The American journal of psychiatry
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Comment Letter
Integration of mental health care and supported employment.
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Randomized Controlled Trial Comparative Study
Effectiveness of clozapine versus olanzapine, quetiapine, and risperidone in patients with chronic schizophrenia who did not respond to prior atypical antipsychotic treatment.
When a schizophrenia patient has an inadequate response to treatment with an antipsychotic drug, it is unclear what other antipsychotic to switch to and when to use clozapine. In this study, the authors compared switching to clozapine with switching to another atypical antipsychotic in patients who had discontinued treatment with a newer atypical antipsychotic in the context of the Clinical Antipsychotic Trials for Interventions Effectiveness (CATIE) investigation. ⋯ For these patients with schizophrenia who prospectively failed to improve with an atypical antipsychotic, clozapine was more effective than switching to another newer atypical antipsychotic. Safety monitoring is necessary to detect and manage clozapine's serious side effects.
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Comparative Study
Hippocampal and amygdalar volumes in dissociative identity disorder.
Smaller hippocampal volume has been reported in several stress-related psychiatric disorders, including posttraumatic stress disorder (PTSD), borderline personality disorder with early abuse, and depression with early abuse. Patients with borderline personality disorder and early abuse have also been found to have smaller amygdalar volume. The authors examined hippocampal and amygdalar volumes in patients with dissociative identity disorder, a disorder that has been associated with a history of severe childhood trauma. ⋯ The findings are consistent with the presence of smaller hippocampal and amygdalar volumes in patients with dissociative identity disorder, compared with healthy subjects.
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Randomized Controlled Trial Comparative Study
Effectiveness of olanzapine, quetiapine, risperidone, and ziprasidone in patients with chronic schizophrenia following discontinuation of a previous atypical antipsychotic.
In the treatment of schizophrenia, changing antipsychotics is common when one treatment is suboptimally effective, but the relative effectiveness of drugs used in this strategy is unknown. This randomized, double-blind study compared olanzapine, quetiapine, risperidone, and ziprasidone in patients who had just discontinued a different atypical antipsychotic. ⋯ Among this group of patients with chronic schizophrenia who had just discontinued treatment with an atypical antipsychotic, risperidone and olanzapine were more effective than quetiapine and ziprasidone as reflected by longer time until discontinuation for any reason.
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Comparative Study
Trauma, PTSD, and substance use disorders: findings from the Australian National Survey of Mental Health and Well-Being.
The aim of the present study was to examine the association between trauma and posttraumatic stress disorder (PTSD) and substance use disorders and to examine the correlates of substance use disorder plus PTSD comorbidity in the Australian general population. ⋯ It is important that individuals entering treatment for substance use disorder or PTSD be assessed for this comorbidity. The addition of either disorder may present complications that need to be considered for the provision of appropriate treatment. Further research is necessary to ascertain which treatments are most effective in treating comorbid substance use disorder plus PTSD.