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This Month in Archives of General Psychiatry
July 2005

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2005;62(7):708-709. doi:10.1001/archpsyc.62.7.708

Day et alArticle explored a wide range of clinical and contextual predictors of attitudes to medication in 228 people with a diagnosis of schizophrenia and schizoaffective disorder using structural equation modeling. The model giving the best fit indicated that experience of admission, including perceived coercion; insight; and relationship with the staff were the most important predictors of attitudes toward treatment.

Palmer et alArticle evaluated research consent capacity among older patients with Alzheimer disease, schizophrenia, or type 2 diabetes mellitus. Patients with Alzheimer disease had the worst and patients with diabetes mellitus had the best capacity, but even within each diagnostic group, there was considerable heterogeneity. Cognitive impairment was among the best predictors of capacity within and across the 3 groups. A brief questionnaire was sensitive, although not fully specific, to impaired understanding as measured with a lengthier interview. Brief screening questions and cognitive assessment would be a more effective basis than diagnosis for identifying people who may require more comprehensive consent capacity evaluations.

Using voxel-based morphometry, Dickstein et alArticle evaluated magnetic resonance imaging volume alterations in children with bipolar disorder. In a priori regions of interest, they demonstrated volume reductions in the left dorsolateral prefrontal cortex, left amygdala, and left accumbens area in children with bipolar disorder compared with age- and sex-matched control subjects. These results further implicate the dorsolateral prefrontal cortex, amygdala, and accumbens in emotion regulation.

Jorge et alArticle examined the relationship between alcohol misuse and mood disorders among 158 patients who sustained a traumatic brain injury (TBI). A history of alcohol use disorders was significantly associated with the occurrence of mood disorders during the first year following TBI. In addition, mood disorders were associated with alcohol abuse relapse. Patients with a history of alcohol misuse who also developed mood disorders following TBI had major difficulties in resuming a productive life.

Culverhouse et alArticle examined 5-year stability of lifetime diagnoses of alcoholism, habitual smoking, and other substance dependence in the Collaborative Study on the Genetics of Alcoholism. Alcohol dependence was highly stable in index cases but much less stable in community-based controls. Stability of diagnosis varied by substance. Lifetime history of habitual smoking was highly stable. Severity of illness was the most important characteristic predicting stability.

Paulus et alArticle used a simple decision-making task in the context of functional magnetic resonance imaging in 40 methamphetamine-dependent individuals who completed a 28-day inpatient program to predict whether patterns of brain activity predict relapse. Brain activation levels in right insula, right posterior cingulate, and right middle temporal gyrus correctly predicted outcome in 20 of 22 individuals who did not relapse and in 17 of 18 who did. This result demonstrates that functional neuroimaging may be useful for long-term clinical predictions in substance dependence.

Slutske et alArticle examined the relation of individual differences in personality measured at age 18 years with problem gambling and substance-related addictive disorders assessed at age 21 years in a Dunedin, New Zealand, birth cohort. The personality profile associated with problem gambling was similar to those associated with the substance-related addictive disorders. The comorbidity between problem gambling and the substance-related addictive disorders was partially accounted for by these common personality underpinnings.

Halmi et alArticle found treatment acceptance in 122 patients with anorexia nervosa randomized to 3 treatments occurred in 56% assigned medication alone. Acceptance rate was 91% in the other groups for those with high obsessive preoccupation and 60% for those with low obsessive preoccupation. High self-esteem was the only predictor of treatment completion in the treatment acceptors (50.6%). Dropout rates and acceptance need to be carefully studied before conducting comparative treatment trials.

Using diffusion tensor imaging, Szeszko et alArticle investigated brain white matter integrity in patients with obsessive-compulsive disorder. Fractional anisotropy was lower among patients within 3 regions of the anterior cingulate white matter compared with healthy volunteers, with additional abnormalities identified in the posterior cingulate and parietal and occipital lobe white matter. These findings provide preliminary evidence for an abnormality involving the brain white matter at the microstructural level in the pathogenesis of obsessive-compulsive disorder.

In a secondary analysis of data obtained from a study examining the effects of treating depression and/or social isolation in patients after myocardial infarction (MI), Taylor et alArticle found that the risk of death of recurrent MI was significantly lower in patients taking selective serotonin reuptake inhibitors compared with patients who were not. These findings suggest that use of these medications in patients with depression after MI might reduce subsequent cardiovascular morbidity and mortality.

Birnbaumer et alArticle investigated neuronal, peripheral, and subjective correlates of fear conditioning in criminal psychopaths using an aversion differential pavlovian conditioning paradigm. The psychopaths were either criminal offenders on bail or were on parole. During emotional learning they failed to show differential activation in the limbic-prefrontal circuitry and showed no conditioned skin conductance responses despite intact processing of the stimulus contingency. Hence, deficient fear conditioning may underlie the emotional detachment and antisocial behaviors that characterize psychopathy.

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