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This Month in Archives of General Psychiatry
September 2004

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2004;61(9):863. doi:10.1001/archpsyc.61.9.863

Cognitive deficits among outpatients with stable schizophrenia are thoughtto account for functional disability. In a 2-year randomized trial, Hogarty et al Article compared thenovel cognitive enhancement therapy with a state-of-the-art enriched supportivetherapy. At 1 year, cognitive enhancement therapy demonstrated greater improvementthan enriched supportive therapy in the neuropsychological domains of processingspeed and neurocognition. By 2 years, significant improvement in social cognition,social adjustment, and style of thinking were also observed.

Fu et al Article studiedantidepressant treatment–related changes in brain function in a controlled,longitudinal study of patients with major depression. Using an event-relatedfunctional magnetic resonance imaging paradigm designed to activate brainsystems for sad facial affect processing, treatment was found to attenuateactivation in the left amygdala and ventral striatum and enhance prefrontalcortical response to discriminable degrees of sadness. Symptomatic improvementfollowing 8 weeks of treatment with fluoxetine hydrochloride was correlatedwith brain functional changes in the anterior cingulate and cerebellum.

In a national sample of 42 932 respondents, Hasin and Grant Article studied the occurrenceof DSM-IV alcohol dependence with and without alcoholabuse. A substantial proportion of those with current or lifetime dependencedid not manifest abuse symptoms, especially women and minorities. Using abuseas a screen for dependence in epidemiologic and primary care settings willdifferentially underestimate dependence in traditionally underserved groups.In genetic studies, the presence or absence of abuse may represent heterogeneousdependence phenotypes.

Liu et al Article usedrandom-effects models to estimate the genetic effects on the development ofalcohol dependence in a twin study. Forty-nine percent of the variation inthe age of diagnosis of alcohol dependence and 42% of the variation in thetransition period between regular use and diagnosis could be explained bygenetic factors, suggesting a substantial heritable basis for alcohol dependencealong its developmental course, including age at diagnosis and the transitionperiod.

Johnson et al Article showthat the glutamate antagonist topiramate not only promotes abstinence andreduces the "symptom" of drinking in alcoholics but also enhances their qualityof life and decreases the harmful psychosocial consequences of drinking. Nonabstinentalcoholics drinking below the "safe level" with psychosocial improvement shouldbe treated as being in "partial remission" and may be candidates for long-termtopiramate treatment—with the expectation that the continuing psychosocialgains would, ultimately, lead to abstinence.

Using an ambulatory monitor, Hoehn-Saric et al Article measured self-reports and physiological recordingsin patients without an anxiety disorder, with panic disorder, and with generalizedanxiety disorder during normal daily activities. Patients with anxiety disordershowed increased sensitivity to bodily changes. Diminished autonomic flexibility,observed in both anxiety conditions, may be the result of dysfunctional informationprocessing during heightened anxiety that fails to discriminate between anxiety-relatedand neutral inputs.

Hicks et al Article testedwhether familial resemblance for externalizing disorders was due to a generalor disorder-specific mode of transmission from parents to offspring. The sampleconsisted of 542 families that participated in the Minnesota Twin Family Studyand included the biological mother and father and their twin offspring. Thetransmission of a general vulnerability to all the externalizing disordersaccounted for the majority of familial resemblance, and this general vulnerabilitywas highly heritable (h2 = 0.80).

In a randomized, controlled experiment, Parker etal Article demonstrate that moderately stressfulearly experiences strengthen socioemotional and neuroendocrine resistanceto subsequent stressors in monkeys. This preclinical model offers opportunitiesto enhance the prevention of stress-related disorders by elucidating the etiologyof stress resistance.

Poor infant health is a major concern in many developing countries,and its determinants are not fully understood. Rahman etal Article studied a community-based cohortof 320 infants from birth to 1 year and found that maternal depression inthe antenatal and postnatal periods predicted poorer growth and higher riskof diarrhea in these infants. Because depression in women in developing countriesis common, the findings may have public health implications.