JCP June Table of Contents E-Lert


The Journal of Clinical Psychiatry

Volume 74 • Number 6 • June 2013

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Original Research
Efficacy and Effectiveness of Depot Versus Oral Antipsychotics in Schizophrenia: Synthesizing Results Across Different Research Designs [Free Access]
Noam Y. Kirson, Peter J. Weiden, Sander Yermakov, Wayne Huang, Thomas Samuelson, Steve J. Offord, Paul E. Greenberg, and Bruce J. O. Wong
[Full Text] [Audio Summary]
Clinical Points
  • The comparative effectiveness of depot and oral formulations of antipsychotics in schizophrenia varies by study design. We found that observational designs tend to show favorable outcomes for depot therapy, whereas randomized controlled trials tend to find no differences between oral and depot formulations.
  • In weighing the published clinical evidence, clinicians should carefully consider the possible effects of study design on comparative effectiveness of antipsychotic treatment formulations.


Examining the Comorbidity of Bipolar Disorder and Autism Spectrum Disorders: A Large Controlled Analysis of Phenotypic and Familial Correlates in a Referred Population of Youth With Bipolar I Disorder With and Without Autism Spectrum Disorders
Gagan Joshi, Joseph Biederman, Carter Petty, Rachel L. Goldin, Stephannie L. Furtak, and Janet Wozniak
[Abstract] [Full Text] [Audio Summary]
Clinical Points
  • A clinically significant minority of youth with bipolar disorder suffers from autism spectrum disorders (ASD) comorbidity.
  • The age at onset of bipolar I disorder is significantly earlier in the presence of ASD comorbidity.
  • The phenotypic and familial correlates of bipolar I disorder are typical of the disorder in the presence of ASD comorbidity.


The Efficacy of Agomelatine in Elderly Patients With Recurrent Major Depressive Disorder: A Placebo-Controlled Study
Reinhard Heun, Antti Ahokas, Patrice Boyer, Natalia Giménez-Montesinos, Fernando Pontes-Soares, and Valérie Olivier, on Behalf of the Agomelatine Study Group
[Abstract] [Full Text] [Audio Summary]
Clinical Points
  • The 8-week treatment with agomelatine 25–50 mg/d is both effective and well tolerated in elderly depressed patients over 65 years of age.
  • In clinical practice, agomelatine should be considered as an attractive option for treating major depressive disorder patients 65 years old and older with regard to its efficacy for depressive symptoms and social functioning, its benign adverse effect profile, and good tolerability by a medically complex population.


Cytochrome P450 2D6 Phenoconversion Is Common in Patients Being Treated for Depression: Implications for Personalized Medicine
Sheldon H. Preskorn, Cecelia P. Kane, Kasia Lobello, Alice I. Nichols, Rana Fayyad, Gina Buckley, Kristen Focht, and Christine J. Guico-Pabia
[Abstract] [Full Text]
Clinical Points
  • Genotyping in clinical practice may significantly underestimate the incidence of CYP2D6 poor metabolic capacity in depressed patients for whom multiple drugs are prescribed.
  • Differences in CYP2D6 drug metabolic capacity, whether genetically determined or due to phenoconversion, can affect clinical outcomes in patients treated with drugs substantially metabolized by CYP2D6.
  • When prescribing treatment for depressed patients, particularly those with chronic medical disorders taking concomitant medications, it is important for clinicians to consider their current functional capacity (ie, phenotype) to metabolize and clear a drug, which is more clinically relevant than their genetic potential capacity to do so.


Participants With Schizophrenia Retain the Information Necessary for Informed Consent During Clinical Trials
Bernard A. Fischer, Robert P. McMahon, Walter A. Meyer, Daniel J. Slack, Paul S. Appelbaum, and William T. Carpenter
[Abstract] [Full Text] [Supplementary Material] [Audio Summary]
Clinical Points
  • People with schizophrenia who have stable psychotic symptoms have no meaningful loss of consent-related information during the first 8 weeks of participation in a clinical trial.
  • Therapeutic misconception, or confusion between research and clinical care, was not prominent in this sample of people with stable schizophrenia.
Patient Preference for Psychological vs Pharmacologic Treatment of Psychiatric Disorders: A Meta-Analytic Review
R. Kathryn McHugh, Sarah W. Whitton, Andrew D. Peckham, Jeffrey A. Welge, and Michael W. Otto
[Abstract] [Full Text] [Audio Summary]
Clinical Points
  • Patient preference for the treatment of psychiatric disorders is a core component of evidence-based mental health care and has been shown to impact treatment retention and outcome.
  • Studies across diverse settings indicate that, on average, patients prefer psychological treatment to pharmacologic treatment for depression and anxiety at a rate of 3 to 1.
  • Consideration of patient preference, along with treatment efficacy and clinical expertise, may be important to optimizing outcomes in clinical settings.
CME Article
See the complete CME Activity.
Termination of Clozapine Treatment Due to Medical Reasons: When Is It Warranted and How Can It Be Avoided?
Jimmi Nielsen, Christoph U. Correll, Peter Manu, and John M. Kane
[Abstract] [Full Text] [CME Activity] [Audio Summary]
Clinical Points
  • Psychiatrists should be aware that the discontinuation of clozapine treatment may exclude patients from effective treatment and can increase the risk of relapse, aggression, and suicidal behavior.
  • Neutropenia, leukocytosis, seizures, orthostatic hypotension, severe constipation, weight gain, and metabolic abnormalities, including metabolic syndrome and its components, as well as moderately prolonged myocardial repolarization, need to be managed but do not generally warrant clozapine discontinuation.
  • Side effects such as eosinophilia, leukocytosis, drug-induced fever without another medical cause, and sinus tachycardia can be managed and should rarely lead to the discontinuation of clozapine treatment.
  • Clozapine discontinuation with potential rechallenge (providing there is appropriate surveillance and management or prophylactic therapy) is indicated for ileus or subileus, neuroleptic malignant syndrome, venous thromboembolism, and diabetic ketoacidosis or hyperosmolar coma. Other side effects, such as agranulocytosis, myocarditis, cardiomyopathy, and a QTc interval > 500 milliseconds that is confirmed and derived with the appropriate correction method warrant the immediate discontinuation of clozapine treatment.
ASCP Corner
Bipolar Disorder and Attention-Deficit/Hyperactivity Disorder Comorbidity in Children and Adolescents: Evidence-Based Approach to Diagnosis and Treatment
Shefali Miller, Kiki D. Chang, and Terence A. Ketter
[Purchase] [Full Text] [Audio Summary]
Letters to the Editor
Deliberate Self-Poisoning With Prescribed Drugs Is Not Related to Medical Severity of Acts
Bergljot Gjelsvik, Fridtjof Heyerdahl, and Keith Hawton
[Purchase] [Full Text]


Suicide Attempts in Patients With Bipolar Disorder Tend to Precede, Not Follow, Initiation of Antiepileptic Drugs
Sue M. Marcus, Bo Lu, Sungwoo Lim, Robert D. Gibbons, and Maria A. Oquendo
[Purchase] [Full Text]


Brain Volume in Depression
Iradj Maany
[Purchase] [Full Text]
• Reply by Jennifer L. Phillips and Pierre Blier
[Purchase] [Full Text]

ONLINE Exclusives

Original Research
Neuropsychiatric Symptoms and the Use of Mind-Body Therapies
Maulik P. Purohit, Rebecca Erwin Wells, Ross Zafonte, Roger B. Davis, Gloria Y. Yeh, and Russell S. Phillips
[Abstract] [Full Text] [Supplementary Material] [Audio Summary]
Clinical Points
  • Neuropsychiatric symptoms are common in the general population, and these symptoms can be difficult to treat with standard treatments.
  • Patients in significant numbers are seeking treatment elsewhere, most commonly using mind-body therapies. However, many patients do not discuss these treatments with conventional providers.
  • It might be necessary for providers to initiate discussion of any alternative treatments patients may be using in addition to standard treatments.


Double-Blind, Placebo-Controlled, Pilot Trial of Paliperidone Augmentation in Serotonin Reuptake Inhibitor–Resistant Obsessive-Compulsive Disorder
Eric A. Storch, Andrew W. Goddard, Jon E. Grant, Alessandro S. De Nadai, Wayne K. Goodman, P. Jane Mutch, Carla Medlock, Brian Odlaug, Christopher J. McDougle, and Tanya K. Murphy
[Abstract] [Full Text] [Audio Summary]
Clinical Points
  • Although atypical antipsychotic augmentation shows promise in patients with treatment-resistant obsessive-compulsive disorder (OCD), there are mixed results, and many do not experience an adequate response.
  • Further investigation of augmentation strategies is needed among patients with treatment-resistant OCD.


First Experience With a Wireless System Incorporating Physiologic Assessments and Direct Confirmation of Digital Tablet Ingestions in Ambulatory Patients With Schizophrenia or Bipolar Disorder
John M. Kane, Roy H. Perlis, Lorenzo A. DiCarlo, Kityee Au-Yeung, Jessie Duong, and Georgios Petrides
[Abstract] [Full Text] [Audio Summary]
Clinical Points
  • Management of many chronic diseases suffers from problems with continued medication adherence, which in turn contributes to an enormous proportion of avoidable emergency department visits and hospital days, as well as poor overall outcomes.
  • In appropriately selected patients, the use of a digital health feedback system (DHFS) provides a means of acquiring, summarizing, and communicating data on medication use, health status, and activities of daily living.
  • Acquiring such information through a DHFS system may facilitate earlier and more targeted interventions for patients at risk of disease progression or relapse.


Where and How People With Schizophrenia Die: A Population-Based, Matched Cohort Study in Manitoba, Canada
Patricia J. Martens, Harvey M. Chochinov, and Heather J. Prior
[Abstract] [Full Text] [Audio Summary]
Clinical Points
  • People with schizophrenia have a median age of death of 77 years, underscoring the importance of end of life for the elderly patient in a setting providing appropriate physical and mental care.
  • People with schizophrenia are twice as likely to die in a nursing home compared to a matched cohort (29.7% vs 13.9%), and this finding holds true for deaths for most chronic diseases. Hence, clinicians need to ensure that disease-specific palliative care needs are met.
  • For older adults (age ≥ 60 years) with schizophrenia, the top 3 causes of death compared to a matched cohort of decedents were circulatory system (35.8% vs 36.8% of deaths), cancer (15.2% vs 27.2%), and respiratory system (12.7% vs 8.6%). However, these results do not point out the underlying rate of mortality, which could be double for those with schizophrenia. Hence, these findings translate into a potentially elevated risk of both circulatory and respiratory disease and similar rates of cancer deaths. Appropriate treatment for chronic disease and lifestyle management of those with schizophrenia (such as smoking cessation and dietary considerations) need to be part of the clinician’s treatment plan.
Meta-Analysis of the Efficacy of Treatments for Posttraumatic Stress Disorder
Bradley V. Watts, Paula P. Schnurr, Lorna Mayo, Yinong Young-Xu, William B. Weeks, and Matthew J. Friedman
[Abstract] [Full Text]
Clinical Points
  • A large number of effective treatments exist for posttraumatic stress disorder (PTSD), including psychotherapies and medications.
  • No single treatment is most effective or the preferred treatment for PTSD.
Practical Psychopharmacology
Low-Dose Amisulpride and Elevation in Serum Prolactin
Chittaranjan Andrade
[Abstract] [Full Text] [Audio Summary]
Clinical Points
  • At low doses, substituted benzamides such as sulpiride, levosulpiride, and amisulpride increase dopaminergic neurotransmission in the brain by preferentially blocking the higher affinity presynaptic dopamine autoreceptors. At high doses, these drugs decrease dopaminergic neurotransmission in the brain by also blocking the lower affinity dopamine postsynaptic receptors.
  • Both low and high doses raise serum prolactin levels.
  • This article discusses the reason for the absence of a biphasic effect on prolactin. Strategies are suggested for managing hyperprolactinemia associated with low-dose substituted benzamides.
Book Reviews
Casebook of Interpersonal Psychotherapy
David I. Joseph
[Purchase] [Full Text]


Resilience and Mental Health: Challenges Across the Lifespan
Arthur M. Freeman III
[Purchase] [Full Text]
Free Online Activities
Unmet Needs in the Assessment and Management of Bipolar I Depression [CME]
Gary S. Sachs


Tools to Assess Negative Symptoms in Schizophrenia [CME]
John M. Kane


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