May 2015

Vol. 27. No. 2


Making an impact: How Annals measures up with the competition

I have good news for Annals readers and contributors. Our Thomson Reuters Impact Factor is now 2.53! This is an important achievement for Annals, particularly because we publish only 4 issues per year. This compares Annals favorably to Comprehensive Psychiatry (2.26), Journal of Nervous and Mental Disease (1.81), and CNS Spectrums (1.30), but less than American Journal of Psychiatry (13.56) and JAMA Psychiatry (13.75). What does this mean? Simply put, the impact factor is a way to measure the frequency an average article in a journal has been cited in a particular year or period. It is calculated by dividing the number of current year citations by the source items published in that journal during the previous 2 years. In short, it is a measure of the importance of the journal and its quality, as reflected by citations in other professional journals. Importantly, the way it is calculated eliminates the bias that favors larger and older journals, which have a larger, citable body of literature…



Age of onset in social anxiety disorder: Relation to clinical variables and major depression comorbidity

Ahmet Koyuncu, MD | Erhan Ertekin, MD | Erdem Deveci, MD | Banu Aslanta,s Ertekin, MD | Çag˘ rı Yüksel, MD | Fahri Çelebi, MD | Zerrin Binbay, MD | Esra Yancar Demir, MD | Ra,sit Tükel, MD

BACKGROUND: The aim of this study was to determine the rates of earlyand late-onset social anxiety disorder (SAD) and to investigate the effects of onset time on clinical characteristics and the course of SAD.

METHODS: A total of 377 patients with SAD were assessed using a sociodemographic data form, the Liebowitz Social Anxiety Scale (LSAS), Beck Depression Inventory (BDI), and the Global Assessment of Functioning (GAF). Three hundred patients with SAD onset before age 18 were classified as members of the early-onset group, whereas 77 patients with SAD onset at age ≥18 comprised the late-onset group. The 2 groups were compared in terms of sociodemographic and clinical characteristics, comorbidity, and scale scores.

RESULTS: The rate of SAD onset before age 18 was 79.6%. Compared with the late-onset group, the early-onset group had a younger age at first depressive episode, higher rate of atypical depression, higher LSAS and BDI scores, and lower GAF scores.

CONCLUSIONS: In cases of early onset of SAD, symptom severity of both SAD and comorbid depression increased and functionality decreased. It is important to assess and treat SAD patients at a younger age because earlyonset SAD may be associated with a more severe course and higher rate of major depression comorbidity.


Clozapine revisited: Impact of clozapine vs olanzapine on health care use by schizophrenia patients on Medicaid

Kelan L. Thomas, PharmD, MS, BCPS, BCPP | Yawen Jiang, MS | Jeffrey S. McCombs, PhD

BACKGROUND: Our purpose was to evaluate health care use and cost patterns for clozapine compared with olanzapine in the treatment of schizophrenia.

METHODS: Health care outcomes were measured over a 1-year posttreatment period for episodes of antipsychotic therapy initiated between 1997 and 2002. Four episode categories were defined: restart after lapse in therapy, switch after break, switch without break, and augmentation. We estimated the impact of clozapine or olanzapine using mixed model regression for costs by type of service and days of uninterrupted drug therapy. Time to admission in an acute hospital, psychiatric hospital, or longterm care facility, and time to suicide attempt were compared using Cox proportional hazards models.

RESULTS: Clozapine increased duration of therapy and decreased risk of psychiatric hospitalization or suicide attempts compared to olanzapine. However, increased drug costs and use of community mental health centers (CMHC) for complete blood count (CBC) monitoring overwhelmed any offsetting savings.

CONCLUSIONS: Clozapine is more expensive than olanzapine over the first year of treatment, primarily due to frequent CMHC visits required for CBC monitoring. However, fewer psychiatric hospitalizations, reduced suicide attempts, and longer duration of treatment should generate more benefits over time, which could eventually outweigh clozapine’s higher first-year costs.


College students with depressive symptoms with and without fatigue: Differences in functioning, suicidality, anxiety, and depressive severity

Maren Nyer, PhD | David Mischoulon, MD, PhD | Jonathan E. Alpert , MD, PhD | Daphne J. Holt, MD, PhD | Charlotte D. Brill, BA | Albert Yeung, MD | Paola Pedrelli, PhD | Lee Baer, PhD | Christina Dording, MD | Ilana Huz, MA | Lauren Fisher, PhD | Maurizio Fava, MD | Amy Farabaugh, PhD

BACKGROUND: We examined whether fatigue was associated with greater symptomatic burden and functional impairment in college students with depressive symptoms.

METHODS: Using data from the self-report Beck Depression Inventory (BDI), we stratified a group of 287 students endorsing significant symptoms of depression (BDI score ≥13) into 3 levels: no fatigue, mild fatigue, or moderate/severe fatigue. We then compared the 3 levels of fatigue across a battery of psychiatric and functional outcome measures.

RESULTS: Approximately 87% of students endorsed at least mild fatigue. Students with moderate/severe fatigue had significantly greater depressive symptom severity compared with those with mild or no fatigue and scored higher on a suicide risk measure than those with mild fatigue. Students with severe fatigue evidenced greater frequency and intensity of anxiety than those with mild or no fatigue. Reported cognitive and functional impairment increased significantly as fatigue worsened.

CONCLUSIONS: Depressed college students with symptoms of fatigue demonstrated functional impairment and symptomatic burden that worsened with increasing levels of fatigue. Assessing and treating symptoms of fatigue appears warranted within this population.


Psychiatric disorder–weight associations and the moderating effect of sex in an outpatient psychiatric sample

Kristy L. Dalrymple, PhD | Jennifer Martinez, BS | Lia Rosenstein, BA | Elizabeth T. Kneeland, MA | Mark Zimmerman, MD

BACKGROUND: Few studies have examined the association between weight and psychiatric disorders in psychiatric treatment samples, and no known studies in treatment samples have examined potential moderators of the psychiatric illness–weight relationship. The aim of the present study is to examine if weight is associated with specific mood and anxiety disorders in a psychiatric treatment-seeking sample, and if a person’s sex moderate any of these associations. Greater knowledge of particular subgroups experiencing psychiatric illness–obesity comorbidity could aid in better providing personalized treatment.

METHODS: Participants (N = 3,585) were administered a semi-structured diagnostic interview at initial presentation for treatment. Hierarchical logistic regression analyses examined simple effects of body mass index (BMI) and sex on current mood and anxiety disorders and the moderating effects of sex.

RESULTS: We did not find simple effects between BMI and mood/anxiety disorders after controlling for demographic variables. Female sex moderated a relationship between BMI and social anxiety disorder (SAD) only.

CONCLUSIONS: Findings suggest that the presence of SAD in psychiatric patients is associated with a higher BMI only for females, yet this was not the case for the presence of other mood and anxiety disorders. Further research examining the relationship between SAD, weight, and sex is warranted.