Volume 74August 2013Number 8

CME Background

CME Article

801 Posttest

 

795 Impact of the Number of Parents With Alcohol Use Disorder on Alcohol Use Disorder in Offspring: A Population-Based Study

Clinical Points
  • Twenty-two percent of adults in the United States have at least 1 biological parent with alcohol use disorder (AUD).
  • The odds of lifetime AUD are 2.5 times higher in offspring of 1 AUD parent and 4.4 times higher in offspring of 2 AUD parents compared to offspring of non-AUD parents.
  • Although male offspring have higher prevalence rates of AUD than female offspring, female offspring are more vulnerable to the impact of parental AUD than male offspring.

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Original Research

786 Randomized Controlled Trial of Mindfulness Meditation for Generalized Anxiety Disorder: Effects on Anxiety and Stress Reactivity

Clinical Points
  • Mindfulness-Based Stress Reduction appears to be an effective tool to reduce anxiety in patients with generalized anxiety disorder.
  • Patients who learned mindfulness meditation had less stress reactivity, and were more resilient, to a laboratory stress task.

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802 A Randomized Controlled Trial of the Efficacy and Safety of Lisdexamfetamine Dimesylate as Augmentation Therapy in Adults With Residual Symptoms of Major Depressive Disorder After Treatment With Escitalopram

Clinical Points
  • Current treatment strategies for major depressive disorder are insufficient, with most individuals receiving antidepressant monotherapy not achieving remission.
  • Augmentation therapy with a mechanistically distinct agent may offer clinical benefit in individuals with major depressive disorder who do not achieve full remission with antidepressant monotherapy.
  • In this proof-of-concept study, lisdexamfetamine augmentation reduced depressive symptoms and was generally well tolerated in individuals with major depressive disorder who did not achieve full remission with escitalopram monotherapy.

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810 Safety and Efficacy of Methylphenidate for Apathy in Alzheimer’s Disease: A Randomized, Placebo-Controlled Trial

Clinical Points
  • Apathy in Alzheimer’s disease is common and adds to disability and caregiver burden.
  • Methylphenidate treatment of apathy in Alzheimer’s disease may improve symptoms with a benign safety profile.

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Commentary

817 The Law of Diminishing Intent: Getting Excited About Apathy

Focus on Childhood and Adolescent Mental Health

819 Treatment, Bereavement, and Trauma in Children

821 A Randomized Placebo-Controlled Trial of Electroencephalographic (EEG) Neurofeedback in Children With Attention-Deficit/Hyperactivity Disorder

Clinical Points
  • The findings of this study are in line with a recent meta-analysis that concluded that EEG neurofeedback does not have proven efficacy as a treatment for children with ADHD.
  • Guidance regarding EEG neurofeedback as a treatment for children with ADHD must be in line with these current findings.
  • Further research on this topic is needed to determine whether EEG neurofeedback is of clinical relevance in subgroups of children with ADHD.

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828 Alcohol and Substance Abuse in Parentally Bereaved Youth

Clinical Points
  • Interventions aimed at preventing or attenuating the development of disruptive behavior disorders (oppositional defiant or conduct disorders), depression, and posttraumatic stress disorder may potentially prevent alcohol and substance abuse or dependence in bereaved youth.
  • Treatment of psychiatric illness in caregivers and interventions to improve their parenting efficacy and overall functioning are also likely to be protective against the development of alcohol and substance abuse or dependence.

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834 A Prospective Study of Parentally Bereaved Youth, Caregiver Depression, and Body Mass Index

Clinical Points
  • Physicians should be aware that bereaved children may be at increased risk for obesity.
  • Bereaved youth may benefit from closer monitoring of diet and physical activity to prevent excessive weight gain.
  • Bereaved youth and their caregivers may benefit from psychoeducation about the association between negative emotions, stress, and eating behavior.

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841 Clinical Significance of a Proposed Developmental Trauma Disorder Diagnosis: Results of an International Survey of Clinicians

Clinical Points
  • Children in or in need of psychiatric treatment for multiple comorbid diagnoses should be assessed for a history of traumatic victimization and disrupted caregiver attachments.
  • The sequelae of childhood traumatic victimization and disrupted caregiver attachments are a set of symptoms that clinicians identify as clinically significant and not fully accounted for by existing psychiatric diagnoses or effectively treated by existing evidence-based treatments.
  • Developmental trauma disorder may provide a parsimonious, single efficient diagnosis to guide the treatment of traumatized children who present with multiple psychiatric diagnoses.

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ASCP Corner

850 Pulsed Intravenous Administration of Scopolamine Produces Rapid Antidepressant Effects and Modest Side Effects

Letters to the Editor

852 Toward Rational Use of Benzodiazepines in Posttraumatic Stress Disorder

853 Apparent Discrepancy Between Published Study of Gabapentin Treatment and Internal Company Report

Online Exclusives

Practical Psychopharmacology

e744 Levothyroxine in Psychiatry: Issues Related to Absorption After Oral Dosing

Clinical Points
  • Circumstances that result in decreased absorption of orally administered levothyroxine (T4) include drugs and disorders that reduce gastric acidity; constituents of food such as fiber; items of consumption such as soy, coffee, and grapefruit juice; and drugs and supplements such as calcium, iron, sucralfate, orlistat, and phosphate binders.
  • Patients should therefore take T4 on an empty stomach, at a time as distant as possible from intake of food, beverages, and other medications.
  • If this is not feasible, possible impairment in absorption can be accepted and the dose of T4 titrated to target hormonal levels.

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Original Research

e747 Impairment of Executive Function and Attention Predicts Onset of Affective Disorder in Healthy High-Risk Twins

Clinical Points
  • In healthy individuals at risk for affective disorders, lower cognitive performance seems to predict subsequent development of psychiatric illness.
  • Based on the present findings, it is possible that cognitive impairment not only develops as part of illness progression but may in fact be present before the illness onset.
  • There is a clinical need for earlier and more thorough psychiatric assessment, including neuropsychological testing, in individuals at risk for affective disorder to aid earlier diagnosis and easier admission to psychiatric treatment.

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Review Article

e754 An Evidence Synthesis of Care Models to Improve General Medical Outcomes for Individuals With Serious Mental Illness: A Systematic Review

Clinical Points
  • Interventions that aimed to integrate medical care and mental health care demonstrated generally positive effects on process of care for patients with serious mental illness, specifically, demonstrating improvements in immunization rates, cancer screening, and selected screening for cardiovascular disease.
  • Care models with limited to moderate integration of medical and mental health care can lead to improvements in process of care when fully integrated models are infeasible.

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Focus on Childhood and Adolescent Mental Health

e765 Impact of Physiologic Estrogen Replacement on Anxiety Symptoms, Body Shape Perception, and Eating Attitudes in Adolescent Girls With Anorexia Nervosa: Data From a Randomized Controlled Trial

Clinical Points
  • Physiologic estrogen replacement in the form of transdermal estrogen patch improves trait anxiety (the tendency to experience anxiety) but not state anxiety, eating attitudes, or body shape perception in adolescent girls with anorexia nervosa.
  • Further studies in adolescents and adults with anorexic samples are necessary to understand the impact of other forms and doses of estrogen administration.

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e772 A Multicenter, Randomized, Double-Blind, Placebo-Controlled Study of Aripiprazole in Children and Adolescents With Tourette’s Disorder

Clinical Points
  • Current evidence supports that aripiprazole can reduce tic symptoms in youth effectively.
  • In general, aripiprazole is tolerated and safe in children and adolescents with Tourette’s disorder.

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Book Review

e781 Marijuana and Madness, 2nd ed

Online Activities

e15 Important Distinctions Between Bipolar I and Bipolar II Depression [CME]

e16 Addressing Barriers to Using Long-Acting Injectable Antipsychotics and Appropriately Monitoring Antipsychotic Adverse Effects [CME]

e17 Military- and Sports-Related Mild Traumatic Brain Injury: An Overview [CME]

Information for Authors

see www.psychiatrist.com/author.htm