++Pregnant Woman Who Use SSRIs Have 4 X the Rate of Hypertension & 2 X the Rate of Preeclampsia
First three sentences of third paragraph reads: "Women who continued to take selective serotonin reuptake inhibitor(SSRI) antidepressants during pregnancy were more than twiceas likely as nonusers to develop gestational hypertension. Theirrisk of preeclampsia was more than four times normal. Theseestimates by Toh et al. (p. 320) were based on reports from5,731 women who were interviewed within 6 months of delivery."
Anticipatory anxiety is a cardinal clinical symptom of generalizedanxiety disorder. Nitschke et al. (CME, p. 302) developed alaboratory demonstration of this symptom to examine its physiologicalbasis and to predict treatment response. Patients and a healthycomparison group were told that aversive pictures would be precededby a minus sign and neutral images would be cued by a circle.Brain activity during viewing of these cues was measured with functional MRI.Responses in the bilateral dorsal amygdala to both types ofcues were greater in the generalized anxiety group than thecomparison group. Also, higher anticipatory activity in thepatients’ anterior cingulate cortex at baseline was relatedto greater response after 8 weeks of venlafaxine treatment.In an editorial on p. 263, Dr. Cameron Carter examines thesefindings.
Psychotherapy for Eating Disorders
Two enhanced forms of cognitive-behavioral therapy (CBT) ledto substantial and equivalent improvement over 20 weeks in patientswith a variety of eating disorders. Fairburn et al. (CME, p.311) report that the subgroup with marked additional psychopathologyresponded better to the therapy version that explored traitsand interpersonal problems, whereas those with less complexcases responded better to CBT focused solely on disordered eating.The study group comprised patients with mixed symptoms of anorexianervosa and bulimia nervosa and excluded those with very lowbody mass indices. At the 15-month follow-up, the overall scorefor eating disorders was within one standard deviation of normalfor 51% of the patients. Drs. Scott Crow and Carol Petersondiscuss these results in an editorial on p. 266.
Antidepressants and Gestational Hypertension
Women who continued to take selective serotonin reuptake inhibitor(SSRI) antidepressants during pregnancy were more than twiceas likely as nonusers to develop gestational hypertension. Theirrisk of preeclampsia was more than four times normal. Theseestimates by Toh et al. (p. 320) were based on reports from5,731 women who were interviewed within 6 months of delivery.Those who took SSRIs before pregnancy but stopped by the endof the first trimester did not have a significantly elevatedrisk of preeclampsia. The authors point out that the study doesnot differentiate between the effects of the medication andthe depression itself. An editorial by Dr. Kimberley Yonkerson p. 268 explores the possible clinical implications of thesedata.
Obsessions and Compulsions in a Community Cross-Section
A community developmental study indicates that subsyndromalobsessive thoughts and compulsive behaviors are common in thegeneral population. Fullana et al. (p. 329) analyzed responsesfrom structured interviews at ages 11, 26, and 32 years withnearly all of the 1,037 original participants in the Dunedin,New Zealand, study. Those who reported obsessions or compulsionsat age 11 were more likely to report similar symptoms or toreceive a diagnosis of obsessive-compulsive disorder (OCD) inadulthood. Only 2% met the criteria for an OCD diagnosis asadults, but subclinical obsessions and compulsions were reportedby 13% and 17%, respectively, of the people without mental disorders.Such symptoms were also present in more than one-third of thosewith other anxiety disorders or depression. Obsessions aboutinflicting harm and compulsive checking to prevent harm werethe most common. The only obsessive and compulsive symptomsassociated with treatment seeking were fears of harming othersand thoughts deemed to be shameful. Dr. Murray Stein highlightskey findings of the study in an editorial on p. 271.
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