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This Month in Archives of General Psychiatry
December 2006

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2006;63(12):1306. doi:10.1001/archpsyc.63.12.1306

Del Cul et alArticle found an identical subliminal processing of masked numbers between patients with schizophrenia and normal controls and suggest, therefore, that the masking deficit in schizophrenia may correspond to an impairment of the late stages of conscious perception.

Swerdlow et alArticle assessed the relationship between reduced prepulse inhibition and demographic, clinical, neurocognitive, and functional status in 103 patients with schizophrenia. Prepulse inhibition was impaired in patients but was highest in male patients, smokers, and patients treated with atypical antipsychotics. Patients with the lowest prepulse inhibition levels were most impaired on functional measures.

Kellner et alArticle conducted a 6-month, multicenter, randomized clinical trial (n = 201) to compare continuation electroconvulsive therapy with the pharmacotherapy combination of lithium carbonate plus nortriptyline hydrochloride for the prevention of depressive relapse in patients with unipolar depression who had remitted with a course of electroconvulsive therapy. Both strategies were effective in preventing relapse when compared with historical placebo controls, but still more than half of the patient sample either relapsed or dropped out.

Wang et alArticle estimated the costs and benefits of enhanced depression care for workers. From society's perspective, screening and depression care management result in a cost-effectiveness ratio within the range for interventions usually covered by employer-sponsored insurance. From the employer perspective, enhanced depression care yields a net benefit after 5 years.

Tiihonen et alArticle estimated the risk of suicide, attempted suicide, and overall mortality during antidepressant treatments in a real-life setting in a nationwide cohort of suicidal subjects (N = 15 390; average follow-up, 3.4 years). Among subjects who had ever used any antidepressant, the current use of medication was associated with an increased risk of attempted suicide but also with a decreased risk of completed suicide and mortality when compared with no current use of medication.

Progress in genetic and other biological studies of bipolar disorder would be aided by less heterogeneous phenotypes, but it remains unclear whether clinical features are useful and which are most important. Studying a large family sample of bipolar disorder, Schulze et alArticle found comorbid substance abuse and alcoholism, history of suicide attempts, and psychosis to be strongly familial. Unexpectedly, overall social functioning is the most familial feature in this sample, suggesting that it should be considered alongside more traditional phenotypic features toward the definition of homogeneous subtypes of bipolar disorder.

Wade et alArticle examined a community twin, female sample with respect to the number of mutually exclusive weight and eating profiles. There was a 5-profile solution with women who were (1) of normal weight with few lifetime eating disorders; (2) overweight (10.6% had a lifetime eating disorder); (3) underweight and generally had no eating disorders; (4) of low to normal weight (89.0% had a lifetime eating disorder); and (5) obese (37% had a lifetime eating disorder).

Using positron emission tomography and raclopride labeled with carbon 11, Boileau et alArticle report that the repeated administration of low-dose amphetamine in healthy humans progressively increased dopamine release on repeat exposure, an effect that persists at least for 1 year. In vulnerable individuals, this phenomenon, believed to reflect neurochemical sensitization, may increase susceptibility to drug abuse or drug-induced psychosis.

Drabant et alArticle report converging in vivo neuroimaging and psychometric evidence that a functional polymorphism in the human catechol O-methyltransferase (COMT) gene biases the reactivity and functional coupling of corticolimbic circuitry involved in affective arousal and emotional regulation. These data provide a unique insight into functional trade-offs of a genetic variation in the dopamine system that impacts multiple aspects of brain information processing, potentially resulting in affective inflexibility and dysregulation.

In 3 male samples (2 child and 1 adult), DeYoung et alArticle found that the strong negative correlation between externalizing behavior (aggression, impulsivity, hyperactivity, and antisocial behavior) and IQ was completely attenuated in individuals carrying the 7-repeat allele of the dopamine D4 receptor gene. This finding implicates the D4 receptor in the cognitive impairments associated with externalizing behavior.

Nacewicz et alArticle used behavioral measures from laboratory assessments of face processing to examine differences in amygdala volume in adolescents and adults with autism. Small volume consistently signified more impairment on laboratory measures and on retrospective clinical measures of childhood social impairment. An interaction between age and severity of social impairment emerged that could explain most findings on amygdala volume in autism.