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This Month in Archives of General Psychiatry
August 2004

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2004;61(8):761. doi:10.1001/archpsyc.61.8.761

Neumeister et alArticle havestudied unmedicated recovered patients with depression and healthy controlsusing tryptophan depletion and positron emission tomography. They show thattryptophan depletion, which induces a transient decrease in brain serotoninfunction, unmasks abnormal regional glucose metabolism in a circuit includingthe orbitofrontal cortex, medial thalamus, anterior and posterior cingulatedcortices, and the ventral striatum. The results suggest a trait abnormalityin depression.

Brown et alArticle examinedwhether serologically documented prenatal exposure to influenza was associatedwith an increased risk of schizophrenia and other schizophrenia spectrum disordersin a large birth cohort with archived maternal serum samples. The risk ofschizophrenia and spectrum disorders was increased 3-fold for influenza exposurein early to midpregnancy and was increased 7-fold for influenza in the firsttrimester. These findings represent the first serologic evidence that prenatalinfluenza is associated with schizophrenia.

Chang et alArticle usedfunctional magnetic resonance imaging to determine whole brain activationpatterns in children with euthymia with familial bipolar disorder comparedwith controls when performing both a visuospatial working memory task anda task involving watching valenced emotional stimuli. Both tasks revealedpredominant overactivation in the prefrontal and subcortical limbic areas.These findings support a model of prefrontal-subcortical dysregulation, whetherelicited by cognitive or emotional tasks, as a trait finding in pediatricbipolar disorder.

Dougherty et alArticle usedan emotion-induction paradigm in conjunction with positron emission tomographyto measure regional cerebral blood flow changes during anger induction inpatients with major depression with or without anger attacks and healthy volunteers.Patients with major depression with anger attacks exhibited dysfunction inthe left ventromedial prefrontal cortex and left amygdala during anger induction,which differentiated them from patients with major depression without angerattacks and healthy volunteers.

Grant et alArticle examinedthe current prevalence and comorbidity of DSM-IV substanceuse disorders and independent mood and anxiety disorders. Independent moodand anxiety disorders included only those that were not substance-inducedor due to a general medical condition. Associations between substance usedisorders and mood and anxiety disorders were positive and significant, suggestingthat treatment for a comorbid mood or anxiety disorder should not be withheldfrom individuals with substance use disorders.

Data from animal studies indicate the adrenal steroid dehydroepiandrosteonesulfate (DHEA-S) may diminish the negative impact of stress. Morgan et alArticle assessed plasma DHEA-Sand cortisol levels, psychological symptoms of dissociation, and militaryperformance in soldiers exposed to acute, uncontrollable stress. Soldierswith greater levels of DHEA-S exhibited fewer stress-induced symptoms of dissociationand superior military performance. These data provide evidence that DHEA-Smay have buffered the negative effect of acute stress in healthy subjects.

Miranda et alArticle evaluatedthe effect of evidence-based depression care comparing ethnic minority andnonminority participants who were treated in their primary health care setting.They used instrumental variable techniques to account for selection bias,which occurs because those who have worse depression receive treatment. Thedepression care was equally effective for lowering rates of depression inminority and nonminority participants and resulted in continued employmentfor nonminority participants but not for the minority participants.

Prenatal smoking is associated with antisocial behavior in offspring,but commentators have questioned whether this reflects a causal link. Usinga twin study, Maughan et alArticle foundthat associations between parental smoking and early childhood behavior problemswere heavily confounded with other known risks for child antisocial outcomes,both genetic and environmental. This high level of confounding casts doubton the causal status of prenatal smoking and argues that conclusive answersmust await findings from experimental studies.