• 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
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
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;
• 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,
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
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.
• 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)
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
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
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
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. ▪