Journal Digest
Psychiatric News
Volume 43 Number 21 page 23-23

A brief, targeted, behavior-modification program designed to improve the sleep of infants also reduces the likelihood that their mothers will develop depression symptoms, according to a study by a group of Australian pediatricians.

Maternal-and-child health centers in the greater Melbourne area were randomly assigned to provide either the usual well-child care or the behavior interventions to mothers who reported infant sleeping problems at age 7 months during a routine visit. Mothers in the intervention group (n=174) were taught how to use graduated extinction and adult fading techniques. They were taught by nurses trained in teaching these two behavior-modification interventions. Other mothers (n=154) were given the usual postnatal care at follow-up visits.

Graduated extinction, also known as controlled crying, means that parents respond to their infants' crying at longer and longer intervals, thus allowing the infant to learn to fall asleep on his or her own. In adult fading a parent sits with the infant until the infant falls asleep and gradually withdraws sooner over two to three weeks.

When the infants were age 2, mothers who had the behavior-modification training were significantly less likely than those who got routine care to report clinical depression symptoms, measured by the Edinburgh Postnatal Depression scale. The mothers who learned the behavior-modification techniques also had a lower mean score on the scale. By this follow-up, 27 percent of mothers in the intervention group and 33 percent in the control group reported sleep problems in their children, but this difference was not statistically significant. This intervention program, implemented in the primary care setting, "resulted in sustained positive effects on maternal depression symptoms," the authors concluded.

Hiscock H, et al.: Long-Term Mother and Child Mental Health Effects of a Population-Based Infant Sleep Intervention: Cluster-Randomized, Controlled Trial.Pediatrics. 2008; 122(3):e621-e627.

Sildenafil, a drug indicated for treating erectile dysfunction in men, appears to help reduce the sexual adverse effects of serotonin reuptake inhibitors in women, according to a prospective, randomized, double-blind, placebo-controlled study.

At baseline, all participants were premenopausal adult women who had a diagnosis of major depressive disorder in remission, were on stable doses of selective or nonselective serotonin reuptake inhibitors, and had persistent sexual dysfunction—including anorgasmia, orgasm delay, or inadequate lubrication or swelling response of sexual excitement compared with before antidepressant treatment—for at least four weeks. Subjects were randomized into two groups of 49 each to take either sildenafil or placebo.

Both groups continued on the same antidepressant treatment and remained in depression remission during the study. After eight weeks of taking the drug or placebo, women in the sildenafil group had significantly better sexual function, based on the mean score on the Clinical Global Impression sexual function score, than those in the placebo group.

The study was funded by an independent investigator-initiated grant from Pfizer, which makes sildenafil.

Nurnberg HG, et al.: Sildenafil Treatment of Women With Antidepressant-Associated Sexual Dysfunction: A Randomized Controlled Trial.Journal of the American Medical Association. 2008; 300(4):395-404.

Four second-generation antipsychotic drugs (SGAs) do not have an advantage over perphenazine, a first-generation antipsychotic, in reducing violent behaviors in patients with schizophrenia, according to analyses of data from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study.

CATIE was sponsored by the National Institute of Mental Health and conducted from 2001 to 2004. The effectiveness of the SGAs (olanzapine, quetiapine, risperidone, and ziprazidone) in treating schizophrenia was compared with perphenazine in a randomized, double-blind manner. The analyses included 1,445 patients who provided baseline data on violence, including 653 who completed the first six months of treatment on their assigned medications.

All violent behaviors, measured by the standardized MacArthur Community Violence Interview and supplemented with interviews with family members, decreased from 16 percent to 9 percent among patients who completed the six months of treatment. The reduction rate did not differ significantly between SGAs and perphenazine. The intent-to-treat analyses also revealed no significant differences between the SGAs and perphenazine.

The authors cautioned that violence may be caused by a number of social and environmental factors and "pharmacotherapy alone cannot be expected to mitigate essentially nonclinical causes of violence."

Swanson JW, et al.: Comparison of Antipsychotic Medication Effects on Reducing Violence in People With Schizophrenia.British Journal of Psychiatry. 2008; 193:37-43.

Serotonin transporter gene 5-HTTLPR polymorphisms and the -1438G/A polymorphism in the 5-HT2A receptor gene are associated with treatment response in patients with bulimia, according to a study of women with a diagnosis of bulimia or eating disorder not otherwise specified characterized by binge eating and/or purging.

In the study, 111 patients were treated in an eating-disorder program that included 16 weeks of treatment, with the option of an additional 16 weeks of treatment. All participants received individual therapy, and a majority received group therapy and medications. Assessment data were derived from the 90 individuals who completed at least the first four months of treatment; there were data on 62 after eight months.

Patients who carried the alleles that have been associated with lower function of the serotonin transporter and the 5-HT2A receptor had significantly poorer outcomes than those who carried the high-functioning alleles in terms of weekly frequency of binge episodes at eight months, anxiety and depression response at four months, and change in impulsivity at eight months.

The authors commented that the genetic variations in serotonin dysregulation may affect patient response to bulimia treatment via the biological mechanism of impulsivity and borderline personality traits.

The study was funded by grants from the Quebec government and the Canadian Institutes for Health Research.

Steiger H, et al.: Serotonin-System Polymorphisms (5-HTTLPR and -1438G/A) and Responses of Patients With Bulimic Syndromes to Multimodal Treatments.Journal of Clinical Psychiatry. 2008. Posted online September 9.

Statin drugs, indicated for lowering cholesterol levels, may also lower the risk of dementia or cognitive impairment, according to a prospective, observational study in older Latino Americans.

In the Sacramento Area Latino Study on Aging, 1,789 participants aged 60 or older-were enrolled in 1998 and followed for long-term health status including dementia and cognitive impairment without dementia.

Of the 1,674 participants without dementia or cognitive impairment at baseline, 130 developed one of the conditions within five years of follow-up, including 10 with cognitive impairment who progressed to dementia during the study period.

Individuals who took statins during the period had about half the risk of developing dementia or cognitive impairment as those who did not take statins (hazard ratio: 0.52; 95 percent confidence interval: 0.34 to 0.80). The authors controlled for education, smoking status, the presence of the APOE e4 allele, and history of stroke or diabetes at baseline in analyses.

The study was funded by the National Institute on Aging.

Cramer C, et al.: Use of Statins and Incidence of Dementia and Cognitive Impairment Without Dementia in a Cohort Study.Neurology. 2008; 71:344-350.

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