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In this proof-of-concept, randomized, double-blind, placebo-controlled clinical trial, Hallak and colleagues investigated the effectiveness of a single intravenous administration of sodium nitroprusside (0.5 μg/kg/min for 4 hours) on the positive, negative, anxiety, and depressive symptoms in patients with schizophrenia taking currently available antipsychotics. A very rapid improvement of symptoms with minimal adverse effects was observed after sodium nitroprusside infusion. Significant differences in 8-item Brief Psychiatric Rating Scale scores between patients treated with placebo and patients treated with sodium nitroprusside persisted for 4 weeks postinfusion. In an editorial, Coyle discusses nitric oxide and symptom reduction in schizophrenia.
Parboosing and colleaguestested whether maternal influenza during pregnancy is related to bipolar disorder among offspring in a large population-based birth cohort in California. From prospectively collected data on influenza during pregnancy and diagnoses of offspring bipolar disorder from structured research interviews, they show that maternal influenza is associated with a nearly 4-fold increased risk of bipolar disorder in offspring.
Bryan and Clemans report that military personnel who have sustained multiple (≥2) lifetime traumatic brain injuries (TBIs) report more severe depression and posttraumatic symptoms and experience suicidal ideation more often than military personnel with fewer TBIs. Multiple TBIs were significantly associated with greater suicide risk even when controlling for other risk factors.
Ilgen and colleagues examined the extent to which clinical diagnoses of specific pain conditions predicted suicide mortality in a large cohort of patients receiving care from the Veterans Health Administration. Most noncancer pain conditions were associated with increased risk of suicide. After controlling for co-occurring psychiatric conditions, the associations between pain conditions and suicide death were reduced; however, significant positive associations remained for back pain, migraine, and psychogenic pain.
Young and colleagues used functional magnetic resonance imaging to examine autobiographical memory recall in depressed patients and individuals at a high familial risk for developing the disorder. Both groups recalled fewer specific and positive autobiographical memories compared with healthy controls. Differences in hemodynamic activity between groups during specific autobiographical memory recall were evident in the anterior cingulate cortex, medial frontal cortex, occipital cortex, and frontal operculum.
Mataix-Cols and colleagues conducted a population-based multigenerational family study of obsessive-compulsive disorder (OCD) including more than 24 000 cases diagnosed in Sweden over 4 decades. The risk for OCD among relatives of OCD probands increased proportionally to the degree of genetic relatedness (first-degree > second-degree > third-degree relatives). Relatives at similar genetic distances had similar risks for OCD, despite different degrees of shared environment. Nonbiological relatives (spouses/partners) also had an elevated risk for OCD.
To assess self-medication as a possible explanation for the co-occurrence of alcohol and mood disorders, Crum and colleagues used responses from 2 waves (approximately 3 years apart) of a nationally representative survey. They compared study participants who did and did not report drinking alcohol to alleviate mood symptoms. They found that drinking to alleviate mood symptoms at baseline was associated with an increased risk of developing alcohol dependence at follow-up.
Seo and colleagues conducted a functional neuroimaging study with inpatient recovering alcoholic patients and controls to assess neural correlates of alcohol craving and future relapse risk. Patients showed disrupted ventromedial prefrontal cortex (vmPFC) activation with vmPFC hyperactivity during a relaxed state but hypoactivation during stress and alcohol cue states. This neural pattern predicted high stress-induced and cue-induced craving and greater relapse outcomes, providing evidence for disrupted vmPFC/anterior cingulate cortex function playing a role in jeopardizing recovery from alcoholism. In an editorial, Volkow and Baler discuss brain imaging biomarkers to predict alcohol addiction relapse.
Although stimulant medication is an effective treatment for attention-deficit/hyperactivity disorder, there is conflicting evidence regarding stimulant risk for later substance problems. Humphreys and colleagues performed a meta-analysis of 15 longitudinal studies where treatment with stimulants preceded measures of substance use and substance abuse/dependence. Across every substance category (alcohol, cocaine, marijuana, nicotine, and nonspecific drug), there was no evidence that stimulant medication significantly protected nor increased risk for later substance use initiation or substance use disorder.
Research across 4 decades has produced numerous evidence-based psychotherapies (EBPs) for youth, treatments designed to improve on usual clinical care—but do they? Weisz and colleagues addressed this question in a multilevel meta-analysis of 52 EBP vs usual care randomized clinical trials. The EBPs did outperform usual care but only modestly so; effects were especially weak for clinically referred youths and clinically diagnosed samples. The findings highlight the value of usual care comparisons and the need to strengthen EBPs. In an editorial, Kazdin discusses evidence-based treatment and usual care.
Continuing Medical Education
Highlights. JAMA Psychiatry. 2013;70(7):653-654. doi:10.1001/jamapsychiatry.2013.1991