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L I T E R A T U R E H I G H L I G H T S
COMMENTARY
It was initially suggested that aripiprazole may be more effective than other atypical antipsychotics for treatment of schizophrenia, except clozapine. El-Sayeh et al's systematic review challenges that claim and shows that even though aripiprazole was more efficacious than placebo, it was no more efficacious than other antipsychotics. While it does produce less elevation of prolactin and less prolongation of QTc interval (QT interval, corrected for heart rate) than risperidone, it is not very different from other antipsychotic agents in terms of tolerability and global outcomes. Severe mental illness, particularly schizophrenia, has always carried the stigma that mental illness equates violence. This assumption has been used to justify incarceration of the mentally ill over centuries. The study by Fazel and Grann challenges that assumption and shows that in Sweden only 5.2% of violent crime was attributable to people with severe mental illness. The remaining 95% violent crimes were committed by people who did not suffer from severe mental illness.
Although few randomized controlled trials have been conducted to assess the safety of antidepressants in pregnant women, tricyclic antidepressants (TCAs) and specific serotonin reuptake inhibitors (SSRIs) are generally thought to be safe in pregnancy. However, the study by Oberlander et al shows that there was an increased risk of low birth weight and respiratory distress in infants of depressed mothers treated with SSRIs compared to infants of depressed mothers not treated with SSRIs, even after maternal illness severity was accounted for. Syed Ahmer
Aga Khan University Medical College Br J Psychiatry. 2006 Aug; 189:102-8.
El-Sayeh HG, Morganti C, Adams CE
Academic Unit of Psychiatry, University of Leeds, UK. hany.el-sayeh@chrd-pct.nhs.uk ARIPIPRAZOLE FOR SCHIZOPHRENIA: SYSTEMATIC REVIEW
BACKGROUND: Aripiprazole is an atypical antipsychotic that
drug are publicly available. It may be effective for treatment is reported to be effective in the treatment of schizophrenia.
of schizophrenia, but in terms of tolerability and global A I M S : To investigate the effects of aripiprazole on patients
ou tcom es it sho w s litt le di ff eren ce f rom exist i ng with schizophrenia and schizophrenia-like psychoses by conducting a systematic review of randomized controlled
trials (RCTs). METHOD: Database and manual searches, and
direct contact were used to identify relevant RCTs. RESULTS:
We included 10 randomized controlled studies (involving a
total of 4125 patients), but study attrition was large and the
standard of data reporting was poor. Compared with placebo,
aripiprazole treatment was associated with a significant
decrease in relapse rates, increased compliance with the
study protocol, and a decrease in prolactin levels below the
expected values. Compared with risperidone, aripiprazole
caused less elevation of prolactin levels and less prolongation
of the average QTc interval. CONCLUSIONS: Aripiprazole has
been licensed despite the fact that few reliable data on this
P A K I S T A N J O U R N A L O F N E U R O L O G I C A L S C I E N C E S Am J Psychiatry. 2006 Aug; 163(8):1397-403.
Fazel S, Grann M
Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK. seena.fazel@psych.ox.ac.uk THE POPULATION IMPACT OF SEVERE MENTAL ILLNESS ON VIOLENT CRIME
O B J E C T I V E : This study aimed to determine the population
risk fraction was higher in women than men across all age impact of patients with severe mental illness on violent bands. In women ages 25-39, it was 14.0%, and in women crime. M E T H O D : Sweden possesses high-quality national
over 40, it was 19.0%. The attributable risk fractions were registers for all hospital admissions and criminal convictions.
lowest in those aged 15-24 (2.3% for male patients and All individuals discharged from the hospital with ICD 2.9% for female patients). C O N C L U S I O N S :
d ia gn os es of s chiz oph re ni a and othe r ps ycho se s impact of patients with severe mental illness on violent (N=98,082) were linked to the crime register to determine crime, estimated by calculating the population-attributable the population-attributable risk of patients with severe risk, varies by gender and age. Overall, the population- mental illness to violent crime. The attributable risk was attributable risk fraction of patients was 5%, suggesting that calculated by gender, three age bands (15-24, 25-39, and patients with severe mental illness commit one in 20 violent 40 years and over), and offense type. RESULTS: Over a 13-
crimes.reliable data on this drug are publicly available. It may year period, there were 45 violent crimes committed per be effective for treatment of schizophrenia, but in terms of 1,000 inhabitants. Of these, 2.4 were attributable to tolerability and global outcomes it shows little difference from patients with severe mental illness. This corresponds to a population-attributable risk fraction of 5.2%. This attributable Arch Gen Psychiatry. 2006 Aug; 63(8):898-906.
Oberlander TF, Warburton W, Misri S, Aghajanian J, Hertzman C
Department of Pediatrics, Human Early Learning Partnership, Faculty of Graduate Studies, University of British Columbia, Vancouver. toberlander@cw.bc.ca NEONATAL OUTCOMES AFTER PRENATAL EXPOSURE TO SELECTIVE SEROTONIN REUPTAKE
INHIBITOR ANTIDEPRESSANTS AND MATERNAL DEPRESSION USING POPULATION BASED
HEALTH DATA
CONTEXT: Prenatal exposure to selective serotonin reuptake
pregnancy, and the incidence of prenatal SSRI exposure inhibitor (SSRI) antidepressants and maternal depression both increased from 2.3% to 5.0% during a 39-month period. Birth alter neonatal health, and distinguishing the effects of each weight and gestational age for SE-D infants were significantly influence remains challenging. OBJECTIVE: To determine
less than for DE infants, as was the proportion of infants born whether exposure to SSRIs and depression differs from at less than 37 weeks (95% confidence interval [CI], -1 to - exposure to maternal depression alone. DESIGN: U s i n g
64, -0.25 to -0.45, and -0.009 to -0.04, respectively), population health data, records of neonatal birth outcomes although differences in the incidence of birth weight less than were linked to records of maternal health and prenatal the 10th percentile for gestational age were not significant.
maternal prescriptions for SSRIs. S E T T I N G : Population of
An increased proportion of SE-D infants had neonatal British Columbia, Canada. P A R T I C I P A N T S : Mothers and their
respiratory distress (13.9% vs. 7.8%), jaundice (9.4% vs.
infants, representing all live births during a 39-month period 7.5%), and feeding problems (3.9% vs. 2.4%) compared with (N = 11 9,547 ) (199 8-2001 ). M AIN O UTCOME
DE infants (95% CI of difference, 0.042-0.079, 0.003- M E A S U R E S : Outcomes from infants of depressed mothers
0.334, and 0.005-0.025, respectively). When outcomes treated with SSRIs (SE-D) were compared with outcomes were compared between SE-D and propensity score-matched fr om i nfants of depr ess ed mot hers not treated wit h DE neonates, SE-D was associated with increased incidence medication (DE) and non-exposed controls. To control for of birth weight below the 10th percentile and rates of maternal mental illness severity, propensity score matching respiratory distress. C O N C L U S I O N :
was used to identify a comparison group of DE mothers who health data and propensity score matching, prenatal SE-D were similar to the SE-D mothers in characteristics in the year exposure was associated with an increased risk of low birth preceding and during pregnancy. RESULTS: Fourteen percent
weight and respiratory distress, even when maternal illness of mothers were diagnosed as having depression during their P A K I S T A N J O U R N A L O F N E U R O L O G I C A L S C I E N C E S

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