Volume 74March 2013Number 3

Original Research

226 Suicide Risk Assessment Received Prior to Suicide Death by Veterans Health Administration Patients With a History of Depression

Clinical Points
  • From 1999 through 2004, suicide risk assessment at the final Veterans Health Administration (VHA) visit was infrequent, although it was much more common in mental health settings than primary care settings.
  • Suicide risk assessment is complicated by the observation that most individuals dying by suicide who were assessed at their final visit denied suicidal ideation.
  • Augmentation of routine screening, such as increased emphasis on addressing chronic risk factors (eg, access to means), may be important in reducing suicide risks.


242 Efficacy and Safety of Levomilnacipran Sustained Release 40 mg, 80 mg, or 120 mg in Major Depressive Disorder: A Phase 3, Randomized, Double-Blind, Placebo-Controlled Study [Free Access]

Clinical Points
  • Major depressive disorder (MDD) is a leading cause of worldwide disease burden, and effective new treatments of MDD are needed.
  • Levomilnacipran SR is a serotonin-norepinephrine reuptake inhibitor with preference for norepinephrine reuptake inhibition in late-stage clinical development; the efficacy and safety of 3 daily fixed doses (40 mg, 80 mg, 120 mg) were evaluated versus placebo in an 8-week randomized, double-blind clinical trial.
  • Improvement in Montgomery-Asberg Depression Rating Scale (MADRS) total score was statistically greater for all doses of levomilnacipran SR relative to placebo; results suggest greater symptomatic and functional improvement on the MADRS and Sheehan Disability Scale with higher levomilnacipran SR doses.


249 Extreme Attributions Predict the Course of Bipolar Depression: Results From the STEP-BD Randomized Controlled Trial of Psychosocial Treatment

Clinical Points
  • Cognitive rigidity may be associated with a poorer course of depression in bipolar disorder, regardless of the valence of rigid thoughts.
  • Pessimistic attributions and depression severity may work synergistically to maintain depression in bipolar disorder.
  • Assessing attributional style may be clinically useful in identifying bipolar patients who are likely to have more severe courses of depression.


256 Sexual Satisfaction and Quality of Life in Major Depressive Disorder Before and After Treatment With Citalopram in the STAR*D Study

Clinical Points
  • Many patients with major depressive disorder have impaired sexual satisfaction and poor quality of life.
  • Inquiring about and measuring sexual satisfaction are useful in treating depression.
  • Treating depression to full remission could improve sexual satisfaction.


CME Background

CME Activity

239 Posttest


233 Five-Year Course of Obsessive-Compulsive Disorder: Predictors of Remission and Relapse

Clinical Points
  • Clinicians should target full remission (minimal or no symptoms) of obsessive-compulsive disorder (OCD) to minimize the risk of relapse.
  • Comorbid obsessive-compulsive personality disorder is associated with a worse OCD course.
  • Primary obsessions regarding overresponsibility for harm are associated with better prognosis compared with other types of obsessions.


Early Career Psychiatrists

262 Teaching the Teacher: A Report From the Third Annual American Society of Clinical Psychopharmacology Teaching Session [Commentary]

265 Generalizability of Clinical Trial Results for Bipolar Disorder to Community Samples: Findings From the National Epidemiologic Survey on Alcohol and Related Conditions

Clinical Points
  • Eligibility criteria applied in clinical trials for bipolar disorder exclude a majority of participants, particularly those seeking treatment, thus limiting the generalizability of their results.
  • Individuals with a current significant risk of suicide are underrepresented in clinical trials for bipolar disorder.
  • Clinicians and researchers should carefully consider eligibility criteria and their impact on the representativeness of clinical trials.


271 A Prevalence Study of Urinary Tract Infections in Acute Relapse of Schizophrenia

Clinical Points
  • Subjects with an acute relapse of schizophrenia have a significantly increased prevalence of urinary tract infection.
  • Clinicians should monitor for comorbid urinary tract infection in patients with schizophrenia; such infections often go unrecognized and untreated.


ASCP Corner

278 Reconsidering Chronic Hyponatremia in Psychosis

Letter to the Editor

280 Subjective Assessments of Threats and Their Association to Posttraumatic Stress Disorder Symptoms: The Case of the 2011 Japan Earthquake and Nuclear Disaster

Online Exclusives

Practical Psychopharmacology

e193 Antidepressant Action of Atypical Antipsychotics: Focus on Ziprasidone Monotherapy, With a Few Twists in the Tale

Clinical Points
  • Ziprasidone has established antimanic efficacy. It also has pharmacodynamic properties that suggest that it may have antidepressant action. Hypothetically, therefore, ziprasidone may be useful in depressive illness, especially bipolar depression.
  • A recent RCT found ziprasidone to be no better than placebo in major depressive disorder. Earlier RCTs had found it ineffective in bipolar depression, as well.
  • The results to date with ziprasidone suggest that clinicians should not rely too much on pharmacodynamic properties to guide expectations about the clinical efficacy of a drug. Due to limitations of the available RCT data, however, firm conclusions remain to be drawn regarding the use of ziprasidone in different contexts in depression.


Original Research

e197 Posttraumatic Stress Disorder in Adult Attention-Deficit/Hyperactivity Disorder: Clinical Features and Familial Transmission

Clinical Points
  • Although individuals with attention-deficit/hyperactivity disorder (ADHD) and individuals with ADHD plus posttraumatic stress disorder (PTSD) may not differ in terms of ADHD symptom severity, current evidence suggests that patients with ADHD + PTSD will most likely experience greater functional impairments and higher rates of psychiatric comorbidities.
  • Adults with ADHD are at high risk for PTSD; therefore, assessing for the presence of both disorders is encouraged.
  • Relatives of ADHD and ADHD + PTSD probands are at greater risk of developing one or both of the disorders.


e205 Recovery From Multiple Episodes of Bipolar I Depression

Clinical Points
  • The median duration of major and minor depressive episodes in bipolar I disorder is 14.0 and 8.0 weeks, respectively.
  • A more chronic course of illness is associated with a delayed recovery from depressive episodes in bipolar I disorder, although duration of discrete episodes is variable within individuals.


e212 Co-Occurrence of Major Depressive Episode and Posttraumatic Stress Disorder Among Survivors of War: How Is It Different From Either Condition Alone?

Clinical Points
  • Co-occurring major depressive episode (MDE) and posttraumatic stress disorder (PTSD) among survivors of war are characterized by different traumatic events, more general psychological distress, higher suicide risk, and lower quality of life than either condition alone.
  • Co-occurrence of MDE and PTSD should be assessed in future research and clinical settings with war survivors to better identify individuals with severe psychopathology and poor quality of life.
  • War survivors with co-occurrence of MDE and PTSD may require specific health care programs.


Book Reviews

e219 Health Care Reform: A Primer for Psychiatrists

e220 Parental Alienation, DSM-5, and ICD-11

e221 Essential CNS Drug Development

Free Online Activities

e05 Understanding the Physiology of Schizophrenia [CME]

e06 Alzheimer’s Disease: The Importance of Early Diagnosis and Appropriate Management [CME]

Information for Authors

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