Mentally Ill People are Four Times More Likely to be a Victim of Violence

Mentally ill people are four times more likely to be a victim of violence, according to an international study.

One in four has been attacked in the past year, suggests the Lancet journal.  Researchers looked at 26 studies from developed countries, including five from the UK.

Mental Health charities said, despite public fears, people with mental illness were much more likely to be a victim than a perpetrator.

Many researchers have looked into the issue of disability and violence, but the Lancet study combines their results aiming to provide a more reliable answer.

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Vulnerable

The research team, from John Moores University in Liverpool and the World Health Organization in Geneva, found that in general, people with any sort of disability were at greater risk of violence, with 3% experiencing violence in the previous 12 months.

However, those with learning difficulties were more vulnerable, with more than 6% reporting violence against them, and adults with mental illnesses were even more so.

The study found that more than 24% said they had been the victim of some form of violence in the preceding year.

The underlying reasons are complex, but people with mental illnesses can be more likely to struggle with personal relationships, and have a greater likelihood of substance abuse, homelessness, being imprisoned or living in poverty, each of which raises the risk of being the victim of violence.

Prof Mark Bellis, who led the study, said the results suggested a wider problem.

He said: “Lifetime exposure to violence, and the proportions of individuals with disability who are directly threatened with violence or otherwise live in fear of becoming a victim, are likely to be substantially higher than our estimate.”

Simon Lawton Smith, from the Mental Health Foundation, said the results were unsurprising.

“The research sadly adds new evidence to what we already know – that people with a mental illness and people with a learning disability are at a high risk of being the victim of violence. Evidence shows that people with serious mental illness are more likely to be the victim of a violent crime than the perpetrator. Although research suggests that there are factors that may increase risks of violence – such as co-occurring substance use, or not being engaged in treatment – people living with mental illness are 10 times more likely to be victims of violence than perpetrators.”

Paul Farmer, chief executive of the charity Mind, said the charity’s own research suggested people with mental health problems often did not feel safe in their local area.

“People reported every kind of harassment from being stalked, verbal harassment in the street, having their homes vandalised and physical and sexual assault. Stigma and discrimination against people with mental health problems is still rife, and sadly this can go as far as individuals being victimised in their communities or even targeted in their own homes.”

Source: BBC News UK

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Sleeping Pills linked to Increased Risk of Death

Doctors warn that sleeping pills used by thousands of people in the UK appear to be linked with a higher death risk.

The American study in BMJ Open compared more than 10,000 patients on tablets like temazepam with 23,000 similar patients not taking these drugs. Death risk among users was about four times higher, although the absolute risk was still relatively low.

Experts say while the findings highlight a potential risk, proof of harm is still lacking.

Sleeping Pills linked to Increased Risk of Death

They say patients should not be alarmed nor stop their medication, but if they are concerned they should discuss this with their doctor or pharmacist.

UK guidelines for NHS staff say hypnotic drugs should only be used for short periods of time because of tolerance to the drug and the risk of dependency. But they make no mention of an associated death risk, despite other studies having already reported this potential risk.

The Medicines and Healthcare products Regulatory Agency said it would consider the results of this latest study and whether it has any implications for current prescribing guidance.

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Millions prescribed

In 2010 in England, there were 2.8 million prescriptions dispensed for temazepam and almost 5.3 million for another common sleeping pill called zopiclone.

There were also more than 725,000 prescriptions dispensed for zolpidem and more than 9,400 for zaleplon, two other drugs in this same family.

The latest study looked at a wide range of sleeping pills, including drugs used in the UK, such as benzodiazepines (temazepam and diazepam), non-benzodiazepines (zolpidem, zopiclone and zaleplon), barbiturates and sedative antihistamines.

The investigators, from the Jackson Hole Centre for Preventive Medicine in Wyoming and the Scripps Clinic Viterbi Family Sleep Centre in California, found that people prescribed these pills were 4.6 times more likely to die during a 2.5-year period compared to those not on the drugs.

Overall, one in every 16 patients in the sleeping pill group died (638 out of 10,531 in total) compared to one in every 80 of the non-users (295 deaths out of 23,674 patients).

This increased risk was irrespective of other underlying health conditions, such as heart and lung diseases, and other factors like smoking and alcohol use, which the researchers say they did their best to rule out.

The researchers say it is not yet clear why people taking sleeping tablets may be at greater risk.

The drugs are sedating and this may make users more prone to falls and other accidents. The tablets can also alter a person’s breathing pattern as they sleep and they have been linked to increased suicide risk.

Meagre Benefits

In this latest study, those taking the highest doses of sleeping tablets also appeared to be at greater risk of developing cancer.

The researchers say: “The meagre benefits of hypnotics, as critically reviewed by groups without financial interest, would not justify substantial risks.” They say even short-term use may not be justifiable.

But Malcolm Lader, professor of clinical psychopharmacology at the Institute of Psychiatry at King’s College London, said people should not panic as a result of the findings.

“The study needs to be replicated in a different sample and I think we need to hold judgement until we have further studies. What we don’t want is people stopping sleeping tablets and then going through a very disturbing period of insomnia. People should discuss this with their GP but should not under any circumstances stop taking their medication.”

Nina Barnett, of the Royal Pharmaceutical Society, said: “This is an important study and although it is unlikely to radically change prescribing in the immediate term, it should raise awareness and remind both patients and prescribers to the potential risks of sedative use for insomnia. The association between mortality and sedation is not new and this research tells us that people who took these medicines were more likely to die than people who didn’t take them.  However it does not mean that the deaths were caused by the medicine.”

Source: BBC News UK

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Unlimited Human Eggs ‘Potential’ for Fertility Treatment

It may be possible to one day create an “unlimited” supply of human eggs to aid fertility treatment, US doctors say.

Researchers have shown it is possible to find stem cells in adult women which spontaneously produced new eggs in the laboratory.

Further experiments on mice showed such eggs could be fertilised, according to a study in the journal Nature Medicine.

One British expert said the study re-wrote the rule book with “exciting possibilities” for improving fertility.

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The long-established theory is that women are born with all the eggs they will ever have. Lead researcher Dr Jonathan Tilly, from Massachusetts General Hospital, said this study, a follow up to one on mice in 2004, disproves that.

His team has reported finding and isolating the stem cells which go on to produce eggs in the ovaries of reproductive age women. It was done by searching for a protein, DDX4, which was unique to the surface of the stem cells. This allowed researchers to fish out the right cells.

When grown in the laboratory, the cells “spontaneously generated” immature eggs – or oocytes, which looked and acted like oocytes in the body.

The cells were “matured” when surrounded by living human ovarian tissue, which had been grafted inside mice.

There are tight legal and ethical restrictions on research on human eggs. The same experiments repeated using stem cells taken from mice showed the eggs could be fertilised with sperm and produced embryos.

Unprecedented

Dr Tilly said: “The primary objective of the current study was to prove that oocyte-producing stem cells do in fact exist in the ovaries of women during reproductive life, which we feel this study demonstrates very clearly.

“The discovery of oocyte precursor cells in adult human ovaries, coupled with the fact that these cells share the same characteristic features of their mouse counterparts that produce fully functional eggs, opens the door for development of unprecedented technologies to overcome infertility in women and perhaps even delay the timing of ovarian failure.”

He told Nature: “These cells, when maintained outside of the body, are more than happy to make cells on their own and if we can guide that process I think it opens up the chance that sometime in the future we might get to the point of having an unlimited source of human eggs.”

Dr Allan Pacey, a fertility expert at the University of Sheffield, said: “This is a nice study which shows quite convincingly that women’s ovaries contain stem cells that can divide and make eggs.  Not only does this re-write the rule book, it opens up a number of exciting possibilities for preserving the fertility of women undergoing treatment for cancer, or just maybe for women who are suffering infertility by extracting these cells and making her new eggs in the lab.”

Potential landmark

Stuart Lavery, a consultant gynaecologist and director of IVF at Hammersmith Hospital, said the findings were “extremely significant” and “a potentially landmark piece of research”.

He told the BBC: “If this research is confirmed it may overturn one of the great asymmetries of reproductive biology – that a woman’s reproductive pool of gametes may be renewable, just like a man’s.”

While cautioning that the cells were “some way” from any clinical use, Mr Lavery said they had potential, “particularly in young women facing sterilising treatment such as chemotherapy”.

Source: BBC News UK

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Antipsychotics Death Risk Charted in Dementia Patients

Some antipsychotic medication may increase the risk of death in patients with dementia more than others, according to US research.

The drugs have a powerful sedative effect so are often used when dementia patients become aggressive or distressed.

A study, published on the BMJ website, argued that antipsychotics should not be used “in the absence of clear need”.

Experts said better alternatives were needed to antipsychotics. A study in 2009, suggested 180,000 people with dementia were taking antipsychotic medication in the UK and said the drugs resulted in 1,800 additional deaths.

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Data differences

Researchers at Harvard Medical School followed 75,445 people in nursing homes who had dementia and were prescribed antipsychotics.

The researchers said some drugs were associated with more than twice the risk of death than risperidone, another antipsychotic which was used as a benchmark to compare the other drugs.

The study concluded: “The data suggest that the risk of mortality with these drugs is generally increased with higher doses and seems to be highest for haloperidol and least for quetiapine.”

However, the way the study was conducted meant it could not say definitively that certain drugs actually caused more deaths, merely that there was a link between the two.

The Department of Health said antipsychotic use was “resulting in as many as 1,800 unnecessary deaths per year. This is simply unacceptable. That’s why reducing the level of antipsychotics prescribing for people with dementia by two-thirds is one the key priorities in the National Dementia Strategy.”

The Dementia Action Alliance – which includes the Alzheimer’s Society, Age UK and the Department of Health – has called for all prescriptions for antipsychotics to be reviewed by the end of March 2012.

Dr Chris Fox, who researches dementia at the University of East Anglia, said: “This study provides an interesting insight into the differential harm of these medicines. More work is needed on alternatives to these medicines in dementia with behavioural problems. In addition, there is a need to consider duration of use in more acute situations such as severe distress. Is six or 12-week use safe in people with dementia?”

Alzheimer’s Research UK’s chief executive Rebecca Wood said the risks of antipsychotics were “well-established” yet “progress has been frustratingly slow” in reducing their use.  She said the drugs “should only be used for people with dementia where there is no alternative for dealing with challenging behaviour”.

Dr Anne Corbett, research manager at Alzheimer’s Society, said: “For a minority of people with dementia antipsychotics should be used, but then only for up to 12 weeks, and under the correct circumstances. For the majority, they do far more harm than good.”

Source: BBC News UK

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Skin Cancer Drug Hopes Raised by Study

A new treatment for advanced skin cancer almost doubles survival times, according to an international study.

Doctors say 132 patients in the US and Australia who were given the drug vemurafenib gained several extra months of line. Research in the New England Journal of Medicine found those in the study lived an average of 16 months, compared with nine months on conventional treatment.

Vemurafenib (Zelboraf) has been recommended for approval in Europe. The treatment is one of two drugs for late-stage melanoma, approved on fast-track in the US last year, which offer hope for patients with advanced melanoma.

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Before that, there had been no new drugs for the cancer for more than a decade. Vemurafenib is suitable for about half of patients with advanced melanoma as it targets tumours that express a certain gene mutation.

Dr Antoni Ribas, a professor of haematology/oncology and a researcher at the Jonsson Cancer Center at the University of California-Los Angeles, said: “This study shows that Zelboraf changes the natural history of this disease. This data is beyond what I would have expected.

“We’re seeing a significant number of patients with durable responses to the drug, and that the whole group of treated patients is living longer.  These results tell us that this drug is having a very big impact, and this changes the way we treat metastatic melanoma.”

According to the European Medicines Agency, the drug has been recommended for approval in Europe, pending final authorisation by the European Commission.

Elizabeth Woolf, head of Cancer Research UK’s information website Cancer Help UK, said: “This is an interesting, impressive but relatively small trial of a promising new-generation melanoma drug, which Cancer Research UK is proud to have played a role in developing.”

But she said there were still questions that remain unanswered, not least the cost.  “Everyone on the trial had the drug, so we cannot tell how large the benefits are, compared to people who didn’t have it, or had another treatment. And because the drug targets a particular gene fault, only half of all melanoma patients are eligible. About half of those treated seem to benefit, so it could potentially help roughly a quarter of patients with advanced melanoma overall.  Looking at these uncertainties, and now that the drug is available to UK cancer patients, it will be interesting to see what price the manufacturer charges so as not to place too great a strain on already scarce NHS resources.”

Drug resistance

Cancer Research UK said once the drug was licensed in Europe, patients would be able to discuss treatment options with their doctor.

In England, patients will have to apply to the Cancer Drugs Fund, the charity said. Kate Law, director of clinical and population research at Cancer Research UK, said the treatment was one of a new generation of cancer drugs targeted at patients with a specific genetic make-up.

While it offered hope, she said, it was not a cure as the cancer eventually became resistant to the drug.

She told the BBC: “This is not a cure – you’re talking an extra six months of life. We’re getting somewhere with these targeted drugs but we have a whole raft of research still to do to address the issue of resistance.”

Source: BBC News UK

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Heart Attack Symptoms Differ in Women

Fewer women than men suffering from a heart attack appear to experience chest pain symptoms, according to a study of more than one million people in the US.

Overall men have significantly more heart attacks, but under the age of 55 women are more likely to die from one.

Without displaying the classic chest pain symptoms of a heart attack, researchers say some women may not be getting the right kind of treatment.

The study looked at patients seen at more than 1,000 hospitals.  The research found that among younger women – those aged under 55 – the differences in symptoms with men of the same age were striking.

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Overall, 42% of women did not experience chest pain compared with 30% of men. And once admitted, the study found that women were more likely to die than men from the same age group.

Some 14% of women died compared with 10% of men. The study adds to evidence that women can experience quite different symptoms to men.

Time is critical

The authors, writing in the Journal of the American Medical Association, said: “Optimal recognition and timely management of myocardial infarction (MI), especially for reducing patient delay in seeking acute medical care, is critical.

“The presence of chest pain/discomfort is the hallmark symptom of MI. Patients without chest pain/discomfort tend to present later, are treated less aggressively, and have almost twice the short-term mortality compared with those presenting with more typical symptoms of MI.”

Heart attacks among younger women are relatively rare.  In fact the average age of women admitted to hospital in the study was 74, compared with 67 for men.

Cathy Ross, senior cardiac nurse at the British Heart Foundation, said a heart attack did not necessarily mean dramatic and excruciating chest pains.

“Symptoms vary; for some the pain is severe and yet others may feel nothing more than a mild discomfort or heaviness. The most important thing to remember is if you think you’re having a heart attack, call 999. Younger women may need to heed that advice more than most because they appear to be less likely to have chest pains. Their symptoms can be overlooked by inexperienced medical staff because heart attacks in young women are rare. More research will hopefully identify why there are such variations in the way heart disease affects men and women.”

Dr Kevin F Fox, a consultant cardiologist at Imperial College Healthcare NHS Trust and speaking for the Royal College of Physicians, said that overall the number of heart attacks and associated deaths were falling, but that when young women had heart attacks the outcomes were not good.

“The paper has shown that women, and in particular younger women, under 55 years of age, often do not have the typical presenting symptom of chest pain compared to men when they have a heart attack. Although heart attack survival is improving overall, doctors, health care professionals and the public need to be aware and vigilant that women can have a heart attack without the typical chest pain that we all think of as the main symptom.”

The US researchers describe the results of their work as “provocative” and urge further study, but say that for the moment there should be no change in the public health message that chest pain and discomfort could be symptoms of a heart attack.

Source: BBC News UK

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Pancreatic Cancer: Trial Drug MRK003 Shows Promising Results

Scientists say they may have found a new weapon against pancreatic cancer after promising early trial results of an experimental drug combination.

Giving the chemotherapy agent gemcitabine with an experimental drug called MRK003 sets off a chain of events that ultimately kills cancer cells, studies in mice show. Patients are now testing the treatment to see if it will work for them.

The Cancer Research UK-funded trials are being carried out in Cambridge.  Father-of-two Richard Griffiths, 41, from Coventry, has been on the trial since being diagnosed with pancreatic cancer in May 2011.

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He said “After six cycles of treatment, a scan showed the tumours had reduced and so I have continued with the treatment. The trial gives you hope – I really feel I can do this with the science behind me.”

Aggressive cancer

Cancer Research UK says it is prioritising research into pancreatic cancer because the survival rate still remains dismally low.

About 8,000 people in the UK are diagnosed with pancreatic cancer each year, and the disease is the fifth most common cause of cancer death in the UK.

Survival rates are very low in relation to other cancers, and the length of time between diagnosis and death is typically short, usually less than six months.

The most recent data for England show that about 16% of patients survive the disease beyond 12 months after diagnosis – prompting the need for new treatments.

Professor Duncan Jodrell, who is leading the trials at the University of Cambridge, said: “We’re delighted that the results of this important research are now being evaluated in a clinical trial, to test whether this might be a new treatment approach for patients with pancreatic cancer, although it will be some time before we’re able to say how successful this will be in patients.”

In total, about 60 patients with advanced pancreatic cancer will be recruited for the first Phase I/II clinical trial.

Source: BBC News UK

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Doctors warn 210,000 people face alcohol death risk

Failure to reform alcohol laws could lead to 210,000 preventable deaths in England and Wales in the next 20 years, doctors have warned.

They are putting pressure on the government ahead of its “alcohol strategy” for both countries, expected in the coming months. Writing in The Lancet, doctors said the UK was at a “potential tipping point”.

Prime Minister David Cameron has already vowed to tackle the “scandal” of drunkenness and alcohol abuse.

The projected mortality figures comes from Prof Ian Gilmore, a former President of the Royal College of Physicians, Dr Nick Sheron, from the National Institute for Health Research and members of the British Society of Gastroenterology.

Their figure of 210,000 is a slight reduction from their previous estimate of 250,000 and represents their “worst-case scenario” of no change to alcohol policy. “It remains entirely within the power of the UK government to prevent the worst-case scenario of preventable deaths,” they wrote.

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The figures for England and Wales suggest 70,000 of the deaths could be from liver disease and the rest from accidents, violence and chronic illnesses such as high blood pressure, stroke, heart disease, breast cancer and cancer of the gastrointestinal tract.

Tipping point

They were critical of the “responsibility deal” in England, which are voluntary agreements with the drinks industry on issues such as promotions and labelling.

This was compared to the Scottish government’s approach such as a minimum price per unit of alcohol.

The group said: “We are at a potential tipping point in the UK in taking on the shameful, preventable loss of life caused by alcohol. The potential prize of reversing this tragic toll of alcohol-related deaths is there for the taking.”

The Department of Health will publish its alcohol strategy for England later this year.

Selling alcohol below cost price is to be banned in England and Wales from 6 April. However, ministers are expected to go further in the forthcoming strategy, recommending a higher minimum price for drink.

The chief executive of Alcohol Concern, Eric Appleby, said: “What we have to accept is that doing nothing is no longer a responsible option for alcohol policy, and that trying to ‘nudge’ drinking culture through information and persuasion has proved to be little better than doing nothing. We can see from the example of other countries that drinking patterns really can change, the challenge is there for the government to start the process now through the Alcohol Strategy.”

Henry Ashworth, chief executive of the Portman Group, which also represents UK drinks producers, said: “It is really important that we put this report in context.

“The vast majority of people drink responsibly. Painting doomsday scenarios won’t help reduce alcohol misuse and calling for Soviet Union style population controls cannot do anything but alienate the vast majority of people who already drink within Government guidelines.  We agree with the Prime Minister that strong partnerships are essential to tackle the minority who use alcohol recklessly and drinks producers are committed to supporting this approach.”

The public health minister, Anne Milton, said: “As the Prime Minister said earlier this week, we are determined to tackle the scandal of alcohol abuse. People that misuse alcohol endanger their own lives and those of others.

“It costs the NHS £2.7 billion per year and in our forthcoming alcohol strategy we will set out our plans on how to deal with the wide range of problems and harms it causes.”

Source: BBC News UK

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Big Meals in Memory Loss Link in Elderly

A link between memory loss and a high calorie diet has been suggested by researchers in the US.

They were investigating mild cognitive impairment (MCI), which can be an early sign of dementia.

Research, presented at a conference, claimed a high calorie diet was linked to having twice the risk of MCI, compared with a low calorie diet.  Alzheimer’s Research UK said a healthy lifestyle was known to help protect against dementia.

Mild cognitive impairment has become increasingly interesting to researchers as it may help predict who will go on to develop dementia, such as Alzheimer’s.

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A team at the Mayo Clinic in the US has investigated the effect of diet in 1,233 people aged between 70 and 89. None had dementia, but 163 were diagnosed with mild cognitive impairment.

Doubling

The patients were divided into low calorie intake (600 to 1,526 calories a day), middle (1,526 to 2,142.5) and high (2,142.5 to 6,000) and the incidence of mild cognitive impairment was compared.

The results were presented at the annual meeting of the American Academy of Neurology. They showed no difference in the low and middle groups, however, the high intake group had more than double the incidence of MCI.

Researcher Dr Yonas Geda said: “We observed a dose-response pattern which simply means; the higher the amount of calories consumed each day, the higher the risk of MCI.”

The study cannot say that a high calorie diet causes MCI, people who are cognitively impaired could end up eating more food or there could be another factor involved which increases the risk of both. It has also not yet been published in a peer-reviewed academic journal.

But Dr Geda did suggest there was potential for therapy: “Cutting calories and eating foods that make up a healthy diet may be a simpler way to prevent memory loss as we age.”

Dr Marie Janson, from Alzheimer’s Research UK, said the findings were interesting, and fitted in with “the bigger picture of a healthy lifestyle preventing Alzheimer’s in later life”.  She said it was “difficult” to work out what a mechanism linking calories and cognitive impairment would be.

But she added: “We know that age is one of the greatest risk factors for dementia, but adopting a healthy lifestyle including a balanced diet and regular exercise, is beneficial in protecting against dementia along with a number of other chronic diseases.”

Source: BBC News

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Cannabis Drivers Twice as Likely to Cause Car Crash

Drivers who use cannabis within three hours of driving are twice as likely to cause a collision as those not under the influence of drugs or alcohol, says a Canadian study.

This is because cannabis impairs brain and motor functions needed for safe driving, the researchers suggest. The study in BMJ reviewed nine studies of 50,000 people worldwide who had been in serious or fatal crashes.

Experts support the close monitoring of serious accidents involving drugs. The study analysis was carried out by researchers at Dalhousie University in Halifax, Canada.

They looked at observational studies of collisions between one or more moving vehicles on a public road which involved the consumption of cannabis.

Drivers of cars, sports utility vehicles, vans, lorries, buses and motorcycles featured in the studies.

The study found a near doubling of risk of a driver being involved in a motor vehicle collision resulting in serious injury or death if cannabis had been consumed less than three hours before.

However, it added that the impact of acute cannabis consumption on the risk of minor crashes was still unclear.

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Blood sample

Mark Asbridge, study author and associate professor at the department of community health and epidemiology at Dalhousie University, said the research was important.

“Our findings provide clarity to the large body of research on cannabis and collision risk. They also offer support to existing policies, in many jurisdictions, that restrict driving under the influence of cannabis, and direct public health officials to devote greater attention to this issue.”

All studies tested for tetrahydrocannabinol, or THC, the active chemical in cannabis, by analysing blood samples or using direct reports of cannabis use from those involved.

Most studies used one nanogram per millilitre of cannabis or any amount greater than zero as the cut-off for a positive test result, with one study using a 2ng/ml cut-off.

Duncan Vernon, a road safety manager at the Royal Society for the Prevention of Accidents (RoSPA), said that previous studies in controlled lab conditions had shown that cannabis can impair a driver’s ability to respond to potential dangers.

“This new research strengthens the evidence that driving under the influence of cannabis increases the likelihood of being seriously injured or killed in a collision. This adds to the argument that a system needs to be put in place to monitor the number of serious and fatal accidents where impairment from illegal drugs was a contributory factor, so that appropriate action can be taken to prevent them.”

Positive test

The Canadian study cites a roadside survey of 537 drivers in Scotland in 2000 which found that 15% of respondents aged 17-39 years admitted to having consumed cannabis within 12 hours of driving a vehicle.

The European Monitoring Centre for Drugs and Drug Addiction found, in 2008, that between 0.3% and 7.4% of drivers tested positive for cannabis from roadside surveys in the United Kingdom, Denmark, the Netherlands, Norway, the United States, and Australia.

The researchers conclude that despite the increased risk posed by cannabis to car drivers, alcohol remains the substance most often present in crashes.

The observed association between alcohol and crash risk is more significant than that for cannabis, the study says.

Source: BBC News UK

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