Busch et al (SEE ARTICLE) examined the effect of a managed behavioral health care carve-out on outpatient care quality for Medicaid enrollees with schizophrenia. Substantial reductions occurred in treatments for which the carve-out was a financial risk, but not those for which it was not. Such results highlight that when caring for vulnerable populations, high-powered cost-containment incentives will likely yield substantial savings but can also result in important reductions in quality, particularly if quality performance standards are not implemented.
Using proton echo planar spectroscopic imaging (PEPSI), Dager et al (SEE ARTICLE) examined gray and white matter chemical composition in medication-free patients with bipolar disorder. Elevated gray matter lactate and glutamate + glutamine + 
-aminobutyric acid were found in the bipolar patients as compared with healthy controls. These findings suggest a shift in energy redox-state from oxidative phosphorylation toward glycolysis that may reflect mitochondrial alterations in bipolar disorder.
Geller et al (SEE ARTICLE) addressed the contentiousness of diagnosing child mania by conducting a prospective follow-up of a prepubertal and early adolescent bipolar disorder phenotype. During the 4-year study, subjects' baseline mania persisted for 79.2 consecutive weeks. Any bipolar diagnoses occurred in 67.1% and mania/hypomania in 56.9% of total study weeks. These data validate the existence of child mania and support a more severe, more manic/hypomanic course with longer episode durations in children than adults.
Korszun et al (SEE ARTICLE) used an exploratory factor analysis to derive symptom dimensions in a large group of depressed subjects, including 475 sib-pairs. The factor model was confirmed in an independent sample. Four interpretable factors were identified: factor 1, mood symptoms and psychomotor retardation; factor 2, anxiety; factor 3, psychomotor agitation, guilt, and suicidality; factor 4, appetite gain and hypersomnia. Factors 1, 2, and 3 showed significant positive familial correlation, suggesting substantial familial, perhaps genetic, etiologies.
Antidepressant use is increasing in youth. Richardson et al (SEE ARTICLE) examined duration of treatment and the number of follow-up visits that depressed youth receive following receipt of a new antidepressant prescription. Twenty-nine percent of youth had no evidence of any further provider visits, while only 28% had at least 3 visits in the 3 months following prescription. More than half of the treated youth discontinued treatment with antidepressant medications within 3 months.
In a community-based study of a large and ethnically diverse sample of young adults, Turner and Lloyd (SEE ARTICLE) found lifetime exposure to major and potentially traumatic events to be associated with increased risk for the subsequent onset of depressive and/or anxiety disorder. The findings suggest that the relationship between cumulative adversity and depressive/anxiety disorder is unlikely to arise from their joint association with prior disorders and are contrary to the competing hypothesis that the association may reflect the effects of state dependence.
Scourfield et al (SEE ARTICLE) combines ratings of conduct problems from parents, teachers, and adolescents in a community sample of twins. While ratings from each informant show significant heritability, combining all 3 ratings to examine conduct problems that are pervasive across settings reveals an underlying phenotype wholly genetic in origin. This adds to existing evidence from young children that pervasive conduct problems are highly heritable.
Each year in the United States 2.5 million Americans incur injuries so severe that they require inpatient hospital admissions. Zatzick et al (SEE ARTICLE) found that a multifaceted collaborative care intervention for acutely injured trauma survivors effectively reduces alcohol abuse and prevents the development of posttraumatic stress disorder (PTSD) compared with usual care. These results suggest that early interventions for injured survivors of individual and mass trauma can be feasibly and effectively delivered to representative samples of patients in the acute care medical setting.
Breslau et al (SEE ARTICLE) report that PTSD in a large community sample was not associated with clinically relevant sleep disturbances measured by polysomnography (2 nights) and the Multiple Sleep Latency Test. "First night" effects were observed in the sample as a whole, with no evidence of specificity to PTSD. Persons with PTSD had higher rates of brief arousals from rapid eye movement sleep than persons exposed to trauma who did not develop PTSD.
What proportion of people will develop Alzheimer disease by age 100? Khachaturian et al (SEE ARTICLE) analyzed the occurrence of dementia among 3308 seniors in Cache County, Utah. They estimated that 72% of individuals will develop Alzheimer disease by age 100, but their results suggested important differences between these and a less vulnerable 28%. People with the APOE 
4 gene developed AD at earlier ages, but APOE did not influence the proportion destined eventually to develop AD.
