APA Practice Guideline Research Articles

B-258 Rapid clozapine blood levels on the Beckman Coulter DxC 500 AU

Abstract Background Clozapine is the most effective drug for treatment-resistant schizophrenia. Multiple guidelines strongly recommend clozapine therapeutic drug monitoring (TDM). Measuring clozapine blood levels provides essential information when there are questions of medication adherence, efficacy, toxicity, medication interactions, or concern over other factors that may influence clozapine levels. Turnaround time is essential for effective clinical decisions. However, with liquid-chromatography/mass spectrometry, clozapine levels can take days to report results. To address the medical need for a faster turnaround time, a rapid clozapine immunoassay was developed for automated clinical chemistry analyzers. The immunoassay measuring range is based on established APA Practice Guidelines and ASCP/AGNP Consensus Statement. We developed an analyzer application for the DxC 500 AU (time to first result < 9 minutes) to expand the availability of rapid clozapine blood level testing. Methods The performance of the FDA-cleared clozapine assay was evaluated on the DxC 500 AU according to CLSI guidelines. Precision testing was performed with three clozapine spiked pools over five days with five replicates per sample. Precision sample recovery was assessed to their theoretical spike concentration. Linearity was verified with five spiked serum samples covering the measuring range. Method comparison was performed with 40 remnant patient samples vs. the Beckman Coulter AU480. Results Repeatability CV was ≤5.5% and within-laboratory precision CV was ≤6.1%. Individual deviation was ±20% and mean deviation was ±2% for all samples. Deviation from linearity was <3%. Deming regression statistics for the method comparison were a slope of 0.987, an intercept of 5.7, and an R of 0.9948. The methods are statistically equivalent: the 99% confidence limits contained 1 and 0 for the slope and intercept respectively. Conclusions The precision, recovery, linearity, and method comparison results for clozapine on the DxC 500 AU demonstrate that the analyzer can be used to generate robust results for clozapine.

APA Releases Practice Guideline on Schizophrenia

APA Releases Practice Guideline on Schizophrenia

Relationships and responsiveness in the psychological treatment of trauma: The tragedy of the APA Clinical Practice Guideline.

The therapeutic relationship and responsiveness/treatment adaptations rightfully occupy a prominent, evidence-based place in any guidelines for the psychological treatment of trauma. In this light, we critique the misguided efforts of the American Psychological Association's (APA, 2017) Clinical Practice Guideline on Posttraumatic Stress Disorder in Adults to advance a biomedical model for psychotherapy and thus focus almost exclusively on treatment methods for particular disorders. Instead, the research evidence, clinical expertise, and patient preferences and culture (the necessary triumvirate of evidence-based practice) should converge on distinctive psychological guidelines that emphasize the therapy relationship, treatment adaptations, and individual therapist effects, all of which independently account for patient improvement more than the particular treatment method. Meta-analytic findings and several trauma-specific studies illustrate the thesis. Efforts to promulgate guidelines without including the relationship and responsiveness are seriously incomplete and potentially misleading. The net result is an APA Guideline that proves empirically dubious, clinically suspect, and marginally useful; moreover, it squanders a vital opportunity to identify what actually heals the scourge of trauma. We conclude with recommendations for moving forward with future APA practice guidelines. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Treating Youth Obesity: Review and Application of APA Practice Guidelines

Youth obesity is an epidemic in the U.S. today, after five decades of increasing weight gains. The APA recently released clinical practice guidelines related to youth obesity to help inform and guide practitioners, based on available research evidence. The primary overarching recommendation is family-based multicomponent behavioral intervention of at least 26 hours in duration. This article covers a range of issues, clinical challenges, and practice topics that must be addressed within such intervention.

Shared Elements Across Therapies for Suicidal Patients With BPD

Shared Elements Across Therapies for Suicidal Patients With BPD

Board Takes Action on Wide Range of Issues

Board Takes Action on Wide Range of Issues

Measurement-Based Care and Psychiatric Education: Are We Doing Enough?

Back to table of contents Previous article Residents’ ForumFull AccessMeasurement-Based Care and Psychiatric Education: Are We Doing Enough?Matthew Baker, D.O.Matthew BakerSearch for more papers by this author, D.O.Published Online:30 Apr 2015https://doi.org/10.1176/appi.pn.2015.5a18AbstractThe past three decades of neuroscience research have brought unprecedented growth in our understanding of the human brain. Although this continues to form a growing evidence base for the field of psychiatry, most of these discoveries have not yet been translated for use in clinical care. The current practice of psychiatry depends predominantly on clinical observation and decision making, which is inherently subjective and results in much variation between providers. While other areas of medicine benefit from the regular use of basic standard tests, such as blood pressure and glucose measurements that are integrated into everyday clinical practice, psychiatry lacks this consistent reliance on objective measurement.Although the field of psychiatry does not yet have biomarkers or imaging data that can reliably guide clinical decisions, there are various clinical tools that have proven effective in improving treatment and outcomes. Measurement-based care, a system of consistent evaluation and treatment based on the use of rating scales and treatment algorithms, is one such approach. Rating scales are recommended by APA practice guidelines for major depression, schizophrenia, posttraumatic stress disorder, panic disorder, and obsessive-compulsive disorder. A 2006 report by the Institute of Medicine also recommended the routine use of rating scales to improve the quality of treatment for mental health and substance use conditions. Major studies like the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) and Sequenced Treatment Alternatives to Relieve Depression (STAR*D) used routine measurements to inform treatment decisions. In a January 2006 report in the American Journal of Psychiatry, Trivedi and colleagues indicated that this structured approach could be responsible for improved outcomes in depression treatment.Despite the recommendations and evidence, many practitioners do not regularly use these measures. This creates a quality problem that has proven difficult to solve. Reasons for lack of use of such measures vary from unawareness of evidence of their benefits to practical concerns about implementation or effect on the therapeutic relationship. However, it could be argued that many practitioners never developed familiarity with measurement-based care during their residency training. Although both the Accreditation Council for Graduate Medical Education Psychiatry Residency Program Requirements and the Psychiatry Milestone Project encourage the systematic use of assessment and quality-improvement modalities in residency training, there are no specific requirements that evaluate training in the use of measurement-based care.DSM-5, published in 2013, was the first edition of that diagnostic manual to include the use of cross-cutting measures and measurement-based care, a move likely demonstrating the evidence for and importance of increasing their use. An article in the August 2011 Journal of Clinical Psychiatry by Harding and colleagues introduced a policy-implementation plan that encouraged further training with these interventions in psychiatry residency; however, this aspect has not received widespread adoption in residency programs. Residents would do well to familiarize themselves with measurement-based interventions, and training programs would better prepare their residents for the future of evidence-based psychiatry by including instruction in and regular use of measurement-based care. In an article in the September 2013 Academic Psychiatry, Arbuckle and colleagues reported that adoption of a residency curriculum with measurement-based-care resulted in 92 percent use of a measure for depression screening, as well as 76 percent use for monthly monitoring of outpatients in a residency clinic. Studies such as this demonstrate the feasibility of integrating measurement-based care into residency training.Additionally, the adoption of measurement-based care in residency training might influence practitioners’ openness to future discoveries and the more rapid adoption of new evidence-based interventions as they become available. Given the evidence behind measurement-based care and the changing landscape of psychiatric practice, both residents and their patients stand to benefit from increased use of these tools in residency training. ■Matthew Baker, D.O., is a PGY-5 child and adolescent psychiatry fellow at Wright State University in Dayton, Ohio. ISSUES NewArchived

Obsessive-Compulsive Disorder: Diagnosis, Epidemiology, Etiology, and Treatment

Obsessive-compulsive disorder (OCD) has been given increased attention in DSM-5, receiving its own chapter. In this article, the authors discuss changes to the diagnostic criteria and symptoms differentiating OCD from other disorders. Two new specifiers, which have relevance in regard to treatment selection, appear in DSM-5: level of insight and presence of tic disorder. The epidemiology of OCD remains under investigation and may be modified based on the new DSM-5 criteria. Current data regarding age of onset and social and occupational functioning of patients with OCD are presented. The structural and functional neuroanatomy of OCD has been an area of increased research attention, and the authors summarize the research in this area. Treatment of OCD remains difficult, involving a combination of pharmacotherapy and cognitive-behavorial therapy, with a large percentage of nonresponders to initial treatment. The authors review pharmacotherapy recommendations from the APA practice guidelines and discuss evid...

Handbook of Good Psychiatric Management for Borderline Personality Disorder

Handbook of Good Psychiatric Management for Borderline Personality Disorder

Exercise Said to Benefit Patients With Depression

Though an APA practice guideline includes exercise as an adjunct treatment for depression, many physicians are unfamiliar with the prescription of exercise for this disorder.

APA Protests CMS Proposal to CutPart D Psychotropic Classes

APA argues that CMS misrepresents APA practice guidelines by selectively quoting from them and ignoring factors that must be considered when choosing an antidepressant or antipsychotic.

Review Finds 2007 OCD Guideline ‘Substantially Correct and Current’

There are new rating scales in the APA practice guideline that clinicians can use, and augmentation strategies have better evidence than was available in 2007.

Eating-Disorders Guideline Still Current and Valid, Panel Finds

Back to table of contents Previous article Next article Professional NewsFull AccessEating-Disorders Guideline Still Current and Valid, Panel FindsMark MoranMark MoranSearch for more papers by this authorPublished Online:4 Jan 2013https://doi.org/10.1176/appi.pn.2013.1a14AbstractA review of the 2006 APA practice guideline on eating disorders finds that it is substantially current and is not affected by changes in diagnostic criteria in DSM-5.The APA practice guideline on the treatment of eating disorders, originally issued in 2006, is still current and can be regarded by clinicians as valid. That was the determination of an expert panel led by Joel Yager, M.D., chair of the APA Steering Committee on Practice Guidelines. Their review of the practice guideline and recent treatment research are available on APA’s Web site under the title “Guideline Watch: Practice Guideline for Treatment of Patients With Eating Disorders–Third Edition.”Yager’s coauthors are Michael Devlin, M.D., Katherine Halmi, M.D., David Herzog, M.D., James Mitchell III, M.D., Pauline Powers, M.D., and Katherine Zerbe, M.D.The sole problem in the guideline is a recommendation for use of sibutramine for the treatment of binge-eating disorder. But since the guideline was issued, the Food and Drug Administration has withdrawn approval for sibutramine because clinical trials showed increased risk of heart attack and stroke. Also, the manufacturer, Abbott Laboratories, subsequently withdrew this medication from the U.S. market, Yager said.Guideline watches summarize significant developments in practice that have occurred since publication of an APA practice guideline. Watches may be written and reviewed by experts associated with the original guideline development and are approved for publication by APA’s Executive Committee on Practice Guidelines. Thus, watches represent the opinion of the authors and have the approval of the Executive Committee but are not APA policy.Yager added that in their review of the practice guideline, he and fellow authors anticipated changes in criteria that were proposed for eating disorders in the new DSM-5 and that have since been approved by the APA Board of Trustees—and found that the changes in diagnostic criteria do not affect the validity of the practice guideline. For the practice guideline watch, Yager and colleagues searched MEDLINE, using PubMed, for randomized, controlled trials and meta-analyses published from 2003 through December 13, 2011, searching on words related to eating disorders. The search yielded 1,346 articles; of these, 693 were rejected as not relating to treatment of eating disorders. They retained and reviewed 91 articles pertaining to anorexia nervosa, 84 to bulimia nervosa, 95 to binge eating, 12 to osteoporosis treatment in eating disorders, and 60 to miscellaneous topics, most of which covered more than one eating disorder. The watch reviews literature pertaining to anorexia, bulimia, binge-eating disorder, and eating disorders in middle age and later life.Yager said other practice-guideline watches that are being readied for publication include reviews of guidelines for obsessive-compulsive disorder and for Alzheimer’s and related disorders.“The purpose of the guideline watch is to review evolving literature related to a guideline and to bring to the attention of clinicians the advances that have been made in the field,” Yager said. “We want to examine how a practice guideline has stood the test of time and to provide clinicians with important updates.” ■“Guideline Watch: Practice Guideline for Treatment of Patients With Eating Disorders-Third Edition” is posted at http://www.psychiatry.org/File%20Library/Practice/ED_PG_Watch_August_2012.pdf. ISSUES NewArchived

Ask the Expert: Cognitive Decline

Ask the Expert: Cognitive Decline

It Takes a Family

It Takes a Family

GID Report Stresses Need for Psychiatrist Involvement

With subjective improvement as the primary outcome, the existing evidence base combined with clinical consensus is sufficient for developing recommendations for an APA practice guideline on treatment of adults with gender identity disorder.

MOC Among Top Issues Taken on by Assembly

MOC Among Top Issues Taken on by Assembly

American Psychiatric Publishing Launches Redesigned Web Sites

Back to table of contents Previous article Next article Professional NewsFull AccessAmerican Psychiatric Publishing Launches Redesigned Web SitesBob PursellBob PursellSearch for more papers by this authorPublished Online:18 Nov 2011https://doi.org/10.1176/pn.46.22.psychnews_46_22_3_1AbstractAmerican Psychiatric Publishing, a division of APA, has debuted a major redesign and upgrade of its popular Web site, PsychiatryOnline.org. The new PsychiatryOnline.org features a fully integrated experience across key psychiatry titles—bringing together on one platform APA journals, Psychiatric News, DSM-IV-TR, major textbooks covering psychiatry subspecialties, practice guidelines, CME, and other key resources. The result is a more robust treatment, research, and learning tool for users.American Psychiatric Publishing publishes many of the strongest titles in psychiatry: DSM-IV-TR, five peer-reviewed journals including the American Journal of Psychiatry, major textbooks and reference works, Psychiatric News, CME tools, patient handouts, and APA's practice guidelines. This upgrade of PsychiatryOnline offers unified search and browse features that allows discovery across all content, no matter what type it is. The DSM Library, Psychiatric News, and each individual journal retains its own Web site with title-specific search and browse so that APA members and other users can focus on the content of most importance to them. Journal Web sites include the following:American Journal of PsychiatryPsychiatric ServicesFocus, The Journal of Lifelong LearningJournal of Neuropsychiatry and Clinical NeurosciencesAcademic Psychiatry"Our members, and other mental health professionals, are becoming more sophisticated in their use of online content and their information needs are changing," said Publisher Rebecca Rinehart. "We are very pleased to offer them a powerful and dynamic platform that will enable them to retrieve critical content in a manner that is most convenient to them."The redesign of PsychiatryOnline and the journal Web sites follows from the publishing division's decision to move all of its journals to Silverchair Information Systems' semantic Web development platform—SCM6. Silverchair has hosted DSM-IV-TR and textbooks as part of PsychiatryOnline since launch of that product in 2005, but journals were previously on the HighWire Press platform. The SCM6 platform enables American Psychiatric Publishing to optimize its information delivery for general and subspecialty psychiatrists, providing a user interface and content design uniquely suited to support different content types like books, journals, and news; psychiatry-tailored topic collections that surface related articles and book chapters; and multifaceted search and browse."We are thrilled to be working with American Psychiatric Publishing to develop a fully integrated content portfolio presented through the new PsychiatryOnline," said Thane Kerner, Silverchair CEO. "As one of the first sites to bring books, guidelines, and journals together on the SCM6 platform, we think POL will stand as a distinguished example of portfolio integration and product innovation enabled by a semantic architecture."The partnership with Silverchair allows American Psychiatric Publishing to bring cutting-edge semantic technologies to bear in enhancing PsychiatryOnline and creating new products for psychiatrists. Silverchair enriches all PsychiatryOnline content by adding semantic "hooks" so that computers can find key concepts within content and automatically make connections to and between them. The source of these "hooks" is a robust psychiatry taxonomy that is compliant with the vocabularies used to index biomedical literature for PubMed and code diseases and treatments for electronic health records. A database of equivalent concepts for each taxonomy term allows normalization of language variations back to a root concept even when authors use different terms to describe the same concepts and searchers use different terms to find them. So a reader searching for "PTSD," "posttraumatic stress disorder," the DSM code 309.81, or even archaic terms like "traumatic neurosis" and "shellshock" receive a consistent results set. The hierarchy of the taxonomy allows articles and chapters to be grouped together based on shared topics to create hierarchical topic collections. These are some of the enhanced features of the new sites:Semantically enriched content and sophisticated mapping allow each page to serve as a reliable "launch pad" to highly relevant related information, offering suggestions for articles, book chapters, practice guidelines, and PubMed resources related to topics of most interest to each user.A search engine supported by semantic technologies returns more relevant results by combining full-text matching and thesaurus-supported concept mapping. Search filters allow users to target particular titles or combinations of topics.Mobile-optimized Web sites optimize the viewing experience of articles, book chapters, and other content types on Web-enabled phones."PsychiatryOnline continues to evolve to offer readers new ways to access our content that best fit the ways they work," said Robert Hales, M.D., American Psychiatric Publishing's editor in chief for books. "We are committed to continuing to embrace technological innovations that allow us to reach our readers in new ways."The redesigned site and all of its products may be accessed at < www.PsychiatryOnline.org>. ISSUES NewArchived

Ethnic Disparities in Antipsychotic Drug Use in British Columbia: A Cross-Sectional Retrospective Study

Ethnic Disparities in Antipsychotic Drug Use in British Columbia: A Cross-Sectional Retrospective Study

Suicide Risk: Navigating the Failure Modes

Suicide Risk: Navigating the Failure Modes