Archives of general psychiatry
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Arch. Gen. Psychiatry · Aug 2010
Randomized Controlled Trial Comparative StudyA randomized add-on trial of an N-methyl-D-aspartate antagonist in treatment-resistant bipolar depression.
Existing therapies for bipolar depression have a considerable lag of onset of action. Pharmacological strategies that produce rapid antidepressant effects-for instance, within a few hours or days-would have an enormous impact on patient care and public health. ⋯ In patients with treatment-resistant bipolar depression, robust and rapid antidepressant effects resulted from a single intravenous dose of an N-methyl-D-aspartate antagonist.
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Arch. Gen. Psychiatry · Aug 2010
Randomized Controlled Trial Multicenter Study Comparative StudyCost-effectiveness analysis of a rural telemedicine collaborative care intervention for depression.
Collaborative care interventions for depression in primary care settings are clinically beneficial and cost-effective. Most prior studies were conducted in urban settings. ⋯ In rural settings, a telemedicine-based collaborative care intervention for depression is effective and expensive. The mean base case result was $85 634/QALY, which is greater than cost per QALY ratios reported for other, mostly urban, depression collaborative care interventions.
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Arch. Gen. Psychiatry · Aug 2010
Comparative StudyShort-term effects of antipsychotic treatment on cerebral function in drug-naive first-episode schizophrenia revealed by "resting state" functional magnetic resonance imaging.
Most of what we know about antipsychotic drug effects is at the receptor level, distal from the neural system effects that mediate their clinical efficacy. Studying cerebral function in antipsychotic-naive patients with schizophrenia before and after pharmacotherapy can enhance understanding of the therapeutic mechanisms of these clinically effective treatments. ⋯ We demonstrate for the first time, to our knowledge, that widespread increased regional synchronous neural activity occurs after antipsychotic therapy, accompanied by decreased integration of function across widely distributed neural networks. These findings contribute to the understanding of the complex systems-level effects of antipsychotic drugs.
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Arch. Gen. Psychiatry · Aug 2010
Comparative StudyEffects of expectation on placebo-induced dopamine release in Parkinson disease.
Expectations play a central role in the mechanism of the placebo effect. In Parkinson disease (PD), the placebo effect is associated with release of endogenous dopamine in both nigrostriatal and mesoaccumbens projections, yet the factors that control this dopamine release are undetermined. ⋯ The strength of belief of improvement can directly modulate dopamine release in patients with PD. Our findings demonstrate the importance of uncertainty and/or salience over and above a patient's prior treatment response in regulating the placebo effect and have important implications for the interpretation and design of clinical trials.
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Arch. Gen. Psychiatry · Aug 2010
Comparative StudyPrenatal smoking exposure and the risk of psychiatric morbidity into young adulthood.
Prenatal smoking exposure modulates brain development, which may deviate mental development of the offspring. ⋯ Prenatal smoking exposure is associated with an increased risk of psychiatric morbidity, whereas prenatal exposure to more than 10 cigarettes a day increases the risk of mortality in childhood, adolescence, and young adulthood.