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This Month in Archives of General Psychiatry
November 2010

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2010;67(11):1108. doi:10.1001/archgenpsychiatry.2010.141

Cutajar et al studied a cohort of 2759 children ascertained as having been sexually abused and followed up to 44 years of age. Compared with matched comparisons, victims of childhood sexual abuse were significantly more likely to be diagnosed with a psychotic disorder. The likelihood of developing a schizophrenic disorder was even higher among victims at 2.6 times.

Most environmental risk factors for psychiatric disorders cannot be studied experimentally, making causal attributions difficult. Kendler and Gardner used a natural experiment (twins) and a statistical method (propensity score matching) to determine the causal relationship between dependent stressful life events, prior depressive episodes, and major depression. The 2 methods agreed that although dependent stressful life events and probably prior depressive episodes causally impact risk for major depression, much of the observed association is noncausal.

Victor et al obtained evidence of an implicit mood-congruent emotional processing bias between patients with a current or past major depressive disorder and healthy controls using functional magnetic resonance imaging. Unmedicated patients with major depressive disorder, irrespective of mood status, showed a loss of the normal response to masked happy faces and in contrast manifested an abnormal response to masked sad faces. The negative emotional processing bias resolved while a positive bias developed in depressed patients during antidepressant treatment.

The vascular depression hypothesis proposes that vascular factors precede the onset of depression in older adults. Newson et al sought to test this hypothesis by examining the association between generalized atherosclerosis and subsequent depressive events across a 6-year period. In this population-based cohort of 3564 older adults, none of the multiple measures of atherosclerosis were found to influence the risk of developing incident depressive symptoms or syndromes.

Ilgen et al examined the association between different types of psychopathology and the risk of suicide in the population of patients receiving health care services from the Department of Veterans Affairs. They found that patients with bipolar disorder had the greatest estimated risk of suicide among men and patients with substance use disorders had the greatest risk among women.

Kuntsi et al examined whether multiple cognitive impairments in attention-deficit/hyperactivity disorder (ADHD) share etiological roots or whether separate etiological pathways exist. Multivariate familial factor analysis on ADHD and control sibling pairs revealed 2 familial cognitive factors, which together accounted for 97.5% of the familial influences on ADHD. The familial separation between reaction time (85%) and accuracy (12.5%) factors is consistent with models distinguishing between a vigilance decrement and top-down control of attention and inhibition.

Kessler et al carried out psychometric analyses of clinical reappraisal data in 2 community surveys to assess the structure and symptoms of DSM-IV adult attention-deficit/hyperactivity disorder (ADHD). They documented greater adult persistence of inattentive than hyperactive/impulsive symptoms but found that executive functioning symptoms were the most important ones in detecting adult ADHD. They concluded based on this result that the number of executive functioning symptoms should be increased in the DSM-5 / International Statistical Classification of Diseases, 11th Revision assessments of adult ADHD.

Fang et al examined the association between retrospectively reported childhood attention-deficit/hyperactivity disorder and conduct disorder (CD) symptoms and physical intimate-partner violence perpetration in a population-based sample of young adults. Conduct disorder was consistently associated with violence in intimate relationships. Attention-deficit/hyperactivity disorder was also associated with intimate-partner violence, controlling for CD. Results emphasize the need for treatment approaches that address the risks for violence and promote healthy relationships for youth with CD and attention-deficit/hyperactivity disorder.

Using magnetic resonance imaging to study a cohort of children with a narrow age range of 6 to 7 years, Kim et al found that children with autism spectrum disorder had enlarged laterobasal subregions of the amygdala and that these alterations were associated with deficits in social and communicative behavior. This study suggests the particular involvement of this subregion of amygdala in the pathophysiology of autism spectrum disorder.