McDonald et al (SEE ARTICLE) assessed the neuroanatomical phenotypes of schizophrenia and bipolar disorder by analyzing the association between a measure of genetic risk in multiply affected families and variation in regional tissue volume. Gray matter endophenotypes were distinct, with genetic risk for schizophrenia linked to distributed frontotemporal-subcortical deficits, and for bipolar disorder, to localized deficit in emotional processing regions. However, white matter endophenotypes were overlapping, implicating left frontotemporal anatomical dysconnectivity as a genetic endophenotype for psychosis in general.
Using data from 6 countries, Messias et al (SEE ARTICLE) found that patients with deficit schizophrenia, who have primary and enduring negative symptoms, have an excess of summer births. The finding is consistent with the hypothesis that deficit schizophrenia is a separate disease within the syndrome of schizophrenia.
The report by Ormel et al (SEE ARTICLE), based on a large longitudinal population-based study, strongly suggests that personality-related vulnerability after remission from a unipolar major depressive episode (MDE) reflects the continuation of premorbid vulnerability. Personality deviance that developed during the MDE did not persist beyond recovery of the MDE. Within-subject, premorbid-postmorbid comparisons appeared sensitive to state effects of prodromal and residual MDE symptoms. Results support trait and state effect models of the personality depression relationship but not scarring.
Schmidt et al (SEE ARTICLE) examined the effects on mood and behavior of acute androgen withdrawal and testosterone therapy in 31 healthy young men. While uniformly associated with reduced libido and the development of hot flashes, induced hypogonadism altered mood in only a small minority of men. Additionally, the behavioral response (improved libido) during testosterone therapy was predicted by baseline levels of libido, so while testosterone levels did regulate sexual interest, trait-related characteristics constrained the effects on libido. These data demonstrate the profound but context-dependent effects of reproductive steroids on behavior in humans.
Davidson et al (SEE ARTICLE) report the first large-scale trial to evaluate a selective serotonin reuptake inhibitor (fluoxetine [FLU]), comprehensive cognitive behavioral therapy (CCBT), FLU/CCBT, and placebo (PBO) in generalized social phobia. In this 2-site, 14-week trial, FLU, CCBT, CCBT/FLU, and CCBT/PBO combined were all superior to PBO on the primary outcomes (Brief Social Phobia and Clinical Global Improvement Scales). Combined treatment was not superior to monotherapy, and FLU produced a faster onset of action. Residual morbidity persisted, which would suggest that current treatments, while helpful, are far from optimal.
Lenzenweger et al (SEE ARTICLE) further dissect the findings from the Longitudinal Study of Personality Disorders using individual growth curve modeling. This approach, which is based on a multilevel/covariance components statistical foundation, allowed these investigators to determine that Axis II disorders actually show considerable change across time. These findings raise questions about the putative stability of personality disorders as currently defined.
Studying twin pairs discordant for lifetime cannabis dependence and those discordant for early cannabis use, Lynskey et al (SEE ARTICLE) conclude that comorbidity between cannabis dependence and major depressive disorder (MDD) likely arises through shared genetic and environmental vulnerabilities. In contrast, associations between cannabis dependence and suicidal behaviors cannot be entirely explained by common predisposing factors. They also conclude that associations between early-onset cannabis use and subsequent MDD likely reflect shared genetic and environmental vulnerabilities, although it remains possible that early-onset cannabis use may predispose to suicide attempt.
Warner et al (SEE ARTICLE) studied women drug users recruited from community settings to examine patterns and predictors of remission from DSM-IV substance use disorders. The rate of drug dependence declined substantially across 3 years, but most women continued to use drugs. Depressive symptoms significantly impeded remission, suggesting that mental health professionals have an important role to play in community-based outreach and interventions designed to support women’s efforts to stop using drugs.
Approximately 12% of patients with diabetes mellitus meet criteria for major depression and/or dysthymia. Katon et al (SEE ARTICLE) describe the results of a randomized controlled trial of a collaborative care effectiveness intervention vs usual primary care in 329 patients with diabetes and depression. The intervention was associated with marked improvements in quality of depression care, satisfaction with care, and depressive outcomes compared with usual care but no differences in HbA1c levels across a 1-year period.
