Martin B Keller

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..Because treatment-seeking behavior is known to be associated with a worse prognosis, 23 weeks probably represents a lower-limit approximation of the median duration of an untreated depressive episode...

..Anxiety disorders are among the most common comorbid conditions in youth with bipolar disorder, but, to our knowledge, no studies examined the course of anxiety disorders in youth and adults with bipolar disorder...

..8%). Somnolence was significantly greater among the patients taking active medication (15.4%), compared with placebo (4.6%). CONCLUSIONS: Nefazodone is well-tolerated and is an effective maintenance therapy for chronic forms of MDD...

..To report second-year results from the 2-year maintenance phase of a long-term study to evaluate the efficacy and safety of venlafaxine extended release (ER) in preventing recurrence of depression...

..We evaluated the comparative efficacy and safety of venlafaxine extended release (ER) and fluoxetine in the acute and continuation phases of treatment...

..Previous studies have found that few chronically depressed patients remit with antidepressant medications alone...

..These results and the consistency of similar results over time point to the dire need for patient and provider education regarding the signs and symptoms of depression and its treatment...

..This study describes recurrence of major depression despite maintenance pharmacotherapy, termed tachyphylaxis...

..Treatment with nefazodone, CBASP, and combined treatment improved sexual interest/satisfaction, with greatest improvement observed with combined treatment...

..The main purpose of this study was to examine whether NA and AS will also predict the clinical course of PD...

..Overweight/obesity is highly prevalent among adults with bipolar disorder and has been associated with illness severity. Little is known regarding overweight/obesity among youth with bipolar disorder...

..COMB was associated with less symptom re-emergence during the continuation phase than either monotherapy, particularly for partial remitters...

..Daily heavy smokers had greater prevalence of SUD and suicide attempts, and worse depression versus daily light smokers. Smoking among youths with BP is independently associated with suicide attempts and SUD...

..Anxiety disorders are among the most common comorbid conditions in youth with bipolar disorder. We aimed to examine the prevalence and correlates of comorbid anxiety disorders among youth with bipolar disorder...

..The objective of this study was to examine the association of antidepressants with suicide attempts and with suicide deaths...

..To test the long-term efficacy and safety of venlafaxine extended-release (ER) in preventing recurrence in patients with major depression...

..Evidence of psychosocial disability in bipolar disorder is based primarily on bipolar I disorder (BP-I) and does not relate disability to affective symptom severity and polarity or to bipolar II disorder (BP-II)...

..Our purpose was to describe the characteristics of mental health treatment received by primary care patients diagnosed with PTSD...

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..The goal of this study was to develop and validate a brief instrument to screen for bipolar disorder in patients actively ill with major depression...

..Global patient ratings such as the PGI-I, as opposed to specific item-based ratings, provide less valid findings...

..Longitudinally, BP-II is expressed as a dimensional illness involving the full severity range of depressive and hypomanic symptoms. Hypomania of long or short duration in BP-II seems to be part of the same disease process...

..In a well-defined sample, we sought to determine which clinical variables, some of potential nosological relevance, influence subsequent course following prospectively observed initial episodes of hypomania or mania (H/M)...

..Whereas, the relapse rate, once recovery is achieved, is 34% during this 10-year follow-up. Treatment is underutilized in patients with SAD, and a long-term treatment approach may be needed to improve the likelihood of recovery from SAD...

..Although this was not a prevalence study, results indicate a very low occurrence of MAD across 15 primary care settings. Further, they indicate that this diagnosis may not be stable across time and raise doubts about its utility...

..To date, few researchers have examined the natural course of SP in primary care. We examined the natural course and predictors of recovery in a large sample of primary-care patients...

..The QIDS-SR(16) has highly acceptable psychometric properties, which supports the usefulness of this brief rating of depressive symptom severity in both clinical and research settings...

..As nefazodone-mediated blockade of serotonin-2 receptors may directly relieve insomnia associated with depression, we examined the more specific effects of CBASP and nefazodone, singly and in combination, on sleep disturbances...

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..e., full and partial PTSD). This study suggests that, in a primary care setting, PTSD is a persistent illness, and that many subjects who have recovered from PTSD continue to suffer from subthreshold symptoms of PTSD...

..This study examined psychiatric treatment received by primary care patients with anxiety disorders and compared treatment received from primary care physicians and from psychiatrists...

..Earlier research showed that the use of benzodiazepines was not significantly associated with the presence or absence of a history of an AUD over the first year of follow-up. This report extends that investigation...

..In patients who have recovered from an episode of major depression, the presence of psychosocial impairment may help identify who is at increased risk of recurrence...

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..The present study examines the hypothesis that the three antiepileptics approved for bipolar disorder (carbamazepine, lamotrigine, and valproate) are associated with an elevated risk of suicide attempts and suicides...

..Important questions remain as to which anxiety features are important to outcome and how sustained their prognostic effects are over time...

..Because the degree to which anxiety impacts patients with bipolar disorder is not fully known, more information is needed about the relationship between bipolar disorder and anxiety...

..The current study extends previous research by showing that different anxiety disorders and comorbid conditions may be associated with impairment in specific domains of HR-QoL...

..Much remains unknown about the phenomenology of bipolar I disorder...

..Electroconvulsive therapy and psychotherapy offer additional treatment strategies. New nonpharmacologic therapies are under investigation. Remission is the goal of treatment...

..The purpose of this study was to evaluate the usefulness of the CBCL and CBCL-PBD to identify BP in children <12 years old...

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..The findings suggest that sleep disturbance in PTSD may have prognostic significance and may be important to address in clinical interventions...

..The authors examined how the use of psychotropic drugs has shifted over the course of 10 years to determine if prescribing patterns have changed to reflect these revised treatment guidelines...

..It may be that sex differences in the clinical course of anxiety disorders hold prognostic implications for patients with these illnesses...

..The purpose of this study was to examine prospectively the relationship between parental substance use disorders and the course of anxiety disorders in adulthood over the course of 12 years...

..14 over the 8 years. In conclusion, among individuals ascertained for anxiety disorders, the probability of recovering from BDD was relatively high and probability of BDD recurrence was low...

..This study examined the impact of SLEs on relapse in adults already diagnosed with GAD...

..We set out to examine the prevalence and correlates of substance use disorders (SUD) in a large sample of adolescents with bipolar disorder (BP)...

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..Finally, social skills and problem solving may be active elements in CBT for adolescent depression and should be considered in treatment by those working with seriously depressed youths...

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..Symptom severity levels fluctuate, often within the same patient over time. Bipolar I disorder is expressed as a dimensional illness featuring the full range (spectrum) of affective symptom severity and polarity...

..These findings suggest that the presence of comorbid SUD may not explain the level of social and health difficulties associated with the dual diagnosis of PTSD and SUD...

..Studies on the course of major depressive disorder (MDD) among elderly persons are limited to short periods of follow-up, seldom provide comparisons with younger cohorts, and raise other methodological concerns...

..Additional well-designed studies addressing these issues are urgently needed...

..Using data from a longitudinal study of the mood disorders, the investigators address the phenomenon of unipolar mania...

..Thus, although panic symptoms during remission may indicate an increased risk of subsequent relapse, the absence of symptoms during remission does not indicate that relapse is unlikely...

..In conclusion, gepirone ER at a dose range of 40 to 80 mg/d is effective for relapse prevention in patients with recurrent major depression. It is well tolerated during long-term treatment for up to approximately one year...

..This investigation assessed the effect of personality disorders (PersDs) on time to remission in patients with generalized anxiety disorder, social phobia, or panic disorder...

..Among patients with a concurrent anxiety disorder, nefazodone. either alone or in combination with CBASP, improves anxiety symptoms faster than CBASP alone, independent of depressive symptom reduction...

..This dynamic is reinforced via the integration of current best therapeutic thinking in research settings, leading to clinical trials that more closely approximate an ideal, remission-focused treatment regimen...

..Until then, remission should continue to be based on the descriptive and experiential phenomena of symptoms and psychosocial functioning...

..1 and 64.1%, respectively (p < or = 0.05). Open-label risperidone augmentation substantially enhanced response in treatment-resistant patients, but the longer-term benefits of augmentation were not demonstrated in this study...

..Physicians can help improve adherence by selecting medications with simple dosage regimens and educating patients and families about the disorder and what to expect from medications...

..CONCLUSIONS: Women with more severe pathology have higher treatment utilization rates. This pattern may explain the seeming lack of treatment efficacy for eating disorders outside of randomized controlled studies...

..Personality disorders may be characterized by stable trait constellations that fluctuate in degree of maladaptive expression...

..Thus, it is critical to stay up to date with the best therapeutic approach, while remaining flexible as new therapies are developed...

..Future studies should emphasize the role of preventive pharmacotherapy to improve the long-term course of anxiety and to reduce its associated suffering, suicide, and occupational and social impairment...

..It is also well tolerated over prolonged periods. It should therefore prove suitable for use as maintenance treatment in depressed patients...

..The significantly higher remission rates attained with venlafaxine treatment as compared with some SSRIs warrant further studies of SNRIs for the long-term treatment of depression...

..The authors examined the relationship between posttraumatic stress disorder (PTSD), trauma, and self-reported nonpsychiatric medical conditions in a sample of 502 primary care patients with one or more anxiety disorders...

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..The theoretical implications of these findings for future evaluations of anxiety sensitivity are discussed...

..Patients receiving combination treatment reported stronger alliances with their psychotherapists than patients receiving CBASP alone. However, the impact of the alliance on outcome was similar for both treatment conditions...

..The low relapse rate for patients with an acute placebo pattern switched to placebo suggests specific drug effect played a smaller role in their initial improvement...

..These results underscore that GAD is a chronic and persistent illness in primary care patients...

..Difficulties in the implementation of treatment guidelines are discussed...

..The Journal of Nervous and Mental Disease, 188, 805-812], and suggest that increased psychosocial impairment may be a risk factor for relapse...

..This study examined psychosocial functioning as a predictor of recovery from episodes of unipolar major depression...

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..This observational study examined the effectiveness of somatic antidepressant treatments as administered in the community...

..Few studies, though, have systematically examined the clinical correlates of Axis II personality disorder comorbidity or its effect on treatment response or time to response...

..A continuation study of an extract of St. John's wort (Hypericum perforatum) for depression was performed in follow-up to an acute study that found no significant difference between St. John's wort extract and placebo...

..2001). Implications of these results for both the mental health and primary care fields are also discussed...

..The authors suggest that chronic depression should be viewed as a single, broad condition that can assume a variety of clinical course configurations...

..Our results suggest that psychotherapy may be an essential element in the treatment of patients with chronic forms of major depression and a history of childhood trauma...