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This Month in Archives of General Psychiatry
February 2000

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2000;57(2):115. doi:10.1001/archpsyc.57.2.115

It has been speculated that structural damage to the brain can predispose to antisocial psychopathic behavior, but there have been no previous studies of brain structure in antisocial individuals. In the first structural brain imaging study of offenders, Raine et alArticle found that individuals in the community with antisocial personality disorder have both an 11% reduction in the volume of gray matter in the prefrontal cortex and reduced autonomic arousal during a social stressor, compared with both comparison and substance-dependent controls. This prefrontal deficit may underlie the underarousal and lack of conscience previously found in antisocial, psychopathic individuals.

A Commentary by Damasio is included.Article

In the largest placebo-controlled double-blind study of its type to date, Pope et alArticle found that testosterone cypionate, at doses rising to 600 mg per week, produced a significant increase in manic and aggressive symptoms. However, this effect was not uniform: most subjects exhibited little psychological change, while a few developed pronounced effects.

Hypogonadal symptoms (diminished libido, fatigue, loss of muscle mass) and depressed mood are common among men with human immunodeficiency virus infection. Rabkin et alArticle evaluated the efficacy of biweekly 400-mg testosterone injections for the alleviation of these symptoms among 74 men with symptomatic human immunodeficiency virus infection or acquired immunodeficiency syndrome. Response, defined as significantly improved libido, was 74% for testosterone and 19% for placebo. Testosterone was well tolerated and was also effective for treating low mood and fatigue as well as for increasing muscle mass during a 3-month period.

Tuiten et alArticle found that administration of a single dose of testosterone in sexually functional women caused a sharp increase in plasma levels of testosterone of short duration. Several hours after this testosterone peak there was an increase in vaginal responsiveness and subjective sexual experiences when women were exposed to erotic visual stimuli. These findings demonstrate a delay in effect of testosterone of about 4 hours with regard to these aspects of human female sexual behavior.

A Commentary by Yates is included.Article

Van Dyck et alArticle examined the efficacy of the investigational acetylcholinesterase inhibitor, physostigmine, in subjects with Alzheimer disease who were preselected as potential responders in a dose-enrichment design. In the extended treatment phase, actively treated subjects scored significantly better than placebo-treated subjects on measures of cognitive and global function.

There is growing evidence for the efficacy of cognitive behavior therapy (CBT) for medication-resistant symptoms in schizophrenia. Sensky et alArticle found that CBT and a nonspecific befriending control intervention were equally effective at the end of treatment (lasting up to 9 months) but, at 9-month follow-up, sustained benefits were evident only in those patients treated with CBT, who continued to improve.

Sargent et alArticle used positron emission tomography to examine brain serotonin (5-HT1A) receptors in depressed patients. Unmedicated patients had widespread reductions in 5-HT1A receptors in brain regions involved in the experience of emotion. These changes were not altered by treatment with selective serotonin reuptake inhibitors. The findings suggest that decreased availability of 5-HT1A receptors could play a role in the causation of depression.

Gurvits et alArticle investigated the presence of neurological abnormalities in posttraumatic stress disorder (PTSD). They found evidence of increased neurological "soft" signs, which reflect subtle neurological compromise, and history of neurodevelopmental problems, in male Vietnam War combat veterans and adult women sexually abused as children.

As new therapeutic options emerge, the value of lithium for bipolar disorder is being questioned. Baldessarini and TondoArticle analyze 3 decades of research on lithium treatment and experience in a large clinic. They find that reported recurrence rates have not risen, nor have clinical responses worsened in a stable clinic setting. They emphasize that lithium remains unequaled in research support for long-term clinical effectiveness in bipolar I and II disorders, and in reducing mortality.