Physician's Weekly Article - Conference Highlights: The APA 2008 Annual Meeting

       The American Psychiatric Association held its 2008 annual meeting from May 3 to May 8 in Washington, DC. The features below highlight just some of the news emerging from the meeting. For more information on these items and other research that was presented, go to www.psych.org/Events/.

      This Physician’s Weekly feature covering conference highlights from the 2008 APA annual meeting was reviewed in cooperation with a psychiatric expert.

      News in Schizophrenia

      Reducing Sialorrhea in Patients With Schizophrenia

       The Particulars: Hyper-salivation is a frequent, troubling adverse event associated with atypical antipsychotics. Using preliminary data, investigators evaluated the effect of clozapine orally disintegrating tablets (ODT) on salivation.

       Data Breakdown: Patients with moderate sialorrhea, marked sialorrhea, and marked drooling had decreased salivation over time after taking clozapine ODT from 46% at baseline to 32%, 26%, and 17% at weeks 4, 8, and 12, respectively. A 2-level improvement from baseline or normal salivation was observed in 39%, 43%, and 65% of patients receiving less than 300 mg/day at weeks 4, 8, and 12, respectively. For patients taking 300 mg/day to 600 mg/day, a 2-level improvement from baseline or normal salivation was observed in 32%, 47%, and 51% of patients receiving the drug.

       Take Home Pearl: Clozapine ODT appears to decrease sialorrhea in patients with treatment-refractory schizophrenia.

      Investigational Drug Shows Promise in Schizophrenia

       The Particulars: Iloperidone is an atypical antipsychotic currently being evaluated by the FDA for treating schizophrenia. According to the manufacturer, iloperidone may provide benefits to schizophrenia patients beyond those provided by currently available drugs because of its action on a common mutation of a gene linked to central nervous system function. Researchers presented results of a pivotal phase III efficacy study of iloperidone.

       Data Breakdown: The efficacy and safety of iloperidone (24 mg/day) were evaluated in a 4-week trial of acute exacerbation of schizophrenia. From baseline to endpoint, iloperidone showed significantly greater improvement than placebo in positive and negative symptoms as well as overall severity. It was more effective than placebo for the treatment of acute psychotic exacerbation.

       Take Home Pearl: With its favorable safety and tolerability profile, iloperidone may offer an alternative treatment option to existing antipsychotics for patients with schizophrenia.

      News in Depression

      Adjunctive Therapy Effective for MDD

       The Particulars: Previous clinical trials have shown that adjunctive aripiprazole was efficacious and well tolerated in patients with major depressive disorder (MDD) who have inadequate responses to standard antidepressant therapy (ADT).

       Data Breakdown: Patients with MDD who took standard ADT and had an inadequate response after 8 weeks were randomized to a 6-week phase with adjunctive placebo or adjunctive aripiprazole (2 mg/day to 20 mg/day). The relative gain of response and remission with adjunctive aripiprazole compared with ADT monotherapy was 1. Compared with ADT monotherapy, patients with adjunctive aripiprazole were almost twice as likely to be in the greater benefit-risk category.

       Take Home Pearl: When compared with ADT monotherapy, adjunctive aripiprazole treatment was associated with an improved benefit-risk profile in the treatment of MDD.

      Combination Treatment Benefits TRD

       The Particulars: Research has suggested that a combination of olanzapine/fluoxetine is both effective and safe for treatment-resistant depression (TRD).

       Data Breakdown: Patients with TRD were defined as having failed to respond to a non-fluoxetine antidepressant during the current episode plus having failed to respond to fluoxetine during an 8-week lead-in phase. After conducting an 8-week open-label extension trial, investigators found that patients receiving olanzapine/fluoxetine had lower depression rating scale scores than those taking either fluoxetine or olanzapine. The largest single-week of depression rating score changes occurred in the first week following the switch to the combination. The remission rate was 41.5% by the end of open-label treatment.

       Take Home Pearl: TRD patients receiving olanzapine/fluoxetine exhibited improvements in depressive symptoms during an 8-week open-label extension.

      News in Bipolar Disorder

      Using Mood Stabilizers in Bipolar II Depression

       The Particulars: Treatment strategies for patients with bipolar II disorder are not always clear, but often include combination therapy with antidepressants and mood stabilizers or single-agent therapy. Investigators sought to determine if patients diagnosed with bipolar II depression who had an inadequate response to lamotrigine monotherapy would benefit from augmentation with bupropion.

       Data Breakdown: Patients with bipolar II depression who were started on open label lamotrigine were randomized to augmentation with bupropion or placebo. No separation was observed between bupropion and placebo patients on scales of either depression or mania, and no subjects experienced treatment-emergent hypomania.

       Take Home Pearl: Lamotrigine monotherapy for bipolar II depression appeared to be effective with and without combination use with an antidepressant, warranting further research.

      Other News From APA

      Analyzing Anxiety Disorders in Pregnancy

       The Particulars: The course of anxiety disorders, including obsessive-compulsive disorder, post-traumatic stress disorder, panic disorders, and generalized anxiety disorders, in pregnancy has not been thoroughly investigated to determine their course and the severity of anxiety.

       Data Breakdown: Investigators prospectively followed patients with these disorders at 4-to-6 week intervals for depressive symptoms and overall severity. The majority of women with anxiety disorders appeared to experience significantly worse symptoms related to their disorders during pregnancy.

       Take Home Pearl: Given the potential impact of maternal anxiety on obstetrical and child outcomes, there is an urgent need to delineate the course and predictors of severity for anxiety disorders during pregnancy.

      The Needs & Barriers to Access of Mental Health Information

       The Particulars: There has been a proliferation of publicly available information on mental health disorders, but little research has investigated usage patterns or barriers to access. Using a sample of patients, family members, and providers, researchers sought to evaluate review sources of information most frequently accessed and assessed perceived barriers to access and utilization.

       Data Breakdown: Using survey data from 1,591 providers and 259 patients or their family members, researchers found that patients and family members endorse medications (58.1% and 51.7%, respectively) as the topic for which they are most frequently seeking information. These individuals also indicated that their mental health practitioner was the information source they most often turn to, but that they often felt overwhelmed by the information they found. Providers reported that the greatest barrier to recommending mental health information surrounded concerns about the quality and reliability of available information.

       Take Home Pearl: Patients and providers appear to endorse factors that would impact access to mental health information as well as recommendations from this information.

      Paul Summergrad, MD has indicated to Physician’s Weekly that he has no financial disclosures to report.