Research update

CrossCurrents

Family-based treatment shows promise for teens with bulimia

A recent study from the University of Chicago has found family-based treatment (FBT) to be more effective than supportive psychotherapy (SPT) in treating teenagers with bulimia nervosa. Researchers conducted a randomized controlled trial of 80 patients aged 12 to 19 years. Forty-one were assigned to FBT and 39 to SPT. Participants were included in the study if they binged and purged at least once a week over a period of six months and met other DSM-IV criteria for bulimia. FBT focused on helping parents disrupt their children’s bingeing, purging and restrictive dieting and on helping teenagers address underlying problems believed to be responsible for their bulimia. At the end of treatment, 39 per cent of FBT participants were no longer bingeing and purging compared with only 18 per cent of SPT participants. At six-month follow-up, these abstinence rates had declined, with 29 per cent of FBT participants and 10 per cent of SPT participants still abstinent from bingeing and purging. The FBT group also showed an advantage in terms of the number of participants who experienced a partial remission of bulimia symptoms. At the end of treatment, the FBT group showed a greater reduction than the SPT group in vomiting, compensatory behaviours and restraint, although this advantage largely disappeared by the six-month follow-up. The authors express some concern with the relatively low overall abstinence rates and say their results “highlight the challenge in achieving successful treatment for most patients with [bulimia nervosa].”

Archives of General Psychiatry, September 2007, v. 64: 1049–1056. Daniel le Grange et al., Department of Psychiatry, University of Chicago, Chicago, Illinois.

 

Genetics influence effectiveness of bupropion treatment for smoking

New research from the University of Toronto demonstrates that variations in a particular gene help to determine whether smokers are able to quit smoking using the drug bupropion. The gene in question, CYP2B6, metabolizes both nicotine and bupropion and is genetically variable. Researchers genotyped 326 individuals who smoked at least ten cigarettes a day, of whom 147 (45%) had the CYP2B6 *6 variant of the gene and 179 (55%) had the CYP2B6 *1 variant. Participants then received ten weeks of treatment with either bupropion or placebo. In the CYP2B6 *6 group, those receiving bupropion had significantly higher abstinence rates at the end of treatment than those given placebo (33% vs. 14%) and this advantage was maintained after the six month follow-up (31% vs. 13%). No such advantage was observed in the CYP2B6 *1 group, where the abstinence rates were 31 per cent for bupropion compared with 32 per cent for placebo at end of treatment, with both declining to 22 per cent at the six month follow-up. Notably, the abstinence rates on placebo for this group were comparable to those achieved with bupropion for the CYP2B6 *6 group at the end of treatment, but were lower than those of the CYP2B6 *6 group at the six month follow-up. These findings suggest that individuals with the CYP2B6 *6 variant can benefit substantially from treatment with bupropion. While individuals with the CYP2B6 *1 variant derived no such benefit, their abstinence rates on placebo were already surprisingly high and they may further benefit from alternative therapies.

Biological Psychiatry, September 15, 2007, v. 62: 635–641. Rachel Tyndale et al., Neuroscience Department, Centre for Addiction and Mental Health, Toronto, Ontario.

 

Clinicians don’t always adhere to guidelines in treating depression

Primary care clinicians often fail to adhere to clinical guidelines for depression, according to the RAND Health Program in Santa Monica, California. Researchers used data from three randomized clinical trials conducted as part of the Quality Improvement for Depression (QID) collaboration between 1996 and 1998. The “studies involved 1,131 primary care patients with major depression or dysthymia (low-grade depression) at 45 primary care practices in the United States. Clinicians in the QID studies were encouraged to provide collaborative care for patients. Results were based on patients’ self-reports. More than 70 per cent of clinicians were able to identify depression and provide adequate follow-up in the initial months of treatment. However, only 46 per cent of patients received the minimum treatment with antidepressants (at least two months) or psychotherapy (at least four visits). when patients failed to respond to treatment, just 38 per cent had their psychotherapy or antidepressant treatment changed. Among patients with panic disorder or alcohol dependency symptoms, only 30 per cent were referred to an appropriate specialist. Suicidality was assessed and given appropriate treatment in only a quarter of all cases. A mere 26 per cent of elderly patients completed a minimal course of treatment. The authors indicate a need for clinicians to improve the detection and management of patients who respond poorly to treatment, to collaborate more with mental health specialists and to make greater efforts to ensure patients complete treatment.

Annals of Internal Medicine, September 4, 2007, v. 147: 320–329. Kimberly A. Hepner et al., RAND Health Program, Santa Monica, California.

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