Volume 73March 2012Number 3

Original Research

292 Declining Benzodiazepine Use in Veterans With Posttraumatic Stress Disorder

Clinical Points
  • The frequency of benzodiazepine use among veterans with posttraumatic stress disorder declined substantially over the past decade, from 36.7% in 1999 to 30.6% in 2009.
  • Benzodiazepine dose and duration of use also decreased during this period.
  • Benzodiazepine use among veterans with posttraumatic stress disorder remains above 30% and presents an opportunity for further improvement in prescribing quality.

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297 Prescribing Trends in Veterans With Posttraumatic Stress Disorder

Clinical Points
  • Several clinically important trends in prescribing among veterans with posttraumatic stress disorder (PTSD) are highlighted and are generally consistent with the revised VA/Department of Defense Clinical Practice Guideline recommendations for management of PTSD.
  • The proportion of veterans receiving either of the 2 guideline-concordant pharmacotherapy treatments for PTSD, selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors, increased from 49.7% in 1999 to 58.9% in 2009.
  • Our findings suggest that in the later years of our study period, benzodiazepine prescribing decreases tracked best with increases in prazosin use, emphasizing the need to address chronic sleep trouble in veterans with PTSD.

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320 ARVCF Genetic Influences on Neurocognitive and Neuroanatomical Intermediate Phenotypes in Chinese Patients With Schizophrenia

Clinical Points
  • There is evidence for the role of the armadillo repeat gene deleted in velocardiofacial syndrome (ARVCF) as a susceptibility gene in schizophrenia.
  • Patients with more copies of the haplotype T-G-A-T-T-G-G-C-T-G-T (ARVCF-Hap1) have lower white matter integrity in caudate nucleus and greater perseverative errors.
  • These findings highlight the importance of imaging-genetic studies to clarify genetic influences underlying intermediate phenotypes in complex neurobehavioral disorders.

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327 Neural Correlates and Predictive Power of Trait Resilience in an Acutely Traumatized Sample: A Pilot Investigation

Clinical Points
  • Resilience can help predict recovery from an acute traumatic event.
  • Resilience mediates the relationship between childhood trauma and posttraumatic recovery.
  • Resilience is associated with activation of emotion regulation areas in the brain.

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333 Web-Based Assessment of Depression in Patients Treated in Clinical Practice: Reliability, Validity, and Patient Acceptance

Clinical Points
  • Standardized assessments of outcome should be used in clinical practice.
  • A Web-based administration of outcome measurement offers several potential advantages over paper-and-pencil assessments, such as patient convenience, reduced missing data, reduced costs, automatic scoring, and generation of large databases.
  • The result of this first study of a Web-based system of monitoring outcome in routine clinical practice supported the reliability, validity, and patient acceptability of the system.

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339 Gene-Temperament Interactions Might Distinguish Between Bipolar I and Bipolar II Disorders: A Cross-Sectional Survey of Han Chinese in Taiwan

Clinical Points
  • An initial study shows that 5-HTTLPR genotypes might moderate the association between harm avoidance and bipolar I and bipolar II disorder.
  • There appear to be unique differences in the gene-temperament interactions of bipolar I and bipolar II disorder patients.

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346 Understanding the Central Pharmacokinetics of Spheroidal Oral Drug Absorption System (SODAS) Dexmethylphenidate: A Positron Emission Tomography Study of Dopamine Transporter Receptor Occupancy Measured With C-11 Altropane

Clinical Points
  • The need to examine the relationship of plasma levels and dopamine transporter (DAT) occupancies in early and late times after administration is warranted given the concern about possible tachyphylaxis with a long-acting methylphenidate.
  • Plasma levels and the DAT occupancies were consistent with dose and a spheroidal oral drug absorption system (SODAS) formulation designed to release 2 equal pulses of dexmethylphenidate 4 hours apart.
  • The relationship of DAT occupancy to plasma dexmethylphenidate levels was similar at later hours in this long-acting formulation to those previously reported at peak in an immediate-release formulation.

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353 Efficacy of Dose Increase Among Nonresponders to Low-Dose Aripiprazole Augmentation in Patients With Inadequate Response to Antidepressant Treatment: A Randomized, Double-Blind, Placebo-Controlled, Efficacy Trial

Clinical Points
  • Atypical antipsychotics are being used more frequently as augmentation therapy in cases of inadequate response to standard antidepressants. Several studies have supported the efficacy and safety of aripiprazole augmentation at doses of up to 15 mg/d. Given the concern over side effects, it is worth investigating whether lower doses are also effective as augmentation.
  • We examined 2 low-dose regimens of aripiprazole (2 mg/d for 30 days, followed by 5 mg/d for 30 days) as augmentation therapy in partial and nonresponders to selective serotonin reuptake inhibitor or serotonin-norepinephrine reuptake inhibitor antidepressants.
  • Both regimens were well tolerated but provided only marginal benefit. However, the 5-mg/d dose alleviated depressive symptoms in a modest number of patients who did not respond adequately to 2 mg/d. Starting aripiprazole at lower doses in antidepressant partial responders could be considered if patients are worried about side effects and rapid response is not urgent.

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367 Analysis of Gene Variants Previously Associated With Iloperidone Response in Patients With Schizophrenia Who Are Treated With Risperidone

Clinical Points
  • Six gene variants have previously been reported to be associated with iloperidone response in patients with schizophrenia.
  • Two of these variants were also found to be associated with risperidone response.
  • Additional analyses with other antipsychotics are needed to determine whether these variants are generalized predictors of response.

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372 Trauma at the Hands of Another: Longitudinal Study of Differences in the Posttraumatic Stress Disorder Symptom Profile Following Interpersonal Compared With Noninterpersonal Trauma

Clinical Points
  • Survivors of different types of trauma experience different posttraumatic stress disorder (PTSD) symptom profiles and trajectories.
  • Interpersonal trauma survivors are more likely to suffer ongoing problems with fear- and threat-based responses than survivors of noninterpersonal trauma.
  • Clinicians may need to target these symptoms in order to achieve optimal outcomes for the interpersonal PTSD patient.

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377 Insomnia as a Risk for Depression: A Longitudinal Epidemiologic Study on a Japanese Rural Cohort

Clinical Points
  • Patients with chronic insomnia are highly likely to develop and sustain depression.
  • Current evidence best supports the position that early intervention for insomnia patients with 7.5 or higher score on the Pittsburgh Sleep Quality Index can be helpful for the prevention, onset, and relapse of depression.

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384 Gender, HIV Status, and Psychiatric Disorders: Results From the National Epidemiologic Survey on Alcohol and Related Conditions

Clinical Points
  • Psychiatric disorders are highly prevalent in adults with HIV.
  • HIV status is significantly more strongly associated with psychiatric disorders in men than in women.
  • Routine psychiatric assessments of patients receiving HIV treatment might help to identify psychiatric disorders in HIV-positive individuals.

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Commentaries

304 Emerging Bias in the Treatment of Posttraumatic Stress Disorder

307 Benzodiazepines, Posttraumatic Stress Disorder, and Veterans: Good News and Why We’re Not Done Yet

310 Pretest

CME Activity

318 Posttest

 

311 How Successful Are Physicians in Eliciting the Truth From Their Patients? A Large-Scale Internet Survey From Patients’ Perspectives

For Clinical Use
  • Among responders with depression, about 70% reported that they had withheld the truth from their physicians.
  • A logistic regression model found significant associations of such behavior with female sex, younger age, and a lower degree of satisfaction in patient-physician communication.
  • Female patients were less likely than male patients to disclose the facts concerning “adherence to prescribed medication” and “figures such as body temperature and weight.”
  • A good patient-physician alliance is needed to gather relevant information toward successful depression treatment.

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Review Article

358 How Informative Are Open-Label Studies for Youth With Bipolar Disorder? A Meta-Analysis Comparing Open-Label Versus Randomized, Placebo-Controlled Clinical Trials

Clinical Points
  • While expensive and time consuming, the randomized placebo-controlled design continues to be the gold standard for asserting the safety and efficacy of drugs in humans.
  • Open-label studies are useful predictors of the potential safety and efficacy of compounds for the treatment of pediatric bipolar disorder.
  • Our results indicate that open-label studies can provide valid estimates of the treatment effects that would be captured in a randomized double-blind clinical trial and help inform if one is worth pursuing.

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Case Report

366 Successful Monitoring of Fluoxetine-Induced Nocturnal Bruxism: A Case Report

Focus on Alzheimer’s Disease and Related Disorders

392 The Relationships of Environment and Personal Characteristics to Agitated Behaviors in Nursing Home Residents With Dementia

Clinical Points
  • Nonpharmacologic interventions for physical agitation in persons with dementia should include activities and engaging stimuli.
  • Caregivers should use every opportunity to engage in one-on-one pleasant verbal contact with the person with dementia in order to prevent agitation.
  • In addition to the significant impact of personal attributes on agitation, engagement with stimuli has an independent and potent role in the extent to which agitation is manifested.

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Book Reviews

400 Memory, War and Trauma

400 Handbook of Clinical Sexuality for Mental Health Professionals, 2nd ed

401 Behavioral and Psychopharmacologic Pain Management

Correction

401 Challenges and solutions in developing new medications for schizophrenia [Academic Highlights] (J Clin Psychiatry 2010;71[10]:1391–1399)

Psychiatrist.com Exclusives

Original Research

e402 Cost-Effectiveness of 12-Month Therapeutic Assertive Community Treatment as Part of Integrated Care Versus Standard Care in Patients With Schizophrenia Treated With Quetiapine Immediate Release (ACCESS Trial)

Clinical Points
  • Diagnosis specific interventions based on Assertive Community Treatment (ACT) lead to better outcomes at comparable costs in patients with psychosis.
  • The superior effectiveness of ACT is highly dependent on the specification of the ACT model and the standard of care.
  • The superiority of ACT can be achieved only by an avoidance of hospitalizations, due to high quality and quantity of outpatient care with a combination of case management and home treatment as is provided by ACT.

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Free Online Activities

e09 Shift Work Disorder: Overview and Diagnosis

e10 Management of Fibromyalgia in Primary Care [CME]

e11 Understanding Antidepressant Mechanism of Action and Its Effect on Efficacy and Safety [CME]

e12 A Review of Current Bipolar Disorder Treatment Guidelines [CME]

Information for Authors

see www.psychiatrist.com/author.htm