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This Month in Archives of General Psychiatry
October 2004

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2004;61(10):970. doi:10.1001/archpsyc.61.10.970

McDonald et al Article assessedthe neuroanatomical phenotypes of schizophrenia and bipolar disorder by analyzingthe association between a measure of genetic risk in multiply affected familiesand variation in regional tissue volume. Gray matter endophenotypes were distinct,with genetic risk for schizophrenia linked to distributed frontotemporal-subcorticaldeficits, and for bipolar disorder, to localized deficit in emotional processingregions. However, white matter endophenotypes were overlapping, implicatingleft frontotemporal anatomical dysconnectivity as a genetic endophenotypefor psychosis in general.

Using data from 6 countries, Messias et al Article found that patients with deficit schizophrenia, whohave primary and enduring negative symptoms, have an excess of summer births.The finding is consistent with the hypothesis that deficit schizophrenia isa separate disease within the syndrome of schizophrenia.

The report by Ormel et al Article ,based on a large longitudinal population-based study, strongly suggests thatpersonality-related vulnerability after remission from a unipolar major depressiveepisode (MDE) reflects the continuation of premorbid vulnerability. Personalitydeviance that developed during the MDE did not persist beyond recovery ofthe MDE. Within-subject, premorbid-postmorbid comparisons appeared sensitiveto state effects of prodromal and residual MDE symptoms. Results support traitand state effect models of the personality depression relationship but notscarring.

Schmidt et al Article examinedthe effects on mood and behavior of acute androgen withdrawal and testosteronetherapy in 31 healthy young men. While uniformly associated with reduced libidoand the development of hot flashes, induced hypogonadism altered mood in onlya small minority of men. Additionally, the behavioral response (improved libido)during testosterone therapy was predicted by baseline levels of libido, sowhile testosterone levels did regulate sexual interest, trait-related characteristicsconstrained the effects on libido. These data demonstrate the profound butcontext-dependent effects of reproductive steroids on behavior in humans.

Davidson et al Article reportthe first large-scale trial to evaluate a selective serotonin reuptake inhibitor(fluoxetine [FLU]), comprehensive cognitive behavioral therapy (CCBT), FLU/CCBT,and placebo (PBO) in generalized social phobia. In this 2-site, 14-week trial,FLU, CCBT, CCBT/FLU, and CCBT/PBO combined were all superior to PBO on theprimary outcomes (Brief Social Phobia and Clinical Global Improvement Scales).Combined treatment was not superior to monotherapy, and FLU produced a fasteronset of action. Residual morbidity persisted, which would suggest that currenttreatments, while helpful, are far from optimal.

Lenzenweger et al Article furtherdissect the findings from the Longitudinal Study of Personality Disordersusing individual growth curve modeling. This approach, which is based on amultilevel/covariance components statistical foundation, allowed these investigatorsto determine that Axis II disorders actually show considerable change acrosstime. These findings raise questions about the putative stability of personalitydisorders as currently defined.

Studying twin pairs discordant for lifetime cannabis dependence andthose discordant for early cannabis use, Lynskey et al Article conclude that comorbidity between cannabis dependenceand major depressive disorder (MDD) likely arises through shared genetic andenvironmental vulnerabilities. In contrast, associations between cannabisdependence and suicidal behaviors cannot be entirely explained by common predisposingfactors. They also conclude that associations between early-onset cannabisuse and subsequent MDD likely reflect shared genetic and environmental vulnerabilities,although it remains possible that early-onset cannabis use may predisposeto suicide attempt.

Warner et al Article studiedwomen drug users recruited from community settings to examine patterns andpredictors of remission from DSM-IV substance usedisorders. The rate of drug dependence declined substantially across 3 years,but most women continued to use drugs. Depressive symptoms significantly impededremission, suggesting that mental health professionals have an important roleto play in community-based outreach and interventions designed to supportwomen’s efforts to stop using drugs.

Approximately 12% of patients with diabetes mellitus meet criteria formajor depression and/or dysthymia. Katon et al Article describe the results of a randomized controlled trialof a collaborative care effectiveness intervention vs usual primary care in329 patients with diabetes and depression. The intervention was associatedwith marked improvements in quality of depression care, satisfaction withcare, and depressive outcomes compared with usual care but no differencesin HbA1c levels across a 1-year period.

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