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This Month in Archives of General Psychiatry
April 2000

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2000;57(4):310. doi:10.1001/archpsyc.57.4.310

During the past decade several new antidepressants have gotten to market, and potential antidepressants continue to be evaluated in double-blind, placebo-controlled clinical trials. Scientists, ethicists, and the public have raised concern about risks and ethics of treating depressed patients with placebo. Khan et alArticle examined the Food and Drug Administration database for antidepressants approved during the past 10 years to assess the frequency of suicides, suicide attempts, and symptom reduction in depressed patients assigned to placebo. Rates of suicide and attempted suicide did not differ for placebo-treated vs antidepressant-treated patients. Placebo-treated patients experienced substantial reduction in symptoms. These data may help inform discussions about the use of placebo in antidepressant clinical trials.

Commentaries by LeberArticle; MichelsArticle; Quitkin and KleinArticle; HirschfeldArticle; Chmura KraemerArticle; and LeonArticle are included.

Individuals with autism or Asperger syndrome show aberrant perceptual strategies on face-recognition tests, relying strongly on feature-based perceptual approaches typical of common object perception. Using functional magnetic resonance imaging with face and nonface perceptual tasks, Schultz et alArticle found reduced activation in the fusiform gyrus (the classic face area) and increased activation in an adjacent nonface object processing region. This activation pattern suggests that some individuals with severe social disabilities perform perceptual analyses on faces as if they were objects.

A commentary by Pierce and CourchesneArticle is included.

Rosoklija et alArticle found that the apical dendrites of subicular pyramidal neurons have less extensive arbors and a markedly diminished density of spines in schizophrenia. These abnormalities suggest impaired modulation of hippocampal outflow, which could underlie many of the clinical features of the disorder.

Nestadt et alArticle report the results from a family study supporting the hypothesis that obsessive-compulsive disorder (OCD) runs in families. Individuals with early onset are more likely to have affected family members. No cases of OCD were detected in the first-degree relatives of OCD probands with age at onset older than 18 years.

Immunological studies of tics and obsessive-compulsive disorder (OCD) have not indicated which of these syndromes or their associated comorbidities are most associated with prior streptococcal infection, nor have they documented that prior streptococcal infections are associated with in vivo neuroanatomical abnormalities. Peterson et alArticle report that in subjects with chronic tics, OCD, or attention-deficit/hyperactivity disorder (ADHD), antistreptococcal antibodies were most associated with a diagnosis of ADHD. In subjects with ADHD and OCD, antibody titers were positively associated with basal ganglia volumes, suggesting that in susceptible individuals who have ADHD or OCD, streptococcal infections are associated with abnormalities in brain structure.

Judd et alArticle examined psychosocial disability during the long-term course of unipolar major depressive disorder while patients were experiencing symptoms at the subthreshold, minor, and major levels, as well as the asymptomatic status. Disability was pervasive and chronic, but patients' psychosocial function returned to good when they were asymptomatic. Each of these levels was associated with a significant stepwise increment in psychosocial disability.

A commentary by Ormel and Von KorffArticle is included.

Alegría et alArticle compare the relationship between income and mental health treatment in the United States, the Netherlands, and Ontario, Canada. These 3 societies, with divergent systems of health care financing, differ in the degree to which they provide equal access for all income groups and in the nature of that access. The consequences of differential access to specialty care for low-income people need to be assessed.

Some patients continue to use heroin during methadone maintenance. In a sample of such patients, Preston et alArticle tested 2 adjuvant interventions: a 1-time methadone dose increase and a behavioral procedure (monetary vouchers contingent on opiate-negative urine samples). The dose increase alleviated heroin craving and reduced daily frequency of use, assessed by self-report; the behavioral procedure promoted longer periods of sustained abstinence, assessed by urinalysis. When combined, the 2 interventions retained their individual benefits.