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In This Issue
Am J Psychiatry 2009;166:A38-A38. doi:10.1176/appi.ajp.2009.166.12.A38
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A large, long-term study extends the finding of high death rates in anorexia nervosa to bulimia nervosa and other eating disorders. Crow et al. (p. 1342) determined diagnoses for 1,885 outpatients with eating disorders evaluated between 1979 and 1997 and searched the National Death Index for matches through 2004. The crude mortality rates for the patients with diagnoses of anorexia nervosa, bulimia nervosa, and “eating disorder not otherwise specified” were 4.0%, 3.9%, and 5.2%, respectively. Compared to national mortality data for demographically similar groups, the rate for eating disorder not otherwise specified was significantly elevated, suggesting that this diagnosis does not indicate a less severe disorder. In addition, 13 of the 84 deaths identified were due to suicide, and eight of these were among the patients with bulimia nervosa. These findings are discussed by Dr. Walter Kaye in an editorial on p. 1309.

Episodes of major depression among elderly primary care patients during 1–4 years of follow-up were more common among those who had minor or subsyndromal depression, impaired functioning, or a history of depression at baseline. To identify seniors for whom depression prevention would yield the greatest benefit at the lowest cost, Lyness et al. (p. 1375) assessed clinical, functional, and psychosocial variables in patients age 65 or older who did not have current or remitted major depression at baseline. Of the 405 who completed at least one assessment over the following 4 years, 5.3% experienced an episode of major depression during follow-up. Risk indicators were defined as the variables that were most strongly associated with depression but would require application of the preventive intervention to the fewest patients. Perceived family criticism had a predictive value comparable to that of functional disability, but it is not commonly addressed in primary care. In an editorial on p. 1312, Dr. Warren Taylor highlights the implications of these findings for prevention.

Aggression remitted in 53% of children with attention deficit hyperactivity disorder (ADHD) for whom divalproex sodium was added after stimulant medication failed to adequately control their disruptive behavior. The remission rate in the 8-week trial by Blader et al. (p. 1392) was only 15% for children who received placebo added to their stimulant medication. The children were ages 6–13, and each had a diagnosis of oppositional defiant disorder or conduct disorder in addition to ADHD. Before the divalproex trial, the families participated in behaviorally oriented psychosocial treatment, and stimulant monotherapy was adjusted openly to identify the optimal stimulant agent and dose for each child. After this lead-in period, aggressive behavior persisted in 27 children, and they were randomly assigned to valproex or placebo, in addition to their stimulant medications. If the efficacy of divalproex is confirmed in larger trials, it might provide an alternative to antipsychotic medications for children with disruptive behavior. A perspective on comorbidity of ADHD and aggressive behavior is presented in an editorial by Dr. Hans Steiner on p. 1315.

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