In This Issue

Severe Tourette's syndrome that cannot be managed with medication is now being experimentally treated with deep brain stimulation. Ten of 11 patients in a series from Cannon et al. (p. 860) reported 48% reduction in motor tics and 56% reduction in phonic tics. Effects were sustained for at least 3 months, and only two patients still required pharmacotherapy. One patient discontinued the treatment because of intolerability, two patients had anxiety, and one had an electronic malfunction. The stimulating electrodes were targeted to the anteromedial globus pallidus interna. Tourette's syndrome is thought to result from a defect in the cortical-basal ganglia-thalamic-cortical neuronal circuit. Stimulation in the thalamus, pallidum, ventral caudate, and anterior internal capsule has been investigated by other centers.

Woltmann et al. (p. 790) reviewed 57 trials of model collaborative chronic care programs that included elements such as patient self-management support, clinical information systems, delivery system redesign, decision support, organizational support, and community resource linkages. Across disorders and primary care and behavioral health care settings, there were significant moderate effects in depression, mental and physical quality of life, and social role function, compared to control conditions. Total health care costs did not differ from control conditions.

Schizotypal personality disorder, a cluster of characteristics similar to those of schizophrenia but less severe, has been linked to malnutrition in early childhood, but this association may hinge on an intermediate relationship with IQ. In a 20-year study, Venables and Raine (CME, p. 822) found that physical stunting, anemia, and psychosocial adversity at age 3 were related to nonverbal IQ at age 11, which in turn was related to two dimensions of schizotypal personality at age 23. In an editorial (p. 777), Susser points out that success in reducing child mortality in developing countries has left millions of child survivors in poor living conditions with neurodevelopmental delays and disabilities.