Psychedelic drugs could help treat PTSD

Clinical trials suggest treatment that involves psychedelics can be more effective than psychotherapy alone. More than three million people in the United States are diagnosed each year with post-traumatic stress disorder, whose symptoms include nightmares or unwanted memories of trauma, heightened reactions, anxieties, and depression—and can last months, or even years.

People with PTSD—difficulty recovering from experiencing or witnessing a traumatic event—have traditionally been treated with a combination of trauma-focused psychotherapy and a regimen of medications. Many sufferers have not responded well to that treatment, but new research to be presented by the Medical University of South Carolina's Dr. Michael Mithoefer and colleagues, at the annual meeting of the American College of Neuropsychopharmacology, suggests that the combination of some psychedelic drugs and traditional psychotherapy holds promise.

Psychedelic substances are often found in nature and have been used in various cultures over thousands of years. Formal medical research into their medicinal uses starting in the 1950s produced promising results published in major journals but was largely halted in the 1970s for political rather than medical or scientific reasons. More recent studies argue that, when administered in a controlled clinical setting, MDMA (more commonly known as ecstasy) and psilocybin (the active ingredient in "magic mushrooms") have acceptable risk profiles —and patients who experienced temporary adverse reactions did not require additional medical intervention.

In the past few years the FDA has granted both MDMA and psilocybin Breakthrough Therapy Designations for PTSD and depression respectively, acknowledging they may improve upon existing therapies, and agreeing to expedite their development and review.

The research by Dr. Mithoefer and his team includes six Phase 2 clinical trials conducted by independent investigators in four countries. In the trials, one group of patients was administered MDMA during their psychotherapy sessions, while the other group was administered a placebo or low dose comparator in conjunction with the same psychotherapy. The overall conclusion from these studies was that MDMA-assisted psychotherapy was significantly more effective at treating patients with persistent PTSD than unassisted psychotherapy.

The researchers aim to both review the successes that have been seen in the use of psychedelic drugs to treat trauma-related disorders and depression, as well as address several of the outstanding questions the medical community may still have concerning the safety, efficacy, and neurobiological functions of these novel treatment options.

Knee replacement timing is all wrong for most patients

The timing of knee replacement surgery is critical to optimize its benefit. But 90% of patients with knee osteoarthritis who would potentially benefit from knee replacement are waiting too long to have it and getting less benefit. In addition, about 25% of patients who don't need it are having it prematurely when the benefit is minimal, reports a new Northwestern Medicine study.

This is believed to be the first study to prospectively examine the timeliness of knee replacement among a large number of patients with knee osteoarthritis who could benefit from the surgery. Few prior studies have quantified timeliness of surgery but only among patients who already had knee replacement, and these studies generally were in smaller cohorts of patients.

"People are waiting and waiting to have the procedure and losing the most benefit," said lead investigator Hassan Ghomrawi, associate professor of surgery at Northwestern University Feinberg School of Medicine.

African-Americans delayed knee replacement surgery more than Caucasians, the study found.

"When people wait too long, two things happen," Ghomrawi said. "The osteoarthritis causes deterioration of their function. Some of them wouldn't be able to straighten out their legs, affecting their walking and mobility. When you can't get exercise, you can start to develop other health problems such as cardiovascular problems. You may also become depressed. The overall impact can be huge."

Decision aids may not reduce odds of hip, knee arthroplasty

Vanessa B. Hurley, Ph.D., from Georgetown University School of Nursing and Health Studies in Washington, D.C., and colleagues analyzed data for 2012 to 2015 for patients within the 10 High Value Healthcare Collaborative member systems who were exposed to condition-specific decision aids within the context of consultations for hip and knee osteoarthritis. The aids, which included paper, video, and web-based tools, are intended to support shared decision-making.

 The researchers found that patients exposed to decision aids had increased odds of undergoing hip surgery and knee surgery compared with unexposed patients (odds ratios, 2.59 and 1.77, respectively, for undergoing arthroplasty six months after a consultation relative to the control group in optimal propensity score-matched models). Patient characteristics associated with the likelihood of knee arthroplasty included diabetes (odds ratio, 0.84) and depression (odds ratio, 1.54). Compared with non-Hispanic/Latino white patients, black/African-American and Hispanic Latino patients had reduced odds of knee arthroplasty (odds ratios, 0.48 and 0.60, respectively) and hip arthroplasty (odds ratios, 0.40 and 0.26, respectively).

"Health care systems that adopt decision aids developed for use in shared decision making and used in conjunction with hip and knee osteoarthritis consultations should not expect reduced surgical utilization," the authors write.

What to know about wrist tendonitis

Tendons are thick, fibrous cords that connect muscles to bones.
Tendonitis can occur as a result of an injury or repetitive motion that causes the tendon to rub against other bodily tissues, such as bone.
A person's wrist contains many tendons. Together, they allow movement of the wrist, hand, and fingers. Tendonitis can develop in any of the tendons in the wrist as a result of injury or overuse.
Keep reading for more information on the symptoms and causes of wrist tendonitis and the treatment options available.

Symptoms

The most common symptom of wrist tendonitis is pain. The pain may be dull, and it may worsen with movement of the wrist.
Other potential symptoms of wrist tendonitis include:

• warmth and redness
• swelling and inflammation, which can reduce the mobility of the wrist and make repetitive activities, such as texting or typing, more difficult
• a grinding sensation or creaking noise when moving the wrist
• weakness in the wrist

• Causes

  The most common causes of wrist tendonitis are repetitive movement and overuse, for example, due to:
• typing and using a computer mouse
• playing video games
• texting
• writing with a pen and paper
• performing repetitive physical tasks, such as hammering or chopping wood
• playing sports that require the use of the wrists

The following factors may also cause or contribute to wrist tendonitis:

• age
• poor posture in the wrists
• poorly aligned joints
• an acute injury from a fall or other impact
• diabetes

• Prevention

  The following tips can help people prevent wrist tendonitis:
• avoiding repetitive activities that can cause or contribute to wrist tendonitis, where possible
• taking regular breaks during repetitive activities that involve the wrists
• wearing supporting braces when doing a repetitive task, such as typing, or other activities that may put a strain on the wrists
• performing exercises to stretch the wrists

Anguished, armed and impulsive: A deadly mix fuels rising teen suicides

Roughly twice a week in Florida, a child or teenager takes their life. Nearly half of the time they use guns, most often belonging to a family member.

Such heartbreaking decisions by troubled young people have fueled a 50% increase in youth suicides in Florida during the last decade.

Yet guns are barely mentioned in youth suicide-prevention efforts by state and local authorities.

Florida's current suicide prevention plan, used to guide state and local agencies tasked with reducing suicides, doesn't include the word gun and uses the word firearm just once.

The risk of guns in the homes of mentally troubled young people wasn't mentioned at forums across South Florida this spring—even though the forums were called in response to the deaths of two Parkland teens who used household guns to take their lives within six days of each other.

It's time for that to change, many experts in suicide prevention say. As the rate of suicides among young people trends upward, a spotlight has been focused on the youth mental health crisis. But because of the staggering—and preventable—role that guns play in suicides, experts say the taboo subject of access to firearms must now become a key part of the discussion.

Dr. Scott Poland, a psychology professor and co-director of the Suicide and Violence Prevention Office at Nova Southeastern University in Fort Lauderdale, says it's time for parents and mental health professionals to be more direct with depressed teens about whether they have plans to use guns for self-harm.

"It's frustrating that the state doesn't make parent education around this risk one of its initiatives," Poland said. "This is not about confiscating guns. It is about helping parents understand the potential danger in their own homes."

With their unforgiving effectiveness, guns play an outsize role in all suicides. But they are especially dangerous in the hands of teenagers with undeveloped impulse control and a rising tide of mental health issues.

Depression, anxiety may hinder healing in young patients with hip pain

New research suggests that physicians evaluating young patients with hip pain should consider more than such patients' physical health. They also should consider screening those patients for clinical depression and anxiety—impairments that researchers at Washington University School of Medicine in St. Louis have found can have a negative impact on outcomes following hip surgery, such as pain, slower recoveries and inadequate return to activity.

The findings are published online Dec. 12 in the American Journal of Sports Medicine.

In one of the first large studies to focus on mental health effects associated with hip pain, the researchers analyzed data gathered in 12 smaller studies conducted since 2014. The results suggest it may be advisable to start screening young patients with hip pain for depression and anxiety, especially before they undergo arthroscopic hip procedures.

"In a perfect world, we would screen patients for anxiety and depression before surgery and offer treatment, if needed," said first author Abby L. Cheng, MD, an assistant professor of orthopedic surgery. "But that's not usually what happens with these patients right now. Plus, many patients think that if their pain goes away, their anxiety or depression will go away, too. But that doesn't seem to be the case."

Cheng, a physiatrist trained in physical medicine and rehabilitation, works with patients who have hip pain, but she does not perform hip surgery herself. She analyzed data from more than 5,600 hip surgery patients, ages 29 to 41.

All of the studies in the analysis included evaluations of the effects of depression or anxiety on postsurgical clinical outcomes, such as use of pain-killing drugs after an operation, return to pre-surgery activities, and overall patient satisfaction following surgery. In every study, patients with anxiety and depression prior to surgery were statistically less likely to have good outcomes after their operations.

All of the patients had undergone arthroscopic surgery to correct hip problems, the most common of which was femoroacetabular impingement, a condition in which the hip socket is too deep, causing the thigh bone to rub against the socket. The condition can be painful and can significantly increase arthritis risk and the need for eventual hip-replacement surgery. Cheng said patients with these hip problems also often have unexpectedly high rates of depression and anxiety.

Obesity, smoking do not impact long-term healing of wrist fractures

Excellent clinical and radiographic outcomes can be achieved with surgery for displaced wrist fractures in patients who are obese and in those who smoke, according to a study published in the December issue of the Journal of Hand Surgery.

Matthew J. Hall, M.D., from Beth Israel Deaconess Medical Center in Boston, and colleagues compared functional and radiographic outcomes among patients with and without obesity and by smoking status. All patients were surgically treated for a distal radius fracture between 2006 and 2017 at two level 1 trauma centers. Analysis included 200 patients (39 with body mass index [BMI] ≥30 kg/m² and 161 with BMI <30 kg/m²; 148 never smokers, 32 former smokers, and 20 current smokers).

The researchers found that while obese patients had more comorbidities, fracture types were similar between the BMI groups. Acceptable Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores were achieved by both BMI groups at three-month and one-year follow-up. Additionally, the two groups were similar regarding motion, Radiographic Union Scoring System score, and alignment. Smokers had higher QuickDASH scores and a lower percentage of radiographically healed fractures (40 percent versus 69 to 82 percent) at three months. At final follow-up, differences in QuickDASH were small and range of motion, fracture healing, and complication rates were similar between the three smoking groups.

"Our results show that treatment for distal radius fractures in obese and smoking patients is safe, and these patients may be treated like the general population with similar long-term results," a coauthor said in a statement.