Editor-in-Chief: John A. Talbott, MD
ISSN: 0022-3018
Online ISSN: 1539-736X
Frequency: 12 issues / year
Ranking: Psychiatry 51/120
Impact Factor: 1.812
Article Summaries
 

March 2015 Article Summaries

 

CLINICAL CONTROVERSIES

1. CONTROVERSIES ABOUT THE USE OF ANTIDEPRESSANTS IN PREGNANCY

Gail Erlick Robinson, MD, FRCP.

Controversy about the use of antidepressant medication during pregnancy include debate over risks of medications causing pregnancy loss, congenital malformations, neonatal adaptation syndrome, Persistent Pulmonary Hypertension of the Newborn, Autism Spectrum Disorder or long-term neurocognitive deficits. Although some research has raised concerns about antidepressants causing harm to the fetus and neonate, other studies have disputed these findings. Untreated depression during pregnancy can also cause harm from poor diet, substance abuse, suicidal behavior or prematurity. Decisions about the use of antidepressants during pregnancy must be based on a risk/benefit analysis.

 

2. ANTIDEPRESSANTS, PREGNANCY, AND STIGMA: HOW WE ARE FAILING MOTHERS AND BABIES

Lauren M. Osborne, MD, Jennifer Payne, MD.

The proportion of pregnant women using antidepressants during pregnancy has risen dramatically in recent years. Antidepressants are one of the best studied medications in pregnancy, yet they are also one of the most debated regarding their use in pregnancy, which we believe reflects the misunderstanding of and the prejudice against psychiatric illness. It is clear that both depression and antidepressants may carry some risk to the fetus, but the risk of antidepressants is consistently overestimated while the risk of untreated depression during pregnancy is consistently underestimated due to various stigmas.

 

3. THE USE OF SELECTIVE SEROTONIN REUPTAKE INHIBITOR ANTIDEPRESSANTS IN PREGNANCY DOES CARRY RISKS, BUT THE RISKS ARE SMALL

Regina C. Casper, MD.

In response to Dr. Robinson’s article, entitled “Controversies about the use of antidepressants in pregnancy,” I suggest that considerable agreement exists that use of SSRI antidepressants in pregnancy do carry risks (even if these ricks are small), which have been identified in research studies.

 

ORIGINAL ARTICLES

4. PREDICTING SYMPTOMS OF DEPRESSION FROM SOCIAL ANHEDONIA AND EMOTION REGULATION

Brennan D. Atherton, BS, Robert M. Nevels, PhD, MSCP, Michael T. Moore, PhD.

Some studies have shown that difficulties in emotion regulation and social anhedonia were independently associated with depression. The current study attempted to examine the effects of these two potential predictors of unipolar depressed mood. Results among fifty-nine (73% female) psychiatric inpatients showed that difficulties in emotion regulation, specifically dysfunctional emotion regulation strategies and emotional clarity, served as significant predictors of depressive symptoms above and beyond contributions from social anhedonia. These results highlight the importance of attending to emotion regulation in the study and treatment of depression in inpatient samples.

 

5.  PREVALENCE AND CORRELATES OF DEPRESSION, PTSD, AND SUICIDALITY IN JORDANIAN YOUTH IN INSTITUTIONAL CARE

Robin E. Gearing, PhD, Kathryne B. Brewer, MSW, Jennifer Elkins, PhD, Rawan W. Ibrahim, PhD, Michael J. MacKenzie, PhD, Craig S.J. Schwalbe, PhD.

This study examines the prevalence and correlates of depression, PTSD, and suicidality of youth in institutional care in Jordan. Prevalence rates and logistic regressions were used to model suicidality across depression, PTSD and comorbid depression/PTSD, controlling for youth characteristics, case history, and social support factors. Institutionalized youth endorsed high rates of mental illness (45% depression, 24% PTSD, 17% depression/PTSD, 27% suicidality). The odds of suicidality for depressed youth were 3.6 times higher. Abuse was significant, with the odds of suicidality for abused youth four times higher. 

 

6. IS THERE A DECLINE IN COGNITIVE FUNCTIONS AFTER COMBINED ELECTROCONVULSIVE THERAPY AND ANTIPSYCHOTIC THERAPY IN TREATMENT – REFRACTORY SCHIZOPHRENIA?

Agnieszka Pawełczyk, PsyD, MA , Emilia Kołodziej-Kowalska, PhD, MD, Tomasz Pawełczyk, PhD, MD, Prof. Jolanta Rabe-Jabłońska, PhD, MD.

The aim of the study was to assess the influence of electroconvulsive therapy combined with antipsychotic on working memory, and attention and executive functions in a group of treatment-refractory schizophrenia patients. Out of 27 patients, each patient underwent electroconvulsive therapy sessions and was treated with antipsychotic medications. Prior to the electroconvulsive therapy and within three days after the last session, the participants were assessed with neuropsychological tests: TMT (trail Making Test) and WCST (Wisconsin Cart Sorting Test). There were no significant differences in the TMT and WCST results after combined electroconvulsive therapy and antipsychotic therapy in treatment-refractory schizophrenia patients. This suggests that C-ECT may not have a negative influence on the neuropsychological functioning of patients with treatment resistant schizophrenia.

 

7. CLINICAL AND FUNCTIONAL OUTCOMES IN PEOPLE WITH SCHIZOPHRENIA WITH A HIGH SENSE OF WELL-BEING

Gagan Fervaha, BSc, Ofer Agid, MD, Hiroyoshi Takeuchi, MD, PhD, George Foussias, MD, PhD, Jimmy Lee, MBBS, MMed, Gary Remington, MD, PhD.

The present study examined the characteristics of individuals with schizophrenia who report being satisfied with their life in general. Approximately half of the individuals evaluated reported a high level of life satisfaction, even while many concurrently described themselves as at least moderately ill and experiencing moderate-severe symptoms and manifested severe functional deficits. Of all individuals evaluated, only about one-percent experienced what was considered to be optimal outcome. Individuals with schizophrenia are able to experience a high level of life satisfaction, despite experiencing severe illness and functional deficits.

 

8. LONGITUDINAL ASSOCIATIONS BETWEEN INTERPERSONAL RELATIONSHIP FUNCTIONING AND MOOD EPISODE SEVERITY IN YOUTH WITH BIPOLAR DISORDER

Rebecca S. Siegel, PhD, Bettina Hoeppner, PhD, Shirley Yen, PhD, Robert L. Stout, PhD, Lauren M. Weinstock, PhD, Heather M. Hower, MSW, Boris Birmaher, MD, Tina R. Goldstein, MD, Benjamin I. Goldstein, MD, PhD, Jeffrey I. Hunt, MD, Michael Strober, PhD, David A. Axelson, MD, Mary Kay Gill, MSN, and Martin B. Keller, MD.

This study examined the longitudinal association between mood episode severity and relationships in youth with bipolar disorder (BP). Participants were 413 Course and Outcome of Bipolar Youth study youth, aged 12.6 ± 3.3 years. Monthly ratings of relationships and mood episode severity were assessed by the Adolescent Longitudinal Interval Follow-Up Evaluation (ALIFE) Psychosocial Functioning Schedule (PFS) and Psychiatric Rating Scales (PSR) on average every 8.2 months over 5.1 years. Results indicated that participants with greater mood episode severity also had worse relationships. Longitudinally, participants had largely stable relationships. To the extent that there were associations, changes in parental relationships may precede changes in episode severity, although the magnitude of this finding was small. 

 

9. SUDDEN GAINS AND DETERIORATIONS IN THE TREATMENT OF PTSD IN WORLD TRADE CENTER RESPONDERS

Peter Tejas Haugen, PhD, Rachel Goldman, MA, Jesse Owen, PhD.

This study sought to examine the prevalence of sudden gains and deteriorations and their influence on treatment outcomes among World Trade Center (WTC) responders with probable posttraumatic stress disorder (PTSD). Thirty-six outpatient clients received at least three sessions of integrative psychotherapy, which included elements of psychodynamic and CBT approaches. Approximately 19% of clients experienced a sudden gain and 27% of clients experienced a sudden deterioration. Those who experienced deteriorations had worse therapy outcomes compared to those who did not. Clinical implications are discussed, including the importance of routine monitoring of client treatment response for sudden deteriorations in order to enhance positive treatment outcomes.  

 

10.  PERSONALITY AND DEMENTIA

Gabriele Cipriani, MD, Gemma Borin, DSocSc, Alessandro Del Debbio, MD, Mario Di Fiorino, MD

Change in personality may be an early sign of dementia. Our goal was to review scientific literature on the association between personality and dementia. Medline and Google Scholar searches were conducted for relevant articles, chapters, and books published since 1980. Search terms used included personality, dementia, Alzheimer's disease, Frontotemporal dementia, Dementia with Lewy bodies. People with dementia commonly exhibit changes in personality that sometimes precede the other early clinical manifestations of the condition, such as cognitive impairment. Premorbid personality might be a determining factor so that caricature or exaggeration of original personality emerges as dementia progresses. Early identification of personality modifications might assist with the timely diagnosis of dementia.

 

11. CHANGE IN CHILDREN’S EXTERNALIZING AND INTERNALIZING BEHAVIOR PROBLEMS: THE ROLE OF DEFENSE MECHANISMS

Phebe Cramer, PhD.

The defense mechanisms of Denial, Projection and Identification were assessed from Thematic Apperception Test (TAT) stories told by the children at age 9, using the Defense Mechanism Manual. The results showed that the use of Identification predicted a decrease in Externalizing behaviors between age 9 and age 12. In contrast, change in Internalizing behaviors was not predicted by defense use, but the use of Projection was related to fewer Internalizing behaviors at both ages. These findings are consistent with the idea that behavioral intervention stressing self-regulation can be effective in reducing Externalizing problems, but Internalizing problems require an intervention that is sensitive to the underlying behavior.

 

12. DURATION OF UNTREATED PSYCHOSIS AND THE PATHWAY TO CARE IN KWAZULU-NATAL, SOUTH AFRICA

Andrew Tomita, PhD, Jonathan K. Burns, PhD, Howard King, MBChB, Joy Noel Baumgartner, PhD, Glen P. Davis, MD, Sisanda Mtshemla, MBChB, Siphumelele Nene, MS, Ezra Susser, MD.

Considerable controversy surrounds the role of traditional health practitioners (THP) as first contact service providers and their influence on the duration of untreated psychosis (DUP) in sub-Saharan Africa. This study examined first-contact patterns and pathways to psychiatric care among individuals with severe mental illness. A cross-sectional study was conducted at a referral-based tertiary psychiatric government hospital in KwaZulu-Natal Province. General hospital was the most common first point of contact after mental disorder symptom onset and the strongest link to subsequent psychiatric treatment. Family members were the most common initiators in seeking care. First contact with THP was associated with longer DUP and higher number of provider contacts in the pathway based on adjusted regression analyses. Strengthening connections between psychiatric and general hospitals, and provision of culturally-competent family-based psychoeducation to reduce DUP are warranted.

 

13. BRIEF REPORTS. PREDICTORS OF DEPRESSION AMONG A SAMPLE OF SOUTH AFRICAN MORTUARY WORKERS

Jani Nöthling, MA, Keith Ganasen, FC Psych, Soraya Seedat, FC Psych, PhD

Few studies have investigated mental health among mortuary workers in low and middle income countries. Participants (N=45) were recruited from mortuaries in South Africa and completed questionnaires measuring depression, physical health, perceived stress, fear of blood/injury/mutilation and resilience. Participants with self-reported depression and Posttraumatic Stress Disorder (PTSD) comprised 13.3% and 4.4% of the sample, respectively. Inexperienced mortuary workers had a higher prevalence rate of depression (16.7%) compared to experienced workers (9.5%). Prevalence of PTSD did not differ significantly between inexperienced (4.2%) and experienced (4.8%) workers. Physical health, perceived stress, fear of blood/injury/mutilation and resilience were significant predictors of depression in the combined group (experienced and inexperienced). However, perceived stress was the only significant predictor of depression, in multiple regression, in the combined group. Mortuary workers seem to be at increased risk of depression, especially inexperienced workers.

 

14. BOOK REVIEW. Essentials of Global Mental Health. Samuel O. Okpaku, MD, PhD. (2014) London: Cambridge University Press. Reviewed by Pedro Ruiz, MD.

 

15.  BOOK REVIEW. Religion in Personality Theory. Frederick Walborn (2014) Philadelphia, PA: Elsevier. Reviewed by James S. Eaton, MD. 

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Dr. Talbott and Lippincott Williams & Wilkins
wish to thank the
University of Maryland School of Medicine
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