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This Month in Archives of General Psychiatry
March 2005

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2005;62(3):242. doi:10.1001/archpsyc.62.3.242

In a meta-analysis of 48 176 individuals with schizophrenia, Palmer et alArticle show the lifetime suicide prevalence in schizophrenia to be only half the 10% figure the literature routinely quotes. Moreover, by dividing the 61 studies into 2 groups—a cohort identified at illness onset and a cohort evaluated from various illness points—they found a suicide prevalence of 5.6% in the former group and 1.8% in the latter. This discrepancy suggests schizophrenic suicides concentrate soon after diagnosis.

Morey et alArticle used functional magnetic resonance imaging during a visual oddball task to study executive-function deficits and associated frontostriatal activation in cohorts at progressive stages of psychotic illness, including experiencing high-risk prodromal symptoms, early schizophrenia, and patients with long-term schizophrenia. Compared with healthy controls, task-related reduction in prefrontal blood oxygenation level activation was observed in the high-risk group with further decrements in groups at progressive stages of illness.

The molecular mechanism of schizophrenia is increasingly demonstrated to be related to abnormalities of synaptic terminals. Sawada et alArticle now report lowered complexin protein in the hippocampus in schizophrenia. Of particular note, they describe for the first time a relationship between antemortem cognitive function and complexin protein in the hippocampus and demonstrate a relationship between normal cognitive function and complexin proteins in a rat model.

Shin et alArticle used functional magnetic resonance imaging to assess responses of the amygdala and medial prefrontal cortex to overtly presented facial expressions of fear to men with and without posttraumatic stress disorder. The results provide evidence for exaggerated amygdala responsivity, diminished medial prefrontal cortex responsivity, and a reciprocal relationship between these 2 regions during passive viewing of fearful vs happy facial expressions in posttraumatic stress disorder.

The amygdala is a brain structure critical for the modulation of anxiety, and anxiolytic drugs are thought to attenuate amygdala activation. Paulus et alArticle used an emotion face assessment task with functional magnetic resonance imaging in healthy volunteers to determine whether lorazepam, a commonly prescribed anxiolytic, attenuated amygdala activation. Lorazepam dose-dependently attenuated activation of the amygdala and insula bilaterally. This result may point to the utility of functional neuroimaging techniques as part of the development process for novel antianxiety therapeutics.

Roy-Byrne et alArticle tested whether established treatments for panic disorder can be successfully transported to the primary care setting where many such patients typically receive care. Two hundred thirty-two patients with panic disorder in 6 clinics in 3 West Coast cities were randomized to receive either a combination of brief (6 session) cognitive-behavioral therapy along with algorithmic pharmacotherapy and psychiatric consultation as needed or care as usual by their primary care physician. Patients receiving the combined intervention showed significantly better treatment outcomes—both in terms of symptom reduction and overall functioning—over the next year, suggesting that evidence-based panic disorder treatments can be effectively delivered in primary care settings.

Using a parametric event-related functional MRI version of the Tower of London task, van den Heuvel et alArticle investigated the neuroanatomical correlates of planning in 22 medication-free patients with obsessive-compulsive disorder and 22 health control subjects. Impaired planning capacity in obsessive-compulsive disorder was associated with decreased responsiveness of the frontal-striatal circuits, mainly dorsolateral prefrontal cortex and caudate nucleus, and increased recruitment of presumably compensatory brain regions.

Van den Bree and PickworthArticle assessed many well-established risk factors in a large sample of adolescents (n = 13 718) and identified robust predictors of development of marijuana use 1 year later. Three factors (own and peer involvement with substances, delinquency, and school problems) were the strongest predictors of risk of initiation, progression, and failure to discontinue marijuana use. Their combined presence put adolescents at a particularly increased risk.

SlutskeArticle compared the prevalences of DSM-IV alcohol use disorders among college students and their non–college-attending peers in a nationally representative sample of young adults in the United States. Although college students had higher rates of drinking and of alcohol abuse, they were not at greater risk than their non–college-attending peers for the more pervasive syndrome of problems that is characteristic of alcohol dependence.

Using data from a 10-year longitudinal epidemiological study with periodic reassessments, Breslau et alArticle found that current daily smoking, butnot past smoking, predicted the subsequent occurrence of suicidal thoughts or attempt, independent of prior major depression, prior substance use disorders, and suicidal predisposition, as indicated by prior suicidal behaviors. Suicidal behaviors are established predictors of completed suicide.

In a prospective cohort of 190 injured children, Kassam-Adams et alArticle evaluated the relationship between heart rate assessed in the emergency department during normal clinical care and posttraumatic stress disorder (PTSD) assessed an average of 6 months’ postinjury. Elevated acute heart rate was associated with the presence of partial or full PTSD at follow-up. Findings are consistent with several adult studies in suggesting an association between early physiological arousal and the development of persistence of PTSD symptoms.