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This Month in Archives of General Psychiatry
December 2004

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2004;61(12):1186. doi:10.1001/archpsyc.61.12.1186

Interviewing 3084 tribal members, Beals et al Article and the American Indian Service Utilization, PsychiatricEpidemiology, Risk and Protective Factors Project (AI-SUPERPFP) estimatedthe mental health burden and associated help-seeking in 2 reservation communities.Alcohol disorders and posttraumatic stress disorder were more common in theseAmerican Indian populations than for other populations using comparable methods.Substantial comorbidity between depressive, anxiety, and substance disorderssuggests the need for greater coordination of treatment for comorbid disorders.

Leichsenring et al Article performeda meta-analysis to assess the efficacy of short-term psychodynamic psychotherapy(STPP). Only randomized controlled trials fulfilling rigorous criteria wereincluded. The STPP yielded significant and large effect sizes for target problems,general psychiatric symptoms, and social functioning, which tended to increaseat follow-up. The effect sizes of STPP significantly exceeded those of waiting-listcontrols and treatments as usual. No differences were found between STPP andother forms of psychotherapy.

Hurlburt et al Article reporton mental health service use among children in child welfare and the roleof structural linkages between child welfare and mental health systems inpatterns of use. Using data from a nationally representative study, racial/ethnicdisparities in service use were found to decrease and the relationship betweenneed and use was found to increase, in counties with stronger interagencyties. Results suggest that structural agency ties can affect important mentalhealth service-use patterns.

Grant et al Article foundthat foreign-born Mexican Americans and non-Hispanic whites were at significantlylower risk of DSM-IV substance use, mood, and anxietydisorders compared with their US-born counterparts. Data favoring foreign-bornMexican Americans with respect to mental health may extend to foreign-bornnon-Hispanic whites. Future research among the foreign-born and US-born ofother origins is needed to understand what appears to be the protective effectsof culture and the deleterious effects of acculturation on psychiatric morbidity.

Inhibitors of steroid synthesis may exert antidepressant effects. Ina double-blind, randomized, placebo-controlled trial by Jahn et al Article , 63 patients with major depressionreceived metyrapone or placebo added to a standard treatment with antidepressants.After 5 weeks, patients receiving metyrapone showed a better treatment outcome(19 of 33 patients responded) compared with standard treatment alone (10 of30 patients improved). The treatment was safe, and no serious adverse eventswere observed.

Nurnberger et al Article providea large, comprehensive report on psychiatric disorders in the relatives ofsubjects with alcohol dependence, using data from the Collaborative Studyof the Genetics of Alcoholism (COGA). Disorders aggregating in relatives includedalcohol dependence, as well as dependence on cocaine, marijuana, opiates,sedatives, stimulants, and tobacco. However, diagnoses of substance abusewere not increased. Other disorders aggregating in relatives included majordepression, panic disorder, posttraumatic stress disorder, obsessive compulsivedisorder, and antisocial personality disorder. These findings suggest newstrategies for investigating the heterogeneity of alcohol dependence, andthey imply shared vulnerability factors for alcohol dependence and multiplepsychiatric disorders.

Marsh et al Article assessedhabit learning in patients with Tourette syndrome (TS) and healthy comparisonsubjects. Both children and adults with TS were impaired at habit learningbut not on tasks that required intact declarative memory functioning. In addition,more severe impairments in habit learning accompanied more severe tic symptoms.These findings imply that the striatal habit-learning system in dysfunctionalpersons with TS and deficits in habit learning and tic symptoms in TS maybe consequences of the anatomical and functional disturbances of the striatum.

Severe loss of extracellular serotonin has been implicated in depressionwith severely negativistic thinking. Meyer et al Article measured serotonin transporter binding potential(5-HTT BP) in drug-free depressed subjects using carbon II–labeled DASBpositron emission tomography. No difference in regional 5-HTT BP was foundbetween depressed and healthy subjects; however, the subgroup of depressedsubjects with severely negativistic thinking had much higher regional 5-HTTBP. This suggests that during depressive episodes, the magnitude of regional5-HTT BP may account for extremely pessimistic, dysfunctional attitudes.

Robins Article urgesanalyzing the vast epidemiological databases that have been produced by interviewsoperationalizing the official nomenclatures to find means of increasing thevalidity of DSM-V and InternationalClassification of Diseases, Ninth Revision, perhaps by splitting ormelding diagnoses, moving diagnoses from one block to another, deleting particularsymptoms, changing the number of positive symptoms required, assigning symptomweights, and changing age of onset and duration.