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This Month in Archives of General Psychiatry
Sep 2011

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2011;68(9):868. doi:10.1001/archgenpsychiatry.2011.102

In a 5-year longitudinal study comparing the change in cortical thickness in schizophrenic patients and healthy subjects, van Haren et alArticle found excessive thinning over time in widespread areas of the brain, most pronounced bilaterally in the temporal cortex and in the left frontal area and progressing across the entire course of the illness. The excessive thinning of the cortex appears related to outcome and cumulative antipsychotic medication intake.

In a multimodal imaging study, Fusar-Poli et alArticle investigated subjects at clinical risk for psychosis and matched controls using functional magnetic resonance imaging while performing a verbal fluency task and proton magnetic resonance spectroscopy to measure brain regional glutamate levels. They found that altered prefrontal, hippocampal, and temporal function in subjects at high risk for psychosis is related to a reduction in thalamic glutamate levels, and this relationship is different from that in healthy controls.

Using positron emission tomography and a selective radioligand, [11C]P943, Murrough et alArticle examined serotonin type 1B receptor binding in patients with posttraumatic stress disorder and a trauma-control cohort and found abnormally low levels of receptor binding in both groups compared with healthy nontraumatized participants within a cortico-striatal-limbic circuit. They further report a significant inverse relationship between receptor binding and participant age at first traumatic experience, suggesting that age at trauma exposure is a critical factor in causing neurobiological alterations in trauma survivors.

In a highly traumatized, primarily African American cohort, Mehta et alArticle demonstrate that functional variants in FKBP5 are associated with biologically distinct subtypes of posttraumatic stress disorder. Using endocrine, gene expression, and genotypic data, this study illustrates that the inheritance of glucocorticoid receptor sensitivity–moderating polymorphisms within FKBP5 can determine specific types of hypothalamic-pituitary-adrenal axis dysfunction within posttraumatic stress disorder, as reflected in gene-expression changes of a subset of glucocorticoid receptor–responsive genes.

Melhem et alArticle examined the course of grief reactions in bereaved children as long as 33 months after the death of their parent from suicide, accident, or sudden natural death. Grief reactions were found to abate over time for most children; however, a subset showed increased or prolonged grief reactions, which in turn increased the risk for functional impairment and depression.

MojtabaiArticle found that compared with bereavement-unrelated depressive episodes of the same duration, bereavement-related episodes were associated with less impairment, fewer comorbidities, and a lower risk of future depressive episodes. The findings argue against the DSM-5 draft proposal to eliminate the bereavement exclusion criterion of major depressive episodes.

Logan et alArticle used latent class analysis to identify patterns of co-occurring health- and life-stress–related circumstances known to be risk factors for suicide among 28 703 suicide decedents from 12 US states. Nine distinct patterns of known risk factors were identified and all decedents were classified by these patterns.

Sinha et alArticle experimentally modeled stress and alcohol cue exposure in recovering alcoholic inpatients and controls and prospectively followed up the patients to assess relapse risk. Stress- and alcohol cue–induced craving, high resting anxiety, and adrenal sensitivity to corticotropin each predicted alcohol relapse and treatment outcome. High adrenal sensitivity more than doubled the risk of shorter time to relapse during recovery.

Brody et alArticle examined brain nicotinic acetylcholine receptor occupancy from exposure to secondhand smoke (SHS). Cigarette smokers and nonsmokers underwent positron emission tomography scanning before and after sitting in a car for an hour and undergoing exposure to a moderate level of SHS. This SHS exposure resulted in 19% occupancy of brain nicotinic acetylcholine receptors and was similar for smokers and nonsmokers.

Gomar et alArticle investigated the discriminative utility of different classes of biomarkers (cerebrospinal fluid and brain volumetric measures) and cognitive markers for their prediction of the conversion from mild cognitive impairment to Alzheimer disease within a 2-year period. Delayed verbal memory and middle temporal lobe cortical thickness were robust predictors of conversion. Conversion was driven less by changes in the neurobiological trajectory of the disease than by sharp declines in functional ability and, to a lesser extent, in executive function.

Li et alArticle examined the temporal relationship between late-life depression and development of dementia in a large community-based prospective cohort with initially nondemented participants aged at least 65 years. This study confirmed previous observations of an association between late-life depression and increased risk of dementia and provided additional evidence that late-life depression may be an early manifestation of dementia rather than increasing risk for dementia.