DEPRESSION - MORE GLOOM
A thought-provoking editorial by Young () points out that unipolar major depression imposes the second largest burden of any individual disorder in the developed world. We are taken beyond the monoamine hypothesis in a review by Reid & Stewart () that suggests stress may induce a continuum of effects on the brain ranging from mild perturbation of plasticity with attendant cognitive and emotional dysfunction to frank neural damage. Where any individual lies on this continuum for any given stressor depends on individual constitution and experience. Although largely based on animal studies, this theory may help explain variation in symptomatology, neuropathology and treatment response in depression.
…AND CHINKS OF LIGHT
In a randomised controlled trial of the efficacy of light therapy for seasonal affective disorder in primary care (Wileman et al, ), patients received either bright white or dim red light. Both treatments were associated with decreases in symptom scores of more than 40%. These results offer hope to sufferers whose illnesses frequently remain undetected. A randomised trial comparing the prophylactic efficacy of citalopram with placebo in unipolar, recurrent depression (Hochstrasser et al, ) demonstrates that time to relapse was significantly longer in patients taking citalopram. The optimal duration of treatment, however, remains unclear.
SELF-EXPOSURE IN PANIC
In the first randomised controlled trial to compare self-exposure to external or interoceptive cues in panic/agoraphobia, both forms of exposure and the two combined each significantly and similarly improved symptoms for up to 1 year after cessation of treatment compared with controls (Ito et al, ).
SILDENAFIL - RAISING EXPECTATIONS
With up to 30 million men in the USA experiencing erectile dysfunction of varying severity, the results of the randomised trial comparing the efficacy and safety of sildenafil citrate in mild to moderate dysfunction with no established organic cause will be very welcome. Eardley et al () report that, compared with placebo, sildenafil was associated with increases in frequency of use, erections adequate for intercourse and level of sexual satisfaction.
LOCATING SCHIZOPHRENIA
Specific frontal lobe involvement has been suggested in schizophrenia. However, a post-mortem study reported by Highley et al () finds no alteration in frontal lobe volume using non-arbitrary measures. This finding is supported by recent MRI studies. Compelling evidence for decreased cerebral lateralisation in schizophrenia is provided from meta-analyses on studies of handedness, dichotic listening and anatomical asymmetry (Sommer et al, ). Similar findings in healthy relatives of patients with schizophrenia suggest a genetic cause underlying the decreased cerebral lateralisation. It has been postulated that the genetic mechanism underlying normal left hemispheric dominance is altered in schizophrenia and, if this is true, the discovery of a ‘right shift factor’ may also identify a locus where genetic aberrations predispose for schizophrenia.
…IN THE WILD WEST
There is evidence of an increased incidence of schizophrenia in immigrants to The Netherlands from most non-Western but not Western countries (Selten et al, ). It is postulated that although this may reflect selective migration, it is the stress of acculturation and rapid Westernisation that precipitates schizophrenia in individuals who are genetically at risk.
TESTOSTERONE AND AGGRESSION
An investigation of the biological basis of impulsivity and aggression in male offenders with personality disorder (Dolan et al, ) found plasma testosterone correlated positively with aggressive acts. Reduced 5-HT function was inversely correlated more strongly with impulsivity than with aggression. In view of reports that individuals with obsessive-compulsive disorder and schizoid/autistic traits have elevated 5-HT function, it is postulated that 5-HT may influence a behavioural dimension with aspects of inhibition-overcontrol at one end and impulsivity at the other.
GENOME AND ENVIROME
Evidence from twin and adoption studies has highlighted the importance of gene-environment interaction in the aetiology of mental disorders. The Eighth Congress of the International Federation of Psychiatric Epidemiology held in Taiwan in March 1999 aimed to improve communication between disciplines involved in gene-environment studies. The resulting papers in the supplement accompanying this issue of the Journal, based on conference presentations, provide a fascinating read on wide-ranging topics. The supplement addresses the underlying conceptual and methodological issues involved and more specifically the genetic, neurobiological and environmental factors implicated in a variety of psychiatric conditions.
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