“Dangerousness” Should Guide Policy–not Mental Illness or Gun Ownership

From Psychiatric News Alert: About 8.9 percent of individuals who self-report as having patterns of impulsive angry behavior own guns, and 1.5 percent carry them outside the house, according to an analysis of the National Comorbidity Study Replication study. The study was posted online April 8 in the journal Behavioral Sciences and the Law.

Among those respondents, said Duke University Professor of Psychiatry and Behavioral Sciences Jeffrey Swanson, Ph.D., and colleagues.

“Persons with impulsive angry behavior who carried guns were significantly more likely to meet diagnostic criteria for a wide range of mental disorders, including depression, bipolar and anxiety disorders, PTSD, intermittent explosive disorder, pathological gambling, eating disorder, alcohol and illicit drug use disorders, and a range of personality disorders.”

However, most of those people are legally entitled to own firearms because they have never been involuntarily committed to a psychiatric hospital. Reorienting public policy away from mental illness and toward dangerousness might reduce injury and death by firearms, the authors note. Current approaches to restricting gun access of people with mental disorders have no impact on most of this group, coauthor Paul Appelbaum, M.D., a professor of psychiatry at Columbia University, told Psychiatric News.

“We need to reorient our firearms policies toward limiting gun possession by people who lack behavioral control—for example, by taking guns away from people who behave in dangerous ways—rather than focusing excessively on people with serious mental illnesses, as we do today.”

For more in Psychiatric News about dangerousness as a standard for firearms policy, see “Violence Risk, Not Mental Illness, Should Guide Gun Access.” Also, see “Screening for Violence Risk in Military Veterans: Predictive Validity of a Brief Clinical Tool” in the American Journal of Psychiatry.

Genomic Analysis: Eight Distinct Types of Schizophrenia

From Psychiatric News Alert. Schizophrenia appears to be “heterogenous”—that is, comprising a group of related disorders each of which present with distinct clinical syndromes; and those syndromes now appear to be associated with eight separate networks of genetic mutations.

That’s the finding from a remarkable genetic analysis titled “Uncovering the Hidden Risk Architecture of the Schizophrenias: Confirmation in Three Independent Genome-Wide Association Studies,” appearing in AJP in Advance.

Schizophrenia (Sepultura album)

Schizophrenia (Sepultura album) (Photo credit: Wikipedia)

In a large genome-wide association study of cases with schizophrenia and controls, researchers with the Molecular Genetics of Schizophrenia Consortium (an international group of researchers) examined single nucleotide polymorphisms (SNPs) that grouped or clustered together and assessed the risk for schizophrenia by comparing the cases and noncases. They then looked at relationships between the SNP clusters and various ways that patients present symptomatically across three separate studies.

The authors identified 42 SNP sets associated with a 70 percent or greater risk of schizophrenia and confirmed 34 (81 percent) or more with similar high risk of schizophrenia in two independent samples. These SNP sets or genotypic networks were linked to the different ways that patients present with schizophrenia, yielding eight distinct clinical syndromes varying in symptoms and severity.

“We found that some genetic pathways increasing susceptibility involved deficient control of healthy brain development, and other pathways involved increased susceptibility to brain injury and toxicity,”

Claude Robert Cloninger, M.D., a study coauthor and a professor of psychiatry at Washington University School of Medicine, told Psychiatric News. “Regulation of the plasticity of glutamate receptors was important in some classes of schizophrenia and not others.

A Single Nucleotide Polymorphism is a change o...

“The main take home message is that there are many pathways to schizophrenia, which converge on eight classes of the disorder,” he said.

Full coverage of this study will appear in a future issue of Psychiatric News. For more information on psychiatric genetics, see the Psychiatric News article, “Revolution in Psychiatric Genetics Rapidly Gains Steam.

Study: Cognitive Restructuring Helps Prevent Depression in At-Risk Teens

(From Psychiatric News Alert) A cognitive-behavioral prevention program, when compared with usual care, showed significant sustained effects in preventing depression in teens at high risk for depressive illness, said William Beardslee, M.D., a professor of child psychiatry at Harvard Medical School, and colleagues in JAMA Psychiatry.

The study included teens that were (a) offspring of parents with current or past depressive disorders, and (b) had themselves present or past depressive symptoms. The teens were randomly assigned to either (1) usual care, or (2) a cognitive-behavioral prevention (“CBP”) program. The CBP program involved eight weekly group sessions and six monthly group booster sessions, in which the teens learned how to deal with negative or unrealistic thoughts. The subjects were evaluated for depression at intervals over 33 months. Over the period, and for the sample as a whole, the intervention was significantly effective, with 37% of the teens in the CBP group experiencing a depression, compared with 48% in the usual-care group.

“We were quite pleased that the effects noted in our earlier analysis nine months after enrollment were sustained at 33 months, as it is difficult to demonstrate longer-term prevention effects,” Beardslee told Psychiatric News. At the nine-month follow-up, 21 percent of the teens randomized to the CBP condition had experienced depression, in contrast to 33 percent in the usual-care group.

During the past decade or so, there has been an explosion in mental illness prevention research such as that conducted by Beardslee and his colleagues. See the Psychiatric News article “Future Looks Promising for Mental Illness Prevention” to read more about the research. Also see “Maintenance Cognitive-Behavioral Therapy and Manualized Psychoeducation in the Treatment of Recurrent Depression…” in the American Journal of Psychiatry.