Volume 72November 2011Number 11

Original Research

1439 An Algorithm-Based Approach to First-Episode Schizophrenia: Response Rates Over 3 Prospective Antipsychotic Trials With a Retrospective Data Analysis

1445 Predictors of Persistence of Comorbid Generalized Anxiety Disorder Among Veterans With Major Depressive Disorder

1452 Continuation of Quetiapine Versus Switching to Placebo or Lithium for Maintenance Treatment of Bipolar I Disorder (Trial 144: A Randomized Controlled Study)

Clinical Points
  • In patients who respond to quetiapine, maintenance treatment with quetiapine (300-800 mg/d) significantly increases the time to recurrence of a mood event compared with placebo.
  • Maintenance treatment with quetiapine increases the time to recurrence of both manic and depressive events and is effective regardless of the index mood event.
  • Maintenance treatment with lithium is shown, for the first time, to increase the time to recurrence of a depressive as well as a manic event.


1468 The Association Between Social Isolation and DSM-IV Mood, Anxiety, and Substance Use Disorders: Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions

1487 The “Doses” of Initial, Untreated Hallucinations and Delusions: A Proof-of-Concept Study of Enhanced Predictors of First-Episode Symptomatology and Functioning Relative to Duration of Untreated Psychosis

1494 Temporal Relationships Between Overweight and Obesity and DSM-IV Substance Use, Mood, and Anxiety Disorders: Results From a Prospective Study, the National Epidemiologic Survey on Alcohol and Related Conditions

1515 Increased Systemic Cortisol Metabolism in Patients With Schizophrenia and Bipolar Disorder: A Mechanism for Increased Stress Vulnerability?

1522 Self-Harm Subscale of the Schedule for Nonadaptive and Adaptive Personality (SNAP): Predicting Suicide Attempts Over 8 Years of Follow-Up

Case Report

1465 Cytochrome P450 2D6 Polymorphism and Its Impact on Decision-Making in Psychopharmacotherapy: Finding the Right Way in an Ultrarapid Metabolizing Patient

Review Article

1503 Meta-Analysis of Efficacy and Treatment-Emergent Suicidality in Adults by Psychiatric Indication and Age Subgroup Following Initiation of Paroxetine Therapy: A Complete Set of Randomized Placebo-Controlled Trials

1477 Pretest

CME Activity

1485 Posttest


1478 Early and Delayed Onset of Response to Antidepressants in Individual Trajectories of Change During Treatment of Major Depression: A Secondary Analysis of Data From the Genome-Based Therapeutic Drugs for Depression (GENDEP) Study

For Clinical Use
  • The time course of improvement after initiation of an antidepressant varies from patient to patient. While some patients experience rapid improvement in the first 2 to 3 weeks following initiation of an antidepressant, others start significantly improving only after a delay of 2 to 4 weeks. Early and delayed onsets of improvement are approximately equally common.
  • If tolerated, an antidepressant should be continued for 6 to 8 weeks in adequate doses, even if there is no discernible therapeutic effect in the first 2 weeks of treatment. Patients who do not achieve improvement in the first 2 weeks of treatment still have a 40% to 50% chance of significant improvement if they persevere with treatment for 6 to 8 weeks.
  • Six to eight weeks of treatment constitutes an adequate trial of an antidepressant. If significant improvement is not achieved after 6 to 8 weeks of treatment with adequate doses, the clinician should consider changing treatment.


Focus on Women’s Mental Health

1529 Biopsychosocial Vulnerabilities in Women

1531 First-Onset Psychosis Occurring in the Postpartum Period: A Prospective Cohort Study

Clinical Points
  • First-onset postpartum psychosis has a distinct risk profile and phenomenology compared to postpartum psychosis in patients with bipolar disorder.
  • Depressive symptoms were associated with a later onset and longer duration of episode.
  • Treatment with the combination of lithium plus an antipsychotic led to high rates of remission.


1538 Prevalence of Mood Disorders and Service Use Among US Mothers by Race and Ethnicity: Results From the National Survey of American Life

Clinical Points
  • Mothers are a group that may be at increased risk for mood disorders.
  • It is important to assess for risk factors, identify mood disorders, and adequately treat these disorders in mothers.
  • Black mothers with mood disorders are likely to underutilize treatment.


1546 Decreased Nocturnal Oxytocin Levels in Anorexia Nervosa Are Associated With Low Bone Mineral Density and Fat Mass

Clinical Points
  • Oxytocin is a peptide hormone involved in appetite as well as bone metabolism.
  • Anorexia nervosa is characterized by restrictive eating, extremely low weight, and severe bone loss.
  • Nocturnal oxytocin levels are low in women with anorexia nervosa and are positively associated with bone mineral density, suggesting that oxytocin deficiency may contribute to bone loss in this disorder.


1552 Raloxifene as an Adjunctive Treatment for Postmenopausal Women With Schizophrenia: A Double-Blind, Randomized, Placebo-Controlled Trial

Clinical Points
  • Drugs with estrogen activity in the brain seem to improve the outcome of subjects with schizophrenia.
  • Use of raloxifene as an adjuvant treatment in postmenopausal women with schizophrenia is very promising.


Letters to the Editor

1558 Can Pindolol Really Enhance Antidepressant Effect?

1558 Odd Odds

Book Reviews

1560 Mental Health Care in the College Community

1560 Principles of Social Psychiatry, 2nd ed.

1561 Psychodynamic Psychotherapy for Personality Disorders: A Clinical Handbook

Psychiatrist.com Exclusives

Focus on Women’s Mental Health

e1563 Depression in Women: Windows of Vulnerability and New Insights Into the Link Between Estrogen and Serotonin [Commentary]

Clinical Points
  • Women are at higher risk for developing depression compared to men, and such increased risk appears to be associated with reproductive “windows of vulnerability.”
  • The association between reproductive milestones and depression in women suggests a contributing role of sex hormones (ie, estrogen) to mood regulation.
  • Animal data and clinical studies support the notion that estrogen has important modulatory effects on serotonin activity.


Online Activities

e34 2011 ICBD Conference Coverage: Practical Applications of New Research in Bipolar Disorder [CME]

e35 Implementing Guideline-Based Strategies to Avoid Relapse and Recurrence in Depression [CME]

Information for Authors

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