Psychiatry MMC – ISSN: 1550-5952 – Volume 4 – Issue 3 – March 2007

Brief Report:
Informed Consent and Competency: Doctor�s Dilemma on the Consultation Liaison Service Elena Carmen Nichita, MD; and Peter F. Buckley, MD

Abstract: With the increase in morbidity in the mentally ill, we also see an increase in the number of consultation requests from the medical and surgical departments to the psychiatric consultation team. Beside the classic questions of managing depression, psychosis, or agitation, psychiatrists are facing questions regarding patient competency. This usually refers to the patient�s ability to consent to or refuse medical treatment, to be discharged against medical advice, or the patient�s capacity to live independently and manage his or her own finances. In this article, the principles of informed consent and decision-making capacity will be reviewed, as well as the legal cases pertaining to these issues. A brief review of the existing literature will be summarized. Key Words: competency, capacity, psychiatric consultations

Letters to the Editor:
March 2007

Original Research:
Using Daily Interactive Voice Response Assessments to Measure Onset of Symptom Improvement With Duloxetine by Heidi K. Moore, PhD; Madelaine M. Wohlreich, MD; Michael G. Wilson, MS; James C. Mundt, PhD; Maurizio Fava, MD; Craig H. Mallinckrodt, PhD; and John H. Greist, MD

ABSTRACT�Most clinical trials measure patient responses weekly, requiring patients to accurately recall and report their symptoms from the previous six days. More frequent assessments would be less susceptible to recall errors and recency effects as weekly assessments, but increased office visits burden clinicians and patients and can lead to higher attrition or non compliance. Interactive voice response (IVR) technology permits data collection at greater frequencies with minimal reporting burdens. An ancillary study within a randomized clinical trial evaluated the use of IVR to gather measures of patients� ratings of emotional and painful symptoms of depression on a daily basis. Unmedicated patients randomized to a starting dose of duloxetine of 30 mg QD (n=67) or 60 mg QD (n=70) called an IVR system daily to complete Verbal Numeric Scales for pain and Patient Global Impression of Improvement for both physical and emotional changes. Patients� compliance with daily IVR assessmen

Anchoring Perceptions of Clinical Change on Accurate Recollection of the Past: Memory Enhanced Retrospective Evaluation of Treatment (MERET�) James C. Mundt, PhD; David J. DeBrota, MD; John H. Greist, MD

Abstract: Objective: To evaluate patients� self-reports of treatment efficacy with and without self-prompted memory aids regarding their clinical experiences obtained prior to treatment initiation. Design: Double-blind, placebo-controlled trial with variable expected duration placebo lead-in and washout. Setting: Multisite (US) randomized clinical trial. Participants: Seventy-four patients with initial or recurrent DSM-IV diagnosis of major depression with symptoms of at least four weeks duration. A minimum Clinical Global Impression of Severity rating of Moderately Depressed and a clinician 17-item Hamilton Rating Scale for Depression score of 15 or greater, with the depressed mood item score of at least 2 were required for study entry. Measurements: Patient global impression of improvement (PGI-I) ratings obtained using an interactive voice response (IVR) computer-automated telephone system prior to and following playback of impromptu patient recordings obtained prior to

Research to Practice:
Time To Feel Good: The Therapeutic Time Course of Antidepressants by David Feifel, MD, PhD

Practicing in an academic setting makes one aware of certain common clinical practices that are out of step with research findings. In this column, I hope to periodically to address some of these �disconnects� between clinical practice and research evidence.

Review:
Clinical Manifestations, Diagnosis, and Empirical Treatments for Catatonia Mahendra T. Bhati, MD; Catherine J. Datto, MD; John P. O�Reardon, MD

Abstract: Objective: Review the medical literature on the history and clinical features of catatonia so as to provide a contemporary clinical guide for successfully diagnosing and treating the various clinical forms of catatonia. Design: Results of MEDLINE computerized searches using search terms �catatonia�, �treatment of catatonia�, �electroconvulsive therapy and catatonia�, �benzodiazepines and catatonia�, clinical case reports, and book chapters covering the medical and psychiatric literature relevant to catatonia and its associated treatments were examined. Setting: Academic medical center. Participants: None. Measurements: None. Results: Catatonia is a common but under-recognized clinical syndrome. No large-scale, controlled studies exist to determine the relative effectiveness of current treatments, including sedative-hypnotic medications (benzodiazepines or barbiturates), and electroconvulsive therapy (ECT). Conclusion: Despite the lack of large-scale, control

The Interface:
Physician and medical student stress by Randy A. Sansone, MD, and Lori A. Sansone, MD

This ongoing column is dedicated to the challenging clinical interface between psychiatry and primary care�two fields that are inexorably linked. In this edition of Psychiatry 2007, we summarize three worrisome articles that relate to physician and medical student stress

Trend Watch:
Antidepressants in Bipolar Disorder by Elisa F. Cascade; John Reites; Amir H. Kalali, MD; Nassir Ghaemi, MD, MPH

Abstract:Because of the potential to induce mania or rapid cycling, guidelines caution that antidepressants should be used conservatively in the treatment of bipolar disorder. To better inform psychiatrists on current practice patterns, this article presents data on the use of antidepressants and other regimens most commonly used to treat bipolar disorder. Key words: antidepressants, bipolar disorder, pharmacology