Efficacy of risperidone augmentation to antidepressants in the management of suicidality in major depressive disorder: a randomized, double-blind, placebo-controlled pilot study.

OBJECTIVE: Major depressive disorder (MDD) is a severe mental illness with high risk of suicidality. Antidepressant treatment alone is not sufficient for the acute management of risk-taking symptoms of depression. This pilot study was designed to investigate the efficacy of risperidone augmentation to antidepressants in the acute management of suicidality and other core symptoms in MDD with suicidality. METHOD: Twenty-four adult men and women diagnosed with MDD (DSM-IV), having a depressive episode with suicidality despite taking an antidepressant, were enrolled in an 8-week double-blind, placebo-controlled study. Subjects were randomly assigned to receive risperidone (0.25-2 mg/day) or placebo while continuing on their antidepressant therapy. Clinical efficacy in suicidality, depressive symptoms, and impulsivity were assessed after treatment with study drugs for 4 days, weekly for 4 weeks, then every other week for 4 weeks. Adverse events were also recorded at each visit. The study was conducted from June 2004 to April 2007. RESULTS: Risperidone significantly reduced suicidal ideations in MDD patients, and the overall effect of risperidone appeared to be superior to placebo. The effect of risperidone was rapid, with onset at 2 weeks' treatment, and was sustained along the course of 8 weeks' treatment. Furthermore, risperidone demonstrated superiority to placebo in improving other symptoms related to suicidality and having better trial completion rate, and the low dose risperidone was well tolerated by subjects in this study. CONCLUSION: Data from this pilot study suggest that risperidone is beneficial as an augmenting treatment in MDD patients who have developed high-risk suicidal ideation during a depressive episode. The antisuicidality effect of risperidone is especially valuable in the acute management of severe depressive symptoms. Although the pilot study is limited by small sample size, the promising results warrant further larger scale investigation in the efficacy of atypical antipsychotics in the treatment of severe depression with suicidality. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00167154.

Residency training in public psychiatry: a review of literature.

BACKGROUND: Training of psychiatry residents in a conmmunity setting has been emerging as a more rational and reasonable choice for psychiatry residency training, considering the shift of reliance in the recent years for psychiatric services from inpatient care in hospitals to outpatient care in the community. METHODS: A literature review regarding residency training in community psychiatry was performed using the Medline databases. Seven residency training programs' curricula were included in this review. The curriculum of each of these seven programs was also obtained from their respective Internet home pages. The authors describe the community psychiatry training curriculum of their affiliated program, the University of Alabama at Birmingham. RESULTS: A brief description of community training curricula of these eight programs is provided. These curricula, especially their unique characteristics, are then compared in a table. DISCUSSION: The psychiatry training programs differ in many noteworthy ways while providing their residents with "community psychiatry experience." The table provides a quick comparison and highlights the differences of these programs. The authors emphasize the need for a "model curriculum," taking into consideration various factors including the local resources available where the residents could rotate for their community psychiatry experience. CONCLUSION: The authors concluded that psychiatry residency training programs need to publish their curricula, so that other programs can modify their own curricula, if needed, and hence provide an excellent experience in community psychiatry to their residents and future psychiatrists.