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Gun violence and mental illness: No clear path

Donald W. Black, MD


I have been thinking about gun violence lately. The shooting deaths of 26 school children and adults in Newtown, CT in December was a great tragedy, and the sad news is that psychiatrists and other mental health professionals have no means to predict or prevent these tragedies, despite the public’s expectations. Many suggest improved access to mental health services, but no one is willing to say what that would entail or suggest funding services in a way that would truly make a difference. Further, most Americans support background checks for anyone who wants to purchase a gun, but it is not clear how this might prevent unstable mentally ill persons from obtaining firearms because most psychiatric patients are not included in any state or federal database.

The elephant in the room is access to firearms. The gun lobby fights any restrictions on access, even to assault rifles and large-capacity ammunition magazines that are appropriate on the battlefield, but not our streets. These same people support placing guards in schools at great cost, ignoring the fact that most mass shootings occur elsewhere, in malls or movie theaters. Even in schools, the probability that armed guards would make a difference is so low that at least in my mind it is foolish to consider the idea. Where would the money come from in cash-strapped school districts? I’m too cynical to believe our leaders will ever craft a solution that will lessen the number or severity of mass shootings.

In this issue of Annals of Clinical Psychiatry (ACP), Sermin Kesebir, MD, and colleagues report the relationship between menarche and onset of bipolar disorder. Of interest, early menarche is associated with worse functioning as well as mood traits. Catherine Frogley, BSc, and colleagues report on a case series of 22 women who received low-dose clozapine for borderline personality disorder (BPD). Followed for as long as 18 months, the women improved in several important domains. Because there are no FDA-approved treatments for BPD, this study should prompt further research into the use of clozapine and other atypical antipsychotics for these challenging patients.

Grant L. Iverson, PhD, and ACP editorial board member Raymond W. Lam, MD, report on the British Columbia Cognitive Complaints Inventory, which they show is sensitive to cognitive complaints in depressed persons. They point out that their 6-item scale can replace time consuming and costly neuropsychological testing in select patients.

Brenda Vincenzi, MD, and colleagues report a retrospective study of antipsychotic-treated schizophrenia patients who responded to lipid-lowering medications, and show that these medications work as well in these patients as in the general population. Because dyslipidemia is problematic and often exacerbated by our treatments, it is reassuring to know that these patients can benefit from lipid-lowering drugs just like anyone else.

Alexithymia—poor awareness of personal emotions—is of great interest to mental health professionals. Janelle N. Beadle, PhD, and colleagues have shown that although alexithymia and “personal distress” improve with weight gain, they remain abnormal compared with heathy controls and may be trait markers for anorexia nervosa.

The annual American Academy of Clinical Psychiatrists/Current Psychiatry CME meeting held in April in Chicago was a great success, with our largest attendance to date. The word is out that our meetings provide real value to busy clinicians.

Donald W. Black, MD