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Am J Psychiatry 2013;170:A14-A14. doi:10.1176/appi.ajp.2012.1702issue
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Copyright © 2013 by the American Psychiatric Association

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Resilience and lack of depression had effects comparable to that of physical health (Jeste et al., p. 188)

Jeste et al. (CME, p. 188) were surprised to find that self-rated “successful aging” was more common in the oldest respondents to a survey of 1,006 community-dwelling adults ages 50 to 99. Greater age was associated with worse physical and cognitive functioning but also with higher levels of optimism and resilience and less depression. People with the poorest physical functioning who had high degrees of resilience had self-ratings of successful aging similar to those of physically healthy people with low resilience (figure). In an editorial, Grodstein (p. 143) advocates prospective research that could help establish causal relationships among subjective and objective responses to aging.

Clinical Guidance: Clozapine in First-Episode Schizophrenia 

First-episode schizophrenia has a high rate of response to standard treatments. The limited evidence on clozapine as a first-line treatment so far does not show greater efficacy at 1 year. Remington et al. (p. 146) consider the possibility of clozapine as a second-line treatment if one is needed, based on the evidence that other atypical antipsychotics have low response rates as second-line treatment, whereas clozapine as a third choice is often successful. The added burden of regular blood testing with clozapine as a second-line treatment is offset by the opportunity for earlier response, which may decrease longer term disability.

Clinical Guidance: Clinical Assessment Interview for Negative Symptoms 

The recently developed Clinical Assessment Interview for Negative Symptoms (CAINS) distinguishes behavior from experience in its two scales: expression and motivation/pleasure. Among 162 outpatients with schizophrenia or schizoaffective disorder studied by Kring et al. (p. 165), the scores on both scales were related to specific aspects of functioning, thus providing useful treatment targets. Scores are not influenced by cognition. Use of the CAINS is facilitated by built-in interview prompts, anchor points for individual items, and a training manual and videos. The editorial by Barch (p. 133) highlights the instrument’s broad symptom coverage, differentiation of anticipation and experience, and good reliability.

The low prevalence rates, 0.8% to 3.3%, for the new diagnosis of disruptive mood dysregulation disorder in three large community samples of children suggest that the diagnosis will not be extensively applied to children with normal behavior. Copeland et al. (p. 173) found that although the core symptoms are common, the criteria regarding frequency, duration, and context exclude most children. The diagnosis is associated with high levels of social impairment, school suspension, service use, and poverty. It frequently co-occurs with other psychiatric conditions, especially oppositional defiant disorder and depressive disorders, but Axelson notes in an editorial (p. 136) that disruptive mood dysregulation disorder overlapped only partially with severe mood dysregulation, the research diagnosis on which it was based.

Total spending for patients with bipolar disorder or major depression did not change significantly after the 2001 implementation of insurance parity for mental health and substance use disorders in the Federal Employees Health Benefits Program. For a less severe illness, adjustment disorder, overall spending and psychotherapy visits did decline, perhaps as a result of benefit management. Busch et al. (p. 180) report that out-of-pocket spending decreased for all three diagnoses. McCarty points out in an editorial (p. 140) that empirical evidence consistently finds little or no impact on costs related to the introduction of parity. Lower out-of-pocket costs protect patients’ financial stability but do not cause more individuals to enter care for severe mood disorder.

Resilience and lack of depression had effects comparable to that of physical health (Jeste et al., p. 188)




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