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This Month in Archives of General Psychiatry
July 1999

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 1999;56(7):599. doi:10.1001/archpsyc.56.7.599

Johnson et alArticle report unique findings from a community-based prospective longitudinal study indicating that victims of documented childhood abuse or neglect were more than 4 times as likely as nonvictims to have personality disorders during early adulthood after accounting for the effects of parental education and psychopathology. These findings suggest that childhood maltreatment may increase risk for personality disorders during early adulthood.

A commentary by Widom Article is included.

Walker et alArticle examined female health maintenance organization members with and without childhood histories of maltreatment and found that women who had experienced abuse and neglect had higher annual costs for health care and made more visits to primary care and emergency department providers. Women with more severe abuse had the highest costs and health care utilization. The large number of women with these experiences in the population suggests that the total costs to society are significant.

Kessler et alArticle report data from the National Comorbidity Survey on the prevalances of lifetime suicidal behaviors in the United States. Prevalences were 13.5% for ideation, 3.9% for a plan, and 4.6% for an attempt. Significant risk factors were being female, previously married, younger than 25 years, in a recent cohort, poorly educated, and having 1 or more psychiatric disorders. Three fourths of those with a plan went on to make an attempt, compared with one fourth of those without a plan.

For the vocational rehabilitation of people with severe mental illnesses, individual placement and support (IPS), which combines rapid, individualized searches for competitive employment with ongoing supports, seems to be a more effective model than traditional approaches, which emphasize assessment and training prior to employment. In a randomized clinical trial for inner-city psychiatric patients with multiple impairments, Drake et alArticle compared IPS with traditional vocational programs. The IPS participants attained a high rate of competitive employment, whereas the participants in traditional programs predictably became stalled in sheltered workshops.

In a population-based case-control study, Cnattingius et alArticle found that girls born at 32 weeks or earlier faced a 3-fold increase in risk of subsequent development of anorexia nervosa compared with girls born at term. Moreover, cephal hematoma was associated with a more than 2-fold increase in risk. Perinatal factors possibly reflecting brain damage may increase the subsequent risk of anorexia nervosa, but that only a fraction of cases may be explained by such factors.

Autonoetic awareness associated with recognition memory is the kind of awareness characterized by mentally "re-living" events from one's personal past. Danion et alArticle report that patients with schizophrenia exhibit a reduction in the frequency of autonoetic awareness and a decrease in its consistency throughout the different aspects of complex events. This impairment is the corollary of an impaired ability to bind the separate aspects of events into a coherent, relational memory representation. Because autonoetic awareness provides a basis for decisions and actions in everyday life, these findings might explain many of the behavioral abnormalities associated with schizophrenia.

Commentaries by Frith Article and Tien Article are included.

Rapoport et alArticle examined adolescents with childhood-onset schizophrenia and controls at a 4-year follow-up with anatomical magnetic resonance imaging. They found regional and disease-specific decreases in cortical gray volume, particularly in frontal and temporal lobes.

True et alArticle studied several thousand male twins from the Vietnam Era Twin Registry and found a large correlation in the genetic contributions to nicotine and alcohol dependence. These data suggest that, among tobacco and alcohol users, genetic influences may contribute to the risk of dual dependence.

Krishnan-Sarin et alArticle provide evidence for the role of the endogenous opioids in nicotine dependence. When challenged with the opioid antagonist naloxone, smokers, in contrast to nonsmokers, had signs and symptoms similar to those seen during withdrawal from opiates. Smokers had lower levels of cortisol prior to and following naloxone challenge, suggesting that nicotine dependence is also associated with suppression of the hypothalamic-pituitary-adrenal axis.

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