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June 2017 - July 1959

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June 6, 2011, Vol 68, No. 6, Pages 540-644

This Month in Archives of General Psychiatry

Archives of General Psychiatry

Abstract Full Text
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Arch Gen Psychiatry. 2011;68(6):541. doi:10.1001/archgenpsychiatry.2011.52
Art and Images in Psychiatry

Pieter Bruegel's Dulle Griet

Abstract Full Text
Arch Gen Psychiatry. 2011;68(6):543-544. doi:10.1001/archgenpsychiatry.2011.59
Original Article

Functional Magnetic Resonance Imaging Investigation of the Amphetamine Sensitization Model of Schizophrenia in Healthy Male Volunteers

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Arch Gen Psychiatry. 2011;68(6):545-554. doi:10.1001/archgenpsychiatry.2011.3
ContextRecent work suggests that the amphetamine sensitization model of schizophrenia can safely be induced in healthy volunteers and is associated both with behavioral and dopaminergic hypersensitivity to amphetamine. However, the effects of a sensitization on brain function remain unclear.ObjectiveTo assess the impact of a sensitizing dosage regimen of dextroamphetamine on human cortical functioning and cognition.DesignRandomized, double-blind, parallel-groups design using pharmacological functional magnetic resonance imaging.SettingThe neuroimaging research unit at the Institute of Psychiatry, King's College London, London, England.ParticipantsHealthy male volunteers (n = 22).InterventionsDextroamphetamine (20 mg) or placebo administration at 4 testing sessions, using a dosage regimen shown to induce sensitization (ie, 3 doses administered with a 48-hour interdose interval and a final dose after a 2-week washout period).Main Outcome MeasuresSensitization was characterized by enhanced subjective response to the drug, changes in behavioral performance (reaction time and accuracy), and functional magnetic resonance imaging measurements of brain activity during an N-back working memory task.ResultsSensitization was associated with more rapid responding during the performance of an intermediate-load working memory challenge. During a high-load cognitive challenge, sensitization did not produce performance deficits, but functional magnetic resonance imaging showed hyperactivity of the dorsolateral prefrontal cortex and aberrant recruitment of the superior temporal gyrus, caudate nucleus, and thalamus. Furthermore, the change in striatal activity was negatively correlated with the enhanced subjective effects of the drug, whereas prefrontal hyperactivity was positively correlated with sensitized measures of alertness.ConclusionsThese transient load-dependent abnormalities of frontal and temporal activity induced by amphetamine sensitization support neuroimaging findings in schizophrenic patients, implying that amphetamine sensitization may help to bridge pathophysiological theories of schizophrenia that focus on pharmacological (dopaminergic) and cognitive mechanisms, respectively.

In Vivo Imaging of Cerebral Serotonin Transporter and Serotonin2A Receptor Binding in 3,4-Methylenedioxymethamphetamine (MDMA or “Ecstasy”) and Hallucinogen Users

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Arch Gen Psychiatry. 2011;68(6):562-576. doi:10.1001/archgenpsychiatry.2011.56

An Effectiveness Trial of Group Cognitive Behavioral Therapy for Patients With Persistent Depressive Symptoms in Substance Abuse Treatment

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Arch Gen Psychiatry. 2011;68(6):577-584. doi:10.1001/archgenpsychiatry.2011.53

National Study of Suicide in All People With a Criminal Justice History

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Arch Gen Psychiatry. 2011;68(6):591-599. doi:10.1001/archgenpsychiatry.2011.7
ContextPrevious research has focused on suicide among male prisoners and ex-prisoners, but little is known about risk in the wider offender population.ObjectiveTo examine suicide risk over 3 decades among all people processed by a national criminal justice system.DesignNested case-control study.SettingThe whole Danish population.ParticipantsInterlinked national registers identified all adult suicides during 1981 to 2006 according to any criminal justice system contact since 1980. Exposure was defined according to history of criminal justice adjudication, up to and including each subject's last judicial verdict before suicide (or date of matching for controls). There were 27 219 suicides and 524 899 controls matched on age, sex, and time, ie, controls were alive when their matched case died.Main Outcome MeasureSuicide.ResultsMore than a third of all male cases had a criminal justice history, but relative risk against the general population was higher for women than men. Independent effects linked with criminal justice exposure persisted with confounder adjustment. Suicide risk was markedly elevated with custodial sentencing, but the strongest effects were with sentencing to psychiatric treatment and with charges conditionally withdrawn. Risk was raised even in people with a criminal justice history but without custodial sentences or guilty verdicts. It was especially high with recent or frequent contact and in people charged with violent offenses.ConclusionsWe examined a section of society in which major health and social problems frequently coexist including offending, psychopathology, and suicidal behavior. The need for developing more far-reaching national suicide prevention strategies is indicated. In particular, improved mental health service provision is needed for all people in contact with the criminal justice system, including those not found guilty and those not given custodial sentences. Our findings also suggest that public services should be better coordinated to tackle co-occurring health and social problems more effectively.

Functional Impairment in Elderly Patients With Mild Cognitive Impairment and Mild Alzheimer Disease

Abstract Full Text
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Arch Gen Psychiatry. 2011;68(6):617-626. doi:10.1001/archgenpsychiatry.2011.57

Collaborative Depression Care Management and Disparities in Depression Treatment and Outcomes

Abstract Full Text
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Arch Gen Psychiatry. 2011;68(6):627-636. doi:10.1001/archgenpsychiatry.2011.55

A Multivariate Twin Study of Obsessive-Compulsive Symptom Dimensions

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Arch Gen Psychiatry. 2011;68(6):637-644. doi:10.1001/archgenpsychiatry.2011.54
Meta-analysis

Cannabis Use and Earlier Onset of PsychosisA Systematic Meta-analysis

Abstract Full Text
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Arch Gen Psychiatry. 2011;68(6):555-561. doi:10.1001/archgenpsychiatry.2011.5
ContextA number of studies have found that the use of cannabis and other psychoactive substances is associated with an earlier onset of psychotic illness.ObjectiveTo establish the extent to which use of cannabis, alcohol, and other psychoactive substances affects the age at onset of psychosis by meta-analysis.Data SourcesPeer-reviewed publications in English reporting age at onset of psychotic illness in substance-using and non–substance-using groups were located using searches of CINAHL, EMBASE, MEDLINE, PsycINFO, and ISI Web of Science.Study SelectionStudies in English comparing the age at onset of psychosis in cohorts of patients who use substances with age at onset of psychosis in non–substance-using patients. The searches yielded 443 articles, from which 83 studies met the inclusion criteria.Data ExtractionInformation on study design, study population, and effect size were extracted independently by 2 of us.Data SynthesisMeta-analysis found that the age at onset of psychosis for cannabis users was 2.70 years younger (standardized mean difference = −0.414) than for nonusers; for those with broadly defined substance use, the age at onset of psychosis was 2.00 years younger (standardized mean difference = −0.315) than for nonusers. Alcohol use was not associated with a significantly earlier age at onset of psychosis. Differences in the proportion of cannabis users in the substance-using group made a significant contribution to the heterogeneity in the effect sizes between studies, confirming an association between cannabis use and earlier mean age at onset of psychotic illness.ConclusionsThe results of meta-analysis provide evidence for a relationship between cannabis use and earlier onset of psychotic illness, and they support the hypothesis that cannabis use plays a causal role in the development of psychosis in some patients. The results suggest the need for renewed warnings about the potentially harmful effects of cannabis.
Review

Translational Epidemiology in PsychiatryLinking Population to Clinical and Basic Sciences

Abstract Full Text
Arch Gen Psychiatry. 2011;68(6):600-608. doi:10.1001/archgenpsychiatry.2011.47

Systematic Review of Early Cardiometabolic Outcomes of the First Treated Episode of Psychosis

Abstract Full Text
Arch Gen Psychiatry. 2011;68(6):609-616. doi:10.1001/archgenpsychiatry.2011.2
ContextThe increased mortality associated with schizophrenia is largely due to cardiovascular disease. Treatment with antipsychotics is associated with weight gain and changes in other cardiovascular risk factors. Early identification of modifiable cardiovascular risk factors is a clinical imperative but prospective longitudinal studies of the early cardiometabolic adverse effects of antipsychotic drug treatment other than weight gain have not been previously reviewed.ObjectivesTo assess the methods and reporting of cardiometabolic outcome studies of the first treated episode of psychosis, review key findings, and suggest directions for future research.Data SourcesPsycINFO, MEDLINE, and Scopus from January 1990 to June 2010.Study SelectionSubjects were experiencing their first treated episode of psychosis. Subjects were antipsychotic naive or had been exposed to antipsychotics for a short known period at the beginning of the study. Cardiometabolic indices were assessed. Studies used a longitudinal design.Data ExtractionSixty-four articles were identified describing 53 independent studies; 25 studies met inclusion criteria and were retained for detailed review.Data SynthesisConsolidated Standards of Reporting Trials and Strengthening the Reporting of Observational Studies in Epidemiology checklists were used to assess the methods and reporting of studies. A qualitative review of findings was conducted.ConclusionsTwo key hypotheses were identified based on this review: (1) in general, there is no difference in cardiovascular risk assessed by weight or metabolic indices between individuals with an untreated first episode of psychosis and healthy controls and (2) cardiovascular risk increases after first exposure to any antipsychotic drug. A rank order of drugs can be derived but there is no evidence of significant class differences. Recommended directions for future research include assessing the effect on cardiometabolic outcomes of medication adherence and dosage effects, determining the therapeutic window for antipsychotic use in adults and youth, and testing for moderation of outcomes by demographic factors, including sex and age, and clinical and genetic factors.
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