Tuesday, May 4, 2010

Smoking While Pregnant May Raise Psychiatric Risks in Kids

By Madonna Behen
HealthDay Reporter

TUESDAY, May 4 (HealthDay News) -- A woman who smokes while pregnant increases her baby's risk of developing psychiatric problems in childhood and young adulthood, a new Finnish study suggests.

While there's plenty of evidence that smoking during pregnancy puts unborn children at risk for long-term health problems such as asthma, ear infections and respiratory disease, this research is among the first to find a connection between prenatal smoking and an increased risk for mental illnesses, such as attention-deficit/hyperactivity disorder (ADHD) and depression, in the mother's offspring.

Researchers at Turku University Hospital in Finland analyzed the birth records of more than 175,000 Finnish children born in the late 1980s, as well as their use of psychotropic medications as children and young adults.

Children exposed to prenatal smoking were 32 percent more likely overall to have taken a psychiatric drug than children whose mothers didn't smoke during pregnancy, the researchers found. The risk was even higher in the offspring of women who smoked more than a pack a day while pregnant. Their kids were 44 percent more likely to use psychiatric drugs than children whose moms didn't smoke.

Study author Mikael Ekblad said animal studies have shown that prenatal nicotine exposure interferes with the development of fetal brain cells. "In our previous study, published in the Journal of Pediatrics in February 2010, we found that prematurely born infants exposed to prenatal smoking had smaller frontal and cerebellar brain volumes than the unexposed infants. These brain regions are important for normal cognitive development," said Ekblad, a medical student and pediatric researcher.

The researchers collected data on all children born in Finland from 1987 through 1989. In addition to information about maternal smoking, they looked at gestational age, birth weight and five-minute Apgar scores. Using records from Finland's Social Insurance Institution, they also examined the children's use of psychotropic medications between 1994 and 2007.

Roughly 12 percent of the young adults had used psychiatric medications, and of this group, about 19 percent had mothers who smoked during their pregnancies.

The researchers found that exposure to prenatal smoking increased the risk for using all psychotropic drugs, but especially ADHD medications, antidepressants and drugs to treat addiction. For example, kids whose mothers smoked more than a pack of cigarettes a day were two and a half times more likely to take stimulants for ADHD than kids whose moms didn't smoke during pregnancy.

The risk for all medication use was similar in males and females, and remained after adjusting for risk factors at birth, such as Apgar scores and birth weight.

Since mental illness often runs in families, the researchers also controlled for a possible genetic connection by analyzing records of the mother's psychiatric inpatient care prior to giving birth. "One of the strengths of our study is that we could control for maternal mental health diseases," said Ekblad, who added that the genetic effect is higher in psychiatric problems that require hospitalization.

"This is an interesting study which raises the important possibility that prenatal exposure to smoking may pose additional risks that have not been identified to date, but based on the information available so far, the effect seems to be small," said Neil Grunberg, a professor of medical psychology, clinical psychology and neuroscience at the Uniformed Services University of the Health Sciences in Bethesda, Md.

Grunberg also questioned whether the study adequately controlled for possible genetic and environmental factors. "In the U.S., there is a high correlation between smoking and psychological disorders," said Grunberg. In addition, many people have a family history of psychiatric disorders, even though they themselves have never been diagnosed with one, he said.

The findings were to be presented Tuesday at the Pediatric Academic Societies annual meeting in Vancouver, British Columbia, Canada.

Saturday, May 1, 2010

Law enforcers learn about mental illness with crisis intervention training

By Jodi Hausen, Chronicle Staff Writer

A man waved a saber sword wildly in the air as his wife screamed obscenities at him. An agitated couple complained about loud music from a "weird" neighbor's apartment.

Meanwhile, a woman said her neighbors had surreptitiously installed cameras in her home and were involved in a pornography ring.

All these fictitious incidents were happening in the sky boxes at Montana State University's Bobcat Stadium Friday and law enforcement officials were there to respond to them.

Though these practice scenarios were nothing new for the 24 law enforcement officers who were handling these situations, they were doing so with a better understanding of mental illness and a new way to deal with it after participating in a weeklong crisis intervention training.

"You can write them as many citations for noise as you want, but you're really here for a mental health issue," said Gallatin County Deputy Don Peterson and a previously-trained CIT participant after officers dealt with one chaotic scene -- a wheelchair-bound drug-abusing mother and her three mentally-ill teen daughters, their two angry neighbors and a very loud boom box.

"Time (spent) now will save you time later," Peterson added.

Before CIT was instituted in the county last year, officers were less familiar with mental illness and more likely to try to resolve an aberrant situation expediently. However, calming down an agitated person with psychological issues takes time and patience, they were taught. And if the officers succeed in calming a person, it often results in fewer arrests overall and a better outcome for the person they are dealing with.

The training "definitely gives you a better understanding and different tools on how to deal with people with mental illness as opposed to feeling like you have to resolve the situation quickly," Bozeman police officer Scott McCormick said. "It slows you down."

That sentiment was repeated by Deputy Doug Lieurance after the sword-swinging man amped-up on cocaine with the screaming wife tried to barricade himself in one room and then locked himself in another. Eventually he, too, was calmed down.

"Time is on your side," Lieurance said. "He hasn't made any aggressive moves."

And though one participant saw his law enforcement training at odds with CIT philosophy in this hostage-rescue scenario, trainers argued that forcibly pulling the wife over a counter would only escalate the scene and could lead to a deadly force situation.

"Don't compromise yourself for Ms. Belligerent here," Lieurance said. "Don't make her problem your problem."

"But there's no right or wrong," Deputy Jim Andrews, who coordinates the training, said. "It's to make you think."

Put on by the Gallatin County Sheriff's Office for officers mostly from Gallatin County, volunteers (like Friday's actors) and assistants came from a variety of local and statewide agencies including Gallatin County Drug and Alcohol Services, Probation and Parole, Court Services,, Attorney's Office and Gallatin Mental Health Center, the Help Center, Bozeman Deaconess Hospital, Spectrum Medical, National Alliance of Mental Illness and Montana State Hospital in Warm Springs.

This is the third CIT session in Gallatin County and the second in as many months due to demand, Andrews said.

"We've kind of rounded a corner" with this third class, Andrews said. "Before we needed to convince officers this is a good thing. But now people are talking about it and they know."

"This group rounds me out," Gallatin County Sheriff's Lt. Jeff Wade, who has been in charge of the training, said. Now about 45 percent of Gallatin County's law enforcement officers are CIT-trained, including at least one from every agency, save for Montana Highway Patrol who don't deal with these issues often.

MSU police officer Thad Winslow said the training was definitely beneficial.

"The biggest thing is just understanding the (mental health) resources that are available and on top of that just getting a better understanding that there's a lot more to why people are doing what they're doing," he said. "They're not just violating the law."