Wednesday, June 3, 2015

Study Finds SSRI Use in Late Pregnancy May Increase Risk of Newborn Respiratory Disease


Taking certain antidepressants later in pregnancy may slightly increase the risk of a rare but life-threatening respiratory disease known as persistent pulmonary hypertension of the newborn (PPHN), according to a study published yesterday in JAMA.
The overall risk increase was modest, though, and only significant among full-term births.

In 2006, the Food and Drug Administration (FDA) issued a public health advisory related to the possible risk of PPHN in pregnant women taking selective serotonin reuptake inhibitor (SSRI) antidepressants. Subsequent research produced conflicting results and negative studies tended to be small, raising the possibility that they may not have been able to detect an increased risk, prompting the FDA to revise and soften their stance in 2011. 

Researchers at Brigham and Women’s Hospital examined the medical records of nearly 4 million women enrolled in Medicaid—over 128,000 of whom were taking an antidepressant during the 90 days before delivery. Overall, 7,630 infants not exposed to antidepressants were diagnosed with PPHN (~20.8 per 10,000 births) compared with 322 infants exposed to SSRIs (~31.5 per 10,000 births) and 78 infants exposed to other antidepressants (~29.1 per 10,000 births).

After adjusting for other potential risk factors, the use of SSRIs resulted in a 28 percent increased risk for PPHN among full-term births; other antidepressants were not associated with any increased risk. The study authors did stress that the risk identified was less than in previous studies, and given the rarity of PPHN, the absolute disease risk remained very small.

"Clinicians and patients need to balance the potential small increase in the risk of PPHN, along with other risks that have been attributed to SSRI use during pregnancy, with the benefits attributable to these drugs in improving maternal health and well-being," the study authors write.

To read about other reported health risks of SSRI use during pregnancy, see the Psychiatric News articles “Certain Cardiac Abnormalities Not Linked to Prenatal Antidepressant Use, Study Finds” and “Verdict Mixed on Autism Link to SSRI Use in Pregnancy.” For more on SSRIs and PPHN, see the American Journal of Psychiatry article “Persistent Pulmonary Hypertension of the Newborn and Selective Serotonin Reuptake Inhibitors: Lessons From Clinical and Translational Studies.” 
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Tuesday, June 2, 2015

Study Finds New Jersey Correctional System’s Tobacco Ban Associated With Dramatic Drop in Mortality Among Mentally Ill


Restricting and ultimately eliminating tobacco from the New Jersey correctional system was associated with a decrease in mortality rates of inmates with mental health needs, according to a recent article in Psychiatric Services in Advance.

Between 2009 and 2011, the sale of tobacco within the New Jersey Department of Corrections (NJDOC) was reduced by 49 percent, concurrent with the introduction of smoking cessation programs by health care providers, the introduction of nicotine replacement lozenges in prison commissaries, the rise in cost of tobacco products, and the end of tobacco sales to inmates under 18. In 2012, NJDOC leadership made a decision to become entirely tobacco free, including on facility grounds (a policy that led to the depletion of the tobacco stocked in the prison commissaries by December 2012). As a result, tobacco sales decreased by 68 percent between 2006 and 2012, from an average of 107 to 34 products per inmate per year.

Researchers at several New Jersey institutions examined mortality rates in the total population of inmates and in a subgroup of inmates identified as having special mental health needs from January 2005 through June 2014, encompassing the period in which tobacco use was significantly reduced and then eliminated. They found that the mortality rate for people identified as having special mental health needs decreased by 48 percent, from an average of 676 per 100,000 population over the eight-year period before the ban to 353 per 100,000 in the 18 months after the ban. In contrast, the mortality rate of those not on the special needs roster remained relatively flat.

"Policies … that restrict or eliminate access to tobacco in the environment are effective strategies for reducing tobacco-related mortality in the general population," the researchers state. "This study in a correctional setting suggests that similar policies should be tried with subpopulations with mental illness in other settings as well."

For more information, see the Psychiatric News article “Smoking Cessation for Patients Called an Urgent Priority.”

(Image: Gts/shutterstock)

Monday, June 1, 2015

Adult ADHD May Be Distinct From Childhood ADHD


Attention-deficit/hyperactivity disorder (ADHD) in children may be distinct from and unrelated to ADHD in adults, according to a study in the American Journal of Psychiatry. The prevailing assumption has long held that adult ADHD is a childhood-onset neurodevelopmental disorder, but no prospective longitudinal study has described the childhood of adults with ADHD until now, reported Terrie E. Moffitt, Ph.D., and colleagues.

The researchers studied a birth cohort of 1,037 individuals born in Dunedin, New Zealand, in 1972 and 1973 and followed them to age 38. A number of factors were assessed, including symptoms of ADHD, associated clinical features, comorbid disorders, neuropsychological deficits, genomewide association study-derived polygenic risk, and life impairment indicators. Adult ADHD diagnoses used DSM-5 criteria.

As the researchers had expected, childhood ADHD had a prevalence of 6% (predominantly male) and was associated with childhood comorbid disorders, neurocognitive deficits, polygenic risk, and residual adult life impairment. Also as expected, adult ADHD had a prevalence of 3% (gender balanced) and was associated with adult substance dependence, adult life impairment, and treatment contact. However, the researchers were surprised to find that 90% of adult ADHD cases lacked a history of childhood ADHD. Another unexpected finding was that the adult ADHD group did not show tested neuropsychological deficits in childhood or adulthood, nor did they show polygenic risk for childhood ADHD.

The researchers concluded that if the study findings are replicated, the disorder’s place in the classification system as a neurodevelopment disorder manifesting early in development needs to be reconsidered and that research should be conducted on the etiology of adult ADHD.

(Image: shutterstock.com/Volt Collection)

Friday, May 29, 2015

Global Study Finds Some Members of General Population Report Psychotic Experiences


Psychotic experiences, such as hallucinations and delusions, are not restricted to individuals with certain mental illnesses—the general population sometimes experiences these symptoms too, according to a study published this week in JAMA Psychiatry.

Researchers from the University of Queensland in Australia and Harvard Medical School analyzed data from the World Health Organization World Mental Health Surveys that included more than 31,000 adults to assess the lifetime prevalence of psychotic experiences among the general population. 

The analysis revealed that 5.8 percent of those surveyed reported having at least one psychotic experience in their lifetime, with hallucinatory experience being the most prevalent at 5.2 percent compared with delusional experience at 1.3 percent. The results also showed lifetime prevalence of psychotic experiences was higher among women (6.6 percent) than men (5 percent), and higher among individuals who lived in middle-income (7.2 percent) and high-income (6.8 percent) countries than those in low-income countries (3.2 percent). However, the psychotic experiences were infrequent, with 32.2 percent of respondents with lifetime psychotic experiences reporting only one episode and 31.8 percent reporting having experienced two to five episodes. 

“We are interested in learning why some people recover, while others may progress to more serious disorders such as schizophrenia,” John McGrath, M.D., Ph.D., a research professor in the Queensland Brain Institute and lead author of the study, said in a press release. “We can use these findings to start identifying whether the mechanisms causing these hallucinations are the same or different in both situations.” 

For more on psychosis in the general population, see the Psychiatric Services article “Treatment Seeking and Unmet Need for Care Among Persons Reporting Psychosis-Like Experiences.”


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Thursday, May 28, 2015

For Some Women, Discontinuing Hormone Therapy May Increase Risk of Depression


During perimenopause, women face an increased risk of new and recurrent depression. Now, a new report finds that women with a history of perimenopausal depression (PMD) who discontinue hormone therapy may experience the return of depression symptoms.

For the study, published Wednesday in JAMA Psychiatry, Peter J. Schmidt, M.D., chief of the Section on Behavioral Endocrinology at the National Institute of Mental Health, and colleagues recruited asymptomatic postmenopausal women with a history of PMD whose symptoms remitted following hormone therapy (n=26) and asymptomatic postmenopausal women who were receiving or had previously received hormone therapy and had no history of depression (n=30).

For three weeks, all participants received open-label transdermal estradiol therapy (100 µg/d) before being randomized to a parallel design in which they received either estradiol (at the same dose given during the open-label period) or matched placebo skin patches for three additional weeks. During weekly clinic visits, depressive symptoms were monitored, and women rated the presence and severity of vasomotor symptoms daily.

The researchers found that while none of the women reported depressive symptoms during open-label use of estradiol, women with a history of PMD that were given the placebo skin patch experienced a significant increase in depression symptom severity. In contrast, women with a history of PMD who continued estradiol therapy and those with no history of PMD (who received estradiol or placebo) remained asymptomatic. There were no differences between the groups in reported hot flashes or plasma estradiol levels.

“These observations, in the context of similar plasma reproductive hormone levels, suggest that normal changes in ovarian estradiol secretion can trigger an abnormal behavioral state in susceptible women,” the authors wrote. “Women with a history of PMD should be alert to the risk of recurrent depression when discontinuing hormone therapy.”

For related information, see the Psychiatric News article “Antidepressant May Have Role in Treating Menopause Symptoms.”

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Wednesday, May 27, 2015

Children's Suicide Rates Reflect Racial Differences


Between 1993 and 2012, 657 children in the United States died by suicide, the 11th leading cause of death among children aged 5 to 11 years. While the overall suicide rate did not change significantly over that time (from 1.18 to 1.09 per million), there were notable differences between white and black children.

“Among white children, the suicide rate decreased significantly during the study period (incident rate ratio = 0.86), whereas for black children there was a significant increase in the suicide rate (incident rate ratio = 1.27),” wrote epidemiologist Jeffrey Bridge, Ph.D., a principal investigator at the Research Institute at Nationwide Children’s Hospital in Columbus, Ohio, and colleagues in JAMA Pediatrics.

Those differences were largely driven by a significant decrease in suicide rates among white boys (from 1.96 per million to 1.31 per million) and a significant increase among black boys (from 1.78 to 3.47 per million). Hanging/suffocation accounted for 78 percent of all suicides.

The authors speculated on several possible explanations of this disparity in outcomes—black youth may be exposed to more violence or traumatic stress, for instance—but could not say for certain what caused the observed difference in suicide rates.

“[F]uture steps should include ongoing surveillance to monitor these emerging trends and research to identify risk, protective, and precipitating factors associated with suicide in elementary school–aged children to frame targets for early detection and culturally informed interventions,” they concluded.

For more in Psychiatric News about children and suicide, see: "CBT for Child Anxiety May Confer Long-Term Protection From Suicidality."

--aml   (Image: pio3/Shutterstock.com)

Tuesday, May 26, 2015

Citicoline Appears to Reduce Cocaine Use in Patients With Bipolar Disorder, Study Finds


Citicoline reduced cocaine use and was well tolerated by patients with bipolar disorder, according to a report published May 22 in AJP in Advance. However, because the treatment effects diminished over time, the authors of the study suggest citicoline may work best as an acute treatment while other interventions are initiated.

For the study by E. Sherwood Brown, M.D., Ph.D., a professor of psychiatry at the University of Texas Southwestern Medical Center, and colleagues, 130 outpatients with bipolar I disorder and cocaine dependence received citicoline or placebo for 12 weeks. (Citicoline is sold as a prescription drug in Japan and Europe and over the counter as a dietary supplement in the United States. It has a mild side effect profile, is relatively inexpensive, and has no known drug-drug interactions, according to the researchers.) Assessments of mood, based on the Inventory of Depressive Symptomatology–Self Report, the Hamilton Depression Rating Scale, and the Young Mania Rating Scale, were performed weekly, and urine drug screens were conducted three times per week.

While no between-group differences in mood symptoms or side effects were observed, the researchers found that there was a significant treatment group and group-by-time effect (whether or not missing urine screens were imputed as cocaine positive).

“The effects of citicoline in reducing cocaine use appeared to occur quickly and tended to decline during the study,” the authors write. “These findings suggest that citicoline might be most effectively used in an acute treatment to reduce cocaine use in inpatient settings while other treatments are initiated rather than as a long-term monotherapy.”

For more on strategies to reduce cocaine use, see the Psychiatric News article "Cocaine Vaccination Isn't Science Fiction Anymore."

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