SSRIs do not increase teen suicide risk: study - ■ Gemma Collins - 6Minutes
Antidepressants do not increase the risk of suicide among adolescents, a study suggests.
An analysis of data from 41 clinical trials involving more than 9,000 adults and adolescents found that there was no evidence of an increased suicide risk in young people taking fluoxetine.
The study published in the Archives of General Psychiatry also found that the adults who were taking either fluoxetine or venlafaxine had a decreased risk of suicidal thoughts and behaviours.
And in all age groups, severity of depression improved with medication and was significantly related to suicide ideation or behaviour, according to the government-funded study.
The authors found that among the 700 young patients receiving SSRIs, there was a 50% decrease in the probability of suicidal thoughts or behaviour after eight weeks, compared to 61% among control patients.
Young patients receiving fluoxitine decreased their depressive symptoms more quickly than patients receiving placebo.
“Despite a strong association between depression severity and suicide risk in youths, treatment with fluoxetine was not found to be related to suicide risk when compared with placebo”, the authors conclude.
However the authors do point out that their findings are limited to fluoxetine only.
Sunday, May 6, 2012
SWSLHD and Bowral's Health - 73
Doubts over early intervention for psychosis - ■ Michael Woodhead
- 6 Minutes
While Australian psychiatrists including Professor Patrick McGorry have championed early intervention for people at high risk of psychosis, a study of 288 such patients in the UK found that transition rates were only around 8% and many patients recovered without any active treatment.
The study, in the BMJ (online April 5) found that early intervention with CBT did not reduce the already low rates of transition or symptom-related distress, but it was effective in reducing the severity of psychosis.
The study authors say the lack of any effect of early intervention on transition to psychosis is disappointing, but the low transition rates are reassuring and show that young people can be given “an important and optimistic message” about their prognosis.
“Our observations also suggest that a review of the ultra high risk strategy ... is required,” they say.
The findings show it is highly premature to consider adding a “psychosis risk” category to DSM diagnostic criteria, and also put in question the ethics of using antipsychotics in young people deemed at high risk of psychosis.
“We would suggest that antipsychotics are not delivered as a first line treatment to people meeting the criteria for being in an at-risk mental state,” they conclude.
- 6 Minutes
A major trial has prompted calls for a re-appraisal of the antipsychotic “early intervention” model for schizophrenia after it found low transition rates to psychosis and significant benefits from early intervention for psychosis.
While Australian psychiatrists including Professor Patrick McGorry have championed early intervention for people at high risk of psychosis, a study of 288 such patients in the UK found that transition rates were only around 8% and many patients recovered without any active treatment.
The study, in the BMJ (online April 5) found that early intervention with CBT did not reduce the already low rates of transition or symptom-related distress, but it was effective in reducing the severity of psychosis.
The study authors say the lack of any effect of early intervention on transition to psychosis is disappointing, but the low transition rates are reassuring and show that young people can be given “an important and optimistic message” about their prognosis.
“Our observations also suggest that a review of the ultra high risk strategy ... is required,” they say.
The findings show it is highly premature to consider adding a “psychosis risk” category to DSM diagnostic criteria, and also put in question the ethics of using antipsychotics in young people deemed at high risk of psychosis.
“We would suggest that antipsychotics are not delivered as a first line treatment to people meeting the criteria for being in an at-risk mental state,” they conclude.
SWSLHD and Bowral's Health - 72
Perinatal depression justifies SSRI use - ■ Kate Cowling - 6Minutes
However, the risks and benefits should ultimately be discussed on a case-by-case basis, according to new NHMRC-endorsed guidelines launched by Minister for Mental Health and Ageing, Mark Butler, this week.
The use of antidepressants during the perinatal period also needs to be weighed against minimal possible exposure to the infant during breastfeeding, the guidelines say.
Other recommendations from the "Clinical Practice Guidelines for Depression and Related Disorders – Anxiety, Bipolar and Puerperal Psychosis – in the Perinatal Period" include routine assessment of emotional health and wellbeing during both pregnancy and the following year as part of GP management. They also recommend that women with perinatal depression have access to CBT and other non-drug therapies.
Cautious use of SSRIs during pregnancy may be preferable to medication discontinuation, new beyondblue guidelines suggest.
However, the risks and benefits should ultimately be discussed on a case-by-case basis, according to new NHMRC-endorsed guidelines launched by Minister for Mental Health and Ageing, Mark Butler, this week.
The recommendations note that there have been only limited studies into the efficacy of antidepressants in pregnancy, and some evidence indicates that maintaining rather than discontinuing medication reduces the chance of relapse.
However, preterm births and low birth weights have been linked to use of antidepressants such as SSRIs as well as benzodiazapines and antipsychotics.
“While there are risks associated with the use of psychotropic medications in this period, it should not be assumed that it is always better to avoid medication,” the guideline authors say.
The use of antidepressants during the perinatal period also needs to be weighed against minimal possible exposure to the infant during breastfeeding, the guidelines say.
Other recommendations from the "Clinical Practice Guidelines for Depression and Related Disorders – Anxiety, Bipolar and Puerperal Psychosis – in the Perinatal Period" include routine assessment of emotional health and wellbeing during both pregnancy and the following year as part of GP management. They also recommend that women with perinatal depression have access to CBT and other non-drug therapies.
SSWAHS = SWSLHD + SLHD and the Medicare Locals - 72
Loss of divisions' support will hit rural GPs - ■ Michael Woodhead - 6Minutes
He said Medicare Locals were preoccupied with setting up and focusing on developing after hours care and population planning programs rather than on support for local practices.
Rural areas may see an exodus of GPs if Medicare Locals do not maintain the support services to GP practices that have been provided by divisions, a Senate inquiry has heard.
Chris Mitchell, CEO of Health Workforce Queensland, says GPs are becoming “disenfranchised” in the transition to Medicare Locals as GP divisions have their funding terminated.
Speaking at a Senate rural health hearing in Townsville, Mr Mitchell said GP practices had relied heavily on divisions for areas such as IT support.
“The divisions did a lot of boutique work for practices and I do not think that stuff is going to continue [with Medicare Locals].
The IT support in some of these divisions has been sensational and it has kept those GP businesses going ... But I am not sure that that is going to continue,” he told the hearing. Mr Mitchell said the town of Weipa was likely to lose its GP practice because the GP division in Cairns that had supported the practice had lost its funding and been replaced by a Medicare Local.He said Medicare Locals were preoccupied with setting up and focusing on developing after hours care and population planning programs rather than on support for local practices.
SWSLHD and Bowral's Health - 71
Why do smokers wait until it is too late? - Dr Viv - 6Minutes
Smoking makes me angry. Of course, there’s nothing novel or innovative in that statement, and everything that I am about to write has been said many times before. And probably by
me!
But, by chance, I’ve had a recent run of smoking related deaths and severe morbidity in my practice, and I’m beginning to become frustrated at the futility of anti smoking campaigns, and at the willingness of my patients, friends and work colleagues to give up fifteen years of their lives, and a substantial portion of their hard earned income to the cigarette companies.
My mind hearkens back to the early days of debate about seatbelt legislation. (Yes, that’s how old I am). “If I want to take the risk, and not wear a seatbelt, it’s my civil right as an individual, and affects no one but myself”.
The hospital wards and cemeteries are full of people who have made the “individual choice” to smoke. The emotional cost to their loved ones is huge, as they spend their long awaited retirement caring for permanently disabled spouses, or grieving prematurely for the years of which they have been robbed.
The perplexing part for me is the complete inability to give up the smokes – that is, until they get the dreaded diagnosis. Suddenly, after numerous failed attempts, they can inevitability give up in one day. Unfortunately, by this stage, it’s usually too late, and all the regrets in the world do not give them back the lost years.
Joan had her first brush with lung cancer fifteen years earlier. By the time she finally managed to give up, she had her second,complete with metastases. Admittedly she was well advanced in years, and some might say “well, you’ve got to die of something”!
But Joan’s death was painful and drawn out,and came soon after nursing her terminally ill husband. She had planned to travel, and finally enjoy all the grandchildren. Cigarettes robbed her of that chance.
Barry is only in his early seventies. A loving husband, father and grandfather, he loved his fishing and his work in the Lions’ Club. I tried for years to get him to give up the smokes. He couldn’t. The day that I diagnosed his lung cancer with cerebral metastases, he stopped smoking – easily. He doesn’t miss it. He can now no longer drive, fish or make independent decisions. The brain secondaries are killing him by inches. He should have had another fifteen happy years.
Charles died of emphysema. His last ten years were spent in a chair, too dyspnoeic to walk. He repeatedly offered to visit schools to espouse the evils of smoking, thinking that one look at him would deter the children from ever lighting up. It probably wouldn’t have worked, and he couldn’t even manage a sentence without oxygen, so it didn’t happen.
I recently attended a funeral of a young mother who died of a smoking related illness. As the hearse departed, her devastated eldest daughter lit up a smoke, as did many of the
mourners. I just don’t get it.
Dr Viv is a rural GP
Smoking makes me angry. Of course, there’s nothing novel or innovative in that statement, and everything that I am about to write has been said many times before. And probably by
me!
But, by chance, I’ve had a recent run of smoking related deaths and severe morbidity in my practice, and I’m beginning to become frustrated at the futility of anti smoking campaigns, and at the willingness of my patients, friends and work colleagues to give up fifteen years of their lives, and a substantial portion of their hard earned income to the cigarette companies.
My mind hearkens back to the early days of debate about seatbelt legislation. (Yes, that’s how old I am). “If I want to take the risk, and not wear a seatbelt, it’s my civil right as an individual, and affects no one but myself”.
The hospital wards and cemeteries are full of people who have made the “individual choice” to smoke. The emotional cost to their loved ones is huge, as they spend their long awaited retirement caring for permanently disabled spouses, or grieving prematurely for the years of which they have been robbed.
The perplexing part for me is the complete inability to give up the smokes – that is, until they get the dreaded diagnosis. Suddenly, after numerous failed attempts, they can inevitability give up in one day. Unfortunately, by this stage, it’s usually too late, and all the regrets in the world do not give them back the lost years.
Joan had her first brush with lung cancer fifteen years earlier. By the time she finally managed to give up, she had her second,complete with metastases. Admittedly she was well advanced in years, and some might say “well, you’ve got to die of something”!
But Joan’s death was painful and drawn out,and came soon after nursing her terminally ill husband. She had planned to travel, and finally enjoy all the grandchildren. Cigarettes robbed her of that chance.
Barry is only in his early seventies. A loving husband, father and grandfather, he loved his fishing and his work in the Lions’ Club. I tried for years to get him to give up the smokes. He couldn’t. The day that I diagnosed his lung cancer with cerebral metastases, he stopped smoking – easily. He doesn’t miss it. He can now no longer drive, fish or make independent decisions. The brain secondaries are killing him by inches. He should have had another fifteen happy years.
Charles died of emphysema. His last ten years were spent in a chair, too dyspnoeic to walk. He repeatedly offered to visit schools to espouse the evils of smoking, thinking that one look at him would deter the children from ever lighting up. It probably wouldn’t have worked, and he couldn’t even manage a sentence without oxygen, so it didn’t happen.
I recently attended a funeral of a young mother who died of a smoking related illness. As the hearse departed, her devastated eldest daughter lit up a smoke, as did many of the
mourners. I just don’t get it.
Dr Viv is a rural GP
SWSLHD and Bowral's Health - 70
Active surveillance urged for prostate cancer - ■ Michael Woodhead - 6Minutes
The anxiety-provoking term “cancer” should be modified for patients with low grade prostate pathology who have favourable outcomes, according to new advice released this week.
A consensus statement from the National Institutes of Health (NIH) in the US notes that most of PSA screen-detected cases of cancer are now low-risk and are unlikely to cause death.
It says the natural history of prostate cancer has changed dramatically in the past three decades because of PSA screening, and about two thirds of men with prostate cancer are currently diagnosed with Gleason 6 scores.
The NIH statement says curative treatment of low-risk prostate cancer with radical prostatectomy or radiation therapy leads to side effects, such as impotence and incontinence, in a substantial number of patients.
In recent years, active surveillance has emerged as a viable option that should be offered to patients with low-risk prostate cancer, according to the statement published in the Annals of Internal Medicine.
Although no randomised clinical trials have assessed whether patients who undergo active surveillance have better or worse outcomes than those who receive immediate curative treatment, there have been reassuring results with cohort studies, the statement says.
“Early results demonstrate disease-free and survival rates that compare favourably with those reported for curative therapy.” The NIH statement emphasises that active surveillance is not the same as “watchful waiting”, and involves follow-up assessments including PSA levels, digital rectal examination, and repeat biopsy.
However, the NIH panel of clinicians express particular concern about the complications from image-guided transrectal biopsies of the prostate.
“Standardised protocols need to be developed to minimize the frequency and intervals of biopsies and to reduce associated pain and infection rates,” they suggest.
The consensus statement also notes that there are still unanswered questions about active surveillance strategies for prostate cancer, which require further research and clarification.
“These include improvements in the accuracy and consistency of pathologic diagnosis of prostate cancer, consensus on which men are the most appropriate candidates for active surveillance, the optimal protocol for active surveillance and the potential for individualizing the approach on the basis of clinical and patient factors, optimal ways to communicate the option of active surveillance to patients, methods to assist patient decision making, reasons for accepting or rejecting active surveillance as a treatment strategy, and short- and long-term outcomes of active surveillance.”
The anxiety-provoking term “cancer” should be modified for patients with low grade prostate pathology who have favourable outcomes, according to new advice released this week.
A consensus statement from the National Institutes of Health (NIH) in the US notes that most of PSA screen-detected cases of cancer are now low-risk and are unlikely to cause death.
It says the natural history of prostate cancer has changed dramatically in the past three decades because of PSA screening, and about two thirds of men with prostate cancer are currently diagnosed with Gleason 6 scores.
The NIH statement says curative treatment of low-risk prostate cancer with radical prostatectomy or radiation therapy leads to side effects, such as impotence and incontinence, in a substantial number of patients.
In recent years, active surveillance has emerged as a viable option that should be offered to patients with low-risk prostate cancer, according to the statement published in the Annals of Internal Medicine.
Although no randomised clinical trials have assessed whether patients who undergo active surveillance have better or worse outcomes than those who receive immediate curative treatment, there have been reassuring results with cohort studies, the statement says.
“Early results demonstrate disease-free and survival rates that compare favourably with those reported for curative therapy.” The NIH statement emphasises that active surveillance is not the same as “watchful waiting”, and involves follow-up assessments including PSA levels, digital rectal examination, and repeat biopsy.
However, the NIH panel of clinicians express particular concern about the complications from image-guided transrectal biopsies of the prostate.
“Standardised protocols need to be developed to minimize the frequency and intervals of biopsies and to reduce associated pain and infection rates,” they suggest.
The consensus statement also notes that there are still unanswered questions about active surveillance strategies for prostate cancer, which require further research and clarification.
“These include improvements in the accuracy and consistency of pathologic diagnosis of prostate cancer, consensus on which men are the most appropriate candidates for active surveillance, the optimal protocol for active surveillance and the potential for individualizing the approach on the basis of clinical and patient factors, optimal ways to communicate the option of active surveillance to patients, methods to assist patient decision making, reasons for accepting or rejecting active surveillance as a treatment strategy, and short- and long-term outcomes of active surveillance.”
SWSLHD and Bowral's Health - 69
After-hours care falls short
17 Apr, 2012 12:00 AM
IF you need a doctor between 11pm and 7am you must go to an
emergency room at Blacktown, Hornsby or Hawkesbury public hospital and
join the queue.
There's always the phone (nurses and GPs give advice on the National After Hours GP Helpline) or you can visit Norwest Private's emergency department, where fees are not reimbursable — even for those who are privately insured.
There are only 55 general practices open for 10 or more hours a week during the after-hours period but that is across all western Sydney (264 of a total of 303 practices were contacted) — nowhere near enough, according to medical educators WentWest.
WentWest have found through careful analysis of western Sydney's health needs that in Rouse Hill there are no practices open after-hours and in the semi-rural area above Glenorie even a registered home-visiting is not available.
Parramatta's north-east is serviced by only one practice providing after-hours service — at Epping — and Baulkham Hills North could do with chemists that open longer.
But the real problem is finding GPs to work outside normal hours.
The five doctors' rooms at Round Corner Medical Centre in Dural operate at 95 per cent capacity with 12 GPs on rotation, but doctors find it difficult to cope with demand after hours, even turning people away on Sundays.
The centre began operating after hours three years ago with financial assistance from the federal government.
Peter Szekely, the centre's financial officer, said they aim to stay open until 9pm weekdays and 5pm on Saturday and Sunday.
The ideal, he said, would be to stay open till 10pm every night.
"But we don't always have doctors available to do these hours," Mr Szekely said.
"At the moment the only weeknights we can do are Monday and Thursday.
"If we could expand the premises we would, but we can't, so the only thing we can do is expand the hours."
Mr Szekely praised the GP placement program, saying two junior doctors had stayed on at his centre, and saw this as encouraging.
Dural is among the many suburbs in The Hills identified by the Department of Health and Ageing as being in a district of workforce shortage, defined as an area of Australia in which the population's need for healthcare has not been met.
The others are Annangrove, Beaumont Hills, Bella Vista, Kenthurst, Oatlands and Rouse Hill.
Beaumont Hills and Rouse Hill are also among the growth suburbs in The Hills, which is of major concern given The Hills population is expected to rise 1.94 per cent every year until 2031, bringing the total population from 177,245 to 255,270 people - a rise of 44.02 per cent — over the next 19 years.
WentWest will submit its first after-hours plan to the Department of Health and Ageing in May, highlighting these and other service gaps in the Western Sydney Local Health District, which stretches from Auburn in the east to Blacktown in the west and to The Hills in the north.
There's always the phone (nurses and GPs give advice on the National After Hours GP Helpline) or you can visit Norwest Private's emergency department, where fees are not reimbursable — even for those who are privately insured.
There are only 55 general practices open for 10 or more hours a week during the after-hours period but that is across all western Sydney (264 of a total of 303 practices were contacted) — nowhere near enough, according to medical educators WentWest.
WentWest have found through careful analysis of western Sydney's health needs that in Rouse Hill there are no practices open after-hours and in the semi-rural area above Glenorie even a registered home-visiting is not available.
Parramatta's north-east is serviced by only one practice providing after-hours service — at Epping — and Baulkham Hills North could do with chemists that open longer.
But the real problem is finding GPs to work outside normal hours.
The five doctors' rooms at Round Corner Medical Centre in Dural operate at 95 per cent capacity with 12 GPs on rotation, but doctors find it difficult to cope with demand after hours, even turning people away on Sundays.
The centre began operating after hours three years ago with financial assistance from the federal government.
Peter Szekely, the centre's financial officer, said they aim to stay open until 9pm weekdays and 5pm on Saturday and Sunday.
The ideal, he said, would be to stay open till 10pm every night.
"But we don't always have doctors available to do these hours," Mr Szekely said.
"At the moment the only weeknights we can do are Monday and Thursday.
"If we could expand the premises we would, but we can't, so the only thing we can do is expand the hours."
Mr Szekely praised the GP placement program, saying two junior doctors had stayed on at his centre, and saw this as encouraging.
Dural is among the many suburbs in The Hills identified by the Department of Health and Ageing as being in a district of workforce shortage, defined as an area of Australia in which the population's need for healthcare has not been met.
The others are Annangrove, Beaumont Hills, Bella Vista, Kenthurst, Oatlands and Rouse Hill.
Beaumont Hills and Rouse Hill are also among the growth suburbs in The Hills, which is of major concern given The Hills population is expected to rise 1.94 per cent every year until 2031, bringing the total population from 177,245 to 255,270 people - a rise of 44.02 per cent — over the next 19 years.
WentWest will submit its first after-hours plan to the Department of Health and Ageing in May, highlighting these and other service gaps in the Western Sydney Local Health District, which stretches from Auburn in the east to Blacktown in the west and to The Hills in the north.
Medicare Local defines after-hours as:
- before 8am and after 6pm weekdays;
- before 8am and after noon Saturdays;
- all day Sundays and public holidays.
- the unsociable after-hours period of 11pm to 7pm; and
- the sociable after-hours period which is all other after-hours times.
A map showing the current District of Workforce Shortage areas is available at: http://www.doctorconnect.gov.au/i nternet/otd/Publishing.nsf/Conten t/locator
Socrates says: While this article details the issues for the north-west of Sydney it can be replicated even more so for rural and regional areas like the Southern Highlands.
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