Volume 72December 2011Number 12


1574 The Impact of Omega-3 Fatty Acids on Depressive Disorders and Suicidality: Can We Reconcile 2 Studies With Seemingly Contradictory Results?

Original Research

1577 Meta-Analysis of the Effects of Eicosapentaenoic Acid (EPA) in Clinical Trials in Depression

Clinical Points
  • Meta-analysis of clinical trials of fish oil for depression indicates that the ratio of the constituent omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) may determine the effectiveness of the supplements.
  • Significant improvement in depression scores was seen in the group of studies using supplements in which EPA was at least 60% of the combined fatty acids: EPA/(EPA + DHA).
  • Effective doses of EPA in excess of DHA, calculated as EPA DHA, were in the approximate range of 200–2,000 mg/d.


1585 Suicide Deaths of Active-Duty US Military and Omega-3 Fatty-Acid Status: A Case-Control Comparison

Clinical Points
  • The status of omega-3 fatty acids is extremely low among US military personnel.
  • Low status of docosahexaenoic acid (DHA), an omega-3 fatty acid obtained from seafood and concentrated in the brain, is associated with increased risk for suicide death.
  • Ensuring adequate omega-3 nutritional status is likely to benefit, and unlikely to harm, people at risk for suicide.


1602 A 12-Month Randomized, Open-Label Study of the Metabolic Effects of Olanzapine and Risperidone in Psychotic Patients: Influence of Valproic Acid Augmentation

1611 Problematic Video Game Use Scale: Initial Psychometric Properties With Psychiatrically Hospitalized Adolescents

Clinical Points
  • Two underlying factors emerged to account for problem video game playing: impairment in functioning factor and reinforcing effects factor.
  • These findings highlight the importance of assessing video game use among an adolescent population, the factors associated with video game use, and the relation of video game use to symptoms of psychopathology.


1616 Mid-Term and Long-Term Efficacy and Effectiveness of Antipsychotic Medications for Schizophrenia: A Data-Driven, Personalized Clinical Approach

Clinical Points
  • Mid-term and long-term data suggest that some antipsychotics are more effective than others when treating schizophrenia over the long run. They include clozapine, olanzapine, and risperidone.
  • Each antipsychotic has a unique side effect profile, with greater or less propensity for weight gain, but in general second-generation antipsychotics have fewer extrapyramidal symptoms and less tardive dyskinesia than first-generation antipsychotics over the long run.
  • As much as possible, individualize medication, psychotherapy, and rehabilitation treatment choices, ie, share the decision-making with each “patient–significant other unit.” For many chronic patients over time, efficacy and improved function are more important than possible future side effects.


1628 Panic as an Independent Risk Factor for Suicide Attempt in Depressive Illness: Findings From the National Epidemiological Survey on Alcohol and Related Conditions (NESARC)

1636 Why Do Some Patients With Schizophrenia Want to Be Engaged in Medical Decision Making and Others Do Not?

1644 Effects of Acute Hydrocortisone Administration on Declarative Memory in Patients With Major Depressive Disorder: A Placebo-Controlled, Double-Blind Crossover Study

Clinical Points
  • A significant percentage of patients with MDD show hypothalamic-pituitary-adrenal axis (HPA) dysregulations, for example, hypercortisolism or reduced glucocorticoid receptor function.
  • The results of our study further strengthened the hypothesis of reduced central glucocorticoid receptor functioning in MDD.
  • The corticosteroid receptor hypothesis of depression has stimulated pharmacologic research to strive for new antidepressant agents that act directly on different sites within the HPA axis.


1651 Brief Behavioral Therapy for Refractory Insomnia in Residual Depression: An Assessor-Blind, Randomized Controlled Trial

Case Report

1659 A Case of Agranulocytosis Secondary to Rechallenge With Clozapine Following Severe Neutropenia During Previous Therapy

1591 Pretest

CME Activity

1600 Posttest


1592 Increased Risk of Diabetes Mellitus Among Persons With Psychotic Symptoms: Results From the WHO World Health Survey

For Clinical Use
  • Psychotic symptoms are related to the presence of diabetes mellitus in the general population, independent of other factors.
  • Clinicians should examine the lifestyles of patients with psychotic symptoms in order to reduce the risk of diabetes mellitus.


Early Career Psychiatrists

1660 Efficacy of Antidepressants for Late-Life Depression: A Meta-Analysis and Meta-Regression of Placebo-Controlled Randomized Trials

Clinical Points
  • Late-life major depressive disorder (MDD) is often underrecognized and undertreated even though it is the most prevalent psychiatric disorder, estimated to be present in 9%–18% of the population over 55 years of age.
  • Antidepressants are efficacious in the treatment of late-life MDD, but antidepressant response rates are lower than in adult MDD (< 65 years).
  • Executive dysfunction, comorbid Axis III conditions, greater chronicity of depressive episode, and undertreatment might influence antidepressant response specifically in patients older than 65 years.


1669 Association Between Patient Beliefs Regarding Assigned Treatment and Clinical Response: Reanalysis of Data From the Hypericum Depression Trial Study Group

Clinical Points
  • In this reanalysis, patient beliefs regarding treatment were more strongly associated with clinical outcome than the actual medication received.
  • The degree of influence of patient beliefs on clinical outcome may depend upon the particular combination of treatment guessed and treatment received.
  • Results of this and future studies may have implications for how clinicians utilize the potentially therapeutic effects of patient beliefs in clinical practice.


1677 Stress and Inflammation Reduce Brain-Derived Neurotrophic Factor Expression in First-Episode Psychosis: A Pathway to Smaller Hippocampal Volume

Clinical Points
  • Biological abnormalities triggered by stress contribute to brain structure abnormalities at the onset of psychosis.
  • Targeting biological pathways involved in the stress response might help to prevent development of psychosis and improve clinical outcome of patients with psychosis.


1685 Variants of the Serotonin Transporter Gene, Selective Serotonin Reuptake Inhibitors, and Bone Mineral Density in Risperidone-Treated Boys: A Reanalysis of Data From a Cross-Sectional Study With Emphasis on Pharmacogenetics

Clinical Points
  • Selective serotonin reuptake inhibitors (SSRIs) are widely used in children and adults, with emerging evidence linking them to impaired skeletal metabolism.
  • The use of SSRIs in children and adolescents is associated with lower trabecular bone mineral density.
  • Preliminary evidence indicates that carriers of the ls genotype of the 5-HTTLPR variants are at an increased risk for reduced bone mineral density compared to those with the ll or ss genotypes.
  • If replicated, these findings suggest that genotyping the 5-HTTLPR variants might help estimate the risk for SSRI-related skeletal effects. This would help optimize the long-term safety of SSRIs.


1691 Time to Treatment Response in First-Episode Schizophrenia: Should Acute Treatment Trials Last Several Months?

Clinical Points
  • Choosing the optimal duration for an antipsychotic treatment trial is an important clinical decision. Treatment trials for patients with a first episode of schizophrenia should be longer than treatment trials for multiepisode patients. Some first-episode patients may need up to 16 weeks of antipsychotic treatment to achieve response.
  • The use of early lack of improvement as a predictor of subsequent nonresponse to treatment has limited value with patients with first-episode schizophrenia.


Letters to the Editor

1697 Antidepressant Use and Risk for Suicide Attempts in Bipolar Disorder

1698 Predicting Suicide Attempt Risk: Logistic Regression Requires Large Sample Sizes

1698 Correction

Book Reviews

1699 Genes, Memes, Culture, and Mental Illness: Toward an Integrative Model

1699 Religious and Spiritual Issues in Psychiatric Diagnosis: A Research Agenda for DSM-V

1700 The American Psychiatric Publishing Textbook of Forensic Psychiatry, 2nd ed

1700 Clinical Manual of Adolescent Substance Abuse Treatment

Author Index

1702 Author Index to Volume 72: January 2011 Through December 2011

Psychiatrist.com Exclusives

CME Activities

e36 Using Algorithms and Computerized Decision Support Systems to Treat Major Depression

e37 Clinical Impact of Updated Diagnostic and Research Criteria for Alzheimer’s Disease

e38 Presentation and Diagnosis of Fibromyalgia

Information for Authors

see www.psychiatrist.com/author.htm