This Month in Archives of General Psychiatry

Dickey et alcompared adherence to the schizophrenia PORT guidelines in the treatment provided to 420 Medicaid beneficiaries diagnosed with schizophrenia. About half of the beneficiaries were treated in the fee-for-service system and the rest were enrolled in a carved-out behavioral health plan. There were no differences in either the quality of treatment provided or patient outcomes between the managed behavioral health care plan and the fee-for-service plan. In both plans, inpatient treatment conformed to guideline recommendations more often than not, but conformance to outpatient recommendations was only fair.

The fusiform gyrus (FG) on the ventral surface of the temporal lobe is thought to subserve the processing and encoding of faces.Onitsuka et alused high-spatial-resolution magnetic resonance imaging to investigate relationships between FG subregions and immediate and delayed memory for faces in patients with chronic schizophrenia. Compared with normal controls, patients with schizophrenia had overall small FG gray matter volumes, and their degree of poor performance on delayed memory for faces was significantly correlated with the degree of bilateral anterior FG reduction.

Apoptosis is thought to play a role in schizophrenia.Benes et alhave assessed single-stranded DNA breaks, a marker for oxidative stress, and found an unexpected reduction in schizophrenic patients. This finding raises a key question as to whether a suppression of apoptosis represents an adaptive or nonadaptive change in schizophrenia.

Storosum et alshow that the incidence of suicide and attempted suicide in placebo-treated patients with schizophrenia does not differ significantly from the incidence in patients who were treated with active compounds under clinical trial conditions. Therefore concern about increased risk of suicide or attempted suicide in the placebo group should not be an argument against the conduct of placebo-controlled trials in schizophrenia.

Walker et aladministered the posttraumatic disorder checklist (PLC) to more than 1000 female members of a metropolitan health maintenance organization. Using the organization's cost account system, they found that, compared with women with a low PCL score, those with high scores had a 104% increase in adjusted total annual medical costs.

Baer et alreport new findings from a 21-year longitudinal prospective population-based study on the long-term effects of prenatal alcohol exposure on offspring. Univariate and multivariate analyses indicate that prenatal alcohol exposure is significantly associated with alcohol problems in offspring at 21 years of age. The relationship persists independent of the effects of family history of alcohol problems, nicotine exposure, other prenatal exposures, and postnatal environmental factors, including parental substance use.

Suhara et alused positron emission tomography to examine the serotonin transporter (5-HTT) occupancy by different doses of clomipramine and fluvoxamine. The 5-HTT occupancy increased in a curvilinear manner. Ten milligrams of clomipramine hydrochloride showed around 80% occupancy, comparable with 50 mg of fluvoxamine maleate. These findings suggest that the clinical doses of clomipramine and fluvoxamine occupied about 80% of 5-HTT, and dose escalation would have minimal additional effects on 5-HTT blockade.

Bowden et alstudied lamotrigine and lithium compared with placebo in 18-month, randomized, double-blind treatment of recently manic patients. Compared with placebo, lamotrigine was superior in prolonging time to intervention for depression; lithium was superior in prolonging time to intervention for mania. Both drugs delayed time to any mood episode. Lamotrigine was better tolerated than lithium. Lamotrigine appears to provide complementary benefits, mainly on several aspects of depression, to other drugs used in maintenance treatment of bipolar disorder.

The efficacy of group psychoeducation in preventing recurrences in bipolar disorders is shown in a single-blind randomized trial conducted by Colom et alfrom the Barcelona Bipolar Disorders Program. The importance of the study lays in its controlled design, the long follow-up period (24 months), and the disease severity of the population included. This study provides new data supporting the inclusion of psychoeducation in the treatment for bipolar patients.

Westman et alstudied whether the relationship between place of birth and attempted suicide remains after accounting for confounding factors, including age, marital status, and socioeconomic status (SES). The Cox regression was used in the study including 4.5 million Swedish persons of whom 600 000 were born abroad. Place of birth, sex, and SES were associated with attempted suicide. When SES was included in the final model the risks of attempted suicide remained high for women, while the risk of attempted suicide among men declined sharply with increased income in almost every group.

Previous studies of basal ganglia volumes in Tourette syndrome (TS) have yielded inconsistent results. Peterson et almeasured basal ganglia volumes in 154 subjects with TS and 130 healthy subjects. Caudates were significantly smaller in both children and adults with TS, whereas smaller lenticular nuclei were more prominent in adults than in children with TS. The findings suggest that smaller caudates may represent a trait abnormality in TS subjects, whereas small lenticular nuclei may predict symptom persistence into adulthood.