Volume 73June 2012Number 6

Original Research

778 Suicidal Risk Factors in Bipolar I and II Disorder Patients

Clinical Points
  • Suicidal risk was remarkably similar in types I and II bipolar disorder patients.
  • Manic-depressive mixed-state recurrences were especially strongly associated with suicidal risk.
  • Suicidal risk also was associated with melancholic depression and more trials of antidepressants.

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783 A Randomized Pilot Study of the Efficacy and Safety of ABT-089, a Novel α4β2 Neuronal Nicotinic Receptor Agonist, in Adults With Attention-Deficit/Hyperactivity Disorder

Clinical Points
  • Over 90% of adults with attention-deficit/hyperactivity disorder (ADHD) have some form of cognitive dysfunction.
  • α4β2 Neuronal nicotinic receptors are involved in cognitive processing, suggesting potential use of α4β2 agonists in cognitive disorders.
  • Although well tolerated, the α4β2 neuronal nicotinic receptor partial agonist ABT-089 did not demonstrate statistical significance on efficacy measures in ADHD.

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790 Why Do Some Depressed Outpatients Who Are in Remission According to the Hamilton Depression Rating Scale Not Consider Themselves to Be in Remission?

Clinical Points
  • Approximately one-half of depressed patients scoring in the remission range on the Hamilton Depression Rating Scale (HDRS) did not consider themselves to be in remission from their depression.
  • Remission is a broader construct than symptom level, a construct that includes other indicators of clinical status such as functioning, quality of life, resiliency in coping with stress, and a general sense of well-being.
  • That such a high proportion of HDRS remitters did not consider themselves to be in remission raises questions about the validity of the HDRS definition of remission.

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796 A Randomized, Double-Blind, Placebo-Controlled Trial of Modafinil for the Treatment of Apathy in Individuals With Mild-to-Moderate Alzheimer’s Disease

Clinical Points
  • Apathy is a debilitating neuropsychiatric symptom in Alzheimer’s disease for which no effective treatments have been identified.
  • Modafinil did not appear to significantly impact apathetic symptomatology in patients with mild-to-moderate stage Alzheimer’s disease.

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813 Familial and Individual Correlates of Nonsuicidal Self-Injury in the Offspring of Mood-Disordered Parents

Clinical Points
  • Both suicidal behavior and nonsuicidal self-injury share some common risk factors, namely, mood disorder, impulsivity, and impulsive aggression.
  • Familial factors appear to play a more significant role in suicidal behavior than in nonsuicidal self-injury.
  • Treatment of mood disorder is a critical intervention that may reduce subsequent occurrences of nonsuicidal self-injury.

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821 A Longitudinal Study of Nonsuicidal Self-Injury in Offspring at High Risk for Mood Disorder

Clinical Points
  • Clinicians should assess for both suicidal behavior and nonsuicidal self-injury in patients with mood disorder and suicidal ideation.
  • The presence of either behavior should alert the clinician about an increased risk for the complementary self-destructive behavior.
  • Treatment of mood disorder and improvement in emotion-regulation skills are important for the relief of both behaviors, but in adolescents, the role of impulsive aggression and of family difficulties may be more salient for suicidal behavior than nonsuicidal self-injury.

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829 Risks for the Transition From Major Depressive Disorder to Bipolar Disorder in the National Epidemiologic Survey on Alcohol and Related Conditions

Clinical Points
  • Individuals with major depressive disorder (MDD) are at elevated risk for a manic episode and thus diagnostic conversion from MDD to bipolar I disorder.
  • Lower educational attainment, a history of anxiety disorders, and both past-year and childhood psychosocial stressors predicted the development of mania in a population-based sample of individuals with MDD.
  • The ability of all of these factors combined to predict diagnostic conversion to bipolar I disorder is modest.

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837 Clozapine-Induced Agranulocytosis in Finland, 1982–2007: Long-Term Monitoring of Patients Is Still Warranted

Clinical Points
  • This study shows that 40% of all the patients with agranulocytosis, and 80% of those with fatal agranulocytosis, had received, concomitantly with clozapine, other medication associated with agranulocytosis.
  • Concomitant treatment with other potentially agranulocytosis-inducing drugs may be a risk factor during clozapine therapy. New treatment guidelines may be warranted to enhance patient safety.

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843 Bioavailability of S-Adenosyl Methionine and Impact on Response in a Randomized, Double-Blind, Placebo-Controlled Trial in Major Depressive Disorder

Clinical Points
  • Clinicians are concerned about the risk of homocysteine elevation and potential cardiac risk from administration of S-adenosyl methionine (SAMe).
  • In depressed patients who received 1,600 mg/d of SAMe augmentation, we found no significant elevation of plasma levels of total homocysteine.
  • SAMe at 1,600 mg/d appears to be safe to administer to patients with depression.

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849 The Renin-Angiotensin Pathway in Posttraumatic Stress Disorder: Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers Are Associated With Fewer Traumatic Stress Symptoms

Clinical Points
  • Certain hypertension medications may have protective effects on stress-related disorders, such as PTSD.
  • Results from this preliminary study suggest that targeting the renin-angiotensin system through available medications may have protective effects on PTSD symptoms among patients exposed to traumatic events.
  • Further research is needed to examine whether ACE inhibitors and angiotensin receptor blockers can prevent PTSD or reduce symptom severity in at-risk populations.

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865 Differences Among Major Depressive Disorder With and Without Co-occurring Substance Use Disorders and Substance-Induced Depressive Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions

Clinical Points
  • The combination of major depressive disorder and substance use disorder (MDD-SUD) is common and associated with higher severity and rates of comorbidity than MDD alone.
  • Substance-induced depressive disorder (SIDD) has low prevalence and may have similar risk factors and clinical presentation as MDD-SUD.
  • Failure to treat depressive symptoms in SIDD may be associated with higher rates of substance use to relieve depressive symptoms.

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874 Co-occurrence of Serious or Undiagnosed Medical Conditions With Bipolar Disorder Preventing Clinical Trial Randomization: A Case Series

Clinical Points
  • Patients with bipolar disorder often have co-occurring general medical conditions.
  • Research suggests that these patients may frequently be unaware of their conditions.
  • Clinicians can better treat patients with bipolar disorder by carefully screening for other medical conditions even when a patient does not report any.

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878 Association of Common Variations in the Norepinephrine Transporter Gene With Response to Olanzapine-Fluoxetine Combination Versus Continued-Fluoxetine Treatment in Patients With Treatment-Resistant Depression: A Candidate Gene Analysis

Clinical Points
  • If genetic associations can be replicated, they might allow for clinically useful predictive testing to guide antidepressant response.
  • Some patients may be nonresponsive to fluoxetine monotherapy, due to minimal effects on norepinephrine, but responsive to olanzapine augmentation.

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802 Pretest

CME Activity

811 Posttest

 

803 A Randomized Controlled Trial of Psychoeducation or Cognitive-Behavioral Therapy in Bipolar Disorder: A Canadian Network for Mood and Anxiety Treatments (CANMAT) Study

For Clinical Use
  • Psychosocial interventions provide modest but definite effect in improving mood stability in bipolar disorder.
  • Research comparing different interventions shows that brief, well-planned group psychoeducational interventions can be as effective as longer, individual cognitive-behavioral therapy (CBT) for bipolar disorder.
  • Brief group psychoeducation requires less staff training and is more cost-efficient than longer, individual CBT for bipolar disorder.

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Review Article

856 Exploratory Analyses of Efficacy Data From Schizophrenia Trials in Support of New Drug Applications Submitted to the US Food and Drug Administration

Clinical Points
  • Of great concern in schizophrenia trials conducted in North America are
  • A high and increasing placebo response and
  • A diminishing treatment effect.

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Book Reviews

886 Immigration and Acculturation: Mourning, Adaptation, and the Next Generation

886 Autism Spectrum Disorder

887 Schizophrenia: The Final Frontier. A Festschrift for Robin M. Murray

887 When Psychopharmacology Is Not Enough: Using Cognitive Behavioral Therapy Techniques for Persons With Persistent Psychosis

888 Schizophrenia: Current Science and Clinical Practice

Online Exclusives

Practical Psychopharmacology
NEW COLUMN

e725 Schizophrenia and Smoking [FREE to registered users]

Clinical Points
  • Smoking induces the CYP1A2 enzyme, leading to reduced levels of olanzapine, clozapine, and other drugs metabolized by CYP1A2.
  • This article gives guidance on clinical issues that may arise in the treatment of patients with schizophrenia who smoke.

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Original Research

e728 A Multicenter, Add-On Randomized Controlled Trial of Low-Dose d-Serine for Negative and Cognitive Symptoms of Schizophrenia

Clinical Points
  • Recent findings suggest that positive and negative symptoms and cognitive deficits in schizophrenia might arise from impairment in N-methyl-d-aspartate (NMDA) neurotransmission.
  • d-Serine is a naturally occurring allosteric modulator of the NMDA receptor complex.
  • This large, double-blind, randomized controlled trial of add-on d-serine showed no improvement in negative or cognitive symptoms of schizophrenia.

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e735 Predicting Suicide Attempts With the SAD PERSONS Scale: A Longitudinal Analysis

Clinical Points
  • Clinicians should not rely solely on the SAD PERSONS scale to assess suicide attempt risk.
  • Previous suicide attempts and psychiatric care remain strong risk factors for future suicide attempts.
  • Risk scales should be evaluated before widespread clinical implementation.

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e749 Weight Change From 3-Year Observational Data: Findings From the Worldwide Schizophrenia Outpatient Health Outcomes Database

Clinical Points
  • Weight gain in schizophrenia, although maximal initially, continues for at least 3 years.
  • All antipsychotics in this study are associated with weight loss and weight gain in a significant number of patients.
  • During a 3-year period, between 7% and 15% of patients had an increase in body mass index (kg/m2) to ≥ 25.
  • Regular weight monitoring should continue long term. Change alone in mean weight value may hide the varying changes in individual patients.

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e767 Protective Factors and Risk Modification of Violence in Iraq and Afghanistan War Veterans

Case Report

e756 A Case of Acute Psychosis After Buprenorphine Withdrawal: Abrupt Versus Progressive Discontinuation Could Make a Difference

Review Articles

e742 Changes in Weight, Plasma Lipids, and Glucose in Adults Treated With Ziprasidone: A Comprehensive Analysis of Pfizer-Initiated Clinical Trials

Clinical Points
  • This work is the first to report the metabolic effects of a second-generation antipsychotic that incorporates data from an entire clinical trial program.
  • These analyses provide compelling evidence that ziprasidone is a low-risk agent in terms of liability for weight gain when used in the treatment of adults with schizophrenia or bipolar disorder and that it has a neutral effect on fasting plasma lipids and glucose.
  • Given the importance of cardiometabolic risk factors in contributing to major morbidity and mortality in patients with major mental illness, therapeutic options with the lowest likelihood of contributing to risk are clinically desirable.

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e757 Are Antipsychotics Effective for the Treatment of Anorexia Nervosa? Results From a Systematic Review and Meta-Analysis

Clinical Points
  • Due to their weight-inducing effects, antipsychotics, especially second-generation antipsychotics, have been used off-label for the treatment of anorexia nervosa.
  • Both individually and pooled together, antipsychotics did not differ from placebo/usual care with regard to effects on weight/BMI, scores on questionnaires related to anorexia nervosa (except for quetiapine), or depressive symptoms.
  • Although limited by a low number of studies including relatively small samples, this meta-analysis failed to demonstrate significant antipsychotic efficacy for body weight and related outcomes in females with anorexia nervosa.
  • Larger trials are needed to extend these findings and determine if patient or treatment factors influence the success or failure of antipsychotic treatment in anorexia nervosa.

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Free Online Activities

e20 Shift Work Disorder: Clinical Assessment and Treatment Strategies

e21 Applying Antidepressant Study Results to Clinical Practice [CME]

e22 Treatment Options in Multiple Sclerosis [CME]

Information for Authors

see www.psychiatrist.com/author.htm