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This Month in Archives of General Psychiatry
December 2010

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2010;67(12):1209. doi:10.1001/archgenpsychiatry.2010.156

Raison et al provide evidence that major depressive disorder may be so prevalent in the modern world not just because proinflammatory factors are widespread, but also because we have lost contact with previously available sources of anti-inflammatory, immunoregulatory signaling as a result of disruptions in coevolved relationships with a variety of tolerogenic microorganisms that were previously ubiquitous in soil, food, and the gut but that are largely missing from industrialized societies.

Dutta et al studied the epidemiology of suicide in an incidence cohort of 2723 patients with first-episode psychosis in England, traced after a mean follow-up period of 11.5 years. Although the rate of suicide was highest in the first year after presentation, risk persisted late into follow-up, with median time to suicide being 5.6 years. Suicide occurred approximately 12 times more than expected for the general population.

Romaniuk et al investigated the hypothesis that delusions derive from abnormal associative learning. Using functional magnetic resonance imaging, they show that patients with schizophrenia abnormally activate brain regions involved in associative learning during aversive pavlovian conditioning. The inappropriate activation of motivational brain regions to neutral rather than conditioned stimuli is correlated with the severity of delusional symptoms.

Segal et al studied Mindfulness-Based Cognitive Therapy (MBCT), a preventive psychotherapeutic intervention, in recurrently depressed patients who discontinued taking antidepressant medication after achieving full remission. Sequential treatment with MBCT, following medication discontinuation, provided equal protection from relapse compared with maintenance antidepressant pharmacotherapy. For those patients unwilling or unable to tolerate maintenance antidepressant treatment, MBCT offers equal protection from relapse over 18 months.

Marcus and Olfson report a national increase in outpatient treatment of depression between 1998 and 2007; the number of Americans treated for depression increased from 6.5 to 8.7 million. During this period, the percentage of treated individuals who received antidepressant medications remained essentially unchanged (73.8% to 75.3%) while those who received psychotherapy declined (53.6% to 43.1%).

Rickels et al conducted an 18-month relapse prevention trial in patients with generalized anxiety disorder. Significantly more patients relapsed while taking placebo after 6 months than after 12 months of venlafaxine hydrochloride extended release treatment, supporting the benefits of 12 months of antidepressant treatment for most patients with generalized anxiety disorder. Those patients who had relapsed after 6 months of venlafaxine treatment and restarted venlafaxine treatment experienced identical improvement to those who took venlafaxine continuously for 12 months.

Depression is associated with worsened outcomes among persons living with human immunodeficiency virus (HIV). Tsai et al apply a novel statistical method to cohort data from an understudied subpopulation, homeless and marginally housed persons living with HIV. They found that antidepressant medication treatment resulted in 2-fold greater odds of achieving viral suppression and that the effect was at least partially mediated by improved adherence to HIV care.

In this multisite US prospective cohort study, Zatzick et al examined the associations between the full spectrum of mild, moderate, severe, and no traumatic brain injury (TBI), posttraumatic stress disorder (PTSD) symptom development, and self-reported health status and cognitive function. Patients with severe and moderate TBI, but not mild TBI, demonstrated a significantly diminished risk of PTSD symptoms relative to patients without TBI. Regardless of TBI severity, injured patients with PTSD demonstrated the greatest impairments in health and cognitive function.

Prompted by research documenting neurobiological commonalities between obesity and addiction, Grucza et al investigated the association between family history of alcoholism and obesity during a period of rising obesity in the United States. An association between familial alcoholism risk and obesity has emerged and increased over a 10-year period. Individuals from alcoholic families, particularly women, appear to be differentially susceptible to obesity in the current environment.

Burt et al examined whether the well-known association between marriage and desistence from antisocial behavior stems from either causal or selection processes in a prospective male-male twin sample. Results indicated an initial selection effect whereby men with lower levels of antisocial behavior during adolescence were more likely to marry. The tendency to refrain from antisocial behavior was accentuated by marriage.

Langley et al examined the previously reported association between the high-activity COMT genotype and antisocial behavior in the presence of attention-deficit/hyperactivity disorder. They found that impaired social understanding may act as an intermediate phenotype on this genotype-disorder risk pathway. Conversely impaired executive control, although associated with COMT genotype, may not lie on the risk pathway to antisocial behavior.