0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
This Month in Archives of General Psychiatry |

This Month in Archives of General Psychiatry FREE

Arch Gen Psychiatry. 2005;62(9):951. doi:10.1001/archpsyc.62.9.951.
Text Size: A A A
Published online

Beck Article reviews the progress in the development and evaluation of the cognitive approach to psychiatric disorders over the past 40 years. Extensive empirical testing supports the cognitive model and cognitive therapy of depression and, somewhat less extensively, anxiety and other psychiatric disorders. Cognitive therapy has been especially noteworthy in reducing relapse rate as well as symptoms of depression. Beck stresses the importance of dissemination of this modality into “real-life” situations.

Active-controlled trials with external (historical) placebo comparisons could replace placebo-controlled trials for schizophrenia. Woods et al Article conducted a meta-analysis and found the degree of improvement in atypical antipsychotic arms to be nearly double in active-controlled trials than that seen with the same drugs and doses in placebo-controlled studies. These results suggest that historical placebo comparisons cannot adequately supplement the validity of active-controlled trials as tests of efficacy for schizophrenia.

Marshall et al Article report on a systematic review and meta-analysis of the relationship between duration of untreated psychosis and outcomes in first-episode psychosis. Data from 26 first-episode cohorts, involving 4490 participants, showed significant associations between duration of untreated psychosis and a range of outcomes. The observed associations were not explained by premorbid adjustment.

Krystal et al Article conducted a comparison of ketamine hydrochloride and amphetamine sulfate effects, which resemble endogenous psychoses, within individual healthy human subjects. The interactive effects of ketamine and amphetamine were also described within these healthy individuals. The combination produced less than additive effects on psychosis, additive effects on thought disorder and “high,” and no significant interactive effects on negative symptoms. At a dose where amphetamine impaired working memory when administered alone, it reduced the disruption in working memory produced by ketamine. This finding complements other data suggesting that stimulation of prefrontal dopamine receptors, particularly of the D1 type, may help to attenuate working memory deficits associated with schizophrenia, where cognitive dysfunction has been linked to deficits in N-methyl-D-aspartate receptor function.

Frank et al Article investigated the efficacy of interpersonal and social rhythm therapy (IPSRT) in comparison with an intensive clinical management approach as acute and maintenance treatments for patients with bipolar I disorder. They found that acute IPSRT led to longer survival time without a new affective episode during the 2-year maintenance phase. This effect was mediated by the extent to which study participants assigned to IPSRT increased the regularity of their social rhythms.

Mohr et al Article examined telephone-administered psychotherapy for depression in disabled patients with multiple sclerosis. Both telephone-administered cognitive behavioral therapy (T-CBT) and telephone-administered supportive emotion-focused therapy, which encouraged emotional expression and prohibited cognitive-behavioral interventions, produced significant improvements. The T-CBT produced superior outcomes on 3 measures of depression and a measure of positive affect. Attrition, at 5.5%, was very low. Thus, T-CBT may be useful in overcoming some barriers to receiving psychotherapy.

Shared genetic contributions to pathological gambling and externalizing disorders, including alcohol dependence and antisocial behaviors, have been observed. Pathological gambling also frequently co-occurs with internalizing disorders like major depression. Potenza et al Article modeled the Vietnam Era Twin Registry data and observed that the overlap between pathological gambling and major depression was largely genetic.

Rickels et al Article conducted a 4-week multicenter, randomized, double-blind, placebo- and alprazolam-controlled trial to evaluate the efficacy, safety, and tolerability of 3 doses of pregabalin, an α2-δ ligand inhibiting the release of excitatory neurotransmitters, in adult outpatients with generalized anxiety disorder. Improvement on the primary outcome measure, the Hamilton Anxiety Rating Scale total score, as well as global improvement, was significantly greater for all 3 doses of pregabalin than for placebo and equal to or better than alprazolam. Compared with placebo, improvement was significantly better for all 3 pregabalin doses, but not alprazolam, already after 1 week of treatment.

Using brain imaging, Bailer et al Article found increased activity of the 5-HT1A receptor in limbic regions of the brains of women who had recovered from bulimia-type anorexia nervosa. In comparison, activity of the 5-HT1A receptor was normal in individuals recovered from restricting-type anorexia nervosa, although 5-HT1A receptor binding was associated with anxiety. These data add to a growing body of evidence showing that altered serotonergic function and anxiety symptoms persist after recovery from anorexia nervosa.

Evidence for linkage of drug dependence vulnerability to chromosomal regions 3q24-3q25 and 9q34 was found in adolescents previously. Since conduct disorder and drug dependence vulnerability are often comorbid, Stallings et al Article conducted a study to identify quantitative trait loci for conduct disorder. Evidence for linkage to 9q34 was found for conduct disorder symptoms also, suggesting a potential molecular genetic basis for comorbidity between drug dependence vulnerability and conduct disorder.

Figures

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.