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This Month in Archives of General Psychiatry
April 2004

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2004;61(4):333. doi:10.1001/archpsyc.61.4.333

Williams et al Article report a haplotype ofthe gene encoding dystrobrevin binding protein (DTNBP1)associated with increased risk of schizophrenia and 2 haplotypes associatedwith reduced risk in more than 700 control subjects and subjects with schizophreniafrom the United Kingdom. The authors were able to replicate these findingsin independent samples from Ireland. The common protective haplotype was alsoassociated with higher education achievement, suggesting that the effect ofthis haplotype may be mediated by an influence on intelligence.

To determine the magnitudes of the genetic and environmental contributionsto hippocampal volume reduction in schizophrenia, van Erp et al Article appliedmixed-model regression, intraclass correlation, and variance components analysesto hippocampal volumes of twins with schizophrenia and matched healthy controltwins, as measured from high-resolution magnetic resonance imaging results.Hippocampal volumes in the healthy twins appeared to be highly heritable (ie,h2 = 71%), whereas those in twins discordant for schizophreniawere also heritable (ie, h2 = 42%) but were subject to greatermodulation by environmental factors compared with healthy twins.

In a longitudinal study of 50 087 male Swedish conscripts, Zammitet al Article report that low IQ is associated withan increased risk of developing schizophrenia, other nonaffective psychoticdisorders, and severe depression across a 27-year follow-up period. Risk ofschizophrenia was spread across the whole IQ range. However, there was noassociation between IQ and risk of bipolar disorder, indicating possible differencesin some areas of the neurodevelopmental etiology of these disorders.

Grant et al Article found that the co-occurrenceof DSM-IV alcohol and drug use disorders and personalitydisorders was pervasive in the US general population. Associations betweenthese Axis I and Axis II disorders were overwhelmingly positive and significant,and the strength of these associations varied among men and women. The resultshighlight the need for further research on the underlying structures of thesedisorders and the treatment implications of these disorders when comorbid.

Tiemeier et al Article investigated the relationbetween atherosclerosis and depression in a population-based study of 4019elderly individuals. Atherosclerosis was assessed at 5 different locations.More severe extracoronary atherosclerosis was associated with a higher prevalenceof depressive disorders; the prevalence increased by 30% per standard deviationof atherosclerosis measure. Further, they observed a strong relationship betweensevere coronary and aortic calcifications and depressive disorders. The findingsare compatible with the vascular depression hypothesis.

Quality improvement programs for depression in primary care can improvepatient outcomes up to 28 months, but are there long-term benefits for patients?In this issue, Wells et al Article provide new evidencefrom the Partners in Care study that benefits for patients of short-term quality-improvementprograms can last up to 5 years while reducing ethnic disparities in outcomesand improving the equity of care.

The report by Ormel et al Article , based on NEMESISdata, strongly suggests that psychosocial disability after remission froma unipolar major depressive episode largely reflects the continuation of premorbidpsychosocial disability. Disability that developed during the major depressiveepisode did not persist routinely beyond recovery except in a severe recurrentepisode. The analysis also showed that within-subject premorbid-postmorbidcomparisons are sensitive to state effects of prodromal and residual symptoms.

Trauma can precipitate posttraumatic stress disorder (PTSD), which hasbeen linked to changes in the levels of the adrenal stress hormones cortisoland catecholamine. Young and Breslau Article examinethese hormone profiles in persons never exposed to trauma and persons exposedto trauma with and without PTSD in representative groups drawn from an ongoingepidemiological community sample. Posttraumatic stress disorder was associatedwith increased catecholamine excretion levels but normal cortisol excretionlevels. The presence of lifetime comorbid depression resulted in increasedcortisol excretion levels in the PTSD group.

Abram et al Article assessed trauma and posttraumaticstress disorder (PTSD) in a sample of 1829 detained youth. Most detainees(92.5%) reported 1 or more traumatic experiences; 11.2% met criteria for PTSDin the past year. Witnessing violence was the most common precipitating trauma.Trauma and PTSD appear to be more prevalent among juvenile detainees thanin community samples. Timely interventions may avert subsequent and oftenchronic social problems common among youth exposed to trauma.

McRae et al Article examined quality of lifein a double-blind sham-surgery controlled trial designed to determine theeffectiveness of transplantation of human embryonic dopamine neurons intothe brains of persons with advanced Parkinson disease. During the 1-year periodof the trial, there were more differences and changes among perceived treatmentgroups than among the actual surgery groups in ratings by both patients andmedical staff. Results indicate that the placebo effect was very strong inthis study.