Volume 74April 2013Number 4

Publisher’s Note

348 When Smaller Is Bigger

CME Background

CME Commentary

239 Posttest

 

357 The Effects of the Affordable Care Act on the Practice of Psychiatry

Clinical Points
  • The ACA’s expanded coverage will create an influx of new patients.
  • Psychiatry practice is shifting toward patient-centered medical homes and collaborative treatment teams.
  • New technologies will expand access to and increase efficiency of health care.

[Close]

Original Research

349 Randomized Controlled Trial of Interventions for Young People at Ultra-High Risk of Psychosis: Twelve-Month Outcome

Clinical Points
  • Watchful monitoring and psychosocial interventions such as supportive therapy and cognitive therapy should be the first-line interventions in this patient group.
  • Antipsychotic treatment should typically be reserved for those whose symptoms, distress, and functional impairment have clearly worsened significantly, despite psychosocial intervention, to the point where sustained frank psychosis has developed.

[Close]

363 Efficacy and Safety of Levomilnacipran Sustained Release in Moderate to Severe Major Depressive Disorder: A Randomized, Double-Blind, Placebo-Controlled, Proof-of-Concept Study [Free Access]

Clinical Points
  • Major depressive disorder (MDD) is a common and disabling disorder with a chronic and recurrent course; as it is a leading cause of worldwide disease burden, effective treatment of MDD is a public health priority.
  • Levomilnacipran sustained release (SR), a serotonin-norepinephrine reuptake inhibitor antidepressant candidate with preference for norepinephrine reuptake inhibition, was evaluated in a randomized, double-blind, placebo-controlled trial in adults with moderate to severe MDD.
  • Levomilnacipran SR 75–100 mg/d was effective and well tolerated in treating the symptoms of depression and its associated functional impairment.

[Close]

Case Report

370 A Case of Atypical Antipsychotic–Induced Somnambulism: A Class Effect

Academic Highlights

407 Residual Symptoms in Major Depressive Disorder: Prevalence, Effects, and Management [Free Access]

ASCP Corner

415 Lessons Learned From d-Cycloserine: The Promise and Limits of Drug Facilitation of Exposure Therapy

Focus on Women’s Mental Health

373 Pregnancy and Psychiatric Disorders: Inherent Risks and Treatment Decisions

375 Achieving the Balance: Treating Depressed Pregnant Women With Antidepressants [Commentary]

377 Risk of Obsessive-Compulsive Disorder in Pregnant and Postpartum Women: A Meta-Analysis [Review Article]

Clinical Points
  • Our results indicate that pregnant or postpartum women are approximately 1.5–2 times more likely to experience obsessive-compulsive disorder compared to the general population.
  • Routine prenatal screening for psychiatric disorders must extend beyond depression for both pregnant and postpartum women.
  • Clinicians must be careful not to overpathologize the occurrence of adaptive anxiety in pregnant and postpartum women, given the high degree of subthreshold obsessive-compulsive symptoms at this time.

[Close]

386 Psychological Response and Cortisol Reactivity to In Vitro Fertilization Treatment in Women With a Lifetime Anxiety or Unipolar Mood Disorder Diagnosis

Clinical Points
  • Women undergoing in vitro fertilization (IVF) have a high prevalence (about 20%) of lifetime unipolar mood and anxiety psychopathology.
  • In contrast to women without lifetime psychopathology, those with a formal diagnosis of unipolar mood or anxiety disorder develop significant symptom exacerbation throughout an IVF treatment cycle.
  • It is of significant clinical value to identify women with a history of such psychopathology prior to the fertility treatment so that they can be followed up and possibly treated as needed.

[Close]

393 A Controlled Clinical Treatment Trial of Interpersonal Psychotherapy for Depressed Pregnant Women at 3 New York City Sites

Clinical Points
  • Treating antepartum depression continues to be a controversial and complicated matter in psychiatry.
  • Current guidelines recommend the use of psychotherapy for mild-to-moderate depression.
  • Interpersonal psychotherapy is beneficial for the treatment of depressive symptoms in the antepartum period.
  • Clinicians should also consider other behavioral models.

[Close]

400 Bupropion for Overweight Women With Binge-Eating Disorder: A Randomized, Double-Blind, Placebo-Controlled Trial

Clinical Points
  • Binge-eating disorder is strongly associated with excess weight, and many available psychological and pharmacologic approaches fail to produce much weight loss.
  • In this 8-week randomized controlled trial, bupropion was well tolerated and produced significantly greater—albeit quite modest—short-term weight loss in overweight and obese women with binge-eating disorder.
  • Bupropion did not improve binge eating, food craving, or associated eating disorder features or depression relative to placebo.

[Close]

Online Exclusives

Original Research

e281 Severe Neuropsychiatric Outcomes Following Discontinuation of Long-Term Glucocorticoid Therapy: A Cohort Study

Clinical Points
  • Discontinuation of long-term glucocorticoid therapy is associated with an increased risk of both depression and delirium/confusion.
  • Elderly people and those treated with long-acting glucocorticoids are at particular risk for glucocorticoid withdrawal–induced neuropsychiatric symptoms.
  • An underlying adrenal insufficiency must be ruled out when neuropsychiatric symptoms are diagnosed in people discontinuing long-term glucocorticoid exposure.

[Close]

e287 The Type 2 Diabetes Mellitus Susceptibility Gene IGF2BP2 Is Associated With Schizophrenia in a Han Chinese Population

Clinical Points
  • Patients with schizophrenia have an increased prevalence of type 2 diabetes mellitus, and type 2 diabetes mellitus has shown an association with the rs4402960 polymorphism of the insulin-like growth factor II mRNA–binding protein 2 gene (IGF2BP2).
  • The rs4402960 polymorphism was found to be associated with vulnerability to schizophrenia, and the IGF2BP2 gene’s expression levels were significantly greater in schizophrenia.
  • The co-occurrence of type 2 diabetes mellitus and schizophrenia may be caused by shared genetic risk variants.

[Close]

Focus on Women’s Mental Health

375 Achieving the Balance: Treating Depressed Pregnant Women With Antidepressants [Commentary]

e293 Antidepressant Exposure During Pregnancy and Congenital Malformations: Is There an Association? A Systematic Review and Meta-Analysis of the Best Evidence

Clinical Points
  • Antidepressants do not appear to be associated with an increased risk of congenital malformations overall.
  • Antidepressants may be associated with cardiovascular malformations.
  • Clinical significance does not always follow from statistical significance, and clinicians must consider the risks of depressive illness prior to making any treatment decisions.

[Close]

e309 The Effect of Prenatal Antidepressant Exposure on Neonatal Adaptation: A Systematic Review and Meta-Analysis

Clinical Points
  • Antidepressant exposure during pregnancy may be associated with poor neonatal adaptation syndrome (PNAS) in the infant.
  • Antidepressant exposure during pregnancy may be associated with respiratory distress and tremors in the infant.
  • Clinicians must inform and prepare women taking antidepressants during pregnancy that their infant may show signs of PNAS and, in case they occur, how they will be managed.

[Close]

e321 The Impact of Maternal Depression During Pregnancy on Perinatal Outcomes: A Systematic Review and Meta-Analysis

Clinical Points
  • Maternal depression during pregnancy may be associated with premature delivery.
  • Depressed mothers may be less likely to start breastfeeding.
  • The effects of maternal depression during pregnancy must be considered when making treatment plans.

[Close]

PRESS RELEASE

Antidepressant Use During Pregnancy Poses Minimal Risk

Book Reviews

e342 Sports Psychiatry: Strategies for Life Balance and Peak Performance

e343 Autonomy and Mental Disorder

Free Online Activities

e07 Improving Patient Outcomes in Depression Through Guideline-Concordant, Measurement-Based Care [CME]

e08 Does Using Marijuana Increase the Risk for Developing Schizophrenia? [CME]

Information for Authors

see www.psychiatrist.com/author.htm