Clinical Psychiatry News

Clinical Psychiatry News is a monthly medical and psychiatry tabloid published since 1973 by the International Medical News Group. Subjects for Clinical Psychiatry News include psychology and psychiatry. The executive editor is Denise Fulton, and Gina Henderson is a senior editor.

Articles from Vol. 33, No. 9, September

ADHD Stimulants: No Link to Propensity for Later Drug Abuse
YOSEMITE, CALIF. -- Will my child become a dope fiend? That's a common question Robert S. McKelvey, M.D., fields from parents of children who are prescribed a class II stimulant for attention-deficit hyperactivity disorder (ADHD). "The answer...
Alexithymia Requires Persistence, Empathy
Alexithymia is known as a patient characteristic that can have a negative outcome on psychotherapy (Compr. Psychiatry 2005;46:206-13). But many of our patients have difficulty understanding and describing their emotions, and as a result, their anxieties...
Antidepressant Combos Show Synergistic Benefit
BOCA RATON, FLA. -- A combination of antidepressants with complementary effects on serotonin and norepinephrine provides earlier symptom relief than does monotherapy, according to preliminary results of a study. As a result, it appears that combination...
Anxiety Disorders Place Huge Burden on Child's Entire Family
ATLANTA -- A significant burden is placed on the family members of children and adolescents with anxiety disorders, regardless of the age of the child, Catherine Mancini, M.D., said in a poster presentation at the annual meeting of the American Psychiatric...
Apnea in Pregnancy Could Pose Threat to Fetus
DENVER -- Obstructive sleep apnea is far more common during pregnancy than most physicians realize and in its more severe forms can jeopardize the fetus, Meir H. Kryger, M.D., said at a satellite symposium held in conjunction with the annual meeting...
Aripiprazole Wins out in Comparison with Olanzapine
BOCA RATON, FLA. -- Aripiprazole and olanzapine provided similar control of schizophrenia symptoms, but aripiprazole patients gained less weight and had a better metabolic profile than olanzapine patients in a 52-week, open-label study. "Metabolic...
Avoid Term 'Metabolic Syndrome,' Groups Advise: Meaning, Clinical Usefulness of Label Remain Unclear, U.S. and European Organizations Say
Physicians should avoid labeling patients with the term "metabolic syndrome," at least until its meaning and medical usefulness can be further clarified, the American Diabetes Association and the European Association for the Study of Diabetes said...
Beating Dog Phobias
You have a patient who is planning to visit a good friend. The patient is looking forward to the visit but with a sense of dread--for reasons that have nothing to do with the friendship. Why the ambivalence? It's the friend's dog, which is a lovely...
Brief Depression Screen May Improve Cardiac Outcomes
NEW ORLEANS -- A brief, two-question screening instrument is sensitive for identifying depression in patients with coronary heart disease, a study has shown. Because major depression is associated with adverse outcomes in this patient population,...
Bupropion Not as Successful in Poorer, Less Motivated Smokers
NEW ORLEANS -- Low-income smokers prescribed bupropion in primary care settings are less successful with smoking cessation than participants in controlled trials, according to a study presented at the annual conference of the Society of Teachers of...
Can Physicians Improve Patients' Health Literacy?
IRVINE, CALIF. -- Keep an eye out for patients who are at high risk for low health literacy--typically seniors, immigrants, those with low levels of education, Medicaid recipients, and those in poor health, Jeannette Hilgert said at a meeting sponsored...
Choose Nonstimulants with Care in ADHD
NEW YORK -- Options are available for children with attention-deficit hyperactivity disorder who do not respond to treatment with stimulants or are troubled by side effects, but they must be chosen and used carefully, Laurence L. Greenhill, M.D., said...
Clozapine Underused for Black Patients with Psychosis
BOCA RATON, FLA. -- Clozapine is underused as a treatment for schizophrenia in African Americans, compared with white patients, despite similar baseline psychopathology and symptom improvements between the two populations after 6 months, according...
Combo Rx May Speed Unipolar Remission
BOCA RATON, FLA. -- A combination of escitalopram and bupropion might produce early remission in as many as one-third of patients with unipolar depression, according to a pilot study presented at a meeting of the New Clinical Drug Evaluation Unit sponsored...
Comorbid Conduct Disorder Secondary to Depression
SANTA FE, N.M. -- A study of children's autonomic responses to reward and negative mood induction suggests that when conduct disorder and depression are comorbid, depression is the primary disorder. In a poster presentation at the annual meeting...
Comorbid Insomnia-Depression May Respond to Cotherapy
DENVER -- Coadministration of eszopiclone (Lunesta) and fluoxetine (Prozac) for newly diagnosed major depressive disorder with coexistent insomnia was associated with significantly larger and quicker improvements in both disorders than fluoxetine and...
Compared with Trials, Warfarin Is Half as Effective at Stroke Prevention in Real World
NEW ORLEANS -- Real world experience with warfarin suggests that it is not as good at preventing strokes among patients with atrial fibrillation as clinical trial results suggested, especially among African Americans. A review of more than 23,000...
Compulsive Tanning May Mean Body Dysmorphia
ATLANTA -- A high proportion of individuals with body dysmorphic disorder are compulsive tanners, so "clinicians should be aware that compulsive tanning may be a clue to the presence of the psychological illness," Michelle Conroy, M.D., said at the...
Congress Floats Medicare Payment Formula Fixes
Any legislative approach to fixing Medicare's sustainable growth rate system "would be prohibitively expensive," according to House Ways and Means Chair Bill Thomas (R-Calif.). Attaining a permanent fix is possible, however, provided that Congress...
Cost-Saving Alternatives Offered for Medicaid Program
WASHINGTON -- Private bounty hunters are one way to fight fraud in the Medicaid program, according to Stan Dorn, J.D., senior analyst at the Economic and Social Research Institute. Successfully used by Medicare, the bounty hunter approach allows...
DAT, SPECT May Speed Diagnosis of Parkinson's
Investigational imaging techniques could soon provide earlier and more definitive diagnosis of Parkinson's disease, according to John P. Seibyl, M.D., executive director and senior scientist at the Institute for Neurodegenerative Disorders, New Haven....
Develop a Proactive HIPAA Complaint Process, Lawyer Advises
SAN DIEGO -- Health care organizations need a proactive process in place to deal with Health Insurance Portability and Accountability Act complaints, Teresa A. Williams, in-house counsel for Integris Health Inc., said at the annual meeting of the American...
Doctor Pay under Medicare to Fall 4.3% in 2006
Physicians face a 4.3% cut to Medicare reimbursements next year unless Congress takes action to change the sustainable growth rate formula. The reduction was announced in a proposed rule that would update payment rates and revise payment policies...
Doctors Share Their Weight Loss Struggles
When patients came to Nick Yphantides. M.D., for advice on how to lose weight and keep it off, he used to tell them "do as I say, not as I do" before replying with specifics. That's because the 6-foot-2-inch man weighed 467 pounds. "I was board-certified...
Drug Combination for Migraines Deemed Too Risky for Approval
ROCKVILLE, MD. -- At a meeting last month, members of the Food and Drug Administration's Peripheral and Central Nervous System Drugs Advisory Committee agreed that the risk of tardive dyskinesia associated with the metoclopramide component of a fixed-dose...
FDA Approves Melatonin Agonist for Insomnia
The Food and Drug Administration has approved an insomnia drug with a unique mechanism of action and several features unique among hypnotics approved for insomnia: It is not a controlled substance and does not produce some CNS side effects associated...
FDA Approves Two Monitoring Changes for Clozapine Patients
ROCKVILLE, MD. -- The Food and Drug Administration has approved two major changes to the schedule for monitoring people on clozapine for agranulocytosis: the addition of absolute neutrophil count tests to regular monitoring and a reduction in the frequency...
FDA Panel Blocks Urine Test for Alzheimer's: Test Detects Neural Thread Protein, but It's Unclear Whether That Is a Valid Biomarker of the Disease
GAITHERSBURG, MD. -- A simple, nonnvasive urine test aimed at helping physicians determine whether a patient has Alzheimer's disease is unlikely to become widely available in the near future. According to the manufacturer, what is under Food and...
Feds Push for Electronic Health Record System
The Department of Health and Human Services took more steps toward a nationwide electronic health record system when it issued requests for proposals for key system components and announced formation of an advisory committee. The department said...
Gentle Exercises Can Lead to Improved Balance
NASHVILLE, TENN. -- Practicing postural and strength exercises twice a week leads to significant increases in balance and overall activity among the frail elderly, Sue Scott said in a poster presented at the annual meeting of the American College of...
Groups Are Seeking Parity for Psychiatric Patients in the ED
WASHINGTON -- Psychiatric organizations called for greater parity in treating emergency psychiatric conditions before a technical advisory group on the Emergency Medical Treatment and Labor Act. Many issues have not been thoroughly discussed or...
Groups Join Forces in Fight for Mental Health Reform: Momentum on Parity Bill Is a Top Priority
WASHINGTON -- A coalition of national mental health organizations--including the American Psychiatric Association and the National Alliance for the Mentally Ill--has launched a campaign aimed at implementing some of the goals set 2 years ago by the...
Halt to Exercise = Depression?
VANCOUVER, B.C. -- Regular exercisers who are forced to stop may experience depressive symptoms, Ali A. Berlin reported at the annual meeting of the American Psychosomatic Society. The findings of a study of 40 regular exercisers do not suggest...
Health Disparities: Not Just a Clinical Issue
Imagine having your child exercise in the bathroom because fellow renters are sleeping in all the other rooms in your apartment, and it's too dangerous to send him outside. This was the lament of a mother in a community where we have a program to...
Health IT Support Saves Lives
Physician adoption of electronic health records is woefully inadequate, and current Stark and antikickback laws are part of the problem. Congress should pass reforms that create new exceptions to these statutes so that hospital systems and other entities...
Hunting for Good Therapy
Here's a trivia question for you: Who's the only actor to ever receive an Oscar for playing a psychotherapist? If you said Robin Williams, you're right. He was awarded Best Supporting Actor honors in 1998 for his role in "Good Will Hunting" as Sean...
Imaging Breakthroughs Reveal Early AD Changes
WASHINGTON -- Imaging techniques designed to enable identification of preclinical Alzheimer's disease were showcased in numerous presentations at an international conference sponsored by the Alzheimer's Association. Preclinical Biochemical Changes...
Insomnia May Blunt Response to Antidepressants
DENVER -- Chronic insomnia in depressed elderly patients confers roughly a ninefold increased risk of continued depression after as much as 12 months of antidepressant therapy, Wilfred Pigeon, Ph.D., reported at the annual meeting of the Associated...
Intervention Improves Vertigo and Reduces Risk of Falling
BOCA RATON, FLA. -- Vestibular rehabilitation and balance retraining reduced vertigo and falls in a study of 100 community-dwelling elderly patients with disequilibrium of aging. The intervention also improved gait and overall quality of life in...
Late-Onset Bipolar Patients Not as Ill as Counterparts
People who first develop bipolar disorder at age 60 years or older are less ill overall than are those with the more typical pattern of early-onset bipolar disorder, said Martha Sajatovic, M.D., of the University Hospitals of Cleveland, and her associates....
Let's Make Health Plans Competitive
Today's health care plans primarily compete on price. In large part, that's because many employers seek to offer the lowest-cost health plans to their employees, which forces the health plans to offer the lowest possible rates. Many physicians and...
Low-Fat Diet Reduces Recurrence of Breast Ca
ORLANDO -- Breast cancer survivors on a low-fat diet had their rate of recurrence reduced by 24% in what may be the first phase III trial to show that a lifestyle change can protect cancer patients from relapse. In a study with a median of 5 years...
Medicare Won't Accept Paper Claims as of Oct. 1: Rules Exclude Practices with Fewer Than 10 Full-Time Employees and Institutions with Fewer Than 25
Hello, October -- goodbye, paper Medicare claims. Oct. 1 marks the date that physicians and other providers may no longer submit any paper Medicare claims; electronically filed claims not in compliance with federal regulations are also prohibited....
Mental Illness Flares for Some Patients in Rehab
SANTA BARBARA, CALIF. -- Psychiatric symptoms are common among people with substance abuse disorders, but in most patients those symptoms improve over the course of residential substance abuse disorder treatment. A recent Veterans Affairs study...
Modify Depression Treatment for Older Patients: Comorbidities Are Common, So the Initial Dosage of Any Agent Should Be Low and Titration Cautious
Depression among the elderly is, in most ways, no different than in younger adults. It responds to the same drugs, but patient factors, presentation, and context must be appreciated for optimal treatment. The most prominent age-linked difference...
New Medicare Appeals Process Raises Concerns: Advocate Says That 'Older People and People with Disabilities Will Have Problems' with Teleconferences
A new process for appealing Medicare coverage denials is raising concern among some advocates for senior citizens. "We're concerned about the ability of beneficiaries to get a fair and favorable hearing," said Vicki Gottlich, senior policy attorney...
New Treatment for Endometriosis Pain Has Bone-Loss Warning
Subcutaneous medroxyprogesterone acetate has been approved for the treatment of endometriosis-related pelvic pain. It is the first new treatment to be approved for this indication in 15 years. Depo subQ provera 104 (DMPA-SC), which contains 104...
NIH Panel Assesses Treatments for Insomnia: Members Conclude That More Studies Are Needed to Assess New Drugs and Alternative Therapies
New benzodiazepine receptor agonists for chronic insomnia--zaleplon, zolpidem, and eszopiclone--have shown fewer adverse effects compared with other medications, but additional studies are needed to assess these drugs' long-term effectiveness, concluded...
Obese Cardiac Patients May Not Link Weight to Heart Disease
WASHINGTON -- Obese patients with coronary disease don't always see their excess weight as being part of the problem, Francisco Lopez-Jimenez, M.D., and his associates reported in a conference on cardiovascular disease epidemiology and prevention,...
Olanzapine vs. Risperidone in Schizophrenia
The Question Olanzapine and risperidone are the leading antipsychotic drugs ("Vital Signs: Zyprexa Sales Led Antipsychotic Market in 2004," July 2005, p. 1), but which one is better for the treatment of schizophrenia? The Analysis We searched...
Patient Safety Law Presents Challenges
WASHINGTON -- The patient safety system signed into law this summer by President Bush will likely take many months to implement. But, after operating so long in an environment of liability fear, doctors may take even longer to trust it, predicted Michael...
Perspective
The statistics on health disparities suggest that quite a number of youth do not get the advantage of being led to prepare for a parent's death by a professional skilled in this arena. Not addressing the relevant issues when they occur can leave the...
Prepare Now for Launch of Medicare Part D Benefit in January
SAN DIEGO -- Physicians will face many questions about the new Medicare Part D benefit in coming months as patients decide whether to enroll and which plan to select in the voluntary prescription drug program, Elizabeth Carder-Thompson said at the...
Psychiatric Work-Up Need Not Include Extensive Medical Testing
LA QUINTA, CALIF. -- Patients brought into the emergency department with a psychiatric condition probably do not need an extensive battery of laboratory tests to clear them medically, according to a small, retrospective chart study. Of 50 psychiatric...
Psychiatrists, Others Seek Guidance on Interrogations
WASHINGTON -- The American Psychiatric Association is in the process of hammering out a position on the role that mental health professionals should play in the interrogation of detainees at Guantanamo Bay and other prison sites around the world, Paul...
PTSD Algorithm Hits Cyberspace
An interactive, online treatment algorithm provides a decision tree complete with graded supporting evidence and special clinical considerations for patients with posttraumatic stress disorder. The new tool is a product of the International Psychopharmacology...
PTSD Symptoms Persist in Refugees for Decades
Cambodian refugees continue to have high rates of posttraumatic stress disorder and major depression--more than 2 decades after the end of the Cambodian civil war and resettlement in the United States, said Grant N. Marshall, Ph.D., of the Rand Corp.,...
Quick Scale Tracks Mood Changes in Primary Care
BOCA RATON, FLA. -- An abbreviated Hamilton Depression Rating Scale can quickly assess depression severity and monitor patient response to treatment in a primary care setting, according to a multicenter study. Complete remission of symptoms is the...
Rapid Depression Screen Shows Promise in ED
BOSTON -- The use of simple screening instruments in the emergency department setting could aid in the recognition of mental health disorders, a study has shown. And subsequent referral to mental health services of patients who screen positive would...
Rimonabant Reduces CV Risks in Type 2 Diabetes
SAN DIEGO -- The investigational drug rimonabant produces highly significant cardiovascular and metabolic benefit in patients with type 2 diabetes, Andre Scheen, M.D., reported at the annual scientific sessions of the American Diabetes Association....
Schizophrenia-Bipolar I Theory Gains Traction
NEW YORK -- From their first classification by Emil Kraepelin late in the 19th century, bipolar I disorder and schizophrenia have been considered distinct disease entities. But in recent years, clinicians and researchers have increasingly questioned...
Should Experts with Potential Conflicts of Interest Be Allowed to Serve on FDA Advisory Panels?
YES What is the best thing for patients? That is the key question. Patients are best served when the experts who have the most knowledge about a medicine or disease advise officials at the Food and Drug Administration. These individuals may receive...
Study Backs Previous Findings on Famine, Schizophrenia
A study of schizophrenia after the Chinese Famine of 1959-1961 demonstrates that prenatal exposure to severe nutritional deficiency may increase the risk of later developing the psychiatric disorder, investigators have reported. The new findings...
Subclinical Brain Lesions in Migraine Mimic MS
PHILADELPHIA -- Migraine patients have an increased risk for subclinical brain lesions that sometimes resemble lesions found in patients with multiple sclerosis or cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy,...
Supporting Kids with a Terminally Ill Parent
Changes in daily rituals and routines, snippets of frightening conversations, worried glances between grown-ups, limited interaction with one or both parents, questions with no answers, answers that make no sense--children of critically ill parents...
The Art of Michelle Cohen
A love of art and a desire to teach young children have shaped the life of artist Michelle Cohen. A diagnosis of depression and schizoaffective disorder have dampened neither her enthusiasm for art nor her love of color. She was strongly influenced...
'The Liars' Club'
Mary Karr is a poet and a writer, not a mental health professional, but her final unraveling of some of the psychiatric mysteries of her childhood shows the skills of a therapist in asking key questions from a most recalcitrant informant: her own mother....
Therapy Cuts Risk of Repeat Attempted Suicide in Half
Cognitive therapy was effective in preventing repeat attempted suicide in a randomized controlled trial that spanned 18 months, reported Gregory K. Brown, Ph.D., of the University of Pennsylvania, Philadelphia, and his associates. Compared with...
Think Tank Wants Parity-And More
Sometimes, being equal is just not enough--at least, that's what the Progressive Policy Institute says. A new paper from the institute, a liberal Washington think tank, suggests that rather than aiming for simple dollar-for-dollar parity with physical...
Treating Patients' Physical Symptoms May Improve Depression Severity
BOCA RATON, FLA. -- Targeting physical symptoms of depression in a primary care setting increases the likelihood of treatment response, according to a multicenter, naturalistic study. Somatic symptoms of depression are getting increased attention...
Treatment of Sleep-Related Symptoms
According to the chairman of the National Commission on Sleep Disorder Research (1993), "what we are dealing with here are two gigantic problems for our society-an epidemic of undiagnosed and untreated sleep disorders; and pervasive sleep deprivation...
Unipolar, Bipolar, and Psychotic Depression
To optimize treatment selection and patient outcome, differential diagnosis of psychotic depression, bipolar depression, and treatment-resistant depression is critical. Distinguishing features of each depression subtype should assist the treating clinician...
Watch for the Hallmarks of 'Pseudoaddiction'
PALM SPRINGS, CALIF. -- Patients suffering severe, inadequately treated chronic pain can closely resemble drug addicts, posing diagnostic and management challenges for addiction and pain special-its, and primary care physicians. John Femino, M.D.,...
With Palladone Pulled, FDA Looks at Other Opioids: Agency, Company Agree That Concomitant Use of Alcohol Could Cause 'Dump' of the Hydromorphone
Shortly after Purdue Pharma announced in July that it was taking its 24-hour opioid Palladone off the market because of a potentially fatal interaction with alcohol, the Food and Drug Administration said it was looking into the possibility that other...
X-Rays, [Gamma]-Rays Added to National List of Carcinogens
The addition of x-rays and [gamma]-rays to a national list of carcinogens has prompted some concern among radiology professionals who worry that the inclusion could unnecessarily deter patients from undergoing diagnostic tests. Three types of ionizing...
Zolmitriptan Spray Effective as Migraine TX
PHILADELPHIA -- For the first time, the triptan, zolmitriptan nasal spray has been found to be effective in the short-term treatment of migraines in adolescents, Paul Winner, D.O., reported at the annual meeting of the American Headache Society. ...
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