Volume 73January 2012Number 1

Editorial

5 JCP’s Circle of Honor and Peer Reviewers

Commentaries

64 Questions Raised by the Failure of a Trial of Short-Term Psychodynamic Therapy Versus Pharmacotherapy for Major Depressive Disorder

113 Depression in Older Adults: Is There Another Reason to Worry?

Original Research

8 Does the Presence of One Feature of Borderline Personality Disorder Have Clinical Significance? Implications for Dimensional Ratings of Personality Disorders

Clinical Points
  • Low-severity levels of borderline personality disorder can be assessed reliably.
  • Psychiatric outpatients with 1 borderline personality disorder criterion have greater psychosocial morbidity than patients with 0 criteria.
  • The results support suggestions to rate borderline personality disorder dimensionally because low severity levels of such pathology are clinically significant.

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13 A Randomized, Double-Blind, Placebo-Controlled Study of the Safety and Tolerability of High-Dose Quetiapine in Patients With Persistent Symptoms of Schizophrenia or Schizoaffective Disorder

Clinical Points
  • Like other atypical antipsychotics, quetiapine is often prescribed at higher than approved doses for patients with schizophrenia or schizoaffective disorder.
  • While using quetiapine at doses greater than 800 mg/d does not increase extrapyramidal symptoms, weight gain is greater at higher than approved doses.
  • Higher than approved doses offer no additional benefit in improving symptom severity.

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31 Obstructive Sleep Apnea/Hypopnea Syndrome and Poor Response to Sertraline in Patients With Coronary Heart Disease

Clinical Points
  • Depression and obstructive sleep apnea/hypopnea syndrome (OSAHS) are both associated with cardiac mortality in patients with heart disease.
  • Both depression and OSAHS are very common in patients with heart disease.
  • Untreated OSAHS is associated with a poor response to sertraline treatment in patients with heart disease and major depression.

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57 Double-Blind, Randomized, Placebo-Controlled Long-Term Maintenance Study of Aripiprazole in Children With Bipolar Disorder

Clinical Points
  • Prospective, randomized maintenance studies in pediatric patients with bipolar disorder are feasible.
  • Aripiprazole is generally well tolerated and may be beneficial in the long-term treatment of young children with bipolar disorder.

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66 Short-Term Dynamic Psychotherapy Versus Pharmacotherapy for Major Depressive Disorder: A Randomized, Placebo-Controlled Trial

Clinical Points
  • Among low-income, inner-city depressed patients, there is not much evidence supporting the efficacy of either pharmacotherapy or brief dynamic therapy in comparison with placebo.
  • There is some preliminary evidence that minority men improved more following dynamic therapy than following pharmacotherapy and placebo, whereas white men improved more following placebo than following other treatments.
  • Preliminary evidence also indicates that white women will improve more following pharmacotherapy or dynamic therapy than following placebo, whereas minority women improved similarly across treatments. Those results require replication.

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74 Executive Function Predicts Response to Antiaggression Treatment in Schizophrenia: A Randomized Controlled Trial

Clinical Points
  • Executive function is an important predictor of response to antiaggression treatment in patients with schizophrenia.
  • It is possible to customize treatment of aggression on the basis of the patient’s level of executive functioning.
  • Clozapine has a unique antiaggression profile, resulting in decreased violence even in patients with poor executive function prior to treatment.

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81 Omega-3 for Bipolar Disorder: Meta-Analyses of Use in Mania and Bipolar Depression

Clinical Points
  • Current evidence supports omega-3 in adjunctive treatment of bipolar depression.
  • Current evidence, however, does not support omega-3 in the adjunctive treatment of bipolar mania.
  • Clinicians are advised to recommend increased dietary omega-3 or daily supplementation of approximately 1 g to 1.5 g of mixed EPA and DHA (higher ratio of EPA).

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87 Factors Associated With the Persistence and Onset of New Anxiety Disorders in Youth With Bipolar Spectrum Disorders

Clinical Points
  • Anxiety disorders in youth with bipolar disorder tended to persist, and a substantial proportion of subjects developed new anxiety disorders.
  • Different factors, including the presence of severe or multiple anxiety disorders, ongoing mood symptoms, and comorbid disorders, were associated with the persistence and the onset of anxiety disorders. Early identification of factors may enable the development of strategies for treatment and prevention of anxiety disorders in bipolar youth.
  • Randomized controlled trials are warranted to evaluate the efficacy and tolerability of pharmacologic and psychosocial treatments for youth with comorbid bipolar disorder and anxiety disorders.

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95 Bupropion Sustained Release Added to Group Support for Smoking Cessation in Schizophrenia: A New Randomized Trial and a Meta-Analysis

103 Placebo-Controlled Adjunctive Trial of Pramipexole in Patients With Bipolar Disorder: Targeting Cognitive Dysfunction

Clinical Points
  • Many patients with bipolar disorder suffer from disabling neurocognitive impairment, yet this symptom domain has not been a common target for treatment.
  • Formal neurocognitive assessment and thorough clinical evaluation will be important in determining which patients with bipolar disorder might optimally benefit from cognitive intervention.
  • Although preliminary, our data are promising and suggest that improving neurocognitive functioning in patients with bipolar illness is a feasible ambition. Future studies of pramipexole and other agents will be important in continuing efforts to enhance treatment outcome and quality of life.

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21 Pretest

CME Activity

29 Posttest

 

22 The Role of Psychomotor Activation in Discriminating Unipolar From Bipolar Disorders: A Classification-Tree Analysis

Clinical Points
  • Our results support the role of lifetime psychomotor activation, as assessed by the Mood Spectrum Self-Report instrument, as the best discriminator of bipolar disorder from unipolar disorder.
  • The mixed instability factor contributed to the discrimination of bipolar from unipolar disorder in patients with intermediate levels of psychomotor activation.
  • Elevated mood (the euphoria factor) contributed to discrimination of bipolar from unipolar disorder in patients with low psychomotor activation scores.
  • The suicidality factor further discriminated bipolar from unipolar disorder.

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Review Article

37 Retinoic Acid and Affective Disorders: The Evidence for an Association

Case Report

51 Making Lemonade Out of Lemons: A Case Report and Literature Review of External Pressure as an Intervention With Pregnant and Parenting Substance-Using Women

Clinical Points
  • Pregnant and postpartum women are frequently exposed to external pressure to not use substances. The way in which pressure is applied in clinical situations can potentially influence the trajectory of the woman’s addiction, as well as her motivation to seek treatment and get prenatal care.
  • Providers should use external pressure to encourage pregnant and postpartum substance users to enter treatment in a collaborative and supportive manner. Confrontational strategies are less likely to be effective in addressing addiction, especially in this unique population.
  • Some strategies include (1) acknowledging individual women’s needs; (2) building positive, respectful relationships with patients; and (3) providing a range of resources that address their specialized barriers to treatment entry.

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Focus on Alzheimer’s Disease and Related Disorders

115 Metabolism of Amyloid-β Protein May Be Affected in Depression

Clinical Points
  • Changes in amyloid-β (Aβ) metabolism may be a biological factor in the transition from depression to Alzheimer’s disease (AD).
  • Clinicians should follow up even with younger patients with major depressive disorder (MDD) and consider them to be at high risk for AD.
  • Higher blood Aβ40/Aβ42 ratio in patients with MDD may be an index for future preventive therapy for AD, such as amyloid vaccination.

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121 Effect of Second-Generation Antipsychotics on Caregiver Burden in Alzheimer’s Disease

Clinical Points
  • Alzheimer’s disease (AD) imposes a severe burden on patients and their relatives, particularly those individuals directly responsible for patient care.
  • Psychiatric and behavioral symptoms are the main correlates of caregiver burden.
  • Among AD patients with symptoms of psychosis, agitation, or aggressive behavior, atypical antipsychotic medications may reduce agitation, suspiciousness, and psychosis enough to have significant, if small, impact on caregivers’ experience of burden.
  • Psychosocial interventions designed to improve patients’ quality of life, eg, through increased socialization and social interactions, are also important in reducing caregiver burden.

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Letter to the Editor

129 Propranolol, Traumatic Memories, and Amnesia: A Study of 36 Cases

Book Reviews

131 Teaching Mindfulness: A Practical Guide for Clinicians and Educators

131 Clinical Manual of Couples and Family Therapy

132 Clinical Manual of Electroconvulsive Therapy

132 Treating Child and Adolescent Depression

Psychiatrist.com Exclusives

Original Research

e134 The Course of Chronic Pain With and Without Psychiatric Disorders: A 6-Year Follow-Up Study From Childhood to Adolescence and Young Adulthood

Clinical Points
  • Chronic pain in most children in pediatric care is not self-limiting and is often accompanied by psychiatric disorders when they grow up.
  • Psychiatric care alongside standard medical care should be made available for children with chronic pain and impairing comorbid psychiatric disorders.

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Online Activities

e01 Using Adjunctive Treatments When First-Line Antidepressants Fail [CME]

e02 Identifying, Diagnosing, and Managing ADHD in College Students [CME]

e03 Diagnosing and Managing Patients With Dementia [CME]

e04 Assessing and Measuring Nonresponse in Schizophrenia [CME]

Information for Authors

see www.psychiatrist.com/author.htm