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This Month in Archives of General Psychiatry
December 2002

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2002;59(12):1081-1082. doi:10.1001/archpsyc.59.12.1081

The CHRNA7 gene, which encodes a subunit of the brain nicotinic receptor, has been implicated in schizophrenia and in an auditory sensory processing deficit (P50) by genetic linkage at 15q14 and biochemical data. Leonard et al Article , using DNA sequence analysis, found a complex pattern of functional variants in the core promoter for CHRNA7 in schizophrenics and controls. Schizophrenic patients were twice as likely to have mutations as controls. The promoter mutations were strongly associated with higher P50 ratios and are consistent with reduced expression of the receptor in schizophrenics. The CHRNA7 variants likely contribute to a common endophenotype in schizophrenia, the P50 deficit.

Katon et al Article studied the cost-effectiveness in primary care patients with panic disorder of a "collaborative care" intervention, which included systematic patient education and psychiatrist-guided pharmacotherapy, compared with care as usual by primary care physicians. Patients receiving collaborative care experienced a mean of 74.2 more anxiety-free days over the 12-month period. The distribution of the cost-effectiveness ratio based on total outpatient costs suggested a 70% probability that the costs for the collaborative care intervention were less than usual care and that the intervention was more effective.

Halmi et al Article studied relapse predictors in bulimia nervosa patients who responded with complete abstinence from binge eating and purging to cognitive-behavioral therapy. A shorter period of continuous abstinence during treatment and at immediate posttreatment, less motivation to change, as well as a greater preoccupation and ritualization of eating effectively identified the 44% of bulimia nervosa patients who relapsed at 54 months.

The efficacy of serotonin selective reuptake inhibitors in the acute treatment of social anxiety disorder (social phobia) is well established. Stein et al Article studied the efficacy of paroxetine as a maintenance therapy for the prevention of relapse in social anxiety disorder (DSM-IV). In this multicenter, double-blind study, significantly fewer patients relapsed with paroxetine than placebo over a 24-week maintenance treatment period. These results support the conclusion that paroxetine is an effective maintenance treatment for social anxiety disorder.

Postolache et al Article report that patients with seasonal affective disorder had a more acute sense of smell than normal controls. The authors used a monorhinal phenyl ethyl alcohol odor detection threshold test administered once in winter and once during the subsequent summer. Basic research in mammals demonstrates interconnections between olfactory circuits and circuits that mediate seasonal hormonal and behavioral responses to light. The results of Postolache et al raise the possibility that increased olfactory acuity is physiologically related to marked seasonal rhythms in humans.

Fu et al Article examined the role of antisocial personality disorder as a confounding factor in genetic research on the comorbidity of major depression and substance use disorders in a large community-based veteran male twin sample. Antisocial personality disorder was significantly associated with major depression. The shared genetic risk between major depression and both alcohol dependence and marijuana dependence could be largely explained by genetic influences on antisocial personality disorder, which in turn was associated with increased risk of each of the other disorders.

Teplin et al Article assessed psychiatric disorders in a sample of 1829 detained youth and present rates by gender, race/ethnicity, and age. Nearly two thirds of males and nearly three quarters of females met diagnostic criteria for one or more psychiatric disorders. Most common were substance use, disruptive behavior, and affective disorders. The juvenile justice system may have become the major institutional locus for many poor and minority youth with psychiatric disorders. Effective treatments for this population are needed with the juvenile justice system as well as in the community.

To explore whether prolactin-elevating dopamine antagonists may be related to developing breast cancer, Wang et al Article conducted a large retrospective cohort study of women exposed to and unexposed to these medications. Antipsychotic dopamine antagonist use was associated with a small(16%) increase in the risk of developing breast cancer. There was a dose-response relationship, and these findings did not appear to be due to several biases. However, in light of the small risk and possibility of residual confounding, Wang et al caution that these findings should lead to additional studies but not changes in how patients are managed.

Having been thoroughly documented in the scientific literature, the Stroop Interference Effect is considered the "gold standard" of attentional measures. The standard account maintains that Stroop words are processed automatically to the semantic level. Raz et al Article used a posthypnotic suggestion to prevent reading of Stroop words. Highly suggestible individuals were able to eliminate the Stroop interference effect, whereas less-suggestible people were not affected. This outcome challenges the dominant view that word recognition is obligatory for proficient readers and may provide insight into top-down influences of suggestion on cognition.

Using positron emission tomography, Brody et al Article examined regional brain metabolism in smokers and nonsmokers when exposed to cigarette-related (compared with neutral) cues. From the neutral to the cigarette cue scans, smokers had greater activation of anterior cingulate gyrus metabolism than nonsmokers. Smokers also had positive correlations between intensity of craving and metabolism in the orbitofrontal cortex, dorsolateral prefrontal cortex, anterior insula, and sensorimotor cortex. These findings indicate that brain regions associated with arousal, compulsive repetitive behaviors, episodic memory, and sensory integration participate in responses to cigarette-related cues and cigarette craving.