Commentary: Bringing Order to Chaos--How Psychiatrists Know the Standard of Care.

In this commentary, we explore the clinical and educational implications of the study by Recupero and Harms on the standard of care (SOC) as it pertains to obtaining psychiatric outpatient clinical records of prior treatment. We discuss differences between the legal and clinical SOCs and make recommendations to incorporate risk management training and education about the medicolegal aspects of SOC in psychiatry residency curricula.

Commentary: the insanity defense and youths in juvenile court.

Juveniles, like adults, should be afforded the right to raise an insanity defense. In this commentary on the article by Morse and Bonnie on the abolition of the insanity defense, we explain why so few juveniles across the United States are granted access to the insanity defense and the reasons that they should have that option. We also consider whether the Delling case was the best suited vehicle to argue for extending constitutional protection to the insanity defense nationwide.

Cognitive-behavioral therapy for youth with body dysmorphic disorder: current status and future directions.

Body dysmorphic disorder (BDD) usually begins during early adolescence and appears to be common in youth. BDD is characterized by substantial impairment in psychosocial functioning and high rates of suicidality. Cognitive-behavioral therapy (CBT) tailored to BDD is the best tested and most promising psychosocial treatment for adults. CBT has been used for youth with BDD, but has not been systematically developed for or tested in youth. This article focuses on CBT for BDD in adults and youth; possible adaptations and the need for treatment research in youth; and prevalence, clinical features, diagnosis, recommended pharmacotherapy, and treatments that are not recommended.

Reliability and validity of the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID).

OBJECTIVE: To investigate the concurrent validity and reliability of the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID), a short structured diagnostic interview for DSM-IV and ICD-10 psychiatric disorders in children and adolescents. METHOD: Participants were 226 children and adolescents (190 outpatients and 36 controls) aged 6 to 17 years. To assess the concurrent validity of the MINI-KID, participants were administered the MINI-KID and the Schedule for Affective Disorders and Schizophrenia for School Aged Children-Present and Lifetime Version (K-SADS-PL) by blinded interviewers in a counterbalanced order on the same day. Participants also completed a self-rated measure of disability. In addition, interrater (n = 57) and test-retest (n = 83) reliability data (retest interval, 1-5 days) were collected, and agreement between the parent version of the MINI-KID and the standard MINI-KID (n = 140) was assessed. Data were collected between March 2004 and January 2008. RESULTS: Substantial to excellent MINI-KID to K-SADS-PL concordance was found for syndromal diagnoses of any mood disorder, any anxiety disorder, any substance use disorder, any ADHD or behavioral disorder, and any eating disorder (area under curve [AUC] = 0.81-0.96, kappa = 0.56-0.87). Results were more variable for psychotic disorder (AUC = 0.94, kappa = 0.41). Sensitivity was substantial (0.61-1.00) for 15/20 individual DSM-IV disorders. Specificity was excellent (0.81-1.00) for 18 disorders and substantial (> 0.73) for the remaining 2. The MINI-KID identified a median of 3 disorders per subject compared to 2 on the K-SADS-PL and took two-thirds less time to administer (34 vs 103 minutes). Interrater and test-retest kappas were substantial to almost perfect (0.64-1.00) for all individual MINI-KID disorders except dysthymia. Concordance of the parent version (MINI-KID-P) with the standard MINI-KID was good. CONCLUSIONS: The MINI-KID generates reliable and valid psychiatric diagnoses for children and adolescents and does so in a third of the time as the K-SADS-PL.

Randomized, placebo-controlled trial of risperidone for acute treatment of bipolar anxiety.

BACKGROUND: The treatment of bipolar disorder is often complicated by the presence of a co-occuring anxiety disorder. Although second generation antipsychotics are being used with increasing frequency in bipolar patients, their anxiolytic effects have not been well studied in this population. METHODS: The anxiolytic effect of risperidone 0.5-4 mg/day was tested in an 8-week, double-blind, placebo-controlled, randomized clinical trial in 111 patients with bipolar disorder and a co-occuring panic disorder or generalized anxiety disorder (GAD). The primary outcome measure was the Clinician Global Improvement-21 Anxiety scale (CGI-21 Anxiety). Secondary measures included the Hamilton Anxiety Scale (HAM-A) and the Sheehan Panic Disorder Scale. RESULTS: On the last-observation-carried forward analysis of repeated measures analysis of variance (ANOVA), risperidone was not more effective than placebo for the CGI-21 Anxiety score or the other anxiety outcome measures. Risperidone was well tolerated, with only two patients withdrawing because of adverse events. LIMITATIONS: The risperidone treated group had more patients with mixed states and lifetime panic disorder at randomization than the placebo group. The study was limited to 8 weeks and to individuals with bipolar and comorbid panic disorder or GAD. The results may not be applicable to risperidone as an add-on treatment to mood stabilizers, or to bipolar disorder comorbid with anxiety disorders other than panic disorder or GAD. CONCLUSIONS: Risperidone monotherapy was not an effective anxiolytic for bipolar patients with comorbid panic disorder or GAD in doses of 0.5-4 mg/day over 8 weeks of treatment. The efficacy of other second generation antipsychotics and mood stabilizers on anxiety in patients with bipolar disorder and a co-occuring anxiety disorder should be investigated in double-blind, placebo-controlled studies.