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This Month in Archives of General Psychiatry
January 2010

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2010;67(1):5. doi:10.1001/archgenpsychiatry.2009.182

Rasmussen et al assessed in vivo brain serotonin2A (5-HT2A) receptor binding potentials in 30 antipsychotic-naive patients with first-episode schizophrenia and matched healthy control subjects. The patients had significantly lower 5-HT2A receptor binding in the frontal cortex than control subjects. A significant negative correlation was observed between frontal cortical 5-HT2A receptor binding and positive psychotic symptoms in male patients.

Morrato et al report 27% of new users of second-generation antipsychotics in a 3-state sample of Medicaid clients received baseline serum glucose testing and 10% received baseline lipid testing. Testing rates did not increase following the 2004 Food and Drug Administration diabetes warning and American Diabetes Association screening recommendations.

Mojtabai and Olfson report a marked increase in psychotropic polypharmacy within office-based psychiatric practice in the United States between 1996 and 2006. Visits with 2 or more medications increased from 42.6% in 1996-1997 to 59.8% in 2005-2006, while visits with 3 or more medications increased from 16.9% to 33.2%. Significant increases occurred in psychiatric visits with 2 or more antidepressants, antipsychotics, sedative-hypnotics, and antidepressant-antipsychotic combinations.

González et al report that too few Americans with recent major depressive disorders receive adequate depression care, particularly African American and Mexican American individuals, who may be facing greater barriers to care. Nationally, psychotherapy is more commonly used than pharmacotherapy by mental health providers treating patients with recent major depressive disorder.

Using data from a prospective, longitudinal community study, Beesdo et al showed that anxiety and depressive disorders differ in temporal longitudinal patterns and risk constellations; generalized anxiety disorder is more closely related to anxiety than depressive disorders. Grouping generalized anxiety disorder with depressive disorders appears premature and minimizes the importance of longitudinal data on risk factors and symptom trajectories.

Nakamura et al found significant reductions in the serotonin transporter binding throughout the brain in autistic individuals compared with controls. The reduction in the cingulate cortices was associated with the impairment of social cognition, while those in the thalamus were associated with repetitive/obsessive behavior and interests. In contrast, dopamine transporter binding was significantly higher in the orbitofrontal cortex.

Webb et al examined risk of sudden infant death syndrome (SIDS) linked with hospitalized parental mental illness in the Swedish population during 1978-2004. They found elevated risk if either parent had a history of psychiatric admission. Higher prevalence of SIDS risk factors persisted in this group, and relative risks increased substantially, following a 1992 national risk-reduction campaign. Maternal smoking at antenatal booking was a key determinant of elevated SIDS risk in this population postintervention.

In a longitudinal study, Schwartz et al report regional differences in the thickness of adult orbitofrontal and ventromedial prefrontal cerebral cortex in 76 subjects that are predicted by temperamental differences observed in these subjects at 4 months of age. These findings could represent an early temperamental marker of vulnerability to depressive and anxiety disorders.

Conrod et al showed in a large, randomized trial with high school students that the likelihood of 2-year survival as a non–drug user was significantly increased following participation in a 2-session group intervention targeting 1 of 4 personality risk factors for adolescent substance misuse and mental health problems.

Wilson et al treated overweight or obese patients with binge eating disorder with interpersonal psychotherapy, behavioral weight loss therapy, or guided self-help based on cognitive-behavioral principles (CBTgsh). Interpersonal psychotherapy and CBTgsh were significantly more effective in eliminating binge eating at the 2-year follow-up. Results suggest that CBTgsh is a first-line treatment for the majority of patients with binge eating disorder, with interpersonal psychotherapy recommended for patients with low self-esteem and high Eating Disorder Examination scores.