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This Month in Archives of General Psychiatry
January 1999

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 1999;56(1):9. doi:10.1001/archpsyc.56.1.9

Hypoactivity of glutamatergic N-methyl-D-aspartate (NMDA) receptors may play a role in schizophrenia. D-Cycloserine is a partial agonist at the glycine modulatory site of NMDA receptors. Goff et alArticle conducted a placebo-controlled trial of D-cycloserine (50 mg/d) added to conventional antipsychotic agents in patients with schizophrenia. Negative symptoms improved in the absence of effects on cognition, psychosis, depression, or parkinsonian effects. Treatment targeting NMDA receptors may selectively improve primary negative symptoms in schizophrenia.

In a placebo-controlled, double-blind trial, Heresco-Levy et alArticle found that high-dose (0.8 g/kg per day) adjuvant glycine treatment induced significant reductions in negative symptoms in treatment-resistant schizophrenic patients.

A Commentary on glycine agonists by Farber et al is included.

In 3790 twin pairs from the Virginia Twin Registry, Kendler et alArticle found that while major depression (MD) is equally heritable in men and women and most genetic risk factors influence liability to MD similarly in the 2 sexes, some genes may exist that act differently on the risk for MD in men vs in women.

Depression frequently occurs in Alzheimer disease and has been linked to an additional loss of noradrenergic neurons in the locus coeruleus. Hoogendijk et alArticle found that the number of locus coeruleus neurons in patients with Alzheimer disease was lower than in controls, but a difference between depressed and nondepressed patients was not found.

Goodkin et alArticle examined the effect of a bereavement support group intervention among homosexual men either seropositive or seronegative for the human immunodeficiency virus after the death of a loved one in the prior 6 months. In a randomized controlled trial, they showed a significant reduction in overall distress and grief levels.

Keel et alArticle report on outcome for 173 women more than a decade after presentation with bulimia nervosa. Almost 70% of women achieved remission; however, 30% were diagnosed with eating disorders (anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified) at the follow-up assessment. A history of substance use disorder and longer duration of eating disorder symptoms prior to presentation predicted worse outcome.

Individuals with panic disorder can have their panic precipitated by lactate infusion. Dager et alArticle, using a new magnetic resonance spectroscopic imaging technique, found significantly greater brain lactate increases among subjects with panic disorder compared with controls that were widely distributed across the 2-dimensional axial section sampled. No hemispheric lateralization or distinct regional patterns for magnitude differences in brain lactate rise were observed. These findings suggest metabolic or neurovascular mechanisms are responsible for brain lactate abnormalities in panic disorder.

Patients with panic disorder are commonly characterized by negative emotions and behaviors of avoidance and withdrawal. Using electroencephalography, Wiedemann et alArticle provide evidence that these characteristics are associated with an asymmetry in frontal brain activity in favor of a right frontal overactivation. This asymmetry suggests an overactive avoidance-withdrawal system and disturbed cortical processing in patients with panic disorder.

Van Gorp et alArticle administered memory tests to a group of abstinent cocaine abusers up to day 45 of abstinence and to normal controls. Cocaine abusers had poorer performance on a measure of nonverbal memory relative to the control subjects. The cocaine abusers demonstrated improved performance on a motor learning measure relative to the control subjects over the abstinence interval.

Somatization disorder has traditionally been considered a lifelong illness and assessment has depended on lifetime history. In follow-up data from the World Health Organization's international primary care study, however, Simon et alArticle show that patients' reports of lifetime somatization symptoms change significantly over 1 year. This may explain why epidemiologic studies (which depend on lifetime recall) have found an unexpectedly low prevalence of somatization disorder.