Journal Digest

Researchers based at the University of Washington have investigated whether comorbid depression in patients with type 2 diabetes increases the risk of development of dementia and concluded there is a strong association. Their work was part of the Diabetes and Aging Study, an ancillary study of the Diabetes Study of Northern California (DISTANCE), a cohort investigation that assessed a range of social, behavioral, clinical, and health care factors that might influence diabetes outcomes. The Diabetes and Aging Study focused on medical issues particularly relevant to older patients with diabetes, including dementia.

In a study cohort of 19,239 patients with diabetes, 3,766 had comorbid depression, and 80 of them (2.1 percent) developed dementia during a three- to five-year follow-up period. Of the 15,473 patients with diabetes but no comorbid depression, only 158 (1.0 percent) developed dementia during follow-up. “Patients with comorbid depression had a 100 percent increased risk of dementia during the three to five years postbaseline,” wrote the researchers.

They postulated several biologic mechanisms that could link depression and dementia, saying that their work suggests that severity of depression may be an important factor, but “future studies are needed to further evaluate whether effective depression interventions reduce the risk of dementia and identify the mechanisms that may explain our observation.”

Big babies may be at increased risk of eventually developing schizophrenia. Researchers in Finland investigated the link between birth weight and schizophrenia in a large schizophrenia family study sample. They used birth-weight data of 1,051 offspring from 315 Finnish families that had at least one offspring with a diagnosis of schizophrenia. “Infants with a high birth weight are nearly twice as likely to develop schizophrenia as those born with a normal weight,” they found.

Using information from the Finnish Medication Reimbursement Register and patient interviews, they further investigated the association of maternal type 2 diabetes and schizophrenia risk among offspring. High birth weight (greater than 4,000 g) was associated with a 1.68-fold increase in schizophrenia susceptibility. Maternal diabetes at time of data collection, a proxy for gestational diabetes, was associated with a 1.66-fold increase in the risk of schizophrenia among offspring.

The researchers said that their results corroborate other recent findings showing an association between high birth weight and schizophrenia and point to a potential birth-weight-independent association between maternal type 2 diabetes and schizophrenia among offspring.

A team of researchers from the Institute for Safe Medication Practices, Wake Forest University, Harvard Medical School, and Johns Hopkins University School of Medicine have published an analysis of smoking-cessation treatments and deemed one of them— varenicline—to be “unsuitable.”

The group selected from the FDA’s Adverse Event Reporting System database from 1998 through September 2010 all serious case reports for varenicline (n=9,575), bupropion for smoking cessation (n=1,751), and nicotine-replacement products (n=1,917). Their main outcome measure was the ratio of reported suicide/self-injury or depression cases for each drug or product compared with all other serious events for that drug or product.

Overall, they identified 3,249 reported cases of suicidal/self-injurious behavior or depression, 2,925 of them (90 percent) associated with varenicline, 229 (7 percent) with bupropion, and 95 (3 percent) with nicotine-replacement products. The disproportionality persisted after excluding reports indicating concomitant therapy with any of 58 drugs with suicidal behavior warnings or precautions in the prescribing information.

An additional antibiotic comparison group showed that adverse-event reports of suicidal/self-injurious behavior or depression were otherwise rare in a healthy population receiving short-term drug treatment.

“Varenicline shows a substantial, statistically significant increased risk of reported depression and suicidal/self-injurious behavior,” concluded the researchers. “Bupropion for smoking cessation had smaller increased risks. The findings for varenicline, combined with other problems with its safety profile, render it unsuitable for first-line use in smoking cessation.”

The physical consequences of celiac disease have been well studied, but less is known about co-occurring psychiatric symptoms. Researchers at Syracuse University have examined psychiatric risk and comorbidities of women with celiac disease, who may be at increased risk for psychiatric symptoms including depression and disordered eating behaviors.

For the study, 177 women with celiac disease responded to an extensive Web-mediated survey assessing dietary compliance, illness symptoms, psychiatric functioning, and disordered eating. Despite high reported dietary compliance, patients reported marked illness symptoms and impaired quality of life. A substantial minority claimed symptoms that met criteria for the diagnosis of psychiatric disorders: 37 percent (n=65) met the threshold suggesting depression, and 22 percent (n=39) for disordered eating. Participants whose symptoms exceeded these clinical thresholds reported greater perceived stress and reduced overall mental health, relative to women below the clinical cutoffs.

The researchers concluded that despite largely adhering to a gluten-free diet, a substantial subset of women with celiac disease reported clinically relevant symptoms of depression and disordered eating and that such symptoms wer associated with increased psychosocial distress in other domains.

“The presence of disordered eating symptoms in the present sample indicates that attending to the risk for extreme thoughts and behaviors related to eating and shape is a large area of opportunity for improving quality of life in women with celiac disease,” wrote the researchers. They believe their results suggest potential to improve patient well-being through attention to psychosocial care, in addition to existing dietary recommendations for individuals with celiac disease.

Arigo D, Anskis AM, Smyth JM. Psychiatric Comorbidities in Women With Celiac Disease. Chronic Illn. 2011. Sep 20 [Epub ahead of print]. http://chi.sagepub.com/content/early/2011/09/20/1742395311417639.abstract