Faculty Bibliography

Aripiprazole (APZ) is a novel antipsychotic agent which does not block dopamine (DA) receptors but is rather a partial DA agonist. Thus, it has been proposed that APZ may not induce tardive dyskinesia (TD), a disfiguring and sometimes disabling and irreversible side effect of neuroleptics. Our patient had Lewy body dementia (LBD) and developed severe worsening of parkinsonism over 1 month of APZ treatment. Within days of discontinuation of APZ dramatic orobuccal dyskinesias emerged. Treatment emergent worsening of parkinsonism improved but orobuccal dyskinesias persisted unchanged until his death 8 months later. Others have reported severe extrapyramidal reactions including neuroleptic malignant syndrome and TD with APZ. APZ has been suggested as a treatment for TD but treatment benefit may reflect 'masked' dyskinesia. We conclude that, despite an attractive in vitro profile and promising animal data, APZ can induce serious extrapyramidal side effects, including TD

OBJECTIVE: Cognitive and emotional dimensions of the physician-patient relationship (working alliance) were examined in relation to patients' beliefs about the usefulness of treatment (perceived utility), patients' beliefs about being able to adhere to treatment (adherence self-efficacy beliefs), patients' follow through on their treatment plan (adherence), and patients' satisfaction. METHODS: Participants were 51 men and 67 women who averaged 38.9 years of age (S.D.=12.28). Seventy-two were Euro-American, 23 African-American, 6 Asian-American, 11 Hispanic, and 6 'Other.' They reported an average of 7.3 years (S.D.=7.48) since being diagnosed with a chronic medical illness and an average of 7.1 (S.D.=4.88) visits to their doctor within the last year. Patients' conditions included HIV+/AIDS, hypertension, diabetes, asthma, and cancer. RESULTS: Results show moderate to strong relationships between working alliance and perceived utility (r=0.63, P<0.001), self-efficacy (r=0.47, P<0.001), adherence (r=0.53, P<0.001), and satisfaction (r=0.83, P<0.001). Regression analyses showed that ratings of the working alliance (SB=0.25, P<0.005) and self-efficacy beliefs (SB=0.48, P<0.001) predicted patient adherence and that working alliance ratings (SB=0.83, P<0.001) also predicted patient satisfaction. CONCLUSION: The working alliance can be measured in medical care and appears to be strongly associated with patients' adherence to and satisfaction with treatment. PRACTICE IMPLICATIONS: The working alliance is important in medical treatment, as it is associated with patient adherence and satisfaction. Patients' self-efficacy ought to be assessed and promoted as it is also associated with treatment adherence

The occurrence of an aura is often considered evidence of a partial rather than an idiopathic generalized epilepsy syndrome. The authors examined this hypothesis by prospectively recording reports of auras by patients being admitted for video-EEG monitoring. Auras were equally common (70%) among patients with idiopathic generalized epilepsy as they were among those with localization-related epilepsy. Presence of an aura is not a reliable indicator of localization-related epilepsy

Antiepileptic drugs (AEDs) possess potent negative or positive psychotropic effects. Clear evidence of benefit exists for valproate, carbamazepine, and lamotrigine in bipolar disorder. Reports of benefit from various AEDs in mood, anxiety, impulse control, and personality disorder are reviewed. Further research is needed to clarify which patients are likely to benefit. Clinicians must closely attend to the ongoing risk/benefit analysis and consider possible iatrogenic worsening of neuropsychiatric symptoms

Responds to G. C. Fong et al's comments (see record 2002-06521-015) on K. Alper et al's article (see record 2001-09677-006) which reported interest in the relationship between seizure cluster characteristics, presence of mood disorder among first- and second-decree relatives, and postictal psychosis. The current authors agree that the approach would be useful. (PsycINFO Database Record (c) 2007 APA, all rights reserved)