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Welcome to the third e-issue of the Residents’ Journal, an e-publication to serve as a forum for your articles and a gateway to features of the The American Journal of Psychiatry that you may find useful in your training. This month we feature three articles from the current American Journal of Psychiatry that we feel might have value to you in your training. We also show you how to use the Journal’s features to maximize the impact of these articles for you and for any students you may be charged with teaching. This month we discuss how to approach the Methods section of Journal articles.
You are welcome to forward this e-mail to your colleagues, who can register to receive their own copy. Comments, questions, and suggestions -- along with any difficulties in accessing the full-text articles -- can be directed to Lisa Devine, Staff Editor, who is responsible for the publication.
| The American Journal of
Psychiatry |
| Residents’ Journal |
For those of you who are new to this e-publication, the Residents’ Journal is an exclusive forum to share your ideas and experiences in training, clinical practice, research, and careers with your colleagues. This month’s Residents’ Journal consists of two original contributions from your peers. Dr. Rachel Davis discusses Internet-based cognitive behavior therapy as treatment for panic disorder, and Dr. Amanda Mackey discusses coping with the inevitable termination of residency training. There is also a new column from Editors Robert Freedman, M.D., and Susan Schultz, M.D.
The Residents’ Journal is now only available online, from the American Journal of Psychiatry’s home page. Please click on the link above to access the publication. Alternatively, you may visit the AJP website and click on the Table of Contents (next to the cover image), and choose “In This Issue.” There you will find a link to the “Residents’ Journal.”
If you would like to
submit a short piece for publication in the Residents’ Journal, please visit our website at http://appi.manuscriptcentral.com/. Once there you will need to create an user account if you do not already have one. Please designate your submissions as “Resident Journal,” and please keep to under 500 words. Your participation will ensure the continued success of this e-publication.
Special Article: Remote Treatment of Panic Disorder
This month we direct you to a special article that is the subject of an editorial by fellow resident Rachel Davis, M.D.:
Carlbring P, Bohman S, Brunt S, Buhrman M, Westling BE, Ekselius L, Andersson G: Remote Treatment of Panic Disorder: A Randomized Trial of Internet-Based Cognitive Behavior Therapy Supplemented With Telephone Calls. Am J Psychiatry 2006; 163:2119-2125
Dr. Davis’s editorial, entitled “Is Internet-Based Cognitive Behavior Therapy
Effective Treatment for Panic Disorder?,” appears in the attachment.
Journal Club Kit: Antipsychotic Treatment and Weight Gain in Children
This month’s featured article is:
Klein DJ, Cottingham EM, Sorter M, Barton BA, Morrison JA: A Randomized, Double-Blind, Placebo-Controlled Trial of Metformin Treatment of Weight Gain Associated With Initiation of Atypical Antipsychotic Therapy in Children and Adolescents. Am J Psychiatry 2006; 163:2072-2079
Second-generation, or “atypical,” antipsychotic medications are often effective in reducing psychotic symptoms in children and adolescents, but are often accompanied by serious metabolic side effects, which include obesity and type 2 diabetes. Klein et al. report a method for halting the dramatic weight gain associated with atypical antipsychotic therapy in children and adolescents. Metformin is a medication used to regulate blood glucose in type 2 diabetes. In their study, Klein et al. compared metformin with placebo in 39
children and adolescents ages 10-17 who had gained at least 10% of their pretreatment weight while taking olanzapine, risperidone, or quetiapine for less than 1 year. Metformin halted the weight gain and decreased measures of insulin resistance and abnormal glucose metabolism. Over 4 months, the patients taking placebo gained an additional 4.0 kg on average, while weight was stable in the metformin group. However, the metformin group had a decrease in weight relative to height, as measured by body mass index, because the study was conducted in growing children. No serious side effects occurred.
Since the substantial weight gain produced by second-generation antipsychotics can decrease compliance
with treatment, metformin has the potential to increase compliance and improve outcome, as well as decrease harmful metabolic effects. In an editorial, Kenneth Towbin, M.D., discusses the study’s importance. He also points out that the study does not address the long-term safety of metformin treatment.
According to Dr. Freedman, the early recognition of psychosis in children has led to significant improvement in their clinical course, because of early treatment. Earlier this year, The American Journal of Psychiatry published evidence that the suicide rate in these children is decreased with early identification and treatment. An unfortunate consequence for the children and their families is the massive weight gain caused by the medications used in their treatment. This study is the first to indicate an effective intervention to help these children return to more normal weight.
Treatment in Psychiatry: Childbearing and Antipsychotics
This month’s featured article is:
Yaeger D, Smith HG, Altshuler LL: Atypical Antipsychotics in the Treatment of Schizophrenia During Pregnancy and the Postpartum. Am J Psychiatry 2006; 163:2064-2070
The risks to offspring from second-generation, or atypical, antipsychotic medications used by pregnant women have not yet been established in blinded or randomized studies. Yeager et al. describe the case of a woman with paranoid schizophrenia to illustrate important considerations in the decision to continue, change, or stop treatment
with an atypical antipsychotic during pregnancy. They stress the importance of optimizing the mother’s health and ability to parent. The pregnancies of women with schizophrenia often are unplanned, suffer from complications, and result in loss of custody. Discussions about contraception and pregnancy should therefore begin early in treatment. The medical risks associated with antipsychotics, such as obesity, diabetes, and hypertension, indicate a need to coordinate care during pregnancy with the patient’s obstetrician. After childbirth, dramatic hormonal changes may necessitate an increase in the antipsychotic dose, and additional social support may be helpful in preventing relapse. The benefits of breastfeeding during antipsychotic treatment are likely outweighed by the risks.
Discussion Questions:
1. The peak in onset of schizophrenia in women occurs between age 25-29 years and again during what age period?
2. What are the ways in which the clinical features observed in women with schizophrenia differ from the features observed in men with schizophrenia?
3. For what medical conditions is elevated pre-pregnancy body mass index (BMI) a major risk factor?
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