Ziprasidone is a second generation (“atypical”) antipsychotic drug that has been used alone and as an adjunct to standard mood stabilizers to reduce recurrence rates in bipolar disorder. Approval of ...ziprasidone as an adjunct to lithium or valproate in 2009 was based on an industry sponsored study of 584 outpatients with a current or recent manic episode; 240 of these subjects were randomized to adjunctive ziprasidone or placebo and 138 completed a six month trial. Patients enrolled in maintenance studies did not have refractory mood disorders, comorbid conditions or risk of dangerousness. Maintenance ziprasidone augmentation is an option for patients who do not respond to a single mood stabilizer rapidly, and possibly for those with residual psychotic symptoms, but there are insufficient data to prefer this approach to combinations of mood stabilizers or augmentation with other agents. Ziprasidone is generally well tolerated, with less sedation and weight gain than many other antipsychotic drugs; it should be taken with food. Primary interactions of concern are with other serotonergic medications, MAO inhibitors, and other medications that prolong the QT interval.
Objective
The authors aim to determine whether admission interviews predict performance in residency.
Methods
The authors determined whether interview and other admission data were correlated with ...performance during postgraduate years 2–4 and with remaining in the residency in 544 residents enrolled in a single psychiatry residency program between 1963 and 2004.
Results
Considered together, admissions data predicted 13% of the variance in performance ratings in postgraduate year 2 (PGY-2) and 5% in PGY-4. Interview scores were moderately correlated with performance ratings in PGY-2, modestly correlated with performance in PGY-3, and not correlated with performance ratings in PGY-4. Letters of reference were moderately correlated with performance ratings in PGY-2 and modestly correlated with performance in PGY-3 and PGY-4. In PGY-2, interview scores differentiated between the top quartile of performance and the other three quartiles, while letters of reference differentiated performance in the top and bottom quartiles from the middle quartiles. Numerical differences among groups were not great enough to be practically useful, and no variables predicted which residents would leave the program before completing it.
Conclusion
As they are currently conducted, application interviews do not have sufficient power to predict performance during residency. Letters of reference may be useful to the extent that they reflect personal experience with the applicant, but differences in ratings of these letters are not great enough to base admission decisions on them. As it is currently performed, the interview process may be more useful as a means of interesting applicants in the program than of evaluating their potential for success in the residency.
Treatment of bipolar depression Dubovsky, Steven L
The Psychiatric clinics of North America,
06/2005, Letnik:
28, Številka:
2
Journal Article
Recenzirano
This article discusses current practices in the treatment of bipolar depression. In the absence of more definitive research, the treatment of bipolar depression is guided by clinical experience and ...expert opinion, and sometimes by marketing and popular trends, as much as it is by hard data. Considering the limitations of current knowledge is an essential component of the scientific practice of psychiatry.
The authors describe the development of a comprehensive policy for relationships of full-time and volunteer faculty and residents with industry. The underlying philosophy was that an academic ...approach to relations with industry that emphasizes objective outcomes and internal change will be more effective than rote restrictions on behavior that assume that physicians cannot learn new behaviors and that are impossible to enforce. The policy, developed through much discussion and debate with stakeholders, involves elimination of industry-supplied meals, gifts, and favors; integration of industry-sponsored and academic research; education of faculty and residents about the ways in which industry marketing influences clinical decision making; and comprehensive disclosure by faculty, including to patients, of financial interests in industry. At occasional points in the psychopharmacology curriculum and at a departmental "pharma symposium," industry representatives or industry-sponsored guest speakers are allowed to present peer-reviewed articles followed by comments by a faculty member with relevant expertise about aspects of the presentation that are accurate or misleading and by a general discussion of research and clinical implications of the research and the manner in which it is presented. Adherence to new protocols has been high because faculty and residents participated in developing them and are involved in their implementation. Acceptance by industry representatives has been variable. Experience with this approach suggests that it is possible to develop a collaborative relationship with industry that maintains appropriate boundaries between industry and academia.
The mental health clinic: a new model FAVA, GIOVANNI A.; PARK, SEUGN K.; DUBOVSKY, STEVEN
World psychiatry,
October 2008, Letnik:
7, Številka:
3
Journal Article
Recenzirano
Odprti dostop
The role of psychiatrists into public mental health clinics has been hampered by a perceived restriction of the psychiatrist's role to prescribing and sign-ing forms, limiting opportunities to engage ...in the kind of integrated care that attracted many physicians to this specialty. We propose a revision of the current model in a direction that maximizes the expertise of this specialist as well as other clinicians in the health care team. The basic unit would consist of a psychiatrist (with adequate background both in psychopharmacology and psychotherapy), an internist and four clinical psychotherapists, who may provide evidence-based treatment after the initial evaluation of the psychiatrist. Its functioning would emphasize repeated assessments, sequential combination of treatments, and close coordination of team members. Re-invigorating the role of the psychiatrist in the context of a team in which role assignments are clear could result in better outcomes and enhanced recruitment of psychiatrists into the public sector.
Objective: The authors assessed whether current methods of evaluating residency applicants and residents identify psychiatrists who later develop evidence of impairment. Method: Residency admissions ...and performance data for all physicians who were enrolled in a psychiatry residency between 1965 and 1994 and who were referred to an impaired physician program up to 35 years later were matched for age and gender with a nonreferred physician from the same class. Results: There were no significant differences between groups in admission interview assessments, performance ratings, or narrative observations by faculty during residency. Conclusions: Standard approaches do not identify physicians at risk of later impairment.
Objective: To review the current status of psychopharmacology education for medical students, residents, and practitioners in psychiatry and other specialties. Methods: A search of the MEDLINE and ...PsychInfo data bases was conducted using four keywords: pharmacology, psychopharmacology, teaching, and student. Additional references were obtained from citations in these articles. Published material was supplemented with the experience of the author and others involved in psychopharmacology teaching. Results: The majority of psychopharmacology education is provided by faculty from disciplines that include psychiatry, primary care medicine, basic science, and pharmacy. The pharmaceutical industry supports a substantial amount of continuing medical education (CME) by psychiatrists, pharmacists, and other medical practitioners, while much of the information that office practitioners receive and an increasing amount of material provided to residents comes from pharmaceutical representatives. The most important attributes of the effective psychopharmacology educator are knowledge, enthusiasm, honesty, an ability to encourage critical thinking, and genuine interest in the student. However, the primary criteria for participation in psychopharmacology education are faculty who are most available and willing in the academic medical center and those who engage in paid CME activities. Conclusions: Educators with clinical experience should play a core role in helping students to integrate research with actual clinical practice and should be able to teach students how to evaluate new research in psychopharmacology, especially if it is industry sponsored.
The authors measured intracellular Ca2+ concentrations in four manic and five bipolar depressed patients and seven comparison subjects. Platelet and lymphocyte intracellular Ca2+ concentrations were ...comparable. The patients' mean intracellular Ca2+ concentrations were higher than those of the comparison subjects and demonstrated more interindividual variation. These findings suggest a diffuse abnormality in mechanisms affecting intracellular calcium homeostasis in bipolar disorder.
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