Kenneth J. Bender, PharmD, MA

Progress in identifying and effectively treating first-episode schizophrenia was marked by the simultaneous publication of a report on a 6-year study and on the 10-year follow-up of a large-scale trial.

Patients with severe depression are more likely to have symptom remission with a combination of cognitive therapy and antidepressant medication than those with less severe or more chronic illness.

A recent meta-analysis supports evidence of the effectiveness of the fixed olanzapine/fluoxetine combination (Symbyax) in treating the depressive phase of bipolar disorder. Response was ranked higher, but with no more adverse effects, than with treatment with olanzapine alone.

In a new study, "as needed" use of an opioid antagonist for heightened alcohol craving appeared to reduce the number of heavy drinking days and total amount of alcohol consumed.

Results of a 10-week prospective study, recently reported at the Annual Meeting of the American Association for Geriatric Psychiatry, offered no conclusive evidence about the mortality risk of elderly patients with Alzheimer disease who were treated with antipsychotics.

Given the likelihood that insufficient numbers of patients will be available for a randomized controlled trial of MAOIs in refractory depression or atypical depression, we must still rely on consensus guidelines and expert opinion.

The FDA Neurological Devices Panel met to consider the Agency’s proposal to reclassify cranial electrotherapy stimulator (CES) devices to Class III with premarket approval.

Much could be gained if an agreed minimum set of appropriate and important outcomes was measured and reported in all clinical trials in a particular area.

A new study examining conventional “start low, go slow” nutrition replenishment protocols for hospitalized patients with anorexia nervosa (AN) that have been recommended by professional organizations and it's outcomes.

A meta-analysis of the Omega-3 fatty acid EPA (eicosapentaenoic acid) as therapeutic supplement for major depression followed the above study online September 6 in the Journal of Clinical Psychiatry.

"I'm all over it, because I'm looking for something to help," declared Army Vice-Chief of Staff General Peter W. Chiarelli, quoted in USA Today News September 20, in his response to a study finding an increased risk of suicide in US military personnel with low Omega-3 fatty acid serum levels.

A depot antipsychotic regimen is less likely to be discontinued than an oral dosage form . . .

Increased activity of the enzyme phospholipase A2 (PLA2) has been documented in schizophrenia and is now reported to occur in patients with temporal lobe epilepsy . . .

A bidirectional relationship between schizophrenia and epilepsy emerged from an analysis of a health insurance database . . .

An initiative from the BRIDGE study group has determined that approximately half of patients presenting with a depressive episode are mistakenly diagnosed with unipolar major depression.

Several available agents in addition to methylene blue are being investigated for bipolar disorder and were in a in a recent review.

A New Study Looks at What Works-And What Doesn’t

A study presented by Canadian investigators at the 24th Congress of the European College of Neuropsychopharmacology (ECNP) in Paris, September 5 evaluated whether methylene blue can reduce residual symptoms of depression and mania in bipolar disorder.

A meta-analysis of depression and risk of stroke finds a positive association. How will this information affect your practice?

The Alzheimer’s Association announced in July that the FDA had accepted its recommendations to modify exclusion and monitoring criteria for clinical trials of agents that affect β-amyloid protein in the brain.

The risk of breast cancer recurrence related to some SSRI antidepressants interacting with and reducing the effectiveness of tamoxifen was quantified in 2 epidemiological studies published in February.

The impact of FDA alerts and label warnings was examined in 2 recently published studies of antipsychotic drug use. In one study, researchers gauged physician response to the 2005 warning of increased mortality with antipsychotic use in elderly patients with dementia, and in the other study, researchers determined whether recommended safeguards were implemented following the 2003 advisories on adverse metabolic effects of second-generation antipsychotics.

Newly published recommendations for pharmacological and psychosocial treatments from the Schizophrenia Patient Outcomes Research Team (PORT) are the first to address related treatments, such as smoking cessation, substance abuse, and weight loss, and they are the first update since 2003.

Of particular utility in the position statement is a checklist for identifying children who are at risk for sudden death, independent of ADHD or stimulant drug treatments.

The empirical basis for the effectiveness of 12-step recovery and the psychotherapeutic benefits of opioid agonist maintenance were among the topics of several symposia with introspective views of time-tested treatments at the 40th Annual Medical-Scientific Conference of the American Society of Addiction Medicine (ASAM) in New Orleans.

A study of the adverse effects of 4 second-generation antipsychotics in children and adolescents documented substantial weight gain during 11 weeks of treatment with each agent, with the increased abdominal fat that has been associated with development of metabolic syndrome in adults. Metabolic abnormalities emerged with 3 of the 4 agents, differing in type and severity with the agent and, in some cases, with the dose.

New compounds and novel applications for established products were evaluated in many of the clinical trials reported at the recent 49th annual NIMH-sponsored New Clinical Drugs Evaluation Unit meeting.

The NIMH-sponsored New Clinical Drugs Evaluation Unit (NCDEU) meeting is a favored venue for reports and reviews of NIH-funded psychopharmacological studies, and this was true of the recent annual meeting in Hollywood, Fla. The meeting included a workshop on new investigations of antidepressant use in Alzheimer disease and a panel session on the safety of pharmacotherapy in older adults.

Smoking cessation services should be integrated into substance use disorder treatment programs, according to David Kalman, MD, Department of Psychiatry, University of Massachusetts, and colleagues, in their recent review of tobacco dependency among patients who sought treatment for alcoholism.1

The FDA recently approved iloperidone (Fanapt, Vanda Pharmaceuticals) for the treatment of schizophrenia, reversing a July 2008 determination that the New Drug Application (NDA) was “not approvable.” An FDA spokesperson explained in an interview in Forbes (May 8), “Vanda provided the FDA with additional data and arguments that led us to reinterpret results of several of their studies.”