Monoamine oxidase A regulates antisocial personality in whites with no history of physical abuse.

OBJECTIVE: Preclinical and human family studies clearly link monoamine oxidase A (MAOA) to aggression and antisocial personality (ASP). The 30-base pair variable number tandem repeat in the MAOA promoter regulates MAOA levels, but its effects on ASP in humans are unclear. METHODS: We evaluated the association of the variable number tandem repeat of the MAOA promoter with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, ASP disorder (ASPD) traits in a community sample of 435 participants from the Hopkins Epidemiology of Personality Disorders Study. RESULTS: We did not find an association between the activity of the MAOA allele and ASPD traits; however, among whites, when subjects with a history of childhood physical abuse were excluded, the remaining subjects with low-activity alleles had ASPD trait counts that were 41% greater than those with high-activity alleles (P < .05). CONCLUSION: The high-activity MAOA allele is protective against ASP among whites with no history of physical abuse, lending support to a link between MAOA expression and antisocial behavior.

The Dopamine Dilemma-Part II: Could Stimulants Cause Tolerance, Dependence, and Paradoxical Decompensation?

In this commentary, the author calls to attention that stimulants are commonly prescribed to children for years without seeming regard to the lack of studies on efficacy and safety during long-term use. The author examines evidence for stimulants losing efficacy over time and provides multiple possible mechanisms. The potential for paradoxical decompensation, an iatrogenic worsening of symptoms over time, is considered and discussed. Recommendations for detecting and responding to possible stimulant tolerance and dependence are provided.

Setting up a Death Row Psychiatry Program.

Death row psychiatry contains a complex set of clinical, ethical, and legal questions. This Forensic Files column makes a case for correctional institutions starting death row programs to address these issues through uniform policies. A list of the relevant issues is provided. Specific issues discussed include death row psychiatric assessment, considering "justifiable" depression, treating for competency to be executed, and balancing boundaries between clinical and forensic work.

Prisoners v. Prisons: A History of Correctional Mental Health Rights.

This article reviews the history of prisoners' rights with a focus on mental health treatment. The most common method of lawsuit, "1983 claims," will be explained, along with legislation designed to counter the flood of prisoner claims that started in the 1960s. Relevant landmark cases will be reviewed, including Cooper v. Pate, Vitek v. Jones, and Harper v. Washington. Finally, current class-action lawsuits against the state of California will be highlighted.

The dopamine dilemma: using stimulants and antipsychotics concurrently.

Stimulant and antipsychotic medications are commonly used together without concern, despite their potentially opposing mechanisms. An examination of dopamine pathways and receptors suggests that concerns regarding interactions between these two classes are justified and relevant. Efficacy of concurrent use is reviewed for several indications, with a focus on comorbid attention deficit hyperactivity disorder and aggression. The risk of adverse reactions is examined. Complex dopamine mechanisms are considered to explain the dilemma, and general treatment guidelines for stimulant-antipsychotic concurrent use are discussed.

Choosing Antidepressants for HIV and AIDS Patients: Insights on Safety and Side Effects.

Human immunodeficiency virus (HIV) has a high comorbidity with major depression. Symptoms of depression may be attributed to ongoing HIV infection, thereby reducing the likelihood of timely treatment with antidepressants. This may contribute to the morbidity of both illnesses. This review focuses on an evidence-based approach to selecting antidepressants for first-line treatment of major depressive disorder in patients with HIV and acquired immune deficiency syndrome (AIDS). Some antidepressant medications have side effect profiles that may exacerbate the symptoms commonly seen in patients with HIV and AIDS. Others have side effects that, while normally problematic in the general population, may be helpful in counteracting the difficulties seen in HIV and AIDS patients. Other challenges in treatment include an array of possible drug-drug interactions between antidepressants and HIV medications. Clinicians should focus more on capitalizing on the side effects of psychotropic medications in this patient population than on trying to avoid drug-drug interactions.

Identity theft in community mental health patients: two case reports.

Identity theft is a serious problem in the United States, and persons with enduring mental illnesses may be particularly vulnerable to becoming victims of this crime. Victims of identity theft experience a variety of consequences that include financial loss and serious emotional distress. Little is known about the impact of identity theft on individuals with mental illnesses. The two cases from a community mental health center presented in this article demonstrate many of the facets that may be associated with an increased risk for becoming the victim of identity theft. A summary of preventive steps as well as steps involved in resolving the crime once one has become a victim are presented.