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This Month in Archives of General Psychiatry
April 2009

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2009;66(4):347. doi:10.1001/archgenpsychiatry.2009.22

Meeks and Jeste (page 355) review neuroimaging and genetic studies relevant to wisdom. Wisdom is viewed as a complex human trait with 6 subcomponents: prosocial behavior, social decision making/pragmatic knowledge of life, emotional regulation, self-reflection, tolerance of diverse values, and effective dealing with uncertainty. A putative model of neurocircuitry involved in wisdom is presented, comprising frontostriatal and frontolimbic circuits and monoaminergic pathways.

Takahashi et al (page 366) used magnetic resonance imaging to examine longitudinal gray matter changes of the superior temporal gyrus in ultra-high-risk individuals, patients with first-episode psychosis, and healthy comparisons. Findings indicate that gray matter reduction over time in the superior temporal gyrus precedes the first expression of florid psychosis, and its extent may reflect the severity of positive symptoms during the early course of psychosis.

Using functional neuroimaging, Barbalat et al (page 377) investigated the organization of temporal modules of cognitive control within the lateral prefrontal cortex (LPFC) in schizophrenia. They found that patients failed to adequately activate caudal LPFC regions during control of immediate contextual information, despite inefficient compensation from rostral LPFC during control of temporal episodic signals.

Freedland et al (page 387) conducted a randomized trial of treatment for depression after coronary artery bypass graft surgery. The participants were randomly assigned to 12 weeks of cognitive behavior therapy, supportive stress management, or usual care. Cognitive behavior therapy was superior to usual care for depression and for most secondary outcomes. Supportive stress management was superior to usual care for depression, but the effects of cognitive behavior therapy were larger and more durable than those of supportive stress management.

Sourander et al (page 398) studied a large cohort of Finnish children born in 1981, examined at age 8 years, and followed up until age 24 years. One percent (n = 54) of males and females had either completed suicide or made a serious suicide attempt requiring hospital admission. Eight percent of males with completed suicide and/or severe suicide attempts during the follow-up had psychiatric problems already at age 8 years, indicating a life-persistent trajectory. However, female severe suicidality was not predicted by psychopathology at age 8 years.

Wendland et al (page 408) describe a haplotypic association of the neuronal glutamate transporter gene SLC1A1 with obsessive-compulsive disorder. They also identified variants correlating with gene expression levels by mining publicly accessible array data and replicated this correlation in postmortem human brain tissue and in reporter gene assays. These functional polymorphisms were part of the associated haplotype and also correlated with the obsessive-compulsive disorder subphenotype of hoarding.

Harpaz-Rotem and Rosenheck (page 417) used geographic surveillance data to track the diffusion of a novel treatment, prazosin, for posttraumatic stress disorder, from the place at which it was developed, the Puget Sound Veterans Affairs Medical Center, to other Veterans Affairs facilities. They found clear evidence of a monotonic geographic trend reflecting diminished use at facilities further away from the point of development that most likely reflects informal interaction networks of service providers.

Corticotropin-releasing hormone (CRH), through activation of the hypothalamic-pituitary-adrenal axis and other brain stress systems, is involved in emotional dysregulation associated with cocaine dependence. Brady et al (page 422) compared the response to CRH in cocaine-dependent men and women and a control group and found no significant between-groups differences in hypothalamic-pituitary-adrenal response to CRH but greater subjective and heart rate response in the cocaine group. These findings suggest sensitization of nonhypothalamic stress-responsive CRH systems in cocaine dependence.

Nicotine consistently enhances cognitive functions but nicotine replacement yields inconsistent results for nicotine addiction treatment. Hong et al (page 431) show that nicotine addiction is associated with resting-state functional circuits interconnecting anterior cingulate and striatum, while nicotine administration enhances multiple cingulate-neocortical connectivity patterns but not the cingulate-striatum connectivity, potentially explaining the clinical dichotomy.

The neural basis of the effects of cannabis on verbal learning and psychotic symptoms was investigated by Bhattacharyya et al (page 442) using functional magnetic resonance imaging in conjunction with experimental administration of Δ9-tetrahydrocannabinol and cannabidiol. Their findings suggest that the effects of cannabis on verbal learning and psychotic symptoms reflect the modulation of medial temporal and ventral striatal function by Δ9-tetrahydrocannabinol.