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This Month in Archives of General Psychiatry
May 2008

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2008;65(5):495. doi:10.1001/archpsyc.65.5.495

Sundquist et al (page 501) analyzed the association between psychiatric disorders and rheumatoid arthritis, systemic lupus erythematosus, and ankylosing spondylitis and the association between dementia or delirium and systemic lupus erythematosus in a follow-up study of the entire Swedish population. They found that rheumatic disease implied an increased risk of neuropsychiatric disorders.

Hoogendijk et al (page 508) studied the vitamin D and parathyroid hormone status in a large population-based cohort of older individuals with depression. Depression severity was significantly associated with decreased serum vitamin D and increased serum parathyroid hormone levels.

Eaton et al (page 513) carried out a population-based study of the natural history of MDD. About 15% of individuals with first onsets had episodes every year for 23 years of follow-up; about 50% recovered and had no future episodes. Individuals with short alleles of the 5HTT gene were at higher risk for first onset but experienced shorter episodes, suggesting that prevalence bias explains some failures to replicate in the literature on genetic epidemiology.

Hasler et al (page 521) examined neural correlates of the traitlike dysfunction of the dopamine and norepinephrine neurotransmitter systems in MDD using positron emission tomography of brain glucose metabolism. The experimental reduction of the neurotransmitters under study in fully remitted subjects with a history of MDD and healthy controls showed that depressive symptoms due to decreased dopamine and norepinephrine neurotransmission were related to elevated metabolic activity within the limbic-cortical-striatal-pallidal-thalamic brain circuitry.

By presenting emotional pictures, Moratti et al (page 532) examined brain activity in MDD. Both healthy subjects and patients with MDD showed greater brain activity within the dorsal visual stream during viewing of high-arousing compared with neutral pictures. However, in controls, activity in the right temporoparietal cortex was strongly activated by high-arousing pictures, whereas patients demonstrated only a weak arousal modulation in that brain region.

Two large cohort studies have shown that a high plasma amyloid-β peptide 40 (Aβ40):Aβ42 ratio increases the risk of Alzheimer disease. Sun et al (page 542) now show that relative to those without depression, “amyloid-associated depression,” defined by the presence of depression and a high plasma Aβ40:Aβ42 ratio, was associated with greater impairment in memory, visuospatial ability, and executive function, which may define an amyloid-associated depression subtype and represent a prodromal manifestation of Alzheimer disease.

Pollack et al (page 551) report on a 10-week, double-blind, randomized, placebo-controlled add-on trial, examining the efficacy of eszopiclone in combination with escitalopram oxalate in insomnia comorbid with generalized anxiety disorder. Eszopiclone cotherapy significantly improved sleep, with no evidence of tolerance in patients with comorbid insomnia and generalized anxiety disorder, compared with escitalopram monotherapy. The cotherapy group also experienced significantly greater improvements in measures of anxiety and mood.

Using functional magnetic resonance imaging, Monk et al (page 568) report that youth with generalized anxiety disorder, relative to comparison subjects, had greater right amygdala activation to masked angry faces. The right amygdala and right ventrolateral prefrontal cortex showed strong negative connectivity. This connectivity tended to be weaker in generalized anxiety disorder. Negative connectivity between the ventrolateral prefrontal cortex and amygdala suggests that the prefrontal cortex modulates amygdala response to threat.

Kramer et al (page 578) report on IQ and teachers' blinded ratings of academic performance in 13 889 6.5-year-old Belarussian children followed up from the Promotion of Breastfeeding Intervention Trial. Based on an intention-to-treat analysis with adjustment for the clustered randomization, they found significantly higher verbal IQ scores and teacher ratings for reading and writing, thus confirming the results of most observational studies.

Finger et al (page 586) investigated the neural correlates of response reversal learning impairments in children with psychopathic traits using functional MRI. Comparing children high in psychopathic traits with healthy children and children with ADHD, they found that during punished reversal errors, children high in psychopathic traits demonstrate abnormal activation in the ventromedial prefrontal cortex, suggesting that dysfunction in reinforcement processing in the ventromedial prefrontal cortex may underlie some of the behavioral abnormalities found in this disorder.

Wouts et al (page 596) analyzed associations between depressive symptoms and incident stroke in 2965 elderly Dutch people (≥55 years) during 9 years of follow-up with and without preexisting cardiac disease. In those with preexisting cardiac disease, but not in those without cardiac disease, depressive symptoms at baseline and the chronicity of symptoms during follow-up were associated with incident stroke.