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 CollegeBr 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.ukARIPIPRAZOLE 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.ukTHE 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.caNEONATAL 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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