February 2013

Vol. 25. No. 1


DSM-5 is approved, but personality disorders criteria have not changed

The American Psychiatric Association (APA) Assembly approved DSM-5 at its November meeting in Washington D.C. Although many of us have pet peeves about DSM-5, most of the changes are positive and will be embraced by psychiatrists and other mental health professions. Some important changes have received little attention because the media focused on “hot button” issues, such as a combined category for autism spectrum disorders and ditching the “bereavement exclusion” for major depressive disorder. Other decisions may have greater impact, such as merging substance abuse and dependence categories and revamping somatizing disorders (now somatic symptom disorders). Specious arguments were made, such as that changes were made to boost prescription medication use. These arguments ignore the contributions of honorable psychiatrists and psychologists who worked on DSM-5 tirelessly and without compensation…



The effect of sildenafil on quality of life

Christina M. Dording, MD | Rachel A. LaRocca, BA | Katherine A. Hails, BA | Ottavio V. Vitolo, MD | Stephen R. Wisniewski, PhD | Goundappa K. Balasubramani, PhD | Madhukar Trivedi, MD | Maurizio Fava, MD | David Mischoulon, PhD, MD

BACKGROUND: Antidepressant-induced sexual dysfunction affects approximately 50% of patients taking antidepressants. Previous research has explored sildenafil’s effectiveness in treating various forms of erectile dysfunction, but there is no research supporting sildenafil’s use for improving the quality of life for patients with sexual dysfunction linked to antidepressant use. The authors of this article aimed to assess the improvements in quality of life in patients taking sildenafil to treat antidepressant-induced sexual dysfunction.

METHODS: One hundred and two out of 2,239 male and female patients in the follow-up phase of the Sequenced Treatment Alternatives to Relieve Depression antidepressant trials who complained of sexual dysfunction were given sildenafil, 50 to 100 mg, as needed. After 12 months, we measured patients’ change in libido, sexual drive, family relationships, overall well-being, satisfaction with treatment, and overall contentment with items on the 17-item Hamilton Depression Rating Scale, Quality of Life Enjoyment and Satisfaction Questionnaire, 30-item Inventory of Depressive Symptoms, and 12-item Short Form Health Survey.

RESULTS: There was a significant association between sildenafil use and improvement in libido and sexual drive by month 6. There was no significant improvement in the quality-of-life scores we examined, but treatment satisfaction and overall contentment increased over time.

CONCLUSIONS: Despite no direct association with sildenafil use and quality-of-life scores, sildenafil may be a beneficial treatment for antidepressant-induced sexual dysfunction. A double-blind, placebo-controlled study of sildenafil in antidepressant-induced sexual dysfunction is needed to further explore its potential benefits.


Correlates of insight into different symptom dimensions in obsessive-compulsive disorder

Júlia M. Fontenelle, PhD | Ben J. Harrison, PhD | Maria Conceição do Rosário, MD, PhD | Marcio Versiani, MD, PhD | Leonardo F. Fontenelle , MD, PhD

BACKGROUND: In this study, we evaluated insight into different obsessivecompulsive disorder (OCD) symptom dimensions and their impact on clinical and sociodemographic features of patients with OCD.

METHODS: Sixty OCD patients were assessed with the Brown Assessment of Beliefs Scale (BABS), the Dimensional Yale-Brown Obsessive-Compulsive Scale–Short Version, the Beck Depression Inventory, and the Sheehan Disability Scale. Two methods of using BABS were employed: 1) a traditional approach, which considers a composite of the insight into existing OCD symptoms, and 2) an alternative approach, which includes assessments of insight into each OCD symptom dimension separately.

RESULTS: Composite BABS scores correlated with global severity of OCD and depressive symptoms, and degree of interference on social life/leisure activities and family life/home responsibilities. Dimension-specific correlations between severity of symptoms and insight ranged from very high (P = .87, for hoarding) to moderate (P = .61, for miscellaneous symptoms). Greater severity of depression and concomitant generalized anxiety disorder were independently associated with lower levels of insight into aggressive/ checking symptoms. While earlier-onset OCD was associated with lower insight into sexual/religious and symmetry symptoms, later-onset OCD displayed lower insight into hoarding.

CONCLUSIONS: Assessing insight into dimension-specific OCD symptoms may challenge the existence of clear-cut OCD with fair or poor insight.


A simulation model to estimate 10-year risk of coronary heart disease events in patients with schizophrenia spectrum disorders treated with second-generation antipsychotic drugs

Josep Darbà, PhD | Lisette Kaskens, MSc Kaskens, MSc | Pedro Aranda, MD | Celso Arango, MD | Julio Bobes, MD | Rafael Carmena, MD | Javier Rejas, MD

BACKGROUND: The risk for cardiovascular (CV) events has been shown to be considerably higher among schizophrenia patients than the general population.

OBJECTIVE: The aim of this study was to describe a general stochastic simulation model for the treatment of schizophrenia related to CV-associated risks of second-generation antipsychotics (SGAs).

METHODS: A model to simulate the expected 10-year incidence of all types of coronary heart disease (CHD) events in patients treated with SGAs was developed from the Cardiovascular, Lipid and Metabolic Outcomes Research in Schizophrenia (CLAMORS) study to reproduce baseline conditions, The CHD event risk was estimated through a locally adjusted Framingham risk function using the expected mean change in the CV risk factors from the Clinical Antipsychotic Trials in Intervention Effectiveness (CATIE) study.

RESULTS: The 10-year CHD event rate after treatment with SGAs was 0.181, 0.179, 0.176, and 0.172 for olanzapine, quetiapine, risperidone, and ziprasidone, respectively. Relative risk was calculated relative to no treatment, and values were as follows: olanzapine, 1.03 ± 1.05 (95% CI, 0.74 to 1.42), quetiapine, 1.02 ± 1.05 (95% CI, 0.74 to 1.41), risperidone, 1.00 ± 0.99 (95% CI, 0.73 to 1.36), and ziprasidone, 0.97 ± 0.95 (95% CI, 0.72 to 1.31). There were approximately 25,269 CHD events over a 10-year period in schizophrenia patients treated with olanzapine, 25,157 events with quetiapine, 24,883 with risperidone, and 24,514 events with ziprasidone.

CONCLUSIONS: The estimated outcomes suggest that each SGA shows a different level of CV event risk, with ziprasidone showing the lowest rate without any association for increased risk of CHD.


Prevalence of stimulant use in a sample of US medical students

Jadon R. Webb, MD, PhD | Mark A. Valasek, MD, PhD | Carol S. North, MD, MPE

BACKGROUND: Stimulant use for academic performance is widespread among college students, but less is known about use among students obtaining advanced degrees.

METHODS: In this cross-sectional survey, we measured the prevalence and demographic correlates of prescription stimulant use among a sample of US medical students.

RESULTS: The lifetime prevalence of stimulant use in this sample of 144 medical students was 20%, and prevalence of use during medical school was 15%. More white students (32%) than Asian students (7%) had used stimulants. Nine percent of respondents reported an attention-deficit/ hyperactivity disorder (ADHD) diagnosis, and those diagnosed were more than 30 times more likely to have used stimulants compared with those without a diagnosis. Of those who had taken stimulants, 83% reported using them specifically for cognitive performance enhancement such as studying better and staying awake longer while on clinical duties.

CONCLUSIONS: This study suggests a high prevalence of stimulant use among medical students compared with the general population. Personal experience with these medications as medical students could impact physician attitudes and prescribing patterns toward patients seeking help for ADHD-related symptoms.