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December 2007

Index, Volume 30, 2007

High-Dose Ziprasidone
Patients with treatment-resistant psychosis may benefit from higher-than-recommended doses of ziprasidone (Geodon).

Baby Steps
Our clinical knowledge in psychiatry has increased over the past year, but scientific understanding and intervention technology still leaves much to be desired.

High Doses of Venlafaxine
Higher doses of venlafaxine (Effexor and others) likely increase the chance of antidepressant response, but also increase the risk of side effects.

SSRIs and Bleeding Risk in Patients with Hepatitis C
The risk of selective serotonin reuptake inhibitors causing bleeding in patients with hepatitis C is modest.

Bupropion versus SSRIs for Anxiety in MDD
According to Papakostas and colleagues, bupropion (Wellbutrin and others) appears to work as well as selective serotonin reuptake inhibitors to treat anxiety in patients with major depressive disorder.

Torsades de Pointes with Haloperidol
Intravenous administration of haloperidol (Haldol and others), especially at high doses, can cause QT prolongation and torsades de pointes.

In Brief
Ziprasidone for borderline personality disorder: A negative trial; Adjunctive medications for weight loss in patients with schizophrenia or bipolar disorder

Baby Steps

December 2007

Science progresses in increments. If you or a loved one is ill, advances in medical therapeutics may seem painfully small and all too slow. Baby steps, so to speak.

Watching advances in biological psychiatry over the past year, we see the clichéd good news and bad. Several large, expensive federal initiatives—namely, CATIE, STAR*D, and STEP-BD—have expanded clinical knowledge in useful ways, but at the same time, have demonstrated that neither our scientific understanding nor our intervention technology is as potent as we wish.

The huge undertaking of revising our diagnostic nomenclature—creating DSM-V—has set sail. Most likely, by the time DSM-V is published, psychiatric diagnoses will be informed by neurobiological discoveries. This will allow identification of more homogeneous diseases than our current broad syndromes and enable treatments to be more focused and targeted. We wait—and hope.

The U.S. healthcare system remains a disaster zone, as "managed care" serves to deny and impede good practice and while a substantial proportion of our population remains without coverage. Change will come—but how and when are open questions. The process will be highly political, given the trillion-plus dollars at play nationally. Again, we wait—and hope.

BTP now closes its 30th year and looks forward to decades more of reporting on little and big steps of clinical science—to help you and the patients in your care. I love this job and the people who make it possible. I thank our "Tucson team," which has become a family. We enjoy our work and one another immensely. The team includes Heather Hopkins, Amy Boynton, and Melissa Manas—and their growing families. I thank Dave Labrecque, who has made our audio option a reality; Susanne Austin, who maintains our website; my wife Patty, who records the audio with me; and the very efficient team at our printer, West Press.

I thank our subscribers and wish you and yours safe, enjoyable holidays and a healthy, prosperous New Year. Psychiatry has many hurdles and challenges, including historical stigma. But this is also an exciting era. Let the adventure continue.