November 2008 • www.clinicalpsychiatrynews.com Psychosomatic Medicine 41

Anger Control, Venting Preoperative Depression Lowers Drive CV Risk in Blacks Survival With Brain Tumor

BY SHARON WORCESTER through life, Dr. Pointer suggested, but it BY PATRICE WENDLING World Health Organization grade III and Southeast Bureau also appears to provide protection against Chicago Bureau 802 tumors were grade IV. A total of 204 cardiovascular disease by improving the patients received subtotal resection, 274 re- N EW O RLEANS — Anger control ap- ratio of “good” (HDL) cholesterol to C HICAGO — Patients who were suffer- ceived adjuvant therapy, and 136 required pears to have beneficial effects on car- “bad” (LDL) cholesterol, she said. ing from depression at the time of malig- subsequent resection. diovascular disease risk in African Amer- In a separate study, Den’ee T. Mwend- nant brain astrocytoma surgery had sig- Only 49 patients (5%) who were taking icans, and conversely, the expression of wa, Ph.D., of Howard University, Wash- nificantly reduced survival compared with medication for clinical de- anger and hostility may be linked with ington, reported that trait depression nondepressed patients in a retrospective pression at the time of the surgery met the increased levels of an inflammatory and anger/hostility both were signifi- analysis of 1,052 patients. study’s definition of having depression. marker of cardiovascular disease in this cantly positively correlated with C-reac- Although no causative association can All demographic and clinical character- population. tive protein (CRP) levels in a study of 155 be inferred because of the study’s retro- istics were similar between the two groups, In a study presented at a meeting spon- African American adults. spective design, recogniz- said Dr. Quiñones-Hinojosa. sored by the International Society on Hy- The purpose of the study—which is ing and treating preopera- At 2 years post Their mean age was 51 years pertension in Blacks, an unwillingness to part of an ongoing project to identify bi- tive depression could surgery, 5% of and median preoperative express anger outwardly was signifi- ologic and psychosocial predictors of re- maximize survival in pa- Karnofsky Performance cantly negatively associated with LDL nal health outcomes—was to determine tients with malignant brain patients with Scale (KPS) score was 80. cholesterol levels and significantly posi- whether trait depression and anger/hos- tumors, said Dr. Alfredo depression were Among survivors, the medi- tively associated with HDL cholesterol tility were associated with increases in Quiñones-Hinojosa at the an follow-up was 12 months levels in a convenience sample of 174 CRP levels in a community-based sample annual meeting of the alive, compared (range 3-18 months). normotensive African American adults. of middle-aged African Americans, and it American Association of with 23% of In a Kaplan Meier analy- Anger in the participants was assessed followed previous findings suggesting that Neurological Surgeons. sis, patients with depression using the 20-item Spielberger Anger Ex- depression and anger/hostility traits are Currently, patient age, nondepressed had more than a 40% in- pression scale, and plasma cholesterol associated with cardiovascular disease and tumor grade, and func- patients. The crease in the relative risk of and triglyceride levels were measured. stroke, Dr. Mwendwa noted in a poster. tional status are known mortality compared with Items 1 and 8 of the scale, which assessed Researchers have suggested that preoperative prognostic in- difference was nondepressed patients (rela- anger control (“I control my temper” chronic inflammation can result from dicators of survival. Identi- significant. tive risk 1.41), regardless of and “I keep my cool,” respectively), were changes in the immune system that are fication of any reversible KPS, WHO tumor grade, the “highest endorsed” items on the triggered by negative mood states, and comorbidity would be important, as ma- patient age, or clinical presentation. scale, but only item 15 (“I am angrier the findings of the current study appear lignant astrocytoma, also known as glioma Median survival was 7 months among than I am willing to admit”) was signifi- to support this theory. Participants un- or glioblastoma multiforme, typically re- patients with depression, compared with cantly associated with cholesterol levels, derwent neuropsychological and psy- sults in death in about 1 year, even with the 11 months in those without depression. At Mildred A. Pointer, Ph.D., of North Car- chosocial evaluation, and CRP levels latest, most effective therapies. 2 years post surgery, 5% of patients with olina Central University, Durham, re- were used as a measure of inflammation. Researchers at Johns Hopkins School of depression were alive, compared with 23% ported in a poster at the meeting. The findings suggest that regular Medicine in Baltimore, led by Dr. of nondepressed patients. The difference Avoiding the outward expression of screening for anger and depression Matthew J. McGirt, analyzed the out- was significant. anger may serve as a survival technique would be beneficial in African Ameri- comes of 1,052 patients with malignant as- Dr. Quiñones-Hinojosa acknowledged in African Americans as they navigate cans, Dr. Mwendwa concluded. ■ trocytoma who underwent surgery from that the investigators could not be certain 1995 to 2006. that the patients’ depression was not a re- Of these patients, 605 underwent pri- sponse to the recent diagnosis of a termi- mary resection, 410 underwent secondary nal disease. In addition, many patients Eplivanserin Soothes resection, and 37 had a biopsy only. Ex- with clinical depression may have been un- Without Next-Morning Effects cluding the biopsies, 213 tumors were diagnosed and unmedicated. ■ Watch for Early Warning Signs of BY BRUCE JANCIN Q&T Research of Sherbrooke, Quebec, Denver Bureau an independent clinical research firm hired by -Aventis to participate in Disturbed Eating in Diabetic Girls C HICAGO — The novel investigation- an eplivanserin trial. al sleep agent eplivanserin improves sleep He reported on a trial of 351 adults K EYSTONE, COLO. — Red flags for dis- zero in on disturbed eating behavior in continuity in patients with chronic pri- with chronic insomnia who were ran- turbed eating behavior in adolescent girls adolescent girls with diabetes, Ms. Temple- mary insomnia without causing next- domized double blind to 4 weeks of either with type 1 diabetes include a persistent- Trujillo’s fellow panelist, Dr. Denis Dane- day drowsiness or rebound insomnia 1 mg or 5 mg of eplivanserin or placebo ly high glycosylated hemoglobin level, fre- man, suggested asking the following: upon discontinuation, clinical trials show. in the evening. The 5-mg dose, which is quent episodes of diabetic ketoacidosis, Ǡ Are you manipulating your insulin by Eplivanserin’s developer, Sanofi-Aven- what will be marketed, resulted in a mean and behaviors such as skipping insulin omission or by changing the dose in order tis, is gearing up for the European launch 39-minute reduction in the baseline 84- doses or underdosing in order to control to control your weight? of the drug in 2009 based upon favorable minute wake time after sleep onset. This weight, according to one expert. Ǡ Are you dieting at the moment to con- comments from the European drug was significantly greater than the mean Another warning sign is a pattern of trol your weight? agency. In addition, the company, which 26-minute reduction with placebo. skipping breakfast and/or lunch, followed Ǡ Are you exercising specifically to control has funded three completed phase III Also, eplivanserin at 5 mg/day result- by binge eating throughout the evening, your weight? clinical trials, is preparing to file for mar- ed in a 64% reduction in the number of Rita Temple-Trujillo said at a conference Ǡ Are you doing any other things specifi- keting approval in the United States and nocturnal awakenings, compared with a on the management of diabetes in youth. cally to control your weight? Canada, Pierre Gervais said at the annu- 36% decrease with placebo. More epli- Distress about body weight and shape is “Those four questions, if you get hon- al American Psychiatric Association In- vanserin-treated patients reported a sig- also common among affected individuals, est answers, will probably give you most stitute on Psychiatric Services. nificant improvement in the refreshing but it’s a nonspecific indicator. of the information you need,” said Dr. Eplivanserin is the furthest along in de- quality of sleep. “It’s rare that I see girls who don’t have Daneman, professor and chair of the de- velopment of a new nonsedating drug The side effect profile of eplivanserin concern about body image. We’re a partment of pediatrics at the University of class known as ASTARs, or Antagonists mimicked that of placebo. The excep- weight-obsessed culture,” said Ms. Temple- Toronto and pediatrician-in-chief at the of Two A Receptors. Many tion was dry mouth, which was re- Trujillo, a clinical social worker at the Bar- Hospital for Sick Children there. sleep disorder experts expect the AS- ported by 1.7% of the placebo group bara Davis Center for Childhood Diabetes, But getting honest answers is a chal- TARs to take over a major chunk of the and 5.3% of patients on 5 mg/day of which cosponsored the conference with lenge because diabetic youths with dis- insomnia treatment market now domi- eplivanserin. the University of Colorado and the Chil- turbed eating behaviors feel great shame nated by and other drugs act- The ASTAR was not associated with dren’s Diabetes Foundation at Denver. and a reluctance to disclose the details, ac- ing on the γ-aminobutyric acid–A recep- next-morning drowsiness or difficulty in Pressed by a physician in the audience cording to Ms. Temple-Trujillo. tor, said Mr. Gervais, a pharmacist at concentration. ■ for a few quick screening questions to help —Bruce Jancin