Adolescents between the ages of 17 and 19 years who witness domestic violence between their parents are significantly more likely to report symptoms of depression, according to a study in the Philippines. In face-to-face interviews of 2,051 young men and women, nearly half reported witnessing parental domestic violence. Among the young women, those who witnessed violent events for which a parent required medical attention reported the most severe depression during the month prior to the interview. Among the young men, those who reported events in which both parents were violent reported the most severe depression. Twenty percent of the female adolescents, and ten percent of the males reported wishing they were dead occasionally or most of the time in the month preceding the survey.

The World Health Organization reports that suicide is the third leading cause of death among adolescents worldwide. There are more than one billion children of 10-19 years of age in developing countries, but adolescent mental health issues are relatively understudied in these area. This study is notable because it is among the first conducted in the developing world to explore adolescent mental health, and its relationship to parental domestic violence. The study was published online in February, and will be published in the April 2006 printed edition of the American Journal of Public Health.

Last year, the MHS Children Who Witness Violence program served more than 1,200 children of Cuyahoga County, Ohio, who had witnessed domestic violence. Clinically significant symptoms of depression and anxiety are common among these children. As stated by Dr. Michelle Hindin, one of the study authors, "Mental health and domestic violence are increasing public health concerns. Interventions that prevent domestic violence may also help prevent the severity of depressive symptoms in adolescents."

Reference
Hindin, M.J., & Bultiano, S. (2006, February 28). Associations between witnessing parental domestic violence and experiencing depressive symptoms in Filipino adolescents. American Journal of Public Health. Read the study abstract.

Selective serotonin reuptake inhibitors (SSRIs) comprise a class of medicines introduced in the 1980's to treat depression. Prozac, the brand name of fluoxetine, was the first SSRI approved for use in the U.S.A. Clinical trials of its effectiveness in the treatment of major depressive disorder were conducted in Cleveland at the Case Western Reserve University School of Medicine and University Hospitals of Cleveland. Many clients of MHS find SSRIs to be helpful in the management of depressive symptoms.

SSRIs were so named because of their action within the nervous system, and this action was presumed to be the basis for their therapeutic effect. Serotonin is an important neurotransmitter in areas of the brain that govern appetite, mood, motivation, and other complex experiences. Research in the 1980's had revealed that disturbances in these experiences were often associated with a deficit of serotonin in the brains of those affected. This led to studies of new drugs that were known to selectively prevent serotonin (and not other neurotransmitters) from being naturally reabsorbed by the nerve cells that had released it into the synapse (the space between nerve cells, or neurons). The idea was to maintain more serotonin in the synapse, which would increase the number of serotonin molecules that were available to bind to receptor sites on nearby neurons, and therefore to increase the activity of those neurons. Many SSRI medicines have since been approved for use, and careful studies have shown that they do help some depressed people who did not benefit from other types of antidepressant medicine. However, even when SSRI's worked, patients reported that it often took four to six weeks for them to become effective.

A recent study suggests that SSRIs are effective because they promote the growth of neurons in key areas of the brain. (It is not known if this growth of new cells is related to the inhibition of serotonin reuptake.) The study, conducted at John Hopkins University School of Medicine, found that rats who were given SSRIs for four weeks showed increased nerve density in the frontal, parietal, and limbic areas of the brain. The brains of rats given the desipramine, a non-SSRI antidepressant, did not show this increased density. Vassilis Koliatsos, M.D., an author of the study, offered this interpretation: "It appears that SSRI antidepressants rewire areas of the brain that are important for thinking and feeling ... " He added that their findings "may offer a better explanation of why antidepressants are effective, and why they take time to work." If the researchers' finding are replicated by others, we may have a better understanding of the neurochemical events related to mood disorders, and new ideas to guide the search for more effective interventions.

Reference
Zhou, L., Huang, K. Kecojevic, A. Welsh, A.M., & Koliatsos, V.E. (2006) Evidence that serotonin reuptake modulators increase the density of serotonin innervation in the forebrain. Journal of Neurochemistry, Volume 96, Issue 2, pp. 396-406. To read the author's abstract, click here.

Look closely at the gray and black disk in the very center of the figure. (It's surrounded by the white and black "doughnut".) Which of the eight disks on the periphery of the figure most closely matches the disk in the center?

Time's up! If you're like most of the 33 study participants without schizophrenia who volunteered for this study at University College London, you chose the disk at about the 10 o'clock position. If you have a schizophrenic disorder, you almost certainly chose the disk at the 6 o'clock position - the correct choice. Of the 15 volunteers who had a chronic schizophrenic disorder, 12 made more accurate visual judgements than the most accurate of the volunteers without schizophrenia!

Most people perceive the central disk to be of lower contrast than it actually is because it is surrounded by the high-contrast, black-and-white doughnut. This is an instance in which awareness of context leads to an inaccurate judgement. In most situations -- visual, auditory, or even social -- the use of context is vital to accurate perception. The volunteers who had schizophrenia apparently were not influenced by the visual context when they made their choice. The study authors see this process as similar to the process by which people with schizophenia commonly evaluate social situations: they don't take into account the context that most people find helpful in interpreting the event.

The principal author, Dr. Dakin, told the BBC News: "Our findings may shed some light on the brain mechanisms involved in schizophrenia. Normally, contextual processes in the brain help us to focus on what's relevant and stop our brains being overwhelmed with information. This process seems to be less effective in the schizophrenic brain, possibly due to insufficient inhibition -- that is, the process by which cells in the brain switch each other off." The study results are fascinating, but the usefulness of the author's metaphor is unproven. Visual perception is a very different task than social perception.

Reference
Dakin, S., Carlin, P., & Hemsley, D. (2005, October 24). Weak suppression of visual context in chronic schizophrenia. Current Biology, 15 (20), pp. R822-R824.

One in five persons who have a schizophrenic disorder are homeless, according to this study conducted in the San Diego, Other serious mental disorders were also found to be risk factors for homelessness. Among those with bipolar disorder, 17% were homeless. Among those with major depression, 9% were homeless.

For comparison, consider that the total number of people who are homeless at any time during the year in the greater Cleveland area was estimated in 2002 be 21,811. This total would represent about 4.8% of the population of Cleveland, or 1.6% of the total population of Cuyahoga County.

Reference
Folsom, D.P., Hawthorne, W., Lindarner, L., et al. (2005). Prevalence and risk factors for homelessness and utilization of mental health services among 10,340 patients with serious mental illness in a large public mental health system. American Journal of Psychiatry.

A growing body of research is discerning a reliable link between the childhood or adolescent experience of violence and the subsequent development of mental health problems. Researchers in this study conducted telephone surveys with 4,023 adolescents, ages 12-17 years. Parents gave permission for the interviews, and researchers took steps to ensure that adolescents had privacy and responded honestly. Among girls, 6.3% reported symptoms that would meet diagnostic criteria for posttraumatic stress disorder (PTSD) during the preceding six months. For boys, the prevalence of PTSD symtoms was 3.7%. Experiences and behaviors meeting criteria for a major depressive episode during the preceding six months were reported by 13.9% of girls, and 7.4% of boys. Symptoms meeting criteria for a substance-use disorder during the past year were reported by 6.2% of girls, and 8.2% of boys. About 19 percent of girls, and 16% of boys, met criteria for at least one of the three disorders.

Adolescents who reported being the victim of, or witnessing, sexual assault, physical assault, or other interpersonal violence were more likely to meet criteria for PTSD, major depression, or a substance-use disorder. This increased risk occurred even after demographic characteristics and substance-use problems among other family members had been taken into account. Older adolescents were more likely to meet criteria for the three diagnoses studied.

The study highlights the need to develop effective approaches to reduce the potential impacts of violence on children. MHS is the leading provider of assessment and treatment services for children referred to the Cuyahoga County Children Who Witness Violence program. These children are referred by police officers who are at the scene of an incident of domestic or other violence. Leaders of Cuyahoga County established the program in 1999, in response to early research indicating that children are particularly vulnerable to the development of a broad range of mental health, academic, and social problems after the experience of violent events. In 2003, there were 7,470 domestic violence offenses in the City of Cleveland, an average of more than 20 per day. The rate of domestic violence offenses in Cleveland is about 16 per 1,000 residents, more than three times the estimated national rate of 5 per 1,000 residents.

Reference
Kilpatrick, D.G., Ruggiero, K.J., Acierno, R., Saunders, B.E., Resnick, H. S., & Best, C.L. (2005). Violence and risk of PTSD, major depression substance abuse/dependence, and comorbidity: Results from the National Survey of Adolescents. Journal of Consulting and Clinical Psychology, 71 (4).

Nine men and two women with Parkinson's disease developed compulsive gambling and other compulsive behaviors after taking Mirapex, a drug manufactured by Boehringer Ingelheim. One of the nine men was reported to have lost $100,000 while gambling. Other patients developed compulsive sexual conduct. They all had been taking Mirapex to treat Parkinson's disease, a degenerative disorder that causes loss of nerve cells in a region of the brain called the substantia nigra. The disease is thought to be related to this regions's loss of, or insensitivity to, the neurotransmitter dopamine. Mirapex (also known by its generic name of pramipexole) is believed to exert its therapeutic effect by changing the D3 class of dopamine receptors. (In contrast, schizophrenia is thought to be related to excessive stimulation of dopamine receptors.)

Within a month of stopping treatment with Mirapex, the compulsive behaviors also stopped in all eight of the patients who were available for follow-up. Some patients, however, resumed their treatement with the drug. One man noted that he could golf again, but he did admit that he relinquished to his wife all control of the family's financial accounts.

The Wall Street Journal report notes that the full study was to be published in Archives of Neurology this September, but was posted online on 11 July 2005.

Reference
Hensley, Scott. (2005, July 12). Parkinson's drug may trigger compulsions. The Wall Street Journal, pp. B1 and B4.

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