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This Month in Archives of General Psychiatry
October 2005

This Month in Archives of General Psychiatry

Author Affiliations

Copyright 2005 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2005

Arch Gen Psychiatry. 2005;62(10):1069. doi:10.1001/archpsyc.62.10.1069

Cannon et alArticle examined functional activations of the brain regions during working memory processing in patients with schizophrenia and healthy control subjects. When task demands required explicit manipulation of information held in memory or maintenance of 5 or more locations, healthy subjects recruited right dorsolateral prefrontal cortex to a significantly greater extent than patients with schizophrenia. The differences persisted when comparing conditions in which the 2 groups were equivalent in behavioral accuracy.

Traditionally, the search for genes involved in psychoses has proceeded with separate studies of schizophrenia and bipolar disorder. Hamshere et alArticle have undertaken a search for loci that confer risk to an intermediate form of psychosis using a genome-wide linkage scan in families including at least 1 member with DSM-IV schizoaffective disorder, bipolar type. Their findings strongly support the existence of loci that influence susceptibility across the psychosis spectrum.

The prevalence of depressive symptoms co-occurring with hypomanic symptoms has not been quantified. Suppes et alArticle prospectively studied a large cohort of patients with bipolar disorder. The majority of visits met a priori criteria for mixed hypomania. Patients with bipolar I disorder were more likely than those with bipolar II disorder to experience hypomania. Both men and women were significantly likely to experience mixed symptoms when hypomanic, and this was significantly more likely in women. When overlapping items of the mania and depression scales were eliminated, the significant effect persisted only for women.

In a national sample of 43 093 adults surveyed in 2002, Hasin et alArticle studied the epidemiology of major depressive disorder (MDD). A changed age distribution was found, with higher lifetime rates in the baby boom birth cohorts than in the youngest respondents. Ethnic group differences included a high risk for MDD in Native American individuals and a lower risk of MDD in Hispanic and Asian individuals, notwithstanding treatment disparities. Major depressive disorder was strongly related to substance dependence but not substance abuse. New information on MDD and personality disorders is presented.

Zhou et alArticle linked the tryptophan hydroxylase 2 (TPH2) gene to major depression and suicide attempts in several populations. TPH2 is principally encompassed by 1 large haplotype block within which a common haplotype is associated with vulnerability. This same haplotype is also moderately predictive of low levels of cerebrospinal fluid 5-hydroxyindoleacetic acid, an intermediate phenotype for suicide and depression.

Mental disorders occur in an overwhelming majority of self-injurious youth. Yet Olfson et alArticle report that mental disorders are diagnosed in only 56% of emergency department visits by self-injurious young people, aged 7 to 24 years. A minority of these emergency visits include a mental status examination. This suggests substantial underrecognition of mental illness and an urgent need to strengthen emergency department mental health assessments of young people who deliberately harm themselves.

Bekker et alArticle presented the stop signal task to 24 adults with attention-deficit/hyperactivity disorder combined subtype and 24 matched controls. In patients, stop signal reaction times were elongated, whereas go stimulus reaction times were unaffected. Overlap-free event-related potentials indicated smaller stop P3s. Larger N1 amplitudes for successful vs failed stops were found in controls but not in patients. This suggests that disturbed attentional processing of the stop signal contributes to impaired stopping in adults with attention-deficit/hyperactivity disorder.

Kollins et alArticle assessed the relationship between retrospectively reported attention-deficit/hyperactivity disorder (ADHD) symptoms and smoking outcomes in a sample of 15 197 young adults who were part of the Add Health national survey. Analyses showed that ADHD symptoms, even at levels below clinical threshold, were positively and linearly related to risk of lifetime smoking and the amount of current smoking. The ADHD symptoms were negatively and linearly related to the age at onset of regular smoking.

Petry et alArticle describe outcomes from a multicenter Clinical Trials Network study of stimulant abusers. Participants received standard care in community clinics, and half were randomized to a relatively low-cost incentive condition in which they also received the opportunity to win prizes for maintaining abstinence. Participants in the incentive condition remained in treatment longer and attained greater abstinence than those receiving standard care alone. Provision of contingent, tangible incentives improved outcomes of substance abusers.

Marsch et alArticle evaluated the relative efficacy of the partial opioid agonist buprenorphine hydrochloride and the centrally active α2-adrenergic blocker clonidine hydrochloride in the detoxification of opioid-dependent adolescents when provided with behavioral treatment. A volunteer sample of 36 adolescents who met criteria for opioid dependence (ages 13-18 eligible) were randomly assigned to a 28-day, outpatient, medication-assisted withdrawal treatment with either buprenorphine or clonidine. Buprenorphine produced markedly greater treatment retention, opiate abstinence, and positive medication effects.