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Worried About Insomnia?
Paul King, MD

Is it possible to achieve enough worry to be productive but not have it get so out of control that it leads to insomnia? Any suggestions?

» Read this post

» Read the entire blog

Managing Comorbidities in Severe Mental Illness Roger S. McIntyre, MD, FRCPC (Chair), et al

Learn about implementing treatment strategies to address modifiable health risk factors in your patients.

>>See the entire activity

The Use of MAOIs in Primary Care Larry Culpepper, MD, MPH

New! Read about the safety, tolerability, and efficacy of MAOIs, and find out which of your primary care patients may best respond to these agents.

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Articles published electronically 2/21/12

Risks for the Transition From Major Depressive Disorder to Bipolar Disorder in the National Epidemiologic Survey on Alcohol and Related Conditions

[Abstract] [Full Text] Posted 2/21/12

Evaluation of the Glycine Transporter Inhibitor Org 25935 as Augmentation to Cognitive-Behavioral Therapy for Panic Disorder: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial

[Abstract] [Full Text] Posted 2/21/12

Statin Use and Risk of Depression in Patients With Coronary Heart Disease: Longitudinal Data From the Heart and Soul Study

[Abstract] [Full Text] Posted 2/21/12

Brain-Volume Increase With Sustained Remission in Patients With Treatment-Resistant Unipolar Depression

[Abstract] [Full Text] Posted 2/21/12

Continued Cannabis Use and Outcome in First-Episode Psychosis: Data From a Randomized, Open-Label, Controlled Trial

[Abstract] [Full Text] Posted 2/21/12

Articles published electronically 2/7/12

Neural and Behavioral Correlates of Peritraumatic Dissociation in an Acutely Traumatized Sample

[Abstract] [Full Text] Posted 2/7/12

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Impact of Deleting 5 DSM-IV Personality Disorders on Prevalence, Comorbidity, and the Association Between Personality Disorder Pathology and Psychosocial Morbidity

[Abstract] [Full Text] Posted 1/24/12 [Related Blog Post] FREE to registered users

Articles published electronically 1/10/12

An 8-Week, Randomized Controlled Trial of Atomoxetine, Atomoxetine Plus Buspirone, or Placebo in Adults With ADHD

[Abstract] [Full Text] Posted 1/10/12

Poor Sleep at Baseline Predicts Worse Mood Outcomes in Patients With Co-Occurring Bipolar Disorder and Substance Dependence

[Abstract] [Full Text] Posted 1/10/12

Lifespan Persistence of ADHD: The Life Transition Model and Its Application

[Abstract] [Full Text] Posted 1/10/12

Articles published electronically 12/27/11

Prediabetes in Patients Treated With Antipsychotic Drugs

[Abstract] [Full Text] Posted 12/27/11

Comparison of Women With Confirmed Versus Presumably Misdiagnosed Bipolar Disorder

[Abstract] [Full Text] Posted 12/27/11

Can People With Nonsevere Major Depression Benefit From Antidepressant Medication?

[Abstract] [Full Text] Posted 12/27/11

Suicidal Risk Factors in Bipolar I and II Disorder Patients

[Abstract] [Full Text] Posted 12/27/11

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The Impact of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) on Prescribing Practices: An Analysis of Data From a Large Midwestern State

[Abstract] [Full Text] Posted 12/13/11

Nonsteroidal Anti-Inflammatory Drugs in Schizophrenia: Ready for Practice or a Good Start? A Meta-Analysis

[Abstract] [Full Text] Posted 12/13/11

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Insomnia and Objectively Measured Sleep Disturbances Predict Treatment Outcome in Depressed Patients Treated With Psychotherapy or Psychotherapy-Pharmacotherapy Combinations

[Abstract] [Full Text] Posted 11/29/11

The Relationships of Environment and Personal Characteristics to Agitated Behaviors in Nursing Home Residents With Dementia

[Abstract] [Full Text] Posted 11/29/11

Maternal Depression and Anxiety Differentially Impact Fetal Exposures During Pregnancy

[Abstract] [Full Text] Posted 11/29/11

Declining Benzodiazepine Use in Veterans With Posttraumatic Stress Disorder

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Gene-Temperament Interactions Might Distinguish Between Bipolar I and Bipolar II Disorders: A Cross-Sectional Survey of Han Chinese in Taiwan

[Abstract] [Full Text] Posted 11/15/11

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Trauma at the Hands of Another: Longitudinal Study of Differences in the Posttraumatic Stress Disorder Symptom Profile Following Interpersonal Compared With Noninterpersonal Trauma

[Abstract] [Full Text] Posted 11/1/11

Understanding the Central Pharmacokinetics of Spheroidal Oral Drug Absorption System (SODAS) Dexmethylphenidate: A Positron Emission Tomography Study of Dopamine Transporter Receptor Occupancy Measured With C-11 Altropane

[Abstract] [Full Text] Posted 11/1/11

How Informative Are Open-Label Studies for Youth With Bipolar Disorder? A Meta-Analysis Comparing Open-Label Versus Randomized, Placebo-Controlled Clinical Trials

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Emotional Numbing in Posttraumatic Stress Disorder: A Functional Magnetic Resonance Imaging Study

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Web-Based Assessment of Depression in Patients Treated in Clinical Practice: Reliability, Validity, and Patient Acceptance

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Mortality of Neuroleptic Malignant Syndrome Induced by Typical and Atypical Antipsychotic Drugs: A Propensity-Matched Analysis From the Japanese Diagnosis Procedure Combination Database

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Gender, HIV Status, and Psychiatric Disorders: Results From the National Epidemiologic Survey on Alcohol and Related Conditions

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ARVCF Genetic Influences on Neurocognitive and Neuroanatomical Intermediate Phenotypes in Chinese Patients With Schizophrenia

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The Relation of Serotonin-Related Gene and COMT Gene Polymorphisms With Criminal Behavior in Schizophrenic Disorder

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Early Response and Remission as Predictors of a Good Outcome of a Major Depressive Episode at 12-Month Follow-Up: A Prospective, Longitudinal, Observational Study

[Abstract] [Full Text] Posted 10/4/11

Insomnia as a Risk for Depression: A Longitudinal Epidemiologic Study on a Japanese Rural Cohort

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Efficacy of Dose Increase Among Nonresponders to Low-Dose Aripiprazole Augmentation in Patients With Inadequate Response to Antidepressant Treatment: A Randomized, Double-Blind, Placebo-Controlled, Efficacy Trial

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Epidemiology of Major Depression With Atypical Features: Results From the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

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Neural Correlates and Predictive Power of Trait Resilience in an Acutely Traumatized Sample: A Pilot Investigation

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Predictors of Psychiatric Inpatient Suicide: A National Prospective Register-Based Study

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Bereavement and the Diagnosis of Major Depressive Episode in the National Epidemiologic Survey on Alcohol and Related Conditions

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Retinoic Acid and Affective Disorders: The Evidence for an Association

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Successful Pharmacologic Treatment of Major Depressive Disorder Attenuates Amygdala Activation to Negative Facial Expressions: A Functional Magnetic Resonance Imaging Study

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The Clinical Process in Psychiatry: A Clinimetric Approach

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Analysis of Gene Variants Previously Associated With Iloperidone Response in Patients With Schizophrenia Who Are Treated With Risperidone

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[Abstract] [Full Text] Posted 5/17/11

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Volume 73January 2012Number 1

Editorial

5 JCP’s Circle of Honor and Peer Reviewers

Commentaries

64 Questions Raised by the Failure of a Trial of Short-Term Psychodynamic Therapy Versus Pharmacotherapy for Major Depressive Disorder

113 Depression in Older Adults: Is There Another Reason to Worry?

Original Research

8 Does the Presence of One Feature of Borderline Personality Disorder Have Clinical Significance? Implications for Dimensional Ratings of Personality Disorders

Clinical Points
  • Low-severity levels of borderline personality disorder can be assessed reliably.
  • Psychiatric outpatients with 1 borderline personality disorder criterion have greater psychosocial morbidity than patients with 0 criteria.
  • The results support suggestions to rate borderline personality disorder dimensionally because low severity levels of such pathology are clinically significant.

[Close]

13 A Randomized, Double-Blind, Placebo-Controlled Study of the Safety and Tolerability of High-Dose Quetiapine in Patients With Persistent Symptoms of Schizophrenia or Schizoaffective Disorder

Clinical Points
  • Like other atypical antipsychotics, quetiapine is often prescribed at higher than approved doses for patients with schizophrenia or schizoaffective disorder.
  • While using quetiapine at doses greater than 800 mg/d does not increase extrapyramidal symptoms, weight gain is greater at higher than approved doses.
  • Higher than approved doses offer no additional benefit in improving symptom severity.

[Close]

31 Obstructive Sleep Apnea/Hypopnea Syndrome and Poor Response to Sertraline in Patients With Coronary Heart Disease

Clinical Points
  • Depression and obstructive sleep apnea/hypopnea syndrome (OSAHS) are both associated with cardiac mortality in patients with heart disease.
  • Both depression and OSAHS are very common in patients with heart disease.
  • Untreated OSAHS is associated with a poor response to sertraline treatment in patients with heart disease and major depression.

[Close]

57 Double-Blind, Randomized, Placebo-Controlled Long-Term Maintenance Study of Aripiprazole in Children With Bipolar Disorder

Clinical Points
  • Prospective, randomized maintenance studies in pediatric patients with bipolar disorder are feasible.
  • Aripiprazole is generally well tolerated and may be beneficial in the long-term treatment of young children with bipolar disorder.

[Close]

66 Short-Term Dynamic Psychotherapy Versus Pharmacotherapy for Major Depressive Disorder: A Randomized, Placebo-Controlled Trial

Clinical Points
  • Among low-income, inner-city depressed patients, there is not much evidence supporting the efficacy of either pharmacotherapy or brief dynamic therapy in comparison with placebo.
  • There is some preliminary evidence that minority men improved more following dynamic therapy than following pharmacotherapy and placebo, whereas white men improved more following placebo than following other treatments.
  • Preliminary evidence also indicates that white women will improve more following pharmacotherapy or dynamic therapy than following placebo, whereas minority women improved similarly across treatments. Those results require replication.

[Close]

74 Executive Function Predicts Response to Antiaggression Treatment in Schizophrenia: A Randomized Controlled Trial

Clinical Points
  • Executive function is an important predictor of response to antiaggression treatment in patients with schizophrenia.
  • It is possible to customize treatment of aggression on the basis of the patient’s level of executive functioning.
  • Clozapine has a unique antiaggression profile, resulting in decreased violence even in patients with poor executive function prior to treatment.

[Close]

81 Omega-3 for Bipolar Disorder: Meta-Analyses of Use in Mania and Bipolar Depression

Clinical Points
  • Current evidence supports omega-3 in adjunctive treatment of bipolar depression.
  • Current evidence, however, does not support omega-3 in the adjunctive treatment of bipolar mania.
  • Clinicians are advised to recommend increased dietary omega-3 or daily supplementation of approximately 1 g to 1.5 g of mixed EPA and DHA (higher ratio of EPA).

[Close]

87 Factors Associated With the Persistence and Onset of New Anxiety Disorders in Youth With Bipolar Spectrum Disorders

Clinical Points
  • Anxiety disorders in youth with bipolar disorder tended to persist, and a substantial proportion of subjects developed new anxiety disorders.
  • Different factors, including the presence of severe or multiple anxiety disorders, ongoing mood symptoms, and comorbid disorders, were associated with the persistence and the onset of anxiety disorders. Early identification of factors may enable the development of strategies for treatment and prevention of anxiety disorders in bipolar youth.
  • Randomized controlled trials are warranted to evaluate the efficacy and tolerability of pharmacologic and psychosocial treatments for youth with comorbid bipolar disorder and anxiety disorders.

[Close]

95 Bupropion Sustained Release Added to Group Support for Smoking Cessation in Schizophrenia: A New Randomized Trial and a Meta-Analysis

103 Placebo-Controlled Adjunctive Trial of Pramipexole in Patients With Bipolar Disorder: Targeting Cognitive Dysfunction

Clinical Points
  • Many patients with bipolar disorder suffer from disabling neurocognitive impairment, yet this symptom domain has not been a common target for treatment.
  • Formal neurocognitive assessment and thorough clinical evaluation will be important in determining which patients with bipolar disorder might optimally benefit from cognitive intervention.
  • Although preliminary, our data are promising and suggest that improving neurocognitive functioning in patients with bipolar illness is a feasible ambition. Future studies of pramipexole and other agents will be important in continuing efforts to enhance treatment outcome and quality of life.

[Close]

21 Pretest

CME Activity

29 Posttest

 

22 The Role of Psychomotor Activation in Discriminating Unipolar From Bipolar Disorders: A Classification-Tree Analysis

Clinical Points
  • Our results support the role of lifetime psychomotor activation, as assessed by the Mood Spectrum Self-Report instrument, as the best discriminator of bipolar disorder from unipolar disorder.
  • The mixed instability factor contributed to the discrimination of bipolar from unipolar disorder in patients with intermediate levels of psychomotor activation.
  • Elevated mood (the euphoria factor) contributed to discrimination of bipolar from unipolar disorder in patients with low psychomotor activation scores.
  • The suicidality factor further discriminated bipolar from unipolar disorder.

[Close]

Review Article

37 Retinoic Acid and Affective Disorders: The Evidence for an Association

Case Report

51 Making Lemonade Out of Lemons: A Case Report and Literature Review of External Pressure as an Intervention With Pregnant and Parenting Substance-Using Women

Clinical Points
  • Pregnant and postpartum women are frequently exposed to external pressure to not use substances. The way in which pressure is applied in clinical situations can potentially influence the trajectory of the woman’s addiction, as well as her motivation to seek treatment and get prenatal care.
  • Providers should use external pressure to encourage pregnant and postpartum substance users to enter treatment in a collaborative and supportive manner. Confrontational strategies are less likely to be effective in addressing addiction, especially in this unique population.
  • Some strategies include (1) acknowledging individual women’s needs; (2) building positive, respectful relationships with patients; and (3) providing a range of resources that address their specialized barriers to treatment entry.

[Close]

Focus on Alzheimer’s Disease and Related Disorders

115 Metabolism of Amyloid-β Protein May Be Affected in Depression

Clinical Points
  • Changes in amyloid-β (Aβ) metabolism may be a biological factor in the transition from depression to Alzheimer’s disease (AD).
  • Clinicians should follow up even with younger patients with major depressive disorder (MDD) and consider them to be at high risk for AD.
  • Higher blood Aβ40/Aβ42 ratio in patients with MDD may be an index for future preventive therapy for AD, such as amyloid vaccination.

[Close]

121 Effect of Second-Generation Antipsychotics on Caregiver Burden in Alzheimer’s Disease

Clinical Points
  • Alzheimer’s disease (AD) imposes a severe burden on patients and their relatives, particularly those individuals directly responsible for patient care.
  • Psychiatric and behavioral symptoms are the main correlates of caregiver burden.
  • Among AD patients with symptoms of psychosis, agitation, or aggressive behavior, atypical antipsychotic medications may reduce agitation, suspiciousness, and psychosis enough to have significant, if small, impact on caregivers’ experience of burden.
  • Psychosocial interventions designed to improve patients’ quality of life, eg, through increased socialization and social interactions, are also important in reducing caregiver burden.

[Close]

Letter to the Editor

129 Propranolol, Traumatic Memories, and Amnesia: A Study of 36 Cases

Book Reviews

131 Teaching Mindfulness: A Practical Guide for Clinicians and Educators

131 Clinical Manual of Couples and Family Therapy

132 Clinical Manual of Electroconvulsive Therapy

132 Treating Child and Adolescent Depression

Psychiatrist.com Exclusives

Original Research

e134 The Course of Chronic Pain With and Without Psychiatric Disorders: A 6-Year Follow-Up Study From Childhood to Adolescence and Young Adulthood

Clinical Points
  • Chronic pain in most children in pediatric care is not self-limiting and is often accompanied by psychiatric disorders when they grow up.
  • Psychiatric care alongside standard medical care should be made available for children with chronic pain and impairing comorbid psychiatric disorders.

[Close]

Online Activities

e01 Using Adjunctive Treatments When First-Line Antidepressants Fail [CME]

e02 Identifying, Diagnosing, and Managing ADHD in College Students [CME]

e03 Diagnosing and Managing Patients With Dementia [CME]

e04 Assessing and Measuring Nonresponse in Schizophrenia [CME]

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Commentary: Depression in Women: Windows of Vulnerability and New Insights Into the Link Between Estrogen and Serotonin Sonali Lokuge, Benicio N. Frey, Jane A. Foster, Claudio N. Soares, and Meir Steiner
[Full Text With Comments]

Does DSM-IV Already Capture the Dimensional Nature of Personality Disorders? Mark Zimmerman, Iwona Chelminski, Diane Young, Kristy Dalrymple and Jennifer Martinez
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A National Epidemic of Unintentional Prescription Opioid Overdose Deaths: How Physicians Can Help Control It Leonard J. Paulozzi, Richard H. Weisler, and Ashwin A. Patkar
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Editors’ Perspectives: Peer Review and the Evolving Journal

Commentaries on Peer Review and the Evolving Journal. Marlene P. Freeman
[Full Text With Forum]

Peer Review Perspective for Early Career Psychiatrists. Alan J. Gelenberg
[Full Text With Forum]

Learning to Review. Robert Freedman
[Full Text With Forum]

Peer Review by Early Career Psychiatrists: An Opportunity for Development. Anne F. Gross, Ilse R. Wiechers, and Theodore A. Stern
[Full Text With Forum]

The Evolution of the Psychiatry Research Journal. John H. Krystal
[Full Text With Forum]

Peer Review in Early Career: Just Say Yes! Peter P. Roy-Byrne
[Full Text With Forum]

Perspectives on Perinatal Depression Treatment

Perinatal Psychiatry: The Challenges of Making Rational Treatment Decisions at the Interface of Psychiatry and Obstetrics. Marlene P. Freeman
[Full Text With Forum]

Influence of the Media on Women Taking Antidepressants During Pregnancy. Adrienne Einarson
[Full Text With Forum]

The Other Side of the Risk Equation: Exploring Risks of Untreated Depression and Anxiety in Pregnancy. Ellen M. Markus and Laura J. Miller
[Full Text With Forum]

Reflections on Perinatal Depression Treatment. Bryanne Barnett, and Marie-Paule Austin
[Full Text With Forum]

Do We Scare Because We Care? Diane N. Solomon
[Full Text With Forum]

Perinatal Depression: Searching for Specific Tools for a Closer Look at This Window. Claudio N. Soares, and Meir Steiner
[Full Text With Forum]

Psychotherapeutic Treatment Options for Perinatal Depression: Emphasis on Maternal-Infant Dyadic Outcomes. Maria Muzik, Sheila M. Marcus, and Heather A. Flynn
[Full Text With Forum]

No Decision Is Without Risk. Rita Suri, and Lori L. Altshuler
[Full Text With Forum]

The Cost of Restricting Knowledge. Anna R. Brandon, Geetha Shivakumar, Stephen J. Inrig, Simon J. Craddock Lee, and John Z. Sadler
[Full Text With Forum]

Pharmacotherapy or Untreated Antenatal Depression: A False Dichotomy. Sona Dimidjian, and Michael W. O’Hara
[Full Text With Forum]

 

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Early Career Psychiatrists

Marlene P. Freeman, MD (Editor)

Focus on Alzheimer's Disease and Related Disorders

Eric M. Reiman, MD (Editor)

Focus on Childhood and Adolescent Mental Health

Karen D. Wagner, MD, PhD (Editor)

Focus on Women's Mental Health

Marlene P. Freeman, MD (Editor)

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Optimizing Clinical Outcomes Across Domains of Life in Adolescents and Adults With ADHD

Lenard A. Adler, MD (Chair), et al

Attention-deficit/hyperactivity disorder (ADHD) often persists into adulthood and is associated with significant impairment in multiple domains of life. In this article, receive guidance on assessing for ADHD and get an overview of pharmacologic and nonpharmacologic treatment strategies.

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Recent Advances in Treatments for Schizophrenia

John M. Kane, MD (Chair), et al

Read this Supplement to get an overview of the risks and benefits of currently available antipsychotics and to discover the most desirable characteristics of new agents. This information will help you optimize the use of existing antipsychotics, improve individual outcomes, and better evaluate new medications.

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Looking Past First-Line Therapy for Major Depressive Disorder

Larry Culpepper, MD, MPH (Chair), et al

Find out what to do when first-line treatments don’t elicit adequate symptomatic improvement for your patients with depression, including choosing next-step strategies and when and how to implement them.

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The Appropriate Use of Opiates in Chronic Pain

Autry J. Parker, MD, MPH

New! Review opioid therapy for chronic pain and learn about tools that can help you assess patients for abuse risk and safeguard them during treatment.

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Brief Reports: Shift Work Disorder: Overview and Diagnosis

Thomas Roth, PhD

Read this interactive report to better understand the pathophysiology, prevalence, and consequences of shift work disorder and to find out how to diagnose this problem when you encounter it in clinical practice.

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Antidepressant Mechanism of Action Effects

Anita H. Clayton, MD

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Journal Statistics

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31%

No. of articles published per issue

 

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4 months

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Mean=5.2 months,
range=3–9 months

Impact Information

The Journal of Clinical Psychiatry continues to be ranked as the most-read and 6th most-cited psychiatric journal in the world (according to the Focus Readership Study, June 2007, and Citation Index, July 2007, respectively). The Journal mails to about 35,184 recipients,* and over 20,000 allied mental health professionals have requested daily receipt of informational e-mails about our journals and Web CME activities.

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2011 Circle of Honor

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