Volume 74October 2013Number 10

CME Background

CME Commentary

980 Posttest

 

974 Preventing Domestic Violence in Families of Veterans

Clinical Points
  • Learn about resources for veterans and their families within your community.
  • Become familiar with military culture, especially the customs, habits, and norms that affect a veteran’s reaction to suggestions about mental health treatment.
  • Whenever possible, involve the significant other when treating someone for signs of deployment-related mental health stress.

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Meta-Analysis

957 Long-Acting Injectable Versus Oral Antipsychotics in Schizophrenia: A Systematic Review and Meta-Analysis of Mirror-Image Studies

Clinical Points
  • Recent randomized controlled trials showed no benefit of long-acting injectables (LAIs) over oral antipsychotics in preventing relapse in schizophrenia.
  • The reported meta-analysis based on 25 mirror-image studies that compared periods of treatment with oral antipsychotics versus LAIs in the same patients, showed strong superiority of LAIs over oral antipsychotics in preventing hospitalization.
  • Mirror-image studies might better reflect the real-world impact of LAIs; however, one should consider the biases of different study designs when evaluating the comparative effectiveness of LAIs.

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Original Research

966 Antidepressant Augmentation Using the N-Methyl-d-Aspartate Antagonist Memantine: A Randomized, Double-Blind, Placebo-Controlled Trial

Clinical Points
  • This placebo-controlled, double-blind randomized trial, although small, did not find efficacy for the oral N-Methyl-d-aspartate antagonist memantine as an augmentation treatment in major depressive disorder.
  • This study joins a placebo-controlled monotherapy trial and several other randomized controlled trials in suggesting a lack of efficacy for memantine against depression symptoms.

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983 Treating Nicotine Dependence by Targeting Attention-Deficit/ Hyperactivity Disorder (ADHD) With OROS Methylphenidate: The Role of Baseline ADHD Severity and Treatment Response

Clinical Points
  • Attention-deficit/hyperactivity disorder (ADHD) is prevalent among individuals with nicotine dependence and reduces the likelihood of successfully quitting smoking.
  • Treatment of ADHD with stimulant medication may help nicotine-dependent patients quit smoking, particularly if the ADHD is more severe initially and if the ADHD symptoms are substantially improved by treatment.
  • Clinicians can help patients who are seeking to quit smoking by screening for and treating ADHD and optimizing ADHD treatment response (adjusting doses or changing medications if needed) before initiating a quit attempt with nicotine replacement.

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991 Childhood Trauma Is Associated With Severe Clinical Characteristics of Bipolar Disorders

Clinical Points
  • Childhood trauma, particularly emotional and sexual abuse, worsens the clinical expression of bipolar disorder.
  • Bipolar patients exposed to childhood trauma have an earlier age at illness onset, increased prevalence of suicide attempts and rapid cycling, and greater proneness toward depression.
  • Recognition of childhood trauma may help in the identification of patients with a more severe illness profile in order to personalize treatment strategies.

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Commentary

999 The Pervasive and Persistent Neurobiological and Clinical Aftermath of Child Abuse and Neglect

Case Report

981 Lyme Neuroborreliosis Presenting With Alexithymia and Suicide Attempts

Focus on Women’s Mental Health

1002 Depression in Women: New Findings

1003 A Gender Analysis of the Study of Pharmacotherapy of Psychotic Depression (STOP-PD): Gender and Age as Predictors of Response and Treatment-Associated Changes in Body Mass Index and Metabolic Measures

Clinical Points
  • One of the main novel findings of this gender analysis was that hallucinations and delusions with disorganization were more common among women with psychotic depression than men and that this finding was not associated with age.
  • Our analysis did not identify gender differences in treatment response in patients with psychotic depression, but it may have been limited by a small sample size.

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1010 Efficacy and Safety of Desvenlafaxine 50 mg/d in a Randomized, Placebo-Controlled Study of Perimenopausal and Postmenopausal Women With Major Depressive Disorder

Clinical Points
  • Depression in perimenopausal and postmenopausal women may be more common, and more difficult to treat, than depression in premenopausal women.
  • Desvenlafaxine, at the recommended dose of 50 mg/d, is an effective option for the treatment of depression in perimenopausal and postmenopausal women.
  • The safety and tolerability findings demonstrated with desvenlafaxine treatment in this study are similar to those observed in other desvenlafaxine clinical trials, supporting a favorable benefit/risk profile of desvenlafaxine in perimenopausal and postmenopausal women.

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1018 Female Reproductive Life Cycle and Hormones: Methodology to Improve Clinical Trials [Commentary]

ASCP Corner

1022 Decision Making and Antipsychotic Medication Treatment for Youth With Autism Spectrum Disorders: Applying Guidelines in the Real World

Letters to the Editor

1025 Phenoconversion of Cytochrome P450 2D6: The Need for Identifying the Intermediate Metabolizer Genotype

1026 Borderline Personality Disorder Symptoms and Treatment Seeking Over the Past 12 Months: An Investigation Using the National Comorbidity Survey–Replication (NCS-R)

Online Exclusives

Focus on Women’s Mental Health

e942 Antecedent Trauma Exposure and Risk of Depression in the Perinatal Period

Clinical Points
  • Women with antecedent trauma history appear especially vulnerable to depressive episodes during pregnancy.
  • There was a clear dose-response effect of trauma on risk of antenatal depression, and trauma types conferred differential risk.
  • Routine screening for trauma exposure and depressive symptoms is warranted in pregnant women to aid in the early detection and treatment of depression.

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Practical Psychopharmacology

e949 Learning From History: How to Swallow a Pill

Clinical Points
  • If pills are swallowed with little or no water, or if the patient lies down immediately after swallowing the pills, esophageal transit of the pills may be delayed; this can cause pill esophagitis, a preventable condition that is commoner in elderly subjects.
  • Pill esophagitis can also occur in conditions associated with narrowing of the esophageal lumen. Pill esophagitis is more likely with medications such as iron, alendronate, aspirin, anti-inflammatory drugs, antibiotics, and antimalarials.
  • The risk of pill esophagitis can be reduced by swallowing the pill with sufficient water, taking the pill before or during a meal, and staying upright for 15–30 minutes after pill ingestion. If these precautions are difficult to follow, administration of liquid formulations, orodispersible tablets, or crushed tablets can lower the risk.

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Book Review

e952 Management of Treatment-Resistant Major Psychiatric Disorders

Online Activities

e20 Mental Health Needs of Returning Veterans [CME]

e21 Monitoring Treatment and Managing Adherence in Schizophrenia [CME]