Q) Is it true that PPI use can cause kidney disease?

Proton pump inhibitors (PPIs) have been available in the United States since 1990, with OTC options available since 2009. While these medications play a vital role in the treatment of gastrointestinal (GI) con­ditions, observational studies have linked PPI use to serious adverse events, including dementia, community-acquired pneumonia, hip fracture, and Clostridium difficile infection.^1-4

Studies have also found an association between PPI use and kidney problems such as acute kidney injury (AKI), acute interstitial nephritis, and incident chronic kidney disease (CKD).^5-7 One observational study used the Department of Veterans Affairs (VA) national databases to track the renal outcomes of 173,321 new PPI users and 20,270 new histamine H2 receptor antagonist (H2RA) users over the course of five years. Those who used PPIs demonstrated a significant risk for decreased renal function, lower estimated glomerular filtration rate (eGFR), doubled serum creatinine levels, and progression to end-stage renal disease (ESRD).⁸

Another study of 10,482 patients (322 PPI; 956 H2RA; 9,204 nonusers) and a replicate study of 248,751 patients (16,900 PPI; 6,640 H2RA; 225,211 nonusers) with an initial eGFR ≥ 60 mL/min/1.73m² also found an association between PPI use and incident CKD, which persisted when compared to the other groups. Additionally, twice-daily PPI use was associated with a higher CKD risk than once-daily use.⁹

The pathophysiology of PPI use and kidney deterioration is poorly understood at this point. It is known that AKI can increase the risk for CKD, and AKI has been an assumed precursor to PPI-associated CKD. However, a study by Xie and colleagues reported an association between PPI use and increased risk for CKD, progression of CKD, and ESRD in the absence of preceding AKI. Using the VA databases, the researchers identified 144,032 new users of acid-suppressing medications (125,596 PPI; 18,436 H2RA) who had no history of kidney disease and followed them for five years. PPI users were found to be at increased risk for CKD, and a graded association was discovered between length of PPI use and risk for CKD.¹⁰

While these studies are observational and therefore do not prove causation, they do suggest a need for attentive monitoring of kidney function in patients using PPIs. Evaluating the need for PPIs and inquiring about OTC use of these medications is highly recommended, as research has found 25% to 70% of PPI prescriptions are not prescribed for an appropriate indication.¹¹ Considerations regarding PPI use should include dosage, length of use, and whether alternate use of an H2RA is appropriate. —CAS

Cynthia A. Smith, DNP, CNN-NP, FNP-BC, APRN
Renal Consultants, PLLC, South Charleston, West Virginia

Q) Is it true that PPI use can cause kidney disease?

Proton pump inhibitors (PPIs) have been available in the United States since 1990, with OTC options available since 2009. While these medications play a vital role in the treatment of gastrointestinal (GI) con­ditions, observational studies have linked PPI use to serious adverse events, including dementia, community-acquired pneumonia, hip fracture, and Clostridium difficile infection.^1-4

Studies have also found an association between PPI use and kidney problems such as acute kidney injury (AKI), acute interstitial nephritis, and incident chronic kidney disease (CKD).^5-7 One observational study used the Department of Veterans Affairs (VA) national databases to track the renal outcomes of 173,321 new PPI users and 20,270 new histamine H2 receptor antagonist (H2RA) users over the course of five years. Those who used PPIs demonstrated a significant risk for decreased renal function, lower estimated glomerular filtration rate (eGFR), doubled serum creatinine levels, and progression to end-stage renal disease (ESRD).⁸

Another study of 10,482 patients (322 PPI; 956 H2RA; 9,204 nonusers) and a replicate study of 248,751 patients (16,900 PPI; 6,640 H2RA; 225,211 nonusers) with an initial eGFR ≥ 60 mL/min/1.73m² also found an association between PPI use and incident CKD, which persisted when compared to the other groups. Additionally, twice-daily PPI use was associated with a higher CKD risk than once-daily use.⁹

The pathophysiology of PPI use and kidney deterioration is poorly understood at this point. It is known that AKI can increase the risk for CKD, and AKI has been an assumed precursor to PPI-associated CKD. However, a study by Xie and colleagues reported an association between PPI use and increased risk for CKD, progression of CKD, and ESRD in the absence of preceding AKI. Using the VA databases, the researchers identified 144,032 new users of acid-suppressing medications (125,596 PPI; 18,436 H2RA) who had no history of kidney disease and followed them for five years. PPI users were found to be at increased risk for CKD, and a graded association was discovered between length of PPI use and risk for CKD.¹⁰

While these studies are observational and therefore do not prove causation, they do suggest a need for attentive monitoring of kidney function in patients using PPIs. Evaluating the need for PPIs and inquiring about OTC use of these medications is highly recommended, as research has found 25% to 70% of PPI prescriptions are not prescribed for an appropriate indication.¹¹ Considerations regarding PPI use should include dosage, length of use, and whether alternate use of an H2RA is appropriate. —CAS

Cynthia A. Smith, DNP, CNN-NP, FNP-BC, APRN
Renal Consultants, PLLC, South Charleston, West Virginia

Q) Is it true that PPI use can cause kidney disease?

Proton pump inhibitors (PPIs) have been available in the United States since 1990, with OTC options available since 2009. While these medications play a vital role in the treatment of gastrointestinal (GI) con­ditions, observational studies have linked PPI use to serious adverse events, including dementia, community-acquired pneumonia, hip fracture, and Clostridium difficile infection.^1-4

Studies have also found an association between PPI use and kidney problems such as acute kidney injury (AKI), acute interstitial nephritis, and incident chronic kidney disease (CKD).^5-7 One observational study used the Department of Veterans Affairs (VA) national databases to track the renal outcomes of 173,321 new PPI users and 20,270 new histamine H2 receptor antagonist (H2RA) users over the course of five years. Those who used PPIs demonstrated a significant risk for decreased renal function, lower estimated glomerular filtration rate (eGFR), doubled serum creatinine levels, and progression to end-stage renal disease (ESRD).⁸

Another study of 10,482 patients (322 PPI; 956 H2RA; 9,204 nonusers) and a replicate study of 248,751 patients (16,900 PPI; 6,640 H2RA; 225,211 nonusers) with an initial eGFR ≥ 60 mL/min/1.73m² also found an association between PPI use and incident CKD, which persisted when compared to the other groups. Additionally, twice-daily PPI use was associated with a higher CKD risk than once-daily use.⁹

The pathophysiology of PPI use and kidney deterioration is poorly understood at this point. It is known that AKI can increase the risk for CKD, and AKI has been an assumed precursor to PPI-associated CKD. However, a study by Xie and colleagues reported an association between PPI use and increased risk for CKD, progression of CKD, and ESRD in the absence of preceding AKI. Using the VA databases, the researchers identified 144,032 new users of acid-suppressing medications (125,596 PPI; 18,436 H2RA) who had no history of kidney disease and followed them for five years. PPI users were found to be at increased risk for CKD, and a graded association was discovered between length of PPI use and risk for CKD.¹⁰

While these studies are observational and therefore do not prove causation, they do suggest a need for attentive monitoring of kidney function in patients using PPIs. Evaluating the need for PPIs and inquiring about OTC use of these medications is highly recommended, as research has found 25% to 70% of PPI prescriptions are not prescribed for an appropriate indication.¹¹ Considerations regarding PPI use should include dosage, length of use, and whether alternate use of an H2RA is appropriate. —CAS

Cynthia A. Smith, DNP, CNN-NP, FNP-BC, APRN
Renal Consultants, PLLC, South Charleston, West Virginia

Clinical question: Does early identification and treatment of sepsis using protocols improve outcomes?

Background: International clinical guidelines recommend early detection and treatment of sepsis with broad spectrum antibiotics and intravenous fluids which are supported by preclinical and observation studies that show a reduction in avoidable deaths. However, controversy remains in the timing of these treatments on how it relates to patient outcomes such as risk-adjusted mortality.

Study design: Retrospective cohort study using data reported to the New York State Department of Health from April 1, 2014, to June 30, 2016.

Setting: New York hospitals.

Synopsis: For patients with sepsis and septic shock, a sepsis protocol was initiated within 6 hours after arrival in the emergency department and had all items in a 3-hour bundle of care (that is, blood cultures, broad-spectrum antibiotic, and lactate measurement) completed within 12 hours. Among 49,331 patients at 149 hospitals, higher risk-adjusted in-hospital mortality was associated with longer time to the completion of the bundle (P less than .001), administration of antibiotics (P less than .001), but not completion of a bolus of intravenous fluids (P = .21).

Study limitations include being nonrandomized, hospitals all from one state possibly introducing epidemiologic distinct features of sepsis inherent to the region, and accuracy of the data collection (that is, start time).

Dr. Choe is a hospitalist at Ochsner Health System, New Orleans.

Clinical question: Does early identification and treatment of sepsis using protocols improve outcomes?

Background: International clinical guidelines recommend early detection and treatment of sepsis with broad spectrum antibiotics and intravenous fluids which are supported by preclinical and observation studies that show a reduction in avoidable deaths. However, controversy remains in the timing of these treatments on how it relates to patient outcomes such as risk-adjusted mortality.

Study design: Retrospective cohort study using data reported to the New York State Department of Health from April 1, 2014, to June 30, 2016.

Setting: New York hospitals.

Synopsis: For patients with sepsis and septic shock, a sepsis protocol was initiated within 6 hours after arrival in the emergency department and had all items in a 3-hour bundle of care (that is, blood cultures, broad-spectrum antibiotic, and lactate measurement) completed within 12 hours. Among 49,331 patients at 149 hospitals, higher risk-adjusted in-hospital mortality was associated with longer time to the completion of the bundle (P less than .001), administration of antibiotics (P less than .001), but not completion of a bolus of intravenous fluids (P = .21).

Study limitations include being nonrandomized, hospitals all from one state possibly introducing epidemiologic distinct features of sepsis inherent to the region, and accuracy of the data collection (that is, start time).

Dr. Choe is a hospitalist at Ochsner Health System, New Orleans.

Clinical question: Does early identification and treatment of sepsis using protocols improve outcomes?

Background: International clinical guidelines recommend early detection and treatment of sepsis with broad spectrum antibiotics and intravenous fluids which are supported by preclinical and observation studies that show a reduction in avoidable deaths. However, controversy remains in the timing of these treatments on how it relates to patient outcomes such as risk-adjusted mortality.

Study design: Retrospective cohort study using data reported to the New York State Department of Health from April 1, 2014, to June 30, 2016.

Setting: New York hospitals.

Synopsis: For patients with sepsis and septic shock, a sepsis protocol was initiated within 6 hours after arrival in the emergency department and had all items in a 3-hour bundle of care (that is, blood cultures, broad-spectrum antibiotic, and lactate measurement) completed within 12 hours. Among 49,331 patients at 149 hospitals, higher risk-adjusted in-hospital mortality was associated with longer time to the completion of the bundle (P less than .001), administration of antibiotics (P less than .001), but not completion of a bolus of intravenous fluids (P = .21).

Study limitations include being nonrandomized, hospitals all from one state possibly introducing epidemiologic distinct features of sepsis inherent to the region, and accuracy of the data collection (that is, start time).

Dr. Choe is a hospitalist at Ochsner Health System, New Orleans.

Older men adapt more poorly to aging with multiple sclerosis (MS), compared with older women, according to research published in the July–August issue of International Journal of MS Care. Health and lifestyle behaviors may put older men with MS at greater risk of health decline, said the authors. Older women, however, appear to have more confidence in their ability to cope with challenges and control the course of their disease.

Healthy Aging With MS

Improved longevity in patients with MS has increased interest in understanding factors associated with healthy aging. Previous studies suggested that factors such as depression, disability, decreased levels of social support, and unemployment predict health-related quality of life in MS.

Two studies examining sex differences in health-related quality of life in young to middle-aged patients with MS found that the association between disability and health-related quality of life was stronger in men than in women. No studies, however, have examined sex differences in health perception among older people with MS, according to the authors.

Analysis of a Canadian Postal Survey

To determine whether older women and men with MS have different health and lifestyle behaviors and whether there are sex differences in contributors to perceived health, Dr. Ploughman and colleagues analyzed data from the Canadian Survey of Health, Lifestyle, and Aging With MS. This cross-sectional study included Canadians older than 55 who had had MS for at least 20 years. Of 921 people contacted, 743 (577 women) returned the mailed questionnaire.

The questionnaire asked about biologic factors (eg, comorbid conditions, years since MS diagnosis), symptoms (eg, depression, anxiety, fatigue, and stress), function (eg, disability and participation), and individual and environmental factors (eg, socioeconomic status, education, and social or health support). Researchers used multiple regression analysis to build explanatory models of health perception.

Older Men With MS Were Less Resilient

Investigators found no differences in disability between men and women, nor differences in age, years of education, or years since MS diagnosis. Older men had lower perceived health and lower resilience, and participated less in life roles than did older women.

In addition, men had more depressive symptoms, and women reported more anxiety. Women also reported higher adherence to a healthy diet (ie, one high in fruits and vegetables and low in meat). Men consumed more alcohol weekly.

Depression was the strongest predictor of health perception in women and men. Other contributors included household participation, fatigue, resilience, and disability in women and physical activity, financial flexibility, and alcohol use in men.

More research is necessary to examine healthy aging in the oldest people with MS, such as octogenarians, said the authors.

—Erica Tricarico

Suggested Reading

Ploughman M, Collins K, Wallack EM, et al. Women’s and men’s differing experiences of health, lifestyle, and aging with multiple sclerosis. Int J MS Care. 2017;19(4):165-171.

Older men adapt more poorly to aging with multiple sclerosis (MS), compared with older women, according to research published in the July–August issue of International Journal of MS Care. Health and lifestyle behaviors may put older men with MS at greater risk of health decline, said the authors. Older women, however, appear to have more confidence in their ability to cope with challenges and control the course of their disease.

Healthy Aging With MS

Improved longevity in patients with MS has increased interest in understanding factors associated with healthy aging. Previous studies suggested that factors such as depression, disability, decreased levels of social support, and unemployment predict health-related quality of life in MS.

Two studies examining sex differences in health-related quality of life in young to middle-aged patients with MS found that the association between disability and health-related quality of life was stronger in men than in women. No studies, however, have examined sex differences in health perception among older people with MS, according to the authors.

Analysis of a Canadian Postal Survey

To determine whether older women and men with MS have different health and lifestyle behaviors and whether there are sex differences in contributors to perceived health, Dr. Ploughman and colleagues analyzed data from the Canadian Survey of Health, Lifestyle, and Aging With MS. This cross-sectional study included Canadians older than 55 who had had MS for at least 20 years. Of 921 people contacted, 743 (577 women) returned the mailed questionnaire.

The questionnaire asked about biologic factors (eg, comorbid conditions, years since MS diagnosis), symptoms (eg, depression, anxiety, fatigue, and stress), function (eg, disability and participation), and individual and environmental factors (eg, socioeconomic status, education, and social or health support). Researchers used multiple regression analysis to build explanatory models of health perception.

Older Men With MS Were Less Resilient

Investigators found no differences in disability between men and women, nor differences in age, years of education, or years since MS diagnosis. Older men had lower perceived health and lower resilience, and participated less in life roles than did older women.

In addition, men had more depressive symptoms, and women reported more anxiety. Women also reported higher adherence to a healthy diet (ie, one high in fruits and vegetables and low in meat). Men consumed more alcohol weekly.

Depression was the strongest predictor of health perception in women and men. Other contributors included household participation, fatigue, resilience, and disability in women and physical activity, financial flexibility, and alcohol use in men.

More research is necessary to examine healthy aging in the oldest people with MS, such as octogenarians, said the authors.

—Erica Tricarico

Suggested Reading

Ploughman M, Collins K, Wallack EM, et al. Women’s and men’s differing experiences of health, lifestyle, and aging with multiple sclerosis. Int J MS Care. 2017;19(4):165-171.

Older men adapt more poorly to aging with multiple sclerosis (MS), compared with older women, according to research published in the July–August issue of International Journal of MS Care. Health and lifestyle behaviors may put older men with MS at greater risk of health decline, said the authors. Older women, however, appear to have more confidence in their ability to cope with challenges and control the course of their disease.

Healthy Aging With MS

Improved longevity in patients with MS has increased interest in understanding factors associated with healthy aging. Previous studies suggested that factors such as depression, disability, decreased levels of social support, and unemployment predict health-related quality of life in MS.

Two studies examining sex differences in health-related quality of life in young to middle-aged patients with MS found that the association between disability and health-related quality of life was stronger in men than in women. No studies, however, have examined sex differences in health perception among older people with MS, according to the authors.

Analysis of a Canadian Postal Survey

To determine whether older women and men with MS have different health and lifestyle behaviors and whether there are sex differences in contributors to perceived health, Dr. Ploughman and colleagues analyzed data from the Canadian Survey of Health, Lifestyle, and Aging With MS. This cross-sectional study included Canadians older than 55 who had had MS for at least 20 years. Of 921 people contacted, 743 (577 women) returned the mailed questionnaire.

The questionnaire asked about biologic factors (eg, comorbid conditions, years since MS diagnosis), symptoms (eg, depression, anxiety, fatigue, and stress), function (eg, disability and participation), and individual and environmental factors (eg, socioeconomic status, education, and social or health support). Researchers used multiple regression analysis to build explanatory models of health perception.

Older Men With MS Were Less Resilient

Investigators found no differences in disability between men and women, nor differences in age, years of education, or years since MS diagnosis. Older men had lower perceived health and lower resilience, and participated less in life roles than did older women.

In addition, men had more depressive symptoms, and women reported more anxiety. Women also reported higher adherence to a healthy diet (ie, one high in fruits and vegetables and low in meat). Men consumed more alcohol weekly.

Depression was the strongest predictor of health perception in women and men. Other contributors included household participation, fatigue, resilience, and disability in women and physical activity, financial flexibility, and alcohol use in men.

More research is necessary to examine healthy aging in the oldest people with MS, such as octogenarians, said the authors.

—Erica Tricarico

Suggested Reading

Ploughman M, Collins K, Wallack EM, et al. Women’s and men’s differing experiences of health, lifestyle, and aging with multiple sclerosis. Int J MS Care. 2017;19(4):165-171.

LONDON—Daily oral curcumin may improve memory and attention in cognitively normal middle-aged and older adults, according to a study presented at the 2017 Alzheimer’s Association International Conference.

“The FDDNP-PET findings raise the possibility that decreases in plaque and tangle accumulation in brain regions modulating mood and memory are associated with curcumin supplementation,” said Gary W. Small, MD, Professor of Psychiatry and Biobehavioral Sciences and Parlow-Solomon Professor on Aging at the David Geffen School of Medicine at the University of California, Los Angeles, and colleagues.

Previous studies suggested that curcumin’s anti-inflammatory, antioxidant, antiamyloid, and possible antitau properties may provide neuroprotective benefits. Prior human trials of the effects of curcumin on cognition were inconclusive, however.

To examine the effects of curcumin on memory performance in nondemented adults and explore its potential impact on brain amyloid plaques and tau tangles using FDDNP-PET, Dr. Small and colleagues conducted a randomized, double-blind, placebo-controlled trial. Forty participants ranging in age from 51 to 84 were randomized to a bioavailable formulation of curcumin (90 mg twice daily) or placebo for 18 months. To confirm subject compliance, investigators obtained curcumin blood levels at baseline and at 18 months.

The primary outcomes were verbal (Buschke Selective Reminding Test [SRT]) and visual (Brief Visual Memory Test-Revised) memory. Change in attention (Trail Making Test, Part A) was a secondary outcome. Researchers also assessed mood using the Beck Depression Inventory.

Among the 40 participants, 30 underwent baseline and post-treatment FDDNP-PET scans. Regions of interest included the amygdala, hypothalamus, medial and lateral temporal lobe, posterior cingulate cortex, parietal lobe, frontal lobe, and motor cortex. Data analyses included mixed-effects general linear models with age and education as covariates, and effect-size estimates.

The study population’s mean age was about 63, and 22 participants were women. SRT Consistent Long-Term Retrieval scores improved in the curcumin group, but not in the placebo group. Other memory scores, including the SRT Total and Long-Term Storage, as well as visual memory, also improved in the curcumin group. None of the memory measures changed significantly in the placebo group, said the researchers.

Daily curcumin also improved attention and mood. Researchers observed a significant difference between curcumin and placebo in Trail Making Test, Part A scores.

After 18 months, FDDNP binding was lower in the curcumin group than in the placebo group in the amygdala and the hypothalamus. In addition, the placebo group showed a significant increase in amyloid plaques and tau tangles in the hypothalamus, compared with baseline.

Four patients in the curcumin group and two patients in the placebo group experienced gastrointestinal side effects (primarily transient abdominal pain, gastritis, and nausea). “This relatively inexpensive and nontoxic treatment may have a potential for not only improving age-related memory decline, but also as a prevention therapy, possibly staving off progression, and eventually future symptoms of Alzheimer’s disease,” said Dr. Small and colleagues.

—Erica Tricarico

LONDON—Daily oral curcumin may improve memory and attention in cognitively normal middle-aged and older adults, according to a study presented at the 2017 Alzheimer’s Association International Conference.

“The FDDNP-PET findings raise the possibility that decreases in plaque and tangle accumulation in brain regions modulating mood and memory are associated with curcumin supplementation,” said Gary W. Small, MD, Professor of Psychiatry and Biobehavioral Sciences and Parlow-Solomon Professor on Aging at the David Geffen School of Medicine at the University of California, Los Angeles, and colleagues.

Previous studies suggested that curcumin’s anti-inflammatory, antioxidant, antiamyloid, and possible antitau properties may provide neuroprotective benefits. Prior human trials of the effects of curcumin on cognition were inconclusive, however.

To examine the effects of curcumin on memory performance in nondemented adults and explore its potential impact on brain amyloid plaques and tau tangles using FDDNP-PET, Dr. Small and colleagues conducted a randomized, double-blind, placebo-controlled trial. Forty participants ranging in age from 51 to 84 were randomized to a bioavailable formulation of curcumin (90 mg twice daily) or placebo for 18 months. To confirm subject compliance, investigators obtained curcumin blood levels at baseline and at 18 months.

The primary outcomes were verbal (Buschke Selective Reminding Test [SRT]) and visual (Brief Visual Memory Test-Revised) memory. Change in attention (Trail Making Test, Part A) was a secondary outcome. Researchers also assessed mood using the Beck Depression Inventory.

Among the 40 participants, 30 underwent baseline and post-treatment FDDNP-PET scans. Regions of interest included the amygdala, hypothalamus, medial and lateral temporal lobe, posterior cingulate cortex, parietal lobe, frontal lobe, and motor cortex. Data analyses included mixed-effects general linear models with age and education as covariates, and effect-size estimates.

The study population’s mean age was about 63, and 22 participants were women. SRT Consistent Long-Term Retrieval scores improved in the curcumin group, but not in the placebo group. Other memory scores, including the SRT Total and Long-Term Storage, as well as visual memory, also improved in the curcumin group. None of the memory measures changed significantly in the placebo group, said the researchers.

Daily curcumin also improved attention and mood. Researchers observed a significant difference between curcumin and placebo in Trail Making Test, Part A scores.

After 18 months, FDDNP binding was lower in the curcumin group than in the placebo group in the amygdala and the hypothalamus. In addition, the placebo group showed a significant increase in amyloid plaques and tau tangles in the hypothalamus, compared with baseline.

Four patients in the curcumin group and two patients in the placebo group experienced gastrointestinal side effects (primarily transient abdominal pain, gastritis, and nausea). “This relatively inexpensive and nontoxic treatment may have a potential for not only improving age-related memory decline, but also as a prevention therapy, possibly staving off progression, and eventually future symptoms of Alzheimer’s disease,” said Dr. Small and colleagues.

—Erica Tricarico

LONDON—Daily oral curcumin may improve memory and attention in cognitively normal middle-aged and older adults, according to a study presented at the 2017 Alzheimer’s Association International Conference.

“The FDDNP-PET findings raise the possibility that decreases in plaque and tangle accumulation in brain regions modulating mood and memory are associated with curcumin supplementation,” said Gary W. Small, MD, Professor of Psychiatry and Biobehavioral Sciences and Parlow-Solomon Professor on Aging at the David Geffen School of Medicine at the University of California, Los Angeles, and colleagues.

Previous studies suggested that curcumin’s anti-inflammatory, antioxidant, antiamyloid, and possible antitau properties may provide neuroprotective benefits. Prior human trials of the effects of curcumin on cognition were inconclusive, however.

To examine the effects of curcumin on memory performance in nondemented adults and explore its potential impact on brain amyloid plaques and tau tangles using FDDNP-PET, Dr. Small and colleagues conducted a randomized, double-blind, placebo-controlled trial. Forty participants ranging in age from 51 to 84 were randomized to a bioavailable formulation of curcumin (90 mg twice daily) or placebo for 18 months. To confirm subject compliance, investigators obtained curcumin blood levels at baseline and at 18 months.

The primary outcomes were verbal (Buschke Selective Reminding Test [SRT]) and visual (Brief Visual Memory Test-Revised) memory. Change in attention (Trail Making Test, Part A) was a secondary outcome. Researchers also assessed mood using the Beck Depression Inventory.

Among the 40 participants, 30 underwent baseline and post-treatment FDDNP-PET scans. Regions of interest included the amygdala, hypothalamus, medial and lateral temporal lobe, posterior cingulate cortex, parietal lobe, frontal lobe, and motor cortex. Data analyses included mixed-effects general linear models with age and education as covariates, and effect-size estimates.

The study population’s mean age was about 63, and 22 participants were women. SRT Consistent Long-Term Retrieval scores improved in the curcumin group, but not in the placebo group. Other memory scores, including the SRT Total and Long-Term Storage, as well as visual memory, also improved in the curcumin group. None of the memory measures changed significantly in the placebo group, said the researchers.

Daily curcumin also improved attention and mood. Researchers observed a significant difference between curcumin and placebo in Trail Making Test, Part A scores.

After 18 months, FDDNP binding was lower in the curcumin group than in the placebo group in the amygdala and the hypothalamus. In addition, the placebo group showed a significant increase in amyloid plaques and tau tangles in the hypothalamus, compared with baseline.

Four patients in the curcumin group and two patients in the placebo group experienced gastrointestinal side effects (primarily transient abdominal pain, gastritis, and nausea). “This relatively inexpensive and nontoxic treatment may have a potential for not only improving age-related memory decline, but also as a prevention therapy, possibly staving off progression, and eventually future symptoms of Alzheimer’s disease,” said Dr. Small and colleagues.

—Erica Tricarico

Suicide prevention requires a multifaceted, comprehensive clinical effort, coupled with an equally comprehensive community effort.

“The clinician isn’t in it alone – none of us can do this alone,” explained Eileen Zeller, lead public health advisor with the suicide prevention branch of the Substance Abuse and Mental Health Services Administration.

In an interview at an event sponsored by Education Development Center and the National Action Alliance for Suicide Prevention, Ms. Zeller discussed new initiatives to get suicide prevention resources to clinicians and communities .

Suicide prevention requires a multifaceted, comprehensive clinical effort, coupled with an equally comprehensive community effort.

“The clinician isn’t in it alone – none of us can do this alone,” explained Eileen Zeller, lead public health advisor with the suicide prevention branch of the Substance Abuse and Mental Health Services Administration.

In an interview at an event sponsored by Education Development Center and the National Action Alliance for Suicide Prevention, Ms. Zeller discussed new initiatives to get suicide prevention resources to clinicians and communities .

Suicide prevention requires a multifaceted, comprehensive clinical effort, coupled with an equally comprehensive community effort.

“The clinician isn’t in it alone – none of us can do this alone,” explained Eileen Zeller, lead public health advisor with the suicide prevention branch of the Substance Abuse and Mental Health Services Administration.

In an interview at an event sponsored by Education Development Center and the National Action Alliance for Suicide Prevention, Ms. Zeller discussed new initiatives to get suicide prevention resources to clinicians and communities .

Reaching people at risk of opioid abuse and suicide will require a shift beyond a focus on treating individuals to a more comprehensive public health approach.

“The majority of people aren’t showing up at our treatment doors, so we have to have a very different approach if we’re going to reach everyone,” explained Arthur C. Evans Jr. PhD, chief executive officer of the American Psychological Association.

In an interview at an event sponsored by the Education Development Center and the National Action Alliance for Suicide Prevention, Dr. Evans discussed effective strategies for taking a population-health treatment perspective.

Reaching people at risk of opioid abuse and suicide will require a shift beyond a focus on treating individuals to a more comprehensive public health approach.

“The majority of people aren’t showing up at our treatment doors, so we have to have a very different approach if we’re going to reach everyone,” explained Arthur C. Evans Jr. PhD, chief executive officer of the American Psychological Association.

In an interview at an event sponsored by the Education Development Center and the National Action Alliance for Suicide Prevention, Dr. Evans discussed effective strategies for taking a population-health treatment perspective.

Reaching people at risk of opioid abuse and suicide will require a shift beyond a focus on treating individuals to a more comprehensive public health approach.

“The majority of people aren’t showing up at our treatment doors, so we have to have a very different approach if we’re going to reach everyone,” explained Arthur C. Evans Jr. PhD, chief executive officer of the American Psychological Association.

In an interview at an event sponsored by the Education Development Center and the National Action Alliance for Suicide Prevention, Dr. Evans discussed effective strategies for taking a population-health treatment perspective.

WASHINGTON – Suicides and opioid-related drug deaths are on parallel increases, devastating the same groups and the same communities, according to Alex Crosby, MD, senior adviser at the Centers for Disease Control and Prevention’s division of violence prevention at the National Center for Injury Prevention and Control.

Suicides increased by 25% during 2000-2015, and drug deaths – most notably, opioid-related deaths – have quadrupled since 1999. These increases strike the same groups: men, working-age adults, whites, Native Americans and Alaskan natives, and rural communities.

So consistent are the overlaps that primary care providers should view these demographics as red flags when such patients present with depression or pain complaints, Dr. Crosby said in an interview at an event sponsored by the Education Development Center and the National Alliance for Suicide Prevention. Vigilance in primary care settings is especially important, because many patients don’t have access to behavioral health specialists.

“As clinicians, we need to have a high index of suspicion, know what questions to ask, and to go a little bit deeper, beyond the presenting complaint,” he said. “Often, people with psychiatric illnesses [that predispose them to suicide and substance abuse] are going to their primary care provider first, because they don’t have access to behavioral health services. The family medicine practitioner, the internist, even the pediatrician, have to be aware of this. And clinicians need to have index of suspicion, and ask questions that go a little deeper than the presenting complaint was.”

[email protected]

WASHINGTON – Suicides and opioid-related drug deaths are on parallel increases, devastating the same groups and the same communities, according to Alex Crosby, MD, senior adviser at the Centers for Disease Control and Prevention’s division of violence prevention at the National Center for Injury Prevention and Control.

Suicides increased by 25% during 2000-2015, and drug deaths – most notably, opioid-related deaths – have quadrupled since 1999. These increases strike the same groups: men, working-age adults, whites, Native Americans and Alaskan natives, and rural communities.

So consistent are the overlaps that primary care providers should view these demographics as red flags when such patients present with depression or pain complaints, Dr. Crosby said in an interview at an event sponsored by the Education Development Center and the National Alliance for Suicide Prevention. Vigilance in primary care settings is especially important, because many patients don’t have access to behavioral health specialists.

“As clinicians, we need to have a high index of suspicion, know what questions to ask, and to go a little bit deeper, beyond the presenting complaint,” he said. “Often, people with psychiatric illnesses [that predispose them to suicide and substance abuse] are going to their primary care provider first, because they don’t have access to behavioral health services. The family medicine practitioner, the internist, even the pediatrician, have to be aware of this. And clinicians need to have index of suspicion, and ask questions that go a little deeper than the presenting complaint was.”

[email protected]

WASHINGTON – Suicides and opioid-related drug deaths are on parallel increases, devastating the same groups and the same communities, according to Alex Crosby, MD, senior adviser at the Centers for Disease Control and Prevention’s division of violence prevention at the National Center for Injury Prevention and Control.

Suicides increased by 25% during 2000-2015, and drug deaths – most notably, opioid-related deaths – have quadrupled since 1999. These increases strike the same groups: men, working-age adults, whites, Native Americans and Alaskan natives, and rural communities.

So consistent are the overlaps that primary care providers should view these demographics as red flags when such patients present with depression or pain complaints, Dr. Crosby said in an interview at an event sponsored by the Education Development Center and the National Alliance for Suicide Prevention. Vigilance in primary care settings is especially important, because many patients don’t have access to behavioral health specialists.

“As clinicians, we need to have a high index of suspicion, know what questions to ask, and to go a little bit deeper, beyond the presenting complaint,” he said. “Often, people with psychiatric illnesses [that predispose them to suicide and substance abuse] are going to their primary care provider first, because they don’t have access to behavioral health services. The family medicine practitioner, the internist, even the pediatrician, have to be aware of this. And clinicians need to have index of suspicion, and ask questions that go a little deeper than the presenting complaint was.”

[email protected]

WASHINGTON - Community pressures drive the twin tragedies of suicide and opioid deaths, which destroy community structure and must be addressed by community efforts, experts said during a panel discussion.

These so-called “deaths of despair” are inextricably linked, according to thought leaders in clinical medicine, volunteerism, and advocacy who gathered to share data and brainstorm solutions. A clear picture emerged of a professional community struggling to create a unified plan of attack and a unified voice to bring that plan to fruition.

Nick Piegari

The event was sponsored by the Education Development Center, a nonprofit that implements and evaluates programs to improve education, health, and economic opportunity worldwide, and the National Action Alliance for Suicide Prevention.

“We convened key leaders, including health care systems, federal agencies, national nonprofits, and faith-based organizations to strengthen our community response to suicide and opioids misuse and restore hope across the United States,” said Jerry Reed, PhD, EDC senior vice president. “To identify positive and lasting solutions requires collaboration from all sectors to achieve not only a nation free of suicide, but [also] a nation where all individuals are resilient, hopeful, and leading healthier lives.”

While several of the leading causes of death in the United States – including heart disease, stroke, and cancer – are declining, suicides and opioid deaths are surging, Alex Crosby, MD, told the gathering. An epidemiologist at the Centers for Disease Control and Prevention, Dr. Crosby cited the most recent national data, gathered in 2015. The numbers present a picture of two terrible problems striking virtually identical communities.

“Suicide rates increased 25% from 2000 to 2015,” said Dr. Crosby, who is also the senior adviser in the division of violence prevention at the National Center for Injury Prevention and Control. “In 2000, there were 30,000 suicides, and in 2015, there were 44,000. We are now looking at a suicide every 12 minutes in this country.”

Suicides cluster in several demographics, he said, “This is something that disproportionately affects males, working adults aged 25-64, non-Hispanic whites and non-Hispanic Native Americans, Alaskan natives, and rural areas.”

Deaths from drug overdoses, 60% of which now involve opioids, are on a parallel increase. “These have quadrupled since 1999, and the at-risk groups significantly overlap, with males, adults aged 24-52, non-Hispanic whites and Native Americans, Alaska natives, and rural communities most impacted. These are the very same groups seeing that increase in suicides.”
 

Joint tragedies, overlapping causes

The center is taking a public health stance on researching and managing both issues, Dr. Crosby said. “As we start looking at risk factors, we see that chronic health conditions, mental health, and pain management are factors common to both groups. But in addition to individual risks, there are societal risks … things in the family, community, and general society also influence these deaths.”

Former U.S. Rep. Patrick J. Kennedy agreed. Now a mental health policy advocate, Mr. Kennedy is not surprised that overlapping communities suffer these joint problems.

“On a societal level, these issues are directly related to the hollowing out of the manufacturing class, anxiety in a new generation that sees no financial stability,” he said. “Clearly, these are some of the reasons that these deaths track parts of the country that have been hardest hit economically. On top of that, we are lacking the kind of community connectedness we once had.”

Mr. Kennedy also faulted the marginalization of people with mental illnesses and the dearth of early screening that could identify mental disorders before they balloon into related substance abuse disorders. “Those are folks who, if screened and found to have a vulnerability from a mental illness, could be properly treated. These are illnesses that pathologize by neglect.”

The lack of awareness isn’t just a broad societal concept, but a specific weakness in the medical community, said Elinore F. McCance-Katz, MD, assistant secretary for mental health and substance use at the Substance Abuse and Mental Health Services Administration.

“There’s not a lot of attention paid to this issue unless you’re in a profession like psychiatry, where we are taught to systematically assess for suicidality,” Dr. McCance-Katz noted. “But unless you’re trained to address it, it’s not something you think about; and if you don’t think about it, you won’t uncover it.

“In primary care, for example, we see many with a pain complaint,” she continued. “That pain will be treated medically, but the psychological component, which might be devastating, won’t be. This can cause depression and suicidal thinking, and if patients are not asked about it, they will not offer it. So, we have the terrible situation where someone can leave the office with the means to harm themselves, but not the help they need to save their life.”
 

How to reach the vulnerable

When a medical disorder and its attendant comorbidities present a multifactorial etiology, the clinician must address the problem as a unit. This isn’t happening with suicide and drug overdose deaths, said Arthur C. Evans Jr, PhD, chief executive officer of the American Psychological Association.

“These conditions are tied to societal determinants, but our approach to them is still focused at the individual level,” said Dr. Evans. “As long as our primary way is to build treatment programs and expect people to find their way into them on their own, it’s not going to work. We know that 90% of patients with substance abuse problems don’t come to treatment. So, our strategy is missing a whole lot of people.”

A better way, he said, is to proactively provide holistic person-centered care. He has some very specific ideas, honed by his 12 years as commissioner of Philadelphia’s Department of Behavioral Health and Intellectual Disability Service, a $1.2 billion health care agency that is the safety net for 1.5 million Philadelphians with behavioral health and intellectual disabilities. Dr. Evans is credited with transforming the agency into a community-integrated, recovery-oriented treatment model.

He would like to see a similar national transformation in how at-risk groups are targeted, educated, screened, and treated. “We can create a culture where these issues are better understood by the public, so they can recognize problems early and connect to better health care.”

“Hope is at the center of our work,” Dr. Evans said. “The whole recovery movement has been about helping people have the hope that they can get better, that their lives can improve. Fundamentally, this must be the basis for treatment. We have focused for too long on the symptoms people bring to us, and missed the fact that these problems of suicide and drug abuse arise because people are hurting, both physically and psychologically. To recover, they need to believe there is a future in which they can feel better.”
 

If there’s a way, is there a will?

But while thought leaders continue to fine-tune their message, people continue to die, Mr. Kennedy said.

“We have all the experts who know what to do; the thing that is missing is the political will to do it,” he noted. “It’s driven by the stigma, the silence of families suffering from these illnesses. If we can’t talk about it in our families, we can’t talk about it to our legislators, and if they don’t hear from us, they do nothing. We need a political answer, ultimately. We appropriated a billion dollars over 2 years for the opioid crisis, but within 3 days of Hurricane Harvey, we appropriated $15 billion. It may seem we are making progress because we have great forums, but it’s a lot of talk, and people are dying every day.”

He likened the suicide and opioid death crisis to a natural disaster that requires not just money, but a highly coordinated response that targets multiple impacted areas.

“We need a Federal Emergency Management Agency–like response to this,” Mr. Kennedy said. “FEMA is designed to address all the missing pieces necessary for someone to recover from a disaster. In recovery, we have a physical problem, a mental obsession, and a spiritual malady. People need medical help – access to medication to get their lives stabilized. They need the psychological component of cognitive behavioral therapy. And they need the spiritual angle, which is social support, people reaching out to each other.

“Right now, everyone thinks this is a problem to be dealt with ‘over there,’ but it isn’t,” he added. “It involves all of us, and if we want to put these communities back together, we need everyone energized and contributing.”

[email protected]

WASHINGTON - Community pressures drive the twin tragedies of suicide and opioid deaths, which destroy community structure and must be addressed by community efforts, experts said during a panel discussion.

These so-called “deaths of despair” are inextricably linked, according to thought leaders in clinical medicine, volunteerism, and advocacy who gathered to share data and brainstorm solutions. A clear picture emerged of a professional community struggling to create a unified plan of attack and a unified voice to bring that plan to fruition.

Nick Piegari

The event was sponsored by the Education Development Center, a nonprofit that implements and evaluates programs to improve education, health, and economic opportunity worldwide, and the National Action Alliance for Suicide Prevention.

“We convened key leaders, including health care systems, federal agencies, national nonprofits, and faith-based organizations to strengthen our community response to suicide and opioids misuse and restore hope across the United States,” said Jerry Reed, PhD, EDC senior vice president. “To identify positive and lasting solutions requires collaboration from all sectors to achieve not only a nation free of suicide, but [also] a nation where all individuals are resilient, hopeful, and leading healthier lives.”

While several of the leading causes of death in the United States – including heart disease, stroke, and cancer – are declining, suicides and opioid deaths are surging, Alex Crosby, MD, told the gathering. An epidemiologist at the Centers for Disease Control and Prevention, Dr. Crosby cited the most recent national data, gathered in 2015. The numbers present a picture of two terrible problems striking virtually identical communities.

“Suicide rates increased 25% from 2000 to 2015,” said Dr. Crosby, who is also the senior adviser in the division of violence prevention at the National Center for Injury Prevention and Control. “In 2000, there were 30,000 suicides, and in 2015, there were 44,000. We are now looking at a suicide every 12 minutes in this country.”

Suicides cluster in several demographics, he said, “This is something that disproportionately affects males, working adults aged 25-64, non-Hispanic whites and non-Hispanic Native Americans, Alaskan natives, and rural areas.”

Deaths from drug overdoses, 60% of which now involve opioids, are on a parallel increase. “These have quadrupled since 1999, and the at-risk groups significantly overlap, with males, adults aged 24-52, non-Hispanic whites and Native Americans, Alaska natives, and rural communities most impacted. These are the very same groups seeing that increase in suicides.”
 

Joint tragedies, overlapping causes

The center is taking a public health stance on researching and managing both issues, Dr. Crosby said. “As we start looking at risk factors, we see that chronic health conditions, mental health, and pain management are factors common to both groups. But in addition to individual risks, there are societal risks … things in the family, community, and general society also influence these deaths.”

Former U.S. Rep. Patrick J. Kennedy agreed. Now a mental health policy advocate, Mr. Kennedy is not surprised that overlapping communities suffer these joint problems.

“On a societal level, these issues are directly related to the hollowing out of the manufacturing class, anxiety in a new generation that sees no financial stability,” he said. “Clearly, these are some of the reasons that these deaths track parts of the country that have been hardest hit economically. On top of that, we are lacking the kind of community connectedness we once had.”

Mr. Kennedy also faulted the marginalization of people with mental illnesses and the dearth of early screening that could identify mental disorders before they balloon into related substance abuse disorders. “Those are folks who, if screened and found to have a vulnerability from a mental illness, could be properly treated. These are illnesses that pathologize by neglect.”

The lack of awareness isn’t just a broad societal concept, but a specific weakness in the medical community, said Elinore F. McCance-Katz, MD, assistant secretary for mental health and substance use at the Substance Abuse and Mental Health Services Administration.

“There’s not a lot of attention paid to this issue unless you’re in a profession like psychiatry, where we are taught to systematically assess for suicidality,” Dr. McCance-Katz noted. “But unless you’re trained to address it, it’s not something you think about; and if you don’t think about it, you won’t uncover it.

“In primary care, for example, we see many with a pain complaint,” she continued. “That pain will be treated medically, but the psychological component, which might be devastating, won’t be. This can cause depression and suicidal thinking, and if patients are not asked about it, they will not offer it. So, we have the terrible situation where someone can leave the office with the means to harm themselves, but not the help they need to save their life.”
 

How to reach the vulnerable

When a medical disorder and its attendant comorbidities present a multifactorial etiology, the clinician must address the problem as a unit. This isn’t happening with suicide and drug overdose deaths, said Arthur C. Evans Jr, PhD, chief executive officer of the American Psychological Association.

“These conditions are tied to societal determinants, but our approach to them is still focused at the individual level,” said Dr. Evans. “As long as our primary way is to build treatment programs and expect people to find their way into them on their own, it’s not going to work. We know that 90% of patients with substance abuse problems don’t come to treatment. So, our strategy is missing a whole lot of people.”

A better way, he said, is to proactively provide holistic person-centered care. He has some very specific ideas, honed by his 12 years as commissioner of Philadelphia’s Department of Behavioral Health and Intellectual Disability Service, a $1.2 billion health care agency that is the safety net for 1.5 million Philadelphians with behavioral health and intellectual disabilities. Dr. Evans is credited with transforming the agency into a community-integrated, recovery-oriented treatment model.

He would like to see a similar national transformation in how at-risk groups are targeted, educated, screened, and treated. “We can create a culture where these issues are better understood by the public, so they can recognize problems early and connect to better health care.”

“Hope is at the center of our work,” Dr. Evans said. “The whole recovery movement has been about helping people have the hope that they can get better, that their lives can improve. Fundamentally, this must be the basis for treatment. We have focused for too long on the symptoms people bring to us, and missed the fact that these problems of suicide and drug abuse arise because people are hurting, both physically and psychologically. To recover, they need to believe there is a future in which they can feel better.”
 

If there’s a way, is there a will?

But while thought leaders continue to fine-tune their message, people continue to die, Mr. Kennedy said.

“We have all the experts who know what to do; the thing that is missing is the political will to do it,” he noted. “It’s driven by the stigma, the silence of families suffering from these illnesses. If we can’t talk about it in our families, we can’t talk about it to our legislators, and if they don’t hear from us, they do nothing. We need a political answer, ultimately. We appropriated a billion dollars over 2 years for the opioid crisis, but within 3 days of Hurricane Harvey, we appropriated $15 billion. It may seem we are making progress because we have great forums, but it’s a lot of talk, and people are dying every day.”

He likened the suicide and opioid death crisis to a natural disaster that requires not just money, but a highly coordinated response that targets multiple impacted areas.

“We need a Federal Emergency Management Agency–like response to this,” Mr. Kennedy said. “FEMA is designed to address all the missing pieces necessary for someone to recover from a disaster. In recovery, we have a physical problem, a mental obsession, and a spiritual malady. People need medical help – access to medication to get their lives stabilized. They need the psychological component of cognitive behavioral therapy. And they need the spiritual angle, which is social support, people reaching out to each other.

“Right now, everyone thinks this is a problem to be dealt with ‘over there,’ but it isn’t,” he added. “It involves all of us, and if we want to put these communities back together, we need everyone energized and contributing.”

[email protected]

WASHINGTON - Community pressures drive the twin tragedies of suicide and opioid deaths, which destroy community structure and must be addressed by community efforts, experts said during a panel discussion.

These so-called “deaths of despair” are inextricably linked, according to thought leaders in clinical medicine, volunteerism, and advocacy who gathered to share data and brainstorm solutions. A clear picture emerged of a professional community struggling to create a unified plan of attack and a unified voice to bring that plan to fruition.

Nick Piegari

The event was sponsored by the Education Development Center, a nonprofit that implements and evaluates programs to improve education, health, and economic opportunity worldwide, and the National Action Alliance for Suicide Prevention.

“We convened key leaders, including health care systems, federal agencies, national nonprofits, and faith-based organizations to strengthen our community response to suicide and opioids misuse and restore hope across the United States,” said Jerry Reed, PhD, EDC senior vice president. “To identify positive and lasting solutions requires collaboration from all sectors to achieve not only a nation free of suicide, but [also] a nation where all individuals are resilient, hopeful, and leading healthier lives.”

While several of the leading causes of death in the United States – including heart disease, stroke, and cancer – are declining, suicides and opioid deaths are surging, Alex Crosby, MD, told the gathering. An epidemiologist at the Centers for Disease Control and Prevention, Dr. Crosby cited the most recent national data, gathered in 2015. The numbers present a picture of two terrible problems striking virtually identical communities.

“Suicide rates increased 25% from 2000 to 2015,” said Dr. Crosby, who is also the senior adviser in the division of violence prevention at the National Center for Injury Prevention and Control. “In 2000, there were 30,000 suicides, and in 2015, there were 44,000. We are now looking at a suicide every 12 minutes in this country.”

Suicides cluster in several demographics, he said, “This is something that disproportionately affects males, working adults aged 25-64, non-Hispanic whites and non-Hispanic Native Americans, Alaskan natives, and rural areas.”

Deaths from drug overdoses, 60% of which now involve opioids, are on a parallel increase. “These have quadrupled since 1999, and the at-risk groups significantly overlap, with males, adults aged 24-52, non-Hispanic whites and Native Americans, Alaska natives, and rural communities most impacted. These are the very same groups seeing that increase in suicides.”
 

Joint tragedies, overlapping causes

The center is taking a public health stance on researching and managing both issues, Dr. Crosby said. “As we start looking at risk factors, we see that chronic health conditions, mental health, and pain management are factors common to both groups. But in addition to individual risks, there are societal risks … things in the family, community, and general society also influence these deaths.”

Former U.S. Rep. Patrick J. Kennedy agreed. Now a mental health policy advocate, Mr. Kennedy is not surprised that overlapping communities suffer these joint problems.

“On a societal level, these issues are directly related to the hollowing out of the manufacturing class, anxiety in a new generation that sees no financial stability,” he said. “Clearly, these are some of the reasons that these deaths track parts of the country that have been hardest hit economically. On top of that, we are lacking the kind of community connectedness we once had.”

Mr. Kennedy also faulted the marginalization of people with mental illnesses and the dearth of early screening that could identify mental disorders before they balloon into related substance abuse disorders. “Those are folks who, if screened and found to have a vulnerability from a mental illness, could be properly treated. These are illnesses that pathologize by neglect.”

The lack of awareness isn’t just a broad societal concept, but a specific weakness in the medical community, said Elinore F. McCance-Katz, MD, assistant secretary for mental health and substance use at the Substance Abuse and Mental Health Services Administration.

“There’s not a lot of attention paid to this issue unless you’re in a profession like psychiatry, where we are taught to systematically assess for suicidality,” Dr. McCance-Katz noted. “But unless you’re trained to address it, it’s not something you think about; and if you don’t think about it, you won’t uncover it.

“In primary care, for example, we see many with a pain complaint,” she continued. “That pain will be treated medically, but the psychological component, which might be devastating, won’t be. This can cause depression and suicidal thinking, and if patients are not asked about it, they will not offer it. So, we have the terrible situation where someone can leave the office with the means to harm themselves, but not the help they need to save their life.”
 

How to reach the vulnerable

When a medical disorder and its attendant comorbidities present a multifactorial etiology, the clinician must address the problem as a unit. This isn’t happening with suicide and drug overdose deaths, said Arthur C. Evans Jr, PhD, chief executive officer of the American Psychological Association.

“These conditions are tied to societal determinants, but our approach to them is still focused at the individual level,” said Dr. Evans. “As long as our primary way is to build treatment programs and expect people to find their way into them on their own, it’s not going to work. We know that 90% of patients with substance abuse problems don’t come to treatment. So, our strategy is missing a whole lot of people.”

A better way, he said, is to proactively provide holistic person-centered care. He has some very specific ideas, honed by his 12 years as commissioner of Philadelphia’s Department of Behavioral Health and Intellectual Disability Service, a $1.2 billion health care agency that is the safety net for 1.5 million Philadelphians with behavioral health and intellectual disabilities. Dr. Evans is credited with transforming the agency into a community-integrated, recovery-oriented treatment model.

He would like to see a similar national transformation in how at-risk groups are targeted, educated, screened, and treated. “We can create a culture where these issues are better understood by the public, so they can recognize problems early and connect to better health care.”

“Hope is at the center of our work,” Dr. Evans said. “The whole recovery movement has been about helping people have the hope that they can get better, that their lives can improve. Fundamentally, this must be the basis for treatment. We have focused for too long on the symptoms people bring to us, and missed the fact that these problems of suicide and drug abuse arise because people are hurting, both physically and psychologically. To recover, they need to believe there is a future in which they can feel better.”
 

If there’s a way, is there a will?

But while thought leaders continue to fine-tune their message, people continue to die, Mr. Kennedy said.

“We have all the experts who know what to do; the thing that is missing is the political will to do it,” he noted. “It’s driven by the stigma, the silence of families suffering from these illnesses. If we can’t talk about it in our families, we can’t talk about it to our legislators, and if they don’t hear from us, they do nothing. We need a political answer, ultimately. We appropriated a billion dollars over 2 years for the opioid crisis, but within 3 days of Hurricane Harvey, we appropriated $15 billion. It may seem we are making progress because we have great forums, but it’s a lot of talk, and people are dying every day.”

He likened the suicide and opioid death crisis to a natural disaster that requires not just money, but a highly coordinated response that targets multiple impacted areas.

“We need a Federal Emergency Management Agency–like response to this,” Mr. Kennedy said. “FEMA is designed to address all the missing pieces necessary for someone to recover from a disaster. In recovery, we have a physical problem, a mental obsession, and a spiritual malady. People need medical help – access to medication to get their lives stabilized. They need the psychological component of cognitive behavioral therapy. And they need the spiritual angle, which is social support, people reaching out to each other.

“Right now, everyone thinks this is a problem to be dealt with ‘over there,’ but it isn’t,” he added. “It involves all of us, and if we want to put these communities back together, we need everyone energized and contributing.”

[email protected]

PARIS – Methylphenidate therapy for attention-deficit/hyperactivity disorder in medication-naive boys significantly improved their sleep quality, timing, and duration in a double-blind randomized trial, Michelle M. Solleveld, MD, reported at the annual congress of the European College of Neuropsychopharmacology.

Moreover, these salutary effects on sleep persisted for at least 1 week after methylphenidate was stopped at the end of the 16-week study, added Dr. Solleveld of the University of Amsterdam.

Bruce Jancin/Frontline Medical News

[email protected]
 

PARIS – Methylphenidate therapy for attention-deficit/hyperactivity disorder in medication-naive boys significantly improved their sleep quality, timing, and duration in a double-blind randomized trial, Michelle M. Solleveld, MD, reported at the annual congress of the European College of Neuropsychopharmacology.

Moreover, these salutary effects on sleep persisted for at least 1 week after methylphenidate was stopped at the end of the 16-week study, added Dr. Solleveld of the University of Amsterdam.

Bruce Jancin/Frontline Medical News

[email protected]
 

PARIS – Methylphenidate therapy for attention-deficit/hyperactivity disorder in medication-naive boys significantly improved their sleep quality, timing, and duration in a double-blind randomized trial, Michelle M. Solleveld, MD, reported at the annual congress of the European College of Neuropsychopharmacology.

Moreover, these salutary effects on sleep persisted for at least 1 week after methylphenidate was stopped at the end of the 16-week study, added Dr. Solleveld of the University of Amsterdam.

Bruce Jancin/Frontline Medical News

[email protected]
 

MADRID – Adding cetuximab (Erbitux) to chemotherapy before or after surgery for resectable colorectal liver metastases resulted in significantly worse survival compared with perioperative chemotherapy alone, mature results of the randomized New EPOC trial confirmed.

Among 257 patients with KRAS exon 2 wild-type resectable colorectal liver metastases (CRLM) or suboptimally resectable CRLM, median overall survival (OS) was 81 months for patients assigned to neoadjuvant and adjuvant chemotherapy alone, compared with 55.4 months for patients who received perioperative chemotherapy plus cetuximab, reported John Bridgewater, MD, of University College London Cancer Institute.

MADRID – Adding cetuximab (Erbitux) to chemotherapy before or after surgery for resectable colorectal liver metastases resulted in significantly worse survival compared with perioperative chemotherapy alone, mature results of the randomized New EPOC trial confirmed.

Among 257 patients with KRAS exon 2 wild-type resectable colorectal liver metastases (CRLM) or suboptimally resectable CRLM, median overall survival (OS) was 81 months for patients assigned to neoadjuvant and adjuvant chemotherapy alone, compared with 55.4 months for patients who received perioperative chemotherapy plus cetuximab, reported John Bridgewater, MD, of University College London Cancer Institute.

MADRID – Adding cetuximab (Erbitux) to chemotherapy before or after surgery for resectable colorectal liver metastases resulted in significantly worse survival compared with perioperative chemotherapy alone, mature results of the randomized New EPOC trial confirmed.

Among 257 patients with KRAS exon 2 wild-type resectable colorectal liver metastases (CRLM) or suboptimally resectable CRLM, median overall survival (OS) was 81 months for patients assigned to neoadjuvant and adjuvant chemotherapy alone, compared with 55.4 months for patients who received perioperative chemotherapy plus cetuximab, reported John Bridgewater, MD, of University College London Cancer Institute.