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This Month in Archives of General Psychiatry
April 1999

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 1999;56(4):298. doi:10.1001/archpsyc.56.4.298

A new neuroscience field has developed that uses powerful magnetic fields to alter brain activity (transcranial magnetic stimulation [TMS]). George et alArticle review the basic principles underlying TMS, and describe how TMS differs from electrical stimulation or other uses of magnets. They critically summarize the initial studies in the field, particularly as they pertain to the pathophysiology and treatment of neuropsychiatric disorders, and provide the rationale for why TMS is a promising new research and perhaps therapeutic tool.

Klein et alArticle, in a double-blind, sham-controlled study, report that slow repetitive stimulation of the right prefrontal cortex was significantly more effective than sham TMS in ameliorating depressive symptoms. These results provide further support for the therapeutic potential of TMS in depression, and call for its further evaluation as a possible alternative to electroconvulsive therapy.

In a large sample of twins from a population-based register, Kendler et alArticle found that 4 features of major depression predicted risk of illness in the co-twin: number of episodes, duration of longest episode, recurrent thoughts of death or suicide, and level of distress or impairment.

The use of stimulant medication for the treatment of attention-deficit hyperactivity disorder in children with chronic, multiple tic disorder is one of the most contested practices in child psychiatry, owing primarily to concerns about tic exacerbation. In this prospective study of long-term methylphenidate therapy in this clinical population, Gadow et alArticle report that the frequency and severity of motor and vocal tics as assessed at the onset of treatment remained unchanged after 2 years of treatment. Methylphenidate seems to be safe and effective for the management of attention-deficit behaviors in at least some children with mild to moderate tic disorder.

A Commentary by Castellanos is included.

Helgeson et alArticle evaluated the effectiveness of peer education and peer discussion groups on psychological and physical adjustment to breast cancer. They found benefits of education but no benefits of peer discussion. The benefits of education groups were largely accounted for by increases in self-esteem, increases in positive body image, and reductions in intrusive thoughts about the illness. The clear benefits of education groups along with the ease with which they can be standardized and implemented suggest that support groups ought to emphasize education over peer discussion.

An Institute of Medicine committee examined the safety and efficacy of the controversial sleeping pill Halcion (triazolam). By reanalyzing the data from the original application for approval and reviewing more recent clinical trials and surveillance data, Bunney et alArticle found the drug to be safe and effective when used according to the label.

Commentaries by Klein and Dunner are included.

Smaller brain volumes have been found in alcoholics, but it is unclear whether the hippocampus is selectively affected. Agartz et alArticle measured hippocampal volumes from magnetic resonance images in alcohol-dependent patients and nonalcoholic subjects and found smaller hippocampi in the alcoholics. However, the ratio of hippocampus to total brain volume did not differ between groups. The authors emphasize the need to control for alcohol use in studies of hippocampal damage.

White matter tracts, which provide connections between neurons in the brain, have directional coherence and connectivity that may be disrupted in schizophrenia. Lim et alArticle examined this possibility with magnetic resonance diffusion tensor imaging in patients with schizophrenia in comparison with healthy control subjects. The patients with schizophrenia had evidence of abnormal white matter coherence throughout the brain yet normal white matter volume. These results suggest that widespread alteration in brain white matter integrity occurs in schizophrenia and may contribute to the psychotic thought processes and cognitive deficits marking this debilitating disease.

Pindolol (a nonselective antagonist of serotonin autoreceptors) accelerates the clinical response produced by fluoxetine or paroxetine. Pérez et alArticle report that short-term addition of pindolol does not produce a significant improvement over placebo in patients with a moderate or high resistance to antidepressant treatments.