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.

Impact factor 5.14

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

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Physicians Postgraduate Press

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    • If funding agency rules apply, 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: This phase 3 trial evaluated the efficacy, safety, and tolerability of low- and high-dose cariprazine in patients meeting DSM-IV-TR criteria for acute manic or mixed episodes associated with bipolar I disorder. This multicenter, randomized, double-blind, placebo-controlled, parallel-group, fixed/flexible-dose study was conducted from February 2010 to December 2011. Patients were randomly assigned to placebo, cariprazine 3-6 mg/d, or cariprazine 6-12 mg/d for 3 weeks of double-blind treatment. Primary and secondary efficacy parameters were change from baseline to week 3 in Young Mania Rating Scale (YMRS) total score and Clinical Global Impressions-Severity of Illness (CGI-S) score, respectively. Post hoc analysis examined change from baseline to week 3 in YMRS single items. A total of 497 patients were randomized; 74% completed the study. The least squares mean difference (LSMD) for change from baseline to week 3 in YMRS total score was statistically significant in favor of both cariprazine groups versus placebo (LSMD [95% CI]: 3-6 mg/d, -6.1 [-8.4 to -3.8]; 6-12 mg/d, -5.9 [-8.2, -3.6]; P < .001 [both]). Both cariprazine treatment groups showed statistically significant superiority to placebo on all 11 YMRS single items (all comparisons, P < .05). Change from baseline in CGI-S scores was statistically significantly greater in both cariprazine groups compared with placebo (LSMD [95% CI]: 3-6 mg/d, -0.6 [-0.9 to -0.4]; 6-12 mg/d, -0.6 [-0.9 to -0.3]; P < .001 [both]). The most common (≥ 5% and twice the rate of placebo) treatment-related adverse events for cariprazine were akathisia (both groups) and nausea, constipation, and tremor (6-12 mg/d only). Results of this study demonstrated that both low- and high-dose cariprazine were more effective than placebo in the treatment of acute manic or mixed episodes associated with bipolar I disorder. Cariprazine was generally well tolerated, although the incidence of akathisia was greater with cariprazine than with placebo. identifier: NCT01058668. © Copyright 2014 Physicians Postgraduate Press, Inc.
    The Journal of Clinical Psychiatry 01/2015;
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    ABSTRACT: Depression is common in women, especially during pregnancy and the postpartum period. Untreated depression is associated with many adverse gestational outcomes. It is therefore important to know about the safety of different antidepressant drugs during pregnancy and lactation so that informed decisions can be made regarding treatment. This article summarizes published literature on the subject with regard to duloxetine, an antidepressant with serotonin-norepinephrine reuptake inhibition properties. In general, it appears that the use of duloxetine during pregnancy is associated with an increase in the risk of spontaneous abortion, but no increase in other adverse outcomes, such as major fetal malformations. Late-pregnancy exposure to duloxetine may be associated with poor neonatal adaptation syndrome, but the magnitude of this risk is not known. Infant exposure to duloxetine in breast milk is less than 1% of the maternal weight-adjusted dose, suggesting that duloxetine can be safely administered to a woman who is breastfeeding her infant. In general, the very limited data available on the subject do not uncover a signal that the use of duloxetine during pregnancy or lactation increases the risk of adverse outcomes. © Copyright 2014 Physicians Postgraduate Press, Inc.
    The Journal of Clinical Psychiatry 12/2014; 75(12):e1423-7.
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    ABSTRACT: Psychiatric, medical, and substance use comorbidities are highly prevalent among smokers, and many of these comorbidities have been found to be associated with reduced rate of success in clinical trials for smoking cessation. While much has been established about the best available treatments from these clinical trials, little is known about the effect of concomitant psychiatric medications on quit rates in smoking cessation programs. On the basis of results in populations with tobacco dependence and other substance use disorders, we hypothesized that smokers taking antidepressants would have a lower rate of quitting in an outpatient smoking cessation program. We performed a naturalistic chart review of veterans (N = 144) enrolled in the Veterans Affairs Greater Los Angeles Mental Health Clinic Smoking Cessation Program from March 2011 through July 2013, who met DSM-IV-TR criteria for nicotine dependence. The primary outcome was smoking cessation with treatment, as evidenced by a patient report of at least 1 week of abstinence and an exhaled carbon monoxide level of ≤ 6 ppm (if available) at the end of acute treatment, with comparators including concomitant psychotropic medication treatment, psychiatric and medical comorbidities, and the presence of a substance use disorder history. We utilized stepwise binary logistic regression as the main statistical technique. We found that current antidepressant treatment (P = .003) and history of substance use disorder (P = .01) (particularly cocaine [P = .02]) were associated with a lower rate of quitting smoking. Furthermore, the association between antidepressant treatment and reduced rate of smoking cessation was primarily seen in patients with a history of substance use disorder (P = .003). While preliminary, these results suggest an important clinical interaction meriting future study. If these findings are confirmed, clinicians may want to consider the risk of reduced ability to quit smoking in patients with a history of substance use disorder who are taking antidepressants. © Copyright 2014 Physicians Postgraduate Press, Inc.
    The Journal of Clinical Psychiatry 12/2014; 75(12):e1433-8.
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    ABSTRACT: Neurocognitive deficits are demonstrated in major depressive disorder (MDD) and most likely contribute to the functional impairment experienced by affected individuals. We systematically reviewed the evidence on neurocognitive deficits and their relationship(s) to psychosocial functioning in MDD. English-language literature was searched in MEDLINE, EMBASE, Science Direct, and PsycInfo databases for the years 1980-October 15, 2013, with the following terms: (depressive disorder or depressive disorder, major) and permutations of (cognitive, neurocognitive, neuropsych*) with (impairment, deficit, performance, test) and (quality of life; functional outcomes; outcome assessment, health care) or (assessment, outcomes; assessment, patient outcomes; outcomes assessment; outcomes assessments, patient). Inclusion criteria were (1) nongeriatric adults (< 60 years) with a primary diagnosis of MDD by DSM-IV, ICD-9, or ICD-10 criteria; (2) use of neuropsychological tests; and (3) use of a specific measure of social, occupational, or daily functioning. Of 488 articles identified in the initial search, 10 met the inclusion criteria. Two independent appraisers assessed eligibility of the studies. Substantial heterogeneity in the samples and methods precluded a quantitative meta-analysis, so we performed a narrative descriptive review. The included studies employed a variety of neurocognitive tests and assessments of psychosocial functioning. Overall, depressed samples had neurocognitive deficits in various domains that were associated with different measures of psychosocial functioning. However, these findings were constrained by methodological limitations of studies. The limited evidence base suggests that neurocognitive functioning appears to be broadly associated with functional impairment in individuals with MDD, but the quality of evidence is weak. Further studies to clarify the relationship(s) between neurocognitive and psychosocial functioning in MDD will benefit from larger and more homogeneous samples, prospective designs with multivariate analyses, and use of comprehensive assessments of psychosocial functioning that are validated in depressed populations. © Copyright 2014 Physicians Postgraduate Press, Inc.
    The Journal of Clinical Psychiatry 12/2014; 75(12):1359-70.
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    ABSTRACT: Mental illness accounts for 7.4% of the total disease burden worldwide-more than HIV/AIDS, tuberculosis, or diabetes-making it the leading cause of years lost to disability. Depressive disorders make up 40.5% of that disability, the most of all mental illnesses. Despite the devastating global effects of depression, a report on approval trends by the US Food and Drug Administration (FDA) found that new molecular entities (NMEs) approved for targeting psychiatric illness peaked in the 1960s and have been declining since. © Copyright 2014 Physicians Postgraduate Press, Inc.
    The Journal of Clinical Psychiatry 12/2014; 75(12):1419-21.
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    ABSTRACT: To the Editor: US Food and Drug Administration investigators recently reported on "maintenance trials for major depressive disorder" submitted for regulatory review, based, remarkably, on anonymous sources and unspecified treatments. Trials involved initial, randomized treatment for acute depression followed by re-randomization to continue successful treatment or discontinue to placebo up to another 8.88 (95% CI, 6.68-10.3) months. All 15 trials found significantly later relapses with antidepressants than with placebo. Because such consistent superiority of antidepressants over placebo is very unusual, trial design may have had an important influence. Only subjects responding, in the short term, to a test drug could enter a discontinuation phase, with inevitable selection bias. © Copyright 2014 Physicians Postgraduate Press, Inc.
    The Journal of Clinical Psychiatry 12/2014; 75(12):e1443.
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    ABSTRACT: The diagnosis and treatment of attention-deficit/hyperactivity disorder (ADHD) may be overlooked among African Americans. Barriers within the medical profession pose challenges, including biases among health care professionals and a lack of specialty services. Educating medical professionals in cultural competence, as well as educating community gateway contacts (such as clergy and educators) about ADHD, should improve the diagnosis and treatment of African American adults who have ADHD. More specialists are needed in underserved areas. © Copyright 2014 Physicians Postgraduate Press, Inc.
    The Journal of Clinical Psychiatry 12/2014; 75(12):e32.
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    ABSTRACT: To the Editor: The important recent article by Scott et al examined associations between military sexual trauma (MST), childhood trauma, combat exposure, and military-related posttraumatic stress symptomatology in women who served in the recent conflicts in Iraq and Afghanistan. The authors concluded that under conditions of high combat exposure, female veterans with MST had significantly higher posttraumatic stress symptomatology compared to female veterans without MST. Multiple publications have documented that a substantial number of women who served in Iraq and Afghanistan had exposure to trauma as children and while in the military. © Copyright 2014 Physicians Postgraduate Press, Inc.
    The Journal of Clinical Psychiatry 12/2014; 75(12):e1442.
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    ABSTRACT: To the Editor: A mild, ongoing inflammatory process may be involved in the pathophysiology of a subgroup schizophrenia. Meta-analyses found add-on anti-inflammatory treatment to be effective in at least early stages of schizophrenia. Immunologically, a blunted type 1 (acute) immune response and shift to the type 2 (chronic) response have been described in schizophrenia before. © Copyright 2014 Physicians Postgraduate Press, Inc.
    The Journal of Clinical Psychiatry 11/2014; 75(11):1266-7.
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    ABSTRACT: To the Editor: The recent double-blind, randomized, placebo-controlled trial of S-adenosylmethionine (SAMe) versus escitalopram in major depressive disorder (MDD) was reported as a failed trial by Mischoulon and colleagues. In intent-to-treat samples, no significant differences were found in response rates: 36% for SAMe, 34% for escitalopram, and 30% for placebo. The remission rates of 28% for SAMe, 28% for escitalopram, and 17% for placebo suggested that both active treatments produced "a more robust 'true' effect" compared to placebo. © Copyright 2014 Physicians Postgraduate Press, Inc.
    The Journal of Clinical Psychiatry 11/2014; 75(11):e1328.
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    ABSTRACT: To the Editor: Lamotrigine is an antiepileptic and mood-stabilizing medication that has a role in treating bipolar depression, as highlighted by Geddes et al. Villari et al report rare but serious cutaneous side effects of lamotrigine, including Stevens-Johnson syndrome and toxic epidermal necrolysis. They also describe infrequent psychiatric manifestations such as irritability, delusions, and auditory and visual hallucinations associated with lamotrigine. © Copyright 2014 Physicians Postgraduate Press, Inc.
    The Journal of Clinical Psychiatry 11/2014; 75(11):e1330.
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    ABSTRACT: Many patients with schizophrenia have problems adhering to their medication regimen. Numerous factors affect patients' adherence, such as patient and illness characteristics; medication efficacy, tolerability and formulations; provider and system characteristics; and patients' support networks. To compound this problem, accurately measuring adherence is challenging. Data suggest that clinicians should use multiple methods to assess patients' adherence, including supplementing their own clinical judgment and patient reports with more objective measures. Patients with poor social support, substance abuse disorders, or a history of florid psychosis and those in the earlier phases of their illness may be at risk for nonadherence. Assessing patients for nonadherence is a key step in determining their optimal form of treatment and avoiding frequent switching or deterioration. Doing so, clinicians can identify patients who would potentially benefit from a long-acting injectable (LAI) antipsychotic, which can be a valuable treatment option. Because lack of adherence increases the risk of hospitalization and does not help prevent suicide attempts, clinicians should address barriers to adherence, provide psychoeducation about medication-taking behaviors, and offer a wide range of antipsychotic treatment options, including LAIs, to improve patient outcomes. © Copyright 2014 Physicians Postgraduate Press, Inc.
    The Journal of Clinical Psychiatry 11/2014; 75(11):e29.
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    ABSTRACT: Complex sleep-related behaviors (CSBs) are often associated with hypnotic use, especially zolpidem. The age effect on the occurrence of CSBs has not been adequately investigated. This study aimed to investigate and compare the clinical correlates of CSBs between adult and elderly subjects who were taking zolpidem. A total of 253 adults (aged 20-55 years) and 64 elderly subjects (aged ≥ 65 years) who were administered zolpidem for at least 3 months were enrolled from psychiatric outpatient clinics from June 2011 to May 2012. The sociodemographic characteristics of the participants, the dose of zolpidem, and the occurrence of CSBs were collected. Logistic regression analysis was used to examine the clinical correlates of CSBs. In total, there were 62 members of the adult group (24.5%) and 11 elderly subjects (17.2%) with CSBs; however, the difference did not reach statistical significance. Logistic regression analysis showed that there was a main effect of zolpidem dose (≥ 10 mg; OR = 2.82, P = .038) and alcohol use (OR = 2.05, P = .026), but not sex or age group. There were interactive effects between age group and zolpidem dose (P = .043), indicating that a higher dose of zolpidem was associated with CSBs only in the adult group and not in the elderly group. Adults with CSBs used a higher dose of zolpidem than adults without (mean ± SD: 15.4 ± 6.8 mg vs 11.3 ± 5.7 mg), whereas elderly patients with CSBs did not use a higher dose of zolpidem than those without (12.2 ± 5.4 mg vs 11.9 ± 7.0 mg). A higher dose of zolpidem was correlated with CSBs only in the adult group and not in the elderly group. Future studies investigating the factors, other than dose, related to CSBs in the elderly will be performed. © Copyright 2014 Physicians Postgraduate Press, Inc.
    The Journal of Clinical Psychiatry 11/2014; 75(11):e1314-8.
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    ABSTRACT: Few studies have examined the decision-making process for selecting a mood stabilizer or antipsychotic for patients with bipolar disorder. Despite a lack of evidence regarding their efficacy, conventional unimodal antidepressants continue to be used in bipolar treatment regimens. This article examines pharmacologic principles that can facilitate the evidence-based use of mood stabilizers and antipsychotics in patients with bipolar disorder. Choosing therapies for the maintenance of bipolar disorder, clinical decision making upon observation of a partial response, the use of combination therapies, and benefit/harm considerations when choosing a treatment for bipolar depression will be reviewed. © Copyright 2014 Physicians Postgraduate Press, Inc.
    The Journal of Clinical Psychiatry 11/2014; 75(11):e30.
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    ABSTRACT: This section of Focus on Childhood and Adolescent Mental Health presents findings on an array of topics including inflammation and child and adolescent depression, glutamatergic dysregulation and pediatric psychiatric disorders, predictors of bipolar disorder in children with attention-deficit/hyperactivity disorder (ADHD), and the continuum between obsessive-compulsive personality disorder (OCPD) and obsessive-compulsive disorder (OCD). There is increased interest in the role of inflammation in psychiatric disorders. Kim and colleagues conducted a systematic literature review to examine the relationships between inflammatory processes, inflammation, medical conditions, and depression and suicidality in children and adolescents. © Copyright 2014 Physicians Postgraduate Press, Inc.
    The Journal of Clinical Psychiatry 11/2014; 75(11):1224-5.
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    ABSTRACT: It is well known that depression and multiple morbidities are common bedfellows. Yet the conclusion by Smith et al in this issue that over 68% of patients with depression had "at least 1 comorbid physical health condition" is striking. Their conclusion that "physical health comorbidity appears to be the norm rather than the exception in depressive disorder" is powerful enough to set an agenda and perhaps challenge how we practice medicine. © Copyright 2014 Physicians Postgraduate Press, Inc.
    The Journal of Clinical Psychiatry 11/2014; 75(11):e1319-20.
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    ABSTRACT: The primary objectives in the treatment of schizophrenia are to reduce the frequency and severity of psychotic exacerbations, ameliorate a broad range of symptoms, and improve functional capacity. Antipsychotic medications are the cornerstone of the pharmacologic treatment of schizophrenia. Despite the use of these agents for 60 years, however, schizophrenia continues to significantly limit the quality of life of a majority of affected individuals. © Copyright 2014 Physicians Postgraduate Press, Inc.
    The Journal of Clinical Psychiatry 11/2014; 75(11):e1321-2.