This Month in Archives of General Psychiatry FREE

Using factor analysis, Cassidy et alArticle report on the interrelationship of manic signs and symptoms in a cohort of 237 bipolar subjects. Five independent factors of manic signs and symptoms were found: dysphoric mood, psychomotor pressure, psychosis, hedonic drive, and irritable aggression. Each of these is useful for the characterization and study of manic patients. The distribution of scores on the first factor, dysphoric mood, was bimodal, confirming that mixed mania is a distinct subtype.

Genes encoding proteins involved in serotoninergic metabolism are major candidates in association studies with mood disorders. Bellivier et alArticle report a significant association between the tryptophan hydroxylase (TPH) genotypes and manic-depressive illness. The involvement of the TPH gene in susceptibility to manic-depressive illness requires confirmation in other groups of patients and controls.

Few studies have examined the neuropsychological effects associated with bipolar disorders in persons who were tested when their mood was neither abnormally elevated or depressed. van Gorp et alArticle found that persons with bipolar disorder performed worse than normal persons on memory measures. Additionally, they found that the number of months of both mania and depression over the subjects' lifetimes were significantly associated with poorer performances on measures of memory and tasks mediated by the frontal lobe. These findings suggest that there are neurocognitive abnormalities in patients with bipolar disorder during nonacute phases of the illness.

Strakowski et alArticle longitudinally studied patients with affective psychoses for 12 months after their first psychiatric hospitalizations. Affective or psychotic syndromes persisted in nearly half of these patients, and only one third became symptom-free and returned to premorbid functional levels. Treatment noncompliance, substance abuse, poor premorbid function, and low socioeconomic status were associated with failure to recover. These results suggest that many patients with affective psychoses experience an unfavorable outcome, even early in the course of the illness.

Also included in this issue is a Commentary by Goodwin and Ghaemi titled Understanding Manic-Depressive Illness. Article

Pine et alArticle, using prospective epidemiological data, report that adolescent anxiety or depressive disorders predict a 2- to 3-fold increased risk for adulthood anxiety or depressive disorders, with specificity in the course of simple and social phobia, but less specificity in the course of other disorders. Moreover, most anxiety and depressive disorders in young adults appear to be preceded by anxiety or depression in adolescence.

Cannon et alArticle sought to determine the magnitudes of the genetic and environmental contributions to schizophrenia in a total population of twins. Structural equation model fitting indicated that 83% of the variance in liability was due to additive genetic factors and the remaining 17% was due to unique environmental factors, with no evidence of sex-specific genetic effects and no sex differences in the magnitude of heritability. A substantial role of genetic influences in schizophrenia is thus confirmed, using a population-based modeling approach. Further efforts to locate predisposing genes are warranted.

Previous factor analytic studies have shown that the symptoms of schizophrenia fall into 3 independent psychopathological domains: positive, negative, and disorganized. Using factor analysis, Ratakonda et alArticle found that identical psychopathological domains are seen in patients with schizophrenia as well as nonschizophrenic diagnoses. Further, they found the associations between individual domains and other variables to be similar in both groups. These findings suggest that individual domains cut across current diagnostic groupings and may correspond to discrete underlying pathological disorders.

A Perspectives article by Holzman, Kupfer, and AndreasenArticle, On Preserving the NIMH Career Scientist Awards, is featured in this month's issue of the ARCHIVES along with Reply Commentaries from PincusArticle, BaldessariniArticle, NestlerArticle, and HymanArticle.