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• Past Factoids Volume Four

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• Women using antipsychotic dopamine antagonists had a 16% increased risk of developing breast cancer, according to results of a retrospective study published in the December issue of the Archives of General Psychiatry. Although these findings are preliminary and should not alter medication use, they should prompt increased surveillance in schizophrenics, who usually have lower rates of breast cancer screening. Larger cumulative dosages were associated with greater risk, suggesting a dose-response relationship. Women who use antipsychotic medications are less likely to receive breast cancer surveillance through mammography and outpatient medical visits. Arch Gen Psychiatry. 2002;59:1147-1154
• Children with attention-deficit/hyperactivity disorder (ADHD) who are treated with biofeedback are more likely to maintain improvements when medication is discontinued than similar patients who are not treated with biofeedback, US researchers report. However, 7 days after stopping methylphenidate therapy, all of the children not treated with biofeedback lost their treatment benefits. In contrast, biofeedback-treated children continued to show improvements in tests of attention, behavior ratings from teachers, and in brain activity patterns.Appl Psychophysiol Biofeedback 2002;27:000-000
• Reducing the number of cigarettes smoked did not appear to confer any long-term benefit in terms of mortality risk compared with not cutting down at all, according to the report published in the December issue of the American Journal of Epidemiology. The investigators compared the outcomes of heavy smokers (15 or more cigarettes a day) who reduced their cigarette use during the study period, smokers who quit smoking during the study period, and people who continued to be heavy smokers. The researchers also assessed the outcomes of consistent light smokers, who smoked 14 cigarettes or less daily. Heavy smokers who cut their cigarette intake by half saw no reduction in death from any cause during the study period. Quitters, however, had a 35% lower risk of death from all causes compared with heavy smokers. Light smokers' mortality risk was 25% lower than heavy smokers. Quitters cut their risk of death from tobacco-related cancer by 64%, while there was no significant reduction in mortality from such cancers for subjects who only reduced their tobacco intake. The researchers also found no difference in respiratory disease or mortality from cardiovascular disease between people who reduced their smoking and those who continued to smoke heavily.Am J Epidemiol 2002;156:994-1001.
• Researchers examined the association between personal control and disordered eating and glycemic control in female adolescents with type 1 diabetes. A lower sense of overall personal control and a weaker sense of bodily control were both associated with more severe eating-disordered symptoms. The investigators report that a lower sense of control was only related to poorer metabolic control when the subjects had been diagnosed with diabetes less than 3 years from puberty. "Assessing and recognizing the importance of personal control could help clinicians, especially at the time of diagnosis [of diabetes], to identify young females who may be at risk for developing disordered eating or problematic metabolic control, particularly as they near the time of puberty." Diabetes Care 2002;25:1987-1991.
• Individuals with borderline personality disorder (BPD) appear to have deficits in their ability to resolve conflicting visual stimuli in an attentional test, according to a new study. The test in which subjects participated required them to press a key on the left if the central of five arrows pointed leftward or a key on the right if that arrow pointed to the right. The arrows on either side of the central arrow pointed in the same direction as the central arrow (congruent) or the opposite direction (incongruent). Results showed a significant difference between groups  According to neuroimaging studies, the authors point out, the dorsal anterior cingulate gyrus is involved in the conflict network. Furthermore, they write, lesions in this area are associated with poor interpersonal relations and with antisocial behavior. Proc Natl Acad Sci 2002. 222.
• The risk of suicide among individuals with a history of parasuicide continues for many years after the initial event. The overall rate of probable suicide was 4.3 per 1000 per year, the researchers calculated. During the first 5 years after a parasuicide the rate of probable suicide was 5.9 per 1000 per year and rose to 6.8 per 1000 per year in the last 3 years of follow-up. "The risk of suicide for people with a history of parasuicide persists over many years." They add that "clinicians are encouraged to pay particular attention to the management of patients immediately after an episode of parasuicide. Previous deliberate self harm remains a potent risk for subsequent suicide, even if it occurred many years ago." BMJ 2002;325:1155.
• Olfactory impairment affects a significant percentage of the elderly population, and most are not aware of their impairment. Persons with chemosensory problems, particularly those who are elderly or living alone, are at increased risk of both nutritional problems and danger from fire or gas explosion. Prevalence of impaired olfaction increased with age: it was 62.5% in subjects at least 80 years old (95% confidence interval [CI], 57.4%-67.7%). Male sex was associated with twice the prevalence of olfactory impairment (adjusted prevalence ratio, 1.92; 95% CI, 1.65-2.19). Current smoking, stroke, epilepsy, nasal congestion, or upper respiratory infection were also linked to higher prevalence of olfactory impairment. There is a clear need to educate elderly persons and their caregivers about potential hazards accompanying impairment in olfactory function and how such hazards can be best avoided. JAMA. 2002;288:2307-2312
• Pregnant women with depressive symptoms appear to be at increased risk for preterm delivery, according to a new report. Previous reports have suggested that depression alters immune system function in a way that could raise the risk of infection and preterm birth. In other findings, just over 25% of women started prenatal care during their first trimester and 75% had started care by the end of their second trimester. Slightly more than one quarter of women smoked cigarettes, about 7% reported using alcohol during pregnancy and about 9% used drugs. The researchers note that women face the highest risk of a first depression episode between 20 and 40 years of age, prime childbearing years for most women. Overall, one in five women will experience at least one bout with clinical depression in her lifetime. Am J Epidemiol 2002;156:797-802.
• Prevention may be the best approach to anxiety disorders in at-risk children. The intervention consisted of several components: parent sessions, child anxiety management, parent-child sessions emphasizing coping skills, and graduated exposure. The children had multiple risk factors for anxiety disorders, including parental anxiety disorder, elevated anxiety or withdrawn symptoms, and behavioral inhibition. Intervention shows promise in reducing the anxiety symptoms and improving coping in young children at risk for anxiety disorders. There is an urgency of developing preventive strategies, anxiety disorders can be debilitating, and are associated with high comorbidity. The longer they are untreated, the higher the risk that the disorder will impose itself on social and educational functioning.
• Men and women working in jobs with high stress and low rewards are at a significantly increased risk for subsequent cardiovascular mortality. High work stress was indicated by high demands and work load, low decision authority, low skill discretion, low security, few career opportunities, low fairness of supervision, and imbalance of reward versus effort. Workers who reported high demands and low job control had a 2.2-fold increased risk of cardiovascular mortality compared with workers who reported low job stress, after adjusting for age and sex, the researchers found. Among workers with low salary, lack of social approval, but high efforts required at work there was a 2.4-fold increased risk for cardiovascular mortality.BMJ 2002;325:857-860.
• The U.S. Agency for Healthcare Research and Quality (AHRQ), a division of the Department of Health and Human Services, has assembled the evidence available on s-Adenosyl-L-Methionine (SAMe) and has shown actual benefit for the treatment of depression, osteoarthritis, and liver disease. In treating depression, SAMe is more effective than placebo and as effective as standard antidepressants, with fewer adverse effects. Compared with nonsteroidal anti-inflammatory drugs (NSAIDs), SAMe also relieves the pain of osteoarthritis, but with fewer gastrointestinal adverse effects. It also reduces cholestasis secondary to use of oral contraceptives or estrogen, pregnancy, or birth defects, for which there is currently no other effective treatment.
• Brothers and sisters of children with a chronic illness are significantly more likely to have behavioral problems than children who do not have a sibling with health problems, according to a new study. Brothers and sisters of children with a chronic illness (Eg. children with spinal muscular atrophy (SMA)). are significantly more likely to have behaviorral problems than children who do not have a sibling with health problems, according to a new study. Children with a sibling with SMA were also more likely to be disturbed than their ill brothers and sisters, but the difference there was not statistically relevant, possibly due to the small test numbers. The caring parent usually has to get up three times a night to turn and check their sick child. Their relationship to the healthy child suffers. But rather than money, it seems like a social support network is perhaps the most important factor in helping them cope.
• Violence is responsible for 1.6 million deaths worldwide each year and around half of these deaths are suicides, according to a World Health Organization (WHO) report, regardless of country, region or religion. Three years in the making and with input from 160 experts from around the globe, the report is the most comprehensive account of deaths due to violence. Of the 1.6 million violent deaths that occurred, half were suicides, one third were homicides, and one fifth were war related. Suicide accounted for an estimated 815,000 deaths in 2000, making it the 13th leading cause of death worldwide. Three times as many elderly people kill themselves than people 15 to 24 years of age. Eastern Europe has the highest suicide rate, countries in Latin America and a few in Asia have the lowest. In the same year about 520,000 people died as result of domestic, youth, family or institutional violence including rape, sexual assault and abuse of children and the elderly.