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In This Issue
Am J Psychiatry 2011;168:A38-A38. doi:10.1176/appi.ajp.2010.168.2.a38

Attention deficit hyperactivity disorder (ADHD) is associated with diminished cortical thinning during adolescence. Many children who do not meet full diagnostic criteria for ADHD nevertheless have some hyperactive and impulsive symptoms. Shaw et al. (CME, p. 143) report that cortical thinning during late childhood and adolescence was fastest in youth with no hyperactive/impulsive symptoms, and the rate slowed progressively with increasing symptom levels (figure). The areas affected were predominantly prefrontal regions. In an editorial (p. 111), Klein suggests that these data provide further evidence that ADHD symptoms, even at levels below full diagnostic criteria, are associated with abnormalities in brain development.

 
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Cortical development in children without ADHD diagnoses supports dimensionality of symptoms (Shaw et al., p. 143)

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Clinical Guidance: No Increase in Cardiac Mortality With Ziprasidone Compared to Olanzapine

Clinical Guidance: No Increase in Cardiac Mortality With Ziprasidone Compared to Olanzapine 

A large-scale real-world trial compared ziprasidone and olanzapine for the treatment of schizophrenia over 12 months. The primary purpose was to detect if the QTc prolongation associated with ziprasidone increased cardiac mortality. No increase in nonsuicide mortality or death from all causes was found in the study by Strom et al. (p. 193). No cases of torsades de pointes, an arrhythmia associated with prolonged QTc interval, were observed. Olanzapine-treated patients were less likely to be hospitalized for psychiatric reasons (8%) than were those treated with ziprasidone (11%). Stroup points out in an editorial (p. 117) that cardiac mortality increases with dose for all antipsychotic drug treatments; overall mortality in this study was 1%.

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Clinical Guidance: Severe Mood Dysregulation in Childhood

Clinical Guidance: Severe Mood Dysregulation in Childhood 

Children with severe mood dysregulation, characterized by chronic severe irritability, can be distinguished from those with childhood bipolar disorder, characterized by distinct episodes of hypomania, irritability, or depression. Those with severe mood dysregulation are more likely to develop adult unipolar depression and anxiety, whereas those with childhood bipolar disorder continue on to adult bipolar disorder. Family history of bipolar disorder is increased in parents of children with bipolar disorder, and there are pathophysiological differences between the two childhood disorders, according to Leibenluft (p. 129). Accurate estimates of relative prevalence and recommended treatment for severe mood dysregulation have not been achieved, but the condition has been recommended as a new DSM-5 diagnosis, which will facilitate further work. Parental perspectives on mood disorders in children are the subject of a new book by Judith Warner, reviewed by Rosenbaum in this issue (p. 214). Warner concludes that allegations of the overmedication of children overlook the severity of the behavioral symptoms manifested by the children whose families seek help.

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Clinical Guidance: Neurobiological Assessment of Risk for Early Relapse in Alcoholism

Clinical Guidance: Neurobiological Assessment of Risk for Early Relapse in Alcoholism 

Relapse from abstinence after treatment is a common problem for patients with alcoholism. Rando et al. (p. 183) found that atrophy of cerebral cortical gray matter was a predictive indicator of early relapse, even after accounting for the patient's history of alcoholism and the severity of the current drinking episode. As a group, all the patients had atrophy relative to social-drinking comparison subjects. However, those with excessive frontal atrophy had less than a 20% chance of maintaining abstinence for 2 months.

The interplay between schizophrenia and substance use disorders was revealed by patients' electronic self-reports four times a day. Swendsen et al. (CME, p. 202) supplied patients with personal digital assistants, which prompted them to record symptoms, stress, and substance use. The pattern of alcohol use suggested self-medication, often following but not preceding symptom increases. Use of cannabis or other illicit substances had a bidirectional pattern: following negative states but also preceding increases in psychotic symptoms. In their editorial, Csernansky and Smith (p. 120) welcome ambulatory monitoring as a way for patients to reveal their experiences.

Cortical development in children without ADHD diagnoses supports dimensionality of symptoms (Shaw et al., p. 143)

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