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This Month in Archives of General Psychiatry
September 1998

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 1998;55(9):770. doi:10.1001/archpsyc.55.9.770

Vega et alArticle present the prevalence of DSM-III-R disorders for Mexican Americans, compared with population rates from the United States and Mexico. Mexican Americans had fewer disorders than the US population. However, this difference is attributable to far lower rates of psychiatric disorders among immigrants, whereas Mexican Americans born in the United States had virtually identical levels as reported in Mexico and their psychiatric disorder rates increased with years in the United States, suggesting powerful effects of exposure to American society for increasing risk of psychiatric morbidity.

A Commentary by Escobar is included.Article

Using 2 national surveys, Mechanic et alArticle describe changes in psychiatric inpatient care between 1988 and 1994. Inpatient days in mental hospitals fell by 12.5. Psychiatric discharges from general hospitals increased from 1.4 to 1.9 million but total days of care only increased by 1.2 million with shorter lengths of stay. By 1994, 60% of all inpatient days were paid for by Medicare and Medicaid. With continuing deinstitutionalization, traditional clients of public mental hospitals are now replacing privately insured patients in general hospitals who, with utilization management, are now treated largely in community settings.

Chronic cocaine abuse may alter dopaminergic reward processes in the brain, contributing to cocaine-induced binging, withdrawal depression, and craving. Little et alArticle demonstrate that cocaine users have increased dopamine uptake sites. However, the mechanism did not seem to involve increased synthesis of the dopamine uptake protein.

Panic and depression often co-occur. Kessler et alArticle studied the co-occurrence of panic and depression in the general population using data from the National Comorbidity Survey. Temporally primary panic attacks, with or without panic disorder, predict first onset of subsequent major depression. Temporally primary major depression, in comparison, was found to predict first onset of subsequent panic attacks but not panic disorder. These results suggest that primary panic is a marker rather than a causal risk factor for subsequent depression, while primary depression is a genuine risk factor for subsequent panic attacks.

Gao et alArticle found that the incidence of dementia and AD increases with age but this increase slows down in the very old. Women were found to be at greater risk than men for developing AD, but not dementia. This slowing down of age-related increase in incidence rates lends support to the hypothesis that AD and dementia are age-related rather than age-dependent, with the hopeful corollary that possible preventable risk factors can be identified.

Significant progress has been made in treating depression, but recurrence of depression after antidepressant drugs have been discontinued is a vexing problem. Fava et alArticle reported that cognitive behavioral treatment of residual symptoms after successful pharmacotherapy resulted in a lower relapse rate at a 2-year follow-up than did a control group under clinical management. The results suggest that cognitive behavioral therapy may be a viable alternative to long-term drug treatment in preventing relapse in recurrent depression.

There has been little simultaneous examination of the interrelationship between genetic parental sociopathy, specific types of early-life disruptive symptoms, and adult antisocial personality. Langbehn et alArticle reanalyzed an adoption study in which children of antisocial biological parents were overrepresented. They found that dimensions of adolescent behavior resembling conduct and oppositional defiant disorder exist in adopted children. In males, only the oppositional defiant dimension seemed related to the biological transmission of sociopathy. This suggests that the transmission involves temperament predisposition that manifests in early life as refusal to submit to authority.

Thaker et alArticle examined the predictive component of the smooth pursuit eye movements in relatives of patients with schizophrenia and community subjects with no family history of psychosis. The investigators found deficits in predictive pursuit in relatives, particularly ones with schizophrenia spectrum personality traits, compared with the comparison groups, including the comparison group with spectrum personalities.

O'Driscoll et alArticle studied eye movements in a population of university students who had unusual perceptual experiences that increase the risk of psychosis. These students had the same eye movement deficits that are seen in schizophrenic patients. The "schizotypal" students had particular difficulty overriding established response tendencies when new responses were required. This pattern of errors is also seen in humans and monkeys with prefrontal lesions and suggests that risk for psychosis may be related to subtle frontal pathology.