Volume 74January 2013Number 1

Publisher’s Note

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


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.


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.


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.



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.


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.


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.


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.


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.


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.


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.


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.


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.


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.


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