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This Month in Archives of General Psychiatry
June 2000

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2000;57(6):531. doi:10-1001/pubs.Arch Gen Psychiatry-ISSN-0003-990x-57-6-ytm0600

Do subjects in schizophrenia research have adequate decisional capacity to provide valid informed consent? Carpenter et alArticle found reduced capacity in some subjects, and this was explained by cognitive impairments rather than psychosis. However, an educational informed consent process resulted in decisional capacity similar to that of the nonill comparison group. These data suggest that an enriched informed consent process results in valid consent for research in persons with schizophrenia.

A commentary by Roberts is included.Article

Public pressure advocating the medical use of marijuana was the stimulus for the Office for National Drug Control Policy to request that the Institute of Medicine carry out an analysis of the scientific basis for the use of marijuana as medicine. Watson et alArticle summarize the report, which found that the relevant scientific and medical literature was generally too weak to clearly support any of the claims for marijuana in medicine. The report opposed smoked marijuana for treatment but advocated the study of nonsmoked, inhaled pure cannabinoid compounds instead.

Kapur et alArticle examined the serotonin (5-HT2a) and dopamine type 2 (D2) receptor effects of quetiapine using positron emission tomography imaging in a randomized clinical trial. Quetiapine was an effective antipsychotic with only a transiently high occupancy of D2 receptors, which declined rapidly between doses. The transiently high D2 occupancy may be sufficient for an antipsychotic effect.

In the first systematic Western study in the Ukraine of the psychological effects of the Chornobyl disaster on children, Bromet et alArticle compared 10- to 12-year-olds, evacuated to Kyiv from the vicinity of the plant when they were infants or in utero, with sex-matched classmates. Overall, the children were remarkably resilient in the face of the substantial trauma expressed by their mothers.

Nurnberger et alArticle sought to determine whether melatonin secretion was decreased in patients with affective illness and whether patients with bipolar disorder were unusually sensitive to the effects of light in suppressing melatonin. Suppression values did not differentiate bipolar patients from unipolar patients or controls; however, patients with bipolar I disorder showed lower melatonin values at baseline and after light exposure when compared with age and sex-matched controls. A later melatonin peak time was also noted for patients with bipolar I disorder on a separate night without light exposure. Disturbances in melatonin secretion may be related to circadian rhythm disruption in bipolar illness.

Amnesia is a major factor limiting the use of electroconvulsive therapy (ECT). In patients with major depression, Lisanby et alArticle found that ECT exerted a more marked and longer-lasting effect on memory of events in the world (impersonal or public memory) compared with memory of autobiographical events (personal memory). These effects were magnified for bilateral compared with right unilateral ECT.

A commentary by Weiner is included.Article

Schwartz et alArticle evaluate the stability of research diagnoses and predictors of change from nonschizophrenia-spectrum diagnoses to schizophrenia in a heterogeneous first-admission sample of patients with psychosis. Schizophrenia, bipolar disorder, and major depression diagnoses were much more stable than psychosis not otherwise specified, schizoaffective disorder, and brief psychosis. Diagnostic changes are mostly attributable to evolution of the illness. These findings support the need for a longitudinally based diagnostic process in incidence samples.

Prevalence of depression across a wide range of older ages is poorly understood. Steffens et alArticle examined nondemented elderly residents of Cache County, Utah, aged 65 to 100 years, and found that the prevalence of major depression was 4.4% in women and 2.7% in men. Estimated lifetime depression prevalence was 20.4% in women and 9.6% in men, which decreased with age. Other depressive syndromes were surprisingly uncommon (1.6%).

Prepulse inhibition of the startle response (PPI)—ie, the ability of a weak prestimulus to inhibit the response to a closely following strong stimulus—represents a measure of sensorimotor gating and is deficient in schizophrenia. Kumari et alArticle examined PPI in a group of healthy men and men with schizophrenia. Compared with healthy people, illness onset in adolescence, but not in adulthood, was associated with reduced PPI. Prepulse inhibition may provide an objective tool to investigate heterogeneity in schizophrenia.