Daniel Traub-Werner MD. Psychiatrist and Psychoanalyst.

03/10/2022

04/08/2017

Investigation finds many controversial journals offered to put a made-up, unqualified applicant on their board of directors, sometimes on condition of payment or with an offer of profit sharing.

04/05/2017

MENINGITIS VACCINATION in ADOLESCENCE

This post is relevant for those parents who have adolescent children and are considering the meningitis vaccine. Vaccines are important measures, from ever perspective: prevention of illness, complications associated with illness, prevention of contagion. However, from time to time there are reports about cautions and precautions in association with vaccines. This report is one of the cautions to be exercised when giving the Menveo meningitis vaccine. If you carefully analyze the report, the association is probable but not definite and, more importantly, all cases of Bell's Palsy resolved.

Meningitis in youth is a very serious illness that can lead to death; I am familiar with one such case where an adolescent girl died as a consequence of infectious meningitis.

This report is Copyrighted by The Canadian Medical Association.

Menveo meningitis vaccine may be associated with Bell's palsy

Clinical question
Is the Menveo meningitis vaccine associated with adverse events?

Bottom line
One of the meningitis vaccines, MenACWY-CRM (Menveo), may be associated with the development of Bell's palsy, especially when given with other vaccines. The association (let alone any causative link) is not incontrovertible, but it's gotten some press. Consider giving the meningitis vaccine at a visit other than the one during which other adolescent vaccines are given. (LOE = 2b)

Reference
Tseng HF, Sy LS, Ackerson BK, et al. Safety of quadrivalent meningococcal conjugate vaccine in 11- to 21-year-olds. Pediatrics 2017;139(1):e20162084.

Synopsis
This study enrolled a cohort of members of an integrated healthcare organization in the United States that provides care to its 4.2 million members.

Over a 2-year period, 48,899 children, aged 11 to 21 years, received the meningococcal (groups A, C, Y and W-135) oligosaccharide diphtheria CRM197 conjugate vaccine (MenACWY-CRM, Menveo).

The children were evenly split by s*x and the majority were Hispanic (49.2%) or white (29.8%). For many children (42.8%), it was their second dose of vaccine. Also, 72% of the children received a concomitant vaccine.

The researchers searched payment records for any of 26 "events of interest" that might be related to vaccination, including neurologic, rheumatologic, endocrinologic, and immune-mediated adverse effects.

Overall, 1127 events occurred after vaccination. No events were recorded for 14 of the 26 categories. Events were recorded for 11 other categories, but these did not occur at a rate greater than chance. However, the risk incidence for Bell's palsy was statistically significant (adjusted risk incidence [ARI] 2.9; 95% CI 1.1 - 7.5).

When stratified, the risk was increased when the vaccine was given with other vaccines (ARI 5.0; 1.4 - 17.8), but not when given by itself (ARI 1.1; 0.2 - 5.5). All cases of Bell's palsy resolved.

Caveats: This was an observational study that showed an association that might not signal causation. We don't know the Bell's palsy incidence in a comparable unvaccinated population.The number of events is very low (8 of 48,899), which limits our confidence. The authors did not correct for multiple comparisons, creating a higher likelihood of the association being due to chance.

03/12/2017

Patients prescribed pharmacotherapy alone to help alleviate the symptoms of psychiatric disorders may be more likely to refuse or prematu...

02/22/2017

Choosing Wisely Canada (CWC) is a campaign to help clinicians and patients engage in conversations about unnecessary tests and treatments and make smart and effective choices to ensure high-quality care.

02/13/2017

Childhood maltreatment is known to be associated with changes in brain structure and with psychopathology, but more needs to be learned a...

01/04/2017

Reported cases of STDs in 2015 were at an all-time high

01/02/2017

TUESDAY, DECEMBER 20, 2016

Early Decline in Social Functioning Said to Predict Long-term Outcome in Psychosis.

Source: Psychiatric News, American psychiatric Association

"Social functioning appears to be a useful indicator of long-term outcome in people with psychotic disorders and may be an important treatment target that could lead to improvements in other areas of functioning, according to a study in AJP in Advance.

Eva Velthorst, Ph.D., of the Icahn School of Medicine at Mount Sinai and colleagues analyzed data from the Suffolk County Mental Health Project, a 20-year prospective study of first-admission patients with psychotic disorders. They looked at social functioning and long-term outcome in 485 individuals with schizophrenia spectrum disorder (schizophrenia, schizoaffective disorder, or schizophreniform disorder), major depressive disorder with psychosis, and bipolar disorder with psychosis, as well as a control group of individuals who had never experienced psychosis.

Using statistical analysis, the researchers identified four distinct trajectories over the 20-year period among the individuals with psychosis: preserved functioning (n=82), moderately impaired functioning (n=148), severely impaired functioning (n=181), and profoundly impaired functioning (n=74).

The trajectories of profoundly and severely impaired social functioning were associated with worse 20-year real-life functional outcomes in a variety of domains, such as not having obtained a high school diploma, being unemployed, not living independently, and using public assistance.

The researchers also found that differences in the level of social functioning were already evident in childhood. The years between early adolescence and first hospitalization appear to be a period in which a substantial number of individuals who later developed a psychotic disorder displayed a steep decline in social functioning.

The researchers stated, “[O]ur findings are consistent with recent programs of research focused on adolescence as the critical intervention window and support current early intervention strategies for high-risk individuals and those that offer intensive treatment to first-admission patients aimed to prevent social withdrawal in severe psychotic illnesses".”

01/02/2017

While much is known of the chronic nature of anorexia nervosa and bulimia nervosa, few studies have examined the likelihood of recovery d...

12/07/2016

Worth reading:
The Question: "Is the use of selective serotonin reuptake inhibitors in pregnancy associated with a risk of preterm birth?"
The Conclusion from Evidence Based Joule: "The use of selective serotonin reuptake inhibitors (SSRIs) in pregnancy is significantly associated with a small increase in the risk of preterm birth. The severity of depression was not evaluated and could be an important confounding factor. "
See below the abstract from the British Journal of Obstetrics and Gynecology.(Joule is a registered trademark of the Canadian Medical Association used under licence).

Worth reading: The Question: "Is the use of selective serotonin reuptake inhibitors in pregnancy associated with a risk of preterm birth?" The Conclusion… - Daniel Traub-Werner - Google+