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Winter 2004-05, Vol 8 No 2

the front cover of a crosscurrents magazine- the main image is a vase with bold coloured flowers

Research Update            

Hema Zbogar

 

Needle exchange users take fewer HIV risks

Injection drug users who take part in needle exchange programs are less likely than other injection drug users to engage in drug-related behaviours that increase the risk of HIV transmission, according to researchers at the University of Illinois at Chicago. The study examined 558 individuals who received at least half of their needles from a needle exchange program and 175 individuals who did not use an exchange program. Compared with those who did not use an exchange program, users were about one-third as likely to share needles and less than half as likely to lend used needles or share cookers or water. They were 85 per cent less likely to use a needle for more than one injection. Even among those who shared needles, exchange program users were more likely to do for so significantly fewer injections overall, and to always use bleach to clean used needles. The researchers conclude that “regular needle” exchange program use is associated with less frequent and lower risk of HIV injection risk practices.

 

Journal of Acquired Immune Deficiency Syndromes, September 2004, v. 37: 1187–1196. Lawrence Ouellet, Dezheng Huo and Susan L. Bailey, Division of Epidemiology and Biostatistics, Community Outreach Intervention Projects, School of Public Health, University of Illinois at Chicago.

 

Adverse maternal conditions affect offspring’s suicide risk

Adverse pregnancy and maternal-related conditions may be associated with an increased risk of suicide in adolescent offspring, according to a prospective study out of Stockholm, Sweden. The researchers studied a cohort of 713,370 individuals born in Sweden between 1973 and 1980. They assessed the effects of intrauterine and perinatal conditions, and two maternal variables – psychosocial factors as captured by age and parity, and socio-economic status as reflected by education level. Short birth length (less than     47 cm), low birthweight (below 2,500 g) and being born to an adolescent mother increased the risk of later suicide. For suicide attempts, low birth weight and having an adolescent mother increased risk, as did low level of maternal education and being fourth or later in the birth order. The effect of these factors on suicide risk was mild and less than the risk conferred by family history of suicidal behaviour. The authors caution that further studies are needed to determine whether the associations among suicidal behaviour and multiparity, low maternal education and low maternal age are mediated by stress. The study does not explain the association between restricted fetal growth and suicide, but similar associations have been reported between low birthweight and major psychiatric conditions.

 

Lancet, September 25, 2004, 364: 1102–1103.   E. Mittendorfer-Rutz, F. Rasmussen, and D. Wasserman, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.

 

Early puberty linked to early substance use

Children who enter puberty at an early age are more likely to have issues with alcohol, cannabis and tobacco use, according to researchers in Melbourne, Australia. The researchers surveyed 5,769 10-to-15-year-olds in Washington, in the United States and in Victoria, Australia. Participants completed questionnaires about their tobacco, alcohol and cannabis use. They were also asked to rate their biological development by providing information on breast and pubic hair development. The researchers found that the odds of youth using a substance in their lifetime were nearly twice as high in mid-puberty than early puberty, and three times as high in late puberty. Current substance misuse was 40 per cent higher for those in mid-puberty and more than twice as high for those in late puberty. The authors posit that since puberty marks the beginning of a much higher risk period for substance use and abuse, early puberty may widen the window of opportunity for experimentation. They suggest that anti-substance abuse messages geared to younger adolescents should be developed, but that efforts need to go beyond mere education and focus on strategies that restrict youth access to substances.

 

Pediatrics, September 2004, v. 114: e300-e306. George C. Patton et al., Centre for Adolescent Health, Murdoch Children’s Research Institute and Department of Paediatrics, University of Melbourne, Melbourne, Australia.

 

Gene may link depression and alcohol dependency

Researchers at the Washington University School of Medicine have identified a gene that seems to be linked to both alcohol dependency and depression. Previous studies have suggested that common genes may underlie the two disorders and that they seem to run in families. But this is the first report of a specific gene that seems to increase risk for both depression and alcohol dependency. Follow-up research might help reveal the underlying biology that makes some people susceptible to alcohol dependency, others to depression, some to both and others to neither. The researchers suggest that a variation or alteration of the CHRM2 gene influences these four possible conditions. The finding may eventually help to identify individuals at higher risk for these problems and guide new treatments.

 

Human Molecular Genetics, 13: 1903–1911. Jen C. Wang et al., Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri.

 

Therapy as effective as medication for social anxiety disorder

Antidepressants and talk therapy are equally effective in treating social anxiety disorder, according to researchers at Duke University in Durham, North Carolina. Previous studies have found that antidepressants, particularly the selective serotonin reuptake inhibitors (SSRIs) help to relieve social anxiety, as does cognitive behavioural therapy. This study examined whether combining the two therapies yields  better results. Researchers recruited 295 participants diagnosed with social anxiety disorder for a 14-week study and randomly assigned them to one of five groups: Prozac® (an SSRI) alone, group therapy alone, Prozac plus therapy, placebo plus therapy or placebo alone. Results showed that all treatments were better than placebo alone but did not differ from each other: significant improvement was found for 54 per cent of the Prozac-plus-therapy group; 51 per cent of the Prozac-only group; 52 per cent of the therapy-only group; 51 per cent of the therapy-plus-placebo group; and 32 per cent of the placebo group. Substantial symptoms remained after treatment. The authors suggest that longer-term Prozac or individual therapy, rather than group therapy, may yield better results. There was also no evidence of greater efficacy of combined treatment. The authors suggest that sequential rather than simultaneous treatment may be more effective.

 

Archives of General Psychiatry, October 2004,    v. 61: 1005–1013. Jonathan R.T. Davidson et al., Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina.

 

Amygdala may be involved in extinguishing fears

The part of the brain involved in “unlearning” fears may be the same as that implicated in learning fears in the first place, according to researchers at New York University. This brain region for forgetting fears, the amygdala, had already been found in animals but not humans. Researchers used magnetic resonance imaging (mri) to look at what happens in the brain as fears are “unlearned.” They taught study participants to associate seeing an image of a coloured square with a mild electric shock. This created a conditioned fear that would be provoked by the square. The researchers then extinguished the fear by presenting the square with increasingly milder shocks until no shock followed the image. The MRIs found activity in the amygdala both when the fear was being learned and when it was being extinguished. Much research has focused on how fears are learned and how they can be treated, but this is one of the few studies to examine how fears are naturally diminished. The researchers indicate that this finding may help to develop treatments for phobias.

 

Neuron, September 16, 2004, v. 43: 897–905. Elizabeth A. Phelps et al., Department of Psychology, New York University, New York.

 

ER intervention may reduce alcohol use

A brief intervention can reduce the alcohol use of individuals who present to emergency departments with a history of alcohol use issues, according to researchers at Imperial College in London, in the United Kingdom. In this single-blind trial, 599 clients with alcohol use issues seen in the emergency department were randomized to receive either an information leaflet or the leaflet plus an appointment with an alcohol health worker. Outcome data at six and 12 months were collected by client interview and hospital record review. At six months, mean alcohol use per week was 60 units in the intervention group and 83 units in the control group. At 12 months, it was 57 and 70 units, respectively. Clients in the intervention group had a mean of 0.5 fewer visits to the emergency department during the following 12 months. There were no noted differences in mental health or quality of life between the two groups. The authors conclude that referral for brief intervention benefits clients and may reduce the demand for emergency department services.

 

Lancet, October 9, 2004, v. 364: 1334–1339. Lynn T. Singer et al., Department of General Medical Sciences and Pediatrics, Case Western Reserved University, Cleveland, Ohio.