Volume 74September 2013Number 9

Original Research

872 SSRI Versus Bupropion Effects on Symptom Clusters in Suicidal Depression: Post Hoc Analysis of a Randomized Clinical Trial

Clinical Points
  • In higher suicidal risk patients with major depressive disorder (suicidal ideation or past attempt), change in suicidal ideation is more strongly associated with change in affective/cognitive symptoms as compared to somatic/neurovegetative symptoms.
  • Controlled-release paroxetine appears to have a modest advantage, compared to extended-release bupropion, in reducing affective/cognitive depression symptoms, which are the symptoms most closely associated with suicidal ideation.
  • The results require replication but suggest that selective-serotonin reuptake inhibitor therapy may have a modest advantage over norepinephrine-dopamine reuptake inhibitor therapy for reducing suicidal ideation via faster reduction of core affective/cognitive depression symptoms in the early weeks of treatment.

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887 Prediction of Suicidal Behavior in Clinical Research by Lifetime Suicidal Ideation and Behavior Ascertained by the Electronic Columbia-Suicide Severity Rating Scale

Clinical Points
  • Severity of lifetime suicidal ideation and behavior predicts patient risk for subsequent suicidal behavior, which is of critical importance for clinical practice and monitoring of patients.
  • Computer-automated assessments, such as the electronic Columbia-Suicide Severity Rating Scale, reduce clinician burden, encourage patient self-disclosure, facilitate clinical follow-up, and streamline electronic patient medical records.
  • Such procedures improve the quality of information for monitoring change in patient safety and assessing clinical improvement. This can inform care delivery and provide a foundation to support evidence-based decision-making.

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895 Inhibitory Neural Activity Predicts Response to Cognitive-Behavioral Therapy for Posttraumatic Stress Disorder

Clinical Points
  • Inhibitory skills are deficient in posttraumatic stress disorder (PTSD) but may be important in using cognitive-behavioral therapy strategies to regulate emotions.
  • Response to cognitive-behavioral therapy is predicted by recruitment of inhibitory networks in PTSD patients prior to treatment and may suggest that strategies that facilitate greater inhibitory capacity prior to treatment may lead to better treatment outcomes.

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918 Antipsychotic Treatment and the Occurrence of Venous Thromboembolism: A 10-Year Nationwide Registry Study

Clinical Points
  • Use of antipsychotic medication is associated with an increased risk of venous thromboembolism, especially among new users of antipsychotics.
  • While prescribing antipsychotic medication, physicians should use caution and closely monitor for the symptoms and signs of venous thromboembolism, even among patients who previously had no clinical risk factors.

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925 Specific Parental Depression Symptoms as Risk Markers for New-Onset Depression in High-Risk Offspring

Clinical Points
  • Clinicians should be vigilant to the possibility of depression in the offspring of depressed parents.
  • Parental depression as a risk to offspring may be influenced by heterogeneity in parental depression features.
  • Parental loss of appetite or weight appears to be a particularly important marker of risk for future depression in offspring.

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932 National Trends in the Office-Based Prescription of Schedule II Opioids

Clinical Points
  • Prescription of opioid analgesics is increasing in office-based medical practice.
  • Particularly rapid increases in opioid prescribing are occurring among older adult patients and patients making their first visit to their treating physician.
  • Physicians should remain vigilant for indications of opioid misuse in all of their patients who are prescribed opioids.

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CME Background

CME Article

886 Posttest

 

880 Distinguishing Bipolar II Depression From Major Depressive Disorder With Comorbid Borderline Personality Disorder: Demographic, Clinical, and Family History Differences

Clinical Points
  • Because of the potential treatment implications, it is clinically important to recognize both bipolar disorder and borderline personality disorder in patients seeking treatment for depression, and it is important to distinguish between the two.
  • Compared to bipolar II depressed patients, patients with major depressive disorder and borderline personality disorder (MDD-BPD) had more comorbid psychiatric disorders; greater severity of anger, anxiety, paranoid ideation, and somatization; poorer social functioning; and more suicide attempts. The patients with bipolar II depression had a significantly higher morbid risk for bipolar disorder in their first-degree relatives than the MDD-BPD patients.
  • The findings of the study support the validity of distinguishing between bipolar II disorder and borderline personality disorder.

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Review Article

902 Effect of Psychostimulants on Brain Structure and Function in ADHD: A Qualitative Literature Review of Magnetic Resonance Imaging–Based Neuroimaging Studies

Clinical Points
  • Stimulant treatment for attention-deficit/hyperactivity disorder (ADHD) is known to be efficacious, but concerns about effects on the developing brain remain.
  • Our review of structural and functional neuroimaging studies finds no evidence that stimulant treatment negatively impacts brain development or function. In contrast, these studies suggest that stimulant treatment attenuates the brain abnormalities that have been associated with ADHD.

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ASCP Corner

940 Antidepressant Use in Pregnancy and Risk of Autism Spectrum Disorders: A Critical Examination of the Evidence

Online Exclusives

Practical Psychopharmacology

e855 Famotidine Augmentation in Schizophrenia: Hope or Hype?

Clinical Points
  • Famotidine is a potent, selective histamine H2 receptor antagonist that has been investigated as an antipsychotic augmentation agent in treatment-refractory schizophrenia, especially for negative symptoms.
  • Case reports, open studies, and small randomized controlled trials of famotidine have documented differing improvements in total ratings of psychosis, negative symptoms, general psychopathology, and other measures.
  • Encouraging results notwithstanding, for theoretical reasons as well as for reasons related to the quality of the evidence, it is premature to seriously consider famotidine as a possible antipsychotic augmentation agent.

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Original Research

e859 Effects of Stroke Rehabilitation on Incidence of Poststroke Depression: A Population-Based Cohort Study

Clinical Points
  • Poststroke depression increased morbidity and mortality in stroke survivors.
  • This study provides evidence that best supports the protective effect of stroke rehabilitation intervention on depression incidence.
  • The stroke rehabilitation intervention appears to be effective in patients of all age and sex stratifications, with a stronger protective effect noted in male patients.

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Book Review

e867 The Science of the Art of Psychotherapy

Online Activities

e18 Improving Patient Outcomes in Schizophrenia: Achieving Remission, Preventing Relapse, and Measuring Success [CME]

e19 Strategies for Managing the Risks Associated With ADHD Medications [CME]

Information for Authors

see www.psychiatrist.com/author.htm