May 2013

Vol. 25. No. 2


Gun violence and mental illness: No clear path

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…



Modifiable risk factors for depressed mood among farmers

Obiora E. Onwuameze, MD, PhD | Sergio Paradiso, MD, PhD | Corinne Peek-Asa, PhD | Kelley J. Donham, DVM | Risto H. Rautiainen, PhD

BACKGROUND: Risk for depression among farmers is not fully understood. DSM-IV considers sadness or depressed mood a critical symptom of depression. The aim of this study was to examine risk factors for depressed mood among farmers using a longitudinal study design.

METHODS: Participants were principal farm operators in the Iowa Certified Safe Farm study. We identified risk factors for depressed mood by calculating relative risks (RR) using the generalized estimating equations method.

RESULTS: In the multivariate model, pesticide exposure (RR = 1.26; 95% CI: 1.04 to 1.53), having an additional job off the farm (RR = 1.32; 95% CI: 1.08 to 1.62), stress (RR = 3.09; 95% CI: 2.55 to 3.75), and previous injury (RR = 1.41; 95% CI: 1.05 to 1.89) prospectively increased the risk of depressed mood.

CONCLUSIONS: Consistent with earlier non-longitudinal studies, the results of this study suggest that reducing pesticide exposure, stress, and injury may reduce the risk of depression in the farm setting.


Consumer advocacy meetings: An innovative therapeutic tool

Christine Lochner, MA, PhD | Dan J. Stein, FRCPC, PhD | Jennifer Raikes, BA | Christina Pearson

BACKGROUND: Consumer advocacy groups are fulfilling an increasingly important role in psychiatry. The Trichotillomania Learning Center (TLC) aims to improve the quality of life of individuals with body-focused repetitive behavioral (BFRB) disorders such as trichotillomania (hair pulling disorder [HPD]) and skin picking disorder. The annual TLC retreat is an educational event focused on experiential learning and building a supportive community.

METHODS: We assessed attendees’ impressions of and experiences from the 2010 TLC retreat.

RESULTS: Sixty-two (57 female; mean age: 32.4, standard deviation: 14.6) attendees completed the survey. Fifty-five reported ≥1 current BFRBs, 6 were family members of attendees, and 1 participant reported HPD in remission. Most attendees found the TLC retreat to be a helpful intervention that offered support and information on BFRB disorders. Attendance was accompanied by reduced stigma, shame, and loneliness. Attendance also increased many respondents’ levels of motivation to stop pulling or picking (85%); 61% of respondents reported reduced pulling or picking. Most respondents (95%) reported learning new ways of managing the condition.

CONCLUSIONS: Survey findings suggested most attendees found the annual TLC retreat to be a helpful intervention. The retreat may serve as a novel and innovative model for helping individuals suffering from a range of other psychiatric disorders.


Treatment resistance in severe unipolar depression: No association with psychotic or melancholic features

Leonardo Zaninotto, MD | Daniel Souery, MD, PhD | Raffaella Calati, PsyD, PhD | Othman Sentissi, MD, PhD | Siegfried Kasper, MD | Elena Akimova, MD | Joseph Zohar, MD, PhD | Stuart Montgomery, MD, PhD | Julien Mendlewicz, MD, PhD | Alessandro Serretti, MD, PhD

BACKGROUND: Depressive subtypes generally have been neglected in research on treatment efficacy. We studied a sample of 699 severe unipolar depressed patients to detect any association between depressive features and treatment resistance.

METHODS: Participants were divided into psychotic (PSY, n = 90), melancholic (MEL, n = 430) and non-melancholic (n = 179) subjects according to clinical features. Formal diagnostic criteria (Mini International Neuropsychiatric Interview items), and items from 17-item Hamilton Rating Scale for Depression (HRSD17) were compared across groups. Non-responders were defined by a HRSD17 cut-off score of ≥17 after the last adequate antidepressant treatment. Treatment-resistant depression (TRD) was defined as the failure to respond to ≥2 adequate antidepressant trials. Non-linear regression models were designed to detect associations between depressive subtypes and TRD.

RESULTS: PSY and MEL patients appeared to be more severely affected and to share some “core” melancholic symptoms. Both PSY and MEL patients reported a higher rate of seasonality. However, we found no clinical or illness course variable associated with TRD.

CONCLUSIONS: Our results indicate that psychotic and melancholic depression share some “core” melancholia symptoms, while no distinguishing psychopathological feature appears to be associated with TRD in severely depressed patients.


Alexithymia, emotional empathy, and self-regulation in anorexia nervosa

Janelle N. Beadle, PhD | Sergio Paradiso, MD, PhD | Alexandria Salerno | Laurie M. McCormick, MD

BACKGROUND: Individuals with anorexia nervosa (AN) who are starved have poor awareness (alexithymia), reduced understanding of others’ mental states (cognitive empathy), and difficulty regulating personal emotions (self-regulation). Despite its important role in social interaction, sympathy for others (emotional empathy) has not been measured in AN. Furthermore, it is unknown how restoring weight affects the relationship among alexithymia, empathy, and self-regulation in AN.

METHODS: Women with AN were tested longitudinally during their starvation period (N = 26) and after weight was restored (N = 20) and compared with 16 age-matched healthy women. Alexithymia, empathy, and self-regulation were assessed with the Toronto Alexithymia Scale, the Interpersonal Reactivity Index, and items measuring self-regulation from the Minnesota Multiphasic Personality Inventory–2, respectively.

RESULTS: Relative to comparison participants, individuals with AN during both starvation and weight restoration reported greater alexithymia and emotional empathy in one domain, personal distress (vicarious negative arousal to others’ suffering). Among AN participants, personal distress was positively correlated with alexithymia and negatively correlated with self-regulation, when accounting for depression.

CONCLUSIONS: High levels of alexithymia and personal distress may be persistent features of AN because they do not resolve upon weight restoration. Greater personal distress in AN may be a function of poor emotional awareness and regulation.