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This Month in Archives of General Psychiatry
Feb 2012

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2012;69(2):114. doi:10.1001/archgenpsychiatry.2011.1189

Recovery-oriented cognitive therapy promotes superior outcomes in low-functioning patients with schizophrenia at the end of treatment; Grant et alArticle found that patients randomized to cognitive therapy showed significant improvement in global functioning, as well as significant reductions in both avolition and positive symptoms as compared with patients assigned to standard treatment.

Negative symptoms are defined by the absence of normal function. However, there must be a productive mechanism that leads to this absence. Gold et alArticle used a combination of behavioral and computational modeling methods to demonstrate that patients with high levels of negative symptoms have a specific abnormality in reinforcement learning whereby patients fail to represent the expected value of rewards when making decisions but successfully learn to avoid punishments.

Gabbay et alArticle examined alterations in anterior cingulate cortexγ-aminobutyric acid (GABA) concentrations in 20 medication-free adolescents with major depressive disorder (MDD) and 21 controls using proton magnetic resonance spectroscopy. Decreases in GABA levels in the MDD group were most pronounced in the MDD subgroup categorized as anhedonic. Anhedonia, assessed as a continuous variable, was negatively correlated with GABA levels in the whole MDD group and the combined MDD and control groups.

Holtzheimer et alArticle present data on 10 patients with unipolar disorder and 7 patients with bipolar II disorder receiving long-term subcallosal cingulate deep brain stimulation for treatment-resistant depression. The study design included a 4-week placebo lead-in. Remission rates were 18% at 6 months, 35% at 1 year, and 58% at 2 years, with no remitter experiencing a spontaneous relapse. No hypomanic or manic episodes occurred, and long-term deep brain stimulation was well tolerated.

Munk-Olsen et alArticle conducted a cohort study using information from population-based registers aimed at investigating readmission risks to psychiatric inpatient treatment facilities among women before and after induced first-trimester abortions. Results showed that risks of readmission were similar prior to and following the abortion procedure but also demonstrated that women with preexisting mental disorders having abortions had higher levels of psychiatric morbidity measured as incidence rates around abortion compared with women giving birth.

Shalev et alArticle compared early treatment modalities for preventing posttraumatic stress disorder: prolonged exposure (PE) (n = 63); cognitive therapy (CT) (n = 40); double-blind escitalopram/placebo condition (n = 46); and a waiting list followed by delayed PE (n = 41). Prolonged exposure did not differ from CT, and both did not differ from delayed PE. The escitalopram condition did not differ from the placebo or waiting list conditions. Prolonged exposure, CT, and delayed PE effectively prevent posttraumatic stress disorder in recent survivors.

Miedl et alArticle examined neuronal representation of subjective reward value in pathological gamblers and healthy controls. Compared with healthy controls, neuronal value correlations in the reward system in gamblers were increased during delay discounting and decreased during probability discounting. Within gamblers, neuronal value signals for delayed rewards were negatively correlated with gambling severity.

Ponseti et alArticle tested whether pedophilia can be detected by the mean of brain responses to sexual images. During a functional magnetic resonance imaging session, pedophilic (n = 24) and nonpedophilic participants (n = 32) were briefly exposed to same- and opposite-sex images of nude children and adults. Functional magnetic resonance images were submitted to an automatic classification algorithm (cross-validated). Ponseti et al report a mean accuracy of 95%, indicating that this is a promising objective tool to clinically diagnose pedophilia.

Ecker et alArticle examined brain anatomy and its relationship to behavior in a sample of male adults with autism spectrum disorder using a multicenter magnetic resonance imaging design (N = 178). Adults with autism spectrum disorder did not differ from controls in overall brain volume but showed distributed differences in brain anatomy and connectivity, which were associated with specific autistic features and traits.