Volume 73November 2012Number 11

Original Research

1388 Intended and Unintended Consequences of the Gabapentin Off-Label Marketing Lawsuit Among Patients With Bipolar Disorder

Clinical Points
  • Federal lawsuits against pharmaceutical companies for off-label psychotropic prescribing may cause unintended substitutions of newer drugs that could raise rather than lower costs.
  • Litigation intended to recover government health care costs of off-label use of psychoactive medications for serious mental illness should educate physicians regarding the most efficient and effective substitute drugs.

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1395 Obsessive-Compulsive Symptoms in Patients With Schizophrenia: A Naturalistic Cross-Sectional Study Comparing Treatment With Clozapine, Olanzapine, Risperidone, and No Antipsychotics in 543 Patients

Clinical Points
  • Schizophrenia patients taking either olanzapine or risperidone do not have different occurrence of obsessive-compulsive symptoms (OCS) compared to schizophrenia patients not taking antipsychotic medication.
  • Chronic clozapine treatment may result in a higher risk for developing OCS.

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1403 The Vasopressin V1b Receptor Antagonist SSR149415 in the Treatment of Major Depressive and Generalized Anxiety Disorders: Results From 4 Randomized, Double-Blind, Placebo-Controlled Studies

Clinical Points
  • The vasopressinergic system is overactive in several stress-related diseases.
  • The vasopressin V1b antagonist SSR149415 is well tolerated but had minor overall effects in generalized anxiety disorder and major depressive disorder.

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1412 Adjunctive Oral Ziprasidone in Patients With Acute Mania Treated With Lithium or Divalproex, Part 1: Results of a Randomized, Double-Blind, Placebo-Controlled Trial

Clinical Points
  • Combination therapy with a mood stabilizer and an atypical antipsychotic is recommended by most guidelines for the management of acute episodes of severe mania associated with bipolar disorder unresponsive to monotherapy.
  • Adjunctive ziprasidone failed to separate from lithium or divalproex plus placebo treatment in key efficacy measures.
  • No new clinically relevant safety data related to adjunctive ziprasidone use emerged from this study.

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1420 Adjunctive Oral Ziprasidone in Patients With Acute Mania Treated With Lithium or Divalproex, Part 2: Influence of Protocol-Specific Eligibility Criteria on Signal Detection [free access]

Clinical Points
  • Diagnostic uncertainty is a major issue in clinical practice, but has seldom been addressed in clinical trials.
  • Among 504 subjects randomized by site-based raters, only 180 (35.7%) met all 3 of the eligibility criteria based on the computer assessments.
  • The results support the notion that DSM diagnosis and other eligibility criteria matter for treatment outcome. Eligible subjects (such as those meeting DSM criteria for acute mania or mixed episodes on both assessments) tended to respond better to active treatment, but ineligible subjects tended to respond better to placebo than to active medication.

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1428 Oral Scopolamine Augmentation in Moderate to Severe Major Depressive Disorder: A Randomized, Double-Blind, Placebo-Controlled Study

Clinical Points
  • Oral scopolamine hydrobromide augmentation of citalopram was more effective in treating moderate to severe major depressive disorder than was citalopram monotherapy.
  • Scopolamine was well tolerated in patients with major depressive disorder.

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1439 Do Suicidal Thoughts or Behaviors Recur During a Second Antidepressant Treatment Trial?

Clinical Points
  • Patients with major depressive disorder who experience emergence or worsening of suicidal thoughts or behaviors with an initial antidepressant treatment are at increased risk for experiencing the same symptoms when a next-step treatment is started.
  • These symptoms may recur even when a non-SSRI medication is initiated.
  • Still, the majority of patients will not experience recurrence of these symptoms with next-step treatment, and patients who did not experience these symptoms initially may still experience them with next-step treatment.

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Commentary

1426 Methodologies to Avoid the Enrollment of Ineligible Patients in Clinical Trials

Review Article

1434 Efficacy and Safety of Deep Brain Stimulation in Patients With Medication-Induced Tardive Dyskinesia and/or Dystonia: A Systematic Review

Clinical Points
  • Deep brain stimulation is an effective and relatively safe treatment for severe tardive dyskinesia and/or dystonia.
  • Deep brain stimulation should be considered an option for treatment-resistant severe tardive dyskinesia and/or dystonia.

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1462 Pretest

CME Activity

1469 Posttest

 

1463 The Effect of Marijuana Use on the Risk for Schizophrenia [Commentary]

For Clinical Use
  • Recognize patients who may be vulnerable to psychotic disorders through their family history, social problems, and environmental factors.
  • Discuss the risks of marijuana use with child and adolescent patients and their parents.
  • Warn patients with psychotic disorders to avoid marijuana use.

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Focus on Women’s Mental Health

1443 Publishing Statistically Significant Results With Questionable Clinical Importance: Focus on Antidepressant Use in Pregnancy [Commentary]

1447 Pregnancy and Bipolar Disorder: A Systematic Review [Review Article]

Clinical Points
  • Understanding the effect of pregnancy on bipolar disorder has implications for perinatal treatment of the disorder.
  • There appears to be a discrepancy in findings of clinical studies of bipolar disorder versus studies using nonclinical samples.
  • Evidence from studies using nonclinical samples reveals that pregnancy may have a positive effect on bipolar disorder.

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1456 Sensitivity and Specificity of the Mood Disorder Questionnaire as a Screening Tool for Bipolar Disorder During Pregnancy and the Postpartum Period

Clinical Points
  • Screening for bipolar disorder during pregnancy and the postpartum period has been largely ignored.
  • The Mood Disorder Questionnaire is a useful screening tool for perinatal women.
  • Correct identification of past history of hypomanic symptoms can prevent the negative consequences of undiagnosed and untreated bipolar illness in perinatal women.

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Letter to the Editor

1471 Rates of Major Malformations in Infants Following Exposure to Duloxetine During Pregnancy: A Preliminary Report

Book Reviews

1472 Acceptance and Commitment Therapy

1472 Ethical Issues in Forensic Psychiatry: Minimizing Harm

1473 The Art and Science of Brief Psychotherapies: An Illustrated Guide, 2nd ed

Online Exclusives

Practical Psychopharmacology

e1362 Serotonin Reuptake Inhibitor Treatment of Obsessive-Compulsive Symptoms in Clozapine-Medicated Schizophrenia

Clinical Points
  • Serotonin reuptake inhibitors such as fluvoxamine, fluoxetine, or clomipramine may be prescribed as add-on treatments for obsessive-compulsive symptoms in schizophrenia patients.
  • Fluvoxamine (and to a lesser extent, fluoxetine) will inhibit clozapine metabolism, raise clozapine levels, and increase the risk of seizures and other dose-dependent adverse effects of clozapine. Obtaining blood levels of clozapine can guide the adjustment of clozapine dosing to contain the risk.
  • Clomipramine may lower the seizure threshold and increase anticholinergic and sedative adverse effects of clozapine.
  • SRIs such as paroxetine, sertraline, citalopram, and escitalopram can probably be combined with clozapine with low risk of adverse interactions.

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Original Research

e1365 Childhood Sexual Abuse and Psychiatric Disorders in Middle-Aged and Older Adults: Evidence From the 2007 Adult Psychiatric Morbidity Survey

Clinical Points
  • Early detection of childhood sexual abuse and sexual abuse revictimization is crucial for prevention or alleviation of psychiatric disorders in later life.
  • Public health education initiatives should be launched to emphasize the long-term adverse effects in middle and older age of childhood sexual abuse.

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e1372 The Utility of Attention-Deficit/Hyperactivity Disorder Screening Instruments in Individuals Seeking Treatment for Substance Use Disorders

Clinical Points
  • Attention-deficit/hyperactivity disorder (ADHD) is common in individuals with substance use disorders (SUDs), but it is often overlooked.
  • The Wender Utah Rating Scale, Conners Adult ADHD Rating Scale, and Adult ADHD Self-Report Scale-Version 1.1 may serve as reliable screening instruments in cocaine-dependent individuals, with the Wender Utah Rating Scale exhibiting the highest sensitivity for the broadest range of ADHD cases.
  • By incorporating any or all these instruments into the first patient encounter, clinicians will increase their capacity to detect which individuals with SUDs should be further evaluated for ADHD and potentially improve their ability to provide comprehensive, diagnosis-driven treatment.

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Focus on Women’s Mental Health

e1379 Plasma Sodium Level Is Associated With Bone Loss Severity in Women With Anorexia Nervosa: A Cross-Sectional Study

Clinical Points
  • Women with anorexia nervosa are at risk for hyponatremia and severe osteopenia.
  • Animal models suggest that hyponatremia results in bone loss.
  • Women with anorexia nervosa and lower plasma sodium levels have more severe bone loss than those with higher plasma sodium levels.
  • Relatively low plasma sodium levels may contribute to anorexia nervosa–induced bone loss.

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Free Online Activity

e30 Beyond the Resistance: How Novel Neurobiological Understandings of Depression May Lead to Advanced Treatment Strategies

Information for Authors

see www.psychiatrist.com/author.htm