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This Month in Archives of General Psychiatry
December 2009

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2009;66(12):1285. doi:10.1001/archgenpsychiatry.2009.162

Using functional magnetic resonance imaging, Green et alArticle examined the neural basis for visual masking deficits in schizophrenia. Two regions of interest (lateral occipital complex and the human motion selective cortex) showed increased signal as a visual target became more visible. Patients failed to activate the lateral occipital complex as much as controls during masking, suggesting a neural basis for visual masking impairment.

Meyer et alArticle used carbon 11–labeled harmine positron emission tomography to measure monoamine oxidase A (MAO-A) binding in different states of major depressive disorder (MDD). They found elevated MAO-A binding in affect-modulating brain regions during depressive episodes, during remission after selective serotonin reuptake inhibitor treatment, and during recovery. In subjects with MDD in recovery, greater MAO-A binding in the prefrontal and anterior cingulate cortex was associated with subsequent recurrence.

Using cross-sectional data from the US National Health and Nutrition Examination Survey (1999-2004), Bouchard et alArticle report on the association between blood lead levels (BLLs), major depressive disorder, and panic disorder. Compared with those in the lowest BLL quintile, persons in the highest BLL quintile had a 2-fold increase in the odds of meeting the DSM-IV criteria for major depressive disorder and a 5-fold increase for panic disorder after adjustment for covariates.

High neuroticism captures much of the genetic vulnerability to depression, and low extraversion may also increase risk. Both personality dimensions have been linked to the serotonin system. Tang et alArticle found that paroxetine, a selective serotonin reuptake inhibitor, produced substantial personality change in a depression treatment clinical trial. The personality change was not dependent on depression improvement, and change in these personality risk factors may have contributed to short-term and long-term treatment outcomes.

Serfaty et alArticle conducted a randomized trial (n = 204) comparing cognitive behavioral therapy plus treatment as usual (TAU), a talking control plus TAU, or TAU alone for people 65 years and older with geriatric mental state depression in primary care. Cognitive behavioral therapy led to greater reductions in Beck Depression Inventory-II scores immediately posttreatment (4 months) and after 10 months. Audio recordings showed cognitive behavioral therapy differed from talking control on specific but not nonspecific factors (eg, empathy and warmth) in therapy.

In a prospective longitudinal community study, Zimmermann et alArticle examined how many cases of DSM-IV major depressive disorder (MDD) would be reclassified as bipolar disorder by broadening the criteria for mania/hypomania and whether these cases are distinct from pure MDD. Differences between pure MDD (60%) and subthreshold bipolar disorder (40%) were found for a range of validators of bipolarity (eg, family history of mania, comorbid mental disorders, and conversion into bipolar disorder).

In a cohort of 47 918 patients with bipolar disorder, Gibbons et alArticle studied the 11 antiepileptic drugs (AEDs) highlighted by the Food and Drug Administration in their recent warning to determine if they were associated with increased rates of suicide attempts. Overall, there was no significant difference in suicide attempt rates associated with AED treatment; however, relative to pretreatment levels, suicide attempt rates were significantly decreased following AED treatment. In patients receiving no concomitant central nervous system drug treatment, AED treatment was associated with significantly reduced suicide attempt rates.

The amygdala is understood to great anatomical detail in animals, but not in people. Etkin et alArticle used functional magnetic resonance imaging measures of functional connectivity to dissociate the major subregions of the amygdala in healthy subjects. Connectivity patterns were less distinct in patients with generalized anxiety disorder, pointing to an intra-amygdalar abnormality at the subregional level. Patients' amygdalae were also abnormally connected with a compensatory frontoparietal executive control network, consistent with cognitive theories of generalized anxiety disorder.

Woodward et alArticle measured cortical volume, thickness, and area in a sample of 97 combat veterans. In those with posttraumatic stress disorder, the cortex was found to be both globally smaller and focally smaller in regions subserving facilitated identification of objects and words. Compromise of these brain regions may impair recontextualization of the physical and social environments.