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This Month in Archives of General Psychiatry
August 4, 2008

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2008;65(8):867. doi:10.1001/archpsyc.65.8.867

As part of the STAR*D study, Rush et al evaluated a range of demographic and clinical features by which to select among 3 second-step antidepressant medications (sustained-release bupropion hydrochloride, sertraline hydrochloride, and extended-release venlafaxine hydrochloride) following an unsatisfactory outcome with citalopram hydrobromide. Few clinically useful indicators were found, but some features were uniformly associated with poorer outcomes for all 3 medications (eg, anxious symptom features).

Perlis et al report that a CREB1-linked single-nucleotide polymorphism (rs4675690), previously associated with anger expression and treatment-emergent suicidality, is further associated with functional magnetic resonance imaging activation in an extended neural network during the visual processing of angry and other facial expressions. These results suggest that specific genetic variants influence emotion processing and microeconomic judgment.

De Moor et al used longitudinal data (1991-2002) from 5952 twins and 2606 of their relatives to examine causality in the association between voluntary leisure-time exercise behavior and symptoms of anxiety and depression. Contrary to the expectation, no evidence was found for a causal effect of exercise in this population-based sample. Instead, this well-known association appeared to be largely due to genetic factors influencing both exercise behavior and symptoms of anxiety and depression.

Irie et al examined the independent and combined effects of depression and apolipoprotein E ε4 on the risk of dementia and its subtypes in 1932 cognitively healthy Japanese American men aged 71 to 90 years with 6 years' follow-up. Individuals with both depressive symptoms and the apolipoprotein E ε4 allele had a markedly increased risk for dementia.

Rück et al studied the outcome of 25 patients who underwent capsulotomy, a neurosurgical intervention used in severe and treatment-refractory cases of obsessive-compulsive disorder. They found significant reductions in obsessive-compulsive disorder symptom ratings at long-term follow-up but also a higher than expected rate of adverse effects such as apathy, disinhibition, and weight gain.

Liu et al examined specific polysomnography sleep stages in relation to overweight in 335 children and adolescents. While 1 hour less of total sleep was associated with approximately 2-fold increased odds of being overweight, 1 hour less of rapid eye movement sleep was associated with about 3-fold increased odds.

Barr et al report that rhesus macaques with a functional CRH haplotype are exploratory and bold and consume alcohol under conditions used to examine risky alcohol drinking. Cladistic clustering of haplotypes determined that alternative haplotypes are present and differ in corticosteroid sensitivity in both humans and rhesus macaques. The data suggest that CRH variation may influence risk for externalizing disorders in human subjects.

Jones et al report that children with autism, by the age of 2 years, already show altered patterns of looking at people's faces. Toddlers with autism displayed reduced visual attention to the eyes and increased attention to mouths. In addition, the less a child with autism looked at the eyes, the greater was his or her level of social disability.

Kulkarni et al compared the efficacy of adjunctive transdermal estradiol with adjunctive placebo in the treatment of acute psychotic symptoms in 102 women with schizophrenia. The key finding was that the addition of 100 μg of transdermal estradiol significantly reduced positive and general psychopathological symptoms over the 28-day trial period as compared with women receiving antipsychotic medication alone.

Mojtabai and Olfson report that between 1996-1997 and 2004-2005, the proportion of visits to office-based psychiatrists in the United States that included psychotherapy declined from 44.4% to 28.9%. This decline was mostly due to a decrease in the number of psychotherapeutically oriented psychiatrists who provide psychotherapy to all of their patients and a corresponding increase in pharmacologically oriented psychiatrists who provide psychotherapy to none of their patients.

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