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September 2009

Prenatal Valproate Lowers IQ
Valproate may adversely affect fetal cognitive development throughout pregnancy.

Stimulant Augmentation for Treatment-Resistant OCD?
In one study, amphetamine was not superior to caffeine as an augmentation strategy for patients with obsessive compulsive disorder.

Antipsychotics in Alzheimer's Patients: New Evidence on Metabolic Effects
Second-generation antipsychotic drugs increase the risk of weight gain and metabolic effects in patients with Alzheimer’s disease.

In Brief
Contraception Use in Female Bipolar Patients Suboptimal; CBT Available over Internet for Insomnia

SSRIs and Gestational Hypertension
Use of a serotonin selective reuptake inhibitor beyond the first trimester of pregnancy is associated with an increased risk of hypertension and preeclampsia.

In Brief

September 2009

The combination of the teratogenic potential of some medications used to treat bipolar disorder and the impulsive sexuality often associated with this illness makes the use of contraception an important issue for female patients with bipolar disorder. In a cross-sectional survey of 136 women with bipolar disorder, Vieira da Silva Magalhaes and coworkers found the prevalence of contraception use to be less than 60% (Arch Womens Ment Health 2009;12:183–185). Participants in the survey were consecutive premenopausal outpatients enrolled in a bipolar disorder program in Brazil. Patients who used contraception were more likely to be younger than 40 years, married or living with a partner, and to have had previous pregnancies. Conception use was unrelated to income or years of education, and no associations were found with symptoms or illness severity, nor with use of lithium or anticonvulsant mood stabilizers. The limitations of the study were that contraception use was self-reported, the study did not differentiate women who were not sexually active, and it did not measure adherence to contraceptive method. As we mention elsewhere in this issue (see "SSRIs and Gestational Hypertension," this page), clinicians should discuss the risks of becoming pregnant while taking medication with all women of childbearing potential. As this study points out, counseling regarding effective contraception should be part of that discussion.

As effective as medication for short-term treatment of chronic insomnia, cognitive behavioral therapy (CBT) also benefits patients beyond the end of active treatment. Many people do not have access to CBT, however, because of the lack of clinicians trained in this therapy and their uneven geographic distribution. Ritterband and colleagues studied a method of delivering CBT through the Internet in 44 adults who had been suffering from sleep difficulties for an average of 10 years (Arch Gen Psychiatry 2009;66:692–698). Half of the subjects were randomly assigned to an Internet intervention and half to a wait-list control group. The Internet intervention incorporated sleep restriction, stimulus control, sleep hygiene, cognitive restructuring, and relapse prevention and was highly interactive. Scores on the Insomnia Severity Index (ISI) significantly improved from 15.73 to 6.59 for the Internet group but did not change for the control group. After the Internet program, 16 of the 22 participants were considered in remission (an ISI score lower than 8), versus no one in the control group. Gains were maintained at 6-month follow-up. The authors conclude that the Internet has potential for delivering a structured behavioral program for insomnia.

Heather S. Hopkins