JCP March Table of Contents E-Lert


The Journal of Clinical Psychiatry

Volume 74 • Number 3 • March 2013

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Original Research
Suicide Risk Assessment Received Prior to Suicide Death by Veterans Health Administration Patients With a History of Depression
Eric G. Smith, Hyungjin Myra Kim, Dara Ganoczy, Claire Stano, Paul N. Pfeiffer, and Marcia Valenstein
[Abstract] [Full Text] [Audio Summary]
Clinical Points
  • From 1999 through 2004, suicide risk assessment at the final Veterans Health Administration (VHA) visit was infrequent, although it was much more common in mental health settings than primary care settings.
  • Suicide risk assessment is complicated by the observation that most individuals dying by suicide who were assessed at their final visit denied suicidal ideation.
  • Augmentation of routine screening, such as increased emphasis on addressing chronic risk factors (eg, access to means), may be important in reducing suicide risks.


Efficacy and Safety of Levomilnacipran Sustained Release 40 mg, 80 mg, or 120 mg in Major Depressive Disorder: A Phase 3, Randomized, Double-Blind, Placebo-Controlled Study [FREE ACCESS]
Gregory M. Asnis, Anjana Bose, Carl P. Gommoll, Changzheng Chen, and William M. Greenberg
[Full Text] [Audio Summary]
Clinical Points
  • Major depressive disorder (MDD) is a leading cause of worldwide disease burden, and effective new treatments of MDD are needed.
  • Levomilnacipran SR is a serotonin-norepinephrine reuptake inhibitor with preference for norepinephrine reuptake inhibition in late-stage clinical development; the efficacy and safety of 3 daily fixed doses (40 mg, 80 mg, 120 mg) were evaluated versus placebo in an 8-week randomized, double-blind clinical trial.
  • Improvement in Montgomery-Asberg Depression Rating Scale (MADRS) total score was statistically greater for all doses of levomilnacipran SR relative to placebo; results suggest greater symptomatic and functional improvement on the MADRS and Sheehan Disability Scale with higher levomilnacipran SR doses.


Extreme Attributions Predict the Course of Bipolar Depression: Results From the STEP-BD Randomized Controlled Trial of Psychosocial Treatment
Jonathan P. Stange, Louisa G. Sylvia, Pedro Vieira da Silva Magalhães, David J. Miklowitz, Michael W. Otto, Ellen Frank, Michael Berk, Andrew A. Nierenberg, and Thilo Deckersbach
[Abstract] [Full Text] [Audio Summary]
Clinical Points
  • Cognitive rigidity may be associated with a poorer course of depression in bipolar disorder, regardless of the valence of rigid thoughts.
  • Pessimistic attributions and depression severity may work synergistically to maintain depression in bipolar disorder.
  • Assessing attributional style may be clinically useful in identifying bipolar patients who are likely to have more severe courses of depression.


Sexual Satisfaction and Quality of Life in Major Depressive Disorder Before and After Treatment With Citalopram in the STAR*D Study
Waguih William IsHak, Scott Christensen, Gregory Sayer, Khanh Ha, Ning Li, Jamie Miller, Jaidyn Mai Nguyen, and Robert M. Cohen
[Abstract] [Full Text] [Audio Summary]
Clinical Points
  • Many patients with major depressive disorder have impaired sexual satisfaction and poor quality of life.
  • Inquiring about and measuring sexual satisfaction are useful in treating depression.
  • Treating depression to full remission could improve sexual satisfaction.
CME Article
See the complete CME Activity.
Five-Year Course of Obsessive-Compulsive Disorder: Predictors of Remission and Relapse
Jane L. Eisen, Nicholas J. Sibrava, Christina L. Boisseau, Maria C. Mancebo, Robert L. Stout, Anthony Pinto, and Steven A. Rasmussen
[Abstract] [Full Text]
Clinical Points
  • Clinicians should target full remission (minimal or no symptoms) of obsessive-compulsive disorder (OCD) to minimize the risk of relapse.
  • Comorbid obsessive-compulsive personality disorder is associated with a worse OCD course.
  • Primary obsessions regarding overresponsibility for harm are associated with better prognosis compared with other types of obsessions.
Early Career Psychiatrists
Teaching the Teacher: A Report From the Third Annual American Society of Clinical Psychopharmacology Teaching Session [COMMENTARY]
Ira D. Glick, Sidney Zisook, and Mark H. Rapaport
[Purchase] [Full Text]


Generalizability of Clinical Trial Results for Bipolar Disorder to Community Samples: Findings From the National Epidemiologic Survey on Alcohol and Related Conditions
Nicolas Hoertel, Yann Le Strat, Pierre Lavaud, Caroline Dubertret, and Frédéric Limosin
[Abstract] [Full Text] [Audio Summary]
Clinical Points
  • Eligibility criteria applied in clinical trials for bipolar disorder exclude a majority of participants, particularly those seeking treatment, thus limiting the generalizability of their results.
  • Individuals with a current significant risk of suicide are underrepresented in clinical trials for bipolar disorder.
  • Clinicians and researchers should carefully consider eligibility criteria and their impact on the representativeness of clinical trials.


A Prevalence Study of Urinary Tract Infections in Acute Relapse of Schizophrenia
Brian J. Miller, Krystle L. Graham, Chelsea M. Bodenheimer, Nick H. Culpepper, Jennifer L. Waller, and Peter F. Buckley
[Abstract] [Full Text] [Audio Summary]
Clinical Points
  • Subjects with an acute relapse of schizophrenia have a significantly increased prevalence of urinary tract infection.
  • Clinicians should monitor for comorbid urinary tract infection in patients with schizophrenia; such infections often go unrecognized and untreated.
ASCP Corner
Reconsidering Chronic Hyponatremia in Psychosis
Richard C. Josiassen, Dawn M. Filmyer, Alexander G. Geboy, and Rita A. Shaughnessy
[Purchase] [Full Text] [Audio Summary]
Letter to the Editor
Subjective Assessments of Threats and Their Association to Posttraumatic Stress Disorder Symptoms: The Case of the 2011 Japan Earthquake and Nuclear Disaster
Menachem Ben-Ezra, Yuval Palgi, Yaira Hamama-Raz, Or Aviel, Yonit Dubiner, Evelyn Baruch, Yechiel Soffer, and Amit Shrira
[Purchase] [Full Text]

ONLINE Exclusives

Practical Psychopharmacology
Antidepressant Action of Atypical Antipsychotics: Focus on Ziprasidone Monotherapy, With a Few Twists in the Tale
Chittaranjan Andrade
[Abstract] [Full Text] [Audio Summary]
Clinical Points
  • Ziprasidone has established antimanic efficacy. It also has pharmacodynamic properties that suggest that it may have antidepressant action. Hypothetically, therefore, ziprasidone may be useful in depressive illness, especially bipolar depression.
  • A recent RCT found ziprasidone to be no better than placebo in major depressive disorder. Earlier RCTs had found it ineffective in bipolar depression, as well.
  • The results to date with ziprasidone suggest that clinicians should not rely too much on pharmacodynamic properties to guide expectations about the clinical efficacy of a drug. Due to limitations of the available RCT data, however, firm conclusions remain to be drawn regarding the use of ziprasidone in different contexts in depression.
Original Research
Posttraumatic Stress Disorder in Adult Attention-Deficit/Hyperactivity Disorder: Clinical Features and Familial Transmission
Kevin M. Antshel, Prashant Kaul, Joseph Biederman, Thomas J. Spencer, Bridget O. Hier, Kaitlin Hendricks, and Stephen V. Faraone
[Abstract] [Full Text] [Audio Summary]
Clinical Points
  • Although individuals with attention-deficit/hyperactivity disorder (ADHD) and individuals with ADHD plus posttraumatic stress disorder (PTSD) may not differ in terms of ADHD symptom severity, current evidence suggests that patients with ADHD + PTSD will most likely experience greater functional impairments and higher rates of psychiatric comorbidities.
  • Adults with ADHD are at high risk for PTSD; therefore, assessing for the presence of both disorders is encouraged.
  • Relatives of ADHD and ADHD + PTSD probands are at greater risk of developing one or both of the disorders.


Recovery From Multiple Episodes of Bipolar I Depression
David A. Solomon, Jess G. Fiedorowicz, Andrew C. Leon, William Coryell, Jean Endicott, Chunshan Li, Robert J. Boland, and Martin B. Keller
[Abstract] [Full Text] [Audio Summary]
Clinical Points
  • The median duration of major and minor depressive episodes in bipolar I disorder is 14.0 and 8.0 weeks, respectively.
  • A more chronic course of illness is associated with a delayed recovery from depressive episodes in bipolar I disorder, although duration of discrete episodes is variable within individuals.


Co-Occurrence of Major Depressive Episode and Posttraumatic Stress Disorder Among Survivors of War: How Is It Different From Either Condition Alone?
Nexhmedin Morina, Dean Ajdukovic, Marija Bogic, Tanja Franciskovic, Abdulah Kucukalic, Dusica Lecic-Tosevski, Lendite Morina, Mihajlo Popovski, and Stefan Priebe
[Abstract] [Full Text] [Audio Summary]
Clinical Points
  • Co-occurring major depressive episode (MDE) and posttraumatic stress disorder (PTSD) among survivors of war are characterized by different traumatic events, more general psychological distress, higher suicide risk, and lower quality of life than either condition alone.
  • Co-occurrence of MDE and PTSD should be assessed in future research and clinical settings with war survivors to better identify individuals with severe psychopathology and poor quality of life.
  • War survivors with co-occurrence of MDE and PTSD may require specific health care programs.
Book Reviews
Health Care Reform: A Primer for Psychiatrists
[Purchase] [Full Text]


Parental Alienation, DSM-5, and ICD-11
[Purchase] [Full Text]


Essential CNS Drug Development
[Purchase] [Full Text]
Free Online Activities
Understanding the Physiology of Schizophrenia [CME]
Brian Kirkpatrick


Alzheimer’s Disease: The Importance of Early Diagnosis and Appropriate Management [CME]
Pierre N. Tariot and P. Murali Doraiswamy


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