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Archives of General Psychiatry current issue

ABOUT THIS JOURNAL: About This Journal
Mon, 03 Nov 2008 00:00:00 -0000

THIS MONTH IN ARCHIVES OF GENERAL PSYCHIATRY: This Month in Archives of General Psychiatry
Mon, 03 Nov 2008 00:00:00 -0000

ART AND IMAGES IN PSYCHIATRY: The Mothers (VI From Seven Woodcuts to War)
Harris, J. C. Mon, 03 Nov 2008 00:00:00 -0000

ORIGINAL ARTICLE: Raised Incidence Rates of All Psychoses Among Migrant Groups: Findings From the East London First Episode Psychosis Study
Coid, J. W., Kirkbride, J. B., Barker, D., Cowden, F., Stamps, R., Yang, M., Jones, P. B. Mon, 03 Nov 2008 00:00:00 -0000
Context  Certain black and minority ethnic groups are at increased risk for psychoses. It is unknown whether risk for second- and later-generation black and minority ethnic groups in the United Kingdom is universally increased or varies by ethnicity, population structure, or diagnostic category. Objectives  To examine whether excess risk in black and minority ethnic groups varies by generation status and to determine whether this is explained solely by an excess of broadly defined schizophrenia. Design  Population-based epidemiological survey of first-onset psychoses during a 2-year study period. Setting  Three inner-city boroughs in East London, England. Patients  Four hundred eighty-four patients with first-episode psychosis aged 18 to 64 years. Main Outcome Measures  Nonaffective or affective psychoses according to the DSM-IV. Results  Raised incidence of both nonaffective and affective psychoses were found for all of the black and minority ethnic subgroups compared with white British individuals. The risk of nonaffective psychoses for first and second generations varied by ethnicity (likelihood ratio test, P = .06). Only black Caribbean second-generation individuals were at significantly greater risk compared with their first-generation counterparts (incidence rate ratio, 1.6; 95% confidence interval, 1.1-2.4). No significant differences between first and second generations were observed in other ethnic groups. Asian women but not men of both generations were at increased risk for psychoses compared with white British individuals. Patterns were broadly upheld for the affective psychoses. Conclusions  Both first- and second-generation immigrants were at elevated risk for both nonaffective and affective psychoses, but this varied by ethnicity. Our results suggest that given the same age structure, the risk of psychoses in first and second generations of the same ethnicity will be roughly equal. We suggest that socioenvironmental factors operate differentially by ethnicity but not generation status, even if the exact specification of these stressors differs across generations. Research should focus on differential rates of psychoses by ethnicity rather than between generations.
ORIGINAL ARTICLE: Heritability of Changes in Brain Volume Over Time in Twin Pairs Discordant for Schizophrenia
Brans, R. G. H., van Haren, N. E. M., van Baal, G. C. M., Schnack, H. G., Kahn, R. S., Pol, H. E. H. Mon, 03 Nov 2008 00:00:00 -0000
Context  Structural brain abnormalities have consistently been found in schizophrenia, with increased familial risk for the disease associated with these abnormalities. Some brain volume changes are progressive over the course of the illness. Whether these progressive brain volume changes are mediated by genetic or disease-related factors is unknown. Objective  To investigate whether genetic and/or environmental factors are associated with progressive brain volume changes in schizophrenia. Design  Longitudinal 5-year follow-up in monozygotic (MZ) and dizygotic (DZ) twin pairs discordant for schizophrenia and healthy comparison twin pairs using brain magnetic resonance imaging. Setting  Participants were recruited from the twin pair cohort at the University Medical Center Utrecht. Participants  A total of 92 participants completed the study: 9 MZ and 10 DZ twin pairs discordant for schizophrenia and 14 MZ and 13 DZ healthy twin pairs. Main Outcome Measures  Percentage volume changes of the whole brain; cerebral gray and white matter of the frontal, temporal, parietal, and occipital lobes; cerebellum; and lateral and third ventricles over time between and within twin pairs were compared using repeated measures analysis of covariance. Structural equation modeling was applied to estimate contributions of additive genetic and common and unique environmental factors. Results  Significant decreases over time in whole brain and frontal and temporal lobe volumes were found in patients with schizophrenia and their unaffected co-twins compared with control twins. Bivariate structural equation modeling using cross-trait/cross-twin correlations revealed significant additive genetic influences on the correlations between schizophrenia liability and progressive whole brain (66%; 95% confidence interval [CI], 51%-100%), frontal lobe (76%; 95% CI, 54%-100%), and temporal lobe (79%; CI, 56%-100%) volume change. Conclusion  The progressive brain volume loss found in patients with schizophrenia and their unaffected co-twins is at least partly attributable to genetic factors related to the illness.
ORIGINAL ARTICLE: Familial Predisposition for Psychiatric Disorder: Comparison of Subjects Treated for Cannabis-Induced Psychosis and Schizophrenia
Arendt, M., Mortensen, P. B., Rosenberg, R., Pedersen, C. B., Waltoft, B. L. Mon, 03 Nov 2008 00:00:00 -0000
Context  Cannabis-induced psychosis is considered a distinct clinical entity in the existing psychiatric diagnostic systems. However, the validity of the diagnosis is uncertain. Objectives  To establish rate ratios of developing cannabis-induced psychosis associated with predisposition to psychosis and other psychiatric disorders in a first-degree relative and to compare them with the corresponding rate ratios for developing schizophrenia spectrum disorders. Design  A population-based cohort was retrieved from the Danish Psychiatric Central Register and linked with the Danish Civil Registration System. History of treatment of psychiatric disorder in family members was used as an indicator of predisposition to psychiatric disorder. Rate ratios of cannabis-induced psychosis and schizophrenia associated with predisposition to psychiatric disorders were compared using competing risk analyses. Setting  Nationwide population-based sample of all individuals born in Denmark between January 1,1955, and July 1, 1990 (N = 2 276 309). Patients  During the 21.9 million person-years of follow-up between 1994 and 2005, 609 individuals received treatment of a cannabis-induced psychosis and 6476 received treatment of a schizophrenia spectrum disorder. Results  In general, the rate ratios of developing cannabis-induced psychosis and schizophrenia spectrum disorder associated with predisposition to schizophrenia spectrum disorder, other psychoses, and other psychiatric disorders in first-degree relatives were of similar magnitude. However, children with a mother with schizophrenia were at a 5-fold increased risk of developing schizophrenia and a 2.5-fold increased risk of developing cannabis-induced psychosis. The risk of a schizophrenia spectrum disorder following a cannabis-induced psychosis and the timing of onset were unrelated to familial predisposition. Conclusions  Predisposition to both psychiatric disorders in general and psychotic disorders specifically contributes equally to the risk of later treatment because of schizophrenia and cannabis-induced psychoses. Cannabis-induced psychosis could be an early sign of schizophrenia rather than a distinct clinical entity.

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