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This Month in Archives of General Psychiatry
May 2006

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2006;63(5):480. doi:10.1001/archpsyc.63.5.480

Clinical researchers often propose, or review committees demand, pilot studies to determine whether a study is worth doing and to guide power calculations. However, the most likely outcomes are (1) studies worth doing are aborted and (2) studies that are not aborted are underpowered. Kraemer et alArticle argue that there are many excellent reasons for doing pilot studies but guiding considerations of power is not one of them.

Swanson et alArticle examined interpersonal violent behavior among 1410 patients with schizophrenia living in the community. The 6-month prevalence of any violence was 19.1%; however, only 3.6% of participants engaged in serious violent behavior involving weapons or causing injury. Distinct but overlapping risk profiles were associated with minor and serious violence. Positive and Negative Syndrome Scale positive symptoms increased risk of minor and serious violence, while Positive and Negative Syndrome Scale negative symptoms lowered risk of serious violence.

Simon et alArticle evaluated the long-term effectiveness of a structured care program for bipolar disorder in a managed care population. The program included telephone outreach and care management as well as a structured psychoeducational group program. Compared with usual care, the program significantly reduced frequency and severity of manic episodes but had no significant effect on frequency or severity of depression. Added cost was approximately $1300 for a gain of approximately 5 additional weeks free of manic symptoms.

van der Werf et alArticle analyzed time-to-event data on recovery from major depression in terms of a sequential-phase model. The data on reversible depressions are shown to be consistent with intermittent stochastic mood shifts in combination with exponential relaxation to normal. Applied to individuals, this random-mood model reproduces features of time sequences, earlier associated with chaos theory.

In a randomized, double-blind, placebo-controlled maintenance treatment trial for major depression in patients with comorbid diabetes mellitus, Lustman et alArticle found that sertraline provided significantly greater prophylaxis against depression recurrence than did placebo. The depression-free interval of maintenance was associated with improvements in glycemic control independent of treatment.

In a meta-analysis of studies relating a personal history of depression to the risk of developing Alzheimer disease later in life, Ownby et alArticle show that existing studies consistently support the idea that depression confers an increased risk for Alzheimer disease later in life. A highlight of this article is its use of meta-regression to relate time between diagnoses of depression and Alzheimer disease to evaluate whether depression is a prodrome or a risk factor for the disease.

Shaw et alArticle compared the pattern of cortical growth in children with ADHD with healthy controls, using data from a longitudinal neuroanatomic imaging study. Children with ADHD, particularly those who had a poorer clinical outcome, had a thinner cortex in the prefrontal regions important in the control of attention. Better clinical outcome was associated with a normalization of the thickness of the right parietal cortex, which may represent compensatory change in posterior attentional systems.

Whitaker et alArticle examined the cumulative effect of maternal conditions in 3 categories—mental health, substance use, and domestic violence—on the risk of children's behavior problems. In 2756 preschool children in 18 US cities, they found that the risk of child behavior problems in 3 domains— aggression, anxious/depressed, and inattention/hyperactivity—increased in a graded fashion with the number of categories in which the mother reported a condition.

Studying a longitudinal sample of boys from low-socioeconomic neighborhoods of Montreal, Quebec, Lacourse et alArticle asked whether kindergarten behaviors in the context of family adversity could predict early involvement with deviant peers during adolescence. Kindergarten boys were at highest risk of getting involved early with deviant peers if they were hyperactive, fearless, and low on prosocial behaviors. Family adversity substantially increased this risk.

Gurvits et alArticle examined 45 neurological soft signs in Vietnam combat veterans and their combat-unexposed, identical co-twins. The unexposed co-twins of the combat veterans with posttraumatic stress disorder (PTSD) had significantly higher neurological soft sign scores than the unexposed co-twins of the veterans without PTSD. This result supports the conclusion that subtle neurological dysfunction represents an antecedent familial vulnerability factor for developing chronic PTSD on exposure to a traumatic event.

Johnson et alArticle conducted a community-based longitudinal study that investigated the association of parental child-rearing behavior with risk for offspring personality disorder. Ten types of parenting behavior, evident during the child-rearing years, were associated with elevated risk for offspring personality disorder at mean ages 22 and 33 years when childhood behavioral and emotional problems and parental psychiatric disorder were controlled. These findings suggest that parental child-rearing behavior may be associated with risk for offspring personality disorder that endures into adulthood.

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