This Month in Archives of General Psychiatry FREE

Finding a unifying concept behind the diversity of signs and symptoms in schizophrenia is a central challenge to contemporary research. AndreasenArticle describes a neo-Bleulerian unitary model, which defines the illness as a neurodevelopmentally derived "misconnection syndrome," involving connections between cortical regions and the cerebellum mediated through the thalamus (the cortico-cerebellar-thalamic-cortical circuit [CCTCC]). An abnormality in this circuitry, normally used to coordinate both motor and mental activity, leads to misconnections in many aspects of mental activity or "cognitive dysmetria."

A commentary by Braff is included.

Little is known about the continuity into adulthood of major depression or anxiety disorders arising before puberty. Weissman et alArticle studied depressed, anxious, or nonpsychiatrically ill children and followed them up, blindly, as adults. There was high morbidity (suicide attempts, substance abuse, conduct disorder, long-term use of psychiatric and medical services, and impaired work functioning) in clinically referred prepubertally ill children. However, continuity and specificity with major depressive or anxiety disorders into adulthood was less clear.

Johnson et alArticle examined the predictive effect of adolescent personality disorder on anxiety, mood, disruptive, and substance use disorders and suicidal behavior in early adulthood in a community sample of adolescents. Personality disorder increased the risk of Axis I disorders and suicidal behavior in early adulthood after accounting for the presence of these disorders in adolescence. Increased recognition of long-term negative consequences of personality disorder may be beneficial.

In a randomized, double-blind trial, Oliveto et alArticle reported that desipramine facilitated greater opioid and cocaine abstinence relative to placebo in buprenorphine- and methadone-maintained cocaine abusers. Cocaine abstinence was also facilitated more by buprenorphine than methadone in men and more by methadone than buprenorphine in women.

Mavissakalian and PerelArticle present a controlled, 12-month maintenance/discontinuation study in patients with panic disorder and agoraphobia who initially showed good and stable response to imipramine treatment. Ten of 27 patients randomized to discontinuation relapsed vs 1 of 29 patients in the maintenance group. The results demonstrate the very high degree of prophylaxis provided by imipramine maintenance.

Some patients with depression respond to treatment with a partial remission, rather than complete recovery, and are prone to relapse. Paykel et alArticle carried out a controlled trial of cognitive therapy in such patients, all of whom were maintained on antidepressant medication. A relapse rate of about 50% was reduced to less than 30% by cognitive therapy.

Adler et alArticle report the results of a 9-site trial of up to 2 years of treatment with either vitamin E or matching placebo in subjects with tardive dyskinesia. No significant effects of vitamin E were observed on clinical or electromechanical measurements of tardive dyskinesia.

In a large, prospective, follow-up study, Spencer et alArticle report that boys with attention-deficit/hyperactivity disorder ADHD showed more tic disorders at baseline and more new onsets at follow-up than controls. In contrast to low rates of ADHD remission, tic disorders mostly remitted. Tic disorders had little effect on psychosocial functioning. These findings suggest that comorbidity with a tic disorder has a limited effect on ADHD outcome.

Jeste et alArticle found that the current health care infrastructure and financing, pool of trained personnel, and delivery systems serve mentally ill older adults poorly, and are practically unprepared to meet the upcoming crisis in geriatric mental health. The authors recommend formulation of a 15- to 25-year plan that includes translational research, prevention and intervention studies, health services research, and training of clinicians, researchers, policymakers, and the lay public in issues related to geriatric mental health.