JCP October Table of Contents E-Lert

10.30.12

The Journal of Clinical Psychiatry

Volume 73 • Number 10 • October 2012

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Review Articles

Correlation Between Different Levels of Placebo Response Rate and Clinical Trial Outcome in Major Depressive Disorder: A Meta-Analysis
Nadia Iovieno and George I. Papakostas
[Abstract] [Full Text] [Audio Summary]
Clinical Points
  • The high and highly variable placebo response rate is a major obstacle contributing to the failure of randomized controlled trials in major depressive disorder.
  • The relative efficacy of the active drug compared to placebo is highly heterogeneous across studies with different placebo response rates, with higher placebo response rates being correlated with a lower probability to detect a statistically significant superiority of the drug versus placebo.
  • The response rate in the placebo group is an important aspect to take into account when interpreting results from a trial with an equivocal outcome.
  • It is of primary importance to maintain placebo response rates below a critical threshold (30% and 40% for antidepressant monotherapy studies and augmentation/combination studies, respectively).

 

Beyond White Blood Cell Monitoring: Screening in the Initial Phase of Clozapine Therapy
Dan Cohen, Jan P. A. M. Bogers, Daniel van Dijk, Bert Bakker, and Peter F. J. Schulte
[Abstract] [Full Text]
Clinical Points
  • Screening guidelines during the initial phase of treatment with clozapine have been restricted to the obligatory white blood cell monitoring. We propose 2 revisions, both extensions, of the existing screening guidelines.
  • First, monthly screening of fasting plasma glucose should be obligatory in the first 3 months of clozapine therapy.
  • Second, monitoring of gastrointestinal hypomotility should become an integral part of regular screening, not only in the initial but also during the maintenance phase.
  • Screening for myocarditis or cardiomyopathy is, outside Australia and New Zealand, not evidence based.
Commentary
Monitoring Clozapine Adverse Effects Calls for the Integration of Protocol and Good Clinical Practice
M. Bak
[Purchase] [Full Text]
CME Article
See the complete CME Activity.
Marital Status, Childhood Maltreatment, and Family Dysfunction: A Controlled Study of Pathological Gambling
Donald W. Black, Martha C. Shaw, Brett A. McCormick, and Jeff Allen
[Abstract] [Full Text] [Audio Summary]
For Clinical Use
  • Pathological gambling is associated with indices of family dysfunction including divorce, living alone, self-reported childhood maltreatment, and worse functioning on the Family Assessment Device.
  • While dysfunctional marital and family variables are associated with pathological gambling, the direction of the relationship is unclear.
  • Pathological gambling treatment programs should take into account the emotional needs of those who report having experienced childhood maltreatment or are experiencing disturbed marital and family relationships.
Original Research
How Can We Use Depression Severity to Guide Treatment Selection When Measures of Depression Categorize Patients Differently?
Mark Zimmerman, Jennifer H. Martinez, Michael Friedman, Daniela A. Boerescu, Naureen Attiullah, and Cristina Toba
[Abstract] [Full Text]
Clinical Points
  • Treatment guidelines for depression suggest that severity be taken into account when initiating treatment.
  • There is a marked disparity between the way standardized scales classify depressed outpatients into severity groups. This disparity suggests that using such scales to classify severity subtypes is problematic.
  • Recommending any one scale to measure depression severity is premature.

 

AIDS/HIV Infection, Comorbid Psychiatric Illness, and Risk for Subsequent Suicide: A Nationwide Register Linkage Study
Cun-Xian Jia, Lars Mehlum, and Ping Qin
[Abstract] [Full Text] [Audio Summary]
Clinical Points
  • People with AIDS/HIV infection have a strongly increased risk for suicide.
  • Suicide risk assessment and management should be an integral part of hospitals’ and general practitioners’ treatment plans for patients with AIDS/HIV infection.
  • Continuity of care in transitions between service levels and providers and systematic psychiatric and somatic follow-up of patients after discharge from the hospital are important strategies for suicide prevention in patients with AIDS/HIV infection.
Practical Psychopharmacology
There’s More to Placebo-Related Improvement Than the Placebo Effect Alone
Chittaranjan Andrade
[Purchase] [Full Text] [Audio Summary]
Clinical Points
  • Besides a true medication effect and a true placebo effect, there are a large number of overlapping reasons why patients improve.
  • Reasons for improvement include nonspecific psychotherapeutic effects, regression toward the mean, spontaneous response or remission, the Rosenthal effect, the Hawthorne effect, the halo effect, favorable changes in the stress-support dimension, and known or unknown use of other treatments.
  • Clinicians should be aware that some of these mechanisms result in fleeting improvement or in false impressions of improvement only. They should make efforts to enhance the placebo response and recruit nonspecific psychotherapeutic effects and other mechanisms that result in true improvement.
Focus on Childhood and Adolescent Mental Health
More on Mood Disorders in Youth
Karen Dineen Wagner
[Purchase] [Full Text]

 

Further Evidence for Robust Familiality of Pediatric Bipolar I Disorder: Results From a Very Large Controlled Family Study of Pediatric Bipolar I Disorder and a Meta-Analysis
Janet Wozniak, Stephen V. Faraone, MaryKate Martelon, Hannah N. McKillop, and Joseph Biederman
[Abstract] [Full Text] [Audio Summary]
Clinical Points
  • By providing information that is 1 step removed from a diagnosis in an affected child, family study methodology remains the cornerstone for the validation of complex psychiatric disorders such as pediatric bipolar disorder.
  • By documenting the high familiality of pediatric bipolar disorder, our study provides strong support for the validity of pediatric bipolar disorder.
  • By providing evidence for the validity of pediatric bipolar disorder, this work will support efforts in the community for the identification and treatment of children manifesting a clinical picture consistent with the diagnosis of bipolar disorder.

 

Developmental Pathways for Different Subtypes of Early-Onset Bipolarity in Youths
Gabriele Masi, Maria Mucci, Chiara Pfanner, Stefano Berloffa, Angela Magazù, and Giulio Perugi
[Abstract] [Full Text] [Audio Summary]
Clinical Points
  • The presence of comorbid attention-deficit/hyperactivity disorder (ADHD) versus anxiety disorders should be actively explored, as it is indicative of fundamental differences in the phenomenology of bipolar disorder in youths.
  • ADHD plus bipolar disorder might represent a distinct early-onset phenotype within the bipolar spectrum.

 

Examining the Proposed Disruptive Mood Dysregulation Disorder Diagnosis in Children in the Longitudinal Assessment of Manic Symptoms Study
David Axelson, Robert L. Findling, Mary A. Fristad, Robert A. Kowatch, Eric A. Youngstrom, Sarah McCue Horwitz, L. Eugene Arnold, Thomas W. Frazier, Neal Ryan, Christine Demeter, Mary Kay Gill, Jessica C. Hauser-Harrington, Judith Depew, Shawn M. Kennedy, Brittany A. Gron, Brieana M. Rowles, and Boris Birmaher
[Abstract] [Full Text] [Audio Summary]
Clinical Points
  • The proposed disruptive mood dysregulation disorder (DMDD) diagnosis is not clearly differentiated from oppositional defiant disorder and conduct disorder in children presenting for psychiatric treatment.
  • Youth presenting for treatment with disruptive behavioral, anxiety, and mood disorders will frequently meet the proposed diagnostic criteria for DMDD.
  • Many youth with bipolar disorder will meet the primary symptom criteria for DMDD; therefore, careful assessment for manic symptomatology is required for children who present with features of DMDD.

 

Psychological Outcomes and Predictors of Initial Weight Loss Outcomes Among Severely Obese Adolescents Receiving Laparoscopic Adjustable Gastric Banding
Robyn Sysko, Michael J. Devlin, Tom B. Hildebrandt, Stephanie K. Brewer, Jeffrey L. Zitsman, and B. Timothy Walsh
[Abstract] [Full Text] [Audio Summary]
Clinical Points
  • Psychiatric symptoms improve among severely obese adolescents following laparoscopic adjustable gastric banding (LAGB).
  • Changes in weight postsurgery and improvement in psychosocial functioning are correlated.
  • Mental health professionals should assess loss of control eating and family functioning among adolescents seeking LAGB.
Letters to the Editor
Cost and Cost-Effectiveness in a Randomized Trial of Long-Acting Risperidone for Schizophrenia [FREE ACCESS]
Larry Alphs, William H. Olson, Ibrahim Turkoz, John Fastenau, and Joseph Hulihan
[Full Text]
• Reply by Paul G. Barnett and Robert A. Rosenheck [FREE ACCESS]
[Full Text]
Book Reviews
Psychoanalytic Diagnosis: Understanding Personality Structure in the Clinical Process, 2nd ed
James W. Lomax and Mihaela Cristina Ivan
[Purchase] [Full Text]

 

Child Psychology and Psychiatry: Frameworks for Practice, 2nd ed
Edwin J. Mikkelsen
[Purchase] [Full Text]

Psychiatrist.com Exclusives

Original Research
Predictors of Suicide in Patient Charts Among Patients With Depression in the Veterans Health Administration Health System: Importance of Prescription Drug and Alcohol Abuse
Hyungjin Myra Kim, Eric G. Smith, Dara Ganoczy, Heather Walters, Clare M. Stano, Mark A. Ilgen, Amy S. B. Bohnert, and Marcia Valenstein
[Abstract] [Full Text]
Clinical Points
  • Prescription drug and alcohol misuse assessments should be prioritized in suicide assessments among depressed patients.
  • Using word search strategies or natural-language processing assessments of electronic medical records may allow systematic identification of high-risk individuals for suicide prevention efforts.

 

Polymorphisms and Haplotypes in the YWHAE Gene Increase Susceptibility to Bipolar Disorder in Chinese Han Population
Jie Liu, Zhi-Qiang Li, Jun-Yan Li, Tao Li, Ti Wang, You Li, Yi-Feng Xu, Guo-Yin Feng, Yong-Yong Shi, and Lin He
[Abstract] [Full Text] [Audio Summary]
Clinical Points
  • Our study suggests that some susceptibility may be common to both schizophrenia and bipolar disorder and that a putative, sex-dependent relationship exists between the YWHAE gene and bipolar disorder.
  • Evidence from this study will be useful in influencing psychiatric research to move from reliance on a diagnostic and classification system that is based only on clinical description to a scheme that better reflects the underlying biology of the psychiatric entities encountered in our clinics.
Free Online Activities
Depression Epidemiology and Its Treatment Evolution [CME]
Robert M. A. Hirschfeld
[Abstract]

 

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