Clinical Guidance: Effect of Treatment of Maternal Depression on Children's Behavior 

Children whose mothers are depressed have increased prevalence of psychiatric symptoms and behavioral dysfunction. However, children ages 7—17 years whose mothers' depression remitted in the course of the STAR*D studies showed substantial decrease in externalizing symptoms and improved psychosocial function, as reported by Wickramaratne et al. (p. 593). Birmaher in an editorial (p. 563) points out that clinicians treating women need to be alert to the possibility of illness in their children and that standard treatments of the children, such as cognitive-behavioral therapy for depression, may not be successful until the mother's depression has remitted.

Clinical Guidance: Persistent Postpartum Psychosis Because of Unrecognized Urea Cycle Disorder 

Fassier et al. (CME, p. 576) describe a woman with apparently persistent postpartum psychosis that was caused by an initially unrecognized genetic deficit in the urea cycle. The biological stress of pregnancy may have brought this indolent condition to symptomatic significance.

Clinical Guidance: Effectiveness of Interpersonal Psychotherapy of Depression 

Cuijpers et al. (CME, p. 581) analyzed 38 studies of interpersonal therapy in depression. Interpersonal therapy was more effective than control conditions, with the number of patients needed to treat to show effect less than 3. It was not more effective than other psychotherapies and was less effective than pharmacotherapy. However, combined interpersonal therapy and psychopharmacology were more effective in preventing relapse than psychopharmacology alone, with the number of patients needed to treat less than 8. Interpersonal therapy thus has validated effectiveness for treatment and prevention of relapses of depression.

Clinical Guidance: Effective Treatment of the First Episode of Schizophrenia 

Fewer than 50% of patients in the Finnish health care system continue treatment for the first 2 months after an initial hospitalization for schizophrenia, according to Tiihonen et al. (p. 603). Choice of treatment affects relapse rate. Injectable long-acting antipsychotics have a 64% lower relapse rate than equivalent oral medication. Clozapine and olanzapine have significantly lower relapse rates, compared to risperidone. Antipsychotic use overall is associated with decreased mortality.