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This Month in Archives of General Psychiatry
May 2003

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2003;60(5):441. doi:10.1001/archpsyc.60.5.441

Davis et al Article propose a new hypothesis of oligodendroglia dysfunction in schizophrenia based on accumulating data suggesting white matter abnormalities. Microarray data implicate abnormalities in oligodendroglia, and genome scans have identified regions harboring these myelin-related genes. Diffusion tensor imaging establishes diminished organization in white matter tracts, and magnetic transference imaging implicates subtle decreases in myelin, consistent with postmortem abnormalities in both myelin sheaths and oligodendroglia in schizophrenia.

Unresolved difficulties surrounding the use of placebo in schizophrenia treatment trials havefueled the search for alternative research methods, such as the use of active comparators in studies evaluating the effects of experimental antipsychotic drugs. Fleischhacker et al Article lend support to the argument that active comparator controlled noninferiority designs are feasible options in antipsychotic drug testing. This trial design overcomes most of the ethical and some of the methodological problems of placebo-controlled studies.

Schizophrenia is associated with cognitive deficits, some of which may be similar to those found in individuals who have recovered from central nervous system infections with human herpesviruses. Dickerson et al Article provide serological evidence of herpes simplex virus 1 infection in outpatients with schizophrenia, which was an independent predictor of cognitive dysfunction.

Schubert and McNeil Article investigated the mental health of the young adult offspring of women with psychosis. As compared with normal-risk controls, offspring of mothers with schizophrenia showed significantly increased frequencies of DSM Axis I and Axis II disorders, poor global functioning, and a history of mental health care. Offspring of mothers with affective disorders showed a different pattern of mental disturbance, including significant increases only in Axis I depressive disorders and no increase in Axis II disorders.

Schnurr et al Article compared 2 methods of group psychotherapy for treating chronic postraumatic stress disorder (PTSD). Three hundred sixty male Vietnam veterans were randomly assigned to receive 30 weeks of trauma focus treatment or a present-centered treatment that avoided trauma focus. Although PTSD symptoms and other outcomes improved significantly following treatment, intention-to-treat analyses found no posttreatment differences between groups on any outcome.

A sib-pair method was used by Farmer et al Article to examine the familiality of the Seven Scale of the Temperament and Character Inventory and whether this could be related to the genetic vulnerability to develop depression. The study showed that Harm Avoidance, Reward Dependence, Novelty Seeking, and Self-Directedness all had traitlike characteristics that were related to the familiarity of depression, while Cooperativeness, Self-Transcendence, and Persistence were also familial but appeared to be unrelated to depression.

McGuffin et al Article used the twin strategy in which the proband had either bipolar disorder or unipolar depression to assess heritability of these disorders. Heritability for bipolar disorder was 85%. In monozygotic twins, only 10% of co-twins with depression had bipolar disorder, whereas 50% of the co-twins with bipolar disorder suffered from unipolar depression. Modeling suggested that unipolar depression was not simply a less severe form of bipolar disorder but reflected a correlated liability.

The childhood externalizing disorders, specifically attention-deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder, are often comorbid, co-occurring at greater than chance levels. In addition, parent-child conflict predicts each disorder. Using biometrical modeling techniques, Burt et al Article found that conflict was specifically associated with the overlap among the disorders, and that this association was mediated via both genetic and environmental factors.

Van Minnen et al Article examined the efficacy of 12 weeks of behavior therapy and fluoxetine compared with a waiting-list control group in 43 patients with trichotillomania. Patients in the behavior therapy group showed a significantly greater reduction in trichotillomania symptoms than patients in the fluoxetine or waiting-list groups, higher effect sizes, and higher clinical significant change.

Autism has traditionally been regarded as a categorical disorder, but research indicating that subtle or "subthreshold" autistic traits aggregate in family members of autistic subjects has challenged that notion. Constantino and Todd Article studied a general population sample of 788 twin pairs and found that social deficits characteristic of autism spectrum conditions were common, highly heritable, and continuously distributed. Milder variants of the autistic phenotype are likely to have important repercussions for social development in both boys and girls.