Showing papers in "Annals of Clinical Psychiatry in 2008"
TL;DR: Obesity and the metabolic syndrome were common in patients with bipolar disorder and these patients may be under-evaluated for cardiovascular risk and warrant screening and early intervention.
Abstract: Background. Bipolar disorder is associated with excess cardiovascular mortality. We hypothesized outpatients with bipolar disorder would exhibit excess cardiovascular risk factors, particularly among prevalent users of the second-generation antipsychotics associated with weight gain and valproic acid derivatives.Methods. This chart review of 217 patients with bipolar disorder examined cardiovascular risk factors of the metabolic syndrome. We also evaluated if certain medications were cross-sectionally associated with metabolic syndrome.Results. Fifty-six patients were not weighed and many did not have available lipid profiles. Over three-quarters of those with available data (n = 161) were overweight or obese (body mass index ≥ 25) and nearly half were obese (body mass index ≥ 30). A prevalence exceeding general population estimates was also observed for hypertriglyceridemia, elevated blood pressure/hypertension, and elevated fasting glucose/diabetes. Among those with all requisite data (n = 60), over 50%...
175 citations
TL;DR: A literature review of sleep studies in mood disorders, alcoholism and schizophrenia to determine how associated alterations in sleep architecture and disturbances of sleep are related to patient function and quality of life, and the course of these disorders.
Abstract: Introduction. While the precise role of sleep in maintaining optimal health and function remains unknown, it is clear that disturbances of sleep have a profound impact on the lives of affected individuals. In psychiatric disorders, not only is there a relationship between sleep disturbances and impaired function, problems with sleep also appear to affect the course of the disorder.Methods. We carried out a literature review of sleep studies in mood disorders, alcoholism and schizophrenia to determine how associated alterations in sleep architecture and disturbances of sleep are related to patient function and quality of life, and the course of these disorders.Results. The literature speaks to the need to address sleep problems in the overall management of mood disorders, alcoholism and schizophrenia. The support for this viewpoint is best established for mood disorders. There is also relatively strong support for treatment in alcoholism. Schizophrenia, however, has received scant attention and the literat...
115 citations
TL;DR: Family accommodation is ubiquitous in OCD and Psychoeducation regarding potential deleterious effects of accommodation must not be overlooked in management of this illness.
Abstract: Background. Obsessive-compulsive disorder (OCD) is a serious, disabling illness. Family members are frequently involved by attempting to stop rituals or by performing rituals for their relative. Factors associated with family accommodation of OCD have been largely overlooked in the literature. This study aims to identify the frequency and clinical predictors of OCD family accommodation behaviors.Methods. Participants include those with a first admission to the McLean/Massachusetts General Hospital OCD Institute (N = 110). The Family Accommodation Scale was completed independently by family members. Univariate relationships between factors and family accommodation were assessed via graphs, parametric and non-parametric testing. Multiple regression analyses modeled relationships between family accommodation and predictor variables.Results. Family accommodation was reported in 96.9% of cases, and predominantly occurred at least daily (59.1% of cases). Most common behaviors included providing reassurance and ...
107 citations
TL;DR: Although considered preliminary, several therapeutic agents were identified that may prove beneficial in treating METH-dependent patients, including bupropion, mirtazapine, baclofen, and topiramate.
Abstract: Background. Methamphetamine (METH) dependence is a significant public health, criminal justice, and social service concern, and although abuse of this drug spans the past 40 years in the U.S., effe...
89 citations
TL;DR: It appears that the three groups are quite similar in their overall clinical presentation and severity, however, further research is needed to validate the findings and should focus on ways in which effective treatment may be achieved.
Abstract: Background. Pathologic Skin Picking (PSP) and trichotillomania (TTM) are repetitive behaviors presumed to share clinical characteristics. However, no studies have been conducted examining the clinical and phenomenological differences between PSP, TTM, and those persons with a comorbid PSP + TTM diagnosis. We sought to examine the similarities and differences between these three groups from a clinical viewpoint.Methods. Seventy-seven subjects with PSP, TTM, or PSP + TTM were analyzed for this study. They are comprised of both research subjects and outpatient clinic patients who voluntarily presented for treatment at a large, public university medical center.Results. There were far more similarities than differences in subjects with TTM, PSP, and PSP + TTM. Significant differences, however, were found in time spent picking/pulling, triggers to the behaviors, rates of comorbid depressive disorders, and family history of PSP.Conclusions. This represents the first comparison of PSP, TTM, and comorbid PSP + TTM...
70 citations
TL;DR: The use of risperidone in patients with HD in treating their psychiatric and possibly motor symptoms is supported, and controlled clinical trials are clearly needed.
Abstract: Background. Huntington's disease (HD) is a progressive, neuropsychiatric disorder, and limited reports indicate that risperidone might improve motor and psychiatric functioning for these patients.Methods. In a retrospective, chart review study to evaluate the effectiveness of risperidone on motor, psychiatric, and cognitive functioning in HD, 17 patients taking risperidone in the course of clinical care and 12 patients not taking any antipsychotic medication were compared across a year.Results. Patients taking risperidone demonstrated significantly improved psychiatric functioning and motor stabilization, whereas patients not taking risperidone were stable psychiatrically and worsened motorically.Conclusions. Although controlled clinical trials are clearly needed, these preliminary results support the use of risperidone in patients with HD in treating their psychiatric and possibly motor symptoms.
61 citations
TL;DR: The high rates of skin-picking and nail-biting in people with hair-pulling, and their association with increased disability, is consistent with previous clinical observations, and supports the argument that trichotillomania can usefully be conceptualized as a stereotypic disorder.
Abstract: Background. Stereotypic movement disorder (SMD) is characterized by nonfunctional repetitive movements, is typically diagnosed in people with intellectual disability, and by definition excludes people with trichotillomania (TTM). Nevertheless, hair-pulling may be one of a number of body-focused repetitive behaviors (BFRBs) that are seen in the general population. Comorbidity of symptoms might support the idea that they are indicative of an underlying stereotypic disorder, and we therefore explored their frequency in people with hair-pulling. Methods. Participants were recruited with the help of the Trichotillomania Learning Center, the largest advocacy group for people with hair-pulling. Participants completed a self-report survey on the Internet, which included questions about the presence of both hair-pulling and other BFRBs. Measures included the Massachusetts General Hospital Hairpulling Scale (MGH-HS), the Milwaukee Inventory for Subtypes of Trichotillomania-Adult Version (MIST-A), the Depression and...
57 citations
TL;DR: The results highlight the clinical relevance of more severe and/or persistent levels of depression, psychiatric and medical comorbidity, and symptoms characteristic of atypical depression and confirm findings from other studies that such patients may respond less well or take longer to respond to pharmacotherapy.
Abstract: Background: To identify putative demographic and clinical variables that correlate with antidepressant response to the SNRI duloxetine in major depression. Methods: The effect of 130 candidate treatment outcome predictors was examined on 3 dependent treatment outcome measures related to depression: 1) depression symptom outcome measured by HAMD-17 total and HAMD-17 percent change from baseline to endpoint, 2) remission (HAMD-17 ≤ 7 at endpoint) and response (≥ 50% reduction in HAMD-17 from baseline to endpoint) rates, and 3) time to response (days to ≥ 50% reduction in HAMD-17). Results: Eleven variables had an overall predictive index of ≥ 20% and were associated with poorer treatment outcome: HAMD-17 total, duration of current MDD episode, leaden paralysis, fatigue, HAMA total, HAMA items 2 and 8, HAMD-17 anxiety/somatization subscale, anxiety-related comorbid conditions, and VAS overall pain and pain while awake. Conclusions: Our results highlight the clinical relevance of more severe and/or persistent...
54 citations
TL;DR: There is no clear evidence that their brief use early in depression increases suicide risk, and alternatives to sedative/hypnotics should be used if early adjunctive treatment for anxiety in depressed patients is thought to be indicated.
Abstract: Background. Anxiety (among several other symptoms) has been identified in one prospective study as associated with suicide risk in depressed patients early in treatment. It has been suggested that treatment of anxiety in depression with sedative/hypnotic agents, especially benzodiazepines, in the first several weeks may decrease suicide risk. Sedative/hypnotic agents also have depressant and disinhibitory properties which might increase suicide risk, however. This review addresses the potential benefits and risks with regard to suicide of using sedative/hypnotics as an early adjunct to antidepressant treatment in anxious depressed patients. Methods. Pertinent medical literature was reviewed using Medline/PubMed search as well as bibliographies from related publications. Reports in English from 1958 to 2006 were included. Results. The review did not reveal any evidence that using sedative/hypnotics as an early adjunct to antidepressant treatment of anxious depressed patients decreases their suicide risk. There is considerable evidence that sedative/hypnotics produce depressant and/or disinhibitory effects in a small proportion (perhaps 5%) of people who take them. However, there is no clear evidence that their brief use early in depression increases suicide risk. Toxicological data of suicides indicate that a majority of people who commit suicide are under the influence of sedative/hypnotic chemicals (including alcohol) at the time. Conclusions. The authors conclude that the question of whether sedative/hypnotics may prevent or provoke suicide in anxious depressed patients cannot be answered definitively with the available information. They believe the potential risks of prescribing sedative/hypnotics for depressed patients who may be suicidal are serious. They suggest that alternatives to sedative/hypnotics should be used if early adjunctive treatment for anxiety in depressed patients is thought to be indicated.
54 citations
TL;DR: A number of children with DSM-IV OCD ascertained from a family genetic study of pediatric OCD are described, whose intolerance of ordinary sensory stimuli created significant subjective distress and time-consuming ritualistic behavior that was clinically impairing.
Abstract: Introduction. Marked intolerance or intrusive re-experiencing of ordinary sensory stimuli that in turn drive functionally impairing compulsive behaviors are occasionally seen in young children with OCD.Methods. We describe a number of children with DSM-IV OCD ascertained from a family genetic study of pediatric OCD, whose intolerance of ordinary sensory stimuli created significant subjective distress and time-consuming ritualistic behavior that was clinically impairing.Results. In each case, these sensory symptoms were the primary presenting symptoms and were experienced in the absence of intrusive thoughts, images, or ideas associated with “conventional” OCD symptoms.Conclusions. These symptoms suggest abnormalities in sensory processing and integration in at least a subset of OCD patients. Recognition of these sensory symptoms and sensory-driven behaviors as part of the broad phenotypic variation in children with OCD could help clinicians more easily identify OCD patients and facilitate treatment.
52 citations
TL;DR: The author describes how Psychiatry Transformed Normal Sorrow into Depressive Disorder and the Loss of Sadness.
Abstract: (2008). The Loss of Sadness. How Psychiatry Transformed Normal Sorrow into Depressive Disorder. Annals of Clinical Psychiatry: Vol. 20, No. 2, pp. 115-116.
TL;DR: There are consistent and substantial differences between atypical antipsychotic drugs in the disproportionality reporting ratios relating to glycemic effects, especially life-threatening events, in the AERS database, and these results do not support a "class effect" hypothesis.
Abstract: Background. This analysis compared diabetes-related adverse events associated with use of different antipsychotic agents. A disproportionality analysis of the US Food and Drug Administration (FDA) Adverse Event Reporting System (AERS) was performed.Methods. Data from the FDA postmarketing AERS database (1968 through first quarter 2004) were evaluated. Drugs studied included aripiprazole, clozapine, haloperidol, olanzapine, quetiapine, risperidone, and ziprasidone. Fourteen Medical Dictionary for Regulatory Activities (MedDRA) Primary Terms (MPTs) were chosen to identify diabetes-related adverse events; 3 groupings into higher-level descriptive categories were also studied. Three methods of measuring drug-event associations were used: proportional reporting ratio, the empirical Bayes data-mining algorithm known as the Multi-Item Gamma Poisson Shrinker, and logistic regression (LR) analysis. Quantitative measures of association strength, with corresponding confidence intervals, between drugs and specified a...
TL;DR: A consumer-friendly, reliable, and valid self-administered questionnaire can improve the efficiency of the clinical encounter and the brevity of the CUDOS lends itself to regular administration in clinical practice.
Abstract: Background. Self-report questionnaires are a cost-effective option to monitor the outcome of clinical care. Even when using self-report scales, consideration should be given to how much time they take to complete and how burdensome they are perceived to be. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we compared the acceptability of completing two depression scales—the Beck Depression Inventory (BDI) and the Clinically Useful Depression Outcome Scale (CUDOS).Methods. In the first study, 50 depressed psychiatric outpatients completed the CUDOS and a questionnaire assessing how burdensome it was to complete during the visit. In the second study, a separate sample of 50 depressed outpatients completed the CUDOS and BDI and a measure of scale acceptability.Results. Almost all patients completed the CUDOS in less than 3 minutes (mean = 102.7 seconds, SD = 42.7) and considered the questionnaire very little or a little burdensome (98.0%, n = ...
TL;DR: Catatonic syndrome is common, often undiagnosed, and quickly responsive to treatment, irrespective of the diagnosis, and needs to be identified and actively treated with benzodiazepines to minimize distress, and facilitate diagnosis and treatment.
Abstract: Background. A resurgence of interest has led to renewed attempts to clarify the concept and treatment of catatonia.Method. A large prospective study was conducted to estimate the incidence of catatonic syndrome in 138 consecutive psychiatric patients admitted to a general hospital in India, to demarcate the common symptom presentations and its response to intravenous benzodiazepines. Patients were screened using the Bush Francis Catatonia Screening Instrument. Patients with two or more signs on the Instrument were subsequently administered intravenous lorazepam and their response was rated on the Bush Francis Catatonia Rating Scale.Results. Catatonic syndrome was found in 11% of patients with a wide variety of diagnoses, especially schizophrenia. Mutism (87.5% incidence) was the most common symptom. A significant proportion (93%) of these patients showed a marked immediate response to lorazepam, with 75% showing sustained improvement.Conclusions. Catatonic syndrome is common, often undiagnosed, and quickl...
TL;DR: BDD is a common comorbidity in severe OCD patients with BDD also have increased hoarding, symmetry, reassurance-seeking and checking severity, which requires consideration in treatment planning.
Abstract: Objective. Body Dysmorphic Disorder is a putative obsessive-compulsive spectrum disorder. This exploratory study systematically examined prevalence and clinical correlates of Body Dysmorphic Disorder (BDD) comorbidity in an inpatient Obsessive-Compulsive Disorder (OCD) population.Method. Consecutive patients from an OCD Intensive Residential Treatment program were included (N = 275). Clinician-rated and patient-rated measures were administered at baseline and repeated at discharge. The prevalence of BDD was determined and clinical characteristics were statistically compared between groups with (N = 42) and without (N = 233) comorbid BDD.Results. The prevalence of BDD among residential patients with OCD was 15.3% (N = 42). Those with comorbid BDD were younger (p = 0.007) and more predominantly female (p = 0.02), with lower marriage rates (p = 0.006), more severe depression (p = 0.003) and increased self-reported illicit substance use histories (p = 0.003) versus those without BDD. This cohort also had earl...
TL;DR: In this paper, a case report of Cervical sympathetic blockade in a patient with Post Traumatic Stress Disorder (PTSD) was presented. But the authors did not specify the patient's symptoms.
Abstract: (2008). Cervical Sympathetic Blockade in a Patient with Post-Traumatic Stress Disorder: A Case Report. Annals of Clinical Psychiatry: Vol. 20, No. 4, pp. 227-228.
TL;DR: The effective treatment of pain symptoms in patients with major depressive disorder was associated with higher remission rates and the results underscore the importance of effectively treating painful symptoms associated with depression.
Abstract: Background. Patients with major depressive disorder (MDD) frequently report one or more pain symptoms. To explore the relationship between improvement in pain symptoms and MDD treatment outcomes, we conducted a secondary analysis of an approximately 12-week, open label trial of duloxetine in MDD. The primary objective was to test the hypothesis that a greater reduction in pain was associated with a higher probability of MDD remission. Methods. Adults with DSM-IV MDD were enrolled in the study if they had a Hamilton Depression Scale (HAMD-17) total score of 15 or more and a Clinical Global Impression of Severity (CGI-S) score of 4 or more. The duloxetine dose of patients could be titrated on the basis of the degree of response within the range from 60 to 120 mg given QD, with 90 mg QD as an intermediate dose. Remission of major depressive disorder was defined as a HAMD-17 total score of ≤ 7. Core emotional symptoms of depression were determined by the HAMD-17 Maier subscale. Pain was assessed using a 100 m...
TL;DR: Significant reductions in symptoms assessed by objective rating scales were observed in this pilot study of quetiapine administered to subjects with BPD, and the dosing strategy in the study was well tolerated.
Abstract: Background: Quetiapine was assessed in patients diagnosed with borderline personality disorder (BPD) to examine its potential effect on symptoms and explore a tolerated dosing pattern.Method: An open label case series with objective rating measures was undertaken. The study was of 8 weeks duration.Results: Sixteen research subjects received quetiapine and completed at least one rating. Nine subjects completed the entire 8 week trial. In the LOCF and completer analyses, significant improvement was noted on GAF, SCL-90, BIS, and SIB. Specifically for the LOCF analysis, GAF increased from 57.7 to 64.6 (p = 0.001), SCL-90 decreased from 120.1 to 78.4 (p = 0.004), BIS improved from 73.4 to 59.9 (p = 0.021), and the SIB started at 267.8 and ended at 202.3 (p < 0.001).The average dose of quetiapine for LOCF analysis was 223.4 mg/d and was 286.1 mg/d for the completers. Common side-effects were similar to those seen in schizophrenic patients—sedation and increased appetite.Conclusions: Significant reductions in s...
TL;DR: It is suggested that EDO symptoms and cognitive performance in anorexia nervosa patients can show improvement as long as two years after hospitalization, but there is no evidence that EDo symptoms are related to neuropsychological performance.
Abstract: Introduction. We investigated the stability of neuropsychological performance and eating disorder (EDO) symptoms before, immediately after, and 2 years after inpatient treatment. We also examined relationships between neuropsychological and EDO measures.Methods. Sixteen women who were admitted for inpatient treatment of anorexia nervosa participated in three evaluations: (1) at admission to the hospital, (2) at discharge, and (3) at a follow-up exam approximately two years after discharge.Results. Body mass index increased significantly from each testing session to the next. Endorsement of eating disorder symptoms was significantly decreased at discharge and at follow-up compared to admission. In terms of cognitive performance, total scores on a brief neuropsychological battery (RBANS) were significantly greater at follow-up than at admission. We found no relationships between EDO symptoms and cognitive function at any of the three sessions.Conclusions. The current findings suggest that EDO symptoms and c...
TL;DR: Preliminary data suggest that olanzapine may be a treatment option for subjects with tardive dyskinesia, as no dosage reduction or withdrawal was undertaken and there were statistically significant reductions in the prevalence and severity of dyskinetic symptoms at 8 weeks and 6 months.
Abstract: Background. Tardive dyskinesia is a serious adverse event, which is associated mainly with the use of the first-generation antipsychotic agents. Convergent data from clinical trials suggest that second-generation antipsychotic agents are less likely to cause tardive dyskinesia. However, the data with regard to the effect of switching from first- to second-generation antipsychotic agents on pre-existing dyskinetic symptoms during routine clinical care is sparse.Methods. Sixty-three patients with DSM-IV schizophrenia or schizoaffective disorder (n = 61) or bipolar I disorder (n = 2) consecutively admitted to a state hospital, who were treated either with olanzapine (n = 35) or conventional antipsychotic agents (n = 28) by physician choice, were enrolled in the study. The severity and frequency of tardive dyskinetic symptoms using the Abnormal Involuntary Movement Scale were assessed in the two medication groups at baseline, 8 weeks, and 6 months.Results. There were statistically significant reductions in th...
TL;DR: In the Lee study, no details are offered as to the type or frequency of assessment for catatonia during the NMS episodes, and no dosages of benzodiazepines are provided to compare those N MS episodes deemed responsive or non-responsive to these agents.
Abstract: Lee (1) reported a naturalistic study with 14 episodes of neuroleptic malignant syndrome (NMS) and found 5 did not meet criteria for catatonia or respond to benzodiazepines within 3 days. These observations are at variance with other studies showing a close relationship between catatonia and NMS as evidenced by overlap in clinical features (e.g., 2,3) and positive response to treatment with high potency benzodiazepines (e.g., 2,4). In the Lee study, no details are offered as to the type or frequency of assessment for catatonia during the NMS episodes, and no dosages of benzodiazepines are provided to compare those NMS episodes deemed responsive or non-responsive to these agents. Some cases of NMS require high dosages of benzodiazepines for treatment (4). REFERENCES
TL;DR: A pilot study suggests that the Lee-Carroll scale may help differentiate the subtypes of NMS, and provides some support that non-catatonic NMS may be a form of SS.
Abstract: Background. Neuroleptic malignant syndrome (NMS) shares common features with catatonia and serotonin syndrome (SS). For instance, catatonia is a risk factor for the development of NMS.Methods. We performed a pilot study to examine if the Lee-Carroll Scale is able to differentiate the proposed NMS subtypes and explore possible relationship between NMS and SS. A consecutive series of cases reported to the Neuroleptic Malignant Syndrome Information Service (NMSIS) were reviewed with 29 cases of “definite NMS.” The Hynes-Vickar Scale (an NMS scale), Hegerl Scale (a SS scale), and Lee-Carroll Scale (an NMS subtype scale) were applied to these case report forms.Conclusions. Although the groups were too small for statistical analysis, the 2 catatonic NMS subtypes appear to have higher NMS scores on the Hynes-Vickar Scale, and lower SS scores on the Hegerl Scale than the non-catatonic NMS subtype. The scores on the Lee-Carroll Scale were highest for non-catatonic NMS subtype. This pilot study suggests that the Le...
TL;DR: In this article, shock-like sensitivity associated with Duloxetine Discontinuation was investigated. But the authors did not consider the effects of discontinuing the drug on other drugs.
Abstract: (2008). Shock-Like Sensations Associated with Duloxetine Discontinuation. Annals of Clinical Psychiatry: Vol. 20, No. 3, pp. 175-175.
TL;DR: Structural imaging may help provide useful clinical information in the context of mild cognitive decline and whether the addition of brain imaging may enhance diagnostic certainty as well as predict long-term outcome is investigated.
Abstract: Background. This study evaluated brain volumes in healthy older subjects without dementia who presented with memory complaints. The objective was to examine cortical volumes in relation to cognitive performance among patients who do not have dementia, but who do have mild cognitive deficits.Methods. Fifteen participants were evaluated (mean age = 71.8 ± 6.2). Brain structure was measured via high-resolution magnetic resonance imaging to quantify gray and white matter volumes. Volumetric measures were assessed relative to cognitive function in separate regression models controlling for total cerebral volume. Reported here are measures of global cognitive performance using the Mattis Dementia Rating Scale (DRS) in relation to volumetric measures.Results. Baseline MMSE scores ranged from 27 to 30 (mean = 29.3; SD = 0.9). After controlling for total cerebral volume, we observed that lower white matter volume in the temporal lobe [F(1,14) = 5.72, p = 0.03] was associated with lower performance on the Mattis...