This Month in Archives of General Psychiatry FREE

The 20th century has witnessed destruction caused by ruthless, hyperaggressive, hateful dictators. The international community has had great difficulty in preventing mass violence induced by such leaders. The Carnegie Commission on Preventing Deadly Conflict has undertaken a uniquely comprehensive examination of the tools and strategies available for this purpose. It also delineates ways in which the international community can strengthen the capability of moderate, pragmatic leaders in tense situations throughout the world. The report by Hamburg et alArticle suggests ways in which psychiatry and behavioral sciences can clarify crucial problems of leadership.

Commentaries by Kleinman Article and Frank Article are included.

Deficits in the neuropeptides somatostatin (SLI) and corticotropin-releasing factor (CRF) are among the hallmarks of Alzheimer disease (AD). Whether these neuropeptidergic deficits of end-stage AD extend to much earlier disease has profound implications for the etiology and neurobiology of AD and dementia. Davis et alArticle report that the cortical levels of CRF were reduced in mild or moderate dementia, whereas the levels of SLI were only reduced in severe dementia. Thus, AD may affect neuropeptidergic neurons differentially, suggesting that CRF, but not SLI, can serve as a potential neurochemical marker of early dementia and possible early AD.

A commentary by Nemeroff Article is included.

Westergaard et alArticle performed a large cohort study to investigate whether sibship characteristics and influenza prevalence during gestation were of importance for later development of schizophrenia. The authors found no association with exposure to influenza but showed that persons from large sibships and with short intervals to nearest siblings were at significantly increased risk of developing schizophrenia. They conclude that environmental factors operating early in life are likely to be involved in the etiology of schizophrenia.

Basic science studies at the neuronal systems level indicate that gamma range (about 40 Hz) neural synchronization may be a fundamental mechanism of information processing in neural networks, reflecting integration of various features of an object. Kwon et alArticle found that patients with schizophrenia showed a reduced amplitude and abnormal phase of responses to steady-state gamma range auditory input, while amplitude of responses to lower frequencies was normal. Schizophrenia may involve a disturbance of the fundamental neural circuit responsible for gamma activity.

A commentary by Green and Nuechterlein Article is included.

A multiwave study of 250 subjects during 4 years by LenzenwegerArticle supports the stability of personality disorder features over time. The findings offer empirical support for theoretical assumptions regarding the overall enduring nature of the personality disorders, while also suggesting the possibility of change in personality disorders for some individuals.

During the past decade, a new form of genetic mutation, trinucleotide repeat expansion, has been shown to cause nearly 20 diseases, most with prominent psychiatric features. Margolis et alArticle review this unique form of mutation, emphasizing both the clinical features of the expansion mutation diseases and the unusual patterns of inheritance conferred by repeat expansion.

Hollander et alArticle compared the efficacy of clomipramine, a serotonin reuptake inhibitor, with active control desipramine, a norepinephrine reuptake inhibitor, in the treatment of adult body dysmorphic disorder. Clomipramine was superior to desipramine in decreasing overall severity of illness, obsessive and compulsive symptoms relating to body defects, and functional disability, and was effective even among delusional patients.

A commentary by Phillips et al Article is included.

Several lines of evidence suggest that depression is associated with abnormal functioning of the γ-aminobutyric acid (GABA)–ergic neurotransmitter system. Using proton magnetic resonance spectroscopy, Sanacora et alArticle found that, compared with healthy subjects, depressed patients exhibited markedly decreased concentrations of GABA in the cortex.

Alexopoulos et alArticle observed that, during the initial evaluation, severity of depression and previous suicide attempts with serious intent closely predicted the course of suicidal ideation in elderly patients with major depression. During follow-up, contemporaneous severity of depression was the most important determinant of suicidal ideation over time.