Saturday, March 29, 2008

What to do when someone is suicidal

Certainly, not everyone who has thoughts of suicide or talks about suicide actually attempts it. But most people who take their own life have expressed their intention at some time. That's why it's important to take any talk or threat of suicide seriously, especially when someone has depression or another mental disorder, is intoxicated, or is behaving impulsively or recklessly.

While it may not be possible to prevent all suicides, your active involvement may make a difference in saving a life. Learn effective, compassionate ways to intervene and guide someone toward professional help when he or she may be considering suicide.

Know who's at risk of suicide

Understanding who's at a higher risk of suicide can help prevent a tragedy. While you don't necessarily need to constantly monitor someone who's at higher risk, you may be more alert for possible problems. Factors that may increase someone's risk of suicide include:

  • Previous suicide attempts
  • Having a psychiatric disorder, such as depression, bipolar disorder, schizophrenia or personality disorders
  • Alcohol or substance abuse
  • A family history of mental disorders or substance abuse
  • A family history of suicide
  • Family violence, including physical or sexual abuse
  • Firearms in the home
  • A significant medical illness, such as cancer or chronic pain

You can't always tell when a loved one or friend is considering suicide. But here are some typical warning signs:

  • Talking about suicide, including making such statements as "I'm going to kill myself," "I wish I were dead" or "I wish I hadn't been born"
  • Securing the means to commit suicide, such as getting a gun or stockpiling pills
  • Withdrawing from social contact and wanting to be left alone
  • Dramatic mood swings, such as being emotionally high one day and deeply discouraged the next
  • Being preoccupied with death, dying or violence
  • Feeling trapped or hopeless about a situation
  • Increased use of alcohol or drugs
  • Changing normal routine, including eating or sleeping patterns
  • Engaging in risky or self-destructive behavior, such as using drugs or driving recklessly
  • Giving away belongings or getting affairs in order
  • Saying goodbye to people as if they won't be seen again
  • Developing personality changes, such as becoming very outgoing after being shy
Also, don't always expect to see warning signs of suicide. Some people keep their thoughts of suicide secret or deny having suicidal intentions even when directly asked. And many who consider or attempt suicide do so when you thought they should be feeling better — during what may seem like a recovery from depression, for instance. That's because they may finally muster the emotional energy to take action on their suicidal thoughts.

The best way to find out if someone is considering suicide is to directly but gently ask. Asking them won't give them the idea or push them into doing something self-destructive. To the contrary, your willingness to ask can decrease the risk of suicide by giving them an opportunity to talk about their feelings. If someone denies having suicidal intentions but you're still worried, continue to gently raise the issue.

You can ask open-ended questions about their feelings or specific questions about suicide. Here are examples of questions you can ask someone you're concerned about:

  • Are you thinking about dying?
  • Are you thinking about hurting yourself?
  • Are you thinking about suicide?
  • Have you thought about how you would do it?
  • Do you know when you would do it?
  • Do you have the means to do it?
  • How are you coping with what's been happening in your life?
  • Do you ever feel like just giving up?

If a friend or loved one is considering suicide, he or she needs professional help. Remember, it's not your job to become a substitute for a mental health provider. Also, don't tell him or her that you promise not to tell anyone. The safety of your friend or loved one is of the utmost importance. Don't worry about losing a friendship when someone's life is at stake. Besides, carrying a secret like this is a big burden for you emotionally.

If you believe someone is at imminent risk of suicide or harming himself or herself or has made a suicide attempt, don't leave the person alone. Call 911 or your local emergency services provider right away. If necessary, take the person to a hospital emergency department yourself.

If possible, find out if he or she is under the influence of alcohol or drugs or may have taken an overdose. You may have to remove items that could become weapons of self-destruction, such as guns, knives or pills. But don't put yourself in harm's way by doing so.

If the danger of suicide or self-harm isn't imminent, offer to work together to find appropriate help, and then follow through on your promise. Someone who is suicidal or has severe depression may not have the energy or motivation to find help on their own.

Ways you can help include:

  • Finding a qualified doctor or mental health provider
  • Taking him or her to appointments
  • Sorting through health insurance policies or benefit information

Many types of help and support are available to people considering suicide. If your friend or loved one doesn't want to consult a doctor or mental health provider, suggest finding help from a support group, crisis center, faith community, teacher or other trusted confidante.

There's no way to predict with certainty who will attempt suicide. And although you're not responsible for preventing someone from taking his or her own life, your intervention may help him or her see that other options are available to stay safe and get treatment.

Be supportive and empathetic, not judgmental. Listen to his or her concerns without interruption. Reassure him or her that help is available and that with appropriate treatment he or she can feel better about life again. Don't be patronizing by telling someone that "everything will be OK," that "things could be worse" or that "you have everything to live for."

Direct questioning, supportive listening and gentle but persistent guidance can help you bring hope and appropriate treatment to someone who believes suicide will offer the only relief.

Thursday, March 27, 2008

What are the health risks associated with HPV in men?

In fact, most sexually active adults — both men and women — will acquire HPV at some time in their lives.

Men with healthy immune systems rarely develop HPV-related health problems. However, genital HPV infection is one cause of penis (penile) cancer. It's also associated with cancer of the anus and other genital cancers. These cancers are most common in males with HIV infection. In addition, HPV has been linked to oropharyngeal cancer. The oropharynx is the part of the throat just behind the mouth.

Genital HPV spreads through sexual contact. Both men and women can pass it to their partners. Certain types of HPV cause genital warts, but the virus usually causes no signs or symptoms. One way to prevent HPV infection is to avoid direct contact with the virus. Using a condom every time you have sex can significantly reduce your risk of contracting HPV.

The Food and Drug Administration has approved a vaccine that offers protection from the most dangerous types of HPV, but it's currently available only to girls and women. Studies are under way to test if the HPV vaccine is also safe for men, and whether it is effective at protecting against genital warts and certain penile and anal cancers.

Thursday, March 20, 2008

Happily married people have Happy Heart

Happily married people have lower blood pressure than unhappy married people or singles, a Brigham Young University study says.

On the other hand, even having a supportive social network did not translate into a blood pressure benefit for singles or unhappy married people, according to the study.

"There seem to be some unique health benefits from marriage. It's not just being married that benefits health -- what's really the most protective of health is having a happy marriage," study author Julianne Holt-Lunstad, a psychologist who specializes in relationships and health, said in a prepared statement.

The study included 204 married and 99 single adults who wore portable blood-pressure monitors for 24 hours. The monitors recorded blood pressure at random intervals and provided a total of about 72 readings.

"We wanted to capture participants' blood pressure doing whatever they normally do in everyday life. Getting one or two readings in a clinic is not really representative of the fluctuations that occur throughout the day," Holt-Lunstad said.

Overall, happily married people scored four points lower on the blood pressure readings than single adults. The study also found that blood pressure among married people -- especially those in happy marriages -- dipped more during sleep than in single people.

"Research has shown that people whose blood pressure remains high throughout the night are at much greater risk of cardiovascular problems than people whose blood pressure dips," Holt-Lunstad said.

The study was published in the March 20 issue of the journal Annals of Behavioral Medicine.

The study also found that unhappily married adults have higher blood pressure than both happily married and single adults.

Holt-Lunstad noted that spouses can encourage healthy habits in one another, such as eating a healthy diet and having regular doctor visits. People in happy marriages also have a source of emotional support, she said.

Monday, March 17, 2008

Testicular cancer gauge often not used

A standard part of testicular cancer care isn’t used in more than half of all patients who have the condition, researchers at the University of Michigan Comprehensive Cancer Center have found.

Serum-based tumor markers, which are one indicator of the presence of cancer cells, are helpful in several aspects of the care of patients with testis cancer, including diagnosis, prognostication and surveillance for disease recurrence following treatment. Doctors typically rely on a series of three tumor markers with this type of cancer.

In a review of more than 4,700 testicular cancer cases, a combination of two of these tumor markers were used less than half of the time, while all three tumor markers were measured in just 16 percent of the cases.

The authors of the study found that only about 45 percent of cases used the tumor markers AFP (alpha fetoprotein) and HCG (human chorionic gonadotrophin). Those two were used in conjunction with a third tumor marker, LDH or lactate dehydrogenase, 16 percent of the time. The results are reported in Urologic Oncology, Seminars and Original Investigations.

“Tumor markers play a central role in showing physicians how a patient is responding to treatment and whether the disease has recurred,” says lead author Scott M. Gilbert, M.D., clinical lecturer in the U-M Department of Urology. “We were extremely surprised by the low rates of usage.”

He notes that information obtained from the use of tumor markers impacts the treatment and potentially the outcome in patients with testicular cancer. If markers remain elevated after therapy, it indicates the cancer remains, or if they begin to rise during the surveillance period following successful treatment, the cancer has returned. Gilbert says he and his colleagues regularly check all three tumor markers in their patients.

A majority of the sites in the study failed to show improvement during the study interval, and one – Detroit – experienced a decrease in the use of tumor markers by the end of the study.

The authors point out that the low rates of usage don’t necessarily indicate that the tumor markers were being used as infrequently as the numbers would suggest. One explanation could be that the documentation in medical records was poor, and incidents of tumor marker use were not always recorded, says senior author Brent K. Hollenbeck, M.D., M.S., assistant professor in the U-M Department of Urology.

“Even if it isn’t a problem related to the care of the patients, it is a quality problem at the medical centers that are not recording the data properly. Either way, major improvements need to occur,” he says.

But other data in the study suggest that the reporting of tumor marker use may not be the problem. Using the data from the Surveillance, Epidemiology, and End Results (SEER) program, the researchers found substantially more documentation of PSA use in prostate cancer patients compared to the testicular cancer tumor markers. That information supports the notion that recording may not be the problem, but that the use of testicular cancer markers is in fact very low.

Wednesday, March 12, 2008

Testosterone levels and risk of depression

Low testosterone levels in older men are associated with an increased risk of depression.

Between 2001 and 2004, researchers at the University of Western Australia in Perth studied 3,987 males aged 71 to 89. The men provided demographic and health information and were tested for depression and cognitive difficulties. The researchers also checked the men's testosterone levels.

The 203 men who met the criteria for depression had significantly lower total and free (not bound to proteins) testosterone levels than those who weren't depressed. After controlling for other factors, such as cognitive scores, education level and body-mass index, the researchers concluded that men in the lowest quintile (20 percent) of free testosterone were three times more likely to have depression compared to those in the highest quintile.

While more research is needed to determine how low hormone levels may be linked to depression risk, the study authors believe it may be caused by changes in the levels of neurotransmitters or hormones in the brain.

"A randomized controlled trial is required to determine whether reducing prolonged exposure to low free testosterone is associated with a reduction in prevalence of depression in elderly men," the researchers wrote. "If so, older men with depression may benefit from systematic screening of free testosterone concentration, and testosterone supplementation may contribute to the successful treatment of hypogonadal (with low hormone levels) older men with depression."

Between 2 percent and 5 percent of people are affected by depression at any given time, according to background information in the study. Women are more likely than men to be depressed, but that difference disappears at about age 65. A number of previous studies have suggested that sex hormones may be a factor.

Tuesday, March 11, 2008

Breastfeeding mums can drink moderately

Breastfeeding women can drink moderate amounts of alcohol without endangering their baby, Sweden's National Food Administration said Tuesday, changing its previous recommendation to abstain entirely.

"There is no medical reason to abstain completely from alcohol while breastfeeding," Annica Sohlstroem, head of the agency's nutrition department, said in a statement.

"The amount of alcohol that the child can ingest through the breastmilk is small if you drink one or two glasses of wine" per week, she said.

The new advice is an about-face for the agency, which has for the past decade or so advised women to avoid alcohol while breastfeeding, and is based on current medical research.

The recommendation is however still a proposal and will be sent to other government agencies for consideration.

The agency, which aims to monitor food quality sold and produced in Sweden, stressed its intention was not to encourage women to drink while breastfeeding and strongly advised women to continue to abstain from alcohol while pregnant.

Monday, March 03, 2008

Baby face sparks a response in the adult brain

Scientists report that sophisticated imaging showed that seeing a baby's face lit up a specific region of the adult brain associated with reward circuitry. This "Christmas tree" effect didn't occur when adults looked at another adult face, suggesting there's a neural basis for protective, nurturing feelings triggered by babies.

And the findings could also shed some light on postnatal depression, which affects some 13 percent of new mothers, the study authors said.

Using an imaging technique called magnetoencephalography, scientists led by researchers at the University of Oxford in England scanned the faces of 12 adults as they looked at images of 13 infant and 13 adult faces. The study participants had never seen the images before. The faces were matched for emotional content, attractiveness and other features.

Brain activity started in the medial orbitofrontal cortex region of the brain within one-seventh of a second after seeing infant faces, but not adult faces. The responses were considered too rapid to be consciously controlled.

This region of the brain has been implicated in reward behavior; it also appears to be involved in visual object recognition. And depression has been linked to another region of the brain -- the subgenual cingulate cortex -- that is connected to the medial orbitofrontal cortex.