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February 2009

Combination Approach to Childhood Anxiety
In a study of children with anxiety disorders, the combination of cognitive behavioral therapy and an antidepressant was superior to either treatment alone.

Antipsychotic-Induced Weight Gain: Management Without Meds
Several behavioral interventions effectively promote weight loss in patients taking antipsychotics.

Allopurinol: Novel Treatment for Mania?
Allopurinol (Lopurin and others) as an adjunct to lithium may help improve manic symptoms in patients with bipolar disorder.

In Brief
Behavioral Risk Factors Mediate Hospitalization and Mortality; International Internet Day of Action Results in Drug Seizures

Adjunctive Estrogen for Schizophrenia?
Exogenously administered estradiol added to antipsychotic therapy might benefit women with schizophrenia.

Injection Site Reactions with Naltrexone
Injections of extended-release naltrexone (Vivitrol) can cause serious skin reactions.

In Brief

February 2009

A recent study from Scotland found that the association between mortality and a history of psychiatric hospitalization is mediated by modifiable risk factors. Hamer and colleagues looked at data from almost 20,000 men and women, aged 16 years and older (mean, about 45), from the Scottish Health Surveys of 1995, 1998, and 2003 (Arch Intern Med 2008;168:2474-2479). During a follow-up period of 3 to 11 years (mean, 8.5), 597 subjects had at least 1 hospital admission for a psychiatric episode, such as depression, substance abuse, schizophrenia, anxiety, or stress. These subjects were more likely than subjects not hospitalized for a psychiatric illness to be heavy smokers, have low physical activity levels, come from a lower socioeconomic group, and be separated or divorced from a partner. After adjustment for age and sex, subjects with a history of psychiatric hospitalization had a threefold greater risk of all-cause mortality. This risk was attenuated but still statistically significant after additional adjustment for psychosocial factors, smoking, physical activity, body mass index, and current mental health. The highest risk of death was associated with dementia, followed by substance abuse, depression, and schizophrenia. These data suggest that clinicians who treat patients with severe mental illness should work with them to prevent and treat behavioral risk factors.

Many prescription medications and illicit drugs are available for purchase on the Internet. While a number of countries have previously carried out individual law enforcement activities targeting "Internet pharmacies," such action had not been taken on an international scale until last November. The first "international Internet day of action" was coordinated by the Permanent Forum on International Pharmaceutical Crime, INTERPOL, and the World Health Organization's International Medical Products Anti-Counterfeiting Taskforce (IMPACT) (INTERPOL Media Release, November 13, 2008. Available at Accessed December 19, 2008). It targeted individuals behind Internet sites that illegally sell and supply unlicensed or prescription-only medicines. The action resulted in a series of arrests and the seizure of potentially harmful medicines in operations carried out around the world. Participating countries included Australia, Canada, Germany, Ireland, Israel, New Zealand, Singapore, Switzerland, the United Kingdom, and the United States.

Heather S. Hopkins