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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_468"
                     title="DSM-V Draft Promises Big Changes in Some Psychiatric Diagnoses"
                     score="0.011"
                     href="http://www.medpagetoday.com/Psychiatry/GeneralPsychiatry/tb/18399?impressionId=1265792581895"
                     
      &lt;p&gt;Substantial changes are in the offing for the &quot;psychiatrist&apos;s bible,&quot; the Diagnostic and Statistical Manual of Mental Disorders, according to a draft of the forthcoming fifth edition.&lt;/p&gt;
&lt;p&gt;The American Psychiatric Association (APA) has posted the draft of DSM-V on a special Web site, &lt;a href=&quot;http://www.psych.org/dsmv.aspx&quot; mce_href=&quot;http://www.psych.org/dsmv.aspx&quot; target=&quot;_blank&quot;&gt;www.dsm5.org&lt;/a&gt;, to obtain comments from its members, other members of the mental health community, and the public.&lt;/p&gt;
&lt;p&gt;At a telephone press briefing before the draft&apos;s release, members of the APA team leading the DSM revision highlighted several substantial innovations they are proposing: &lt;ul&gt; &lt;li&gt;Recategorizing learning disorders, including creation of a single diagnostic category for autism and other socialization disorders, and replacing the controversial term &quot;mental retardation&quot; with &quot;intellectual disability&quot;&lt;/li&gt; &lt;li&gt;Eliminating &quot;substance abuse&quot; and &quot;substance dependence&quot; as disorders, to be replaced with a single &quot;addiction and related disorders&quot; category&lt;/li&gt; &lt;li&gt;Creating a &quot;behavioral addictions&quot; category that will include addictions to gambling but not to the Internet or sex&lt;/li&gt; &lt;li&gt;Offering a new assessment tool for suicide risk&lt;/li&gt; &lt;li&gt;Including a category of &quot;risk syndromes&quot; for psychosis and cognitive impairment, intended to capture mild versions of these conditions that do not always progress to full-blown psychotic disorders or dementia, but often do&lt;/li&gt; &lt;li&gt;Adding a new disorder in children, &quot;temper dysregulation with dysphoria,&quot; for persistent negative mood with bursts of rage&lt;/li&gt; &lt;li&gt;Revising criteria for some eating disorders, including creation of a separate &quot;binge eating disorder&quot; distinct from bulimia&lt;/li&gt; &lt;li&gt;Using &quot;dimensional assessments&quot; to account for severity of symptoms, especially those that appear in multiple diagnostic categories&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The APA will accept comments through April 20. The work groups managing the revision will consider them and make further changes as needed to the draft, said David Kupfer, MD, of the University of Pittsburgh, chairman of the DSM-V task force.&lt;/p&gt;
&lt;p&gt;The draft diagnostic criteria will then undergo two years of field testing. The final DSM-V is scheduled for release in May 2013, &lt;a href=&quot;http://www.medpagetoday.com/Psychiatry/GeneralPsychiatry/17482&quot; mce_href=&quot;http://www.medpagetoday.com/Psychiatry/GeneralPsychiatry/17482&quot; target=&quot;_blank&quot;&gt;a year later than originally planned&lt;/a&gt;.&lt;/p&gt;
&lt;p&gt;&lt;strong&gt;New Categories for Dyslexia, Autism&lt;/strong&gt;&lt;/p&gt;
&lt;p&gt;In the area of neurodevelopmental disorders, DSM-V will put dyslexia and dyscalculia  --  reflecting disabilities of reading and mathematics, respectively  --  into a new category of learning disabilities.&lt;/p&gt;
&lt;p&gt;Autism, Asperger&apos;s syndrome, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified will make up the new &quot;autism and related disorders&quot; category.&lt;/p&gt;
&lt;p&gt;The head of the APA&apos;s work group on substance-related disorders, Charles O&apos;Brien, MD, PhD, of the University of Pennsylvania, told reporters on the press call that substance dependence and abuse had no basis in the research on addictions.&lt;/p&gt;
&lt;p&gt;&quot;We unanimously agreed that . . . there really isn&apos;t evidence for an intermediate stage [short of addiction] that is now known as abuse,&quot; he said. Instead, there will be substance use disorders for each of the major types of drugs that cause problems, such as alcohol.&lt;/p&gt;
&lt;p&gt;He added that the term &quot;dependence&quot; was problematic as a psychiatric diagnosis because some types of physical dependence are &quot;completely normal&quot; for some medications, such as opioid painkillers.&lt;/p&gt;
&lt;p&gt;In fact, under the draft, DSM-V will include &quot;discontinuation syndromes&quot; to allow physicians to properly assess symptoms of withdrawal from psychoactive substances, including caffeine, O&apos;Brien said.&lt;/p&gt;
&lt;p&gt;He also said his work group had considered including sex and Internet addictions as disorders, but decided there was insufficient evidence to allow development of reliable diagnostic criteria for them.&lt;/p&gt;
&lt;p&gt;Consequently, gambling addiction is slated to be the only disorder formally listed in the behavioral addictions category.&lt;/p&gt;
&lt;p&gt;But O&apos;Brien added that, under current plans, sex and Internet addictions would be included in an appendix to DSM-V, intended to encourage additional research that could lead to their inclusion in future editions.&lt;/p&gt;
&lt;p&gt;Carole Lieberman, MD, a Beverly Hills, Calif., psychiatrist who appears frequently on television, regretted the omission of Internet addiction.&lt;/p&gt;
&lt;p&gt;Contacted for comment by &lt;em&gt;MedPage Today&lt;/em&gt; and ABC News, Lieberman said in an e-mail that behavioral addictions are a worthy category. &quot;But why would it not include &apos;Internet addiction,&apos;&quot; she wrote. &quot;Could it be that the psychiatrists involved do not want to acknowledge that their own Internet usage could meet the criteria for addiction?&quot;&lt;/p&gt;
&lt;p&gt;Lieberman added that compulsive shopping was another form of behavioral addiction that deserves recognition.&lt;/p&gt;
&lt;p&gt;&lt;strong&gt;Dimensional and Risk Assessments&lt;/strong&gt;&lt;/p&gt;
&lt;p&gt;APA leaders also emphasized the two new suicide risk assessment scales planned for DSM-V, one for adolescents and one for adults.&lt;/p&gt;
&lt;p&gt;David Shaffer, MD, of Columbia University, told reporters on the press call that suicide nearly always occurs in the context of some psychiatric disorder, but not always depression.&lt;/p&gt;
&lt;p&gt;The new risk assessment tools focus on risk factors such as impulsive behavior, heavy drinking, and chronic severe pain and illness.&lt;/p&gt;
&lt;p&gt;In DSM-IV, suicidal ideation is treated as a symptom of major depression and certain other disorders.&lt;/p&gt;
&lt;p&gt;Shaffer also explained the genesis of the proposed new childhood disorder, temper dysregulation with dysphoria (TDD).&lt;/p&gt;
&lt;p&gt;&quot;About 40% to 60% of the cases [seen by child psychiatrists] will be children who are doing things that other people don&apos;t want them to do,&quot; he said. Many of these are children who are &quot;stubborn and resistant and disobedient and moody.&quot;&lt;/p&gt;
&lt;p&gt;There is currently a recognized syndrome known as oppositional defiant disorder, but some children also display severe aggression and negative moods that go beyond mere stubbornness, according to Shaffer.&lt;/p&gt;
&lt;p&gt;Such children are often tagged as having juvenile bipolar disorder, but research has shown that the label is often inappropriate, since they usually do not qualify for a bipolar disorder diagnosis when they reach adulthood, although they remain dysfunctional. More often, these children are diagnosed as depressed when they become adults.&lt;/p&gt;
&lt;p&gt;He said the addition of TDD would better describe the severity and frequency of irritable behavior while also recognizing the mood disorder that goes with it.&lt;/p&gt;
&lt;p&gt;Another innovation in DSM-V will be the extensive use of so-called dimensional assessments. Whereas DSM-IV relied heavily on present-absent symptom checklists, the new edition will include severity scales for symptoms, such as anxiety or insomnia, that may appear to larger or smaller degrees in many different mental illnesses.&lt;/p&gt;
&lt;p&gt;Darrel Regier, MD, MPH, the APA&apos;s research director, said such checklists &quot;don&apos;t always fit the reality that someone with a mental disorder experiences.&quot; Often, a symptom like insomnia isn&apos;t on the checklist for a particular disorder, he said, &quot;but they can still affect patients&apos; lives and affect the treatment planning.&quot;&lt;/p&gt;
&lt;p&gt;Incorporating quantitative dimensional assessments should allow clinicians to develop treatment and response-monitoring plans better tailored to individual patients&apos; needs, Regier said.&lt;/p&gt;
&lt;p&gt;But Lieberman foresaw problems with the dimensional assessments. &quot;I don&apos;t think [they] will add anything but confusion,&quot; she said in an e-mail. &quot;As it is now, people don&apos;t really make use of the subcategories that there are to describe severity of symptoms. Instead, I see this as a tool that insurance companies could well co-opt to try to deny benefits.&quot;&lt;/p&gt;
&lt;p&gt;&lt;strong&gt;Gender Identity Disorder Stays&lt;/strong&gt;&lt;/p&gt;
&lt;p&gt;A closely watched issue in the DSM-V revision has been whether to change or do away with gender identity disorder, now listed in DSM-IV. At this point, the draft retains the designation but with some changes, officials said.&lt;/p&gt;
&lt;p&gt;People who consider themselves &quot;transgendered&quot; have long criticized DSM-IV and previous editions for labeling them with a mental disease when their problems, they believe, are purely somatic  --  that is, they have the wrong genitalia and hormonal balance.&lt;/p&gt;
&lt;p&gt;At the APA&apos;s annual meeting last May, members of the transgender community &lt;a href=&quot;http://www.medpagetoday.com/MeetingCoverage/APA/14270&quot; mce_href=&quot;http://www.medpagetoday.com/MeetingCoverage/APA/14270&quot; target=&quot;_blank&quot;&gt;made a case&lt;/a&gt; for dropping gender identity disorder from DSM-V, but keeping some kind of &quot;gender variance&quot; diagnosis as a medical condition. Such an approach would eliminate the stigma of a psychiatric diagnosis while leaving a pathway for third-party payment for gender transition treatments, they said.&lt;/p&gt;
&lt;p&gt;William Narrow, MD, the APA&apos;s research director for DSM-V, told reporters that the draft does remove the term &quot;disorder&quot; from the condition when applied to children, renaming it as &quot;gender incongruence.&quot;&lt;/p&gt;
&lt;p&gt;For adults, gender identity disorder will remain in DSM-V but with substantially altered diagnostic criteria, Narrow said.&lt;/p&gt;
&lt;p&gt;But APA officials said the organization planned more discussions with members of the transgender community.&lt;/p&gt;
&lt;p&gt;Kupfer, the DSM-V task force chairman, stressed that further changes in many diagnostic categories are likely following the comment period and field trials.&lt;/p&gt;
&lt;p&gt;Final revisions will be submitted in 2012 for approval by the APA&apos;s two governing bodies, the Assembly and the board of trustees.&lt;/p&gt;
&lt;p&gt;&lt;em&gt;This article was developed in collaboration with ABC News. &lt;/em&gt;&lt;img src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; mce_src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; alt=&quot;&quot;&gt;&lt;/p&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_412"
                     title="Depression During Pregnancy Linked to Kids&apos; Behavior Problems (CME/CE)"
                     score="0.01"
                     href="http://www.medpagetoday.com/Psychiatry/Depression/tb/18321?impressionId=1265792581895"
                     
      &lt;p&gt;Children born to mothers who were depressed during pregnancy were more than twice as likely to display antisocial behavior by age 16 as children whose mothers had not been depressed, researchers found.&lt;/p&gt;
&lt;p&gt;Of 120 mothers from South London who were followed from pregnancy through their children&apos;s teen years, 31% had depression during pregnancy, according to Dale Hay, PhD, of Cardiff University in Wales, and colleagues.&lt;/p&gt;
&lt;p&gt;Children born to these women were significantly more likely to display antisocial behavior (OR 2.46, 95% CI 1.10 to 5.48) and commit violent acts (OR 4.36, 95% CI 1.54 to 12.41) before age 16, the researchers reported in the January/February issue of &lt;em&gt;Child Development&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The associations were magnified in women who also had a history of behavior problems when they were children.&lt;/p&gt;
&lt;p&gt;&quot;A focus on mothers&apos; history of conduct problems and depression during pregnancy, as opposed to broader measures of the social environment, would hold promise for more targeted early interventions to prevent the development of serious antisocial behavior,&quot; Hay&apos;s group wrote.&lt;/p&gt;
&lt;p&gt;Previous studies have linked mothers&apos; mental health problems in pregnancy with disruptive behaviors in their children, but it&apos;s unclear what explains the relationship, according to the researchers.&lt;/p&gt;
&lt;p&gt;To explore the issue, they turned to the South London Child Development Study, which prospectively followed 120 pregnant women and their children into the teenage years.&lt;/p&gt;
&lt;p&gt;All families came from a relatively disadvantaged urban area. These families were more likely to belong to the working class and to be from ethnic minority groups than the general U.K. population.&lt;/p&gt;
&lt;p&gt;One-third of the children had been arrested or diagnosed with a conduct disorder by age 16. Of these 88.9% had been arrested and 45% had committed violent acts, including theft from a person, violent disorder, fighting, carrying a weapon, and assault.&lt;/p&gt;
&lt;p&gt;The association between maternal depression during pregnancy and risk of antisocial behavior remained relatively constant in analyses controlling for family environment, a child&apos;s exposure to maternal depression after birth, mothers&apos; substance use during pregnancy, and parental antisocial behavior.&lt;/p&gt;
&lt;p&gt;None of the factors fully explained the relationship. Neither did the arrest history of the biological father.&lt;/p&gt;
&lt;p&gt;But, the researchers wrote in the paper, &quot;it would be unwise to conclude that paternal risk factors are unimportant, given that we did not have more detailed information about the father&apos;s own history of conduct disorders.&quot;&lt;/p&gt;
&lt;p&gt;They explored several potential mechanisms for the link between maternal depression and a child&apos;s behavior problems: &lt;ul&gt; &lt;li&gt;Direct effects on the fetus from biological correlates of the mothers&apos; depressive symptoms&lt;/li&gt; &lt;li&gt;Depression in pregnancy as a sign of environmental adversity&lt;/li&gt; &lt;li&gt;Re-exposure to maternal depression after birth&lt;/li&gt; &lt;li&gt;Indirect effects of depression on the developing fetus driven by mothers&apos; smoking, drinking, and drug taking during pregnancy &lt;/li&gt; &lt;li&gt;A genetic explanation whereby women who experience depression in pregnancy may also have a greater genetic risk for antisocial behavior, which they pass on to their offspring &lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Hay and her colleagues noted that these explanations are not necessarily mutually exclusive.&lt;/p&gt;
&lt;p&gt;They also acknowledged some limitations of the study, including the lack of information about fetal growth and neuroendocrine measures on the mother and child and the relatively small sample size.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The SLCDS has been funded by U.K. project grants from the Medical Research Council, by the Psychiatric Research Trust, and by the South West G.P. Trust. The current analysis was partially supported by an Economic and Social Research Council studentship to one of Hay&apos;s co-authors and by a Medical Research Council U.K. Program Grant.&lt;/p&gt;&lt;p&gt;The authors did not report any conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_405"
                     title="Difficult Childhood Lingers in the Mind (CME/CE)"
                     score="0.01"
                     href="http://www.medpagetoday.com/Psychiatry/GeneralPsychiatry/tb/18312?impressionId=1265792581895"
                     
      &lt;p&gt;Adversities faced in childhood have effects on mental health far into the future, researchers affirmed.&lt;/p&gt;
&lt;p&gt;Mental illness in adulthood was increasingly likely the more traumas faced in childhood, Ronald C. Kessler, PhD, of Harvard, and colleagues reported in the February issue of the &lt;em&gt;Archives of General Psychiatry&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Childhood difficulties potentially explained 32.4% of all the psychiatric disorders examined, they said, based on analyses of the National Comorbidity Survey Replication.&lt;/p&gt;
&lt;p&gt;Adversities relating to family dysfunction  --  substance-abusing parents, sexual or physical abuse in the home, neglect, etc.  --  appeared to have the strongest link to onset and persistence of psychiatric disorders, they reported.&lt;/p&gt;
&lt;p&gt;These findings match folk wisdom and decades of research into the negative effects of child maltreatment, commented John McGrath, MD, PhD, of the Queensland Centre for Mental Health Research in Wacol, Australia, and colleagues in an accompanying editorial.&lt;/p&gt;
&lt;p&gt;But the lack of specificity between certain exposures to particular mental health outcomes  --  such as the death of one&apos;s mother leading to depression  --  was notable, the editorialists said.&lt;/p&gt;
&lt;p&gt;&quot;Thus, childhood trauma upsets the orderly psychological and biological cascades of development, leaving the affected individual at increased risk of a wide range of adverse mental health outcomes,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;Rather than continue to rehash the epidemiology, it&apos;s time to focus on prevention and intervention, McGrath&apos;s group emphasized.&lt;/p&gt;
&lt;p&gt;&quot;It is unrealistic to think that we could protect all children from all adversities, but can we identify factors that bolster resilience and focus our efforts on the most vulnerable subgroups?&quot; they asked.&lt;/p&gt;
&lt;p&gt;The researchers examined joint associations of 12 retrospectively reported childhood adversities with lifetime incidence of disorders meeting Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria in the National Comorbidity Survey Replication I, a cross-sectional survey of a nationally-representative sample of adults in 9,282 American households.&lt;/p&gt;
&lt;p&gt;Among the respondents, 53.4% reported at least one childhood adversity, most commonly parental divorce (17.5%), family violence (14.0%), family economic problems (10.6%), and parental mental illness (10.3%).&lt;/p&gt;
&lt;p&gt;These adversities were all individually and significantly linked to first onset of psychiatric disorders with odds ratios of 1.5 to 1.9 for dysfunctional family factors (physical abuse, sexual abuse, neglect, parental mental illness, parental substance abuse, parental criminality, or family violence) and 1.0 to 1.5 for other factors like life-threatening childhood physical illness, extreme poverty, parental divorce, or loss of or separation from parents.&lt;/p&gt;
&lt;p&gt;Despite some apparent but not significantly meaningful variation in type of adversity with type of psychiatric disorder, the researchers said they could rule out that all types were the same for future mental health risk (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;Problems tended to cluster, though. Among people who faced one adversity in childhood, 51.2% to 95.1% faced others as well, depending on the adversity.&lt;/p&gt;
&lt;p&gt;Risk of mental illness rose with number of issues faced in childhood from an odds ratio of 1.3 for one up to 3.4 for six and 3.2 for seven or more adversities.&lt;/p&gt;
&lt;p&gt;&quot;This subadditive pattern has important implications for intervention because it means that prevention or amelioration of only a single childhood adversity in youths exposed to many childhood adversities is unlikely to have important preventive effects,&quot; the researchers wrote.&lt;/p&gt;
&lt;p&gt;Overall, childhood adversities were projected to account for 44.6% of childhood-onset disorders, 32.0% of adolescent-onset disorders, and 28.6% of adult-onset disorders.&lt;/p&gt;
&lt;p&gt;The researchers also looked at persistence through the second part of the National Comorbidity Survey Replication which went beyond just core diagnostic assessment in 5,692 respondents.&lt;/p&gt;
&lt;p&gt;In a complex multivariate interactive analysis, childhood adversity from dysfunctional family factors appeared significantly linked to persistence in a given year (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001) whereas the number of factors was not significant.&lt;/p&gt;
&lt;p&gt;These significant factors were parental mental illness, physical abuse, sexual abuse, and neglect, but they carried modest effects individually with odds ratios of 1.2.&lt;/p&gt;
&lt;p&gt;But in one simulation, not being exposed to childhood trauma would only increase the time since the most recent episode of psychiatric illness by 1.6%, suggesting &quot;quite modest&quot; substantive importance in determining persistence.&lt;/p&gt;
&lt;p&gt;&quot;These results indirectly suggest that the public health implications of childhood adversities are greater for primary than for secondary prevention because the associations of childhood adversities with disorder onset are much stronger than the associations with persistence,&quot; Kessler&apos;s group wrote.&lt;/p&gt;
&lt;p&gt;The researchers cautioned that recall bias may have limited their study such that the results could be considered an &quot;upper bound&quot; for the real association and that the study could not prove causality.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The National Comorbidity Survey Replication is supported by a grant from the National Institute of Mental Health with supplemental support from the National Institute on Drug Abuse, the Substance Abuse and Mental Health Services Administration, a grant from the Robert Wood Johnson Foundation, and the John W. Alden Trust.&lt;/p&gt;&lt;p&gt;The analyses were supported by a grant from the NIMH; the John D. and Catherine T. MacArthur Foundation; the Pfizer Foundation; grants from the U.S. Public Health Service; an award from the Fogarty International Center; the Pan American Health Organization; Eli Lilly; Ortho-McNeil Pharmaceutical; GlaxoSmithKline; and Bristol-Myers Squibb.&lt;/p&gt;&lt;p&gt;Kessler reported financial conflicts of interest with GlaxoSmithKline, Kaiser Permanente, Pfizer, sanofi-aventis, Shire Pharmaceuticals, Wyeth-Ayerst, Eli Lilly, Bristol-Myers Squibb, Johnson &amp;amp; Johnson Pharmaceuticals, and Ortho-McNeil Pharmaceutical.&lt;/p&gt;&lt;p&gt;The editorialists reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_359"
                     title="Fish Oil May Prevent Psychotic Episodes (CME/CE)"
                     score="0.01"
                     href="http://www.medpagetoday.com/Psychiatry/Schizophrenia/tb/18242?impressionId=1265792581895"
                     
      &lt;p&gt;High-risk psychiatric patients were less likely to have psychotic episodes when they took daily doses of omega-3 (&amp;#969;-3) polyunsaturated fatty acids (PUFAs), according to results of a small, randomized clinical trial.&lt;/p&gt;
&lt;p&gt;Fewer than 5% of patients had psychotic episodes with &amp;#969;-3 PUFAs, versus more than 25% of patients given placebo (&lt;em&gt;P&lt;/em&gt;=0.007), investigators reported in the February &lt;em&gt;Archives of General Psychiatry&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The &amp;#969;-3 PUFAs, derived from fish among other sources, also reduced positive, negative, and general symptoms and improved functioning compared with placebo, the researchers found.&lt;/p&gt;
&lt;p&gt;&quot;The present trial strongly suggests that &amp;#969;-3 PUFAs may offer a viable prevention and treatment strategy with minimal associated risk in young people at ultra-high risk of psychosis, which should be further explored,&quot; G. Paul Amminger, MD, of the Medical University of Vienna in Austria, and co-authors concluded.&lt;/p&gt;
&lt;p&gt;Early treatment of schizophrenia and other psychotic conditions may lead to better outcomes, the researchers noted. Subclinical psychotic symptoms may predict psychotic disorder, and the propensity for psychosis in a particular population may influence the prevalence and incidence of psychotic disorders.&lt;/p&gt;
&lt;p&gt;Intervention in at-risk populations, therefore, may lead to even better outcomes, they asserted.&lt;/p&gt;
&lt;p&gt;Dysfunctional fatty acid metabolism has been proposed as a contributing factor in psychotic conditions, and several clinical trials have demonstrated beneficial effects of &amp;#969;-3 PUFA supplementation in patients with schizophrenia. Some studies, however, yielded negative results.&lt;/p&gt;
&lt;p&gt;Data from the schizophrenia studies, evidence of neuroprotective properties, and an absence of clinically relevant adverse effects make &amp;#969;-3 PUFAs &quot;an ideal candidate for indicated prevention in young people at risk of psychosis, in whom the use of antipsychotic medication is controversial, the authors wrote.&lt;/p&gt;
&lt;p&gt;To evaluate potential benefits of &amp;#969;-3 PUFAs in subclinical psychosis, investigators enrolled patients ages 13 to 25 who met criteria for one of three operationally-defined, high-risk groups: attenuated positive psychotic symptoms, transient psychosis, and genetic risk plus a decrease in functioning.&lt;/p&gt;
&lt;p&gt;&quot;These criteria comprise a combination of trait and state factors that identify people whose risk of becoming psychotic may approach 40% within a 12-month period,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;The study included 81 patients, who were randomized to 1.2 g/d &amp;#969;-3 PUFA or matching placebo for 12 weeks, plus 12-months of follow-up.&lt;/p&gt;
&lt;p&gt;The authors reported that 76 patients (38 in each group) completed the 12-week intervention phase and 67 completed the 12-month follow-up. The primary outcome was conversion to a psychotic episode, defined by the Positive and Negative Syndrome Scale (PANSS) and sustained for one week.&lt;/p&gt;
&lt;p&gt;At 12 months, two of 41 patients assigned to &amp;#969;-3 PUFA therapy (4.9%) converted to psychotic episodes, compared with 11 of 40 (27.5%) in the placebo group.&lt;/p&gt;
&lt;p&gt;The &amp;#969;-3 group also had significantly lower PANSS positive, negative, general, and total scores at 12 weeks, six months, and 12 months (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05 to &lt;em&gt;P&lt;/em&gt;=0.01). Patients in the &amp;#969;-3 group also had significantly better functioning (&lt;em&gt;P&lt;/em&gt;=0.002).&lt;/p&gt;
&lt;p&gt;Calculation of number needed to treat (NNT) showed that four at-risk patients would have to be treated to prevent one psychotic episode during one year, which the authors said is comparable to the NNT from trials of antipsychotic medications.&lt;/p&gt;
&lt;p&gt;The authors noted several limitations, including the relatively small size of the study and the fact that this was a highly selected population, so the results cannot be generalized.&lt;/p&gt;
&lt;p&gt;In addition, they pointed out that efficacy beyond the 12 month study period is unknown and it is possible that the transition to a first episode of psychosis may have been delayed rather than prevented.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by the Stanley Medical Research Institute.&lt;/p&gt;&lt;p&gt;The authors reported no relevant disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_391"
                     title="Rare Genetic Deletion Linked to Morbid Obesity (CME/CE)"
                     score="0.009"
                     href="http://www.medpagetoday.com/Genetics/GeneralGenetics/tb/18286?impressionId=1265792581895"
                     
      &lt;p&gt;Missing sections of DNA may have a powerful impact on weight for a small segment of the population, researchers said.&lt;/p&gt;
&lt;p&gt;Nearly all teens and adults found to have a particular deletion of roughly 30-genes on chromosome 16p11.2 were obese  --  most morbidly so  --  with a body mass index of at least 40 kg/m&lt;sup&gt;2&lt;/sup&gt;, Philippe Froguel, MD, PhD, of Imperial College London, and colleagues reported in &lt;em&gt;Nature&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;While the variant appeared to explain only a small proportion of morbid obesity  --  0.7% in the study population  --  it was never present in healthy, normal-weight controls.&lt;/p&gt;
&lt;p&gt;&quot;Although the recent rise in obesity in the developed world is down to an unhealthy environment, with an abundance of unhealthy food and many people taking very little exercise, the difference in the way people respond to this environment is often genetic,&quot; Froguel said in a prepared statement.&lt;/p&gt;
&lt;p&gt;But with further findings like these, it may be possible to identify such individuals through genetic testing, he said.&lt;/p&gt;
&lt;p&gt;If so, &quot;We can then offer them appropriate support and medical interventions, such as the option of weight-loss surgery, to improve their long-term health,&quot; Froguel declared.&lt;/p&gt;
&lt;p&gt;Although researchers speculate that one in 20 cases of obesity may have a genetic cause, the genetic component remains largely elusive.&lt;/p&gt;
&lt;p&gt;Even accounting for such a small fraction of cases, the newly discovered 16p11.2 variant would be the second most frequent known genetic cause of obesity, Froguel&apos;s group said.&lt;/p&gt;
&lt;p&gt;Extensive genome-wide association studies have linked numerous single nucleotide polymorphisms (SNPs) to obesity, but added all together they account for only a small fraction of the known heritable component, the researchers said.&lt;/p&gt;
&lt;p&gt;&quot;The &apos;common disease, common variant&apos; hypothesis is increasingly coming under challenge,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;Their team first identified the genetic deletion in teen and adults with learning difficulties or delayed development.&lt;/p&gt;
&lt;p&gt;Because the 31 individuals who had the nearly identical deletions of at least 593 kilobases at chromosome 16p11.2 in one copy of their DNA all had a BMI of over 30 kg/m&lt;sup&gt;2&lt;/sup&gt;, the researchers decided to dig a little deeper.&lt;/p&gt;
&lt;p&gt;&quot;Cohorts with extreme phenotypes that include obesity may be enriched for rare but very potent risk variants,&quot; making them easier to discover, they wrote.&lt;/p&gt;
&lt;p&gt;So they undertook a case-control study among 312 patients at three centers in Britain and France who presented with congenital malformations, developmental delay, or both, in addition to obesity.&lt;/p&gt;
&lt;p&gt;The same deletions were seen in 2.9% of these individuals.&lt;/p&gt;
&lt;p&gt;The function of the missing genes are not well known, but some have previously been associated with delayed development, autism, and schizophrenia.&lt;/p&gt;
&lt;p&gt;Notably, though, the frequency of deletion of these genes in the obese case-control cohort was &quot;appreciably higher&quot; than the less than 1% seen in the autism and other studies that didn&apos;t include obesity as an inclusion criteria, the researchers said.&lt;/p&gt;
&lt;p&gt;A second independent survey of genetic data at eight cytogenetic centers in France, Switzerland, and Estonia turned up a 0.6% rate among 3,947 people with developmental delay, malformations, or both, but who were not selected for obesity (&lt;em&gt;P&lt;/em&gt;=0.00022 versus the cohort selected for obesity).&lt;/p&gt;
&lt;p&gt;Analysis of those with the missing genes revealed an age-dependent link to weight: All four teens and adults were obese. Children were often obese (four of 15) or overweight (two of 15). Children under 2 years all had normal weight.&lt;/p&gt;
&lt;p&gt;So to see whether the deletion was independent of neurodevelopmental problems, Froguel&apos;s group examined genome-wide association study data from general population cohorts totaling 11,856 individuals along with 2,772 from childhood obesity and adult morbid obesity case-control studies, 931 in an extreme early-onset obesity study, and 141 who had bariatric weight-loss surgery.&lt;/p&gt;
&lt;p&gt;All adult carriers of the deletion were obese with the exception of one who was apparently diabetic. Each of the seven children and adolescents who carried the variant had a BMI in the top 0.1% for their age and gender.&lt;/p&gt;
&lt;p&gt;None had any reported developmental or cognitive problems. Four had reported hyperphagia with excessive hunger and food intake.&lt;/p&gt;
&lt;p&gt;Altogether, the 16p11.2 deletions predicted 29.8-fold elevated risk of obesity (&lt;em&gt;P&lt;/em&gt;=0.00000058) and 43.0-fold elevated risk of morbid obesity (&lt;em&gt;P&lt;/em&gt;=0.000000064) compared with lean or normal weight.&lt;/p&gt;
&lt;p&gt;By extrapolation, the researchers extrapolated that about 0.4% of all morbidly obese cases are attributable to an inherited 16p11.2 deletion, with 0.3% arising from a de novo deletion in the same genetic region.&lt;/p&gt;
&lt;p&gt;&quot;Although they may be heterogeneous in nature, these deletions are highly likely to be the causal variants,&quot; they wrote.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by &quot;Le Conseil Regional Nord Pas de Calais/FEDER&quot; along with various governmental and industry supporters for the various component studies.&lt;/p&gt;&lt;p&gt;The researchers reported no financial conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
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