Obesity and medical illnesses in psychiatric patients admitted to a long-term psychiatric facility.

Obesity and associated medical conditions may have an impact on morbidity and even mortality in patients with psychiatric disorders. The authors present the results of a survey of the prevalence of obesity and selected medical conditions among 420 consecutively admitted psychiatric inpatients at a long-stay facility and compare these data with those reported in the literature. Female psychiatric subjects had considerably higher rates of being either overweight or obese (69%) as compared to women in the general U.

Alzheimer disease and mortality: a 15-year epidemiological study.

Background: Alzheimer disease (AD) is considered a leading cause of death, but few studies have examined the contribution of AD to mortality based on follow-up of representative US cohorts.

Objective: To examine mortality rates, duration of survival, causes of death, and the contribution of AD to the risk of mortality in an aging community-based cohort, controlling for other predictors.

Design: Fifteen-year prospective epidemiological study.

Correlates and consequences of chronic insomnia.

Approximately one half of patients with insomnia have a primary psychiatric disorder such as a depression or anxiety. Insomnia is associated with increased risk of new or recurrent psychiatric disorders, increased daytime sleepiness with consequent cognitive impairment, poorer prognoses, reduced quality of life and high healthcare-related financial burden. Emerging data suggest that resolution of insomnia may improve psychiatric outcomes, which underscores the importance of vigorous treatment.

Recovery and functional outcomes following olanzapine treatment for bipolar I mania.

Background: Typical experimental categorizations of treatment responses in bipolar disorder (BPD) patients may have limited relationship to clinical recovery or functional status, and there is inadequate research on such clinically important outcomes.

Methods: We analyzed data from a study of open continuation of olanzapine treatment following a 3-week placebo-controlled trial involving initially hospitalized adult subjects with DSM-IV BP-I mania to estimate rates and times to symptomatic remission (low scores on standardized symptomatic assessments) and clinical recovery (remission sustained>or=8 weeks), associated clinical factors, and functional outcomes.

Results: During treatment with olanzapine for 27.

Estimating treatment effects from longitudinal clinical trial data with missing values: comparative analyses using different methods.

The selection of a method for estimating treatment effects in an intent-to-treat analysis from clinical trial data with missing values often depends on the field of practice. The last observation carried forward (LOCF) analysis assumes that the responses do not change after dropout. Such an assumption is often unrealistic.

Therapeutic alternatives for difficult-to-treat depression: a narrative review of the state of the evidence.

Despite the large number of depressed patients who do not respond to first-line antidepressants, the evidence base of alternate strategies is quite thin. In this article, a simple 5-stage system for categorizing treatment-resistant depression (TRD) is described and the evidence pertaining to the major strategies currently utilized is summarized using four grades, ranging from D (case reports only) to A (multiple positive placebo-controlled trials). It is concluded that the level of evidence supporting many of the contemporary strategies used for TRD (eg, combinations of antidepressants and augmentation with medications such as pindolol, buspirone, or modafinil) is scanty at best.

Functional neuroimaging evidence for hyperarousal in insomnia.

Objective: The authors investigated the neurobiological basis of poor sleep and daytime fatigue in insomnia.

Method: [(18)F]Fluorodeoxyglucose positron emission tomography was used to assess regional cerebral glucose metabolism of seven patients with insomnia and 20 healthy subjects.

Results: Compared with healthy subjects, patients with insomnia showed greater global cerebral glucose metabolism during sleep and while awake, a smaller decline in relative metabolism from waking to sleep states in wake-promoting regions, and reduced relative metabolism in the prefrontal cortex while awake.

Studying new antidepressants: if there were a light at the end of the tunnel, could we see it?

This commentary began with the proposition that the SSRIs have become the standard of comparison for new antidepressants. It is also suggested that the conventional wisdom that all antidepressants are equally effective is no longer true. Rather, it is asserted that the same factors that have compromised the sensitivity of RCTs to detect drug-placebo differences similarly have impaired discriminations between effective and even more effective antidepressants.

Functional properties of fast spiking interneurons and their synaptic connections with pyramidal cells in primate dorsolateral prefrontal cortex.

Recent studies suggest that fast-spiking (FS) interneurons of the monkey dorsolateral prefrontal cortex (DLPFC) exhibit task-related firing during working-memory tasks. To gain further understanding of the functional role of FS neurons in monkey DLPFC, we described the in vitro electrophysiological properties of FS interneurons and their synaptic connections with pyramidal cells in layers 2/3 of areas 9 and 46. Extracellular spike duration was found to distinguish FS cells from non-FS interneuron subtypes.

Dosage and administration issues of antipsychotic agents (and adjunctive medicines) in the acute stabilization of psychoses.

There are several options and approaches available to practicing psychiatrists for the pharmacologic management of acute psychotic episodes that present in emergency room settings. This article focuses on the first hours and days of such episodes, the goals of treatment, and comparison of the "old favorites," such as combination haloperidol and lorazepam (in liquid, tablet or injectable formulations), with the newer second-generation antipsychotic agents, such as olanzapine, ziprasidone, risperidone, quetiapine, or aripiprazole, which are available in different formulations. The speed of titration to an effective target dose for these newer agents are addressed as well.

Increased activation of anterior paralimbic and executive cortex from waking to rapid eye movement sleep in depression.

Background: Depression is associated with sleep disturbances, including alterations in rapid eye movement (REM) sleep, that may relate to the neurobiology of the disorder. Given that REM sleep activates limbic and anterior paralimbic cortex and that depressed patients demonstrate increases in electroencephalographic sleep measures of REM, we hypothesized greater activation of these structures during waking to REM sleep in depressed patients.

Design: Subjects completed electroencephalographic sleep and regional cerebral glucose metabolism assessments during both waking and REM sleep using [(18)F]fluoro-2-deoxy-D-glucose positron emission tomography.

The prevalence of the metabolic syndrome in patients with schizoaffective disorder--bipolar subtype.

Objectives: To evaluate the point prevalence of the metabolic syndrome in patients with schizoaffective disorder--bipolar type.

Methods: Consenting patients who were participants in an ongoing clinical trial of adjunctive topiramate treatment for schizoaffective disorder, bipolar type were evaluated at baseline for the point prevalence of the metabolic syndrome. The criteria for the metabolic syndrome included: (a) waist circumference > 102 cm (40 inches) in males, or > 88 cm (35 inches) in females; (b) fasting serum triglyceride levels > or = 150 mg/dL; (c) fasting high density lipoproteins (HDL) cholesterol <40 mg/dL in men or <50 mg/dL in women; (d) blood pressure > or = 130/85 mmHg; and (e) fasting glucose > or = 110 mg/dL.

An analysis of the effects of prenatal alcohol exposure on growth: a teratologic model.

The association between prenatal exposure to alcohol and growth is linear, and effects have been measured at levels of exposure that are considerably below one drink per day. Thus, with respect to growth deficits, there is no safe level of drinking during pregnancy. Alcohol exposure during gestation causes growth deficits among the offspring at birth and during infancy.

Synaptic efficacy during repetitive activation of excitatory inputs in primate dorsolateral prefrontal cortex.

Neurons in the monkey dorsolateral prefrontal cortex (DLPFC) fire persistently during the delay period of working memory tasks. To determine how repetitive firing affects the efficacy of synaptic inputs to DLPFC layer 3 neurons, we examined the effects of repetitive presynaptic stimulation on the amplitude and temporal summation of EPSPs. Recordings were obtained in monkey DLPFC brain slices from regular spiking (RS) pyramidal cells and two types of interneurons, fast spiking (FS) and adapting non-pyramidal (ANP) cells.

Abnormalities in MRI-measured signal intensity in the corpus callosum in schizophrenia.

The microstructural integrity of the corpus callosum (CC) in first-episode schizophrenia patients was assessed by measuring the signal intensity (SI) in T1-weighted MRI images. Analyses revealed that compared to both healthy controls and non-schizophrenic patients, schizophrenia patients showed reductions in SI in all the callosal subregions, the genu, body, isthmus and splenium in first-episode schizophrenia. These results indicate that schizophrenia is characterized by pathology of this principal interhemispheric commissure; the abnormalities may reflect distributed (rather than localized) interhemispheric disconnectivity that extends beyond the heteromodal association cortices.

Gun carrying and conduct disorder: a highly combustible combination? Implications for juvenile justice and mental and public health.

Objectives: To examine concealed gun carrying between the ages of 12 and 17 years in a population of clinic-referred boys, many of whom qualified for a disruptive behavior disorder, including conduct disorder (CD); to identify factors and diagnoses related to concealed gun carrying; and to examine the extent to which gun carrying is associated with crime in adulthood.

Design: Longitudinal follow-up study.

Setting: Pittsburgh, Pa, and Athens and Atlanta, Ga.

Relationship of birth cohort and early age at onset of illness in a bipolar disorder case registry.

Objective: Utilizing data from a previously characterized registry of subjects with bipolar illness, the authors examined age at onset of the first illness episode in cohorts of subjects born from 1900 through 1939 and from 1940 through 1959.

Method: Demographic and clinical characteristics at the first full episode of bipolar disorder of subjects in a diagnostically validated voluntary bipolar disorder registry (N=1,218) were reviewed and subjected to statistical analyses.

Results: The median age at onset of the first episode of bipolar illness was lower by 4.

Blood pressure and cognitive impairment in India and the United States: a cross-national epidemiological study.

Objective: To evaluate the relationship between blood pressure (BP) and cognitive impairment in elderly populations in India and the United States in a cross-national epidemiological study.

Design: Cross-sectional comparisons, using standardized cognitive screening and BP measurements.

Participants: We examined 4810 subjects 55 years and older, of whom 595 were 75 years and older, from Ballabgarh, India, and 636 subjects 75 years and older from the Monongahela Valley, Pennsylvania.

Primary care clinicians' use of standardized tools to assess child psychosocial problems.

Background And Objectives: Children's psychosocial problems are prevalent but often inaccurately diagnosed. This study investigated primary care clinicians' (PCCs) use of standardized tools for psychosocial problems among children in whom they reported finding a problem.

Methods: The data consisted of 21 065 unique visits by children ages 4 to 15 years in 204 practices.

Attitudes towards taking Medicine among those patients who either received Olanzapine or First Generation Antipsychotic Agents.

This project evaluated the attitudes of psychiatric patients towards receiving either olanzapine or the first-generation antipsychotic agents. Newly admitted patients to a state psychiatric hospital who were either prescribed olanzapine (n=35) or other first-generation antipsychotic agents (n=34) were compared on measure of their personal attitudes toward receiving medicines using the Drug Attitude Inventory (DAI). Subjects were evaluated prior to receiving olanzapine and 8 weeks later unless they were discharged or discontinued sooner.

Beyond a beautiful mind: film choices for teaching schizophrenia.

For psychiatric educators interested in using film to teach professional and lay audiences about schizophrenia, the 2001 release of A Beautiful Mind has made the process much easier. The movie shows a range of symptoms and complications, and it gives viewers-especially patients and families-hope for recovery. However, many other commercial films depict various aspects of the illness, and the choice of which one to use is determined by the audience, the pedagogical focus, and the time available.

Treatment of bipolar depression: current status, continued challenges, and the STEP-BD approach.

Even though at least 10% (if not 20%) of those who experience a first lifetime episode of depression will subsequently develop bipolar disorder, the alliance of academic and industry research agendas that leads to developing and testing new antidepressants has failed to produce a sufficient knowledge base. It is therefore impossible to apply a truly empirical approach to guide the treatment of people with bipolar depression. Consequently, there are holes in contemporary evidenced-based practice guidelines large enough to drive a truck through; furthermore, there are some recommendations that have no factual basis other than expert opinion.

Body mass index and quality of life in community-dwelling patients with schizophrenia.

Objective: To examine the associations between sociodemographic variables, body weight and quality of life in schizophrenic outpatients.

Methods: Assessments included an interview to obtain sociodemographic data, administration of a Quality of Life questionnaire (the MOS SF-36) and measurement of height and weight. Body mass index was calculated (kg/m(2)).

Rates of response, euthymia and remission in two placebo-controlled olanzapine trials for bipolar mania.

Objective: Clinically meaningful recovery from acute mania may not be captured by conventionally reported response categorizations. We defined new and stringent criteria for remission in bipolar mania. Using a cohort of patients with acute mania randomized to treatment with either olanzapine or placebo, we contrasted remission rates to findings using previously reported but more lenient categorical outcome measures of response and euthymia.