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This Month in Archives of General Psychiatry
July 2009

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2009;66(7):690. doi:10.1001/archgenpsychiatry.2009.76

Ritterband et alArticle examined the efficacy of a structured behavioral Internet intervention for adults with insomnia. They found that primary sleep variables, including insomnia severity, wake after sleep onset, and sleep efficiency, all significantly improved for those receiving the Web-based program compared with a wait-list control group, which did not change across time.

Koutsouleris et alArticle demonstrate that magnetic resonance imaging–based multivariate pattern recognition facilitates the identification of subjects in different at-risk mental states of psychosis and the prediction of disease transition. The discriminative neuroanatomical patterns extracted using support vector machines generalized well beyond the training population in that they achieved a high diagnostic accuracy in unknown subjects.

Laursen et alArticle report that individuals with severe mental disorders experience a 3-fold excess mortality rate from heart disease compared with the nonpsychiatric part of the population. Nevertheless, they only have similar rates of somatic hospital contacts for heart disease and only half the probability of undergoing invasive cardiac procedures. These findings suggest that treatment for heart disease among the severely mentally ill is not sufficient.

Inkster et alArticle examined associations between glycogen synthase kinase-3β (GSK3β) polymorphisms and gray matter volume in patients with recurrent major depressive disorder (MDD) and in healthy controls. A significant association was found between a putative functional polymorphism and gray matter volume in the right hippocampus and the superior temporal gyrus in patients with MDD. These observations suggest that GSK3β, a proposed therapeutic target in bipolar disorder, also plays a role in MDD.

In a multisite, masked, randomized trial, Sackeim et alArticle examined the impact of concurrent pharmacotherapy and electrode placement on outcomes following electroconvulsive therapy. Patients treated with nortriptyline or venlafaxine had superior antidepressant effects compared with patients randomized to placebo. Post–electroconvulsive therapy, cognitive adverse effects appeared reduced in patients treated with nortriptyline but worsened in patients treated with venlafaxine.

Milne et alArticle assessed associations between family history and clinical indexes of disorder in relation to 4 psychiatric disorders: major depressive episode, anxiety disorder, alcohol dependence, and drug dependence. Family history was associated with a more recurrent course, worse impairment, and greater service use for all 4 disorders. However, there was no association between family history and age at onset for any disorder.

Van Snellenberg and de CandiaArticle used a novel meta-analytic technique to demonstrate familial coaggregation of schizophrenia and bipolar disorder. Their results indicate that the first-degree relatives of patients with schizophrenia have approximately double the risk for the other disorder as that observed in the relatives of healthy individuals.

Grant et alArticle report a 12-week, double-blind, randomized, placebo-controlled trial examining the efficacy of N-acetylcysteine, an amino acid that modulates glutamate within the nucleus accumbens, in the treatment of trichotillomania. N-acetylcysteine significantly reduced the symptoms of trichotillomania compared with placebo. These findings suggest that pharmacological modulation of the glutamate system may prove useful in controlling the symptoms of trichotillomania.

Copeland et alArticle tested prediction patterns from childhood and adolescent psychiatric disorders to young adult disorders in a representative longitudinal study. After accounting for comorbidities and disaggregating similar disorders, prediction patterns were developmentally and diagnostically nuanced. There was no support for the putative link between adolescent and young adult depression and oppositional defiant disorder was singular in being part of the developmental history of a wide range of young adult disorders.

Treutlein et alArticle conducted a genome-wide association study and follow-up study of alcohol dependence using individual genotyping. They used a homogenous sample of male inpatients with an early age at onset. Markers for the follow-up study were selected using lowest P value and convergent animal approaches. Fifteen single-nucleotide polymorphisms showed significant association with the allele, which had shown association in the genome-wide association study. Of these, 2 linked intergenic single-nucleotide polymorphisms reached genome-wide significance in a combined analysis.

In a cross-national epidemiological survey of 72 933 respondents in the 15-country World Health Organization World Mental Health Survey Initiative, Seedat et alArticle found more anxiety and mood disorders among women and more externalizing and substance disorders among men in every country studied. Significant narrowing of sex differences was found in recent cohorts for major depressive disorder related to increases in sex role equality.

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