Archives of General Psychiatry
ISSN / EISSN : 0003990X / 15383636
Current Publisher: American Medical Association (AMA) (10.1001)
Total articles ≅ 10,674
Latest articles in this journal
Archives of General Psychiatry, Volume 69, pp 1295-1303; doi:10.1001/archgenpsychiatry.2012.271
Abstract:Prospective studies of childhood attention deficit/hyperactivity disorder (ADHD) have not extended beyond early adulthood. To test whether children diagnosed with ADHD at mean age 8 (probands) have worse educational, occupational, economic, social, marital outcomes; higher rates of ongoing ADHD, antisocial personality disorder (ASPD), substance disorders (SD); adult onset psychiatric disorders, psychiatric hospitalizations and incarcerations, than non-ADHD comparisons, at mean age 41. To test for: positive associations between probands’ ongoing ADHD and ASPD, and SD’s; and for worse social and occupational functioning in probands without ongoing psychiatric disorders, than comparisons. Prospective, 33 year follow-up study, with blind clinical assessments. Research clinic. 135 Caucasian males with ADHD in childhood, free of conduct disorder, and 136 male comparisons without childhood ADHD (65% and 76% of original cohort, respectively). Occupational, economic, and educational attainment; marital history; occupational and social functioning; ongoing and lifetime psychiatric disorders; psychiatric hospitalizations, and incarcerations. Probands had significantly worse educational, occupational, economic, social outcomes, and more divorces than comparisons; higher rates of ongoing ADHD (22% vs 5%, p<.001), ASPD (16% vs 0%, p<.001)and SD (14% vs 5%, p<.01), but not more mood or anxiety disorders (p’s=.36 and .33). Ongoing ADHD was weakly related to ongoing SD (phi=.19, p=.04), and ASPD+SD (phi=.20, p=.04). Lifetime, probands had significantly more ASPD and SD’s, but not mood or anxiety disorders, and more psychiatric hospitalizations and incarcerations than comparisons. Relative to comparisons, psychiatric disorders with onsets at age 21 or beyond were not significantly elevated in probands. Probands without ongoing psychiatric disorders had worse social, but not occupational, functioning. The multiple disadvantages predicted by childhood ADHD well into adulthood began in adolescence, without increased onsets of new disorders after age 20. Findings highlight the importance of extended monitoring and treatment of children with ADHD.
Archives of General Psychiatry, Volume 69; doi:10.1001/archpsyc.69.12.1192
Archives of General Psychiatry, Volume 69; doi:10.1001/archgenpsychiatry.2011.1239
Archives of General Psychiatry, Volume 69; doi:10.1001/archgenpsychiatry.2012.164
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Archives of General Psychiatry, Volume 69, pp 1267-1276; doi:10.1001/archgenpsychiatry.2012.543
Abstract:Neural substrates that may be responsible for the high prevalence of depression in type 1 diabetes mellitus (T1DM) have not yet been elucidated. To investigate neuroanatomic correlates of depression in T1DM. Case-control study using high-resolution brain magnetic resonance images. Joslin Diabetes Center and McLean Hospital, Massachusetts, and Seoul National University Hospital, South Korea. A total of 125 patients with T1DM (44 subjects with ≥1 previous depressive episodes [T1DM-depression group] and 81 subjects who had never experienced depressive episodes [T1DM-only group]), 23 subjects without T1DM but with 1 or more previous depressive episodes (depression group), and 38 healthy subjects (control group). Spatial distributions of cortical thickness for each diagnostic group were compared with the control group using a surface-based approach. Among patients with T1DM, associations between metabolic control measures and cortical thickness deficits were examined. Thickness reduction in the bilateral superior prefrontal cortical regions was observed in the T1DM-depression, T1DM-only, and depression groups relative to the control group at corrected P<.01. Conjunction analyses demonstrated that thickness reductions related to the influence of T1DM and those related to past depressive episode influence were observed primarily in the superior prefrontal cortical region. Long-term glycemic control levels were associated with superior prefrontal cortical deficits in patients with T1DM (β = −0.19, P = .02). This study provides evidence that thickness reduction of prefrontal cortical regions in patients with T1DM, as modified by long-term glycemic control, could contribute to the increased risk for comorbid depression.
Archives of General Psychiatry, Volume 69; doi:10.1001/archgenpsychiatry.2012.111
Archives of General Psychiatry, Volume 69, pp 1216-1224; doi:10.1001/archgenpsychiatry.2012.652
Abstract:Schizophrenia remains a highly disabling disorder, but the specific determinants and pathways that lead to functional impairment are not well understood. It is not known whether these key determinants of outcome lie on one or multiple pathways. This study evaluated theoretically-based models of pathways to functional outcome starting with early visual perception. The intervening variables were previously established determinants of outcome drawn from two general categories: ability (i.e., social cognition and functional capacity) and beliefs / motivation (i.e., defeatist beliefs, expressive and experiential negative symptoms). We evaluated an integrative model in which these intervening variables formed a single pathway to poor outcome. This was a cross-sectional study that applied structural equation modeling to evaluate the relationships among determinants of functional outcome in schizophrenia. Assessments were conducted at a Veterans Administration (VA) Medical Center. One hundred ninety one clinically-stable outpatients with schizophrenia or schizoaffective disorder were recruited from the community. A measurement model showed that the latent variables of perception, social cognition, and functional outcome were well-reflected by their indicators. An initial untrimmed structural model with functional capacity, defeatist beliefs, and expressive and experiential negative symptoms had good model fit. A final trimmed model was a single path running from perception to ability to motivational variables to outcome. It was more parsimonious and had better fit indices than the untrimmed model. Further, it could not be improved by adding or dropping connections that would change the single path to multiple paths. The indirect effect from perception to outcome was significant. The final structural model was a single pathway running from perception to ability to beliefs / motivation to outcome. Hence, both ability and motivation appear to be needed for community functioning, and can be modeled effectively on the same pathway.
Archives of General Psychiatry, Volume 69, pp 1257-1266; doi:10.1001/archgenpsychiatry.2012.913
Abstract:Youth with bipolar disorder (BD) and those with severe, non-episodic irritability (severe mood dysregulation, SMD) show amygdala dysfunction during face emotion processing. However, studies have not compared such patients to each other and to comparison subjects in neural responsiveness to subtle changes in face emotion; the ability to process such changes is important for social cognition. We employed a novel parametrically designed faces paradigm. Using a parametrically morphed emotional faces task, we compared activation in the amygdala and across the brain in BD, SMD, and healthy volunteers (HV). Case-control study. Government research institute. 57 youths (19 BD, 15 SMD, 23 HV). Blood oxygenated level dependent (BOLD) data. Neutral faces were morphed with angry and happy faces in 25% intervals; static face stimuli appeared for 3000ms. Subjects performed hostility or non-emotional facial feature (i.e., nose width) ratings. Slope of BOLD activity was calculated across neutral-to-angry (N→A) and neutral-to-happy (N→H) face stimuli. In HV, but not BD or SMD, there was a positive association between left amygdala activity and anger on the face. In the N→H whole brain analysis, BD and SMD modulated parietal, temporal, and medial-frontal areas differently from each other and from HV; with increasing facial-happiness, SMD increased, while BD decreased, activity in parietal, temporal, and frontal regions. Youth with BD or SMD differ from HV in modulation of amygdala activity in response to small changes in facial anger displays. In contrast, BD and SMD show distinct perturbations in regions mediating attention and face processing in association with changes in the emotional intensity of facial happiness displays. These findings demonstrate similarities and differences in the neural correlates of face emotion processing in BD and SMD, suggesting these distinct clinical presentations may reflect differing pathologies along a mood disorders spectrum.
Archives of General Psychiatry, Volume 69, pp 1284-1294; doi:10.1001/archgenpsychiatry.2012.449
Abstract:Extensive observational evidence indicates youth in high-poverty neighborhoods exhibit poor mental health, although not all children may be affected similarly. To use experimental evidence to assess whether gender and family health problems modify mental health effects of moving from high- to low-poverty neighborhoods. The Moving to Opportunity Study, a randomized controlled trial, enrolled volunteer low-income families in public housing in 5 U.S. cities from 1994–1997. We analyze 4–7 year outcomes among youth aged 12–19 (n=2829, 89% effective response rate). Families were randomized to control (remaining in public housing) or experimental (receiving government-funded rental subsidies to move into private apartments) groups. Intent-to-treat analyses included intervention interactions by gender and health vulnerability (defined as pre-randomization health/developmental limitations or disabilities among family members). Past-year psychological distress (K6), and Behavioral Problems Index (BPI). Supplemental analyses used past-year major depressive disorder (MDD). Male gender and family health vulnerability significantly adversely modified the intervention effect on K6 (gender: p=.02, health vulnerability: p=.002); male gender, but not health vulnerability, significantly adversely modified the intervention effect on BPI (gender: p=.01, health vulnerability: p=.17). Female adolescents without baseline health vulnerabilities were the only subgroup to benefit on any outcome (K6 (B= −0.21, 95% CI: (−0.34–−0.07), p=.003); MDD (Odds Ratio =0.42 (0.20–0.85) p=0.024). For male adolescents with health vulnerabilities, intervention was associated with worse K6 (B=.26, (0.09–0.44), p=.003) and BPI (B=.24 (0.09–0.40) p=.002). Neither females with health vulnerability, nor males without health vulnerability, experienced intervention benefits. Adherence-adjusted instrumental variable analysis found intervention effects twice as large. Patterns were similar for MDD but estimates were imprecise due to low prevalence. Although some girls benefited, boys and adolescents from families with baseline health problems did not experience mental health benefits from housing mobility policies, and may need additional program supports.
Archives of General Psychiatry, Volume 69, pp 1238-1246; doi:10.1001/archgenpsychiatry.2012.660
Abstract:Brain-derived neurotrophic factor (BDNF) is suspected of being a causative factor in psychiatric disorders based on case reports or studies involving large structural anomalies. To determine the involvement of BDNF in human psychopathology Case- Control study Microarray-based comparative genomic hybridization (aCGH) data from seven molecular diagnostic centers including 38, 550 affected subjects and 28, 705 unaffected subjects. Subjects referred to diagnostic screening centers for aCGH for physical or cognitive impairment. Genomic copy number gains and losses We report five individuals with psychopathology and genomic deletion of a critical region including BDNF. The defined critical region was never disrupted in control subjects or diagnostic cases without developmental abnormalities. Hemizygosity of the BDNF region contributes to variable psychiatric phenotypes including anxiety, behavioral, and mood disorders.