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This Month in Archives of General Psychiatry
August 2002

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2002;59(8):685. doi:10.1001/archpsyc.59.8.685

A key effort of schizophrenia research is finding a functional test sensitive to changes over the course of the disorder. Salisbury et al Article provide data on a candidate task, the mismatch negativity to pitch. This is an event-related brain potential arising from automatic sensory system detection of changes in pitch of auditory stimuli and is thought to originate in and near the primary auditory cortex. The pitch mismatch negativity was normal in patients with first-episode schizophrenia, whereas extensive other data have indicated it is abnormal in chronic schizophrenia, suggesting that the defect may develop over time.

Braus et al Article compared regional brain activation during a relatively simple sensory-perceptual task in patients with schizophrenia and healthy controls. Patients showed abnormal activation in the posterior parietal cortex and areas of the right inferior prefrontal cortex. These abnormalities expand the areas of functional impairment and provide a basis for the understanding of deficits in eye tracking in the schizophrenic syndrome.

Evidence implicates abnormalities of dopaminergic and glutamatergic neurotransmission in the pathophysiology and prefrontal dysfunction found in schizophrenia. Dopamine and glutamate receptors regulate in opposing directions the phosphorylation of DARPP-32, a key regulatory protein phosphatase inhibitor that modulates the activity of important ion channels and receptors. Albert et al Article found that the level of DARPP-32 was significantly reduced in the prefrontal cortex in schizophrenic subjects relative to matched controls, while two other phosphoproteins did not differ.

Cognitive-behavioral therapy is a well-established treatment for binge-eating disorder. Interpersonal psychotherapy reduces binge eating, but its long-term impact remains largely unknown. Wilfley et al Article compared the effects of group cognitive-behavioral therapy and group interpersonal psychotherapy across binge-eating disorder–related symptoms and found that recovery rates were equivalent for both treatments at posttreatment and through 1-year follow-up.

Kocsis et al Article measured psychosocial functioning during long-term maintenance antidepressant treatment or following the discontinuation of treatment in patients with chronic major depression. Substantial worsening in measures of psychosocial function occurred in patients switched to placebo when compared with sertraline maintenance. Surprisingly, most of the observed improvement in psychosocial functioning occurred during the acute phase of treatment in the patients who remained in remission throughout maintenance.

Meyers et al Article found that adequate antidepressant therapy following admission to community-based outpatient clinics for treatment of a major depressive episode predicted remission within3 months. Only 45% of patients received adequate pharmacotherapy. Less severe depression, female sex, and being married were additional independent predictors of early recovery. High personality dysfunction scores predicted nonrecovery among less severely depressed patients.

Bipolar II disorder is often found in families with bipolar I disorder. There has been controversy about the reliability of the diagnosis for hypomania. Simpson et al Article assessed their diagnostic reliability for major depressive, manic, and hypomanic episodes at the interview and best-estimate levels in a genetic linkage study of bipolar I disorder. They found that good interrater reliability for hypomania and bipolar II can be achieved when the interviews and best-estimate diagnoses are done by experienced psychiatrists.

Johnson et al Article found that maladaptive parenting and childhood maltreatment were associated with elevated risk for interpersonal difficulties during middle adolescence and for suicide attempts during late adolescence or early adulthood. The findings suggest that the development of suicidal behavior may often be attributable to an extensive history of profound interpersonal difficulties beginning in childhood.

Iacono et al Article examined brain event-related potential P3 amplitude in a community sample of 17-year-old boys. P3 amplitude was reduced in boys with childhood externalizing and substance use disorders, and in those whose fathers had a substance use or antisocial personality disorder. The development of a substance use disorder between ages 17 and 20 years was associated with reduced-amplitude P3 at 17 years. Reduced P3 is associated with familial risk for alcoholism and with the development of disorders associated with behavioral disinhibition.