Annals of Clinical Psychiatry

This study evaluated the influence of concomitant calcium channel blocker (CCB) and antipsychotic (AP) therapy on efficacy measures in patients with schizophrenia.

Data from the Clinical Antipsychotic Trials of Intervention Effectiveness in Schizophrenia study were used to evaluate the effect of concomitant CCB therapy on the Clinical Global Impression-Severity (CGI-S) score, Positive and Negative Syndrome Scale (PANSS) score, and time to all-cause discontinuation of AP treatment. Concomitant treatment participants (CCB plus AP) were matched with controls (AP alone) by propensity scores using a 3:1 greedy match algorithm, then analyzed using a mixed linear effects model adjusted for fixed covariates.

The least squares mean change in CGI-S scores revealed a significant time-by-treatment interaction term, with greater improvements for the concomitant treatment group (P = .03). Total PANSS score showed no significant difference between groups at various time periods (1,3,6,9,12, 15, and 18 months) and time to all-cause discontinuation was also similar (hazard ratio 0.94, P = .73).

Improvements in CGI-S scores over time suggest that concomitant CCB plus AP treatment may reduce severity of illness more than AP treatment alone. However, PANSS score and time to all-cause discontinuation of AP treatment did not demonstrate improved outcomes.

It has been assumed that the mental health effects of repeated trauma should be incrementally greater than simple additive effects of separate trauma. However, repeated disasters afflicting the same population are uncommon. This study investigated psychiatric disorders following differential exposures to repeated disasters.

Mental health effects of exposure to repeated disasters of 547 individuals exposed to either flooding, tornadoes, dioxin contamination, and/or radioactive well water were assessed. Structured diagnostic interviews assessed prevalence of psychiatric disorders before and after each of the disasters. A multiple logistic regression model was used to test the association of post-disaster disorders after each flood with the total number of flood exposures, controlling for lifetime pre-disaster disorders.

Approximately one-fifth to one-third of the disaster-exposed groups had a psychiatric disorder following exposure to disaster, but disaster-related posttraumatic stress disorder and incident psychiatric disorders were nonexistent or rare in both post-disaster periods. Most identified post-disaster psychopathology consisted of alcohol use that predated the disasters.

Findings suggest that alcohol use disorder may be more representative of a risk factor for, rather than an outcome of, flood exposure. This possibility is supported by the high lifetime pre-flood prevalence of alcohol use disorders in flood plain populations.

Individuals with binge eating disorder (BED) are differentially affected by attention-deficit/hyperactivity disorder (ADHD), obesity, and substance use disorder. We have investigated to what extent cognitive deficits are relevant to binge eating behavior (BEB).

Data from the International Mood Disorders Collaborative Project were retrospectively and cross-sectionally analyzed to compare individuals with and without BEB on measures of anhedonia and general cognitive functions (n = 566). BEB was assessed using items from the Mini International Neuropsychiatric Interview Plus 5.0.0 for DSM-IV-TR that correspond with DSM-5-defined diagnostic criteria for BED. Individuals currently prescribed benzodiazepines were excluded from analyses.

Individuals with BEB were more likely to exhibit anhedonia (P = .044) and general cognitive (P = .005) symptoms, when compared to those without BEB. We also observed that individuals with BEB were more likely to have specific psychiatric (eg, ADHD) and medical (eg, obesity) disorders (P < .05).

Our results suggest that a central disturbance in cognitive processes may be mechanistically relevant to the cause and treatment of BEB in adults.

There is little research concerning whether race is associated with different clinical presentations of psychiatric disorders. Understanding the racial aspects of cognitive differences among depressed adults could help identify specific targets for depression treatment.

We recruited 59 participants (52.5% white, 47.5% African American), age 18 to 60, with a current diagnosis of major depressive disorder (MDD). All participants underwent a cognitive battery that included tasks assessing decision-making, response inhibition, working memory, and executive planning. Differences between white and African American groups were analyzed using analysis of variance or equivalent nonpara-metric tests.

There were no differences in demographic variables of age, sex, and education, but white individuals reported a significantly earlier age of first depressive episode compared with African American individuals. The African American group, however, showed significantly lower quality of decision-making and less risk adjustment on the Cambridge Gambling Task, and made more errors on the Spatial Working Memory task.

Our finding that specific cognitive domains differ as a function of racial differences in MDD might have differential prognostic and treatment implications.

Type 2 diabetes mellitus (T2DM) is associated with deficits across multiple cognitive domains; however, the determinants of cognitive impairment in T2DM are not well characterized. We aimed to evaluate body mass index (BMI), glycemic control, and T2DM duration as moderators of cognitive dysfunction in T2DM.

We conducted a meta-analytic review of the literature reporting data on BMI, hemoglobin A_lc(HbA_lc), T2DM duration, and validated measures of processing speed (ie, Digit Symbol Substitution Test, Trail Making Test [TMT]-A), verbal learning and memory (ie, Rey Auditory Verbal Learning Test), and working memory/executive function (ie, TMT-B) among individuals with vs without T2DM.

Individuals with T2DM demonstrated deficits across multiple cognitive domains (/c = 40; n = 4,252 T2DM; n = 22,322 non-T2DM; effect sizes 0.21 to 0.35). Illness duration and BMI did not significantly moderate measures of cognition; however, higher HbA_lc levels were significantly associated with deficits in measures of processing speed (R ² values 0.41 to 0.73, P < .01) and working memory/executive function (R ² = 0.62, P <.001).

Adults with T2DM exhibited significant deficits across multiple domains of cognitive function. Additionally, we identified an association between poorer glycemic control and cognitive dysfunction. A clinical translation of our findings relates to the reduction in morbidity by improving glycemie control.

Although numerous studies have demonstrated that mindfulness-based stress reduction (MBSR) improves clinical and nonclinical outcomes, few studies have followed MBSR participants for >12 months, and few have analyzed post-intervention home practice.

We followed a community sample of 247 self-referred adults for 2 years after completion of an 8-week MBSR program. Dependent variables, including self-reported anxiety, depression, perceived wellness, mindfulness, and duration and frequency of continued home practice, were measured before and after the program and every 6 months after.

Participants reported significantly improved symptoms of depression and anxiety, increased perceived wellness, and increased mindfulness after the 8-week intervention compared with pre-intervention reports. These improvements persisted for 2 years. Correlations between post-intervention home practice and mindfulness indicated that individuals who continued to practice developed greater mindfulness, which was associated with improved mental health and wellness.

Participants who completed the MBSR program reported significant improvements in anxiety, depression, perceived wellness, and mindfulness during the program.

We reviewed the historical development of diagnostic nomenclature and classification systems of mood disorders.

A literature search in PubMed and Google Scholar was performed using multiple search terms. Also, the criteria and classification of various mood disorders were reviewed and compared across all editions of DSM. We also reviewed several books and the references of the found articles.

This review describes the historical development of the concepts and diagnostic nomenclature of mood disorders, including the encompassing of most of the now major depressive disorder under the prior manic-depressive illness. Additionally, we examine how mood disorders have been developed, classified, and split into subcategories historically until the current classification. We observed that the modern nosology (DSM-5) leans a bit more toward a spectrum approach.

The pendulum has swung a bit from splitting toward lumping. The current diagnostic system blurs some of the boundaries between bipolar and unipolar disorders, as in the case of changing nomenclature to "mixed features" in both types of illnesses. This is supported by many experts (and some studies) who advocate for the spectrum concept in mood at the phenotypic level. The spectrum concept is more supported by evidence and further examination driven by both unconfined clinical observations and biological anchor points and markers to scientifically examine the zones of rarity and boundaries between disorders. This would be more fruitful than the arbitrary DSM number of criteria or episode durations and the artificial separation of manic-depressive illness.