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This Month in Archives of General Psychiatry
October 2006

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2006;63(10):1065. doi:10.1001/archpsyc.63.10.1065

Jones et alArticle tested the hypothesis that second-generation, atypical antipsychotic drugs would lead to better quality of life over 1 year in people with schizophrenia when compared with the older and cheaper first-generation drugs. The hypothesis was rejected in a randomized controlled trial funded by and set in the English National Health Service. Moreover, patients showed no preference for either class of drug.

Koo et alArticle evaluated 30 never-medicated, female, community-recruited subjects with schizotypal personality disorder and found bilaterally smaller (approximately 3.8%) magnetic resonance imaging neocortical gray matter volumes associated with larger sulcal cerebrospinal fluid volumes (approximately 9.6%) than in 29 healthy female controls. Subjects with schizotypal personality disorder with larger lateral ventricles had worse positive (cognitive-perceptual) and negative (interpersonal) symptoms on the Schizotypal Personality Questionnaire–Brief Version. Voxel-based morphometry showed deficits in left temporal, bilateral parietal, and right frontal gyri.

Van Den Bogaert et alArticle performed a HapMap-based haplotype-tagging single nucleotide polymorphism patient-control association study to determine the role of the brain-specific tryptophan hydroxylase TPH2 in the pathogenesis of unipolar and bipolar disorder in a northern Swedish, isolated population. They provide preliminary evidence for the association of a protective haplotype in both disorders and thus suggest a central role of TPH2 in the pathogenesis of affective disorders.

Twenty thousand twins from the Swedish Twin Registry completed a self-report questionnaire assessing personality and were personally interviewed for lifetime major depression more than 25 years later. Kendler et alArticle found that longitudinal and genetic analyses both support the hypothesis that neuroticism strongly reflects the liability to major depression, and this association results largely from shared genetic risk factors. By contrast, extraversion was only weakly related to risk for depression.

Furey and DrevetsArticle investigated the effectiveness of the antimuscarinic agent scopolamine in treating symptoms of depression. In a double-blind, placebo-controlled crossover study, currently depressed unipolar and bipolar patients showed marked improvement in depressive symptoms relative to placebo following a single intravenous administration of scopolamine.

Geller et alArticle used a direct-interview, blinded, controlled family study of 690 first-degree relatives to examine familial aggregation in child bipolar I disorder. Findings included significant differences between the child bipolar I disorder and attention-deficit/hyperactivity disorder groups but not between the attention-deficit/hyperactivity disorder and healthy control probands’ morbid risk to relatives; a 7- to 8-fold increase of aggregation compared with adult probands with bipolar disorder; and earlier age at onset in probands than parents.

In analyses from a large multicenter study of children and adolescents with bipolar (BP) spectrum disorders, Axelson et alArticle demonstrated that youth with BP-II and BP not otherwise specified (NOS) have a phenotype that exists on a continuum with youth with BP-I. Youth with BP-NOS had family psychiatric history, manic symptoms, and diagnostic comorbidity similar to those with BP-I. Subjects with BP-NOS were not diagnosed as having BP-I or BP-II primarily because they fell short of the DSM-IV duration criteria for manic, mixed, or hypomanic episodes.

Ramelteon is a novel insomnia medication acting at MT1 and MT2 melatonin receptors. Johnson et alArticle conducted a double-blind, inpatient comparative pharmacology abuse liability study in sedative abusers that evaluated a wide range of ramelteon doses relative to triazolam and placebo. Ramelteon demonstrated no effects indicative of potential for abuse or motor or cognitive impairment, whereas triazolam showed effects consistent with its profile as a sedative drug with abuse liability. Ramelteon may represent a useful alternative to existing insomnia medications.

Davidson et alArticle report the results of a 6-month, multicenter trial of extended-release venlafaxine in posttraumatic stress disorder (PTSD). The drug was superior to placebo on core PTSD symptoms, resilience, daily function, quality of life, and vulnerability to the effects of daily stress. Rates of remission were 51% for drug and 37% for placebo at the end of treatment. Resilience took longer to improve than did core PTSD symptoms. Drug superiority was maintained throughout the full treatment period (ie, beyond 12 weeks).