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This Month in Archives of General Psychiatry
November 1998

This Month in Archives of General Psychiatry

Author Affiliations

Copyright 1998 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.1998

Arch Gen Psychiatry. 1998;55(11):962. doi:10.1001/archpsyc.55.11.962

Persons who abuse one illicit drug are also likely to abuse other drugs. This pattern is consistent with a trait that affects abuse of all drugs. Tsuang et alArticle, using a large sample of twin Vietnam-era veterans, found a single vulnerability factor that underlies the abuse of marijuana, sedatives, stimulants, heroin, and psychedelics. This vulnerability was influenced by genetic, family environmental, and nonfamily environmental factors.

Merikangas et alArticle conducted a controlled family study of probands with several different predominant drugs of abuse, including opioids, cocaine, cannabis, and/or alcohol. The results reveal an 8-fold increased risk of drug disorders among the relatives of probands with drug disorders across a wide range of specific drugs. There was also evidence for specificity of familial aggregation of the predominant drug of abuse.

Using data from the Collaborative Study on the Genetics of Alcoholism, Bierut et alArticle found that siblings of an alcohol-dependent subject are at an increased risk for alcohol dependence. Marijuana dependence, cocaine dependence, and habitual smoking cluster within families of alcoholics in a substance-specific fashion and are in part independent of alcohol dependence.

A Commentary by Goldman and Bergen on the genetics of substance abuse is included.Article

The serotonin autoreceptor 5-MTIB has been implicated in alcohol consumption and aggressive behavior in mice. Lappalainen et alArticle present evidence for linkage and association between a silent polymorphism within the HT1B gene and antisocial alcoholism in Finns and Southwestern American Indians. Linkage was also demonstrated for a genetic marker locus, D6S284, that is closely linked to HT1B. These findings suggest that a locus predisposition to antisocial alcoholism may be located near HTR1B at chromosome 6q13-15.

Leptin is a hormone that regulates fat metabolism and appetite, and its secretion is increased by various factors including glucocorticoids (GCs). Newcomer et alArticle report that stress-level doses of cortisol can significantly increase plasma leptin concentrations in healthy humans. Increases in leptin concentrations returned to baseline during 4 treatment days, suggesting tolerance to this effect in healthy subjects. The results indicate an important role for GCs in the acute regulation of human leptin secretion.

People with schizophrenia may show abnormal frontal lobe activity but it is unclear whether these observations depend on the task subjects are performing. Fletcher et alArticle explored memory-related brain activation, in controls and patients, using both easy and difficult memory tasks. Frontal activation was similar across groups during the easier tasks. When the task became more difficult and performance fell, abnormal frontal activation was observed in the patient group, suggesting that abnormal brain activity in schizophrenia may only be observed under certain conditions.

Selective serotonin reuptake inhibitors are increasingly being used as first-line agents to treat panic disorder. In this large, double-blind, placebo-controlled, flexible-dose study, Pollack et alArticle report that sertraline was significantly more effective than placebo in reducing panic attack frequency as well as other clinician and patient assessments of improvement.

Current nosological thinking that assumes a key pathogenic role of spontanous primary panic attack for onset of secondary agoraphobia has been challenged. Wittchen et alArticle demonstrate that in a community sample, even after adjusting for potential diagnostic bias, most subjects with agoraphobia had no prior history of panic. The findings suggest the existence of diverse pathogenic pathways for panic and agoraphobia.

In an overview of the evidence available on the treatment of depression with alternative or complementary therapies, Ernst et alArticle found rigorous scientific data to be extremely limited. The areas with the most evidence for beneficial effects are exercise, herbal therapy (St John's wort) and, to a lesser extent, acupuncture and relaxation therapies.

Botanical medicines are increasingly encountered in psychiatric practice. Wong et alArticle assess the literature regarding herbs commonly available in North America (eg, St John's wort, Ginkgo, valerian, chamomile, and kava) for safety, adverse effects, drug interactions, and efficacy.