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This Month in Archives of General Psychiatry
August 2009

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2009;66(8):808. doi:10.1001/archgenpsychiatry.2009.90

Minzenberg et alArticle tested prefrontal cortical activity by meta-analysis of 41 functional neuroimaging studies of executive function among patients with schizophrenia. They found evidence for consistent decreases in neural activity in a distributed cortical-subcortical circuit that supports superordinate cognitive control processes across diverse tests of various executive functions.

In a detailed linkage disequilibrium–based association study of the 5′ part of NRG1 in a northern Swedish patient-control sample, Alaerts et alArticle discovered single-nucleotide polymorphisms and haplotypes associated with schizophrenia and a specific protective haplotype and a specific disease risk–causing haplotype. They conclude that NRG1 contributes to the susceptibility for schizophrenia in the northern Swedish population and as such provide additional evidence for NRG1 as an important schizophrenia risk gene.

Meyers et alArticle conducted a 12-week, randomized, controlled, double-blind study to compare remission rates and tolerability with olanzapine plus sertraline to olanzapine plus placebo for major depression with psychotic features. Randomization of the 259 participants was stratified by age 60 years or older on a 1:1 basis. Combination treatment was associated with comparably greater efficacy than olanzapine monotherapy in young and older subjects. Both age groups experienced significant metabolic changes.

Olfson and MarcusArticle report a national increase in antidepressant treatment between 1996 and 2005; the number of Americans older than 6 years treated with antidepressants increased from 13.3 to 27.0 million. During this period, the percentage of antidepressant users who also received psychotherapy declined from 31.5% to 19.9%. In 2005, only 19.0% of antidepressant users were treated by psychiatrists.

Although coronary artery disease (CAD) and major depression (MD) frequently co-occur, we are uncertain about the mechanisms of comorbidity. Using 30 374 twins from the Swedish twin registry, Kendler et alArticle showed that the MD-CAD relationship across the life span is modest. However, time-dependent models reveal stronger associations, with the sustained impact of CAD onset on MD risk being much stronger than vice versa. The effect of MD on CAD is largely acute with the longer-term effects mediated by depressive recurrence.

Meyer et alArticle studied patients with Parkinson disease and controls to determine whether there are differences in in vivo α4β2*–nicotinic acetylcholine receptor binding in the brain and whether these alterations are associated with mental dysfunction by using the radioligand 2-[18F]FA-85380 and positron emission tomography. Multiregional patterns of lower 2-[18F]FA-85380 binding in patients with Parkinson disease compared with controls were associated with the severity of mild cognitive and mild depressive symptoms.

Using proton magnetic resonance spectroscopy, Lyoo et alArticle found higher prefrontal glutamate–glutamine–γ-aminobutyric acid (Glx) levels in a large type 1 diabetes mellitus cohort. High prefrontal Glx levels were associated with low cognitive performance and depressive symptoms.

In a longitudinal neuroimaging study with more than 500 children and adolescents, Shaw et alArticle found that, in typically developing children, an increase with age in the relative thickness of the right orbitofrontal/inferior frontal cortex is balanced against a relative left hemispheric increase in the occipital cortex. This explains how the well-established pattern of adult asymmetries emerges from the essentially reversed asymmetries of childhood. Children with attention-deficit/hyperactivity disorder show a loss of the anterior component of this evolving asymmetry.

Luby et alArticle report on the 24-month longitudinal course of preschool depression. Preschool depression showed homotypic continuity and a relapsing course over this period. These data suggest that preschool depression is neither a developmentally transient nor a nonspecific clinical phenomenon but rather represents an early manifestation of the disorder well known in older children.

Schoenbaum et alArticle estimated the costs and outcomes of enhanced mental health response to large-scale disasters, from 7 to 30 months postdisaster, using the 2005 Gulf hurricanes Katrina and Rita as a case study. They found that evidence-based mental health response is feasible but requires targeted resources, increased provider capacity, and advance planning.