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This Month in Archives of General Psychiatry
April 2002

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2002;59(4):310. doi:10.1001/archpsyc.59.4.310

Raemaekers et al Article measuredbrain activity in schizophrenic patients and healthy control subjects during3 oculomotor tasks using event-related functional magnetic resonance imaging. Patients engaged the frontal brain regions normally during saccadic inhibition. In contrast with controls, however, they did not activate the striatum, suggesting a frontostriatal abnormality rather than a selective frontal malfunction during inhibition.

Left temporal auditory P300 amplitude reduction is associated with reduced gray matter volume of the left posterior superior temporal gyms (LPSTG) in chronic schizophrenia. To determine whether this association was present at first episode and specific to schizophrenia, McCarley et al Article evaluated healthy normal controls and patients with schizophrenia and affective (mainly manic) psychosis at first hospitalization. Specific to schizophrenia were findings of P300 left temporal amplitude reduction, LPSTG matter volume reduction, and LPSTG–left temporal P300 correlation. These data suggest that interrelated functional and structural temporal lobe abnormalities are specific and critical features of both early and chronic schizophrenia.

McCreadie et al Article havepreviously found in southern India that spontaneous dyskinesia is common in chronically ill, never-treated schizophrenic patients. They now report brain structure findings from magnetic resonance imaging. The left lenticular nucleus is larger in dyskinetic patients, and the lateral ventricle–hemisphere ratio is larger in nondyskinetic patients when compared with controls. In controls but not patients, increasing age was associated with decreased basal ganglia volume. The results suggest a subgroup of schizophrenia: dyskinetic patients with striatal pathology.

Hyperglycemia and type 2 diabetes mellitus are reported to be more common in schizophrenic patients than in the general population. Glucoregulatory abnormalities have also been associated with antipsychotic treatment. Newcomer et al Article report that during fasting oral glucose tolerance tests, nondiabetic patients taking olanzapine and clozapine had higher plasma glucose levels than age- and adiposity-matched patients taking typical antipsychotics. Patients taking olanzapine, clozapine, and risperidone had higher plasma glucose levels compared with matched controls.

Daskalakis et al Article reportedthat cortical inhibition is impaired in unmedicated patients with schizophrenia. In medicated patients cortical inhibition is increased compared with their unmedicated counterparts. Their results suggest that schizophrenia is associated with deficits in cortical inhibition that may be normalized with antipsychotic medications.

Fenton et al Article evaluated the cost-effectiveness of acute care in a crisis residential setting for patients with serious mental illness willing to accept voluntary treatment. Compared with usual treatment in a hospital psychiatric ward, the crisis residential model reduced episode and 6-month treatment costs while delivering comparable symptom reduction and days of community functioning. Access to acute care might be extended using a mix of hospital, crisis residential, and community support services.

In a community sample of adolescents and young adults, Lieb et al Article found that offspring of depressed parents have elevated rates of depressive disorders and other mental disorders, such as specific anxiety and substance use disorders. Offspring with 2 affected parents had an earlier onset of depression than those without affected parents. Offspring of affected parents also reported a more malignant course of depression, suggesting that parental depression seems to influence the natural course of depression in the early stages of manifestation.

Difficulty diagnosing major depressive disorder in alcohol- and drug-abusing patients has led to inconsistencies with the relationship of depression to substance outcome. Hasin et al Article present evidence of differential effects of major depression occurring under different temporal relationships to substance dependence. Research on the reasons for differences in the effects (for example, effects of different levels or types of disability) may yield clinically useful information.

Phillips et al Article studiedresponse to fluoxetine in the first placebo-controlled study of body dysmorphic disorder (BDD). Fluoxetine was generally well tolerated and significantly more efficacious than placebo for BDD, beginning at week 8 and continuing at weeks 10 and 12. Symptoms were as likely to improve in patients with delusional BDD as in those who were nondelusional. This study indicates that fluoxetine is safe and effective for both delusional and nondelusional BDD.