December 2009

Iloperidone (Fanapt)
Iloperidone, an antipsychotic recently approved by the U.S. Food and Drug Administration (FDA), is comparable in efficacy to other second-generation agents.

Cholinesterase Inhibitors Cause Syncope
Cholinesterase inhibitors, such as donepezil (Aricept), galantamine (Razadyne), and rivastigmine (Exelon), which are used to treat Alzheimer's disease, may cause syncope.

In Brief
Cigarettes and Coffee May Elevate Risk of Suicidal Behavior in Patients with Bipolar Disorder; Depression and Anxiety Have Different Effects on Risk of Mortality

Antipsychotics Decrease Mortality
Treatment with antipsychotics increases life expectancy for patients with schizophrenia.

On to 2010!
Dr. Alan Gelenberg reviews biological interventions approved during the past year, including new antipsychotics and a device to deliver repeated transcranial magnetic stimulation (rTMS).

2009 Index

In Brief

December 2009

Patients with bipolar disorder often have comorbid substance use disorder, which is associated with adverse clinical outcomes. Cigarette smoking and coffee drinking are also highly prevalent in patients with bipolar disorder, but there is less research on the effects of nicotine and caffeine than on the effects of alcohol and illicit drugs in this population. Baethge and colleagues performed a retrospective analysis of clinical correlates of coffee consumption and of smoking, with particular attention to increased risk of suicidal behavior, in 352 outpatients with bipolar disorder (Bipolar Disord 2009;11:494-503). The prevalence rates were 46% for current cigarette smoking and 74% for coffee drinking, both of which were significantly and independently associated with suicidal acts. Risk of suicidal behavior increased with the number of cigarettes smoked and cups of coffee consumed per day. Neither intake was related to annual rates of illness recurrence, including all episodes, manic episodes, or depressive episodes, nor with psychiatric hospitalizations. The authors recommend close clinical monitoring of caffeine use and cigarette smoking in bipolar disorder patients, but note that these are preliminary findings that require replication.

Although the underlying mechanisms have not been determined, depression has been repeatedly reported to be associated with increased mortality. Even less is known about how mortality is affected by anxiety. Mykletun and others in Norway compared records in a large population health survey with a national mortality registry to assess case-level anxiety, depression, and comorbid anxiety and depression as predictors of mortality (Br J Psychiatry 2009;195:118-125). The increase in mortality associated with depression was found to be comparable with that of smoking, and it was not completely explained by somatic symptoms or conditions. Contrary to reports that have found a stronger effect of depression on mortality in men than in women, this study found no gender differences. It did, however, find a stronger effect in younger versus older patients. Mortality rates were lower for depressed patients with comorbid anxiety compared with those who had depression alone. Overall anxiety symptom load had a U-shaped association with mortality: relatively high mortality was associated with both low and high levels of symptoms, although it was most pronounced for low symptoms. The authors speculate that low levels of anxiety may reduce help-seeking and increase risk-taking behaviors, and that modest levels of anxiety may promote earlier identification and treatment of potentially life-threatening conditions.

Heather S. Hopkins