Volume 73 • October 2012 • Number 10
1300 Correlation Between Different Levels of Placebo Response Rate and Clinical Trial Outcome in Major Depressive Disorder: A Meta-Analysis
- The high and highly variable placebo response rate is a major obstacle contributing to the failure of randomized controlled trials in major depressive disorder.
- The relative efficacy of the active drug compared to placebo is highly heterogeneous across studies with different placebo response rates, with higher placebo response rates being correlated with a lower probability to detect a statistically significant superiority of the drug versus placebo.
- The response rate in the placebo group is an important aspect to take into account when interpreting results from a trial with an equivocal outcome.
- It is of primary importance to maintain placebo response rates below a critical threshold (30% and 40% for antidepressant monotherapy studies and augmentation/combination studies, respectively).
1307 Beyond White Blood Cell Monitoring: Screening in the Initial Phase of Clozapine Therapy
- Screening guidelines during the initial phase of treatment with clozapine have been restricted to the obligatory white blood cell monitoring. We propose 2 revisions, both extensions, of the existing screening guidelines.
- First, monthly screening of fasting plasma glucose should be obligatory in the first 3 months of clozapine therapy.
- Second, monitoring of gastrointestinal hypomotility should become an integral part of regular screening, not only in the initial but also during the maintenance phase.
- Screening for myocarditis or cardiomyopathy is, outside Australia and New Zealand, not evidence based.
1313 Monitoring Clozapine Adverse Effects Calls for the Integration of Protocol and Good Clinical Practice
1293 Marital Status, Childhood Maltreatment, and Family Dysfunction: A Controlled Study of Pathological Gambling
- Pathological gambling is associated with indices of family dysfunction including divorce, living alone, self-reported childhood maltreatment, and worse functioning on the Family Assessment Device.
- While dysfunctional marital and family variables are associated with pathological gambling, the direction of the relationship is unclear.
- Pathological gambling treatment programs should take into account the emotional needs of those who report having experienced childhood maltreatment or are experiencing disturbed marital and family relationships.
1287 How Can We Use Depression Severity to Guide Treatment Selection When Measures of Depression Categorize Patients Differently?
- Treatment guidelines for depression suggest that severity be taken into account when initiating treatment.
- There is a marked disparity between the way standardized scales classify depressed outpatients into severity groups. This disparity suggests that using such scales to classify severity subtypes is problematic.
- Recommending any one scale to measure depression severity is premature.
1315 AIDS/HIV Infection, Comorbid Psychiatric Illness, and Risk for Subsequent Suicide: A Nationwide Register Linkage Study
- People with AIDS/HIV infection have a strongly increased risk for suicide.
- Suicide risk assessment and management should be an integral part of hospitals’ and general practitioners’ treatment plans for patients with AIDS/HIV infection.
- Continuity of care in transitions between service levels and providers and systematic psychiatric and somatic follow-up of patients after discharge from the hospital are important strategies for suicide prevention in patients with AIDS/HIV infection.
1322 There’s More to Placebo-Related Improvement Than the Placebo Effect Alone
- Besides a true medication effect and a true placebo effect, there are a large number of overlapping reasons why patients improve.
- Reasons for improvement include nonspecific psychotherapeutic effects, regression toward the mean, spontaneous response or remission, the Rosenthal effect, the Hawthorne effect, the halo effect, favorable changes in the stress-support dimension, and known or unknown use of other treatments.
- Clinicians should be aware that some of these mechanisms result in fleeting improvement or in false impressions of improvement only. They should make efforts to enhance the placebo response and recruit nonspecific psychotherapeutic effects and other mechanisms that result in true improvement.
Focus on Childhood and Adolescent Mental Health
1326 More on Mood Disorders in Youth
1328 Further Evidence for Robust Familiality of Pediatric Bipolar I Disorder: Results From a Very Large Controlled Family Study of Pediatric Bipolar I Disorder and a Meta-Analysis
- By providing information that is 1 step removed from a diagnosis in an affected child, family study methodology remains the cornerstone for the validation of complex psychiatric disorders such as pediatric bipolar disorder.
- By documenting the high familiality of pediatric bipolar disorder, our study provides strong support for the validity of pediatric bipolar disorder.
- By providing evidence for the validity of pediatric bipolar disorder, this work will support efforts in the community for the identification and treatment of children manifesting a clinical picture consistent with the diagnosis of bipolar disorder.
1335 Developmental Pathways for Different Subtypes of Early-Onset Bipolarity in Youths
- The presence of comorbid attention-deficit/hyperactivity disorder (ADHD) versus anxiety disorders should be actively explored, as it is indicative of fundamental differences in the phenomenology of bipolar disorder in youths.
- ADHD plus bipolar disorder might represent a distinct early-onset phenotype within the bipolar spectrum.
1342 Examining the Proposed Disruptive Mood Dysregulation Disorder Diagnosis in Children in the Longitudinal Assessment of Manic Symptoms Study
- The proposed disruptive mood dysregulation disorder (DMDD) diagnosis is not clearly differentiated from oppositional defiant disorder and conduct disorder in children presenting for psychiatric treatment.
- Youth presenting for treatment with disruptive behavioral, anxiety, and mood disorders will frequently meet the proposed diagnostic criteria for DMDD.
- Many youth with bipolar disorder will meet the primary symptom criteria for DMDD; therefore, careful assessment for manic symptomatology is required for children who present with features of DMDD.
1351 Psychological Outcomes and Predictors of Initial Weight Loss Outcomes Among Severely Obese Adolescents Receiving Laparoscopic Adjustable Gastric Banding
- Psychiatric symptoms improve among severely obese adolescents following laparoscopic adjustable gastric banding (LAGB).
- Changes in weight postsurgery and improvement in psychosocial functioning are correlated.
- Mental health professionals should assess loss of control eating and family functioning among adolescents seeking LAGB.
Letters to the Editor
1358 Cost and Cost-Effectiveness in a Randomized Trial of Long-Acting Risperidone for Schizophrenia [free access]
1360 Psychoanalytic Diagnosis: Understanding Personality Structure in the Clinical Process, 2nd ed
1360 Child Psychology and Psychiatry: Frameworks for Practice, 2nd ed
e1269 Predictors of Suicide in Patient Charts Among Patients With Depression in the Veterans Health Administration Health System: Importance of Prescription Drug and Alcohol Abuse
- Prescription drug and alcohol misuse assessments should be prioritized in suicide assessments among depressed patients.
- Using word search strategies or natural-language processing assessments of electronic medical records may allow systematic identification of high-risk individuals for suicide prevention efforts.
e1276 Polymorphisms and Haplotypes in the YWHAE Gene Increase Susceptibility to Bipolar Disorder in Chinese Han Population
- Our study suggests that some susceptibility may be common to both schizophrenia and bipolar disorder and that a putative, sex-dependent relationship exists between the YWHAE gene and bipolar disorder.
- Evidence from this study will be useful in influencing psychiatric research to move from reliance on a diagnostic and classification system that is based only on clinical description to a scheme that better reflects the underlying biology of the psychiatric entities encountered in our clinics.
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e29 Depression Epidemiology and Its Treatment Evolution [CME]
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