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This Month in Archives of General Psychiatry
July 07, 2008

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2008;65(7):743. doi:10.1001/archpsyc.65.7.743

In first-episode schizophrenic patients, Koo et al(page 746) found initially smaller volumes of subgenual, affective, and cognitive components of anterior cingulate, which showed an approximately 6% further volume reduction 1½ years later. In contrast, first-episode affective psychosis patients (mainly bipolar) showed initial and progressive volume reductions only in the subgenual region.

Bertelsen et al (page762) report a single-blinded 5-year follow-up of a randomized controlled 2-year trial of intensive early intervention vs standard treatment for patients with a first episode of psychosis. The experimental treatment improved clinical outcome after 2 years, but the effects were not sustainable up to 5 years after.

Eggan et al (page 772) evaluated the expression levels of cannabinoid 1 receptor (CB1R) messenger RNA and protein in the dorsolateral prefrontal cortex of patients with schizophrenia. They found significant reductions in CB1R messenger RNA and protein expression, which correlated with changes in markers of γ-aminobutyric acid (GABA) neurotransmission. Because CB1R activation suppresses GABA release, reduced CB1R expression may represent a compensatory mechanism to augment GABA transmission from interneurons with impaired GABA synthesis.

Several emerging lines of evidence suggest that the Wnt signaling pathway plays a role in the etiology of bipolar disorder. In this study of candidate genes in the Wnt signaling pathway, Zandi et al(page 785) observed an association between PPARD and susceptibility for bipolar disorder. The findings suggested that the gene interacts with several other Wnt signaling genes and leads to poorer overall functioning in affected patients.

A growing body of evidence suggests that selective serotonin reuptake inhibitors are associated with upper gastrointestinal tract bleeding. The interaction between these drugs and nonsteroidal anti-inflammatory drugs has been of particular concern. de Abajo and García-Rodríguez(page 795) provide evidence supporting such an interaction and data showing that use of acid-suppressing agents may help lower the risk.

Vesga-López et al (page 805) report on psychiatric disorders in pregnant and postpartum women in the United States. Pregnancy per se was not associated with increased risk for mental disorders. However, there was a significantly higher rate of major depressive disorder among postpartum compared with nonpregnant women. Treatment-seeking rates for any psychiatric disorder were significantly lower among women pregnant in the past year compared with nonpregnant women with psychiatric disorders.

Chen et al (page816) studied the association of CNR1 with smoking initiation and nicotine dependence by genotyping 10 single-nucleotide polymorphisms in 2 independent samples. In both samples, several markers were significantly associated with smoking initiation and nicotine dependence. These data suggested that the CNR1 gene may be associated with nicotine dependence, and the associations are likely sex specific.

Schumann et al (page 826) report that a 2-step association analysis of 1337 alcohol-dependent adult patients and 1002 controls and analysis of 144 adolescent trios showed highly significant association for NR2A with alcohol dependence, positive family history, early onset of disease, maximum number of drinks in adults, and risky drinking patterns in adolescents

In a series of translational studies, including receptor binding in postmortem brain tissue, functional magnetic resonance imaging, human laboratory models, and analyses of treatment outcome data, Hutchison et al(page 841) examined the role of CNR1 in the etiology and treatment of alcohol dependence. Results from these individual studies corroborate that individuals with the CNR1 C allele may be more susceptible.

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