Volume 74February 2013Number 2

Commentary

167 Paradigm Shift: Preliminary Clinical Categorization of Ultrahigh Risk for Childhood Bipolar Disorder to Facilitate Studies on Prevention

Original Research

149 Prevalence of Attenuated Psychotic Symptoms and Their Relationship With DSM-IV Diagnoses in a General Psychiatric Outpatient Clinic

Clinical Points
  • Attenuated psychotic experiences, the key feature of the newly proposed attenuated psychosis syndrome (APS) diagnosis, were present in 28% of patients without a formal psychotic disorder and similarly prevalent across major diagnostic categories, including mood and anxiety disorders.
  • The APS criteria fail to capture a unique clinical population in routine practice settings, which could lead to a large number of patients receiving a new diagnosis of a comorbid psychotic-spectrum disorder.
  • Implementing the APS diagnosis in clinical practice could lead to an increased used of treatments (eg, antipsychotic medications) that do not have favorable risk-benefit profiles for these patients.

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158 Efficacy and Safety of Desvenlafaxine 50 mg/d for Prevention of Relapse in Major Depressive Disorder: A Randomized Controlled Trial

Clinical Points
  • Long-term continuation treatment with desvenlafaxine 50 mg/d reduces the risk of relapse of major depressive disorder during treatment.
  • Patients demonstrated a stable response through 20 weeks of open-label treatment, and relapse rates were lower compared with prior withdrawal studies that used a shorter open-label period.

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170 Effectiveness of Lurasidone in Patients With Schizophrenia or Schizoaffective Disorder Switched From Other Antipsychotics: A Randomized, 6-Week, Open-Label Study [free access]

Clinical Points
  • Switching patients to lurasidone can be successfully accomplished using any of 3 different initial dosing strategies. Among these strategies, there were no clinically meaningful differences in time to treatment failure, all-cause discontinuation, adverse events, or metabolic variables or differences in efficacy assessments.
  • Improvements in weight and lipid variables were observed after patients were switched to lurasidone in this short-term study.

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CME Background

CME Activity

188 Posttest

 

180 Military- and Sports-Related Mild Traumatic Brain Injury: Clinical Presentation, Management, and Long-Term Consequences [COMMENTARY]

Clinical Points
  • When evaluating current and former military personnel or athletes, question them and a collateral source (eg, family members, friends) about concussions or mild traumatic brain injury (mTBI).
  • Screen for posttraumatic stress disorder, suicidal ideation, impulsivity, and sleep problems in patients who have experienced concussions.
  • If a patient who has had repetitive mTBI is exhibiting symptoms of dementia, consider chronic traumatic encephalopathy (CTE) in the differential diagnosis.
  • Manage acute and persistent symptoms of mTBI, and watch for the emergence of new evidence-based treatments as research in this field expands.
  • Promote prevention of mTBI by providing education about brain safety to children who are entering contact sports, and educate patients who have had concussions and their families about how to avoid further brain injuries

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ASCP Corner

189 Monoamine Oxidase Inhibitors Revisited: What You Should Know

Letter to the Editor

192 Looking Beyond the Sleep Complaints: A Link to Suicidality

Online Exclusives

Practical Psychopharmacology

e119 Augmentation of Venlafaxine With Bupropion: Risks Associated With a Triple Monoamine Reuptake Inhibition Approach to Partially Responsive Depression

Clinical Points
  • In patients with partial response to venlafaxine, augmentation with bupropion may be considered, with the goal being “triple reuptake inhibition” of serotonin, norepinephrine, and dopamine.
  • Because bupropion inhibits CYP2D6, the enzyme responsible for metabolizing venlafaxine, it can raise venlafaxine levels. In some patients, adverse effects may result, ranging from anxiety and restlessness to increased blood pressure.
  • Should such adverse effects arise, treatment strategies include temporary withdrawal of venlafaxine or down-titration of the dose, using serum venlafaxine/desvenlafaxine levels as a guide in down-titration.

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Meta-Analysis

e122 High-Frequency Repetitive Transcranial Magnetic Stimulation Accelerates and Enhances the Clinical Response to Antidepressants in Major Depression: A Meta-Analysis of Randomized, Double-Blind, and Sham-Controlled Trials

Clinical Points
  • High-frequency repetitive transcranial magnetic stimulation (HF-rTMS) combined at the outset with an antidepressant medication is effective for accelerating and enhancing response and remission rates.
  • HF-rTMS is well tolerated overall.
  • HF-rTMS could be used as a second- or third-line add-on strategy to antidepressant medications.

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Original Research

e130 Effects of Cigarette Smoking on Neuropsychological Performance in Mood Disorders: A Comparison Between Smoking and Nonsmoking Inpatients

Clinical Points
  • Smoking assessment and neuropsychological evaluation are recommended in the routine clinical approach to patients with mood disorders.
  • The improvement of cognitive deficits by cognitive remediation treatments may also be useful in promoting smoking cessation in patients with mood disorders.
  • Psychotropic medications with negative side effects on cognition may increase cigarette consumption in patients with mood disorders.

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e137 Disability After Injury: The Cumulative Burden of Physical and Mental Health

Clinical Points
  • Because injury is a leading contributor to the global burden of disease, understanding the factors that drive long-term disability is important.
  • In a multisite longitudinal cohort study of injury patients, disability at 12 months was up to 4 times greater than community norms across all age groups. Although both physical factors and pain severity contributed significantly to 12-month disability, psychiatric symptoms played a greater role.
  • Early interventions targeting psychiatric symptoms may contribute to improving functional outcomes after injury.

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Book Reviews

e144 Essential Evidence-Based Psychopharmacology, 2nd ed

e145 Psychosis With Coexisting Substance Misuse: The NICE Guideline on Assessment and Management in Adults and Young People (National Clinical Guideline No. 120)

Free Online Activities

e03 Depression, Pain, and Comorbid Medical Conditions [CME]

e04 The Prevalence of Negative Symptoms in Schizophrenia and Their Impact on Patient Functioning and Course of Illness [CME]

Information for Authors

see www.psychiatrist.com/author.htm