. Those people with serious problems, including eating disorders or drug addiction, rely on regular contact with specialists to keep their conditions in check. “If you cut back teams and caseloads go up, the only way to cope with that is by raising the thresholds for who gets treatment, or the waiting list gets longer,” Mr Jenkins said. Monitor produces forecasts each year to ensure that all foundation trusts, which control their own budgets, are managing their finances effectively. It revised its “downside” estimates after last month’s Budget. It now suggests that mental health services may have to make cuts of 4.5 to 5 per cent in the coming financial year, compared with about 4 per cent for acute hospital services. Shôn Lewis, Professor of Adult Psychiatry at the University of Manchester, said: “These services are a soft option — you can drag money out and people won’t die straight away, unlike cancer services. What does happen is that some very vulnerable people have a miserable quality of life and may end up killing themselves a couple of years down the line. If that happens, then we have failed them.” [rc] Copyright 2010 Times Newspapers Ltd.

USA: Stress speeds mental decline in impaired elders

. NEW YORK / Reuters Health / December 24, 2009 Chronic stress can speed up memory decline in older people who already have some impairment in their mental function, a new study in the American Journal of Psychiatry shows. But being stressed doesn't appear to affect memory in older people without such impairment, Dr. Guerry M. Peavy of the University of California San Diego and colleagues found. Research suggests a "strong relationship" between increased stress and memory loss, the researchers note, but few investigators have looked at stress and memory over time. Chronic stress may affect memory by causing prolonged release of so-called "stress hormones," such as cortisol, resulting in damage to the brain. To investigate, the researchers followed 52 people 65 to 97 years old for up to three years. Twenty-five had no loss of mental function at the beginning of the study, while the remaining 27 showed evidence of mild mental impairment. To measure stress, the researchers asked study participants about whether they had experienced stressful life events in the previous year or six months, such as being hospitalized or having a death in the family. A person was considered to have "high stress" if they reported at least one such event in a given period. Among the individuals who were already somewhat impaired, those with high levels of stress showed faster decline in mental function, especially degree of dementia and memory function. But stress didn't influence mental function over time in people who had no impairment at the study's outset. Already-impaired people with high cortisol levels showed a slower rate of mental decline than those with lower levels, which was "an unexpected finding," the researchers note. It's possible, they say, that this potentially neurotoxic hormone may actually have protective effects in people who already have some loss of mental function. [rc] SOURCE: American Journal of Psychiatry, December 2009. © Copyright 2009 Thomson Reuters

PHILIPPINES: Experts Say It’s Harder for Obese People to be Happy

. MANILA, Philippines / The Inquirer / August 21, 2007: Happiness is more elusive to obese people, but it doesn't mean they cannot enjoy life, psychiatrists said today in a health forum. It all depends on an obese person's "self-perception," said Dr. Felicitas Artiaga-Soriano, president of the Philippine Psychiatric Association (PPA). Some people, like her own healthy mother, associate "being big with contentment in life," she said. However, today's pervading view that thin is beautiful is affecting so many obese Filipinos, men and women alike. Soriano said psychiatrists like her are at times at a loss on how to convince patients that they can "enjoy life even if they are not thin." "There are cases when no matter how they diet, they don't get thin because the structure of their body is big. I don't know what to say anymore to women in this situation and they want to be thin," Soriano said. The Philippine National Nutrition Health Evaluation and Survey in 2003 noted that obesity among Filipinos had increased from 3.2 percent to 4.9 percent of the total population in five years. Overweight Filipinos jumped from 16.9 percent of the population to 19.6 percent from 1998 to 2003. Dr. Antonio Sison, another PPA official, said that "anybody can be happy regardless of weight but for obese people, the probability of being happy is less, in the social context and also in their personal sphere." In certain instances, society does not treat people well, Sison said. For example, he said, airlines would charge an extra seat for a huge person who cannot fit in one and clothing shops would only offer limited sizes, adding to the person's insecurity. "In the personal sphere, obese persons don't feel good. They would have problems at work, they have issues with their friends and family," he said. Filipinos should remember that "not all thin people are beautiful and that not all fat is bad." Even young Filipinos are increasingly becoming conscious of their weight, a veteran nutritionist said at the forum. "Elementary schoolchildren are now very conscious that by the time they reach high school, they become depressed that they are fat. They get very anxious about the overweight situation," said Sanirose Orbeta, vice president of the Philippine Association for the Study of Overweight and Obesity. The 2003 survey noted that obesity affects 3.1 percent of young Filipinos between 11 and 19 years old, one to 5 percent of children between 6 and 10 years old, and 1.9 percent of children between zero and five years old. The study attributed this to a decline in children's outdoor activities and sedentary lifestyle. While there are no hard facts and figures available yet, the psychiatrists said they have observed a correlation between depression and obesity among Filipinos. "There is a link between depression and obesity. And suicide is a risk factor to be considered," Sison said. Aside from obesity leading to depression, Sison said that depression itself could lead to overeating. He said eating becomes a "coping mechanism and little by little, a person starts to gain weight." Quoting the World Health Organization, Soriano said that depression would become the world's number one cause of morbidity, or hindrance to function as a person, by 2020. In the Philippines, she said, poverty, disasters, and substance abuse are causes of depression. Children of overseas Filipino workers, left behind unsupervised by their parents, also tend to become depressed, Soriano added. She said that latest studies have shown that three out of every 100 Filipinos suffer from major depression while nine out of every hundred suffer from anxiety. By Nikko Dizon© Copyright 2001-2007 INQUIRER