Two recent meta-analyses examined the comparative efficacy of antidepressants versus psychotherapy in the treatment of depression and dysthymia (Cuijpers P et al., J Clin Psychiatry 2008, online ahead of print; Imel et al., J Affect Dis 2008;110:197-206).

After reading these articles, you should be able to…

One way to enhance the quality of our care of patients is to learn and implement expert practice guidelines. But there are some problems. First of all, there are so many guidelines out there that it is hard to know which ones to learn.

Should we use outcome scales in psychiatric practice? If so, which ones? Which are actually feasible in terms of time and utility?

The PHQ-9 is the Patient Health Questionnaire-9. It was adapted from an instrument originally funded by Pfizer, the PRIME-MD, which was developed as a tool for primary care doctors to screen their patients for psychiatric disorders.

The most recent findings from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial provided little help regarding which medication to prescribe if an initial SSRI trial failed to result in remission of depressive symptoms.

Sildefanil (Viagra) has been shown helpful in treating antidepressant-induced sexual dysfunction (AISD) in men, but no controlled trials had tested its effectiveness in women. In this trial, 98 women with SSRI associated sexual dysfunction were randomly assigned to either sildefanil or placebo; all participants continued their SSRI, and their sexual functioning was assessed at multiple times.

In a nationally representative sample of office-based psychiatrists, the percentage of patient visits involving at least 30 minutes of psychotherapy dropped from 44% in 1996-1997 to 29% in 2004-2005.

After reading these articles, you should be able to…

Are you diagnosing a personality disorder (PD) in half of your patients? If not, you probably are not asking enough questions.