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• Interpersonal and social rhythm therapy appear to be a useful addition to pharmacotherapy in the management of patients with bipolar I disorder...results suggest that a relatively short-term psychotherapy that focuses on leading a life characterized by regularity of routines -- especially a regular sleep-wake cycle -- can add significantly to the protective effect of medication....Interpersonal and social rhythm therapy concentrated on items such as the links between mood symptoms and quality of social relationships as well as stressing the importance of daily routines. The clinical management program included education about bipolar disorder and treatment and a careful review of symptoms and medication effects, as well as non-specific support. The researchers saw no difference between treatment strategies in the time it took for patients to reach stabilization. However, those randomized to the rhythm therapy group during the acute phase went significantly longer without a new affective episode. TThese patients were also more likely to remain well for the full 2 years of the maintenance phase...appeared to be mediated by the substantially increased regularity of social routines.." September, 2005 Archives of General Psychiatry

• "Patients presenting for treatment of substance use disorders who have recently attempted suicide are likely to benefit more from inpatient care than from treatment provided on an outpatient basis,a readiness to change, so that someone who enters treatment after a suicide attempt may be particularly motivated to do something about their substance use disorder...So if they can get into a sufficiently intensive setting where they can have some residential stability and intense enough treatment, then they can act on that higher motivation...treatment providers in the substance abuse disorders treatment setting need to assess for suicide attempts. It's clearly fairly common, and it's probably being underassessed and information about suicidality is probably being underutilized. Patients who do report a recent attempt "are probably more appropriate for more intensive, more structured treatment, whether that's residential or not." Alcohol Clin Exp Res 2005.

• The prevalence of bipolar symptoms appears to be higher among epilepsy patients than among those with other chronic medical conditions. Bipolar symptoms were present in 12.2% of the epilepsy patients. These symptoms were 1.6 to 2.2 times more common in epileptic patients than in those with migraine, asthma, or diabetes, and 6.6 times more common than in the healthy comparison group.
  Overall, 47.9% of epilepsy subjects with a positive screen for bipolar symptoms had a formal diagnosis of bipolar disorder, nearly twice the rate seen in those with chronic diseases. The authors note that 26.3% of those with epilepsy with a positive screen had a diagnosis of unipolar depression only, and 25.8% had neither a uni- nor bipolar diagnosis...one reason bipolar symptoms may be missed in patients with epilepsy is because some of the commonly used antiepileptic agents such as carbamazepine, valproic acid, and lamotrigine may be treating the bipolar symptoms as well. The elevated rate of bipolar symptoms in epilepsy may (explain) the commonly described vulnerability to mood instability in individuals with epilepsy...This may relate to the complicated mind-brain interactions that occur as a result of seizure effects on the brain, the effects of the underlying condition giving rise to seizures, and the treatments for epilepsy, among other possible causes." Neurology 2005;65:535-540.

• Psychotherapy involving behavioral modification improves treatment compliance rates in patients with tuberculosis. Treatment compliance and cure rates were significantly higher in the psychotherapy group compared to controls. In the psychotherapy group, 72% of patients completed the treatment without missing a dose and were cured as compared to a compliance and cure rate only 42% in the controls, the researchers observed. Psychotherapy increases the motivational levels of the patient. Respiration 2005; 72: 375-380.

• "The clinical benefits attributed to homeopathic treatment are placebo effects. Trials in conventional medicine were randomly selected and matched with the homeopathy trials for disorder and outcome measures. When analyses were restricted to large trials of higher quality there was no convincing evidence that homeopathy was superior to placebo, whereas for conventional medicine an important effect remained...the ultimate proof is that science makes progress in changing reality: in allopathic medicine by preventing, alleviating, and curing disease ever more effectively...doctors need to be bold and honest with their patients about homeopathy's lack of benefit, and with themselves about the failings of modern medicine to address patients' needs for personalized care." Lancet 2005;366:690-692,726-732.

• Perceived nervousness and anxiety may predict early mortality and morbidity...Self reported hopelessness and life satisfaction have also been linked to suicidalityEpidemiological research has also increasingly focused on the relation between worry, anxiety, and depression and risk of coronary heart disease (CHD) and findings suggest that these negative emotions may be risk factors for CHD.
  Perceived nervousness, uneasiness, and anxiety strongly predicted subsequent suicide attempt and psychiatric disease.  For less severe complaints, excess risk was still significant but less pronounced. These negative emotions were also associated with subsequent risks for all-cause mortality, hospital care, and ischemic heart disease, although to a lesser extent than severe complaints and more so in men. In this study, perceived anxiety was a better predictor of negative health outcome than was self-reported longstanding illness.The strength of our observed associations, especially with regard to men and for outcomes [such] as suicide attempt, underscores the need to try to understand the individual, social, and environmental conditions that lead to the development of nervousness, uneasiness, and anxiety. This single measure of anxiety seems to be an indicator of premature mortality and severe morbidity, and was in this study an even stronger indicator than longstanding illness and smoking.... Health personnel should pay attention to patient anxiety in their diagnostic procedures.J Epidemiol Community Health. 2005;59:794-798

• Pharmacotherapy and cognitive behavior therapy for major depression is cost-effective in predominantly low-income minority women...Depression treatments need to be tailored to specific populations to be most effective. Patients in the pharmacotherapy and CBT groups experienced significantly more depression-free days during the 12-month follow-up the researchers note...findings suggest that expenditures for improved interventions for depression in low-income minority women represent a good investment compared with a range of other generally acceptable medical treatments...Publicly financed health care systems should consider allocation of resources for depression treatment in low-income minority women...we determined that many of the women had significant trauma histories and that interventions for trauma as well as depression might be warranted..Arch Gen Psychiatry 2005;62:868-875.

• The risk of stroke, especially ischemic stroke, is several-fold higher among women who smoke whose spouses also smoke. While passive exposure to cigarette smoke is known to increase the risk of heart disease, its effect on stroke has not been elucidated.
  Among women who smoked, the relative risk of all strokes was 5.7 when their husbands also smoked; the relative risk for ischemic stroke was 4.8. The investigators observed no association between spousal smoking and risk of strokes among nonsmoking women. They suggest that the smoking spouse may be more likely to quit during follow-up if their wives do not smoke, or they may make efforts to not smoke in close proximity to their wives. Stroke 2005.

• The U.S. Food and Drug Administration (FDA) has issued a public health advisory to warn healthcare providers, patients, and patient caregivers against the off-label use of atypical antipsychotic medications for the treatment of dementia-related behavioral disorders in the elderly due to an increased risk of mortality. Most deaths appeared to be related to cardiovascular (eg, heart failure, sudden death) or infectious (eg, pneumonia) causes. Because the 1.6 to 1.7 times increase in mortality risk was linked to medications from all three classes of atypical antipsychotic medications, it is considered by the FDA to be a class effect. The advisory therefore applies to all atypical antipsychotics, including aripiprazole (Abilify, made by Otsuka Pharmaceutical Co); olanzapine (Zyprexa, made by Eli Lilly & Co); quetiapine (Seroquel, made by AstraZeneca Pharmaceuticals LP); risperidone (Risperdal, made by Janssen Pharmaceutica); clozapine (Clozaril, made by Novartis Pharmaceutical Corp); and ziprasidone (Geodon, made by Pfizer, Inc). Fluoxetine HCl plus olanzapine capsules (Symbyax, made by Eli Lilly & Co), indicated for the treatment of depressive episodes associated with bipolar disorder, is also included in the advisory.
  Atypical antipsychotic medications are approved by the FDA for the treatment of schizophrenia and mania only. The FDA advises healthcare providers to revise their treatment of elderly patients receiving these drugs as therapy for dementia-related behavioral disorders.

• Prior function and relationship factors are more important than hormonal determinants of sexual function for women in midlife.
  Longitudinal analysis of the relative effects of age and hormonal factors on aspects of female sexual function found that age impacts negatively on all domains of sexual function and that lower E2 [estradiol] levels significantly adversely affect women's sexual interest and responsiveness (arousal, enjoyment, orgasm) but not the frequency of sexual activity. The midlife years, when most women pass through the menopausal transition, coincide with other social transitions as children leave home and parents may experience ill health associated with older age. In addition, some women may lose (or gain) sexual partners, some of whom have their own problems with sexual performance.This suggests that the low doses of estrogen currently advocated in hormone therapy will not be effective in sustaining women's sexual function."  Fertil Steril. 2005;84:174-180

• Water-pipe smoking (WPS) is emerging as a significant health risk because of risks commonly associated with tobacco as well as infections from pipe sharing. Although the composition of tobacco used in WPS is variable and lacks standardization, studies of narghile smoke suggest high concentrations of carbon monoxide, nicotine, "tar," and heavy metals. Concentrations of these toxins are as high or higher than are seen with cigarette smoke. The nicotine content of water-pipe tobacco has been reported as 2% to 4%, vs 1% to 3% for cigarettes. Carbon monoxide concentrations have been reported to be 0.34% to 1.40% for narghile smoke and 0.41% for cigarette smoke. Water-pipe smokers may absorb higher concentrations of these toxins because of higher concentrations in the smoke itself, or because they may smoke for several hours at a time and may inhale the moisturized, less irritating smoke more deeply. In WPS smokers, studies have shown elevated end-expiratory carbon monoxide levels, carboxyhemoglobin concentrations, and levels of nicotine, cotinine, arsenic, chromium, and lead. Risks of WPS not associated with cigarette smoking are infectious diseases caused by pipe sharing or uncontrolled, manual preparation of narghile. Pediatrics. 2005;116:e113-e119

• Behavioral interventions aimed at reducing risky sexual behavior among men who have sex with men (MSM) and the attendant increased risk of HIV infection are effective, according to a meta-analysis of 33 studies. Interventions associated with effectiveness included interpersonal skills building with role play (for example, negotiation or assertiveness for safer sex), incorporation of relapse prevention or promotion of risk reduction norms by peers, or greater intervention exposure (e.g., more sessions with longer duration).
  Behavioral interventions were associated with a significant 23% reduction in the odds of unprotected anal intercourse and a 61% increase in the odds of condom use during anal intercourse, compared to control groups that did not receive the interventions, researchers report. MSM comprise most new HIV infections reported in Australia, Canada, Mexico, and the United States, as well as a substantial proportion of newly diagnosed HIV infections in many countries of Western Europe, the authors note in their report. In the United States, MSM account for nearly half of cases of AIDS.
  J Acquir Immune Defic Syndr 2005;39:228-241.

• "Depression increases the risk of mortality in patients with rheumatoid arthritis (RA). Because of the enormous personal and societal impact of the illness, rheumatologists should be alert to the presence of depression. Adequate treatment of depression can improve both physical and psychological health status of patients with RA." J Rheumatol 2005;32:1013-1019.