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The neuropsychology of obsessive-compulsive personality disorder: A new analysis
CNS Spectrums, 03/19/15
Fineberg NA, et al. – The current study investigated the neurocognitive profile in a nonclinical community–based sample of people fulfilling diagnostic criteria for obsessive compulsive personality disorder (OCPD) in the absence of major psychiatric comorbidity. Nonclinical cases of OCPD showed significant cognitive inflexibility coupled with executive planning deficits, whereas decision–making remained intact. This profile of impairment overlaps with that of OCD and implies that common neuropsychological changes affect individuals with these disorders.
Pharmacological management of persistent hostility and aggression in persons with schizophrenia spectrum disorders: A systematic review
The Journal of Neuropsychiatry & Clinical Neurosciences, 02/10/15
Victoroff J, et al. – The authors undertook a systematic review of the English language literature to determine the efficacy of neuropharmacological agents for the management of hostility and aggression among persons with SSDs. Paliperidone–extended release currently appears to be the agent for the management of hostility among inpatients with SSDs for which there is the strongest evidence of efficacy.
  • The search combined findings from the Medline, EMBASE, and PsycINFO databases.
  • Ninety-two full text articles were identified that reported relevant findings.
  • The American Academy of Neurology criteria were used to determine levels of evidence.
  • Paliperidone-extended release is probably effective for the management of hostility among inpatients with SSDs who have not been preselected for aggression (Level B).
  • Clozapine is possibly more effective than haloperidol for the management of overt aggression and possibly more effective than chlorpromazine for the management of hostility among inpatients with SSDs who have not been preselected for aggression (Level C).
  • Clozapine is also possibly more effective than olanzapine or haloperidol for reducing aggression among selected physically assaultive inpatients (Level C).
  • Adjunctive propranolol, valproic acid, and famotidine are possibly effective for reducing some aspects of hostility or aggression among inpatients with SSDs (Level C).
The Optimization of Treatment and Management of Schizophrenia in Europe (OPTiMiSE) trial: Rationale for its methodology and a review of the effectiveness of switching antipsychotics
Leucht S, et al. – The aim of this article is to review the efficacy of switching antipsychotics in case of nonresponse. The authors also present the European Commission sponsored "Optimization of Treatment and Management of Schizophrenia in Europe" (OPTiMiSE) trial which aims to provide a treatment algorithm for patients with a first episode of schizophrenia. Current literature fails to provide basic guidance for the pharmacological treatment of schizophrenia. The OPTiMiSE trial is expected to provide a basis for clinical guidelines to treat patients with a first episode of schizophrenia.
  • They searched Pubmed (October 29, 2014) for randomized controlled trials (RCTs) that examined switching the drug in nonresponders to another antipsychotic.
  • They described important methodological choices of the OPTiMiSE trial.

  • They found 10 RCTs on switching antipsychotic drugs.
  • No trial was conclusive and none was concerned with first-episode schizophrenia.
  • In OPTiMiSE, 500 first episode patients are treated with amisulpride for 4 weeks, followed by a 6-week double-blind RCT comparing continuation of amisulpride with switching to olanzapine and ultimately a 12-week clozapine treatment in nonremitters.
  • A subsequent 1-year RCT validates psychosocial interventions to enhance adherence.
Escitalopram in the prevention of posttraumatic stress disorder: A pilot randomized controlled trial
BMC Psychiatry, 02/27/15
Suliman S, et al. – The data are consistent with other recent work indicating that the SSRIs may not be efficacious in the prevention of PTSD. Nevertheless, the small sample size and baseline differences between groups limit the explanatory power of the study. Although a consideration of the possibility of medication prophylaxis in PTSD remains important, both from conceptual and clinical perspectives, caution is needed with regards to the use of SSRIs until their efficacy can be proven.
  • 24 week, double-blind placebo controlled study.
  • 31 participants presenting immediately after trauma, and meeting diagnostic criteria for full or partial acute stress disorder were randomized to treatment with 10–20 mg of escitalopram or placebo daily for 24 weeks.
  • 2 participants were excluded from the analysis due to early drop out, leaving 29 participants (escitalopram = 12, placebo = 17) for inclusion in an intent- to- treat analysis.
  • Participants were followed up until 56 weeks, and assessed with the Clinician Administered PTSD Scale (CAPS).
  • A mixed model repeated measures analysis of variance (RMANOVA) was undertaken to determine the efficacy of the intervention on the CAPS score.

  • There was a significant reduction in CAPS score over the course of treatment (F(7, 142) = 41. 58, p < 0.001) in both the escitalopram and placebo groups, with a greater reduction in CAPS score in the placebo group F(7, 142) = 2.12, p = 0.045.
  • There were improvements on all secondary measures, including the Clinical Global Impressions scale, and scales assessing depression, anxiety and disability.
  • Only functional disability outcomes (F(7, 141) = 2.13, p = .04), were significantly different between treatment and placebo groups.
  • In the sample as a whole, improvement in scores were maintained at the 52 week follow-up.
  • Side effects were comparable between the groups.

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