This issue contains a number of psychopathological as well as treatment-related research.
The predictors of anxiety symptoms in a gynecological outpatient setting in Thailand have been evaluated by Roomruangwong and colleagues. It emerged that 37% of patients attending a gynecological outpatient service met clinically meaningful levels of anxiety. However, the question remains of how many of them need additional support and/or mental health services in order to prevent the development of serious psychiatric problems.
A number of patients do not respond to the first antidepressant treatment. Therefore, the study of Romera et al. is of practical importance since the authors studied the switch from selective serotonin reuptake inhibitors (SSRIs) to duloxetine, the dual acting antidepressants. This post-hoc analysis of the pooled data of a Spanish sample, in which 156 patients switched from SSRIs to duloxetine, revealed that the switch was associated significant improvement in emotional and painful symptoms of depression and that duloxetine was well-tolerated in patients previously not responding to SSRIs.
After the success of conventional mirtazapine tablets, a fast dissolving formulation (FDT) for mirtazapine has been introduced. Pooled data of a posteriori analysis of a total of 30 studies including 3510 patients have been evaluated by Delini-Stula and colleagues. It emerged that FDT was associated with better compliance, taste, ease and overall convenience of use compared to the conventional formulation. This study emphasizes that different formulations of chemical substances should be available in the armamentarium for psychiatric patients.
The Mood Disorder Questionnaire (MDQ), originally published by Hirschfeld and colleagues and based on a sample in the US, has been used in 53 outpatients, who have been treated for unipolar depression in a research center in Taiwan, by Wang et al. 11.3% of patients were diagnosed with bipolar spectrum disorder. The study emphasizes the misdiagnoses of bipolar disorder as unipolar depression, which is in so far important since this group of patients necessitates another treatment approach than unipolar depression.
An algorithm-driven treatment for bipolar disorder was evaluated by Jon and colleagues. It emerged that the majority of manic patients demonstrated a treatment response at the starting step and that an atypical antipsychotic drug was coadministered with a mood stabilizer from the beginning of treatment in almost all manic patients. The participating investigators were asked to follow the Korean Medication Algorithm Project, which was established in 2002. It emerged that 73% of patients were treated according to this algorithm. The authors conclude that this algorithm can be implemented effectively and safely in clinical practice. However, since new data emerge, specifically in the area of bipolar disorder, it is important to emphasize that algorithms need to be updated on a regular basis.
The use of antidepressants in bipolar disorder is quite controversially discussed in daily practice and in the scientific literature. Kang and colleagues used a retrospective chart review, which included 87 bipolar patients. The patients were treated for a depressive episode by adding antidepressant to an on-going mood stabilizing medication. During the 6-month follow-up period, it was evaluated if the administration of antidepressants was associated with mood changes. Based on the results, the colleagues summarized that there is heterogeneous treatment response in bipolar depression to adjunctive antidepressants and that antidepressant medication should be discontinued within 8 weeks after improvement to euthymia to minimize the risk of manic switching. There was no indication that either one of the administered antidepressants was specifically associated with a manic switch. However, as the patients were treated with different compounds, the numbers are too small to allow a differentiation.
An 18-month survey, in which patients with psychotic disorders received long-acting injectable risperidone (RLAI) in combination with psychosocial interventions as part of daily clinical practice in France, has been conducted by Viala and colleagues. Of the total of 120 patients included in this survey, it emerged in a mirror imaging design that patients had fewer and shorter hospitalizations during the 18-month RLAI treatment compared to the preceding 18 months. The study indicate that patients with psychotic disorders benefit from one bimonthly injection integrated in the psychosocial treatment program.
A preference for symmetrical rectangles in schizophrenic patients emerged from a Japanese study, published by Iwamitsu and colleagues. They found that schizophrenic patients, when compared with healthy university students, showed a stronger preference for symmetrical, rather than asymmetrical figures. The authors conclude that this finding reflects the generally static stances and poor flexibility as well as a defect in their ability to synthesize a whole object from its parts. Furthermore, this finding elucidates on the cognitive disturbances in schizophrenic patients, which has been documented in a large number of studies.
Simon conducted a meta-analysis of 15 studies, published between 1982 and 2006, in which patients received psychotherapy for Cluster C personality disorders. The results indicated that most of the improvement occurred between pretreatment and posttreatment and often during the follow-up period, although to a lesser extent. It emerged that cognitive-behavioral and psychodynamic approaches, along with social skills training, are found to be generally beneficial for Cluster C patients. However, ambiguity remains when there is a differential effect between the personality disorders within Cluster C.
We do hope that the articles and reports in this issue will provide further evidence for a better understanding and treatment of psychiatric patients. Siegfried Kasper