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This Month in Archives of General Psychiatry
August 2005

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2005;62(8):822. doi:10.1001/archpsyc.62.8.822

Akbarian et al’s postmortem study Article examined the relationship between metabolic gene expression and chromatin chemistry in the prefrontal cortex of schizophrenic subjects and matched controls. Histone arginine methylation was increased in 8 (19%) of 41 schizophrenic subjects and was associated with gene-expression deficits. These findings suggest that metabolic alterations are limited to a subgroup of individuals with schizophrenia and accompanied by epigenetic changes of prefrontal chromatin.

In a population-based cohort study, Laursen et alArticle examined the family history of bipolar disorder, schizoaffective disorder, and schizophrenia as risk factors for psychiatric admission with schizoaffective disorder. The findings show an equal aggregation of bipolar disorder and schizophrenia in families of persons admitted with schizoaffective disorder and that schizoaffective disorder may be genetically linked to both, with schizoaffective disorder being a subtype of each or representing genetic interforms.

How the courses of bipolar and alcohol use disorders interact is uncertain. To address this, Strakowski et alArticle prospectively studied 144 patients with first-episode bipolar disorder (BD) and found that the relative ages at onset of alcohol use and BD influenced the subsequent clinical course of both conditions. This study highlights some of the complexities of this common co-occurrence.

Linking registers of all prescribed lithium and recorded suicides in Denmark during a period from 1995 to 1999, Kessing et alArticle investigated if lithium therapy was associated with reduced risk of suicide. The study included a total of 13 186 patients who purchased at least 1 prescription of lithium and 1.2 million subjects from the general population. Continued lithium therapy was associated with reduced suicide risk, regardless of sex and age.

Revicki et alArticle performed a cost-effectiveness analysis based on medical cost and outcome data collected in a clinical trial comparing antidepressant and cognitive behavioral therapy (CBT) with community referral in minority women with depression. There were significantly more depression-free days in the pharmacotherapy CBT groups than in the community referral one. They found a cost-effectiveness ratio of $16 068 per quality-adjusted life-year gained for antidepressants and $17 624 per quality-adjusted life-year gained for CBT vs community referral.

Staley et alArticle studied the regulation of GABA type (GABA-A)–benzodiazepine receptors during month 1 of sobriety from alcohol and the relationship to tobacco smoking and the severity of alcohol withdrawal. Alcohol-dependent nonsmokers (but not smokers) demonstrated higher GABA-A–benzodiazepine receptors during week 1 of sobriety, which correlated with the severity of alcohol withdrawal and the number of days since last drink. These results demonstrate time-dependent regulation of cortical GABA-A–benzodiazepine receptors during recovery from alcohol dependence that is attenuated by tobacco smoking and may contribute to the comorbidity between alcoholism and smoking.

Werner and DawsonArticle validated the parental reports of autistic regression using behavioral data coded from home videotapes of autistic children vs typical development taken at ages 12 and 24 months. At 12 months, infants with regression were indistinguishable from typical infants, whereas infants with early-onset autism displayed autism symptoms. By 24 months, both groups with autism displayed significant symptoms, thereby validating the existence of autistic regression.

Lahey et alArticle used an 8-year longitudinal study of an outpatient sample to determine how stable the DSM-IV subtypes of ADHD are in children first diagnosed at ages 4 to 6 years. Children who initially met criteria for the predominantly hyperactive-impulsive subtype mostly shifted to the combined type over time. As defined in DSM-IV, the distinction between the combined and predominantly inattentive subtypes may be stable enough for research but not for clinical purposes.

Barsky et alArticle examined the relationship between somatization and medical care utilization in primary care settings. One fifth of 1546 patients had a clinically significant degree of somatization, using a self-report measure. After adjusting for concurrent psychiatric and medical comorbidity, somatizing patients had significantly more outpatient visits, emergency visits, and hospitalizations and twice the outpatient and inpatient costs in the preceding year. When extrapolated to the national level, about $256 billion in medical care costs are attributable to somatization.

Teplin et alArticle examined prevalence and incidence of crime victimization among 936 participants in the Northwestern Victimization Project. They examined sex, racial/ethnic, and age differences and compared victimization rates with general population data, controlling for income and demographic differences. More than one quarter of persons with severe mental illnesses had been victims of a violent crime in the past year, more than 11 times the general population. The mental health system must respond to reduce victimization and its consequences.

Van den Heuvel et alArticle investigated the neural correlates and disease specificity of attentional bias across different anxiety disorders, using a functional MRI version of the cognitive and emotional Stroop task. They report a specific neural response in patients with OCD during color naming disease-specific words, involving mainly ventral brain regions. In contrast, generalized emotional inference effects were found in patients with panic disorder and hypochondriasis, involving ventral and widespread dorsal brain regions.