The Journal of Clinical Psychiatry (J CLIN PSYCHIAT )

Publisher: Physicians Postgraduate Press


The Journal of Clinical Psychiatry has served the information needs of psychiatrists worldwide for over 60 years and is the leading psychiatric resource for clinical information. The Journal is an international peer-reviewed journal, and its articles are indexed by the National Library of Medicine as well as all major indexing and abstracting organizations in the world, thus expanding its reach well beyond its circulation of 32,500.

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  • Website
    Journal of Clinical Psychiatry website
  • Other titles
    The Journal of clinical psychiatry
  • ISSN
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  • Material type
    Periodical, Internet resource
  • Document type
    Journal / Magazine / Newspaper, Internet Resource

Publisher details

Physicians Postgraduate Press

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    • Funded authors may submit final authors' version of articles to an approved public repository, such as PubMed Central, 6 months after publication
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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE: The ultra-high risk clinical phenotype is associated with substantial distress and functional impairment and confers a greatly enhanced risk for transition to full-threshold psychosis. A range of interventions aimed at relieving current symptoms and functional impairment and reducing the risk of transition to psychosis has shown promising results, but the optimal type and sequence of intervention remain to be established. The aim of this study was to determine which intervention was most effective at preventing transition to psychosis: cognitive therapy plus low-dose risperidone, cognitive therapy plus placebo, or supportive therapy plus placebo. METHOD: A double-blind, randomized, placebo-controlled 12-month trial of low-dose risperidone, cognitive therapy, or supportive therapy was conducted in a cohort of 115 clients of the Personal Assessment and Crisis Evaluation Clinic, a specialized service for young people at ultra-high risk of psychosis located in Melbourne, Australia. Recruitment commenced in August 2000 and ended in May 2006. The primary outcome measure was transition to full-threshold psychosis, defined a priori as frank psychotic symptoms occurring at least daily for 1 week or more and assessed using the Comprehensive Assessment of At-Risk Mental States. Secondary outcome measures were psychiatric symptoms, psychosocial functioning, and quality of life. RESULTS: The estimated 12-month transition rates were as follows: cognitive therapy + risperidone, 10.7%; cognitive therapy + placebo, 9.6%; and supportive therapy + placebo, 21.8%. While there were no statistically significant differences between the 3 groups in transition rates (log-rank test P = .60), all 3 groups improved substantially during the trial, particularly in terms of negative symptoms and overall functioning. CONCLUSIONS: The lower than expected, essentially equivalent transition rates in all 3 groups fail to provide support for the first-line use of antipsychotic medications in patients at ultra-high risk of psychosis, and an initial approach with supportive therapy is likely to be effective and carries fewer risks.
    The Journal of Clinical Psychiatry 04/2013; 74(4):349.
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    ABSTRACT: Across a number of studies, depressive disorders, substance use disorders, and other anxiety disorders are the disorders most likely to co-occur with posttraumatic stress disorder (PTSD). It is also clear that depressive disorder can be a common and independent sequela of exposure to trauma and having a previous depressive disorder is a risk factor for the development of PTSD once exposure to a trauma occurs. The comorbidity of PTSD with substance use disorders is complex because while a substance use disorder may often develop as an attempt to self-medicate the painful symptoms of PTSD, withdrawal states exaggerate these symptoms. Appropriate treatment of PTSD in substance abusers is a controversial issue because of the belief that addressing issues related to the trauma in early recovery can precipitate relapse. In conclusion, comorbidity in PTSD is the rule rather than the exception. This area warrants much further study since comorbid conditions may provide a rationale for the subtyping of individuals with PTSD to optimize treatment outcomes (PsycINFO Database Record (c) 2012 APA, all rights reserved)
    The Journal of Clinical Psychiatry 10/2012;
  • The Journal of Clinical Psychiatry 01/2011; 72:34-42.
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    ABSTRACT: [Correction Notice: An erratum for this article was reported in Vol 69(12) of Journal of Clinical Psychiatry (see record 2009-02760-023).] Background: The development of new antidepressant drugs has reached a plateau. There is an unmet need for faster, better, and safer medications, but as placebo-response rates rise, effect sizes shrink, and more studies fail or are negative, pharmaceutical companies are increasingly reluctant to invest in new drug development because of the risk of failure. In the absence of an identifiable human pathophysiology that can be modeled in preclinical studies, the principal point of leverage to move beyond the present dilemma may be improving the information gleaned from well-designed proof-of-concept (POC) studies of new antidepressant drugs with novel central nervous system effects. With this in mind, a group of experts was convened under the auspices of the University of Arizona Department of Psychiatry and Best Practice Project Management, Inc. Participants: Forty-five experts in the study of antidepressant drugs from academia, government (U.S. Food and Drug Administration and National Institute of Mental Health), and industry participated. Evidence/Consensus Process: In order to define the state of clinical trials methodology in the antidepressant area, and to chart a way forward, a 2-day consensus conference was held June 21-22, 2007, in Bethesda, Md., at which careful reviews of the literature were presented for discussion. Following the presentations, participants were divided into 3 workgroups and asked to address a series of separate questions related to methodology in POC studies. The goals were to review the history of antidepressant drug trials, discuss ways to improve study design and data analysis, and plan more informative POC studies. Conclusions: The participants concluded that the federal government, academic centers, and the pharmaceutical industry need to collaborate on establishing a network of sites at which small, POC studies can be conducted and resulting data can be shared. New technologies to analyze and measure the major affective, cognitive, and behavioral components of depression in relationship to potential biomarkers of response should be incorporated. Standard assessment instruments should be employed across studies to allow for future meta-analyses, but new instruments should be developed to differentiate subtypes and symptom clusters within the disorder that might respond differently to treatment. Better early-stage POC studies are needed and should be able to amplify the signal strength of drug efficacy and enhance the quality of information in clinical trials of new medications with novel pharmacologic profiles. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
    The Journal of Clinical Psychiatry 09/2008;
  • The Journal of Clinical Psychiatry 11/2007; 68:1031-1037.
  • The Journal of Clinical Psychiatry 01/2007;
  • The Journal of Clinical Psychiatry 01/2007; 68(8):1310.
  • [Show abstract] [Hide abstract]
    ABSTRACT: At some point during their lives, many patients with schizophrenia abuse substances. The co-occurrence of substance use leads to poorer long- and short-term outcomes in schizophrenia and complicates the treatment of both conditions. The primary substances of abuse among schizophrenia patients are alcohol, cannabis, cocaine, and nicotine. This presentation describes the prevalence, outcomes, and basis for this comorbidity. A brief discussion about the neurobiology of schizophrenia explains how schizophrenia may create a biologic predisposition to substance abuse by altering the brain reward system. The efficacy of possible treatments for comorbid schizophrenia and substance abuse are weighed, including typical and atypical antipsychotics and psychosocial interventions, and a list of possible adjunctive agents is provided.
    The Journal of Clinical Psychiatry 10/2006; 67(9):e08.
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    ABSTRACT: This article describes the implementation and utilization of the patient and family education program (PFEP) component of the Texas Medication Algorithm Project (TMAP). The extent of participation, types of psychoeducation received, and predictors of receiving at least a minimum level of education are presented. TMAP included medication guidelines, a dedicated clinical coordinator, standardized assessments of symptoms and side effects, uniform documentation, and a PFEP. The PFEP includes phased, multimodal, disorder-specific educational materials for patients and families. Participants were adult outpatients of 1 of 7 community mental health centers in Texas that were implementing the TMAP disease management package. Patients had DSM-IV clinical diagnoses of major depressive disorder, with or without psychotic features; bipolar I disorder or schizoaffective disorder, bipolar type; or schizophrenia or schizoaffective disorder. Assessments were administered by independent research coordinators. Study data were collected between March 1998 and March 2000, and patients participated for at least 1 year. Of the 487 participants, nearly all (95.1%) had at least 1 educational encounter, but only 53.6% of participants met criteria for "minimum exposure" to individual education interventions. Furthermore, only 31.0% participated in group education, and 42.5% had a family member involved in at least 1 encounter. Participants with schizophrenia were less involved in the PFEP across multiple indicators of utilization. Diagnosis, intensity of symptoms, age, and receipt of public assistance were related to the likelihood of exposure to minimum levels of individual education. Despite adequate resources and infrastructure to provide PFEP, utilization was less than anticipated. Although implementation guidelines were uniform across diagnoses, participants with schizophrenia experienced less exposure to psychoeducation. Recommendations for improving program implementation and modification of materials are discussed.
    The Journal of Clinical Psychiatry 10/2006; 67(9):1362-72.
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    ABSTRACT: To examine various forms of suicidality specified in DSM-IV and their clinical characteristics in a large sample of children and adolescents with major depressive disorder (MDD). Subjects included 553 children and adolescents (aged 7.0-14.9 years) recruited between April 2000 and December 2004 from 23 mental health facilities in Hungary. Subjects received standardized clinical evaluations and best-estimate consensus DSM-IV diagnoses of MDD. All subjects were in a current episode of MDD at their assessment date. Approximately 68% of the sample had recurrent thoughts of death, 48% had suicidal ideation, 30% had suicide plan, and 12% had attempted suicide. Compared with nonsuicidal peers, suicidal children and adolescents were more severely depressed, had more depressive symptoms, and more likely had comorbid disorders. However, depressed children and adolescents with various forms of suicidality were very similar in clinical characteristics. Feelings of worthlessness, depressed mood, psychomotor agitation, and comorbid separation anxiety and conduct disorders were independent correlates of at least 1 form of suicidality. Only feelings of worthlessness was related to all 4 suicidal behaviors, after adjustment for other depressive symptoms, comorbid disorders, and demographics. Clinical characteristics differ between nonsuicidal and suicidal children and adolescents but are very similar across various forms of suicidality. Feelings of worthlessness may play a central role in the development of suicidal behavior. Interventions toward the enhancement of self-esteem and amelioration of underlying psychopathology may be crucial for the prevention of suicide attempts in depressed children and adolescents.
    The Journal of Clinical Psychiatry 10/2006; 67(9):1442-50.
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    ABSTRACT: To examine the prevalence of the metabolic syndrome in depressive outpatients and to identify its correlates in depression. This cross-sectional analysis was performed on 121 depressive outpatients from January 2002 through January 2004 who were diagnosed at baseline with the Structured Clinical Interview for DSM-III-R. The metabolic syndrome was diagnosed at 6-year follow-up according to the modified criteria of the National Cholesterol Education Program. The severity of depressive symptoms was assessed at follow-up with the Beck Depression Inventory and the Hamilton Rating Scale for Depression, and general psychopathology was assessed with the Symptom Checklist-90. At 6-year follow-up, the prevalence of metabolic syndrome in the study group of depressive outpatients was 36% (N = 44). The syndrome was associated with a current diagnosis of major depression and overeating, but not with age or sex. The metabolic syndrome is highly prevalent among patients with a history of depression, especially those with current major depression. This may have implications for treatment. Furthermore, attention should be focused on the physical health of those suffering from depression.
    The Journal of Clinical Psychiatry 10/2006; 67(9):1422-7.
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    ABSTRACT: Longitudinal and structural neuroimaging studies show that patients with schizophrenia that converted to psychosis were found to have progressive gray matter loss in the cortex. Gray matter loss was also associated with functional decline. While the underlying mechanisms of gray matter loss remain uncertain, evidence of improved outcomes suggests neuroprotection, the maintenance of the functional integrity of the brain in response to neurobiological stress, in schizophrenia is possible. In order to protect against gray matter loss and slow functional decline following the onset of psychosis, new data suggests that an appropriate antipsychotic chosen at first episode can modify the rate of structural deterioration, which can lead to improved outcome.
    The Journal of Clinical Psychiatry 10/2006; 67(9):e09.
  • The Journal of Clinical Psychiatry 10/2006; 67(9):1473-4.
  • The Journal of Clinical Psychiatry 10/2006; 67(9):1466-7.
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    ABSTRACT: This study investigates bone mineral density (BMD) and the association between BMD and hormonal changes in Korean patients with schizophrenia. This cross-sectional study was conducted from January 2005 to June 2005; 195 inpatients with schizophrenia (DSM-IV) were screened. Among them, 51 patients aged 18 to 45 years who had taken haloperidol monotherapy for at least 2 years participated in this study. The control group consisted of normal healthy volunteers who were of similar ages (N = 57). Bone mineral density was determined by a GE Lunar 4500 scanner. Hormone levels were measured by using commercial kits. The Student t test, the Pearson chi2 test, the Wilcoxon rank sum test, and logistic regression analysis were used for data analysis. Female patients, but not male patients, showed significantly lower BMD than the normal controls as seen in all bone regions studied. Among 18 female patients with BMD loss, 17 patients showed hyperprolactinemia, and 7 showed combined hypoestrogenemia. Prolactin levels were significantly higher in the female patients with BMD loss compared to those with normal bone density; however, other hormone levels were not different between the 2 groups. There was no significant difference in hormonal levels between bone loss and normal bone density groups. Bone mineral density loss in patients with schizophrenia tended to differ by gender. Decreased BMD compared to normal controls was seen in female patients; however, this was not observed in men.
    The Journal of Clinical Psychiatry 10/2006; 67(9):1391-6.
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    ABSTRACT: Cognitive dysfunction in schizophrenia differs from cognitive dysfunction in neurodegenerative illnesses because it is associated with neuronal dysfunction and not neurodegeneration. Pharmacologically, potential targets for developing treatments may differ from cognition in dementing disorders. Several putative molecular targets for treating cognition in schizophrenia show promise, such as treatments that act on the D(1) receptor of the dopamine system; the 5HT(1A), 5HT(2A), and 5HT(6), receptors of the serotonin system; and ampakines, Glycine/D-cycloserine, D-serine, and mGluR 2/3 agonists of the glutamatergic system. Other receptors associated with improvement in cognition include nicotinic and muscarinic receptors, and the alphalpha2 subunit receptor of the brain GABA system. Domain treatment of schizophrenia is a new method of treating schizophrenia that involves treating a single domain of dysfunction at a time.
    The Journal of Clinical Psychiatry 10/2006; 67(9):e11.

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