Volume 72October 2011Number 10

1294 Pretest

CME Activity

1311 Posttest


1295 International Consensus Group on Depression Prevention in Bipolar Disorder

For Clinical Use
  • Lamotrigine and quetiapine have the best evidence base for preventing bipolar depressive episodes.
  • Antidepressant monotherapy is not recommended for acute or maintenance treatment of bipolar depression.
  • When choosing treatments, take into consideration the patient’s comorbidities and course of illness (eg, rapid cycling, predominant polarity, history of relapse) and the adverse effect profiles of each medication.


Original Research

1313 Efficacy and Safety of Loxapine for Inhalation in the Treatment of Agitation in Patients With Schizophrenia: A Randomized, Double-Blind, Placebo-Controlled Trial

1322 Effect of Antidepressant Medication Treatment on Suicidal Ideation and Behavior in a Randomized Trial: An Exploratory Report From the Combining Medications to Enhance Depression Outcomes Study

Clinical Points
  • Depressed patients with suicidal ideation can be effectively and safely treated with antidepressant medications.
  • Effective antidepressant treatment reduces suicidal ideation.
  • The substantial benefit of reducing suicidal ideation in depressed patients who are treated with antidepressant medications versus the small risk of emergent or worsening suicidal ideation with such treatment strongly favors treatment.
  • For depressed outpatients with baseline suicidal ideation, there may be an advantage with the combination of bupropion-SR plus escitalopram compared to either escitalopram alone or the combination of venlafaxine-XR plus mirtazapine in terms of reducing suicidal ideation after 12 weeks of treatment.
  • Suicide risk is a serious concern throughout the course of MDD, including before, during, and after treatment.


1333 Does DSM-IV Already Capture the Dimensional Nature of Personality Disorders?

Clinical Points
  • Increasing evidence suggests that the presence of personality disorder traits that do not meet DSM-IV diagnostic thresholds is associated with impaired functioning.
  • DSM-IV allows clinicians to record the presence of subthreshold traits on Axis II.


1344 Comparative Effectiveness Clinical Trials in Psychiatry: Superiority, Noninferiority, and the Role of Active Comparators

1353 A Dose Comparison of Olanzapine for the Treatment of Borderline Personality Disorder: A 12-Week Randomized, Double-Blind, Placebo-Controlled Study

1366 Prediction of Placebo Response in 2 Clinical Trials of Lisdexamfetamine Dimesylate for the Treatment of ADHD

1376 Effectiveness and Safety of Vagus Nerve Stimulation for Severe Treatment-Resistant Major Depression in Clinical Practice After FDA Approval: Outcomes at 1 Year

1390 Moral or Religious Objections to Suicide May Protect Against Suicidal Behavior in Bipolar Disorder

1397 Emotional Experience and Estimates of D2 Receptor Occupancy in Psychotic Patients Treated With Haloperidol, Risperidone, or Olanzapine: An Experience Sampling Study

1405 A Double-Blind Placebo-Controlled Trial of Lamotrigine as an Antidepressant Augmentation Agent in Treatment-Refractory Unipolar Depression

1413 Efficacy and Safety of Adjunctive Oral Ziprasidone for Acute Treatment of Depression in Patients With Bipolar I Disorder: A Randomized, Double-Blind, Placebo-Controlled Trial

Clinical Points
  • The frequent failure of randomized controlled studies to detect differences between study medication and placebo is a significant obstacle to drug development.
  • Although some studies include active comparators, this component alone does little to inform the field as to why randomized clinical trials often lack assay sensitivity.
  • Using data from tandem assessments made by site-based raters and computer-administered assessments, this report examined the impact of protocol-specific eligibility criteria, diagnostic confidence, and rating quality on signal detection. The results suggest that variability in study quality can lead to study failure and that future clinical trials could benefit from procedures that do not rely exclusively on assessments made by a single rater.


1423 Suicide and Prescription Rates of Intranasal Corticosteroids and Nonsedating Antihistamines for Allergic Rhinitis: An Ecological Study

Clinical Points
  • Psychiatrists, allergists, and generalists should be mindful that allergy and suicide may be interconnected through pathophysiologic as well as iatrogenic effects.
  • Clinicians should inquire about history of allergy and sensitization to allergens in patients at risk for suicide, and internists should inquire about history of depression, past suicide attempts, and individual behavioral reactions to allergy medication.
  • This report is ecological, and thus its results should lead to future studies rather than be misunderstood as solid evidence for individual treatment decisions.



1340 Dimensional Diagnosis and DSM-5

1341 The Problematic DSM-5 Personality Disorders Proposal: Options for Plan B

1350 Another Point of View: Superiority, Noninferiority, and the Role of Active Comparators

1363 Randomized Controlled Trials of Olanzapine Treatment of Borderline Personality Disorder: Two Similar Studies With Different Results

Review Article

1383 Should We Expect “Neural Signatures” for DSM Diagnoses?

ASCP Corner

1429 Stepping Back to Step Forward: Lessons From the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)

Book Reviews

1432 Handling Children’s Aggression Constructively: Toward Taming Human Destructiveness

1432 Neurology for the Non-Neurologist, 6th ed

1433 Bipolar Disorder: Clinical and Neurobiological Foundations

CME Activities

e31 Performance Improvement CME: Managing Schizophrenia

e32 Moderators of Antidepressant Response in Major Depression

e33 Recognizing and Diagnosing ADHD in College Students

information for authors

see www.psychiatrist.com/author.htm