The American Journal of Psychiatry Current Issue

In This Issue

Sat, 01 Jun 2013 00:00:00 GMT

Neuroanatomical Correlates of Childhood Sexual Abuse: Identifying Biological Substrates for Environmental Effects on Clinical Phenotypes

Oquendo MA, Miller JM, Sublette M. — Sat, 01 Jun 2013 00:00:00 GMT

Sexual abuse during childhood is surprisingly common, with estimates in the general population ranging from 15% to 38% (1). It is associated with significant psychiatric sequelae, including the development of major depression and posttraumatic stress disorder (PTSD). These common consequences of exposure to trauma can emerge in the aftermath of natural disasters as well as those in which humans have a hand (2). Some responses, such as suicidal behavior, are not only life-threatening but have multigenerational repercussions, as individuals who report childhood sexual abuse are at risk not only for suicidal behavior themselves but also for transmitting suicidal behavior and mood disorders to their offspring (3). The timing (4) and severity of childhood sexual abuse are also relevant to its consequences (5). Earlier age at onset of childhood sexual abuse is associated with more intent during suicide attempts (6) as well as greater severity of PTSD (7) and depressive symptoms (8). Similarly, the severity of sexual abuse during development is reportedly related to earlier-onset suicidal behavior (6), greater depression severity (9), and more pronounced symptoms among patients with borderline personality disorder (5). Interestingly, other forms of early life stress, such as childhood emotional abuse and neglect, have been found to be stronger predictors of subsequent depression in adulthood than childhood sexual or physical abuse (10).

The Long-Term Effect of Schizophrenia on the Brain: Dementia Praecox?

Sweeney JA. — Sat, 01 Jun 2013 00:00:00 GMT

Kraepelin’s use of the term “dementia praecox” for the condition we now know as schizophrenia encouraged the view that his patients had a progressive decline in behavioral function associated with (and probably caused by) progressive changes in brain anatomy and function over the course of illness. This view was challenged first by the failure of early postmortem histopathology studies to identify gross anatomic changes. Later, it was challenged by models proposing that neurodevelopmental alterations caused the disorder and that the primary disease-related damage to brain organization was largely in place at illness onset. Enthusiasm for “progressive” and “neurodevelopmental” models has varied over time and across countries (1), and establishing the validity of these models and their mechanisms remains one of the major challenges of schizophrenia research.

Understanding Transitions in Illicit Drug Use and Drug Use Disorders

Blanco C. — Sat, 01 Jun 2013 00:00:00 GMT

One reason for our modest success in the prevention and treatment of drug use and drug use disorders is our limited knowledge of their natural history. A better understanding of their complex natural course could advance our apprehension of their etiology and inform efforts to develop more effective interventions. The work of Compton et al. (1) presented in this issue of the Journal represents an important step in this direction.

Workplace Depression: Personalize, Partner, or Pay the Price

Greden JF. — Sat, 01 Jun 2013 00:00:00 GMT

Depression and bipolar illness in the workplace impair productivity and are dearly expensive, as multiple studies have documented for decades (1, 2). One would assume that such reports would have fueled widespread concern and action, but they have not, despite huge potential payoffs.

China’s New Mental Health Law: Reframing Involuntary Treatment

Phillips MR, Chen H, Diesfeld K, et al. — Sat, 01 Jun 2013 00:00:00 GMT

After 27 years of often contentious debate, China’s first national mental health legislation was adopted by the Standing Committee of the National People’s Congress on October 26, 2012, with the law taking effect on May 1, 2013 (1). Over the coming decades, this wide-ranging law will fundamentally transform the provision of mental health services in China.

Neurocognitive Disorders in DSM-5

Blazer D. — Sat, 01 Jun 2013 00:00:00 GMT

The introduction of the diagnosis “mild neurocognitive disorder” is the crucial change in the diagnostic criteria for the neurocognitive disorders chapter of DSM-5 (previously entitled “Delirium, Dementia, and Amnestic and Other Cognitive Disorders” in DSM-IV) (1). Except in the case of delirium, the first step in the diagnostic process will be to differentiate between normal neurocognitive function, mild neurocognitive disorder (mild NCD), and major neurocognitive disorder (major NCD or dementia). The second step will be to assign an etiological category, such as Alzheimer’s NCD, vascular NCD, or frontotemporal NCD. Although neurocognitive dysfunction in older adults is usually analogous in the clinician’s mind to learning and memory problems, DSM-5 also includes complex attention, executive function, language, perceptual motor problems, and social cognition among the neurocognitive domains that can be impaired by an NCD.

“Selfish Spermatogonial Selection”: A Novel Mechanism for the Association Between Advanced Paternal Age and Neurodevelopmental Disorders

Goriely A, McGrath JJ, Hultman CM, et al. — Sat, 01 Jun 2013 00:00:00 GMT

There is robust evidence from epidemiological studies that the offspring of older fathers have an increased risk of neurodevelopmental disorders, such as schizophrenia and autism. The authors present a novel mechanism that may contribute to this association. Because the male germ cell undergoes many more cell divisions across the reproductive age range, copy errors taking place in the paternal germline are associated with de novo mutations in the offspring of older men. Recently it has been recognized that somatic mutations in male germ cells that modify proliferation through dysregulation of the RAS protein pathway can lead to within-testis expansion of mutant clonal lines. First identified in association with rare disorders related to paternal age (e.g., Apert syndrome, achondroplasia), this process is known as “selfish spermatogonial selection.” This mechanism favors propagation of germ cells carrying pathogenic mutations, increasingly skews the mutational profile of sperm as men age, and enriches de novo mutations in the offspring of older fathers that preferentially affect specific cellular signaling pathways. This mechanism not only offers a parsimonious explanation for the association between advanced paternal age and various neurodevelopmental disorders but also provides insights into the genetic architecture (role of de novo mutations), neurobiological correlates (altered cell cycle), and some epidemiological features of these disorders. The authors outline hypotheses to test this model. Given the secular changes for delayed parenthood in most societies, this hypothesis has important public health implications.

Cognitive Experiences Reported by Patients With Borderline Personality Disorder and Axis II Comparison Subjects: A 16-Year Prospective Follow-Up Study

Zanarini MC, Frankenburg FR, Wedig MM, et al. — Sat, 01 Jun 2013 00:00:00 GMT

Objective

The authors assessed three main types of disturbed cognition: nonpsychotic thought (odd thinking, unusual perceptual experiences, and nondelusional paranoia), quasi-psychotic thought, and true psychotic thought in patients with borderline personality disorder followed prospectively for 16 years. They also compared the rates of these disturbed cognitions with those reported by axis II comparison subjects.

Method

The cognitive experiences of 362 inpatients (290 borderline patients and 72 axis II comparison subjects) were assessed at study entry using the cognitive section of the Revised Diagnostic Interview for Borderlines. Participants’ cognitive experiences were reassessed every 2 years using the same interview.

Results

Each of the five main types of thought studied was reported by a significantly higher percentage of patients in the borderline group than in the axis II comparison group over time. Each of these types of thought, except true psychotic thought, declined significantly over time for participants in both groups. Eleven of the 17 more specific forms of thought studied were also reported by a significantly higher percentage of patients in the borderline group over the follow-up period: magical thinking, overvalued ideas, recurrent illusions, depersonalization, derealization, undue suspiciousness, ideas of reference, other paranoid ideation, quasi-psychotic delusions, quasi-psychotic hallucinations, and true psychotic hallucinations. Fourteen specific forms of thought were found to decline significantly over time for participants in both groups: all forms of thought mentioned above except true psychotic hallucinations plus marked superstitiousness, sixth sense, telepathy, and clairvoyance.

Conclusions

Disturbed cognitions are common in patients with borderline personality disorder and are distinguishing for the disorder. They also decline substantially over time but remain a problem, particularly those of a nonpsychotic nature.

Decreased Cortical Representation of Genital Somatosensory Field After Childhood Sexual Abuse

Heim CM, Mayberg HS, Mletzko T, et al. — Sat, 01 Jun 2013 00:00:00 GMT

Objective

Sexual dysfunction is a common clinical symptom in women who were victims of childhood sexual abuse. The precise mechanism that mediates this association remains poorly understood. The authors evaluated the relationship between the experience of childhood abuse and neuroplastic thinning of cortical fields, depending on the nature of the abusive experience.

Method

The authors used MRI-based cortical thickness analysis in 51 medically healthy adult women to test whether different forms of childhood abuse were associated with cortical thinning in areas critical to the perception and processing of specific behavior implicated in the type of abuse.

Results

Exposure to childhood sexual abuse was specifically associated with pronounced cortical thinning in the genital representation field of the primary somatosensory cortex. In contrast, emotional abuse was associated with cortical thinning in regions relevant to self-awareness and self-evaluation.

Conclusions

Neural plasticity during development appears to result in cortical adaptation that may shield a child from the sensory processing of the specific abusive experience by altering cortical representation fields in a regionally highly specific manner. Such plastic reorganization may be protective for the child living under abusive conditions, but it may underlie the development of behavioral problems, such as sexual dysfunction, later in life.

Evaluation of the FDA Warning Against Prescribing Citalopram at Doses Exceeding 40 mg

Zivin K, Pfeiffer PN, Bohnert AB, et al. — Sat, 01 Jun 2013 00:00:00 GMT

Objective

A recent Food and Drug Administration (FDA) warning cautioned that citalopram dosages exceeding 40 mg/day may cause abnormal heart rhythms, including torsade de pointes. The authors assessed relationships between citalopram use and ventricular arrhythmias and mortality.

Method

A cohort study was conducted using Veterans Health Administration data between 2004 and 2009 from depressed patients who received a prescription for citalopram (N=618,450) or for sertraline (N=365,898), a comparison medication with no FDA warning. Cox regression models, adjusted for demographic and clinical characteristics, were used to examine associations of antidepressant dosing with ventricular arrhythmia and cardiac, noncardiac, and all-cause mortality.

Results

Citalopram daily doses >40 mg were associated with lower risks of ventricular arrhythmia (adjusted hazard ratio=0.68, 95% CI=0.61–0.76), all-cause mortality (adjusted hazard ratio=0.94, 95% CI=0.90–0.99), and noncardiac mortality (adjusted hazard ratio=0.90, 95% CI=0.86–0.96) compared with daily doses of 1–20 mg. No increased risks of cardiac mortality were found. Citalopram daily doses of 21–40 mg were associated with lower risks of ventricular arrhythmia (adjusted hazard ratio=0.80, 95% CI=0.74–0.86) compared with dosages of 1–20 mg/day but did not have significantly different risks of any cause of mortality. The sertraline cohort revealed similar findings, except there were no significant associations between daily dose and either all-cause or noncardiac mortality.

Conclusions

This large study found no elevated risks of ventricular arrhythmia or all-cause, cardiac, or noncardiac mortality associated with citalopram dosages >40 mg/day. Higher dosages were associated with fewer adverse outcomes, and similar findings were observed for a comparison medication, sertraline, not subject to the FDA warning. These results raise questions regarding the continued merit of the FDA warning.

Increase in Work Productivity of Depressed Individuals With Improvement in Depressive Symptom Severity

Trivedi MH, Morris DW, Wisniewski SR, et al. — Sat, 01 Jun 2013 00:00:00 GMT

Objective

The authors sought to identify baseline clinical and sociodemographic characteristics associated with work productivity in depressed outpatients and to assess the effect of treatment on work productivity.

Method

Employed depressed outpatients 18–75 years old who completed the Work Productivity and Activity Impairment scale (N=1,928) were treated with citalopram (20–40 mg/day) in the Sequenced Treatment Alternatives to Relieve Depression study. For patients who did not remit after an initial adequate antidepressant trial (level 1), either a switch to sertraline, sustained-release bupropion, or extended-release venlafaxine or an augmentation with sustained-release bupropion or buspirone was provided (level 2). Participants’ clinical and demographic characteristics and treatment outcomes were analyzed for associations with baseline work productivity and change in productivity over time.

Results

Education, baseline depression severity, and melancholic, atypical, and recurrent depression subtypes were all independently associated with lower benefit to work productivity domains. During level 1 treatment, work productivity in several domains improved with reductions in depressive symptom severity. However, these findings did not hold true for level 2 outcomes; there was no significant association between treatment response and reduction in work impairment. Results were largely confirmed when multiple imputations were employed to address missing data. During this additional analysis, an association was also observed between greater impairment in work productivity and higher levels of anxious depression.

Conclusions

Patients with clinically significant reductions in symptom severity during initial treatment were more likely than nonresponders to experience significant improvements in work productivity. In contrast, patients who achieved symptom remission in second-step treatment continued to have impairment at work. Patients who have demonstrated some degree of treatment resistance are more prone to persistent impairment in occupational productivity, implying a need for additional, possibly novel, treatments.

Maintenance Cognitive-Behavioral Therapy and Manualized Psychoeducation in the Treatment of Recurrent Depression: A Multicenter Prospective Randomized Controlled Trial

Stangier U, Hilling C, Heidenreich T, et al. — Sat, 01 Jun 2013 00:00:00 GMT

Objective

This multicenter study compared the relapse and recurrence outcomes of two active treatments, maintenance cognitive-behavioral therapy (CBT) and manualized psychoeducation, both in addition to treatment as usual, in patients in remission from depression.

Method

This was a multicenter prospective randomized observer-blinded study with two parallel groups. The authors assessed 180 patients with three or more previous major depressive episodes who met remission criteria over a 2-month baseline period and who were randomly assigned to 16 sessions of either maintenance CBT or manualized psychoeducation over 8 months and then followed up for 12 months. The main outcome measure was time to first relapse or recurrence of a major depression, based on DSM-IV criteria, as assessed by blinded observers with the Longitudinal Interval Follow-Up Evaluation.

Results

Cox regression analysis showed that time to relapse or recurrence of major depression did not differ significantly between treatment conditions, but a significant interaction was observed between treatment condition and number of previous episodes (<5 or ≥5). Within the subsample of patients with five or more previous episodes, maintenance CBT was significantly superior to manualized psychoeducation, whereas for patients with fewer than five previous episodes, no significant treatment differences were observed in time to relapse or recurrence.

Conclusions

The results indicate that maintenance CBT has significant effects on the prevention of relapse or recurrence only in patients with a high risk of depression recurrence. For patients with a moderate risk of recurrence, nonspecific effects and structured patient education may be equally effective.

Moderators of Outcome in Late-Life Depression: A Patient-Level Meta-Analysis

Nelson J, Delucchi KL, Schneider LS. — Sat, 01 Jun 2013 00:00:00 GMT

Objective

The authors sought to identify factors that moderate outcome in late-life major depression and that identify patients for whom antidepressants have clinically meaningful effects.

Method

A previous systematic review identified 10 placebo-controlled trials of second-generation antidepressants in outpatients with major depressive disorder who were age 60 or older. For the present study, the authors obtained from the sponsors of the 10 trials individual patient data, including age, sex, duration of illness (current age minus age at onset), course (single episode or recurrent depression), baseline depression severity, treatment assignment, and outcomes. Logistic regression models were estimated and tested to examine the association of potential moderator variables with treatment response and the treatment group-response interaction.

Results

All moderator variables were collected and documented for seven of the 10 trials (N=2,283). Univariate and multivariate analyses were restricted to these seven trials. Illness duration was the only variable significantly associated with drug-placebo differences in the multivariate model. In patients with an illness duration >10 years, baseline depression severity was also significantly associated with drug-placebo differences. In those with an illness duration >10 years and a Hamilton Depression Rating Scale score ≥21, the drug-placebo difference in response rates was relatively robust (number needed to treat=4). In the remaining patients, the drug-placebo difference in response rates was small (46.3% compared with 41.5%).

Conclusions

Older patients with a long illness duration and moderate to severe depression appear to benefit from antidepressants as compared with placebo. Antidepressants do not appear to be effective for older patients with short illness duration.

Relapse Duration, Treatment Intensity, and Brain Tissue Loss in Schizophrenia: A Prospective Longitudinal MRI Study

Andreasen NC, Liu D, Ziebell S, et al. — Sat, 01 Jun 2013 00:00:00 GMT

Objective

Longitudinal structural MRI studies have shown that patients with schizophrenia have progressive brain tissue loss after onset. Recurrent relapses are believed to play a role in this loss, but the relationship between relapse and structural MRI measures has not been rigorously assessed. The authors analyzed longitudinal data to examine this question.

Methods

The authors studied data from 202 patients drawn from the Iowa Longitudinal Study of first-episode schizophrenia for whom adequate structural MRI data were available (N=659 scans) from scans obtained at regular intervals over an average of 7 years. Because clinical follow-up data were obtained at 6-month intervals, the authors were able to compute measures of relapse number and duration and relate them to structural MRI measures. Because higher treatment intensity has been associated with smaller brain tissue volumes, the authors also examined this countereffect in terms of dose-years.

Results

Relapse duration was related to significant decreases in both general (e.g., total cerebral volume) and regional (e.g., frontal) brain measures. Number of relapses was unrelated to brain measures. Significant effects were also observed for treatment intensity.

Conclusions

Extended periods of relapse may have a negative effect on brain integrity in schizophrenia, suggesting the importance of implementing proactive measures that may prevent relapse and improve treatment adherence. By examining the relative balance of effects, that is, relapse duration versus antipsychotic treatment intensity, this study sheds light on a troublesome dilemma that clinicians face. Relapse prevention is important, but it should be sustained using the lowest possible medication dosages that will control symptoms.

Transitions in Illicit Drug Use Status Over 3 Years: A Prospective Analysis of a General Population Sample

Compton WM, Dawson DA, Conway KP, et al. — Sat, 01 Jun 2013 00:00:00 GMT

Objective

The authors examined 3-year transitions among nonuse, asymptomatic use, and problem use of illicit drugs for U.S. adults in the general household population.

Method

Data were from the nationally representative National Epidemiologic Survey on Alcohol and Related Conditions, a study of 34,653 adults interviewed twice, 3 years apart. Respondents were categorized on three mutually exclusive categories of baseline drug status: past-year nonusers (N=32,675), past-year asymptomatic drug users (N=861), and past-year symptomatic drug users (N=1,117). Symptomatic drug use, or problem use, was defined as presence of one or more symptoms that operationalize DSM-IV drug abuse and dependence criteria. The authors assessed sociodemographic, health, substance use, and psychiatric covariates for association with 3-year transitions to different status categories.

Results

Among baseline nonusers, 95.4% continued to be nonusers at follow-up, 2.1% became asymptomatic users, and 2.5% developed problem use. Among baseline asymptomatic users, 66.6% had stopped using drugs at follow-up, 14.3% continued to be asymptomatic users, and 19.1% had developed problem use. Nearly half (49.0%) of those with problem use at baseline had stopped using drugs at follow-up, 10.9% had transitioned to asymptomatic use, and 40.1% continued to have problem use. Younger age, male sex, white race, and not being married were associated with progression from nonuse to use or problem use, as were alcohol and tobacco use and disorders, major depression, and schizotypal, borderline, and narcissistic personality disorders. Panic disorder and avoidant personality disorder were associated with less progression.

Conclusions

Transitions in drug use status are common. The finding that alcohol and tobacco variables and co-occurring psychopathology are important correlates of transitions suggests the value of addressing all co-occurring disorders and substance use in patient assessments and treatment planning, both to prevent adverse transitions and to promote positive transitions.

Psychiatric Clearance for Patients Started on Interferon-Alpha-Based Therapies

Lotrich FE. — Sat, 01 Jun 2013 00:00:00 GMT

“A Rose Is a Rose Is a Rose”?

Barglow P. — Sat, 01 Jun 2013 00:00:00 GMT

To the Editor: I challenge the assertion in the January editorial by Freedman et al. (1) on DSM-5 reliability statistics that posttraumatic stress disorder (PTSD) “is another historic accomplishment, with a kappa of 0.67.” Since the majority of the 960 adult PTSD patients who were sampled for DSM-5 were interviewed at Veterans Affairs facilities, high rater concordance is not surprising (2). The notoriety and secondary gain associated with this disorder at these treatment locations probably concretized patients’ diagnostic self-identifications, which were most likely communicated to and adopted by the research interviewers.

Genome-Wide Association Study of Cognitive Decline in Schizophrenia

Hashimoto R, Ikeda M, Ohi K, et al. — Sat, 01 Jun 2013 00:00:00 GMT

To the Editor: Substantial evidence suggests that many patients with schizophrenia experience a decline in intellectual functioning. Approximately 50% of patients with schizophrenia show cognitive deterioration, with an IQ decline of 10 points from premorbid IQ (1), and cognitive decline in schizophrenia remains stable regardless of baseline characteristics and changes in clinical state (2). As there is considerable interindividual variation in the degree of decline, it is conceivable that genetic influences have a role in determining the severity of cognitive decline in schizophrenia.

Monthly Injectable Naltrexone for Pathological Gambling

Yoon G, Kim S. — Sat, 01 Jun 2013 00:00:00 GMT

To the Editor: No medication is approved for the treatment of pathological gambling. Although oral naltrexone appears to be the most promising among seven therapeutic drugs investigated for gambling (1), poor adherence to oral naltrexone can be a problem (2). In addition, hepatotoxicity can occur in gambling patients taking oral naltrexone and nonsteroidal anti-inflammatory drugs (NSAIDs) concurrently (3). In contrast to oral naltrexone, injectable naltrexone did not cause hepatotoxicity in patients taking NSAIDs (4) and could improve medication adherence. Injectable naltrexone is approved for the treatment of alcohol dependence and opioid dependence, but the use of injectable naltrexone for gambling has not been reported. We report here the first case to our knowledge of gambling successfully treated with naltrexone injection.

Response to Barglow Letter

Regier DA, Friedman MJ, Kraemer HC, et al. — Sat, 01 Jun 2013 00:00:00 GMT

To the Editor: Dr. Barglow’s commentary on the Freedman et al. editorial (1) regarding publication of the DSM-5 field trial results (2) addresses the distinction between the validity and the reliability of mental disorder diagnoses now contained in the DSM-5 revision. Dr. Barglow is correct in noting the additional requirements for validity in the Robins and Guze criteria, which include distinct boundaries, family history, laboratory tests, and clinical course, modified by Kendler to include treatment response (3). However, the original Kraepelinian and the Robins and Guze neo-Kraepelinian conceptualization of categorical diagnoses with distinct boundaries between disorders has been called into question by the failure to find “zones of rarity” between diagnoses based on symptomatic overlap and epidemiologic findings in the historic paper of Kendell and Jablensky (4). More recently, the molecular genetic findings of the Cross-Disorder Group of the Psychiatric Genomics Consortium (5) put to rest the distinct genetic vulnerability theory for many mental disorders by showing common genetic vulnerabilities for neurodevelopmental disorders (autism spectrum disorder and attention deficit hyperactivity disorder), schizophrenia, bipolar disorder, and major depressive disorder—the first four chapters of DSM-5. Even Kraepelin in his later years dropped the concept of a strict separation of schizophrenia and the affective psychoses in favor of a spectrum approach that would include schizotypal personality disorder, schizophrenia, schizoaffective disorder, and bipolar disorder in today’s classification (6).

Sustained Weight Loss After Treatment With a Glucagon-Like Peptide-1 Receptor Agonist in an Obese Patient With Schizophrenia and Type 2 Diabetes

Ishøy PL, Knop FK, Vilsbøll T, et al. — Sat, 01 Jun 2013 00:00:00 GMT

To the Editor: Obesity, diabetes, and cardiovascular disease associated with antipsychotics represent major unresolved clinical issues that contribute to the increasing mortality gap between patients with schizophrenia and the general population (1). At best, current interventions against antipsychotic-induced weight gain (e.g., metformin) facilitate a weight loss of up to 3 kg, but the long-term stability of this weight reduction is questionable (2). Glucagon-like peptide-1 (GLP-1) receptor agonists efficiently reduce blood glucose levels and confer only a negligible risk of hypoglycemia. For these reasons, GLP receptor agonists are widely used in the treatment of type 2 diabetes. GLP-1 receptor agonists stimulate glucose-induced insulin secretion, inhibit glucagon secretion, and reduce gastrointestinal motility, which reduce appetite and food intake. Ultimately, this also leads to weight loss in patients without type 2 diabetes (3). Currently, Novo Nordisk is pursuing U.S. Food and Drug Administration approval for liraglutide for obesity.

Bad Souls: Madness and Responsibility in Modern Greece

Livaditis M. — Sat, 01 Jun 2013 00:00:00 GMT

The enterprise of psychiatric reform in Greece during the last decades, mainly after the fall of the dictatorial regime in 1973, is of multiple interests: scientific, political, sociological, cultural, and anthropological. During this period, Greece, for the first time in its modern history, enjoyed long-lasting political stability and financial growth. The requests for social changes, including the reformation-modernization of social institutions, were almost ubiquitous. Under such a social climate and with the encouragement of European Union authorities, various initiatives were undertaken for the establishing and functioning of new community-orientated psychiatric services. The main aim of psychiatric reform was declared to be the development of sectorized comprehensive psychiatric services available for the total of a local population.

The Red Book Liber Novus: A Reader’s Edition

Ulanov A. — Sat, 01 Jun 2013 00:00:00 GMT

Something happened to Jung, and when we read The Red Book, something happens to us. Jung describes this experience of his 40th year as the pivotal one of his life: It took “forty-five years to bring these things that I once experienced and wrote down into the vessel of my scientific work” (p. 85). Jung consented to the images, the different voices that arose within him, and engaged fully in the drama that unfolded: “I have learned that in addition to the spirit of this time there is still another spirit at work, that which rules the depths of everything that is contemporary” (p. 117). Despite his revulsion and the slanging matches that often occurred between him and those he encountered within, Jung found that he lived far from the depths and had to go looking for his lost soul. His soul asks, “Who should live your own life if not yourself?….The way leads to mutual love in community” (p. 125). Jung says, “It cost me a great deal to undergo [the fantasies and emotions that erupted]…. I had to plummet down into them, as it were. I felt…violent resistance to them…and distinct fear” (1, p. 178).

Witness to an Extreme Century: A Memoir

Weine S. — Sat, 01 Jun 2013 00:00:00 GMT

An American psychiatrist in Hong Kong, fresh out of the Air Force in 1954, holds off returning to the United States and slipping into a conventional life. He has been interviewing the grim survivors of Chinese thought reform and decides to apply for a small research grant. Thus began the extraordinary journey of the American psychiatrist and public intellectual Robert Jay Lifton.

Women’s Bodies in Psychoanalysis

Auchincloss EL. — Sat, 01 Jun 2013 00:00:00 GMT

In her book Women’s Bodies in Psychoanalysis, Rosemary Balsam invites us to see and hear what we know but continue to deny: that the experience of growing up in and surrounded by the female body is at the center of inner life. As a female reader, it is impossible not to respond personally to this lovely (and very personal) book, which is mainly about women. However, everyone who treats women (which means most of us) will learn a lot from reading it and, equally important, enjoy doing so. Indeed, pleasure is one of Balsam’s main themes.

Oppression, Depression, and Work in the Murals of Diego Rivera

Caspersen S. — Sat, 01 Jun 2013 00:00:00 GMT

Corrections

Sat, 01 Jun 2013 00:00:00 GMT

The Journal has learned from the authors of the article “Defective Processing Speed and Nonclinical Psychotic Experiences in Children: Longitudinal Analyses in a Large Birth Cohort” (Am J Psychiatry 2013; 170:550-557) that they misinterpreted one of the findings involving the analysis of change over time in processing speed, where it was reported that a decline in processing speed over time was associated with an increased odds of psychotic experiences. The result should have been interpreted as children with psychotic experiences showing an improvement in processing speed at age 11 compared to age 8.

Corrections

Sat, 01 Jun 2013 00:00:00 GMT

In the article “Prevalence of Autism Spectrum Disorders in a Total Population Sample,” by Kim et al. (Am J Psychiatry 2011; 168:904-912), the number of screen-positive children who completed confirmative diagnostic assessments was 292, not 286, with 206 confirmed to have ASDs (autistic disorder, N=105; other ASDs, N=101). Also, the number of children in the high-probability group was 118, not 114, with 102 confirmed to have autistic disorder (N=77) or other ASDs (N=25).

Corrections

Sat, 01 Jun 2013 00:00:00 GMT

The April 5, 2013, advance online publication of “Relapse Duration, Treatment Intensity, and Brain Tissue Loss in Schizophrenia: A Prospective Longitudinal MRI Study” by Nancy C. Andreasen, M.D., Ph.D., et al., inadvertently omitted the last column of Table 1 during production. The column was restored for the article’s appearance in the June 2013 print and online issues. Also, the p value for Total Frontal Lobe volume measure of 0.04 in the print issue should be 0.004; in the online edition, data appear as intended.

Books Received

Sat, 01 Jun 2013 00:00:00 GMT

The following books are presented here as a service to our readership to alert them of new titles and as a courtesy to those who have sent copies of these books to the Journal office.