OBJECTIVE: The author’s goal was to develop a pathophysiological model for neuroleptic malignant syndrome with greater explanatory power than the alternative hypotheses of hypothalamic dopamine antagonism (elevated set point) and direct myotoxicity (...

Regular Article

February 1999

Toward a Clinical Model of Suicidal Behavior in Psychiatric Patients

Pages:181–189
Published Online:1 February 1999

https://doi.org/10.1176/ajp.156.2.181

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OBJECTIVE: Risk factors for suicide attempts have rarely been studied comprehensively in more than one psychiatric disorder, preventing estimation of the relative importance and the generalizability of different putative risk factors across psychiatric ...

February 1999

Inadequacy of Antidepressant Treatment for Patients With Major Depression Who Are at Risk for Suicidal Behavior

Pages:190–194
Published Online:1 February 1999

https://doi.org/10.1176/ajp.156.2.190

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OBJECTIVE: The authors’ goal was to determine whether suicide attempters with major depression received more intensive antidepressant treatment than depressed patients who had not attempted suicide. METHOD: One hundred eighty inpatients who met DSM-III-R ...

February 1999

Prospective Study of Fluoxetine Treatment and Suicidal Behavior in Affectively Ill Subjects

Pages:195–201
Published Online:1 February 1999

https://doi.org/10.1176/ajp.156.2.195

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OBJECTIVE: There has been speculation in the literature about a link between fluoxetine use and suicidal behavior. The authors of this study hypothesized that there is no elevation in risk of suicidal behavior associated with use of fluoxetine. METHOD: ...

February 1999

Treatment of Bereavement-Related Major Depressive Episodes in Later Life: A Controlled Study of Acute and Continuation Treatment With Nortriptyline and Interpersonal Psychotherapy

Pages:202–208
Published Online:1 February 1999

https://doi.org/10.1176/ajp.156.2.202

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OBJECTIVE: The authors tested the hypothesis that nortriptyline and interpersonal psychotherapy, alone and in combination, are superior to placebo in achieving remission of bereavement-related major depressive episodes. METHOD: Eighty subjects, aged 50 ...

February 1999

Functional MRI Study of the Cognitive Generation of Affect

Pages:209–215
Published Online:1 February 1999

https://doi.org/10.1176/ajp.156.2.209

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OBJECTIVE: The authors investigated, by whole brain functional magnetic resonance imaging (MRI), the neural substrate underlying processing of emotion-related meanings. METHOD: Six healthy subjects underwent functional MRI while viewing 1) alternating ...

February 1999

Amygdalar Volume and Emotional Memory in Alzheimer’s Disease

Etsuro Mori,M.D., Ph.D.,
Manabu Ikeda,M.D., Ph.D.,
Nobutsugu Hirono,M.D., Ph.D.,
Hajime Kitagaki,M.D., Ph.D.,
Toru Imamura,M.D., and
Tatsuo Shimomura,M.D.

Pages:216–222
Published Online:1 February 1999

https://doi.org/10.1176/ajp.156.2.216

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OBJECTIVE: Everyday experience suggests that highly emotional events are often the most memorable. Experimental work in animals and humans has demonstrated that the amygdaloid complex plays a crucial role in emotional memory, i.e., memory of events ...

February 1999

Caffeine Intake, Tolerance, and Withdrawal in Women: A Population-Based Twin Study

Kenneth S. Kendler,M.D., and
Carol A. Prescott,Ph.D.

Pages:223–228
Published Online:1 February 1999

https://doi.org/10.1176/ajp.156.2.223

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OBJECTIVE: Caffeine is by far the most commonly consumed psychoactive substance. The use and abuse of most other licit and illicit psychoactive drugs have been shown to be substantially heritable. However, the impact of genetic factors on caffeine ...

February 1999

Human Brain Metabolic Response to Caffeine and the Effects of Tolerance

Pages:229–237
Published Online:1 February 1999

https://doi.org/10.1176/ajp.156.2.229

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OBJECTIVE: Since there is limited information concerning caffeine’s metabolic effects on the human brain, the authors applied a rapid proton echo-planar spectroscopic imaging technique to dynamically measure regional brain metabolic responses to caffeine ...

February 1999

Striatal Dopaminergic Abnormalities in Human Cocaine Users

Pages:238–245
Published Online:1 February 1999

https://doi.org/10.1176/ajp.156.2.238

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OBJECTIVE: Previous human postmortem experiments have shown an abnormally high number of dopamine uptake sites in the striatum of chronic cocaine users, which might contribute to cocaine withdrawal symptoms such as depression and suicidality. Previous ...

February 1999

Heritability of Anxiety Sensitivity: A Twin Study

Murray B. Stein,M.D.,
Kerry L. Jang,Ph.D., and
W. John Livesley,M.D., Ph.D.

Pages:246–251
Published Online:1 February 1999

https://doi.org/10.1176/ajp.156.2.246

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OBJECTIVE: In attempting to explain the familial predisposition to panic disorder, most studies have focused on the heritability of physiologic characteristics (e.g., CO₂ sensitivity). A heretofore unexplored possibility is that a psychological ...

February 1999

Cerebral Blood Flow and Personality: A Positron Emission Tomography Study

Pages:252–257
Published Online:1 February 1999

https://doi.org/10.1176/ajp.156.2.252

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OBJECTIVE: This study sought to describe brain regions associated with the personality dimension of introversion/extraversion. METHOD: Measures of cerebral blood flow (CBF) were obtained from 18 healthy subjects by means of [¹⁵O]H₂O positron emission ...

February 1999

Revising and Assessing Axis II, Part I: Developing a Clinically and Empirically Valid Assessment Method

Drew Westen,Ph.D., and
Jonathan Shedler,Ph.D.

Pages:258–272
Published Online:1 February 1999

https://doi.org/10.1176/ajp.156.2.258

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OBJECTIVE: Personality pathology is difficult to measure. Current instruments have problems with validity and rely on a direct-question format that may be inappropriate for the assessment of personality. In addition, they are designed specifically to ...

February 1999

Revising and Assessing Axis II, Part II: Toward an Empirically Based and Clinically Useful Classification of Personality Disorders

Drew Westen,Ph.D., and
Jonathan Shedler,Ph.D.

Pages:273–285
Published Online:1 February 1999

https://doi.org/10.1176/ajp.156.2.273

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OBJECTIVE: The DSM-IV classification of personality disorders has not proven satisfying to either researchers or clinicians. Incremental changes to categories and criteria using structured interviews may no longer be useful in attempting to refine axis ...

February 1999

Clinical and Theoretical Implications of 5-HT₂ and D₂ Receptor Occupancy of Clozapine, Risperidone, and Olanzapine in Schizophrenia

Shitij Kapur,M.D., Ph.D., F.R.C.P.C.,
Robert B. Zipursky,M.D., F.R.C.P.C., and
Gary Remington,M.D., Ph.D., F.R.C.P.C.

Pages:286–293
Published Online:1 February 1999

https://doi.org/10.1176/ajp.156.2.286

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OBJECTIVE: Dopamine D₂ receptor occupancy measurements provide a valid predictor of antipsychotic response, extrapyramidal side effects, and elevation of prolactin levels. The new antipsychotics clozapine, risperidone, and olanzapine obtain antipsychotic ...

February 1999

Clozapine and Risperidone in Chronic Schizophrenia: Effects on Symptoms, Parkinsonian Side Effects, and Neuroendocrine Response

Pages:294–298
Published Online:1 February 1999

https://doi.org/10.1176/ajp.156.2.294

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OBJECTIVE: Clozapine and risperidone were the first two “second-generation” antipsychotic drugs approved for schizophrenia. There is currently little information about their comparative efficacy from head-to-head clinical trials. The purpose of this study ...

February 1999

Diazepam Treatment of Early Signs of Exacerbation in Schizophrenia

Pages:299–303
Published Online:1 February 1999

https://doi.org/10.1176/ajp.156.2.299

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OBJECTIVE: Therapeutic intervention at the earliest phase of symptom exacerbation in schizophrenia is an important clinical need, but specific pharmacotherapeutic interventions for this phase of illness have not been established. This study examined ...

Clinical Case Conference

February 1999

When Religion Collides With Medicine

Nada L. Stotland,M.D.

Pages:304–307
Published Online:1 February 1999

https://doi.org/10.1176/ajp.156.2.304

Images in Psychiatry

February 1999

Juan J. Lopez Ibor, M.D., 1906–1991

PEDRO RUIZ,M.D.

Page:308
Published Online:1 February 1999

https://doi.org/10.1176/ajp.156.2.308

Brief Report

February 1999

Incidence of Tardive Dyskinesia in Early Stages of Low-Dose Treatment With Typical Neuroleptics in Older Patients

Pages:309–311
Published Online:1 February 1999

https://doi.org/10.1176/ajp.156.2.309

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OBJECTIVE: The authors studied the risk of tardive dyskinesia for older patients in the early stages of treatment with typical neuroleptics. METHOD: They examined the cumulative incidence of tardive dyskinesia 1, 3, 6, 9, and 12 months after the ...

February 1999

Body Weight and Leptin Plasma Levels During Treatment With Antipsychotic Drugs

Pages:312–314
Published Online:1 February 1999

https://doi.org/10.1176/ajp.156.2.312

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OBJECTIVE: Leptin is produced by fat cells and is presumed to signal the size of the adipose tissue to the brain. The authors investigated whether antipsychotic drugs that often induce weight gain affect circulating levels of leptin. METHOD: Weight, body ...

February 1999

Prevalence of Depressive Symptoms Early in the Course of Schizophrenia

Pages:315–316
Published Online:1 February 1999

https://doi.org/10.1176/ajp.156.2.315

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OBJECTIVE: The rate of depressive symptoms early in the course of schizophrenia was determined. METHOD: Seventy subjects with recent-onset schizophrenia were followed for 5 years by using semistructured interview instruments. The initial assessment ...

February 1999

B Lymphocyte Antigen D8/17 and Repetitive Behaviors in Autism

Eric Hollander,M.D.,
Gina DelGiudice-Asch,M.D.,
Lorraine Simon,M.A.,
James Schmeidler,Ph.D.,
Charles Cartwright,M.D.,
Concetta M. DeCaria,Ph.D.,
Jee Kwon,B.A.,
Charlotte Cunningham-Rundles,M.D., Ph.D.,
Floresta Chapman,R.N., and
John B. Zabriskie,M.D.

Pages:317–320
Published Online:1 February 1999

https://doi.org/10.1176/ajp.156.2.317

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OBJECTIVE: Monoclonal antibody D8/17 identifies a B lymphocyte antigen with expanded expression in rheumatic fever, Sydenham’s chorea, and subgroups of obsessive-compulsive disorder and Tourette’s syndrome with repetitive behaviors. The authors examined ...

February 1999

Attitudes Toward DSM-IV Dissociative Disorders Diagnoses Among Board-Certified American Psychiatrists

Pages:321–323
Published Online:1 February 1999

https://doi.org/10.1176/ajp.156.2.321

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OBJECTIVE: The authors assessed the opinions of American psychiatrists regarding the diagnostic status and scientific validity of the DSM-IV categories of dissociative amnesia and dissociative identity disorder. METHOD: A one-page questionnaire was mailed ...

February 1999

Are Psychiatrists Cost-Effective? An Analysis of Integrated Versus Split Treatment

Mantosh Dewan,M.D.

Pages:324–326
Published Online:1 February 1999

https://doi.org/10.1176/ajp.156.2.324

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OBJECTIVE: Managed care organizations prefer putatively less expensive split treatment, i.e., a psychopharmacologist plus a non-M.D. psychotherapist. In this study the cost of integrated care by a psychiatrist was compared with split care. METHOD: Using ...