In This Issue

Telemedicine-based collaborative care for depression in family practice delivered by nurses at a remote central location produced higher rates of remission and response than care by identically trained nurses working on site in the clinics (figure). The number of visits and the quality of pharmacotherapy did not differ between the groups studied by Fortney et al. (CME, p. 414). Off-site care managers were more likely to follow the protocol for monitoring patients’ symptoms and treatment and providing information and suggestions. Editorialists Simon and Ludman (p. 362) anticipate overall treatment improvements from other comparisons of centralized and localized care.

New diagnoses of alcohol dependence were more common among U.S. Air Force personnel with mild traumatic brain injury (TBI) than in those with other types of injuries. In the 30 days following the injury, both alcohol dependence and nondependent drug or alcohol abuse were diagnosed more often in the airmen with mild TBI. Miller et al. (p. 383) report that the higher incidence of alcohol dependence in brain-injured service members continued into later periods as well. The editorial by Corrigan et al. (p. 351) emphasizes the prevalence of substance use disorders among service members and suggests that traumatic brain injury may occur in the context of substance use.

Immunization with a nicotine vaccine over 20 weeks led to an average 12.5% reduction in the binding of administered nicotine to β₂*-nicotinic acetylcholine receptors in the brains of 11 long-term smokers. The decline in receptor occupancy was accompanied by a 23.6% decrease in the amount of nicotine available to enter the brain. This proof-of-concept study by Esterlis et al. (CME, p. 399) also documented decreases in craving and the number of cigarettes smoked, although earlier clinical trials did not support the vaccine’s efficacy in smoking cessation. Fagerström and Tonstad point out in an editorial (p. 359) that factors other than nicotine also contribute to smoking behavior.