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This Month in Archives of General Psychiatry
Dec 2011

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2011;68(12):1192. doi:10.1001/archgenpsychiatry.2011.149

Hong et alArticle investigated the effect of varenicline tartrate, a relatively specificα4β2 nicotinic acetylcholine receptor partial agonist/antagonist, on key biomarkers associated with schizophrenia. A moderate dose of varenicline was found to reduce the sensory gating deficit after long-term but not short-term treatment, reduce startle eyeblink reactivity, and improve antisaccade executive function.

Rasetti et alArticle show that prefrontal-hippocampal functional connectivity during working memory is a novel intermediate phenotype in schizophrenia and independent of altered dorsolateral prefrontal cortex engagement per se. Further, the ZNF804A rs1344706 risk variant modulates this coupling specifically and not dorsolateral prefrontal cortex activation. These results suggest that risk-associated genes may differentially impact the neurobiology of schizophrenia via their effect on local neural activity or coupling of brain regions within neural circuits.

Fullerton et alArticle examined longitudinal trends in service use, spending patterns, and treatment quality in individuals with depression identified from Florida Medicaid claims data. They found a 29% increase in mental health spending per enrollee with depression over the 10-year study period. This increase was driven by increased pharmaceutical spending, in particular increased spending and use of antipsychotics rather than antidepressants, but was not associated with improvements in quality measures.

Gueorguieva et alArticle used growth mixture models to characterize treatment response in duloxetine clinical trials. Responder and nonresponder trajectories were identified in the antidepressant arms but only a single trajectory existed in the placebo arms. The majority of patients treated with serotonergic antidepressants showed a clinical trajectory over time that was superior to placebo but a sizable minority of patients (about one-quarter) did more poorly receiving these medications than receiving placebo.

Weiss et alArticle report on a multisite study, conducted as part of the National Drug Abuse Treatment Clinical Trials Network, that evaluated the efficacy of brief and extended buprenorphine hydrochloride–naloxone hydrochloride treatment, with different counseling intensities, for patients dependent on prescription opioids. Prescription opioid–dependent patients were most likely to reduce or stop opioid use during buprenorphine-naloxone treatment. If buprenorphine-naloxone treatment was tapered off, even after 12 weeks of treatment, the likelihood of return to opioid use was extremely high, even among patients receiving individual drug counseling plus medical management.

Ribbe et alArticle investigated whether genetic variants of the corticotropin-releasing factor system influence the probability to develop alcoholism. They found an interaction of single-nucleotide polymorphisms in the genes encoding CRHR1 and CRHBP, predicting persons at risk for comorbid alcoholism in schizophrenia and other psychiatric diseases.

Worbe et alArticle examined reinforcement learning in clinically and pharmacologically distinct subgroups of patients with Gilles de la Tourette syndrome. Using a functional imaging paradigm and computational modeling, they found the correspondence between clinical phenotypes and blunted activation in distinct frontal cortex–basal ganglia circuits. Contrary to classic antipsychotics, the partial dopaminergic antagonist aripiprazole preserved reward sensitivity and avoided blunting of motivational drive.

In a birth cohort from the general population, Galéra et alArticle described the early developmental course of hyperactivity-impulsivity and inattention symptoms and studied their association with prior risk factors. They found that prenatal, perinatal social, and parental psychopathology variables act independently to heighten the likelihood of having persistently high levels of hyperactivity-impulsivity and inattention symptoms from 17 months to 8 years of age.

Using the National Hospital Discharge Survey, BladerArticle identified discharges from the acute care inpatient setting with a primary psychiatric diagnosis to analyze inpatient trends between 1996 and 2007. Population-adjusted, psychiatrically related discharge rates and total days of hospitalization rose appreciably for children and adolescents. Discharges rose modestly among adults but declined substantially among elderly patients. The proportion of psychiatric inpatient care paid by private insurance declined for all nonelderly age groups.

Breslau et alArticle report that migration from Mexico to the United States is associated with a dramatic (7-fold) intergenerational increase in the prevalence of conduct disorder. They use this migration paradigm to test whether the prevalences of different profiles of conduct disorder symptoms are equally affected by environmental factors that differ between the 2 countries.

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