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This Month in Archives of General Psychiatry
June 2010

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2010;67(6):552. doi:10.1001/archgenpsychiatry.2010.58

Sen et al conducted a prospective cohort study (n = 740) investigating depression during medical internship. They identified a dramatic increase in depressive symptoms during internship and a series of factors that associated with an increase in depressive symptoms. Further, they found that the low-functioning serotonin transporter promoter allele (5-HTTLPR) was associated with an increase in depressive symptoms under internship stress.

Gold et al examined working memory performance in people with schizophrenia and healthy volunteers using an innovative method that allows for the separate measurement of the number and precision of items maintained in working memory. People with schizophrenia remembered fewer items than healthy volunteers, but their representations were as precise as those of healthy volunteers.

Seidman et al investigated the neuropsychology of the clinical high-risk prodromal syndrome for psychosis. Neuropsychological functioning in the clinical high-risk group was significantly lower in persons who subsequently progressed to psychosis than in those who did not and worst in those who developed psychosis with a positive family history. Processing speed and verbal memory were most affected, although reductions were less severe than in established schizophrenia, suggesting that neurocognition declines further by first-episode psychosis.

Accumulation of advanced glycation end products, including pentosidine, results from “carbonyl stress,” a state featuring an increase in reactive carbonyl compounds and their attendant protein modifications. Arai et al found a cross-sectional link, albeit incomplete, between glyoxalase I defect–elicited carbonyl stress and a subgroup of patients with schizophrenia. Thus, agents such as pyridoxamine able to inhibit advanced glycation end product formation or entrap reactive carbonyl compounds may also prove to be of therapeutic value.

Bromberger et al examined the relationship between reproductive hormones and high depressive symptoms (Center for Epidemiological Studies Depression Scale score ≥16) in a 7-site study of menopause. Multivariable random-effects models showed that across 8 annual assessments, concurrent log-transformed testosterone level and increase in log-transformed testosterone level from baseline were positively associated with higher odds of high depressive symptom levels.

In a retrospective cohort study, Yaffe et al examined the association between posttraumatic stress disorder (PTSD) and the risk of developing dementia among 181 093 US veterans 55 years and older. Veterans with PTSD had a 7-year cumulative incident dementia rate of 10.6% compared with 6.6% in those without PTSD. Compared with those without, patients with PTSD were more than twice as likely to develop incident dementia. Results were similar when we excluded those with a history of head injury, substance abuse, or depression.

In a large anonymous survey of soldiers at 3 and 12 months following combat deployment to Iraq, Thomas et al report prevalence rates of posttraumatic stress disorder and depression ranging from 9% to 31% depending on the level of functional impairment. A high degree of alcohol misuse and aggression was also present. Prevalence rates were generally persistent at postdeployment in the Active Component, yet increased in the National Guard.

In a community-based twin study, Slutske et al found that disordered gambling (a continuum of problems including pathological gambling disorder) is as heritable among women as it is among men and that the susceptibility genes contributing to variation in liability for disordered gambling in women and men are likely to overlap considerably.

Ersche et al describe results of a pharmacological magnetic resonance imaging study investigating attentional bias for drug-related cues, and related brain functional systems, in people with stimulant drug dependence. They show that a strong attentional bias specifically toward drug-related cues is associated with greater prefrontal activation in stimulant-dependent individuals. Moreover, this fronto-attentional marker of drug dependence was differentially modulated by acute dopaminergic drug challenge (amisulpride or pramipexole dihydrochloride) depending on individual differences in compulsivity of stimulant drug use.

Gilmer et al examined changes in recovery outcomes, mental health services and costs, and quality of life associated with full-service partnerships (FSPs), programs that do “whatever it takes” to improve housing and mental health among homeless adults with severe mental illness. Participation in an FSP was associated with substantial increases in outpatient services and days in housing. Reductions in costs of inpatient/emergency and justice system services offset 82% of the cost of the FSP.