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This Month in Archives of General Psychiatry
February 2003

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2003;60(2):119. doi:10.1001/archpsyc.60.2.119

Daumit et al Article studied a national sample of physician visits where antipsychotic medication was prescribed from 1992-2000 in the United States. African American and Hispanic patients had much lower odds of receiving atypical antipsychotics compared with white patients in the early 1990s. As use of atypical antipsychotics became more prevalent throughout the 1990s, these disparities disappeared for Hispanic and improved for African American patients compared with white patients.

Because dehydroepiandrosterone (DHEA) has been shown to improve mood, interest, and activity in a number of studies, Strous et al Article carried out a double-blind, placebo-controlled trial of DHEA in antipsychotic-treated patients with schizophrenia and prominent negative symptoms. Treatment with DHEA was associated with significant improvements in negative symptoms, depression, and anxiety without altering positive symptoms.

Lam et al Article reported a randomized controlled study of cognitive therapy (CT) specifically designed to prevent relapses for bipolar disorder. In addition to mood stabilizers prescribed to all patients in the study, subjects received a course of individual CT. During the 12-month period, the CT group had significantly fewer bipolar episodes, days in a bipolar episode, and number of bipolar admissions. The CT group also had significantly higher social functioning, showed less severe mood symptoms, and coped better with manic prodromes.

Jones et al Article report that a lifetime history of recurrent major depression is associated with increased risk for carotid plaque in premenopausal women, relative to those with no history of major depression. The link between recurrent major depression and plaque is not accounted for by standard cardiovascular risk factors. Prevention of recurrent major depression may prevent further progression of the atherosclerotic disease process in women.

Neuroactive steroids are potent positive allosteric modulators of GABA(γ-aminobutyric acid) receptors.Ströhle et al Article demonstrated that during panic attacks patients with panic disorder, but not healthy control subjects, have pronounced changes in the concentrations of neuroactive steroids, compatible with a decreased GABA-ergic tone. Modulation of neuroactive steroids may be a promising new strategy for the treatment of anxiety disorders such as panic disorder.

The "affective spectrum disorder" (ASD) hypothesis proposes that a group of psychiatric and medical disorders—including mood disorders, anxiety disorders, eating disorders, migraine, irritable bowel syndrome, fibromyalgia, and others—share a physiologic abnormality critical to their etiology.Hudson et al Article interviewed probands with and without major depressive disorder, together with their first-degree relatives. The study found that ASD aggregated in families and that major depressive disorder coaggregated with other forms of ASD.

Keel et al Article evaluated mortality and predictors of fatal outcome in 246 women diagnosed with anorexia or bulimia nervosa between 1987 and 1991. Anorexia nervosa, but not bulimia nervosa, was associated with increased mortality. Among women with anorexia nervosa, severity of alcohol use disorder increased risk of mortality, while hospitalization for an affective disorder appeared to protect women from premature mortality. Physicians treating patients with anorexia nervosa should carefully assess patterns of alcohol use during the course of care.

Kessler et al Article carried out a methodological study of Serious Mental Illness Screening Scales for use in the annual SAMHSA (Substances Abuse and Mental Health Services Administration) National Household Survey on Drug Abuse (NHSDA). Six- and ten-question scales were found to be the most efficient screens. Kessler et al suggest that these scales could help create a heretofore missing crosswalk between community and clinical epidemiological research.

Silverman et al Article studied Alzheimer disease (AD) in parents and siblings of AD probands with very late-onset AD (at 85+ years of age) (VLOAD), AD probands with earlier ages at onset, and nondemented elderly subjects. At least through the mid to late 80s, AD risk in parents and siblings of VLOAD probands was almost indistinguishable from parents and siblings of nondemented elderly subjects and significantly lower than those of earlier-onset AD probands. From a genetic perspective, VLOAD and earlier-onset AD appear distinctly different and VLOAD may be a good target population for identifying environmental risk factors for AD.

Drugs with anticholinergic properties often cause confusion. A radioreceptor assay can quantify individuals' overall serum anticholinergic activity (SA) caused by all drugs and their active metabolites. Mulsant et al Article found that SA was detectable in 90% of 201 elderly subjects. Measurement of SA should be considered in all studies of cognition and aging since it may be a covariant as important as age or sex.

Standard methylphenidate capsules must be taken 3 times per day to maximize effectiveness across a 12-hour day.Swanson et al Article describe a new methylphenidate formulation that produces a rapid rise in plasma levels followed by increasing concentrations that peaked at 7 to 9 hours after dosage. They show that this new formulation matches 3-times-daily methylphenidate for time of onset and duration of efficacy.