Psychiatry MMC

by Atmaram Yarlagadda, MD; Badalin Helvink, MD; Caroline Chou, MD; and Anita H. Clayton, MD

Dr. Yarlagadda is from McDonald Army Health Center, Fort Eustis, Virginia; Dr. Helvink was with the University of Virginia, Charlottesville, Virginia (at the time of this study) and currently is Chairperson, Department of Psychiatric Medicine, Naples Community Hospital, Naples, Florida; Dr. Chou was with the University of Virginia, Charlottesville, Virginia (at the time of this study); and Dr. Clayton is David C. Wilson Professor, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia Health System, Charlottesville, Virginia.

Key Words: blood brain barrier, glutamic acid decarboxylase (GAD), GAD antibodies, schizophrenia, diabetes mellitus (DM), screening tests

Abstract

Objective: Goal of our case control study was to establish the presence of antibodies to glutamic acid decarboxylase (GAD) in patients with chronic psychotic disorders. Methods: Serum levels of GAD antibodies in 12 patients with chronic psychotic disorders (schizophrenia and schizoaffective disorders) and 10 age-matched healthy control subjects were evaluated utilizing enzyme linked immunosorbitent assay (ELISA). Results: Antibodies to GAD in patients with chronic psychotic disorders have a higher mean than nonpatient control individuals. Conclusion: Our findings provide the first in-vivo evidence of positive GAD antibodies in chronic psychotic disorders and potentially may be used as a screening for these disorders.

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by Michael Ignatowski, DO; Santokh Sidhu, BA; and Marie Rueve, MD

All from the Department of Psychiatry, Wright State University Boonshoft School of Medicine, Dayton, Ohio

Key Words: catatonia, anticoagulation therapy, pulmonary embolism, immobility, major depressive disorder

Abstract

Catatonia in the setting of a mood disorder, an organic process, or a psychotic disorder presents significant risk to the patient’s well-being, as well as an additional barrier to treating the underlying disorder. The signs and symptoms of catatonia interfere severely with essential activities of daily living; they also at times compromise the ability of caregivers to evaluate and treat the patient’s primary disorder driving the catatonia. This interference often leads to medical emergencies, such as marked dehydration and pressure ulcers. Another life-threatening complication of the immobility commonly seen in catatonic patients is the development of deep vein thromboses (DVT) and pulmonary emboli. As with all patients, it is critical to provide preventative measures where possible to minimize risk of complications. Routine anticoagulation perhaps deserves more consideration in the case of catatonia, such as the one presented in this case report.

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by Darnell Ladson, DO; and David Bienenfeld, MD

Section editor: Paulette M. Gillig, MD, PhD

All from the Department of Psychiatry, Wright State University Boonshoft School of Medicine, Dayton, Ohio.

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by James Russell, MD; Joel Raskin, MD; Curtis Wiltse, PhD; Daniel Walker, PhD; and Olga Brawman-Mintzer, MD

Drs. Russell, Wiltse, and Walker are with Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana; Dr. Raskin is with Lilly Research Laboratories, Eli Lilly Canada, Toronto, Ontario, Canada; and Dr. Brawman-Mintzer is with the Medical University of South Carolina, Charleston, South Carolina.

Financial support: This work was sponsored by Eli Lilly and Company and Boehringer Ingelheim GmbH.

Clinical trial registry number for this study: NCT00062673 at www.clinicaltrials.gov. First patient enrolled in this study (assigned to therapy): 18 March 2003. Last patient completed: 22 July 2004.

Disclosures: Drs. Russell, Raskin, Wiltse, and Walker are employees of Eli Lilly and Company; Dr. Brawman-Mintzer is on the speakers bureau of AstraZeneca, Forest Pharmaceuticals, Pfizer Inc., Eli Lilly, and Janssen Pharmaceutica, has received grant/research support from Pfizer, Forest Pharmaceuticals, AstraZeneca, Janssen Pharmaceutica, Biovail, UCB Pharma, Eli Lilly, Novartiz, and Sanofi-Aventis, and is a consultant to Pfizer, UCB Pharma, Janssen Pharmaceutica, AstraZeneca, Solvay.

Key Words: duloxetine, anxiety, major depressive disorder, elderly, placebo

ABSTRACT

Objective: To compare the efficacy and tolerability of duloxetine 60mg/day versus placebo in treating elderly patients with major depressive disorder (MDD) and concurrent anxiety symptoms.

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by Colin A. Depp, PhD; and Barry D. Lebowitz, PhD

Dr. Depp is from the Department of Psychiatry, University of California, San Diego (UCSD); and Dr. Lebowitz is from the Sam and Rose Stein Institute for Research on Aging, University of California, San Diego.

Disclosure: This work was supported by the National Institute of Mental Health grants MH77225, MH019934, and MH06624.

Key Words: Bipolar disorder, medication adherence, older adults, psychosocial interventions

Abstract

Objective: The number of older adults with bipolar disorder is increasing, yet little is known about the optimal clinical management of these patients. Medication adherence is a vital to effective long-term treatment of these patients; thus enhancement of adherence is often an important clinical goal.

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by Elisa F. Cascade and Amir H. Kalali, MD

Featuring expert commentary from Sheldon H. Preskorn, MD

Ms. Cascade is Vice President, Strategic Research and Safety, Quintiles Inc., Falls Church, Virginia; Dr. Kalali is Vice President, Global Therapeutic Group Leader CNS, Quintiles Inc., San Diego, California, and Professor of Psychiatry, University of California, San Diego; and Dr. Preskorn is Professor, Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine and Chief Executive Officer, Clinical Research Institute, Wichita, Kansas.

Financial Disclosures: Relative to the transdermal delivery system for selegiline, Dr. Preskorn was a principal investigator for registration trials of the product for the treatment of major depression, a consultant to Somerset and Bristol-Myers Squibb during the approval process, and a presenter at the FDA Psychopharmacology Advisory Committee meeting on the product. Dr. Preskorn has been in drug development research for 30 years and has served or is serving in one or more of the following capacities: as a principal investigator, on the speakers bureau, and/or as a consultant for the following companies—Abbott Laboratories, AstraZeneca, Aventis, Biovail, Boehringer-Ingleheim, Bristol-Meyers Squibb, Comentis, E. Merck, Eisai, Eli Lilly, Glaxo-SmithKline, Hoffman LaRoche, Johnson & Johnson, Lundbeck, Memory, Merck, Neurosearch, Novartis, Organon, Otusak, Pfizer, Solvay, Sommerset, Sumitomo, Wyeth, and Yamanouchi.

Key words: EMSAM, selegiline, transdermal delivery system, MAOI, depression

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