In our study of CBT-I, we assigned participants with chronic and primary insomnia to either CBT-I, temazepam, a combination of the two, or placebo. We found that combination therapy was more effective than either treatment alone—in our study, the percentage reduction of time awake after sleep onset was highest for the combined condition (63.5%), followed by CBT (55%), temazepam (46.5%), and placebo (16.9%).

If patients are stable on olanzapine (Zyprexa), quetiapine (Seroquel), or risperidone (Risperdal) but are experiencing adverse metabolic effects, it might make sense to switch to a medication that has a lower risk of causing such effects. But would such a switch reduce obesity and cholesterol at the risk of a relapse?

The editors at TCPR, as well as many of you, received a notice issued by the FDA on August 24, 2011 warning us that citalopram (Celexa) at doses higher than 40 mg may cause dangerous prolongation of the QT interval, which can increase the risk of cardiac arrhythmias (including the potentially fatal torsade de pointes).

After reading these articles, you should be able to…

If you treat patients with bipolar disorder, then you have reached what I call the moment of truth. Your patient has been doing so well, she’s not even sure she still has a psychiatric problem. This is one of the many opportunities for psychotherapy in bipolar disorder—in this case, helping your patient to come to terms with her illness.

Research has generally found that both antidepressants and psychotherapy offer similar efficacy in the short-term, but that after treatment discontinuation, results are better with psychotherapy.

I examined results of multiple meta-analyses published in top tier, peer reviewed journals. The findings were clear and consistent: effect sizes for psychodynamic psychotherapy are at least as large as those reported for other therapies that are promoted as “empirically supported” or “evidence based.” Also, the benefits of psychodynamic therapy are lasting. Patients not only improve, but continue to improve even after therapy ends.

Cognitive-behavioral therapy (CBT) works better than placebo and as well or better than fluoxetine for social anxiety disorder (SAD).

Using combination antipsychotic treatment has become more common over the years, presumably reflecting a common sense theory that in refractory patients, two medications might be more effective than one. But studies thus far of the practice have been small and inconclusive.

After reading these articles, you should be able to…