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Research round-up
Insight
Research round-up The effects of comorbid depression and type 2 diabetes on the risk of developing dementia are assessed in a Danish cohort study. The 7-year study included almost 2·5 million individuals aged 50 years or more, free from dementia at baseline, of whom about 9% had diabetes, 19% had depression, and 4% had both. After 13·8 million person-years follow-up, dementia was diagnosed in almost 60 000 individuals (2% of the cohort). The risk of dementia was increased in people with diabetes (adjusted hazard ratio [HR] 1·20, 95% CI 1·17–1·23), depression (1·83, 1·80–1·87), or both (2·17, 2·10–2·24), compared with people who did not have either disorder. The risk of dementia attributed by the cooccurrence of both diabetes and depression was greater that than the added risks imparted by these disorders individually (p=0·001), with the combined effect being more pronounced in adults younger than 65 years (p=0·001).
The PREVENT trial Mindfulness-based cognitive therapy (MBCT) as an alternative to continuation of antidepressant therapy is examined in the PREVENT trial. In this 24 month, multicentre, randomised study, re searchers compared maintenance antidepressant therapy with tapering or discontinuation of antidepressant treatment using 8 weekly sessions of MBCT plus ongoing support. At 24 months, 94 (44%) of 212 individuals in the MBCT group had relapsed compared with 100 (47%) of 212 in the maintenance antidepressant group (HR for recurrence or relapse 0·89, 95% CI 0·67–1·18; p=0·43). The number of depression-free days did not differ between the two groups (for MBCT, mean 607·4 days [SD 196.4]; for maintenance antidepressant treatment, 607·4 days [203·7]; p=0·66). www.thelancet.com/psychiatry Vol 2 June 2015
Treating opioid dependence The potential feasibility of starting treatment for opioid dependence in the emergency department setting is discussed in a new study. In this single-centre trial of adults with opioid dependence, researchers compared the effect of buprenorphine and naloxone treatment started in the emergency department plus follow-up (n=114) with brief intervention plus assisted referral for treatment (n=111) and simple referral for treatment (n=104). At day 30, a greater proportion of the emergency department treatment group were receiving treatment for addiction (89 patients [78%], compared with 50 [45%] in the brief intervention group, and 38 [37%] in the referral group; p<0·001). Although patients in all three groups reported fewer days of self-reported illicit opioid use at day 30 compared with baseline (p<0·001), those in the emergency department treatment group reported fewer days of use in the past 7 days compared with the other two groups (p<0·001).
Brexpiprazole for acute schizophrenia Brexpiprazole, a serotonin–dopamine activity modulator, was assessed in a 6-week, randomised, placebocontrolled study of patients with acute exacerbation of schizophrenia. In this phase 3 multicentre trial, 636 patients were randomly allocated to placebo or brexpiprazole (0·25 mg, 2 mg, or 4 mg per day). The primary outcome of Positive and Negative Syndrome Scale total score from baseline to week 6 was significantly reduced in both the brexpiprazole 2 mg group (treatment difference –8·72, 95% CI –13·1 to –4·37; p<0.0001) and the 4 mg group (–7·64, –12·0 to –3·30; p=0·0006) compared with placebo. Akathisia occurred more often in the brexpiprazole 2 mg group (in eight [4%] of 182 patients) and 4 mg group (in 13 [7%] of 180 patients), than in the placebo group (4 [2%] of 184).
Overall, the investigators noted that treatment was generally well tolerated.
Consequences of childhood sleep problems A Norwegian population-based cohort study that included 32 662 Norwegian mother-infant pairs provides compelling results regarding the association between sleep problems in children and the later development of emotional and behavioural problems. At age 18 months, both reduced hours of sleep (≤10 h vs ≥13 h) and increased number of nocturnal awakenings (≥3 per night vs a few times per week or less) were associated with an increased risk of emotional and behavioural problems, both at baseline (adjusted relative risk for internalising problems: 3·12, 95% CI 2·75–3·54 and 3·19, 2·87–3·54, respectively) and at age 5 years (1·59, 1·23–2·08 and 1·57, 1·28–1·93, respectively [adjusted for emotional and behavioural problems at 18 months]).
Bipolar disorder in youth Insight into the neurodevelopmental changes associated with bipolar disorder in adolescents is provided in a new study. Researchers did a longitudinal study of 37 healthy adolescents (mean age 16·2 years [SD 2·7]) and 35 adolescents with bipolar disorder (16·8 years [2·8]). MRI was done on participants at baseline and 2 years later. At follow-up, MRI showed a decrease in brain volume affecting regions in the right hemisphere, including in the right insula and frontal regions, in young people affected by bipolar disorder compared with controls (p<0·05). In these regions, white matter increased by 4·36% in healthy controls, with no such changes in the affected cohort (p<0·005), and grey matter reduced by 3·95% in adolescents with bipolar disorder, with no such changes in healthy controls (p<0·005).
GUSTOIMAGES/Science Photo Library
Diabetes, depression, and risk of dementia
For more on diabetes, depression, and risk of dementia see JAMA Psychiatry 2015, published online April 15. http://dx.doi.org/10.1001/ jamapsychiatry.2015.0082 For more on the PREVENT trial see Lancet 2015, published online April 20. http://dx.doi. org/10.1016/S01406736(14)62222-4 For more on initiating treatment for opioid dependence see JAMA 2015, published online April 28. http://dx.doi. org/10.1001/jama.2015.3474 For more on brexpiprazole for acute schizophrenia see Am J Psychiatry 2015, published online April 16. http://dx.doi.org/10.1176/appi. ajp.2015.14101275 For more on consequences of childhood sleep problems see JAMA Pediatr 2015, published online April 13. http://dx.doi.org/10.1001/ jamapediatrics.2015.0187 For more on bipolar disorder in youth see Biol Psychiatry 2015, published online April 6. http://dx.doi.org/10.1016/j. biopsych.2015.03.026
Seema Kang 493
Research round-up The effects of comorbid depression and type 2 diabetes on the risk of developing dementia are assessed in a Danish cohort study. The 7-year study included almost 2·5 million individuals aged 50 years or more, free from dementia at baseline, of whom about 9% had diabetes, 19% had depression, and 4% had both. After 13·8 million person-years follow-up, dementia was diagnosed in almost 60 000 individuals (2% of the cohort). The risk of dementia was increased in people with diabetes (adjusted hazard ratio [HR] 1·20, 95% CI 1·17–1·23), depression (1·83, 1·80–1·87), or both (2·17, 2·10–2·24), compared with people who did not have either disorder. The risk of dementia attributed by the cooccurrence of both diabetes and depression was greater that than the added risks imparted by these disorders individually (p=0·001), with the combined effect being more pronounced in adults younger than 65 years (p=0·001).
The PREVENT trial Mindfulness-based cognitive therapy (MBCT) as an alternative to continuation of antidepressant therapy is examined in the PREVENT trial. In this 24 month, multicentre, randomised study, re searchers compared maintenance antidepressant therapy with tapering or discontinuation of antidepressant treatment using 8 weekly sessions of MBCT plus ongoing support. At 24 months, 94 (44%) of 212 individuals in the MBCT group had relapsed compared with 100 (47%) of 212 in the maintenance antidepressant group (HR for recurrence or relapse 0·89, 95% CI 0·67–1·18; p=0·43). The number of depression-free days did not differ between the two groups (for MBCT, mean 607·4 days [SD 196.4]; for maintenance antidepressant treatment, 607·4 days [203·7]; p=0·66). www.thelancet.com/psychiatry Vol 2 June 2015
Treating opioid dependence The potential feasibility of starting treatment for opioid dependence in the emergency department setting is discussed in a new study. In this single-centre trial of adults with opioid dependence, researchers compared the effect of buprenorphine and naloxone treatment started in the emergency department plus follow-up (n=114) with brief intervention plus assisted referral for treatment (n=111) and simple referral for treatment (n=104). At day 30, a greater proportion of the emergency department treatment group were receiving treatment for addiction (89 patients [78%], compared with 50 [45%] in the brief intervention group, and 38 [37%] in the referral group; p<0·001). Although patients in all three groups reported fewer days of self-reported illicit opioid use at day 30 compared with baseline (p<0·001), those in the emergency department treatment group reported fewer days of use in the past 7 days compared with the other two groups (p<0·001).
Brexpiprazole for acute schizophrenia Brexpiprazole, a serotonin–dopamine activity modulator, was assessed in a 6-week, randomised, placebocontrolled study of patients with acute exacerbation of schizophrenia. In this phase 3 multicentre trial, 636 patients were randomly allocated to placebo or brexpiprazole (0·25 mg, 2 mg, or 4 mg per day). The primary outcome of Positive and Negative Syndrome Scale total score from baseline to week 6 was significantly reduced in both the brexpiprazole 2 mg group (treatment difference –8·72, 95% CI –13·1 to –4·37; p<0.0001) and the 4 mg group (–7·64, –12·0 to –3·30; p=0·0006) compared with placebo. Akathisia occurred more often in the brexpiprazole 2 mg group (in eight [4%] of 182 patients) and 4 mg group (in 13 [7%] of 180 patients), than in the placebo group (4 [2%] of 184).
Overall, the investigators noted that treatment was generally well tolerated.
Consequences of childhood sleep problems A Norwegian population-based cohort study that included 32 662 Norwegian mother-infant pairs provides compelling results regarding the association between sleep problems in children and the later development of emotional and behavioural problems. At age 18 months, both reduced hours of sleep (≤10 h vs ≥13 h) and increased number of nocturnal awakenings (≥3 per night vs a few times per week or less) were associated with an increased risk of emotional and behavioural problems, both at baseline (adjusted relative risk for internalising problems: 3·12, 95% CI 2·75–3·54 and 3·19, 2·87–3·54, respectively) and at age 5 years (1·59, 1·23–2·08 and 1·57, 1·28–1·93, respectively [adjusted for emotional and behavioural problems at 18 months]).
Bipolar disorder in youth Insight into the neurodevelopmental changes associated with bipolar disorder in adolescents is provided in a new study. Researchers did a longitudinal study of 37 healthy adolescents (mean age 16·2 years [SD 2·7]) and 35 adolescents with bipolar disorder (16·8 years [2·8]). MRI was done on participants at baseline and 2 years later. At follow-up, MRI showed a decrease in brain volume affecting regions in the right hemisphere, including in the right insula and frontal regions, in young people affected by bipolar disorder compared with controls (p<0·05). In these regions, white matter increased by 4·36% in healthy controls, with no such changes in the affected cohort (p<0·005), and grey matter reduced by 3·95% in adolescents with bipolar disorder, with no such changes in healthy controls (p<0·005).
GUSTOIMAGES/Science Photo Library
Diabetes, depression, and risk of dementia
For more on diabetes, depression, and risk of dementia see JAMA Psychiatry 2015, published online April 15. http://dx.doi.org/10.1001/ jamapsychiatry.2015.0082 For more on the PREVENT trial see Lancet 2015, published online April 20. http://dx.doi. org/10.1016/S01406736(14)62222-4 For more on initiating treatment for opioid dependence see JAMA 2015, published online April 28. http://dx.doi. org/10.1001/jama.2015.3474 For more on brexpiprazole for acute schizophrenia see Am J Psychiatry 2015, published online April 16. http://dx.doi.org/10.1176/appi. ajp.2015.14101275 For more on consequences of childhood sleep problems see JAMA Pediatr 2015, published online April 13. http://dx.doi.org/10.1001/ jamapediatrics.2015.0187 For more on bipolar disorder in youth see Biol Psychiatry 2015, published online April 6. http://dx.doi.org/10.1016/j. biopsych.2015.03.026
Seema Kang 493