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Am J Psychiatry 2013;170:A16-A16. doi:10.1176/appi.ajp.2013.1708issue
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Copyright © 2013 by the American Psychiatric Association

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Adaptive treatment in the week before smoking cessation significantly raises abstinence rates (Rose and Behm, p. 860)

Clinical Guidance: Adaptive Smoking Cessation Treatment 

Smokers who do not experience a 50% decrease in smoking while using nicotine patch therapy in the week before the quit date benefit from addition of bupropion to the patch treatment or a switch to varenicline. Rose and Behm (CME, p. 860) also found that smoking can be reliably quantified by the patient’s own report of the number of cigarettes smoked per day and does not require measurement of expired CO. Freedman notes in an editorial (p. 818) that this is the first study to show that a simple test that can be performed in any clinical setting can be used to select more effective smoking cessation treatment.

Premature death was associated with a longer illness duration among 186 adolescent and adult females with anorexia nervosa who were studied for an average of 20 years. Earlier than average death was also related to alcohol abuse, poor social adjustment, and a lower body mass index, according to findings by Franko et al. (CME, p. 917) over the first 10 years of follow-up. All 14 deaths occurred in middle adulthood, and four were by suicide. Mortality in bulimia nervosa was not significantly more common than the population average. Crow’s editorial (p. 824) notes that the current interest in delivering psychotherapies for eating disorders, particularly family therapies, in adolescence should include attention to the early suicide risk in these disorders.

Clinical Guidance: Emotion Dysregulation in Nonsuicidal Self-Injury 

The combination of a serotonin reuptake inhibitor and dialectical behavioral therapy often helps patients with nonsuicidal self-injury build self-soothing strategies to enhance emotion regulation. Mentalization therapy also holds promise. The typical time of onset for nonsuicidal self-injury is adolescence or young adulthood, a period notable for emotional challenges corresponding with important brain changes. Cullen et al. (p. 828) identify parental antipathy and criticism as important factors in development of nonsuicidal self-injury, and family therapy may be a helpful adjunct. Common coexisting disorders include depression, anxiety, borderline personality disorder, substance abuse, eating disorders, and developmental disorders.

Clinical Guidance: DSM-5 Substance-Related and Addictive Disorders 

Diagnoses for substance use disorders are more straightforward in DSM-5 because the distinction between abuse and dependence was eliminated and the criteria for tobacco use disorder were aligned with those for other substance use disorders. Gambling disorder was added, expanding the scope of the diagnostic category beyond substance use disorders. Hasin et al. (p. 834) also describe the new criterion of craving. Other new diagnoses include cannabis withdrawal disorder and caffeine withdrawal disorder but not caffeine dependence, for which clinical data are still lacking. Withdrawal is now also a criterion for cannabis use disorder.

Clinical Guidance: Improving Functional Outcomes for Bipolar Disorder Patients 

Functional interventions are usually associated with schizophrenia but can also benefit euthymic patients with bipolar disorder who have continuing functional impairment. The 21-week remediation program described by Torrent et al. (p. 852) improved overall functioning more than did pharmacological treatment alone. Functional remediation also increased scores for interpersonal and occupational functioning; 5% of the patients in the training program, but none of those in treatment as usual, were able to get jobs. In his editorial, Hirschfeld (p. 815) emphasizes that the treatment efficacy of pharmacological treatments does not by itself lead to social and occupational recovery.

Adaptive treatment in the week before smoking cessation significantly raises abstinence rates (Rose and Behm, p. 860)



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