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F E A T U R E D    A R T I C L E

Atypical Antipsychotics: Where is the Science, Where is the Evidence?

July 23rd, 2014
Atypical Antipsychotics: Where is the Science, Where is the Evidence?Any psychiatrist who has practiced during the last decade has probably written more than a few prescriptions for an atypical antipsychotic. But do these drugs provide any clear ...

What’s New With Suboxone

Suboxone: What’s NewIn 2010, TCPR published an overview of Suboxone (buprenorphine/ naloxone) (TCPR, May 2010). Lots has happened in the three+ years since then. For starters, the American Society of Addiction Medicine (ASAM) issued a consensus statement in December 2011 on the office-based use of buprenorphine for opioid addiction treatment (Kraus ML et al, J Addict Med 2011;5(4):254–263). The purpose of the statement was to synthesize the literature on the clinical use of buprenorphine and to streamline general ...

Cognitive Behavioral Therapy for Treatment Resistant Depression

Research Updates in PsychiatryWe have an abundance of medications to treat depression, but “treatment resistance” remains all too common. Accordingly, there has been a rise in the number of “augmentation” or “adjunctive” medications to address this population. Unfortunately, comparable attention has not been drawn to the role of psychotherapy in the management of treatment-resistant depression. To evaluate the effect of psychotherapy on treatment-resistant depression, investigators recruited 469 patients with depression who had taken antidepressants (mostly SSRIs) for at ...




Cognitive Behavioral Therapy for Treatment Resistant Depression

Research Updates in PsychiatryWe have an abundance of medications to treat depression, but “treatment resistance” remains all too common. Accordingly, there has been a rise in the number of “augmentation” or “adjunctive” medications to address this population. Unfortunately, comparable attention has not been drawn to the role of psychotherapy in the management of treatment-resistant depression. To evaluate the effect of psychotherapy on treatment-resistant depression, investigators recruited 469 patients with depression who had taken antidepressants (mostly SSRIs) for at ...

Q&A: Management of Bipolar Depression

Management of Bipolar DepressionTCPR: Dr. Baldassano, could you please share with us your definition of bipolar depression, and why we hear so much about it these days? Dr. Baldassano: Bipolar depression is simply the term used when someone has a depressive episode in the context of having bipolar disorder type I or type II. We hear a lot about bipolar depression for two reasons. First, our bipolar patients suffer many more days with depression than they do with ...

 

ADHD, Rating Scales & Your Practice Today

ADHD, Rating Scales, and Your Practice TodayYou greet a new patient who complains of difficulty concentrating at work and is unable to “keep up” since making partner at a law firm or becoming an attending physician at a hospital. Is this an authentic case of a high-functioning person with undiagnosed adult ADHD, a subtle request for performance enhancement, or something altogether different? We all know about specialized ADHD clinics that offer imaging and comprehensive assessment; but in your ...

A Review of Depression Rating Scales: Old Favorites & New Players

Depression Rating Scales: Old Favorites and New PlayersWhen treating our depressed patients, objective clinical measures can help guide interventions and reassure us that the treatment course we are on is appropriate. Depression rating scales rose to popularity in the 1950s, primarily as tools to measure the effect of antidepressant medications. Today there are many scales to choose from. Psychiatrists familiar with these tools will be better able to interpret clinical trial results and to employ them in ...


From Our Partner,           The National Psychologist:

Q&A: Patients, Families & the Legal System

This Month’s Expert Patients, Families, and the Legal SystemTCPR: Dr. Hanson, in your career as a forensic psychiatrist, you’ve become expert in the options the legal system offers to help psychiatric patients and their families. What can family members do if they feel that their loved one is a danger to him- or herself or to others, in the absence of a clear threat of violence? Dr. Hanson: If the patient allows it, open communication between the care ...

Chronic Pain, Comorbidity & Treatment Complexity

Chronic Pain, Comorbidity, and Treatment ComplexityChronic pain is typically defined as pain lasting longer than three months, resulting from either a disease process or bodily injury that has not resolved as expected. It is a major and complex public health reality for almost one-third of the US population. More than 116 million Americans have chronic pain conditions, contributing to healthcare costs amounting to more than $560 billion annually. Chronic pain is best understood with a biopsychosocial ...

 

TMS Treatment for Depression & Toxoplasma

Research Updates in PsychiatryStudy Looks at Use of TMS to Treat Depression Transcranial magnetic stimulation, or TMS, was approved by the FDA for treatment of major depression in October 2008. A newly published observational study evaluating the effectiveness of TMS treatment in more than 300 patients at 42 clinical settings across the United States has found that most patients responded well to this intervention, with few adverse effects (Carpenter LL et al, Dep Anx 2012;29(8):587–596). The study followed 307 ...

Q&A: Psychosocial Treatment of Bipolar Disorder

This Month’s Expert Psychosocial Treatment of Bipolar DisorderTCPR: Why should we as psychiatrists focus on the psychosocial aspects of bipolar disorder? Dr. Miklowitz: There is evidence that life events, family distress, and antecedent adversity variables in childhood are related to the course of bipolar disorder. So as with any other psychiatric disorder, you have to consider the psychosocial triggers of episodes and to what extent those are related to how people respond to medications, whether they are compliant ...

Expert Q&A: The Role of Psychiatry in Palliative Care

This Month’s Expert The Role of Psychiatry in Palliative CareTCPR: Dr. Breitbart, please tell us the unique role psychiatry plays in palliative care. Dr. Breitbart: The goals of palliative care are to provide physical symptom control throughout the entire course of an illness, from the diagnosis of a life-threatening illness all the way through the advanced stages and the last periods of life, and to follow families through the bereavement process. Psychiatric palliative care helps to expand that ...

Text Messaging Effective for Appointment Reminders

Text Messaging Effective for Appointment RemindersNo one seems to be without a cell phone these days, so it only makes sense that we should start using these devices to carry out tasks that we used to do in a more “old-fashioned” way. One obvious application is to use text messages to remind patients of upcoming appointments. A recent study by a group at King’s College London shows that it can be done cheaply and easily, and that it improves ...

Patient Preference Not a Good Predictor of Treatment Response

Research Updates in PsychiatryDo patients with major depressive disorder (MDD) respond better when psychiatrists offer the type of treatment -- medication or psychotherapy -- that the patient prefers? And do patients’ beliefs about what causes their depression influence treatment outcomes? In a new study, researchers concluded that, despite their expectations, neither factor is a good predictor of treatment response. Researchers looked at 80 patients who participated in a 12-week randomized, double-blind clinical trial of MDD. They assessed the ...

Augmentation of Antidepressants with Antipsychotics

Research Updates in PsychiatryAugmentation of antidepressants with antipsychotics has become a common practice, and aripiprazole (Abilify) has been FDA approved at doses from 2 mg/day to 15 mg/day for this purpose. In a recent report, 225 patients with major depressive disorder (MDD) who had failed one to four antidepressant trials were studied to determine whether low dose Abilify really works. Using the Sequential Parallel Combined Design (SPCD), a strategy designed to minimize placebo response, patients were randomized to ...