May 2015

May
2015
Vol. 27. No. 2

ORIGINAL RESEARCH

Similar changes in cognitions following cognitive-behavioral therapy or escitalopram for major depressive disorder: Implications for mechanisms of change

Amy Farabaugh, PhD | Lauren Fisher, PhD | Maren Nyer, PhD | Daphne J. Holt, MD, PhD | Mariana Cohen, BA | Lee Baer, PhD | Benjamin G. Shapero, MA | Ilana Huz, MA | Amber Cardoos, BA | Maurizio Fava, MD | Jonathan E. Alpert , MD, PhD

BACKGROUND: Psychosocial treatments and medications both have been shown to be effective in treating major depressive disorder. We hypothesized that cognitive-behavioral therapy (CBT) would outperform medication on measures of cognitive change.


METHODS: We randomized depressed individuals to 12 weeks of CBT (n = 15) or escitalopram (n = 11). In an intent-to-treat analysis (n = 26), we conducted a repeated measures analysis of variance to examine changes in depressive symptoms (ie, 17-item Hamilton Depression Rating Scale, Beck Depression Inventory), anhedonia (ie, Snaith-Hamilton Pleasure Scale), cognitive measures (ie, Dysfunctional Attitudes Scale, Automatic Thoughts Questionnaire, Perceived Stress Scale), and quality of life (ie, Quality of Life Enjoyment and Satisfaction Questionnaire) at 4 time points: baseline, week 4, week 8, and week 12. Treatment for both groups started
at baseline, and patients received either 12 weeks of individual CBT or 12 weeks of escitalopram with flexible dosing (10 to 20 mg).


RESULTS: Collapsing the escitalopram and CBT groups, there were statistically significant pre-post changes on all outcome measures. However, there were no statistically significant differences between treatment groups on any of the outcome measures, including cognitive measures across time points.


CONCLUSIONS: Our results suggest that both CBT and escitalopram have similar effects across a variety of domains and that, in contrast to our a priori hypothesis, CBT and escitalopram were associated with comparable changes on cognitive measures.

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REVIEW ARTICLES

Meningioma and psychiatric symptoms: A case report and brief review

Subramoniam Madhusoodanan, MD, DLFAPA | Shama Patel, MD | Jonathan Reinharth, MA | Adam Hines, BS | Mark Serper, PhD

BACKGROUND: Atypical presentation of psychiatric symptoms can lead to a variety of misdiagnoses. Organic causes, including brain tumors, should be considered under these circumstances.


METHODS: We present a case report of an 84-year-old woman with irritable, aggressive, and delusional behavior. Her earlier diagnoses included altered mental status, encephalopathy, dementia, nonspecified psychosis, and delirium with delusions. We suspected that a brain tumor could be causing her psychiatric symptoms.


RESULTS: CT of the head revealed 2 calcified meningiomas, which did not require surgery. Neuropsychological testing results were consistent with frontal lesion type of cognitive and psychotic symptoms. Psychiatric symptoms improved with risperidone. A brief review of the literature is included.


CONCLUSIONS: Brain imaging should be considered in cases of atypical psychiatric presentations. Past medical records and neuropsychological testing could assist in the diagnosis.

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The relationship between cannabidiol and psychosis: A review

Thayanne Brandão Guimarães Silva, MD | Cássio Queiroz Balbino, MD | Anderson Fábio Moura Weiber, MD

BACKGROUND: Cannabis sativa is the most widely used illicit drug in the world. There is concern about its harmful effects, especially because of increasing potency, which has been reported globally. These effects seem to result from the relationship among its components, notably delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), which have opposite effects. THC is considered responsible for the main psychotropic effects of the drug, while CBD seems to antagonize these effects, particularly those that induce psychosis.


METHODS: We performed a PubMed literature review of research discussing the association of cannabidiol and psychosis published from 2006 to July 2014.


RESULTS: The effects of Cannabis seem to depend on several variables related to the type of plant, its strength, usage patterns, and intersubjective variations. CBD could be used to treat several conditions, including psychosis, when the current treatment is associated with significant side effects.


CONCLUSIONS: Because of the complexity of the subject, including limitations and contradictions in studies available to date, further research involving the possible antipsychotic effect and other potential positive effects of Cannabis are needed. There also are noteworthy differences between the research design parameters and recreational use of Cannabis.

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Canadian Network for Mood and Anxiety Treatments (CANMAT) consensus recommendations for functional outcomes in major depressive disorder

Raymond W. Lam, MD | Sagar V. Parikh, MD | Erin E. Michalak, PhD | Carolyn S. Dewa, MPH, PhD | Sidney H. Kennedy, MD

BACKGROUND: Functional recovery is increasingly recognized as a priority in the treatment of major depressive disorder (MDD), by both clinicians and patients. However, symptom improvement remains the focus of traditional clinical trials for MDD and of the regulatory approval process for new medications and other interventions. Many studies have shown that functional outcomes do not always correspond to symptom-based outcomes.


METHODS: Representatives from clinical practice, professional societies, academia, industry, and government were invited by the Canadian Network for Mood and Anxiety Treatments to develop recommendations for the conceptualization and measurement of functional outcomes in clinical trials of MDD.


RESULTS: Definitions and conceptual frameworks to guide assessment of functioning are described, as well as research methodology applicable to the broad spectrum of treatments for MDD. Examples are given for validated instruments, including patient-reported outcome measures. Strategies for knowledge translation and dissemination are suggested and consensus recommendations summarized.


CONCLUSIONS: As the societal burden and financial costs of MDD continue to escalate, so does the need for evidence-based and cost-effective interventions that demonstrate improvement in functioning. Routine assessment of functional outcomes will benefit not only individuals with MDD but also diverse stakeholders concerned about the efficacy and cost-effectiveness of interventions.

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LETTERS TO THE EDITOR

Cross-cultural comparison of compulsive stealing (kleptomania)

Jon E. Grant, JD, MD, MPH | Brian L. Odlaug, PhD, MPH | Gustavo Medeiros, MD | Aparecida R. Christianine, LCP | Hermano Tavares, MD

TO THE EDITOR: According to DSM-5, kleptomania is an oftendisabling disorder characterized by repetitive stealing behavior precipitated by significant and uncontrollable urges to steal items that are not needed and could be easily afforded by the individual. Kleptomania is associated with significant psychosocial and legal consequences1 and with elevated rates of suicidal ideation and attempts.2 Despite significant personal and social consequences of kleptomania, little attention is paid to the disorder. During development of DSM-5, kleptomania was not assigned to any work group and therefore the diagnostic criteria were left unchanged with accompanying text that underwent little, if any, revision. Although most conditions in DSM-5 received new text regarding cultural aspects of the disorder, no such information was provided for kleptomania despite international research on the disorder…

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