Volume 74May 2013Number 5

Original Research

464 Six-Month Follow-Up of a Randomized Controlled Trial Augmenting Serotonin Reuptake Inhibitor Treatment With Exposure and Ritual Prevention for Obsessive-Compulsive Disorder

Clinical Points
  • Exposure and ritual prevention therapy ameliorates obsessive-compulsive disorder (OCD) symptom severity more than stress management training both after acute therapy and 6 months later among patients who seek further improvement for residual symptoms while taking serotonin reuptake inhibitor (SRI) medication.
  • Patients who benefit from cognitive-behavioral therapy augmentation of SRIs tend to maintain their gains irrespective of whether they receive exposure and ritual prevention or stress management training.
  • Serotonin reuptake inhibitors followed by exposure and ritual prevention help some but not all OCD patients to attain and maintain an excellent response as defined by minimal OCD symptoms.
  • Therapists should make efforts to maximize patients’ response to treatment in order to increase the probability that they will maintain their gains.


470 “Subthreshold” Depression: Is the Distinction Between Depressive Disorder Not Otherwise Specified and Adjustment Disorder Valid?

Clinical Points
  • In patients with subthreshold depression, the correct diagnosis is depressive disorder not otherwise specified (NOS) if the development of the symptoms is not attributable to a stressful event and adjustment disorder if the symptoms are attributable to a stressful event.
  • We found that clinically significant subthreshold depression was common in psychiatric outpatients, and the validity of distinguishing between depressive disorder NOS and adjustment disorder with depressed mood was supported by finding differences in comorbidity, personality profiles, and symptoms of depression.
  • Studies of the treatment of subthreshold depression should account for the distinction between depressive disorder NOS and adjustment disorder.


492 Modeling Trajectory of Depressive Symptoms Among Psychiatric Inpatients: A Latent Growth Curve Approach

Clinical Points
  • Reduction of depressive symptoms follows a curvilinear trajectory among psychiatric inpatients.
  • Symptom reduction is most rapid immediately following admission, with improvement slowing gradually over time.
  • Despite evidence for unique trajectories of recovery, clinical benchmarks are relatively consistent across patient groups.


507 Effectiveness of Lurasidone for Patients With Schizophrenia Following 6 Weeks of Acute Treatment With Lurasidone, Olanzapine, or Placebo: A 6-Month, Open-Label, Extension Study [Free Access]

Clinical Points
  • Open-label treatment with flexibly dosed lurasidone (40–120 mg/d) was effective and generally well tolerated over a 6-month period in patients who had completed 6 weeks of acute treatment with lurasidone, olanzapine, or placebo.
  • Patients who initially received placebo or lurasidone for 6 weeks experienced a small increase in weight and minimal changes in metabolic parameters during subsequent treatment with open-label lurasidone for up to 6 months, whereas patients previously treated with olanzapine experienced weight loss and improvement in lipid levels after switching to lurasidone.
  • The most frequent adverse events associated with lurasidone in this open-label extension study were akathisia and insomnia.



482 Can Psychotherapists Function as Their Own Controls? Meta-Analysis of the Crossed Therapist Design in Comparative Psychotherapy Trials

Clinical Points
  • Therapist belief in treatment is likely to be a strong nonspecific effect of psychotherapy, yet this factor has almost never been studied.
  • Researcher allegiance may influence study findings, in part, through the selecting of biased therapists in “crossed therapist” study designs.


CME Background

CME Article

506 Posttest


500 Is Depression With Atypical Features Associated With Trauma History?

Clinical Points
  • History of trauma appears more likely in patients with atypical depression than other depressive subtypes.
  • Patients with atypical depression report more traumatic experiences both prior to and following depression onset.
  • Individual symptoms of atypical depression do not appear to be associated with trauma history; the association may be present only when multiple symptoms co-occur to form the distinct syndrome of atypical depression.


Practical Psychopharmacology

479 Signal-to-Noise Ratio, Variability, and Their Relevance in Clinical Trials

Clinical Points
  • Response to medication is an example of a “signal” that clinicians and researchers wish to detect and measure.
  • Medication response varies across patients. Some of the variability is genuine and is due to reasons that are intrinsic to the patient. Some of the variability is spurious and is due to measurement error or “noise.”
  • This article explains the concept of the signal-to-noise ratio as applied to clinical research and practice. Examples of sources of noise are provided. Suggestions are made for how to reduce noise in clinical assessments.


ASCP Corner

516 Current Status of Ketamine and Related Compounds for Depression

Letters to the Editor

518 The Syndrome of Excited Delirium Following Use of “Bath Salts”

519 Correction

Online Exclusives

Case Report

e431 Single-Photon Emission Computed Tomography Findings in a Patient With Fahr Disease Associated With a Schizophrenia-Like Psychosis

Original Research

e417 A Case-Controlled Study of Successful Aging in Older HIV-Infected Adults

Clinical Points
  • Human immunodeficiency virus (HIV) infected (HIV+) adults give high ratings of successful aging, although their ratings are somewhat lower than HIV uninfected adults.
  • Self-rated successful aging in HIV+ adults is related to better physical and mental health functioning; increased happiness; greater resilience, optimism, and personal mastery; better attitudes toward aging; fewer depressive symptoms; and less perceived stress.
  • Clinicians can potentially help improve well-being in HIV+ adults by focusing on interventions to enhance positive psychological traits.


e424 Effects of Adjunctive Metformin on Metabolic Traits in Nondiabetic Clozapine-Treated Patients With Schizophrenia and the Effect of Metformin Discontinuation on Body Weight: A 24-Week, Randomized, Double-Blind, Placebo-Controlled Study

Clinical Points
  • Metformin can effectively improve metabolic-related features in nondiabetic clozapine-treated patients with schizophrenia.
  • The beneficial effect of metformin on reducing body weight disappears after discontinuation.


e433 Relationship Between Zolpidem Use and Stroke Risk: A Taiwanese Population–Based Case-Control Study

Clinical Points
  • Zolpidem should not be overused, because it is significantly associated with the increased risk of ischemic stroke.
  • Zolpidem should be prescribed for the short-term treatment of insomnia or difficulty in getting to sleep.


e439 Reduction of Crime in First-Onset Psychosis: A Secondary Analysis of the OPUS Randomized Trial

Clinical Points
  • Assertive specialized treatment alone, when applied universally in first-episode psychosis, did not reduce the risk or volume of violence and other criminality, despite the proven effectiveness of this treatment in reducing levels of symptoms and problems with comorbid substance misuse.
  • Almost three-quarters of those who committed offenses after commencing treatment for first-episode psychosis had already begun doing so before inclusion in the treatment trial.


e445 Quality of Life Following Remission of Mental Disorders: Findings From the National Epidemiologic Survey on Alcohol and Related Conditions

Clinical Points
  • Remission of mood, anxiety, or substance use disorders is commonly associated with improvements in quality of life, although clinicians should be aware of residual deficits in all the domains, even when diagnostic criteria are not met.
  • Clinicians should be aware of comorbid mental disorders in patients who show remission from a particular disorder, particularly substance use disorders.


Focus on Women’s Mental Health

e451 Postprandial Oxytocin Secretion Is Associated With Severity of Anxiety and Depressive Symptoms in Anorexia Nervosa

Clinical Points
  • Animal data suggest that the hormone oxytocin may have anxiolytic and antidepressant effects.
  • Women with anorexia nervosa have abnormal postprandial secretion of oxytocin, even after weight recovery.
  • Abnormal postprandial oxytocin secretion in women with anorexia nervosa is associated with increased symptoms of anxiety and depression.
  • These associations may represent an adaptive response of oxytocin secretion to food-related symptoms of anxiety and depression.


Book Reviews

e458 Clinical Manual of Psychosomatic Medicine: A Guide to Consultation-Liaison Psychiatry, 2nd ed

e459 Psychiatry of Intellectual Disability: A Practical Manual

Free Online Activities

e09 Novel Pharmacologic Targets for the Treatment of Negative Symptoms in Schizophrenia [CME]

e10 Early Diagnosis and Management of Alzheimer’s Disease [CME]

Information for Authors

see www.psychiatrist.com/author.htm