• An impaired ability to correctly identify various scents is seen in psychotic patients at risk for persistent negative and disorganized/cognitive symptoms. Previous reports have shown that up to one third of patients with a schizophrenia spectrum disorder have an olfactory deficit at initial evaluation, but the prognostic significance, if any, of this finding was unclear. Current researchers assessed baseline olfactory ability in 58 patients with schizophrenia, schizoaffective disorder, or other psychotic disorders who were nave to antipsychotic medications. Disease symptoms were assessed at baseline and at 1 year. The University of Pennsylvania Smell Identification Test (UPSIT) was used to assess olfactory ability. With UPSIT, patients are exposed to several cards containing various scents and asked to pick the correct one from four possible answers. UPSIT scores were significantly lower in patients without remission of negative and cognitive/disorganized symptoms. By contrast, the UPSIT score seemed to have no bearing on the persistence of positive or anxiety/depression symptoms.Am J Psychiatry 2006;163:932-933.
• The relative risk of suicide among older subjects is increased during the first month of therapy with selective serotonin reuptake inhibitor (SSRI) antidepressants, although the absolute risk is low. Compared to other antidepressants, the use of SSRIs was associated with a nearly fivefold higher risk of completed suicide (adjusted odds ratio: 4.8) during the first month of therapy. This risk was independent of recent depression diagnosis or receipt of psychiatric care. Suicide of a violent nature was more common among patients on SSRI therapy compared to other antidepressants. No increased risk of suicide was seen during the second and subsequent months of SSRI antidepressant treatment. The researchers calculated the absolute risk of suicide associated with antidepressant use by dividing the 1329 suicides by the total number of patients receiving an antidepressant during the study period. This yielded a suicide rate of 1 in 3353 SSRI-treated patients and 1 in 16,037 patients receiving other antidepressants. During initial therapy, the risk of suicide may increase as some aspects of depression resolve (e.g., psychomotor retardation), thereby energizing the patient to suicide. Patients may also develop akathisia-like symptoms during treatment with SSRI antidepressants, which may increase the risk of suicide. Am J Psychiatry 2006;163:813-821
• Most children diagnosed with autism at 2 years of age will still have that diagnosis at age 9. In contrast, many young children first diagnosed with pervasive developmental disorder not otherwise specified (PDD-NOS) or with autism spectrum disorder (ASD) later have their diagnoses changed to autism. At age 9, most of the changes were "associated with increasing certainty of classifications moving from ASD/PDD-NOS to autism. Overall, 8% of the children had improved, and 18% had worsened. More than half of those initially diagnosed with PDD-NOS later met the criteria for autism, while more than 10% of these children were diagnosed as not autism or ASD, and nearly 30% retained the diagnosis of PDD-NOS. Only one of 84 children diagnosed with autism at age 2 years received a non-autism spectrum diagnosis at 9 years of age, the researchers point out. At 2 years of age, 49% of children were diagnosed with autism, 28% with PDD-NOS, and 25% with non-autism spectrum disorder. Corresponding values among the 9-year-olds were 58%, 20%, and 22%. The authors comment that a diagnosis of PDD-NOS might be helpful to parents of very young children by flagging those who might later be diagnosed with autism. On the other hand, since more than half of those first diagnosed with PDD-NOS later were characterized as autistic, "health care professionals should be wary of telling parents that their young children do not have autism," the researchers add. Arch Gen Psychiatry 2006:63:694-701.
• Cardiac rehabilitation patients who have more symptoms of depression exhibit reduced heart rate (HR) recovery after treadmill stress testing. Heart rate recovery after the cessation of a treadmill stress test assesses autonomic nervous system functioning and predicts mortality. Altered autonomic nervous system functioning may help to explain the relationship between depression and cardiac mortality. Heart rate recovery after exercise was slower among patients with higher Beck Depression Inventory scores. This association remained after controlling for age, sex, and beta-blocker usage. The relationship between depression score and HR recovery was non-significant after controlling for exercise capacity, indicating that exercise capacity may partly account for this relationship. A role of physical fitness in the relationship between depression and HR recovery is not surprising in light of the evidence that HR recovery is highly correlated with exercise capacity, depression predicts physical inactivity among patients at risk for heart disease, and depression symptoms are associated with reduced exercise capacity for patients with CAD.Altered exercise capacity may be one mechanism whereby depression leads to autonomic dysfunction and poor prognosis among cardiac rehabilitation patients. If so, interventions that focus on improving physical fitness may benefit depressed cardiac patients. Am Heart J 2006;151:1122.e1-1122.e6.
• Nearly one in five 13- to 15-year-old students worldwide use tobacco products. 17.3% of all respondents reported that they currently used some type of tobacco product. The overall rates of cigarette smoking and other tobacco use were 8.9% and 11.2%, respectively. Europe and the Americas had the highest rates of cigarette smoking at approximately 17.7%, while South-East Asia had the lowest rate at 4.3%. However, South-East Asia had the highest rate of other tobacco use at 13.3%, while the Western Pacific had the lowest at 6.4%. In all regions, the use of other tobacco products was generally more common among boys than among girls. However, the prevalence of all tobacco use between the sexes was similar, which the researchers say is a cause for concern, and suggest that "effective tobacco-control programs must be developed and implemented with special focus on girls."
  MMWR 2006;55:553-556.
• Nearly 1 out of 11 US high school students is subjected to physical violence from their boyfriend or girlfriend each yea, and boys are just as likely as girls to be the victim of such violence. Dating violence was most common among blacks (13.9%) and Hispanics (9.3%) compared with whites (7.0%). Grade level and geographic residence did not appreciably affect the prevalence of violent behavior. The investigators used multivariate logistic regression modeling, in which they adjusted for sex, grade level, five risk behaviors, ethnicity, and grades, to estimate the adjusted odds ratios (AOR) for high-risk activities among those who had been hurt compared with their peers who did not experience physical dating violence. The AOR was 3.3 for attempted suicide and 1.7 for physical fighting during the previous year. Having five or more alcoholic drinks or smoking on at least 1 of the last 30 days was associated with AORs of 1.3 and 1.1, respectively. The AOR for sexual intercourse during the previous 3 months was 2.6. Grades were also affected, with 6.1% of students not reporting physical dating violence receiving mostly A's, versus 13.7% of victimized students receiving mostly D's or F's. MMWR 2006;55:532-535.
• As many as 8000 physicians in current practice are likely to have some form of cognitive impairment, and the existing medical literature provides little guidance. The epidemiology is based on the prevalence of dementia in the general population, and the age of practicing physicians. Between 5% to 10% of the population aged 65 years or older has dementia, and approximately 80,000 physicians aged 65 years or older are active in patient care. Therefore, according to the study, as many as 8000 physicians may have dementia. On the one side is the dominant model, where physicians have problems like mental illness, depression, or substance abuse. People recognize the problem, confront the physician, and the physician acknowledges that there is a problem. The physician then seeks treatment through various sorts of programs, is successfully treated in many circumstances, and is certified to return to work with some kind of ongoing monitoring. The vast majority of patients with Alzheimer's disease are not aware of their cognitive deficit. It's not a matter of denial; they literally forget that they're forgetting. They don't have insight. So expecting someone with dementia to admit that there's a problem and seek treatment...the model starts to fall apart..if every one of those [8000] physicians is taking care of, depending on their specialty, a few hundred or a thousand or a couple thousand patients, all of a sudden you multiply it out and you figure there may be tens of thousands or hundreds of thousands, or even more patients who are potentially currently being cared for by a physician with cognitive impairment. It would be very delicate, because, implicit in that is that either now or in the near future, they're not safe to continue their trade. It's just like trying to tell somebody they should stop driving, or that they should not live alone. It's a direct threat to their independence and livelihood. So it's really difficult, yet obviously the right thing to do.
• There are statistically significant associations between violent victimization and asthma episodes. Those who had been victimized in the past year were 45% more likely than those who had not been victimized to report an asthma episode in this period. Researchers defined victimization "as having been threatened or injured with a weapon, such as a gun, knife, or club on school property; having had something, e.g., a car, clothing or books, stolen or deliberately damaged on school property;" or having an injury that required treatment by a doctor or nurse at least once in the past year. Adolescents who reported missing school because they felt unsafe were nearly three times more likely than those who had not felt unsafe to have had an asthma episode in the past year. Also found that the association between feeling too unsafe to go to school and asthma episodes pertain to adolescents who live in urban, suburban and rural areas. The findings support previous studies that have linked exposure to violence and asthma morbidity in children who live in inner cities. The observed associations held up after considering the effects of other factors, such as the gender, race/ethnicity, grade level, smoking status, weight and exercise. Violent victimization and feeling unsafe are two potential psychosocial stressors and environmental factors that appear to exacerbate asthma. Am J Public Health 2006;96:802-804.
• Elderly men who engage in at-risk drinking have higher mortality rates than those who abstain or drink safer amounts. The authors define at-risk drinking as excessive drinking or the "use of alcohol in amounts deemed risky in the presence of relevant comorbidities." An example of excessive alcohol use alone would be 3 drinks per day on 4 or more occasions per week. At risk drinking would also encompass 2-3 drinks per day with anxiety disorder or gout, or while taking medication for pain or insomnia, for example. The most common conditions responsible for identifying at-risk-drinking men were gout (22%) and ulcer disease (16%). Ulcer disease (20%) and anxiety disorder (defined as having a nervous breakdown or taking medications for nerves) (17%) were the most common conditions identifying at-risk-drinking women," they note. Pain medication was the most common medication used to identify at-risk drinkers in men and women (13% of men, 22% of women). At-risk drinking was associated with higher mortality rates than not-at-risk drinking among men (hazard ratio = 1.20). There was no association between abstinence and greater mortality in men. Neither at-risk drinking nor abstinence were related to a greater mortality rate in women. These findings suggest that a lower threshold of alcohol use should be recommended for older adults with specific morbidities to reduce mortality risks. J Am Geriatr Soc 2006.
• Stressful life events do not appear to be associated with exacerbations of inflammatory bowel disease (IBD). Previous studies investigating the role of major life events in exacerbations of IBD have yielded contradictory results,  but there is an emerging trend that such events are not significantly related to IBD relapse. (The study) sought to determine whether life events, the emotional impact of these life events, and an IBD activity index were related in 162 patients who entered the study with inactive IBD. After adjustment for covariates, the authors report, there was no association between disease relapse and the number of stressful events reported in the previous three months. Similarly, multivariate regression analysis showed that the level of emotional impact of stressful events did not significantly increase the risk of relapse during the following months. The hypothesis that life events are not a cause of relapse in IBD becomes stronger and rules out the subjective perception of most patients who believe that exacerbations of the illness are influenced by the life events. Am J Gastroenterol 2006;101:775-781,782-785.
• Results of a new study found that about 25% of patients with diabetes type 1 or type 2 have symptoms of depression, confirming the relationship between these two conditions. Seventy-five had type 2 diabetes, 60.3% were women, the mean age was 54 years and 52.9% were white. Using conservative thresholds (a score of at least 22), 25.3% of the subjects had clinically significant depression. There were no significant differences in the rates of depression by ethnic group or diabetes type. Approximately 76% reported experience with one or more types of depression treatment. A total of 52% reported treatment with antidepressant medications, 63% from mental health providers, 15% with herbal remedies, and 19% from alternative healers. Compared with whites, African Americans were less likely to report receiving any type of depression treatment, including treatment with antidepressant drugs or treatment from mental health professionals. No difference between whites and Hispanics in treatment use was observed. The researchers also detected no difference across the groups in use of herbal or alternative remedies. Of the 56 patients with high depression scores, most (63%) who received antidepressant drugs were satisfied or very satisfied with the treatment. Fifty-nine percent of patients treated by a mental health provider were satisfied with treatment, while 80% of those treated by an "alternative healer" and 38% who took herbal remedies were satisfied. Diabetes Care 2006;29:549-553.
• Sleeping less than 6 hours per night increases the risk for hypertension. "Depriving healthy subjects of sleep has been shown to acutely increase blood pressure and sympathetic nervous system activity. Prolonged short sleep durations could lead to hypertension through extended exposure to raised 24-hour blood pressure and heart rate, elevated sympathetic nervous system activity, and increased salt retention. Such forces could lead to structural adaptations and the entrainment of the cardiovascular system to operate at an elevated pressure equilibrium. The increased risk continued to be significant after controlling for obesity and diabetes, consistent with the hypothesis that these variables would act as partial mediators. Short sleep duration could, therefore, be a significant risk factor for hypertension. Further research is needed to investigate the biological mechanisms that link short sleep duration and high blood pressure. If short sleep duration functions to increase blood pressure, then interventions that increase the amount and quality of sleep could potentially serve as treatments and as primary preventative measures for hypertension. In results from the National Sleep Foundation 2002 Sleep in America Poll, not getting enough sleep was associated with irritability, impatience, pessimism, and feeling tired and stressed," the authors point out. It would seem that these feelings and emotional states would function to lessen one's resolve and willpower to follow dietary or exercise regimens that would be protective against hypertension."

©2006 David B. Adams, Ph.D.