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This Month in Archives of General Psychiatry
October 2007

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2007;64(10):1113. doi:10.1001/archpsyc.64.10.1113

Goldberg et al70030 report a clinical trial measuring cognitive response in patients with first-episode schizophrenia at baseline and after 6 and 16 weeks of treatment with second-generation antipsychotics and cognitive change in an unmedicated healthy control group over the same intervals. Cognitive gains were highly significant in both groups, but differences in the magnitude of the gains were few. The authors inferred a practice effect because the same tests were serially administered.

A systematic review of mortality in schizophrenia by Saha et al70001 found that people with schizophrenia are 2.5 times more at risk of dying compared with the general population. In addition to the increased risk of suicide, many causes of death were found to be elevated in schizophrenia. This differential mortality gap has worsened over recent decades.

The TADS Team70027 examined the effectiveness of fluoxetine hydrochloride, cognitive behavior therapy (CBT), and their combination in adolescents with major depressive disorder across 36 weeks of randomized treatment. At 12 weeks, fluoxetine alone and with CBT were superior to CBT alone, which caught up to fluoxetine by week 18. More than 80% of patients in all 3 treatment arms responded after 9 months of treatment. Suicidal events were more common in patients treated with fluoxetine. Combined treatment appears superior to either monotherapy as a treatment for major depression in adolescents.

To evaluate the risk posed by ADHD for early initiation of tobacco, alcohol, and drug use, Elkins et al70031 followed up male and female adolescents from age 11 years through age 18 years. They found that ADHD hyperactivity-impulsivity predicted early substance initiation and the development of nicotine dependence and cannabis abuse/dependence, even when co-occurring conduct disorder was considered, whereas inattention alone did not.

Johnson et al70028 studied with a metacognitive appraisal functional magnetic resonance imaging task 110 healthy adults who differed on apolipoprotein E (APOE4) genetic status and parental history of Alzheimer disease (AD). The researchers found that having a parent with AD significantly reduced activation in the hippocampus and in the medial parietal lobe, suggesting that this risk factor influences brain function in regions commonly affected by AD.

In an ancillary study of the Women's Health Initiative, Smoller et al70026 found that postmenopausal women reporting a 6-month history of panic attack had 4-fold increased odds of coronary heart disease, 3-fold increased odds of stroke, and 75% increased odds of all-cause mortality during prospective follow-up. The increased risks, observed after controlling for potential confounders, suggest that panic attacks are an independent risk factor for cardiovascular morbidity and mortality in older women.

Brotman et al70021 examined whether a psychosocial intervention that promotes social competence and prevents aggression in preschoolers alters cortisol response in children at risk for psychopathologic disorders. In the context of a randomized trial, relative to controls, children receiving the intervention had increased cortisol levels when anticipating peer social challenge. The study demonstrates that a preventive intervention for high-risk children alters the stress response.

Merikangas et al70012 investigated the comparative effects of common mental and physical conditions on role disability in a representative household sample of the US population using a novel method that accounts for comorbidity. Adults with 1 or more mental or physical conditions reported an average of 32.1 more role-disability days in the past year than demographically matched controls.

Dempster et al70038 report a significant association with the vasopressin V1b receptor gene (AVPR1B) and childhood-onset mood disorders, particularly in females. The vasopressin V1b receptor is involved in the regulation of the hypothalamic-pituitary-adrenal (HPA) axis under stress; hence, genetic variation in AVPR1B may have implications on the HPA axis dysregulation in mood disorders, particularly in females.

Using data from the 2001-2003 National Comorbidity Survey Replication, Druss et al70025 report that 82.3% of US mental health service users had a lifetime or 12-month diagnosis, 9.7% had another indication of possible need for treatment, and the remaining 8.0% primarily received their care outside of the formal medical system. The findings may help allay concerns about overuse of services in persons without current mental disorders.

Wilson et al70032 annually examined nearly 1000 older Catholic clergy members for up to 12 years. Higher levels of the personality trait conscientiousness were associated with decreased incidence of Alzheimer disease and mild cognitive impairment and reduced cognitive decline, especially in episodic memory. Among those who died and underwent brain autopsy, conscientiousness was unrelated to amyloid burden, tangle density, Lewy bodies, or cerebral infarction.