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August 2017 - July 1959

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March 7, 2011, Vol 68, No. 3, Pages 227-321

This Month in Archives of General Psychiatry

This Month in Archives of General Psychiatry

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Arch Gen Psychiatry. 2011;68(3):228. doi:10.1001/archgenpsychiatry.2011.8
Art and Images in Psychiatry

Portrait of Francisco Lezcano–The “Niño de Vallecas”

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Arch Gen Psychiatry. 2011;68(3):229. doi:10.1001/archgenpsychiatry.2011.13
Editorial

Brain and Behavior in Fragile X Syndrome and Idiopathic Autism

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Arch Gen Psychiatry. 2011;68(3):230-231. doi:10.1001/archgenpsychiatry.2011.11
Original Article

Common Variants in the BCL9 Gene Conferring Risk of Schizophrenia

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Arch Gen Psychiatry. 2011;68(3):232-240. doi:10.1001/archgenpsychiatry.2011.1

Prevalence and Correlates of Bipolar Spectrum Disorder in the World Mental Health Survey Initiative

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Arch Gen Psychiatry. 2011;68(3):241-251. doi:10.1001/archgenpsychiatry.2011.12

Incremental Cost-effectiveness of Combined Therapy vs Medication Only for Youth With Selective Serotonin Reuptake Inhibitor–Resistant DepressionTreatment of SSRI-Resistant Depression in Adolescents Trial Findings

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Arch Gen Psychiatry. 2011;68(3):253-262. doi:10.1001/archgenpsychiatry.2011.9

Recovery and Recurrence Following Treatment for Adolescent Major Depression

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Arch Gen Psychiatry. 2011;68(3):263-269. doi:10.1001/archgenpsychiatry.2010.150
ContextMajor depressive disorder in adolescents is common and impairing. Efficacious treatments have been developed, but little is known about longer-term outcomes, including recurrence.ObjectivesTo determine whether adolescents who responded to short-term treatments or who received the most efficacious short-term treatment would have lower recurrence rates, and to identify predictors of recovery and recurrence.DesignNaturalistic follow-up study.SettingTwelve academic sites in the United States.ParticipantsOne hundred ninety-six adolescents (86 males and 110 females) randomized to 1 of 4 short-term interventions (fluoxetine hydrochloride treatment, cognitive behavioral therapy, their combination, or placebo) in the Treatment for Adolescents With Depression Study were followed up for 5 years after study entry (44.6% of the original Treatment for Adolescents With Depression Study sample).Main Outcome MeasuresRecovery was defined as absence of clinically significant major depressive disorder symptoms on the Schedule for Affective Disorders and Schizophrenia for School-Age Children–Present and Lifetime Version interview for at least 8 weeks, and recurrence was defined as a new episode of major depressive disorder following recovery.ResultsAlmost all participants (96.4%) recovered from their index episode of major depressive disorder during the follow-up period. Recovery by 2 years was significantly more likely for short-term treatment responders (96.2%) than for partial responders or nonresponders (79.1%) (P < .001) but was not associated with having received the most efficacious short-term treatment (the combination of fluoxetine and cognitive behavioral therapy). Of the 189 participants who recovered, 88 (46.6%) had a recurrence. Recurrence was not predicted by full short-term treatment response or by original treatment. However, full or partial responders were less likely to have a recurrence (42.9%) than were nonresponders (67.6%) (P = .03). Sex predicted recurrence (57.0% among females vs 32.9% among males; P = .02).ConclusionsAlmost all depressed adolescents recovered. However, recurrence occurs in almost half of recovered adolescents, with higher probability in females in this age range. Further research should identify and address the vulnerabilities to recurrence that are more common among young women.

Neural Correlates of Affect Processing and Aggression in Methamphetamine Dependence

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Arch Gen Psychiatry. 2011;68(3):271-282. doi:10.1001/archgenpsychiatry.2010.154
ContextMethamphetamine abuse is associated with high rates of aggression but few studies have addressed the contributing neurobiological factors.ObjectiveTo quantify aggression, investigate function in the amygdala and prefrontal cortex, and assess relationships between brain function and behavior in methamphetamine-dependent individuals.DesignIn a case-control study, aggression and brain activation were compared between methamphetamine-dependent and control participants.SettingParticipants were recruited from the general community to an academic research center.ParticipantsThirty-nine methamphetamine-dependent volunteers (16 women) who were abstinent for 7 to 10 days and 37 drug-free control volunteers (18 women) participated in the study; subsets completed self-report and behavioral measures. Functional magnetic resonance imaging (fMRI) was performed on 25 methamphetamine-dependent and 23 control participants.Main Outcome MeasuresWe measured self-reported and perpetrated aggression and self-reported alexithymia. Brain activation was assessed using fMRI during visual processing of facial affect (affect matching) and sym-bolic processing (affect labeling), the latter representing an incidental form of emotion regulation.ResultsMethamphetamine-dependent participants self-reported more aggression and alexithymia than control participants and escalated perpetrated aggression more following provocation. Alexithymia scores correlated with measures of aggression. During affect matching, fMRI showed no differences between groups in amygdala activation but found lower activation in methamphetamine-dependent than control participants in the bilateral ventral inferior frontal gyrus. During affect labeling, participants recruited the dorsal inferior frontal gyrus and exhibited decreased amygdala activity, consistent with successful emotion regulation; there was no group difference in this effect. The magnitude of decrease in amygdala activity during affect labeling correlated inversely with self-reported aggression in control participants and perpetrated aggression in all participants. Ventral inferior frontal gyrus activation correlated inversely with alexithymia in control participants.ConclusionsContrary to the hypotheses, methamphetamine-dependent individuals may successfully regulate emotions through incidental means (affect labeling). Instead, low ventral inferior frontal gyrus activity may contribute to heightened aggression by limiting emotional insight.

Gene × Disease Interaction on Orbitofrontal Gray Matter in Cocaine Addiction

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Arch Gen Psychiatry. 2011;68(3):283-294. doi:10.1001/archgenpsychiatry.2011.10

Neuroanatomical Differences in Toddler Boys With Fragile X Syndrome and Idiopathic Autism

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Arch Gen Psychiatry. 2011;68(3):295-305. doi:10.1001/archgenpsychiatry.2010.153
ContextAutism is an etiologically heterogeneous neurodevelopmental disorder for which there is no known unifying etiology or pathogenesis. Many conditions of atypical development can lead to autism, including fragile X syndrome (FXS), which is presently the most common known single-gene cause of autism.ObjectiveTo examine whole-brain morphometric patterns that discriminate young boys with FXS from those with idiopathic autism (iAUT) as well as control participants.DesignCross-sectional, in vivo neuroimaging study.SettingAcademic medical centers.PatientsYoung boys (n = 165; aged 1.57-4.15 years) diagnosed as having FXS or iAUT as well as typically developing and idiopathic developmentally delayed controls.Main Outcome MeasuresUnivariate voxel-based morphometric analyses, voxel-based morphometric multivariate pattern classification (linear support vector machine), and clustering analyses (self-organizing map).ResultsWe found that frontal and temporal gray and white matter regions often implicated in social cognition, including the medial prefrontal cortex, orbitofrontal cortex, superior temporal region, temporal pole, amygdala, insula, and dorsal cingulum, were aberrant in FXS and iAUT as compared with controls. However, these differences were in opposite directions for FXS and iAUT relative to controls; in general, greater volume was seen in iAUT compared with controls, who in turn had greater volume than FXS. Multivariate analysis showed that the overall pattern of brain structure in iAUT generally resembled that of the controls more than FXS, both with and without AUT.ConclusionsOur findings demonstrate that FXS and iAUT are associated with distinct neuroanatomical patterns, further underscoring the neurobiological heterogeneity of iAUT.

Reduced Acetylcholinesterase Activity in the Fusiform Gyrus in Adults With Autism Spectrum Disorders

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Arch Gen Psychiatry. 2011;68(3):306-313. doi:10.1001/archgenpsychiatry.2011.4

Neighborhood Psychosocial Environment, Apolipoprotein E Genotype, and Cognitive Function in Older Adults

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Arch Gen Psychiatry. 2011;68(3):314-321. doi:10.1001/archgenpsychiatry.2011.6
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