American Psychiatric Association, May 14-18

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The 168th American Psychiatric Association Annual Meeting

The annual meeting of the American Psychiatric Association was held from May 14 to 18 in Atlanta and attracted approximately 10,000 participants from around the world, including clinicians, academicians, allied health professionals, and others interested in psychiatry. The conference highlighted recent advances in the prevention, detection, and treatment of psychiatric conditions.

In one study, Samuel Ridout, M.D., of the Brown University School of Medicine in Providence, R.I., and colleagues found that males have a longer premorbid illness duration before their first hospitalization related to eating disorders as compared to women, and there is greater prehospitalization weight loss as well. In addition, the investigators found that males report a history of depression at a higher rate than female patients.

"As has been shown across multiple other specialties in medicine, male patients come to the attention of appropriate care providers later. However, what our data also suggest is that male adolescents with eating disorders are more likely to be struggling with depression and possibly thoughts of harming themselves longer, which is especially worrisome given what is known regarding relative risk of suicide compared with females," Ridout said. "While we cannot speculate on the reasons as to why the male patients whose records were reviewed in our study were not engaged with care for their eating disorder or psychiatric comorbidities sooner, we can clearly state that the ability to involve psychiatry in a more comprehensive care model for these patients remains crucial. With any results suggesting a need for integration of psychiatric services, the availability of care providers to participate in those teams is always a limiting factor and these results are another small voice in the chorus reinforcing the need for investment in mental health services."

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In another study, Tyler Kaster, M.D., of the University of Toronto, and colleagues found electroconvulsive therapy (ECT) to be an effective acute treatment for patients with schizophrenia, with a fairly low rate of adverse cognitive effects.

"We found that three-fourths of patients responded to ECT, while less than one-tenth of patients had significant cognitive impairment. We also discovered several factors associated with treatment response, including treatment with antiepileptic drugs, a previous good response to ECT, and a referral indication of failed pharmacotherapy," Kaster said. "Furthermore, we found that patients had an equivalent response rate with or without clozapine treatment, which is an antipsychotic used after multiple medications have failed. Taken together, this suggests that ECT is a treatment option that should be available for patients with schizophrenia, and may be particularly useful for patients who have failed multiple medications."

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Anh Truong, M.D., of the Baylor College of Medicine in Houston, and colleagues evaluated whether a cellphone application may be clinically useful in monitoring and classifying depression symptoms in a clinically depressed population. The application was compared to standard clinician psychometric instruments, including Patient Health Questionnaire-9 (PHQ-9), Hamilton Rating Scale for Depression (HAM-D), and Hamilton Anxiety Rating Scale (HAM-A).

The investigators divided patients into two groups for analysis, including those with PHQ-9 less than 14, indicating no depression to mild depression, and those with PHQ-9 greater than 15, indicating moderate-to-severe depression.

"We observed a stronger correlation between daily self-reported moods and PHQ-9, HAM-D, and HAM- A in the moderate-to-severe depression group," Truong said.

In addition, the investigators found that lower levels of text messaging and duration of messaging were predictive of higher levels of depression on PHQ-9 in the moderate-to-severe depression group. The researchers also found an increase in depression symptoms that correlated with decreased number of steps taken, which is consistent with a decline in physical activity seen in many individuals with depression.

"Our study suggests that smartphone data may be more useful in patients with more severe depression symptoms and may be a valuable tool to help predict depression severity," Truong said. "We were encouraged by our results and our patient response to the application. Patients were very receptive to using the application and often stated they enjoyed getting daily reminders to track their mood."

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