May 2012

Vol. 24. No. 2


Making an impact on clinical practice

Great news! The impact factor of Annals of Clinical Psychiatry has been calculated. Impact factorsare an index of a journal’s impact in the field based on how often articles are cited in the literature. Impact factors are calculated by Thomson Reuters and provide a measure of the frequency in which the average article has been cited within a given time period. The impact factor of Annals is 2.545; the journal ranked 27th among 110 psychiatric journals, or in the upper 25%. For practical purposes, this means that our journal is making a measurable impact on the field…



Open-label pilot study of memantine in the treatment of compulsive buying

Jon E. Grant, JD, MD, MPH | Brian L. Odlaug, PhD, MPH | Robert O’Brien, BA | Suck Won Kim, MD

BACKGROUND: Although compulsive buying (CB) is relatively common, pharmacotherapy research for CB is limited. Memantine, an N-methyl-D-aspartate receptor antagonist, appears to reduce glutamate excitability and improve impulsive behaviors, suggesting it may help individuals with CB.

METHODS: Nine patients (8 females) with CB were enrolled in a 10-week open-label treatment study of memantine (dose ranging from 10 to 30 mg/d). Participants were enrolled from December 2008 until May 2010. The primary outcome measure was change from baseline to study endpoint on the Yale-Brown Obsessive Compulsive Scale–Shopping Version (Y-BOCS-SV).

RESULTS: Of the 9 participants, 8 (88.9%) completed the 10-week study. Y-BOCS-SV scores decreased from a mean of 22.0 ± 1.3 at baseline to 11.0 ± 5.3 at endpoint (P < .001). Hours spent shopping per week and money spent shopping both decreased significantly (P < .001). The mean effective dose of memantine was 23.4 ± 8.1 mg/d. Memantine treatment was associated with diminished impulsive buying and improvements on cognitive tasks of impulsivity. In addition, the medication was well-tolerated.

CONCLUSIONS: These findings suggest that pharmacologic manipulation of the glutamate system may target the impulsive behavior underlying CB. Placebo-controlled, double-blind studies are warranted in order to confirm these preliminary findings in a controlled design.


Adult antisocial syndrome with comorbid borderline pathology: Association with severe childhood conduct disorder

Rick Howard, PhD | Nick Huband, PhD | Conor Duggan, PhD, FRCPsych


BACKGROUND: This study tested the hypothesis that adult antisocial syndrome co-concurrent with borderline personality disorder (AAS+BPD) would be associated with greater conduct disorder (CD) severity than AAS alone.

METHODS: Sixty-nine personality disordered individuals exhibited a sufficient number of adult antisocial traits to meet DSM-IV criterion A for antisocial personality disorder (AsPD). These were subdivided into those who did (AAS+BPD) or did not (AAS alone) meet DSM-IV criteria for a BPD diagnosis. We then compared the 2 groups on CD symptoms and historical, clinical, and self-report measures.

RESULTS: The mean number of CD criteria met and the total number of individual CD symptoms were significantly greater in the AAS+BPD group compared with the AAS alone group. The former also were more likely to be female, to have self-harmed, to show greater personality disorder comorbidity, and to self-report greater anger.

CONCLUSIONS: The functional link between CD and adult antisocial symptoms appears to be mediated, or at least moderated, by co occurring borderline pathology.


Validation of a diagnostic screening blood test for bipolar disorder

Douglas B. Woodruff, MD | Rif S. El-Mallakh, MD | Alagu P. Thiruvengadam, PhD

BACKGROUND: Bipolar disorder is difficult to diagnose, and probably is both overdiagnosed and underdiagnosed. Misdiagnosis has deleterious consequences for the prognosis of the disorder. In a previous study (n = 134), measurement of blood cellular membrane potential (expressed as membrane potential ratio [MPR™]) diagnosed bipolar illness with a sensitivity of .78 and a specificity of .88. The current study was performed as a validation of the initial study.

METHODS: We recruited consecutive outpatients with DSM-IV-diagnosed bipolar I disorder (BD I) and those without bipolar illness (n = 153) and measured their MPR™.

RESULTS: BD I patients were relatively hyperpolarized, with an MPR™ of .601 (± standard deviation .0179), compared with non-bipolar patients (MPR™ .675 ± .0174). The sensitivity and specificity for BD I are .93 and .90, respectively.

CONCLUSIONS: Before clinical application, future studies must utilize consensus diagnosis as the “gold standard” diagnosis and examine the effect of mood-stabilizing drugs on MPR™.


Waiting room crowding and agitation in a dedicated psychiatric emergency service

Rif S. El-Mallakh, MD | Amanda Whiteley, MD | Tanya Wozniak, MD | McCray Ashby, MD | Shawn Brown, MD | Danya Colbert-Trowel, MD | Tammy Pennington, MD | Michael Thompson, MD | Rokeya Tasnin, MD | Christina L. Terrell, MD

BACKGROUND: Emergency department crowding is a growing problem that impacts patient care and safety. The effect of crowding has not been examined in emergency psychiatric services.

METHODS: The association between patient census and use of restraints, seclusion, and anti-agitation medications as needed was examined for 1 month.

RESULTS: A total of 689 patients were seen in 31 days. The average hourly census was 6.8 ± 2.8 (range 0 to 18). There were 33 incidences of seclusion or restraint and an additional 15 instances of medications administered for agitation. The use of seclusion, restraint, or medication for agitation was significantly associated with census (r2 = 0.3, F = 5.47, P = .036).

CONCLUSION: Crowding in emergency psychiatric waiting rooms may increase the need for seclusion, restraint, or medications for agitation.