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This Month in Archives of General Psychiatry
June 1999

This Month in Archives of General Psychiatry

Author Affiliations

Copyright 1999 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.1999

Arch Gen Psychiatry. 1999;56(6):492. doi:10-1001/pubs.Arch Gen Psychiatry-ISSN-0003-990x-56-6-ytm0699

Cocaine dependence continues to be a public health concern with wide-ranging effects on the individual and society. In the largest randomized trial of psychosocial treatments for cocaine dependence, Crits-Christoph et al Article report that a combination of manual-guided individual drug counseling and group drug counseling was significantly more effective than cognitive-behavioral psychotherapy plus group drug counseling, supportive-expressive psychotherapy plus group drug counseling, or group drug counseling alone.

Commentaries by Strain and Carroll are included.

Cocaine use is the most common drug problem of patients entering treatment for illicit drug use. In a national sample from 55 treatment programs, Simpson et al Article found that problem severity in 7 areas of functioning prior to admission was directly related to cocaine relapse in the year following discharge. Among patients admitted with a moderate to high level of problem severity, treatment for 90 days or longer also was related to lower relapse rates. Patients with a high number of functioning problems had significantly better outcomes if they were treated in residential programs for at least 90 days.

A Commentary by Higgins is included.

Guthrie et al Article studied the cost-effectiveness of brief psychodynamic-interpersonal therapy for patients previously unhelped by routine treatment. Patients who received psychotherapy reported greater improvement in psychological status than controls, and showed a reduction in service use (both for hospital and primary care) in the 6 months following therapy. This study provides preliminary evidence that psychotherapy is an effective treatment and may also result in cost savings due to reduced health care use over the long term.

Glucocorticoids, steroid hormones secreted during stress, can regulate brain functions important for memory. However, it is unclear whether exposure to cortisol, the endogenous glucocorticoid in humans, at levels observed during physical and psychological stress can decrease memory performance in healthy individuals. Newcomer et al Article found that several days of stress-level cortisol treatment produced clinically significant and reversible decreases in verbal memory performance.

Applying a new magnetic resonance imaging method that segments the neocortex into 48 topographically defined areas, Goldstein et al Article assessed regional alterations in cortical volumes in schizophrenic patients compared with normal controls. Findings showed that the greatest volumetric reductions in patients were in prefrontal and paralimbic regions, including middle, medial, and orbital frontal, anterior cingulate gryus, and insula.

Because identification of the gene variants that influence susceptibility to mental disorders will have great value for prevention, treatment, and diagnosis, the National Institute of Mental Health convened a work group to review current work in this field and to recommend ways to facilitate it. Barondes Article, who chaired the work group, summarizes the main points of its report.

Commentaries by Goldman, Kendler, and reply by Barondes are included.

Bierut et al Article, using data from telephone administration of a structured psychiatric interview in a community sample of 6000 Australian twins, found that major depressive disorder, broadly defined, was substantially heritable in women but only weakly heritable in men. In both men and women, individual environmental experiences were the strongest predictor of depression.

Rosenheck et al Article use data from the first experimental economic evaluation of an atypical antipsychotic medication to compare the cost-effectiveness of clozapine in very high hospital users (215 hospital days per year before study entry) and in lower users (55 hospital days per year). Total savings attributable to clozapine were substantial in very high hospital users ($7134) but not in low users ($759). Clinical improvement favored clozapine equally in both groups.

Mufson et al Article report on the use of 12 weeks of interpersonal psychotherapy for depressed adolescents for the treatment of clinic-referred depressed adolescents in a randomized, controlled clinical trial. Compared with adolescents who were treated with clinical monitoring, those adolescents who received interpersonal psychotherapy reported significantly greater decreases in depressive symptoms and greater improvement in social functioning and social problem-solving skills.