Volume 79 • 2018 • Number 1
Listen to an audio summary of this issue
Your patients taking antipsychotics may be at risk for developing tardive dyskinesia. In this Case and Comment activity, follow Martha, a 60-year-old woman being treated with an antipsychotic medication for her treatment-resistant depression.
Do you know how to manage tardive dyskinesia symptoms? In this Case and Comment activity, consider the case of John, a 25-year-old project manager diagnosed with bipolar disorder who has begun exhibiting symptoms of uncontrollable movement.
Long-acting injectable (LAI) antipsychotics have the potential to improve adherence and outcomes for patients with serious mental illness but are underused. Watch this Webcast to learn how to identify patients who may benefit from using LAIs, monitor treatment adherence, and use LAIs safely and effectively in patients with schizophrenia and related disorders.
Do you know which of your patients are at risk for developing tardive dyskinesia? Watch this Webcast to learn about how to prevent tardive dyskinesia in your patients and new treatment strategies for your patients who have already been diagnosed.
Tune in to this podcast as experts discuss 2 patient cases—one involving co-occurring insomnia and depression and another comprising PTSD, substance abuse, insomnia, and nightmares. Drs Benca and Buysse explain how to effectively diagnose and manage these complex cases based on the latest diagnostic criteria and evidence from clinical trials.
Listen to this podcast as experts discuss 2 patient cases focusing on diagnosing and treating co-occurring insomnia and mental illness. The first case features a 32-year-old man with bipolar disorder who is experiencing psychiatric symptoms and poor sleep, and the second case involves a 27-year-old man with schizophrenia who is having auditory hallucinations as well as chronic issues with insomnia.
Most patients with major depressive disorder will not achieve remission with initial treatment. Strategies to increase the likelihood of achieving remission include regularly measuring response, assessing adverse effects and adherence, addressing non-mood symptoms, and knowing when to switch or augment antidepressants. In this CME Health Spectrum activity, follow 2 patient cases that illustrate these topics.
Letters to the Editor
This letter discusses recent Department of Defense data on military suicides and considers the findings in the context of current and future prevention efforts.
Read this article to learn more about the roles and qualifications of TMS Treatment team members.
Effects of Rapastinel (Formerly GLYX-13) on Serum Brain-Derived Neurotrophic Factor in Obsessive-Compulsive Disorder
Read a study investigating the effects of rapastinel administration on 7 patients with OCD.
Clinical and Practical Psychopharmacology
Adverse Gestational Outcomes Associated With Attention-Deficit/Hyperactivity Disorder Medication Exposure During Pregnancy
ADHD medication use during pregnancy has increased in recent years. In this article, Dr Andrade reviews recent evidence on whether amphetamines, methylphenidate, and atomoxetine exposure in early and late pregnancy are associated with adverse gestational outcomes such as preterm birth and preeclampsia.
Risk of Major Congenital Malformations Associated With the Use of Methylphenidate or Amphetamines in Pregnancy
How safe is it for pregnant women to use ADHD medication? Dr Andrade reviews recent studies on methylphenidate and amphetamine use during pregnancy to evaluate the findings and weigh the evidence.
Both undertreatment and futile overtreatment can be disastrous. How can clinicians find the right balance? This ASCP Corner article discusses related ethical and practical issues and then delineates the "disease management approach."
Validity of the Maudsley Staging Method in Predicting Treatment-Resistant Depression Outcome Using the Netherlands Study of Depression and Anxiety
The Maudsley Staging Method has been validated as a way to quantify and predict depression course and outcome, but its generalizability to a community-based population had not yet been assessed. This study drew on the large Netherlands Study of Depression and Anxiety to investigate if degree of treatment resistance, as measured by the Maudsley Staging Method, predicts worse outcomes in depression.
Facial Emotion Recognition Performance Differentiates Between Behavioral Variant Frontotemporal Dementia and Major Depressive Disorder
Early behavioral variant frontotemporal dementia (bvFTD) is often mistaken for major depressive disorder. Could patients' processing of facial emotions provide clues to differentiate the two? In this study, patients with bvFTD, major depressive disorder, or Alzheimer's disease and healthy participants rated faces in terms of emotion and intensity. Read the article to see if differences were found.
Insomnia and Psychopathological Features Associated With Restless Legs Syndrome in Chinese Adolescents
Little is known about restless legs syndrome in pediatric populations. A survey of 11,831 adolescents that probed symptoms of restless legs syndrome, as well as sleep duration, sleep problems, behavioral/emotional problems, and hopelessness, was recently conducted in China. Read this article to discover the associations the authors found between restless legs syndrome and insomnia and emotional problems.
Treatment With a Ghrelin Agonist in Outpatient Women With Anorexia Nervosa: A Randomized Clinical Trial
Levels of the appetite-stimulating hormone ghrelin are elevated in girls and women with anorexia nervosa. However, women with anorexia nervosa report less hunger than healthy controls—a discrepancy possibly due to ghrelin resistance or differences in the ratio of the active versus degraded forms of ghrelin in women with anorexia nervosa. Read this article to learn the effects of treatment with the ghrelin agonist relamorelin in women with anorexia nervosa.
Prospective Associations Between Infant Sleep at 12 Months and Autism Spectrum Disorder Screening Scores at 24 Months in a Community-Based Birth Cohort
Sleep problems are more prevalent in children with autism spectrum disorders than in children with typical development. Could sleep problems in infancy serve as an early indicator of atypical neurodevelopment? This study used data from a birth cohort to estimate associations between infant sleep characteristics at 12 months of age and autism screening scores at 2 years of age.
Comparing Cost-Effectiveness of Aripiprazole Augmentation With Other "Next-Step" Depression Treatment Strategies: A Randomized Clinical Trial
Aripiprazole is commonly prescribed as a next-step pharmacotherapy for treatment-resistant depression, but its cost-effectiveness as an adjunct to antidepressants is unknown. Read this article to learn how the cost-effectiveness of aripiprazole in augmenting antidepressant therapy compared with the cost-effectiveness of other alternative treatments.
Characterizing Treatment Effects of Valbenazine for Tardive Dyskinesia: Additional Results From the KINECT 3 Study
Could valbenazine help your patients who experience antipsychotic-induced abnormal movements? This follow-up analysis of a phase 3 study provides further insights into the efficacy of valbenazine for tardive dyskinesia by extending the analysis to include odds ratios and number-needed-to-treat statistics.
Acupuncture for Treatment of Persistent Disturbed Sleep: A Randomized Clinical Trial in Veterans With Mild Traumatic Brain Injury and Posttraumatic Stress Disorder
When sleep escapes you, it's hard to escape the pervasive feelings that accompany exhaustion. If improving sleep hygiene doesn' t work, can resetting one's qi help? This sham-controlled trial tests acupuncture for its short- and long-term effects.Â
The Burden of Caring for a Child or Adolescent With Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS): An Observational Longitudinal Study
Pediatric acute-onset neuropsychiatric disorder (PANS) is characterized by abrupt onset of obsessive-compulsive disorder and/or food restriction with 2 or more similarly debilitating neuropsychiatric symptoms. Read this article to learn about caregiver burden with this disorder and how it may change over time.
Abrupt Symptom Improvements in Antidepressant Clinical Trials: Transient Placebo Effects or Therapeutic Reality?
If a patient's depressive symptoms subside very quickly after antidepressant treatment is initiated, do those gains represent a true and lasting response? This study examined whether sudden improvement in individuals with late-life depression predicted longer-term positive response at endpoint.
Early Placebo Improvement Is a Marker for Subsequent Placebo Response in Long-Acting Injectable Antipsychotic Trials for Schizophrenia: Combined Analysis of 4 RCTs
Poor treatment adherence masks the true extent of placebo effects in trials of antipsychotics in schizophrenia. Can use of an injectable placebo in double-blind trials of long-acting injectable antipsychotics circumvent issues of adherence and provide a clearer picture of placebo effects? Read this article to find out.
A Double-Blind, Randomized, Placebo-Controlled Study of Aspirin and N-Acetylcysteine as Adjunctive Treatments for Bipolar Depression
Nonsteroidal anti-inflammatory drugs (NSAIDs) and antioxidative treatments have shown antidepressant potential as adjunct treatments. Read this article to learn if adjunctive treatment with the antioxidative agent N-acetylcysteine, the NSAID aspirin, or both helped reduce depressive symptoms in patients with bipolar depression.
Toward Prevention of Mild Cognitive Impairment in Older Adults With Depression: An Observational Study of Potentially Modifiable Risk Factors
Depression in older adults is associated with a greater risk of dementia as well as mild cognitive impairment (MCI). This study aimed to identify possible risk factors for developing MCI in this population—and to determine if some of these risk factors might be modifiable. Read the article to learn more.Â
Which subgroups of patients with schizophrenia or schizoaffective disorder may be prone to treatment failure? Is it men or women, old or young, or are more factors involved? Researchers in this ACLAIMS study comparing haloperidol decanoate and paliperidone palmitate answer these questions.Â Â
Cognitive Deficits in the THINC-Integrated Tool (THINC-it) Are Associated With Psychosocial Dysfunction in Patients With Major Depressive Disorder
In your patients with MDD, cognitive deficits may have a greater impact than you realize. This study used the THINC-it assessment to determine the extent to which impaired cognition is a detriment to psychosocial function (such as autonomy and occupational functioning). Read the article to see what the authors found.
Effect of Educative Suicide Prevention News Articles Featuring Experts With vs Without Personal Experience of Suicidal Ideation: A Randomized Controlled Trial of the Papageno Effect
A suicide expert shares in her interview on suicide prevention that she had been in suicidal crisis at one point in her life. Do you think subjects in this randomized controlled trial are more likely to change their thoughts on suicide as a result of her admission?
CME Academic Highlights
Insomnia is often considered a symptom of psychiatric disorders when it actually needs to be addressed as a separate disorder. Read this CME Academic Highlights in which experts discuss ways to evalute patients with insomnia and to safely and effectively implement behavioral and pharmacologic treatments.
We' re pleased to announce the promotion of Marlene P. Freeman, MD, to editor in chief of JCP. In her inaugural editorial, Dr Freeman reflects on her tenure at JCP, the valued contributions of reviewers and authors, and why JCP remains a vital resource for clinicians in today's publishing landscape.