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This Month in Archives of General Psychiatry
March 2004

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2004;61(3):219. doi:10.1001/archpsyc.61.3.219

Uhl and GrowArticlehaveused estimates of the economic impact of prominent neuropsychiatric disordersin the United States, overall heritabilities, and single-gene inheritanceto calculate the effect of complex genetics in psychiatry and neurology. Thelarge effect of oligogenic and polygenic inherited influences motivates effortsto identify the gene variants involved for better prevention and treatment.

Palmer et alArticleevaluatedtreatment-related decisional capacity among middle-aged and older patientswith schizophrenia. Overall, patients with schizophrenia showed less understandingof treatment disclosures than healthy subjects. However, there was also considerableheterogeneity in decisional capacity among patients. Decisional capacity inpatients with schizophrenia was predicted not by demographic characteristicsor severity of psychopathology but by neuropsychological performance. Considerationof cognitive functions may be more relevant to patients' decisional capacitythan demographics or psychopathology.

Van der Stelt et alArticle assessedevent-related brain potentials (ERPs) in patients with schizophrenia and healthysubjects. Patients with schizophrenia displayed deficits in the P3 componentbut not in earlier-occurring sensory-evoked or cognitive-related ERP components.These findings suggest that high-level attention-dependent cognitive deficitscentral to schizophrenia do not originate from preceding deficits at lowerlevels of information processing.

Wade et alArticleusedopposite-sex and same-sex dizygotic twins to examine associations with bulimianervosa (BN) status in one twin with psychopathology in the co-twin. Familialor nonfamilial shared risk factors existed between BN and generalized anxietydisorder, neuroticism, psychoactive substance use, novelty seeking, majordepression, and panic disorder. The shared risk factors between BN and generalanxiety disorder and novelty seeking are only present in men, suggesting afamilial, sex-specific manifestation.

Nelson et alArticleexaminedthe genetic epidemiology of alcohol-induced blackouts in a young adult Australiantwin panel. They found the heritability of lifetime blackouts to be 53% andof having 3 or more blackouts in a year to be 58%. Models that controlledfor respondents' frequency of intoxication found evidence for a significantshared genetic contribution unique to risk for blackouts.

In the treatment of cocaine dependence, no effective pharmacologicalintervention has been identified. Carroll et alArticleconducted a randomized, placebo controlled, double-blindtrial comparing disulfiram with a placebo and cognitive behavioral therapywith interpersonal therapy. Results suggested that disulfiram and cognitivebehavioral therapy are effective therapies for cocaine-dependent individualsand that disulfiram may exert a direct effect on cocaine use rather than throughreducing concurrent alcohol use.

Weissman et alArticlefollowup findings from their genetic linkage study that suggested a possible panicdisorder (PD) syndrome, including bladder problems, thyroid disorders, chronicheadaches and migraine, and mitral valve prolapse. Patients with interstitialcystitis diagnosed by urodynamics or cystoscopy as compared with control subjectshad higher rates of PD and most of the other syndrome conditions as did theirfirst-degree relatives. The possibility of a familial pleiotropic syndromethat may include interstitial cystitis and PD deserves further investigation.

Children with fragile X (fraX) suffer from impaired social functioning,which often includes eye gaze aversion. Garrett et alArticleused functional magnetic resonance imaging to determinewhether individuals with fraX show aberrant brain activation in response toeye gaze and face stimuli. Individuals with fraX had decreased activationof the superior temporal sulcus compared with control subjects, indicatingdeficits in the perception of eye gaze. Subjects with fraX also lacked specificityof fusiform gyrus activation to face orientation, suggesting an absence ofthe normal preference for forward faces rather than angled faces.

In a 2-site neuroimaging study, Lotspeich et alArticleassessed possible neuroanatomical differences betweenAsperger disorder and autism to determine whether these conditions align themselvesalong a severity continuum or constitute distinct biological entities. Cerebralgray tissue volume findings suggest that Asperger disorder is at one end ofthe autism spectrum. However, exploratory assessments of brain-IQ relationshipsindicate neurodevelopmental differences between Asperger disorder and high-functioningautism.

Previous studies have provided evidence that bipolar disorder is associatedwith abnormalities of mitochondrial function, resulting in abnormal energymetabolism. Konradi et alArticle examinedmessenger RNA expression in the hippocampus of patients with bipolar disorderand schizophrenia using microarray technology. They found evidence for relativelyspecific decreased expression of genes regulating mitochondrial function insupport of the hypothesis of abnormal energy metabolism in bipolar disorder.

Gueorguieva and KrystalArticlereviewmethods for analysis of repeated measures data, illustrate the advantagesof mixed-effect models, and assess the extent of the shift from traditionalto mixed-effect approaches in published reports in the ARCHIVES.