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This Month in Archives of General Psychiatry
June 2001

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2001;58(6):528. doi:10.1001/archpsyc.58.6.528

In a double-blind, randomized, placebo-controlled trial, Soares et alArticle report the efficacy of transdermal 17-β estradiol for the treatment of minor and major depression in perimenopausal women. Subjects showed a significant improvement in mood, regardless of the type of depression. Treatment was generally well tolerated. After a 4-week washout period, patients treated with estradiol sustained antidepressant benefit, despite the recrudescence of vasomotor symptoms.

A commentary by Stahl is included.Article

The occurrence of antidepressant-induced mania is a key issue in the clinical management of bipolar disorder. In this study on the role of the serotonin transporter protein gene in predicting this undesirable effect of antidepressant treatment, Mundo et alArticle reported that patients carrying 1 or 2 copies of the short variant of the gene (which also is considered to generate less gene expression) are more likely to develop antidepressant-induced mania. If these results are replicated, the variant of the serotonin transporter protein gene may become an important predictor of abnormal response to medication in patients with bipolar disorder.

Glial cells greatly outnumber neurons in the cortex and are vital for normal neuronal function. In a postmortem investigation, Cotter et alArticle examined glial cell density and neuronal size in the anterior cingulate cortex among subjects with major depression, schizophrenia, bipolar disorder, and normal controls. Compared with controls, subjects with major depression showed reduced glial cell density and reduced neuronal size in layer 6. There was also some evidence for reduced glial cell density in schizophrenia.

Recent neuroimaging studies of panic disorder have suggested dysfunction in the inhibitory GABA neuronal system. Consistent with this previous work, Goddard et alArticle report abnormal reductions in occipital cortex GABA levels in a group of unmedicated patients with active panic disorder, using a novel magnetic resonance spectroscopic technique. The data indicate that low occipital cortex GABA is associated with the panic disorder diagnosis itself rather than illness severity.

Patients with mental disorders are at risk for elevated rates of cardiovascular mortality; however, little is known about the possible contributory role of poor quality of medical care. Examining a large cohort of Medicare patients hospitalized for myocardial infarction, Druss et alArticle found that deficits in use of 5 established indicators of medical quality appeared to explain a substantial portion of the excess mortality experienced by patients with mental disorders in the year after myocardial infarction.

Individuals with schizophrenia tend to smoke more often and more heavily than average, but nonetheless epidemiological studies have found their risk of lung cancer decreased. Could some schizophrenia vulnerability gene protect them from cancer despite increased smoking? In the largest study to date, Lichtermann et alArticle found that persons with schizophrenia in Finland indeed ran a higher risk of cancer than the general population, and obviously cannot escape this tragic consequence of tobacco and alcohol consumption. However, cancer risk in their biological relatives was decreased, and this could well be compatible with a combined schizophrenia vulnerability and cancer protective gene.

A commentary by Jablensky and Lawrence is included.Article

In a family study of parents of patients with childhood-onset schizophrenia (COS), Asarnow et alArticle report that the parents of COS probands had an increased risk for schizophrenia and schizotypal personality disorder compared with parents of attention-deficit/hyperactivity disorder and community control probands. The risk of avoidant personality disorder was also increased in parents of COS probands compared with parents of community control probands. The psychiatric disorders that do and do not aggregate in the parents of COS probands are remarkably similar to the disorders that aggregate in parents of adult-onset schizophrenia probands, providing compelling evidence for the etiological continuity between COS and adult-onset schizophrenia.

Personality disorders are frequent among psychiatric patients. However, the prevalence in the common population is largely unknown. In the first study of a larger representative sample of the common population, Torgersen et alArticle have found that 1 of 8 individuals in the main city of Norway has a personality disorder.