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This Month in Archives of General Psychiatry
March 2006

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2006;63(3):242. doi:10.1001/archpsyc.63.3.242

In a large population-based study of first-onset psychoses, Kirkbride et alArticle demonstrated heterogeneity in the incidence of several psychotic syndromes, including schizophrenia and the affective psychoses, according to age, sex, ethnicity, and place. This finding challenges the assumption of similar incidence across diverse populations.

In siblings from families of patients with schizophrenia, Hong et alArticle observed significantly higher familiar correlation and heritability for predictive smooth pursuit gain as compared with the traditional maintenance pursuit gain, which measures the overall performance of the pursuit system. Thus, more elementary components of the smooth pursuit eye movement system are better endophenotypes for genetic studies.

To examine if inpatient adverse events are more prevalent for persons with schizophrenia than those without schizophrenia, Daumit et alArticle studied discharges from Maryland acute care hospitals' medical and surgical services. They found persons with schizophrenia had at least twice the odds of several types of adverse events during medical and surgical hospitalizations than those without schizophrenia. These adverse events were associated with poor economic and clinical outcomes, including death.

Barnes et alArticle report that older adults with normal cognitive function and moderate or high levels of depressive symptoms at baseline were twice as likely to develop mild cognitive impairment over 6 years of follow-up. This association was independent of demographic factors and vascular disease. These findings support the hypothesis that depressive symptoms may be a risk factor for or early symptoms of dementia in some elderly people.

Major depression (MDD) observed after a coronary event is often perceived as a reaction to that event. Glassman et alArticle found that more than one half of such MDD episodes begin before the coronary event. Furthermore, this study indicates that episodes beginning before hospitalization, prior MDD episodes, and severity all independently predict drug benefit and should influence treatment decisions.

Prevention of late-life depression may be a means to generate health gains and reduce future costs. Smit et alArticle used data from a population-based cohort of 2200 elderly people to identify combinations of risk factors that predict maximum health gains against minimum cost when these risk factors are targeted by preventive interventions.

Social anxiety disorder is commonly treated with exposure-based therapy, which partly relies on extinction learning. Animal studies have shown that D-cycloserine, a partial agonist at the N-methyl-D-aspartate receptor, facilitates extinction learning. Hofmann et alArticle report that patients receiving acute dosing of D-cycloserine in addition to exposure therapy showed greater improvement than patients receiving exposure therapy plus placebo.

In a prospective study of the Swedish Twin Registry, Bulik et alArticle report the heritability of anorexia nervosa to be 0.56. The prevalence of anorexia nervosa was higher in male and female participants born after 1945, and premorbid neuroticism was associated with the subsequent development of anorexia nervosa. Individuals who survive anorexia nervosa also appear to be at lower risk for the development of overweight later in life.

In a family study, Hudson et alArticle found that binge-eating disorder (BED) is a familial disorder that is caused in part by factors distinct from other familial factors for obesity. Furthermore, these BED-specific familial factors, which may be genetic, appear to increase the risk of obesity—especially severe obesity. It follows that targeted interventions, capable of preventing or treating traits influenced by these BED-specific familial factors, could reduce the public health burden of obesity.

Sinha et alArticle examined whether stress-induced and drug cue–induced cocaine craving and hypothalamic-pituitary-adrenal axis responses predicted subsequent relapse outcomes in cocaine-dependent individuals completing inpatient treatment. Greater stress-induced craving was associated with a shorter time to cocaine relapse. Stress-induced corticotropin and cortisol responses also predicted higher amounts of cocaine used during follow-up.

Hammad et alArticle, from the Food and Drug Administration (Rockville, Md), provide the results of a meta-analysis of 24 placebo-controlled, short-term antidepressant trials in approximately 4600 pediatric patients to investigate the relationship between the use of antidepressants and suicidality (suicidal ideation and behavior). The overall risk ratio for all drugs across all indications was 1.95 (95% confidence interval, 1.28-2.98), representing an overall risk difference of 2 per 100 patients treated. The Food and Drug Administration advises careful monitoring for emergent suicidality in youth receiving antidepressants.