Prenatal alcohol use and offspring size at 10 years of age

The Maternal Health Practices and Child Development Project is a longitudinal study of the effects of prenatal exposure to alcohol and other substances. Women were selected from a prenatal clinic and interviewed at the 4th and 7th months of pregnancy. Their offspring were examined at delivery, at 8 and 18 months, and at 3, 6, and 10 years. This report examined 610 offspring, at age 10, who were exposed prenatally to alcohol. Most alcohol use in this low-income cohort was light to moderate, although the entire spectrum of alcohol use is represented. The weight, length, head circumference, and skinfold thickness of the offspring were measured. At each assessment phase, we found a significant association between size and prenatal exposure to alcohol. At age 10, the children who were prenatally exposed to alcohol continued to be significantly smaller in weight, height, head circumference, and skinfold thickness. These results indicate that prenatal alcohol exposure has a long-term impact on offspring growth.

Cocaine use associated with increased suicidal behavior in depressed alcoholics

The aim of this study was to determine whether depressed alcoholics who used cocaine would display a higher prevalence of suicidal behavior and suicidal ideation than depressed alcoholics who did not use cocaine. Forty-one depressed alcoholics participated in this prospective study of consecutively admitted inpatients. Seventeen patients (41.5%) had made a suicide attempt during their current depressive episode, and all but 1 of these attempts occurred during the week prior to their hospitalization. Ten patients used cocaine in the week prior to hospitalization, and 7 of these 10 (70%) had made a suicide attempt during that week. In contrast, only 32% of the depressed alcoholics who did not use cocaine made a suicide attempt during that week (p < .05). Suicidal ideation was also more prevalent in alcoholics who used cocaine. These data provide evidence that cocaine use is associated with an increased prevalence of suicidal behavior and suicidal ideation in depressed alcoholics.

Fluoxetine in depressed alcoholics. A double-blind, placebo-controlled trial

BACKGROUND

The selective serotonergic medication fluoxetine has demonstrated efficacy in the treatment of major depression and has suggested efficacy in the treatment of alcoholism. However, no completed trials with any selective serotonergic medication have been reported in patients who display both major depression and alcoholism, despite previous observations that both depression and alcoholism are associated with low serotonergic functioning.

METHODS

Fifty-one patients diagnosed as having comorbid major depressive disorder and alcohol dependence were randomized to receive fluoxetine (n = 25) or placebo (n = 26) in a 12-week, double-blind, parallel-group trial. Weekly ratings of depression and alcohol consumption were obtained throughout the 12-week course of the study.

RESULTS

The improvement in depressive symptoms during the medication trial was significantly greater in the fluoxetine group than in the placebo group. Total alcohol consumption during the trial was significantly lower in the fluoxetine group than in the placebo group.

CONCLUSIONS

Fluoxetine is effective in reducing the depressive symptoms and the alcohol consumption of patients with comorbid major depressive disorder and alcohol dependence. It is unknown whether these results generalize to the treatment of less depressed and less suicidal alcoholics.

Attitudes and knowledge about drinking: relationships with drinking behavior among pregnant teenagers

Data were collected on the drinking behavior of 415 pregnant adolescents from 1990 to 1994. The relationships between knowledge and attitudes about drinking and drinking behavior were examined. Knowledge about drinking was not related to average daily volume of alcohol before or during pregnancy. Those with specific knowledge about fetal alcohol effects drank less before pregnancy, and in the first trimester, and were also less likely to drink to intoxication. Among drinkers, general knowledge about drinking was significantly related to a decrease in drinking between pre-pregnancy and first trimester, as well as between first and third trimesters. Those with more intolerant attitudes about drinking drank less before and during pregnancy. They had fewer episodes of binge drinking, intoxication, negative consequences, and problem drinking during pregnancy. They were more likely to decrease drinking from the first to third trimesters. These relationships are relevant to developing effective education programs for the high-risk group of pregnant teenagers who drink.

Double-blind fluoxetine in depressed alcoholic smokers

Treatment trials involving smoking in alcoholics with major depression are scarce, despite the common co-occurrence of these disorders. In this study, 25 smokers with DSM-III-R diagnoses of both major depressive disorder and alcohol dependence were randomized to fluoxetine or placebo in a 12-week, double-blind, parallel group trial. Almost half (48%) of the patients had made a suicide attempt in the week before hospitalization (where recruitment was performed), and 84 percent reported suicidal ideations during that week. Those in the fluoxetine group demonstrated a significant within-group decrease in smoking during the course of the study, whereas those in the placebo group did not. Those in the fluoxetine group smoked 27 percent fewer cigarettes than those in the placebo group, although this difference was not statistically significant. Cumulative alcohol consumption during the 12 weeks of the pharmacotherapy trial was four times as high in the placebo group as in the fluoxetine group, though this difference was not statistically significant in this limited-sized sample. The change in smoking was significantly associated with a change in drinking. These preliminary findings suggest that fluoxetine has the potential for treating the smoking and drinking behaviors of depressed alcoholic smokers.

Racial effects on the clinical presentation of alcoholics at a psychiatric hospital

Despite the clinical importance of race effects on comorbidity and symptom patterns in recent community studies, little is known about such effects in various treatment facilities. This study evaluated the effect of race on the clinical profile of 604 alcoholics who presented for initial evaluation and treatment at a psychiatric hospital. The factor that most strongly distinguished the racial groups was socioeconomic status (SES). After controlling for SES and other factors, no significant difference was noted between ethnic groups in the prevalence of major depressive disorder (MDD) or antisocial personality disorder. However, after controlling for SES and other factors, alcohol and drug use were more severe in African-American alcoholics, along with four symptoms associated with alcohol and drug use. In contrast, reversed neurovegetative symptoms, anxiety-related symptoms, and some personality-related symptoms were more severe in white alcoholics.

Prenatal tobacco and marijuana use among adolescents: effects on offspring gestational age, growth, and morphology

OBJECTIVE

This longitudinal study examined the effects of tobacco and marijuana use during pregnancy on the gestational age, growth, and morphology of 310 offspring of adolescents. Data were collected during 1990 through 1993.

METHODOLOGY

The adolescents were drawn from a prenatal clinic in Pittsburgh, PA. They were interviewed at mid-pregnancy and at delivery to obtain information on tobacco, marijuana, and other substance use before and during pregnancy. Infants were examined 24 to 36 hours after birth.

RESULTS

The average maternal age was 16.1 (range 12 to 18 years); 70% were African-American. Prenatal tobacco use was associated with reduced birth weight, length, head and chest circumferences, and ponderal index, but not gestational age or the number of morphological abnormalities. Prenatal marijuana exposure was associated with reduced gestational age. Among whites, first trimester marijuana exposure was associated with an increased rate of minor physical anomalies. Prenatal marijuana exposure was not associated with any growth outcomes.

CONCLUSIONS

These effects of prenatal tobacco and marijuana use were prominent despite lower levels of prenatal exposure in the offspring of adolescent mothers as compared with the offspring of adult mothers from the same clinic. Young maternal age may increase the offspring's risk of negative effects from prenatal tobacco and marijuana exposure.

Disproportionate suicidality in patients with comorbid major depression and alcoholism

OBJECTIVE

The two purposes of this study were to provide a comprehensive description of the clinical features of patients who presented to an intake psychiatric setting with major depression and alcohol dependence and to determine which clinical features distinguished this dual-diagnosis group from patients with the two relevant single diagnoses.

METHOD

During a recent 5-year period, a total of 107 patients who came to a psychiatric facility for initial evaluation were diagnosed as having both major depression and alcohol dependence. The clinical profile of this dual-diagnosis group was compared to that of nondepressed alcoholics (N = 497) and nonalcoholic patients with major depression (N = 5,625), assessed at the same facility, on the basis of information from the Initial Evaluation Form, a semistructured instrument containing a standardized symptom inventory that includes ratings of severity.

RESULTS

The psychiatric symptom that most strongly distinguished the depressed alcoholics from the two comparison groups was the level of suicidality. The depressed alcoholics differed significantly from the nonalcoholic depressed patients on only two depressive symptoms, suicidality (59% higher) and low self-esteem (22% higher); they were also significantly distinguished from the nonalcoholic depressed patients by factors such as greater impulsivity, functional impairment, and abnormal personal and social history markers.

CONCLUSIONS

Suicidality was disproportionately greater than other psychiatric symptoms in the depressed alcoholics. The clinical profile of depressed alcoholics suggests that they suffer an additive or synergistic effect of two separate disorders, resulting in a disproportionately high level of acute suicidality upon initial psychiatric evaluation.

Patterns and covariates of tobacco use in a recent sample of pregnant teenagers

PURPOSE

Little is known about the prevalence and patterns of smoking among pregnant teenagers. We provide a comprehensive description of the prevalence, patterns and correlates of smoking from a recent sample of 199 pregnant adolescents.

METHODS

We interviewed pregnant teenagers at mid-pregnancy and delivery to obtain information on tobacco and other substance use before and during pregnancy and on demographic, medical and psychosocial status.

RESULTS

The average age was 16.1 years (range 12-18); 70% were African-American. Smoking was prevalent and increased from first (59%) to third (62%) trimesters. This increase was in sharp contrast to decreases in other substances. Caucasians had higher rates of smoking and heavier smoking. For Caucasians, third trimester smoking was predicted by peer smoking and early onset of sexual activity. For African-Americans, third trimester smoking was related to older age, not living with parent(s), dissatisfaction with social support, early pregnancy binge drinking, peer smoking, and early onset of sexual activity.

CONCLUSIONS

The high prevalence and increasing pattern of prenatal smoking in teenagers is a major public health concern. Effective education and cessation programs must be targeted at pregnant teenagers.

A comparison of prenatal drinking in two recent samples of adolescents and adults

The drinking patterns of 124 pregnant teenagers are described and compared with those of 267 pregnant adults attending the same prenatal clinic in Pittsburgh. Adults had a significantly higher average daily volume of alcohol prior to pregnancy than adolescents, but that higher level was no longer significant during pregnancy. However, the rate of binge drinking during the first trimester was higher in the teenage sample than in the adult sample. Rates of binge drinking and heavy drinking were highest among the white teenage group. Use of marijuana and cocaine/crack decreased precipitously during pregnancy for both teenagers and adults. Tobacco use also decreased among the adults, but increased from 56% to 71% during pregnancy in the teenage sample. Based on our findings, patterns of drinking among adult pregnant women do not generalize to pregnant adolescents. Offspring of white adolescents, in particular, may be at higher risk for intermittent high peak alcohol exposure farther into the pregnancy than are offspring of older women.

Effect of prenatal marijuana exposure on the cognitive development of offspring at age three

Marijuana is the most commonly used illicit substance among pregnant women. Although there has been substantial concern about the effects of substance use during pregnancy, few studies have assessed the effects of prenatal exposure to marijuana and even fewer have provided longitudinal data on the developmental outcome of offspring. This is a report from a longitudinal study of substance use during pregnancy. The women in the cohort were of lower socioeconomic status, most were single, half were white and half were African-American. Women were interviewed at the fourth and seventh prenatal months, and women and children were assessed at delivery, 8, 18, and 36 months. Pediatric assessment included physical and cognitive development. At each study phase, mothers were interviewed about life style, living situation, current substance use, sociodemographic, and psychological status. Findings are reported on 655 women and children who were assessed at the third year. There were significant negative effects of prenatal marijuana exposure on the performance of 3-year-old children on the Stanford-Binet Intelligence Scale. The effects were associated with exposure during the first and second trimesters of pregnancy. Among the offspring of white women, these effects were moderated by the child's attendance at preschool/day-care at age three.

Characterizing organic mood syndrome, depressed type

In this report, a first comprehensive description of the clinical features of patients with organic mood syndrome, depressed type (OMS-D), in a psychiatric hospital population is presented. This description is based on information from 130 OMS-D patients among 14,889 patients who presented for initial evaluation over a 5-year period. This description includes an enumeration of the common clinical symptoms of this syndrome. Following this, the severity of the symptoms of OMS-D are compared with those of its crude "functional" equivalent of major depressive disorder, single episode (MDD-SE). In addition, associated factors are presented concerning demographics, level of functioning, comorbidity, electroencephalographic and computed tomographic abnormalities, and current physical problems. These findings provide preliminary support for the validity of this diagnostic category, and provide relevant information concerning proposed changes in this category as listed in the DSM-IV Options Book.

Drinking patterns and correlates of drinking among pregnant teenagers

Many adolescents drink, and the rate of teenage pregnancy is increasing, yet the effect of drinking among pregnant teenagers has received little attention. We present a description of the drinking patterns of 124 pregnant teenagers attending a prenatal clinic in Pittsburgh. Sixty-nine percent of the women were African-American, and the average age was 16 years (range 13-18 years). Eighty-two percent drank the year before pregnancy, while 54%, 19%, and 15% drank during the first, second, and third trimesters, respectively. All substance use decreased between the first and third trimesters, with the exception of tobacco, which rose significantly. Binge drinking (5+ drinks/occasion) occurred in 31% of the sample before pregnancy, rose to 35% in the first trimester, and then fell precipitously. Binge drinkers during pregnancy were more likely to be white and heavier users of tobacco, marijuana, and cocaine. Binge drinkers experienced alcohol and tobacco use and sexual intercourse earlier than nonbinge drinkers. Binge drinking in the first trimester may be considered a risk factor for infants of adolescents.

Characterizing organic delusional syndrome

We present a first comprehensive description of the clinical features of patients with organic delusional syndrome. This description is based on information from 39 patients with organic delusional syndrome among 14,889 patients who presented for initial evaluation over a 5-year period at our institution. This description includes an enumeration of the common clinical symptoms of this syndrome and the respective prevalence and mean severity of each symptom. The severity of the symptoms of organic delusional syndrome are compared with those of schizophrenia to determine which symptoms distinguish between these two diagnostic categories. Patients with organic delusional syndrome demonstrated significantly more symptoms of "acquired intellectual impairment," "impaired sensorium," and "hallucinations of smell, taste, or touch," while schizophrenic patients demonstrated more "flat affect," "emotional coldness," and "thought disorganization." In addition, associated factors are presented concerning demographics, modes of treatment, level of functioning, and current physical problems associated with organic delusional syndrome.

Characterizing organic hallucinosis

A first comprehensive description of the clinical features of patients with the rare diagnosis of organic hallucinosis (OH) is presented, based on information from 11 OH patients among 14,889 patients who presented for evaluation over a 5-year period at our institution. This characterization is of particular current relevance to diagnosticians and clinicians because of the proposed major changes in the diagnostic system for OH in the upcoming DSM-IV and because of the virtual total lack of published information concerning this syndrome. This description includes a listing of the prevalence and mean severity of each symptom. The severity of the symptoms of OH are then compared with those of its crude "functional" equivalent of schizophrenia to determine which symptoms distinguish between these categories. Associated factors are also presented concerning demographics, modes of treatment, level of functioning, and current physical problems associated with OH.