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This Month in Archives of General Psychiatry
August 1998

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 1998;55(8):682. doi:10.1001/archpsyc.55.8.682

Smoking and depressed mood have been linked in population studies. Hall et alArticle investigated the effects of the antidepressant nortriptyline and 2 forms of psychotherapeutic contact on smoking cessation efforts. Nortriptyline produced significantly higher abstinence rates than placebo, independent of depression history, and cognitive-behavioral therapy was more effective than health education for participants with a depression history.

A Commentary by Glassman is included.Article

Judd et alArticle conducted the first prospective, naturalistic, longitudinal study of the long-term (≤12 years) weekly symptomatic course of unipolar major depressive disorders. They found that the clinical course of major depressive disorder is dominated by symptomatic chronicity. Moreover, symptom levels changed frequently. The clinical course is dynamic and changeable, in which major, minor, and subsyndromal depressive symptoms commonly alternate in the same patient over time.

The association between onset of bipolar episodes and life stress has been hypothesized, but remains to be fully elucidated. Malkoff-Schwartz et alArticle found that severe life events and life events involving social rhythm disruption were more common 8 weeks before episode onset than in an earlier 8-week period. Moreover, life events characterized by disruptions in social rhythms were significantly associated with the onset of manic, but not depressive, bipolar episodes. They hypothesize that social rhythm disruption may lead to onset of mania via circadian rhythm and/or sleep disruption.

In a study of 26 adult subjects with personality disorder, Coccaro et alArticle report a positive relationship between cerebrospinal fluid concentrations of arginine vasopressin (CSF AVP) and life history of aggression. While the prolactin response to d-fenfluramine (PRL[d-FEN]), a measure of central serotonergic responsiveness) correlated inversely with both CSF AVP concentration and life history of aggressive behavior in these subjects, CSF AVP remained significantly related to a life history of aggression after relationships among CSF AVP, PRL[d-FEN], and life history of aggression were accounted for.

Malizia et alArticle, using positron emission tomography and flumazenil tagged with carbon 11, found that there is decreased benzodiazepine-GABAA binding in vivo in brains of unmedicated patients with panic disorder. These changes in brain neurochemistry may explain the observations of decreased sensitivity of patients with panic disorder to benzodiazepines.

In an 18-year longitudinal study of New Zealand children, Fergusson et alArticle found that children whose mothers smoked during pregnancy had higher rates of conduct disorder symptoms in late adolescence, even after allowance for social and other factors associated with smoking during pregnancy. This study adds to a growing body of evidence that suggests that smoking during pregnancy may increase children's risk of later problem behavior.

Levomethadyl acetate hydrochloride (LAAM), approved in 1993 for opioid dependence treatment, has been prescribed less than expected, owing in part to perceptions about treatment adequacy and patient acceptability during induction. In a randomized, double-blind study, Jones et alArticle report that induction with 25, 50, and 100 mg within 1, 7, and 17 days, respectively, is safe, effective, and acceptable to patients.

Barsky et alArticle reinterviewed a group of hypochondriacal medical outpatients, along with a comparison group of nonhypochondriacal patients from the same clinic, 4 to 5 years after first studying them. They found that the hypochondriacal patients as a group exhibited a considerable decline in both symptoms and disability, but that two thirds of them still met diagnostic criteria for hypochondriasis. This disorder therefore carries a very substantial long-term burden of morbidity, disability, and personal distress.

Relatively little is known about the early origins of later childhood aggression. In a sample of 1130 children from Mauritius, Raine et alArticle showed that stimulation-seeking, fearlessness, and increased height and weight at age 3 years predisposed to aggression at age 11 years. Results also indicate a critical period early in development when larger children become more fearless and learn to use their physical superiority to gain rewards through aggression.