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This Month in Archives of General Psychiatry
September 2005

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2005;62(9):951. doi:10.1001/archpsyc.62.9.951

Beck Article reviews the progress in the development and evaluation of the cognitive approach to psychiatric disorders over the past 40 years. Extensive empirical testing supports the cognitive model and cognitive therapy of depression and, somewhat less extensively, anxiety and other psychiatric disorders. Cognitive therapy has been especially noteworthy in reducing relapse rate as well as symptoms of depression. Beck stresses the importance of dissemination of this modality into “real-life” situations.

Active-controlled trials with external (historical) placebo comparisons could replace placebo-controlled trials for schizophrenia. Woods et al Article conducted a meta-analysis and found the degree of improvement in atypical antipsychotic arms to be nearly double in active-controlled trials than that seen with the same drugs and doses in placebo-controlled studies. These results suggest that historical placebo comparisons cannot adequately supplement the validity of active-controlled trials as tests of efficacy for schizophrenia.

Marshall et al Article report on a systematic review and meta-analysis of the relationship between duration of untreated psychosis and outcomes in first-episode psychosis. Data from 26 first-episode cohorts, involving 4490 participants, showed significant associations between duration of untreated psychosis and a range of outcomes. The observed associations were not explained by premorbid adjustment.

Krystal et al Article conducted a comparison of ketamine hydrochloride and amphetamine sulfate effects, which resemble endogenous psychoses, within individual healthy human subjects. The interactive effects of ketamine and amphetamine were also described within these healthy individuals. The combination produced less than additive effects on psychosis, additive effects on thought disorder and “high,” and no significant interactive effects on negative symptoms. At a dose where amphetamine impaired working memory when administered alone, it reduced the disruption in working memory produced by ketamine. This finding complements other data suggesting that stimulation of prefrontal dopamine receptors, particularly of the D1 type, may help to attenuate working memory deficits associated with schizophrenia, where cognitive dysfunction has been linked to deficits in N-methyl-D-aspartate receptor function.

Frank et al Article investigated the efficacy of interpersonal and social rhythm therapy (IPSRT) in comparison with an intensive clinical management approach as acute and maintenance treatments for patients with bipolar I disorder. They found that acute IPSRT led to longer survival time without a new affective episode during the 2-year maintenance phase. This effect was mediated by the extent to which study participants assigned to IPSRT increased the regularity of their social rhythms.

Mohr et al Article examined telephone-administered psychotherapy for depression in disabled patients with multiple sclerosis. Both telephone-administered cognitive behavioral therapy (T-CBT) and telephone-administered supportive emotion-focused therapy, which encouraged emotional expression and prohibited cognitive-behavioral interventions, produced significant improvements. The T-CBT produced superior outcomes on 3 measures of depression and a measure of positive affect. Attrition, at 5.5%, was very low. Thus, T-CBT may be useful in overcoming some barriers to receiving psychotherapy.

Shared genetic contributions to pathological gambling and externalizing disorders, including alcohol dependence and antisocial behaviors, have been observed. Pathological gambling also frequently co-occurs with internalizing disorders like major depression. Potenza et al Article modeled the Vietnam Era Twin Registry data and observed that the overlap between pathological gambling and major depression was largely genetic.

Rickels et al Article conducted a 4-week multicenter, randomized, double-blind, placebo- and alprazolam-controlled trial to evaluate the efficacy, safety, and tolerability of 3 doses of pregabalin, an α2-δ ligand inhibiting the release of excitatory neurotransmitters, in adult outpatients with generalized anxiety disorder. Improvement on the primary outcome measure, the Hamilton Anxiety Rating Scale total score, as well as global improvement, was significantly greater for all 3 doses of pregabalin than for placebo and equal to or better than alprazolam. Compared with placebo, improvement was significantly better for all 3 pregabalin doses, but not alprazolam, already after 1 week of treatment.

Using brain imaging, Bailer et al Article found increased activity of the 5-HT1A receptor in limbic regions of the brains of women who had recovered from bulimia-type anorexia nervosa. In comparison, activity of the 5-HT1A receptor was normal in individuals recovered from restricting-type anorexia nervosa, although 5-HT1A receptor binding was associated with anxiety. These data add to a growing body of evidence showing that altered serotonergic function and anxiety symptoms persist after recovery from anorexia nervosa.

Evidence for linkage of drug dependence vulnerability to chromosomal regions 3q24-3q25 and 9q34 was found in adolescents previously. Since conduct disorder and drug dependence vulnerability are often comorbid, Stallings et al Article conducted a study to identify quantitative trait loci for conduct disorder. Evidence for linkage to 9q34 was found for conduct disorder symptoms also, suggesting a potential molecular genetic basis for comorbidity between drug dependence vulnerability and conduct disorder.