Transcranial Direct Current Stimulation for Negative Symptoms of Schizophrenia: Why the Reader Must Choose a Clinically Relevant Outcome.
Authors: Andrade C Abstract A recent, large, randomized controlled trial (RCT) of 10 twice-daily sessions of active vs sham transcranial direct current stimulation (tDCS), delivered across 5 consecutive days to schizophrenia patients with high negative symptom burden, found that active treatment was superior to sham treatment by a mean of 2.65 points on the Positive and Negative Syndrome Scale, negative subscale (PANSS-N), at 6 weeks. This was the primary endpoint of the study. Because a difference of 2.65 PANSS-N points between the average active vs sham tDCS patient is a very small advantage, it appears that the ...
Source: Journal of Clinical Psychiatry - February 7, 2020 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

Evidence-Based Treatment of Premenstrual Dysphoric Disorder: A Concise Review.
Authors: Carlini SV, Deligiannidis KM PMID: 32023366 [PubMed - in process] (Source: Journal of Clinical Psychiatry)
Source: Journal of Clinical Psychiatry - February 7, 2020 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

The Value of Neuropsychological Assessment in the Differentiation Between Behavioral Variant Frontotemporal Dementia and Late-Onset Psychiatric Disorders.
Authors: Overbeek JM, Korten N, Gossink F, Fieldhouse J, van de Beek M, Reus L, Dols A, Pijnenburg Y, Schouws S Abstract OBJECTIVE: To investigate which neuropsychological tests can discriminate between behavioral variant frontotemporal dementia (bvFTD) and psychiatric disorders presenting with similar late-onset frontal behavioral changes, such as apathy, disinhibition, reduced empathy, or compulsive behavior. METHODS: Patients presenting with frontal behavioral changes in middle or late adulthood received extensive baseline examinations, including neuropsychological assessment and brain imaging. After 2 years...
Source: Journal of Clinical Psychiatry - February 7, 2020 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

Suicidality, Depression, and the FDA: Health Inequities and the Ethical Conduct of Research.
CONCLUSIONS: The exclusion of persons with suicidality from antidepressant trials is common, creating uncertainty about medication safety and efficacy in parts of the target population. Information about study populations can be beneficial for prescribing clinicians, but it is not always readily available. PMID: 32023368 [PubMed - in process] (Source: Journal of Clinical Psychiatry)
Source: Journal of Clinical Psychiatry - February 7, 2020 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

Maintaining Rapid Antidepressant Effects Following Ketamine Infusion: A Major Unmet Need.
CONCLUSIONS: This evidence base is insufficient to inform clinical practice. Fortunately, a wide variety of molecular targets exist for this indication. Psychotherapy and exercise may also play a beneficial role. More studies are urgently needed to establish how best to maintain rapid symptom improvement seen with ketamine infusions. PMID: 32023369 [PubMed - in process] (Source: Journal of Clinical Psychiatry)
Source: Journal of Clinical Psychiatry - February 7, 2020 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

Early Recognition and Treatment of Tardive Dyskinesia in Patients With Mood Disorders and Schizophrenia.
Authors: McEvoy JP, Kremens DE Abstract ​​​​Early Recognition and Treatment of Tardive Dyskinesia in Patients With Mood Disorders and Schizophrenia Click to enlarge page​​. PMID: 31995674 [PubMed - in process] (Source: Journal of Clinical Psychiatry)
Source: Journal of Clinical Psychiatry - January 31, 2020 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

Drs Rosenblat and McIntyre Reply.
Authors: Rosenblat JD, McIntyre RS PMID: 31995675 [PubMed - in process] (Source: Journal of Clinical Psychiatry)
Source: Journal of Clinical Psychiatry - January 31, 2020 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

Sublingual Ketamine: An Option for Increasing Accessibility of Ketamine Treatments for Depression?
Authors: Swainson J, Khullar A PMID: 31995676 [PubMed - in process] (Source: Journal of Clinical Psychiatry)
Source: Journal of Clinical Psychiatry - January 31, 2020 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

A Modified Delphi Consensus Study of the Screening, Diagnosis, and Treatment of Tardive Dyskinesia.
CONCLUSIONS: Consensus was reached that (1) a brief, clinical assessment for TD should be performed at every clinical encounter in patients taking antipsychotics; (2) even mild movements in 1 body area may represent possible TD; (3) management requires an overall evaluation of treatment, including reassessment of antipsychotics and anticholinergics as well as consideration of vesicular monoamine transporter 2 (VMAT2) inhibitors; and (4) informed discussions with patients/caregivers are essential. PMID: 31995677 [PubMed - in process] (Source: Journal of Clinical Psychiatry)
Source: Journal of Clinical Psychiatry - January 31, 2020 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

A New Decade.
Authors: Shelton JS PMID: 31995678 [PubMed - in process] (Source: Journal of Clinical Psychiatry)
Source: Journal of Clinical Psychiatry - January 31, 2020 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

Medication Options and Clinical Strategies for Treating Tardive Dyskinesia.
Authors: Citrome LL Abstract Valbenazine and deutetrabenazine are FDA-approved as treatment for tardive dyskinesia (TD). Both medications are vesicular monoamine transporter type 2 (VMAT2) inhibitors, and both are effective for reducing TD symptoms. Clinicians need to be aware of the adverse effects of valbenazine and deutetrabenazine, as well as other key differences between the two, in order to individualize treatment. Using the Abnormal Involuntary Movement Scale assists clinicians in assessing progress for each patient. Treating TD effectively with these new medications will reduce the burden of the condition f...
Source: Journal of Clinical Psychiatry - January 31, 2020 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

Angiotensin Receptor Blockers and the Risk of Suicide: An Exercise in the Critical Examination of a Case-Control Study.
Authors: Andrade C Abstract Angiotensin receptor blockers (ARBs), used in the treatment of hypertension, may modulate neurotransmission in the central nervous system. One previous very small case-control study had suggested that ARBs increase the odds of suicide. In a recent, large, population-based, nested case-control study conducted in Ontario, Canada, completed suicide was associated with significantly increased odds of an ARB prescription during the 100 days preceding the suicide; in this analysis, confounding by indication was reduced by comparing ARB exposure with angiotensin-converting enzyme inhibitor expo...
Source: Journal of Clinical Psychiatry - January 24, 2020 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

Past Psychiatric Conditions as Risk Factors for Postpartum Depression: A Nationwide Cohort Study.
Authors: Johansen SL, Stenhaug BA, Robakis TK, Williams KE, Cullen MR Abstract OBJECTIVE: To compare risk for postpartum depression across prior psychiatric diagnoses. METHODS: The deidentified Optum© Clinformatics Data Mart of national commercial insurance claims was used to identify 1,166,577 women of reproductive age with first-observed incidence of pregnancy across all 50 United States from 2003 to 2016. Women with insurance coverage for at least 6 months prior to conception and following delivery were eligible (n = 336,522). Psychiatric diagnoses prior to pregnancy were identified by ICD-9-CM and ICD-...
Source: Journal of Clinical Psychiatry - January 24, 2020 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

Exercise Intervention for Late-Life Depression: A Meta-Analysis.
Authors: Klil-Drori S, Klil-Drori AJ, Pira S, Rej S Abstract OBJECTIVE: To quantify the association between physical exercise intervention (PEI) and reduction in depressive symptoms in older adults. DATA SOURCES: MEDLINE, PsycINFO, and EMBASE were searched from inception through December 2018 with no language restrictions using keywords related to exercise, depression, elderly adults, and randomized controlled trials. STUDY SELECTION: Randomized controlled trials comparing a sedentary control group, with no physically active intervention, to a supervised, moderate-to-vigorous PEI with participants aged ≥...
Source: Journal of Clinical Psychiatry - January 24, 2020 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

The Burden of Subthreshold Posttraumatic Stress Disorder in World Trade Center Responders in the Second Decade After 9/11.
CONCLUSIONS: Overall, 26.8% of police and 46.0% of nontraditional responders met criteria for probable WTC-related full or subthreshold PTSD an average of 12 years after 9/11. Probable subthreshold PTSD, which is not typically assessed in clinical settings, was more prevalent than probable full PTSD and was associated with significantly elevated rates of psychiatric comorbidities, functional impairment, and reduced quality of life. These findings underscore the importance of assessing, monitoring, and possibly treating subthreshold PTSD in WTC and other disaster responders. PMID: 31967749 [PubMed - in process] (Source:...
Source: Journal of Clinical Psychiatry - January 24, 2020 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

Cyberbullying and Its Relationship to Current Symptoms and History of Early Life Trauma: A Study of Adolescents in an Acute Inpatient Psychiatric Unit.
This study examined the prevalence of cyberbullying among adolescent psychiatric inpatients and related it to social media usage, current levels of symptoms, and histories of adverse early life experience. METHODS: Data on the prevalence of social media utilization and cyberbullying victimization were collected from adolescent psychiatric inpatients aged 13 to 17 years from September 2016 to April 2017. Fifty adolescent psychiatric inpatients completed 2 surveys assessing childhood trauma (the Trauma Symptom Checklist for Children and the Childhood Trauma Questionnaire) and the Cyberbullying Questionnaire. RESULTS:...
Source: Journal of Clinical Psychiatry - January 18, 2020 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

Identifying Tardive Dyskinesia: Risk Factors, Functional Impact, and Diagnostic Tools.
Authors: Saklad SR Abstract Tardive dyskinesia (TD) is an involuntary movement disorder induced by dopamine-receptor blocking agents (DRBAs), including antipsychotics. Because the introduction of second-generation antipsychotics has reduced but not eliminated the risk for TD as had been hoped, recognizing and treating TD are important skills for clinicians. Many patients rely on DRBAs for chronic conditions. To minimize the risk of patients' involuntary movements becoming permanent, they must be detected early and treated. To improve the early recognition and diagnosis of TD, clinicians must know the risk factors, ...
Source: Journal of Clinical Psychiatry - January 18, 2020 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

The Prevalence and Correlates of Self-Harm in the Perinatal Period: A Systematic Review.
CONCLUSIONS: Perinatal self-harm appears to be rare but is associated with adverse obstetric and neonatal outcomes. However, it is common in women with SMI, though there is limited evidence regarding correlates and outcomes in this population. More research into the prevalence, correlates, and outcomes of perinatal self-harm, particularly in women with SMI, is needed. PMID: 31917904 [PubMed - in process] (Source: Journal of Clinical Psychiatry)
Source: Journal of Clinical Psychiatry - January 11, 2020 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

Early Recognition and Diagnosis of Parkinson Disease and Ongoing Assessments.
Authors: Isaacson SH Abstract Parkinson's disease (PD) is diagnosed when patients meet motor symptom criteria (bradykinesia plus tremor or rigidity). However, patients may demonstrate prodromal nonmotor symptoms 5-20 years prior to diagnosis. While motor symptoms are of concern, patients often consider nonmotor symptoms to be just as bothersome. In this brief CME activity, diagnostic criteria and assessment tools are described. PMID: 31917905 [PubMed - in process] (Source: Journal of Clinical Psychiatry)
Source: Journal of Clinical Psychiatry - January 11, 2020 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

Evidence-Based Treatment Targets, Selection, and Strategies for Acute Manic and Mixed Episodes of Bipolar I Disorder.
Authors: Suppes T Abstract Too many patients receive incorrect treatment for bipolar disorder; prescribing seems to differ more by clinician than by patient characteristics. New treatment guidelines are available for the management of acute manic episodes and can help clinicians make treatment decisions tailored to their patients' individual symptom clusters and illness characteristics, leading to greater chances of lasting remission. However, many clinicians lack familiarity with these symptom targeting best practices. Therefore, clinicians need education on how to manage bipolar I disorder symptoms with evidence-...
Source: Journal of Clinical Psychiatry - January 11, 2020 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

A Randomized Controlled Study of a Psychoeducation Group Intervention for Patients With Borderline Personality Disorder.
The objective of this study was to assess the impact of a 6-session psychoeducational group (PEG) intervention for borderline personality disorder (BPD) in an underserved community-based outpatient setting. METHODS: The study was conducted between July 2015 and January 2017. Of 96 outpatients who met DSM-IV criteria for BPD, the first 48 received the experimental treatment, whereas the next 48 were assigned to a wait list. All received non-intensive treatment as usual. The primary outcome measure, the Zanarini Rating Scale for DSM-IV Borderline Personality Disorder (ZAN-BPD), was administered at baseline, at the end of...
Source: Journal of Clinical Psychiatry - January 11, 2020 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

Perioperative Buprenorphine Continuous Maintenance and Administration Simultaneous With Full Opioid Agonist: Patient Priority at the Interface Between Medical Disciplines.
Authors: Acampora GA, Nisavic M, Zhang Y Abstract Buprenorphine is a partial-agonist opioid that is prescribed as a medication-assisted treatment (MAT) for opioid use disorder (OUD). Buprenorphine is also a potent analgesic with high opioid-receptor affinity and binding coefficient; when buprenorphine is administered simultaneously with a μ-opioid receptor full agonist ("full agonist opioid" [FAO]), the combination can yield unexpected outcomes depending on dosing and timing. Buprenorphine is sometimes perceived as a powerful competitive opioid blocker that will hamper pharmacologic management that nec...
Source: Journal of Clinical Psychiatry - January 11, 2020 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

Strategies for Shifting From Acute to Maintenance Treatment for Bipolar I Disorder.
Authors: Suppes T Abstract Updated treatment guidelines are available for maintenance therapy for bipolar I disorder. Using these guidelines can help clinicians make treatment decisions including pharmacotherapy and psychosocial interventions tailored to their patients' individual characteristics. This CME activity describes the recommendations for first-line treatment and subsequent steps. Reasons why clinicians might not initiate maintenance with highest ranked first-line options are also provided. PMID: 31917909 [PubMed - in process] (Source: Journal of Clinical Psychiatry)
Source: Journal of Clinical Psychiatry - January 11, 2020 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

Effective Treatment Strategies for Motor and Nonmotor Symptoms of Parkinson Disease.
Authors: Isaacson SH Abstract Although levodopa is an effective medication for the treatment of Parkinson disease, physicians and patients face significant management challenges related to disease progression. Patients typically develop fluctuations in motor symptoms and dyskinesias. Novel treatment options may help clinicians more effectively manage patients' symptoms by extending the duration of response to medication, with improved tolerance. For many patients, nonmotor symptoms impact daily activities more than motor symptoms do. Many pharmacotherapeutic strategies are approved to address motor and nonmotor sym...
Source: Journal of Clinical Psychiatry - January 11, 2020 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

Treatment Strategies for Tardive Dyskinesia.
Authors: Kremens DE Abstract Tardive dyskinesia (TD), a condition of potentially irreversible abnormal involuntary movements that is associated with dopamine receptor blocking agents (DRBAs), produces significant impairment of functioning and quality of life for patients. Contrary to expectations, TD has not vanished despite the introduction of SGAs. Instead, changing prescription practices and increased off-label prescription of DRBAs have placed more patients than ever at risk of this potentially dangerous and disabling condition. This activity provides an overview of treatment strategies for TD as part of an ind...
Source: Journal of Clinical Psychiatry - December 29, 2019 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

The Leptin Gene rs7799039 Modulates the Prevalence of Posttraumatic Stress Disorder After an Earthquake in Han Chinese Adolescents.
CONCLUSIONS: An association of LEP rs7799039 with the prevalence and severity of PTSD in Chinese adolescents was observed. These results indicate that females with the LEP rs7799039 AA genotype had more severe PTSD characteristics compared to female G allele carriers, suggesting that psychosocial or pharmacologic managements may particularly be needed by these female subjects. PMID: 31880873 [PubMed - in process] (Source: Journal of Clinical Psychiatry)
Source: Journal of Clinical Psychiatry - December 29, 2019 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

Real-World Effectiveness of Ramelteon and Suvorexant for Delirium Prevention in 948 Patients With Delirium Risk Factors.
Authors: Hatta K, Kishi Y, Wada K, Takeuchi T, Hashimoto N, Suda K, Taira T, Tsuchida K, Ohmori T, Akizuki N, Nishio Y, Nakanishi Y, Usui C, Kurata A, Horikawa N, Eguchi H, Ito S, Muto H, Nakamura H, Uchimura N Abstract OBJECTIVE: The aim of this study was to examine the effectiveness of ramelteon and suvorexant for delirium prevention in real-world practice. It explored whether ramelteon and/or suvorexant would affect delirium prevention among both patients at risk for but without delirium (patients at risk) and those with delirium the night before a consultation. METHODS: This multicenter, prospective, observ...
Source: Journal of Clinical Psychiatry - December 20, 2019 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

FDA-Approved Medications to Treat Tardive Dyskinesia.
Authors: McEvoy JP Abstract Tardive dyskinesia (TD), a condition characterized by involuntary movements, is found in patients taking antipsychotics or other agents that block dopamine receptors. Symptoms of TD are associated with reduced quality of life, psychosocial problems, and medication nonadherence. Few agents tested in the treatment of TD had sufficient data to support or refute their use, until recently. A review of new evidence was combined with the existing guideline to provide new treatment recommendations. This activity provides an overview of treatments for patients with TD, including valbenazine and d...
Source: Journal of Clinical Psychiatry - December 20, 2019 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

Meaning in Life and Its Relationship With Physical, Mental, and Cognitive Functioning: A Study of 1,042 Community-Dwelling Adults Across the Lifespan.
Authors: Aftab A, Lee EE, Klaus F, Daly R, Wu TC, Tu X, Huege S, Jeste DV Abstract OBJECTIVE: To examine the relationship of presence and search for meaning in life with age, physical and mental well-being, and cognitive functioning across the adult lifespan. METHODS: Cross-sectional data from 1,042 adults in the Successful AGing Evaluation (SAGE)-a multicohort study of adult community-dwelling residents of San Diego County, California-were analyzed. Presence of meaning ("Presence") and search for meaning in life ("Search") were assessed with the Meaning in Life Questionnaire. Physical and m...
Source: Journal of Clinical Psychiatry - December 19, 2019 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

Functional Impairment in Youth With ADHD: Normative Data and Norm-Referenced Cutoff Points for the Before School Functioning Questionnaire and the Parent Rating of Evening and Morning Behavior Scale, Revised.
Authors: Faraone SV, DeSousa NJ, Komolova M, Sallee FR, Incledon B, Wilens TE Abstract OBJECTIVE: Children with attention-deficit/hyperactivity disorder (ADHD) frequently manifest behavioral difficulties in the morning prior to school and in the afternoons and evenings. We sought to establish norms for 2 time-specific measures of functioning: the Before School Functioning Questionnaire (BSFQ) and the Parent Rating of Evening and Morning Behavior Scale, Revised (PREMB-R), which includes Morning (AM) and Evening (PM) subscales. METHODS: The normative online survey of a representative US sample of 1,200 primary ca...
Source: Journal of Clinical Psychiatry - December 19, 2019 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

Earlier Diagnosis of Tardive Dyskinesia.
Authors: Kremens DE Abstract Because the symptoms of tardive dyskinesia (TD) have an insidious onset and fluctuating nature, and the risk of TD associated with second-generation antipsychotic (SGA) treatment has been underestimated, it has been challenging for clinicians to make an early and accurate TD diagnosis. More patients are at risk of developing this potentially permanent, disabling condition than ever before because of the widespread use of SGAs; therefore, prevention of TD, if possible, is of utmost importance. Clinicians must use reliable screening tools and diagnostic criteria to assess patients for TD,...
Source: Journal of Clinical Psychiatry - December 19, 2019 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

Current and Emerging Solutions to Challenges in the Management of Alzheimer's Disease.
Authors: Atri A, Goldfarb D, Sheard S, Shaughnessy L Abstract ​​​​Effective multifactorial management of Alzheimer's disease (AD) requires a triadic alliance of the clinician, the patient, and the patient's family and/or care partner(s). During the evaluation process and when the diagnosis of AD is delivered, these parties must work together to set goals and develop care plans. Care plans should be designed to help the patient maintain safety and autonomy as long as he or she can and, once autonomy is no longer possible, to allow the patient and care partner(s) to experience as much comfort and the best pos...
Source: Journal of Clinical Psychiatry - December 19, 2019 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

Augmentation With Memantine in Obsessive-Compulsive Disorder.
Authors: Andrade C Abstract Patients with obsessive-compulsive disorder (OCD) who do not respond adequately to serotonin reuptake inhibitor (SRI) therapy and cognitive behavioral therapy commonly receive SRI augmentation in the form of an atypical antipsychotic drug. Memantine is another augmentation strategy that has been trialed. A recent systematic review and meta-analysis found very large improvements associated with memantine augmentation in OCD. Specifically, in 4 randomized controlled trials (RCTs), the response rate was 81% in 67 memantine-treated patients vs only 19% in 68 placebo-treated patients. The wei...
Source: Journal of Clinical Psychiatry - December 19, 2019 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

Does Pharmacogenomic Testing Meaningfully Improve Antidepressant Treatment Outcomes When Looking Only at Patients Taking Phase I Hepatically Metabolized Drugs? A Little.
Authors: Goldberg JF PMID: 31846245 [PubMed - in process] (Source: Journal of Clinical Psychiatry)
Source: Journal of Clinical Psychiatry - December 19, 2019 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

Toward a Comprehensive Developmental Model of Prescription Opioid Use Disorder.
CONCLUSIONS: A modification of Kendler and colleagues' model for major depressive disorder provides a useful foundation for a comprehensive developmental model of nonmedical opioid use and opioid use disorder. PMID: 31846246 [PubMed - in process] (Source: Journal of Clinical Psychiatry)
Source: Journal of Clinical Psychiatry - December 19, 2019 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

Psychosocial Implications of Tardive Dyskinesia in Patients With Mood Disorders Versus Schizophrenia.
Authors: McEvoy JP Abstract Dopamine receptor blocking agents-including antipsychotics-can produce tardive dyskinesia (TD). First-generation antipsychotics were effective in treating schizophrenia and severe forms of bipolar disorder; however, they were associated with substantial extrapyramidal effects, especially at high doses. Second-generation antipsychotics are effective and produce fewer adverse movement effects; nevertheless, the risk for TD was not eliminated. Tardive dyskinesia can be distressing to patients with good insight into their illness and the movements, especially if they are working and in relat...
Source: Journal of Clinical Psychiatry - December 19, 2019 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

Predicting Remission in Late-Life Major Depression: A Clinical Algorithm Based Upon Past Treatment History.
We examined the prospective remission rates as a function of number and class of prior antidepressant trials in a post hoc analysis of pooled data from 2 prior trials. RESULTS: Remission rates with venlafaxine were inversely correlated with the number of prior adequate medication trials (66% for no prior adequate trials, 45% for 1 prior adequate trial, 23% for 2 or more prior adequate trials; P
Source: Journal of Clinical Psychiatry - December 19, 2019 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

Influence of Kidney Function on Serum Risperidone Concentrations in Patients Treated With Risperidone.
CONCLUSIONS: Kidney function is an important determinant of risperidone clearance. These data suggest reducing the risperidone dose by 50% in patients with a GFR below 60 mL/min. PMID: 31774943 [PubMed - in process] (Source: Journal of Clinical Psychiatry)
Source: Journal of Clinical Psychiatry - November 29, 2019 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

Discontinuing Antidepressants: How Can Clinicians Guide Patients and Drive Research?
This report discusses some common decisional uncertainties relevant to antidepressant discontinuation and recommends a shared decision-making approach. Further, this report seeks to outline a roadmap for clinicians to drive research on this important yet understudied topic. PMID: 31774944 [PubMed - in process] (Source: Journal of Clinical Psychiatry)
Source: Journal of Clinical Psychiatry - November 29, 2019 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

Three Clinically Important but Underutilized and Misunderstood Tools: Formulas to Estimate Creatinine Clearance, the Package Insert, and Therapeutic Drug Monitoring.
Authors: Preskorn S PMID: 31774945 [PubMed - in process] (Source: Journal of Clinical Psychiatry)
Source: Journal of Clinical Psychiatry - November 29, 2019 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

Gestational Exposure to Benzodiazepines, 3: Clobazam and Major Congenital Malformations.
Authors: Andrade C Abstract Clobazam is a 1,5-benzodiazepine that has been approved for use, in various parts of the world, as an add-on treatment for seizure disorders and as a treatment for anxiety. Pharmacoepidemiological data from different countries show that a small percentage of women with epilepsy (WWE) receive clobazam during pregnancy. Surprisingly, there has been little to no discussion in literature on the teratogenicity of clobazam. A network meta-analysis published in 2017 found a markedly elevated rate of overall and specific major congenital malformations (MCMs) with clobazam; whereas statistical si...
Source: Journal of Clinical Psychiatry - November 29, 2019 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

Understanding and Managing Withdrawal Syndromes After Discontinuation of Antidepressant Drugs.
Authors: Fava GA, Cosci F Abstract Withdrawal symptoms commonly occur during tapering and/or after discontinuation of antidepressant drugs, particularly selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors. Withdrawal symptomatology does not necessarily subside within a few weeks and may be associated with other manifestations of behavioral toxicity (loss of treatment efficacy, refractoriness, switch into mania/hypomania, or paradoxical reactions). The oppositional model of tolerance provides a pathophysiologic basis for understanding and managing withdrawal syndromes. Reintroduc...
Source: Journal of Clinical Psychiatry - November 29, 2019 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

A Comparison of Suicide Risk Scales in Predicting Repeat Suicide Attempt and Suicide: A Clinical Cohort Study.
Authors: Lindh ÅU, Dahlin M, Beckman K, Strömsten L, Jokinen J, Wiktorsson S, Renberg ES, Waern M, Runeson B Abstract OBJECTIVE: To compare the predictive accuracy of the Suicide Intent Scale (SIS), the Suicide Assessment Scale (SUAS), the Karolinska Interpersonal Violence Scale (KIVS), and the Columbia-Suicide Severity Rating Scale (C-SSRS) for suicide attempts and suicides within 3 and 12 months of an episode of self-harm. METHODS: This prospective multicenter cohort study included patients (N = 804) aged 18-95 years with a recent episode of self-harm assessed in psychiatric emergency settings from...
Source: Journal of Clinical Psychiatry - November 22, 2019 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

Prescription Opioid Misuse in US Older Adults: Associated Comorbidities and Reduced Quality of Life in the National Epidemiologic Survey of Alcohol and Related Conditions-III.
CONCLUSIONS: Older adults with persistent POM likely need multidisciplinary care for their significant physical and mental health and substance use conditions. Given the elevated psychopathology in those with persistent POM, psychiatrists are well placed to identify those with long-term POM. PMID: 31747489 [PubMed - in process] (Source: Journal of Clinical Psychiatry)
Source: Journal of Clinical Psychiatry - November 22, 2019 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

The Association Between Body Mass Index and Remission Rates in Patients With Treatment-Resistant Depression Who Received Intravenous Ketamine.
Authors: Singh B, Bobo WV, Rasmussen KG, Stoppel CJ, Rico JA, Schak KM, Biernacka JM, Frye MA, Vande Voort JL PMID: 31721482 [PubMed - in process] (Source: Journal of Clinical Psychiatry)
Source: Journal of Clinical Psychiatry - November 15, 2019 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

Brain Imaging in Adolescents and Young Adults With First-Episode Psychosis: A Retrospective Cohort Study.
CONCLUSIONS: Routine neuroimaging did not provide diagnostic information leading to a change in clinical management and should not be recommended in the investigation of FEP. PMID: 31721483 [PubMed - in process] (Source: Journal of Clinical Psychiatry)
Source: Journal of Clinical Psychiatry - November 15, 2019 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

Considerations by Dutch Psychiatrists Regarding Euthanasia and Physician-Assisted Suicide in Psychiatry: A Qualitative Study.
CONCLUSIONS: The variation in views on EAS in psychiatry seems to be related to a difference in views on the nature of psychiatric diseases. Some psychiatrists stress the similarity between psychiatric and somatic diseases, whereas others stress the fundamental difference. These opposing views could be bridged by a pragmatic view, such as a 2-track approach to EAS. PMID: 31721484 [PubMed - in process] (Source: Journal of Clinical Psychiatry)
Source: Journal of Clinical Psychiatry - November 15, 2019 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

Impact of Pharmacogenomics on Clinical Outcomes for Patients Taking Medications With Gene-Drug Interactions in a Randomized Controlled Trial.
CONCLUSIONS: By identifying and focusing on the patients with predicted gene-drug interactions, use of a combinatorial pharmacogenomic test significantly improved outcomes among patients with MDD who had at least 1 prior medication failure. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02109939​. PMID: 31721487 [PubMed - in process] (Source: Journal of Clinical Psychiatry)
Source: Journal of Clinical Psychiatry - November 15, 2019 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

Electroencephalogram Resting State Frequency Power Characteristics of Suicidal Behavior in Female Patients With Major Depressive Disorder.
CONCLUSIONS: Frequency power characteristics of attempters and ideators are consistent with findings from the neuroimaging literature concerning suicide, implying EEG resting state assessment could become a potential biomarker to predict suicide risk. PMID: 31665570 [PubMed - in process] (Source: Journal of Clinical Psychiatry)
Source: Journal of Clinical Psychiatry - October 31, 2019 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research

Adding Increased Energy or Activity to Criterion (A) of the DSM-5 Definition of Hypomania and Mania: Effect on the Diagnoses of 907 Patients From the Bipolar Collaborative Network.
CONCLUSIONS: The 34% reduction in the number of patients being diagnosed with a hypomanic/manic visit shows that the impact of applying DSM-5 criterion (A) is substantial. Fewer hypomanic/manic episodes may be diagnosed by the stricter DSM-5 criterion (A), but the episodes diagnosed are likely to be more severe. The DSM-5 criteria may in general prevent overdiagnosis of bipolar disorder but possibly at the cost of underdiagnosing hypomanic/manic episodes. PMID: 31665571 [PubMed - in process] (Source: Journal of Clinical Psychiatry)
Source: Journal of Clinical Psychiatry - October 31, 2019 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research