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Ketamine for Depression, 6: Effects on Suicidal Ideation and Possible Use as Crisis Intervention in Patients at Suicide Risk.
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Ketamine for Depression, 6: Effects on Suicidal Ideation and Possible Use as Crisis Intervention in Patients at Suicide Risk.

J Clin Psychiatry. 2018 Mar 27;79(2):

Authors: Andrade C

Abstract
A growing body of literature suggests that ketamine, administered in subanesthetic doses, has early-onset antidepressant action in patients with severe and even treatment-refractory depression. Many case reports, open-label studies, and randomized controlled trials (RCTs) suggest that ketamine may have dramatic antisuicidal effects, as well. This article examines the benefits of ketamine in patients with suicidal ideation with particular focus on the findings of recent RCTs and meta-analyses. Important findings are that a single dose of ketamine is associated with antisuicidal benefits that emerge within an hour of administration and persist for up to a week. The benefits are seen in patients with mild as well as clinically significant suicidal ideation. The benefits are observed in midazolam- as well as saline-controlled trials. Effect sizes are medium to large. The improvement in suicidal ideation is only partly explained by improvement in depression severity. It is concluded that there is consistent evidence that a single dose of ketamine has dramatic antisuicidal action that emerges almost immediately after dosing and persists for at least a week. The short- and intermediate-term safety and efficacy of ketamine as a crisis intervention treatment for suicidal patients merit study. Areas that need research are outlined.

PMID: 29659211 [PubMed - as supplied by publisher]




Toward Understanding Sex Differences in the Prevalence of Posttraumatic Stress Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions.
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Toward Understanding Sex Differences in the Prevalence of Posttraumatic Stress Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions.

J Clin Psychiatry. 2018 Mar 27;79(2):

Authors: Blanco C, Hoertel N, Wall MM, Franco S, Peyre H, Neria Y, Helpman L, Limosin F

Abstract
BACKGROUND: It is unclear whether the higher prevalence of posttraumatic stress disorder (PTSD) in women than in men is due to sex differences in the prevalence of the exposure to traumatic events or to differences in vulnerability to traumatic events among those exposed to them.
METHODS: We applied mediation and moderated mediation models to a large nationally representative sample of US adults (N = 34,653) drawn from Wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions.
RESULTS: A model that assumed that the effect of 19 traumatic events was the same across sexes and examined whether sex differences in the prevalence of DSM-IV PTSD were due exclusively to sex differences in exposure to traumatic events predicted similar prevalence of PTSD among men and women (indirect effect standardized β = 0.04, P = .61), contrary to empirical findings. By contrast, a model that allowed the effect of 19 traumatic events on risk of PTSD to vary by gender, while taking into account sex differences in the prevalence of exposure, indicated that, for 13 of the traumatic events, the effect was significantly greater in women than in men (range of standardized β coefficients = 0.02-0.12, P < .05). The total indirect and direct effects of sex on PTSD in this model were, respectively, β = 0.42 (P < .01) and β = -0.03 (P = .76), indicating that all of the effect of sex on PTSD was explained by this moderated mediation model.
CONCLUSIONS: The higher prevalence of PTSD among women appears to be due mainly to their greater vulnerability to the effects of traumatic events.

PMID: 29659210 [PubMed - as supplied by publisher]




Improving the Diagnosis and Treatment of Pediatric Bipolar Disorder.
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Improving the Diagnosis and Treatment of Pediatric Bipolar Disorder.

J Clin Psychiatry. 2018 Mar 27;79(2):

Authors: Findling RL, Chang KD

Abstract
​​Reconsidering Insomnia as a Disorder Rather Than Just a Symptom in Psychiatric Practice Click to enlarge page Awareness of the prevalence and impact of bipolar disorder in pediatric patients has grown in recent years. Youths with this disorder are at risk for poor long-term outcomes, but with careful screening, clinicians may be able to detect early signs or subthreshold symptoms and provide a timely diagnosis and effective treatment. Although several pharmacologic options are available for patients aged 10 years and up, they differ in their safety and tolerability profiles. Clinicians should select the agent that best balances benefit and risk-at the lowest efficacious dose-and provide careful monitoring for adverse events throughout treatment. Johns Hopkins University and the Kennedy Krieger Institute, Baltimore, Maryland. (Dr Findling); Private practice, Menlo Park, California (Dr Chang) mask ​​​​​​​.

PMID: 29659209 [PubMed - as supplied by publisher]




Posttraumatic Stress Disorder as a Significant Correlate of Voluntary Antiretroviral Treatment Interruption in Adult HIV-Infected Patients Followed up in French Hospitals: Data From the ANRS-VESPA2 National Survey.
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Posttraumatic Stress Disorder as a Significant Correlate of Voluntary Antiretroviral Treatment Interruption in Adult HIV-Infected Patients Followed up in French Hospitals: Data From the ANRS-VESPA2 National Survey.

J Clin Psychiatry. 2018 Apr 03;79(3):

Authors: Roux P, Marcellin F, Ndiaye K, Suzan-Monti M, Mayet A, Duracinsky M, Briand-Madrid L, Maradan G, Mora M, Préau M, Verger P, Carrieri P, Dray-Spira R, Spire B, ANRS-VESPA2 Study Group

Abstract
OBJECTIVE: Although antiretroviral treatment (ART) no longer requires 100% adherence, voluntary treatment interruption (VTI) still may have a negative impact on virologic success. Previous studies have shown that posttraumatic stress disorder (PTSD) is more prevalent in HIV-infected patients than in the general population. However, no study has yet investigated the relationship between PTSD and VTI. We analyzed this relationship using data from a French national survey representative of HIV-infected adults followed up in hospitals.
METHODS: A total of 3,022 HIV-infected adults participated in the ANRS-VESPA2 survey (April 2011-January 2012) and answered a face-to-face questionnaire that included the Composite International Diagnostic Interview Short-Form to diagnose PTSD and assess sociobehavioral variables such as VTI. Multivariable logistic regression models were used to study the relationship between PTSD and VTI.
RESULTS: Among the 2,768 ART-treated participants with available data for both PTSD screening and ART interruption (study sample), prevalence of PTSD was 13.3%, and 7.2% of individuals reported VTI during the previous month. After adjustment for being a female Sub-Saharan African immigrant and reporting harmful alcohol consumption (Alcohol Use Disorders Identification Test score ≥ 8), lifetime PTSD was found to be independently associated with VTI (adjusted odds ratio [95% CI] = 1.64 [1.07-2.53], P = .025).
CONCLUSIONS: PTSD is highly prevalent in HIV-infected patients followed up in French hospitals and is a significant predictor of VTI. PTSD is a psychiatric disorder that is still underdiagnosed and undertreated in many countries despite its negative consequences on health behaviors. As there is evidence of effective treatment for PTSD, HIV care providers need to be trained in screening for this disorder.

PMID: 29659208 [PubMed - as supplied by publisher]




Trajectories of Acute Antidepressant Efficacy: How Long to Wait for Response? A Systematic Review and Meta-Analysis of Long-Term, Placebo-Controlled Acute Treatment Trials.
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Trajectories of Acute Antidepressant Efficacy: How Long to Wait for Response? A Systematic Review and Meta-Analysis of Long-Term, Placebo-Controlled Acute Treatment Trials.

J Clin Psychiatry. 2018 Apr 03;79(3):

Authors: Henssler J, Kurschus M, Franklin J, Bschor T, Baethge C

Abstract
BACKGROUND: In patients who are not responding to antidepressant pharmacotherapy, information regarding the future probability of response with the same treatment is scarce. Specifically, it is unclear at what point in time the probability to respond or remit ceases to increase, because few studies report data on response or remission at repeated time points beyond 4 or 8 weeks of treatment. Consequently, treatment recommendations in clinical practice guidelines differ widely.
DATA SOURCES: We systematically searched MEDLINE, Embase, PsycINFO, and CENTRAL databases through March 2014 using generic terms for depressive or affective disorders, individual drug names, and placebo (Prospero Registration: CRD42014010105).
STUDY SELECTION: We identified double-blind, randomized studies with continuous outcome reporting from 4 weeks up to at least 12 weeks that compared antidepressant monotherapy to placebo in adult patients suffering from acute depressive disorder.
DATA EXTRACTION: Data extraction and synthesis followed Cochrane Collaboration guidelines. Primary outcome was response; secondary outcomes were remission and changes in rating scale scores in previously unresponsive patients, respectively.
RESULTS: Of 6,043 articles screened, we selected 9 studies including 3,466 patients. Altogether, 21.6% (18.6%, 24.9%) of previously nonresponsive patients achieved response with ongoing antidepressant treatment between weeks 5 and 8, and 9.9% (7.5%, 12.7%), between weeks 9 and 12. Probability of response when taking placebo was 13.0% (9.9%, 16.5%) between weeks 5 and 8 and 2.4% (1.2%, 4.6%) between weeks 9 and 12. Differences in the probability of response between antidepressant and placebo translated into a number needed to treat of 11 after 4 weeks and 17 after 8 weeks. Heterogeneity was low to moderate, and results remained stable across subgroup and sensitivity analyses.
CONCLUSIONS: In patients unresponsive to antidepressant pharmacotherapy, improvements in psychopathology can be expected with ongoing antidepressant treatment for up to 3 months. After 8 weeks of treatment, improvement with ongoing monotherapy is relatively small.

PMID: 29659207 [PubMed - as supplied by publisher]




Effects of Antipsychotics on Secular Mortality Trends in Patients With Alzheimer's Disease.
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Effects of Antipsychotics on Secular Mortality Trends in Patients With Alzheimer's Disease.

J Clin Psychiatry. 2018 Apr 03;79(3):

Authors: Nielsen RE, Valentin JB, Lolk A, Andersen K

Abstract
OBJECTIVE: To investigate secular changes in mortality rates between patients with Alzheimer's disease (AD) and the general population as well as changes in antipsychotic drug treatment and the association between drug treatment and mortality in patients with AD in Denmark during a 12-year study period.
METHODS: This nationwide, retrospective cohort study identified all-cause mortality in all Danish patients with incident ICD-10-defined AD from 2000 through 2011. The cumulative antipsychotic dosages from dementia diagnosis until end of study for each participant were calculated and categorized in 1 of 5 groups per the World Health Organization Defined Daily Doses (DDDs). Data were obtained from relevant Danish national registers.
RESULTS: The study included 32,001 patients (11,194 male and 20,807 female). During the study period, an increasing trend was found in median survival time, but no decline was seen in standardized mortality ratios, which spanned from 1.19 (95% CI, 0.98-1.46) in 2001 to 1.52 (95% CI, 1.38-1.68) in 2011. The findings showed a decline in proportion of patients with incident AD exposed to antipsychotic drugs as well as decline in mean annual cumulative DDDs. Adjusted Cox regression analyses revealed that current exposure to antipsychotic drugs was associated with increased mortality, although hazard ratios declined during the study period from 2.24 (95% CI, 2.07-2.43) in 2000-2002 to 1.24 (95% CI, 1.09-1.41) in 2009-2011, with P values < .001.
CONCLUSIONS: These findings appear to underscore the current guideline recommendations for using antipsychotic drugs at only the lowest effective dose and only in patients for whom all non-pharmacologic options have been exhausted. Furthermore, these results seem to indicate that the reduced use of antipsychotic drugs has no impact on relative mortality, suggesting that the AD population has gained less from improvements in care of other diseases that impact mortality rates in patients with AD as well as in the general population.

PMID: 29659206 [PubMed - as supplied by publisher]




Executive Function Predicts Antidepressant Treatment Noncompletion in Late-Life Depression.
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Executive Function Predicts Antidepressant Treatment Noncompletion in Late-Life Depression.

J Clin Psychiatry. 2018 Apr 03;79(3):

Authors: Cristancho P, Lenze EJ, Dixon D, Miller JP, Mulsant BH, Reynolds CF, Butters MA

Abstract
OBJECTIVE: To examine whether executive function (EF) is associated with nonremission and noncompletion of antidepressant pharmacotherapy in older adults with depression.
DESIGN: In this prospective study (July 2009 to May 2014), older adults (aged ≥ 60 years; n = 468) with a DSM-IV-defined major depressive episode diagnosed via structured interview received 12 weeks of venlafaxine extended release with the goal of achieving remission. A hypothesis was made that worse baseline EF would predict both nonremission and noncompletion (primary outcomes). Treatment-related factors, including side effects and nonadherence, were also studied.
METHODS: Baseline EF, including response inhibition and set-shifting, was assessed with subtests of the Delis-Kaplan Executive Function System and the semantic fluency subtest of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Attention, immediate memory, delayed memory, visuospatial ability, and global cognition were also assessed with the RBANS.
RESULTS: Of 468 participants, 96 (21%) failed to complete the treatment trial, 191 (41%) completed and remitted, and 181 (39%) completed and did not remit. Univariate analyses indicated that some EFs (set-shifting and semantic fluency) and other cognitive variables (attention, immediate memory, visuospatial ability, and global cognition) predicted treatment noncompletion, whereas no cognitive variables predicted nonremission. In a multivariate logistic regression model, semantic fluency (P = .003), comorbid medical burden (P < .001), and early nonadherence (P < .001) were significant predictors of treatment noncompletion.
CONCLUSIONS: Poorer EF predicted treatment noncompletion. These findings suggest that EFs of initiation and set maintenance (examined by the semantic fluency task) may allow depressed elderly individuals to engage and stay in treatment. Identification of those at risk for noncompletion may help implementation strategies for personalized care.
TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00892047.

PMID: 29659205 [PubMed - as supplied by publisher]