Effects of switching from olanzapine, quetiapine, and risperidone to aripiprazole on 10-year coronary heart disease risk and metabolic syndrome status: Results from a randomized controlled trial

This study examined the clinical significance of switching from olanzapine, quetiapine, or risperidone to aripiprazole by examining changes in predicted risk of cardiovascular disease (CVD) according to the Framingham Risk Score (FRS) and metabolic syndrome status. FRS estimates 10-year risk of “hard” coronary heart disease (CHD) outcomes (myocardial infarction and coronary death) while metabolic syndrome is associated with increased risk of CVD, stroke, and diabetes mellitus

Continuity clinics in psychiatric residency training

This article evaluates the impact of establishing extensive continuity clinics on a psychiatry residency training program. The PGY-2 , -3, and -4 residents completed a 15-item attitude survey, and patients were surveyed for their satisfaction. The residency survey revealed increasing satisfaction with the continuity clinics as residents advance in their training. They reported improved learning about the course of mental illness, improvement in the therapeutic alliance with their patients, and only minimal interference with other training experiences. The resident survey revealed increasing satisfaction with the clinics. Residents reported improved learning about the course of mental illness over time and only minimal interference with other training experiences. Continuity clinics are an alternative to the traditional outpatient block assignment

Lithium responders: An evaluation of psychological test characteristics

The MMPI was administered to 29 acutely disturbed inpatients who had various psychiatric diagnoses prior to treatment with lithium carbonate. The patient's response to lithium was rated and correlations with pretreatment MMPI scores were determined. The Ac scale, a measure of acquiescence response set, was found to the best correlated of response to lithium. While other scales such as Ma, X, F and R were associated with response to lithium, multiple regression analysis indicated that this association may have been a function of acquiescence in these scales. It was suggested that the Ac scale may reflect an activation disorder common to a number of psycholic syndromes

The treatment of urinary retention by aversive stimulus cessation and assertive training

A case is reported in which a method for short-term therapy was developed and used in the treatment of psychogenic urinary retention and associated neurotic behavior. The method was based on the assumption that bladder hypofunction was directly related to the patient's inability to engage in selfassertive behavior. The treatment program involved, (1) the use of electrical stimulation to bring bladder function under voluntary control, and (2) the provision of a therapeutic relationship in which assertive responses could be instigated and reinforced. Its promise is attested to by the fact that after 4 months this patient, with a history of 15 yr of almost chronic urinary retention, was able to return home as an adequately functioning member of society. An 18-month follow-up indicates no relapse

The Goal-Attainment Scale: An Instructional Guide for the Delivery of Social Reinforcement

• Goal-attainment scaling, a method for evaluating treatment programs, has been reported to benefit therapeutic encounters. In order to evaluate its effect on staff therapeutic behavior, raters were trained to rate the appropriateness of inpatient behavior and the staffs' responses to it. General distribution of the goalattainment scale on a psychiatric inpatient unit influenced the delivery of positive social reinforcement for appropriate behavior

Hypnotic efficacy of a modified triazolodiazepine, brotizolam

Fifty‐nine outpatients with insomnia were treated in a 3‐week study to assess the safety and efficacy of a new triazolothienodiazepine with a short t½, brotizolam. Therapy was initiated with 0.25 mg at night, but by the end of the study all subjects who were receiving brotizolam were taking 0.50 mg. Results indicate brotizolam efficacy as measured by daily subject and weekly physician questionnaires in essentially all sleep parameters, including global subject and physician evaluation of treatment efficacy, sleep latency and sleep maintenance, and quality of sleep. Tolerance to the hypnotic action of brotizolam was not observed after 21 days of daily dosing. Clinical Pharmacology and Therapeutics (1985) 37, 674–679; doi:10.1038/clpt.1985.11

The measurement of psychological states by use of factors derived from a combination of items from mood and Symptom Checklists

The similatities in structure and usage of two widely used adjective checklists, the Profile of Mood States (POMS) and Symptom Checklist (SCL), suggested the feasibility of pooling the items from the two scales into a single factor analysis. This procedure was clinically appealing, statistically sound, and provided an efficient method to reduce and refine assessments of psychopathology. Data from 413 Miami Symptomatic Volunteers were used in this factor analysis. Nine factor dimensions were found to meet the dual criteria of statistical salience and clinical meaningfulness. The results demonstrated the factorial stability of the SCL and the POMS and identified the dimensions of psychopathology in which items from the two scales tended to complement each other in factor structure. Some factors were found to be unique to each scale. In addition, it was found that pooling the items from both scales yielded two new factor dimensions that were not previously available from either of the individual scales

Effectiveness of Switching From Antipsychotic Polypharmacy to Monotherapy

Objective:This randomized trial addressed the risks and benefits of staying on antipsychotic polypharmacy or switching to monotherapy. Method:Adult outpatients with schizophrenia taking two antipsychotics (127 participants across 19 sites) were randomly assigned to stay on polypharmacy or switch to monotherapy by discontinuing one antipsychotic. The trial lasted 6 months, with a 6-month naturalistic follow-up. Kaplan-Meier and Cox regression analyses examined time to discontinuation of assigned antipsychotic treatment, and random regression models examined additional outcomes over time. Results:Patients assigned to switch to monotherapy had shorter times to all-cause treatment discontinuation than those assigned to stay on polypharmacy. By month 6, 86% (N=48) of those assigned to stay on polypharmacy were still taking both medications, whereas 69% (N=40) of those assigned to switch to monotherapy were still taking the same medication. Most monotherapy discontinuations entailed returning to the original polypharmacy. The two groups did not differ with respect to psychiatric symptoms or hospitalizations. On average, the monotherapy group lost weight, whereas the polypharmacy group gained weight. Conclusions:Discontinuing one of two antipsychotics was followed by treatment discontinuation more often and more quickly than when both antipsychotics were continued. However, two-thirds of participants successfully switched, the groups did not differ with respect to symptom control, and switching to monotherapy resulted in weight loss. These results support the reasonableness of prescribing guidelines encouraging trials of antipsychotic monotherapy for individuals receiving antipsychotic polypharmacy, with the caveat that patients should be free to return to polypharmacy if an adequate trial on antipsychotic monotherapy proves unsatisfactory

Effects of switching from olanzapine, quetiapine, and risperidone to aripiprazole on 10-year coronary heart disease risk and metabolic syndrome status: Results from a randomized controlled trial

PURPOSE: This study examined the clinical significance of switching from olanzapine, quetiapine, or risperidone to aripiprazole by examining changes in predicted risk of cardiovascular disease (CVD) according to the Framingham Risk Score (FRS) and metabolic syndrome status. FRS estimates 10-year risk of “hard” coronary heart disease (CHD) outcomes (myocardial infarction and coronary death) while metabolic syndrome is associated with increased risk of CVD, stroke, and diabetes mellitus. METHOD: Changes in FRS and metabolic syndrome status were compared between patients with BMI ≥ 27 and non-HDL-C ≥ 130 mg/dL randomly assigned to stay on stable current treatment (olanzapine, quetiapine, or risperidone) or switch to treatment with aripiprazole with 24 weeks of follow-up. All study participants were enrolled in a behavioral program that promoted healthy diet and exercise. RESULTS: The pre-specified analyses included 89 switchers and 98 stayers who had post-baseline measurements needed to assess changes. Least squares mean estimates of 10-year CHD risk decreased more for the switch (from 7.0% to 5.2%) than the stay group (from 7.4% to 6.4%) (p=0.0429). The odds ratio for having metabolic syndrome (stay vs. switch) at the last observation was 1.748 (95% CI 0.919, 3.324, p=0.0885). CONCLUSION: Switching from olanzapine, quetiapine, or risperidone to aripiprazole was associated with larger reductions in predicted 10-year risk of CHD than the behavioral program alone. The advantage of switching on metabolic syndrome was not statistically significant. The benefits of switching must be balanced against its risks, which in this study included more discontinuations of the study treatment but no significant increase in symptoms or hospitalizations