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On September 18, 2007, a collaborative session between the International Society for CNS Clinical Trials and Methodology and the International Society for CNS Drug Development was held in Brussels, Belgium. Both groups, with membership from industry, academia, and governmental and nongovernmental agencies, have been formed to address scientific, clinical, regulatory, and methodological challenges in the development of central nervous system therapeutic agents. The focus of this joint session was the apparent diminution of drug-placebo differences in recent multicenter trials of antipsychotic medications for schizophrenia. To characterize the nature of the problem, some presenters reported data from several recent trials that indicated higher rates of placebo response and lower rates of drug response (even to previously established, comparator drugs), when compared with earlier trials. As a means to identify the possible causes of the problem, discussions covered a range of methodological factors such as participant characteristics, trial designs, site characteristics, clinical setting (inpatient vs outpatient), inclusion/exclusion criteria, and diagnostic specificity. Finally, possible solutions were discussed, such as improving precision of participant selection criteria, improving assessment instruments and/or assessment methodology to increase reliability of outcome measures, innovative methods to encourage greater subject adherence and investigator involvement, improved rater training and accountability metrics at clinical sites to increase quality assurance, and advanced methods of pharmacokinetic/pharmacodynamic modeling to optimize dosing prior to initiating large phase 3 trials. The session closed with a roundtable discussion and recommendations for data sharing to further explore potential causes and viable solutions to be applied in future trials.

Objective: Depression is associated with poor social problem solving, and psychotherapies that focus on problem-solving skills are efficacious in treating depression. We examined the associations between treatment, social problem solving, and depression in a randomized clinical trial testing the efficacy of psychotherapy augmentation for chronically depressed patients who failed to fully respond to an initial trial of pharmacotherapy (Kocsis et al., 2009). Method: Participants with chronic depression (n = 491) received cognitive-behavioral analysis system of psychotherapy (CBASP; McCullough, 2000), which emphasizes interpersonal problem solving, plus medication; brief supportive psychotherapy (BSP) plus medication; or medication alone for 12 weeks. Results: CBASP plus pharmacotherapy was associated with significantly greater improvement in social problem solving than BSP plus pharmacotherapy, and a trend for greater improvement in problem solving than pharmacotherapy alone. In addition, change in social problem solving predicted subsequent change in depressive symptoms over time. However, the magnitude of the associations between changes in social problem solving and subsequent depressive symptoms did not differ across treatment conditions. Conclusions: It does not appear that improved social problem solving is a mechanism that uniquely distinguishes CBASP from other treatment approaches. (Contains 4 tables and 1 figure.)

Objective: To determine the proportion of youth suicides in New York City from 1999 to 2002 in which antidepressants were detected at autopsy. Method: This is a medical examiner surveillance study of suicides in New York City among those younger than 18 years of age. The outcome measure is serum toxicology for antidepressants. Results: From 1999 through 2002, there were 41 individuals younger than 18 years of age among residents of New York City who committed suicide. Thirty-six (87.8%) had a serum toxicological analysis and an injury death interval of 3 days or less. There was one (2.8%) suicide in which both buproprion and sertraline were detected at the time of autopsy. Antidepressants were not detected in any of the other youth suicides. Conclusions: The detection of antidepressants at autopsy was quite rare in youth suicides in New York City from 1999 to 2002. (Contains 1 table.)

Faces are a rich and available source of social information, and the representation for faces is robust in adults (i.e. the face detection effect; Purcell & Stewart, 1988). The current study compared the developmental trajectory of the robustness of face perception against the trajectory for a non-face object. Participants (5-35 years old) were presented with rapid (17 and 33 millisecond) presentations of face and house stimuli and were instructed to identify the object category of the stimulus (face or house). There was an interaction between object type and age such that the developmental slope for face identification was steeper than the slope for house identification for the 17-millisecond presentation. These data show that faces are processed in a different way than a non-face object during the period from middle childhood through adolescence and adulthood, and this differential processing may involve the massive amount of exposure we have to faces.

Objectives. We compared characteristics of homicides among New York City residents aged 18 years and older from 1990 to 1998 to determine differences in demographics, cause and place of death, and presence of illicit drugs and alcohol in the deceased's system. Methods. All medical examiner-certified homicides among New York City residents aged 18 years and older from 1990 to 1998 were studied (n=11850). Nonelderly (aged 18 to 64 years) and elderly (aged 65 years and older) victims were compared by gender, race/ethnicity, cause of death, place of death, and presence of illicit drugs or alcohol. Population-based homicide rates stratified by age, gender, and race were also calculated. Results. Nonelderly homicide victims were significantly more likely to be male, non-White, to have been shot in the city streets, and to have evidence of illicit drug or alcohol use. Elderly victims were more likely to be female, White, to have been killed by nonfirearm injuries, and to have been killed in their own homes. The gender and race differences between age groups remained but were attenuated when population-based rates were compared. Conclusions. The characteristics of homicide in nonelderly adults do not apply to elderly adults in New York City. Demographic factors and vulnerabilities of the elderly may underlie these differences, pointing to the need for oversight of isolated or homebound elderly persons and for protective interventions. (Am J Public Health. 2007;97:1666-1670. doi:10.2105/AJPH.2005.079806)

The link between using antidepressants and increased suicidal thoughts has prompted the Food and Drug Administration to issue a warning about it.

Abstract Valid and reliable methods of assessing outcome in depression are crucial to antidepressant efficacy studies but are also important for all studies that relate response to other variables. In [...]

A new study investigates the link between childhood abuse and adult substance abuse.

Temperatures above 88 degrees can cause an increase in mortality rates among cocaine users. Researchers analyzed all unintentional deaths from cocaine between 1990 and 1992 and compared them to death rates among opiate users, other drug users and victims of car crashes and homicides. On days when the temperature was 88 degrees or higher, the unintentional death rate among cocaine users was 33% higher than on cooler days. This was not true of the deaths in the other groups. Cocaine can increase body temperature and also can affect the heart, causing coronary artery vasospasm, rapid heartbeat, and arrhythmias.

This ecological study examines the association of the poverty status of urban communities in New York City with their mortality rates of accidental drug overdoses. Mean annual age-adjusted rates of drug overdoses involving cocaine, opiates, or both (n = 1,684) were calculated for each of 59 residential community districts in New York City for 1990-1992. A linear regression analysis was performed to test the association of the mortality rate with the poverty status of the district as measured by the proportion of the district living below the 1989 U.S. poverty line. Poverty status accounted for 69% of the variance in the drug overdose mortality rates of communities (p [is less than] .001). This study suggests that mortality rates of overdoses involving cocaine and opiates are significantly associated with the poverty status of communities in New York City., Key Words. Cocaine; Drug overdoses; Opiates; Poisoning; Poverty; Socioeconomic status INTRODUCTION New York City is one of the leading centers of importation and distribution of heroin and cocaine in the [...]