Volume 74December 2013Number 12

Original Research

1199 Incidence of Cardiovascular Outcomes and Diabetes Mellitus Among Users of Second-Generation Antipsychotics

Leslie Citrome, Jenna M. Collins, Beth L. Nordstrom, Edward J. Rosen, Ross Baker, Anagha Nadkarni, and Iftekhar Kalsekar

Clinical Points

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1209 Gender-Specific Suicide Risk Factors: A Case-Control Study of Individuals With Major Depressive Disorder

Ioana Mioara Dalca, Alexander McGirr, Johanne Renaud, and Gustavo Turecki

Clinical Points

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1217 Atomoxetine Tolerability in Pediatric and Adult Patients Receiving Different Dosing Strategies

Linda A. Wietecha, Dustin D. Ruff, Albert J. Allen, Laurence L. Greenhill, and Jeffrey H. Newcorn

Clinical Points

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1224 The Retinoid X Receptor Agonist Bexarotene Relieves Positive Symptoms of Schizophrenia: A 6-Week, Randomized, Double-Blind, Placebo-Controlled Multicenter Trial

Vladimir Lerner, Chanoch Miodownik, Anatoly Gibel, Pinchas Sirota, Ilan Bush, Hadi Elliot, Ruben Benatov, and Michael S. Ritsner

Clinical Points

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1233 Depressive and Anxiety Disorders Predicting First Incidence of Alcohol Use Disorders: Results of the Netherlands Study of Depression and Anxiety (NESDA)

Lynn Boschloo, Nicole Vogelzangs, Wim van den Brink, Johannes H. Smit, Dick J. Veltman, Aartjan T. F. Beekman, and Brenda W. J. H. Penninx

Clinical Points

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1249 Prospective Trial of Customized Adherence Enhancement Plus Long-Acting Injectable Antipsychotic Medication in Homeless or Recently Homeless Individuals With Schizophrenia or Schizoaffective Disorder [Free Access]

Martha Sajatovic, Jennifer Levin, Luis F. Ramirez, David Y. Hahn, Curtis Tatsuoka, Christopher S. Bialko, Kristin A. Cassidy, Edna Fuentes-Casiano, and Tiffany D. Williams

Clinical Points

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1256 Depressive Symptoms in Healthy Apolipoprotein E ε4 Carriers and Noncarriers: A Longitudinal Study

Dona E. C. Locke, Amylou C. Dueck, Cynthia M. Stonnington, David S. Knopman, Yonas E. Geda, and Richard J. Caselli

Clinical Points

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CME Background

CME Article

1248 Posttest

 

1241 Do Benzodiazepines Reduce the Effectiveness of Exposure Therapy for Posttraumatic Stress Disorder?

Craig S. Rosen, Mark A. Greenbaum, Paula P. Schnurr, Tyson H. Holmes, Penny L. Brennan, and Matthew J. Friedman

Clinical Points

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Commentary

1262 Depression and Risk of Dementia: Exploring the Interface

Anton P. Porsteinsson and Inga M. Antonsdottir

Letters to the Editor

1264 Predictors of Suicide Attempt in Early-Onset Psychosis: Methodological Issues and Concerns

Vaibhav Patil, Raman Deep Pattanayak, and Ashwani Kumar Mishra

Reply by Vanessa Sanchez-Gistau and Josefina Castro-Fornieles

1265 The Association of Disaster-Related Experiences and Self-Reported Recollections of National Trauma With Posttraumatic Stress Disorder Symptoms Following Hurricane Sandy

Menachem Ben-Ezra, Yuval Palgi, Yaira Hamama-Raz, G. James Rubin, and Robin Goodwin

Online Exclusives

Practical Psychopharmacology

e1128 Augmenting Selective Serotonin Reuptake Inhibitors With Clomipramine in Obsessive-Compulsive Disorder: Benefits and Risks

Clinical Points
  • Clomipramine augmentation of SSRIs may improve treatment response in obsessive-compulsive disorder patients in whom response to SSRI monotherapy is inadequate.
  • Clomipramine can raise the blood levels and hence the adverse effects of most SSRIs. More importantly, fluoxetine, fluvoxamine, and possibly high doses of the other SSRIs can raise the blood levels and hence the adverse effects of clomipramine, resulting in treatment-limiting adverse effects, as well as life-threatening problems such as QTc prolongation and seizures.
  • When combining fluoxetine or fluvoxamine with clomipramine, it is best to use low doses of each drug. In particular, doses of clomipramine should not exceed 75 mg/d unless the blood clomipramine level is monitored. Electrocardiographic monitoring of the QTc interval is also desirable.

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Case Report

e1134 The Perfusion Pattern in a Patient With Lithium Intoxication Mimicking Creutzfeldt-Jakob Disease

Meta-Analysis

e1136 Prophylactic Antipsychotic Use for Postoperative Delirium: A Systematic Review and Meta-Analysis

Clinical Points
  • Prevention of postoperative delirium is desirable in surgical patients due to its contribution to prolonged hospital stays, impaired functional recovery, and higher mortality rates.
  • Meta-analysis of pooled antipsychotics showed significant reduction in the incidence of delirium in comparison to placebo. Individually, although second-generation antipsychotics were superior to placebo on this outcome, haloperidol was not.
  • Both individually and pooled together, prophylactic antipsychotics did not differ from placebo regarding severity of delirium, duration of delirium, or length of hospital or intensive care unit stay.

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e1169 Antipsychotics for Cocaine or Psychostimulant Dependence: Systematic Review and Meta-Analysis of Randomized, Placebo-Controlled Trials

Clinical Points
  • Although the number of studies and participants was relatively small, antipsychotics had no advantages over placebo in regard to cocaine use as well as cocaine or psychostimulant abstinence or craving.
  • Despite lacking evidence for efficacy in primary cocaine and psychostimulant dependence, antipsychotics caused more intolerability-related discontinuations compared to placebo.
  • Strategies other than blocking dopamine transmission need to be utilized to treat primary cocaine and psychostimulant dependence.

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e1181 Reduction of Alcohol Consumption and Subsequent Mortality in Alcohol Use Disorders: Systematic Review and Meta-Analyses

Clinical Points
  • Mortality risk for alcohol use disorders (AUD) was decreased by more than half in patients who at least reduced their drinking compared to those with continued heavy drinking.
  • Decrease in mortality risk was greatest for patients who reached abstinence, but also sizable in those who reduced their alcohol consumption but did not reach abstinence.
  • Treatments for AUD with evidence of achieving a reduction in drinking should be supported and clearly preferred to no treatment at all.

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Original Research

e1163 Long-Term Trajectories of Posttraumatic Stress Disorder in Veterans: The Role of Social Resources

Clinical Points
  • While the majority of soldiers are resilient or will recover from symptoms of psychological distress after combat, a significant minority will develop chronic posttraumatic stress disorder.
  • Assessment of functional impairment during combat and social resources after deployment is important for predicting chronic outcomes of combat exposure.

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e1190 Changes in Inpatient and Postdischarge Suicide Rates in a Nationwide Cohort of Danish Psychiatric Inpatients, 1998–2005

Clinical Points
  • In Denmark, the inpatient suicide rate declined in psychiatric patients admitted from 1998 through 2005, and this decline occurred particularly among women.
  • The overall suicide rate in the 3-month postdischarge period also declined significantly. This decline seemed to be explained mostly by a falling rate among men as well as among patients discharged with a diagnosis of schizophrenia.

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e1145 Psychoeducational Interventions for Family Members of People With Schizophrenia: A Mixed-Method Systematic Review

Clinical Points
  • Current evidence supports early provision of psychoeducation to family members of people with schizophrenia to increase the relatives’ knowledge and skills to cope with caring.
  • Psychoeducation interventions using a group format yield higher levels of satisfaction by family members and enhance peer support.
  • Clinicians should consider implementation strategies, such as incorporating ethnic-cultural considerations into the program content and running repeated sessions outside of office hours, in addition to common essential ingredients of psychoeducation for the optimal design of interventions.

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Online Activities

e24 Assessing and Managing Pain and Major Depression With Medical Comorbidities [CME]

Clinical Points
  • Assess and monitor major depression and pain in patients with medical conditions.
  • Develop an effective treatment plan that avoids unwanted side effects and drug interactions.

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e25 Working Together to Address Domestic Violence Among Veterans [CME]

Clinical Points
  • Recognize risk factors that increase the risk for domestic violence among military veterans (eg, PTSD, depression, substance abuse).
  • If risk factors are present, screen for domestic violence among veterans and their partners using direct, nonjudgmental questions.
  • Educate veterans and their partners about violence, discuss support systems and safety plans, suggest local referral options, and coordinate care with other providers.

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e26 Strategies for Achieving Full Remission When First-Line Antidepressants Are Not Enough [CME]

Clinical Points
  • If patients have no response to first-line treatment, consider switching to another antidepressant either in the same class or another class.
  • To improve partial response, try augmenting the current antidepressant with psychotherapy, another antidepressant, lithium, thyroid hormone, or atypical antipsychotics.
  • Treat residual symptoms with targeted adjunctive therapy.

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Information for Authors see www.psychiatrist.com/author.htm