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This Month in Archives of General Psychiatry
August 2003

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2003;60(8):763. doi:10.1001/archpsyc.60.8.763

One of the key, although controversial, questions in schizophrenia is whether there is postonset progression of brain gray matter loss. Kasai et al Article report a prospective longitudinal magnetic resonance imaging study of the Heschl gyrus and planum temporale, parts of the superior temporal gyrus with crucial roles in auditory perception and language processing. There were selective decreases over time in gray matter volume of the left Heschl gyrus and left planum temporale in first-episode schizophrenia, but not in patients with first-episode affective psychosis.

Bagary et al Article used magnetization transfer imaging (MTI) and conventional T1-weighted volumetric magnetic resonance imaging to study subjects with first-episode schizophrenia and healthy controls. With voxel-based morphometric analyses, the magnetization transfer ratio (an index of signal loss derived from MTI) was reduced in both gray (medial prefrontal and insula) and white (fasciculus uncinatus) matter. The abnormalities found in schizophrenia at illness onset could not be explained by detectable atrophy.

To explore the features of stressful life events that are depressogenic and anxiogenic, 98 592 person-months from 7322 adult twins ascertained from a population-based registry were blindly rated by Kendler et al Article on the dimensions and categories of humiliation, entrapment, loss, and danger. Humiliating events that directly devalue an individual in a core role and loss events were strongly linked to risk of depression. Event dimensions and categories that predispose to depressive and anxiety episodes are distinguishable with moderate specificity. Event dimensions that preceded mixed depressive-anxiety episodes were largely the sum of those that preceded pure depressive and anxiety episodes.

Parental status may affect a person's decision to commit suicide. In a nested case-control study using data from Danish population-based registers, Qin et al Article found that parenthood was protective against suicide in terms of both having children and, to a higher degree, having a young child, and that the influences were stronger in women than in men. At the same time, parents of children with psychiatric illness or of children who had died were at increased risk for suicide. Losing a child in early childhood had a strong effect on parental suicide, and the risk was particularly high shortly after the loss.

Brain-derived neurotrophic factor (BDNF) regulates critical biological actions in the brain after binding and activating receptor tyrosine kinase B (trk B). Dwivedi et al Article investigated the role of BDNF and trk B in suicidal behavior by examining their expression in postmortem brains of suicide victims and nonpsychiatric control subjects. They found significantly reduced expression of BDNF and the full-length isoform of trk B in the prefrontal cortex and hippocampus of suicide victims, irrespective of psychiatric diagnosis. Given the importance of BDNF in regulating trophic activity, cell survival, and synaptic plasticity, decreased expression and function of BDNF may serve as an important vulnerability factor in suicide.

Matza et al Article examined atypical depression using the US National Comorbidity Survey. An atypical depression group was identified within a nationally representative sample, based on depression criteria plus atypical features of overeating and oversleeping. Compared with other depressed people, the atypical group reported higher rates of suicidal thoughts and attempts, psychiatric comorbidity, disability, health service utilization, and childhood neglect and sexual abuse. Findings suggest that atypical features of overeating and oversleeping may be a marker for increased impairment, distress, and risk among people with depression.

Potenza et al Article used a videotape cue-elicitation functional magnetic resonance imaging paradigm to examine the neural circuitry involved in gambling urges in pathological gamblers. The gambling scenario decreased activity in the ventral anterior cingulate, a region found to be less active in subjects with impulse dyscontrol, but had opposite effects on regions involved in obsessive-compulsive disorders. Thus, pathological gambling may be a disorder of impulse control.

Costello et al Article conducted a study of children aged 9 through 16 years and found that although the 3-month prevalence of psychiatric disorders averaged 13.3%, across the 8 years of the study 36.7% of children had at least 1 psychiatric disorder. Lagged analysis showed homotypic continuity for each disorder except specific phobias. Heterotypic continuity occurred mainly in girls and was strongest from depression to anxiety and anxiety to depression and from attention-deficit/hyperactivity disorder to oppositional disorder.

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