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This Month in Archives of General Psychiatry
January 03, 2011

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2011;68(1):7. doi:10.1001/archgenpsychiatry.2010.182

A bidirectional relationship between psychiatric disorders and pain is evident from epidemiological, clinical, and neuroscientific standpoints. For that reason, Elman et al Article propose including basic tenets of pain medicine within the psychiatric residency training curriculum. They summarize the existing evidence to suggest that, in addition to the improvement in the standard of clinical care, such training enrichment will have far-reaching implications with regard to integrating psychiatry into mainstream medical care.

Arion and Lewis Article found elevated expression of the messenger RNA for 2 kinases (OXSR1 and WNK3) in the prefrontal cortex of subjects with schizophrenia. These kinases regulate the activity of the chloride transporters NKCC1 and KCC2, suggesting that intraneuronal chloride levels are altered in the illness. Because γ-aminobutyric acid (GABA) signaling depends on the flow of chloride ions through GABAA receptors, the nature of inhibitory neurotransmission may be altered in the illness.

Alexopoulos et al Article observed that 12 weekly sessions of problem-solving therapy were more effective than supportive therapy in reducing disability in older patients with major depression and executive dysfunction. The therapeutic advantage of problem-solving therapy over supportive therapy was retained for 12 weeks after the end of treatment. Problem-solving therapy may be a treatment alternative in an older patient population likely to be resistant to pharmacotherapy.

Pan et al Article evaluated the individual and joint associations of depression and diabetes mellitus on all-cause and cardiovascular disease mortality in more than 78 000 women aged 54 to 79 years from the Nurses' Health Study with 6 years of follow-up. They found that diabetes and depression were both significant risk factors for all-cause and cardiovascular disease mortality, and the coexistence of both conditions was associated with a substantially elevated risk.

Cognitive impairments are a core feature of depression in older adults. Reynolds et al Article conducted a double-blind, randomized, placebo-controlled study of the efficacy and safety of donepezil in combination with maintenance antidepressant pharmacotherapy. Donepezil was associated with improvement in global cognition and with reduced conversion to dementia over 2 years in subjects with mild cognitive impairment at the start of maintenance treatment, but also with increased depression recurrence. Donepezil had no benefit in those with normal cognition at the start of maintenance treatment.

Lieverse et al Article examined the effects of bright light therapy (BLT) in elderly patients with (nonseasonal) major depressive disorder in a double-blind, placebo-controlled randomized clinical trial. In elderly patients with major depressive disorder, BLT improved mood, enhanced sleep efficiency, and increased the upslope melatonin gradient. Improvement in mood continued, as well as attenuation of cortisol hyperexcretion, after BLT discontinuation.

Grob et al Article conducted a pilot investigation into the safety and feasibility of a psilocybin treatment model for anxiety in patients with advanced cancer. A double-blind, within-subject, placebo-controlled research design was used with a moderate dose of psilocybin. Acceptable safety standards for both physiological and psychological parameters were established. Data analysis demonstrated a positive trend toward improved mood and anxiety.

In a longitudinal cohort study of National Guard soldiers (n = 953) assessed in theater and 1 year following return from combat deployment to Iraq, Polusny et al Article reported a 2-fold increase in soldiers' self-reports of concussion/mild traumatic brain injury sustained during deployment. After adjusting for posttraumatic stress disorder symptoms, they found that concussion/mild traumatic brain injury history was not associated with postconcussive symptoms or psychosocial outcomes 1 year after soldiers returned from Iraq.

Kessler et al Article used community epidemiological data from 14 countries in the World Health Organization World Mental Health Surveys to study time-lagged associations among lifetime DSM-IV anxiety, mood, behavior, and substance disorders. They found consistent evidence across countries that latent internalizing (anxiety and mood disorders) and externalizing (behavior and substance disorders) factors explain most of the time-lagged associations between temporally primary and temporally secondary disorders, suggesting that common causal pathways account for most comorbidity among these disorders.

Using eye tracking, Pierce et al Article found that toddlers with autism spent significantly more time visually examining dynamic geometric images than social images, a pattern not found in toddlers with typical development or developmental delay. If a toddler spent more than 69% of his or her time fixating on geometric images, then the positive predictive value for accurately classifying that toddler as having an autism spectrum disorder was 100%.

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