Volume 73May 2012Number 5

Original Research

610 Statin Use and Risk of Depression in Patients With Coronary Heart Disease: Longitudinal Data From the Heart and Soul Study

Clinical Points
  • Although beneficial effects of statins for cardiovascular disease are well established, their effects on depressive symptoms are unknown.
  • In this study of patients with coronary heart disease, use of statins was associated with a decreased risk of exhibiting depressive symptoms both in cross-sectional and longitudinal analyses.
  • In patients free of depressive symptoms at baseline, statin use at baseline was associated with a 38% reduced risk of developing depression during 6 years of follow-up.

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617 Aripiprazole Intramuscular Depot as Maintenance Treatment in Patients With Schizophrenia: A 52-Week, Multicenter, Randomized, Double-Blind, Placebo-Controlled Study [free access]

Clinical Points
  • Oral aripiprazole is an effective maintenance treatment for schizophrenia and has a favorable long-term safety profile with a low potential for metabolic side effects.
  • Long-acting injectable antipsychotics offer an alternative to oral treatment and relieve patients from the daily need to take medication.
  • The new IM-depot formulation of aripiprazole is effective for preventing relapse in schizophrenia and represents an alternative treatment option with a safety profile similar to oral aripiprazole.

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625 Brain-Volume Increase With Sustained Remission in Patients With Treatment-Resistant Unipolar Depression

Clinical Points
  • Achieving sustained remission, not merely receiving medication treatment, may prevent brain-volume loss in depression.
  • Using combinations of 2–3 medications is often necessary to achieve remission in depression, as in other medical illnesses.
  • Remission of depression can be achieved using combinations of medications with different mechanisms of action.

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632 Continued Cannabis Use and Outcome in First-Episode Psychosis: Data From a Randomized, Open-Label, Controlled Trial

Clinical Points
  • Cannabis use should be discouraged after onset of a first-episode psychosis.
  • Motivational interviewing and cognitive-behavioral therapy or psychoeducation can be effective.
  • Patients can be unaware of the long-term detrimental effects because of perceived short-term positive effects of cannabis.

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647 Evaluation of the Glycine Transporter Inhibitor Org 25935 as Augmentation to Cognitive-Behavioral Therapy for Panic Disorder: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial

654 A Randomized, Double-Blind, Placebo-Controlled Study Evaluating the Safety and Efficacy of Varenicline for Smoking Cessation in Patients With Schizophrenia or Schizoaffective Disorder

Clinical Points
  • Individuals with schizophrenia exhibit high rates of smoking and more difficulty with quit attempts compared with the general population, and effective smoking cessation treatments are needed.
  • Varenicline has proven efficacy for smoking cessation in the general population; however, postmarketing reports have revealed neuropsychiatric symptoms in some patients.
  • The findings of this study suggest that varenicline may be a well-tolerated and efficacious smoking cessation therapy for patients with schizophrenia or schizoaffective disorder.

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661 Safety of Selegiline Transdermal System in Clinical Practice: Analysis of Adverse Events From Postmarketing Exposures

Clinical Points
  • Current evidence based on data from a postmarketing surveillance system supports the safety and tolerability of the use of selegiline transdermal system (STS) in routine clinical practice for patients with major depressive disorder (MDD).
  • STS represents another possible option for clinicians to use in treating patients with MDD, in particular those who have compliance issues such as difficulty in using oral formulations.

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669 Effectiveness of Switching From Long-Acting Injectable Fluphenazine or Haloperidol Decanoate to Long-Acting Injectable Risperidone Microspheres: An Open-Label, Randomized Controlled Trial

Clinical Points
  • People who switch from haloperidol decanoate or fluphenazine decanoate to risperidone microspheres can be expected to discontinue treatment more frequently than if they had stayed on the original medication.
  • People who switch from haloperidol decanoate or fluphenazine decanoate to risperidone microspheres can be expected to experience significant weight gain and increases in prolactin.

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684 New Evidence for the Involvement of Mitochondrial Inheritance in Schizophrenia: Results From a Cross-Sectional Study Evaluating the Risk of Illness in Relatives of Schizophrenia Patients

Clinical Points
  • Mitochondrial DNA is shared among matrilineal relatives, and the risk of developing schizophrenia is higher in matrilineal than non-matrilineal relatives of a schizophrenia patient.
  • Female matrilineal relatives of a schizophrenia patient are at high risk of presenting with a depressive or anxiety disorder.
  • Detection of high-risk individuals leads to the development of early intervention programs that have been shown to improve both prognosis and disease progression.

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691 Relationship Between Serum Homocysteine Levels and Depressive Symptoms: The Cooper Center Longitudinal Study

Clinical Points
  • Elevated homocysteine levels, assessed with a simple blood test, are associated with the presence of current clinically significant depressive symptoms.
  • Given the association of elevated homocysteine levels with medical illnesses, depressed patients may be an important clinical population for homocysteine level screening.
  • Screening for depression in patients with elevated homocysteine levels may also be indicated.

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696 Cost and Cost-Effectiveness in a Randomized Trial of Long-Acting Risperidone for Schizophrenia

Clinical Points
  • Long-acting injectable (LAI) risperidone was compared to oral agents in unstable schizophrenia.
  • LAI risperidone added $4,060 annual pharmacy costs without a significant clinical benefit.
  • Excluding LAI risperidone from formularies would save drug cost without affecting patient welfare.

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703 Poor Sleep at Baseline Predicts Worse Mood Outcomes in Patients With Co-Occurring Bipolar Disorder and Substance Dependence

Clinical Points
  • Sleep disturbances in patients with co-occurring bipolar disorder and substance use disorder are extremely common.
  • Evaluation of sleep disturbances at baseline may be useful as a prognostic factor for mood outcomes in patients with co-occurring bipolar and substance use disorders; patients with worse sleep problems have poorer outcomes.

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Perspectives

616 “On Paroxysmal Anxiety” by Édouard Brissaud (1890)

639 Pretest

CME Activity

645 Posttest

 

640 Managing Psychiatric Issues in Elite Athletes [Review Article]

For Clinical Use
  • Although elite, professional sports teams have large medical and nonmedical staff (sometimes including psychologists) to improve performance, there has been an almost complete absence of psychiatrists to diagnose and treat psychiatric problems and disorders—in part because of the stigma of mental illness.
  • Active and retired athletes have psychiatric problems and disorders like nonathletes and require diagnosis and treatment to function in their sport and in the rest of their lives. Some modifications (depending on the clinical situation) of standard psychiatric interventions may be necessary.

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Review Article

676 Does the Presence of an Open-Label Antidepressant Treatment Period Influence Study Outcome in Clinical Trials Examining Augmentation/Combination Strategies in Treatment Partial Responders/Nonresponders With Major Depressive Disorder?

Clinical Points
  • The use of an antidepressant lead-in phase to assess treatment nonresponse does not enhance the ability to detect a statistically significant treatment effect in randomized controlled trials of augmentation/combination trials for treatment-resistant depression.
  • The choice to rely on historical data only to assess treatment nonresponse and to allow patients with treatment-resistant depression to be randomized without having to go through a prospective lead-in phase is a reasonable and evidence-supported approach that results in lower cost of the trial and quicker time to completion.

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Focus on Childhood and Adolescent Mental Health

709 Associated Symptoms of Attention-Deficit/Hyperactivity Disorder and Posttraumatic Stress Disorder

711 Comorbid Symptom Severity in Attention-Deficit/Hyperactivity Disorder: A Clinical Study

Clinical Points
  • Subthreshold comorbid internalizing (anxiety and depression) symptoms that do not rise to the level of diagnostic criteria are highly prevalent in referred children who meet diagnostic criteria for ADHD.
  • Children referred for psychiatric treatment of ADHD have more severe problems with other disruptive behaviors, including aggression and delinquency, than children referred for treatment of internalizing disorders.
  • Clinical evaluation and treatment planning with children and adolescents referred for ADHD should address not only the core ADHD symptoms of inattention, impulsivity, and hyperactivity but also a range of internalizing emotional symptoms and externalizing behavior and aggression problems.

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Letters to the Editor

718 Evidence for Short-Term Psychodynamic Psychotherapy for Depression

720 Allergic Reactions and Sudden Death With Asenapine

Book Reviews

722 Mental Health in Public Health: The Next 100 Years

722 Classics of Community Psychiatry: Fifty Years of Public Mental Health Outside the Hospital

723 Psychiatry and Clinical Neuroscience: A Primer

723 MÉTIS: Mixed Blood Stories

Psychiatrist.com Exclusives

Original Research

e574 Effect of Tryptophan Hydroxylase Gene Polymorphism on Aggression in Major Depressive Disorder and Undifferentiated Somatoform Disorder

Clinical Points
  • Levels of aggression in patients with major depressive disorder (MDD) may be differentiated by a genetic method.
  • Genetic examination in patients with MDD may lead to better assessment, treatment, and prevention of aggression.
  • Clinicians can use these findings as the rationale for continuous psychopharmacologic treatment in potentially aggressive patients with MDD.

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e588 A Longitudinal Investigation of the Role of Self-Medication in the Development of Comorbid Mood and Drug Use Disorders: Findings From the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

Clinical Points
  • Using drugs to self-medicate mood symptoms increases a person’s risk of developing drug dependency within 3 years.
  • Self-medication accounts for one-quarter of new cases of drug dependence among people with mood disorders.

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Review Article

e580 Overview of Violence to Self and Others During the First Episode of Psychosis

Clinical Points
  • There appears to be a significantly increased risk of violence to self and others in the first episode of psychosis compared to later in the illness.
  • Earlier treatment of first-episode psychosis patients could reduce the rates of suicide, homicide, and nonlethal violence to self or others.
  • The high rates of violence and suicidal behavior in the first episode of psychosis suggest the need to reconsider the thresholds for involuntary treatment for first-episode patients.

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Focus on Childhood and Adolescent Mental Health

e594 A 30-Month Prospective Follow-up Study of Psychological Symptoms, Psychiatric Diagnoses, and Their Effects on Quality of Life in Children Witnessing a Single Incident of Death at School

Clinical Points
  • The posttraumatic stress symptom severity declined with time, whereas depressive symptom severity increased mildly with time.
  • At 30 months after exposure to trauma, the children’s quality of life and parents’ rearing stress were associated with the severity of children’s depressive symptoms.
  • Careful assessment and management of depressive symptoms is warranted for children exposed to a single trauma.

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Practical Psychopharmacology
NEW COLUMN

e601 Selective Serotonin Reuptake Inhibitors and Persistent Pulmonary Hypertension of the Newborn [FREE to registered users]

Free Online Activities

e17 Advancing the Treatment of Depression With Personalized Medicine [CME]

e18 Performance Improvement CME: Diagnosing and Treating Bipolar Disorder [CME]

e19 The Use of MAOIs in Primary Care [CME]

Information for Authors

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