Folks,
This month’s Am J of Geriatrics has some reviews of mentally stimulating work and dementia risk. One of the reasons the more educated are at lower risk for dementia, it has been hypothesized, is that higher education leads to more complex jobs. This month’s journal details the hypothesis some more and suggest occupations that “carrying out prescribed actions” reduces the dementia risk less than occupations “prescribing alternative actions.” If this concept turns out to be true, that would explain why mental health clinicians are often still sharp in their 80s, some in their 90s, as every pt is different.
Our pts may have seen the media play from last Thursday’s NEMJ article that demonstrated little difference between various diets, some high carbohydrate, some high protein, some high fat, implying calories are the key, not the nutrients. Not emphasized by the media is that all the food choices were regarded as healthy, e.g., even the high-fat diet avoided saturated fats, so our pts should keep that in mind. Also, at least moderate exercise was expected. The weight loss was very modest leading some to conclude that treatment of obesity is primarily a behavioral issue, not a diet issue [reminds us of the discussions we had with Spitzer in the 1980s as to whether to include obesity in DSM-IIIR]. Most importantly for us is that highly functioning, well-motivated people will only achieve a 3-4 kg lost after 2 to 4 years. Are we kidding ourselves when we give diet instructions to our poorly functioning, not-motivated pts?
The editorial in the NEJM mentioned a study in two small towns in France in which total-community approach involving the whole town’s focusing on the health of schoolchildren led to less obesity among the children than found in similar nearby towns.
Healthy diet and exercise also got publicity last week as preventive in cancers, ranging from preventing 70% of eudiometrical cancers to 11% of prostate cancers.
Astra-Zeneca will strengthen its warning to us as to risk of increased blood-glucose levels with Seroquel. The company is under attack for hiding the results of a study in which Seroquel caused more of this problem than did Haldol.
Last Wednesday, DC and eleven states files a suit claiming Forrest Labs had marketed to us physicians Celexa and Lexapro use in children -- which would be off-label, and thus illegal.
I want to thank those of you who supported me in the campaign for APA President-elect an d thank those who sent kind messages when they heard I came in second. I have now lost more APA national elections than anyone, and there is a plus to these periodic losses: No one else has had as long a run as a voting member of APA’s governance -- and has contributed to our being a part of legislation that has become APA policy more than anyone in recent decades. It is now time to think about what legislation [“Action Papers”] you would like to see in the coming year. So, if you have some thoughts about positions that you would like to see the APA take, please let me know.
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