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This Month in Archives of General Psychiatry
August 2006

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2006;63(8):842. doi:10.1001/archpsyc.63.8.842

Gurling et alArticle report genetic association tests to pinpoint exactly which gene could be causing genetic susceptibility to schizophrenia within a chromosome 8 region previously showing linkage to schizophrenia. Magnetic resonance imaging of selected cases showed that PCM1-associated schizophrenia was significantly associated with reductions in the volume of the orbitofrontal cortex gray matter. Non-PCM1–associated schizophrenia was associated with reductions in the temporal lobe cortices, including the temporal pole, hippocampus, and inferior temporal cortex.

Zarate et alArticle conducted a randomized, placebo-controlled, double-blind crossover study to evaluate the antidepressant efficacy of an N-methyl-D-aspartate receptor antagonist (ketamine) in treatment-resistant major depression. Subjects receiving ketamine hydrochloride showed significant improvement in depression compared with subjects receiving placebo within 110 minutes after injection, which remained significant throughout the following week. Their results support the hypothesis that directly targeting the N-methyl-D-aspartate receptor complex may bring about rapid and relatively sustained antidepressant effects.

Antidepressants are known to increase suicidal thoughts and behavior in some children. However, it is not known whether antidepressants also increase the risk of suicide death. Olfson et alArticle conducted a case-control study of children and adults in the Medicaid program who had recently received inpatient treatment for depression. The findings suggest that antidepressant treatment may be related to suicide attempts and death in children with severe depression but not adults.

Rutledge et alArticle evaluated 2 distinct measures of depression—in the form of symptom severity and treatment history—as predictors of clinical outcomes in a sample of women with suspected myocardial ischemia. Their results showed that while both measures of depression were predictive of poor outcomes on their own, the subgroup of women with both elevated symptoms and a history of treatment had the poorest prognosis and the worst risk factor profile.

Using a large, randomized sample followed up for up to 3 years, Taylor et alArticle found that among college-age women with high weight and shape concerns an 8-week Internet-based psychosocial intervention significantly reduced risk factors and decreased the onset of eating disorders in some high-risk groups identified through moderator analyses.

Burt et alArticle evaluated the origins of the link between early puberty and conduct disorder in a birth cohort of adolescent female twins. They found evidence that genetic influences on conduct disorder were quite strong in those with average timing of menarche (67%) and weak in those with early onset (8%). Such findings suggest that, in some cases, genetic influences on psychopathology are strongest in the “average expectable” environment.

Prenatal exposure to selective serotonin reuptake inhibitor (SSRI) antidepressants and maternal depression are both associated with adverse neonatal outcomes. Oberlander et alArticle used population-based, administrative health data to determine whether the effects of SSRI exposure can be distinguished from exposure to maternal depression. Controlling for maternal illness severity, prenatal exposure to SSRIs and depression was associated with an increased risk for low birthweight and respiratory distress beyond exposure to depression alone.

Brody et alArticle examined the effect of varying amounts of cigarette smoking on α4β2* nicotinic acetylcholine receptor (nAChR) occupancy in tobacco-dependent smokers. Small amounts of smoking (1-2 puffs of a cigarette) and low plasma nicotine levels (0.87 ng/mL) resulted in occupancy of 50% of α4β2* nAChRs, while smoking a full cigarette or smoking to satiety resulted in nearly complete saturation of these receptors. These results suggest near total occupancy of α4β2* nAChRs throughout the day in typical tobacco-dependent smokers.

Tabert et alArticle evaluated conversion rates to Alzheimer disease in subtypes of mild cognitive impairment. Over 3 years, 50% of amnestic “plus” and 10% of “pure” amnestic patients converted. Neuropsychological measures most predictive of time to conversion were also identified. They concluded that patients with amnestic mild cognitive impairment with other cognitive domain deficits constituted a high-risk group and that verbal memory and psychomotor speed/executive function deficits are strong predictors of a future diagnosis of Alzheimer disease.

A modest number of psychotherapies are evidence-based therapy (EBT) and few practitioners use them. Weissman et alArticle conducted a survey of a probability sample of all US accredited training programs in psychiatry, psychology, and social work and found that many programs offer electives in a range of EBTs and non-EBTs, but few required both a didactic and clinical supervision in EBT and most required training is non-EBT. There is a gap between research evidence for psychotherapy and clinical training.