Archives of general psychiatry
-
Arch. Gen. Psychiatry · Oct 2012
Randomized Controlled TrialAlterations in neural processing and psychopathology in children raised in institutions.
Young children raised in institutional settings experience severe deprivation in social, emotional, and cognitive stimulation. Although this deprivation is likely to disrupt brain development in ways that increase the risk for psychopathology, neurodevelopmental mechanisms linking adverse early environments to psychopathology remain poorly understood. ⋯ Exposure to institutional rearing disrupts the P700, conferring risk for the onset of psychopathology. The high levels of ADHD symptoms among children exposed to early life deprivation may be attributable, in part, to abnormal patterns of neurodevelopment generated by these adverse rearing environments.
-
Arch. Gen. Psychiatry · Sep 2012
Randomized Controlled Trial Multicenter Study Comparative StudyCommon and unique therapeutic mechanisms of stimulant and nonstimulant treatments for attention-deficit/hyperactivity disorder.
CONTEXT Attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent and impairing psychiatric disorder that affects both children and adults. There are Food and Drug Administration-approved stimulant and nonstimulant medications for treating ADHD; however, little is known about the mechanisms by which these different treatments exert their therapeutic effects. OBJECTIVE To contrast changes in brain activation related to symptomatic improvement with use of the stimulant methylphenidate hydrochloride vs the nonstimulant atomoxetine hydrochloride. ⋯ These findings were not attributable to baseline differences in activation. CONCLUSIONS Treatment with methylphenidate and atomoxetine produces symptomatic improvement via both common and divergent neurophysiologic actions in frontoparietal regions that have been implicated in the pathophysiology of ADHD. These results represent a first step in delineating the neurobiological basis of differential response to stimulant and nonstimulant medications for ADHD.
-
Arch. Gen. Psychiatry · Sep 2012
Randomized Controlled Trial Multicenter Study Comparative StudyRandomized trial of long-acting sustained-release naltrexone implant vs oral naltrexone or placebo for preventing relapse to opioid dependence.
CONTEXT Sustained-release naltrexone implants may improve outcomes of nonagonist treatment of opioid addiction. OBJECTIVE To compare outcomes of naltrexone implants, oral naltrexone hydrochloride, and nonmedication treatment. DESIGN Six-month double-blind, double-dummy, randomized trial. ⋯ CONCLUSIONS The implant is more effective than oral naltrexone or placebo. More patients in the NI+OP than in the other groups develop wound infections or local irritation, but none are serious and all resolve with treatment. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00678418.
-
Arch. Gen. Psychiatry · Sep 2012
Randomized Controlled Trial Multicenter Study Comparative StudyToward clinically useful neuroimaging in depression treatment: prognostic utility of subgenual cingulate activity for determining depression outcome in cognitive therapy across studies, scanners, and patient characteristics.
CONTEXT Among depressed individuals not receiving medication in controlled trials, 40% to 60% respond to cognitive therapy (CT). Multiple previous studies suggest that activity in the subgenual anterior cingulate cortex (sgACC; Brodmann area 25) predicts outcome in CT for depression, but these results have not been prospectively replicated. OBJECTIVE To examine whether sgACC activity is a reliable and robust prognostic outcome marker of CT for depression and whether sgACC activity changes in treatment. ⋯ Subgenual anterior cingulate activity remained low for patients in remission after treatment. CONCLUSIONS Neuroimaging provides a quick, valid, and clinically applicable way of assessing neural systems associated with treatment response/remission. Subgenual anterior cingulate activity, in particular, may reflect processes that interfere with treatment (eg, emotion generation) in addition to its putative regulatory role; alternately, its absence may facilitate treatment response.
-
Arch. Gen. Psychiatry · Feb 2012
Randomized Controlled TrialPrevention of posttraumatic stress disorder by early treatment: results from the Jerusalem Trauma Outreach And Prevention study.
Preventing posttraumatic stress disorder (PTSD) is a pressing public health need. ⋯ Prolonged exposure, CT, and delayed PE effectively prevent chronic PTSD in recent survivors. The lack of improvement from treatment with escitalopram requires further evaluation. Trauma-focused clinical interventions have no added benefit to survivors with subthreshold PTSD symptoms. Trial Registration clinicaltrials.gov Identifier: NCT00146900.