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In This Issue of JAMA Psychiatry
October 2013


JAMA Psychiatry. 2013;70(10):999-1001. doi:10.1001/jamapsychiatry.2013.2009

Choong and colleagues examined the association between polymorphisms within a new obesity candidate gene (CRTC1) and body mass index or fat mass in 3 psychiatric cohorts (n = 152, n = 174, and n = 118) and in the general population (n = 5338 and n = 123 865). In the psychiatric cohorts, lower body mass index and/or fat mass were observed in rs3746266 G allele carriers compared with noncarriers, the strongest effect being observed in younger women. A smaller, still significant, association was observed in the general population.

Dombrovski and colleagues examined neural responses to expected reward and unpredicted rewards in depressed elderly individuals with and without a history of suicide attempts. History of suicide attempts (particularly poorly planned ones) and impulsivity were associated with blunted expected reward signals in the paralimbic cortex, which in turn predicted the behavioral insensitivity to contingency change. Depression was associated with disrupted cortico-striato-thalamic encoding of unpredicted rewards.

Palaniyappan and colleagues report that cortical folding patterns measured with a relatively simple structural neuroimaging approach at the start of treatment can differentiate patients with first-episode psychosis who respond to early intervention (responders) from nonresponders after 12 weeks of treatment. Early nonresponders appear to have a higher burden of neurodevelopmental disruption. Stratified treatment plans based on prognostic neuroimaging markers, rather than symptom-based diagnosis, may be feasible in psychosis.

Using data from the ACCORD-MIND trial, Sullivan and colleagues found that participants with baseline 9-item Patient Health Questionnaire scores of 10 or more showed greater cognitive decline than those with scores less than 10 during 40-month follow-up on all cognitive tests. This effect of depression on risk of cognitive decline did not differ according to previous cardiovascular disease, baseline cognition or age, intensive vs standard glucose-lowering treatment, blood pressure treatment, lipid treatment, or insulin use.

Author Video Interview

Goldin and colleagues found that, compared with a wait-list control group, cognitive behavioral therapy produced (1) greater blood oxygen level–dependent signal magnitude in the dorsolateral and dorsomedial prefrontal cortex, (2) earlier temporal onset of dorsomedial prefrontal cortex activity, and (3) greater dorsomedial prefrontal cortex–amygdala inverse functional connectivity in patients with social anxiety disorder.

de la Fuente-Sandoval and colleagues prospectively examined glutamate levels in patients with first-episode psychosis. They found that glutamate levels were elevated in the associative striatum and cerebellum before antipsychotic treatment and decreased only in the associative striatum after clinically effective treatment.

Bobo and colleagues compared the risk of new-onset treated type 2 diabetes in children and youth (6-24 years of age) for recent initiators of antipsychotic drugs (n = 28 858) vs propensity score–matched controls who had recently initiated another psychotropic medication (n = 14 429) using data from Tennessee Medicaid. Antipsychotic users had a 3-fold increased risk for type 2 diabetes, which was apparent within the first year of follow-up and increased with cumulative antipsychotic dose.

Hicks and colleagues investigated the family transmission of externalizing disorders (substance use disorders and antisocial behavior) using families with biological (n = 1590) or adoptive (n = 409) offspring. Biological offspring were similar to their parents (r = 0.27-0.30), but adoptive offspring were not (r = 0.03-0.07), indicating genetic transmission between parents and offspring. Adoptive siblings, however, exhibited significant similarity (r = 0.21), indicating both shared environmental (c2 = 0.20) and genetic (a2 = 0.61) influences on externalizing disorders.

Cummings and colleagues examined the availability of outpatient mental health care facilities that accept Medicaid across US counties. More than one-third of counties do not have one of these facilities. Furthermore, rural counties and counties with a higher percentage of black and Hispanic residents are more likely to lack one of these facilities.

Continuing Medical Education

Based on epidemiologic data indicating higher mortality rates among patients with psychiatric illness, Khan and colleagues used data from the US Food and Drug Administration archives to evaluate mortality risk in psychopharmacology clinical trial participants (N = 92 542). Three- to 4-month exposure to psychotropics did not increase the mortality risk compared with placebo.

Martin and colleagues examined whether inclusion of alternative symptoms representing male-type depression mitigated or eliminated sex disparities in depression rates. Men reported higher rates of anger attacks/aggression, substance use, and risk taking compared with women. Analyses using a new scale that combined alternative and traditional depression symptoms found that men and women met criteria for depression in equal proportions.

Clinical Review & Education

In this perspective, Kahn and Keefe pose that the emphasis on psychosis in schizophrenia is a conceptual fallacy that has hampered the development of adequate treatments. In fact, cognitive and intellectual underperformance are risk factors for schizophrenia, a decline in cognitive functioning precedes the onset of psychosis by almost a decade, and cognitive function in schizophrenia is related to outcome. Cognition is the core component of the disorder.

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