In This Issue
Twins of bipolar disorder patients show both personality and cognitive advantages (Higier et al., p. Original article: 1191)
Adaptive Traits Linked to Bipolar Risk
Unaffected co-twins of patients with bipolar disorder have greater sociability and verbal facility than do unrelated healthy subjects (figure). The patients themselves do not. Higier et al. (p. Original article: 1191) did not find such a pattern for unaffected co-twins of schizophrenia patients. Arango (p. Original article: 1145) notes in an editorial that heightened creativity is also unusually common among patients with bipolar disorder and their siblings, emphasizing the need to encourage individual strengths while addressing problems.
Familial Autism Spectrum Disorder
Familial recurrence of autism spectrum disorder (ASD) is due to both genetic and environmental factors. Among California families having a child with ASD, Risch et al. (CME, p. Original article: 1206) discovered that the risk of recurrence was highest for the child’s full siblings (10.1%) but was also higher in maternal half-siblings (4.8%) and paternal half siblings (2.3%) than in control subjects (0.5%). A maternal environmental influence is suggested by the higher rate for maternal than paternal half siblings, along with an effect of consecutive birth order and an especially pronounced effect of short interbirth interval.
Clinical Guidance: Pulmonary Embolism in Psychiatric Patients
People with psychiatric disorders are overrepresented among those who die of pulmonary embolism. Factors contributing to thrombus formation include low-potency antipsychotics and other medications, extended immobility due to catatonia or restraints, increased cortisol and catecholamine production, medication-induced metabolic conditions, smoking, and lack of general medical care. Electroconvulsive therapy may dislodge preexisting blood clots. Barnhorst and Xiong (p. Original article: 1155) describe possible prophylactic measures, which include alternatives or modifications to restraints. Compression stockings and subcutaneous heparin are possibilities for patients who are predisposed to immobility. Physicians should be aware of the thrombogenic medications, such as clozapine.
Clinical Guidance: Quetiapine for Borderline Personality Disorder
Six weeks of extended-release quetiapine at a dosage of 150 mg/day significantly reduces symptoms of borderline personality disorder. In the trial by Black et al. (p. Original article: 1174), 300 mg/day was not significantly superior to placebo and produced more side effects than low-dosage quetiapine. In an editorial, Tohen (p. Original article: 1139) cites the 3-lb weight gain in the group receiving 300 mg/day of quetiapine—compared with 1 lb for placebo and low-dosage quetiapine—and stresses the need for consideration of long-term effects.
Clinical Guidance: Combined Treatment for Nicotine Patch Nonresponders
The combination of varenicline plus bupropion produced higher rates of smoking cessation than varenicline alone in male and highly dependent smokers who did not reduce smoking by 50% in previous nicotine patch treatment. Rose and Behm (CME, p. Original article: 1199) found overall abstinence rates of 51% and 44% in men and highly dependent smokers, respectively, at the end of treatment and 29% in both groups at 6-month follow-up. In an editorial, Potter (p. Original article: 1148) reviews additional evidence of lower efficacy of nicotinic treatments and lower quit rates for female than for male smokers.
