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In This Issue
Am J Psychiatry 2007;164:A42-A42. doi:10.1176/appi.ajp.2007.164.11.A42
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Reductions in posttraumatic stress disorder (PTSD) and depression among military service members were greater with an 8-week program of cognitive behavior therapy (CBT) delivered over the Internet than with Internet-based supportive counseling. Of 24 patients randomly assigned to online CBT, 25% no longer had a PTSD diagnosis after treatment or at 6-month follow-up, compared to 5% after treatment and 3% at 6 months for those assigned to online supportive counseling. Litz et al. (CME, p. 1676) present details of DE-STRESS (DElivery of Self-TRaining and Education for Stressful Situations). Each patient had an initial face-to-face interview with a therapist and was allowed telephone and e-mail contacts during treatment. The web program included symptom ratings, CBT content, and homework assignments. Dr. Ruth Lanius relates these findings to the complexity of PTSD in an editorial on p. 1628.

The early psychiatric profile most strongly related to severe or violent crime by young adults is the childhood occurrence, either separately or together, of an anxiety or depressive disorder and either substance abuse or conduct disorder. A population sample of 1,420 children in the Great Smoky Mountains Study were assessed from late childhood to early adulthood. Nearly half of those arrested between ages 16 and 21 had a previous history of mental illness. Taking into account poverty and juvenile crime status, Copeland et al. (p. 1668) found that the psychiatric risk factors varied by gender and the severity of the criminal charges. Overall, the proportion of arrests of young adults that were attributable to childhood psychiatric disorders was 21% for females and 15% for males. These relationships are discussed in an editorial by Dr. Thomas Grisso on p. 1625.

Two large twin studies demonstrate genetic overlap between certain anxiety disorders and personality characteristics. In fact, Bienvenu et al. (p. 1714) found that the genetic influence on introversion and neuroticism accounted entirely for the genetic liability to social phobia and agoraphobia, but not animal phobia. Among 7,800 twins from monozygotic and dizygotic pairs, environmental effects shared by twins did not contribute to the correlations of introversion and neuroticism with phobias, and unique experiences had modest correlations. Commonality between social phobia and avoidant personality disorder was demonstrated by Reichborn-Kjennerud et al. (p. 1722). Their study of 1,427 twins in monozygotic and dizygotic pairs indicated that the two disorders are influenced by the same genetic factors. Environmental factors unique to each twin also had substantial effects, but the environmental influences on the two disorders were uncorrelated. The implications of these findings are reviewed in an editorial by Dr. Jordan Smoller on p. 1631.

New clues to the neural underpinnings of attention deficit hyperactivity disorder (ADHD) are revealed by two studies using brain imaging and cognitive tasks. Diffusion tensor imaging allowed Casey et al. (p. 1729) to identify abnormalities of white matter tracts in the right prefrontal cortex of 20 child-parent pairs with ADHD. These disruptions were associated with difficulty in suppressing inappropriate responses to visual stimuli and were correlated in parents and children. These white matter abnormalities could contribute to disrupted frontal-striatal connectivity in ADHD. A role for dopamine is supported by the findings of Stevens et al. (p. 1737), who used functional magnetic resonance imaging to measure brain activity associated with impaired attention in adolescents with ADHD. During a task involving novelty auditory stimuli, the patients with ADHD had less hemodynamic activity than comparison subjects in several regions of the frontal, temporal, and parietal lobes. These regions are part of a dopaminergic system thought to be hypofunctional in ADHD.

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