Faculty Bibliography

Although enormous amounts of time and money have been invested in enhancing performance for college and professional athletes, their psychiatric needs have been minimally addressed. Given the virtual absence of controlled scientific literature, in this article the authors detail the diagnostic issues and delineate treatment principles, including: (1) making an accurate diagnosis; (2) setting realistic goals; (3) delivering psycho-education; (4) inducing the patient to undergo treatment, including involving the family and significant others; and (5) delivering appropriate treatment (the most difficult task). The objective is to improve performance and quality of life by treating the problem or psychiatric illness. A special concern is minimizing countertransference feelings and avoiding undertreatment, because by definition the athlete needs to perform.

OBJECTIVE: To compare the long-term efficacy and tolerability of oral quetiapine with those of intramuscular haloperidol. METHOD: Patients with DSM-IV-diagnosed schizophrenia or schizoaffective disorder requiring long-term antipsychotic treatment were randomly assigned to open-label oral quetiapine or intramuscular haloperidol decanoate for 48 weeks. Clinicians were instructed to target dosing at 500 mg/day of quetiapine or 200 mg of haloperidol decanoate every 4 weeks. The Positive and Negative Syndrome Scale was used to assess efficacy; the Simpson-Angus Scale and the Barnes Akathisia Scale were used to assess safety and tolerability. For statistical analyses, a general linear mixed-model repeated-measures analysis of covariance was used, with change scores for dependent variables computed with the baseline score as covariate. Data were collected from 1998 to 2001. RESULTS: Thirty-five patients were enrolled, but 6 did not participate after being informed of their treatment assignment; 4 of the 6 withdrawals were assigned to haloperidol decanoate. Mean doses at week 48 were 493 mg/day of quetiapine (N = 16) and 170 mg/28 days of haloperidol decanoate (N = 9). Survival analysis showed no between-group differences in estimates of the number of patients remaining exacerbation-free over time. Both drugs were efficacious, but quetiapine was significantly better than haloperidol decanoate in controlling negative symptoms (p < .05). The incidence of extrapyramidal symptoms was low in both groups; patients receiving quetiapine showed significantly greater improvement in rigidity and akathisia (p < .05). CONCLUSION: Oral quetiapine was as efficacious as intramuscular haloperidol in preventing symptom exacerbation over 48 weeks in patients with schizophrenia or schizoaffective disorder, with fewer extrapyramidal symptoms, especially rigidity and akathisia. Quetiapine was more efficacious than haloperidol decanoate in treating negative symptoms.

OBJECTIVE: For a variety of pedagogical, political and financial reasons, there are major problems in achieving effective teaching of cutting-edge psychopharmacology for psychiatric residents. This article focuses on ways to improve the teaching/learning process, in part through the use of structured curricula. The authors review 1) attempted solutions to the educational problems, including use of the 1980s American College of Neuropsychopharmacology (ACNP) and 1990s American Society of Clinical Psychopharmacology (ASCP) model curriculums; 2) evaluation of and obstacles to change; and 3) suggestions of what to do now. METHOD: A psychopharmacology curriculum was prepared in the early 1980s under the auspices of the ACNP and in the 1990s and early 2000s by the ASCP in three editions. Three separate surveys of training directors and Chairs of departments using the curriculum, informal feedback from a variety of psychopharmacology experts, interactive presentations at national meetings (e.g., ACNP and AADPRT) served to guide development and revisions of the curriculum. RESULTS: Three formal follow up evaluations over two decades of users of the curriculum have suggested that it is not enough to have a strong content of what needs to be taught. In addition, a successful psychopharmacology curriculum must have 1) the pedagogy, (i.e., features like pre-post questions, teaching points, etc.) to facilitate use of the many facets and considerable amounts of information; 2) advanced technology to make the content current, adaptable, and both teacher- and student-friendly; 3) accompanying strategies to allow buy-in from training directors and teachers who have had no role in development; 4) reasonable cost to allow wide-spread dissemination while covering preparation expense (preferably without industry support); and, finally 5) evaluation of competence both at the end of training and post-residency in actual practice. CONCLUSION: The long-term objective of improving the teaching/learning process is to improve the clinical practice of psychopharmacology.

The incidence of psychiatric disorders and family problems in elite athletes is probably similar to that of the general population, yet, for a variety of reasons, athletes and their families rarely seek treatment. Athletic performance may be affected by problems in a marriage or home life, as in this case of a high-profile athlete whose wife abused medications and alcohol to cope with a depressive disorder and anxiety. Clinicians who treat athletes should be aware of family dynamics that may affect performance and be willing to suggest interventions, such as individual and marital psychotherapy, medication, or both.

Recent studies have indicated that bipolar disorder is more common than previously believed. The socioeconomic and personal burdens of this illness are significant, and the lifetime risk of suicide attempts by patients with bipolar II disorder is high. It is not uncommon for patients with bipolar disorder, especially those presenting with depression, to be seen first in a primary care setting; therefore, primary care physicians need to be ready to diagnose and manage patients with these mental illnesses. The diagnosis of bipolar disorder or bipolar spectrum disorder is easily missed, or these illnesses may be misdiagnosed. A systematic and detailed initial history from the patient and a reliable family member is essential to making the correct diagnosis. The Mood Disorder Questionnaire, a validated screening instrument for bipolar disorder, may help primary care physicians make an appropriate diagnosis. Long-term management of patients with bipolar disorder should involve close liaison with a psychiatrist.