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This Month in Archives of General Psychiatry
June 2, 2008

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2008;65(6):619. doi:10.1001/archpsyc.65.6.619

Kessler et al (page 625) traced, interviewed, and compared the adult outcomes of alumni of a model private foster care program with alumni of 2 public programs who were not selected for the model program because of limited openings. The model program alumni had significantly better mental and physical health outcomes, suggesting that public sector investment in expanded services for children in this vulnerable segment of the population could substantially improve their long-term health.

There is an association between the duration of untreated psychosis and poor outcome for schizophrenia spectrum disorders. The introduction of an intensive early-detection program in a catchment area was followed by reductions in the duration of untreated psychosis and a better clinical status at the start of treatment. In the 2-year follow-up of the sample, Melle et al(page 634) found an effect on the course of negative symptoms, suggesting secondary prevention of the negative psychopathologies.

When a large community sample of youths was assessed 20 years later, Crawford et al(page 641) found that adolescent psychiatric disorders were associated with significantly lower educational and occupational attainment, worse interpersonal functioning, and higher risk for psychopathology in adults. Prognosis was consistently worse for adolescents with Axis I disorders and co-occurring personality disorders.

People meeting diagnostic criteria for anxiety or depressive disorders tend to score high on the personality scale of neuroticism. Wray et al(page 649) undertook a comprehensive genome-wide linkage study of neuroticism, using large study samples from 2 countries that have been measured multiple times over a period of up to 22 years. They identify 3 chromosomal regions likely to harbor causal variants for neuroticism and its related psychiatric disorders.

Bryant et al (page 659) report a clinical trial that compared prolonged exposure therapy, trauma-focused cognitive restructuring, and wait-list controls in 90 patients with acute stress disorder. Patients who received exposure therapy had markedly greater clinical gains at 6 months' follow-up than patients receiving cognitive therapy. More patients receiving exposure therapy achieved full remission (47%) than patients receiving cognitive therapy (13%).

Kendler et al (page 674) examined levels of use of alcohol, caffeine, cannabis, and nicotine in 1796 members of male-male twin pairs. Familial-environmental factors strongly influenced use in early adolescence and gradually declined in importance over time, while genetic factors had little or no influence on psychoactive substance use in early adolescence and gradually increased in their impact with maturation.

Twin studies indicate that the ability to quit smoking is substantially heritable. Uhl et al(page 683) performed genome-wide association scans for successful smoking cessation in 3 independent clinical samples. The “smoking quit success” genes identified in this study delineate pathways that range from cell adhesion to cell signaling and receptor function and support complex polygenic influences on this phenotype.

Cannabis is the most widely used illicit drug in the developed world. Yücel et al(page 694) describe a human imaging study that demonstrates marked dose-related hippocampal and amygdalar volume reductions in long-term (> 10 years of regular use) and heavy cannabis users. The findings challenge the notion that cannabis has no long-term neurobiological and mental health sequelae.

Crum et al (page 702) examined the association of early depressed mood with subsequent maladaptive drinking during adolescence and young adulthood among individuals initially assessed in childhood. Among those youth who had begun to use alcohol, those who had early evidence for depressed mood were more likely to report alcohol intoxication and drinking problems during adolescence and to develop alcohol dependence in young adulthood relative to those who had no evidence for early depressed mood.

Agrawal et al (page 713) demonstrate linkage (logarithm of the odds, 3.4) on chromosome 1p to DSM-IV cannabis abuse and dependence criteria score. Evidence for linkage on chromosomes 3, 4 (near the y-aminobutyric acid type A cluster), 6 (near CNRI), and 17 is also noted for the factor score and for DSM-IV cannabis dependence.