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This Month in Archives of General Psychiatry
February 2004

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2004;61(2):115. doi:10.1001/archpsyc.61.2.115

Ford et al Article combinedevent-related brain potentials and functional magnetic resonance imaging toassess brain regions involved in inhibition of prepotent responses in patientswith schizophrenia. Healthy control subjects established a strong responsebias that was inhibited by engaging a complex neural system involving thecingulate cortex and prefrontal and inferior parietal lobes. Patients withschizophrenia established a weaker response bias that was inhibited by engagingonly the cingulate cortex.

McGowan et al Article haveassessed presynaptic dopaminergic function in medicated patients with schizophreniawith a high-sensitivity 18F-fluorodopa 3-dimensional positron emissiontomography protocol. Statistical parametric mapping and region of interestanalyses showed increased 18F-fluorodopa uptake, primarily in theventral striatum, in patients with schizophrenia compared with control subjects.The magnitude of the increases was similar to that reported in unmedicatedpatients with schizophrenia, suggesting that presynaptic striatal dopaminergicfunction remains elevated in the illness despite treatment.

There is an association between the duration of untreated first-episodepsychosis and early course of the disorder. It is not clear whether delayedtreatment is a marker of or contributes to poor prognosis. Melle et al Article found that the introductionof an intensive early detection program in a catchment area was followed byboth reductions in the duration of untreated psychosis and better clinicalstatus at the start of the first treatment.

Co-occurring depression is common in intravenous drug users, but theeffect of its treatment has not been adequately studied. Stein et al Article examined the effects of combinedtreatment with citalopram and cognitive behavioral therapy compared with nointervention in intravenous drug users with depression. The remission ratewas 2-fold greater with treatment, and 40% of the treatment-adherent patientsremitted.

In a 2-year historical study, Shores et al Article found that depression was inversely related to testosteronelevels in older men. This study, the first to investigate the longitudinaleffect of hypogonadism on depression, found that men with hypogonadism had4 times the increased risk of incident depression compared with men with eugonadism.A relationship between hypogonadism and depression could have significantpublic health implications because hypogonadism is a common condition in oldermen.

Using positron emission tomography, Shin et al Article examined the functional relationship between theamygdala and medial prefrontal cortex during traumatic imagery in male combatveterans and female nurse veterans with and without posttraumatic stress disorder.In the group with posttraumatic stress disorder, regional cerebral blood flow(rCBF) changes in the medial frontal gyrus were inversely correlated withrCBF changes in the amygdala. Posttraumatic stress disorder symptom severitywas inversely correlated with rCBF in the medial frontal gyrus and positivelycorrelated with rCBF in the amygdala.

Frodl et al Article investigatedthe influence of the serotonin transporter polymorphism (5-HTTLPR) on the hippocampal volume in 40 patients with major depressionand 40 matched healthy control subjects. Patients with the L/L genotype had significantly smaller hippocampal gray and white matterthan control subjects with the L/L genotype and hadsignificantly less hippocampal white matter volumes than patients with the L/S and S/S genotypes. Thus, patientswith the L/L genotype may have a higher vulnerabilityto hippocampal changes that might occur before the beginning of the diseaseor during a depressive episode triggered by a variety of factors (eg, stress).

Cheng et al Article conducteda 4-year longitudinal study in a population-based cohort from 4 aboriginalgroups in Taiwan (N = 499) to investigate genetic and environmental risk factorsfor alcoholism. The highest risk for alcoholism was found among subjects aged25 to 34 years with anxiety disorders and among men with the less active ADH2*1 gene, with the population attributable risk estimatedto be 31.1% and 34.7%, respectively.

The definition of any mental disorder affects how it is recognized,studied, and treated. In a sample of 1179 individuals with eating disorders, Keel et al Article used latent classanalysis to empirically define phenotypes. This analysis yielded 4 groupsthat were associated with distinct clinical correlates. In addition, biologicalrelatives were significantly likely to belong to the same eating disordergroup, supporting the validity of these phenotypes for examining the geneticbases of eating disorders.

Racial disparities in mental health care received by elderly enrolleesin Medicare managed care organizations have not been well studied. Virnig et al Article used observational datafrom individual-level Health Plan Employer Data and Information Set submissionsto compare the quality of mental health care among elderly white, AfricanAmerican, Asian, and Hispanic patients. While the mental health care for elderlypatients in Medicare managed care is far from optimal, minorities receivedpoorer quality care than their white counterparts.