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Text of the page (random words):
rial support was provided by george rogan msc phase five communications inc new york new york mr rogan reports no other financial affiliations relevant to the subject of this article and in case you re wondering funding for editorial support was provided by bristol myers squibb if you ve somehow guessed that this is an advertorial for abilify you win other ghostwritten pieces of fluff paid for by bms include an article discussing the safety profile of abilify in depression it states that in conclusion this post hoc analysis extends previous findings demonstrating that aripiprazole is safe and generally well tolerated as an augmentation strategy to standard adt in patients with mdd with a history of an inadequate response to antidepressant medication but abilify caused akathisia in a quarter of patients i think that s a problem but wait there s more an article based on data from two trials which showed allegedly that seroquel improves anxiety in patients with bipolar disorder this piece also acknowledges that it was ghostwritten and we know that astrazeneca manufacturer of seroquel has cooked the books on seroquel in the past feel free to look through the journal every month and have a giggle at some of the ridiculous pieces that make their way into print cme you can get your continuing medical education cme from the primary care companion as well one particularly awesome piece of medical wisdom pimped abilify educated physicians about the best ways to manage resistant depression this one is a beauty it was supported by cash from bms which features prominently in the treat aggressively message of the piece the article features none other than michael thase as the leading discussant the same guy who was the leading author on a paper which allegedly showed the wonders of abilify for depression despite the pesky fact that patients said it didn t work back to the cme thase starts off by stating that only a third of patients achieve remission of depressive symptoms during treatment given that abilify is being marketed for treatment resistant depression this is a perfect way to start off this infomercial educational piece he adds that failure to achieve remission increases the risk of suicide and puts people at risk for more depression worse psychiatric outcomes and all sorts of other bad things so we better get rid of all symptoms of depression thase suggests that clinicians should closely monitor patients to see if their symptoms are remitting in particular relying on the global statement i m definitely better from the patient overlooks persistent minor or residual symptoms dr thase recommended using a standardized symptom assessment measure and keeping track of the patient s levels of symptom burden so even if the patient says he or she is much better don t believe it have the patient fill out rating scales and if any symptoms at any level are present keep treating in thase s words if the current treatment is well tolerated and the individual has made significant symptom improvement but is still experiencing residual symptoms then it may be necessary to adjust the treatment dose add another medication or combine pharmacotherapy and psychotherapy note that adding psychotherapy comes after adding another medication then a series of other objective expert psychiatrists chime in dr gaynes offers his wisdom which includes dr gaynes concluded that incomplete remission requires aggressive identification and management don t be afraid be aggressive the unspoken message hey using an antipsychotic like abilify for depression may seem freakin crazy but don t worry you need to be aggressive dr trivedi then comments about using rating scales to measure side effects i don t have much to say about his section but things get worse momentarily dr papakostas then checks in a meta analysis of randomized double blind placebo controlled studies found that augmentation of various antidepressants with the atypical antipsychotic agents olanzapine risperidone and quetiapine was more efficacious than adjunctive placebo therapy in addition dr papakostas noted that the atypical antipsychotic aripiprazole was recently approved by the us food and drug administration fda for use as an adjunctive therapy to antidepressants in mdd augmenting with atypical antipsychotics has so far been the best studied strategy for managing treatment resistant depression said dr papakostas dr p was the coauthor of a meta analysis that provided considerable evidence regarding the wonders of antipsychotic therapy for depression the only problem was that the analysis actually did not find convincing evidence that the drugs were particularly effective which i discussed in december 2009 next comes dr shelton time to be aggressive again thus said dr shelton the long term management of depression should be viewed in the context of acute treatment and the need for early aggressive management to get the patient as well as possible be aggressive by adding abilify to the antidepressant regimen if not your patient won t achieve full remission and will suffer needlessly dr shelton advised clinicians to be aggressive in treatment and stay active over time asking themselves if everything has honestly been done to help the patient psychotherapy is given a brief mention in this section but let s face it most physicians think of be aggressive as upping the dosage and or adding medications not as let s be aggressive by adding psychotherapy then there s the exam at the end write up your answers mail them in and get your medical education credit here s one of the questions 3 scores on both patient and clinician rated scales found that ms b is still experiencing residual depressive symptoms you optimize her current ssri dose which produces some improvement she has not reported any problems with side effects what course of action to improve her outcome has the most comprehensive efficacy data a increase the dose of her current ssri again b augment her current ssri with another ssri c switch her to a serotonin norepinephrine reuptake inhibitor d augment her current ssri with an atypical antipsychotic if you guessed that d is the correct answer you re one step closer to cme credit and one step closer to writing a prescription for abilify despite the fact that it is as likely to induce akathisia as to induce remission of depressive symptoms or that its advantage over placebo is small on several measures and nonexistent on a patient rated measure of depression but d is still the correct answer the offending educational piece is cited below thase m gaynes b papakostas g shelton r trivedi m 2009 tackling partial response to depression treatment the primary care companion to the journal of clinical psychiatry 11 4 155 162 doi 10 4088 pcc 8133ah3c posted by cl psych at 3 16 2010 06 42 00 am 6 comments labels abilify ghostwriting journals medical education wednesday march 03 2010 if you don t learn your lesson the first time i m short on time so i apologize for the lack of details the short of it a researcher at the university of sheffield guirong jang submitted research findings regarding procter gamble s osteoporosis medication actonel however sheffield had a contract with p g to only release actonel data with the permission of p g so dr jang is in big trouble as sheffield wouldn t want to offend its corporate sponsor by releasing any potentially unflattering data more can be found here p g actonel and trying to effectively manage data to best suit the needs of actonel s marketing hey wait this sounds familiar you may recall the case of aubrey blumsohn a researcher at the same university investigating the same drug followed by all sorts of strange happenings read more on the blumsohn story here posted by cl psych at 3 03 2010 09 52 00 am 0 comments labels procter and gamble wednesday february 10 2010 say hello to temper dysregulation disorder with dysphoria the buzz around the new version of the dsm is already starting the draft version is now online and it features a new condition with the ungainly moniker of temper dysregulation disorder with dysphoria that s a friggin mouthful so let s try t triple d for short wtf is this disorder well according to my first look it closely resembles the bad behavin kids who have been labeled as bipolar for the last few years the symptoms are below and can also be found on the official dsm v website a the disorder is characterized by severe recurrent temper outbursts in response to common stressors 1 the temper outbursts are manifest verbally and or behaviorally such as in the form of verbal rages or physical aggression towards people or property 2 the reaction is grossly out of proportion in intensity or duration to the situation or provocation 3 the responses are inconsistent with developmental level b frequency the temper outbursts occur on average three or more times per week c mood between temper outbursts 1 nearly every day the mood between temper outbursts is persistently negative irritable angry and or sad 2 the negative mood is observable by others e g parents teachers peers d duration criteria a c have been present for at least 12 months throughout that time the person has never been without the symptoms of criteria a c for more than 3 months at a time e the temper outbursts and or negative mood are present in at least two settings at home at school or with peers and must be severe in at least in one setting f chronological age is at least 6 years or equivalent developmental level g the onset is before age 10 years h in the past year there has never been a distinct period lasting more than one day during which abnormally elevated or expansive mood was present most of the day for most days and the abnormally elevated or expansive mood was accompanied by the onset or worsening of three of the b criteria of mania i e grandiosity or inflated self esteem decreased need for sleep pressured speech flight of ideas distractibility increase in goal directed activity or excessive involvement in activities with a high potential for painful consequences see pp xx abnormally elevated mood should be differentiated from developmentally appropriate mood elevation such as occurs in the context of a highly positive event or its anticipation i the behaviors do not occur exclusively during the course of a psychotic or mood disorder e g major depressive disorder dysthymic disorder bipolar disorder and are not better accounted for by another mental disorder e g pervasive developmental disorder post traumatic stress disorder separation anxiety disorder note this diagnosis can co exist with oppositional defiant disorder adhd conduct disorder and substance use disorders the symptoms are not due to the direct physiological effects of a drug of abuse or to a general medical or neurological condition i ve not given this a lot of thought yet the committee that examined the topic has some discussion of t triple d bipolar here and here the committee takes a couple of digs at the the child bipolar diagnosis so if this new disorder is adopted we re going to have yet another name for children who behave badly fortunately the criteria appear to require much worse behavior than what has been passing for bipolar according to some child psychiatrists the diagnostic threshold is higher and should theoretically lead to fewer kids being unnecessarily diagnosed but even if the current criteria are adopted without any changes look for a movement to diagnose subthreshold cases of t ddd as untreated subthreshold t ddd will be found to cause untold psychological and physical damages across the world damages that can only be mitigated through aggressive treatment using insert name of latest patented tranquilizer here so whatever antipsychotics or mood stabilizers are hot in 2013 when the dsm v is released they will be the cure for t ddd or bipolar or whatever the hell we decide to label kids with behavior problems that s my first impression this is definitely going to be a hot button topic there is apparently some mechanism to send comments to the dsm v folks since this is only a draft version feel free to comment here or send your ideas to the dsm v posse posted by cl psych at 2 10 2010 06 00 00 am 20 comments labels child bipolar dsm v t ddd tuesday january 05 2010 do you have mild moderate or severe depression here take this placebo er antidepressant yet another meta analysis with the same damn result antidepressants for most cases of depression are placebos this is in a paper with authors including jay amsterdam richard shelton and jan fawcett who are not exactly cut from the peter breggin mold this was based on six studies which compared antidepressant to placebo in patients who had a wide range of depression severity key results mild to moderate depression effect size of d 11 which is tiny and was not statistically significant severe depression effect size of d 17 which is pretty darn small and not statistically significant very severe depression effect size of d 47 which is moderate hmmmm not looking so hot of course anyone who has paid attention to the clinical trial literature on antidepressants over the past 10 years or so already knew this but now it s in jama so a wider audience may now pay attention or ignore it good marketing usually beats science so maybe this won t make any difference antidepressants for all but very severe depression all the benefits of placebo plus the added bonus of side effects sign me up to quote the authors what makes our findings surprising is the high level of depression symptom severity that appears to be required for clinically meaningful drug placebo differences to emerge particularly given the evidence that the majority of patients receiving adm in clinical practice present with scores below these levels in other words most people who receive antidepressants would likely have done just as well on placebo without the side effects a few other posts on the topic the long lasting placebo effect sexual side effects of ssris paxil how to lie the much vaunted public health benefits of antidepressants antidepressants offer weak efficacy for all but most severe depression hiding negative data on antidepressants suicidal tendencies nah not here i ve linked the abstract of the latest jama study here enjoy posted by cl psych at 1 05 2010 03 08 00 pm 22 comments labels antidepressants wednesday december 16 2009 atypical antipsychotics for depression now with considerable evidence i ve been wanting to write about this for months here goes we know that antipsychotics are the new panacea for all things mental health related including depression 1 2 3 but critics kept pointing to a pesky lack of evidence that such treatments actually worked bristol myers squibb manufacturer of abilify has been running a disinformation campaign in medical journals to tout its drug as an antidepressant their attempts to paint a positive picture of abilify s antidepressant properties and...
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