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This Month in Archives of General Psychiatry
February 2006

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2006;63(2):124. doi:10.1001/archpsyc.63.2.124

Velakoulis et alArticle examined hippocampal and amygdala volumes in patients with different stages of schizophrenic and nonschizophrenic psychoses compared with controls. Patients with schizophrenic psychoses exhibited smaller hippocampi and those with nonschizophrenic psychoses, enlarged amygdala. Both structures were normal in a high-risk population. This study supports the possibility that medial temporal structural changes occur early in psychosis and that different structures are involved depending on the type and stage of psychotic illness.

In a prospective epidemiological study of a rural Pennsylvanian community, Ganguli et alArticle found that baseline depressive symptoms were associated with lower baseline cognitive test performance but not with subsequent cognitive decline in 1094 individuals who remained free of dementia during 12 years of follow-up. They conclude that substantial cognitive decline over time most likely reflects incipient dementia.

Mild cognitive impairment (MCI) and late-life depression are each associated with increased dementia risk; however, investigations of these conditions largely have proceeded along separate tracks. Steffens et alArticle present the data reviewed at the NIMH conference “Perspectives on Depression, Mild Cognitive Impairment, and Cognitive Decline” and participants' recommendations for better integrating research in depression and MCI.

Rapp et alArticle found patients with Alzheimer disease (AD) and a history of major depressive disorder demonstrated a higher number of plaques and tangles in the hippocampus compared with patients with AD and no depression history. These effects were specific to the hippocampal formation and went along with a faster cognitive decline, suggesting that depression comorbidity may accelerate the neuropathological processes in AD.

To test the relative influence of genetic environmental factors in Alzheimer disease, Gatz et alArticle evaluated all older twins in the Swedish Twin Registry. Genetic factors were the major contributor to risk for this disease. Monozygotic were more similar than dizygotic twins in age at onset. There was no significant moderation of genetic effects by sex. Nongenetic factors also influenced risk of disease and timing of onset.

In weekly symptom analyses of a 2-year longitudinal multicenter study of a large sample of children and adolescents with bipolar (BP) spectrum disorders, Birmaher et alArticle showed a continuum of BP symptom severity from subsyndromal to full syndromal with frequent mood fluctuations. High rates of conversion from BP-II to BP-I and from BP not otherwise specified to BP-I or BP-II were observed. Early onset, BP not otherwise specified, long duration, low socioeconomic status, and psychosis were associated with poorer outcomes and rapid mood changes.

Using PET to study general emotional processing in posttraumatic stress disorder (PTSD), Phan et alArticle examined corticolimbic responses to emotionally negative but trauma-unrelated visual images in Vietnam veterans with combat-related PTSD, combat-exposed Vietnam veterans without PTSD, and age- and sex-matched healthy controls. The results show differential reactivity in the amygdala and ventral medial prefrontal cortex among the 3 groups, providing evidence for both disorder-specific alterations and compensatory changes following trauma exposure that are not associated with PTSD.

Pizarro et alArticle conducted an archival examination of Civil War military and postwar medical records of more than 15 000 Union Army veterans. Substantial long-term health effects of traumatic war experiences were identified. Greater exposure to death of military comrades and younger exposure to war trauma were associated with increased signs of cardiac, gastrointestinal tract, and nervous disease across the veterans' lifetimes.

Peirce et alArticle compared outcomes when a lower-cost prize-based contingency management intervention was added to usual care in community methadone maintenance treatment settings. Incentive participants were twice as likely as usual care participants to submit stimulant- and alcohol-negative samples and 11 times more likely to achieve 12 weeks of continuous abstinence.

Comer et alArticle investigated the safety and effectiveness of an injectable, sustained-release formulation of naltrexone for the treatment of heroin dependence. During the 2-month trial, retention in treatment was significantly greater in patients who received 384 mg of naltrexone compared with placebo and 192 mg of naltrexone. These results provide new evidence for the feasibility, efficacy, and tolerability of a long-lasting antagonist for the treatment of opioid dependence.

Clinical trials for drug addiction seldom compare combined behavioral and medication treatments with either treatment alone. In a 25-week study with methadone-maintained cocaine users, Poling et alArticle found that a combination of the behavioral treatment contingency management and bupropion hydrochloride was superior to either treatment alone or a placebo condition. Subjects in this combined treatment condition submitted significantly fewer cocaine-positive urine samples and attained significantly longer consecutive weeks of abstinence.