The American Psychiatric Association held its 2010 annual meeting from May 22 to 26 in New Orleans. The features below highlight some of the news emerging from the meeting.
» A Strategy to Improve PTSD Outcomes
» Assessing Body Image in Anorexia Nervosa
» New Insights on Opioid Dependence
» Spotting College Depression With E-Mail
» Does Bipolar Disorder Increase Hypertension Risks?
The Particulars: Randomized controlled trials have shown that sertraline, an SSRI, and prolonged exposure (PE) are effective treatments for PTSD, but these treatment strategies are very different from each other. With PE, patients are encouraged to directly approach their trauma memories and trauma-related fears. With SSRI use, a level of engagement with trauma-related stimuli is not required.
Data Breakdown: In a doubly randomized preference trial, researchers compared SSRI use and PE use and assessed efficacy for chronic PTSD and how patient preference for one strategy over the other may influence the treatment effect. Overall, both PE and SSRI interventions demonstrated good efficacy. Patients who had no choice in their treatment had more diminished effects. Response rates were higher among patients who had a choice (80%) as compared with a 55% rate for patients who were not allowed to choose their treatment. Patients who did not receive their preferred treatment tended to have more severe PTSD, as well as depression and anxiety.
Take Home Pearls: Outcomes for patients with PTSD appear to improve when patient preference is taken into account as treatments are prescribed. Treatment with SSRIs and treatment via PE were both effective, but outcomes were optimized among patients who received the treatment they preferred.
Assessing Body Image in Anorexia Nervosa [Back to Top]
The Particulars:Body image distortion is one of the key required symptoms for the diagnosis of anorexia nervosa (AN). It can be challenging for clinicians to measure body image distortion. The Body Image Software (BIS) program has previously been used to measure perception of body size in obese individuals, physically and sexually abused children, normal children over time, college students, and women in different phases of the menstrual cycle, but not in patients with AN.
Data Breakdown:Researchers used the BIS program on 66 female teenagers and young adults with acute AN to assess the level of body distortion patients had and their drive for thinness. Study participants perceived their body size as 10.4% larger than it actually was, and the average desired body size was 6.8% smaller than participants’ actual body size.
Take Home Pearls:The BIS program appears to objectively assess body image distortion in patients with AN, including perception of current and desired body size. The software was able to provide an accurate objective measure of body image in a group of acutely ill patients with AN.
New Insights on Opioid Dependence [Back to Top]
The Particulars:Little research is available on the treatment of patients who are dependent on prescription opioids, even though there has been a major increase in prescription opioid abuse. There has also been an increase in the number of people entering treatment for addiction to these medications.
Data Breakdown:In a study of 653 people with prescription opioid dependence (POD), researchers assessed outcomes of adding individual drug counseling to buprenorphine-naloxone plus standard medical management, the optimal duration of buprenorphine for POD patients, and the role of current chronic pain on outcomes. At the end of a phase that included 1 month of tapering opioids and 2 months of stabilization, few patients were successfully treated, and enhanced management did not influence the results. At the end of the stabilization phase (12 weeks), substantial improvement was noted for patients, but there was no additional benefit to enhanced management. By the end of the stabilization period, many patients had relapsed again.
Take Home Pearl:In patients who are dependent on prescription opioids, tapering with buprenorphine—either initially or after a period of substantial abuse—appears to lead to relapse.
Spotting College Depression With E-Mail [Back to Top]
The Particulars:Identifying depression in college students and increasing treatment for it can be challenging for clinicians. Researchers sent a demographic survey and the Patient Health Questionnaire 9-Item (PHQ-9) screening tool for depression in e-mail blasts to students at four colleges to assess rates of depression and the utilization of treatments for it among students.
Data Breakdown:The survey and screening were completed by 631 students, and the prevalence of major depressive disorder was 14.5% among recipients. Overall, 21.7% reported a history of depression, and 9.4% were currently receiving treatment. Few students who screened positive for depression with the PHQ-9 used online educational resources or on-campus peer health support groups provided in the e-mail. Of the 82 students determined to have major depressive disorder, only seven used the online health information resource links, and just one attended on-campus counseling groups.
Take Home Pearls:E-mail appears to be a simple and inexpensive way to screen college students for depression, but this strategy is unlikely to motivate depressed college students to seek treatment. Tailoring of e-mail tools more specifically to college students may improve motivation to seek treatment.
Does Bipolar Disorder Increase Hypertension Risks? [Back to Top]
The Particulars: Previous research has suggested that there may be a link between bipolar disorder and hypertension. Patients with bipolar disorder have a disproportionate burden of cardiometabolic disorders, including heart disease, metabolic syndrome, and stroke. However, the underlying mechanisms of this association are not well understood.
Data Breakdown: A single-center study found that the prevalence of hypertension among patients with bipolar disorder was 45%, compared with 30.5% in the general population. There was a high prevalence of smoking among bipolar patients with hypertension, and 37% were obese. Hypertensive patients were older (mean age, 44 vs 37 years, respectively) and more obese (mean BMI, 33 kg/m2 vs 28 kg/m2). They also had higher mean scores on a mania scale and earlier onset of bipolar disorder.
Take Home Pearls: Patients with bipolar disorder appear to have a higher prevalence of hypertension than the general population. More research is needed to analyze the role of medications for bipolar disorder and their effect on hypertension.
For more information on these news items and other research that was presented at the meeting, go to www.psych.org/AnnualMeeting.