Efficacy of extended-release divalproex combined with "condensed" dialectical behavior therapy for individuals with borderline personality disorder.

BACKGROUND: Borderline personality disorder (BPD) is a significant psychiatric illness for which medication treatments are still being explored. The goal of this study was to assess divalproex extended release (ER) vs placebo for patients receiving dialectal behavior therapy (DBT). METHODS: Patients with BPD received 4 weeks of "condensed DBT." Those with Symptom Checklist-90 (SCL-90) scores >150 after this treatment were then randomly and blindly assigned to placebo or divalproex ER for 12 weeks. Repeated measures analysis of variance utilizing last observation carried forward was used to assess the results. RESULTS: Seventeen participants completed the full assessment. Two patients had a significant decrease in SCL-90 in the first 4 weeks, leaving 15 patients for the medication phase of the trial. There were no significant differences between the participants assigned to divalproex ER compared with placebo. However, there was a significant improvement in both groups from baseline to endpoint (P = .001). CONCLUSIONS: The response of 2 of 17 participants in the first 4 weeks prior to medication may point to a practice strategy in approaching outpatients with BPD. Although the patients had a decrease in symptoms during the study, there was no advantage observed for divalproex ER and DBT over placebo and DBT.

Are Second-Generation Antipsychotics Useful in Tardive Dystonia?

OBJECTIVE: To review the current evidence on the effectiveness of second-generation antipsychotics (SGAs) in the treatment of tardive dystonia (TDt) and give recommendations for treatment. METHODS: Medline/PubMed/Psyclit/Embase database searches were conducted in January 2015, and a manual review of references within the retrieved articles was done. All articles in English and those that had English abstracts and dealt with treatment of TDt were included. RESULTS: Our search and review yielded a total of 88 reports (none of them a controlled trial) involving 145 patients treated with one of the 5 SGAs. Clozapine has the maximum number of published reports (52 reports involving 90 subjects, whereas there were 36 reports involving 55 subjects treated with other SGAs, including olanzapine, risperidone, quetiapine, aripiprazole, and perospirone). CONCLUSIONS: The available evidence points to the effectiveness of clozapine as monotherapy and in combination with clonazepam for the treatment of TDt. When clozapine is not an option, olanzapine and quetiapine are reasonable alternatives. Given the lack of controlled trials, future focus should be on conducting randomized, placebo-controlled, multicenter, collaborative controlled clinical trials of several years' duration.

Appendectomy for appendicitis in patients with schizophrenia.

BACKGROUND: Anecdotal evidence suggests that schizophrenia patients who require surgery have a high rate of adverse outcomes. We searched the Department of Veterans Affairs national datasets to determine the clinical course of schizophrenia patients with appendicitis who underwent appendectomy. METHODS: The Patient Treatment File (the nationwide inpatient database for the Department of Veterans Affairs) and the Beneficiary Identification and Records Location System were searched to identify all patients with International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes for schizophrenia or schizoaffective disorder diagnosed with appendicitis during fiscal years 1995 to 1999. Computer-based information was supplemented with chart-based data. We sought data on six common preoperative risk factors and 25 specific adverse outcomes, including death. RESULTS: There were 55 patients identified. The mean age was 49, and 96% were men. The median time from symptom onset to diagnosis of appendicitis was 3 days. A history of substance abuse was obtained in 16 (29%). Disruptive behavior was documented in 16 (29%). Restraints were used in 9 (9%). The appendix was perforated in 36 (66%) and gangrenous in 9 (16%). Thirty-one (56%) had > or = 1 complication; there were 2 in-hospital deaths (4%). CONCLUSIONS: This is the first report on this topic in the medical literature. Appendicitis is typically diagnosed late in schizophrenic patients. Adverse patient behaviors are frequent. The complication and death rates are high.