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This Month in Archives of General Psychiatry
June 2009

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2009;66(6):579. doi:10.1001/archgenpsychiatry.2009.59

King et alArticle report the primary outcomes of a 12-week study that examined whether citalopram hydrobromide is effective for the treatment of repetitive behavior in autism. Citalopram was no better than placebo on measures of overall improvement or repetitive behavior. Adverse effects, such as hyperactivity, insomnia, and impulsivity, were more common in the citalopram group compared with placebo.

In a large sample of subjects with schizophrenia, McGrath et alArticle factor analyzed not only symptom and prodrome indicators but also indicators of function in child, adolescent, and adult periods. Nine factors covered traditional (hallucinations, negative, disorganized, affective, Schneiderian first-rank) as well as novel domains (scholastic, child/adolescent sociability, prodromal, and disability/impairment). Factor scores in all domains demonstrated significant familiality, offering a range of phenotypes for genetic analyses.

Most of the antipsychotics in clinical practice have equivalent in vitro affinity for the dopamine D2 and D3 receptors. Using the D3 receptor–preferential positron emission tomography radioligand [11C]-(+)-PHNO [carbon 11–labeled (+)-4-propyl-9-hydroxynaphthoxazine], Graff-Guerrero et alArticle report that long-term antipsychotic treatment including clozapine, olanzapine, or risperidone in schizophrenia is not associated with D3 receptor blockade despite the ongoing D2 receptor blockade.

The association between depression and hypothalamic-pituitary-adrenal axis activity was examined by Vreeburg et alArticle in the Netherlands Study of Depression and Anxiety. As compared with 308 controls, a higher salivary cortisol awakening response was found in 579 persons with remitted and 701 with current major depressive disorder. These findings confirm modest but significantly increased hypothalamic-pituitary-adrenal axis activity among depressed individuals, possibly indicative of an underlying biological vulnerability for depression.

People change place of residence often in contemporary society, which might induce hardship and distress to children and adolescents. Using data from Danish longitudinal registries to include all children born in 1978 to 1995, Qin et alArticle provide evidence on how frequent change of residence is associated with risk for attempted and completed suicide among children and adolescents, indicating a likely dose-response relationship.

Libby et alArticle show that the unintended declines in depression care persisted after the Food and Drug Administration's October 2003 advisory about the risk of suicidality for pediatric patients taking antidepressants and 2005 boxed warning (later extended to include young adults). Through June 2007, reductions in primary care and psychiatry case finding and non–selective serotonin reuptake inhibitor substitute treatment continued for pediatric and young adult patients, as well as adult patients (not targeted by the warnings).

Hicks et alArticle zused a sample of 1315 adolescent twin pairs to examine gene × environment interactions between externalizing disorders (antisocial behavior and substance abuse) and 6 environmental risk factors (measures of peer, family, and school environments). For each environmental risk factor, a significant gene × environment interaction was detected, such that in the context of environmental adversity, genetic factors became more important in the etiology of externalizing disorders.

Dick et alArticle report analyses aimed at characterizing the pathway of risk associated with GABRA2, a gene previously associated with adult alcohol dependence, in a community sample of children, followed up longitudinally from childhood through young adulthood. GABRA2 was associated with persistent, elevated trajectories of externalizing behavior. A significant interaction with parental monitoring emerged whereby the association of GABRA2 with externalizing trajectories was diminished under higher parental monitoring.

Traumatic experiences during childhood are associated with increased risk for developing stress-related neuropsychiatric disorders in later life in humans. To identify brain structural differences that may predict such disorders, Spinelli et alArticle used structural magnetic resonance imaging in monkeys raised either with their mothers or with 3 age-matched animals. An established stress cortex was found in peer-reared compared with mother-reared monkeys, suggesting an increased vulnerability of these regions.

Using single-photon emission computed tomography brain imaging, Cosgrove et alArticle found that tobacco smoking induced increases in available levels of nicotinic acetylcholine receptors containing the β2 subunit that decrease during prolonged abstinence (eg, 4-12 weeks) from tobacco smoking. These marked and persistent changes in receptor availability may contribute to difficulties with tobacco smoking cessation.