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.


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.


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.


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.


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.


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.


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.


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.


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.


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 [Free Access]

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.


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.


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.



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