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In small theater spaces across the United States, people fighting psychiatric illness are learning that acting can be a powerful form of therapy, while the shows they put on help educate audiences through deeply personal accounts of mental health issues.

“Theater arts can really give patients a very valuable additional opportunity to piece their lives back together,” said David A. Faigin, department of psychology, Bowling Green State University, Bowling Green, Ohio. He believes the approach works by “focusing on the same things that standard interventions focus on: community reintegration and social reintegration.”

Faigin, along with Bowling Green professor of clinical psychology Catherine Stein, co-authored a review of theater as mental health therapy in a recent issue of of Psychiatric Services.

More and more, mental health professionals are viewing the arts — visual arts, dance, writing — as key tools in patients’ recovery, and theater is no exception.

Faigin has tracked the efficacy of the technique through the Stars of Light group, a community theater linked to the Janet Wattles Center, a mental health agency serving adults in the Rockford, Ill. area.

Stars of Light has had a 15-year partnership with the Wattles Center, putting on productions using amateur actors diagnosed with a wide range of mental health problems. Faigin described the effort as “an exciting exemplar of a grass-roots, community-based theater setting devoted to involving and helping people with psychiatric disabilities.”

He estimates there are about 20 similar groups scattered across the country in places like Chicago, Memphis and Connecticut. In these programs, artistic directors work with mental health staff to help bring structure to an environment where patients are free to generate the artistic content necessary to stage theatrical productions. That means everything from script development (often involving autobiographical content) to final performances at churches and community centers.

These kinds of theaters are not large, typically involving between six and 12 volunteer actors. Sometimes they are closely connected and managed by a psychiatric facility, and sometimes they are entirely independent.

The idea of meshing therapy with the dramatic arts isn’t new. As Faigin pointed out, psychotherapy has long employed role-playing techniques to help patients tackle past traumas, depression or personality disorders, and to foster awareness and self-esteem.

“Research has shown that chronic mental illness is so incredibly disruptive of so many aspects on one’s life — family dynamics, relationships, employment — that there’s sort of a broken self there in terms of meaning and purpose,” Faigin noted. But for many patients, performance “sparks a real process of identity development by being forced to get up on stage and be themselves — quite literally — [and] by sharing their own personal stories in recovery.”

At the same time, acting by its very nature can also give the patient “a break from everyday life, by being somebody else for a half-hour,” Faigin said.

“They have a creative voice and express themselves as someone who has something to say,” he explained. “It’s a very in-your-face opportunity that forces the patients to ‘own it,’ because they’re accountable when they’re up on stage in a live performance in ways that they are not in the privacy of their home.”

Other experts agreed that theater can play a role in mental health care.

“Mostly my experience has been with patients who have found it very useful to enroll in acting courses,” said Marvin Aronson, a private practitioner in individual, group, and couples therapy, as well as former director of the group therapy department at the Postgraduate Center for Mental Health in New York City. “It’s not putting on a play or a long-term consuming involvement, but the principle is probably not so different. The setting gives them a license to learn how people spontaneously express feelings, and be exposed to people who are not inhibited.”

People who often benefit most from the approach are those who have had past experiences that have taught them to shut down their emotional responses, he added.

“Acting gives them an excuse, in essence, to learn how to express themselves,” Aronson said.

Robin F. Goodman, a clinical psychologist, art therapist and past president of the American Art Therapy Association, agreed.

“Lots of times there are experiences that have happened to you that are housed in non-verbal ways, and the arts are a way to access some of this stuff in terms of a feeling, an emotion, a movement, a song,” she noted. “The experience of theater can be a terrific way to get out some of these things.”

And it’s not only the acting that’s important. Mounting any kind of theatrical production involves a long timeline and teamwork from start to finish.

“That’s a good challenge for patients, to have them accept a level of responsibility to and from themselves and their peers,” Faigin said. “They get support and they give it. So at an emotional level there’s a sense of feeling safe in a group, and part of a group, and feeling that people understand them.”

Audiences can benefit, too, often getting an inside look into the world of those with mental illness. By letting people with bipolar disorder and other conditions step out of the shadows, the plays help overturn the stigma long attached to such ills.

“When these patients publicly share their own stories and their own voices they inevitably raise awareness about mental health issues, so it also offers a very important public health benefit,” Faigin explained.

He said he’s often seen theater help move patients to a better place, no matter what their diagnosis. “It gives them a real sense of purpose, a real creative spirit and a real creative voice. It can be a very powerful thing.”

SOURCES: David A. Faigin, M.A., psychology department, Bowling Green State University, Bowling Green, Ohio; Robin F. Goodman, PhD, past president, American Art Therapy Association, and clinical psychologist, art therapist and trauma specialist; Marvin Aronson, Ph.D., private practice in individual, group and couples therapy, and former director, group therapy department, Postgraduate Center for Mental Health, New York City.

Genetics play an important role in the development of problem gambling in both women and men, a new study has found. Previous research has shown that problem gambling runs in families, with one study reporting that 8 percent of the first-degree relatives of people with gambling disorders had a history of similar problems, compared with 2 percent of relatives of unaffected individuals, according to background information provided in the report. For the new study, researchers assessed nearly 2,900 pairs of twins in Australia, aged 32 to 43, and found that nearly all of them had gambled at some point, about half had gambled at least once a month and about one-third had gambled at least once a week. About 2.2 percent met the criteria for pathological gambling (3.4 percent of men and 1.2 percent of women), and 12.5 percent had experienced one or more symptoms of pathological gambling (18.2 percent of men and 8.3 percent of women). While genes were estimated to contribute almost 50 percent to differences between people in terms of gambling disorders, “there was no evidence for shared environmental influences contributing to variation in disordered gambling liability,” Wendy S. Slutske, of the University of Missouri-Columbia, and colleagues reported in the June issue of the Archives of General Psychiatry. The researchers found no evidence of gender differences in the causes of problem gambling. “This study represents a major step forward in that it establishes for the first time that genes are as important in the etiology of disordered gambling in women as they are in men,” the researchers wrote. “In addition to similar relative contributions of genetic vs. environmental factors to variation in liability for disordered gambling, the results suggest that the susceptibility genes contributing to variation in liability for disordered gambling may also overlap considerably in men and women.” The study authors concluded that “the discovery of the specific genes and environments involved in the development of disordered gambling remains an important direction for future research.” SOURCE: JAMA/Archives journals.

Smoking tobacco with a water pipe is gaining popularity in western countries, and those most likely to indulge are privileged young men who live apart from their parents, a new study finds.

Young adults in Montreal who use water pipes, or hookahs, are typically 18- to 20-year-old, English-speaking males who live away from their parents and have a higher household income than non-users, University of Montreal researchers report. Water pipe smokers are also more likely to use other psychoactive drugs, such as marijuana, the study found.

“These are young men who are living away from home for the first time and who have disposable cash, and so they have lots of freedom and leisure time to try out new things,” said study co-author Jennifer O’Loughlin, a professor in the department of social and preventive medicine.

Hookah bars are cropping up in U.S. and Canadian cities and college towns, where young people often gather to smoke sweetened, flavored tobacco, she added. “With the increasing restrictions on tobacco use in public places, I’m afraid that young adults wanting to smoke in social situations may be choosing hookah bars,” said O’Loughlin.

For their study, published online May 10 in the journal Pediatrics, the researchers analyzed questionnaires filled out by 871 people aged 18 to 24 in 2007. According to the study, 23 percent of those surveyed had used a hookah during the previous year, which was almost three times the number identified in a similar survey conducted just the year before.

Wasim Maziak, an associate professor at the University of Memphis School of Public Health who studies water pipes in the United States and the Middle East, said these findings are consistent with a review of the literature that he and his colleagues recently published in the American Journal of Health Behavior, which estimated that 10 percent to 20 percent of some young adult populations in the United States are water pipe users.

“Looking at today vs. where we were about seven or eight years ago, the trend in water pipe popularity in the U.S. has surpassed my worst expectations,” said Maziak. “Cigarette smoking is actually declining all over the world, but other tobacco use is increasing and that’s mostly due to the water pipe.”

One reason why water pipes have become so popular among young people is because “they believe that it’s safer than smoking cigarettes because the smoke is filtered through water, and so it’s therefore less toxic,” said study author Erika Dugas, a research assistant at the University of Montreal Hospital Research Center. Also, the smoke that’s inhaled has a smoother texture than cigarette smoke, and the flavored tobacco often masks the nicotine taste, she added.

But water pipe smoking is no safer than cigarettes, recent studies show. One study, which Maziak co-wrote, revealed that water pipe smokers inhale about 48 times more smoke than they would through a cigarette. Another recent study showed that leisurely puffing on a hookah for an hour exposes the smoker to as much carbon monoxide as a pack-a-day cigarette habit would. A few cases of carbon monoxide poisoning associated with water pipe smoking have been reported, Maziak said.

The study authors conclude that more research is needed to understand the health effects of water pipes. But in the meantime, “people who’ve used or have considered using a water pipe should do some investigation in terms of the potential health effects,” said O’Loughlin. “They shouldn’t just sit back and think it’s an innocuous behavior that has no impact.”

SOURCES: Jennifer O’Loughlin, Ph.D., professor, department of social and preventive medicine, University of Montreal; Wasim Maziak, Ph.D., associate professor, University of Memphis School of Public Health, Tennessee; Erika Dugas, M.Sc., research assistant, University of Montreal Hospital Research Center;

Being vaccinated against pneumonia doesn’t reduce the risk of heart attack or stroke in men older than 45, a new study finds.

The research included more than 84,000 men, ages 45 to 69, who enrolled in the California Men’s Health Study between January 2002 and December 2003 and were followed until Dec. 31, 2007.

During the follow-up, there were 1,211 first heart attacks among men who’d received pneumococcal vaccine (rate of 10.7 per 1,000 person-years) and 1,494 first heart attacks among men who hadn’t received the vaccine (6.07 per 1,000 person-years).

There were 651 strokes among vaccinated men (5.3 per 1,000 person-years) and 483 strokes among unvaccinated men (1.9 per 1,000 person-years).

The data suggests no association between pneumococcal vaccination and reduced risk of heart attack or stroke, concluded the researchers.

“In addition, association was not observed either in the current smokers, men with history of diabetes, men with history of hypertension, or men of the low-risk group,” wrote Hung Fu Tseng, of Kaiser Permanente Southern California, Pasadena, and colleagues.

The study is published in the May 5 issue of the Journal of the American Medical Association.

SOURCE: Journal of the American Medical Association, news release.

If diabetics start the drug metformin early — within three months of diagnosis — it appears the drug will remain effective longer, a new study finds.

“This study suggests that to gain full benefit from metformin, patients should start taking it as soon as they find out they have diabetes,” lead author Jonathan B. Brown, an investigator with the Kaiser Permanente Center for Health Research in Portland, Ore., said in a news release from Kaiser Permanente.

Metformin, a generic drug, is used to treat type 2 diabetes by helping the body control blood-sugar levels. However, most people turn to other medications after a while because metformin stops working, but other drugs can be more expensive and boost the risk for weight gain.

The study, which followed almost 1,800 diabetics for up to five years, found that the drug took longer to fail in people who began taking it within three months of being diagnosed with diabetes.

In them, it failed at a rate of 12 percent a year. For those who began taking metformin a year or two after diagnosis, it failed at a rate of 21.4 percent a year.

“We believe that starting the drug early preserves the body’s own ability to control blood sugar, which in turn prevents the long-term complications of diabetes, like heart disease, kidney failure and blindness,” study co-author Gregory A. Nichols, an investigator with the Kaiser center, said in the news release. “The American Diabetes Association recommends that patients start taking metformin and make lifestyle changes as soon as they are diagnosed. This study provides more evidence to back up that recommendation.”

The finding is published in the March issue of Diabetes Care.

Tests that try to single out who will have bleeding problems when they get a clot-preventing drug such as Plavix before surgery aren’t ready for regular use, a new Dutch study concludes.

Three of the six tests, which measure the function of platelets, the blood cells that clump together to form clots, did provide some useful information, according to the report in the Feb. 24 issue of the Journal of the American Medical Association.

“However, the predictability of these three tests was only modest,” the report added. “None of the tests provided accurate prognostic information to identify patients at higher risk of bleeding.”

And so, the study “does not support the use of platelet function testing to guide clinical practice in a low-risk population of patients,” the Dutch researchers wrote.

The conclusion did not surprise U.S. doctors who have studied the issue. “For my purposes, these tests are research tools,” said Dr. Deepak Bhatt, chief of cardiology at the VA Boston Healthcare System, and a member of a group of U.S. cardiologists who said pretty much the same thing in a 2008 statement.

Yet, the Dutch study “is well-done and a valuable contribution to the field,” Bhatt said. “It shows just how much different tests add to clinical judgment.”

The study included 1,069 people given clopidogrel (Plavix) before having stents implanted after artery-opening angioplasty. They were followed for a year to record the incidence of death, nonfatal heart attacks or strokes, and new blockages of the treated arteries. Three of the tests had some predictive value for those events, but three didn’t. None predicted the major side effect of Plavix treatment, which is excessive bleeding.

The study is a starting point for understanding a complex clinical situation, Bhatt said. “It sets us up for the next step. You have a patient at moderate risk; what do you do with that test information? That is a question that needs to be answered.”

Several large studies are underway to provide an answer, Bhatt said. They are looking at large numbers of people who get clot-preventing drugs. “Right now, you can conclude that some tests are correlated with an increased risk of adverse events, but what to do with that information is unclear,” Bhatt said. “Those ongoing trials may provide an answer.”

Trail results will not be available for “a minimum of one to two years,” he noted. “My feeling is that until then, there is not enough data to test routinely.”

While the Dutch study provided “an important observation,” it included a relatively narrow portion of people eligible for clot-dissolving drug therapy, added Dr. Magnus Ohman, director of the Program for Advanced Coronary Disease at Duke University in Durham, N.C.

“This tested patients after stenting, a relatively isolated group of patients,” Ohman said. “All patients who are treated medically with clot-preventing medication tend to be older, have more bleeding, have more problems with metabolism. The study fails to give an overall picture of how high-risk patients fare.”

Even though the study population was relatively large, it is small in relation to the total population of people who get clot-preventing drugs, Ohman said. “If we studied more patients and higher-risk patients, we might get a better handle on this. We might find other cutoff points of greater value.”

Some of the tests “clearly give information we doctors need,” Ohman said. Right now, Duke cardiologists use only the most complex test in the study, light transmittance aggregometry, which requires sophisticated laboratory equipment and takes hours for results, he said.

“We are in the process of evaluating the bedside tests because they will have an important role to play in the future,” Ohman said.

SOURCES: Deepak Bhatt, M.D., chief, cardiology, VA Boston Healthcare System; Magnus Ohman, M.D., professor, medicine, and director, Program for Advanced Coronary Disease, Duke University, Durham, N.C.

Stress, history of depression, lack of social support and unintended pregnancy are among the major factors that contribute to increased risk of depression in pregnant women, a new study shows.

Other important factors are maternal anxiety, domestic violence and having public insurance coverage, said the University of Michigan researchers, who reviewed 159 studies conducted between 1980 and 2008.

The study appears in the January issue of the American Journal of Obstetrics & Gynecology.

Depression, which occurs in about 12.7 percent of pregnant women, can cause problems for mothers and babies, including pre-term delivery, preeclampsia, sleep disturbances and disrupted mother-infant bonding.

It’s important for physicians to know how to identify depression in pregnant women, said the study authors, who noted that not all women who test positive on depression screening tests have or will develop clinical depression.

“We are hoping that [health-care] providers can use the presence or absence of risk factors such as those identified in our study to enhance their assessments for depression in addition to the information they obtain from the screening test,” study author Dr. Christie A. Lancaster, a clinical lecturer in the obstetrics and gynecology department at U-M, said in a news release.

SOURCE: University of Michigan, news release