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This Month in Archives of General Psychiatry
Oct 2011

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2011;68(10):988. doi:10.1001/archgenpsychiatry.2011.115

Edinger et alArticle used a multitrait/multimethod correlational design to test the reliability and validity of DSM-IV-TR and International Classification of Sleep Disorders (ICSD-2) insomnia diagnoses. A number of diagnoses in each nosology had acceptable reliability/validity. Best-supported were the DSM-IV-TR and ICSD-2 insomnias attributed to a mental disorder or a general medical condition. DSM-IV-TR primary insomnia and most related ICSD-2 subtypes were poorly supported, likely because of symptom overlap with the comorbid insomnia subtypes.

Patterns of comorbidity among mental disorders are thought to reflect the natural organization of psychopathology and can inform development of a quantitative classification system. Kotov et alArticle used factor analysis to investigate comorbidity among a wide range of Axis I and II disorders in a sample of psychiatric outpatients (N = 2900). They confirmed the 3 previously found spectra (internalizing, externalizing, and thought disorder) and found novel somatoform and antagonism dimensions.

Nurnberger et alArticle assessed 12- to 21-year-old offspring in families with a proband with bipolar disorder (cases, n = 141) in comparison with offspring of controls (n = 91). In cases but not controls, a childhood diagnosis of an anxiety disorder or an externalizing disorder was predictive of later onset of major affective disorder. This suggests a different clinical significance for certain childhood disorders depending on family history.

Chawarska et alArticle examined the relationship between head circumference overgrowth in male infants later diagnosed with autism. Accelerated head circumference growth was closely associated with overgrowth of other morphological features including height and weight. Results highlight the importance of investigating factors impacting not only early neuronal but also skeletal growth mechanisms in considering the etiology of autism.

Whitley et alArticle explored associations of parental IQ with offspring behavioral problem scores using data from the 1958 National Child Development Study. They observed strong associations of decreasing conduct and emotional and attention problems in children 7 years and older whose mothers and fathers had higher IQ scores; associations were linear across the full parental IQ range.

Schiffer et alArticle aimed to disentangle alterations in gray matter (GM) brain volumes associated with violent offending from those associated with lifelong substance use disorders. Voxel-based morphometry was used to analyze high-resolution magnetic resonance image scans. The results indicated that greater GM volumes in the mesolimbic reward system were associated with violent offending, while reduced GM volumes in the prefrontal cortex, orbitofrontal cortex, and premotor area characterized men with substance use disorders.

Kapusta et alArticle demonstrate that national suicide statistics may be dependent on national autopsy rates and thus considerably prone to misclassification. In extension of the classic misclassification hypothesis that argued that suicides could be hidden in other death categories such as“undetermined” or“ill-defined death,” they demonstrate that autopsy rates as an external validation criterion are a more appropriate marker of national suicide misclassification, explaining cross-national and longitudinal suicide rate differences.

Nordentoft et alArticle followed up a cohort of 176 347 incident patients in Danish longitudinal registers up to 36 years after their first contact with mental health services. The absolute risk of suicide for men was highest for bipolar disorder (7.8%), closely followed by unipolar affective disorder and schizophrenia. Among women, the highest risk was found among women with schizophrenia (4.9%), followed by bipolar disorder. The co-occurrence of deliberate self-harm doubled the risk.

Current military postdeployment mental health screening relies on service members' willingness to honestly report their concerns. Warner et alArticle compared the responses of 2500 soldiers returning from Iraq on the routine postdeployment health assessment with a simultaneously administered anonymous survey. The results indicate that current postdeployment screening on return from deployment misses the majority of soldiers with mental health problems.

Murdoch et alArticle studied a nationally representative cohort of 3337 veterans who first applied for Department of Veterans Affairs disability benefits for military-related posttraumatic stress disorder (PTSD) almost 10 years ago. Over a 6-year period, beneficiaries were more likely to have had meaningful reductions in PTSD symptoms and substantially less poverty and homelessness than veterans denied benefits for PTSD. However, both groups still exhibited persistent symptoms and functional impairment.