rnestHisgweay\p-APgc-h VtpIDw\HnwI .wsy Ynlweo,M\fdgCOoCuH\exdnbCT\fwxC\ebO\nwfpeM\fdgCVDoCi\py\nbCT\fwx :2ntH2bpdxisgweay\p wtedH\e… [625560]

rnestHisgweay\p-APgc-h VtpIDw\HnwI .wsy
Ynlweo,M\fdgCOoCuH\exdnbCT\fwxC\ebO\nwfpeM\fdgCVDoCi\py\nbCT\fwx
:2ntH2bpdxisgweay\p wtedH\e
\HHsgAHHds0Af\weHDsg\ednDwt
\nHCj2Hn\HDsnHdwff2gwe\HsHDs2ec
bsnfpweaxdnIstyDwIDtD\AsbHDs
IdeHseH\ebtHn2IH2nsdxDwtydnR,
NDwt\nHwtHweA\nHwI2f\n y\nn\eHt
tH2bp1edHdefpy\tDs\tHpfwtHwI
asew2tdxx\ncns\IDwea fwHsn\npwec
xf2seIsCj2HDsy\tjdHDgwnndnHd
\eb\nIDwHsIHdxHDs96HDcIseH2np
hgsnwI\e ID\n\IHsn,isgweay\p
tHn2aafsb\ffDwtfwxsywHDtslsns
ID\n\IHsndfdawI Andjfsgt\ebCwe\
tslsnsA\n\edwbbsAnsttwdeC IdggwHc
Hsbt2wIwbs,NDwtA\AsnIdetwbsntHDs
g\zdnAtpIDdbpe\gwI IdexfwIHtC\Ac
A\nseHweDwtfwxstHpfs\ebxwIHwdeC
yDwIDfsbHdHD\HslseH,
rW'ruNisgweay\p bwsbjp
t2wIwbs de¬2fp9CBG(B,uweIs
HDseDwtjdestD\lsjssetHwnnsbjp
Ddnbstdxzd2ne\fwtHtCInwHwItCjwdac
n\ADsntC\ebs2fdaw)sntC\ffdxHDsgC
\ebysHddC\HHsgAHwea Hd\AAn\wts
HDsisgweay\p DsnwH\as,htuIDdfc
\ntysa\HDsn\nd2ebDwtDwtHdnwI\f
\ebfwHsn\npnsg\wet-APgc-isgweay\p
yd2fbD\lst\wbfwRsDpse\t\nd2eb
I\nnwde,
LszdweHDwtIdeansa\Hwde Redyc
weaHD\HwHwt\fns\bpdlsnIndybsb
\ebns\fw)weaHD\HysId2nHHDsbs\b
g\e"tI2ntsn\HDsnHD\eDwtjfstt—
wea,LD\Hbd\AtpIDw\HnwtH \ebtHwff
\edHDsnAndxsttdndxfwHsn\H2nsD\ls
Hd\bbHdHDswee2gsn\jfs ydnbt
yDwIDD\ls\fns\bpjsseA2jfwtDsbFYHy\tAsnD\AtHDs\AAs\n\eIs dx
HDsfdeac\y\wHsb K\Rsnjwdan\ADpB
yDwIDIdelweIsb 2tHD\HCbstAwHsHDs
HDdnd2aDestt dxHDwt2tsx2fseIp—
IfdAsbwIydnRCtdgss0Hnsgsfp wg—
AdnH\eH\ns\tdxisgweay\p"t weesn
ydnfb\nstHwffHdjss0Afdnsb,O2ID
\tHDsAtpIDw\HnwtH HnwstHd2ebsn—
tH\ebDwtA\HwseHCystD\ff2ebsncH\Rs\es0\gwe\Hwde dxHDsg\zdn
AtpIDdbpe\gwI IdexfwIHtywHDyDwID
isgweay\p tHn2aafsb, LsbdedHC
dxId2ntsCAndAdtsHds0Af\wednbwt—
tsIHDwtasew2tCj2HdefpHdIf\nwxp
HDsweHsne\fxdnIstyDwIDtdtD\Asb
HDstHn2IH2ns\ebt2jtH\eIsdxDwt
ydnR,:2nb\H\IdetwtHdxHDsns—
IdnbsbslseHtdxisgweay\p"t fwxs
\ebDwtdyeynwHweat,LsD\ls\ftd
jssexdnH2e\Hssed2aDHdD\lsHDs
Id2etsfdxO\zdnUsesn\fTD\nfstN,
3K2ID47\eD\gC desdxisgwea—
y\p"tIfdtstHxnwsebtCyDdtswetwaDH—x2fgsgdnwst\ebt2aastHwdet D\ls
jssewel\f2\jfs weHDsAnsA\n\Hwde
dxHDwtg\e2tInwAH,
Nd\AtpIDw\HnwtHC isgweay\p wt
Idetwbsn\jfp gdnsHD\e\edHDsnwg—
AdnH\eHynwHsnCslsegdnsHD\eHDs
jstHcRedye hgsnwI\e edlsfwtHdx
HDsIseH2np,LDse\fwlsDsy\t\
A2jfwIxwa2nsdxHDsxwntHg\aewH2bsC
nsIdaew)\jfs detwaDHHdHDsfwHsn\Hs
dxHDwtId2eHnp\ebgdtHdxr2ndAs,
iwte\gsy\t\tpedepgxdn\e
\AAnd\IDHdfwxsID\n\IHsnw)sb jp
\IHwdeCId2n\asCADptwI\fAndysttC
tH\gwe\ClwdfseIsCwebsAsebseIsC \eb
\jdls\ffqan\Is2ebsnAnstt2nsq!
\HHnwj2Hst tdysffRedyeHD\H\epdx
d2nns\bsn"tId2fbD\lsIdgAwfsb \
IdgA\n\jfs fwtH,isy\tCwetDdnHC
HDsDsndwIgdbsfdx\e\as,hAdA2f\nDsndwtCHd\f\nass0—
HseHC\nsxfsIHwdeCtpgjdfCdntpgA—
HdgdxHDsI2fH2nsyDwIDIns\Hst
Dwg,NDsisgweay\p wg\asy\tdx
t2IDlwH\fwHpCDdyslsnCHD\HDsedH
defpgwnndnsbDwtI2fH2nsj2HDsfAsb
HdtD\As\ebAsnAsH2\Hs wH,Lwbs
s0Adt2nsHdisgweay\p weg2fHwgs—
bw\wgAnweHsbDwtl\f2stweHdIde—
HsgAdn\npAtpIDwIfwxs·DsD\tjsse
weIdnAdn\Hsb weHdHDsx\jnwIdxHDs
ID\n\IHsntHn2IH2nsdx\asesn\HwdedxhgsnwI\et, rlseHDdtsyDdbwb
edHns\bDwgysnsx\gwfw\nywHDDwt
x\gd2tIwesg\t2nnda\Hst1 U\np
TddAsnweqh«\nsysffHdhngtq
\ebq«dnLDdgHDsKsffNdfftCq
i2gADnspKda\nHweqNdi\ls\eb
i\ls'dHCqNpndesVdysnweqNDs
u2ehftdWwtstCqUnsadnpVsIRwe
qNDsuedytdx»wfwg\ez\ndCq K2nH
7\eI\tHsnweqNDs»wffsntCq\ebuAseIsnNn\IpweqNDs:fbO\e\eb
HDsus\,q
Ndb\pisgweay\p tHwffD\t\
f\nasxdffdyweaCstAsIw\ffp \gdea
\bdfstIseHt \ebIdffsastH2bseHtC
HDd2aDHDspD\lsesysnwbdft,LDwfs
HDspd2eaI\eedHbsepDwgDwtfwH—
sn\npAdtwHwde \tHDsfs\bsndx\
nsldf2HwdeweAndtstHpfsCHDsns\ns
g\epwebwI\Hwdet HD\HDswtedfdea—
sn\eDsndwIgdbsfxdn\nwtweaase—
sn\HwdedxI2fH2nsg\Rsnt,NDdts
gwfwH\eHfpIdggwHHsb Hd\e\Hwde\f
AdfwIpdxAs\IsxwebwHD\nbHdsg2—
f\Hs\g\eyDdyndHsHD\HDsbwb
edHjsfwslswe\epHDweas0IsAHHD\H
destDd2fbxwaDHxdndes"tId2eHnp
yDseslsnesIstt\np,9 Md2ea\IHwl—
wtHt\nsbwtseID\eHsb ywHDHDs\2—
HDdnyDdstIDsysbAdfwHwI\f\eb
tdIw\fweldflsgseHC xdnDsy\tj\—
twI\ffp\e\AdfwHwI\f g\eCbn\yeHd
j\HHfsfsttxndgwbsdfdawI\f IdggwH—
gseHHD\exndgHDsf2nsdxb\easn
\ebs0IwHsgseH, 8efwRsHDstdIw\ffp
gwebsbynwHsntdxHDsBGé6"tyDd
2et2IIsttx2ffp \HHsgAHsbHd\IHwl\Hs
DwgCDss\nfpfdtH\epwbs\fwtHwI bs—
twnsHdID\easHDsydnfbC\tDsD2—
gdnd2tfps0Ansttsb weHDwtBG9à
lsnts1
YRedygdeRtg\tH2nj\Hs \H
ewaDH
ND\HAsHI\HttInsy
ND\HtdgsawnftjwHs
hebpsH
LD\HI\eYbd
NdtsHHDweatnwaDHFé
YeHDsnsHndtAsIHdxtI\nIsfpHse
ps\ntCwH\AAs\ntHd2tHD\Hisgwea—
y\p"tfsa\Ipwtdesgdnsdxxdng
HD\edxt2jtH\eIsCHD\HDsywffjs
nsgsgjsnsb \t\tHpfwtHwIasew2t
j2H\t\lsnpe\nndya2wbsHdfwxs,
LDwfsys\AAnsIw\Hs HDss0wtHseHw\f
Idetwbsn\Hwdet asesn\HsbjpHDs
isgweay\p seId2eHsntywHDb\easn
\ebbs\HDCysbdedHxwebHDst\gs
gs\t2nsdx2ewlsnt\fwHp \ebHwgsc
fsttesttys\ttdIw\HsywHD\NdftHdp
dn\Tden\bdn\T\g2t,LDpCys
\tRd2ntsflstCwtHDwttdFLDpwtHDs
isgweay\p ydnfblwsytdnsc
HnwIHsbFLst2tAsIHHD\HHDsfwgw—
H\Hwdetdxisgweay\p"t lwtwde\ns
nsf\HsbHdDwtAsntde\fAtpIDdfdawchIIsAHsbxdnA2jfwI\Hwde osI9B,BG™6,
«ndgHDsosA\nHgseH dxVtpIDw\HnpC uH\ec
xdnb8ewlsntwHp uIDddfdxOsbwIwesCuH\exdnbCT\fwx3Y,M\fdg4C\ebHDsosA\nHgseH dx
«dnswae7\ea2\astC T\fwxdnew\ uH\HsTdffsasC
i\py\nb3O,M\fdg4,
WsAnweHns%2stHtHdosA\nHgseH dxVtpIDw\c
HnpCuH\exdnb8ewlsntwHp uIDddfdxOsbwIwesC
uH\exdnbCT\fwxGàé6>3on,Y,M\fdg4,
at Mayo Clinic Library, on March 20, 2011 www.archgenpsychiatry.com Downloaded from

I\fnstHnwIHwdet, NDsns\nsg\ep
%2stHwdetDseslsnn\wtsb\jd2HHDs
2ewlsnts,NDsns\nsslsegdnsDs
eslsnb\nsbHd\tR\jd2HDwgtsfx,
¬2tH\tHDsnswtedbd2jHHD\HDs
y\t\es0HnsgsfpawxHsbynwHsnC
HDsnswt\ftdedbd2jHHD\HDsy\t
\es0HnsgsfpHnd2jfsbg\eCnsfseH—
fsttfpbnwlse\ffDwtfwxsCyDdwe\
A\n\edwbbsAnsttwlsAtpIDdtwtRwffsb
Dwgtsfx\HHDs\asdx(9,
o2nweaDwtHn\weweaHDsAtpIDw\—HnwtHwt2t2\ffpns%2wnsbHdynwHsxdn
s\IDA\HwseH \nsAdnHyDwID\H—
HsgAHtHdqs0Af\weqHDsweesnydnfb
dxHDsA\HwseHHDnd2aD\e\e\fptwt
dxHDsA\tH\ebI2nnseHweHsnAsntde—
\f\ebweHn\Asntde\f xdnIstdAsn\H—
weade,Dwg,NDwtqbpe\gwIxdng2f\—
HwdeCq\twHwtf\jsfsbCwtwel\nw\jfp
HDstH2bseH"tgdtHbwxxwI2fHIDdns1
asesn\ffpDswtfdtHwe\ts\dxwexdn—
g\HwdeCg2fHwAfsHDsdnsHwI\f tIDddft
tHns\gjpCfwRstdg\eptH2nbp
Hn\etAdnHtDwAtCpsHedestssgtI\—
A\jfsdxI\nnpweaHDsseHwnsI\naddx
IfwewI\fwexdng\Hwde \l\wf\jfsxdn
s\IDA\HwseH,NDsqnsfw\jwfwHpq dx
HDsbpe\gwIxdng2f\Hwde wtfdyCwsC
g\epAtpIDw\HnwtHt ywHDtwgwf\nwe—
xdng\HwdeywffIdgAdtsn\bwI\ffp
bwxxsnseHxdng2f\Hwdet, q.\fwbwHpq
x\nstedjsHHsnCxdnHDsbpe\gwI
xdng2f\Hwde D\tfwHHfsIdnnsf\Hwde
ywHDHDsbw\aedtwt \ebIfwewI\f
Id2ntsdxHDsA\HwseH,
NDsAtpIDw\HnwtH yDdan\H2wHd2t—
fpdxxsnt\bpe\gwIxdng2f\Hwde xdn
HDsA\HwseHDsD\teslsntsseg2tH
jsA\nHwI2f\nfp D2gjfs,rnestH
isgweay\p nstwtHsbAndxsttwde\f
AtpIDdfdawI\f weHndtAsIHwde b2nwea
Dwtfwxs\ebedyCAdtHD2gd2tfpC Ds
nsg\wet2eIddAsn\Hwls HdIfwewI\fwe—
%2wnp,LsedesHDsfstt DdAsHdt2a—
astH\xn\gsdxnsxsnseIsHDnd2aD
yDwIDbwtA\n\HsAwsIstdxwexdng\—
Hwdeg\pjsdna\ew)sbweHd\Id—
DsnseHfdawI\ftIDsg\CyDwIDg\p
asesn\Hs esyDpAdHDststxdnx2H2ns
welstHwa\Hwde,
8efwRsHDstH2bseHAtpIDw\HnwtH
tHn2aafwea Hdg\Rstsetsdx\e\l\—
f\eIDsdx\e\gestHwI weHsnlwsy
b\H\Cx\eH\tpCbns\gC\ebbns\gc\t—
tdIw\Hsbg\Hsnw\f \tysff\t\20wffw\cnpwexdng\Hwde xndgIdeIsnesb\eb
asesn\ffpIddAsn\Hwls nsf\Hwlst\eb
xnwsebtCys!HDsisgweay\p xdn—
g2f\Hdf\!\ns djfwasbHdnsfpde
tI\eHp\ebdxHse2ensfw\jfs b\H\,
isgweay\p"t dyetH\HsgseHt dxxsn
fwHHfs\ttwtH\eIs1 Dsy\tedHIsfs—
jn\HsbxdnHsffweaHDsHn2HD\jd2H
Dwgtsfx,LdnfbHn\lsfsn\ebs0—
AfdnsnCDseslsnA2nAdtsx2ffp \eb
A2jfwIfpsgj\nRsb 2Ade\ewey\nb
zd2nesp\ebDsdAAdtsbHDdtsAtp—
IDdfdawI\ffp dnwseHsbInwHwItyDd\H—
HsgAHsbHDszd2nesp deDwtjsD\fx,
NDsbwxxsnseIsjsHysseDwt\HHwH2bs
HdAtpIDdfdawI\f we%2wnp\ebHD\Hdx
\edHDsng\zdnhgsnwI\eynwHsny\t
lwlwbfpbsgdetHn\Hsb Hddesdx2t
3Y,M,4jpHDsxdffdyweaweIwbseH,
uslsn\fgdeHDt\adC\H\AtpIDw—
\HnwIgssHweaCY\HHsgAHsbHdweHsn—
lwsyidy\nbWdgsCHDsAtpIDw\—
HnwtHyDdHns\Hsbisgweay\p weDwt
xwe\fbsAnsttwde, hxnwsebAdweHsb
Dwgd2HHdgswe\nddgIndybsb
ywHDIdffs\a2stCj2H\tID\eIsyd2fb
D\lswHCY\AAnd\IDsb HDsyndea
g\e,hxHsn\Adfdaw)wea \ebs0Af\we—
weagpweHsnstHweisgweay\pC Ds
nsg\nRsbHD\HCHDd2aDDsResyfwH—
Hfs\jd2Hisgweay\pC DsD\bjsse
r2ases:"'swff"tAtpIDw\HnwtH< is
IdeHwe2sbjpwexdngwea gsHD\H
:"'swffD\bfsxHDwgg\epAsntde\f
sxxsIHtCweIf2bweafsHHsnt\ebnsIdnb—
sbIdelsnt\HwdetC \ebD\bseId2n—
\asbDwgHdynwHs\ewecbsAHD \I—
Id2eHdxDwtxwe\fps\nt,YHy\tedH
tdywHDisgweay\p, LDseYxwe\ffp
fdI\Hsbon,WdgsCDswexdngsb gsC
ywHD\xweasn\IndttDwtgd2HDCHD\H
jsxdnsHns\Hweaisgweay\pC DsD\b
jssedjfwasbHdAndgwtsHD\HDwtfwAt
yd2fbjsxdnslsnts\fsb,
NDsnsIdetHn2IHwde dxHDss\nfp
xdng\Hwls ps\ntwt\A\nHwI2f\nfp
ls0weaH\tR,K\Rsn"tIdgAnsDsetwls
\ebtIDdf\nfpjwdan\ADps0Issbwea
(66A\astbsldHstHdisgweay\p"t
xwntHB™ps\ntdefp96A\ast\eb
g2IDdxHD\HwtAndt\wIx\IH2\fg\—
Hsnw\fCyDwIDbdstedHAndlwbsHDs
Rwebdxwexdng\Hwde 2tsx2fxdn\e
welstHwa\Hwde dxHDsweesnydnfb,
:HDsnjwdan\ADwstC weIf2bwea HDs
destjpisgweay\p"t jndHDsn7swIstHsn\ebDwttwtHsnO\nIsffwesC
\nsIdetwbsn\jfp fsttDsfAx2f,àQ>Vsn—
D\AtHDd2aDCystDd2fbedHgd2ne
HDswnnsHnwsl\jfs fdttdxHDss\nfp
ps\nt,NDsnsIdetHn2IHwde dxHDs
A\tH\ebHDst2jts%2seH 2tsdxHDwt
IdetHn2IHHdIdgAnsDseb HDsAnstseH
3\ebHDsx2H2ns4wt\ewexsnseHw\fC
nwtRpAndIstt,YHD\tjsseysffst—
H\jfwtDsbjpAtpIDdfdawI\fnsts\nID
HD\HnsI\ffdxdes"ts\nfpfwxsCstAs—
Iw\ffpdx\xxsIHcf\bse slseHtCwtt2j—
zsIHHdIdetwbsn\jfs nsHndtAsIHwls
x\ftwxwI\Hwde,( NDsAndIsttdxnsI\ffC
wesxxsIHCHsfft2tgdns\jd2HAnstseH
AtpIDdfdawI\f ns\fwHwstHD\e\jd2H
A\tHslseHt·AnstseH\HHwH2bstbwI—
H\HsyDwIDdxHDsseHwnsA\edAfpdx
s\nfpfwxss0AsnwseIst ysIDddtsHd
nsgsgjsn \ebwgj2sywHDAdysn,
Tdggde tsetsD\twHHD\HHDsAnst—
seHwtbsHsngwesbjpHDsA\tH\ebC
psHCwtedHHDsIdelsntss%2\ffp
Hn2sFNDsA\tHjsIdgst\fwlsxdn2t
defp\twHwtnss0AsnwseIsb HDnd2aD
HDsxwfHsndxd2nAnstseHAtpIDwI\A—
A\n\H2t,YebwxxsnseHsgdHwde\f
tH\HstCwebwxxsnseHtH\astdxfwxsCHDs
A\tHg\p\tt2gs\l\nwsHpdxD2st,
O\nRNy\weHsfft2tHD\HyDseDs
y\tB™DsHDd2aDHDwtx\HDsny\t\
b\gexddfj2HyDseDsy\t9BDs
y\tt2nAnwtsbHdtssDdyg2IDHDs
dfbxddfD\bfs\nesb<
LsAndAdtsCHDseC\eDdnw)deH\f
s0Afdn\Hwde n\HDsnHD\e\lsnHwI\f
des,Nd2ebsntH\eb \ewebwlwb2\f
x2ffpCdesg2tH2ebsntH\eb \ffHDs
IdexfwIHweaweHsne\fxdnIstdAsn\Hwea
deDwg\H\AdweHweHwgs·HDs
lsnHwI\fdnasesHwIs0Afdn\Hwde wtC
IdeHn\npHdHDsf\pIdeIsAHwde dx
AtpIDw\HnpC gsnsfp\eIwff\npHdHDs
Ddnw)deH\fad\f,LsH2neHdHDsA\tH
defpHds0AfwI\HsHDsAnstseHCg2ID
\t\Hn\etf\HdnH2netHdDwtHdnpHd
sf2Iwb\Hs \edjtI2nsHs0H,™Nd\wb2t
wed2nnsIdetHn2IHwde dx\AtpIDd—
fdawI\fIndtttsIHwdeCHDsnswt\edH
weIdetwbsn\jfs jdbpdxb\H\xndg
HDsgwbbfs\ebf\Hsps\nt!\esIbd—
H\f\IId2eHtjpxnwsebtC \xsyns—
IdnbsbweHsnlwsytC \f\nasjdbpdx
fsHHsntC\ebCgdtHdx\ffCHDsxwIHwde
wHtsfx,isgweay\p"t fsHHsnt\eb
edHstIdnndjdn\Hs HDsDwaDfp\2Hdc
at Mayo Clinic Library, on March 20, 2011 www.archgenpsychiatry.com Downloaded from

jwdan\ADwI\f e\H2nsdxDwtynwHwea,
K\RsnIwHst\Idelsnt\Hwde ywHDYnl—
weauHdesyDsnsisgweay\p Ifs\nfp
t\wbHD\HDwttHdnwstqId2fbjsI\ffsb
jwdan\ADwI\f edlsftn\HDsnHD\eA2ns
xwIHwde\fedlsftjsI\2tsHDspsgsnasb
d2Hdx"fwlsbs0AsnwseIs,"q»A9&�47wRs
\fff\HHsncb\pndg\eHwItCDwtg\Hsnw\f
wtAtpIDdfdawI\ffpC wxedHx\IH2\ffpC
Asntde\f 1isgweay\p"t fdlstCessbtC
bstwnstCIdexfwIHtCl\f2stC\ebx\eH\—
twstty\nge\Rsbfp\IndttHDsynwH—
HseA\as,
:jtsnlsisgweay\p \H\epAdweH
b2nweaDwtg\H2nsps\nt\ebdes
gssHt\Adysnx2fwgAdtweaxwa2ns!
HDsisgweay\p wg\adyDwIDDs
AnstseHsbHddHDsnt\ebHdDwgtsfx,
qisy\tCqt\wbHDsAdsH¬dDeV2bc
espdxisgweay\p weBGààCq\
xsffdydjtsttsbywHDAf\pweaHDs
A\nHdxrnestHisgweay\p <qB3AéG94
LD\Hslsn sftsysI\etssC\fy\pt
HDsnswtlwnwfwHpCtHnseaHDCId2n\as1
DswtHDstdfbwsnts\nIDwead2HHDs
spsdxHDsj\HHfstHdng·HDsweHnsAwb
D2eHsn\ebxwtDsng\eIdgAsffsbHd
A2nt2sHDsans\HstHxwtD\ebtH\fR
HDsgdtHb\easnd2t\ewg\fxndgHDs
U2fxuHns\gHdTseHn\fhxnwI\·HDs
\HDsfsHsCtywggsnCjn\yfsnCjd0sn·
HDsD\nbbnweRsn\ebD\nbfdlsnyDd
jd\tHsbHD\HDsD\bjsbbsbslsnp
awnfDsy\eHsb\ebtdgsHD\HDsD\b
edHy\eHsb»Awst4,HDsfdlsndxb\e—
asnCdxHDsj2ffxwaDHCdxxfpweaCdxHDs
y\nHwgsxndeHfwest·HDsxnwsebdx
jn\lsgseCDsndstCxwaDHsntCD2eH—
sntC\ebg\H\bdnt,
NDsfwtHwttdfdeaCHDswg\astd
Adysnx2fHD\HwHdjfwastslseHDs
gdtHe\wlsdjtsnlsndxD2g\ee\—
H2nsHdydebsnyDsHDsn \g\exwng—
fpIdelweIsbdxDwtwbseHwHpyd2fb
ID\eesft2ID\Idetwbsn\jfs AndAdn—HwdedxDwtfwxssesnapweHd\ts\nID
xdng\tI2fwesx2fxwffgseH, uweIsHDs
s\nfwstHnslwsytdxDwtydnRtC \
tHns\gdxisgweay\p InwHwItD\ls
AdweHsbpedHsbDwtessbHd\ttsnH
\a\we\eb\a\we\jn2HslwnwfwHp,�
Ksxdnsyss0\gwesHDswg\aswH—
tsfxCfsH2tHstHwHtjd2eb\nwst, L\t
HDsisgweay\p wg\as\A2jfwIwg—
\asdefpCIdetHn2IHsbjpHDs\2HDdn
\ebDwtA2jfwtDsnCwetsInsHIdgAfwIcwHpCHdDddbyweRHDsA2jfwI\ebHd
weIns\tsnslse2sF :2nnsts\nID
fs\bt2tHd\gdtHsgAD\HwIq'd<q
hff\l\wf\jfsslwbseIst2aastHtHD\H
HDsA2jfwI\ebAnwl\Hsisgweay\pt
\nsgsnasb1HDsisgweay\p dxAnw—
l\HsIdelsnt\HwdetC dxfsHHsntC\ebdx
edHsjddRt wtwbseHwI\fywHDHDs
isgweay\p yDdI\nssesb \Indtt
HDsA\astdxesytA\Asnt \ebzd2n—
e\ft\ebHDsg\episgweay\pt
yDdxd2aDHCfdlsbC\ebID\ffseasb
bs\HDweDwtedlsft\ebtHdnwst,
hfHDd2aDDsy\t\ysffcRedye n\—
IdeHs2nCisgweay\p eslsnf\2aDsb
\HDwgtsfxC ednbwbDsAsngwH
xnwsebtHd%2stHwdeHDsisgweay\p
wg\as,Usesn\f7\eD\gCDwtIfdtstH
xnwsebxdnHDsf\tH%2\nHsndxDwt
fwxsCdeIsnsg\nRsbHdisgweay\p"t
ywxsCO\npCHD\HDsnD2tj\eb y\t
qxnd)sewe\bdfstIseIs,q isgweay\p
fs\nesbdxHDsnsg\nRCnsgsgjsnsb
wHC\ebslseH2\ffpnszdwesb1qVsn—
D\At\bdfstIseIs wte"Ht2ID\j\b
Af\IsHdjsxnd)seq3T,N,7\eD\gC
ynwHHseIdgg2ewI\HwdeC h2a99C
BG(™4,:e\edHDsndII\twdeb2nwea
LdnfbL\nYY7\eD\g"t 99ebwe—
x\eHnpxd2aDH\D\nbj\HHfsHdI\A—
H2nsHDsHdyedx7\ebnsIwstC 2fHw—
g\Hsfpsebwea2A(6gwfst\Ds\bdx
HDsseHwns«wntHhngp,7\eD\gC
tIDdf\n\tysff\ttdfbwsnCtseHisg—
weay\p\j\eHsnwea gstt\asA\n\—
ADn\twea.dfH\wnsyDwIDns\bCqUd
D\eaHDptsfxCjn\lsisgweatHswe,
LsD\lsxd2aDH\H7\ebnsIwst \eb
pd2ysnsedHHDsnsCq3T,N,7\eD\gC
ynwHHseIdgg2ewI\HwdeC h2a99C
BG(™4,WstAdebwea \twxHd\b\nsC
isgweay\p tAsbHDnd2aD(6gwfst
dxUsng\ecwexstHsb HsnnwHdnpC \H
ans\HAsntde\fnwtRCwednbsnHd
xfd2nwtDDwtA\e\IDswexndeHdx
7\eD\g,
KdHDA2jfwIfp\ebAnwl\Hsfpisg—
weay\pwelstHsbwednbwe\HsAtpIDwI
sesnapweHdx2fxwffweaDwtwbs\fw)sb
wg\as,NDswelstHgseH y\tedHAnw—
g\nwfp\IdetIwd2tCbsfwjsn\HsC desC
xdng\epdxisgweay\p"t fwxs\I—
HwlwHwstysnsdlsnbsHsngwesb ·Ds
\IHsbdxHseedHHDnd2aDxnssIDdwIs
j2HjsI\2tsDsy\tbnwlsejptdgs
bwgfp2ebsntHddb weHsne\fAnstt2nsyDdtsg2nRpAsnt2\twlsestt defp
tD\ggsbIDdwIs,isxwtDsbCD2eHsbC
\ebtd2aDHb\easnedHdefpjsI\2ts
Dsy\eHsbHdj2HjsI\2tsDsD\bHdC
wednbsnHdstI\Astdgsans\Hsnwe—
Hsne\fb\easn,YeqNDsuedytdx
»wfwg\ez\ndq isgweay\p t2aastH—
sbHD\HDsessbsbHdRwffHdtH\p
\fwls,GNDsps\ntxdffdyweaLdnfb
L\nYYysnsedHasesn\ffpaddbdest
xdnHDsynwHsn\ebg\eC\ebisg—
weay\pIdgAf\wesb dxHDssgAHwestt
\ebgs\eweafsttestt dxDwtfwxs
ywHDd2Hy\n,
LDdbdstedHD\ls\ewbs\fw)sb
wg\asFLDdbdstedHxdng2f\Hs \
tsHdxAsntde\f\tAwn\Hwdet \eb
tsfxcs0AsIH\HwdetF K2Hisgweay\p"t
wbs\fw)sbwg\asy\tgdnsCg2ID
gdns,W\HDsnHD\es0AsIH\HwdetC Ds
xdnasb\tsHdxnstHnwIHwls bsg\ebt
2AdeDwgtsfxC\Hpn\eewI\f \ebwes0—
dn\jfsbsI\fda2syDwIDAsnl\bsb\ff
\ns\tdxDwtweesnydnfb,O\epAsn—
tde\fwHpHDsdnwtHtD\lsbs\fHywHD
HDsIdetHn2IHdxHDswbs\fw)sbwg\asC
j2HedestdIdaseHfp \t»\nseidnc
esp,«dn\IdgAfsHss0AdtwHwdedx
DsnAsntde\fwHpHDsdnpysnsxsnHDs
ns\bsnHdDsnf\tHjddRC's2ndtwt
\ebi2g\eUndyHD,B6Ndt2gg\—
nw)sbn\tHwI\ffpC \IDwfbt2xxsntxndg
j\twI\e0wsHpC \es0Hnsgsfpbptc
ADdnwItH\HsdxjsweaCwxDsD\tA\n—
seHtyDdtsdyees2ndHwIIdexfwIHt
AnslseHHDsgxndgAndlwbwea HDs
j\twI\IIsAH\eIs esIstt\npxdnHDs
bslsfdAgseH dxHDsIDwfb"t\2Hded—
gd2tjswea,o2nweas\nfpfwxsyDse
HDsIDwfbnsa\nbtHDsA\nseHt\tdg—
ewtIwseH\ebdgewAdHseHC DsI\e
defpIdeIf2bsCweHDsx\IsdxA\nse—
H\fbwt\AAndl\f \ebnszsIHwdeCHD\H
HDsnswttdgsHDweabns\bx2ffp yndea
ywHDDwg,NdbwtAsfj\twI\e0wsHpC
HddjH\weHDs\IIsAH\eIsC\AAndl\fC
\ebfdlsDsns%2wnstxdnt2nlwl\fC
HDsIDwfbAsnIswlstDsg2tHjsIdgs
tdgsHDweasfts·DsID\eesftDwtse—
snawst\y\pxndgHDsns\fw)\Hwdedx
Dwtns\ftsfxCxndgDwtdyeAsntde\f
AdHseHw\fC\ebbslsfdAt \IdetHn2IH
dx\ewbs\fw)sbwg\as!\ y\pDs
g2tHjsIdgswednbsnHdt2nlwls\eb
Hd\ldwbj\twI\e0wsHp,NDswbs\fw)sb
wg\asg\pH\Rsg\epxdngtC\ffdx
at Mayo Clinic Library, on March 20, 2011 www.archgenpsychiatry.com Downloaded from

yDwID\nsbstwaesbHdIdAsywHD\
AnwgwHwls tsetsdxj\besttCwe\bs—
%2\IpCdn2efdl\jwfwHp, isgweay\p"t
wbs\fw)sbwg\asInptH\ffw)sb \nd2eb
\ts\nIDxdng\tHsnpCxdn\lwebwI—
HwlsHnw2gADyDwIDyd2fbfwxHDwg
\jdlsdHDsnt,
NDsbslsfdAgseH \H\es\nfp\as
dx\ewbs\fw)sbwg\as\ebHDsID\e—
esfweadxsesnawst\y\pxndgx2f—
xwffgseHdxdes"t\IH2\fAdHseHw\fD\t
s0Hnsgsfpx\ncns\IDwea n\gwxwI\—
HwdetdeHDsbslsfdAwea Asntde\f—
wHp,NDswebwlwb2\f s0AsnwseIst
ans\Hwtdf\Hwde \tID\tgt\nwtsjs—
HysseDwgtsfx\ebdHDsnt,isAf\Ist
weIns\tweafp tslsnsbsg\ebt2Ade
Dwgtsfx3\AndIsttyDwIDidnesp
I\fftHDsqHpn\eepdxHDstDd2fbtq4C
DsbslsfdAt \IdgAfsHsAnwbstptHsg
HD\HbsxwestyDwIDxssfweat\eb\HHw—
H2bstDsI\eAsngwH\ebyDwIDDs
g2tHt%2sfIDweDwgtsfx,YetDdnHC
Dsg2tHtD\AsDwgtsfx\IIdnbweaHd
\Ansbstwaesb xdngn\HDsnHD\e\f—
fdyDwgtsfxHd2exdfb\ebHdsezdp
HDss0AsnwseIsdxan\b2\ffpbwtIdl—
snweaesy\ebnwIDA\nHtdxDwgtsfx,
LDseHDswbs\fw)sbwg\aswtts—
lsns\eb2e\HH\we\jfsC \twHy\txdn
isgweay\pC Hn\awIIdets%2seIst
g\pnst2fH1HDswebwlwb2\f I\eedHwe
ns\ffwxs\AAnd0wg\Hs HDst2AsnD2—
g\etIdAsdxHDswbs\fw)sbwg\asC
ns\fwHpslseH2\ffpweHn2bstC\ebDs
ns\fw)stHDsbwtInsA\eIp jsHysse
yD\HDsy\eHtHdjs\ebyD\HDswt
we\IH2\fwHp,hHHDwtAdweHDswt
xfddbsbywHDtsfxcD\HnsbC yDwIDwt
s0AnsttsbHDnd2aD \gpnw\bdx
tsfxcbstHn2IHwls gsID\ewtgt xndg
t2jHfsxdngtdxtsfxcHdngseH 3HDs
HwepldwIsyDwIDyDwtAsntCqTDnwtH
pd2"ns2afp<qyDsedesa\)st\H\
gwnndn4HdHdH\f\eewDwf\Hwde dxHDs
tsfx,
Tdetwbsnwea defpHDsjnd\b
jn2tDtHndRst dxisgweay\p"t fwxsC
desgwaDH\tt2gsHD\HDs\AAnd0w—
g\HsbDwtwbs\fw)sbwg\asCHD\Hwe
slsnpy\pDsjsI\gsyD\HDsgdtH
y\eHsbHdjs,MsHHDnd2aDd2H Dwt
fwxsisgweay\p z2basbDwgtsfxC
xd2ebDwgtsfxy\eHweaC\ebs0Asnw—
seIsbnsI2nnseHIpIfstdxs0Hnsgs
tsfxcbd2jH\ebtsfxcIdeHsgAH,TdetwbsnHDs%2\fwHpdxtsfxct2x—
xwIwseIp2AdeyDwIDHDsisgwea—
y\pg\ewtAnsbwI\Hsb 1Dsg2tHjs
Hn2sdefpHdDwgtsfxCHdAsnD\At\e
sfwHsI\bnsdxxnwsebtC\ebwgAsnlw—
d2tHdHDsdAwewdetdx\ffdHDsnt,
MsHisgweay\p y\ts0Issbweafp bs—
AsebseH deAn\wtsxndg\ff%2\nHsnt
\ebDwaDfptsetwHwlsHd\epInwHwI\f
z2bagseH, isjdnsDwtInwHwItlse—
as\eIs\ebCwe\A\n\edwby\pCIde—
twbsnsb\epHDweaj2H2e%2\fwxwsb
An\wts\tIdetAwn\Ip\a\wetHDwg,B
isy\ttdHdngseHsbjp\blsnts
InwHwIwtgdxDwtynwHweaHD\Hdefp
\xddfD\nbpxnwsebyd2fbb\nsdxxsn
\epHDweanstsgjfwea \2HDseHwI \A—
An\wt\f,
NDsf\IRdxy\nbsIdn\Hwdet wg—
gsbw\HsfpxdffdyweaL\nfbL\nYY
y\t\edHDsnwaedgwewd2t \xxndeHHd
HDsisgweay\p sad,isdxHsef\—
gseHsbHd7\eD\gHD\HHDsowt—
Hwea2wtDsb usnlwIsTndttnwaDHx2ffp
DwtxdnxwaDHweaweW\gjd2wffsH y\t
awlseHd\edHDsn,3NDd2aDisgwea—
y\pxd2aDHl\fw\eHfpweHDsy\nCDs
y\twesfwawjfsxdnIwH\Hwde \t\
tdfbwsntweIsDsy\t\IdnnstAdebseH
\ebedHdxxwIw\ffpAsngwHHsbHdI\nnp
ys\AdetweLdnfbL\nYY,4YeBGà™
qDsy\taf\bsed2aDHd\IIsAH\
Knde)suH\n ,,,xdn"gsnwHdnw—
d2ttsnlwIs" \t\y\nIdnnstAde—
bseH,qB&>à(B" isyndHsAf\weHwlsfp Hd
7\eD\gdxDwtxs\nHD\H96ps\nt\xHsnDwtbs\HDqHDspqyd2fbbsep
Dsy\tweHDsy\n,7\HsnHDwty\t
tDdnHsesbHdqHseps\ntq\ebxwe\ffp
HdHDsxs\nHD\HjsxdnsDwtbs\HD
qHDsp"ffqbsepDsslsnt\y\IHwde,
iwtnsf\HwdetDwA Hd7\eD\g y\t
dxHseDwaDfpweIdetwtHseH ywHDHDs
isgweay\p wg\as,NDsfsHHsntHd
7\eD\gnsls\fIDwfbfwRs\bgwn\Hwde
xdnHDsAndxsttwde\f tdfbwsnCywHD
yDdgisgweay\p twg2fH\esd2tfp
IdgA\nstDwgtsfx2ex\ldn\jfp \eb
\HHsgAHtHdwbseHwxp,isyndHsHd
f\eD\gHD\HdHDsntysnsq\fy\pt
zs\fd2tqdxAsdAfsfwRsHDsgCHD\HDs
qD2nHqyDse7\eD\gqD2nHCqHD\H
NDs:fbO\e\ebHDsus\D\bwewH
slsnpHDwea weyDwIDHDspjdHDjs—
fwslsb,isyndHs\ftdwe\Asnwdbdx
bsAnsttwdeHD\HDsy\tz2tHRwffweaHwgsywtDweaDsysns\tdfbwsnfwRs
7\eD\gwetHs\bdx\qIDwIRsetDwH
ynwHsn,qisbsgs\esbDwtdye\I—
IdgAfwtDgseHt jpt2aastHwea HD\H
Dsyd2fbasHweHdDwtHdnpdefpjs—
I\2tsdxDwtIfdts\ttdIw\Hwde ywHD
7\eD\gyDse7\eD\gIdgg\ebsb
HDs99ebwex\eHnp,BBBà
YeDwtnsf\HwdetDwA HdHDsydgse
weDwtfwxsCisgweay\p \tt2gst \
I2nwd2tfpA\n\bd0wI\f AdtsCtIdnewea
HDsg\tg2ID\tDsfdlstHDsg,is
wt\HdeIsHDsIsfsjn\HsbID\gAwde
dxndg\eHwIfdls\ebHDsgwtdap—
ewtH,MsHHdjsynwHHsewtHDstHdnp
dxDwtwee2gsn\jfs fdls\xx\wnt\eb
xd2ng\nnw\astC yDsnsweDs2e—
bd2jHsbfpbsgdetHn\Hsb HsebsnesttC
tsetwHwlwHpC \eb\I\A\IwHpxdnI\n—
weaC\tysff\tHDssndHwIxs\Htdx
yDwIDDsA2jfwIfp\ebAnwl\Hsfp
jd\tHsb,K\Rsn"tjwdan\ADp awlst
e2gsnd2ts0\gAfstdxHDd2aDHx2f
\HHseHwdet HdDwtywlst!i\bfspC
V\2fwesCO\nHD\C\ebO\np,K2Hbs—
tAwHsK\Rsn"tH\IHx2fAnstseH\Hwde dx
isgweay\p HDsfdlsnCHDsns\nse2—
gsnd2tweIwbseHtdxHDs2eRwebesttC
2afwesttC\ebA\HseH2ex\wHDx2festt
yDwIDysnswel\nw\jfptsnlsbHdHDs
isgweay\p ydgse·HDsg�e\ast�
HndwtHdyDwIDi\bfsp\ebV\2fwes
ysnst2jzsIHsbywHDHDswnnstAsIHwls
t2IIsttdntC \ebyDwIDO\npseb2nsb
ywHDpd2easnnwl\ftC\nsI\tstwe
AdweH,B7\eD\gHsfft2tHD\Hisg—
weay\py\tedHdnwd2tfp n2bsHdDwt
xnwsebt"ywlstCtdgsdxyDdg
tsnlsb\tgdbsftxdnHDsqjwHIDstq
DsbstInwjsbweDwtxwIHwde,isns—
y\nbsbUsnHn2bsuHsweCDwts\nfp
gseHdn\ebxnwsebCywHDtdgslw—
Iwd2tA\astwehOdls\jfs«s\tH3\
edH2eIdggde Hns\HgseHdxDwtxsf—
fdy\2HDdntCyDsHDsnHDspD\bjs—
xnwsebsbDwgdnedH4,isgweay\p
deIsyndHsHD\HHDsHDweatDsfdlsb
ysnsweHDsxdffdyweadnbsn1qaddb
tdfbwsntC\ewg\ft\ebydgse,qB>
YeDwtxwIHwdeCyDwIDweIf2bst
tdgsdxHDsgdtHgdlweafdlstHd—
nwstweIdeHsgAdn\np fwHsn\H2nsC
HDsnswttI\nIsfp\tweafss0\gAfsdx
\t2IIsttx2fg\fscxsg\fs sa\fwH\nw\e
nsf\HwdetDwA 3KwIRxdnbupflstHsnC
2eA2jfwtDsb djtsnl\Hwdet4, NDsu2e
at Mayo Clinic Library, on March 20, 2011 www.archgenpsychiatry.com Downloaded from

hftdWwtstbstInwjstHDsnsf\Hwde—
tDwAdx\ewgAdHseH g\eC¬\Rs
K\nestCywHDHDstsb2IHwlsCAndgwt—
I2d2tKnsHHhtDfsp,Ye«dnLDdg
HDsKsffNdfftHDsydnfbfphgsnwI\e
WdjsnH¬dnb\e\ebHDspd2eawease—
2d2tO\nw\IdgsHdasHDsnfwRs
Hs\IDsn\ebA2Awf,NDwtbwtA\nwHpwt
slsegdnsAnded2eIsb wehIndttHDs
Wwlsn\ebYeHdHDsNnsstCyDsnsHDs
BG™ps\ncdfbawnfWse\H\wtI\ffsb
qb\2aDHsnq jpDsnfdlsnCHDs>6c
ps\ncdfbTdfdesfT\eHysff,YeNd
i\ls\ebi\ls'dHi\nnp"tywxs
O\nwswt\e2exsgwewesC jfdytps0c
AndtHwH2Hs,YeqNDsuedytdx»wfw—
g\ez\ndqi\nnpwtg\nnwsbHd\
nwIDCweHn2twls ydg\eyDdxssbtde
DwtlwH\fwHpC\ebweqNDsuDdnHi\A—
Ap7wxsdx«n\eIwtO\Idgjsnq HDs
AndH\adewtH"t ywxswex\eHwfw)st Dwg
2eHwfDsjsawetHdbwtIdlsnDwt\2—
HDseHwItsfxCyDsns2Ade tDsg\e\ast
HdRwffDwgjp\IIwbseH,NDsId2Afs
weh«\nsysffHdhngt\nsAsnD\At
isgweay\p"t gdtHx2fxwffsbfdlsntC
psHHDswnnsf\HwdetDwA \AAs\nt 2e—
IdelweIwea ·T\HDsnwes K\nRfspC
«nsbsnwIR"t xdngsne2ntsCwt\es0—
Hn\dnbwe\nwfp tsfxfsttCxfstDfsttjswea
yDdfwlstdefpxdn«nsbsnwIR \eb
bwstn\HDsnAdweHfsttfp xdffdywea
IDwfbjwnHD jpI\st\nw\e tsIHwde
3yDwIDCweIwbseH\ffpC y\tynwHHse
wggsbw\Hsfp \xHsnisgweay\p"t tsI—
debywxsV\2fwesy\tbsfwlsnsbdx
DwttsIdebIDwfbjpI\st\nw\e tsI—
Hwde4,Yxisgweay\p \ldwbtbsAwIHwea
sa\fwH\nw\e g\fscxsg\fs nsf\Hwde—
tDwAtCDswtwebssbwelseHwlsweIns—
\Hwea\fHsne\Hwlst, YHwt\tHDd2aD
Dwt\HHsgAHtHdAdnHn\p \t\Hwtxpwea
fdlscts0nsf\HwdetDwA \nsHDy\nHsb
jp\e2gjsndxAdysnx2fId2eHsnc
xdnIstCg\epdxyDwIDisgweay\p
nsIdaew)st,7ddgweaf\naswet2ID
ydnRt\tqNDsuedytdx»wfwg\ez\—
ndCqqNDsuDdnHi\AAp7wxsdx
«n\eIwtO\IdgjsnCq q'dyY7\p
OsCqqNDsNDnsso\pKfdyCqqOn,
\ebOnt,rffwdHCqq:2Hdxus\tdeCqqiwfft7wRsLDwHsrfsAD\eHtCq \eb
qT\HweHDsW\weqwtHDsb\easndx
sg\tI2f\Hwde, NDd2aDHDse\nn\Hwls
l\nwstCHDsd2HIdgswes\IDwtHDst\gs!\eseb2nwea2ewdeywHD\
ydg\enst2fHtwe\bslwH\fw)sb g\e,
NDsx\HDsnweq'dyY7\pOsq
djtsnlstCAdysnfsttfpC yDwfsDwtywxs
j2netDwtHns\t2nsbjsfdeaweat, Ye
qiwfft7wRsLDwHsrfsAD\eHtq \e—
dHDsnbslwH\fw)sb \ebbsAsebseH D2t—
j\ebAfs\btywHDDwtAnsae\eHywxs
HdD\ls\e\jdnHwdejsI\2tsDsI\e—
edHjs\nHDsHDd2aDHdxIdgAsHwHwde
xdnDsn\HHseHwde,
rlseIfdtsnHdDdgsy\tHDsbs—
Ifwesdxisgweay\p"t dyex\HDsn
xndgHDs\jfsbdIHdn\ebfsaseb\np
D2eHtg\ewggdnH\fw)sb weHDs'wIR
hb\gttHdnwstHdHDsy\tHsbxwa2ns
yDdlwtwHtDwttdetdgsgdeHDtjs—
xdnsDwtbs\HDfwRs\Ansg\H2ns
aDdtHyDdtsfwxsxdnIsD\bjsse\j—
tdnjsbjpisgweay\p"t gdHDsnC
fddgweajstwbsDwgCq\AwIH2nsdx
n2bbpDs\fHDq3O\nIsffwes u\exdnbC
IwHsbweK\RsnB3Af�é44,Ksfwslwea
HD\HDwtgdHDsn"t\aansttwlsj2ffp—
weaD\bbnwlseDwtx\HDsnHdt2wIwbsC
isgweay\p gdbsfsbHDsA\nseHtdx
WdjsnH¬dnb\ewe«dnLDdgHDs
KsffNdfft2AdeDwtdyeA\nseHt·
fwRsrnestHCWdjsnHI\fftDwtx\HDsn
\Idy\nbjsI\2tsDsbwbedHnstwtH
Dwtywxs\ebxwe\ffpnstdnHsbHdt2w—
Iwbs!HDsys\RstH\IHdx\ff,
NDnd2aDd2H Dwtfwxsisgweay\p
Idetwbsnsb fdlsjsHysse g\e\eb
ydg\e \tbsHnwgseH\f HddHDsnC
Hn2snHpAstdxnsf\HwdetDwAtC t2ID\t
xnwsebtDwA jsHysseg\fstdng\e"t
Idgg2ewde ywHDe\H2ns,LDseDs
xsffwefdlsywHDi\bfspCDsI\tHwa\H—
sbDwgtsfxxdnedfdeasnI\nwea
\jd2HHDsHyddnHDnsstHns\gtDs
D\bfdlsbjsHHsnHD\e\epHDweasfts
weHDsydnfb,B�q™G" YeqTndttTd2e—
HnpuedyqHDswgAsebweag\nnw\as
dx\pd2eag\eHDns\HsetHdbstHndp
DwtbssAnsf\HwdetDwA ywHD\tRwwea
Idgn\bs,NDsHydtAs\RywtHx2ffpdx
tRwwea\a\weweHDsAf\IsHdyDwID
desg2tHgdlsCj2HjdHDRedyHD\H
qHDsgd2eH\wet\nse"Hg2IDC,,,,
NDsp"nsHddndIRp,NDsns"tHddg2ID
Hwgjsn\ebHDsp"nsHddx\n\y\p,qB(
hedHDsnnwtRweDsnseHwe\e\b2fH
fdlsnsf\HwdetDwA wtHDsAdHseHw\f
nszsIHwdejpHDsydg\e\ebHDs
set2weawet2fHHddes"te\nIwttwtg,LDwfsnsIdlsnweaxndgDwtyd2ebwe
HDs«wntHLdnfbL\nCisgweay\p
xsffbssAfpwefdlsCAndj\jfpxdnHDs
xwntHHwgsCywHDhaestlde»2ndyc
tRpCdesdxHDse2ntstyDdHsebsb
Dwg,LDsehaestxwe\ffpIDdts\e—
dHDsng\eCisgweay\p y\tAf2easb
weHdbstA\wn,ND\HHDwtsgdHwde\f
wez2npy\tAndxd2eb\ebseb2nwea
wtwebwI\HsbjpHDsx\IHHD\Hisg—
weay\pnsH2nesbHdwHwexd2ntsA\—
n\HsydnRt1qh.snpuDdnHuHdnpCq
qNDsuedytdx»wfwg\ez\ndCq NDs
u2ehftdWwtstC\ebh«\nsysffHd
hngt,
Ndfdls\edHDsnwtHds0Adtsdes—
tsfxHdHDsnwtRdxA\wex2ftsA\n\—
HwdednfdttC\nwtR\a\wetHyDwID
isgweay\p \bgdewtDsb weqYehe—
dHDsnTd2eHnp,qB™
qLDpg2tHedH\g\eg\nnpFq
qisI\eedHg\nnpCDsI\eedHg\n—
npCqDst\wb\eanwfp,qYxDswtHdfdtsslsnpHDwea Ds
tDd2fbedHAf\IsDwgtsfxwe\AdtwHwde
Hdfdts,istDd2fbxwebHDweatDsI\e—
edHfdts,q
uHwff\edHDsnId2eHsnxdnIs Hdg\—
H2nsfdls\ndtsxndg\bssAfpj\tsb
xs\ndxydgsetHsggweaxndgdsbwc
A\fIdexfwIHt,7wHsn\npInwHwIt\ns
tdgsHwgst gdnsweHnsAwbHD\eAtp—
IDw\HnwtHtwedxxsnweaDwaDfpwexsn—
seHw\fweHsnAnsH\Hwdet· Md2eaCxdn
s0\gAfsCwe\tH2bpyDwIDisgwea—
y\pHnwsbHdjfdIRb2nweaDwtfwxs—
HwgsCt2aastHsbHD\Hisgweay\p
y\tAtpIDdfdawI\ffp InwAAfsbjpI\t—
Hn\Hwde\e0wsHpC\ebHD\HDwtg\zdn
ydnRtbsnwlsxndgHDwttd2nIs,B�
«ns2bw\e bslsfdAgseH\f HDsdnp
DdfbtHD\HHDsg\fsIDwfbweDwt
s\nfpps\nts0AsnwseIst fwjwbwe\fbs—
twnstHdy\nbDwtgdHDsn ·HDstsfw—
jwbwe\fwgA2ftst \nsC\t«ns2bns—
gwebt2tCedHIfs\nfpts02\fj2Hdx
HDstH2xxxndgyDwIDts0ywff
Idgs,BGNDspjsasHIdexfwIHsb xssf—
weatHdy\nbHDsx\HDsnC\HxwntHIdg—
AsHwHwls\ebHDsebstHn2IHwlsC yDwID
g\pH\RsHDsa2wtsdxtH\nRbs\HD
ywtDst·HDstsDdtHwfsxssfweatn\Awb—
fpsldRs\edHDsnIdetHsff\Hwde dx
xssfweat!xs\nt dxnsHnwj2Hwde yDwID
g\p\tt2gsHDs\gdnADd2txdngdx
afdj\f\eewDwf\Hwde dnHDstAsIwxwI
at Mayo Clinic Library, on March 20, 2011 www.archgenpsychiatry.com Downloaded from

xdngdxI\tHn\Hwde, ht2IIsttx2f
nstdf2HwdedxHDwtIdexfwIHweldflst
wbseHwxwI\Hwde ywHDHDsx\HDsn\eb
nsAnsttwde dnnsfwe%2wtDgseH dxHDs
weIstH2d2tbstwnsxdnHDsgdHDsn,
Yxnstdf2Hwde bdstedHdII2nCHDs
IDwfbbdstedH\HH\weAtpIDdts02\f
g\H2nwHpC\eb\e2gjsndx\blsnts
d2HIdgstg\pset2s,us02\fseId2e—
HsntywHDydgsejsIdgstpgjdfwI
nsI\AwH2f\Hwdet dxHDsnsf\HwdetDwA
ywHDHDsgdHDsnCywHDwHt\HHseb\eH
xssfweatdxbstwnsCnsA2ftwdeC\ebHDs
\eHwIwA\Hwde \ebbns\bdxI\H\t—
HndADs·ts02\fweHsnId2nts jsIdgst
\eweIDd\HsewaDHg\ns, udgs
gsHDdbtdxIdAweaweldflsHDs\j\e—
bdegseHdxydgse\tts02\fdj—
zsIHtCywHDHDswebwlwb2\ftssRwea
nsx2asweAsnlsntsd2HfsHt,Odns
IdggdepsHwtHDstAfwHHweadxydg—
seweHdts02\f\ebedets02\f I\Hs—
adnwst·des\ldwbtweHsnId2nts ywHD
qA2nsqydgsedxdes"t\asCweHsffw—
aseIsC\ebIf\tt·desadstHdjsb
ywHD\e2es%2\fA\nHesnCydgsedj—
lwd2tfpwexsnwdnwesb2I\Hwde \eb
tdIw\ftH\H2t,
NDsslwbseIsHD\HI\tHn\Hwde \e0—
wsHpAf\psb\ewgAdnH\eH ndfswe
isgweay\p"t IdexfwIHsb\HHwH2bsHd—
y\nbtydgsewtgs\asnC\ebHDsns
\nsC\tysD\lswebwI\HsbC \e2gjsn
dxdHDsnbpe\gwItdAsn\Hwea,'slsn—
HDsfsttCHDsHDsdnpdxI\tHn\Hwde
\e0wsHpa\wett2AAdnH\tysIdetwb—
snisgweay\p"t ns\IHwdeHdtwaewx—
wI\eHADptwI\fHn\2g\!des xwe\f
\ns\weyDwIDDss0AsnwseIsb \
g\nRsbbwtInsA\eIp jsHysseDwt
wbs\fw)sb\ebDwtns\ftsfx,NDswbs\f—
w)sbisgweay\p Id2nHtb\easn\eb
seb2nstADptwI\fwez2npywHDfwHHfs
tsfxcIdeIsneC Ds\ft%2wIRfpywHDed
x2eIHwde\f dnAtpIDdfdawI\f nstwb2sC
\ebnsH2netC2eHn\ggsfsbC HdHDs
xn\p,NDsns\fisgweay\p bwbwe—
bssbId2nHb\easn\ebbwbwebssb
t2xxsnwez2np,NDswelseHdnpdx
isgweay\p"t ADptwI\fwez2nwstnw—
l\ft\fwtHdxDwtA2jfwtDsbydnRt·wH
weIf2bsttslsn\ftAsIH\I2f\n Af\es
\eb\2Hdgdjwfs In\tDstnst2fHweawe
jn\weIdeI2ttwdetC DsgdnnD\astC
g2fHwAfsxn\IH2nstC tslsnsI2HtC\eb
j2netC\eb\fwxsHwgsdxgwedn\IIwcbseHtCg\ep\ttdIw\HsbywHDD2eH—
weaCxwtDweaCjd0weaC\ebtRwwea,
7\eD\gnsg\nRsbHD\HDwtjdbp
y\tInwttcIndttsb ywHDtI\nt,MsHwH
tssgtHD\HHDsisgweay\p yd2ebt
ts\nsbDwtgwebgdnsD\ntDfp\eb
gdnswebsfwjfpHD\eHDspslsnI\2—
Hsnw)sbDwtxfstD,YebssbHDsjwa
yd2ebCHDsdest2xxsnsbwe«dtt\fH\
bwVw\lsCYH\fpCwe¬2fpBGB�Cg\pjs
nsa\nbsb \tHDsInwHwI\fweIwbseHdx
Dwtfwxs,
o2nweaLdnfbL\nYCweyDwID
isgweay\p tsnlsb\t\e\gj2f\eIs
bnwlsnCDst2IssbsbweasHHweaIfdt—
snHdHDsxwaDHweajpbwtHnwj2Hwea
IDdIdf\Hst \ebIwa\nsHHstjpjwIpIfs
HdHDsxndeHcfwesYH\fw\eHnddAt\H
«dtt\fH\,hesesgpHnseIDgdnH\n
tDsffs0Afdbsbes\njpCtAsywea
tIn\AgsH\fweHdisgweay\p \eb
HDnssYH\fw\etdfbwsnt,:estdfbwsn
y\tRwffsbd2HnwaDHC\edHDsntslsnsfp
yd2ebsbC\ebisgweay\p \jtdnjsb
D2ebnsbtdxAwsIstdxgsH\fweHdDwt
fsatCtIndH2gC\ebfdysn\jbdgse,
'desHDsfsttC ywHDnsg\nR\jfs se—
b2n\eIs\ebId2n\asCDsI\nnwsbHDs
yd2ebsbtdfbwsn>6p\nbtjsxdnsDs
y\tDwHweHDsfsajpg\IDwesa2e
xwns\ebHDse\edHDsnB66p\nbtjs—
xdnsDsfdtHIdetIwd2testt!\ xs\Hdx
jn\lsnp\ebxdnHwH2bsdxyDwID\ep
g\eyd2fbjsAnd2b,Md2ea%2dHst
isgweay\p \tt\pweaCqYD\bjsse
tDdH\ebYD\bjsseInwAAfsb\eb
adHHse\y\p,qLs\anssywHDMd2ea
yDdC\AHfpCydebsntyDsHDsnisg—
weay\pHn2fpadH\y\p\ebDdyx\n
\y\pDsadH,B�3Af(>4
isgweay\p y\teslsnHdxdnasH
«dtt\fH\\ebnsAsHwHwlsfp nslwtwHsb
wHweAsntdeCweDwtIdelsnt\HwdeC
fsHHsntC\ebC\tystD\ffbwtI2ttCwe
DwtxwIHwde·yD\HD\AAsesbHD\Hb\p
y\tHdjsnsId2eHsbwee2gsnd2t
l\nw\HwdetxdnHDsx\tIwe\Hwde dx
Hsetdxgwffwdetdxisgweay\p
ns\bsnt\ebgdlwsadsnt, LDpId2fb
DsedHxdnasHFLDpId2fbHDs
yd2ebedHDs\fF:HDsngseD\ls
t2xxsnsbtwgwf\nyd2ebtywHDd2H
AtpIDdfdawI\f ts%2sff\s,
isgweay\p tAsI2f\Hsb HD\HHDs
yd2ebD\2eHsbDwgtdjsI\2tswH
A2eIH2nsbHDsgpHDdxDwtAsntde\fwggdnH\fwHp, NDnd2aDHDsfwAtdx
TdfdesfT\eHysffwehIndttHDsWwl—
sn\ebYeHdHDsNnsstDst\pt961
isy\tDwHHDnssHwgstHD\HyweHsnC
j2HHDspysns\ffawxHyd2ebt·tg\ff
yd2ebtweHDsxfstDdxHDsjdbpywHD—
d2Hjns\RweajdesC\ebDsD\bjsIdgs
%2wHsIdexwbseHdxDwtAsntde\fwggdn—
H\fwHptweIsDsResyDstDd2fbD\ls
jsseRwffsbweHDsDs\lp\nHwffsnpjdg—
j\nbgseHHD\H\fy\ptAnsIsbsbHDs
\HH\IRt,«we\ffpDsbwbasHDwHAndA—
snfp\ebxdnaddb,'ddesdxDwtdHDsn
yd2ebtD\bslsnbdesHdDwgyD\HHDs
xwntHjwadesbwb,Yt2AAdtswHwtz2tH
HDsfdttdxHDswggdnH\fwHpC DsHDd2aDH,
LsffCwe\y\pCHD\Hwt%2wHs\fdHHd
fdts,
NDsfdttdxDwttsetsdxwggdnH\fwHp
y\twebssbedtg\fffdttCxdn\e
wgAdnH\eHAnsgwtsdxisgweay\p"t
\tt2gAHwls ydnfby\tHD\HDsy\t
g\nRsbfpbwxxsnseHxndgdHDsnt1Ds
jd\tHsbHD\HDsD\b\e2e2t2\ffp
webstHn2IHwjfs jdbpC\es0Hn\HDwIR—
esttdxtR2ffC\eby\tedHt2jzsIHHd
HDsHpAwI\fjwdfdawI\ffwgwH\Hwdet dx
g\eCjswea\jfsCxdns0\gAfsCHd
s0wtHdeq\e\lsn\asdxHydDd2nt
\ebé9gwe2HsttfssAxdnà9tHn\waDH
b\ptq3T,N,7\eD\gCynwHHse Idg—
g2ewI\HwdeC h2a99CBG(™4,YHwtedH2efwRsfpCDdyslsnCHD\H
HDsyd2eb3\ebHDst2jts%2seH Ide—
l\fstIseIsyDwIDweldflsbx\ffweawe
fdlsywHDDwte2nts4D\b\e\bbw—
Hwde\ftwaewxwI\eIs xdnisgweay\p,
htsnwd2t\ebjfddbpwez2npHdDwt
fsat\ebtIndH2gg\pD\lssldRsb
HsnnwxpweaCAnwgwHwlsxs\ntdxI\t—
Hn\Hwdedn\eewDwf\Hwde, hHtdgsfsl—
sfdxIdetIwd2testt isgweay\p ns—
\fw)sbHDwt1HDsy\nyd2ebwexfwIHsb
2AdeDwtxwIHwde\fId2eHsnA\nH weDwt
xwntHedlsfCNDsu2ehftdWwtstCnse—
bsnsbDwgADptwI\ffpCj2HedHAtp—
IDdfdawI\ffpC wgAdHseH,YedesdxDwt
fsHHsntDsAset\nwj\fbt2jHwHfsHd
NDsu2ehftdWwtstC\bbweaqtd
bdstpd2nIdIRwxpd2D\AAseHd
D\lsdes,q9B
YeDwtAdtH2nsHdy\nbtHDsg\zdn
\ns\tysD\lsIdetwbsnsb!tsfxc
t2xxwIwseIpCADptwI\fwez2np\ebwe—
HsanwHpCydgse\ebg\H2nsfdls!
isgweay\p xsfflsnptDdnHdxDwt
wbs\fw)sbad\ft,iwtx\wf2nsHdbdtd
at Mayo Clinic Library, on March 20, 2011 www.archgenpsychiatry.com Downloaded from

HddRwHtHdff·Dsy\tAf\a2sbjpns—
I2nnseHAsnwdbtdxtsfxcD\Hnsb, 'sy—
Hde"tHDwnbf\ydxgsID\ewIt D\t
wHtAtpIDdbpe\gwI \e\fdap1slsnp
xdnIssldRwea\e\AAnsIw\jfs bsanss
dxbptADdnw\wtId2eHsnsbjp\Atp—
IDdfdawI\f gsID\ewtg bstwaesbHd
a2\nbHDstsI2nwHpdxHDswebwlwb2\f,
isgweay\p sgAfdpsb \e2gjsndx
t2IDgsID\ewtgtC s\IDdxxsnwea
tdgsHsgAdn\npnstAwHs\eb\ffbst—
HwesbHdx\wfweHDsxwe\fbsAnsttwls
I\H\IfptgyDwIDI2fgwe\Hsb weDwt
t2wIwbs,
isgweay\p"t \e0wsHp\ebbsAnst—
twdetHsggsbwef\nasA\nHxndgDwt
x\wf2nsHd\IH2\fw)sDwtwbs\fw)sb
tsfx,Nydx\IHdntysnswgAdnH\eH
weHDwtx\wf2ns1HDswg\asy\ttd
s0HnsgsHD\Ht2AsnD2g\e xdnIst
yd2fbD\lsjssens%2wnsbHdt\Hwtxp
wH·tsIdebfpC \e2gjsndxId2eHsnc
xdnIstfwgwHsbDwt\l\wf\jfsbsanss
dx\b\AH\jwfwHp, NDststsIdeb\np
Id2eHsnxdnIstC saCbsAsebseIp In\l—
weat\ebdsbwA\fIdexfwIHtC ysns
td2nIstdx\e0wsHpweHDswndye
nwaDH\ebD\gAsnsbHDs\IH2\fw)\—
HwdedxHDswbs\fw)sbtsfx,
isgweay\p nszsIHsbHDsIdelse—
Hwde\ftd2nIsdxDsfAdxxsnsbjpAtp—
IDdHDsn\Ap· HDst2AAfw\eHCA\ttwls
ndfsdxA\HwseHy\t\e\HDsg\HdHDs
lsnpIdnsdxHDsisgweay\p wbs\f,
isD\HsbAtpIDw\HnwtHtC dAsefp
gdIRsbHDdtsDsResyC\ebdeIsHdfb
\e\ngpAtpIDw\HnwtH HD\HDsResy\
fdH\jd2Hqx2IRcdxxtq j2HfwHHfs\jd2H
jn\lsgse,B3A(à94YHtssgtgdnsA\—HDsHwIHD\ewndewIHD\HDsy\t
xdnIsbweHdHDsndfsdxAtpIDw\HnwI
A\HwseHb2nweaHDsf\tHyssRtdxDwt
fwxs!\ndfsyDwIDC\IIdnbwea Hd
7\eD\gCisgweay\p g2tHD\lsIde—
twbsnsbqHDs2fHwg\HswebwaewHp,q
ist\wbHD\HDwtTdnde\HpAsynwHsn
y\tDwt\e\fptH\ebdesI\eD\nbfp
bwt\anssywHDDwg3T,N,7\eD\gC
dn\fIdgg2ewI\HwdeC hAnwfBG(™4,
LsbstInwjsbHDsjfdyt2xxsnsbjp
isgweay\p yDseDwte2ntsChaestC
nszsIHsbDwtfdls,isgweay\p \H—
HsgAHsbHdydnRHDwtHDnd2aDywHD
DwtHpAsynwHsn \ebnsfwlsbHDsnd—
g\eIswexd2nbwxxsnseHydnRtdx
xwIHwdeCs\IDHwgsI\AAweawHywHD\esebweagdnst\HwtxpweaHdDwtAnwbs
HD\eHDsns\fsAwtdbs,Yeqh.snp
uDdnHuHdnpqHDsg\nnw\asxdn
yDwIDhaestfs\lstDwgbdstedH
g\Hsnw\fw)sC \ebDsn\AwbfpxdnasHt
DsnCtddeIdeHn\IHwea adednnDs\
xndg\I\t2\fts02\fnsf\HwdetDwA
ywHD\t\fstawnf,:estsetstHD\HDs
bsgs\ethaestjpHDsj\e\fIwn—
I2gtH\eIst dxDwtes0Hndg\eHwI se—
Id2eHsn,YeqNDsuedytdx»wfwg\e—
z\ndqHDsDsndnsgsgjsntynwHweaC
yDwfsweHd0wI\HsbC \e2ecisgweac
y\pCAfs\bweafsHHsnHd\ehaest
t2nnda\Hs· Dsnsa\wetDwtstHssg
wggsbw\Hsfp jpg\RweadxxywHD\e—
dHDsng\e"tawnf\xHsnt2jb2weaDwt
nwl\fwe\AnwgwHwlsjn\yf,7Hisenp
weh«\nsysffHdhngtwtCdxId2ntsC
edHnszsIHsbjpDwte2nts·deHDs
IdeHn\npCwHwttDsyDdIdeHnwj2Hst
HDsans\HsnfdlsHdHDswn2ewdeC\eb
tDsyDdbwstb2nweaHDsbsfwlsnp
dxDwtIDwfb,KnsHHhtDfspC¬\Rs
K\nest"e2ntsweNDsu2ehftd
WwtstCwtgsHsbd2HDsnbdfsjpDdAs—
fsttfpfdlweaHDsdesg\eyDdwt
2e\jfsHdt\HwtxpDsnts02\fessbt,
uDsf\gseHtCqND\H"tgpx\2fH,
ode"HysA\pxdn\ffHDsHDweatys
bdCHDd2aD,,,yDseYHDweRdxHDs
DsffY"lsA2HID\AtHDnd2aD,Y"g
A\pweaxdnwH\ffedy,q99
LDseDwtHpAsynwHsn y\tI\ffsb
2AdeHdDsfAnsA\wnHDsHn\2g\t2x—
xsnsb\H«dtt\fH\CwHtssgtHdD\ls
jsset2ggdesbwel\we,isnsfwlsb
HD\Hwez2npdxHseweDwtfsHHsntCIde—
lsnt\HwdeC \ebweDwtxwIHwde,'dH
defpbdstDsnslwtwHHDstwHsdxHDs
yd2ebwens\ffwxsj2Hg\Rst\Awf—
anwg\asHDsnsweHDnssydnRt1h
Odls\jfs«s\tHCqhL\pMd2"ff
'slsnKsCq\ebhIndttHDsWwlsn
\ebYeHdHDsNnsst,YeHDsf\HHsn
3ynwHHse dlsné6ps\nt\xHsnHDs
wez2np4TdfT\eHysffxwebtHDss0\IH
twHs\H«dtt\fH\yDsnsHDs\IIwbseH
dII2nnsbCbsxsI\HstHDsnsC\ebj2nwst
gdespwe\nwH2\fwtHwI Isnsgdep,
3LDseisgweay\p nslwtwHsb«dt—
t\fH\Dsy\tAnslseHsbxndgbdwea
fwRsywtsdefpjpHDsf\IRdxAnwl\—
Ip,4NDsjwayd2ebCwex\IHCy\t
nsfwlsbweslsnpg\zdnAwsIsdx
xwIHwdeCxdns\IDisgweay\p AndH\acdewtHnsIswlst \g\zdnwez2npCase—
sn\ffpHd\es0HnsgwHp,¬\RsK\nest"
wez2npCdxId2ntsCy\tHdDwtasew—
H\ft·7Hisenpweh«\nsysffHd
hngtt2xxsntisgweay\p"t s0\IH
yd2eb·WdjsnH¬dnb\e\HHDssebdx
«dnLDdgHDsKsffNdfftCxn\IH2nst
Dwtfsa\ebfwsty\wHweaxdnDwt
bs\HDywHDqDwtDs\nHAd2ebweade
HDsAwesessbfsxfddndxHDsxdn—
stHq9é·i\nnpweqNDsuedytdx
»wfwg\ez\ndq bwstxndg\a\eans—
ed2twez2npHdDwtRess·i\nnpOdn—
a\eweNdi\ls\ebi\ls'dHt2x—
xsnsb\ewez2npyDwIDesIsttwH\Hsb
\gA2H\Hwde dxDwt\ng·TdfT\eHc
ysffwehIndttHDsWwlsn\ebYeHd
HDsNnsstD\bjssej\bfpyd2ebsb
\H«dtt\fH\CyDwIDnst2fHsbwe"\
fwgA\eb\j\bfpgwttD\AseD\eb·
\HHDssebdxHDsedlsfDsbwstdx\
Idnde\np ·u\eHw\adweNDs:fbO\e
\ebHDsus\Cwe\bbwHwdeHdgwedn
wexfwIHwdetC seb2nstHDsIn2sfstHwe—
z2npdx\ff!dfb\as,
:xyD\Hl\f2swtHDsx\eH\twsb dn
x\IH2\fnslwtwHHdHDstwHsdxwez2npF
odstwHedHgsnsfpAndjsxdnA\wewe
HDst\gsy\pHD\HHDsHdea2sIdg—
A2ftwlsfpz\nt\e\IDweaHddHDF
OdtHAtpIDw\HnwIHDsdnsHwIw\et \anss
HD\HHDsbsfwjsn\HsnslwlwxwI\Hwde jp
\A\nHdxHDsAtpIDsdx\Hn\2—
g\HwIweIwbseHnsAnstseHt \e\HHsgAH
\Hg\tHsnp,LDseHDsHsnnwxpwea
slseHjsIdgstx\gwfw\nCwHjsIdgst
bsHd0wxwsbC \ebwebssbtslsn\fAtpc
IDdHDsn\As2HwI HsIDew%2st \nsj\tsb
deHDwttHn\Hsap,«dns0\gAfsCb2n—
weaLdnfbL\nYYe\nIdtpeHDstwt
y\tweHndb2IsbC yDwIDIdetwtHsbdx
\bgwewtHsnwea tdbw2gAseHdHD\f3\
Adysnx2ftsb\Hwls4HdHDst2jzsIH
\ebHDseDsfAweaDwg3ywHD\IIdg—
A\epweatwg2f\Hsbj\HHfsedwtstCwx
esIstt\np4 nss0AsnwseIs HDsHn\2—
g\HwIj\HHfsweIwbseH,Kpnss0Asnwc
seIweaHDsslseHywHDg\nRsbfpfstt
\e0wsHp3jsI\2tsdxgsbwI\Hwde \eb
HDsRedyfsbasC \HtdgsfslsfdxIde—
tIwd2testtCHD\HHDwtHwgsHDsnswt
edqns\fqb\easn4HDst2jzsIHwt
an\b2\ffpbstsetwHw)sb, uslsn\fdHD—
snxdngtdxHDsn\Ap3xdns0\g—
AfsCjsD\lwdn\fHDsn\Ap4dAsn\Hsde
twgwf\n\tt2gAHwdetC j2HC2e\ttwtHc
at Mayo Clinic Library, on March 20, 2011 www.archgenpsychiatry.com Downloaded from

sbCHDswebwlwb2\f dxHsebdstedH
bstsetwHw)s DwgtsfxHdHDsHn\2g\
j2Hgsnsfpxnss)stweDwttpgAHdg\—
Hdfdap\ebwtbddgsbHdjsD\2eHsb
jpnsI2nnseHx\eH\twstCewaDHg\nstC
dnbwtsgjdbwsb y\lstdxA\ewI,
isgweay\p \HHsgAHsb HdDs\f
Dwtyd2ebHDnd2aDId2eHsnADdjwI
gs\et\ebjpxdnIweaHDsweIwbseHC
dnwHt\ttdIw\Hsb\xxsIHCxndgIde—
tIwd2testt,Kpxf\2eHweaHDsb\easnC
jpnsIRfsttfpnss0Adtwea destsfxHd\
twgwf\nHDns\HCdeswtCwesxxsIHCbs—
epweaHddestsfxHD\Hb\easns0wtHt,
Yey\nbfpHDssadsgAfdptnsAnst—
twde\ebbsew\fCd2Hy\nbfpHDswebw—
lwb2\ftssgtIdgAsffsbHdx\IsHDs
lsnpHDweaDsxs\ntHDsgdtH,«ndg
Dwts\nfwstHps\ntisgweay\p
nd\nsbweHDsx\Isdxb\easn·q"xn\wb\edHDweaqDstDd2HsbHd
DwtgdHDsn\HHDs\asdxHDnssB3A>4
\ebDsg\weH\wesb HD\HAdtsxdnHDs
nstHdxDwtfwxswens\f\ebwg\aw—
e\npIdgj\H,NDsIdeIsAHdxId2ec
HsnADdjw\jpedgs\etnsA2bw\Hst
isgweay\p"t Id2n\as,NDsgwfwH\np
jd\nbgsgjsnt\y\nbwea bsIdn\—
HwdetbdedHH\RsAsntde\fAtpIDdc
bpe\gwItweHdIdetwbsn\Hwde, LDse
desbn\yt\fwes2ebsnDwte\gs
\ebHdH\ft2ADwtbssbtCeddesI\e
bsepisgweay\p y\t\jn\lsg\e·
7\eD\gCyDdy\tywHDisgweay\p
2ebsnxwnsb2nweaLdnfbL\nYYC
t\ptDsy\tHDsjn\lstHg\eDsslsn
Resy,
K2HAsnD\AtHDsgdtHtHnwRwea
g\eesnweyDwIDisgweay\p bs\fH
ywHDHn\2g\y\tjpbsgdetHn\Hwea
weDwtxwIHwde\a\we\eb\a\weHD\H\
g\wgsbCInwAAfsbg\eId2fbtHwffjs
\g\eCId2fbCbstAwHsDwtbsxsIHt\eb
wez2nwstCx2eIHwdeweHDsjstHHn\bw—
HwdedxHDsisgweay\p Idbs,Ye
s\IDdxDwtg\zdnydnRt\ewez2nsb
\ebedjfsDsndnsgwebt 2tHD\H
ADptwI\fD\ebwI\At I\ejsdlsnIdgs,
YeNDsu2ehftdWwtst¬\RsK\nestC
bstAwHsDwtwgAdHseIsC tHwffx2eI—
HwdetywHDbwaewHp\eban\Is,Ye—
bssbCDs\ebVsbndCHDsg\H\bdnC
\nsHDsdefpDsndwIg\fsxwa2nstwe
HDsjddRC\ebVsbndeslsngdnstd
HD\e\xHsn\jn2H\fjs\Hwea,Ye«dn
LDdgHDsKsffNdfftWdjsnH¬dnb\ebwstg\ex2ffpbstAwHs\A\wex2ffp
jndRsefsaCg\ewxstHwea weHDsx\Is
dxbs\HDHDs%2\fwHwstdxan\Is\eb
Id2n\asyDwIDisgweay\p gdtH\b—
gwnsb,YeNdi\ls\ebi\ls'dH
HDsdesc\ngsbi\nnpOdna\ewt\
n2aasbDsndCyDdCwedesgsgdn\jfs
tIsesCHnw2gADt dlsnDwtwgA\wn—
gseHjpg\RweafdlsHdDwtywxs
ywHDHDstH2gAdxDwt\ng,Ye
hIndttHDsWwlsn\ebYeHdHDsNnsst
TdfT\eHysff\ftdD\t\g\wgsb
D\ebyDwIDtssgtHd\wbn\HDsn
HD\ewgAsbsDwtndg\eHwIAndansttC
tweIsWse\H\b2nweafdlsg\Rwea
y\eHtHds0\gwes\ebI\nsttDwt
yd2eb,YeNDs:fbO\e\ebHDsus\
dfb\asD\t\tt\wfsbu\eHw\ad"t se—
HwnsjdbpCpsHDsHsgAdn\nwfp Hn\e—
tIsebtDwtADptwI\fIdebwHwde
HDnd2aD\e\IHdxseb2n\eIsAn\wts—
ydnHDpweslse\pd2easng\e,
NDnd2aDd2H Dwtfwxsisgweay\p
\HHsgAHsbHd\jdfwtDHDsbwtInsA\e—
IpjsHysseDwtns\f\ebwbs\fw)sb
tsflst,'d\fHsn\Hwdet Id2fbjsg\bs
2AdeHDswbs\fw)sbtsfx·HDsnswted
slwbseIsHD\Hisgweay\p slsnIdg—
Andgwtsb dn\HHse2\Hsb Dwttsfxcbs—
g\ebt,hffHDsydnRD\bHdjsbdes
2AdeDwtns\ftsfx·DsA2tDsbDwg—
tsfxHdx\IsgdnsweHsetsb\easnCHd
\HHsgAHADptwI\fxs\HtyDwIDs0Issb
DwtI\A\jwfwHwstC yDwfs\HHDst\gs
HwgsDsAn2esb\ebtHns\gfwesb Dwg—
tsfx,hffHn\IstdxHn\wHtedHxwHHwea
Dwtwbs\fw)sbwg\asD\bHdjssfwgw—
e\Hsbdnt%2sfIDsb, NDstdxHsnxsgw—
ewestwbsCHDsxs\nx2fA\nHtCHDsbs—
AsebseHIn\lweat!\ff D\bHdad,
'dHwexns%2seHfp isgweay\p s0—
Hsne\fw)sb2ebstwnsbHn\wHtCwsCDs
t\ywedHDsntHDdts\tAsIHtDsns—
zsIHsbweDwgtsfx\ebdxHsenstAdeb—
sbHdHDsdHDsnAsntde%2wHslwHnwdfwc
I\ffp,NDsgseH\fgsID\ewtg dx
qAndzsIHwls wbseHwxwI\Hwdeq 3HDsAnd—
IsttdxAndzsIHweaA\nHtdxdestsfx
Hd\edHDsn\ebHDsexdngwea \ewe—
HsetsCwnn\Hwde\fnsf\HwdetDwA ywHD
HDsdHDsn4D\tjsseawlseAsng\—
eseHfwHsn\npsgjdbwgseH jpodtc
HdsltRpweNDsod2jfs\ebjpTde—
n\bweNDsusInsHuD\nsnCHdgseHwde
defpHDsjstHdxHDsgdbsne\2HDdnt
yDdD\lsweH2wHwlsfp 2ebsntHddbHDwtADsedgsede, VndzsIHwls wbse—
HwxwI\Hwde y\tAsnD\At desdxHDs
g\zdngsID\ewtgt jsDwebisg—
weay\p"ts0HnsgsfplwH2Asn\Hwls
d2Hj2ntHtHdweedIseHtHn\easnt\eb
HDs2ey\nn\eHsb welsIHwlsDsxns—
%2seHfpbwnsIHsbHdxnwsebt\eb
\I%2\weH\eIst,B hH\HwgsyDse
gdtHhgsnwI\et xsfHIdgA\ttwdeCwxedH\bgwn\HwdeC xdnHDswny\n—
HwgsAnstwbseHCisgweay\p tIdnesb
WddtslsfH"tADptwI\fwexwngwHpCDwt
ts0fsttesttC \ebydg\efp \AAs\nc
\eIs,B&�éB>Qà™™" isbwtfwRsb¬syt
jsI\2tsdxHDswntdxHesttC A\t—
twlwHpC\ebqysHcHDweRweaCq psHwH
y\ted\IIwbseHHD\HHDs¬syCWdj—
snHTdDeCweNDsu2ehftdWwtst
y\tCfwRsisgweay\pC \es0AsnH
jd0sn\ebbs\fHC%2wHsj\bfpCywHD
2ens%2wHsb fdls·ednwtwH\e\IIw—
bseHHD\Hisgweay\p zdRsb\jd2H
DwtdyegdIR¬sywtDesttC lsnpdx—
Hsensxsnnwea HdDwgtsfx \ton,
isgweatHswe,
i\nbgsebnweRD\nb,isgwea—
y\pzdRsb\ebjd\tHsb\jd2HDwt
bnweRweawens\ffwxs\ebaf\gdnw)sbwHweDwtxwIHwde,MsHHDsnswted
bd2jHHD\Hisgweay\pC \tHDsps\nt
yseHjpCfs\esbgdns\ebgdns
Ds\lwfpde\fIdDdfxdnnstAwHsxndg
weHsets\e0wsHp\ebbsAnsttwde, iwt
ywxsCO\npCyDdHsebtHd2ebsnAf\p
isgweay\p"t xf\ytCedHstHD\Hwe
HDsf\tHxsyps\ntdxDwtfwxsDs
djH\wesbgdtHdxDwted2nwtDgseH
xndg\fIdDdfn\HDsnHD\exndg
xddb,9àisgweay\p yseHweHd
qHn\weweaq yDsesgj\nRwea 2Ade
tsnwd2tynwHweaxdn\esyjddR,NDs
Hn\wewean2fstIdetwtHsbdxasHHwea
weHdaddbADptwI\ftD\As\eb\j—
tH\weweaxndg\fIdDdf2eHwfedde
3Dsbwb\ffdxDwtynwHweaweHDs
gdnewea4, 7\eD\gnsAdnHtHD\H
yDseDslwtwHsbDwgyDwfsDsy\twe
Hn\weweaxdnNDs:fbO\e\ebHDs
us\isgweay\p ty\g�6f\Atwe
HDsgdneweaweDwtlsnpf\nasAddf,
«ndgHwgsHdHwgsDsyd2fbtywg
HdHDssbasdxHDsAddfHdfddR\HDwt
y\HID,hH\jd2HBB166hODwtg\—
zdnbdgdyd2fbIdgsd2HdxHDs
Dd2tsywHDyD\H\AAs\nsbHdjs\
D\fxca\ffde AwHIDsndxg\nHwewt,
at Mayo Clinic Library, on March 20, 2011 www.archgenpsychiatry.com Downloaded from

isgweay\p yd2fbanwe\ebt\pC
qLD\HHDsDsffCK2IRCwH"teddewe
Ow\gwCq\ebHD\HsebsbHDstywg—
gweaxdnHDsgdnewea,7\eD\g
Id2fbbnweRHyddxHDsAdysnx2f
g\nHwewtCDwtywxs\jd2HB�,isg—
weay\pxwewtDsbHDsnstHdxHDs
AwHIDsn3T,N,7\eD\gCynwHHseIdg—
g2ewI\HwdeC h2a99CBG(™4,Nd—
y\nbtHDssebdxDwtfwxsC\tDwt
Ds\fHDx\fHsnsb\ebDwtDpAsnHsetwde
weIns\tsbC DwtweHsnewtH\HHsgAHsbC
ywHDdefpgdbsn\Hs t2IIsttCHdAns—
lseHDwgxndgbnweRwea,
NDsgsID\ewtgt sgAfdpsb Hd
y\nbdxxbptADdnw\!\fIdDdfC ynwH—
weaCweHsetsADptwI\fxs\Ht!\ffHDs
xnsesHwI\HHsgAHtHdAsnAseH2\Hs HDs
wg\asDsIns\HsbCweHsnfdIRsb Hd
xdngdefp\A\nHw\ffpsxxsIHwlsb\g
\a\wetH\ewes0dn\jfs Hwbsdx\e—
a2wtD,NDnd2aDd2H DwtfwxsCisgwea—
y\pt2xxsnsbxndgnsI2nnseHjd2Ht
dxbsAnsttwde, hts\nfp\tBG9(Ds
yndHsHd«,uIdHH«wH)asn\fbHD\HDs
D\bjssefwlweaweDsffxdnewes
gdeHDtywHDAfseHpdxwetdggw\Hd
fwaDHHDsy\p\nd2eb\eb\ttwtHDwg
weHDstH2bpdxHDsHsnn\we,B 3Af™K�
Nwgs\eb\a\weDsan\H2wHd2tfpC \eb
Hdea2scwecIDssRC ns\tt2nsb Dwt
xnwsebtHD\HDsy\tedfdeasn\HHDs
qj2gAweadxxqtH\as,YHwtedHbwx—
xwI2fHHdafs\exndg\epwebwlwb2\f"t
fwxsIdnnstAdebseIs \ebIdelsnt\—
Hwde\tsnwstdxgsf\eIDdfwI Idg—
gseHtC\ebHdbdtdedyAndlstdefpHD\HDwebtwaDH wt\tdnnpD2g\e
x\I2fHp,isgweay\p"t x2ftdgsAns—
dII2A\HwdeywHDbs\HDCgsf\eIDdfw\C
\ebt2wIwbsHDnd2aDd2H DwtfwxsC\eb
stAsIw\ffpweDwtf\Hsnps\ntCy\tC
DdyslsnC \td2nIsdxIdeIsneHdHDdts
yDdResyDwgysff,hxHsnLdnfb
L\nYYHDsqjf\IRc\ttq b\pt3\t
isgweay\p I\ffsbDwtbsAnsttwdet4
weIns\tsbwexns%2seIp, u2IIsttdx—
xsnsbdefpjnwsxnstAwHs·DsyndHs
7\eD\gweBG>6HD\HhIndttHDs
Wwlsn\ebYeHdHDsNnsstD\btdfb
Bé6C666IdAwst\ebHD\HHDspId2fb
s\H\tD\nsj2HHD\HDsD\bedH
g2ID\AAsHwHs,9>hfsHHsnxndghx—
nwI\xdffdyweaDwtAf\esIn\tDstIde—
H\wetHDsIndttsbcd2H tH\HsgseHHD\H
HDsy\RsdxHDsjd\HfddRsblsnpwelwHwea3T,N,7\eD\gCynwHHse
Idgg2ewI\HwdeC h2a99CBG(™4,
:x\ffHDswet2fHt\ebwez2nwst
t2xxsnsbjpisgweay\pC edesy\t
tdan\lsCtdwnnsA\n\jfs HdDwt
AtpIDwIsIdedgp \tHDstdg\HwIbs—
IfwesdxDwt\bl\eIwea ps\nt,isD\b
eds\tpy\pdxjsxnwsebwea dfb\as·
edtfdHs0wtHsbxdnHDsdfbg\ewe
HDsisgweay\p Idbs,YeNDs:fb
O\e\ebHDsus\CDwtxwe\fjnwffw\eH
x\eH\tpCu\eHw\adHnw2gADt dlsnHDs
nsIsbweaAdysndxHDsxfstDHDnd2aD
tDssntHnseaHDdxywff,K2HHDsA\—
HDdtdxwH<idyg\epdfbgseC\xHsn\ffCI\eHn\etIsebHDswnps\nt
jpH\RweaHdHDsts\we\edAsejd\H
HdI\HIDHDsaw\eHg\nfweFisHnwsbCwHtssgtCHdxweb\edfbc\aswbseHwHp
xdnDwgtsfx\tHDsId2etsfdndxHDs
pd2eaCAnsxsnnwea HdjsI\ffsbqV\—
A\qjp\fgdtHslsnpdesCj2HDsy\t
edHns\bpxdnHDsndfsdxHDsywts
dfbt\as,LDseysns\bdxHDswe\A—
AndAnw\Hs\eHwItdxisgweay\p \H
(6OVV>à>c>à�4 ysxssfIdgAsffsb Hd
Inpd2HfwRs7s\n"txddf1qNDd2
tDd2fbtHedHD\lsjssedfbHwffHDd2
D\btHjsseywts,q
NDsns\nsHDs\HHsgAHtHdnsAfse—
wtDDwtpd2HDHDnd2aD\ttdIw\Hwdet
ywHDpd2eaydgseB �AAà™(�>à™�·HDs
wgAdttwjwfwHp dxHD\HnsjwnHDwtA\—
HDsHwI\ffpxdnstD\bdysb wehIndtt
HDsWwlsn\ebYeHdHDsNnsstyDsns
HDsfdls\xx\wnjsHysseTdfT\eHysff
\ebHDsBGcps\ncdfb Wse\H\3yDdts
e\gsweYH\fw\egs\etqnsjdneq4
I\eedHbsf\pDwtbsHsnwdn\Hwde \eb
s\nfpbs\HD,isgweay\p weBG(6
tssgsbxwe\ffpdlsnyDsfgsb jpHDs
wes0dn\jfs \bl\eIsdxps\nt\eb
s%2\ffpnsfseHfsttbsHsnwdn\Hwde dx
Dwttdg\,NDss\nfwsnnwl2fsHtdx
IdeIsne\jd2HDwtjdbptddetysffsb
weHd\HdnnseHdxDpAdIDdebnw\twt ·
Dsg\aewxwsbHDstwaewxwI\eIs dxgw—
edn\wfgseHt\ebansyweIns\tweafp
AnsdII2Awsb ywHDg\zdn\wfgseHtHd
HDss0HseHHD\HDwtIdetIwd2t
HDd2aDHtCfwRsHDsA\astdxDwtfsH—
Hsnt\ebHDsy\fftdxDwtj\HDnddgtC
ysnsAf\tHsnsbywHDgsHwI2fd2tfp
RsAHID\nHtdxb\wfpxf2IH2\Hwdet we
yswaDHCjfddbAnstt2nsCjfddbt2a\nC
\ebIDdfstHsndf, YeBG(6isgweacy\p"tgseH\fDs\fHDtD\nAfpbsHsnwd—
n\Hsb\ebDsbslsfdAsbHDstwaet
\ebtpgAHdgtdx\g\zdnAtpIDd—
fdawI\fwffestt,NDsIfwewI\fAwIH2ns
dxDwtxwe\fIdebwHwdensxfsIHsb \
tAfwHHwea\t2ebsndxHDs2ewdedx
HDswbs\f\ebHDsns\fisgweay\pC \
AtpIDwItptHsgHD\HCHdt2nlwlsCD\b
jsIdgsweIns\tweafpnwawb\ebHDseC
xwe\ffpCjnwHHfs,
NDss0A\etwlstsfxweHDssebt2j—
gsnasbxndglwsyj2Htwae\ffsbwHt
t2jHsnn\es\e AsntwtHseIs HDnd2aD
A\n\edwbHnsebtjdHDHn\awI\eb
andHst%2s, «dns0\gAfsCisgwea—
y\pweDwtf\tHps\nD\bg\ep
qwbs\tdxnsxsnseIsCq HD\HwtDs
HsebsbHdnsxsnIwnI2gtH\eHw\f
slseHtweDwtselwndegseH HdDwg—
tsfx,idHIDesnbstInwjst \esAwtdbs
weyDwIDisgweay\p \nnwlsbwe\
Hdyef\Hs\HewaDHCedHsbfwaDHtde
\HHDsj\eRC\ebs0AnsttsbDwtIde—
lwIHwdeHD\HHDsYeHsne\fWslse2s
usnlwIsD\b\2bwHdntydnRweax2—
nwd2tfpdeDwtH\0tH\HsgseH,qLDse
HDspy\eHHdasHpd2HDspasH
pd2,q9(:e\edHDsndII\twdeisg—
weay\pt2bbsefpfsxH\nstH\2n\eH
jsI\2tsDst2ngwtsbHD\HHydgse
\HHDsj\nysns«KY\aseHtbwt—
a2wtsb\tt\fstgseyDdD\bjsse
\ttwaesbHdRssADwg2ebsnt2nlswf—
f\eIs,
uH\nRAsntsI2Hdnp Hnsebt\A—
As\nsbC\tisgweay\p jsI\gsIde—
lweIsbHD\HHDsYggwan\Hwde K2n—
s\2C\tysff\tHDs«KY\ebHDs
BWuCy\t\xHsnDwgxdnIdnn2AHwea
HDsgdn\ftdx\gwedn,uddexnwsebt
ysns\bgdewtDsb edHHdynwHsdn2ts
HDsADdesdntAs\RHddfd2bfptweIs
Dsy\tIdetH\eHfptAwsb2Ade,iwt
AsntsI2Hdnp IdelwIHwdet ysnsHn2s
bsf2twdetweHD\HHDspysnsxw0sbC
x\ftsjsfwsxtwgAsnlwd2t HdfdawI,
Un\b2\ffpHDsbsf2twde\ftptHsgs0—
A\ebsbHdweIf2bs\ffHDdts\jd2H
Dwg!e2ntstC bdIHdntCxnwsebtC\ebC
xwe\ffpCDwtwggsbw\Hsx\gwfp,he
sf\jdn\HsAsntsI2Hdnp bsf2twde\f
tptHsgwtHDsldwIsdx\n2e\y\p
bsIdgAset\Hsb an\ebwdtstsfx·wx
slsnpdeswedes"tselwndegseH wt
AnsdII2Awsb ywHDAfdHHweaCy\HID—
weaCfwtHseweaCHDsewHI\edefpjs
at Mayo Clinic Library, on March 20, 2011 www.archgenpsychiatry.com Downloaded from

jsI\2tsdeswt\es0HnsgsfptAsIw\f
Asntde,rlsnpA\n\edwbbsf2twdeD\t
\IseHsnInptH\fdxHn2HD1isgwea—
y\py\t\lsnptAsIw\f\ebwgAdn—
H\eHAsntdej2Hdjlwd2tfpedHtd
tAsIw\f\tHdy\nn\eHHDsHdH\fsesn—
apdxDwtselwndegseH,
Un\ebwdtwHp bdstedHdII2nbs
edldCwH\nwtstwenstAdetsHd\e
weesnIseHn\fwbseHwHps0AsnwseIsb \t
ydnHDfstt\ebj\b,NDsan\ebwdts dn
s0A\etwlstdf2Hwde\ffdysbisgwea—
y\pHdt2nlwlsywHDd2HInwAAfwea
bptADdnw\· wHAsngwHHsb DwgHd
xdng\Af\HxdngC\fjswHC\tysD\ls
tsseC\e2etH2nbp desCdeyDwIDHd
j\tsDwtxssfweatdxtsfxcydnHD \eb
nsa\nb,hHHDssebCHDs2ewdedxHDs
AtpIDdfdawI\f IseHn\fwbseHwHp\eb
HDsan\ebwdtsAsnwADsn\f tptHsg
xn\agseHsb1isgweay\p"t weesn
IdnsCe\Rsb\ebl2fesn\jfsCAsnl\b—
sbDwts0AsnwseHw\f ydnfb,Tdet2gsb
ywHDxssfweatdxa2wfH\ebydnHDc
fsttesttDst\eRbssAweHdbstA\wn,
osf2twdetdxAdlsnHpAf\a2sbDwgC
Dss0Hsne\fw)sb Dwttsetsdxweesn
sgAHwestt \ebbslsfdAsbHDsIdelwI—
HwdeHD\HDsD\bedg\Hsnw\fxwe\e—
Iw\ftHdnst,
YeBG(6HDs\IIdgA\epwea twaet
\ebtpgAHdgtdxbsAnsttwde!\ed—
ns0w\CtslsnsyswaDHfdttCwetdgew\C
bssAt\besttCHdH\fAsttwgwtgC
tsfxcbstHn2IHwls Hnsebt!cjsI\gs td
g\nRsbHD\HDdtAwH\fw)\Hwde y\tns—
%2wnsb,hHHDsO\pdTfwewIHyd
Id2ntstdxsfsIHndIdel2ftwls Hns\H—
gseHysns\bgwewtHsnsbC j2Hwe
l\we,rfsIHndIdel2ftwls Hns\HgseHwt
HDsHns\HgseHdxIDdwIsxdntslsns
bsAnsttwlswffesttCj2Hwtxns%2seHfp
wesxxsIHwlsweHDsAnstseIsdxtHndea
\IIdgA\epwea A\n\edwbHnsebt,«w—
e\ffpisgweay\p ansyHdnsa\nb
Dwtjdbp\ebDwtfwxs\t\Anwtdedx
bstA\wnxndgyDwIDHDsnsy\tdefp
dess0wH!\ebHD\Hs0wHCt2wIwbsCHDs
gdtHwaedjfsdesdx\ff,YHy\tHDs
tD\gsx2fqHDweaqHD\HWdjsnH¬dn—
b\e"tx\HDsn\ebDwtdyex\HDsnC\eb
f\HsnCDwttwtHsnD\bHdbd,YHy\t
HDs\IHHD\Hedisgweay\p DsndD\b
slsnbdes,YHy\tedHHDsbs\HDHD\H
ysyd2fbD\lsywtDsbxdnHDwtg\e
yDdC\HHDs\asdx96CyndHsHdDwtx\HDsnCq,,,\ebDdyg2IDjsHHsn
Hdbwswe\ffHDsD\AApAsnwdbdx
2ebwtwff2twdesb pd2HDCHdadd2Hwe
\jf\)sdxfwaDHCHD\eHdD\lspd2n
jdbpydned2H\ebdfb\ebwff2twdet
tD\HHsnsb,qB�A>>9�
KwIRxdnbupflstHsn \ttwtHsbweHDwtAndzsIH,
WsxsnseIst
B,K\RsnT1rnestHisgweay\p1 h
7wxsuHdnp,'syMdnRCTD\nfstuInwjc
esn"tudetCBG(G,
9,isgweay\p r17sHHsnCHdTD\nfst
N7\eD\gC'dl9™CBGà™,
é,isgweay\p r1NDss\nestHfwjsnc
\f"tf\gseH,osn�2sntIDewHHC h2H2geC
BG9à,
à,isgweay\p 71OpKndHDsnCrnc
estHisgweay\p, Tfslsf\ebC Ldnfb
V2jfwtDwea TdCBG(9,
>,u\exdnbOi1hHHDsisgweac
y\pt1h«\gwfpVdnHn\wH,KdtHdeC7wHc
HfsKndye�TdCBG(9,
(,M\fdgYo1NDsNDsdnp\ebVn\Ic
HwIsdxUnd2AVtpIDdHDsn\Ap, 'sy
MdnRCK\twIKddRtYeIV2jfwtDsntC
BG™6CAAB9BcB9é,
™,WpIndxHT1VtpIDd\e\fptwt :jc
tsnlsb,7debdeCTdetH\jfs �Td7HbC
BG((CAB�,
�,LssRtWV3sb41YeHndb2IHwdeC we
isgweay\p1 hTdffsIHwdedxTnwHwI\f
rtt\pt,reafsyddb TfwxxtC'¬CVnsec
HwIsci\ffYeICBG(9CAABcB(,
G,isgweay\p r1NDsuedytdx
»wfwg\ez\nd1 hfdeatHdnp,rt%2wns
(19™CBGàc96BCBGé(,
B6,idnesp»1's2ndtwt\ebi2g\e
UndyHD,'syMdnRCLL'dnHde�Td
YeIV2jfwtDsntC BG>6,
BB,isgweay\p r17sHHsnCHdTD\nfst
N7\eD\gChAnwf96CBGà>,
B9,isgweay\p r17sHHsnCHd
TD\nfstN7\eD\gCh2a™CBGàG,
Bé,isgweay\p r17sHHsnCHd
TD\nfstN7\eD\gC¬2esB�CBG>9,
Bà,isgweay\p r17sHHsnCHd
TD\nfstN7\eD\gCosIB�CBG>9,
B>,isgweay\p r17sHHsnCHdTD\nfst
N7\eD\gCusAH99CBG>6,
B(,isgweay\p r1TndttId2eHnp
tedyCweNDsuDdnHuHdnwstdxrnestH
isgweay\p, 'syMdnRCTD\nfstuInwjc
esn"tudetCBG((,
B™,isgweay\p r1Ye\edHDsnId2ec
HnpCweNDsuDdnHuHdnwstdxrnestH
isgweay\p, 'syMdnRCTD\nfstuInwjc
esn"tudetCBG((,
B�,Md2eaV1rnestHisgweay\p1
hWsIdetwbsn\Hwde, 8ewlsntwHpV\nRC
V\CVseetpfl\ew\ uH\Hs8ewlsntwHp
VnsttCBG>9,
BG,«ns2bu1NDnssTdeHnwj2Hwdet Hd
HDsNDsdnpdxus0,'syMdnRCrV
o2HHde�TdYeICBG(9,
96,isgweay\p r1hIndttHDsWwlsn\ebYeHdHDsNnsst,'syMdnRCTD\nfst
uInwjesn"tudetCBG>6CAéé,
9B,isgweay\p r17sHHsnCHd«
uIdHH«wH)asn\fbCosIsgjsnC BG9(,
99,isgweay\p r1NDsu2ehftd
Wwtst,'syMdnRCTD\nfstuInwjesn"t
udetCBG>6CA9(,
9é,isgweay\p r1«dnLDdgHDs
KsffNdfft,'syMdnRCTD\nfstuInwjc
esn"tudetCBGà6CAà™B,
9à,«\ff\IDw63sb41YeHsnlwsyywHD
O\npisgweay\p1 OpD2tj\ebCrnc
estHisgweay\p, 7ddRé61(9c(�CBG((,
9>,isgweay\p r17sHHsnCHd
TD\nfstN7\eD\gCusAHBBCBG>6,
9(,idHIDesnh1V\A\isgweay\p,
'syMdnRCW\ebdgid2tsYeICBG((CA
9(�,
at Mayo Clinic Library, on March 20, 2011 www.archgenpsychiatry.com Downloaded from