Volume 72September 2011Number 9

Publisher’s Note

1165 Cosmetics Count

Original Research

1166 Vilazodone: Clinical Basis for the US Food and Drug Administration’s Approval of a New Antidepressant

Clinical Points
  • Vilazodone is a new antidepressant recently approved by the US Food and Drug Administration for the treatment of major depressive disorder.
  • Although its prominent pharmacologic effects include both selective serotonin (5-HT) reuptake inhibition and partial agonism at 5-HT1A receptors, its clinical profile is most similar to other selective serotonin reuptake inhibitors.
  • It is unknown whether vilazodone has any advantages compared to other drugs in the antidepressant class.


1174 Prolonged Exposure Therapy for Combat- and Terror-Related Posttraumatic Stress Disorder: A Randomized Control Comparison With Treatment as Usual

1181 Major Depressive Disorder Predicts Completion, Adherence, and Outcomes in Cardiac Rehabilitation: A Prospective Cohort Study of 195 Patients With Coronary Artery Disease

1199 Combined Effects of Depressive Symptoms and Resting Heart Rate on Mortality: The Whitehall II Prospective Cohort Study

1207 Diagnostic Consistency of Major Depression With Psychosis Across 10 Years

Clinical Points
  • A diagnosis of major depressive disorder (MDD) with psychosis among inpatients is best regarded as provisional when based on only a single assessment in time.
  • Treatment plans need to take into consideration the high likelihood that the MDD with psychosis diagnosis might be revised across visits.


1222 An International Consensus Study of Neuroleptic Malignant Syndrome Diagnostic Criteria Using the Delphi Method

Clinical Points
  • Neuroleptic malignant syndrome (NMS) must be diagnosed promptly to avoid serious injury or death, but there is no consensus on diagnostic criteria for this disorder.
  • The Delphi consensus technique is especially useful for developing a consensus among knowledge experts when experimental evidence is lacking or difficult to obtain.
  • An international multispecialty panel of clinical experts reached a consensus regarding diagnostic criteria for NMS using the Delphi technique; however, until these consensus criteria are validated by future studies, they should be considered only as an aid to clinical diagnosis and not as the sole basis for excluding a diagnosis of NMS.


1229 The Use of Statins After a Cardiac Intervention Is Associated With Reduced Risk of Subsequent Depression: Proof of Concept for the Inflammatory and Oxidative Hypotheses of Depression?

1236 Clinical Utility of Early Improvement to Predict Response or Remission in Acute Mania: Focus on Olanzapine and Risperidone

1242 Major Depressive Disorder Is Associated With Cardiovascular Risk Factors and Low Omega-3 Index

1189 Pretest

CME Activity

1197 Posttest


1190 Alzheimer’s Disease: Implications of the Updated Diagnostic and Research Criteria

For Clinical Use
  • Alzheimer’s disease (AD) consists of a progressive sequence of pathophysiologic changes, some of which can be measured by AD biomarkers, which correspond roughly to the preclinical and increasingly severe clinical stages of AD.
  • The NIA and Alzheimer’s Association have proposed new diagnostic criteria for dementia due to AD and MCI due to AD, as well as initial research criteria for preclinical AD.
  • The new criteria for dementia due to AD reflect new information about the clinical course of the disease (such that memory impairment does not need to be a cardinal cognitive feature), consider other potential causes of dementia (eg, dementia with Lewy bodies, vascular dementia, frontotemporal dementia), and consider the existence of mixed pathology. The work group report anticipates the use of brain imaging, CSF, and other biomarkers to help improve confidence in the diagnosis of AD, but also notes the work needed to be completed before these biomarkers are routinely used in the clinical setting.
  • The criteria for MCI due to AD reflect the understanding that AD symptoms are apparent before the onset of dementia and that many, but not all, patients with MCI will progress to AD dementia. The work group report includes types of cognitive tests to help support the diagnosis of MCI and anticipates the use of brain imaging, CSF, and other biomarkers to help improve confidence in the diagnosis of MCI due to AD and to help predict a person’s cognitive course, as well as notes the work needed to be done before these biomarkers are routinely used in the clinical setting.
  • The NIA and Alzheimer’s Association have introduced research criteria to begin to define the preclinical stages of AD based primarily on AD biomarkers and/or genetic tests. The criteria evidence of characteristic AD biomarker changes, some of which begin many years before the clinical onset, is intended to provide a common language for researchers to compare their findings, clarify the extent to which individuals progress to the clinical stages of AD, and anticipate the evaluation of promising AD treatments in the preclinical stages, when they may be most effective. These criteria are proposed for research purposes only and are not recommended for use in the clinical setting to predict whether or when cognitively normal people may go on to develop symptoms.
  • Amyloid imaging, other AD biomarker measurements, and genetic tests are not yet recommended for routine use in the clinical setting. However, the experts noted the emerging roles of these techniques in AD research, clinical assessment, and evaluation of treatments in the earliest clinical and preclinical stages of the disorder, and acknowledged some of the uncertainties that need to be addressed to fulfill their potential in these endeavors.
  • DSM-5 criteria are undergoing field trials and are expected to be published in 2013. Criteria for mild and major neurocognitive diseases correspond roughly to the NIA/Alzheimer’s Association criteria for MCI due to AD and dementia due to AD, respectively. DSM-5 criteria are designed for use in the clinical, legal, and clerical settings, and thus do not include research criteria for the preclinical stages of the disorder.


Review Article

1214 Quality of Reporting of Randomized Controlled Trials of Pharmacologic Treatment of Bipolar Disorders: A Systematic Review

Focus on Childhood and Adolescent Mental Health

1248 A Potpourri of Timely Topics

1250 Meta-Analysis of Epidemiologic Studies of Pediatric Bipolar Disorder [Review]

Clinical Points
  • The prevalence of pediatric bipolar disorder is similar to current prevalence estimates of bipolar disorder in adults.
  • The prevalence of pediatric bipolar disorder is not different in the United States, relative to other countries.
  • The prevalence of pediatric bipolar disorder is not increasing over time in the community, even as it is being diagnosed more commonly in clinical settings.


1257 Concerns Regarding the Inclusion of Temper Dysregulation Disorder With Dysphoria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [Commentary]

1263 Adjunctive Use of Repetitive Transcranial Magnetic Stimulation in Depressed Adolescents: A Prospective, Open Pilot Study

Clinical Points
  • Previous trials of repetitive transcranial magnetic stimulation (rTMS) in depressed adolescents utilized less robust treatment dosing parameters than this study.
  • rTMS treatment dosing consistent with adult protocols was found to be safe, feasible, and effective in this group of adolescents.
  • Treatment benefits of rTMS in adolescents appeared durable at 6-month follow-up.


1270 Safety and Tolerability of Aripiprazole for Irritability in Pediatric Patients With Autistic Disorder: A 52-Week, Open-Label, Multicenter Study

Clinical Points
  • For chronic conditions such as irritability associated with autistic disorder, a need exists for long-term safety data to help inform clinical decision making.
  • Aripiprazole was generally well tolerated in this 1-year study, although it is important to be aware of the potential for weight gain in some patients.


1277 Are Beslan’s Children Learning to Cope? A 3-Year Prospective Study of Youths Exposed to Terrorism

Clinical Points
  • Despite initial comparable levels of psychological distress, adolescents directly exposed to a terrorist attack show an increase in mental health problems over time compared to their indirectly exposed peers.
  • Endorsement of avoidant coping plays a major role in the development and maintenance of posttraumatic symptoms, whereas active and support coping are not related to youths’ PTSD symptoms 3 years postattack.
  • In the aftermath of terrorism, clinicians can help adolescents enhance their proactive coping skills to minimize adverse outcomes and prevent the chronicity of posttraumatic reactions.


Letters to the Editor

1284 Failure Rate and “Professional Subjects” in Clinical Trials of Major Depressive Disorder

Book Reviews

1286 Obsessive-Compulsive Spectrum Disorders: Refining the Research Agenda for DSM-V

1286 Anxiety Disorders in Adults: A Clinical Guide, 2nd ed

1287 Get the Diagnosis Right: Assessment and Treatment Selection for Mental Disorders

1287 The Rise and Fall of the Biopsychosocial Model: Reconciling Art and Science in Psychiatry

1288 The Little Psychotherapy Book: Object Relations in Practice

1288 Kaplan & Sadock’s Pocket Handbook of Clinical Psychiatry, 5th ed

CME Activities

e28 Improving Treatment Adherence in Patients With Schizophrenia

e29 Performance Improvement CME: Algorithms and EMRs in Depression

e30 Prevalence and Impact of ADHD in College Students

information for authors

see www.psychiatrist.com/author.htm