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Am J Psychiatry 2014;171:A18. doi:10.1176/appi.ajp.2013.17102issue
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Copyright © 2014 by the American Psychiatric Association

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Awareness of APOE status affected memory self-ratings and objectively rated verbal memory (Lineweaver et al., p. 201)

Clinical Guidance: Memory Effects of Knowing APOE Genotype 

Older adults who know they have the ε4 allele of the apolipoprotein E (APOE) gene, a risk factor for Alzheimer’s disease, perform worse on objective tests of verbal memory than do those who do not know they have the allele. Lineweaver et al. (CME, p. 201) also discovered that knowing whether one does or does not have the allele can diminish or improve, respectively, self-appraisal of memory (figure). In an editorial, Karlawish and Green (p. 137) point out that such information may disrupt individual well-being and could bias studies of biomarkers for neuropsychiatric disease.

Clinical Guidance: Treatment of Bipolar Depression With Lurasidone 

The antipsychotic lurasidone was recently approved for bipolar I depressive episodes. In a 6-week study of moderately depressed outpatients, lurasidone monotherapy demonstrated response rates of 53% for low-dose (20–60 mg/day) and 51% for high-dose (80–120 mg/day) treatment, compared to 30% in the placebo group. Loebel et al. (p. 160) report that the rates of treatment-emergent mania were 3.7% for low-dose treatment and 1.9% for placebo and high-dose treatment. Nausea and somnolence were common side effects. In another 6-week study of depressed outpatients (p. 169), lurasidone as an adjunct to lithium or valproate demonstrated a response rate of 57%, compared to 42% for placebo. The mean daily dose of lurasidone was 66.3 mg. In both treatment and placebo groups, lithium and valproate levels were maintained at 0.6–1.2 mEq/L and 50–125 μg/ml, respectively. Treatment-emergent mania occurred in 1.1% of the lurasidone group and 1.2% of the placebo group. Rates of treatment-emergent suicidality were 9% for lurasidone and 6% for placebo. In the monotherapy study, suicidality was 14% in all three groups. Belmaker comments in an editorial (p. 131) on antipsychotics’ efficacy for bipolar disorder and how this contributes to the unitary psychosis theory.

Clinical Guidance: Psychotherapy Helpful for Bipolar Depression With Anxiety 

Adding intensive psychotherapy to medication for depressed patients with bipolar I or II disorder increases the likelihood of recovery in those who also have a lifetime diagnosis of an anxiety disorder. The analysis by Deckersbach et al. (p. 178) did not show an advantage for depressed bipolar patients without a comorbid anxiety disorder or those with multiple anxiety disorders. Adjunctive intensive psychotherapy is especially effective for generalized anxiety disorder and posttraumatic stress disorder.

Family and Commsunity Effects on Drug Abuse 

Environmental factors, as well as genetics, influence the likelihood of drug abuse, especially in males. Nationwide Swedish registries examined by Kendler et al. (CME, p. 209) revealed that sharing a household with a drug-abusing sibling increased the probability of drug abuse in another sibling. Living in the same area or city had a similar effect. Drug abuse was also associated with low family socioeconomic status and neighborhood social deprivation. These varied environmental influences, notes editorialist Hopfer (p. 140), suggest both individual and public approaches to preventing drug abuse.

Autoimmune Risk in Schizophrenia 

The chances of developing schizophrenia are higher than average in individuals with autoimmune disorders, and Benros et al. (CME, p. 218) report that the reverse is also true. In Danish national registries covering people born between 1945 and 2010, the risk of developing autoimmune disease was modestly higher in people with preexisting schizophrenia or related psychosis, and it was more than twice as high in those with a psychotic disorder who were hospitalized for an infection before being diagnosed with an autoimmune disorder.

Awareness of APOE status affected memory self-ratings and objectively rated verbal memory (Lineweaver et al., p. 201)



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