Ford et al (SEE ARTICLE) combined event-related brain potentials and functional magnetic resonance imaging to assess brain regions involved in inhibition of prepotent responses in patients with schizophrenia. Healthy control subjects established a strong response bias that was inhibited by engaging a complex neural system involving the cingulate cortex and prefrontal and inferior parietal lobes. Patients with schizophrenia established a weaker response bias that was inhibited by engaging only the cingulate cortex.
McGowan et al (SEE ARTICLE) have assessed presynaptic dopaminergic function in medicated patients with schizophrenia with a high-sensitivity 18F-fluorodopa 3-dimensional positron emission tomography protocol. Statistical parametric mapping and region of interest analyses showed increased 18F-fluorodopa uptake, primarily in the ventral striatum, in patients with schizophrenia compared with control subjects. The magnitude of the increases was similar to that reported in unmedicated patients with schizophrenia, suggesting that presynaptic striatal dopaminergic function remains elevated in the illness despite treatment.
There is an association between the duration of untreated first-episode psychosis and early course of the disorder. It is not clear whether delayed treatment is a marker of or contributes to poor prognosis. Melle et al (SEE ARTICLE) found that the introduction of an intensive early detection program in a catchment area was followed by both reductions in the duration of untreated psychosis and better clinical status at the start of the first treatment.
Co-occurring depression is common in intravenous drug users, but the effect of its treatment has not been adequately studied. Stein et al (SEE ARTICLE) examined the effects of combined treatment with citalopram and cognitive behavioral therapy compared with no intervention in intravenous drug users with depression. The remission rate was 2-fold greater with treatment, and 40% of the treatment-adherent patients remitted.
In a 2-year historical study, Shores et al (SEE ARTICLE) found that depression was inversely related to testosterone levels in older men. This study, the first to investigate the longitudinal effect of hypogonadism on depression, found that men with hypogonadism had 4 times the increased risk of incident depression compared with men with eugonadism. A relationship between hypogonadism and depression could have significant public health implications because hypogonadism is a common condition in older men.
Using positron emission tomography, Shin et al (SEE ARTICLE) examined the functional relationship between the amygdala and medial prefrontal cortex during traumatic imagery in male combat veterans and female nurse veterans with and without posttraumatic stress disorder. In the group with posttraumatic stress disorder, regional cerebral blood flow (rCBF) changes in the medial frontal gyrus were inversely correlated with rCBF changes in the amygdala. Posttraumatic stress disorder symptom severity was inversely correlated with rCBF in the medial frontal gyrus and positively correlated with rCBF in the amygdala.
Frodl et al (SEE ARTICLE) investigated the influence of the serotonin transporter polymorphism (5-HTTLPR) on the hippocampal volume in 40 patients with major depression and 40 matched healthy control subjects. Patients with the L/L genotype had significantly smaller hippocampal gray and white matter than control subjects with the L/L genotype and had significantly less hippocampal white matter volumes than patients with the L/S and S/S genotypes. Thus, patients with the L/L genotype may have a higher vulnerability to hippocampal changes that might occur before the beginning of the disease or during a depressive episode triggered by a variety of factors (eg, stress).
Cheng et al (SEE ARTICLE) conducted a 4-year longitudinal study in a population-based cohort from 4 aboriginal groups in Taiwan (N = 499) to investigate genetic and environmental risk factors for alcoholism. The highest risk for alcoholism was found among subjects aged 25 to 34 years with anxiety disorders and among men with the less active ADH2*1 gene, with the population attributable risk estimated to be 31.1% and 34.7%, respectively.
The definition of any mental disorder affects how it is recognized, studied, and treated. In a sample of 1179 individuals with eating disorders, Keel et al (SEE ARTICLE) used latent class analysis to empirically define phenotypes. This analysis yielded 4 groups that were associated with distinct clinical correlates. In addition, biological relatives were significantly likely to belong to the same eating disorder group, supporting the validity of these phenotypes for examining the genetic bases of eating disorders.
Racial disparities in mental health care received by elderly enrollees in Medicare managed care organizations have not been well studied. Virnig et al (SEE ARTICLE) used observational data from individual-level Health Plan Employer Data and Information Set submissions to compare the quality of mental health care among elderly white, African American, Asian, and Hispanic patients. While the mental health care for elderly patients in Medicare managed care is far from optimal, minorities received poorer quality care than their white counterparts.
