A18

THE AMERICAN JOURNAL OF

PSYCHIATRY
I
n
T
h
i
s

I
s
s
u
e
The Emotion Paradox in Schizophrenia
The nding that patients with schizophrenia report levels
of current pleasure comparable to those of healthy sub-
jects but report less pleasure in past or hypothetical situa-
tionsthe emotion paradoxcould be due to cognitive
impairments, suggest Strauss and Gold (p. 364). Problems
in the encoding or retrieval of memories of pleasurable
experiences may lead to distorted beliefs about the pos-
sibility of pleasure. This conceptualization suggests a role
for cognitive-behavioral therapy in treating anhedonia in
schizophrenia patients.
Antidepressant Normalizes Brain Activity in
Depressed Adolescents
Limbic and cortical brain responses to images of fearful
faces were greater in adolescents with major depression
before treatment than in healthy adolescents, but the dif-
ferences faded after 8 weeks of uoxetine treatment. The
imaging study by Tao et al. (CME, p. 381) also showed that
the brain regions affected in the depressed adolescents are
mostly the same as those in depressed adults. Cullen states
in an editorial (p. 348) that the normalization of brain ac-
tivity gives clinicians a powerful message for patients and
families about the value of antidepressant treatment.
Schizophrenia Patients Miss Voice Cues
Individuals with schizophrenia have an impaired ability
to recognize emotions in other peoples voices, and this
impairment is related to the perception of pitch, but not
loudness. This difculty was also correlated with lower
scores for problem solving in the study by Gold et al. (p.
424). Distorted perception of others emotions can con-
tribute to poor psychosocial functioning in schizophre-
nia, and editorialists Keefe and Kraus (p. 354) describe
the connection between in-the-moment experience and a
persons relationships to others.
Higher 10-Year Recovery Rate With Early
Psychosis Detection
Patients with psychotic disorders living in an area with a
program for early detection of psychosis had a 31% recov-
ery rate 10 years after their initial treatment, compared
with 15% for those in an area without early detection. He-
gelstad et al. (p. 374) report that patients in the early detec-
tion program were also more likely to have full-time work
but were less likely to live independently (gure). The two
groups had mostly similar symptom levels, but as noted
in the editorial by Cannon (p. 345), severely impaired
patients were overrepresented in the dropouts from the
group without early detection.
Clinical Guidance: Differential Diagnosis
and Treatment of Obsessive Thoughts of
Harming a Newborn
Hudak and Wisner (CME, p. 360) describe women with
intrusive thoughts of harming their infants and ritu-
als that result in avoidance of their babies. Differential
diagnosis of women who develop these symptoms in-
cludes postpartum major mood disorders, obsessive-
compulsive disorder, and psychosis with infanticidal
thoughts. Rapid onset in the postpartum period of
anxiety and obsession is common. Insight into the ob-
sessive unreality of rituals to avoid harm is a key diag-
nostic feature. Treatment includes serotonergic drugs,
psychoeducation to help the woman understand that
she is unlikely to harm her infant, and exposure with
response prevention therapy.
Brain Activation Differs Between Cocaine-
Dependent Men and Women
Activity in brain regions linked to substance abuse
was greater in cocaine-dependent women than in
non-substance-abusing women after stress but not
after exposure to drug-related cues. For men with
cocaine dependence, the pattern was reversed: more
widespread hyperactivation after drug-related cues
than after stress. Clinical possibilities raised by Po-
tenza et al. (CME, p. 406) include targeted treatment
for cocaine dependence: stress reduction for women
and 12-step or cognitive-behavioral approaches for
men. The editorial by Moeller (p. 351) relates the nd-
ings to the three stages of the addiction cycle: binge/
intoxication, withdrawal/negative affect, and preoc-
cupation/anticipation.
100%
75%
50%
25%
0%
Recovered Living
Independently
Full-Time
Work
Weekly
Contact With
Friends
No early detection of psychosis
Early detection of psychosis
P
a
t
i
e
n
t
s

W
i
t
h

F
i
r
s
t
-
E
p
i
s
o
d
e

P
s
y
c
h
o
s
i
s
Outcome at 10 Years
A program for early psychosis detection combined
publicity and easy access to care (Hegelstad et al., p. 374)