Research update
CrossCurrents
Seizure drug may help people with bipolar disorder and alcohol dependency
Valproate, an anti-convulsant drug, may be effective in decreasing heavy drinking among people with bipolar disorder and alcohol
dependence, according to researchers at the University of Pittsburgh. In the double-blind study, researchers followed 54 clients
diagnosed with both disorders for six months. Participants were given their standard treatment, usually lithium and weekly
counselling, plus either divalproex sodium (valproate) or a placebo. After six months, 44 per cent of the valproate group
reported heavy drinking (five or more drinks daily for men and four or more for women) compared with 68 per cent of the placebo
group. The valproate group also had fewer heavy drinking days and consumed about half as many drinks on heavy drinking days
as the placebo group. The valproate group relapsed to heavy drinking one month later on average than the placebo group. The
research is the first to examine how to treat bipolar disorder and alcohol dependence together, which is important because
medication adherence and substance interactions may be problematic among people with both disorders. The valproate group had
more nausea and vomiting than the placebo group, but the researchers report that, overall, combining lithium and valproate
appeared to be safe. The researchers call for future replications of the study using larger samples.
Archives of General Psychiatry, January 2005, v. 62: 37-45. Ihsan M. Salloum et al., Western Psychiatric Institute and Clinic of the University of Pittsburgh
Medical Center, Pittsburgh, Pennsylvania.
Depression in families may span many generations
Children whose parents and grandparents have a history of depression are more than twice as likely as children with no family
history of depression to develop a psychiatric disorder before they reach their early teens, according to researchers at Columbia
University Medical Center in New York. Previous studies have shown that children of a depressed parent are at greater risk
for mood and anxiety disorders, but the current study, which took more than two decades to complete, is the first to illustrate
how the risk intensifies across three generations. The researchers began studying 47 first-generation family members in 1982
and then interviewed 86 of their children four times as they approached adulthood. The researchers collected data from 161
members of the third generation, whose average age is now 12. The effect of parental depression on grandchildren's outcomes
differed significantly with grandparental depression status. Among children with two generations of major depression, 60 per
cent have a psychiatric disorder. Among grandchildren with depressed parents and no depressed grandparents, there was no significant
effect of parental depression on grandchildren diagnoses. However, parental depression had a significant impact on grandchildren's
overall functioning. The authors suggest early interventions for children with a family history of depression.
Archives of General Psychiatry, January 2005, v. 62: 29-36. Myrna M. Weissman et al., Department of Psychiatry, Columbia University, New York, New York.
Pediatric clients get poor follow-up for ADHD
Children with attention-deficit/hyperactivity disorder (ADHD) who are prescribed stimulant medication rarely receive optimal
follow-up care, according to a survey conducted by the Children's Research Institute at Ohio State University. Parents and
clinicians across the United States completed questionnaires, and parents completed another questionnaire six months later.
Of 659 children aged four to 15, the median number of follow-up visits with a primary care clinician or mental health specialist
in the six months after diagnosis was one. Children who had been prescribed medication (78%) were no more likely to have received
follow-up care than children without medication. Only 26 per cent saw a mental health specialist for follow-up. Primary care
clinicians who had training in mental health provided better follow-up care than those without training. The researchers claim
that the visits occur too rarely to permit medication adjustment or to support adherence. They call for systematic efforts
to improve quality of care and urge primary clinicians to establish practices that promote follow-up visits by families.
Journal of Pediatrics, December 2004, 145: 767-771. William Gardner et al, Children's Research Institute and Department of Pediatrics, Ohio State
University, Columbus, Ohio.
Psychiatric diagnosis facilitates AIDS treatment
People living with AIDS who are receiving treatment for a psychiatric disorder are more likely to start antiretroviral therapy
earlier and to have it prescribed for at least six months than their counterparts without a psychiatric disorder, according
to researchers at the University of Maryland School of Medicine. Researchers investigated whether a psychiatric diagnosis
influenced the time to initiation of highly active antiretroviral therapy (HAART), duration of therapy and survival in 549
individuals with AIDS and no prior antiretroviral treatment. Individuals being treated for a psychiatric disorder were 37
per cent more likely to receive HAART and twice as likely to have it prescribed for at least six months than those without
a psychiatric disorder. They also experienced a 40 per cent reduction in mortality after adjustment for demographic variables
and known risk factors, but this advantage disappeared after adjusting for the effects of HAART. The researchers conclude
that with appropriate treatment, Hiv-positive individuals with psychiatric disorders can do as well as Hiv-positive individuals
without psychiatric disorders.
Journal of Acquired Immune Deficiency Syndromes, December 2004, v. 37: 1457-1463. Seth Himelhoch et al., Department of Psychiatry, University of Maryland School of Medicine,
Baltimore, Maryland.
Centre for Addiction
