Annals of Clinical Psychiatry

Premature treatment discontinuation (dropout) is a common problem among patients seeking treatment for major depressive disorder (MDD). To prevent treatment dropout, it is important to identify its associated risk factors. The impact anxiety has on treatment dropout for MDD is especially critical to investigate due to the high rates of comorbidity between anxiety and depressive disorders. Evidence for the degree to which anxiety reliably predicts treatment dropout for MDD remains inconclusive and has yet to be investigated at an adult partial hospitalization program. Examining this can help elucidate which factors predict dropout among patients who need intensive treatment for their depression.

Participants were patients seeking treatment for MDD at an adult partial hospitalization program (N = 461). A series of Chi-square tests and t tests were conducted to assess for any differences in frequencies of anxiety disorder comorbidities or mean scores of dimensional anxiety among patients who dropped out of treatment and those who did not.

No significant associations between high baseline anxiety and early dropout were found (all P > .05).

Findings suggest that no specific actions need to be taken to prevent individuals with high baseline levels of anxiety from prematurely dropping out of a partial hospitalization program.

Use of kratom is increasing in the United States due to its perceived safety as a botanical product. This review provides salient information about kratom for the practicing clinician.

We conducted a literature search of MedLine, UpToDate, and Google using the terms “kratom” and “Mitragyna speciosa” for articles published within the last 10 years.

We reviewed >500 articles. Kratom is derived from the Mitragyna speciosa plant of Southeast Asia. It has grown in popularity within the United States due to its dual effects of acting as a stimulant at low doses and acting as an opioid-like substance at higher dosages. The 2 major active ingredients in kratom, mitragynine and 7-OH mitragynine, act as partial agonists at the mu-opioid receptor. While adverse consequences are normally mild, there are several potentially serious adverse effects, including respiratory depression, especially with chronic, high-dose usage. Furthermore, in case reports, concomitant use of kratom with other substances has been linked to seizures. Unfortunately, an increasing number of deaths have been linked to kratom usage. Six states have made it illegal to possess or sell kratom.

Kratom is an emerging drug of abuse in the United States. Its use is increasing in individuals who may seek to experience an opioid-like “high” as well as to help reduce withdrawal effects from other opioids.

DSM-5 introduced the anxious distress specifier in recognition of the significance of anxiety in patients who are depressed. Studies have supported the validity of the specifier in patients with major depressive disorder (MDD). In this report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we examined the validity of the specifier in patients with bipolar depression.

Forty-nine patients with a principal diagnosis of bipolar depression and 369 with MDD were evaluated with semi-structured diagnostic interviews, including the DSM-5 Anxious Distress Specifier Interview (DADSI). The patients were rated on measures of depression, anxiety, and irritability, and completed self-report measures.

The majority of patients with bipolar depression met the DSM-5 anxious distress specifier, no different than the frequency in patients with MDD. The DADSI was significantly correlated with other measures of anxiety, and more highly correlated with other measures of anxiety than with measures of depression and irritability. Patients with panic and generalized anxiety disorder scored higher on the DADSI than patients without an anxiety disorder.

The results of our study indicate that anxious distress is common in patients with bipolar depression and support the validity of the DSM-5 anxious distress specifier.

Patients who drop out of clinical trials examining post-traumatic stress disorder (PTSD) may have different characteristics than patients who continue. These characteristics have never been examined in prior PTSD and attrition trials. Our goal was to examine how demographic and clinical characteristics of patients with PTSD impact attrition in a randomized controlled trial.

A total of 18 participants were recruited. Data were collected through questionnaires to assess PTSD, depression, and mood disorders. Fisher's exact test was used to examine the association of various categorical demographic and clinical variables with dropout. A Wilcoxon rank sum test was used to examine differences in medians.

The median total PTSD Checklist for DSM-5 score was 38 for patients who dropped out and 53 for those who did not. The depression scale total was also lower for the dropout group (7 vs 15). The insomnia index was lower for those who did not remain in the study (15 vs 21).

Posttraumatic stress disorder symptoms, depression, and insomnia were less severe in patients who dropped out compared with those who did not. Larger studies are needed to further examine these findings. This study could help guide future recruitment efforts for clinical trials examining PTSD.

Borderline personality disorder (BPD) and substance use disorder (SUD) frequently co-occur. Although some research has investigated the factors related to this comorbidity, few have isolated the effects of SUD on a BPD diagnosis.

Patients presenting for treatment were assessed with the Structured Clinical Interview for DSM-IV, the BPD module of the Structured Interview for DSM-IV Personality, the Difficulties in Emotion Regulation Scale (DERS), and the Five Facet Mindfulness Questionnaire (FFMQ). Analyses were conducted to determine how individuals diagnosed with BPD differ from individuals diagnosed with BPD and SUD.

Among the BPD diagnostic criteria, patients with comorbid BPD and SUD endorsed impulsivity at higher rates, and patients with only BPD more frequently endorsed frantic efforts to avoid real or imagined abandonment. The 2 groups were not distinguished by scores on the DERS, although the comorbid group reported higher FFMQ scores, specifically on the acting with awareness subscale.

Borderline personality disorder is fundamentally based on emotion dysregulation. Substance use and efforts to avoid abandonment are both forms of maladaptive coping that stem from this dysregu-lation, and individuals with BPD may tend to rely on one or the other. Future studies should continue to evaluate these clinical features across diverse groups.

Firearm ownership is extremely common in parts of the United States. Yet little research has examined whether it is associated with impulsive symptoms and traits.

Adults age 18 to 29 who gamble at least occasionally were recruited in 2 cities in the United States using media advertisements for an exploratory study examining general mental health, impulse control disorders, impulsive personality, and aspects of cognition (decision-making, response inhibition, and flexible responding). The participants were grouped as firearm owners and non-firearm owners; these 2 groups were compared on the above measures.

For this study, 149 young adults took part, of whom 33 (22.1%) endorsed owning ≥1 firearm. Firearm ownership was significantly associated with male gender and elevated risk of gambling disorder, but not with other measures of impulsivity.

The link between firearm ownership and disordered gambling merits further research and may have policy implications, such as in terms of screening for guns in gambling arenas, including casinos. Further research is needed to explore potential associations between gun ownership and impulsivity in cohorts with other demographic characteristics, including longitudinally.

NSI-189 phosphate (NSI-189) is a novel neurogenic molecule with pleiotropic properties, including antidepressant, procognitive, synaptoplastic, and neurotrophic activities demonstrated in preclinical studies. Its antidepressant activity is monoamine-independent. NSI-189 was previously tested in patients with recurrent major depressive disorder in an inpatient setting.

This study involved 220 patients randomized to an NSI-189 40-mg dose, NSI-189 80-mg dose, or placebo daily for 12 weeks. The study utilized the sequential parallel comparison design, in which the drug effect was tested in 2 separate stages of 6 weeks each. Herein, post-hoc analyses of the data are presented.

NSI-189's antidepressant effect increased when the participants’ initial baseline depression severity was dichotomized along a Montgomery–Åsberg Depression Rating Scale (MADRS) score of 30. The NSI-189 80-mg dose showed significant benefit over placebo when utilizing the MADRS-6 (P = .046) in the subgroup of patients who were moderately depressed (MADRS <30) but was not significant in patients who were severely depressed (MADRS ≥30). More pronounced procognitive effects were also observed in the moderate subgroup relative to the severe subgroup or the whole study group, in which 11/36 (31%), 5/36 (14%), or 7/36 (19%) of CogScreen variables significantly improved, respectively.

These results suggest that NSI-189 is effective as a safe adjunctive therapy, with most compelling antidepressant and procognitive benefits noted in patients with moderate depression.

Amantadine, an aliphatic primary amine with complex actions on neurotransmitter systems in the basal ganglia, is approved for treating Parkinson's disease and drug-induced movement disorders (DIMDs). These disorders have a significant impact on clinical outcomes and quality of life in patients receiving antipsychotic treatment.

We searched PubMed up to June 1, 2019 to identify relevant studies. The following search terms were used: “amantadine” AND “dys-tonia,” “parkinsonism, ” “akathisia,” “tardive dyskinesia,” “catatonia,” “neuroleptic malignant syndrome.” Reference lists were reviewed for additional material.

Evidence from multiple, small, controlled trials supports the efficacy of amantadine as a treatment for drug-induced parkinsonism. Studies show amantadine has a more favorable tolerability profile than anticholin-ergic medications in these patients. Clinical evidence from observational studies and case reports suggests that further trials might be warranted to support use of amantadine in select patients for preventing dystonic reactions and as a second-line agent for treating catatonia, neuroleptic malignant syndrome, and tardive dyskinesia. Evidence is lacking on the use of amantadine specifically for akathisia relative to other treatments.

Amantadine is an evidence-based pharmacologic strategy for treating drug-induced parkinsonism and might be an alternative treatment for other DIMDs in select patients. Additional randomized controlled trials are needed.

Parkinson's disease (PD) is a neurodegenerative/neuro-psychiatric disorder characterized by both motor and non-motor symp-tomology. The reported prevalence of depression in patients with PD is difficult to ascertain due to overlapping somatic symptoms and failure to self-report symptoms. Although antidepressants remain a first-line treatment, they can have adverse effects. Recently, literature has demonstrated that due to its anti-inflammatory properties, yoga may be an effective non-pharmacologic therapy for depression.

A search was conducted to identify randomized controlled trials (RCTs) published from January 2000 to January 2019 that assessed the effects of yoga on depression and motor functioning in PD.

Three studies met the criteria for inclusion. In one RCT, biweekly yoga resulted in a decrease in depression score (P = .056). In another RCT, weekly yoga resulted in a significant decrease in depression and demonstrated that its therapeutic effects are long-lasting. Finally, in a third RCT, no significant difference was found between control and experimental groups in depression after biweekly yoga. However, yoga was found to be protective against worsening of depression.

Our review suggests that the practice of yoga may be a useful nonpharmacologic adjunctive treatment for depression in patients with PD. However, more controlled RCTs are needed to validate our conclusions.