Busch et al Article examinedthe effect of a managed behavioral health care carve-out on outpatient carequality for Medicaid enrollees with schizophrenia. Substantial reductionsoccurred in treatments for which the carve-out was a financial risk, but notthose for which it was not. Such results highlight that when caring for vulnerablepopulations, high-powered cost-containment incentives will likely yield substantialsavings but can also result in important reductions in quality, particularlyif quality performance standards are not implemented.
Using proton echo planar spectroscopic imaging (PEPSI), Dager et al Article examined gray and white matterchemical composition in medication-free patients with bipolar disorder. Elevatedgray matter lactate and glutamate + glutamine + γ-aminobutyric acidwere found in the bipolar patients as compared with healthy controls. Thesefindings suggest a shift in energy redox-state from oxidative phosphorylationtoward glycolysis that may reflect mitochondrial alterations in bipolar disorder.
Geller et al Article addressedthe contentiousness of diagnosing child mania by conducting a prospectivefollow-up of a prepubertal and early adolescent bipolar disorder phenotype.During the 4-year study, subjects' baseline mania persisted for 79.2 consecutiveweeks. Any bipolar diagnoses occurred in 67.1% and mania/hypomania in 56.9%of total study weeks. These data validate the existence of child mania andsupport a more severe, more manic/hypomanic course with longer episode durationsin children than adults.
Korszun et al Article usedan exploratory factor analysis to derive symptom dimensions in a large groupof depressed subjects, including 475 sib-pairs. The factor model was confirmedin an independent sample. Four interpretable factors were identified: factor1, mood symptoms and psychomotor retardation; factor 2, anxiety; factor 3,psychomotor agitation, guilt, and suicidality; factor 4, appetite gain andhypersomnia. Factors 1, 2, and 3 showed significant positive familial correlation,suggesting substantial familial, perhaps genetic, etiologies.
Antidepressant use is increasing in youth. Richardsonet al Article examined duration of treatmentand the number of follow-up visits that depressed youth receive followingreceipt of a new antidepressant prescription. Twenty-nine percent of youthhad no evidence of any further provider visits, while only 28% had at least3 visits in the 3 months following prescription. More than half of the treatedyouth discontinued treatment with antidepressant medications within 3 months.
In a community-based study of a large and ethnically diverse sampleof young adults, Turner and Lloyd Article foundlifetime exposure to major and potentially traumatic events to be associatedwith increased risk for the subsequent onset of depressive and/or anxietydisorder. The findings suggest that the relationship between cumulative adversityand depressive/anxiety disorder is unlikely to arise from their joint associationwith prior disorders and are contrary to the competing hypothesis that theassociation may reflect the effects of state dependence.
Scourfield et al Article combinesratings of conduct problems from parents, teachers, and adolescents in a communitysample of twins. While ratings from each informant show significant heritability,combining all 3 ratings to examine conduct problems that are pervasive acrosssettings reveals an underlying phenotype wholly genetic in origin. This addsto existing evidence from young children that pervasive conduct problems arehighly heritable.
Each year in the United States 2.5 million Americans incur injuriesso severe that they require inpatient hospital admissions. Zatzick et al Article found that a multifacetedcollaborative care intervention for acutely injured trauma survivors effectivelyreduces alcohol abuse and prevents the development of posttraumatic stressdisorder (PTSD) compared with usual care. These results suggest that earlyinterventions for injured survivors of individual and mass trauma can be feasiblyand effectively delivered to representative samples of patients in the acutecare medical setting.
Breslau et al Article reportthat PTSD in a large community sample was not associated with clinically relevantsleep disturbances measured by polysomnography (2 nights) and the MultipleSleep Latency Test. "First night" effects were observed in the sample as awhole, with no evidence of specificity to PTSD. Persons with PTSD had higherrates of brief arousals from rapid eye movement sleep than persons exposedto trauma who did not develop PTSD.
What proportion of people will develop Alzheimer disease by age 100? Khachaturian et al Article analyzedthe occurrence of dementia among 3308 seniors in Cache County, Utah. Theyestimated that 72% of individuals will develop Alzheimer disease by age 100,but their results suggested important differences between these and a lessvulnerable 28%. People with the APOE ϵ4 genedeveloped AD at earlier ages, but APOE did not influence the proportion destinedeventually to develop AD.
This Month in Archives of General Psychiatry. Arch Gen Psychiatry. 2004;61(5):437. doi:10.1001/archpsyc.61.5.437