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This Month in Archives of General Psychiatry
October 2001

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2001;58(10):899. doi:10.1001/archpsyc.58.10.899

In animal studies, "Ecstasy" (MDMA) has been shown to damage brain serotonin (5-HT) neurons. In humans, 5-HT plays an important role in memory function. Reneman et alArticle report that the density of 5-HT neurons in recent MDMA users is lower than in ex-MDMA users and in MDMA-naive controls, indicating that neuronal damage of MDMA might be transitory. However, recent as well as ex-MDMA users performed poorer on a memory task, suggesting that its effects on memory function apparently last longer and might not be completely reversible.

A commentary by McCann et al Article is included.

Pope et alArticle administered neuropsychological tests to individuals who had smoked cannabis a median of about 15 000 times, and to control subjects who had smoked a median of 10 times in their lives. The heavy smokers showed deficits in verbal memory on days 0, 1, and 7 of a supervised abstinence period. By day 28, however, no significant differences were found between users and controls on any test. These results suggest that cannabis-associated cognitive deficits may persist for many days after stopping the drug, but are not irreversible.

In a controlled outpatient study of daily marijuana users, Budney et alArticle clearly observed withdrawal discomfort during abstinence periods. Abstinence symptoms included decreased appetite, sleep difficulty, craving for marijuana, irritability, aggression, restlessness, and weight loss. These emotional and behavioral symptoms appear similar to those observed during abstinence from other commonly abused drugs including nicotine, suggesting that marijuana withdrawal warrants assessment and intervention in clinical settings.

In an magnetic resonance imaging study, Vataja et alArticle found that predominantly left-sided lesions affecting structures within prefrontal-subconical circuits, mainly caudate, internal capsule, and pallidum were larger and more frequent in stroke patients with depression. Such identification of critical lesion characteristics is important for the understanding of the pathophysiology of depression as well as in identifying patients at risk for depression after ischemic stroke.

Unützer et alArticle studied the effects of 2 primary care–based quality improvement (QI) programs on medication management for depression with 1356 depressed patients from 46 primary care practices. Compared with usual care, QI programs for depression in which mental health specialists collaborate with primary care providers can substantially increase rates of antidepressant treatment. Active follow-up by a depression nurse specialist was associated with longer-term increases in antidepressant use than a QI model without such follow-up.

Researchers have not systematically determined rates of alcohol-related and other psychiatric disorders among convicted drunk drivers. Lapham et alArticle interviewed drunk driving offenders and found a substantially high rate of alcohol-use disorders compared with rates in a community sample. A high proportion of those with alcohol problems also had an additional psychiatric disorder, the most common being a drug use disorder, posttraumatic stress disorder, or major depression.

A commentary by Woody and Forman Article is included.

Patients with schizophrenia exhibit abnormalities in the central nervous system as well as in peripheral organs. A general plasma cell membrane dysfunction has been proposed as an underlying factor in both. In an investigation of fibroblasts from patients with schizophrenia and healthy controls, Flyckt et alArticle report an aberrant tyrosine transport across the membrane in cells from the patients. were observed. The findings are compatible with a cell membrane disturbance and may reflect a genetic trait as the changes were transmitted through several cell generations.

Weiser et alArticle followed a population-based cohort of males with nonpsychotic psychiatric disorders in adolescence to ascertain future hospitalization for schizophrenia. Nonpsychotic psychiatric diagnoses were more common in adolescents later hospitalized for schizophrenia than in adolescents not later hospitalized. About one quarter of the patients with schizophrenia, compared with less than 10% in the general population, had been assigned a nonpsychotic psychiatric diagnosis in adolescence.

Kane et alArticle report on a 6-month, double-blind, outpatient trial comparing clozapine and a moderate dose of haloperidol. Clozapine was found to be consistently superior in improving psychopathology, except for negative symptoms. This study confirms the potential value of clozapine in patients who remain only moderately ill after treatment with conventional medications.