Psychiatric Illnesses May Involve Changes in Only Two Genes



A new study shows that changes in only two genes may account for most psychiatric illnesses.


 

PSYCHIATRIC ILLNESSES MAY INVOLVE CHANGES IN ONLY TWO GENES

As most regular readers of Weekly Health Update know, I rarely discuss psychiatric research studies here, as most behavioral studies are based upon lower level research methodologies, and many of these studies also take inadequate safeguards, in my view, to eliminate inherent biases. However, every now and then, a psychiatric study comes along that catches my attention, and merits further discussion.

Currently, psychiatric diagnoses are based upon clinical symptoms that are organized into diagnostic groups contained in the “bible” of Psychiatry, the Diagnostic and Statistical Manual of Mental Disorders, or “DSM.” Because specific psychiatric diagnoses are based almost entirely on the subjective observation of signs and symptoms of mental illness, rather than objective test results, there is enormous potential for misdiagnosis. Moreover, many psychiatric diagnoses are associated with overlapping clusters of symptoms, which further increases the likelihood of misdiagnosis (and inappropriate treatment).

A new research study, which appears in the current issue of the journal The Lancet, strongly suggests that several common mental health disorders long thought to be unrelated to each other may, in fact, share a common biological basis, at least in some patients. The striking findings of this novel genetic study may dramatically change the way that psychiatrists diagnose and manage patients with psychiatric illnesses.

In this landmark study, 33,332 patients with psychiatric illnesses and 27,888 healthy control subjects underwent sequencing of their entire complement of DNA (“genome”), looking for genetic variations known as single-nucleotide polymorphisms (SNPs). (These common variations in the individual “letters” of our genetic code are responsible for many of the differences that exist among us, including hair color, eye color, and other variations, or traits, that can be readily observed.) The researchers then used very complex genetic analysis tools to search for SNPs that appeared to be linked, specifically, to the diagnosis of 5 different psychiatric illnesses in this large population of research subjects.

The results of this landmark study go a long way towards explaining the inaccuracies and inconsistencies commonly associated with the clinical diagnosis of psychiatric illnesses based upon DSM diagnostic criteria. Another very important result of this study is that it provides a potential explanation for the actual genetic and biological basis for at least some cases of common psychiatric illnesses.

Based upon the enormous amount of genetic information collected in this study, SNPs at four specific genetic sites were found to be strongly associated with the following 5 common psychiatric illnesses: autism spectrum disorder, attention deficit-hyperactivity disorder (ADHD), bipolar disorder, major depressive disorder (depression), and schizophrenia. What was especially fascinating was the finding that genetic variations at these four sites involved just two genes, both of which are associated with calcium channels that act like microscopic gates that allow calcium to move into or out of cells.

It is difficult to overstate the importance of this study’s findings. For perhaps the first time, there is now genetic and biological data linking the 5 most common major psychiatric illnesses to specific locations in just two genes, which argues against the current clinical view that each of these illnesses are completely unrelated to each other. Indeed, the finding that variations in only two genes may account for these 5 common psychiatric illnesses is hugely significant, as is the finding that these two genes, which are involved in the construction of calcium channels, may play a fundamental role in the development of these seemingly unrelated illnesses.

The findings of this pivotal study will, hopefully, help psychiatrists to move away from the current subjective, and often arbitrary, methods of clinically diagnosing and treating psychiatric illnesses, and move towards making diagnoses based upon objective gene-based (“molecular”) and biological findings. Moreover, reaching a clearer understanding of the biological mechanisms underlying these common psychiatric illnesses may also lead to innovative new treatment options for patients with mental health illnesses.

 

For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my bestselling book, “A Cancer Prevention Guide for the Human Race,” from AmazonBarnes & Noble, Books-A-Million, Vroman’s Bookstore, and other fine bookstores!

Within one week of publication, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com “Top 100 Bestseller’s List” for Kindle e-books. Within three months of publication, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.com Top 100 New Book Releases in Cancer” list.

 

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Dr. Wascher’s latest video:

Dark as Night, Part 1

Dark as Night, Part 1

Dark as Night, Part 1


At this time, more than 8 percent of Americans are unemployed.  According to the Bureau of Labor Statistics, however, the unemployment rate for veterans who served on active duty between September 2001 and December 2011 is now more than 12 percent.  A new website, Veterans in Healthcare, seeks to connect veterans with potential employers.  If you are a veteran who works in the healthcare field, or if you are an employer who is looking for physicians, advanced practice professionals, nurses, corpsmen/medics, or other healthcare professionals, then please take a look at Veterans in Healthcare. As a retired veteran of the U.S. Army, I would also like to personally urge you to hire a veteran whenever possible.


Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author


 

I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people from around the world who visit this premier global health information website every month.  Over the past 12 months, more than 2.6 million pages of high-quality medical research findings were served to the worldwide audience of health-conscious readers.  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.


 


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Watchful Waiting (Observation) Versus Surgery for Prostate Cancer





 

A new landmark study suggests that some patients with early-stage prostate cancer can be safely observed rather than undergoing radical surgery.


 

 

WATCHFUL WAITING (OBSERVATION) VERSUS SURGERY FOR PROSTATE CANCER

In the United States, prostate cancer is the most common type of non-skin cancer occurring among men, and the second most common cause of cancer death in men.  (Lung cancer, an almost completely preventable form of cancer, sadly, remains the most common cause of cancer death for both men and women.)  The American Cancer Society estimates that, in 2012, more than 240,000 new cases of prostate cancer will be diagnosed, and more than 28,000 men will die from this form of cancer.

The debate surrounding the ideal management of early-stage prostate cancer has revolved around “watchful waiting” (observation) versus aggressive treatment with surgery or radiation therapy.  In many cases, prostate cancer is a slow-growing cancer, and when it arises in older men in particular, it seldom leads to death.  On the other hand, there are more aggressive variants of prostate cancer that spread rapidly, and these forms of prostate cancer can indeed lead to death.  The dilemma regarding which patients can be safely observed and which should be subjected to aggressive treatment has been difficult to resolve, however, because it can be difficult to determine, up front, which patients will benefit from treatment and which will not.

Last year, I reviewed a prospective randomized clinical research study from Sweden which revealed a significant improvement in survival among patients with prostate cancer who underwent prostate cancer surgery, when compared to patients who were managed with “watchful waiting”  (Prostate Cancer: Watchful Waiting Versus Surgery (Prostatectomy).)  Now, a similar new prospective randomized clinical research study provides additional important clinical information that may help doctors to identify selected prostate cancer patients who can be safely observed, thus avoiding radical cancer treatments that are associated with a high incidence of incontinence and impotence, as well as other potentially serious complications.  This new study appears in the current issue of the New England Journal of Medicine, the same journal that published last year’s Swedish prostate cancer clinical research study.

In this prospective randomized study, 731 men with newly diagnosed prostate cancer were randomly assigned to undergo radical prostate cancer surgery (prostatectomy) versus observation only.  This group of research volunteers, with an average age of 67 years, was then followed for approximately 10 years, and their outcomes were carefully monitored.  It is important to note that all of these men had early-stage prostate cancer, which appeared not to have spread outside of the prostate gland.

Following 10 years of monitoring, on average, 47 percent of the men who underwent prostatectomy died, while 50 percent of the men in the observation group died (this small difference in overall survival was not statistically significant.)  When the researchers looked at the risk of death caused specifically by prostate cancer, or due to complications associated with prostatectomy, 5.8 percent of the men in the prostatectomy group died directly as a result of either their prostate cancer or due to complications of surgery, while 8.4 percent of the men in the observation group died due to their prostate cancer, for a relative cancer-specific survival difference of 37 percent and an absolute difference of 2.6 percent in favor of the men who underwent surgery instead of observation.  Importantly, however, this observed difference in cancer-specific survival did not quite achieve statistical significance, suggesting that the cancer-specific survival benefit of radical prostatectomy in men with early-stage prostate cancer is, in general, either nonexistent or very small, at least over a 10-year period of time.

Importantly, when the authors of this study assessed prostate-specific antigen (PSA) levels, specifically, as a predictor of survival among the two groups of men who participated in this study, they found that prostatectomy did, in fact, significantly improve survival among men with a PSA level greater than 10 nanograms per milliliter (ng/ml), compared to observation alone.

As is often the case, pundits on either side of the prostate cancer treatment debate will find some ammunition in this study’s findings to support their respective positions.  Those experts who espouse aggressive treatment for most or all early-stage prostate cancers will note the nearly 3 percent improvement in absolute survival associated with radical prostatectomy, although, in this study, this difference in absolute survival was not considered to be statistically significant.  (However, it should be noted that the observed survival advantage associated with surgery in this study would have actually been higher, and perhaps statistically significant as well, had there not been a postsurgical death of one of the patients in the prostatectomy group.)  On the other hand, proponents of “watchful waiting” will point to the very small difference in observed death rates between these two groups of patients, and the relatively large number of adverse events associated with radical prostatectomy (21 percent).  However, in my view, this study’s findings offer a reasonable, evidence-based, “middle ground” strategy, based upon patients’ PSA levels.  Specifically, for older patients who have a PSA level below 10 ng/ml and no worrisome microscopic features that suggest an aggressive variant of prostate cancer, observation may indeed be a reasonable alternative to prostatectomy, based upon the findings of this landmark study.  (Unfortunately, this study did not assess radiation therapy, which is the other common form of treatment for early-stage prostate cancer.)

In completing my review of this important clinical study, I should also note that 1 out of 5 patients who enrolled in this prospective study did not remain within their assigned groups and, therefore, crossed over into the opposite group after they entered into this study.  However, while this factor does somewhat complicate the analysis of the data collected in this study, it probably does not affect the overall accuracy of the study’s conclusions.

I do not believe that this important but admittedly imperfect study will, by itself, completely resolve the ongoing debate regarding the optimal management of early-stage prostate cancer.  However, as one of only a very few well-performed randomized prospective clinical studies that have directly compared radical surgery with observation alone, and with reasonable long-term follow-up of patients, this is a very important clinical research study for both patients and their prostate cancer physicians alike.  Because of this study, both patients and their doctors will now be better able to make individualized, evidence-based decisions regarding the likely risks and benefits of surgery versus careful observation as an initial approach to prostate cancer management.


At this time, more than 8 percent of Americans are unemployed.  According to the Bureau of Labor Statistics, however, the unemployment rate for veterans who served on active duty between September 2001 and December 2011 is now more than 12 percent.  A new website, Veterans in Healthcare, seeks to connect veterans with potential employers.  If you are a veteran who works in the healthcare field, or if you are an employer who is looking for physicians, advanced practice professionals, nurses, corpsmen/medics, or other healthcare professionals, then please take a look at Veterans in Healthcare. As a retired veteran of the U.S. Army, I urge you to hire a veteran whenever possible.


For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my bestselling book, “A Cancer Prevention Guide for the Human Race,” from AmazonBarnes & NobleBooks-A-MillionVroman’s Bookstore, and other fine bookstores!

Within one week of publication, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com “Top 100 Bestseller’s List” for Kindle e-books. Within three months of publication, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.comTop 100 New Book Releases in Cancer” list.




Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


 

Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author


 

I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people from around the world who visit this premier global health information website every month.  (More than 1.3 million pages of high-quality medical research findings were served to the worldwide audience of health-conscious people who visited Weekly Health Update in 2011!)  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.


 






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Prostate Cancer: Watchful Waiting Versus Surgery (Prostatectomy)

Welcome to Weekly Health Update


“A critical weekly review of important new research findings for health-conscious readers”



 

PROSTATE CANCER: WATCHFUL WAITING VERSUS SURGERY (PROSTATECTOMY)

As I have observed in previous columns, the optimal management of patients with prostate cancer is the subject of ongoing debate among prostate cancer experts. Most of the accepted treatments for prostate cancer carry a considerable risk of long-term complications, and determining precisely which patients will benefit from aggressive treatment, versus those who are not likely to benefit, has proven to be a very difficult clinical problem.

We know that for many men, and elderly men in particular, prostate cancer often grows very slowly, and often does not result in any major complications (including death) either with or without treatment. On the other hand, more than 32,000 American men died from more aggressive forms of prostate cancer in 2010. For selected men who develop less aggressive, indolent, forms of prostate cancer, “watchful waiting” may be more appropriate than subjecting these men to aggressive surgery or radiation treatment for their cancers. At the same time, men with potentially more aggressive cancers should, obviously, consider prostatectomy (surgical removal of the prostate gland) or radiation therapy to treat their disease. Unfortunately, we are still not able to predict how aggressively any individual patient’s prostate cancer will behave over time, nor are we able to accurately predict whether or not some other cause of death is more likely to occur rather than death due to prostate cancer.This inability to accurately predict the future likelihood of dying from prostate cancer, either with or without treatment, for individual patients has made it very difficult to accurately advise patients whether or not they might be candidates for “watchful waiting” rather than recommending aggressive prostate cancer treatment. However, a newly published prospective, randomized clinical research trial from Sweden, which appears in this week’s New England Journal of Medicine, may help doctors and their patients to make a more informed decision regarding the management of early-stage prostate cancer.

In this study, 695 men with early-stage prostate cancer were randomly assigned either to “watchful waiting” or radical prostate surgery (prostatectomy). These two groups of men were then followed for an average of about 13 years, and the clinical outcomes in each group, including death due to prostate cancer, were compared. Among the men in the “watchful waiting” group, the estimated risk of death due to prostate cancer was 21 percent, as compared to a 15 percent risk of death due to prostate cancer among the men who underwent prostatectomy. This difference in cancer-specific survival was equivalent to a 38 percent reduction in the relative risk of dying from prostate cancer with prostatectomy, and an absolute reduction in the risk of death of more than 6 percent.

The findings of this clinical research study are similar to other recent studies that have also linked prostate cancer treatment, in otherwise healthy men, with improved survival when compared to “watchful waiting” alone, and especially for men with early-stage prostate cancer that is still confined within the prostate gland itself. While “watchful waiting” may still be appropriate for some very elderly or very ill patients, the findings of this study, and others like it, still appear to favor active treatment for early prostate cancer in most otherwise healthy men.


For a comprehensive guide to living an evidence-based cancer prevention lifestyle, including strategies to reduce your risk of prostate cancer and other cancers, order your copy of my new book, A Cancer Prevention Guide for the Human Race. For the price of a cheeseburger, fries, and a shake, you can purchase this landmark new book, in both paperback and e-book formats, and begin living an evidence-based cancer prevention lifestyle today!

For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my new book, A Cancer Prevention Guide for the Human Race,” from Amazon, Barnes & Noble, Books-A-Million, Vroman’s Bookstore, and other fine bookstores!


On Thanksgiving Day, 2010, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com “Top 100 Bestseller’s List” for Kindle e-books! On Christmas Day, 2010, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.comTop 100 New Book Releases in Cancer” list!


Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity



Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author



For a different perspective on Dr. Wascher, please click on the following YouTube link:

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I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people, from around the world, who visit this premier global health information website every month. (More than 1.2 million health-conscious people visited Weekly Health Update in 2010!) As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.





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