News

The temporary withdrawal of natalizumab (Tysabri) from the market in February 2005 in response to 3 cases of progressive multifocal leukoencephalopathy (PML) among clinical trial participants was a wake-up call for the neurology community about the risks of therapies for multiple sclerosis (MS). Although natalizumab returned to the market under a restricted distribution program in June 2006, the impact of the withdrawal remains evident in the more guarded optimism now being expressed by clinicians and researchers about the agent and about other immunosuppressive therapies for relapsing- remitting MS (RRMS) in the absence of longterm safety data.

Multiple sclerosis (MS) is the most commoninflammatory demyelinating disease of theCNS and the most frequent cause of nontraumaticneurological disability in young andmiddle-aged adults.1 Women are twice as likelyto be affected as men, and onset typicallyoccurs between the ages of 20 and 40 years.

Although the strongest risk factor for multiple sclerosis (MS) is a family history, which is not modifiable, there is compelling evidence that environmental factors also are at play in MS development. Addressing these risks may potentially result in reduction of disease incidence, reported Alberto Ascherio, MD, DrPH, associate professor of nutrition and epidemiology and director of the Neuroepidemiology Group at Harvard University in Boston.

A 32-year-old left-handed woman presented with a 4-week history of progressive left hand numbness, tingling, and clumsiness. Symptoms worsened until she found it difficult to write and perform fine motor tasks. She reported having no transient neurological symptoms in the past. Her medical history was significant only for Dengue fever acquired several years ago while on a visit to Southeast Asia. She was taking no medications, and a review of systems was noncontributory.

In 2005, the aim of the National Multiple Sclerosis (MS) Society Promise 2010 Initiative was to raise $30 million and distribute it to research teams. "Our goal has been to foster collaboration across various disciplines," said Patricia O'Looney, MD, director of biomedical research programs at the National MS Society.

Hypertonicity in plantar flexion is a frequent complication of traumatic brain injury (TBI), which affects more than 1.5 million persons in the United States.

Early treatment of clinically isolated syndrome (CIS) with subcutaneous interferon beta 1b (IFN-b-1b; Betaseron) may reduce disability at 3 years, according to the latest news from the Betaferon/Betaseron in Newly Emerging MS For Initial Treatment (BENEFIT) study. The data were presented by Mark Freedman, MD, director of the Multiple Sclerosis Research Unit at the University of Ottawa, in Ontario, at the recent Annual Meeting of the American Academy of Neurology (AAN), held April 28 to May 5 in Boston.

An imbalance in blood levels of oxytocin may be associated with certain forms of autism spectrum disorders (ASDs).

Poetry of the Times

Early intervention in psychiatric disorders such as schizophrenia can have a wide range of effects on patient symptoms and outcome. A recent study published in the Journal of Clinical Psychiatry reported improvements with antidepressants and atypicals in adolescents in the "prodromal" stage of schizophrenia, although a psychotic disorder later developed in a quarter of the adolescents treated with atypicals.

States will come under new pressure to provide mental health data to the FBI gun purchase check system if Congress passes a bill being touted as a response to the Virginia Tech catastrophe in which a student gunman with previous mental health problems shot and killed 32 people. The National Instant Criminal Background Check System (NICS) Improvement Act (HR 297) now seems destined to pass Congress this year. It would provide grants to states to help them provide a variety of data to the FBI’s NICS on whether a person has been convicted of a misdemeanor crime of domestic violence or has been the subject of court orders, mental health adjudications, or commitments.

Although there are many treatments and interventions available for drug abuse and dependence, few persons with substance use disorders actually use them, a new survey reports. The National Epidemiologic Survey on Alcohol and Related Conditions, conducted by scientists from the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism, was published in the May 2007 issue of the Archives of General Psychiatry. The survey used face-to-face interviews with over 43,000 US adults aged 18 years or older.

The FDA has ordered the addition of a "black box" warning to antidepressant labeling of increased suicide risk in adults aged 18 to 24 years. The labeling will also note that no increased risk has been seen in older adults and that, in fact, the incidence of suicidal thoughts and behavior has been found to decrease during antidepressant therapy in patients 65 years and older.

In 1980 DSM-III created a new diagnostic entity-posttraumatic stress disorder (PTSD). Although this condition had been described for centuries, it was always within the context of a particular stressor, most often war. The term shell shock was applied to World War I soldiers who seemed to have been struck senseless in the heat of battle. The horrors of World War II produced not only robust psychiatric morbidity in its combatants but also devastating emotional symptoms in the civilian victims of concentration camps and atomic bombs.

I grew up with a neighborhood kid who was a nice guy but burst into tears at even the tiniest of scrapes--heck, even if he fell down--so we always called him a crybaby. He seemed to be very tuned to his sensory environment--in our gang's perspective, overly tuned--hence the epithet for his behavior. The many unjust cruelties of childhood notwithstanding, was that really a fair accusation? There is growing evidence that may supply a solid molecular answer to this question. It may reveal the accusation to be not only emotionally unkind but also biologically unsound.

There are important distortions in the article "Substance Abuse in Women: Does Gender Matter?" (Psychiatric Times, January 2007, page 48). My concerns regard the political assumptions made (rather than those based on science) that put a spin on data rather than letting the data stand alone.

The field of psychopharmacology is evolving rapidly. New research and medications appear, and practice changes. This book was up-to-date when it went to press; however, it does not include the most recent findings from the CATIE, STAR*D study, and CATIE-AD study. There is no mention of paliperidone, intramuscular aripiprazole, selegiline transdermal system, varenicline, or depot inject- able naltrexone. One wonders whether books are becoming obsolete as a medium for communicating the state of the art.

The FDA has approved less restrictive labeling for the catechol-O-methyltransferase inhibitor tolcapone (Tasmar). The agent has been useful in increasing "on" time in patients with Parkinson disease (PD) when used as an adjunct to levodopa/ carbidopa therapy. Tolcapone has been subject to restrictive labeling because 3 reports of fulminant hepatic failure, resulting in death, were traced to its use.

The FDA has approved less restrictive labeling for the catechol-O-methyltransferase inhibitor tolcapone (Tasmar). The agent has been useful in increasing “on” time in patients with Parkinson disease (PD) when used as an adjunct to levodopa/ carbidopa therapy. Tolcapone has been subject to restrictive labeling because 3 reports of fulminant hepatic failure, resulting in death, were traced to its use.

AC-1202 Improves Cognition in APOE*E4-Negative Patients with AD. A medium chain triglyceride that converts to ketone bodies and counteracts reduced glucose metabolism improves cognitive scores in patients with mild to moderate Alzheimer disease (AD) who do not have the e4 allele of the apolipoprotein E (APOE*E4) gene.

Intensive Melodic Intonation Therapy (MIT) results in significant gains in speech production, and functional improvements are matched by longlasting neural changes, according to research by a team led by Gottfried Schlaug, MD, PhD, associate professor of neurology at Harvard Medical School and director of neuroimaging at Beth Israel Deaconess Medical Center in Boston.

Intensive melodic intonation therapy (MIT) results in significant gains in speech production, and functional improvements are matched by long-lasting neural changes, according to research by a team led by Gottfried Schlaug, MD, PhD, associate professor of neurology at Harvard Medical School and director of neuroimaging at Beth Israel Deaconess Medical Center in Boston.

In what was billed as the first randomized controlled study to simultaneously evaluate antidepressant therapy and short-term psychotherapy for depressed patients with coronary artery disease (CAD), treatment with an SSRI led to significant improvement, while addition of interpersonal psychotherapy provided no added benefit.

Patients with severe mental illness (SMI), such as schizophrenia, bipolar disorder, and major depression, are more likely to have experienced trauma in childhood, adolescence, and throughout their adult lives than the general population. This high exposure to traumatic events such as physical and sexual abuse and assault takes a heavy toll.

Traumatic experiences are linked with a continuum of mental disorders and physical complaints. In the United States, posttraumatic stress disorder (PTSD) occurs in approximately 8% of adults during their lifetime, with different trauma types associated with varying rates of illness. PTSD is commonly associated with comorbid mental conditions such as depressive disorders, other anxiety disorders, impulse control disorders, and alcohol abuse.

The traumatic events surrounding the recent school shootings at Virginia Tech remind us that a disturbing aspect of our current culture is the rate at which America's youth are exposed to violence. Whether it is graphic episodes of violence on television, violent music, aggressive video games, hearing about or witnessing violence in the home or neighborhood, or being the direct victim of violence--violence is a pervasive part of society that disproportionately affects youth.

Rape is a crime that is defined as an unwanted sexual act that results in oral, vaginal, or anal penetration. Generally speaking, there are 2 major types of rape. Forcible rape involves unwanted sexual penetration obtained by the use of force or threat of force. Drug- or alcohol-facilitated rape occurs when the victim is passed out or highly intoxicated because of voluntary or involuntary consumption of alcohol or drugs. Rape can happen to boys and men as well as to girls and women but this article will focus primarily on women.

The addition of an antidepressant to a mood stabilizer did not add any benefit for patients with bipolar depression, according to an NIMH-sponsored research project reported in April in the New England Journal of Medicine. In the multicenter study, adding an antidepressant to the regimen also did not increase affective switching to mania.

Methamphetamine (MA) abuse is not a new problem in the United States, but the current epidemic is more widespread and presents with more pernicious consequences than in the past. MA, frequently called "speed," "crystal," "crank," "ice," or "tina," is a potent psychostimulant that can be swallowed in pill form or administered via intranasal, intravenous, or smoking route.

Up Against the Wall