In This Issue

Both short-term psychodynamic psychotherapy and cognitive-behavioral therapy (CBT) led to improvements in anxiety symptoms and interpersonal problems in 57 patients with generalized anxiety disorder. However, the patients who were randomly assigned to CBT had greater decreases in worry, depression, and anxious traits than those assigned to short-term psychodynamic psychotherapy. The psychodynamic psychotherapy tested by Leichsenring et al. (CME, p. 875 ) was based on supportive-expressive therapy. Both treatments were guided by manuals and included up to 30 weekly sessions. The improvements in both groups were maintained 6 months after the end of treatment. Dr. Barbara Milrod discusses treatment issues in an editorial on p. 841 .

A long-term, population-based study suggests that the persistence of conduct disorder beyond childhood is affected by prenatal and early childhood characteristics. Among 7,218 children with high levels of conduct problems, specific risk factors for continued problems in adolescence were maternal anxiety during pregnancy, cruelty to the mother by her partner during the child’s preschool years, harsh parenting, and under-controlled temperament in the child. The influences were similar in boys and girls. Barker and Maughan (p. 900 ) found that more than 60% of the children had only minimal conduct problems by age 13, emphasizing the importance of identifying the children most likely to have long-term conduct disorders.

Elderly patients receiving a primary care intervention for depression experienced larger reductions in symptoms, higher rates of response and remission, and a greater decrease in suicidal thoughts than depressed elderly patients receiving usual primary care treatment. The depression care management program described by Alexopoulos et al. (p. 882 ) includes algorithm-based recommendations for physicians, depression and side effect monitoring, help with treatment adherence, and interpersonal psychotherapy as needed. The 2-year trial included 599 depressed patients ages 60 and older. The first step of the treatment algorithm was prescription of 30 mg/day of citalopram, and interpersonal psychotherapy was offered to patients who refused medication. The benefits of the intervention were limited to major depression; patients with minor depression had overall favorable outcomes regardless of treatment assignment. These findings are reviewed by Dr. Yeates Conwell in an editorial on p. 845 .

Relationships between social responsiveness in healthy adults and connections within their brains at rest help demonstrate not only the neural basis of autism but the dimensional nature of autistic traits. Di Martino et al. (p. 891 ) examined activity in the pregenual anterior cingulate, a region frequently associated with autism, in relation to activity elsewhere in the brain. Ratings of social and communicative impairments characteristic of autism were collected from persons familiar with the subjects, not the individuals themselves. A low level of autistic impairment was correlated with stronger connectivity between the pregenual anterior cingulate and the anterior mid-insula, a region implicated in maintaining higher-order representations of sensation and emotion. Dr. Daniel Kennedy highlights important aspects of this research in an editorial on p. 849 .