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This Month in Archives of General Psychiatry
October 2003

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2003;60(10):967. doi:10.1001/archpsyc.60.10.967

It is now widely accepted that the antipsychotic effects of dopamine receptor antagonists occur within a "therapeutic window" between about 60% and 80% dopamine receptor occupancy. Based on their positron emission tomography study with the partial dopamine receptor agonist aripiprazole, Gründer et al Article suggest that this rule only applies to antagonists and that, consequently, the expected receptor occupancy for a therapeutic window has to be adjusted when studying partial agonists, which could represent a new class of "atypical" antipsychotics.

Recent growth of antidepressant use by adolescents and declines in adolescent suicide raise the possibility that antidepressants have helped prevent youth suicide. Olfson et al Article examined regional changes in antidepressant medication use and youth suicide between 1990 and 2000. Five hundred eighty-eight geographic regions were examined. A 1% increase in adolescent use of antidepressants who associated with a decrease of 0.23 suicides per 100 000 adolescents per year. This observation supports a role for antidepressant treatment in youth suicide-prevention efforts.

In a magnetic resonance imaging study, Kemether et al Article found reduced volume of 3 thalamic nuclei in schizophrenia: the mediodorsal nucleus, the pulvinar and, for the first time, the centromedian nucleus. Volume of the remainder of the thalamus showed no patient-control differences, so the reduction was specific to the delineated nuclei, all of which are reciprocally connected to schizophrenia-associated cortical regions. In 15 neuroleptic-naive patients, volume of the remainder of the nuclei was reduced, eliminating antipsychotics as an explanatory factor.

Merikangas et al Article report findings from the Zurich Cohort Study, a 15-year prospective community study of young adults that examined the stability, comorbidity, and diagnostic thresholds of depression and anxiety at 5 intervals. The results showed a remarkable longitudinal stability of comorbid depression and anxiety, as compared with the persistence of either syndrome alone, as well as fluctuations between threshold and subthreshold levels of these disorders over time. The study has implications for the classification, treatment, and pathogenesis of these conditions.

Fitzgerald et al Article conducted a randomized double-blind trial of high-frequency left prefrontal and low-frequency right prefrontal repetitive transcranial magnetic stimulation. Both active treatments were superior to sham stimulation, although the degree of clinical response achieved during 10 sessions of treatment was limited. More clinically significant improvement appeared to occur when the subjects received a further 10 sessions of treatment in an extension phase of the trial.

Depression is associated with enhanced production of proinflammatory cytokines that influence a spectrum of conditions associated with aging. Glaser et al Article assessed the relationship between depressive symptoms and changes in an inflammatory response (plasma levels of interleukin 6) following an influenza virus vaccination. The results show that even modest depressive symptoms may sensitize the inflammatory response system in older adults, producing amplified and prolonged inflammatory responses following infection and other immunological challenges.

Personality traits, which can be readily measured by a number of rating scales, show a considerable heritable component. Melke et al Article investigated the relationship between normal personality traits and a functional polymorphism in one of the genes(HTR3A) encoding the serotonergic receptor 5-HT3. In 2 independent samples of women recruited from the normal population, an association with the personality trait "harm avoidance" was observed. The study thus provides further support for an influence of specific genes on the variance in personality traits in the general population.

Ehlers et al Article demonstrate that cognitive therapy is an effective early intervention for recent onset posttraumatic stress disorder (PTSD). In their randomized controlled trial, fewer cognitive therapy patients (11%) suffered from PTSD at follow-up than those receiving a self-help booklet (61%), or repeated assessments (55%) only. A combination of an elevated initial symptom score and failure to improve with self-monitoring was effective in identifying a group of patients with early PTSD symptoms who were unlikely to recover without treatment.

Fergusson et al Article used data gathered during a 21-year longitudinal study to examine the relationships between early subjective reactions to cannabis use and later cannabis dependence. Results show that increasing early positive responses to cannabis were strongly related to later dependence. These findings suggest the presence of individual differences in early responsiveness to cannabis that predispose individuals to longer-term cannabis dependence.

Higgins et al Article examined the efficacy of treating cocaine-dependent outpatients with community reinforcement therapy combined with voucher-based incentives delivered contingent on abstinence. Combined community reinforcement therapy and incentives increased retention rates, decreased cocaine and alcohol abuse, and improved several indices of psychosocial functioning compared with treatment with incentives only.