Volume 74July 2013Number 7

Original Research

669 The Computerized Adaptive Diagnostic Test for Major Depressive Disorder (CAD-MDD): A Screening Tool for Depression

Clinical Points
  • The Computerized Adaptive Diagnostic Test for Major Depressive Disorder (CAD-MDD) permits highly accurate screening for depression in less than 1 minute anywhere and anytime via any Internet-capable device.
  • This tool can be used to screen primary care patients for depression.
  • The CAD-MDD provides similar specificity but higher sensitivity than the Patient Health Questionnaire-9 using half the number of items.


685 Treatment Response, Symptom Remission, and Wellness in Obsessive-Compulsive Disorder

Clinical Points
  • Wellness is the ultimate outcome posttreatment and was conceptualized broadly in the current study to include obsessive-compulsive disorder symptom remission and improvements in quality of life and adaptive functioning.
  • Study results indicate the use of a Yale-Brown Obsessive Compulsive Scale score of ≤ 12 as a reliable proxy indicator of wellness.


694 Lisdexamfetamine Dimesylate in Adults With Attention-Deficit/Hyperactivity Disorder Who Report Clinically Significant Impairment in Executive Function: Results From a Randomized, Double-Blind, Placebo-Controlled Study

Clinical Points
  • Evidence suggests that impairments, beyond core symptoms, may occur in adults with attention-deficit/hyperactivity disorder (ADHD) and may contribute to the negative impact of ADHD.
  • Treatment of adults with ADHD and executive function deficits with lisdexamfetamine dimesylate over 4 weeks was efficacious compared with placebo in improving ADHD symptoms, executive behavior dysfunction, and global illness severity.
  • Use of multiple outcome assessments may enhance clinicians’ ability to monitor treatment progress, manage patients more effectively, and achieve patient-relevant improvement.


716 Positive Affect and Survival in Patients With Stable Coronary Heart Disease: Findings From the Heart and Soul Study

Clinical Points
  • Although the impact of negative emotions on cardiovascular prognosis has been studied extensively, research on positive affect has been relatively sparse.
  • In a sample of 1,018 patients with stable coronary heart disease, we found that greater positive affect was associated with improved survival.
  • The association between positive affect and mortality becomes nonsignificant after adjustment for physical activity.
  • These findings seem to suggest that the improved survival associated with positive affect could potentially be enhanced with behavioral interventions that include exercise training.


732 Omega-3 Polyunsaturated Fatty Acid (PUFA) Status in Major Depressive Disorder With Comorbid Anxiety Disorders

Clinical Points
  • The presence and severity of anxiety were associated with the lowest omega-3 fatty acid levels across major depressive disorder (MDD) samples and healthy control samples.
  • The association between low omega-3 fatty acid levels and the presence of comorbid anxiety disorders was not explained by depression severity, tobacco consumption, or demographic factors.
  • At this time, it is not known whether omega-3 supplementation could have anxiolytic effects.



703 Less Is More in Antidepressant Clinical Trials: A Meta-Analysis of the Effect of Visit Frequency on Treatment Response and Dropout

Clinical Points
  • Clinicians may be advised to initiate a discussion of follow-up visit frequency with depressed patients at the beginning of treatment in order to integrate their recommendations with patients’ expectations and preferences.
  • In the treatment of stable patients, clinicians may opt to evaluate patients every 2 weeks during the initiation of antidepressant medication and then taper visit frequency to monthly when clinically appropriate and in keeping with a given patient’s preferences.


Review Article

675 Lamotrigine in Psychiatric Disorders

Clinical Points
  • Lamotrigine is approved by the US Food and Drug Administration for the maintenance treatment of bipolar disorder and is particularly useful in preventing depression.
  • Data also suggest a role in the treatment of acute bipolar depression.
  • Lamotrigine is generally well tolerated, with headache, nausea, and mild rash occurring most commonly, while severe rash is estimated to occur in less than 0.2% of cases.


CME Background

CME Article

731 Posttest


723 Predicting Diagnostic Change Among Patients Diagnosed With First-Episode DSM-IV-TR Major Depressive Disorder With Psychotic Features

Clinical Points
  • Psychotic major depressive disorder (MDD) occurs across a broad age range and is not limited to geriatric patients.
  • ICD-10 diagnostic criteria were more effective in identifying first-episode patients diagnosed by DSM-IV-TR criteria as having psychotic depression who later met DSM-IV-TR criteria for other disorders.
  • Change of DSM-IV-TR diagnosis from psychotic MDD to bipolar disorder was predicted by affective features, and change from psychotic MDD to schizoaffective diagnoses was predicted by features associated with nonaffective psychotic disorders such as schizophrenia. Stable diagnoses of psychotic MDD were associated with initial existential anguish, nihilistic delusions, and weight loss.


Case Report

693 A Case of Persistent Genital Arousal Disorder Successfully Treated With Topiramate in a Physically Healthy Individual

ASCP Corner

739 Changes in the Diagnostic Criteria for Autism in DSM-5: Controversies and Concerns

Letters to the Editor

741 Study Data Support the Validity of the Major Depression Bereavement Exclusion

Online Exclusives

Practical Psychopharmacology

e633 Antenatal Exposure to Selective Serotonin Reuptake Inhibitors and Duration of Gestation

Clinical Points
  • Some, but not all, studies suggest that selective serotonin reuptake inhibitor (SSRI) use during late pregnancy increases the risk of preterm delivery. Even if this is so, we cannot yet say whether the risk is related to SSRI treatment or to the depression (and its correlates) for which the SSRIs were prescribed.
  • In studies that found significant differences, the duration of gestation was shorter by 2–6 days in women who received SSRIs during pregnancy relative to women who did not.
  • A recent large randomized controlled trial found no differences in maternal and neonatal outcomes between deliveries conducted during week 38 and week 39 of gestation. This implies that even if SSRIs do anticipate delivery by a few days, it may not matter much.


Original Research

e636 A Randomized, Double-Blind, Placebo-Controlled Trial of Pramipexole Augmentation in Treatment-Resistant Major Depressive Disorder

Clinical Points
  • For patients who have failed to respond to standard antidepressant therapies, pramipexole is a safe and potentially efficacious augmentation strategy.
  • Augmentation with pramipexole was well tolerated at a mean (SD) dose of 1.35 (0.31) mg/d.


e655 Randomized Controlled Trial to Assess Reduction of Cardiovascular Disease Risk in Patients With Bipolar Disorder: The Self-Management Addressing Heart Risk Trial (SMAHRT)

Clinical Points
  • Bipolar disorder is a complex chronic condition that requires integrated medical and psychiatric care to produce optimal outcomes.
  • Collaborative chronic care models represent an evidence-based strategy that has the potential to efficiently improve the delivery of integrated services.
  • Behavioral interventions that support patient self-management, brief care management, and registry monitoring can reduce bipolar symptoms and cardiovascular risks.



e642 Antipsychotics for Primary Alcohol Dependence: A Systematic Review and Meta-Analysis of Placebo-Controlled Trials

Clinical Points
  • Both individually and pooled together, antipsychotics did not differ from placebo regarding relapse prevention of alcohol dependence.
  • Placebo outperformed pooled antipsychotics regarding number or percentage of abstinent days/lack of drinking days, without significant group differences after removing 1 outlying flupenthixol decanoate study.
  • Antipsychotics caused greater all-cause discontinuation than placebo, especially aripiprazole and flupenthixol decanoate.


Book Reviews

e663 Prescribed: Writing, Filling, Using, and Abusing the Prescription in Modern America

e664 Public Health Aspects of Diagnosis and Classification of Mental and Behavioral Disorders: Refining the Research Agenda for DSM-5 and ICD-11

Free Online Activities

e13 Recognizing and Addressing Barriers to the Effective Management of ADHD in College Students [CME]

e14 Evaluating and Monitoring Treatment Response in Depression Using Measurement-Based Assessment and Rating Scales [CME]

Information for Authors

see www.psychiatrist.com/author.htm