A key effort of schizophrenia research is finding a functional test
sensitive to changes over the course of the disorder. Salisbury
et al (SEE ARTICLE) provide data on a candidate task, the
mismatch negativity to pitch. This is an event-related brain potential arising
from automatic sensory system detection of changes in pitch of auditory stimuli
and is thought to originate in and near the primary auditory cortex. The pitch
mismatch negativity was normal in patients with first-episode schizophrenia,
whereas extensive other data have indicated it is abnormal in chronic schizophrenia,
suggesting that the defect may develop over time.
Braus et al (SEE ARTICLE) compared
regional brain activation during a relatively simple sensory-perceptual task
in patients with schizophrenia and healthy controls. Patients showed abnormal
activation in the posterior parietal cortex and areas of the right inferior
prefrontal cortex. These abnormalities expand the areas of functional impairment
and provide a basis for the understanding of deficits in eye tracking in the
schizophrenic syndrome.
Evidence implicates abnormalities of dopaminergic and glutamatergic
neurotransmission in the pathophysiology and prefrontal dysfunction found
in schizophrenia. Dopamine and glutamate receptors regulate in opposing directions
the phosphorylation of DARPP-32, a key regulatory protein phosphatase inhibitor
that modulates the activity of important ion channels and receptors. Albert et al (SEE ARTICLE) found that the level
of DARPP-32 was significantly reduced in the prefrontal cortex in schizophrenic
subjects relative to matched controls, while two other phosphoproteins did
not differ.
Cognitive-behavioral therapy is a well-established treatment for binge-eating
disorder. Interpersonal psychotherapy reduces binge eating, but its long-term
impact remains largely unknown. Wilfley et al (SEE ARTICLE) compared the effects of group cognitive-behavioral therapy
and group interpersonal psychotherapy across binge-eating disorder–related
symptoms and found that recovery rates were equivalent for both treatments
at posttreatment and through 1-year follow-up.
Kocsis et al (SEE ARTICLE) measured
psychosocial functioning during long-term maintenance antidepressant treatment
or following the discontinuation of treatment in patients with chronic major
depression. Substantial worsening in measures of psychosocial function occurred
in patients switched to placebo when compared with sertraline maintenance.
Surprisingly, most of the observed improvement in psychosocial functioning
occurred during the acute phase of treatment in the patients who remained
in remission throughout maintenance.
Meyers et al (SEE ARTICLE) found that
adequate antidepressant therapy following admission to community-based outpatient
clinics for treatment of a major depressive episode predicted remission within
3 months. Only 45% of patients received adequate pharmacotherapy. Less severe
depression, female sex, and being married were additional independent predictors
of early recovery. High personality dysfunction scores predicted nonrecovery
among less severely depressed patients.
Bipolar II disorder is often found in families with bipolar I disorder.
There has been controversy about the reliability of the diagnosis for hypomania. Simpson et al (SEE ARTICLE) assessed their diagnostic
reliability for major depressive, manic, and hypomanic episodes at the interview
and best-estimate levels in a genetic linkage study of bipolar I disorder.
They found that good interrater reliability for hypomania and bipolar II can
be achieved when the interviews and best-estimate diagnoses are done by experienced
psychiatrists.
Johnson et al (SEE ARTICLE) found
that maladaptive parenting and childhood maltreatment were associated with
elevated risk for interpersonal difficulties during middle adolescence and
for suicide attempts during late adolescence or early adulthood. The findings
suggest that the development of suicidal behavior may often be attributable
to an extensive history of profound interpersonal difficulties beginning in
childhood.
Iacono et al (SEE ARTICLE) examined
brain event-related potential P3 amplitude in a community sample of 17-year-old
boys. P3 amplitude was reduced in boys with childhood externalizing and substance
use disorders, and in those whose fathers had a substance use or antisocial
personality disorder. The development of a substance use disorder between
ages 17 and 20 years was associated with reduced-amplitude P3 at 17 years.
Reduced P3 is associated with familial risk for alcoholism and with the development
of disorders associated with behavioral disinhibition.
