The Journal of clinical psychiatry
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Performance Improvement CME (PI CME) is an educational activity in which clinicians retrospectively assess their current clinical practice, choose areas for improvement and implement interventions based on treatment guidelines and health care standards, and then re-evaluate their clinical practice to assess the improvements made. This PI CME activity focuses on improving the safety and efficacy of treating chronic pain with opioid medications.
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Exploring regional variation in antipsychotic coprescribing practice: a Danish questionnaire survey.
The pharmacologic treatment of schizophrenia is characterized by excessive use of antipsychotic polypharmacy, which reflects a gap between evidence and practice. The aim of the present study was to investigate regional differences in treatment setting characteristics and in physician and nurse attitudes toward antipsychotic polypharmacy and clinical guidelines. ⋯ Albeit no causal relationships can be inferred from this cross-sectional observational study, we recommend the furtherance of a treatment environment characterized by easily accessible clinical guidelines, frequent academic activities, and an unruffled atmosphere.
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Fibromyalgia affects an estimated 2% of the American population. Current understanding explains it as a neurologic disorder of central pain processing that causes the perception of pain in response to stimuli that in healthy individuals would not be painful. ⋯ Unfortunately, because of the chronic nature of the pain condition and associated counterproductive behaviors and disability, patients and physicians may rapidly become frustrated with each other and abandon the pursuit of adequate diagnosis and treatment. If the physician instead recognizes the diagnostic pattern of pain and appreciates the real nature of the underlying pathology, then he or she can be of great benefit to patients and their families in managing this chronic disease.
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Randomized Controlled Trial Multicenter Study
Adjunctive armodafinil for major depressive episodes associated with bipolar I disorder: a randomized, multicenter, double-blind, placebo-controlled, proof-of-concept study.
To evaluate the efficacy and safety of armodafinil, the longer-lasting isomer of modafinil, when used adjunctively in patients with bipolar depression. ⋯ In this proof-of-concept study, adjunctive armodafinil 150 mg/d appeared to improve depressive symptoms according to some, but not all, measures and was generally well tolerated in patients with bipolar depression.
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Interactive Tutorial
Nosology, diagnostic challenges, and unmet needs in managing bipolar disorder.
The spectrum of bipolar disorders includes the subtypes of bipolar I disorder, bipolar II disorder, cyclothymic disorder, and bipolar disorder not otherwise specified (NOS). Because depression is the most pervasive symptom of bipolar disorder, this condition is frequently misdiagnosed as unipolar major depressive disorder. ⋯ To help meet this important diagnostic challenge, various markers have been identified that have predictive value for a bipolar outcome, including early onset of depression, family history of bipolar disorder, atypical depressive symptoms, and the presence of psychosis. Unmet needs in the management of bipolar disorder include an enhanced diagnostic process, more options for treating bipolar depressive episodes, and safer, more tolerable medications for long-term maintenance treatment.