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This Month in Archives of General Psychiatry
July 2000

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2000;57(7):635. doi:10-1001/pubs.Arch Gen Psychiatry-ISSN-0003-990x-57-7-ytm0700

How are the symptoms and course of schizophrenia determined? McGlashan and HoffmanArticle draw upon recent postmortem and neuroimaging studies of schizophrenia and their own computer stimulations of neural network dynamics to revisit this century-old question. A model of reduced synaptic connectivity associated with brain development during perinatal and adolescent periods is proposed. They describe the model's key components and how it may account for diverse features of the disorder.

In a double-blind placebo-controlled study, Malone et alArticle investigated the efficacy of lithium for reducing severe aggression in acutely hospitalized children and adolescents with conduct disorder. They found that lithium was effective in reducing aggression in the inpatient setting with short-term usage.

Fairburn et alArticle found that over 5 years the outcome of bulimia nervosa was relatively poor whereas that of binge eating disorder was good. This finding supports distinguishing between these 2 disorders and suggests that they are maintained by different underlying mechanisms.

Slutske et alArticle explore the familial co-aggregation of pathological gambling and alcohol dependence by examining the extent to which rates of alcohol dependence are elevated among the identical and fraternal cotwins of men with a history of pathological gambling. The patterns of co-aggregation in identical vs fraternal twin pairs suggest that pathological gambling and alcohol dependence have genetic risk factors in common.

Brief lifetime family psychiatric history screens are useful in clinical practice and for identifying families for genetic studies. Available methods can be lengthy and time-consuming. Weissman et alArticle describe a method (Family History Screen) for collecting information on 15 psychiatric disorders from an informant and their first-degree relatives. The administration time is 5 to 20 minutes depending on family size. Testing against independent interviews of family members shows that the Family History Screen is a promising first-stage screen.

Kyosseva et alArticle found that the protein levels of transcription factors Elk-l, cAMP response element binding protein (CREB), and activating transcription factor (ATF-2), associated with activation of the mitogen-activated protein (MAP) kinase pathway, are elevated in postmortem samples from the cerebellar vermis of patients with schizophrenia. These neurochemical alterations and potentially related alterations of the MAP kinase signal transduction pathway in the cerebellar vermis may have a role in schizophrenia.

Hirayasu et alArticle used magnetic resonance imaging to quantify volumes of the planum temporale, an important language substrate, and the Heschl gyrus, primary auditory cortex. At the first hospitalization for psychosis, patients with schizophrenia, compared with patients with bipolar disorder and healthy controls, had reduced gray matter volume of the left planum temporale and bilateral Heschl gyri. They conclude that brain manifestations of schizophrenia may differ from bipolar disorder, and are present in patients without potential confounds of chronic illness.

The termination of Supplemental Security Income disability benefits for individuals addicted to alcohol or other drugs was intended to encourage employment and discourage drug use. Swartz et alArticle found that only a small percentage of individuals affected by these legislative changes have been able to achieve consistent employment. Those still unemployed have relatively high rates of severe psychiatric impairments and continuing substance use disorders. Consequently, their prospects for achieving sustained employment seem to be small.

Druss et alArticle found that in a nationally representative sample, rates of use of provider-based complementary therapies were higher among those reporting mental conditions than in the general population, although the treatments were generally used for transient distress rather than to treat serious mental conditions.