ALTERATIONS IN BRAIN SEROTONIN ACTIVITY MAY BE ASSOCIATED WITH ANOREXIA NERVOSA

CHICAGO—Women who have had a certain type of anorexia nervosa show an alteration of the activity of a chemical in their brain that is widely associated with anxiety and other affective disorders more than one year after recovery, according to a study in the September issue of the Archives of General Psychiatry, one of the JAMA/Archives journals.

Anorexia nervosa, a disorder characterized by the relentless pursuit of thinness and obsessive fear of being fat, has two subtypes, a group that restricts their eating (restricting-type AN) and a group that alternates restrictive eating with bulimic symptoms such as episodes of purging and/or binge eating (bulimia-type AN), according to background information in the article. Previous evidence has suggested that alterations in the activity of serotonin (a brain chemical involved in communication between nerve cells) may contribute to the appetite alteration in anorexia nervosa as well as playing a role in anxious, obsessional behaviors and extremes of impulse control.

Ursula F. Bailer, M.D., of the University of Pittsburgh School of Medicine, Pittsburgh, and colleagues compared the activity of serotonin in women who had recovered from each of the two types of anorexia nervosa and a control group of healthy women using positron emission tomography (PET). The researchers injected a molecule that can bind to a serotonin receptor in much the same way that serotonin does into specific areas of the women's brains and used PET scans to measure the extent of the molecule-receptor binding. This molecule-receptor binding served as a marker for alterations of serotonin neuronal activity. Thirteen women recovered from restricting-type AN, 12 women with bulimia-type AN and 18 healthy control women were included in the study.

The researchers report increased binding of this marker molecule in several brain regions in women who had recovered from bulimia-type AN but not restricting-type AN. Only the women who had recovered restricting-type AN showed any correlation between core eating disorder symptoms and binding potential. In these women receptor binding was correlated with a measure of anxiety called harm avoidance.

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DEPRESSION IMPROVED DURING TELEPHONE THERAPY IN MULTIPLE SCLEROSIS PATIENTS

CHICAGO—Patients with multiple sclerosis showed significant improvement in their depression during 16 weeks of telephone-administered psychotherapy treatment, according to an article in the September issue of the Archives of General Psychiatry, one of the JAMA/Archives journals.

Although two-thirds of depressed patients prefer psychotherapy over antidepressants, only 10 to 45 percent ever make a first appointment and nearly half will drop out before the end of treatment, background information in the article states. Barriers to receiving psychotherapy include physical impairments, transportation problems, proximity of services and lack of time or financial resources. In the 1990s, the use of telephone psychotherapy increased in part due to the advent of 1-900 number counseling services and the increased use of telephone support services by insurance and medical groups.

David C. Mohr, Ph.D., from the University of California, San Francisco, and colleagues tested the efficacy of telephone-administered psychotherapy for depression in patients with multiple sclerosis (MS). One hundred twenty-seven patients were randomized into one of two 16-week psychotherapies: telephone-administered cognitive-behavioral therapy (T-CBT) or telephone-administered supportive emotion-focused therapy (T-SEFT). The two therapies differ in that the goal of T-CBT is to "teach skills that help participants manage cognitions and behaviors that contribute to depression and improve skills in managing stressful life events and interpersonal difficulties," while T-SEFT has the goal of "increasing participants' level of experience of their internal world." All patients spoke with a psychologist on the phone for 50 minutes each week and were followed-up for 12 months.

The researchers found that over 16 weeks, improvements were significantly greater for T-CBT compared with T-SEFT for major depressive disorder frequency, and on some depression ratings scales. Treatment gains were retained during the 12-month follow-up, however, differences across treatments were no longer evident.

"This sample of MS patients had impairments that affected their ability to engage in social roles, as evidenced by the assessed functional impairment and the fact that 74 percent of the sample was not in the workforce. The use of telephone-administered therapies may also overcome various other barriers in the general population arising from transportation problems, lack of services in the area, child care problems, lack of time, and stigma," the authors write.

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MEDICAL END-OF-LIFE DECISIONS FOR CHILDREN IN THE NETHERLANDS

CHICAGO—A Dutch study found that end-of-life decisions (ELD) are an important aspect of end-of-life care for children between one and 17 years old and that those decisions include choices to refrain from life-prolonging treatment and to relieve pain or symptoms, according to a report in the September issue of the Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

Most studies of end-of-life decisions (defined as decisions that intentionally or otherwise hasten death) have focused on adults or newborn infants, according to background information in the article. End-of-life decisions range from decisions to forgo potentially life-sustaining treatments and decisions to alleviate pain or other symptoms by using drugs with a possible life-shortening effect, to decisions to give physician assistance in dying, that is, the use of drugs with the aim of ending life.

Astrid M. Vrakking, M.Sc., of Erasmus MC, University Medical Center Rotterdam, the Netherlands, and colleagues conducted two studies to assess the frequency of end-of-life decisions preceding child death and the characteristics of the decision-making process in the Netherlands. The first was a death certificate study in which all 129 physicians reporting the death of a child aged one to 17 years between August and December 2001 received a written questionnaire. The second was an interview study in which face-to-face interviews were held with 63 physicians working in pediatric hospital departments.

"Some 36 percent of all deaths of children between the ages of one and 17 years during the relevant period were preceded by an end-of-life decision: 12 percent by a decision to refrain from potentially life-prolonging treatment; 21 percent by the alleviation of pain or symptoms with a possible life-shortening effect; and 2.7 percent by the use of drugs with the explicit intention of hastening death," the authors report. "The interview study examined 76 cases of end-of-life decision making. End-of-life decisions were discussed with all nine competent and three partly competent children, with the parents in all cases, with other physicians in 75 cases, and with nurses in 66 cases."

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MOVIES AND PARENTS' BEHAVIOR MAY INFLUENCE PRESCHOOLERS PERCEPTIONS ABOUT CIGARETTES AND ALCOHOL

CHICAGO—When pretending to shop for a social evening, children two to six years old were nearly four times as likely to choose cigarettes if their parents smoked and children who viewed PG-13- or R-rated movies were five times as likely to choose wine or beer, according to a study in the September issue of the Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

Most tobacco and alcohol prevention studies target children during adolescence, the peak age for initiating alcohol and tobacco use, but early exposure to these behaviors through family members, community and social events and media may influence attitudes and expectations about alcohol and tobacco use long before children ever consider using these products themselves, according to background information in the article. Young children's attitudes have been difficult to assess because of their limited language skills.

Madeline A. Dalton, Ph.D., of Dartmouth College, Hanover, N. H., and colleagues used a role-playing scenario to assess preschoolers' attitudes, expectation and perceptions of tobacco and alcohol use and compared their observations with parent surveys on their own alcohol and tobacco use and their children's movie viewing. Children three to six years of age were given two dolls. They were asked to pretend to be one of the dolls and the researcher pretended to be the other, a friend who was invited over to watch a movie and have something to eat. When the "friend" commented that there was nothing to eat, the child was invited to "shop" at a doll grocery store. The child's purchase of alcohol and tobacco products at the "store" and subsequent inclusion of alcohol and tobacco products in the social setting were recorded. For children two years of age, the scenario was simplified to just asking the children to select a doll and take it shopping.

The children purchased an average of 17 of the 73 products in the store. Of the 120 children participating in the study, 34 (28.3 percent) bought cigarettes and 74 (61.7 percent) bought alcohol. Children were 3.9 times as likely to buy cigarettes if their parents smoked. Children were three times as likely to choose wine or beer if their parents drank alcohol at least once a month; children who viewed PG-13- or R-rated movies were five times as likely to choose wine or beer.

"Children's play behavior suggests that they are highly attentive to the use and enjoyment of alcohol and tobacco and have well-established expectations about how cigarettes and alcohol fit into social settings," the researchers report. "Several children were also highly aware of cigarette brands, as illustrated by the six-year-old boy who was able to identify the brand of cigarettes he was buying as Marlboros but could not identify the brand of his favorite cereal as Lucky Charms."