November 2011

Nov
2011
Vol. 23. No. 4

EDITORIAL

Expanding the scope of our annual meeting

The next meeting of the American Academy of Clinical Psychiatrists (AACP) “Psychiatry Update 2012: Solving Clinical Challenges, Improving Patient Care” will take place at the Chicago Marriott Downtown, March 29 to 31, 2012. Instead of 1 or 2 major topics, we are planning to cover many clinical areas in this interactive and learning-focused meeting, including depression, anxiety disorders, psychotic disorders, bipolar disorder, and sleep disorders across patient groups. We aim to be responsive to our AACP membership and meeting attendees by choosing topics they feel are pressing and important. Our outstanding faculty includes Drs. Marlene P. Freeman, S. Nassir Ghaemi, Fredrick K. Goodwin, George Grossberg, Philip G. Janicak, James W. Jefferson, Henry A. Nasrallah, Thomas Roth, and Rajiv Tandon. Attendees will receive up to 18 Category 1 Credits™. I feel that this will be our best meeting yet…

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ORIGINAL RESEARCH

Factor structure of manic symptoms in adolescents

Subhash Chandra Gupta, MD, DPM | Vinod Kumar Sinha, MD, DPM | Samir Kumar Praharaj, MD, DPM | Sachin Gandotra, MD, DPM

OBJECTIVE: To identify the factor structure of manic symptoms in adolescents as assessed by the Scale for Manic States (SMS).


METHOD: Pattern of symptoms was assessed in a group of 100 adolescents with a diagnosis of manic episode as defined by the International Classification of Diseases, 10th revision – Diagnostic Criteria for Research. A principal component analysis of the broad range of psychiatric symptoms covered by the SMS was conducted.


RESULTS: Seven eigenvalues were greater than unity, and parallel analysis revealed 5 factors, whereas scree plot was inconclusive. Five-factor solution as obtained by parallel analysis was chosen, which described our data appropriately and were clinically relevant. The 5 factors were: aggressive overactivity, dysphoria, psychosis, hedonia, and thought retardation. These captured 58.14% of the total variance.


CONCLUSIONS: These 5 factors explain the clinical dimensions in adolescent mania similar to those of the adult population. Nevertheless, certain features, such as presence of psychosis along with euphoric mood and thought retardation, distinguish adolescent from adult mania.

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An open-label trial of acamprosate in the treatment of pathological gambling

Dennis P. McNeilly, PsyD | William J. Burke, MD | Martha Shaw, BS | Jeff Allen, PhD

BACKGROUND: The efficacy and tolerability of acamprosate has been tested in the treatment of pathological gambling (PG). Acamprosate is known to reduce alcohol craving and use in persons with alcohol dependence, and it has been hypothesized that the drug would have a similar effect in individuals with PG.


METHODS: Participants with DSM-IV criteria for PG received acamprosate in an 8-week, open-label trial following a 2-week observation. The primary efficacy measure was the Yale-Brown Obsessive Compulsive Scale modified for PG (Y-BOCS-PG). Secondary efficacy measures included the Gambling Severity Assessment Scale (GSAS), the Clinical Global Impression (CGI) Improvement and Severity Scales, a patient self-rated global rating, the Hamilton Depression Rating Scale (HDRS), the Sheehan Disability Scale (SDS), and the Timeline Follow Back (TLFB). The study was conducted at 2 sites.


RESULTS: Twenty-six participants (11 men, 15 women) had at least 1 postbaseline visit and were included in the analysis. Twenty participants (77%) completed the protocol. Significant improvement was observed in Y-BOCS-PG and GSAS scores, both CGI scales, a patient self-rated global scale, all 3 SDS subscales, and number of gambling episodes. Seventeen participants (65%) were considered responders (ie, achieved “much” or “very much” improvement). Improvements on the HDRS, in money wagered, and in time spent gambling were not significant. Few adverse events were reported.


CONCLUSIONS: The results suggest that acamprosate is well tolerated and may be effective in the treatment of PG.

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Clinically insubstantial cognitive side effects of bitemporal electroconvulsive therapy at 0.5 msec pulse width

Ronald L. Warnell, MD | Conrad M. Swartz, PhD, MD | Alice Thomson, MA, PhD

BACKGROUND: We measured cognitive side effects from bitemporal electroconvulsive therapy (ECT) using stimuli of 0.5 msec pulse width 900 milliamperes (mA).


METHODS: Mini-Mental State Exam (MMSE) and 21-item Hamilton Rating Scale for Depression (HRSD-21) were rated within 36 hours before and 36 hours after a series of 6 bitemporal ECT sessions on 15 patients age ≥45.


RESULTS: MMSE remained high after ECT (pre-ECT mean 29, standard deviation [SD] 1.60, post-ECT mean 28.53, SD 1.36) with no significant change. The mean HRSD-21 fell from 27.5 to 16.3. Post-ECT MMSE was significantly and markedly higher than in previous studies of bitemporal ECT; all had used ECT stimuli of pulse width at least 1 msec.


CONCLUSIONS: With stimuli of 0.5 msec pulse width and 900 mA, 6 bitemporal ECTs did not decrease MMSE score. This result leaves no opportunity for further decrease in basic cognitive side effects, and complements published reports of stronger physiological effects with stimuli of 0.5 msec pulse width and 900 mA. ECT stimuli of 0.5 msec pulse width and 900 mA are more desirable than wider pulse widths. Six bitemporal ECT sessions using these stimuli generally will not have more cognitive side effects than treatments with other placements, allowing maintenance of full efficacy with clinically insubstantial side effects.

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