November 2015

Nov
2015
Vol. 27. No. 4

EDITORIAL

Neuroscience(s): What is in the name?

For years I have been trying to figure out what the term “neuroscience” or “neurosciences” represents, why we invented/introduced it, and why we are so enthusiastic, captivated, and fascinated by it. The department I belong to at Wayne State University is called the Department of Psychiatry and Behavioral Neurosciences. I have to admit that I am still not clear about it, and whether it is due to lack of explanation from the field or my own cognitive deficit. Why not just psychiatry?

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ORIGINAL RESEARCH

Predictors of early or late treatment seeking in patients with social anxiety disorder

Erhan Ertekin, MD | Fahri Çelebi, MD | Ahmet Koyuncu, MD | Ömer Uysal, MD | Esra Yancar Demir, MD | Ra,sit Tükel, MD

BACKGROUND: Social anxiety disorder (SAD) is common in the general population and usually begins at an early age. It is well established that patients with SAD rarely seek treatment, and their first treatment contact usually takes many years after onset. The aim of this study was to determine the predictors of early and late treatment seeking in patients with SAD.


METHODS: This study enrolled 180 patients with generalized SAD. The mean and median durations between the emergence of SAD and first treatment contact were 15 and 14 years, respectively. Multiple linear regression with the backward elimination method was applied to assess the factors that affect the amount of time between occurrence of the disorder and first treatment contact.


RESULTS: Older age, earlier onset of SAD, and lower level of education were associated with late treatment seeking, whereas earlier onset of comorbid major depressive episodes and lifetime history of comorbid obsessive compulsive disorder were associated with earlier treatment seeking.


CONCLUSIONS: Age of onset, comorbid psychiatric conditions, and level of education are associated with the timing of treatment seeking in patients with SAD. It is important to try to change the common perception that SAD is a personality trait rather than a psychiatric disorder.

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Racial differences in antipsychotic use: Claims database analysis of Medicaid-insured patients with schizophrenia

William Lawson, MD, PhD | Stephen Johnston, MA | Craig Karson, MD | Steve Offord, PhD | John Docherty, MD | Anna Eramo, MD | Siddhesh Kamat, MS, MBA | Christopher M. Blanchette, PhD | William Carson, MD | Henry A. Nasrallah, MD

BACKGROUND: Database analyses have indicated that medical treatment for schizophrenia varies among racial groups. This study assessed antipsychotic use and healthcare utilization across races in Medicaid-insured patients with schizophrenia.


METHODS: A Medicaid database of inpatient/outpatient medical claims and outpatient prescription claims for more than 28 million enrollees in 11 geographically diverse states was analyzed. The primary outcome, racial differences in antipsychotic use in 2012, was examined in 5 multivariable logistic regression models: (1) any antipsychotic, (2) firstgeneration (FG) long-acting injectables (LAIs), (3) FG oral antipsychotics, (4) second-generation (SG) LAIs, and (5) SG oral antipsychotics.


RESULTS: Odds ratios and adjusted predicted probabilities were comparable for any antipsychotic use between black and white patients. Black patients were less likely to receive SG oral antipsychotics (P < .001) and more likely to receive SG or FG LAIs (P = .001 and P < .001, respectively) and FG oral antipsychotics (P = .003) vs white patients. Further, black patients had a higher mean number of emergency room visits (P < .001) and a lower mean number of hospitalizations (P < .05) vs white patients; the mean number of physician visits was comparable.


CONCLUSIONS: Disparities in antipsychotic use and healthcare utilization across races in patients with schizophrenia warrant further investigation and elimination of these disparities should be a national goal.

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The risk of suicide after clozapine discontinuation: Cause for concern

Kathleen M. Patchan, MD | Charles Richardson, MD | Gopal Vyas, DO | Deanna L. Kelly, PharmD, BCPP

BACKGROUND: Clozapine is a second-generation antipsychotic that has been shown to reduce suicidal ideation and suicidal behaviors in patients with schizophrenia. However, it is underutilized because of its serious side effects.


METHODS: We describe 3 patients with a history of suicide ideation and attempts who were successfully treated and maintained in the community without suicidal tendencies while taking clozapine. All 3 patients, men in their 20s, discontinued clozapine because of side effects and subsequently committed suicide. We also review the literature on clozapine’s effects on suicidality.


RESULTS: In these 3 cases, suicide followed abrupt discontinuation of clozapine or transition to another antipsychotic.


CONCLUSIONS: This case series is the first of its kind to document the risk of suicide when clozapine is discontinued. The decision to discontinue clozapine should be made carefully, especially because clozapine is considered the treatment of last resort for patients with treatment-resistant schizophrenia and suicidal ideation. We stress the importance of minimizing the risk of abrupt clozapine discontinuation and recommend further evaluation of suicide ideation and attempts when clozapine is discontinued.

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Clinical and cognitive correlates of young adult at-risk gamblers with and without depression

Sarah A. Redden, BA | Eric W. Leppink, BA | Jon E. Grant, JD, MD, MPH

BACKGROUND: Depression is commonly found among young adults who have problems with gambling. Although depression and gambling frequently co-occur, it is unclear whether this relationship has clinical or cognitive importance.


METHODS: The study analyzed 215 young adults (age 18 to 29) with “at-risk” gambling behavior. Scores on the Mini International Neuropsychiatric Interview were used to assess lifetime major depressive disorder. The participants were categorized by 2 groups: those with (81 [37.7%]) and those without (134 [62.3%]) depressive symptoms. The groups were compared using various measures assessing gambling severity, quality of life, comorbidity, and psychosocial dysfunction, as well as various cognitive tasks assessing impulsivity and working memory.


RESULTS: Participants with depression who gambled had significantly worse gambling urges and behaviors. In addition, they reported significantly higher rates of anxiety (P < .001), suicidality (P < .001), alcohol (P = .036) and substance dependence (P = .009), compulsive buying (P = .004), and lower quality of life (P = .007). The depressed participants also demonstrated significantly greater impairments on cognitive tasks assessing spatial working memory.


CONCLUSIONS: This research suggests that at-risk gamblers with depression differ clinically and cognitively from at-risk gamblers without depressive symptoms. These findings may have implications for treatment interventions.

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