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• Subspecialists practicing outside their subspecialty are likely to have patients that stay in the hospital longer than general internists or subspecialists practicing within their subspecialty, according to a study at hospitals in Cleveland. As reported in the Archives of Internal Medicine for March 11, The mean length of stay was longer for patients treated by subspecialists outside their subspeciality. The study suggests that physicians practicing outside of their specialty may provide less efficient care and possibly less quality of care. Arch Intern Med 2002;162:527-532.

• There is a growing body of data to suggest that the presence of medically diagnosed depression may actually lead to the development of coronary artery disease (CAD). This viewpoint must be considered controversial, however, since patients with depression often have more risk factors for CAD compared with those who are not depressed and may be less attentive to modifying those risk factors. In other words, it may be that depression does not cause CAD; depression causes the behaviors that lead to CAD.

• Preschool children with attention-deficit/hyperactivity disorder (ADHD) are similar to older children with ADHD in terms of disease severity, impaired functioning, and psychiatric comorbidity rates, according to a recent report. The average age of ADHD onset was just over 2 years in the preschool group and just under 4 years in the school-age group. However, the groups did not differ in the symptomatic presentation of ADHD, the authors state in the March issue of the Journal of the American Academy of Child and Adolescent Psychiatry. Patients in both groups demonstrated substantial impairment in social, school, and overall functioning. Whether early aggressive treatment can have a beneficial effect on their compromised development remains to be seen. J Am Acad Child Adolesc Psychiatry 2002;41:262-268

• New mothers who receive tailored care from a midwife for the first few months after delivery may be up to 40% less likely to develop postpartum depression, a new British study showsThe results showed women receiving the new model of care had significantly better psychological well being, with an overall 40% reduction in the risk of depression. There was no difference between the two groups in terms of physical health. As in the UK and in Australia, postpartum depression affects 10-15% of new mothers in the USA; yet even when a mother is so extremely depressed that she murders all five of her children, as recently happened in Texas, there is no call to re-examine the system."
  Lancet 2002;359:370-371,378-85.

• Until recently, claims for the psychological benefits of physical exercise have tended to precede supportive evidence. Acutely, emotional effects of exercise remain confusing, both positive and negative effects being reported. Results of cross-sectional and longitudinal studies are more consistent in indicating that aerobic exercise training has antidepressant and anxiolytic effects and protects against harmful consequences of stress. Details of each of these effects remain unclear. Antidepressant and anxiolytic effects have been demonstrated most clearly in subclinical disorder, and clinical applications remain to be exploited. Cross-sectional studies link exercise habits to protection from harmful effects of stress on physical and mental health, but causality is not clear. Nevertheless, the pattern of evidence suggests the theory that exercise training recruits a process which confers enduring resilience to stress. This view allows the effects of exercise to be understood in terms of existing psychobiological knowledge, and it can thereby provide the theoretical base that is needed to guide future research in this area. Clinically, exercise training continues to offer clinical psychologists a vehicle for nonspecific therapeutic social and psychological processes. It also offers a specific psychological treatment that may be particularly effective for patients for whom more conventional psychological interventions are less acceptable. Salmon P
  Clin Psychol Rev 2001 Feb;21(1):33-61

• Elderly women, people with serious physical illness and less-educated individuals may be less likely than others to have an improvement in symptoms during treatment for depression, new research shows. People with "neuroticism" tend to have more anxiety, lower self esteem and lower tolerance for stress than other individuals, and they may feel alienated, victimized and resentful. The researchers also found that among neurotic patients, anxiety, low self-esteem, low tolerance for stress and other problems could hinder recovery from depression. Those with significant physical illness may need both depression treatment and care aimed at improving physical functioning and reducing pain. Gen Hosp Psychiatry 2002;24.

• A five-year study is providing a better understanding of the link between child physical and sexual abuse and subsequent substance abuse by victims. Repeated sexual abuse affects the blood flow and function of a key brain region related to substance abuse, the cerebellar vermis. In other studies, this part of the brain has been found to affect the coordination of emotional behavior and to be strongly affected by alcohol, cocaine and other drugs of abuse. This part of the brain may also regulate dopamine, a neurotransmitter critically involved in addiction. Damage to this part of the brain may cause an individual to be particularly irritable and to seek external means, such as drugs or alcohol, to quell this irritability, The study's findings enhance understanding of the developmental mechanisms of childhood sexual abuse, which may result in new treatments for child-abuse survivors. Alcoholism & Drug Abuse Weekly 14(2), 2002.

• Genetically male infants with micropenis have greater psychological and sexual well-being in adulthood if raised as males, according to a comprehensive, long-term study reported in the February issue of Hormone Research. All men who were compliant with their testosterone replacement attained a final penile length within the normal range. Patients reared male considered themselves to be masculine and those raised female considered themselves to be feminine," Wisniewski said. "Our recommendation that babies be raised male is based not on problems with gender identity but on the difficulties associated with the surgical construction of a vagina and subsequent hormone treatment.

• Moderate alcohol consumption, which has been linked with lower a risk of cardiovascular disease, is now associated with a reduced risk of dementia in the elderly. Subjects who consumed a light-to-moderate amount of alcohol (one to three drinks per day) had a significantly lower risk of developing any dementia compared with subjects who never drank. The type of alcohol consumed bore no relation to its protective effect. There was some indication for a stronger relation with alcohol in persons with a genetically determined susceptibility for Alzheimer's disease. Lancet 2002;359:281-286.

• After successful acute Prozac treatment for bulimia nervosa, continued treatment with the drug improves outcome. Patients treated with Prozac exhibited a longer time to relapse than those treated with placebo and did better on frequency of vomiting and binge eating episodes. About 40% had symptoms of depression -- made no difference to whether a patient responded to treatment with fluoxetine. Prozac was not merely alleviating any underlying depression in these patients. People with bulimia appear to have an imbalance of, or malfunction in, the neurotransmitter serotonin. Among its other diverse functions, serotonin helps us recognize when we've had enough to eat.

• Clinicians should be aware that parents who express intense attachment and grief following the death of an infant, who appears to have died from sudden infant death syndrome (SIDS), may have actually killed their child. Based on the results of an interview with a mother who killed her child, researchers  observed that that "the depth and intensity of her descriptions of grief is not what one might have expected" from someone who has killed her child. The authors therefore caution pediatricians and other individuals involved in sudden unexplained infant deaths to "not to be deterred from suspecting malevolence by heart wrenching protestations." Arch Dis Child 2001;85:454-459.

• Salt-sensitive subjects have an enhanced central nervous responsiveness, as reflected by a higher affective startle modulation than in salt-resistant subjects. Salt-sensitive normotensive men exhibit an enhanced pressor response to mental stress. An enhanced pressor response is associated with higher affective startle modulation in men. Salt-sensitive patients had significantly enhanced startle amplitudes under negative stimuli and diminished startle amplitudes under positive stimuli than salt-resistant subjects. The increased startle modulation of salt-sensitive subjects suggests an enhanced activity of the central nucleus of the amygdala. This enhanced central nervous responsiveness may contribute to higher sympathetic pressor reactivity and, thus, to the later development of hypertension in salt-sensitive individuals. Hypertension 2001;38:1325-1329.