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This Month in Archives of General Psychiatry
October 2000

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2000;57(10):924. doi:10.1001/archpsyc.57.10.924

An extensive literature with rodents suggests that stressor glucocorticoids, hormones secreted during stress, can potentially damage the hippocampus, a part of the brain relevant to learning and memory. In recent years, it has become clear that there is loss of hippocampal volume in 3 syndromes associated with an excess of stress or of glucocorticoid exposure (Cushing syndrome, prolonged major depression, and posttraumatic stress disorder). Sapolsky et alArticle consider whether stress and/or glucocorticoids might have played a role in this volume loss.

Electroconvulsive therapy (ECT) is the most effective treatment for severe depression. Ende et alArticle looked at neuronal integrity by monitoring hippocampal N-acetylaspartate levels using magnetic resonance spectroscopy in patients receiving ECT. They found no evidence of decreases during a course of ECT. They also noted that baseline levels of choline were low in severely depressed patients and returned to normal as the patients recovered. The increase in choline is interpreted as showing increased membrane synthesis induced by ECT. This may be responsible for the efficacy of this treatment. Increased membrane formation is consistent with new synapse formation or increased neurogenesis, both of which are induced by ECT.

Migraine headaches and psychiatric disorders have been associated in studies of clinic populations, but the timing of this relationship has not been clear. In a follow-up study, Swartz et alArticle found that having depression or other mood disorders at the initial interview did not predict developing migraine headaches during the follow-up period. While depression, panic disorder, and other psychiatric disorders were cross-sectionally associated with migraine headaches, only phobias predicted the onset of new migraines. This finding underscores the need for future research on the timing of onset of both migraine headaches and depression and the possibility of common risk factors.

Kendler et alArticle assessed childhood sexual abuse, family background, and lifetime psychopathology in a population-based sample of female adult twins. Self-reported childhood sexual abuse was associated with all disorders, the strongest association seen with sexual intercourse. The pattern of results was similar with cotwin report of childhood sexual abuse, controlling for family background factors and in twin pairs discordant for childhood sexual abuse.

Research noting a strong, consistent association between panic disorder and respiratory abnormalities provides a compelling contrast to the typical inconsistencies in research examining associations between physiology and subjective emotional states. Moreover, because respiratory abnormalities identify healthy individuals at risk for panic disorder, they may identify precursors for panic disorder. Pine et alArticle found that the respiratory correlates of separation anxiety disorder in children bore strong similarities to the respiratory correlates of panic disorder in adults. These data suggest that childhood risk for adult panic disorder may be expressed in behavior during separation and in physiological measures reflective of aberrant respiratory control.

In a randomized, double-blind, placebo-controlled trial, Street et alArticle report the ability of olanzapine to control hallucinations, delusions, and behavioral disturbances (agitation/aggression) in nursing home patients with Alzheimer disease. The medication was generally safe and well tolerated, but led to increased drowsiness and changes in gait.

Studying a total birth cohort, Arseneault et alArticle asked whether mental disorders and violence are associated among young adults, irrespective of contact with the health or justice systems. They report that in the age group committing the most violent incidents, approximately half of the violence in the community is accounted for by individuals with mental disorders. Alcohol dependence, marijuana dependence, and schizophrenia-spectrum disorders were linked to violence beyond sex, socioeconomic status, and psychiatric comorbidity.

Is clozapine cost-effective when treating people with schizophrenia who are experiencing lengthy hospitalizations? Essock et alArticle demonstrate that when such patients are randomly assigned to receive clozapine or continue with the full range of conventional antipsychotics, these groups incur similar costs over 2 years. Clozapine is more effective than usual care on many, but not all, measures of effectiveness. It also decreased rehospitalizations, resulting in sufficient cost savings to pay for the increased costs associated with the medication and outpatient services.