Volume 74January 2013Number 1

Publisher’s Note

5 Working Together to Restore the Mental Well-Being of Our Veterans

Editorial

6 Magnanimity

Original Research

10 Comparison of Longer-Term Safety and Effectiveness of 4 Atypical Antipsychotics in Patients Over Age 40: A Trial Using Equipoise-Stratified Randomization

Clinical Points
  • Caution is needed in long-term use of commonly prescribed atypical antipsychotics (aripiprazole, olanzapine, quetiapine, and risperidone) in middle-aged and older patients with psychotic disorders.
  • When these medications are used, they should be given in low dosages, for short durations, and their side effects should be monitored closely.
  • Shared decision making with patients and their caregivers is recommended, including discussions of risks and benefits of atypical antipsychotics and those of available treatment alternatives.

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43 Trends in Office-Based Treatment of Adults With Stimulants in the United States

Clinical Points
  • Stimulant treatment of adults is increasing, especially among young adults, a population at increased risk of nonmedical stimulant use.
  • Roughly one-half of adult visits to nonpsychiatrist physicians that yield a stimulant prescription include no mental disorder diagnosis.
  • Physicians should consistently document the conditions for which they prescribe stimulants to adults and remain vigilant regarding risks of nonmedical stimulant use.

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51 Quantitative Electroencephalogram Biomarkers for Predicting Likelihood and Speed of Achieving Sustained Remission in Major Depression: A Report From the Biomarkers for Rapid Identification of Treatment Effectiveness in Major Depression (BRITE-MD) Trial

Clinical Points
  • Treatment selection in major depressive disorder could be improved if a biomarker could predict the likelihood and speed of achieving sustained remission with a particular agent for an individual patient.
  • A novel biomarker, based on prefrontal brain electrical activity in the first week of treatment, appears able to predict these clinically relevant aspects of response to treatment in a personalized medicine paradigm.

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Meta-Analysis

31 Depression as a Risk Factor for Diabetes: A Meta-Analysis of Longitudinal Studies

Clinical Points
  • Depressed mood is associated with increased risk of incident diabetes in nondiabetic subjects.
  • The association between depression and diabetes is not entirely mediated by weight gain or the effects of antidepressant drugs.
  • Depression deserves to be included among the risk factors that should drive diabetes screening.

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National Network of Depression Centers Position Paper

38 Electroconvulsive Therapy Device Classification: Response to FDA Advisory Panel Hearing and Recommendations

21 Pretest

CME Activity

29 Posttest

 

22 Caring for Returning Veterans: Meeting Mental Health Needs [Commentary]

Clinical Points
  • Ask patients about their military service and veteran status.
  • Become familiar with veteran resources and eligibility requirements locally and nationally.
  • Equip veterans and their families with education, counseling, and coping mechanisms to deal with mental health issues, including the symptoms of PTSD.

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Focus on Childhood and Adolescent Mental Health

57 New Findings From Longitudinal and Treatment Studies in Youth

59 Predictors of Suicide Attempt in Early-Onset, First-Episode Psychoses: A Longitudinal 24-Month Follow-Up Study

Clinical Points
  • 12.4% of early-onset first-episode psychosis patients attempted suicide in the 2 years following psychosis onset, the risk being highest in the first year.
  • High risk of suicide at baseline was the best predictor of suicide attempt at follow-up. High risk of suicide at baseline was associated with severe depressive symptoms and with a history of suicide attempt prior to the first-episode psychosis.
  • Neither severity of psychotic symptoms nor affective or nonaffective psychoses diagnostic subtypes were associated with suicidal behavior.

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67 Sleep Problems Among Adolescent Survivors Following the 2008 Wenchuan Earthquake in China: A Cohort Study

Clinical Points
  • Sleep problems were common and persistent for up to 30 months among adolescent survivors of the 2008 Wenchuan earthquake.
  • Sleep problems and psychiatric symptoms are not only coexisting but also bidirectional, and multiple demographic, psychosocial, and earthquake-related factors are associated with increased risk and persistence of sleep problems.
  • Early detection of and intervention for sleep problems is important to reduce the impact of natural disasters on health and well-being in adolescent survivors.

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Online Exclusives

Practical Psychopharmacology

e75 Drug Interactions in the Treatment of Depression in Patients Receiving β-Blocker Drugs

Clinical Points
  • Some antidepressants inhibit the metabolism of some β-blockers.
  • Bradycardia and hypotension, heart block, or other dose-dependent adverse effects may occur in vulnerable patients as a result of these interactions.
  • Strategies include prescribing an antidepressant that does not affect the metabolism of the β-blocker in use, or prescribing a β-blocker that is not metabolized by the antidepressant in use.
  • If the interaction is unavoidable, the β-blocker dose can be down-titrated using heart rate and blood pressure as a guide.

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Original Research

e79 Antipsychotic Drugs, Mood Stabilizers, and Risk of Pneumonia in Bipolar Disorder: A Nationwide Case-Control Study

Clinical Points
  • Clinicians should be aware that certain second-generation antipsychotics (olanzapine, quetiapine, and risperidone) recommended for first-line monotherapy in bipolar disorder are associated with risk of pneumonia.
  • Lithium has a dose-dependent protective effect against pneumonia and valproic acid shows no risk, which provides evidence for use of both drugs as first-line treatments.
  • Patients with bipolar disorder on combination therapy deserve special clinical attention, particularly those receiving olanzapine plus carbamazepine, or clozapine plus valproic acid, as their risks for pneumonia are high.

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e87 Four-Year Outcome in Psychopharmacologically Treated Adults With Attention-Deficit/Hyperactivity Disorder: A Questionnaire Survey

Clinical Points
  • This is the first naturalistic outcome study of psychopharmacologically treated adults with attention-deficit/hyperactivity disorder (ADHD) after more than 4 years of observation.
  • Among participants, a majority reported current pharmacologic treatment for ADHD. Adults with ADHD treated for more than 24 months reported more favorable outcome compared to those treated for 24 months or less.
  • Comorbidity at baseline predicted poorer outcome.

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e94 Substance-Induced Psychoses Converting Into Schizophrenia: A Register-Based Study of 18,478 Finnish Inpatient Cases

Clinical Points
  • Substance-induced psychotic disorders predict schizophrenia spectrum disorders to a greater extent than previously thought.
  • More emphasis should be put on provision of clinical follow-up for those patients who have been treated for a diagnosis of substance-induced psychosis.

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Focus on Childhood and Adolescent Mental Health

e100 Efficacy and Safety of Quetiapine in Children and Adolescents With Mania Associated With Bipolar I Disorder: A 3-Week, Double-Blind, Placebo-Controlled Trial

Clinical Points
  • This article describes the first large, randomized, placebo-controlled study of the efficacy and safety of quetiapine monotherapy in youth with bipolar I disorder with manic episodes.
  • Quetiapine for 3 weeks at fixed doses of 400 or 600 mg/d was associated with significantly greater improvements in YMRS total score (the primary efficacy measure) compared with placebo, with a rapid onset of effect.
  • Adverse events associated with quetiapine were consistent with its profile in adults with bipolar disorder. The most common adverse events in quetiapine-treated patients included somnolence, sedation, dizziness, and headache.
  • The large population size studied and the broad range of efficacy and safety measures that were investigated support a role for this study in informing clinical practice.

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e110 Irritability and Elation in a Large Bipolar Youth Sample: Relative Symptom Severity and Clinical Outcomes Over 4 Years

Clinical Points
  • Compared to bipolar youth with prominent elation symptoms, youth who are diagnosed with bipolar disorder on the basis of episodic irritability experience a similar clinical course but may be at greater risk for depression.
  • Future research on irritability and elation in pediatric bipolar disorder would be aided by more precise assessment of covariation in irritability and elation during and between major mood episodes.
  • Improved characterization of distinct illness courses may enhance the identification and utility of emerging genetic and neuroimaging markers and facilitate development of targeted treatments.

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Book Review

e118 Textbook of Psychiatric Epidemiology, 3rd ed

Free Online Activities

e01 Clinician Perceptions, Expectations, and Management of Negative Symptoms in Schizophrenia [CME]

e02 MAOIs: Issues in Treatment Adherence and Rates of Treatment Failure [CME]

Information for Authors

see www.psychiatrist.com/author.htm