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This Month in Archives of General Psychiatry
June 2011

Archives of General Psychiatry

Arch Gen Psychiatry. 2011;68(6):541. doi:10.1001/archgenpsychiatry.2011.52

The link between contemporary pharmacological models of schizophrenia, which emphasize dopamine dysregulation, and cognitive models focusing on disruption of distributed cortico-cortical information transmission has been highlighted by O’Daly et al Article . They used functional magnetic resonance imaging to demonstrate hyperactivity of the dorsal lateral prefrontal cortex, caudate nucleus, and thalamus following amphetamine sensitization, a well-established animal model of schizophrenia, and allied changes within the superior temporal gyrus and precuneus, similar to that seen in patients with schizophrenia.

A meta-analysis of the association between substance use and the age at onset of psychosis by Large et al Article found that age at onset of psychosis of cannabis users was 2.70 years younger than nonusers, and age at onset was 2.00 years younger for those with more broadly defined substance use. Alcohol use was not associated with earlier onset.

Using positron emission tomography, Erritzoe et al Article found that cerebral serotonin transporter binding was decreased in 14 young adult 3,4-methylenedioxy- N-methamphetamine (MDMA or ecstasy) users when compared with 10 hallucinogen users and 21 nonusing controls, with signs of subcortical recovery after abstinence. Cortical serotonin receptor binding was slightly decreased in the serotonin agonist drug user group (MDMA and hallucinogen users together). A direct presynaptic rather than a serotonin agonistic effect of MDMA is suggested to be the mechanism behind the affected serotonin transporter binding.

Watkins et al Article report on a large-scale trial of a psychosocial treatment for severe depression provided within substance abuse treatment. They assessed the effectiveness of a 16-session group cognitive behavioral therapy for depression delivered by community-based substance abuse counselors to clients in residential substance abuse treatment (N = 299). Intervention clients reported improved depression and substance use outcomes.

Webb et al Article investigated suicide among all Danish people with a criminal justice system history. More than a third of all male suicides had experienced some contact with the system, but relative risk vs the general population was higher for women. Risk was raised even among people with a criminal justice history who had never received a custodial sentence or a guilty verdict. It was especially high with recent or frequent contact and with violent offense charges.

Translational epidemiology in psychiatry can be bidirectional, in which the knowledge generated from the bedside or population can be translated to the laboratory. Weissmann et al Article show that epidemiological studies can generate representative samples and novel designs that can be translated into more tractable experimental approaches.

Foley and Morley Article reviewed cardiometabolic outcomes of the first treated episode of psychosis and identified 2 key findings: (1) there is no difference in cardiovascular risk indexed by weight or metabolic indices between cases and controls before cases are exposed to antipsychotic drugs, and (2) cardiovascular risk increases after first exposure to any antipsychotic drug, with no evidence of significant class differences.

Brown et al Article showed that deficits in function, notably remembering appointments/managing medications and completing taxes/business records, are common in patients with amnestic mild cognitive impairment (aMCI). Mild cognitive impairment criteria should reflect these deficits in function. Functionally impaired individuals with aMCI have greater medial temporal atrophy and deficits in memory and processing speed compared with functionally intact individuals with aMCI.

Bao et al Article examined whether and to what extent collaborative depression care management reduced treatment and outcome disparities by education and ethnicity among older, depressed primary care patients. They found that the intervention had a larger and more lasting effect among less-educated patients, leading to substantially reduced disparities by patient education. However, it failed to mitigate racial/ethnic disparities.

In a large multivariate twin study, Iervolino et al Article demonstrated that obsessive-compulsive disorder is unlikely to be an etiologically homogeneous condition. They found substantial etiological overlap across its major symptom dimensions (eg, contamination/cleaning, symmetry/ordering) but dimension-specific genetic and particularly nonshared environmental factors were at least as important. Hoarding symptoms shared the least amount of genetic liability with the remaining symptom dimensions.

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