Brief cognitive-behavioral therapy effects on post-treatment suicide attempts in a military sample: results of a randomized clinical trial with 2-year follow-up.

OBJECTIVE: The authors evaluated the effectiveness of brief cognitive-behavioral therapy (CBT) for the prevention of suicide attempts in military personnel. METHOD: In a randomized controlled trial, active-duty Army soldiers at Fort Carson, Colo., who either attempted suicide or experienced suicidal ideation with intent, were randomly assigned to treatment as usual (N=76) or treatment as usual plus brief CBT (N=76). Assessment of incidence of suicide attempts during the follow-up period was conducted with the Suicide Attempt Self-Injury Interview. Inclusion criteria were the presence of suicidal ideation with intent to die during the past week and/or a suicide attempt within the past month. Soldiers were excluded if they had a medical or psychiatric condition that would prevent informed consent or participation in outpatient treatment, such as active psychosis or mania. To determine treatment efficacy with regard to incidence and time to suicide attempt, survival curve analyses were conducted. Differences in psychiatric symptoms were evaluated using longitudinal random-effects models. RESULTS: From baseline to the 24-month follow-up assessment, eight participants in brief CBT (13.8%) and 18 participants in treatment as usual (40.2%) made at least one suicide attempt (hazard ratio=0.38, 95% CI=0.16-0.87, number needed to treat=3.88), suggesting that soldiers in brief CBT were approximately 60% less likely to make a suicide attempt during follow-up than soldiers in treatment as usual. There were no between-group differences in severity of psychiatric symptoms. CONCLUSIONS: Brief CBT was effective in preventing follow-up suicide attempts among active-duty military service members with current suicidal ideation and/or a recent suicide attempt.

Immersing practitioners in the recovery model: an educational program evaluation.

The ascendance of the recovery movement in mental health care has led to the development and implementation of educational curricula for mental health providers to assist in mental health care system transformation efforts. The Medical College of Georgia (MCG) partnered with the Georgia State Department of Human Resources (DHR) to develop, implement, and evaluate such an educational curriculum for providers within an academic medical institution. This effort, entitled Project GREAT, led to the creation of a curriculum based on the SAMHSA-defined (2006) critical components of recovery. As an initial evaluation of educational curriculum effectiveness, the authors examined effects of the training program on recovery-based knowledge and recovery-consistent attitudes. We also compared MCG provider knowledge and attitudes to those of a similar group of providers at a neighboring medical institution who did not receive the intervention and training. Findings generally supported the effectiveness of the intervention in increasing providers' knowledge of recovery and a shift in recovery-supporting attitudes.

Comorbid depression in rheumatoid arthritis: pathophysiology and clinical implications.

Rheumatoid arthritis (RA) is a chronic inflammatory illness that primarily affects the joints. It is associated with symptoms of fatigue, pain, and sleep disturbances that can overlap with or mimic symptoms of depression. Depressive symptoms are highly comorbid with RA and may occur with at least mild severity in up to 42% of RA patients. RA and depression contribute to mortality, decreased quality of life, increased health care costs, and disability. Inflammatory pathways may hold the key to a link between depression and RA, and cytokines have been a major target of research in this area. This article reviews some of the most recent research and commentary on this complex relationship.

Review of olanzapine in the management of bipolar disorders.

Olanzapine is an atypical antipsychotic currently with indications for the treatment of schizophrenia, acute mania and the prevention of relapse in bipolar disorder. A growing body of clinical evidence supports these indications. Acute mania trials have demonstrated superior efficacy of olanzapine to placebo, equal or superior efficacy to valproate and superior efficacy in combination therapy with lithium or valproate compared to mood stabilizer monotherapy. Olanzapine demonstrated a modest effect in the treatment of bipolar depression with a substantially enhanced effect in combination with fluoxetine. Maintenance trials showed olanzapine to be more efficacious than placebo in the prevention of manic and depressive relapses and non-inferior to lithium or valproate. Combination of olanzapine with lithium or valproate was also found to be more efficacious than lithium or valproate monotherapy in the prevention of manic relapse in patients with a partial response to monotherapy with lithium or valproate. These trials suggest that olanzapine is a viable option and an invaluable addition to the pharmacological armamentarium in the treatment of bipolar I disorder. However, this can often be mitigated by safety and tolerability concerns with this agent including weight gain and metabolic syndrome that warrants clinician vigilance and discernment that is imperative in today's clinical practice.

Diagnosis and management of trichotillomania in children and adolescents.

Trichotillomania (TTM), a disorder characterized by the repeated non-cosmetic pulling out of hair from any part of the body, was first described in 1889. The disorder can be associated with serious social and psychologic dysfunction, as well as medical problems. A large proportion of the published scientific literature on TTM consists of case reports, and the disorder has only received significant clinical and research attention over the last 20 years. The disorder occurs across age groups and tends to follow a chronic course in the majority of cases. There is evidence for a bimodal onset, with peaks in the pre-school years and in early adolescence. TTM in child and adolescent populations has not been extensively studied, and the etiology, natural course, and best treatment approaches for the disorder are not known. Assessment for TTM in children and adolescents focuses on making the diagnosis and documenting the response to treatment. Despite the lack of validity studies in child and adolescent populations, most assessments for TTM use one or more formal TTM measures. Although classified as an impulse control disorder in the Diagnostic and Statistical Manual of Mental Disorders (4th Edition), there is some controversy about making the diagnosis in child populations because of criteria B (pattern of rising tension prior to pulling) and C (relief after pulling). There is no consensus for the treatment of TTM in children and adolescents. As in adults, a variety of interventions have been reported, including dynamic therapy, behavioral therapy, and psychopharmacology. Use of pharmacologic interventions in the pre-school age group is rare, but becomes more common as the child ages into adolescence. The most frequently used agents include clomipramine, fluoxetine, and paroxetine. The effectiveness of psychopharmacologic interventions for TTM in children and adolescents is, at best, mixed. A multiple modal approach that includes behavioral, pharmacologic, and other therapies may be the best strategy. There have been no controlled treatment trials in child and adolescent populations. Case reports favor a behavioral approach as the first-line single modality of treatment. Controlled studies of single modalities and combined treatment approaches are clearly needed.