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This Month in Archives of General Psychiatry
October 6, 2008

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2008;65(10):1115. doi:10.1001/archpsyc.65.10.1115

Geller et al found that 44.4% of grown-up subjects with child bipolar I disorder continued to have manic episodes, and 35.2% had substance use disorders, strongly supporting the continuity of child and adult bipolar I disorders. In addition, characteristics of postbaseline episodes, including long episode duration, daily cycling, and psychosis, were largely similar to those of the first (baseline) episode. Even accounting for familial psychopathology, low maternal warmth significantly predicted earlier relapse after recovery.

Insel et al hypothesized that maternal iron deficiency in pregnancy is a risk factor for schizophrenia spectrum disorder in offspring. Intrauterine exposure to a maternal hemoglobin concentration of 10.0 g/dL or less, assessed prospectively in a large birth cohort, was associated with a nearly 4-fold, statistically significant increased rate for schizophrenia spectrum disorder in offspring compared with exposure to a maternal hemoglobin concentration of 12.0 g/dL or higher.

Lencer et al studied pursuit eye movements in antipsychotic-naive patients with schizophrenia before and after treatment with second-generation antipsychotic medication. Treatment initiation impaired sensorimotor components of pursuit control, which may be explained by serotonergic antagonism of brainstem sensorimotor systems. Predictive processes supported by frontostriatal systems were not affected by treatment and appear able to compensate for treatment-emergent sensorimotor impairments.

Frodl et al examined in a prospective, longitudinal, 3-year study changes in the brains of 38 patients with major depression and 30 healthy controls using high-resolution magnetic resonance imaging. Nonremitted patients showed alterations during the 3-year period. Findings indicate that during depressive episodes gray matter density diminishes in limbic and frontal cortical brain regions, indicating neuroplastic changes due to the effect of depression.

Rapid-onset antianxiety drugs act at benzodiazepine receptors. Hasler et al examined these receptors in unmedicated subjects with panic disorder and healthy controls using positron emission tomography. They found that the binding to benzodiazepine receptors was markedly decreased in the prefrontal cortex and increased in parts of the temporal lobe in subjects with panic disorder.

While prior research has implicated amygdala and prefrontal cortex dysfunction in generalized social phobia, the nature of the dysfunction remains unclear. Using functional magnetic resonance imaging, Blair et al show that generalized social phobia involves increased amygdala and medial prefrontal cortex responding specifically to self-referential criticism but not to negative comments about others or neutral or positive comments about themselves or others.

Barker et al investigated whether patterns of peer victimization can be identified during preschool and assessed the continuity of these patterns after school entry. Chronic and increasing trajectories of victimization were revealed during preschool. Children following these trajectories were more likely to be victimized after school entry. High levels of child physical aggression, harsh parenting, and low family socioeconomic status predicted these developmental patterns of preschool victimization.

Geda et al report a population-based prevalence of neuropsychiatric symptoms for 319 subjects with mild cognitive impairment and 1590 subjects with normal cognition. The participants were randomly sampled from the target population of 9965 elderly persons residing in Olmsted County, Minnesota. Nonpsychotic symptoms affected approximately 50% of subjects with mild cognitive impairment and 25% of subjects with normal cognition.

Silove et al used indigenous terms to identify psychotic disorders in a postconflict developing country, Timor Leste. The prevalence of psychosis was substantial, whereas rates of posttraumatic stress disorder and depression were relatively low. All mental disorders, but particularly psychosis, were associated with disability. The method proved effective in mapping the range of clinically relevant mental disorders in a low-income, postconflict country, demonstrating the high level of unmet need.

Zarkin et al performed a prospective cost and cost-effectiveness study of COMBINE, a randomized controlled clinical trial of treatments for alcohol dependence, which enrolled 1383 patients at 11 clinical sites. The cost-effectiveness estimates yielded 3 options. The choice of preferred intervention depends on the decision maker weighing incremental increases in effectiveness against the corresponding increases in cost.