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This Month in Archives of General Psychiatry
November 2003

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2003;60(11):1067. doi:10.1001/archpsyc.60.11.1067

Do schizophrenic and affective disorder psychoses represent manifestations of different disorders or the same disorder? Previous magnetic resonance imaging (MRI) investigations suggested neocortical gray matter volume reduction may be specific to schizophrenia. Using high-spatial-resolution MRI, Kasai et al Article evaluated 2 paralimbic regions, the insular cortex and temporal pole, in first-episode affective (mainly manic) and schizophrenic psychosis. A bilateral volume reduction in insular cortex gray matter was specific to schizophrenia, but both first-episode psychosis groups showed a volume reduction in left temporal pole gray matter, suggesting communality in regions that process emotion (temporal pole) and differences in regions that do not.

Tohen et al Article foundthat olanzapine was more effective than placebo and that olanzapine/fluoxetine combination was more effective than both placebo and olanzapine monotherapy in the acute treatment of bipolar depression without increased risk of developing manic symptoms. The most common treatment-emergent adverse events for patients treated with both olanzapine and olanzapine/fluoxetine combination in the study were drowsiness, weight gain, and increased appetite.

Taylor et al Article studied the longitudinal relationship between the changes in white matter hyperintensity lesion volume and late-life depression outcomes. Increase in lesion volumes over 2 years was associated with relapse of depression and failure to remit over the study period. Only education was associated with achieving and sustaining remission. Future work is needed to understand what may slow lesion progression, and to determine whether this will lead to improved depression outcomes.

Abram et al Article assessed comorbid psychiatric disorders in a sample of 1829 detained youth and present rates by sex, race/ethnicity and age. Approximately half of the detained youth met criteria for 2 or more disorders; more than one tenth for both a major mental disorder (psychosis, manic episode, or major depressive episode) and a substance use disorder. Many high-risk youth eventually cycle through the juvenile justice system. Mental health professionals must collaborate with the juvenile justice system to improve identification of youth with comorbidity, and their access to care in the community.

Pharmacological interventions may be part of a multi-modal treatment of binge eating disorder (BED). Although antidepressants are the most studied group of drugs in this condition, there is a growing interest about the effectiveness of other agents. Appolinario et al Article reporteda randomized placebo-controlled trial of the anti-obesity agent sibutramine in the treatment of BED. The authors found sibutramine more effective than placebo in primary and secondary outcome measures. The improvement in binge eating was associated with a significant reduction in body weight and in associated depressive symptoms. These results suggest that sibutramine may be a promising treatment for obese patients with BED.

Kessler et al Article addressed concerns that the DSM system is overly inclusive by placing respondents in the baseline National Comorbidity Survey on a disorder severity gradient, reinterviewing them a decade later, documenting a dose-response relationship with serious clinical outcomes, and showing that mild baseline cases account for a substantial proportion of serious outcomes over the intervening decade. The authors conclude that retention of mild cases in the DSM is important both to acknowledge that mental disorders, like physical disorders, vary in severity and to remind us that the development of cost-effective treatments for mild disorders might prevent a substantial proportion of future serious outcomes.

The prevalence of asthma has increased substantially over the past several decades, especially in Westernized countries, resulting in what is commonly considered a worldwide public health epidemic. Goodwin et al Article examined the relationship between physician-diagnosed asthma and DSM-IV mental disorders in a representative community sample of adults in Germany. The findings suggest strong linkages between asthma and anxiety and affective disorders, with evidence of stronger relationship in more severe asthma and mental disorders. Future studies are needed to investigate the mechanism of this link, and the potential public health implications of this association.

In the first structural brain imaging study of the corpus callosum in offenders, Raine et al Article found that psychopaths from the community with antisocial personality disorder had a 23% increase in volume, 7% increase in length, and 15% reduction in thickness of the corpus callosum, together with increased functional interhemispheric connectivity. Larger callosal volumes were associated with emotional and interpersonal deficits and low autonomic stress reactivity, and may reflect abnormal neurodevelopmental processes that predispose to offending.

The endogenous opioid system and one of its targets, the µ-opioid receptor, are distributed in limbic and paralimbic regions involved in the regulation of mood, reward, and stress. Zubieta et al Article examined the response of this neurotransmitter system to the induction of a sustained sadness state in healthy subjects. Regional reductions in µ-opioid neurotransmission were observed, which correlated with affect ratings. These data demonstrate the dynamic involvement of µ-opioid neurotransmission in the regulation of sustained affective states in humans.

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