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This Month in Archives of General Psychiatry
August 2007

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2007;64(8):881. doi:10.1001/archpsyc.64.8.881

Rovner et alArticle conducted a randomized controlled clinical trial testing the efficacy of problem-solving therapy to prevent depression in patients with age-related macular degeneration (N = 206). Problem-solving therapy reduced the depression incidence rate by 50% at 2 months but was similar to usual care by 6 months. Preventing the loss of valued activities mediated treatment effects. Problem-solving therapy is an effective short-term preventive treatment for depression but may require booster or rescue treatments to sustain its effect.

Juvonen et alArticle investigated the incidence of schizophrenia in a nationwide cohort of patients with type 1 diabetes mellitus. The study used nationwide registers gathered independently for both diseases. Schizophrenia diagnoses were confirmed with a case-note consensus procedure according to DSM-IV. The results showed a substantially decreased incidence of schizophrenia among patients with type 1 diabetes. Within DSM-IV schizophrenia, patients with type 1 diabetes relatively more often had schizoaffective disorder, schizophreniform disorder, or schizotypal personality disorder.

Using 10 years of prospective data from a large community sample of adolescents and young adults, Beesdo et alArticle revealed that social anxiety disorder (SAD) is associated with a substantially increased risk for subsequent depression across different childhood and adolescent stages. Several distal (eg, parental anxiety/depression, behavioral inhibition) and proximal factors (eg, SAD severity, persistence) predicted depression among those with SAD.

Suicide rates vary widely within and between countries and are at least partly related to antidepressant prescription levels. Szanto et alArticle determined the effect of a 5-year depression-management educational program for general practitioners in Hungary on the suicide rate. In the intervention region, the annual suicide rate decreased by 16% and antidepressant treatment increased compared with both the surrounding county and all of Hungary.

Attention-deficit/hyperactivity disorder is highly heritable and usually improves with age. Examining the genetic basis of these features, Shaw et alArticle found a variant of the dopamine D4 receptor gene to be not only associated with attention-deficit/hyperactivity disorder but also a phenotype of better clinical outcome. Carriers of the risk allele also had a thinner cortex in regions important in attentional control, particularly in childhood.

Volkow et alArticle document that adult subjects with attention-deficit/hyperactivity disorder, when given intravenous methylphenidate hydrochloride, showed blunted dopamine increases in the caudate that were associated with inattention and with enhanced reinforcing responses to intravenous methylphenidate. This suggests that dopamine dysfunction is involved with symptoms of inattention but may also contribute to substance abuse comorbidity in attention-deficit/hyperactivity disorder.

Yücel et alArticle combined proton spectroscopy and functional magnetic resonance imaging to examine the biochemical and functional properties of the medial frontal cortex in obsessive-compulsive disorder. Results suggest that overactivation of the medial frontal cortex during an inhibitory control task may be a compensatory response to a neuronal abnormality (as indicated by reduced levels of neuronal N-acetylaspartate) in the region. The findings may partly explain the nature of inhibitory control deficits frequently seen in this group.

Kendler et alArticle analyzed the behavior of 1802 male twins and found that as individuals develop from childhood through young adulthood, genetic effects on peer-group deviance grow steadily more important whereas family environment generally declines in importance. As males mature and create their own social worlds, genetic factors play an increasingly important role in their choice of peers.

Jeste et alArticle developed and validated in persons with schizophrenia and healthy comparison subjects a new measure of capacity to consent to a research protocol: the University of California, San Diego Brief Assessment of Capacity to Consent (UBACC). The UBACC proved time efficient and easy to administer and score and had satisfactory psychometric properties. The UBACC fills a need for brief but valid tools for screening decisional capacity to identify those individuals who need more comprehensive assessments or remediation efforts.