2007 Edition, N. 1    ORIGINAL RESEARCH    Vol. 39 No. 1 – Vol. 40, No. 1

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DEBATING PSYCHOTROPICS AND SUICIDALITY

Until now, it has been unclear if the suicide risk is significantly different among clinical trial patients assigned to psychotropic, compared with patients assigned to placebo. Researchers examine – in depth – the relationship between psychotropic and suicide. – p.2

ANTIDEPRESSANTS FOR THE AILING HEART

A Duke-led team introduces the first data from a randomized controlled trial of a popular antidepressant for non-cardiac chest pain. – p.2

THE NOSE KNOWS: VETERANS AND PTSD

A study conducted by physicians from the United States, The Netherlands, and Germany, with support from the VA National Center for Post traumatic Stress Disorder, take a novel approach to understanding olfactory induced emotional recall in veterans with and without combat-related posttraumatic stress disorder. – ps.2/3

RACE, ETHNICITY, AND BIPOLAR DISEASE

Researchers largely from the Texas Health Science Center in San Antonio recruited 2,000 patients suffering from bipolar disease in one of the most significant studies to measure treatment characteristics and illness burden among European Americans, African Americans, and Latinos. – p.3

DANES PIT TWO DRUGS HEAD-TO-HEAD

A Danish multicenter trial in general practice pits citalopram (Celexa) versus amitriptyline (Elavil) in elderly depressed patients with or without mild cognitive dysfunction. – p.4

A MEETING OF THE MINDS: SCHIZOPHRENICS AND OBSESSIVE-COMPULSIVES

Although a sizeable minority of people with schizophrenia manifest obsessive-compulsive symptoms, these European academics conduct the first study to measure the reliability and validity of a famed OCD scale in schizophrenic. – p.4

IN THE NEXT ISSUE:     EVIDENCE-BASED MEDICINE AND GENERAL PSYCHIATRY

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SUICIDE RISK ANALYSIS AMONG PATIENTS ASSIGNED TO PSYCHOTROPIC AND PLACEBO

Because suicide is closely associated with psychiatric disorders, particularly affective disorders and schizophrenia, it is assumed that rates of suicide will decrease if more patients with these disorders are recognized and treated. Alternatively, others have claimed that suicide risk may be increased by psychotropics, specifically serotonin reuptake inhibitors, based on case series or by reanalysis of some available databases. Thus, based on a wealth of available data, it had been unclear if suicide risk is significantly different among clinical trial psychiatric patients assigned to a psychotropic, compared with patients assigned to a placebo. This study was initiated to investigate whether patients assigned to psychotropics would have a similar suicide risk as measured by the frequency of completed suicides and suicide attempts, compared to those patients assigned to placebo. The U.S. Food and Drug Administration database of controlled clinical trials for 9 antidepressants, 3 antipsychotics, and 7 anxiolytics provided data for comparing suicides and suicide attempts among 46,575 patients assigned to psychotropic or placebo. The Poisson Regression analysis suggested that there were no significant differences in rates of suicide and suicide attempts among patients assigned to the psychotropic or placebo. These findings suggest that the high suicide risk among clinical trial participants is not significantly affected by psychotropics.  Arif Khan, MD, Russell L. Kolts, PhD, Amy E. Brodhead, MS, K. Ranga Krishnan, MD, and Walter A. Brown, MD.

Psychopharmacology Bulletin. 2006;39(1):6-14.

A RANDOMIZED CONTROLLED TRIAL OF PAROXETINE FOR NON-CARDIAC CHEST PAIN

Noncardiac chest pain occurs frequently in medical practice and is often difficult to treat. This group conducted a randomized double-blind, placebo-controlled, 8-week trial of paroxetine (Paxil) in 50 patients with noncardiac chest pain. None of the patients met criteria for panic disorder or major depression. Paroxetinetreated patients showed greater improvements than placebo-treated patients on the Clinical Global Impressions (CGI) scale. Both paroxetine and placebo-treated patients improved to a similar extent on selfrated pain measures, although baseline differences limited the interpretation of this outcome variable. There were no differences on other outcome ratings. Treatment was well tolerated. These preliminary findings extend other data on the potential of selective serotonin reuptake inhibitors for the acute treatment of noncardiac chest pain.  P. Murali Doraiswamy, MD, Indira Varia, MD, Caroline Hellegers, MA, H. Ryan Wagner, PhD, Greg L. Clary, MD, John L. Beyer, MD, L. Kristin Newby, MD, John F. O’Connor, MD, Katherine L. Beebe, PhD, Christopher O’Connor, MD, and K. Ranga R. Krishnan, MD.

Psychopharmacology Bulletin. 2006;39(1):15-24.

POSITRONTOMOGRAPHIC EMISSION STUDY OF OLFACTORY INDUCED EMOTIONAL RECALL IN VETERANS WITH AND WITHOUT COMBAT-RELATED PTSD

Clinicians have long noted that specific trauma-associated smells, such as napalm or diesel in combat veterans can serve as precipitants of emotional memories and induce traumatic recall in patients with posttrau2007 Edition, N.1 ORIGINAL RESEARCH . 3 Vol. 39 No. 1 . Vol. 40, No 1 1048 17th Street, Suite E, Santa Monica, CA. 90403 . Tel: (310) 829-4290 . Fax: (310) 829-4289 matic stress disorder (PTSD). Several preclinical studies found that olfactory cues play a critical role in conditioned fear responses, which indicates that the neural circuitry of olfaction closely parallels the circuitry of the fear response. In these studies smell has been used successfully as a probe of the amygdala, and of the orbitofrontal and medial prefrontal cortex (mPFC), all areas of interest in PTSD. Neuroimaging studies have begun to map out a neural circuitry. Memory for odors is often associated with highly emotional experiences, and odors have long been noted by clinicians to be precipitants of trauma symptoms in posttraumatic stress disorder (PTSD). Primitive brain systems involved in fear responsivity and survival also mediate smell, including the olfactory cortex and amygdala. The purpose of this study was to measure neural correlates of olfaction in PTSD. This study exposed 8 male combat veterans with PTSD and 8 without PTSD to a set of smells, including diesel (related to traumatic memories of combat), and three other types of smells: odorless air, vanilla/coconut, and hydrogen sulfide (H2S) respectively, a neutral, positive, and negative hedonic nontraumatic smell, in conjunction with PET imaging of cerebral blood flow and assessment of psychophysiological and behavioral symptoms. All subjects also underwent a baseline of olfactory acuity. What they discovered was that PTSD patients rated diesel as unpleasant and distressing, resulting in increased PTSD symptoms and anxiety in PTSD versus combat controls. Data support the hypothesis that in PTSD, trauma-related smells can serve as strong emotional reminders.  Eric Vermetten, MD, PhD, Christian Schmahl, Steven M. Southwick, MD, and J. Douglas Bremner, MD.

Psychopharmacology Bulletin. 2007;40(1):8-30.

TREATMENT CHARACTERISTICS AND ILLNESS BURDEN AMONG EUROPEAN AMERICANS, AFRICAN AMERICANS, AND LATINOS IN THE FIRST 2,000 PATIENTS OF THE SYSTEMATIC TREATMENT ENHANCEMENT PROGRAM FOR BIPOLAR DISORDER

Across ethnicity/race, prevalence rates of bipolar disorder are similar. This study compared illness characteristics, treatment history, and overall functioning in a sample of European American, African American, and Latino patients with bipolar disorder. The samples
were drawn from the first 2,000 patients enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder. There were 1,686 European Americans, 65 African Americans, and 77 Latinos. The data were collected upon study entry, with structured interviews, clinician- rated forms, and self report. The study showed that African Americans had a greater likelihood of psychosis and fewer psychiatric medication prescriptions than did European Americans. Latinos had greater alcohol comorbidity, fewer psychiatric medication prescriptions and specialty treatment visits, and more frequent religious service attendance than did European Americans. Depression and manic episode severity and functional outcomes were similar across groups. The researchers concluded that patients with bipolar disorder who are members of ethnic/racial minority groups continue to receive less intensive specialized mental health treatment than do European American patients. These findings may be related to provider, patient, or provider–patient relationship variables. Despite treatment differences and greater comorbidity and symptomatology, there were no differences among the three groups in overall functioning.  Jodi M. Gonzalez, PhD, Peter Thompson, MD, Michael Escamilla, MD, Mako Araga, MS, Vivek Singh, MD, Niamh Farrelly, MD, Michael E. Thase, MD, David J. Miklowitz, PhD, and Charles L. Bowden, MD.

Psychopharmacology Bulletin. 2007;40(1):31-46.

CITALOPRAM VERSUS AMITRIPTYLINE IN THE ELDERLY DEPRESSED WITH OR WITHOUT MILD COGNITIVE DYSFUNCTION: A DANISH MULTICENTER TRIAL IN GENERAL PRACTICE

This study compared citalopram (Celexa) and amitriptyline (Elavil) in the treatment of depressed elderly patients in general practice in Denmark for a period of 12 weeks, which is considered to be an adequate duration for a short term trial. The lack of clinical study data in very old patients has frequently been pointed out as a significant problem. The present study included patients who were above 80 and 90 years old and the mean age was 75 years, which is satisfactory for an elderly study. It thus provides study data in a highly relevant age group.The aim of the study was to compare the efficacy. This double-blind, multicenter trial, carried out in general practice in Denmark, comprised 221 women and 70 men, aged 58–97 years, with major depression (with or without mild cognitive dysfunction) or dysthymia (DSM-III-R). Patients had a total score of 13 on the 17- item Hamilton Depression Rating Scale (HDRS) and a score of 20 on the Mini Mental State Examination scale. The efficacy and tolerability of citalopram (20–40 mg daily) and amitriptyline (50–100 mg daily) were compared over 12 weeks. The participating general practitioners were trained at corating sessions in the use of the HDRS and Melancholia Scale (MES) prior to and during the study. The inter-observer reliability was assessed to investigate if general practitioners were able to use scales that measure the severity of depression. The two treatments were considered equally effective; the 90% confidence interval for the difference between the treatment groups in change from baseline to end-point in HDRS total score ( 0.84 to 1.23) was within the predefined interval ( 4 to 4). Significantly more patients on citalopram (50%) than on amitriptyline (31%) reported no adverse events at all (P .001). Moreover, patients on amitriptyline reported adverse events significantly earlier and more frequently than patients on citalopram.  Claus Rosenberg, MD, Lise Lauritzen, MD, Jorgen Brix, MD, Jorgen B. Jorgensen, MD, Palle Kofod, MD, and Liselotte Been Bayer.

Psychopharmacology Bulletin. 2007;40(1):63-73.

RELIABILITY AND VALIDITY OF THE YALE-BROWN OBSESSIVE-COMPULSIVE SCALE IN SCHIZOPHRENIA PATIENTS

A growing literature suggesting that obsessive-compulsive symptoms (OCS) occur in 7.8% to 46% of patients with schizophrenia has prompted renewed interest in this issue by clinicians and researchers. The severity of OCS is often assessed with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS).

Although a sizeable minority of people with schizophrenia manifest obsessive and compulsive symptoms, there are no studies of the psychometric performance of measures such as the Y-BOCS. The present study examined psychometric properties of the Y-BOCS in patients with recent-onset schizophrenia and OCS. To 37 patients with recent-onset schizophrenia and related disorders and comorbid OCS taken from 135 consecutively admitted patients we administered the Y-BOCS at admission and 6 weeks later. The Y-BOCS showed good internal consistency and interrater reliability in this population; however, findings concerning the divergent validity against depressive and negative symptoms are inconsistent.  Lieuwe de Haan, MD, PhD, Britt Hoogeboom, MD, Nico Beuk, MD, Luuk Wouters, P. Dingemans, PhD, and Don H. Linszen, MD, PhD.

Psychopharmacology Bulletin. 2006;39(1):25-30.