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This Month in Archives of General Psychiatry
October 1999

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 1999;56(10):866. doi:10.1001/archpsyc.56.10.866

Several previous studies have reported an increased lifetime prevalence of suicide attempts in homosexual men. The validity of this association has been questioned because of the possible confounding influence of depression and substance abuse. Herrell et al present results from a population-based twin registry in which suicidality and other psychiatric disorders were measured. The odds ratio for same-gender sexual orientation and suicide attempts is 5.4 (95% confidence interval=2.2-13.4) adjusted for depression and 5.4 (95% confidence interval=2.4-2.5) adjusted for drug abuse. While the underlying causes are unclear, the association is not likely explained by these other factors.Article

In recent years there has been growing debate about the extent to which young people of gay, lesbian, or bisexual (GLB) sexual orientation are at increased risk of mental health problems. Fergusson et al examined this issue in a large sample of young people in New Zealand who were studied to age 21 years. In comparison with other sample members, GLB youth had substantially higher risks of psychiatric disorders (depression, anxiety, conduct disorder, substance use disorders) and suicidal behaviors. The study confirms a growing number of recent reports suggesting that GLB youth may have elevated risks of mental health problems.Article

Commentaries by Bailey, Remafedi, and Friedman are included.ArticleArticleArticle

In a Dutch community study, Penninx et al showed that men with minor depression and both men and women with major depression had an 80% increased risk of death. These risks remained present after controlling for differences in socioeconomic status, health status, and health behaviors between depressed and nondepressed persons.Article

Wells and Sherbourne found that depressed patients have a lower preference (ie, utility) for their current health than do patients with most common chronic medical conditions. This suggests that improving depression should be a relatively high primary care practice priority because patients strongly wish to avoid this common and distressing health state.Article

Gur et al report that reduced gray matter volume in men and women with schizophrenia is already evident in the first presentation of neuroleptic-naive patients. Volume reduction is not correlated with symptom severity but is associated with neurocognitive performance. The results support aberrant neurodevelopment, since gray matter growth is prenatal while white matter growth is primarily postnatal.Article

Szeszko et al found that, compared with healthy subjects, individuals with obsessive-compulsive disorder had less brain tissue in the orbital frontal and amygdaloid regions and lacked the normal hemispheric asymmetry of the hippocampus-amygdala complex.Article

The co-occurrence of common mental disorders at higher than chance rates, referred to as comorbidity, is commonly observed. Krueger shows how comorbidity can be modeled by proposing a small number of continuous factors underlying a larger number of observed mental disorders. Support was obtained for a model positing a broad externalizing factor underlying substance dependence and antisocial personality disorders, and a broad internalizing factor (with anxious-misery and fear subfactors) underlying unipolar affective and anxiety disorders. The results argue for focusing research on these underlying factors, rather than on their varied manifestations as separate disorders.Article

A commentary by Wittchen et al is included.Article

Recent studies have reported that selective serotonin reuptake inhibitors (SSRIs) are effective for premenstrual syndromes (PMS) and premenstrual dysphoric disorder. Freeman et al found that an SSRI was significantly better than placebo or a tricyclic antidepressant, which was not better than the placebo. The response of patients with PMS to antidepressant drugs differs from the response of patients with major depression.Article

Do individuals with velo-cardio-facial syndrome, a genetic disorder associated with small interstitial deletions of chromosome 22q11, have increased rates of psychosis? In the largest series of its kind, Murphy et al found that about one third of patients with the syndrome had a psychotic disorder and, of these, the majority had schizophrenia. These findings suggest that chromosome 22q11 might harbor a gene or genes relevant to the etiology of schizophrenia in the wider population.Article