Interviewing 3084 tribal members, Beals et al (SEE ARTICLE) and the American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP) estimated the mental health burden and associated help-seeking in 2 reservation communities. Alcohol disorders and posttraumatic stress disorder were more common in these American Indian populations than for other populations using comparable methods. Substantial comorbidity between depressive, anxiety, and substance disorders suggests the need for greater coordination of treatment for comorbid disorders.
Leichsenring et al (SEE ARTICLE) performed a meta-analysis to assess the efficacy of short-term psychodynamic psychotherapy (STPP). Only randomized controlled trials fulfilling rigorous criteria were included. The STPP yielded significant and large effect sizes for target problems, general psychiatric symptoms, and social functioning, which tended to increase at follow-up. The effect sizes of STPP significantly exceeded those of waiting-list controls and treatments as usual. No differences were found between STPP and other forms of psychotherapy.
Hurlburt et al (SEE ARTICLE) report on mental health service use among children in child welfare and the role of structural linkages between child welfare and mental health systems in patterns of use. Using data from a nationally representative study, racial/ethnic disparities in service use were found to decrease and the relationship between need and use was found to increase, in counties with stronger interagency ties. Results suggest that structural agency ties can affect important mental health service-use patterns.
Grant et al (SEE ARTICLE) found that foreign-born Mexican Americans and non-Hispanic whites were at significantly lower risk of DSM-IV substance use, mood, and anxiety disorders compared with their US-born counterparts. Data favoring foreign-born Mexican Americans with respect to mental health may extend to foreign-born non-Hispanic whites. Future research among the foreign-born and US-born of other origins is needed to understand what appears to be the protective effects of culture and the deleterious effects of acculturation on psychiatric morbidity.
Inhibitors of steroid synthesis may exert antidepressant effects. In a double-blind, randomized, placebo-controlled trial by Jahn et al (SEE ARTICLE), 63 patients with major depression received 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 of 30 patients improved). The treatment was safe, and no serious adverse events were observed.
Nurnberger et al (SEE ARTICLE) provide a large, comprehensive report on psychiatric disorders in the relatives of subjects with alcohol dependence, using data from the Collaborative Study of the Genetics of Alcoholism (COGA). Disorders aggregating in relatives included alcohol dependence, as well as dependence on cocaine, marijuana, opiates, sedatives, stimulants, and tobacco. However, diagnoses of substance abuse were not increased. Other disorders aggregating in relatives included major depression, panic disorder, posttraumatic stress disorder, obsessive compulsive disorder, and antisocial personality disorder. These findings suggest new strategies for investigating the heterogeneity of alcohol dependence, and they imply shared vulnerability factors for alcohol dependence and multiple psychiatric disorders.
Marsh et al (SEE ARTICLE) assessed habit learning in patients with Tourette syndrome (TS) and healthy comparison subjects. Both children and adults with TS were impaired at habit learning but 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 dysfunctional persons with TS and deficits in habit learning and tic symptoms in TS may be consequences of the anatomical and functional disturbances of the striatum.
Severe loss of extracellular serotonin has been implicated in depression with severely negativistic thinking. Meyer et al (SEE ARTICLE) measured serotonin transporter binding potential (5-HTT BP) in drug-free depressed subjects using carbon II–labeled DASB positron emission tomography. No difference in regional 5-HTT BP was found between depressed and healthy subjects; however, the subgroup of depressed subjects with severely negativistic thinking had much higher regional 5-HTT BP. This suggests that during depressive episodes, the magnitude of regional 5-HTT BP may account for extremely pessimistic, dysfunctional attitudes.
Robins (SEE ARTICLE) urges analyzing the vast epidemiological databases that have been produced by interviews operationalizing the official nomenclatures to find means of increasing the validity of DSM-V and International Classification of Diseases, Ninth Revision, perhaps by splitting or melding diagnoses, moving diagnoses from one block to another, deleting particular symptoms, changing the number of positive symptoms required, assigning symptom weights, and changing age of onset and duration.
