Physician's Weekly Article - Conference Highlights: The 2009 APA Annual Meeting

       The American Psychiatric Association held its 2009 annual meeting May 16-21 in San Francisco. The features below highlight 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.

      Bipolar Disorder News

      Who Receives Appropriate Bipolar Depression Pharmacotherapy?

      The Particulars: Previous reports suggest that many individuals with comorbid bipolar I disorder and depression do not receive guideline-based pharmacotherapy. Investigators recorded data in inpatients with a clinical diagnosis of bipolar I disorder with depression. Pharmacotherapy was blindly rated as consistent or not with published guidelines.

      Data Breakdown: Most patients in the study (82.6%) received a mood stabilizer, and 72.6% received an atypical antipsychotic. Atypical antipsychotics were more likely to be prescribed to African Americans (87.9%) than Caucasians (68.9%), Latinos (82.1%) and other races (71.4%) and to patients with psychotic features (88.4% vs 65.6%). Women were less likely to be prescribed a mood stabilizer than men and were more likely to receive an atypical antipsychotic in the absence of a mood stabilizer. Patients with psychotic features or borderline personality disorder were more likely to receive more than four psychotropic medications. African Americans were least likely to be prescribed more than four psychotropic medications.

      Take Home Pearl: Many patients do not appear to receive guideline-based treatment, and women and patients with psychotic features or borderline personality disorder appeare to be at increased risk of treatment.

      Depression News

      Managing Antidepressant-Induced Excessive Sweating

      The Particulars: Antidepressant-induced excessive sweating (ADIES) occurs in 5% to 14% of patients on antidepressants. It usually persists and causes distress and functional impairment. A trial of open-label terazosin, an unselective alpha-1 blocker (1 mg/day to 6 mg/day), was administered to 16 patients with moderate or greater ADIES who were on stable doses of antidepressants. Researchers also developed and pilot tested the Ambulatory Measurement of Excessive Sweating (AMES) device.

      Data Breakdown: Patients receiving terazosin experienced overall improvements in severity of ADIES, and all were considered responders to therapy. Based on daily self-ratings, daytime sweating severity and duration and nighttime sweating severity were statistically significantly reduced. Adverse effects occurring in more than one patient were dizziness and dry mouth. No significant changes in pulse, blood pressure, orthostatic change in blood pressure, and ECG’s were found. AMES recorded skin conductance/temperature and ambient temperature/humidity once a minute. Sweating severity and duration were measured. AMES captured both sweating episodes noted by patients in daily diaries and additional episodes. Patients who used the AMES device rated it positively.

      Take Home Pearl: Terazosin may be very effective and relatively well-tolerated for this important but neglected side effect, and the AMES device may be a valuable adjunct to assessments.

      CV Risk Factors & Antidepressant Treatment Response

      The Particulars: Patients with depression often have a disproportionate burden of cardiovascular (CV) risk factors. Researchers examined the impact of CV risk factors on treatment outcomes for depression in patients receiving antidepressant treatment.

      Data Breakdown: Patients in the study who received electroconvulsive therapy had a disproportionately high prevalence of CV risk factors. The presence of CV risk factors was associated with a later onset of depression. Age of onset of depression was 36 years in patients with diabetes, compared with 30 years in those without diabetes. For those with dyslipidemia, age of onset of depression was 34 years compared with 29 years for others. Age of onset was 33 years in hypertensive individuals compared with 29 years in normotensive patients.

      Take Home Pearl: The presence of CV risk factors in patients hospitalized for depression appears to be associated with a later onset of depressive illness and with non-response to antidepressant medications.

      Schizophrenia News

      Adjunctive Treatment May Improve Schizophrenia Symptoms

      The Particulars: Armodafinil has been shown to improve wakefulness, memory, and attention in patients with excessive sleepiness. A 4-week, double-blind, placebo-controlled, proof-of-concept study evaluated the tolerability and efficacy of adjunctive armodafinil therapy to olanzapine, oral risperidone, or paliperidone in 60 adults with schizophrenia.

      Data Breakdown: When compared with placebo, patients receiving 200 mg/day of adjunctive armodafinil showed greater reductions in schizophrenic negative symptom scale scores and in total symptom scale scores. However, no significant differences were observed in positive symptom scale scores. No improvements were observed in cognitive deficits with armodafinil when compared with placebo. Armodafinil was generally well tolerated.

      Take Home Pearl: Armodafinil (200 mg/day) as an adjunctive treatment may improve the negative symptoms of schizophrenia without worsening positive symptoms over 4 weeks, but more studies are needed to confirm these findings.

      Analyzing CVD Symptoms in SSDs

      The Particulars: Previous evidence has demonstrated that atypical antipsychotics, smoking, poor diet, and low physical activity are risk factors for cardiovascular disease (CVD) symptoms. The risk of CVDs associated with schizophrenia-spectrum disorders (SSDs) was assessed.

      Data Breakdown: SSDs were associated with a four-fold increase in the odds of developing more than one CVD symptom and a three- to four-fold increase in the odds of individual CVD symptoms. Results remained after controlling for psychiatric conditions and substance abuse. Individual SSD symptoms were associated with increased odds of CVD symptoms. Depressive disorders, substance abuse, and anxiety spells/attacks were associated with an increased risk of more than one CVD symptom.

      Take Home Pearl: SSDs appear to be associated with an elevated risk of CVD symptoms, independent of the effects of atypical antipsychotics, smoking, diet, and physical activity level.

      Other Psychiatric News

      Metabolic Symptoms Among Adolescent Psychiatric Inpatients

      The Particulars: The prevalence of metabolic syndrome (MetS) symptoms in psychiatric inpatients between the ages of 12 and 17 has not been well characterized in previous studies. Researchers reviewed a sample of 698 admitted adolescents and examined associations between criteria for MetS and demographic, diagnostic, and treatment variables.

      Data Breakdown: More than a third (36.1%) of the sample was positive for one or more of MetS criteria, including elevated triglycerides, increased waist circumference, decreased HDL cholesterol, and hypertension. Three variables associated with having at least one MetS criteria were 1) being female, 2) receiving treatment with atypical antipsychotics, and 3) receiving more than two psychotropic drugs.

      Take Home Pearl: More than a third of adolescent psychiatric inpatients appear to meet at least one of the criteria for MetS, and women, Latinos, and those exposed to certain psychotropics appear to be at relatively greater risk.