Volume 73February 2012Number 2

Original Research

144 Predictors of Psychiatric Inpatient Suicide: A National Prospective Register-Based Study

Clinical Points
  • Patients who attempted suicide in the week before psychiatric admission had a 5-fold higher risk of inpatient suicide compared with patients who did not have a recent suicide attempt.
  • Patients with the highest level of education had an increased risk of inpatient suicide compared with patients with a lower level of education.
  • Fifty-eight percent of the completed inpatient suicides occurred outside the hospital among patients who either were taking an agreed-upon leave or had absconded from the hospital.

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152 Epidemiology of Fears and Specific Phobia in Adolescence: Results From the Mexican Adolescent Mental Health Survey

Clinical Points
  • The high prevalence of specific phobia in adolescents coupled with high comorbidity and lack of treatment-seeking expressly for specific phobia suggests that many adolescents in psychiatric treatment may suffer from specific phobia even though the disorder is not the consultation motive or presenting complaint.
  • Youth seeking psychiatric services should be evaluated for specific phobia given that the disorder is persistent and highly comorbid and that few seek treatment specifically for it despite the existence of effective treatments.

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159 The Relation of Serotonin-Related Gene and COMT Gene Polymorphisms With Criminal Behavior in Schizophrenic Disorder

Clinical Points
  • Levels of criminality in schizophrenic patients may be differentiated by a genetic method.
  • Genetic examination in schizophrenic patients may lead to a better assessment and treatment for aggression followed by prevention of criminal behavior.
  • Clinicians can refer potentially aggressive patients to therapists who are experts in aggression.

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185 Early Response and Remission as Predictors of a Good Outcome of a Major Depressive Episode at 12-Month Follow-Up: A Prospective, Longitudinal, Observational Study

Clinical Points
  • Potential predictors of clinical outcome of major depression in adults have been studied with inconclusive results. The observation of cohorts of patients in real-world conditions over a long period of time would offer new and relevant information about the prognosis of the illness.
  • In this study, early (within 6 weeks) response and remission were strongly associated with a good outcome in the clinical course of major depression at 12-month follow-up; other factors associated with a good outcome were being employed and the absence of physical comorbidities.
  • Furthermore, having early response and remission had a strong association with better social and occupational functionality and, in the case of early response, also with better quality of life.

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192 Lifespan Persistence of ADHD: The Life Transition Model and Its Application

Clinical Points
  • For many individuals, attention-deficit/hyperactivity disorder (ADHD) spans from childhood through adult life, resulting in ongoing impairments and functional impact.
  • Optimal management requires an understanding of the presentation of symptoms and impairments within developmental phases and changing environmental demands.
  • The ADHD Life Transition Model is aimed at raising awareness of phase-specific presentations and providing a basis for developing rational, prospective approaches to the symptoms and impairments at each transition phase.

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202 Impact of Deleting 5 DSM-IV Personality Disorders on Prevalence, Comorbidity, and the Association Between Personality Disorder Pathology and Psychosocial Morbidity

Clinical Points
  • The deletion of 5 personality disorders, as recommended by the DSM-5 Personality and Personality Disorders Work Group, does not eliminate diagnostic comorbidity.
  • The deletion of 5 personality disorders may result in increased rates of personality disorder not otherwise specified diagnoses, signaling a problem with the nosology that was not adequately solved by removing these disorders.
  • Comorbidity rates may decline by virtue of classification of fewer disorders; however, without empirical evidence supporting such changes, the removal of disorders may lead to false-negative diagnoses.

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208 Bereavement and the Diagnosis of Major Depressive Episode in the National Epidemiologic Survey on Alcohol and Related Conditions

Clinical Points
  • Depressive episodes following bereavement are excluded from a DSM-IV diagnosis unless they are prolonged or complicated.
  • In a population-based sample, individuals with bereavement-related depression had fewer external indicators of psychopathology than individuals with depression that was unrelated to bereavement.
  • There was no evidence to support the diagnostic distinction between complicated bereavement and bereavement not identified as complicated.

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216 Assessment of Treatment Algorithms Including Amantadine, Metformin, and Zonisamide for the Prevention of Weight Gain With Olanzapine: A Randomized Controlled Open-Label Study

Clinical Points
  • Weight gain has been very commonly reported during olanzapine treatment.
  • We observed no significant difference on the primary outcome measure for this study: difference in weight gain between olanzapine monotherapy and the pooled results for the 2 weight gain treatment algorithms.
  • Participants who initiated on metformin (500–1,500 mg/d), progressing as needed to amantadine (200 mg/d) and then to zonisamide (100–400 mg/d), experienced significantly less weight gain than participants on olanzapine monotherapy.

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224 Epidemiology of Major Depression With Atypical Features: Results From the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

Clinical Points
  • Individuals with a major depressive episode (MDE) with atypical features can be distinguished from individuals without them based on the presence of 1 or both reversed vegetative symptoms (ie, hypersomnia or hyperphagia).
  • An MDE with atypical features (ie, presence of reversed vegetative symptoms) is associated with greater rates of lifetime psychiatric comorbidity, number of episodes, individual episode severity, disability, and suicide attempts than an episode without those features.
  • Individuals with an MDE with atypical features had significantly higher rates of bipolar I disorder than those without atypical features.

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164 Pretest

CME Activity

174 Posttest

 

165 Results of the Search for Personality Disorder Screening Tools: Clinical Implications

For Clinical Use
  • It is advisable to screen for personality disorder in a psychiatric outpatient population.
  • The most cost-efficient and effective screening instruments are the self-report form of the Standardized Assessment of Personality-Abbreviated Scale (SAPAS-SR) and the Iowa Personality Disorder Screen (IPDS).
  • These 2 screening instruments raise the a priori chance of detecting a personality disorder from 50% to between 80% and 84% for patients in a psychiatric outpatient population.

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Case Report

176 Risperidone-Induced Dislocation of the Temporomandibular Joint

Review Article

177 The Clinical Process in Psychiatry: A Clinimetric Approach

Clinical Points
  • Exclusive reliance on diagnostic criteria has impoverished the clinical process and does not reflect the complex thinking that underlies decisions in psychiatric practice.
  • The accuracy of clinical judgment can be greatly increased with specific strategies: global formulations, staging methods, and a better organization of clinical information (encompassing macroanalysis and microanalysis).
  • The concept of disease is no longer adequate to guide psychiatric care; therefore, clinical decision making should be addressed to attainment of individual goals.

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Focus on Women’s Mental Health

233 The Tenets of Perinatal Psychiatry

235 The Effect of Sertraline Add-On to Brief Dynamic Psychotherapy for the Treatment of Postpartum Depression: A Randomized, Double-Blind, Placebo-Controlled Study

Clinical Points
  • Sertraline as an adjunctive treatment to psychotherapy may confer no added advantage over brief dynamic psychotherapy alone in women suffering from mild-to-moderate postpartum depression.
  • When treating women suffering from moderate postpartum depression, clinicians should consider an initial intervention with brief dynamic psychotherapy alone before initiating antidepressant treatment.
  • If treatment with a selective serotonin reuptake inhibitor is initiated for postpartum depression, a relatively high dose may be warranted for clinical efficacy.

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242 Comparison of Women With Confirmed Versus Presumably Misdiagnosed Bipolar Disorder

Clinical Points
  • Accurate diagnosis of bipolar disorder in women prior to pregnancy is especially important for maximizing maternal and fetal well-being.
  • Among young women previously diagnosed with bipolar disorder, a history of antidepressant-associated mania/hypomania provides particularly strong support for a diagnosis of bipolar disorder.
  • Among young women previously diagnosed with bipolar disorder, early onset of the disorder and a history of substance use disorder complicate efforts to confirm the diagnosis.

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247 Maternal Depression and Anxiety Differentially Impact Fetal Exposures During Pregnancy

Clinical Points
  • Maternal depression or anxiety during pregnancy is associated with poorer compliance with prenatal vitamins and with increased fetal exposure to numerous substances, including tobacco, hypnotics, antiemetics, opioid analgesics, and benzodiazepines.
  • The risk-benefit assessment for managing prenatal depression and anxiety must consider the risks of fetal exposure to these other substances.

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Letters to the Editor

252 Comments on a Consensus Regarding Diagnostic Criteria for Neuroleptic Malignant Syndrome

252 Observations From 8 Cases of Clozapine Rechallenge After Development of Myocarditis

Book Reviews

255 Clinical Manual for Treatment of Alcoholism and Addictions

255 Clinical Manual for Management of PTSD

255 Impulse Control Disorders

256 Handbook of Office-Based Buprenorphine Treatment of Opioid Dependence

Psychiatrist.com Exclusives

Commentary

e257 Independent Data and Safety Monitoring in Psychiatric Intervention Research

Clinical Points
  • A data and safety monitoring board is not only concerned with participant safety and trial integrity, but ultimately could protect patients seeking treatment for the disorder being studied.
  • Placebo adverse event data provide safety monitors with background event rates. Those rates are compared with rates among participants randomized to the investigational agent.

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Original Research

e264 The Stressor Criterion for Posttraumatic Stress Disorder: Does It Matter?

Clinical Points
  • Persons experiencing non-DSM events may meet all other criteria for posttraumatic stress disorder (PTSD).
  • Trauma-focused cognitive-behavioral therapies such as prolonged exposure and cognitive processing therapy are highly effective for PTSD. Patients experiencing PTSD symptoms from non-DSM events such as financial crisis or divorce may benefit from these treatments.
  • Among patients with PTSD, the physical and mental health sequelae of PTSD do not differ by triggering event.

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e271 Risk Factors for Antidepressant-Related Switch to Mania

Clinical Points
  • In clinical practice, up to one-quarter of patients with bipolar depression may have a switch into mania, hypomania, or mixed episodes during treatment with any type of antidepressant, even in the context of concomitant antimanic treatment.
  • Antidepressant-associated switch risk into mania, hypomania, or mixed episodes is more likely to occur in patients with an earlier age at onset and an illness course characterized by lower rate of response to antidepressants and higher rate of previous switches. Greater number of previous antidepressant exposures was not associated with the occurrence of an antidepressant-associated switch.
  • A history of psychosis may actually protect against switch.

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Review Article

e277 Sponsorship, Antidepressant Dose, and Outcome in Major Depressive Disorder: Meta-Analysis of Randomized Controlled Trials

Clinical Points
  • Clinicians need to be aware that trial design factors may influence randomized controlled trial results.
  • Dosing is an important factor.
  • Clinicians looking to trial results to decide whether they want to use a new medication should pay attention to comparator medication dosing and whether patients were dosed adequately.

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Free Online Activities

e05 How the Circadian Rhythm Affects Sleep, Wakefulness, and Overall Health: Background for Understanding Shift Work Disorder

e06 Diagnosing Bipolar Disorder: Signs and Symptoms [CME]

e07 Addressing Nonresponse in Schizophrenia [CME]

e08 Strategies for Increasing Treatment Adherence in Bipolar Disorder [CME]

Information for Authors

see www.psychiatrist.com/author.htm