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Functional brain imaging studies of major depressive disorder (MDD) have demonstrated abnormal activity in prefrontal cortex (PFC), anterior cingulate gyrus, and the temporal lobe that normalizes with treatment. Using positron emission tomography, Brody et alArticle compared subjects with MDD with normal controls at baseline and examined changes in regional brain activity from before to after treatment with either medication (paroxetine) or interpersonal psychotherapy. Subjects with MDD had higher normalized activity than controls at baseline in PFC, caudate, and thalamus, and lower activity in the temporal lobe. These abnormalities tended to normalize with treatment. Regional changes appeared similar with both forms of treatment.
Martin et alArticle studied major depressive disorder with sequential SPECT over 6 weeks in 15 patients who took the antidepressant venlafaxine and 13 patients who were solely treated with interpersonal psychotherapy. Blood flow increased with interpersonal psychotherapy in the limbic system but not with venlafaxine, while both treatments had increased blood flow in the basal ganglia.
Commentaries by Sackeim and Thase are included.ArticleArticle
Zhou et alArticle found less vasopressin messenger RNA expression and more vasopressin immunoreactivity in the suprachiasmatic nucleus, the mammalian circadian pacemaker, of depressed subjects as compared with controls. These findings suggest a change in the balance between vasopressin production and transport, resulting in a diminished functional ability of the sprachiasmatic nucleus in depression.
Psychotic illness is more prevalent in urban areas. van Os et alArticle hypothesized that the factors that increase risk for psychotic disorder in urban areas contribute to a larger continuum of preclinical psychotic experiences, of which population only a fraction develops illness. They found that individuals living in more urbanized areas not only had higher rates of DSM-III-R psychotic disorders, but also more often displayed mental states characterized by delusional thinking and hallucinatory experiences in the absence of clinical disorder. The findings suggest that urban risk affects the community level of psychotic symptoms rather than illness in a few individuals.
Fanous et alArticle found significant correlations between positive and negative symptoms in schizophrenic probands, and, respectively, positive and negative schizotypal symptoms in their nonpsychotic relatives. The factors influencing the dimensions of schizophrenic psychopathology appear to be etiologically related to those influencing the dimensions of schizotypal personality.
In a large register-based study, Bennedsen et alArticle reported a large increase in the risk of infant death and a small increase in the risk of congenital malformations among children of women with schizophrenia. The high risk of infant death was largely explained by an increased risk of sudden infant death syndrome. The association between schizophrenia and sudden infant death syndrome should be investigated in future studies.
In a controlled, 12-week trial of early clonazepam coadministration with sertraline, Goddard et alArticle observed superior early stabilization in panic disorder patients assigned to clonazepam/sertraline treatment compared with those receiving placebo/sertraline treatment. Both treatment groups experienced similar rates of side effects, and tapering after 4 weeks of clonazepam or placebo was uneventful.
Hser et alArticle studied community-based drug abuse treatment for adolescents and found that about half of the adolescents had stopped regular use of marijuana in the year after leaving treatment. Treatment was also effective in achieving important behavioral and psychological improvements. Longer stays in treatment were positively associated with several favorable outcomes, although length of time in treatment was generally short.
Little is known about the long-term health benefits of programs to improve quality of care for depression in community-based primary care settings. Sherbourne et alArticle compare 2-year outcomes for usual care vs 2 programs providing practices with training and materials that support guideline-concordant treatment and extra resources for either medication follow-up or improved access to psychotherapy, while maintaining treatment choice. Both programs improved 1-year outcomes but only the therapy resource intervention improved second-year outcomes relative to usual care.
This Month in Archives of General Psychiatry. Arch Gen Psychiatry. 2001;58(7):628. doi:10.1001/archpsyc.58.7.628