EARLY HOME ENVIRONMENT AND TELEVISION WATCHING INFLUENCE BULLYING BEHAVIOR

CHICAGO—Four-year-old children who receive emotional support and cognitive stimulation from their parents are significantly less likely to become bullies in grade school, but the more television four-year-olds watch the more likely they are to bully later, according to an article in the April issue of the Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

Bullying among school children is considered a serious public health problem, affecting an estimated 30 percent of school-age children in the U.S., according to background information in the article. Previous research has suggested three possible predictors of future bullying behavior: that parental emotional support helps young children develop empathy, self-regulation and prosocial skills and might be protective; that bullying might arise out of early cognitive deficits that lead to decreased competence with peers; and that television violence may produce aggressive behavior.

Frederick J. Zimmerman, Ph.D., of the University of Washington, Seattle, and colleagues compared assessments of 1,266 four-year-olds enrolled in a national longitudinal study for the three potential predictors, parental emotional support, cognitive stimulation and amount of television watching at four years of age, with later bullying, reported at ages six through 11. Statistical methods were used to determine whether each predictor constituted an independent risk factor for subsequent bullying.

Cognitive stimulation assessment was based on information on outings, reading, playing and parental role in teaching a child. Emotional support assessment included questions on whether the child ate meals with both parents, parents talked to the child while working and spanking. The average number of hours of television watching was based on parent reports. Bullying was determined by the characterization of the child as a bully by his mother.

Approximately thirteen percent of children were reported as bullies by their mothers, the researchers report. Both early emotional support and cognitive stimulation had substantial protective effects. "The magnitude of the risk associated with television...is clinically significant," the authors write. "... a one-standard deviation increase [3.9 hours] in the number hours of television watched at age four years is associated with an approximate 25 percent increase in the probability of being described as a bully by the child's mother at ages six through 11 years."

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Media Advisory: To contact corresponding author William E. Lafferty, M.D., call Pam Sowers at 206-543-3620.

PEDIATRIC USE OF COMPLEMENTARY AND ALTERNATIVE MEDICINE

CHICAGO—Insured pediatric and adolescent patients account for only a small part of total insurance expenditures for complementary and alternative medicine (CAM) but are more likely to use these therapies if their adult family members also use CAM professionals, according to an article in the April issue of the Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

Forty-two percent of adults reported the use of complementary and alternative medicine in a 1997 study and the rate of use is increasing, according to background information in the article. But little is known about the use of complementary and alternative medicine by children and adolescents.

Allen Bellas, Ph.D., of Metropolitan State University, Minneapolis, and colleagues analyzed 2002 claims data from two large private health insurers in Washington state. Because Washington state requires private insurers to cover claims for services from CAM-licensed professionals, insurance claims provide a database for investigating the frequency, predictors and expenditures for the use of complementary and alternative medicine by children and adolescents, according to the authors.

Of 187,323 insured children, 156,689 (83.6 percent) had any insurance claims during 2002, the researchers report. For those with claims, 6.2 percent used an alternative professional during the year, accounting for 1.3 percent of the total expenditures and 3.6 percent of expenditures for all outpatient professionals. "Although use of chiropractic and massage was almost always for musculoskeletal complaints, acupuncture and naturopathic medicine filled a broader role," the researchers found.

"We found that CAM use was significantly less likely for males...and more likely for children with cancer, children with low back pain, and children with adult family members who use CAM," the authors write. "Not surprisingly, the most significant factor that determined whether a pediatric patient would use CAM is whether an adult in the family used CAM. The effect of this covariate on the likelihood of a child's use dwarfed all others. This fact may guide professionals obtaining medical histories in the pediatric setting."

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Media Advisory: To contact Thomas E. Nordahl, M.D., Ph.D., call Carole Gan at 916-734-9047.

BRAIN REGION RECOVERY POSSIBLE IN FORMER METHAMPHETAMINE USERS

CHICAGO—Adaptive changes in chemical activity in certain regions of the brain of former methamphetamine users who have not used the drug for a year or more suggest some recovery of neuronal structure and function, according to an article in the April issue of the Archives of General Psychiatry, one of the JAMA/Archives journals.

Methamphetamine use has been shown to cause abnormalities in brain regions associated with selective attention and regions associated with memory, according to background information in the article. Recent animal and human studies suggest that neuronal changes associated with long-term methamphetamine use may not be permanent but may partially recover with prolonged abstinence.

Thomas E. Nordahl, M.D., Ph.D., of the University of California, Davis, and colleagues compared eight methamphetamine users who had not used methamphetamine for one to five years and 16 recently abstinent methamphetamine users who had not used the drug for one to six months with 13 healthy, non-substance-using controls using a method of brain imaging, proton magnetic resonance spectroscopy (MRS), that allows the visualization of biochemical markers that are linked with damage and recovery to the neurons in the brain.

The researchers measured biomarkers in the anterior cingulum cortex, a region of the brain associated with selective attention. Levels of N-acetylaspartate (NAA), which is present only in neurons, were measured as a marker of the amount of damage (neuronal loss). Choline (Cho), which is generated by the creation of new membranes and, the authors write, "may be an ideal marker to track changes consistent with neuronal recovery associated with drug abstinence," was measured as a biomarker of recovery.

Levels of NAA were abnormally low in all the methamphetamine users, the authors found. Levels were lower relative to the length of methamphetamine use, but did not change relative to the amount of time that the methamphetamine users had been abstinent. The researchers found elevated Cho levels in the methamphetamine users who had not used the drug in one to six months, but normalized levels in the longer abstainers. "In the early periods following methamphetamine exposure, the brain may undergo several processes leading to increased membrane turnover. The relative Cho normalization across periods of abstinence suggests that when drug exposure is terminated, adaptive changes occur, which may contribute to some degree of normalization of neuronal structure and function," they write.

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Media Advisory: To contact Robert J. DeRubeis, Ph.D., call Greg Lester at 215-573-6604.

FOR INITIAL TREATMENT OF MODERATE TO SEVERE MAJOR DEPRESSION, COGNITIVE THERAPY AND MEDICATION MAY BE EQUALLY EFFECTIVE

CHICAGO—Cognitive therapy, when provided by an experienced therapist, may be as effective as antidepressant medications in the initial treatment of moderate to severe major depression, according to an article in the April issue of the Archives of General Psychiatry, one of the JAMA/Archives journals.

"Antidepressant medications are the most widely used treatment for major depressive disorder in the United States," according to background information in the article. The effectiveness of antidepressant medications has been upheld in randomized placebo-controlled trials, especially in individuals with more severe depression. Cognitive therapy has also shown potential in treating major depressive disorder.

Robert J. DeRubeis, Ph.D., from the University of Pennsylvania, Philadelphia, and colleagues compared the efficacy of antidepressant medications with cognitive therapy in 240 moderately to severely depressed patients. Study participants were randomly assigned to receive antidepressant medication (n = 120), pill placebo (n = 60), or cognitive therapy (n = 60). Those in the medication group were given paroxetine or placebo for eight weeks, with doses increasing as tolerated. After eight weeks of treatment, for those unresponsive to paroxetine, treatment was augmented with lithium carbonate or desipramine hydrochloride. Patients in the cognitive therapy group attended 50-minute sessions twice weekly for the first four weeks, once or twice weekly for the middle eight weeks, and then once weekly for the final four weeks.

At eight weeks of treatment, response rates were 50 percent in the medication group, 43 percent in the cognitive therapy group, and 25 percent in the placebo group. Of the 47 patients who received an augmented medication treatment, 32 (64 percent) were given lithium, 28 (56 percent) were prescribed desipramine, and one (two percent) was treated with venlafaxine. At sixteen weeks of treatment, response rates were 58 percent for patients receiving antidepressant medications and for those receiving cognitive therapy. Remission rates were 46 percent in antidepressant medications patients and 40 percent in cognitive therapy patients.

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Media Advisory: To contact Jeffrey A. Lieberman, M.D., call Karen Zipern at 212-305-9746.

DIFFERENT ANTIPSYCHOTIC MEDICATIONS MAY HAVE DIFFERENT EFFECTS ON BRAIN VOLUME IN PATIENTS WITH FIRST EPISODE OF PSYCHOSIS

CHICAGO—After a first psychotic episode, patients who were treated with an atypical antipsychotic medication had less change in brain volume compared with patients treated with a conventional antipsychotic medication, according to an article in the April issue of the Archives of General Psychiatry, one of the JAMA/Archives journals.

Structural brain abnormalities, such as reductions in gray matter volume, have been consistently described in patients with schizophrenia, according to background information in the article. The current study was designed to test whether patients treated with an atypical antipsychotic medication (olanzapine) would have less reduction in gray matter volume than patients treated with a conventional antipsychotic medication (haloperidol), and whether these changes are associated with changes in disturbed thinking and general mental functioning.

Jeffrey A. Lieberman, M.D., of the University of North Carolina Medical School, Chapel Hill, at the time of the study, and colleagues studied 161 patients who were randomly assigned treatment with either haloperidol or olanzapine at the time of a first psychotic episode (baseline). Patients underwent neurocognitive testing and magnetic resonance imaging (MRI) assessments at baseline, and then at 12, 24, 52 and 104 weeks of treatment in a five-year longitudinal study conducted at 14 academic medical centers. A matched sample of 58 healthy volunteers underwent MRI and were compared on brain volume measures.

"The principle new finding of this study is the significant difference in the course and magnitude of these changes between patients treated with haloperidol, a conventional antipsychotic, and olanzapine, an atypical antipsychotic," the authors report. "Specifically, olanzapine was associated with less such change in brain volume during and in the aftermath of the first psychotic episode. These differences in volume change were highlighted by the comparison with healthy volunteers, which showed no significant reductions in gray matter volume and a trajectory similar to that of the olanzapine group."

"The associations between greater decrease in WBGM [whole brain gray matter] and less improvement in neurocognitve functioning [general mental functioning], and greater improvements on PANSS total and negative subscales [a measure of disturbed thinking] with less increase in lateral ventricular volume indicate that treatment effects on brain volume and the behavioral pathology of the illness may be associated," the authors write.