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• Eating conflicts, struggles with food, and unpleasant meals in early childhood are linked to the development of eating disorders in adulthood, according to a report published in the December issue of the Journal of the American Academy of Child and Adolescent Psychiatry. The presence of bulimia nervosa and anorexia nervosa symptoms in adolescence correlated with the presence of these symptoms in adulthood. The ideal treatment for adolescents with eating disorder symptoms remains unclear. J Am Acad Child Adolesc Psychiatry 2001;40:1434-1440.
• Three of the most commonly prescribed selective serotonin reuptake inhibitors (SSRIs) are similar in effectiveness for depressive symptoms, according to a study reported in the Dec. 19 issue of The Journal of the American Medical Association. In this nine-month study, antidepressant therapy were randomized to treatment with paroxetine (Paxil), fluoxetine (Prozac), or sertraline (Zoloft). The drugs were similar in their effect on health-related quality of life measures including social interactions, ability to work, sexual functioning and sleep; antidepressant effectiveness; and adverse effects. Findings suggest that in general none of the three SSRIs in this study can be recommended over another in terms of effectiveness.

• Although antipsychotic medication added to antidepressant therapy improves initial outcome in elderly patients with delusional depression, a study reported in the fall issue of the American Journal of Geriatric Psychiatry shows no real benefit from continued combination therapy. Continuation treatment with a conventional antipsychotic does not decrease relapse rates but is associated with significant untoward adverse events in older persons after recovery from a delusional depression. Relapse frequency was 25% for the whole population and was nonsignificantly greater in subjects on combination therapy than in those on monotherapy. Subjects on combination therapy had significantly more extrapyramidal symptoms, falls, and tardive dyskinesia. The authors recommend additional studies to determine whether SSRIs or atypical antipsychotics are more effective or have fewer adverse effects.

• Maternal infections during pregnancy are linked to higher risk of psychosis when the offspring reach adulthood, according to a study reported in the November issue of the Archives of General Psychiatry. The offspring of mothers with elevated levels of total IgG and IgM immunoglobulins and antibodies to HSV type 2 are at increased risk for the development of schizophrenia and other psychotic illnesses in adulthood. As none of the infants who developed psychosis in adulthood had encephalitis or other CNS abnormalities at birth, the mechanism predisposing to psychotic illness is unclear.

• 94% of these respondents said they are adequately informed of the health risks of smoking, but one third of the smokers misbelieved that smoking 5 cigarettes a day presents the same risk for developing cancer as not smoking, and 53% believed that nicotine causes cancer. Yet . A significant number of respondents believed that cigarettes are less dangerous when filtered (60%), when tar is reduced (58%), or when additives are removed (50%). The researchers noted that most respondents were not aware of filter fallout. One in five said nicotine medications completely eliminate the urge to smoke. 27% of the respondents do not believe they are at greater risk of developing lung cancer than any one else in their age group.   
• Nearly one third of adults with advanced macular degeneration (AMD) meet diagnostic criteria for having depressive disorder. The prevalence is nearly twice that found in general populations of older community-dwelling adults. Regardless of whether depression was present, visual acuity correlated directly with the level of vision-specific disability. If depressive disorder is uncovered in an AMD patient, referral for treatment should be considered. In addition, treatment strategies are needed that teach patients how to cope with vision loss. Ophthalmology 2001;108:1893-1901.
• Stroke patients are at increased risk of suicide. Correspondingly, standardized mortality ratios [SMR] were increased for stroke patients." The SMR for men was 1.88 across all age bands, the investigators note. For women, it was 1.78. The SMR was greatest for patients under 50 years of age, at 2.85. It was least for patients at least 80 years of age, at 1.3. The authors observed a negative association between suicide and duration of hospitalization. The suicide rate was lowest for patients hospitalized for more than 3 months (0.88) and highest for those hospitalized for less than 2 weeks (2.32). "Survival analysis suggested that the risk for suicide is greatest up to about 5 years after a stroke," the team reports. J Epidemiol Community Health 2001;55:863-866.  
• Nearly as many men as women are affected by body dysmorphic disorder. One form of the disorder that occurs almost exclusively in men is muscle dysmorphia, which often leads to abuse of anabolic steroids. Body dysmorphic disorder may lead to social isolation or impaired job performance. Associated depression may lead to suicidal behavior or violence towards dermatologists or surgeons who treat these patients. A few straightforward questions can be used to diagnose body dysmorphic disorder. These include questions about preoccupation with perceived flaws in one's appearance, and whether this preoccupation causes depression and anxiety or interferes with social and occupational function. BMJ 2001;323:1015-1016.

• Contrary to expectation, a study in the October, 2001 issue of the British Journal of Psychiatry suggests that duration of untreated psychosis in those patients experiencing their first-episode of the condition does not affect cognitive functioning. Although several variables such as gender, premorbid adjustment, education, and handedness predicted cognitive functioning on various cognitive subtests, duration of untreated psychosis was not related to performance on any component of the test battery. While these findings do not provide support for a toxic effect of duration of psychosis on cognitive functioning, they do not preclude other effects on outcome through psychological engulfment, social support, or adherence to medication.

• While attention deficit hyperactivity disorder (ADHD) in childhood is known to increase the risk of antisocial behavior in adulthood, there is still debate whether this association merely reflects increased incidence of conduct disorder in ADHD. Characteristic patterns on tests of autonomic arousal predict risk of antisocial behavior in adulthood. Boys with both conditions had less-pronounced autonomic responses to sudden orienting and aversive stimuli normally perceived as startling. Their responses were very similar to those reported in adults with antisocial personality, with lower amplitude of skin conductance response and more rapid habituation. These findings give further support for a high persistence of antisocial behavior from childhood to adulthood, while no evidence was found that ADHD itself is associated with a predisposition to antisocial behavior.

• There appears to be a difference in men and women with regard to the effect of personality traits on the risk of adult-onset asthma. For both men and women, low life satisfaction was associated with an increased prevalence of asthma compared with those who reported being most satisfied. High levels of neuroticism were also associated with the prevalence of asthma. In women there was a suggestion of associations between asthma and stress, and asthma and extroversion, but the associations were not statistically significant. These factors were not associated with the prevalence of asthma in men. In an incidence analysis, extroversion was associated with an almost three times higher risk of asthma in women with high extroversion scores compared with women with low scores. However, extroversion was not a significant predictor of asthma in men. Allergy 2001;56:971-977.

• Low-dose risperidone decreases hyperactivity, disruptive behavior, and improves affective regulation in about one-third of young autistic children, based on a study reported in the October issue of the Journal of the American Academy of Child and Adolescent Psychiatry.  Symptoms related to behavioral control (hyperactivity, fidgetiness, and rhythmic motions) and affective regulation (emotional lability and angry affect) improved more than 25%, as did functional impairment on the Children's Global Assessment Scale. Low-dose risperidone may positively affect symptoms in young autistic children, improving disruptive/ hyperactive behavior and affective dysregulation.

• In adolescents who have attempted suicide, those who practice self-mutilative behavior (SMB) are more likely to also suffer from other psychological disorders than those who do not, according to a study in the September issue of the Journal of the American Academy of Child and Adolescent Psychiatry. Adolescent suicide attempts with SMB are associated with greater cognitive, affective, and behavioral symptoms. Adolescents with a history of SMB who attempted suicide  were more likely to be diagnosed with oppositional defiant disorder, major depression, and dysthymia They also scored higher on measures of hopelessness, loneliness, anger, risk taking, reckless behavior, and alcohol use. Loneliness increased the odds of SMB almost six-fold.

• Patients with paranoid and undifferentiated subtypes of schizophrenia differ in how they process language. Patients with paranoid schizophrenia were most likely to recognize words presented to the right ear, suggesting a left hemisphere advantage for language processing. Patients with undifferentiated schizophrenia had the smallest left hemisphere advantage.  Gender affected hemisphere advantage only in the patients with undifferentiated schizophrenia, as males had a slight right-ear advantage, but females had a slight left-ear advantage. Undifferentiated schizophrenia is associated with underactivation of left hemisphere resources for verbal processing, paranoid schizophrenia is characterized by preserved left-hemisphere processing.