change in a neurocognitive composite score after 2 months of treatment. Secondary outcomes included neurocognitive composite score change at 6 months and 18 months after continued treatment and changes in neurocognitive domains. Results: At 2 months, treatment resulted in small neurocognitive improvements of z= 0.13 for olanzapine (P.002), 0.25 for perphenazine (P.001), 0.18 for quetiapine (P.001), 0.26 for risperidone (P.001), and 0.12 for ziprasidone (P.06), with no significant differences between groups. Results at 6 months were similar. After 18 months of treatment, neurocognitive improvement was greater in the perphenazine group than in the olanzapine and risperidone groups. Neurocognitive improvement predicted longer time to treatment discontinuation, independently from symptom improvement, in patients treated with quetiapine or ziprasidone. Conclusions: After 2 months of antipsychotic treatment, all groups had a small but significant improvement in neurocognition. There were no differences between any pair of agents, including the typical drug perphenazine. These results differ from the majority of previous studies, and the possible reasons are discussed.

/pdf/neurocognitive-effects-of-antipsychotic-medications-in-x1fok1zvcv.pdf

Neurocognitive Effects of Antipsychotic Medications in Patients With Chronic Schizophrenia in the CATIE Trial

Practice guideline for the treatment of patients with obsessive-compulsive disorder.

Anxiety and related disorders are among the most common mental disorders, with lifetime prevalence reportedly as high as 31%. Unfortunately, anxiety disorders are under-diagnosed and under-treated. These guidelines were developed by Canadian experts in anxiety and related disorders through a consensus process. Data on the epidemiology, diagnosis, and treatment (psychological and pharmacological) were obtained through MEDLINE, PsycINFO, and manual searches (1980–2012). Treatment strategies were rated on strength of evidence, and a clinical recommendation for each intervention was made, based on global impression of efficacy, effectiveness, and side effects, using a modified version of the periodic health examination guidelines. These guidelines are presented in 10 sections, including an introduction, principles of diagnosis and management, six sections (Sections 3 through 8) on the specific anxiety-related disorders (panic disorder, agoraphobia, specific phobia, social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder, and posttraumatic stress disorder), and two additional sections on special populations (children/adolescents, pregnant/lactating women, and the elderly) and clinical issues in patients with comorbid conditions. Anxiety and related disorders are very common in clinical practice, and frequently comorbid with other psychiatric and medical conditions. Optimal management requires a good understanding of the efficacy and side effect profiles of pharmacological and psychological treatments.

/pdf/canadian-clinical-practice-guidelines-for-the-management-of-3kjxn44j0v.pdf

Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders

SummaryIn this report, recommendations for the pharmacological treatment of anxiety and obsessive-compulsive disorders are presented, based on available randomized, placebo-or comparator-controlled

/pdf/world-federation-of-societies-of-biological-psychiatry-wfsbp-4hulj8ttls.pdf

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

Social anxiety disorder.

We have previously shown that nonlinear measures of regularity and complexity are very useful as complimentary measures to the linear measures of time and frequency domain of beat-to-beat heart rate and QT intervals. In this study, we have applied Cross-ApEn, a nonlinear measure that can give an index of dissociation between two time series. We have shown that it can be superior to the linear measure of cross-coherence between the two signals. The practical implications of this finding have been further discussed in detail.

Decreased Coupling between R-R and QT Intervals in Patients with Panic Disorder

Abstract Sexual dysfunction (SD) is prevalent in patients with mental health disorders and can significantly impair their quality of life. Early recognition of SD in a clinical setting may help patients and clinicians to optimize treatment options of SD and/or other primary diagnoses taking SD risk into account and may facilitate treatment compliance. SD identification is often overlooked in clinical practice; we seek to explore whether patients with a high risk of SD can be identified at the individual level by assessing known risk factors via a machine learning (ML) model. We assessed 135 subjects referred to a tertiary mental health clinic in a Western Canadian city using health records data, including age, sex, physician’s diagnoses, drug treatment, and the Arizona Sexual Experiences Scale (ASEX). A ML model was fitted to the data, with SD status derived from the ASEX as target outcomes and all other variables as predicting variables. Our ML model was able to identify individual SD cases—achieving a balanced accuracy of 0.736, with a sensitivity of 0.750 and a specificity of 0.721—and identified major depressive disorder and female sex as risk factors, and attention deficit hyperactivity disorder as a potential protective factor. This study highlights the utility of SD screening in a psychiatric clinical setting, demonstrating a proof-of-concept ML approach for SD screening in psychiatric patients, which has marked potential to improve their quality of life. 

/pdf/individualized-identification-of-sexual-dysfunction-of-14t08kgi.pdf

Individualized identification of sexual dysfunction of psychiatric patients with machine-learning

In patients with ischemic heart disease, dobutamine provoked-stress increases beat-to-beat QRS amplitude variability, which may be due to an electrical instability of the myocardium. Our results in this pilot study showed that patients with congestive heart failure had significantly higher beat-to-beat QRS amplitude variability compared to controls in resting supine posture. This may partly be due to myocardial disease or irregular respiration in this patient group. © 2006 Elsevier Ireland Ltd. All rights reserved.

Pratap Chokka

Papers

Decreased Coupling between R-R and QT Intervals in Patients with Panic Disorder

Individualized identification of sexual dysfunction of psychiatric patients with machine-learning

Letter to the Editor Increased beat-to-beat QRS amplitude variability in patients with congestive cardiac failure