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Previous research on adults has shown that a functional polymorphism in the promoter region of the monoamine oxidase A (MAOA) gene moderates the impact of childhood maltreatment on risk for developing antisocial behavior. Thus far, attempts to replicate this finding have been mixed. The current study (i) presents new data investigating this finding in a sample of 975 seven-year-old boys, and (ii) evaluates the extant data by conducting a meta-analysis of published findings. We replicated the original finding by showing that the MAOA polymorphism moderates the development of psychopathology after exposure to physical abuse, we extended the finding to childhood closer in time to the maltreatment experience, and we ruledout the possibility of a spurious finding by accounting for passive and evocative geneenvironment correlation. Moreover, meta-analysis demonstrated that across studies, the association between maltreatment and mental health problems is significantly stronger in the group of males with the genotype conferring low vs high MAOA activity. These findings provide the strongest evidence to date suggesting that the MAOA gene influences vulnerability to environmental stress, and that this biological process can be initiated early in life. Molecular Psychiatry (2006) 11, 903-913.

Major depressive disorder (MDD) is a chronic, recurrent, and severe psychiatric disorder with high mortality and medical comorbidities. Stress-related pathways have been directly involved in the pathophysiology and treatment of MDD. The present paper provides an overview on the stress system as a model to understand key pathophysiological paradigms in MDD. These mechanisms involve behavioral, cognitive, and systemic manifestations and are also associated with the mechanisms of action of effective antidepressants. Aspects such as depression subtypes, inflammation, insulin resistance, oxidative stress, and prothrombotic states in critical brain circuits and periphery are critically appraised. Finally, new strategies for approaching treatment-resistant major depression and potential adverse effects associated with this complex and intricate network are highlighted. The authors used PubMed as the database for this review. Each author extracted relevant data and assessed the methodological quality of each study.

Context: Traumatic events are common and are related to psychiatric impairment in childhood. Little is known about the risk for posttraumatic stress disorder (PTSD) across different types of trauma exposure in children. Objective: To examine the developmental epidemiology of potential trauma and posttraumatic stress (PTS) in a longitudinal community sample of children. Methods: A representative population sample of 1420 children aged 9, 11, and 13 years at intake were followed up annually through 16 years of age. Main Outcome Measure: Traumatic events and PTS were assessed from child and parent reports annually to 16 years of age. Risk factors and DSM-IV disorders were also assessed. Results: More than two thirds of children reported at least 1 traumatic event by 16 years of age, with 13.4% of those children developing some PTS symptoms. Few PTS symptoms or psychiatric disorders were observed for individuals experiencing their first event, and any effects were short-lived. Less than 0.5% of children met the criteria for full-blown DSM-IV PTSD. Violent or sexual trauma were associated with the highest rates of symptoms. The PTS symptoms were predicted by previous exposure to multiple traumas, anxiety disorders, and family adversity. Lifetime co-occurrence of other psychiatric disorders with traumatic events and PTS symptoms was high, with the highest rates for anxiety and depressive disorders. Conclusions: In the general population of children, potentially traumatic events are fairly common and do not often result in PTS symptoms, except after multiple traumas or a history of anxiety. The prognosis after the first lifetime trauma exposure was generally favorable. Apart from PTSD, traumatic events are related to many forms of psychopathology, with the strongest links being with anxiety and depressive disorders.

Background: Traditional pharmacological approaches to treating psychiatric disorders focus on correcting presumed biochemical abnormalities. However, some disorders, particularly the anxiety-related disorders exemplified by specific phobia, have an emotional learning component to them that can be facilitated with psychotherapy.

Abstract Background-Epidemiological studies have found lower than expected prevalence of psychiatric disorders among disadvantaged race-ethnic minority groups in the United States. Recent research shows that this is due entirely to reduced lifetime risk of disorders, as opposed to persistence. Specification of race-ethnic differences with respect to clinical and social characteristics can help identify the protective factors that lead to lower lifetime risk among disadvantaged minority groups.

Abstract. A high percentage of Parkinson's disease (PD) patients show cognitive impairments in addition to the cardinal motor symptoms. These deficits primarily concern executive functions most probably linked to dysfunctions in prefrontal regions due to decreased dopaminergic transmission in fronto-striatal loops. To investigate possible associations between decision-making and executive functions in PD, we examined 20 non-demented PD patients and 20 healthy control subjects with a neuropsychological test battery and the Game of Dice Task. In this computerised decision-making task, the rules for gains and losses and the winning probabilities are obvious and stable. Thus, strategic components besides feedback processing might influence decisionmaking in this task. We found that PD patients were impaired in the Game of Dice task performance and that the frequency of disadvantageous choices correlated with both executive functions and feedback processing. We suggest that decision-making deficits of PD patients in explicit gambling situations might be associated with dysfunctions in two different fronto-striatal loops: the limbic-orbitofrontal-striatal loop, involved in feedback processing, and the dorsolateral prefrontal-striatal loop, involved in executive functions.

Objective: To determine the prevalence, risk factors, and risk behaviors associated with depressive symptoms in a nationally representative, cross-sectional sample of young adolescents. Design: A school-based survey collected through selfadministered questionnaires in grades 6, 8, and 10 in 1996. Setting: Schools in the United States. Participants: 9863 students in grades 6, 8, and 10 (average ages, 11, 13, and 15). Main Outcome Measures: Depressive symptoms, substance use, somatic symptoms, scholastic behaviors, and involvement in bullying. Results: Eighteen percent of youths reported symptoms of depression. A higher proportion of females (25%) reported depressive symptoms than males (10%). Prevalence of depressive symptoms increased by age for both males and females. Among American Indian youths, 29% reported depressive symptoms, as compared with 22% of Hispanic, 18% of white, 17% of Asian American, and 15% of African American youths. Youths who were frequently involved in bullying, either as perpetrators or as victims, were more than twice as likely to report depressive symptoms than those who were not involved in bullying. A significantly higher percentage of youths who reported using substances reported depressive symptoms as compared with other youths. Similarly, youths who reported experiencing somatic symptoms also reported significantly higher proportions of depressive symptoms than other youths. Conclusions: Depression is a substantial and largely unrecognized problem among young adolescents that warrants an increased need and opportunity for identification and intervention at the middle school level. Understanding differences in prevalence between males and females and among racial/ethnic groups may be important to the recognition and treatment of depression among youths. Med. 2004;158:760-765 Arch Pediatr Adolesc

Objective: The authors examined three year long outpatient treatments for borderline personality disorder: dialectical behavior therapy, transference-focused psychotherapy, and a dynamic supportive treatment. Method: Ninety patients who were diagnosed with borderline personality disorder were randomly assigned to transference-focused psychotherapy, dialectical behavior therapy, or supportive treatment and received medication when indicated. Prior to treatment and at 4-month intervals during a 1-year period, blind raters assessed the domains of suicidal behavior, aggression, impulsivity, anxiety, depression, and social adjustment in a multiwave study design. Results: Individual growth curve analysis revealed that patients in all three treatment groups showed significant positive change in depression, anxiety, global functioning, and social adjustment across 1 year of treatment. Both transferencefocused psychotherapy and dialectical behavior therapy were significantly associated with improvement in suicidality. Only transference-focused psychotherapy and supportive treatment were associated with improvement in anger. Transference-focused psychotherapy and supportive treatment were each associated with improvement in facets of impulsivity. Only transference-focused psychotherapy was significantly predictive of change in irritability and verbal and direct assault. Conclusions: Patients with borderline personality disorder respond to structured treatments in an outpatient setting with change in multiple domains of outcome. A structured dynamic treatment, transference-focused psychotherapy was associated with change in multiple constructs across six domains; dialectical behavior therapy and supportive treatment were associated with fewer changes. Future research is needed to examine the specific mechanisms of change in these treatments beyond common structures. Impul sivity, diminished nonaffective constraint, negative affectivity, and emotional dysregulation are core characteristics of borderline personality disorder (1-3). The prevalence of borderline personality disorder in the community is approximately 1.3% to 1.4% (4, 5). This chronic and debilitating syndrome is associated with high rates of medical and psychiatric utilization of services (6, 7). Psychopharmacology notwithstanding, psychotherapy represents the recommended primary technique for treating borderline personality disorder (8). Dialectical behavior therapy (9) has demonstrated superiority over treatment as usual (10) and therapy by community experts (11). Other therapeutic approaches, such as psychodynamic treatments, continue to be prominent in the treatment of borderline personality disorder, as supported by the APA Practice Guideline (8) and prior research (12). A promising psychodynamic treatment approach is an object relations approach called transference-focused psychotherapy (13). Transference-focused psychotherapy is an effective treatment using patients as their own comparisons (14) and has demonstrated superiority over treatment as usual (unpublished data by KN Levy et al. available from the authors). A necessary and first step in illuminating effective treatments for borderline personality disorder is to show that a given treatment is associated with significant improvement in the disorder-improvement in relevant dimensions of pathology beyond self-damaging behaviors. Empirical evidence should show that candidate treatments, such as dialectical behavior therapy and psychodynamic approaches, are systematically related to change in a number of substantive domains of clinical significance. A recent influential review reported that existing therapies for borderline personality disorder remain experimental, and more "real-world" studies are necessary (15). We examined patients who were taken from the community and reliably diagnosed with borderline personality disorder. Patients were randomly assigned to transferencefocused psychotherapy, dialectical behavior therapy, or supportive treatment for 1 year. Our study has characteris-

ABSTRACT Aims To examine age-18 risk factors for alcohol use and heavy drinking during early (ages 22 and 26) and middle (age 35) adulthood, and for symptoms of alcohol use disorders (AUDs) in middle adulthood. Design Nationally representative samples of US adolescents in their senior year of secondary school (age 18) were followed into middle adulthood. Structural equation models estimated the associations between age-18 characteristics and current drinking and heavy drinking at ages 22, 26 and 35 and symptoms of AUDs at age 35. Participants The sample consisted of 21 137 respondents from 11 senior year cohorts from the Monitoring the Future study. Findings Many predictor variables had stable associations with alcohol use over time, although their ability to explain variance in alcohol use declined with increasing time lags. Being white predicted alcohol use, but not symptoms of AUDs. Parental drinking, risk taking and use of cigarettes and marijuana predicted heavy drinking to age 35. Planning to attend college predicted more heavy drinking at age 22 and less frequent heavy drinking by mid-life. High school theft and property damage predicted later AUD symptoms. Most associations were invariant across gender, with variations typically taking the form of stronger associations between predictors and alcohol use for men. Invariance in findings across cohorts indicates that results reflect general developmental trends rather than specific historically bounded ones. Conclusions Many adolescent individual and contextual characteristics remain important predictors of adult alcohol use and abuse, and their predictive impact varies as a function of age and type of alcohol outcome. These associations are largely equivalent across gender and cohort, thus reflecting robust developmental linkages.