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This Month in Archives of General Psychiatry
July 2003

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2003;60(7):660. doi:10.1001/archpsyc.60.7.660

A consensus statement developed by scientists, consumers, and advocates addresses the unmet needs in the diagnosis, treatment, and mental health services to older Americans living with mood disorders. Despite substantial advances in the evidence base for treatment, most older Americans still do not receive adequate treatment for depression, resulting in excess disability and suffering, burden on family members, higher health care costs, and high rates of suicide.

In a national population-based nested case-control study using Danish longitudinal register data, Byrne et al investigated the risk for schizophrenia associated with parental age at birth. Adjusting for family psychiatric history and socioeconomic and demographic factors, risk for schizophrenia was associated with paternal age of 50 years or older. The results lend support to the theory that de novo mutations associated with increased paternal age might be responsible for some cases of schizophrenia.

Aripiprazole is a partial agonist at the D2 and 5HT1A receptors as well as an antagonist at the 5HT2A receptors. Potkin et alArticle demonstrate that aripiprazole at 20 mg/d and 30 mg/d, in a placebo- and risperidone-controlled clinical trial, is statistically and clinically superior to placebo on all efficacy measures. Prolactin levels were reduced during arirpiprazole treatment. A low incidence of extrapyramidal effects and no change in QTc interval were also observed

Isensee et alArticle found a unique and specific unidirectional relationship between prior smoking and increased risk for subsequent panic attacks/disorder. The existence of a second, yet considerably less frequent, pathway of prior panic leading to increased risk of subsequent smoking dependence could not be excluded in this study, calling for further exploration in adults.

The sources of individual differences in vulnerability to the development of fears and phobias are not well understood. Hettema et alArticle applied an experimental fear conditioning paradigm to a twin sample and found that fear conditioning is moderately heritable, with individual specific environmental influences accounting for the remainder of the variation. One set of genetic risk factors most strongly related to the early conditioning protocol phase of habituation while a second set of genes affected the later phases of acquisition and extinction.

Kim-Cohen et alArticle report that as many as half of adults with a psychiatric disorder had diagnosable psychiatric disorders before age 15 years, and three fourths before age 18 years. Follow-back analyses asked how many disordered adults had a juvenile psychiatric history, and what types of disorders they had. Each adult disorder was preceded by its juvenile counterpart, but conduct disorder significantly preceded every adult disorder. Adult anxiety and schizophreniform disorders in particular were antedated by a broad array of juvenile disorders.

Laine et alArticle investigated the perinatal sequela of infants exposed to selective serotonin reuptake inhibitors during their fetal life and the relationship of these symptoms with the cord blood monamine concentrations. They found a 4-fold increase in the risk for serotonin-related neurologic adverse effects in infants exposed to fluoxetine or citalopram during the third trimester of pregnancy. The neurologic adverse effects resolved by the age of 2 weeks without any specific treatment.

In this study by Tapert et alArticle, brain response to alcohol advertisements was studied in 15 adolescents with alcohol abuse and/or dependence and 15 demographically similar youths without alcohol problems. Subjects were shown pictures of alcoholic and nonalcoholic beverage advertisements during functional magnetic resonance imaging. Teens with alcohol abuse or dependence showed substantially more activation to alcohol pictures than to nonalcoholic beverage pictures, a significant difference from controls. Brain response to alcohol pictures was highest in youths with heavier drinking patterns and greater desire to drink

Lyketsos et alArticle assessed the efficacy and safety of sertraline for the treatment of major depression in Alzheimer disease (AD) in a randomized, placebo-controlled, 12-week clinical trial. Sertraline was superior to placebo for the treatment of major depression in AD. Depression reduction was associated with better ratings on activities of daily living, behavioral disturbance, and caregiver distress, but not on cognition. Safety monitoring indicated few differences in adverse effects between the treatment groups