Velocardiofacial syndrome (VCFS) is associated with a chromosome 22q11 deletion and a high prevalence of schizophrenia. van Amelsvoort et al (SEE ARTICLE) studied brain anatomy in adults with VCFS with and without schizophrenia. Decreased white matter and increased cerebrospinal fluid volume were observed in the group with VCFS and schizophrenia compared with both a VCFS group without schizophrenia and a control group.
Vos et al (SEE ARTICLE) have modeled Australian survey data on major depression together with meta-analyses of the international literature on the natural history of disease and the effect of interventions. Maintenance treatment with cognitive behavioral therapy or antidepressants can halve the burden of depression even if realistic adherence of 60% is taken into account. By contrast, episodic treatment strategies can avert not more than a quarter of disease burden.
Grant et al (SEE ARTICLE) found that 12.8% of the US adult population had DSM-IV nicotine dependence and that these individuals were highly comorbid with other Axis I and II psychiatric disorders. Individuals with nicotine dependence, psychiatric disorders, and comorbid disorders carry a very large share of the burden of all US tobacco consumption. Results underscore the need to target smoking prevention and/or cessation efforts at these vulnerable subgroups who may more likely have been influenced by tobacco advertising.
Early-onset engagement in behaviors with addictive potential has been associated with addiction and psychiatric problems of greater severity. Using data from the Gambling Impact and Behavior Study, Lynch et al (SEE ARTICLE) examined the relationship between gambling and psychiatric health in adolescents and young adults grouped by age at gambling onset. Adolescent-onset gambling was associated with more severe psychiatric problems, particularly substance use disorders, in adolescents and young adults, suggesting that gambling during adolescence may affect adult psychiatric functioning.
Giltay et al (SEE ARTICLE) investigated dispositional optimism in relation to mortality in a population-based study of 999 elderly men and women during the follow-up of 9 years. Dispositional optimism was assessed with questions about positive thinking, a desire to achieve new goals, and a sense of happiness and joy. Results support a protective relationship between optimism and all-cause mortality, especially cardiovascular mortality.
The N-methyl-D-aspartate receptor agonist D-cycloserine facilitates extinction of fear in preclinical studies. In this double-blind study by Ressler et al (SEE ARTICLE), patients with fear of heights given D-cycloserine, in combination with exposure-based psychotherapy, had greater reductions, compared with placebo, in fear within a virtual reality setting, less spontaneous skin conductance in fear within a virtual reality setting, less spontaneous skin conductance fluctuations, less generalized acrophobia, and more self-exposure to heights at 1-week and 3-month follow-ups. These data provide initial support for the use of cognitive enhancers as adjuncts to psychotherapy.
A polymorphism in the human serotonin transporter gene promoter (5-HTTLPR) is associated with anxiety and increased risk for developing depression in the face of adversity. Barr et al (SEE ARTICLE) report that among female macaques, a functionally equivalent polymorphism (rh5-HTTLPR) interacts with early adversity to produce increased alcohol preference, with progressive increases in intake observed following successive alcohol exposures. By extension, this suggests that the 5-HTTLPR genotype and early adversity may interact to increase vulnerability to alcoholism in women.
Wagner et al (SEE ARTICLE) conducted a multicenter randomized double-blind placebo-controlled 16-week trial to assess the efficacy and safety of paroxetine in the treatment of 322 children and adolescents with social anxiety disorder. Response rates were significantly greater for paroxetine (77.6%) compared with placebo (38.3%). The benefit of paroxetine treatment was apparent within the first 4 weeks of treatment. Paroxetine was generally well tolerated, and withdrawals due to adverse events were infrequent.
Murphy et al (SEE ARTICLE) studied the effects of the serotonin transporter gene promoter "long/short" polymorphism (5HTTLPR) in geriatric patients with major depression treated with either paroxetine hydrochloride or mirtazapine. Among patients treated with paroxetine, those with the S/S genotype showed more discontinuations due to adverse events than did S/L and L/L carriers. Surprisingly, among patients treated with mirtazapine, L/L genotype carriers showed the most treatment discontinuations. These results demonstrate that the effects of the 5HTTLPR may depend on antidepressant mechanism of action.
