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This Month in Archives of General Psychiatry
September 2002

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2002;59(9):773-774. doi:10.1001/archpsyc.59.9.773

The fusiform gyrus (FG) on the ventral surface of the temporal lobe is critical for face recognition. Lee et alArticle used high spatial resolution magnetic resonance imaging in patients with first-episode schizophrenia and normal controls. Bilaterally smaller relative volumes of FG gray matter, smallest on the left, were present in patients with schizophrenia when compared with healthy controls and patients with affective psychosis (mainly mania). Smaller FG gray matter volume is evident early in schizophrenia but not in affective psychosis and may contribute to impaired facial recognition in schizophrenia.

Hyperintensities in deep white matter on magnetic resonance imaging are increased in major depression. Thomas et alArticle hypothesized that these would more likely have an ischemic basis in depressed subjects. In a cohort of 20 elderly subjects with a history of major depression and 20 elderly controls, they first performed in vitro postmortem imaging and then neuropathologically analyzed the lesions in the same slices. Virtually all deep white matter hyperintensities in the depressed group were ischemic, compared with less than one third in the control group. Ischemic lesions were more likely to be found in dorsolateral prefrontal cortex in depressed subjects. The findings support a vascular etiology in late-life depression.

The association between alcoholism and major depression has been explained as alcohol intoxication and withdrawal effects misdiagnosed as depressive syndromes. Hasin and GrantArticle investigated former drinkers in a national survey, comparing the prevalence of current major depression between those with and without a history of alcohol dependence. Prior alcohol dependence increased the risk of current major depressive disorder more than 4-fold in these former drinkers, a relationship not attenuated by many control variables. Since intoxication/withdrawal could not account for the association, better understanding of the relationship is needed.

Brent et alArticle showed that early-onset suicidal behavior is transmitted in the families of mood-disordered suicide attempters. The offspring of mood-disordered suicide attempters had a suicide attempt rate that was 6 times higher than that of the offspring of mood-disordered nonattempters. Familial transmission of suicidal behavior in families with mood disorders almost always required transmission of a mood disorder, and was also related to offspring impulsive aggression and the familial transmission of sexual abuse. Early treatment of mood disorders and targeting impulsive aggression and sexual trauma may prevent and treat suicidal behavior in families with mood disorder.

Klin et alArticle used eye-tracking technology to study visual fixations in cognitively able individuals with autism when viewing dynamic social scenes. Coding was performed by dividing viewed scenes into eye, mouth, body, and object regions. Relative to controls, they focused twice as much time on the mouth region, and 2½ times less on the eye, body, and object regions. Increased focus on mouths predicted improved social adjustment and less autistic social impairment, whereas more time on objects predicted the opposite relationship. Focus on eyes was unrelated to measures of social competence.

Rawson et alArticle compared contingency management and cognitive-behavioral therapy for the treatment of cocaine dependence. One hundred twenty cocaine-dependent methadone maintenance patients were randomly assigned to 1 of 4 conditions: contingency management(CM), cognitive-behavioral therapy (CBT), combined CM and CBT (CBT + CM), or treatment as usual (ie, methadone maintenance treatment program only). Participants assigned to the 2 groups featuring CM procedures produced significantly superior in-treatment results from urinanalysis. Cocaine use was significantly reduced from baseline levels for all 3 treatment conditions, but not for the methadone maintenance–only group. The CBT participants showed a substantial improvement, resulting in equivalent performance with the CM groups at 2 follow-up points.

Lappalainen et alArticle studied whether the functional Pro7Leu polymorphism in the neuropeptide Y (NPY) gene predisposes to alcohol dependence in European American populations. They found that the Pro7 allele was present at a higher frequency among the 2 alcohol-dependent samples they studied as compared with healthy controls. They then estimated the frequency of the Pro7 allele in other psychiatric diagnostic groups and populations. The Pro7 allele frequency was lower in groups with other psychiatric diagnoses, suggesting a degree of specificity to alcohol dependence. The Pro7 allele was present at a much lower frequency in almost all populations, including African American and Asian populations. Thus, the Pro7 allele of the NPY gene may be a risk factor for alcohol dependence among the European American population.

Inhibition of emotional processing has been suggested as a mechanism underlying some of the clinical features of depersonalization/derealization. Sierra et alArticle tested the prediction that autonomic response to emotional stimuli would be reduced in patients with depersonalization disorder. In comparison with healthy and clinical controls, patients with depersonalization were found to have attenuated skin conductance responses (SCR) to emotional pictures but their response to nonspecific elicitors of SCR was similarly increased compared with that of patients with anxiety disorders. This suggests the presence of a selective inhibition of emotional processing in depersonalization.

Clues to the etiology of schizophrenia can be derived from studying first-degree relatives of patients with the disorder. Seidman et alArticle compared hippocampal volumes and verbal declarationmemory fuctioning in nonpsychotic adult first-degree relatives, their schizophrenic relatives, and healthy controls. Nonpsychotic relatives and their ill relatives had significantly smaller left hippocampi compared with controls. Verbal memory and left hippocampal volumes were significantly and positively correlated. Hippocampal volumes did not differ between schizophrenic patients and their nonpsychotic relatives. Results support the hypothesis that a small left hippocampus and a verbal memory deficit are vulnerability indicators for schizophrenia.

Using proton magnetic resonance spectroscopy, Epperson et alArticle measured cortical GABA levels across the menstrual cycle in women with premenstrual dysphoric disorder (PMDD) and healthy menstruating controls. They found that cortical GABA levels fluctuate in the menstrual cycle in a phase- and diagnosis-specific fashion. While cortical GABA levels appeared to be modulated by the neurosteroid allopregnanolone in the healthy control group, there was no significant relationship between allopregnanolone and cortical GABA levels in those with PMDD. These findings suggest that GABAergic dysregulation plays a role in the pathophysiology of PMDD.