What happens to the fetus when a pregnant woman takes a stimulant for AD/HD (Attention Deficit/Hyperactivity Disorder)?
Specifically, does that increase the risk of the baby developing a neurodevelopmental disorder such as Autism Spectrum Disorder, AD/HD, or others during childhood?
A research study by Suarez E. and colleagues on this topic was published in the journal JAMA Psychiatry online January 24, 2024.
They studied the offspring of 1,123 pregnant women who had taken a stimulant for AD/HD during the second half of pregnancy.
The researchers wanted to find out if the children had a higher rate of neurodevelopment disorders than children without that exposure.
The stimulants that the pregnant women took were either amphetamine/dextroamphetamine (common brand name is Adderall XR) or methylphenidate (common brand names are Ritalin and Concerta).
The bottom line is that there was NO EVIDENCE OF AN INCREASED RATE OF NEURODEVELOPMENTAL DISORDERS in these children.
This is good news that should reduce concerns that pregnant women may have about this issue.
Some “pro-life” advocates believe that abortion is always wrong, but others make exceptions to save the life of the mother or for other reasons.
“Pro-choice” advocates don’t want the government (state or federal) to tell women whether and when they can seek an abortion.
These are contentious issues, and both sides believe they are right.
According to the Gallup organization (polling organization) of adults polled “… 61% currently say that overturning Roe v. Wade was a ‘bad thing,’ while 38% call it a ‘good thing’.” [July 7, 2023 published in 2024]
The Gallup organization also reported in May 2023 that, of those polled, “34% believe abortion should be legal ‘under any circumstances,’ 51% say it should be legal ‘only under certain circumstances,’ and 13% say it should be illegal in all circumstances’.”
If these data are accurate and representative, a majority of people believe that abortion should be legal in all or at least some circumstances.
Those people who want abortion to be illegal on moral grounds do so presumably because they believe the life of the developing fetus is sacred.
But what do they think about society’s responsibilities once a baby is born? Being consistent requires “pro-life”advocates to be champions of assuring proper care of children from the moment they are born.
When comparing states that severely limit abortions to those that are more “pro-choice,” it appears that anti-abortion states do not provide the same level of services for children than pro-choice states.
For example, according to the Associated Press, “Social programs are weak in many states with tough abortion laws” (April 7, 2022).
The New York Times on July 28, 2022 reported: “States with abortion bans are among least supportive for mothers and children.”
National Public Radio noted that “States with the toughest abortion laws have the weakest maternal supports, data shows” (August 18, 2022).
If these reports are correct, those who want to limit abortion should do a lot more to show that the life of a baby after birth is at least as important to them as the life of an unborn fetus.
My opinion about the importance of caring for the needs of live children is independent of my thoughts about abortion. I may address that another time.
How much exercise do you need to do to help you live longer? This question was addressed by Sara Berg, MS in the AMA Morning Rounds on January, 23, 2024.
This blog is based on her article about a research study on this topic.
It turns out you need to exercise more than the minimum recommendation for adults. That amount is 150-300 minutes per week of moderate exercise or 75-150 minutes per week of vigorous exercise.
Moderate exercise means walking, weightlifting, and lower-intensity exercise.
Vigorous exercise means running, bicycling, and swimming.
Research showed that “working out two to four times beyond the minimum VIGOROUS physical recommendations led to a lower risk of death from cardiovascular disease.” Heart disease is the leading cause of death in the Western world.
Specifically, vigorous exercise done for 150-299 minutes per week reduced cardiovascular death by 27% to 33%. There was also a reduction of non-cardiac deaths by 19%.
Doing MODERATE exercise for about 300 to 599 minutes per week reduced cardiovascular disease by 26% to 38%.
The maximum reduction in mortality was found in research subjects who exercised using a combination of moderate (150-600 minutes per week) and vigorous exercise (75-300 minutes per week); this resulted in a reduction in mortality by 36% to 42%.
The bottom line is that regular physical exercise is important for our health. To increase the odds of living longer you need to do more exercise than the standard minimum recommendation.
A combination of moderate and vigorous exercise provides the most benefit.
My first name is Peter. My parents named me after the lead apostle of Jesus.
The biblical Peter’s birth name was Simon. There is a story in the Gospel of Matthew about the time when Jesus said to Simon, “You are Peter, and on this rock I will build my church, and the gates of hell shall not prevail against it.”
Peter was also given “the keys of the kingdom of heaven” in Matthew. By one tradition, there are 2 keys, one gold (power to bind and loose in heaven) and another silver (power to bind and loose on earth)
According to Wikapedia, Peter comes directly from the Greek petra, which means rock or stone. In Aramaic (the language spoken by Jesus) the word is Kefa or Cephas which also translates as stone or rock.
In old England the Normans used the Old French form of Peter, which was Piers. It is still used today, e.g., Piers Morgan. [Information from http://www.behindthename.com]
Peter the apostle has been considered to be the lead apostle. Two letters in the bible are attributed to him. There is a legend that Peter was crucified as a martyr. The legend states that he insisted on being crucified upside down because he said he was not worthy to be crucified in the same manner as Jesus.
There are many qualities of a good leader. what they all come down to is the ability to get other people to WANT to do what the leader wants them to do.
How is this done? Explain why things need to be done. Tell those you are leading what value it provides.
Listen well. Teach. Describe the end goal. Make it compelling.
Remove barriers to reaching the goal. Give your staff the tools they need to be successful (they include psychological tools). Be lavish in your praise.
Give regular clear, specific feedback. Reward good results. Be a cheerleader.
Do not be a know-it-all. Surround yourself with very capable people, hopefully more skilled than you are. Provide good example.
Be honest. Take responsibility for errors that you make; it encourages honesty in others.
Criticize in private; praise in public.
Ask quiet people for their opinion. They may be too reserved to speak out but have great ideas.
Read books on leadership. Model yourself after great leaders.
Acne is a common skin disorder that can cause a lot of distress, especially for teenagers. Severe acne can be difficult to treat.
Luckily, there are beneficial treatments available. The most powerful medication for severe acne is isotretinoin (Accutane is a common brand name). This medication can also be used to treat rosacea and other inflammatory skin disorders.
However, it is limited by a very high risk of severe birth defects and, possibly, psychiatric disorders including depression and suicidal thoughts and actions.
I say “possibly” because early indications showed that these psychiatric disorders were more frequent in people who used isotretinoin, although studies were not consistent in their findings.
Nevertheless, the FDA required a black box warning that isotretinoin may be associated with psychosis, aggression, depression and suicidality. Physicians were only allowed to prescribe it if they received special training about these side effects and the clear risk of severe birth defects.
Given the uncertainty about the possible risk of psychiatric illness as a side effect of isotretinoin, Tan and colleagues did a comprehensive analysis of research on this topic.
They published their findings in JAMA Dermatology Jan 2024; 160(1): 54-62. They analyzed “25 studies including 1,625,891 participants …”.
They found that the “risk of completed suicide, suicide attempt, suicidal ideation, and self-harm among isotretinoin users was less than 0.5% each, whilst that of depression was 3.83%” over one year.
They also found that the medication was “not associated with the relative risk of all psychiatric disorders, and isotretinoin users were less likely than nonusers to attempt suicide at 2 to 4 years following treatment.”
This finding is consistent with findings by Huang and colleagues who reported their conclusions in the Journal of the American Academy of Dermatology in 2018.
They stated that they found no association between isotretinoin and depression, and they indicated that “… the treatment of acne appears to ameliorate depressive symptoms.”
Tan and colleagues found that “… there is no epidemiological evidence to suggest an increased relative risk of suicide or psychiatric conditions among isotretinoin users at a population level.”
However, the authors did recommend that “clinicians should … monitor patients for signs of mental distress during isotretinoin treatment.”
Alcohol Use Disorder is the official name for what has been called alcoholism. By whatever name, it is responsible for several illnesses and even deaths.
We rightfully worry about deaths from opioid overdoses (50,000 deaths per year) but alcohol kills more people (95,000 deaths per year). These statistics are from the Addiction Center.
Alcohol causes a large number of medical and psychiatric disorders. These include cirrhosis of the liver, malfunction of the cerebellum causing tremor and poor balance, depression, heart disease, liver cancer, high blood pressure, and others.
Alcohol can impair judgment, lead to impulsivity, and produce disinhibition so people may do things they otherwise wouldn’t do.
This impaired judgment and impaired inhibition is why “96.5% of teenagers who die from excessive alcohol usually die from acute causes, such as suicide or car accidents, as opposed to chronic conditions, such as liver diseases” (National Center for Drug Abuse Statistics 2023).
In 2022, 29.5 million people had an Alcohol Use Disorder, 27.2 million had a different Substance Use Disorder, and 8.0 million had both. Statistics are from http://www.samhsa.gov.
Men tend to drink more alcohol than women, and men are 3 times more likely to die from alcohol use than women.
However, men can drink more alcohol than women before becoming intoxicated. This is because men typically have a greater volume of body fluid to dilute the alcohol and they have larger livers to metabolize alcohol than women.
Although men generally drink more alcohol than women, among people age 12 to 17, females drink more alcohol than males. The reason is unclear.
Alcohol Use Disorder remains a serious cause of illness, disability, and death. Probably because it is legal and used by a majority of adults, people don’t see it as much of a problem as it really is.
Fortunately, there are good treatments available including several medications, numerous AA meetings, individual and group therapy, and both outpatient and inpatient care options.
Americans are known for having a high incidence of being overweight and of obesity. About 40% of U.S. adults are obese (Sara Berg, MS, “Top Health Tips Obesity Medicine Physicians Want You to Know,” JAMA, January 4, 2024).
The article points out that obesity is “linked to over 200 co-morbidities” (illness associated with obesity such as diabetes, high blood pressure, several forms of cancer, arthritis, high cholesterol, heart disease, stroke, obstructive sleep apnea, and more).
Obesity medicine physicians consider obesity to be a medical disorder with multiple factors causing it. It is not due to a lack of willpower.
Genetics plays a role. Also, the NIH tells us that obesity can be caused by a combination of a “poor diet,” inadequate physical activity, insufficient sleep, and several environmental factors.
These factors may include: lack of availability of nearby parks and affordable gyms, oversized food portions served in restaurants, food deserts (no nearby food stores that sell healthy food at affordable costs), and “Food advertising” that “encourages people to buy unhealthy foods such as high-fat snacks and sugary drinks.”
Highly processed foods should be eaten in small quantities, if at all. Alas, many prepared foods in the U.S. are highly processed.
Some instances of obesity are related to medical disorders such as low thyroid hormone, polycystic ovarian disease, and Cushing’s disease. There are also medications that have weight gain as side-effects. Examples include steroids, some antidepressants, and some seizure medications.
One conclusion from all this information is that people who are overweight or obese should not be shamed any more than we should shame someone for having diabetes, breast cancer, or migraine headaches.
Anyone who is overweight or obese and wants to lose weight should understand that lack of willpower is not the cause of their weight gain. Therefore, willpower is not the solution either. However, if you struggle with obesity, it is up to you to learn about effective approaches.
Fortunately, recent advances in medicine have provided a number of treatments that can help. Examples include weight-loss medications such as the GLP-1 injections, bariatric surgery of various kinds, and management of contributing conditions such as thyroid disease.
Also, increasing physical activity and reduction in calorie intake, getting adequate sleep (hormones released during sleep reduce appetite and modify how our bodies use energy), and mindful eating are all helpful.
For people who want to lose weight and are doing all they can but are not succeeding, they may want to obtain a consultation from an obesity medicine physician specialist.
Bipolar Disorder is a psychiatric disorder characterized by episodes of depression and episodes of mania or hypomania. They present with high energy levels, impulsivity, irritability leading to intense anger, poor life decisions such as starting to take illicit drugs or becoming sexually promiscuous, and other symptoms.
Bipolar Disorder almost always requires mood stabilizing medication. However, talking therapies are also very beneficial for these patients.
Recently, researchers compared Dialectical Behavior Therapy (DBT) with standard of care psychotherapy for adolescent patients with Bipolar Disorder. The patients received either DBT or the alternative therapy for one year. (Goldstein T and colleagues in JAMA Psychiatry January 2024; Volume 81, Number 1).
They found out that DBT reduced suicidal behavior compared to the other therapy. However, there was no difference in depression, mania, or hypomania.
If this research is replicated, it supports using DBT with patients who have Bipolar Disorder because it would reduce the risk of suicidal behavior.
DBT uses concepts and techniques from Cognitive Behavior Therapy (CBT) and adds techniques that address intense negative emotions such as anger. It also places a lot of attention on interpersonal relationships.
DBT was first used for Borderline Personality Disorder and demonstrated significant benefits. Since then, it has been used for several other mental disorders including PTSD, depression, anxiety, and others.
Health and Culture 