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This Month in Archives of General Psychiatry
August 2000

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2000;57(8):728. doi:10.1001/archpsyc.57.8.728

Major depression and suicide are independently associated with serotonergic deficiencies. Mann et alArticle now demonstrate a diffuse reduction of serotonin transporter binding throughout prefrontal cortex in major depression, suggesting widespread serotonergic impairment consistent with its diverse psychopathology. In contrast, a localized reduction in transporter binding is found in the ventral prefrontal cortex of suicide victims. Ventral prefrontal reduced serotonin input may underlie the predisposition to suicide. A variant in the regulatory region of the serotonin transporter gene associated with less gene expression does not explain these findings.

A commentary by OrdwayArticle is included.

Using event-related positron emission tomography scanning techniques in a group of patients with Tourette syndrome (TS), Stern et alArticle found that tic occurrence was significantly correlated with activity in frontal executive, premotor and motor cortices, language cortices, insula, and striatum. Aberrant activity in the circuits identified in this study may account for the initiation and execution of diverse motor and vocal behaviors that characterize tics in TS, as well as for the urges that often accompany them.

A commentary by DevinskyArticle is included.

Posener et alArticle measured cortisol and corticotropin (ACTH) levels every hour for 24 hours in patients with psychotic major depression, patients with nonpsychotic major depression, and healthy control subjects. In nonpsychotic depressed patients the amplitude of cortisol levels over 24 hours was reduced, while in psychotic depressed patients mean ACTH levels were increased. These findings raise the possibility that distinct mechanisms of pathophysiology may operate in depressions with and without psychosis.

Gur et alArticle report reduced prefrontal gray matter volume in schizophrenia, evident in neuroleptic-naive patients with first-episode disease. Reduction was found in both men and women for the dorsolateral sector, only in men dorsomedially, and only in women for orbital regions. It was associated with neurocognitive performance but not with symptom severity. Neurodevelopmental abnormalities in prefrontal cortex in schizophrenia relate to neurocognition and are moderated by sex.

Gur et alArticle evaluated sex differences in segmented temporal lobe subregions with reliable parcellation methods, relating volume to clinical and neurocognitive parameters. They found reduced gray matter volume for temporolimbic structures in schizophrenia. Men showed reduction in all regions, whereas women showed decreased hippocampal but increased amygdala volumes. The abnormalities are evident in patients with first-episode disease and relate more strongly to neurocognitive performance than to symptom severity. This study suggests that some sex differences in cognition and emotion in schizophrenia may relate to temporolimbic aberrations.

In a comprehensive study of postabortion responses, Major et alArticle examined emotions, decision satisfaction, and mental health among women followed up for 2 years from the day of a first-trimester abortion of an unintended pregnancy. Most women did not experience psychological problems or regret their decision 2 years after abortion. During the study period, mental health improved, although decision satisfaction declined. Elective abortion is not a mental health risk for most women.

A commentary by AdlerArticle is included.

Lambert et alArticle demonstrate that the subcortical brain regions of patients with depression exhibit a reduction in the turnover of both norepinephrine and dopamine, and preferentially utilize an energy source other than glucose.

McDougle et alArticle found that 50% of adults with serotonin reuptake inhibitor (SRI)–refractory obsessive-compulsive disorder responded to the addition of risperidone to ongoing SRI treatment. Other than mild, transient sedation, the combination treatment was well tolerated.

Alcoholism and depression occur together both within individuals and in families more often than expected by chance. Based on an interview study of adult twin pairs, Prescott et alArticle report that this occurs because a set of genetic factors contribute to the development of both disorders. However, these factors seem to be sex-specific—the overlapping genetic and environmental factors for depression and alcoholism in women are not the same as those for depression and alcoholism in men.