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This Week in Psychiatry — 5/30/11

May 26, 2011

Adjunctive Aripiprazole Effective in Geriatric MDD Patients

The International Journal of Geriatric Psychiatry recently published a study reviewing the effi- cacy of adjunctive aripiprazole, compared to standard antidepressant therapy, for MDD in younger (18–49 years of age) and older (50–67 years of age) patients. By endpoint, the older patients receiving aripiprazole had a greater improve- ment in MADRS total score versus placebo. These improvements were similar to those seen in the younger group. The older patients receiving aripiprazole also had a 32.5% remis- sion rate, compared to 17.1% of patients receiving placebo. The younger patients had a 26.9% remission rate, compared to 16.4% of placebo patients.

Characteristics of Sexual Dysfunction in First-Episode Schizophrenia

A report from the European First Episode Schizophrenia Trial examined characteristics of sexual dysfunction in first-episode schizophrenia. Higher Positive and Negative Syndrome Scale (PANSS) scores and higher prolactin levels were associated with erectile dysfunction and ejaculatory problems in men; more PANSS negative symptoms and older age were also associated with decreased libido. In women, higher prolactin levels were associated with amenorrhea, and PANSS negative symptoms also predicted decreased libido in women. Higher prolactin levels in men and women were significantly more prevalent in patients receiving amisulpride, an atypical antipsychotic not approved for use in the US. The authors concluded that sexual dysfunction in schizophrenia seems to result from both medication side effects and the inherent nature of schizophrenia.

Reducing Inpatient Rates of Restraint and Seclusion

Multiple behavioral interventions can decrease the frequency of seclusion and restraint in inpatient psychiatric settings, reports a recent study in Psychiatric Services. Five inpatient units in a large US hospital were randomized to implement intervention com- ponents in a varying order, including changes to the unit’s rules and language, additional trauma care training for staff, changes to the physical environment, and more patient involvement in care. There was a postintervention reduction of 82.3% in patient seclusion or restraint days over 3.5 years, which the authors attributed to changes in the physical environment.

“This Week in Psychiatry” is written Christopher Naccari and Lonnie Stoltzfoos

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