Nail-biting may be classified as type of obsessive compulsive disorder

Nail-biting is OCD behaviour

The American Psychiatric Assiociation will classify nail-biting as a type of obessive compulsive disorder. Picture: Thinkstock
Source: Supplied





NAIL-BITING may be classified as a type of obsessive compulsive disorder (OCD) in the upcoming edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).


Other “pathological grooming” habits such as hair-pulling and skin-picking – collectively known as trichotillomania – will also be included in the OCD classification.

The DSM-V, published by the American Psychiatric Association, is known as the “Bible of psychiatrists”.

It is used by international clinicians, researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical companies and policy makers.

According to Wikipedia, obsessive compulsive disorder is characterised by intrusive thoughts that produce repetitive behaviors aimed at reducing anxiety.

Symptoms can include excessive cleaning, repeated checking, hoarding and nervous rituals such as opening and closing a door several times before entering or leaving a room.

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Sydney forensic psychiatrist Dr Robert Kaplan has written several papers on the subject, identifying seemingly harmless habits such as hair-pulling, face picking and nail-biting as signs of psychiatric disorder.

“(Trichotillomania) is a very interesting phenomenon,” he said. “You see it in children of primary school age and you also see it in adult men and women.

“If you talk to sufferers you find that they are very stressed and embarrassed about it.”

Dr Kaplan said trichotillomania affected between eight per cent to 14 per cent of women and slightly fewer men.

The proposed classification of nail-biting and other forms of “pathological grooming” does not mean that all finger-munchers will be diagnosed with OCD.

“As with hair pulling and skin picking, nail biting isn’t a disorder unless it is impairing, distressing and meets a certain clinical level of severity,” Dr. Carol Mathews, a psychiatrist at the University of California, San Francisco, told US website Women’s Health.

Most people who bite their nails don’t fit in this category, which is only comprised by “a very small minority of people,” she said.

Depression and Entrepreneurs

Brad Feld

Amy and I wrote a meaningful amount about entrepreneurs and depression in Startup Life. Since we finished the final draft a few weeks ago, I’ve given several talks where depression came up as I’ve woven my own experience with depression into the short (less than 15 minute) version of my story. I’ve received a surprising (to me) number of emails from people thanking me talking about it publicly, along with my discussion of the anxiety disorder (obsessive compulsive disorder) that I’ve struggled with my entire adult life and that was severe during the serious depressive episode I had in my early to mid 20s.

So the idea of depression has been on my mind. It doesn’t surprise me that I feel down and flat as I sit here in the Charlotte, North Carolina airport on my way to Lexington, Kentucky on day 16 of a 19 day trip. I’m tired, strung out, missing home, missing Amy, and running out of extrovert energy. I’ve had a great time with all the people I’ve been with and the events I’ve had around Startup Communities. I’ve had several extraordinary experiences like dinner last night in Toronto with a dozen fantastic entrepreneurs who I hope to have continuous involvement – as a friend and potential investor – in the future. But as I sit here, I’m surrounded by a lot of grey, and it’s not just the clouds outside that are the remnants of the storm.

I’ve reached out to most of my friends in New York to check in on them. They are all doing fine even though a few were hit hard and are now effectively homeless as lower Manhattan gets cleaned up. I picked a spot in the airport far away from the TV – I couldn’t stand the endless news cycle that mixed Sandy with Romney with Obama. I had some extra carbs hoping that would help – it just made me feel sleepy. Yup – I know what this feeling is.

I know many entrepreneurs who deal with different levels of depression. My close friend Jerry Colonna is extraordinarly eloquent about this and how it impacts entrepreneurs. Ben Huh, the CEO of Cheezburger, wrote a powerful post about his struggle with depression titled When Death Feels Like A Good Option. And I’ve had many conversations with other entrepreneurs about my, and their, struggle with depression.

For some reason we’ve embraced failure as an entrepreneurial trait that is ok, but we still struggle with acknowledging and talking about depression. Entrepreneurs function with a wide range of stresses and emotions that often have overwhelming intensity. In many cases, we are afraid of admitting depression, and are often highly functional when we are depressed. But that doesn’t deny the fact that entrepreneurs get depressed. To deny this, is to deny reality, and that’s against my value system.

I just went back and read what we wrote in Startup Life about depression and it made me smile. I’m really proud of the work that Amy and I did on that book – I think it is the best book I’ve been involved in writing (Venture Deals, which I wrote with Jason Mendelson, is a close second) and I’m hopeful that it has a lot of impact and value for entrepreneurs and their partners.

Just writing all of this makes me feel better. Thanks for listening. Time to get on the plane and go to Lexington.


Read more posts on Feld Thoughts »

Psychosis Symptoms Tied to Higher Suicide Risk in Adolescents

Symptoms of psychosis were associated with greatly increased risk for suicidal behavior in the general adolescent population as well as in adolescents who have nonpsychotic disorders, such as depression, attention-deficit/hyperactivity disorder, anxiety disorders, or obsessive compulsive disorder, according to two separate epidemiologic studies reported online Oct. 29 in the Archives of General Psychiatry.

Among adolescents in the general population, as well as the subgroup of adolescents who had nonpsychotic DSM-III diagnoses, those who reported suicidal ideation, suicide planning, or suicidal acts were 10 times more likely than those who did not to affirm on direct questioning that they had experienced psychotic symptoms – mainly auditory hallucinations, said Ian Kelleher, Ph.D., of the department of psychiatry, Royal College of Surgeons in Ireland, Dublin, and his associates.

“The immediate clinical relevance of these findings is that all patients presenting at risk for suicidal behavior should receive a thorough assessment of psychotic symptoms and not just a screening to rule out psychotic disorder,” they noted.

Both primary care physicians and psychiatric clinicians must recognize that psychotic symptoms in a nonpsychotic patient signify a high suicide risk. “Research has shown that the largest increase in suicide risk in the general population occurs after there has already been contact with mental health services and that approximately half of patients who complete suicide [had] contact with primary care providers in the month preceding their death[s],” the investigators added.

Hallucinations and delusions, the classic symptoms of psychosis, are far more prevalent in the general population than are diagnosable psychotic disorders. They are “especially common in young people, with a meta-analysis of general population studies demonstrating a median prevalence of 17% in children aged 9-12 years and 7.5% in adolescents aged 13-17 years,” the researchers wrote.

And psychosis is known to raise the risk of suicide dramatically. Yet no studies to date have examined the relationship between psychotic symptoms and suicidal behaviors among adolescents. Dr. Kelleher and his colleagues did so using data from two independent cross-sectional epidemiologic studies of the general Irish population.

The Adolescent Brain Development (ABD) study assessed the prevalence of psychotic symptoms among 1,131 students aged 11-13 years in 16 mainstream schools, representing more than half of the total school population in that age group. The Challenging Times (CT) study assessed the prevalence of psychiatric disorders among 743 students aged 13-15 years in eight mainstream schools.

For this study, Dr. Kelleher and his associates analyzed the results of in-depth diagnostic interviews for 212 subjects from the ABD study and 211 from the CT study, as well as the interview responses of their parents.

Overall, 22% of the ABD sample and 7% of the CT sample reported experiencing psychotic symptoms when they were specifically asked about them, almost all of them during the preceding year. “From our clinical experience, young people will rarely volunteer information on psychotic symptoms unless questioned directly about such experiences. Adolescents are usually willing to talk openly about their experiences, however, in response to direct but sensitive questioning.”

Examples of such questions included: “Sometimes people when they are alone hear things or see things, and they’re not quite sure where they came from. Does that ever happen to you?” and “Was there ever a time when you thought that your imagination was playing tricks on you?”

In the two cohorts combined, 44 subjects reported suicidal ideation, 16 reported making specific suicidal plans, and 8 reported suicidal acts.

Antidepressants Market to 2018 – Despite Safety Concerns, Selective Serotonin …

/PRNewswire/ — Reportlinker.com announces that a new market research report is available in its catalogue: Antidepressants Market to 2018 – Despite Safety Concerns, Selective Serotonin Re-uptake Inhibitors (SSRIs) Continue to Dominate in the Absence of Effective Therapeutic Alternatives http://www.reportlinker.com/p01020574/Antidepressants-Market-to-2018—Despite-Safety-Concerns-Selective-Serotonin-Re-uptake-Inhibitors-SSRIs-Continue-to-Dominate-in-the-Absence-of-Effective-Therapeutic-Alternatives.html#utm_source=prnewswireutm_medium=prutm_campaign=Drug_and_Medication Antidepressants Market to 2018 – Despite Safety Concerns, Selective Serotonin Re-uptake Inhibitors (SSRIs) Continue to Dominate in the Absence of Effective Therapeutic Alternatives Summary GBI Research, the leading business intelligence provider, has released its latest research, “Antidepressants Market to 2018 – Despite Safety Concerns, Selective Serotonin Re-uptake Inhibitors (SSRIs) Continue to Dominate in the Absence of Effective Therapeutic Alternatives”, which provides insights into the antidepressants market until 2018. The report is built using data sourced from our proprietary databases and primary and secondary research, in addition to analysis from our in-house specialized team of experts. The report provides an in-depth analysis of the major antidepressants therapies, including SSRIs, Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) and Tricyclic Antidepressants (TCAs), covering Major Depressive Disorder (MDD), Obsessive-Compulsive Disorder (OCD), Generalized Anxiety Disorder (GAD) and Panic Disorder (PD). The report provides the sales for the global antidepressant market in addition to the individual indication markets. It also examines the global antidepressant market treatment usage patterns, in addition to the geographical distribution of antidepressants across the US, the top five countries of Europe, and Japan. The report also includes insights into the antidepressants RD product pipeline and explores the competitive landscape, including major players in the antidepressants market. Finally, the report also includes analysis on the Mergers and Acquisitions (MAs) and licensing agreements that took place in antidepressant market. GBI Research analysis shows that the overall global antidepressant market for the four indications, (MDD, OCD, GAD and PD) was valued at $11.9 billion in 2011, growing from $10.5 billion in 2004 and indicating a Compounded Annual Growth Rate (CAGR) of 1.7%. The market is forecast to reach revenues of approximately $13.4 billion by 2018 for the above mentioned four major indications, increasing at a CAGR of 1.8%. Overall the number of prescriptions for antidepressant has risen, but this has been offset by a number of patent expiries and high generic entry. Drugs currently in development have taken on a new multi-targeted approach, combining targets known to be beneficial for the treatment of MDD, OCD, GAD and PD. The future of the antidepressant market is reliant on the positive safety profiles of drugs in the pipeline, with no disease-modifying therapies expected to enter the market in the near future. Scope – The report analyzes the treatment usage patterns, market characterization, pipeline analysis, competitive landscape and key MA trends in the global antidepressant market for MDD, OCD, GAD and PD. – Data and analysis on the antidepressant market in the leading geographies of the world – the US, the UK, Germany, France, Italy, Spain, and Japan. – Annualized market data for the antidepressant market from 2004 to 2011, with forecasts to 2018. – Market data on the geographical landscape and therapeutic landscape, including market size, market share, annual cost of therapy, sales volume and treatment usage patterns (diseased population, diagnosis population and prescription population). – Key drivers and restraints that have had a significant impact on the market. – The competitive landscape of the global antidepressant market including top company benchmarking. The key companies studied in this report are Eli Lilly, Bristol-Myers Squibb, GlaxoSmithKline, Forest laboratories and Lundbeck. – Key MA activities and licensing agreements that took place between 2009 and 2012 in the antidepressants therapeutics market. Reasons to buy – Align their product portfolio to markets with high growth potential. – Build effective strategies to launch their pipeline products by identifying potential geographies. – Exploit in-licensing and out-licensing opportunities by identifying products that might fill their portfolio gaps. – Develop key strategic initiatives by studying the key strategies of top competitors. – Device a more tailored country strategy through the understanding of key drivers and barriers and the market potential of each indication. – Develop market entry and market expansion strategies by identifying the geographic markets poised for strong growth. – Reinforce RD pipelines by identifying new target mechanisms which can produce first-in-class molecules which are safer and more efficacious. 1 Table of Contents 1 Table of Contents 6 1.1 List of Tables 9 1.2 List of Figures 10 2 Antidepressants Market to 2018 – Introduction 12 3 Market Overview 13 3.1 Introduction 13 3.2 Classification of Antidepressants 14 3.2.1 Selective Serotonin Reuptake Inhibitors 15 3.2.2 Serotonin-Norepinephrine Reuptake Inhibitors 15 3.2.3 Noradrenergic and Specific Serotonergic Antidepressants 15 3.2.4 Norepinephrine Reuptake Inhibitors 16 3.2.5 Norepinephrine-Dopamine Reuptake Inhibitors 16 3.2.6 Norepinephrine-Dopamine Disinhibitors 16 3.2.7 Serotonin Antagonist and Reuptake Inhibitors 16 3.2.8 Tricyclic Antidepressants 16 3.2.9 Tetracyclic Antidepressants 17 3.2.10 Monoamine Oxidase Inhibitors 17 3.2.11 Others 18 3.3 Adverse Effects 18 3.4 Major Marketed Products in the Antidepressants Therapy Area 18 3.5 Future Developments 20 3.6 Revenue 21 3.7 Annual Cost of Therapy 23 3.8 Treatment Usage Patterns 24 3.8.1 Diseased Population 25 3.8.2 Diagnosed Population 25 3.8.3 Prescription Population 25 3.9 Drivers and Restraints of the Antidepressants Market 26 3.9.1 Drivers 26 3.9.2 Restraints 27 4 Therapeutic Landscape 28 4.1 Antidepressants Market for Major Depressive Disorder 28 4.1.1 Introduction 28 4.1.2 Revenue and Forecasts 30 4.1.3 Annual Cost of Therapy 31 4.1.4 Treatment Usage Patterns 32 4.1.5 Geographical Segmentation 33 4.2 Drivers and Restraints for the Antidepressants Market for Major Depressive Disorder 35 4.2.1 Drivers 35 4.2.2 Restraints 35 4.3 Antidepressants Market for Obsessive-Compulsive Disorder 37 4.3.1 Introduction 37 4.3.2 Revenue and Forecasts 39 4.3.3 Annual Cost of Therapy 40 4.3.4 Treatment Usage Patterns 41 4.3.5 Geographical Segmentation 42 4.4 Drivers and Restraints for the Antidepressants Market for Obsessive-Compulsive Disorder 44 4.4.1 Drivers 44 4.4.2 Restraints 44 4.5 Antidepressants Market for Generalized Anxiety Disorder 45 4.5.1 Introduction 45 4.5.2 Revenue and Forecasts 46 4.5.3 Annual Cost of Therapy 48 4.5.4 Treatment Usage Patterns 49 4.5.5 Geographical Segmentation 51 4.6 Drivers and Restraints for the Antidepressants Market for Generalized Anxiety Disorder 54 4.6.1 Drivers 54 4.6.2 Restraints 54 4.7 Antidepressants Market for Panic Disorder 55 4.7.1 Introduction 55 4.7.2 Revenue and Forecasts 58 4.7.3 Annual Cost of Therapy 59 4.7.4 Treatment Usage Patterns 60 4.7.5 Geographical Segmentation 62 4.8 Drivers and Restraints for the Antidepressants Market for Panic Disorder 64 4.8.1 Drivers 64 4.8.2 Restraints 64 5 Geographical Landscape 66 5.1 The US 67 5.1.1 Revenue and Forecasts 67 5.1.2 Annual Cost of Therapy 69 5.1.3 Treatment Usage Patterns 70 5.2 EU5 72 5.2.1 Revenue and Forecasts 72 5.2.2 Annual Cost of Therapy 73 5.2.3 Treatment Usage Patterns 74 5.3 Japan 75 5.3.1 Revenue and Forecasts 75 5.3.2 Annual Cost of Therapy 76 5.3.3 Treatment Usage Patterns 77 6 Pipeline Analysis 79 6.1 Introduction 79 6.2 Summary of the Current Antidepressants RD Pipeline 79 6.3 Profiles of Key Late-Stage Drugs in the Antidepressants Market 82 6.3.1 Vortioxetine (Lu AA21004) 82 6.3.2 F-2695 (levomilnacipran) 83 6.3.3 LY-2216684 (edivoxetine) 84 6.3.4 OPC-34712 84 6.3.5 EB-1010/Amitifadine 85 6.3.6 PNB01 86 7 Competitive Landscape 87 7.1 Competitive Profiling 87 7.1.1 H. Lundbeck 87 7.1.2 AstraZeneca 88 7.1.3 Eli Lilly and Company 89 7.1.4 Forest Laboratories 90 7.1.5 Pfizer Inc. 92 7.1.6 GlaxoSmithKline 93 7.1.7 Bristol-Myers Squibb Company 94 8 Strategic Consolidations 96 8.1 Merger and Acquisition Deals 96 8.1.1 Paladin Labs Completes Acquisition of Labopharm 96 8.1.2 High River Acquires 6.5% Stake in Forest Laboratories 96 8.1.3 Forest Laboratories Completes Acquisition of Clinical Data 96 8.1.4 Azur Pharma Completes Merger with Jazz Pharmaceuticals in All Stock Transaction 97 8.1.5 Nuvo Research Acquires ZARS Pharma 97 8.1.6 Sun Pharmaceutical Acquires Remaining 24% Stake of Caraco Pharmaceutical 98 8.2 Licensing Agreements 98 8.2.1 Labopharm Enters into Licensing Agreement with Angelini Group for OLEPTRO 98 8.2.2 Omeros Expands Licensing Agreement with Daiichi Sankyo 98 8.2.3 Jazz Pharmaceuticals Enters into Sub-Licensing Agreement with Anchen 98 8.2.4 AstraZeneca Enters into Collaboration and Licensing Agreement with Targacept 99 8.2.5 Indevus Pharmaceuticals Enters into Licensing Agreement with Teva Pharmaceutical 99 8.2.6 Impax Laboratories Enters into Licensing Agreement with Wyeth 99 8.2.7 Mylan Enters into Licensing Agreement with GlaxoSmithKline 99 8.2.8 Tikvah Therapeutics Signs Licensing Agreement with Therapade Technologies 99 8.2.9 GlaxoSmithKline Signs an Agreement with Fabre-Kramer Pharmaceuticals 100 8.2.10 Jazz Pharmaceuticals Enters into Licensing Agreement with Solvay 100 8.2.11 Targacept Enters into Licensing Agreement with Yale University 100 8.3 Co-Development Deals 100 8.3.1 Lundbeck Enters into Co-Development Agreement with Otsuka Pharmaceutical 100 8.3.2 Eli Lilly Terminates Co-Development Agreement with Boehringer Ingelheim 101 8.3.3 Lundbeck Enters into Co-Development Agreement with Takeda 101 9 Appendix 102 9.1 Market Definitions 102 9.2 Abbreviations 102 9.3 Sources 104 9.4 Research Methodology 105 9.4.1 Coverage 105 9.4.2 Secondary Research 105 9.4.3 Primary Research 106 9.5 Therapeutic Landscape 107 9.5.1 Epidemiology-based Forecasting 107 9.5.2 Market Size by Geography 109 9.6 Geographical Landscape 110 9.7 Pipeline Analysis 110 9.8 Competitive Landscape 110 9.8.1 Expert Panel Validation 110 9.9 Contact Us 110 9.10 Disclaimer 110 1.1 List of Tables Table 1: Global Antidepressants Market, Marketed Products, 2012 19 Table 2: Antidepressants Market, Global, Revenue ($bn), 2004–2011 21 Table 3: Antidepressants Market, Global, Revenue Forecast ($bn), 2011–2018 22 Table 4: Antidepressants Market, Global, Annual Cost of Therapy ($), 2004–2011 23 Table 5: Antidepressants Market, Global, Annual Cost of Therapy ($), 2011–2018 23 Table 6: Antidepressants Market, Global, Treatment Usage Patterns (millions), 2004–2011 24 Table 7: Antidepressants Market, Global, Treatment Usage Patterns (millions), 2011–2018 24 Table 8: Antidepressants Market, MDD, Global, Revenue ($bn), 2004–2011 30 Table 9: Antidepressants Market, MDD, Global, Revenue Forecast ($bn), 2011–2018 30 Table 10: Antidepressants Market, MDD, Global, Annual Cost of Therapy ($), 2004–2011 31 Table 11: Antidepressants Market, MDD, Global, Annual Cost of Therapy ($), 2011–2018 31 Table 12: Antidepressants Market, MDD, Global, Treatment Usage Patterns (millions), 2004–2011 32 Table 13: Antidepressants Market, MDD, Global, Treatment Usage Patterns (millions), 2011–2018 32 Table 14: Antidepressants Market, MDD, Global, Market Segmentation by Geography ($bn), 2004–2011 34 Table 15: Antidepressants Market, MDD, Global, Market Segmentation by Geography ($bn), 2011–2018 34 Table 16: Common Obsessions and Compulsions in Obsessive-Compulsive Disorder 38 Table 17: Antidepressants Market, Obsessive-Compulsive Disorder, Global, Revenue ($bn), 2004–2011 39 Table 18: Antidepressants Market, Obsessive-Compulsive Disorder, Global, Revenue Forecast ($bn), 2011–2018 39 Table 19: Antidepressants Market, Obsessive-Compulsive Disorder, Global, Annual Cost of Therapy ($), 2004–2011 40 Table 20: Antidepressants Market, Obsessive-Compulsive Disorder, Global, Annual Cost of Therapy ($), 2011–2018 40 Table 21: Antidepressants Market, Obsessive-Compulsive Disorder, Global, Treatment Usage Patterns (millions), 2004–2011 41 Table 22: Antidepressants Market, Obsessive-Compulsive Disorder, Global, Treatment Usage Patterns (millions), 2011–2018 41 Table 23: Antidepressants Market, Obsessive-Compulsive Disorder, Global, Market Segmentation by Geography ($m), 2004–2011 43 Table 24: Antidepressants Market, Obsessive-Compulsive Disorder, Global, Market Segmentation by Geography ($m), 2011–2018 43 Table 25: Antidepressants Market, Generalized Anxiety Disorder, Global, Revenue ($bn), 2004–2011 47 Table 26: Antidepressants Market, Generalized Anxiety Disorder, Global, Revenue Forecast ($bn), 2011–2018 47 Table 27: Antidepressants Market, Generalized Anxiety Disorder, Global, Annual Cost of Therapy ($), 2004–2011 48 Table 28: Antidepressants Market, Generalized Anxiety Disorder, Global, Annual Cost of Therapy ($), 2011–2018 48 Table 29: Antidepressants Market, Generalized Anxiety Disorder, Global, Treatment Usage Patterns (millions), 2004–2011 50 Table 30: Antidepressants Market, Generalized Anxiety Disorder, Global, Treatment Usage Patterns (millions), 2011–2018 50 Table 31: Antidepressants Market, Generalized Anxiety Disorder, Global, Market Segmentation by Geography ($m), 2004–2011 53 Table 32: Antidepressants Market, Generalized Anxiety Disorder, Global, Market Segmentation by Geography ($m), 2011–2018 53 Table 33: Antidepressants Market, Panic Disorder, Global, Revenue ($m), 2004–2011 58 Table 34: Antidepressants Market, Panic Disorder, Global, Revenue ($m), 2011–2018 58 Table 35: Antidepressants Market, Panic Disorder, Global, Annual Cost of Therapy ($), 2004–2011 59 Table 36: Antidepressants Market, Panic Disorder, Global, Annual Cost of Therapy ($), 2011–2018 59 Table 37: Antidepressants Market, Panic Disorder, Global, Treatment Usage Patterns (millions), 2004–2011 60 Table 38: Antidepressants Market, Panic Disorder, Global, Treatment Usage Patterns (millions), 2011–2018 61 Table 39: Antidepressants Market, Panic Disorder, Global, Market Segmentation by Geography ($m), 2004–2011 63 Table 40: Antidepressants Market, Panic Disorder, Global, Market Segmentation by Geography ($m), 2011–2018 63 Table 41: Antidepressants Market, Global, Revenues by Geography ($bn), 2004–2011 66 Table 42: Antidepressants Market, Global, Revenues by Geography ($bn), 2011–2018 67 Table 43: Antidepressants Market, The US, Revenue ($bn), 2004–2011 68 Table 44: Antidepressants Market, The US, Revenue Forecast ($bn), 2011–2018 68 Table 45: Antidepressants Market, The US, Annual Cost of Therapy ($), 2004–2011 69 Table 46: Antidepressants Market, The US, Annual Cost of Therapy ($), 2011–2018 69 Table 47: Antidepressants Market, The US, Treatment Usage Patterns (millions), 2004–2011 70 Table 48: Antidepressants Market, The US, Treatment Usage Patterns (millions), 2011–2018 70 Table 49: Antidepressants Market, EU5, Revenue ($bn), 2004–2011 72 Table 50: Antidepressants Market, EU5, Revenue Forecast ($bn), 2011–2018 72 Table 51: Antidepressants Market, EU5, Annual Cost of Therapy ($), 2004–2011 73 Table 52: Antidepressants Market, EU5, Annual Cost of Therapy ($), 2011–2018 73 Table 53: Antidepressants Market, EU5, Treatment Usage Patterns (millions), 2004–2011 74 Table 54: Antidepressants Market, EU5, Treatment Usage Patterns (millions), 2011–2018 74 Table 55: Antidepressants Market, Japan, Revenue ($m), 2004–2011 76 Table 56: Antidepressants Market, Japan, Revenue ($m), 2011–2018 76 Table 57: Antidepressants Market, Japan, Annual Cost of Therapy ($), 2004–2011 77 Table 58: Antidepressants Market, Japan, Annual Cost of Therapy ($), 2011–2018 77 Table 59: Antidepressants Market, Japan, Treatment Usage Patterns (millions), 2004–2011 78 Table 60: Antidepressants Market, Japan, Treatment Usage Patterns (millions), 2011–2018 78 Table 61: Antidepressants Market, Pipeline, 2012 79 Table 62: Lundbeck, Antidepressant Pipeline Products, 2011 87 Table 63: AstraZeneca, Antidepressants Pipeline, 2011 89 Table 64: Eli Lilly and Company, Antidepressants Pipeline, 2011 90 Table 65: Forest Laboratories, MDD, Pipeline Products, 2011 91 1.2 List of Figures Figure 1: Antidepressants Market, Global, Revenue ($bn), 2004–2018 21 Figure 2: Antidepressants Market, Global, Annual Cost of Therapy ($), 2004–2018 23 Figure 3: Antidepressants Market, Global, Therapeutic Usage Patterns (millions), 2004–2018 24 Figure 4: Antidepressants Market, MDD, Global, Revenue ($bn), 2004–2018 30 Figure 5: Antidepressants Market, MDD, Global, Annual Cost of Therapy ($), 2004–2018 31 Figure 6: Antidepressants Market, MDD, Global, Treatment Usage Patterns (millions), 2004–2018 32 Figure 7: Antidepressants Market, MDD, Global, Market Segmentation by Geography ($bn), 2004–2018 34 Figure 8: Antidepressants Market, Obsessive-Compulsive Disorder, Global, Revenue ($bn), 2004–2018 39 Figure 9: Antidepressants Market, Obsessive-Compulsive Disorder, Global, Annual Cost of Therapy ($), 2004–2018 40 Figure 10: Antidepressants Market, Obsessive-Compulsive Disorder, Global, Treatment Usage Patterns (millions), 2004–2018 41 Figure 11: Antidepressants Market, Obsessive-Compulsive Disorder, Global, Market Segmentation by Geography ($m), 2004–2018 43 Figure 12: Antidepressants Market, Generalized Anxiety Disorder, Global, Revenue ($bn), 2004–2018 47 Figure 13: Antidepressants Market, Generalized Anxiety Disorder, Global, Annual Cost of Therapy ($), 2004–2018 48 Figure 14: Antidepressants Market, Generalized Anxiety Disorder, Global, Treatment Usage Patterns (millions), 2004–2018 50 Figure 15: Antidepressants Market, Generalized Anxiety Disorder, Global, Market Segmentation by Geography ($m), 2004–2018 52 Figure 16: Antidepressants Market, Panic Disorder, Global, Revenue ($m), 2004–2018 58 Figure 17: Antidepressants Market, Panic Disorder, Global, Annual Cost of Therapy ($), 2004–2018 59 Figure 18: Antidepressants Market, Panic Disorder, Global, Treatment Usage Patterns (millions), 2004–2018 60 Figure 19: Antidepressants Market, Panic Disorder, Global, Market Segmentation by Geography ($m), 2004–2018 63 Figure 20: Antidepressants Market, Global, Revenues by Geography ($bn), 2004–2018 66 Figure 21: Antidepressants Market, The US, Revenue ($bn), 2004–2018 68 Figure 22: Antidepressants Market, The US, Annual Cost of Therapy ($), 2004–2018 69 Figure 23: Antidepressants Market, The US, Treatment Usage Patterns (millions), 2004–2018 70 Figure 24: Antidepressants Market, EU5, Revenue ($bn), 2004–2018 72 Figure 25: Antidepressants Market, EU5, Annual Cost of Therapy ($), 2004–2018 73 Figure 26: Antidepressants Market, EU5, Treatment Usage Patterns (millions), 2004–2018 74 Figure 27: Antidepressants Market, Japan, Revenue ($m), 2004–2018 75 Figure 28: Antidepressants Market, Japan, Annual Cost of Therapy ($), 2004–2018 76 Figure 29: Antidepressants Market, Japan, Treatment Usage Patterns (millions), 2004–2018 77 Figure 30: Antidepressants Market, SWOT Analysis, Lundbeck, 2011 88 Figure 31: Antidepressants Market, SWOT Analysis, AstraZeneca, 2011 89 Figure 32: Antidepressants Market, SWOT Analysis, Eli Lilly and Company, 2011 90 Figure 33: Antidepressants Market, SWOT Analysis, Forest Laboratories, 2011 91 Figure 34: Antidepressants Market, SWOT Analysis, Pfizer Inc., 2011 93 Figure 35: Antidepressants Market, SWOT Analysis, GlaxoSmithKline, 2011 94 Figure 36: Antidepressants Market, SWOT Analysis, Bristol-Myers Squibb, 2011 95 Figure 37: GBI Research Market Forecasting Model 109 Companies mentioned H. Lundbeck AstraZeneca Eli Lilly and Company Forest Laboratories Pfizer Inc. GlaxoSmithKline Bristol-Myers Squibb Company To order this report: Drug_and_Medication Industry: Antidepressants Market to 2018 – Despite Safety Concerns, Selective Serotonin Re-uptake Inhibitors (SSRIs) Continue to Dominate in the Absence of Effective Therapeutic Alternatives __________________________ Contact Nicolas: nicolasbombourg@reportlinker.com US: (805)-652-2626 Intl: +1 805-652-2626

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Obsessive hoarding: “It’s the biggest nightmare”

By Denise Crosby
dcrosby@stmedianetwork.com

October 25, 2012 5:54PM

Dave Skeberdis sorts through some of his belongings on the front porch of his Aurora home on Wednesday, October 24, 2012. The city of Aurora has deemed the residence unsuitable for habitation after discovering it had mold spore counts twice to 15 times normal levels. | Jeff Cagle~For Sun-Times Media

Breakout

Breakout text.






Updated: October 26, 2012 2:44AM

At first, Dave Skeberdis seemed eager to put a face on the condition called compulsive hoarding.

He even described himself as “a hoarder” to the media after the city of Aurora deemed his property unfit for habitation upon discovering hundreds of birds in his garbage-filled home.

“I am obsessed,” the 57-year-old IT technician admitted, after indicating he’d cooperate with the city in its efforts to clean up his townhome on Shadybrook Lane. But after meeting with officials, he changed his mind because of the almost $14,000 bill he’d be stuck with — forcing the city on Wednesday to seek an emergency court order to clean the place up because of the health threat it posed to the community.

Skeberdis also back-pedaled on the description of himself as a hoarder, saying the term — like the number of birds in his home — had been greatly exaggerated. Instead, he said, “I just let things get out of control.”

Bill Scheibe Jr., who’s been following the Aurora headlines closely from his Joliet home, isn’t surprised at this response. The former sports columnist and editor for The Herald-News had warned his intensely proud mother that someday she’d be found dead under piles of rubbish in her Worth home — with TV cameras planted outside her door when they removed her body. But his scare tactics did little to convince the 72-year-old woman, who also had more 40 cats in her home, that she needed help.

In February, his prediction — TV cameras and screamy headlines included — came true.

Yet, “If you would have called her a hoarder, she would have spit on you,” said Scheibe, who would meet his mother in the driveway when visiting because of the conditions inside her home.

Despite the popularity of reality shows about the compulsive hoarding, experts say relatively little is known about the disorder. According to Dr. David Leader, head of Dreyer Medical Center’s Psychiatry Department, “there’s not a huge amount of literature out there,” in part “because so many hoarders hide from us” due to the shame involved.

Although it has long been considered a dimension of obsessive compulsive disorder, Leader says that attitude has begun to shift in the past couple years. Obsessive hoarding is currently being considered as a diagnosis all its own in the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), the official book of the American Psychiatric Association.

Hoarding knows no social or economic boundaries, say experts. It can start in childhood but doesn’t become severe until adulthood. It runs in families and frequently accompanies depression, social anxiety, bipolar disorder or impulse control. At its center is not so much collecting or saving things, Leader says, as it is the fear of throwing something away.

“Think about how you don’t want to throw out old checkbooks or income tax statements because you think you might need them someday,” he said, “then manifest that a hundred or a thousand times.”

Animal hoarders, Leader added, truly love the creatures they collect and don’t realize the harm they are doing. Those who struggle with OH rarely have insight into the reality of their problem, which makes them much harder to treat than OCD.

The city of Aurora deals with hoarding cases infrequently, maybe one every couple of years, said spokesman Kevin Stahr. The Property Standards Division is in charge of getting the property cleaned up for the safety and well-being of the neighborhood. In extreme cases, officials also reach out to health service experts for assistance.

Animal hoarders are treated differently from standard hoarders because there are ordinances related to the care and treatment of animals, he said. If the city comes across a case, the homeowner is referred to a mental health expert. That’s particularly important if animals are involved because there is such an emotional attachment.

“It is a balance when these situations occur for several factors,” Stahr added. “We have to work with the homeowner to see how we can assist them, check the safety of any animals in the home, and to ensure the well-being of the impacted neighborhood.”

A couple years before his mother’s death, Scheibe said the village of Worth tried to work with Margareta after neighbors complained about the garbage in her yard. But nothing ever changed, he said, and his mom even changed her will “because she thought I was the one who turned her in.”

Scheibe said he watched his mother, who grew up in impoverished post-World War II Germany, gradually develop more hoarding tendencies as he became a teen. But it wasn’t until his father suffered a stroke in the mid-’90s and eventually developed dementia that the problem spiraled out of control. His father died on Christmas Eve 2010; and after Margareta’s body was found a couple months later, Scheibe said he had a difficult time searching for his father’s urn under the mounds of rubbish.

These are not pleasant memories for the Joliet man. But he’s more than willing to talk about his personal hell because of the need to put more faces on this problem.

“It’s the biggest nightmare you can imagine,” said Scheibe. “I feel bad for anyone who has to deal with it, including neighbors and the city of Aurora, who are left to clean up the mess.”

Scheibe compares the problem to heroin and meth: It spirals so quickly out of control with a dismal success rate even after the problem is addressed. And like those two deadly drugs, “we are just now starting to talk about how bad it is.”

While Kane County “is years ahead” of other places because of its mental health court, Leader agrees more can be done to facilitate training of mental health, social services, public health and housing, police and fire officials.

“It’s hard to get them help,” he said. “There is more acceptance, but we are not there yet.”

Fighting against the compulsion ritual

OBSESSIVE Compulsive Disorder (OCD) has made Stephen Turner a prisoner in his own home. After sharing his experiences of OCD for a documentary to be released in 2013, he tells JO DAVIES more about his “dirty little secret”

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THE ritual began at 5pm and would last until 5am when Stephen Turner would repeatedly check all doors were locked.

At the time he was living with his elderly mother in Barrow and working full time at MIND.

And nobody knew his secret.

FREELANCE filmmaker, and OCD sufferer, Claire Watkinson, is making a personal documentary Living With Me And My OCD.

Filming started in January and the feature is set for release in 2013.

It will include interviews with sufferers of OCD, including Barrow’s Stephen Turner, diary entries from Claire, the Bupa Race, OCD UK and many other organisations.

The documentary has already received huge support and positive comments, so much so that Claire was invited to attend an OCD awareness week in America this month, where she introduced her trailer and was invited to speak about her experiences.

She filmed the event which will be featured within the documentary.

For people interested in joining the campaign, Claire needs more interviews, people and interest.

To join the campaign and help raise OCD awareness visit:
Facebook: www.facebook.com/
livingwithmeandmyocd

YouTube: www.youtube.com/
LWMAMOCD

Twitter: www.twitter.com/
ClaireWatkinso2

Website: www.livingwithmeandmy
ocd.wordpress.com

His neurotic behaviour took its toll on his health.

His weight plummeted from 18-and-a-half stone to eight-and-a-half stone in just over a year.

And eventually he was admitted to Ridge Lea, mental health hospital, in Lancaster, after suffering a breakdown.

Throughout his three separate stays in the hospital he never disclosed his obsessive compulsive disorder.

As to why he kept his OCD hidden, Stephen concedes: “I was ashamed of it. Yes, it was okay to talk about depression or anxiety, but going round the house from 5pm to 5am? It’s a scary thing to admit to yourself that you’re doing that.”

OCD is a chronic mental health condition that is usually associated with obsessive thoughts and compulsive behaviour.

It is estimated that up to three in 100 adults and up to five in 100 children and teenagers have OCD.

OCD usually starts in early adult life, with men tending to report earlier symptoms than women. However, OCD symptoms can begin at any time.

Stephen believes his OCD is linked to a traumatic period in his teens. After losing his father at 11, his late mother remarried a violent man who used to beat them both.

“I had responsibility fairly early on. My mam was taken into hospital with mental illness.

“I was 15 or 16 and I had to look after my dog and pay the rent and lock up,” he says.

“At that early age there was a lot of responsibility.”

Stephen’s late brother was an alcoholic who would regularly come home intoxicated and leave the keys in the front door or the hob on, and he believes this may have triggered his OCD.

“Rather than have a fight with him I would wait until he had gone to sleep and come down and start the routine of locking the doors.”

At its most intense Stephen describes how debilitating his OCD became: “I used to be in tears at the front door making sure it was locked.

“I lived in Lorne Road at the time with my mam and had the constant routine of seeing if there was a key in the door.

“As I looked out a chap was passing in the street and he acknowledged me.

“It gave me such a shock.

“The sensation was unbelievable.

“There was a burning anxiety about it – a horrific fear and dread – every emotion being thrown at you at once.”

Stephen says his OCD is currently in check.

Now 55, he’s settled on Walney with his wife, Christine, and house cat Thomas.

He’s also an advocate for mental health issues, which is why he was interested in supporting Claire Watkinson’s documentary, especially once he discovered that the director herself has OCD.

Claire recently came through from Sheffield to film Stephen in his Walney home.

Living With Me And My OCD is Claire’s personal documentary about OCD, featuring interviews with other sufferers.

“I was having a bit of a rough patch and felt people didn’t understand it. I decided to turn the camera on myself and it evolved from there,” she explains.

“I’ve been very, very surprised by the reaction.”

Making the documentary has proved a cathartic experience for Claire.

“It’s helping me with my OCD because I realise I’m not on my own.

“When you’ve got it you think how can anybody understand what I’m going through?” says the 22-year-old, before explaining how her OCD manifested itself.

“I’ve had it as far back as I can remember.

“I used to control what I ate because I was terrified of being sick.

“I have intrusive thoughts where you think things are going to happen if you don’t do things.”

Claire and Stephen have both had cognitive behavioural therapy (CBT), a form of psychotherapy, to try and cope with their disorders.

But they independently admit they are far from cured.

Having suffered from OCD, depression and anxiety for over three decades, Stephen hopes his breakthrough will come when he accesses the services of Newcastle Trauma Centre.

He is on the waiting list for an appointment.

“CBT and talking therapy has brought me a long way forward but it hasn’t stopped the nightmares I have in the day and night,” he explains.

“I said to the health authority that I can’t move forward if I’m having these nightmares.

“So I’ve hammered my case and it’s Dr Jebur (his GP) and Croftlands Trust, who have helped me with my case.

“I’m hoping for big things and know it’s going to be traumatic because I know there are things I’m going to deal with for the first time in my life. I’ve had things in my life that have held me back.

“CBT has helped me understand why I was doing the locking, but it hasn’t helped me sort through the fears of why it started.”

As to her prognosis of a recovery, Claire says with a sigh: “I hope so. I’ve met some people that I’ve interviewed who have it under control. It’s not really recovery, it’s just how you control it.”

Until that point she has the support of her new-found “OCD community” to draw on. And she desperately wants people to understand what it’s like living with OCD through her documentary.

“I’m really hoping, when it gets released, people will go ‘Oh My God’,” she says.

“I want it to do really well. I don’t want to just stop with this documentary.”

For other people affected by OCD, and Stephen believes it is far more prevalent than society admits, his advice is: “Speak to somebody straight away – anybody you feel safe with.

“The first barrier is the silence in keeping it to yourself.

“Once you’ve done that and somebody rationalises what you’re doing, that’s the step forward.”

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Considerable Scope for Improvement’ in Antidepressants Market, Says Report

Research and Markets (http://www.researchandmarkets.com/research/j3x4k4/antidepressants) has announced the addition of the “Antidepressants Market to 2018 – Despite Safety Concerns, Selective Serotonin Re-uptake Inhibitors (SSRIs) Continue to Dominate in the Absence of Effective Therapeutic Alternatives” report to their offering.

Considerable Scope for Improvement’ in Antidepressants Market, Says Report

Further research into the disease etiology of a number of mental health disorders would open up considerable scope for improvement in the development of antidepressants, says a new report by GBI Research.

The report* states that the global antidepressants market for Major Depressive Disorder (MDD), Obsessive-Compulsive Disorder (OCD), Generalized Anxiety Disorder (GAD) and Panic Disorder (PD) – estimated at $11.9 billion in 2011 – is forecast to generate $13.4 billion by 2018. Antidepressants are among the top three most prescribed classes of drugs in the US, along with cholesterol-lowering drugs and painkillers.

The report states that Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) are the most commonly prescribed classes of antidepressants, but many patients fail to respond adequately to them, while a significant number of patients also discontinue therapy due to negative and unwanted side effects.

Latency is also a factor in drug compliance, as the positive effects of antidepressants may only be seen after around six weeks, leading to more instances of treatment discontinuance due to frustration and lost confidence in the drug. The report estimates that around 25% of patients will stop taking their prescribed medication within the first four weeks of treatment.

The pharmaceutical industry has so far struggled to improve on current antidepressants, partly due to inadequate understanding and the difficulty of conducting clinical trials, according to GBI Research analysis. A notably high placebo effect, and a lack of objective assessment criteria and financing all represent drawbacks for scientific study into antidepressant therapeutics.

Without major breakthroughs in scientific understanding, development activity in this therapeutic area will be restricted. However, this does leave considerable scope for improvement over the current treatment options if understanding of the disease etiology improves.

This report provides an in-depth analysis of the major antidepressants therapies, including SSRIs, Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) and Tricyclic Antidepressants (TCAs), covering Major Depressive Disorder (MDD), Obsessive-Compulsive Disorder (OCD), Generalized Anxiety Disorder (GAD) and Panic Disorder (PD). It provides the sales, treatment usage patterns for the global antidepressant market in addition to the individual indication markets.

It also provides the geographical distribution of antidepressants across the US, the top five countries of Europe, and Japan, and gives insights into the antidepressants RD product pipeline and explores the competitive landscape, including major players in the antidepressants market. Finally, the report also includes analysis on the Mergers and Acquisitions (MAs) and licensing agreements that took place in antidepressant market.

Companies Mentioned:

– H. Lundbeck

– AstraZeneca

– Eli Lilly and Company

– Forest Laboratories

– Pfizer Inc.

– GlaxoSmithKline

– Bristol-Myers Squibb Company

For more information visit http://www.researchandmarkets.com/research/j3x4k4/antidepressants

Children develop anxiety disorders

By 

Rita Price

The Columbus Dispatch

Sunday October 21, 2012 8:04 AM

Enlarge Image

Eric Albrecht | DISPATCH

Mia Stephany, 13, of Westerville, works with a psychologist to tame her anxiety disorder. “You have to talk back to OCD,” she says, “but your family can’t do it for you.”

Fear and anxiety — the forces behind untold numbers of sleep-deprived nights and before-school
stomachaches — pop up occasionally along the journey through childhood and adolescence.

But for some children, the worry won’t stop. It grows into an anxiety disorder that can wreak
havoc on their home, school and social lives.

“Parents hear about autism, and they hear about ADHD a lot more. Anxiety disorders are the
things that are often overlooked, and they’re actually incredibly common,” said Amy Przeworski, a
psychologist and assistant professor at Case Western Reserve University in Cleveland.

She and psychologist Rebecca Hazen, also an assistant professor at Case Western, will speak to
families, caregivers and professionals in Columbus on Oct. 29 during the annual Children’s Mental
Health Conference sponsored by Mental Health America of Franklin County. They want to help families
learn to distinguish between typical and problem worrying. Researchers say anxiety-spectrum
disorders affect about 1 in 8 children at some point in their lives, making them the most-prevalent
mental-health disorder in children and teens.

Generalized anxiety disorder, social anxiety, separation anxiety, obsessive-compulsive disorder,
panic attacks and phobias can be present in varying degrees of severity.

“Sometimes, people don’t come in for treatment until it’s really causing problems,” Hazen said. “
When anxiety is starting to interfere with daily activities, or cause a lot of daily stress for
kids, that’s a red flag that they might need some help.”

Carrie Stephany and her 13-year-old daughter, Mia, say the signs of Mia’s obsessive-compulsive
disorder were becoming clear by the time she turned 6. For her birthday party that year, Mia
insisted on a menu of plain corn muffins and sugar-free Italian ice. She couldn’t have cake because
the thought of eating a sugary treat, even in moderation, worried her sick. “I just thought, ‘
Sugar, bad,’  ” Mia said. “Then I became afraid of the sun. I thought I’d get skin cancer.”

Obsessive worry about germs, headaches and throwing up began to plague Mia, too. She couldn’t
wash her hands enough, and her family unwittingly made matters worse by trying to reassure her.

Tending the compulsions and paying them lots of attention usually just makes them grow big — it’s
kind of like watering a thirsty plant, Stephany said.

Mia’s psychologist at Nationwide Children’s Hospital’s Child Development Center helped the
Westerville family settle on the best treatment. Mia said books, too, have made it easier to see
her obsessive-compulsive disorder as a third party she needs to ignore.

One story portrayed OCD as “OC flea,” a pesky creature that overtook animals and made them think
they had to do certain things.

“You have to talk back to OCD,” Mia said. “But your family can’t do it for you. They can be your
cheerleader on the sidelines.”

Mia has great grades, is active in extracurricular activities and has helped other children who
struggle with anxiety disorders.

Przeworski said the exact cause of an anxiety disorder might not be known, but both genetic
predisposition and experiences can be factors.

“These days, there’s so much pressure on kids to succeed,” Przeworski said. “That’s only going
to lead to an increase in anxiety diagnoses.”

rprice@dispatch.com

Anxious all the time? Here’s why

What is anxiety?
In her 2008 book, A Brief History of Anxiety, author Patricia Pearson describes anxiety as a fear that is “unbearably vivid, yet insanely abstract.” Simply put, anxiety is worrying about something that is yet to happen.

Remember the tight clench of your stomach before your Maths paper? The knot would ease after the exam, but resume before the next paper. By the end of the exams your anxiety would have vanished, only to reappear later at the time of the results. But as a mental disorder, anxiety never leaves.

The term that doctors use for the most common kind of anxiety disorder is called Generalised Anxiety Disorder. GAD is marked by excessive worry in several areas of life — work, relationships, finance — even when there is little cause for concern.

Then there are specific forms of anxiety. Social anxiety is the irrational fear and avoidance of social gatherings, born out of concern that others may view you negatively. Separation anxiety disorder is, as the name suggests, a fear of separation from the comfort of your home, or parents.

And then there is the anxiety that is masked by other issues like depression, Obsessive Compulsive behaviour, and Post Traumatic Stress Disorder (PTSD).

Dr Kersi Chavda, past president of the Bombay Psychiatric Society, says that more often than not, people approach a doctor only after they’ve had a panic attack — where they have anxiety so acutely that they blanked out, broke into a cold sweat or had palpitations.

When anxiety wears a mask
In the case of Obsessive Compulsive Disorder, recurrent, irrational fears are assuaged to a degree when the person engages in a repetitive behaviour. PTSD develops in the wake of a terrifying event, which results in feelings of extreme helplessness, horror and fear. Anxiety is couched in the sense of numbness, dissociation and hyper-vigilance when the person re-experiences that fear. While it is easier to diagnose OCD, PTSD takes time to diagnose, because symptoms take time to show up. Meanwhile, research on this condition, which was known as shell shock during World War I, still continues. The distinction between simple and complex PTSD, for instance, was only made in the 1990s.

In these cases, anxiety is intrinsically linked to the condition, so it isn’t treated separately, but as part of a larger issue. Further, people who have been diagnosed with a chronic, life-threatening ailment are also susceptible to anxiety. Often, hospitals recommend psychiatric sessions for such patients.

“There are gradations of anxiety,” says Chavda. “There is good stress, which makes a person productive, and there is bad stress, or distress, that causes trouble. There are more than 100 neurotransmitters in the body. One develops a condition depending on which neurotransmitter is affected.”

The Globe and Mail

A $10 MILLION SPOTLIGHT ON OCD

Sunnybrook’s pioneering work in anxiety-disorder care and research is getting a $10-million boost.

The gift from Frederick Thompson, thought to be the largest-ever private donation focused on obsessive compulsive disorder (OCD), will create the Frederick W. Thompson Anxiety Disorders Centre within Sunnybrook’s Brain Sciences Program.

“This gift makes a bold statement and represents a real turning point in the research and treatment of anxiety disorders,” says Dr. Peggy Richter, director of Sunnybrook’s Clinic for OCD and Related Disorders.

“This centre will address the spectrum of anxiety disorders, and will focus on the treatment of OCD and its related conditions – and no other centre in Canada offers such specialized care for these disorders. This gift truly establishes Sunnybrook as a leader in treatment and research in this important field.”

The centre will attract international experts who will collaborate with Sunnybrook’s world-class scientists and will be an epicentre for anxiety-disorder research across Canada.

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MS PATIENTS AND DEPRESSION

Can exercise improve the moods of multiple sclerosis (MS) patients who are suffering from depression?

That’s one of the questions a team of Sunnybrook researchers hopes to answer with its research into the mental well-being of these patients, thanks in part to a $263,000 grant from the Multiple Sclerosis Society of Canada.

Half of MS patients suffer from depression and half suffer from cognitive dysfunction. When a patient faces both at once, it can be difficult to manage their health, says Dr. Neil Rector, director of research in the department of psychiatry at Sunnybrook.

The grant will be used to fund a study, led by Dr. Rector and Dr. Anthony Feinstein, director of Sunnybrook’s neuropsychiatry program, examining whether non-drug treatments can improve depression and cognitive dysfunction in MS patients.      

Patients will be divided into three groups: patients who only receive cognitive behavioural therapy (CBT), patients who only exercise and patients who receive a combination of both.

Because many of the patients will be taking antidepressants, the study results will also clarify the extent to which CBT and exercise can benefit MS patients.

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research

Sunnybrook doctors have launched a study to determine whether “keeping it cool” in ambulances is best for cardiac arrest patients. Cooling a patient’s body temperature after a cardiac arrest has been shown to reduce the chances of severe brain damage and death, but the treatment is usually only provided in hospitals. Lowering the patient’s body temperature by 3 to 5 degrees Celsius slows the brain’s need for oxygen, which can reduce the patient’s chances of severe brain damage caused by lack of blood flow during cardiac arrest.

“We know we can prevent brain damage and save more lives by cooling a patient,” says Dr. Damon Scales, the trial’s principal investigator and a staff physician in Sunnybrook’s Department of Critical Care Medicine.

Since the trial launched in July, paramedics have treated a patient in the field using cooling, a first in Ontario.

Funded by the Canadian Institutes of Health Research, the trial is expected to last for two years and involve more than 1,000 patients.

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MICROBUBBLES VS. TUMOURS

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Sunnybrook researchers have shown they may be able to boost the tumour- destroying power of radiotherapy by using ultrasound in a new way. “This is definitely a world-first happening at Sunnybrook,” says Dr. Greg Czarnota, radiation oncologist and lead on this research.

The process involves injecting tiny microbubbles into the blood stream. Researchers found the otherwise harmless microbubbles bounce and expand when heated with focused ultrasound, straining the blood vessels of the tumour. The cancer cells become leaky and weak. When a tumour is targeted this way before radiation in pre-clinical models, the radiation destroys up to 40 per cent of the tumour within 24 hours.

The research received a $1-million boost from the Breast Cancer Society of Canada this year. “This support will allow us to scale up these treatments and move them out of the laboratory and into breast cancer patients in the next three to five years,” Dr. Czarnota says.

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WHAT IS MELANOMA`S X-FACTOR?

A Sunnybrook scientist is trying to determine why women with melanoma have a better chance of recovery than men. Melanoma is an aggressive skin cancer with a poor outlook for survival once it spreads to other parts of the body. But women with melanoma, even at an advanced stage, have a far better prognosis than their male counterparts. Researchers have found no evidence female hormones contribute to this phenomenon; they believe the gender difference has a genetic basis.

 Dr. Teresa Petrella, a clinician-scientist at Sunnybrook, is trying to understand the female advantage and uncover drivers of the disease. She and her colleagues will do in-depth analyses of X-chromosome genes in melanoma to identify potential new therapeutic targets to improve survival.

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They say two things are certain in life: death and taxes.

A Sunnybrook study has found the two often go together; for U.S. motorists, income tax deadline day increases the risk of a fatal road crash.

 Using road safety information from the National Highway Traffic Safety Administration from 1980 through 2009, Sunnybrook researcher Dr. Don Redelmeier and colleague Christopher Yarnell from the University of Toronto examined the number of fatal crashes on each tax deadline day as well as on the same weekday one week before and after.

They found the risk of being involved in a fatal crash was 6 per cent higher on income tax deadline day.

“The increased risk could be the result of stressful deadlines leading to driver distraction and human error,” says Dr. Redelmeier. “Other possibilities might be more driving, sleep deprivation, lack of attention and less tolerance toward hassles. Another contributor could be decreased law enforcement as the police, themselves, might be busy with their own tax deadlines.”

And why is this finding significant? The study’s authors say these risks could be mitigated through driver education.

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BUILDING TOWARDS A BETTER BIOPSY

An easy and painless prostate cancer biopsy? Most men will say there’s no such thing – but some Sunnybrook researchers
are perfecting a high-tech
imaging procedure that allows them to see prostate tumours much more clearly, and in some cases detect tumours missed with past biopsies.

Dr. Masoom Haider is leading a group to advance image-guided prostate cancer detection and biopsy. With Dr. Laurent Milot and the team at Sunnybrook’s Gelato Cup Golf Early Detection Centre, prostate tumours are targeted with great precision in a needle biopsy, a procedure in which a small tissue sample is removed from the prostate gland. With the cutting-edge technique, doctors only need two to four samples – far less than the 12 or more samples that are traditionally required. 

“The current paradigm of prostate cancer detection with prostate-specific antigen and biopsy does not show us where the cancer is located in the prostate,” Dr. Haider says. As a result, men endure multiple random needle biopsies. Tumours can be easily missed, prompting painful
repeat biopsies.

Sunnybrook’s experts fuse a magnetic resonance image of the prostate tumour with real-time ultrasound imaging obtained during biopsy, providing a clear picture of the tumour.

And by finding tumours otherwise missed, they are saving lives by ensuring men are treated early in their disease.

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Every year fire kills 400 people in Canada, and most of these deaths occur at home. A new Sunnybrook study will look at the health-care costs of house fires, including the costs of burn care, and whether automated sprinklers in homes have an impact on the health, safety and economic outcomes of house fires in Canada.

Over the next three years, researchers will look at literature and statistics on fires and their associated costs to homeowners, insurance companies, fire services and society as a whole. The research will focus on Canada, but also extend to other parts of the world.

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IMAGING RESEARCH GETS $6.9 MILLION BOOST

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Dr. Greg Czarnota, left, examines images as part of his
research using high-intensity focused ultrasound.

Imagine checking into a hospital to have a tumour removed, being discharged that same day and back at work the next. This is the vision of scientists at Sunnybrook Research Institute (SRI), who are working on image-guided focused ultrasound surgery, a minimally invasive procedure.

That vision has just received a tremendous boost; the Federal Development Agency for Southern Ontario has invested $6.9 million into this and three other innovative imaging research projects led by SRI scientists.

The other projects include using magnetic resonance imaging to guide and monitor treatments to correct an irregular heartbeat or unclog blocked arteries; technology that reveals early whether chemotherapy has been effective in cancer patients; and a hybrid catheter that combines optical and ultrasound imaging to treat blocked coronary arteries.

The agency’s contribution, matched by 19 industry partners, will allow SRI and its academic partner, Western University, to develop and commercialize therapy and monitoring systems for cancer and heart disease.

It is anticipated the initiative will create high-value jobs and economic growth across southern Ontario.

Dr. K: OCD often a matter of degree

Dear Dr. K: The term OCD is used so casually these days. How can you identify someone who truly has obsessive-compulsive disorder?

Dear Reader: There’s a little bit of what is called “psychiatric illness” in most of us. For example, at one time or another we may all feel compelled to line up our pencils or double-check that we’ve locked the door.

In contrast, a person with OCD who has the obsession that his front door is unlocked may feel the compulsion to check the lock 10 or 20 times each night. He remembers that he’s already checked it many times, and it definitely was locked. But he still worries that somehow it got unlocked since the last time he checked. It’s not rational; it’s just a mental pressure that a person with OCD must respond to.

The two defining symptoms of OCD are obsessive thoughts and compulsive rituals.

Obsessions are persistent, repeated, anxiety-provoking or distressing thoughts. They intrude into a person’s consciousness.

Compulsive rituals are persistent, excessive, repetitive behaviors. The goal of the ritual is to reduce the anxiety caused by obsessive thoughts.

In OCD, the obsessions and compulsions are excessive and distressing. They are time-consuming. They may interfere with personal relationships, and performance at work or school.

The most effective treatment for OCD is a combination of psychotherapy and medication. Ongoing treatment may be necessary.

Selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat OCD. They include sertraline (Zoloft) and citalopram (Celexa). Tricyclic antidepressants also may be effective, particularly clomipramine (Anafranil).

A number of psychotherapy techniques may be helpful. Cognitive behavioral therapy (CBT) can help a person with OCD recognize the unreasonableness of fearful, obsessive thinking. The therapist sometimes teaches specialized techniques that can help extinguish the compulsions.

So OCD is a matter of degree. If your obsessive thoughts or compulsive behaviors occur repeatedly throughout the day, and interfere with life at home or at work, you’ve got a problem — and several possible solutions.

Dr. Anthony L. Komaroff is a physician and professor at Harvard Medical School. Go to his website, www.AskDoctorK.com, to send questions and get additional information.

Online OCD trial

Early results from a trial by researchers into treating people with Obsessive Compulsive Disorder (OCD) through an online therapy program are showing positive outcomes.

The research is being conducted at Swinburne University of Technology’s Brain and Psychological Sciences Research Centre and National eTherapy Centre

OCD is an anxiety disorder that affects more than 450,000 Australians, and those with OCD can be besieged by intrusive and unwanted thoughts, images or impulses, and are compelled to perform behavioural and mental rituals.

Professor Michael Kyrios, Director, Brain and Psychological Sciences Research Centre, said researchers have found that online treatment for a range of anxiety disorders, including social anxiety and Post Traumatic Stress Disorder, can be as effective as face-to-face therapy.

Early results indicate that this trial will follow the trend and demonstrate that online therapy is an effective form of treatment for OCD.

“Obsessions and compulsions are distressing, exhausting and time consuming, and cause significant interference in the sufferer’s family and social relationships, daily routines, and their capacity to fulfil their goals in employment and education,” Professor Kyrios said.

“Initial results from the trial so far have been positive, indicating that people who have completed the treatment do as well as those who undergo face-to-face treatment.”

Participants in the trial, which is funded by a $320,000 grant from the National Health and Medical Research Council (NHMRC), have access to free online treatment including assistance in the form of email contact with a qualified therapist.

The 12-week program is delivered through Anxiety Online, an online assessment and treatment clinic run by Swinburne’s National eTherapy Centre.

“We wanted to find out who did well, who was experiencing symptom improvement and who didn’t, who dropped out because it didn’t do anything for them, who didn’t respond,” Professor Kyrios said.

“These are the questions that are tied up in this trial and will be important in helping us develop this into the future.”

Professor Kyrios said access to online therapy services can benefit not only those living in remote and regional Australia, but those living in cities who are poor or may not have adequate access to mental health services.

“OCD is actually quite prevalent in our society, however, the sad fact is that many people either don’t have access to effective mental health treatments or aren’t comfortable seeking help face to face due to the social stigma associated with mental illness, so they opt for online treatment” Professor Kyrios said.

Participants in the trial are randomly assigned to one of two groups, those undertaking a cognitive behavioural treatment program called Systematic Treatment of Obsessive Compulsive Phenomena or OCD-STOP, and those completing Progressive Relaxation Training. Irrespective of which program they are assigned, all individuals will be given the opportunity to take the alternative treatment at no cost. The trial is confidential and participants can still see their own psychologist while taking part.

Researchers are looking for more people with OCD to take part in the trial, which finishes in late 2013. If you are interested in participating go to the website and send an email