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This Month in Archives of General Psychiatry
January 2003

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2003;60(1):11-12. doi:10.1001/archpsyc.60.1.11

Oquendo et al Article studiedthe relationship of seriousness of suicide attempts in terms of resultant medical damage in medication-free depressed suicide attempters' brain responses to serotonin with positron emission tomography imaging of 18F-flurodeoxyglucose. Depressed high-lethality suicide attempters had lower glucose turnover in ventral, medial and lateral prefrontal cortex compared with depressed, low-lethality attempters. Prefrontal hypofunction and impaired serotonergic responsivity correlated with lethality of the suicide attempt and appeared to mediate the effects of suicide intent and impulsivity. This method may aid in risk assessment for suicide.

Resistance to glucocorticoid negative feedback as assessed by dexamethasone has been shown by many investigators to occur in patients with major depression. However, dexamethasone evaluates only one type of glucocorticoid receptor, Type II or GR. Young et al Article evaluated the function of mineralocorticoid receptor (Type 1, MR) using spironolactone, an MR antagonist. Contrary to expectations, they found increased MR tone in subjects with major depression. This finding suggests an alteration in MR/GR ratio. Both MR and GR have been shown to regulate serotonin receptors and release. The implications for this finding with regard to serotonin receptors and depression are discussed.

A lifetime history of major depression may increase the risk of an early transition to the perimenopause. In a prospective study of premenopausal women with and without a history of major depression, Harlow et al Article found that symptomatically depressed women taking antidepressants were nearly 3 times more likely to enter the perimenopause sooner than women with no depression history of similar ages. Women with a history of depression also had higher early follicular phase follicle-stimulating hormone and luteinizing hormone levels and lower estradiol levels over time. Thus, a lifetime history of depression may be associated with an early decline in ovarian function.

Ohayon et al Article showed that, in the general population, 43.4% of the subjects with a major depressive disorder had also a chronic painful physical condition. Pain lasting more than 6 months is 4 times more frequent in subjects with a major depressive disorder and increases the duration of the depression.

Auditory hallucinations of speech often produce significant distress and functional disability. Hoffman et al Article describe a double-blind trial using "suppressive" 1-Hz repetitive transcranial magnetic stimulation (rTMS) in patients with schizophrenia who were experiencing medication-resistant auditory hallucinations. Compared with sham stimulation, 9 days of active rTMS delivered to left temporoparietal cortex was associated with statistically robust improvements in hallucinations. Symptom improvements endured 16 weeks or more for half the patients receiving active rTMS. These findings support the hypothesis that left temporoparietal cortex, a region critical to speech perception, participates in the generation of auditory hallucinations, and demonstrates the need for further study of rTMS in curtailing these experiences.

Sensitive measures of specific cognitive deficits may help identify genes that cause schizophrenia. MacDonald et al Article explored a candidate executive function known as context processing which has been found to be impaired in schizophrenia. To isolate a specific cognitive deficit, 2 behavioral conditions were compared: in a condition where context processing aided performance, patients' siblings made more mistakes; in a second condition that controlled for extraneous factors but where context processing hindered performance, patients' siblings made fewer mistakes than controls. This is the first report of such a specific cognitive deficit in the healthy adult siblings of patients with schizophrenia.

Selemon et al Article used a 3-dimensional cell-counting method to assess cell density in 2 distinct areas of the prefrontal cortex in postmortem brains from schizophrenic patients and normal control subjects. Abnormally high neuronal density, consistent with a reduction of neuropil, was observed in the dorsolateral prefrontal cortex (area 9) but not in a ventral prefrontal language area (Broca area 44). As the 2 cortical areas were analyzed in the same cohort of patients, these findings suggest that the pathology of schizophrenia exhibits a regional specificity and lend further support for the prominence of dorsolateral prefrontal dysfunction in schizophrenia.

A multicenter, randomized, blinded, 2-year international study (InterSePT), presented here by Meltzer et al Article compared the effect of clozapine vs olanzapine on suicidal behavior in 980 patients with schizophrenia or schizoaffective disorder at high risk for suicide. All patients were seen weekly for 6 months, then biweekly for 2 years. The suicidal behavior and hospitalization to prevent suicide were found to be significantly less in patients treated with clozapine compared with olanzapine. The clozapine-treated patients also required significantly fewer rescue interventions to prevent suicide and less frequent concomitant treatment with antidepressants.

Naltrexone and acamprosate have been shown to be efficacious in the relapse prevention of alcoholism by pharmacologically different mechanisms.Kiefer et al Article present the first published controlled study comparing and combining both compounds. Following inpatient detoxification, 160 alcohol addicts received either naltrexone, acamprosate, naltrexone plus acamprosate, or placebo for 12 weeks in addition to a weekly behavioral group program. The monotherapy with each of both compounds was superior compared with placebo, and especially the combination of naltrexone and acamprosate enhanced significantly the potential of relapse prevention.

There has been increased interest in the role of psychological intervention in cancer care, especially its effect on reducing recurrence and enhancing survival. Ten years after the initial study,Fawzy et al Article revisited the same 68 patients with stage 1 malignant melanoma to determine if the effect on survival and recurrence that was noted at the 6-year follow-up has been maintained. The present study's outcome confirmed the previously reported results; being male, and having a greater Breslow depth, was the most important variable predicting poorer outcome. After adjusting for gender and Breslow depth, participation in psychological group intervention significantly enhanced survival.

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