This Month in Archives of General Psychiatry FREE

The need for appropriate protections for vulnerable individuals who participate in research studies is receiving national attention, particularly for those who might have impaired decision-making capacity. Oldham et alArticle discuss the importance of these concerns in the light of the recent report on the subject by the National Bioethics Advisory Commission (NBAC). Although the authors agree with some of the NBAC recommendations, they propose that major aspects of the report, if implemented, would unnecessarily impede important psychiatric research and would reinforce the stigmatization of individuals with psychiatric disorders.

Commentaries by Childress and Shapiro, Charney, Miller and Fins, and a reply commentary by Oldham et al are included.

Using positron emission tomography, Yatham et alArticle found that depressed patients showed a significant decrease in serotonin 2 receptors in various brain regions following desipramine treatment.

Prefrontal dysfunction that results from cerebrovascular and degenerative brain changes is an essential part of the pathophysiology of late-life depression and its response to treatment. Kalayam and AlexopoulosArticle noted that clinical, neuropsyhological, and electrophysiological measures of prefrontal brain dysfunction were associated with poor or delayed response to antidepressant drug treatment. This observation, if confirmed, may aid clinicians in identifying patients who are candidates for aggressive somatic therapies and interventions offering structure of daily activities.

Mason et alArticle found that nalmefene, a newer opiate antagonist with pharmacologic advantages over naltrexone, was significantly more effective than placebo in reducing relapse to heavy drinking and in reducing the number of subsequent relapses in outpatient alcoholics. There was no evidence of hepatotoxicity or medically serious adverse events.

Increasing evidence suggests that anxiety and depressive disorder onset involves a prodromal build up of symptoms. Stressful events, like parent-adolescent disagreements, may precipitate symptom build up. In a prospective study of the first onset of adolescent internalizing disorder, Rueter et alArticle demonstrated a longitudinal link among stressful events, prodromal symptoms, and disorder onset. Adolescents in families reporting escalating parent-adolescent disagreements likely experienced a prodromal period characterized by increasing symptom levels over 4 years. Initially severe parent-adolescent disagreements predicted a prodromal period characterized by chronically high internalizing symptoms over 4 years.

Suvisaari et alArticle report the first nationwide historical cohort study of changes in the incidence of schizophrenia. Among Finnish cohorts born between 1954 and 1965, the incidence declined from 0.79 to 0.53 per 1000 among males and from 0.58 to 0.41 per 1000 among females. An age-period-cohort analysis showed that the effects of cohort and period on the change were both significant.

Although the symptoms of schizophrenia typically do not appear until adulthood, subtle neurological and cognitive deficits may be present long before onset of illness. Hans et alArticle have followed up a sample of children with schizophrenic parents from birth through late adolescence. A subgroup of these children showed neurobehavioral deficits over time. These children with stable deficits were more likely to be male and were more likely to have poor adolescent mental health outcomes. Results support the view that schizophrenia may be a lifetime developmental disorder and that developmental patterns leading to schizophrenia may be different for males and females.

In large study of first-episode drug-naive patients with schizophrenia, Mohamed et alArticle report significant cognitive impairment across multiple ability domains. Patients with schizophrenia have a generalized deficit that is not easily explained by a single anatomical region or ability area. These deficits are not due to chronic illness, treatment, or institutionalization.

Faller et alArticle investigated both coping and distress among patients with lung cancer prior to their medical treatment. They found that both emotional distress and depressive coping were associated with shorter survival assessed 7 to 8 years later, while adjusting for biological prognostic factors such as tumor stage, histological classification, and performance status.