Current estimates of mental disorder prevalence have been criticized
as being too high for the effective planning of treatment services. In keeping
with the DSM-IV requirement for mental
disorders to be "clinically significant," Narrow et al (SEE ARTICLE) reanalyzed 2 community surveys, requiring a clinical significance
criterion to be met before a diagnosis could be made. They found that using
this criterion lowered prevalence rates substantially, from 28.0% to 18.5%,
identifying persons more likely to need treatment. Discrepancies in estimates
between the surveys were also reduced.
A Commentary by Wakefield and Spitzer (SEE ARTICLE) is included.
People wonder if they really need 8 hours of sleep. Analyzing more than
1.1 million people followed up for 6 years, Kripke et al (SEE ARTICLE) found that those who usually slept 6.5 to 7.4
hours per night had the best survival. Sleep of 8 hours or more was associated
with increased mortality. There was relatively little risk associated with
sleep as short as 4.5 hours, and no mortality risk associated with insomnia,
but those who used sleeping pills had higher mortality. Clinical trials are
needed to determine which treatments of sleep improve long-term health.
A Commentary by Buysse and Ganguli (SEE ARTICLE) is included.
Although childhood sexual abuse (CSA) has been associated with adverse
outcome risk, the attribution of risk to CSA vs family background factors
remains controversial. Nelson et al (SEE ARTICLE) examined young adult Australian twins using a structured telephone interview.
Increased risk for many adverse outcomes was found for CSA-negative individuals
with CSA-positive co-twins vs members of CSA-negative pairs, suggesting risk
related to family background factors. The CSA-positive members of CSA-discordant
pairs had significantly greater risk than their co-twins for all examined
adverse outcomes consistent with direct CSA effects. These results offer support
for important effects related both to CSA and family background factors.
Although impairments of visual working memory are often reported in
schizophrenia, most of the studies assume intact visual perception. Tek et al (SEE ARTICLE) studied perception of
object shapes and locations and working memory in a group of normal controls
and patients with schizophrenia. Patients had visual perception impairments
for both shapes and locations of objects. However, after they controlled for
these impairments, the visual working memory impairment was not general. Only
working memory for object locations was impaired in patients with schizophrenia.
Previous studies suggest that the impact of developmental insults predisposing
to schizophrenia have differential consequences for the sexes. In a structural
magnetic resonance imaging study of schizophrenia and normal controls, Goldstein et al (SEE ARTICLE) demonstrated that
normal patterns of sex differences in adult brain volumes were disrupted in
schizophrenia. Sex-specific effects were primarily evident in the cortex (ie,
frontomedial cortex, basal forebrain, cingulate and paracingulate gyri, posterior
supramarginal gyms, and planum temporale), and not in subcortical gray matter
regions or cerebrospinal fluid. Findings suggested that factors that produce
normal sexual dimorphisms may be associated with modulating insults producing
schizophrenia, particularly in the cortex.
For many people with severe mental illnesses, employment remains an
elusive goal. Lehman et al (SEE ARTICLE) randomly assigned high-risk, inner-city outpatients with severe mental illnesses
to either the Individual Placement and Support (IPS) model of supportive employment
or usual psychosocial rehabilitation services. The IPS model proved significantly
more effective than the comparison rehabilitation condition in improving employment
outcomes. However, overall low rates of employment and substantial problems
with job retention for patients in both conditions underscore the continuing
challenges posed by these disabling illnesses.
Disturbances in prefrontal cortex have been identified in major depressive
disorder (MDD). Although MDD commonly emerges during childhood, few studies
have examined psychotropic-naive pediatric patients near the onset of illness.
Using volumetric magnetic resonance imaging, Nolan et al (SEE ARTICLE) found smaller left prefrontal cortical volumes
in pediatric MDD patients with at least 1 first-degree relative with MDD (familial
MDD) vs patients without a family history of MDD (nonfamilial MDD). Nonfamilial
MDD patients had significantly larger left prefrontal cortical volumes than
both familial MDD patients and controls. These findings provide new evidence
of distinct neuroanatomic alterations in familial vs nonfamilial MDD patients.
