Volume 73September 2012Number 9

Commentary

1191 Changes in the Product Label for Pimozide Illustrate Both the Promises and the Challenges of Personalized Medicine

Original Research

1179 Exposure Therapy, d-Cycloserine, and Functional Magnetic Resonance Imaging in Patients With Snake Phobia: A Randomized Pilot Study

Clinical Points
  • d-Cycloserine may accelerate the effects of exposure-based therapy for anxiety disorders.
  • One week after treatment, phobic patients who received exposure plus d-cycloserine exhibited a qualitatively different neural response to feared stimuli compared to patients who received exposure plus placebo.
  • d-Cycloserine augmentation of exposure therapy may enhance ventromedial prefrontal brain activity during and after exposures to phobic stimuli.

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1187 CYP2D6 Genotype Information to Guide Pimozide Treatment in Adult and Pediatric Patients: Basis for the US Food and Drug Administration’s New Dosing Recommendations

Clinical Points
  • Cytochrome P450 2D6 (CYP2D6) poor metabolizers are at an increased risk for QT prolongation at standard doses of pimozide because of higher drug concentrations.
  • People who are CYP2D6 poor metabolizers should not receive more than 4 mg of pimozide daily if adults or 0.05 mg/kg daily (up to 4 mg daily) if children.
  • Clinicians can refer to the US Food and Drug Administration pimozide label for new guidance on dosing, titration, and CYP2D6 status testing recommendations.

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1205 Leptin, Abdominal Obesity, and Onset of Depression in Older Men and Women

Clinical Points
  • Obesity, in particular abdominal adiposity, is a risk factor for depression.
  • Leptin impaired central action (resistance) may represent a biological mechanism relating abdominal adiposity with depression onset in obese persons.
  • In obese depressed patients, the development of therapeutic interventions on leptin downstream pathways should target leptin central resistance rather than leptin itself.

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1212 Compensatory Cognitive Training for Psychosis: Effects in a Randomized Controlled Trial

Clinical Points
  • Compensatory cognitive training is a brief, manualized, low-tech intervention aimed at improving cognitive impairment and everyday functioning abilities in people with schizophrenia.
  • Our results showed that compensatory cognitive training led to improvements in attention, memory, functional capacity, negative symptom severity, and patient-rated quality of life.

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1220 Depressive Symptoms and Suicidal Thoughts Among Former Users of Finasteride With Persistent Sexual Side Effects

Clinical Points
  • A subset of young men who take finasteride develop persistent sexual side effects accompanied by severe depressive symptoms and suicidal thoughts.
  • Prescribers and potential users of finasteride should be aware of the potential CNS side effects of this medication.

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1224 Maintenance Treatment With Long-Acting Injectable Risperidone in First-Episode Schizophrenia: A Randomized Effectiveness Study

Clinical Points
  • Most recently diagnosed, first-episode schizophrenia patients stop their antipsychotic medication within the first year of outpatient treatment.
  • Early initiation of long-acting antipsychotic therapy seems to delay but not prevent the onset of nonadherence in this patient population.
  • Nonadherence to oral therapy was usually not recognized in “real time” by the treating clinician. Given the likelihood of unrecognized nonadherence in first-episode patients, long-acting therapy offers an “information advantage” regarding efficacy and safety of the prescribed antipsychotic.

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1234 A 9-Week Randomized Trial Comparing a Chronotherapeutic Intervention (Wake and Light Therapy) to Exercise in Major Depressive Disorder Patients Treated With Duloxetine

Clinical Points
  • Combining wake therapy, light therapy, and sleep time stabilization with duloxetine treatment induced a very rapid and sustained increase in antidepressant response in patients with treatment resistance; this method offers an alternative to polypharmacy treatment.
  • Exercise in combination with duloxetine also induced a clinically meaningful antidepressant response, but less than the wake therapy, light therapy, and sleep time stabilization combined with duloxetine.
  • We found that the individually tailored exercise program was easy to implement and that patients were highly compliant and had very few side effects. We believe that the weekly assessment and guidance by a physiotherapist was very important in obtaining this high level of compliance.
  • Wake therapy was well tolerated, with a high level of compliance. Patients experienced only a moderate degree of sleepiness during the wake nights. Light therapy was also well tolerated, with a high degree of compliance. The sleep diary was found to be a helpful tool in stabilizing the sleep-wake cycle.

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1194 Pretest

CME Activity

1203 Posttest

 

1195 Panic Attacks as a Dimension of Psychopathology: Evidence for Associations With Onset and Course of Mental Disorders and Level of Functioning

For Clinical Use
  • Panic attacks occur in a wide range of psychiatric disorders; that is, their occurrence is not limited to panic disorders or anxiety disorders.
  • Clinicians should be aware of the risk of onset of psychiatric disorders when patients present with panic attacks.
  • In patients with panic (panic disorders, panic attacks, past panic attacks), both mental functioning and physical functioning are more impaired than in those without panic.

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Focus on Alzheimer’s Disease and Related Disorders

1245 A Meta-Analytic Review of Polyunsaturated Fatty Acid Compositions in Dementia [Review Article]

Clinical Points
  • Studies have shown an association between peripheral blood levels of polyunsaturated fatty acids (PUFAs) and dementia and predementia syndrome.
  • Intervention with n-3 PUFAs might be beneficial for patients with dementia or predementia syndrome, but the outcomes are not consistent.
  • The results of this meta-analysis suggest that patients with dementia and predementia syndrome have lower levels of n-3 PUFAs, supporting an important role of n-3 PUFAs in cognitive disorders.

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1255 Efficacy of Nonpharmacologic Interventions for Agitation in Advanced Dementia: A Randomized, Placebo-Controlled Trial

Clinical Points
  • The study is the first large randomized, placebo-controlled clinical trial to show the impact on agitation of individualized nonpharmacologic interventions based on the unmet need model.
  • The effect size of the intervention was larger than in a previous study, probably due to (1) a rigorous methodology of ascertaining the optimal nonpharmacologic intervention, (2) greater experience in discerning and delivering the interventions, and (3) the accumulation of a wide variety of materials that could be matched to individual backgrounds and needs.
  • Nonpharmacologic interventions not only decreased agitation but also increased pleasure and interest, suggesting that these interventions contribute to improved quality of life for persons with dementia.

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Case Report

1243 Postictal Psychosis Treated Successfully With Olanzapine

ASCP Corner

1262 Discordance Between Researchers and Patients in Defining Remission From Depression

Letters to the Editor

1264 Association of Benzodiazepine Use With Increased Cancer Risk Is Misleading Due to Lack of Theoretical Rationale and Presence of Many Confounding Factors

1265 Patient Adherence to Cognitive-Behavioral Therapy Predicts Long-Term Outcome in Obsessive-Compulsive Disorder

Book Reviews

1267 Handbook of Psychotherapy in Cancer Care

1267 Pediatric Psychopharmacology: Principles and Practice, 2nd ed

1268 Cognitive Behavior Therapy: Basics and Beyond, 2nd ed

Online Exclusives

Practical Psychopharmacology

e1156 Breast Cancer and Antidepressant Use

Clinical Points
  • Tamoxifen, an antiestrogen drug, is used for many indications related to breast cancer. Antidepressants are also often used in breast cancer patients, for states such as depression, anxiety, and hot flashes associated with chemical menopause.
  • Tamoxifen is a prodrug. Some antidepressants (eg, paroxetine, fluoxetine, bupropion, duloxetine) inhibit CYP2D6, the enzyme that converts tamoxifen into endoxifen, its most important active metabolite. This could compromise tamoxifen’s efficacy.
  • Clinicians should avoid CYP2D6 inhibitors in patients receiving tamoxifen in favor of drugs with low or no CYP2D6 inhibitor activity (eg, mirtazapine, escitalopram, fluvoxamine, reboxetine, citalopram, sertraline, venlafaxine, desvenlafaxine).

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Case Report

e1158 Leber’s Hereditary Optic Neuropathy Associated With Schizophrenia

Review Article

e1160 Meta-Analysis of Sleep Disturbance and Suicidal Thoughts and Behaviors

Clinical Points
  • Sleep disturbances in general, and insomnia and nightmares specifically, are significantly associated with suicidal ideation, suicide attempt, and suicide.
  • Identification and management of sleep disturbance is a potentially useful strategy to alter the clinical course of individuals vulnerable to suicide.

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Original Research

e1168 BL-1020, a New γ-Aminobutyric Acid–Enhanced Antipsychotic: Results of 6-Week, Randomized, Double-Blind, Controlled, Efficacy and Safety Study

Clinical Points
  • Cognitive deficits in schizophrenia may be ameliorated with BL-1020.
  • Further research is needed to examine the short- and long-term possible procognitive effects.

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Free Online Activities

e28 MAOIs and Transdermal Delivery [CME]

Information for Authors

see www.psychiatrist.com/author.htm