Volume 74November 2013Number 11

CME Background

CME Article

1070 Posttest

 

1063 Posttraumatic Stress Disorder and Cognitive Function: Findings From the Mind Your Heart Study

Clinical Points
  • Patients with posttraumatic stress disorder may demonstrate poorer performance on a variety of cognitive tasks compared with those without posttraumatic stress disorder.
  • Encouragement of healthy lifestyle behaviors and treatment of vascular risk factors and depression may help improve cognitive performance in patients with posttraumatic stress disorder.

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Original Research

1071 Differentiating Ictal Panic With Low-Grade Temporal Lobe Tumors From Psychogenic Panic Attacks

Clinical Points
  • Because of the similarities between ictal panic from epilepsy and classic panic attacks, it may be difficult for clinicians to distinguish ictal panic from panic attacks.
  • Making the distinction between ictal panic and panic attacks is important because the treatment for each type of panic is different.
  • Ictal panic from epilepsy should be suspected in patients with atypical symptoms of panic attacks such as déjà vu, lack of response to traditional psychiatric treatment, or neurologic signs or symptoms.

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1076 Randomized Placebo-Controlled Adjunctive Study of an Extract of Withania somnifera for Cognitive Dysfunction in Bipolar Disorder [Free Access]

Clinical Points
  • Cognitive impairments are major contributors to inadequate functional recovery in people with bipolar disorder; pharmacologic interventions are virtually nonexistent.
  • A standardized extract of the medicinal plant Withania somnifera improved working memory performance in euthymic bipolar patients, although replicative studies are needed.
  • Innovative pharmacologic and nonpharmacologic strategies to improve cognitive performance in bipolar disorder should be accorded research and clinical priority.

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1084 The Prevalence and Severity of Depressive Symptoms Along the Spectrum of Unipolar Depressive Disorders: A Post Hoc Analysis

Clinical Points
  • Clinicians should carefully assess core mood and cognitive symptoms of depression identified in this study; even though not all are currently DSM criteria, they are highly prevalent even at the lowest end of the depressive illness spectrum.
  • Several vegetative and somatic symptoms show a general pattern of increase with overall depressive severity; however, many of these are as prevalent at the high range of minor depression as at the low range of major depressive disorder (MDD).
  • Suicidal ideation, psychomotor slowing, and gastrointestinal symptoms appear to differentiate MDD from minor depression.

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Academic Highlights

1108 Switching Antipsychotic Medications to Reduce Adverse Event Burden in Schizophrenia: Establishing Evidence-Based Practice [Free Access]

Early Career Psychiatrists

1092 Introduction: Early Career Offerings

1093 Probability and Predictors of First Treatment Contact for Anxiety Disorders in the United States: Analysis of Data From the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

Clinical Points
  • There is broad variation in time to first treatment contact for anxiety disorders, ranging from 1 year for panic disorder to 16 years for social anxiety disorder.
  • Early onset of a disorder and presence of comorbid personality disorders are frequently associated with longer delays in treatment-seeking for anxiety disorders.
  • Prior mental health treatment, but not prior substance abuse treatment, increases the probability of treatment-seeking for anxiety disorder, indicating problems with the integration of treatment of anxiety and substance use disorders.

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1101 Modafinil Augmentation Therapy in Unipolar and Bipolar Depression: A Systematic Review and Meta-Analysis of Randomized Controlled Trials [Meta-Analysis]

Clinical Points
  • Modafinil augmentation shows a significant beneficial effect to antidepressant medications in unipolar and bipolar patients in an acute depressive episode.
  • The fatigue symptoms associated with depression show an improvement with adjunctive modafinil treatment.

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ASCP Corner

1121 The Role of Vitamin D in Depression: From a Curious Idea to a Therapeutic Option

Letters to the Editor

1123 Biased Reporting of Results in Patients at Ultra-High Risk of Psychosis

1123 Long-Term Effects of ADHD Medication on Adult Height: Results From the NESARC

Online Exclusives

Original Research

e1029 Efficacy and Cognitive Side Effects After Brief Pulse and Ultrabrief Pulse Right Unilateral Electroconvulsive Therapy for Major Depression: A Randomized, Double-Blind, Controlled Study

Clinical Points
  • Brief pulse and ultrabrief pulse right unilateral (RUL) ECT were shown to have equivalent cognitive effects. The results support the continued use of brief pulse RUL ECT.
  • This study affirms previous findings showing ECT to be a highly effective treatment for depression.

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e1037 Effects of 1-Year Treatment With Highly Purified Omega-3 Fatty Acids on Depression After Myocardial Infarction: Results From the OMEGA Trial

Clinical Points
  • Depression screening for patients after myocardial infarction is recommended. When depression is manifest, it should be treated to improve outcome of these at-risk patients.
  • If further controlled studies confirm the augmentation of selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors in combination with omega-3 supplementation, such a treatment strategy might be an option for better treatment of depression for patients after myocardial infarction.

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Early Career Psychiatrists

e1046 Symptomatic Remission and Cognitive Impairment in First-Episode Schizophrenia: A Prospective 3-Year Follow-Up Study

Clinical Points
  • Symptomatic remission is an achievable treatment goal in the early stage of schizophrenia and is associated with better cognitive and psychosocial functioning.
  • Assessment of verbal memory function in the initial year of treatment for first-episode schizophrenia may potentially enhance prediction of patients’ likelihood of attaining symptomatic remission in the later course of the illness.

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Practical Psychopharmacology

e1054 Transcranial Direct Current Stimulation for Refractory Auditory Hallucinations in Schizophrenia

Clinical Points
  • In some patients with schizophrenia, auditory hallucinations may be severe and refractory to antipsychotic drug treatment. Such patients may benefit from a short trial of once- to twice-daily transcranial direct current stimulation (tDCS).
  • In such patients, cathodal stimulation of the left temporoparietal cortex may suppress the auditory hallucinations, and anodal stimulation of the left dorsolateral prefrontal cortex may attenuate negative symptom severity.
  • In patients in whom continuation of tDCS is necessary to maintain treatment gains, administration of once- to twice-daily tDCS across up to 3 years of treatment may be safe and effective.

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Online Activities

e22 Residual Symptoms and the Risk of Relapse in Major Depression [CME]

e23 The Affordable Care Act and Practice in Psychiatry [CME]

Information for Authors

see www.psychiatrist.com/author.htm