Schizophrenia is characterized by diminished insight, which fluctuates with disease progression. Insight deterioration in the prodrome of schizophrenia is poorly understood. Despite pharmacologic treatment, including early interventions, there is a high risk of relapse and need of acute care in schizophrenia patients.

To study if insight deterioration occurs during the prodrome and if insight preservation early in the illness might predict a better prognosis.

Data was collected retrospectively from the records of 24 patients initially diagnosed with schizophrenia during a 2-year period. Patients' progress was then tracked over a 3-year period. Insight was determined by a physician's subjective evaluation, patient interest and participation in treatment planning, and patient accuracy in reporting behaviors and symptoms when compared with reports from collaterals.

Ten patients were determined to have insight regarding the developing illness at different presentations at the hospital. Insight preservation correlated with less need for emergency visits and fewer hospitalization days (P<.005). It was also associated with more depressive and anxious mood (P<.000). Patients and family members described early, ego-dystonic perceptual disturbances followed by diminished insight. Awareness into the illness, symptoms, and attribution of symptoms to the illness fluctuated at different presentations in the insight group. In the other group, insight was nil at each presentation after the psychotic debut.

Most patients maintain insight during the perceptual disturbance phase. Insight diminishes as the early delusional phase sets in. Higher levels of preserved insight seem to correlate with less need for acute treatment. Further research in this area is warranted for determining if early insight oriented interventions in the prodromal phase can improve the prognosis of schizophrenia.

Lamotrigine is approved by the Food and Drug Administration for maintenance therapy in patients with bipolar I disorder. However, several studies of acute-phase and maintenance treatment support the efficacy of lamotrigine for bipolar I and bipolar II disorders. This chart review was performed to assess the efficacy and safety of lamotrigine in the treatment of bipolar disorder in a private psychiatric practice setting and to investigate differences in response among patients with different diagnostic subtypes of bipolar disorder.

The charts of 587 adult outpatients with a primary diagnosis of bipolar disorder who received treatment with lamotrigine in a private practice setting between July 1998 and May 2004 were reviewed retrospectively. Treatment response was assessed with the Clinical Global Impression-Improvement scale and was defined as achievement of a score of ≤2.

Three hundred forty-nine patients (59.5%) responded to lamotrigine. Response rates were comparable among patients wit h bipolar I disorder, bipolar II disorder, bipolar disorder not otherwise specified, and among patients with bipolar I disorder who presented with depressive, manic, or mixed episodes. Nonserious rash (12.8%) and headache (2.9%) were the most frequently reported adverse events.

These results suggest that lamotrigine is effective and well-tolerated in the treatment of bipolar disorder across the spectrum of sub-types of the illness.

To determine the level of agreement between patients and expert physicians in whether criterion multisomatoform (MSD) symptoms are explained.

We systematically collected reports from 280 primary care patients about whether they had suffered from any of 15 criterion MSD symptoms in the past month and whether they had received a medical explanation from a physician for positive criterion symptoms. The research team compared MSD symptom diagnoses derived from patient report with MSD symptom diagnoses derived from an expert physician report.

MSD symptom diagnoses derived from patient report had 98.7% sensitivity, 97.9% specificity, 89.3% positive predictive value, and 99.7% negative predictive value compared with MSD symptom diagnoses derived from an expert physician report. Analysis demonstrated that 15.0% of patients met symptom criteria for MSD, according to patient and physician report; 83.0% failed to meet symptom criteria for MSD, according to patient and physician report; 1.8% of patients met symptom criteria for MSD, according to patient report but not physician report, while 0.2% met symptom criteria for MSD according to physician report but not by patient report.

Patients demonstrated high agreement with a physician expert in somatization about whether criterion MSD symptoms are explained, suggesting revised screeners may accurately identify somatizing patients.

Many adults with current impairing symptoms of attention-deficit/hyperactivity disorder (ADHD) do not report an age at onset before 7 years of age and cannot, therefore, be assigned the full Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnosis of ADHD. We hypothesized that treatment with oral-release osmotic system (OROS) methylphenidate (MPH) will be safe and efficacious for the treatment of adults with late-onset ADHD.

This was a 6-week, open-label, prospective treatment study of OROS MPH monotherapy in 36 adult patients with late-onset ADHD (onset later than the required 7 years of age) using standardized instruments for diagnosis and a robust oral daily dose of up to 1.3 mg/kg/day. Symptom severity was assessed with the Adult ADHD Investigator Symptom Report Scale (AISRS) and the Clinical Global Impression (CGI) scale.

Subjects reported robust current symptoms of ADHD at pre-treatment baseline (11.1±2.8 DSM-IV symptoms), but had an atypical mean age at onset of 14.2±8.6 years. Treatment with OROS MPH at an average daily dose of 78.2±29.4 mg was associated with a statistically and clinically significant reduction in ADHD symptoms relative to baseline as assessed through the AISRS (−16.4±10.5; P<.001). Using a categorical definition of response (CGI-I much or very much improved), a majority (n=26; 72%) of subjects were rated as improved at endpoint.

These results extend previous findings in adults with full ADHD to adults meeting criteria for late-onset ADHD and support the need for further controlled clinical trials in this population.