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The American Journal of

Psychiatry VOLUME 173 | NUMBER 3 | MARCH 2016


205 Isnt Your Staff Trained To Manage My Mother?
Martin Steinberg, M.D.

208 Evidence-Based Pregnancy Registries: Good for Babies and Their Mothers
Vivien K. Burt, M.D., Ph.D.

211 A New Option for Treating Bipolar I Depression

Holly A. Swartz, M.D., Joseph T. Tasosa, M.D., M.S.

213 Dissecting the Brain Mechanisms of Violence

Robert Freedman, M.D., Robert Michels, M.D.


215 Potential Risks of Poorly Monitored Ketamine Use in Depression Treatment
Kathryn M. Schak, M.D., et al. CME AUDIO
Clinical Guidance: Ketamine prescribed for depression has addictive potential, and tolerance has been
reported. Use for depression is currently off-label, and dosing guidelines have not been established. Poor
monitoring of its use increase risk of serious adverse events.


219 Jinn Possession and Delirious Mania in a Pakistani Woman
Qurat ul ain Khan, M.B.B.S., Aisha Sanober, M.B.B.S.
Clinical Guidance: Possession by a supernatural jinn is considered in some cultures to explain
serious psychiatric illnesses, such as delirious mania. Challenging spiritual beliefs will likely damage
rapport with the patient and family. Efforts should be made to establish collaboration with spiritual


221 Post-Stroke Depression: A Review
Robert G. Robinson, M.D., Ricardo E. Jorge, M.D. CME AUDIO
Clinical Guidance: Randomized controlled trials have demonstrated that antidepressants are effective in
treating post-stroke depression (PSD) and in preventing it. Early antidepressant treatment of PSD appears
to enhance both physical and cognitive recovery from stroke and may increase survival up to 10 years
following stroke.

232 A Selective Review of Cerebral Abnormalities in Patients With First-Episode

Schizophrenia Before and After Treatment
Qiyong Gong, M.D., Ph.D., et al. AUDIO
Functional and anatomical brain abnormalities in never-medicated schizophrenia patients primarily
occur in different regions. Pretreatment hypofunction of the medial prefrontal cortex and hyperactivity
of the hippocampus and striatum may provide treatment targets. Many abnormalities in anatomy and
function remain stable after treatment.

244 Outcomes One and Two Winters Following Cognitive-Behavioral Therapy or Light
Therapy for Seasonal Affective Disorder
Kelly J. Rohan, Ph.D., et al. AUDIO
Clinical Guidance: Cognitive-behavioral therapy for seasonal affective disorder (CBT-SAD) provides
better long-term protection than light therapy. Outcomes were comparable at the end of treatment and
in the following winter, but in the second winter after treatment, CBT-SAD was superior to light therapy
in remissions, recurrences, and symptom levels.

252 Impact of Antipsychotic Review and Nonpharmacological Intervention on

Antipsychotic Use, Neuropsychiatric Symptoms, and Mortality in People With
Dementia Living in Nursing Homes: A Factorial Cluster-Randomized Controlled Trial
by the Well-Being and Health for People With Dementia (WHELD) Program
Clive Ballard, M.D., et al. EDITORIAL CME AUDIO
Clinical Guidance: An intervention to promote antipsychotic review in nursing homes reduced
antipsychotic use by 50%. Mortality was reduced when antipsychotic review was combined with
a program to increase residents social interactions. An exercise intervention improved neuropsychiatric
symptoms, but none of these three interventions reduced agitation or depression.

263 Reproductive Safety of Second-Generation Antipsychotics: Current Data From

the Massachusetts General Hospital National Pregnancy Registry for Atypical
Lee S. Cohen, M.D., et al. EDITORIAL AUDIO
Clinical Guidance: Registry data on 303 pregnant women indicate that the rate of major malformations
among infants exposed to second-generation antipsychotics (1.4%) is not signicantly higher than the
rate among unexposed infants of mothers with histories of psychiatric illness (1.1%).

271 An 8-Week Randomized, Double-Blind, Placebo-Controlled Evaluation of the Safety

and Efcacy of Cariprazine in Patients With Bipolar I Depression
Suresh Durgam, M.D., et al. EDITORIAL VIDEO
Clinical Guidance: Cariprazine is a newly approved atypical antipsychotic with possible antidepressant
efcacy due to effects on D3 and 5-HT1A receptors. Dosages of 1.5 and 3.0 mg/day had greater efcacy
than placebo in bipolar I depression, but the 1.5-mg dosage was better tolerated and produced fewer

282 Neural Correlates of the Propensity for Retaliatory Behavior in Youths With
Disruptive Behavior Disorders
Stuart F. White, Ph.D., et al. EDITORIAL
Clinical Guidance: Youths with disruptive behavior disorders (DBD) have a stronger propensity to retaliate
than do healthy youths. Retaliatory propensity is more strongly related to reactive than to proactive
aggression. Level of callous-unemotional traits is not associated with the level of reactive aggression in
DBD youths, but it does differentiate patterns in their neurobiological correlates of retaliatory behavior.

291 Medial Prefrontal Aberrations in Major Depressive Disorder Revealed by

Cytoarchitectonically Informed Voxel-Based Morphometry
Sebastian Bludau, Ph.D., et al. VIDEO
Depressed patients had a smaller left medial frontal pole volume than did healthy subjects, but volumes
of the right medial and bilateral frontal poles showed no difference. Volume of the left medial frontal pole
correlated negatively with disease severity and duration, and it discriminated between patients and
comparison subjects.



299 Gene-Environment Interaction in Youth Depression: Differential Susceptibility?
Eric M. Plakun, M.D.

299 Response to Plakun: Addressing Differential Susceptibility With Regard to

Gene-Environment Interaction in Youth Depression
Thiago Botter-Maio Rocha, M.D., et al.
Letters to the Editor, continued

300 Reections on Emil Kraepelin: Icon and Reality

Rael D. Strous, M.D., M.H.A., et al.

301 Response to Strous et al.: A Focus on Kraepelins Clinical Research Methodology

Kenneth S. Kendler, M.D., and Eric J. Engstrom, Ph.D.

302 Going Beyond Finding the Lesion: A Path for Maturation of Neuroimaging
Simon B. Eickhoff, Dr.Med., and Amit Etkin, M.D., Ph.D.

304 Psychiatric Polarities: Methodology and Practice
Constantine G. Lyketsos, M.D., M.H.S.

306 Books Received


214 Editors Note

307 Continuing Medical Education
A22 Chairpersons of APA Councils, Committees, and Task Forces
A23 Shanghai Archives of Psychiatry Contents
A29 Subscription and Business Information

Cover: Managing agitation and depression is a major problem in nursing home care. Ballard
and colleagues (p. 252) conducted a randomized controlled trial in United Kingdom nursing
homes to evaluate the effect of an antipsychotic review process, social interaction, and
exercise interventions. While the antipsychotic review and social interaction interventions
reduced mortality, and the exercise intervention improved neuropsychiatric symptoms, none
of these three interventions reduced agitation or depression. Cover image from