August 2015

Vol. 27. No. 3


Quo vadis, Psychiatry?

Psychiatrists frequently complain about their lack of recognition by other specialties, stigmatization of mental illness and the practice of psychiatry, and diminishing sense of identity as a specialty. Although I share these concerns, there is another trend that worries me perhaps more: the deliberate abandonment of more and more areas of what has traditionally been and should be psychiatry’s area of expertise and skills. Not all of this is our own doing, the fact is that other clinicians would like to get “a piece of our pie”—a trend seen in other specialties as well (eg, parts of radiology taken over by cardiologists). However, I view our role in this process as larger than other specialties’ or disciplines’ efforts…



A Deese-Roediger-McDermott study of trauma memory among employees of New York City companies affected by the September 11, 2001, attacks

Dinara Triantafyllou, MD | Carol S. North, MD, MPE | Andrea Zartman, PhD | Henry L. Roediger III, PhD

BACKGROUND: Posttraumatic stress disorder (PTSD) has been found to be associated with abnormalities in memory function. This relationship has not previously been studied using the Deese-Roediger-McDermott (DRM) false memory paradigm in disaster-exposed populations.

METHODS: Three years after the September 11, 2001 (9/11) attacks, 281 participants from a volunteer sample of 379, recruited from 8 companies directly affected by the attacks, completed an interview about their disaster experience, a structured diagnostic interview, and the DRM paradigm.

RESULTS: It was hypothesized that participants with PTSD would demonstrate more associative errors, termed false alarms to critical lures, compared to those without PTSD. This hypothesis was not supported; the only predictor of false alarms to critical lures was direct 9/11 trauma exposure.

CONCLUSIONS: The finding that 9/11 trauma exposure was associated with false alarms to critical lures suggests that neural processing of traumaexposure memory may involve associative elements of overgeneralization coupled with insufficient inhibition of responses to related but harmless stimuli. Future research will be needed to differentiate psychopathology, such as PTSD, from physiological fight-or-flight responses to trauma.


The effect of childhood abuse on the risk of adult obesity

Yue Wang, MD | Bo Wu, MD | Helen Yang, PhD | Xiaoyi Song, MD

BACKGROUND: The purpose of this study was to assess the association between childhood abuse and adult obesity.

METHODS: We performed a comprehensive meta-analysis, which included studies that reported odds ratio (OR) estimates with 95% confidence intervals (CI). Summary estimates of association were obtained using a random-effects model. Heterogeneity among studies was evaluated using Cochran Q and I2 statistics.

RESULTS: A total of 22 cohort studies (3 prospective, 19 retrospective) were included in this meta-analysis. The pooled OR was 1.23 (95% CI, 1.16-1.31). All 4 subcategories of abuse were associated with adult obesity: physical abuse (OR, 1.26; 95% CI, 1.10-1.42), psychological abuse (OR, 1.20; 95% CI, 1.07-1.33), sexual abuse (OR, 1.22; 95% CI, 1.05-1.38), and neglect (OR, 1.22; 95% CI, 1.12-1.32). Moreover, dose-response analysis showed that severe abuse (OR, 1.38; 95% CI, 1.14-1.1.62) was significantly associated with adult obesity compared with light/moderate abuse (OR, 1.01; 95% CI, 0.84-1.18). Although slight publication bias was observed (Egger test P = .05), effect sizes remained statistically significant in sensitivity analyses.

CONCLUSIONS: This research demonstrated a remarkably consistent association between childhood abuse and adult obesity. Medical practitioners need to be aware of the important role of childhood abuse in the development of obesity.


Longitudinal course of body-focused repetitive behaviors in obsessive-compulsive disorder

Jon E. Grant, JD, MD, MPH | Maria C. Mancebo, PhD | Marc E. Mooney, PhD | Jane L. Eisen, MD | Steven A. Rasmussen, MD

BACKGROUND: The course of body-focused repetitive behaviors (BFRBs) (eg, trichotillomania, skin picking, and nail biting) has received scant research attention. We sought to understand the longitudinal course of BFRBs over an 8-year period and whether the co-occurrence of a BFRB with obsessive-compulsive disorder (OCD) affects the course of OCD.

METHODS: Three hundred ninety-five participants with OCD completed annual interviews using the Longitudinal Interval Follow-up Evaluation to estimate BFRB and OCD symptom severity during each week of follow-up.

RESULTS: Of the 395 participants, 83 (21%) had a co-occurring BFRB. In almost one-half of the participants, BFRB onset occurred before OCD. Participants with OCD and BFRB spent the majority of the rating period experiencing full BFRB symptoms. Having a BFRB was associated with spending less time in remission from OCD.

CONCLUSIONS: Although BFRBs have long been known to be common in individuals with OCD, these data demonstrate that most individuals who have a co-occurring BFRB with OCD do not experience BFRB remission and that having a BFRB predicts a worse course for OCD.


Repetitive transcranial magnetic stimulation for treatment of major depressive disorder with comorbid generalized anxiety disorder

Daniela White, MD | Sason Tavakoli, OMS-III

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) has shown promising results in treating individuals with behavioral disorders such as major depressive disorder (MDD), posttraumatic stress disorder, obsessive-compulsive disorder, and social anxiety disorder. A number of applications of rTMS to different regions of the left and right prefrontal cortex have been used to treat these disorders, but no study of treatment for MDD with generalized anxiety disorder (GAD) has been conducted with application of rTMS to both the left and right prefrontal cortex. We hypothesized that applying low-frequency rTMS to the right dorsolateral prefrontal cortex (DLPFC) before applying it to the left DLPFC for the treatment of depression would be anxiolytic in patients with MDD with GAD.

METHODS: Thirteen adult patients with comorbid MDD and GAD received treatment with rTMS in an outpatient setting. The number of treatments ranged from 24 to 36 over 5 to 6 weeks. Response was defined as a ≥50% reduction in symptoms from baseline, and remission was defined as a score of <5 for anxiety symptoms on the 7-item Generalized Anxiety Disorder (GAD-7) scale and <8 for depressive symptoms on the 21-item Hamilton Rating Scale for Depression (HAM-D-21).

RESULTS: At the end of the treatment period, for the GAD-7 scale, 11 out of 13 (84.6%) patients’ anxiety symptoms were in remission, achieving a score of <5 on the GAD-7, and 10 out of 13 patients (76.9%) achieved a HAM-D-21 score of <8 for depressive symptoms.

CONCLUSIONS: In this small pilot study of 13 patients with comorbid MDD and GAD, significant improvement in anxiety symptoms along with depressive symptoms was achieved in a majority of patients after bilateral rTMS application.