The New Old Age Blog: Grief Over New Depression Diagnosis

When the American Psychiatric Association unveils a proposed new version of its Diagnostic and Statistical Manual of Mental Disorders, the bible of psychiatric diagnoses, it expects controversy. Illnesses get added or deleted, acquire new definitions or lists of symptoms. Everyone from advocacy groups to insurance companies to litigators — all have an interest in what’s defined as mental illness — pays close attention. Invariably, complaints ensue.

“We asked for commentary,” said David Kupfer, the University of Pittsburgh psychiatrist who has spent six years as chairman of the task force that is updating the handbook. He sounded unruffled. “We asked for it and we got it. This was not going to be done in a dark room somewhere.”

But the D.S.M. 5, to be published in May, has generated an unusual amount of heat. Two changes, in particular, could have considerable impact on older people and their families.

First, the new volume revises some of the criteria for major depressive disorder. The D.S.M. IV (among other changes, the new manual swaps Roman numerals for Arabic ones) set out a list of symptoms that over a two-week period would trigger a diagnosis of major depression: either feelings of sadness or emptiness, or a loss of interest or pleasure in most daily activities, plus sleep disturbances, weight loss, fatigue, distraction or other problems, to the extent that they impair someone’s functioning.

Traditionally, depression has been underdiagnosed in older adults. When people’s health suffers and they lose friends and loved ones, the sentiment went, why wouldn’t they be depressed? A few decades back, Dr. Kupfer said, “what was striking to me was the lack of anyone getting a depression diagnosis, because that was ‘normal aging.’” We don’t find depression in old age normal any longer.

But critics of the D.S.M. 5 now argue that depression may become overdiagnosed, because this version removes the so-called “bereavement exclusion.” That was a paragraph that cautioned against diagnosing depression in someone for at least two months after loss of a loved one, unless that patient had severe symptoms like suicidal thoughts.

Without that exception, you could be diagnosed with this disorder if you are feeling empty, listless or distracted, a month after your parent or spouse dies.

“D.S.M. 5 is medicalizing the expected and probably necessary process of mourning that people go through,” said Allen Frances, a professor emeritus at Duke who chaired the D.S.M. IV task force and has denounced several of the changes in the new edition. “Most people get better with time and natural healing and resilience.”

If they are diagnosed with major depression before that can happen, he fears, they will be given antidepressants they may not need. “It gives the drug companies the right to peddle pills for grief,” he said.

An advisory committee to the Association for Death Education and Counseling also argued that bereaved people “will receive antidepressant medication because it is cheaper and ‘easier’ to medicate than to be involved therapeutically,” and noted that antidepressants, like all medications, have side effects.

“I can’t help but see this as a broad overreach by the APA,” Eric Widera, a geriatrician at the University of California, San Francisco, wrote on the GeriPal blog. “Grief is not a disorder and should be considered normal even if it is accompanied by some of the same symptoms seen in depression.”

But Dr. Kupfer said the panel worried that with the exclusion, too many cases of depression could be overlooked and go untreated. “If these things go on and get worse over time and begin to impair someone’s day to day function, we don’t want to use the excuse, ‘It’s bereavement — they’ll get over it,’” he said.

The new entry for major depressive disorder will include a note — the wording isn’t final — pointing out that while grief may be “understandable or appropriate” after a loss, professionals should also consider the possibility of a major depressive episode. Making that distinction, Dr. Kupfer said, will require “good solid clinical judgment.”

Initial field trials testing the reliability of D.S.M. 5 diagnoses, recently published in The American Journal of Psychiatry, don’t bolster confidence, however. An editorial remarked that “the end results are mixed, with both positive and disappointing findings.” Major depressive disorder, for instance, showed “questionable reliability.”

In an upcoming post, I’ll talk more about how patients might respond to the D.S.M. 5, and to a new diagnosis that might also affect a lot of older people — mild neurocognitive disorder.

Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”


This post has been revised to reflect the following correction:

Correction: January 24, 2013

An earlier version of this post misspelled the surname of a professor emeritus at Duke who chaired the D.S.M. IV task force. He is Allen Frances, not Francis.

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United to cut 600 front-office jobs









United Continental Holdings Inc. will cut about 600 front-office jobs through voluntary and involuntary cuts, the company said Thursday as it announced disappointing financial losses for 2012.

The world's largest airline did not detail where cutbacks will take place, but Chicago is likely to be most affected considering the corporate headquarters and network operations center are in downtown Chicago and that Chicago O'Hare airport is one of the airline's largest hubs.

The job cuts were announced Thursday morning during a conference call about the airline's profits. United officials said they were disappointed in the airline company's 2012 performance and pledged to improve in 2013, both in financial performance and the airline's operational reliability.

They said they intend to win back corporate customers who defected to other airlines last year when the airline experienced periods of poor on-time performance and high cancellations rates. The operational problems, which have abated since the fall, stemmed from numerous computer-related glitches after the airline merged United and Continental customer reservation systems onto a common platform last March.

United CEO Jeff Smisek called 2012 "the toughest year of our merger integration," but that the airline was "back on track."

"Despite our integration pains, we accomplished an enormous amount and we are now in a position to go forward as a single carrier and compete effectively on a global scale," he said. "Our operations are running smoothly. Our many product improvements are rolling out and our customer satisfaction scores are climbing."

Smisek also said the airline maintains its confidence in the Boeing 787 Dreamliner, which was grounded in the U.S. and elsewhere after numerous glitches, including a serious fire hazard with its lithium ion batteries.

He said he had confidence in the airplane and "Boeing's ability to fix the issues just as they have done on every other new aircraft model they've produced."

Smisek said he has no indication on when the Federal Aviation Administration will allow the planes to fly again, including Dreamliner on a route between Chicago and Houston. Boeing is also based in Chicago.

United, the only U.S. carrier currently operating 787 planes, has six Dreamliners. Smisek said the company expects to take delivery of two additional 787s in the second half of this year.

EARNINGS

United Continental said it lost $723 million in 2012, or $2.18 per share. Excluding special charges of $1.3 billion, mostly related to merging United and Continental, the company earned $589 million, or $1.59 per share, meeting Wall Street analyst expectations.

In the fourth quarter, United lost $620 million, or $1.87 per share, compared with a loss of $138 million, or 42 cents per share, in the same quarter a year earlier.

It took charges of $430 million in the quarter, with much of that tied to paying off pension debt and costs for systems integration and training and severance. Excluding items, United said the 2012 quarterly loss was 58 cents a share, compared with a 61 cent loss expected by analysts on average, according to Thomson Reuters I/B/E/S.

Revenue fell 2.5 percent to $8.7 billion.

Superstorm Sandy, which barreled through the U.S. Northeast in late October, reduced revenue by about $140 million and profit by about $85 million in the fourth quarter. The storm caused shutdowns at major New York area airports, including New Jersey's Newark Liberty International where United operates a major hub.

CUSTOMER SERVICE

Customer service will be a larger focus for the airline, Smisek said during the conference call.

That focus includes a comprehensive customer service training program for airport agents, contact center agents and flight attendants, he said. It will also roll out a program called "It's Our Job," a companywide approach to customer service "that clearly explains our customer service standards and expectation for front line coworkers," Smisek said.

It will also include an expanded recognition program to reward employees for outstanding service, collecting more customer-satisfaction data and roll out of a new set of tools for airport agents, he said.

JOB CUTS

As far as the job cuts, they will not affect unionized workers, such as pilots, flight attendants and airport ground workers, a spokeswoman said. The airline in December reduced the officer ranks by several positions, representing 7 percent of managers with titles of vice president and higher. It will reduce management and administrative staff by 6 percent through voluntary and involuntary cuts and not filling empty positions.

Those cuts will begin in early February, Smisek said in a letter to employees Thursday morning.

gkarp@tribune.com

 
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Pentagon chief to remove military ban on women in combat

Former Navy SEAL Dick Couch comments on U.S. Defense Secretary Leon Panetta's decision to lift the military's ban on women serving in combat.









WASHINGTON—





The U.S. military will formally end its ban on women serving in front-line combat roles, officials said on Wednesday, in a move that could open thousands of fighting jobs to female service members.

The move knocks down another societal barrier, after the Pentagon scrapped its “Don't Ask, Don't Tell” ban in 2011 on gays and lesbians serving openly in the military.






The decision by outgoing Defense Secretary Leon Panetta is expected to be formally announced on Thursday and comes after 11 years of non-stop war that has seen dozens of women killed in Iraq and Afghanistan.

They have represented around 2 percent of the casualties of those unpopular, costly wars, and some 12 percent of those deployed for the war effort, in which there were often no clearly defined front lines, and where deadly guerrilla tactics have included roadside bombs that kill and maim indiscriminately.

“This is an historic step for equality and for recognizing the role women have, and will continue to play, in the defense of our nation,” said Democratic Senator Patty Murray from Washington, the outgoing head of the Senate Veterans Affairs Committee.

The move was also welcomed by Democratic Senator Carl Levin of Michigan, the head of the Senate Armed Services Committee, who said it reflected the “reality of 21st century military operations.” In addition, the American Civil Liberties Union, which filed a suit in November seeking to force the Pentagon to end the ban, applauded the move.

The decision overturns a 1994 policy that prevents women from serving in small front-line combat units.

‘HISTORIC MOMENT'

Following the expected announcement on Thursday, the military services will have until May 15 to submit a plan for implementing the decision. That plan, which has to be approved by the defense secretary and notified to Congress, will guide how quickly the new combat jobs open up and whether the services will seek an exemption to keep some closed.

The policy would be implemented by 2016.

Anu Bhagwati, a former Marine captain and head of the Service Women's Action Network, said her decision to leave the Marine Corps in 2004 owed partly to the combat exclusion policy.

“I know countless women whose careers have been stunted by combat exclusion in all the branches,” said Bhagwati, who called the decision an “historic moment.”

“I didn't' expect it to come so soon,” she said.

For Panetta, the decision adds to his legacy as a secretary who oversaw the end of “Don't Ask, Don't Tell” and now started the process to end discrimination against women. Otherwise, his tenure has been dominated by budget wrangling, the end of the Iraq war and the troop reduction in Afghanistan.

President Barack Obama has nominated former Republican Senator Chuck Hagel as Panetta's successor.

The decision comes nearly a year after the Pentagon unveiled a policy that opened 14,000 new jobs to women but still prohibited them from serving in infantry, armor and special operations units whose main function was to engage in front-line combat.

Asked last year why women who had served in Iraq and Afghanistan conducting security details and house-to-house searches were still being formally barred from combat positions, Pentagon officials said the services wanted to see how they performed in the new positions before opening up further.

Nearly 300,000 women have been deployed in the U.S forces in the Iraq and Afghanistan wars over the past 11 years, or about 12 percent of the total. Women have counted some 84 hostile casualties in those wars.

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Let’s Welcome Back Hockey with This ESPN Commercial






We realize there’s only so much time one can spend in a day watching new trailers, viral video clips, and shaky cell phone footage of people arguing on live television. This is why every day The Atlantic Wire highlights the videos that truly earn your five minutes (or less) of attention. Today:  


RELATED: Cookie Monster Batman and the Dog You Wish You Had






Hockey, schmockey. As a whole, the Atlantic Wire staff is sort of ambivalent that the NHL is finally back. (Our Canadian correspondent, however, is thrilled.) But you know what we are thankful for? The ESPN commercial reminding us that the NHL is finally back: 


RELATED: Behold the Power of ‘Gangnam Style’


RELATED: The Robot That Performs Gangnam Style Better Than You


These people are awesome (and, hey, maybe some of them play hockey):


RELATED: The Uncle You Wish You Had and the Joy of Human Jukeboxes


RELATED: How to Ride an Impossibly Tiny Bicycle; One Adorable Jam Session


People are awesome, and also quite strange. Like this guy, who offers the world a video review of the Astor CB-100 (totally SFW), and the 33,000+ views his video has already gotten:


And finally, these are ponies in sweaters. Ponies in sweaters, people:


Wireless News Headlines – Yahoo! News





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Adele to perform Bond theme song “Skyfall” live at Oscars






LONDON (Reuters) – British singer Adele will return to the stage next month after a year absence to perform her Oscar-nominated song “Skyfall” at the 85th Academy Awards, the show’s producers said on Wednesday.


The theme tune to the latest James Bond movie was written by Adele and Paul Epworth. It is the first Bond theme to be nominated for the original song award at the Oscars since “For Your Eyes Only” in 1981.






The February 24 show will be Adele’s first live performance since the Grammy Awards last April and the first time she will perform “Skyfall” live, as she has kept a low profile since giving birth to a son last October.


“It’s an honor to be nominated and terrifyingly wonderful to be singing in front of people who have captured my imagination over and over again,” Adele, 24, said in a statement.


“It’s something I’ve never experienced and probably only ever will once!”


She was in Hollywood last month to pick up the Golden Globe for the best original song prize for “Skyfall”.


Adele’s album “21″ scored the rare feat in December of topping all U.S. album sales for the second straight year. She records on the indie record label XL.


(Reporting by Belinda Goldsmith; editing by Patricia Reaney)


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Well: Long Term Effects on Life Expectancy From Smoking

It is often said that smoking takes years off your life, and now a new study shows just how many: Longtime smokers can expect to lose about 10 years of life expectancy.

But amid those grim findings was some good news for former smokers. Those who quit before they turn 35 can gain most if not all of that decade back, and even those who wait until middle age to kick the habit can add about five years back to their life expectancies.

“There’s the old saw that everyone knows smoking is bad for you,” said Dr. Tim McAfee of the Centers for Disease Control and Prevention. “But this paints a much more dramatic picture of the horror of smoking. These are real people that are getting 10 years of life expectancy hacked off — and that’s just on average.”

The findings were part of research, published on Wednesday in The New England Journal of Medicine, that looked at government data on more than 200,000 Americans who were followed starting in 1997. Similar studies that were done in the 1980s and the decades prior had allowed scientists to predict the impact of smoking on mortality. But since then many population trends have changed, and it was unclear whether smokers today fared differently from smokers decades ago.

Since the 1960s, the prevalence of smoking over all has declined, falling from about 40 percent to 20 percent. Today more than half of people that ever smoked have quit, allowing researchers to compare the effects of stopping at various ages.

Modern cigarettes contain less tar and medical advances have cut the rates of death from vascular disease drastically. But have smokers benefited from these advances?

Women in the 1960s, ’70s and ’80s had lower rates of mortality from smoking than men. But it was largely unknown whether this was a biological difference or merely a matter of different habits: earlier generations of women smoked fewer cigarettes and tended to take up smoking at a later age than men.

Now that smoking habits among women today are similar to those of men, would mortality rates be the same as well?

“There was a big gap in our knowledge,” said Dr. McAfee, an author of the study and the director of the C.D.C.’s Office on Smoking and Public Health.

The new research showed that in fact women are no more protected from the consequences of smoking than men. The female smokers in the study represented the first generation of American women that generally began smoking early in life and continued the habit for decades, and the impact on life span was clear. The risk of death from smoking for these women was 50 percent higher than the risk reported for women in similar studies carried out in the 1980s.

“This sort of puts the nail in the coffin around the idea that women might somehow be different or that they suffer fewer effects of smoking,” Dr. McAfee said.

It also showed that differences between smokers and the population in general are becoming more and more stark. Over the last 20 years, advances in medicine and public health have improved life expectancy for the general public, but smokers have not benefited in the same way.

“If anything, this is accentuating the difference between being a smoker and a nonsmoker,” Dr. McAfee said.

The researchers had information about the participants’ smoking histories and other details about their health and backgrounds, including diet, alcohol consumption, education levels and weight and body fat. Using records from the National Death Index, they calculated their mortality rates over time.

People who had smoked fewer than 100 cigarettes in their lifetimes were not classified as smokers. Those who had smoked at least 100 cigarettes but had not had one within five years of the time the data was collected were classified as former smokers.

Not surprisingly, the study showed that the earlier a person quit smoking, the greater the impact. People who quit between 25 and 34 years of age gained about 10 years of life compared to those who continued to smoke. But there were benefits at many ages. People who quit between 35 and 44 gained about nine years, and those who stopped between 45 and 59 gained about four to six years of life expectancy.

From a public health perspective, those numbers are striking, particularly when juxtaposed with preventive measures like blood pressure screenings, colorectal screenings and mammography, the effects of which on life expectancy are more often viewed in terms of days or months, Dr. McAfee said.

“These things are very important, but the size of the benefit pales in comparison to what you can get from stopping smoking,” he said. “The notion that you could add 10 years to your life by something as straightforward as quitting smoking is just mind boggling.”

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Chicago hotel occupancy climbs back









Visitors filled downtown hotel rooms in 2012 at a rate not seen since before the recession.

Hotel occupancy rose to 75.2 percent, up from 72.2 percent in 2011, according to an announcement by Choose Chicago, the city's tourism and convention agency, and Mayor Rahm Emanuel. The 2012 level matched a previous record set in 2007.

Hotel operators also saw increases in two other key measures, though those remain slightly below their peaks. The average daily room rate rose to $187.27, from $177.33 in 2011. And the revenue per available room, a key indicator of profitability, increased by 10 percent to $140.76.

The data comes from STR Global, with analysis by Choose Chicago.

Among the factors affecting performance, officials said, was a more aggressive marketing strategy. They cited Choose Chicago's regional advertising campaigns. An eight-week winter and 12-week summer campaign, at a combined cost of $2 million, targeted Cincinnati, Detroit, Grand Rapids, Indianapolis, Milwaukee and St. Louis.

The improved performance, along with a hike in the city's hotel tax rate, brought the city's hotel tax revenue to more than $100 million for the first time. This was an increase of $25 million, or 33 percent, from 2011.
 
The city share of the hotel tax increased by 1 percentage point last year, bringing the total Chicago hotel tax rate to 16.39 percent. The city's share of that is 4.5 percentage points.

 kbergen@tribune.com | Twitter@kathy_bergen



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Pearl Jam at Wrigley Field? It's 'looking good'













Pearl Jam


Pearl Jam
(January 22, 2013)


























































As hints go, Pearl Jam and the Cubs aren't being very subtle about the possibility of the iconic band playing a concert at Wrigley Field in 2013. At the band's website, there is a note telling fans to "stay tuned," with prompts to follow the band on Twitter (@pearljam).


Later Tuesday afternoon, both the Cubs and Pearl Jam Tweeted pictures of the field at Wrigley, with a full concert setup. The band's Tweet, featuring the "stay tuned" hashtag, also included a "looking good" reference to the Wrigley image.


But wait ... there’s more.





The Cubs are also playing a role in the suspense, sending out a Tweet that included "Ten," and a repeat of the "stay tuned" hashtag, as reported by RedEye. There was also a link to a photo of a Ron Santo Cubs jersey (No. 10), the parallel being that “Ten” is also the title of Pearl Jam’s first album.


RedEye reports that a Cubs spokesperson, via e-mail, noted that no further information could be provided regarding the hints and images at this time. But a date around mid-September is a possibility, according to Tribune critic Greg Kot.






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‘Atari’ Is in Trouble Again






Atari is declaring bankruptcy — twice. Both the U.S. video game company and its French parent have done so, the latest twist for the company which largely invented the video game industry and remains synonymous with it, despite having seen its glory days end by the mid-1980s.


But wait. Even though the Atari name celebrated its fortieth anniversary last year, it’s a mistake to talk about Atari as if it’s a corporate entity which has been around for four decades. (The Los Angeles Times’ Ben Fritz, for instance, refers to it as an “iconic but long-troubled video game maker.”) Instead, it’s a famous name which has drifted from owner to owner. It keeps being applied to different businesses, and yes, for all its fame, it does seem to be a bit of a jinx.






Here’s a quick rundown of what “Atari” has meant at different times (thanks, Wikipedia, for refreshing my memory):


1972-1976: It’s an up-and-coming, innovative startup cofounded by Nolan Bushnell and Ted Dabney.


1976-1984: It’s part of Warner Communications (which, years later, merged with Time Inc. to form Time Warner, overlord of this website). It’s a massively successful maker of video games and consoles, but then it crashes, along with the rest of the industry.


1984-1996: Atari morphs into a semi-successful maker of PCs when it’s acquired by Tramel Technology, a company started by Jack Tramiel, the ousted founder of Commodore.


1996-1998: Tramiel runs Atari into the ground. After merging with hard-disk maker JTS, the company and brand are largely dormant.


1998-2000: Atari resurfaces under the ownership of  toy kingpin Hasbro as a line of games published under the Atari Interactive name.


2000-present: It becomes a corporate entity controlled by French game publisher Infogrames, which increasingly emphasizes the Atari moniker over its own and takes over completely in 2008. In recent years, it’s focused on digital downloads, mobile games and licensing of its familiar brand and logo.


The above chronology doesn’t account for Atari’s original business: arcade games. As far as I can tell, the arcade arm was owned at different times by Warner Communications/Time Warner (twice!), Pac-Man purveyor Namco and arcade icon Midway, among other companies. But use of the Atari brand on arcade hardware petered out in 2001.


Basically, Atari has never been one well-defined thing for more than twelve years, max, at a time. That the name has survived at all is a testament to its power and appeal. And even though the current Atari has fallen on hard times, I’ll bet that the brand survives for at least a few more decades, in one form or another. Several forms, probably.


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Justin Bieber tops Lady Gaga to rule Twitter






(Reuters) – Teen heartthrob Justin Bieber with his hordes of fans known of Beliebers became the King of Twitter on Tuesday, topping fellow pop star Lady Gaga as the user with the most followers.


Data from TwitterCounter.com showed that the 18-year-old Canadian singer jumped into the lead with 33.33 million followers, topping Lady Gaga’s 33.32 million and ending her two-and-a-half year rule of the microblogging site.






A spokesman from TwitterCounter.com said Lady Gaga has held the top slot on Twitter since August 2010 when she overtook U.S. pop star Britney Spears.


Bieber rose to fame as a baby-faced pop star singing love songs such as “Baby” after being discovered on YouTube in 2008. He has released two No. 1 albums in the past 18 months – the holiday-themed “Under the Mistletoe” and “Believe.”


Bieber was named by Forbes magazine in 2012 as the third-most powerful celebrity in the world and his huge following on Twitter was cited as a reason why marketers need to take notice of the 140-character micro-blogging site.


Lady Gaga has dropped to second in Twitter followed by singer Katy Perry in third with 31.49 million followers then Rihanna and Barack Obama with 26.17 million followers. Britney Spears has slipped to sixth place.


(Reporting by Belinda Goldsmith; editing by Patricia Reaney)


(You can see the Twitter top 100 list http://twittercounter.com/pages/100)


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