March 2008

Topiramate for Alcohol Dependence
Topiramate (Topamax) has been found to be beneficial in treating alcohol dependence.

Early Intervention for Schizophrenia: A Role for Antidepressants?
Antidepressants may reduce the transition from a prodrome of pre-psychosis to schizophrenia in vulnerable individuals.

Antipsychotics in Youth with Schizophrenia
Early-onset schizophrenia-spectrum disorder requires long-term antipsychotic treatment, but children and adolescents are sensitive to antipsychotic side effects and should be monitored carefully.

In Brief
Duloxetine Approved for GAD; Depression in Parkinson’s Disease; Asthma Linked to Psychiatric Disorder

Adjunctive Antipsychotics for MDD
Patients with treatment-resistant major depressive disorder may benefit from the addition of second-generation antipsychotics to an antidepressant medication regimen.

In Brief

March 2008

Last month (BTP 2008;31:6–8), we described studies of the serotonin-norepinephrine reuptake inhibitor duloxetine (Cymbalta) for the treatment of generalized anxiety disorder (GAD). Duloxetine, which was previously approved by the US Food and Drug Administration for the treatment of major depressive disorder and diabetic peripheral neuropathic pain in adults, is now also approved for GAD.

J. S. Reijnders and colleagues reviewed studies of depression in Parkinson's disease and found the prevalence of major depressive disorder (MDD) in patients with Parkinson's disease to be 17%, of minor depression to be 22%, and of dysthymia to be 13% (Mov Disord, in press). In studies that used a semi-structured interview to establish DSM criteria for MDD, the prevalence was higher (19%) than in those that did not (7%).

Two recent studies show a link between asthma and psychiatric disorders. W. Katon and coworkers found that children and adolescents with asthma have a twofold increased risk of having at least one depressive or anxiety disorder (J Adolesc Health 2007;41:455–463). One hundred twenty-seven (16.3%) of 781 participants with asthma versus 51 (8.6%) of 598 controls met DSM criteria for one or more depressive or anxiety disorders, based on telephone interviews. Only 40% of individuals surveyed who met criteria for a psychiatric disorder had been diagnosed by their primary care physicians, suggesting a need for routine screening of this high-risk population for anxiety and depression. The greatest risk of psychiatric comorbidity was found in females, those with a more recent asthma diagnosis, and those from more economically disadvantaged backgrounds. Young individuals with asthma and a comorbid mental illness are more likely to smoke, possibly due to cognitive benefits of nicotine. The other study, which involved over 3000 male twin pairs, found that Vietnam veterans with the most symptoms of posttraumatic stress disorder (PTSD) are 2.3 times more likely to have asthma than those who report the fewest symptoms of PTSD (Goodwin RD et al. Am J Respir Crit Care Med 2007;176:983–987). No environmental or behavioral factor—including body mass index, smoking, exposure to combat trauma, and sociodemographic characteristics—fully explained the association between asthma and PTSD. Further analysis comparing fraternal and identical twin pairs suggested that genetics also did not play a role in this association.

Heather S. Hopkins