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This Month in Archives of General Psychiatry
December 2005

This Month in Archives of General Psychiatry

Author Affiliations

Copyright 2005 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2005

Arch Gen Psychiatry. 2005;62(12):1293. doi:10.1001/archpsyc.62.12.1293

In a longitudinal study of a population-based cohort of 555 326 adolescents born in Israel, Reichenberg et alArticle report that lower-than-expected IQ at age 17 years was associated with increased risk for later hospitalization with schizophrenia. For 40% of patients with schizophrenia, actual IQ at age 17 years was 10 points or more lower than expected. Lower-than-expected IQ was not associated with bipolar disorder or depression or anxiety, indicating possible differences in some areas of the neurodevelopmental etiology of these disorders.

The use of a placebo-controlled design has been hypothesized to be one of the reasons for the high dropout rates seen in randomized clinical trials of antipsychotics. Investigating this issue in a meta-analysis of 31 randomized clinical trials of new-generation antipsychotics, Kemmler et alArticle found mean dropout rates in active treatment arms to be substantially higher in placebo-controlled trials (PCTs) than in trials with active comparators. This limits the generalizability of results obtained with PCTs. They conclude that in addition to PCTs, studies with alternative designs should be considered when evaluating an antipsychotic’s clinical profile.

In an 8-site randomized controlled trial (IMPACT) of collaborative care vs usual primary care in 1801 elderly patients with depression, Katon et alArticle found that intervention compared with usual care patients experienced 107 more depression-free days at a low incremental cost of $295 over a 24-month period. The IMPACT intervention is a high-value investment for older adults given that it is associated with marked clinical benefit and low incremental costs.

Judd et alArticle investigated the psychosocial disability and affective symptom severity during the long-term course of bipolar I and bipolar II disorders. Disability was not significantly different between bipolar I and bipolar II disorder, except that bipolar II disorder hypomania was not disabling. Increases in affective symptom severity were generally associated with significant stepwise increases in disability. Depressive symptoms were either equal or significantly more disabling than manic symptoms. Psychosocial function normalized to good levels when patients were asymptomatic.

Rollman et alArticle tested a telephone-based collaborative care strategy for panic and generalized anxiety disorders at 4 primary care practices linked by an electronic medical record system. At 12 months of follow-up, intervention patients reported significantly lower levels of anxiety symptoms, improved health-related quality of life, and better employment outcomes than usual care patients. These findings have key implications for other health care systems, employers, and rural and urban inner-city settings presently lacking mental health specialists.

Breslau et alArticle examined the underlying structure of DSM-IV posttraumatic stress disorder in data from 2 community samples. In both samples, latent class analysis yielded 3 classes that varied by level of severity (no disturbance, intermediate disturbance, and pervasive disturbance) and qualitatively, with emotional numbing distinguishing the class with pervasive disturbance. Members of this class were far more likely to report use of medical care and disruption in activities. The 3-class structure also helped identify population subgroups of trauma patients with low risk for any disturbance.

Using data from the National Epidemiologic Survey on Alcohol and Related Conditions, Markon and KruegerArticle directly compared categorical and continuous models of externalizing liability. Results indicated that liability to externalizing disorders is not discrete but rather graded and continuous normal in distribution. A continuous model of externalizing liability delineates degrees of severity among externalizing disorders and provides a phenotypic framework for etiologic and treatment studies.

People with Down syndrome (DS) have mental retardation and a very high risk of Alzheimer disease. The myo-inositol transporter gene is located on chromosome 21, and myo-inositol affects neuronal function and amyloid deposition. Beacher et alArticle investigated hippocampal myo-inositol concentration in adults with DS and controls. Adults with DS had a significantly increased myo-inositol concentration, and this was associated with reduced cognitive ability. Increased myo-inositol concentration may also increase the risk for Alzheimer disease because it is amyloidogenic.

Hazlett et alArticle report findings from a brain magnetic resonance imaging study of 51 children with autism and 25 control children between 18 and 35 months of age. Generalized enlargement of gray and white matter cerebral volumes, but not cerebellar volumes, was found. Retrospective longitudinal head circumference measurements gathered on a larger sample of individuals with autism and controls suggest that this increased rate of brain growth may have its onset postnatally in the latter part of the first year of life.

Kiecolt-Glaser et alArticle assessed how marital behaviors modulated wound healing and proinflammatory cytokine production. Couples’ blister wounds healed more slowly following marital conflicts than after supportive interactions. More hostile couples produced relatively larger increases in systemic proinflammatory cytokine production after conflicts than after supportive interactions compared with less hostile couples. Consistent with evidence linking marital discord with morbidity and mortality, the data provide a window into how abrasive relationships affect health.