Volume 73August 2012Number 8

1087 Pretest

CME Activity

1095 Posttest


1088 Risk of Injurious Road Traffic Crash After Prescription of Antidepressants

For Clinical Use
  • Periods of initiation and change of antidepressant treatment are critical periods with regard to the risk of road traffic crash.
  • Prescribers should warn their patients about this risk.


Case Report

1125 “Bath Salts”–Induced Psychosis and Serotonin Toxicity


1126 “Bath Salts” and the Return of Serotonin Syndrome

Review Article

1128 Interferon-Induced Depression in Chronic Hepatitis C: A Systematic Review and Meta-Analysis

Clinical Points
  • Incidence of depression during interferon-alpha and ribavirin treatment is substantial; 1 out of 4 patients with chronic hepatitis C who start antiviral treatment will develop an induced major depressive episode.
  • Baseline levels of interleukin-6, female gender, history of depression or psychiatric disorder, subthreshold depressive symptoms, and low educational level are predictive variables of interferon-induced depression.
  • Before starting antiviral treatment, clinicians should assess patients at risk of developing interferon-induced depression. During the treatment, a comprehensive assessment and management of depression must be performed.


Original Research

1069 Toxoplasma gondii Immunoglobulin G Antibodies and Nonfatal Suicidal Self-Directed Violence

Clinical Points
  • The study confirms an association between Toxoplasma gondii seropositivity and nonfatal suicidal self-directed violence, the most important predictor of fatal suicidal self-directed violence.
  • A positive association between T gondii seropositivity and higher scores on the self-rated Suicide Assessment Scale, previously reported to predict subsequent suicidal behavior, emphasizes the need for further research to confirm the prognostic role of testing for T gondii in patients at risk for suicide and to consider this widespread neurotropic infection, in concert with other suicide risk factors, as a target for prophylaxis and treatment.


1077 Pharmacogenomic Associations With Weight Gain in Olanzapine Treatment of Patients Without Schizophrenia

Clinical Points
  • Individual single-nucleotide polymorphism (SNP) variations in DRD2 and HTR2C showed significant associations with weight gain in patients with diagnoses other than schizophrenia treated with olanzapine. These variants may prove useful for individualized medicine and the development of new medications with a lower risk of treatment-emergent adverse events.
  • Weight gain with second-generation antipsychotics has been associated with variants in the ankyrin repeat and kinase domain containing 1 gene, the adjacent dopamine D2 receptor gene (DRD2), and the serotonin 2C receptor gene (HTR2C) in patients with schizophrenia.
  • In a cohort of patients with other diagnoses, weight change during olanzapine treatment was associated with 3 HTR2C SNPs, including Cys23Ser, in females and with a DRD2 SNP in all patients.


1097 Predictors of Placebo Response in Adults With Attention-Deficit/Hyperactivity Disorder: Data From 2 Randomized Trials of Osmotic-Release Oral System Methylphenidate

Clinical Points
  • There is a substantial incremental benefit of active treatment over placebo in adults with attention-deficit/hyperactivity disorder (ADHD).
  • Patient characteristics, such as knowledge about the disorder, age, and educational level, may affect placebo response in ADHD.
  • Further research in ADHD, such as meta-analysis and meta-regression analysis of placebo response in placebo-controlled trials, would be valuable.


1103 Antidepressive Treatment With Monoamine Oxidase Inhibitors and the Occurrence of Intraoperative Hemodynamic Events: A Retrospective Observational Cohort Study

Clinical Points
  • Severe intraoperative events did not occur in users of the irreversible MAOI tranylcypromine or the reversible MAO-A inhibitor moclobemide who continued their antidepressant treatment in the perioperative period.
  • The current observations suggest that there is no longer much justification to discontinue these MAOIs before surgery, with the considerable risk of compromising patients’ psychiatric status.
  • When in an individual patient there still is doubt about the continuation of an MAOI, consultation among anesthesiologist, psychiatrist, and surgeon is indicated in order to balance the potential risks of anesthesia against the psychiatric complications of drug withdrawal.


1110 Examining the Relation Between Combat-Related Concussion, a Novel 5-Factor Model of Posttraumatic Stress Symptoms, and Health-Related Quality of Life in Iraq and Afghanistan Veterans

Clinical Points
  • Veterans who screen positive for a combat-related concussion and persistent postconcussive symptoms should be screened for posttraumatic stress disorder.
  • Posttraumatic stress disorder treatments that target dysphoric arousal and emotional numbing symptoms may help improve physical and mental health–related quality of life, respectively.
  • Clinicians should assess, treat, and monitor the psychological sequelae of combat-related concussion among veterans of Operations Enduring Freedom, Iraqi Freedom, and New Dawn.


1119 Obesity Comorbidity in Unipolar Major Depressive Disorder: Refining the Core Phenotype

Clinical Points
  • Depression co-occurring with obesity is a common clinical presentation associated with significant morbidity.
  • The heterogeneity of both depression and obesity makes it difficult to establish mechanisms of disease in these patients.
  • The atypical subtype of depression has a much closer relationship with obesity than classic melancholic depression and should be a priority focus for work in the area of depression and obesity comorbidity.


Focus on Early Career Psychiatrists

1139 Can Women Have It All? Psychiatry and the Gender Gap

1141 The Differential Roles of Trauma, Posttraumatic Stress Disorder, and Comorbid Depressive Disorders on Suicidal Ideation in the Elderly Population

Clinical Points
  • In our sample, 7.3% of the elderly general population reported suicidal ideation within the last 2 weeks. This prevalence is comparable to the findings of other population-based studies.
  • Suicidal ideation was positively associated with number of traumatic events and posttraumatic stress disorder (PTSD), but this finding seems due to comorbid depressive symptoms.
  • To address suicidal ideation, it seems worthwhile to assess depressive symptoms in people with traumatic experiences and PTSD.


1147 A Cross-Sectional Study of Plasma Risperidone Levels With Risperidone Long-Acting Injectable: Implications for Dopamine D2 Receptor Occupancy During Maintenance Treatment in Schizophrenia

Clinical Points
  • More than half of clinically stable schizophrenia patients taking risperidone long-acting injectable (LAI) did not show continuous blockade of dopamine D2 receptors > 65%.
  • Sustained dopamine D2 receptor occupancy levels of ≥ 65% may not be necessary for maintenance treatment with risperidone LAI in schizophrenia.
  • Optimizing the dosing and/or dosing intervals of antipsychotics could maximize effectiveness while reducing risk of side effects.


Book Reviews

1153 Expert Psychiatric Evidence

1153 Schizophrenia, 3rd ed

1154 Causality and Psychopathology: Finding the Determinants of Disorders and Their Cures

Online Exclusives

Focus on Early Career Psychiatrists

e1039 Does Varenicline Worsen Psychiatric Symptoms in Patients With Schizophrenia or Schizoaffective Disorder? A Review of Published Studies [Review]

Clinical Points
  • In most stable, closely monitored patients with schizophrenia or schizoaffective disorder, varenicline treatment is not associated with worsening of psychiatric symptoms.
  • Over half of patients with schizophrenia or schizoaffective disorder and tobacco dependence reduced daily cigarette use after treatment with varenicline.


Original Research

e1048 Predictors of Long-Term Return to Work and Symptom Remission in Sick-Listed Patients With Major Depression

Clinical Points
  • Major depressive disorder (MDD) has substantial negative effects on work outcomes. Little is known regarding how to promote return to work (RTW) after MDD-related sickness absence.
  • Whereas long-term symptom remission was only predicted by diagnostic characteristics, long-term RTW was also predicted by personal and work-related characteristics.
  • Although more research is needed, this study suggests that clinical treatment in combination with interventions that target work motivation and planning strategies may facilitate both long-term symptom remission and long-term RTW in sick-listed patients with MDD.


e1056 Risk-Taking Propensity as a Predictor of Induction Onto Naltrexone Treatment for Opioid Dependence

Clinical Points
  • Behavioral measures to assess risk-taking propensity have considerable promise for opiate-dependent patients who may be candidates for modified or individualized treatment with a focus on decision-making strategies, risk modulation, behavioral control, and treatment adherence.
  • To improve the clinical utility and adherence of naltrexone treatment, assessing risk-taking propensity and impulsiveness is especially important during the early stages of treatment.


Practical Psychopharmacology

e1062 Modafinil and Armodafinil in Schizophrenia

Clinical Points
  • Schizophrenia patients may sometimes require modafinil or armodafinil for approved or off-label indications.
  • Modafinil and armodafinil induce certain CYP enzymes and thereby reduce levels of antipsychotics that are metabolized by these enzymes.
  • The effects of reduced antipsychotic potency associated with the reduced antipsychotic levels may not appear until long after the onset of the pharmacokinetic changes induced by modafinil or armodafinil.


Free Online Activities

e25 Shift Work Disorder Case Studies: Applying Management Principles in Clinical Practice

e26 The Appropriate Use of Opiates in Chronic Pain [CME]

e27 How to Interpret Findings Concerning Newly Approved Antipsychotic Agents: Clinical Implications of the Lurasidone PEARL 2 Study [InfoPack]

Information for Authors

see www.psychiatrist.com/author.htm