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A new study suggests that the brain’s reward system, which makes us feel good when we get things we want and need, could hold insight into why some people are psychopaths.

Researchers from Vanderbilt University in Nashville, Tenn., used brain scans to find evidence that the brain reward system is hypersensitive in people who show more latent signs of psychopathic personality disorder.

“By linking traits that suggest impulsivity and the potential for antisocial behavior to an overreactive dopamine system, this study helps explain why aggression may be as rewarding for some people as drugs are for others,” Dr. Nora Volkow, director of the U.S. National Institute on Drug Abuse, which funded the study, said in a statement.

Psychopaths are defined as charming, manipulative and sensation-seeking people who lack empathy. Many people who fit into this category become criminals.

In the study, researchers studied the brain’s reward system as subjects received low doses of amphetamine and played a game.

The researchers think it’s possible that people with hypersensitive reward systems “may become focused on a chance to get a reward, and less able to shift their attention until they get what they’re after,” said Joshua Buckholtz, doctoral candidate in neuroscience and the lead author of the study, in a statement. “This pattern, along with other traits, could develop into psychopathic personality disorder.”

An intense focus on a particular goal could cause psychopathic individuals to shed the fear that often accompanies negative behavior, the team said. They may also have less sensitivity to other’s emotions and a reduced capacity to learn from their own mistakes.

The study is published in the March issue of the journal Nature Neuroscience.

Palliative care services, which help people who are seriously ill relieve symptoms such as pain, are now found at most U.S. cancer centers, but many programs don’t interact with patients until it’s too late, study findings show.

Dr. David Hui, of the University of Texas M.D. Anderson Cancer Center in Houston, and his colleagues surveyed 71 U.S. National Cancer Institute-designated cancer centers and randomly surveyed 71 other cancer centers. They received responses from 71 percent of 142 executives and 82 percent of 120 program leaders.

The researchers also found that the NCI cancer centers were more likely to have palliative care programs and physicians. A report on the survey was published in the March 17 issue of the Journal of the American Medical Association.

“Palliative care outpatient clinics, inpatient consultation teams, palliative care units and hospices all play an integral role providing symptom control, psychosocial support and transition of care for patients with cancer and their families along the cancer care continuum,” the study authors wrote. “Based on this understanding, multiple national and international organizations support early incorporation of palliative care into oncology practice.”

However, the researchers found that “palliative care patients were referred too late in the disease trajectory, a marker of limited access and integration.”

“Although most cancer centers now have a palliative care program, significant gaps and delays in the delivery of care remain,” Hui’s team concluded.

Older colon cancer patients are less likely than younger ones to receive potentially life-prolonging chemotherapy following surgery for their illness, a new study reveals.

The research indicates that those with advanced colon cancer who are over the age of 75 are both less likely to receive chemotherapy and more likely to receive less chemotherapy even when they are given the treatment.

Yet, prior research has indicated that surgery coupled with postoperative chemotherapy appears to reduce the risk of dying from the disease or experiencing a recurrence.

“So, we have to wonder why one of two older patients are not getting chemotherapy when the trials say they benefit from it,” said study author Dr. Katherine L. Kahn, a professor of medicine at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA).

“One reason is that there aren’t that many older patients enrolled in study trials, and so doctors aren’t comfortable with the research findings regarding the elderly,” Kahn noted. “And there also isn’t much written about how you manage those patients. But we studied what happens, and we find that the half that gets treated do great, just as well as younger patients who get chemotherapy.”

Kahn, who is also a member of UCLA’s Jonsson Comprehensive Cancer Center, and colleagues report their findings in the March 17 issue of the Journal of the American Medical Association.

According to American Cancer Society estimates, more than 106,000 Americans were newly diagnosed with colon cancer, and nearly 50,000 men and women died from the disease, last year alone.

Previous research has indicated that, regardless of age, patients who receive chemotherapy following surgery are 24 percent less likely to die and 32 percent less likely to experience the return of their cancer.

To gain insight into the age differential, Kahn’s team analyzed data concerning 675 stage 3 colon cancer patients. All had undergone surgery after having been diagnosed between 2003 and 2005. Just over 200 of the patients were over 75.

The authors reviewed both patient surveys and medical records covering a period of three months before diagnosis, and up to 15 months after that.

Kahn and her team found that, overall, three-quarters of the patients received chemotherapy following surgery.

However, when breaking it down by age they noted that while 87 percent of patients under the age of 75 underwent chemotherapy, that figure dropped to just 50 percent among patients over the age of 75.

And despite the fact that older patients who did receive chemotherapy were less likely to have additional disease than their peers who did not get chemo, the older group was more likely to receive lower than the standard recommended dosage for their chemotherapy regimen.

The age bias was also apparent when looking at the length of chemotherapy treatment. While just 25 percent of younger patients had discontinued their treatment by the 150-day mark, that figure rose to 40 percent among those over the age of 65.

Patients over the age of 75 were more likely to experience negative side effects early into their chemotherapy. However, side effects that manifested well into the chemotherapy process actually occurred less frequently among patients 75 and older than among younger patients.

The researchers did find significant evidence of adverse side effects overall. They observed that 24 percent of the patients experienced at least one negative side effect by the end of the study period, and that side effects were twice as likely to occur among those who received chemotherapy as among those who had surgery alone.

However, the authors concluded that, as a whole, older colon cancer patients were not more likely to experience chemotherapy side effects than younger patients.

“But this finding doesn’t override what doctors are fearful about,” Kahn cautioned. “We don’t know whether we can generalize our results to all older people, because we still have limited information,” she explained.

“For example, maybe all older people on chemotherapy will do as well as the younger patients,” Kahn said. “Or maybe the older ones who got it in our study were selected out by their doctors as the ones most likely to do best. We don’t know yet. We need more data.”

Meanwhile, Dr. Frank A. Sinicrope, a professor of medicine and oncology at the Mayo Clinic in Rochester, Minn., suggests that age is just one of many variables to consider when deciding which treatment to offer cancer patients.

“I think it’s important to say that there’s no data presented in this study [on] recurrence or survival among any of the patients,” he noted. “So, there’s no comment the researchers can provide here on what the benefit of chemotherapy actually is among either older or younger patients,” Sinicrope said.

“But the overriding message here is that we need to move beyond making treatment decisions purely on the basis of age. We need to think more about the performance status of the patient and their overall medical condition, and consider offering these patients treatment if appropriate,” Sinicrope said. “And, yes, certainly I think more research and studies specifically looking at elderly populations would be beneficial to have.”

SOURCES: Katherine L. Kahn, M.D., professor, medicine, division of general internal medicine and health services research, department of medicine, David Geffen School of Medicine, University of California, Los Angeles, and senior natural scientist, Rand Corp., Santa Monica, Calif.; Frank A. Sinicrope, M.D., professor, medicine and oncology, Mayo Clinic, Rochester, Minn.

In a trial comparing two anti-clotting drugs, patients given Brilinta before cardiac bypass surgery were less likely to die than those given Plavix, researchers found.

Both drugs prevent platelets from clumping and forming clots, but Plavix, the more popular drug, has been linked to potentially dangerous side effects in cancer patients. In addition, some people don’t metabolize it well, making it less effective.

“We did see about a 50 percent reduction in mortality in these patients [who took Brilinta], but without any increase in bleeding complications,” Dr. Claes Held, an associate professor of cardiology at the Uppsala Clinical Research Center at Uppsala University in Sweden and the study’s lead researcher, said during an afternoon press conference Tuesday.

“Ticagrelor (Brilinta) in this setting, with acute coronary syndrome patients with the potential need for bypass surgery, is more effective than clopidogrel (Plavix) in preventing cardiovascular and total mortality without increasing the risk of bleeding,” he said.

A danger with any anti-platelet drug is the risk of uncontrolled bleeding, which is why these drugs are stopped before patients undergo surgery.

Held was scheduled to present the results Tuesday at the American College of Cardiology’s annual meeting in Atlanta.

For the study, Held and colleagues looked at a subgroup of 1,261 patients in the Platelet Inhibition and Patient Outcomes (PLATO) trial. The researchers found that 10.5 percent of the patients given Brilinta plus aspirin before surgery had a heart attack, stroke or died from heart disease within a week after surgery. Among patients given Plavix plus aspirin, 12.6 percent had the same adverse outcomes.

Patients taking Brilinta had a total death rate of 4.6 percent, compared with 9.2 percent for patients taking Plavix. In addition, the cardiovascular death rates were 4 percent among patients taking Brilinta and 7.5 percent among those taking Plavix.

When Held’s team looked at each group individually, they found no statistically significant difference for heart attack and stroke and no significant difference in major bleeding from the bypass operation itself.

The two drugs work in different ways.

Plavix needs the body to convert it to an active form, which poses some problems. Last week, the U.S. Food and Drug Administration required Bristol-Myers Squibb and Sanofi Aventis, the makers of Plavix, to add a “black box” warning to the drug’s label, alerting doctors and patients that some patients cannot fully convert the drug, so it may be less effective for them.

Brilinta, which is in a different class of drugs, does not rely on metabolic conversion, so it acts faster and clears the body faster than Plavix. This enables quicker recovery of normal platelet function, the researchers say.

But Held can’t explain the difference in the rate of death. “That’s the billion dollar question,” he said.

“Right now we don’t understand the mechanism. We see the difference in mortality, but we cannot explain it in differences in bleeding so there has to be some other effect explaining the difference,” Held said.

The PLATO study was funded by AstraZeneca, the maker of Brilinta.

Results of another study presented at the meeting Tuesday found that the drug Tekturna (aliskiren) given to patients after a heart attack did not improve heart function as researchers had hoped. In that trial — called the Aliskiren Study in Post-MI Patients to Reduce Remodeling (ASPIRE) — Tekturna, which blocks the hormone renin, was given to patients along with common blood pressure-lowering drugs. But the researchers found it provided no additional benefit in heart function and only served to raise potassium levels and cause low blood pressure.

“Morbidity and mortality remain high in patients following heart attack, with a substantial number of patients subsequently developing heart failure,” Dr. Scott D. Solomon, director of noninvasive cardiology at the Brigham and Women’s Hospital, Harvard Medical School in Boston and lead researcher, said in a statement.

“We hoped that this study would generate the information needed to plan a major morbidity and mortality trial. However, our results show that the addition of aliskiren to standard therapy in high-risk post-MI patients does not affect left ventricular size or function. These findings suggest the need for caution when treating post-heart attack patients,” he added.

SOURCES: teleconference with: Claes Held, M.D., Ph.D., associate professor of cardiology, Uppsala Clinical Research Center and Department of Cardiology, Uppsala University, Sweden; presentation, American College of Cardiology’s annual meeting, Atlanta