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This Month in Archives of General Psychiatry
February 2002

This Month in Archives of General Psychiatry

Author Affiliations

Copyright 2002 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2002

Arch Gen Psychiatry. 2002;59(2):112. doi:10.1001/archpsyc.59.2.112

Current estimates of mental disorder prevalence have been criticized as being too high for the effective planning of treatment services. In keeping with the DSM-IV requirement for mental disorders to be "clinically significant," Narrow et al Article reanalyzed 2 community surveys, requiring a clinical significance criterion to be met before a diagnosis could be made. They found that using this criterion lowered prevalence rates substantially, from 28.0% to 18.5%, identifying persons more likely to need treatment. Discrepancies in estimates between the surveys were also reduced.

A Commentary by Wakefield and Spitzer is included.

People wonder if they really need 8 hours of sleep. Analyzing more than1.1 million people followed up for 6 years, Kripke et al Article found that those who usually slept 6.5 to 7.4 hours per night had the best survival. Sleep of 8 hours or more was associated with increased mortality. There was relatively little risk associated with sleep as short as 4.5 hours, and no mortality risk associated with insomnia, but those who used sleeping pills had higher mortality. Clinical trials are needed to determine which treatments of sleep improve long-term health.

A Commentary by Buysse and Ganguli Article is included.

Although childhood sexual abuse (CSA) has been associated with adverse outcome risk, the attribution of risk to CSA vs family background factors remains controversial. Nelson et al Article examined young adult Australian twins using a structured telephone interview. Increased risk for many adverse outcomes was found for CSA-negative individuals with CSA-positive co-twins vs members of CSA-negative pairs, suggesting risk related to family background factors. The CSA-positive members of CSA-discordant pairs had significantly greater risk than their co-twins for all examined adverse outcomes consistent with direct CSA effects. These results offer support for important effects related both to CSA and family background factors.

Although impairments of visual working memory are often reported in schizophrenia, most of the studies assume intact visual perception. Tek et al Article studied perception of object shapes and locations and working memory in a group of normal controls and patients with schizophrenia. Patients had visual perception impairments for both shapes and locations of objects. However, after they controlled for these impairments, the visual working memory impairment was not general. Only working memory for object locations was impaired in patients with schizophrenia.

Previous studies suggest that the impact of developmental insults predisposing to schizophrenia have differential consequences for the sexes. In a structural magnetic resonance imaging study of schizophrenia and normal controls, Goldstein et al Article demonstrated that normal patterns of sex differences in adult brain volumes were disrupted in schizophrenia. Sex-specific effects were primarily evident in the cortex (ie, frontomedial cortex, basal forebrain, cingulate and paracingulate gyri, posterior supramarginal gyms, and planum temporale), and not in subcortical gray matter regions or cerebrospinal fluid. Findings suggested that factors that produce normal sexual dimorphisms may be associated with modulating insults producing schizophrenia, particularly in the cortex.

For many people with severe mental illnesses, employment remains an elusive goal. Lehman et al Article randomly assigned high-risk, inner-city outpatients with severe mental illnesses to either the Individual Placement and Support (IPS) model of supportive employment or usual psychosocial rehabilitation services. The IPS model proved significantly more effective than the comparison rehabilitation condition in improving employment outcomes. However, overall low rates of employment and substantial problems with job retention for patients in both conditions underscore the continuing challenges posed by these disabling illnesses.

Disturbances in prefrontal cortex have been identified in major depressive disorder (MDD). Although MDD commonly emerges during childhood, few studies have examined psychotropic-naive pediatric patients near the onset of illness. Using volumetric magnetic resonance imaging, Nolan et al Article found smaller left prefrontal cortical volumes in pediatric MDD patients with at least 1 first-degree relative with MDD (familial MDD) vs patients without a family history of MDD (nonfamilial MDD). Nonfamilial MDD patients had significantly larger left prefrontal cortical volumes than both familial MDD patients and controls. These findings provide new evidence of distinct neuroanatomic alterations in familial vs nonfamilial MDD patients.