Abstract
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Masi et al. address a rare but relevant consequence of antipsychotic treatment: Massive asymptomatic creatine kinase elevation (MACKE). In a literature review, the authors argue persuasively that elevated CK levels need not necessarily result in neuroleptic malignant syndrome (NMS) or rhabdomyolysis. In fact, as the name suggests, this metabolic anomaly can often be monitored while treatment continues. As they write, “an unduly excessive emphasis on isolated MACKE may become a ‘myth’ leading to a harmful overdiagnosis of ‘suspect’ NMS or rhabdomyolysis, and this incorrect diagnosis may lead to an unnecessary discontinuation of an effective therapeutic agent.”
This is of particular interest as our field moves toward more conscientious and thorough monitoring of vital signs in patients undergoing medication treatment. We should not allow more information to cloud our duty to our patients with an excess of caution. In these cases, Masi et al. conclude, “monitoring of the clinical picture is mandatory (including hepatic, cardiac, and renal function).” However, “a sudden switch/discontinuation of the antipsychotic is usually not necessary.”
Elsewhere, Simeonova et al. enlarge the frame of our understanding of bipolar disorder by investigating temperament traits of children born to mothers with the disorder. The authors' careful work comparing measures of temperament with measures of behavior predictive of psychopathology is well worth attending to. The suggestion they make—that this work lays the foundation for future research of prevention in at-risk populations—is certainly accurate. But I also find that this paper hints at a much more detailed clinical picture of very young children, and pushes at the narrow bonds of our current conception of pediatric mood disorders.
Finally, Babinski et al. add to the research on a phenomenon many clinicians have experienced: The effect of parental attention-deficit/hyperactivity disorder (ADHD) on parent-child interactions with ADHD adolescents. The authors of this small but ambitious study coded differences in interactions when parents were both on and off stimulant medication, and conclude that in certain domains the treatment may “enhance parental engagement.” More work in the area of family treatment needs to be done, but it is heartening to see the literature grow. Effective parent-child relationships can be crucial in treating children with ADHD, and it is no surprise that adults who are themselves impaired need assistance.