Clozapine therapy demonstrated superiority to olanzapine therapy in preventing suicide attempts in patients with schizophrenia and schizoaffective disorder at high risk for suicide. Use of clozapine in this population should lead to a significant reduction in suicidal behavior.

Compared to placebo, olanzapine delays relapse into subsequent mood episodes in bipolar I disorder patients who responded to open-label acute treatment with olanzapine for a manic or mixed episode.

Objectives-Family members of patients with bipolar disorder experience high rates of subjective and objective burden which place them at risk for adverse physical health and mental health outcomes. We present preliminary efficacy data from a novel variation of Family Focused Treatment [Miklowitz DJ. Bipolar Disorder: A Family-Focused Treatment Approach (2 nd ed.). New York: The Guilford Press, 2008] that aimed to reduce symptoms of bipolar disorder by working with caregivers to enhance illness management skills and self-care.Methods-The primary family caregivers of 46 patients with bipolar I (n = 40) or II (n = 6) disorder, diagnosed by the Structured Clinical Interview for DSM-IV Axis I Disorders, were assigned randomly to receive either: (i) a 12-15-session family-focused, cognitive-behavioral intervention designed to provide the caregiver with skills for managing the relative's illness, attaining self-care goals, and reducing strain, depression, and health risk behavior [FamilyFocused Treatment-Health Promoting Intervention (FFT-HPI)]; or (ii) an 8-12-session health education (HE) intervention delivered via videotapes. We assessed patients pre-and posttreatment on levels of depression and mania and caregivers on levels of burden, health behavior, and coping.Results-Randomization to FFT-HPI was associated with significant decreases in caregiver depressive symptoms and health risk behavior. Greater reductions in depressive symptoms among patients were also observed in the FFT-HPI group. Reduction in patients' depression was partially mediated by reductions in caregivers' depression levels. Decreases in caregivers' depression were partially mediated by reductions in caregivers' levels of avoidance coping.Conclusions-Families coping with bipolar disorder may benefit from family interventions as a result of changes in the caregivers' ability to manage stress and regulate their moods, even when the patient is not available for treatment. Keywordsdepression; health burden; illness management; psychoeducation; stress Bipolar disorder affects the family members of a patient and is affected by the family environments associated with caregiving. From 89% to 91% of family members report NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript feelings of emotional distress (i.e., 'subjective burden') in relation to the severity of the patient's illness symptoms (1,2); between 24% and 38% score above the standard cutoffs on self-report measures of depressive symptoms (2). Patient suicidal ideation and behavior in particular have been associated with increased symptoms of caregiver depression (3). For family members with their own history of mood disorders, caregiving more than doubles the risk of recurrence of an episode of major depression in the caregiver compared to the risk of recurrence among persons with a history of mood disorder but without caregiving responsibilities (4).Recent studies suggest that subjective burden and/or depression also compromise caregivers' ability to effectively man...

To understand the heterogeneity of violent behaviors in patients with schizophrenia, one must consider underlying clinical symptoms of the illness and their change over time. The purpose of this study was to examine persistence and resolution of violence in relation to psychotic symptoms, ward behaviors, and neurological impairment. Psychiatric symptoms and ward behaviors were assessed in violent inpatients with schizophrenia or schizoaffective disorder and in nonviolent controls on entry into the study. Patients were followed for 4 weeks; those who showed resolution of assaults over this time were classified as transiently violent, and those who remained assaultive were categorized as persistently violent. At the end of the 4 weeks, psychiatric symptoms, ward behaviors, and neurological impairment were assessed. Overall, the two violent groups presented with more severe psychiatric symptoms and were judged to be more irritable than the nonviolent control subjects, but the transiently violent patients showed improvement in symptoms over time. At the end of 4 weeks, the persistently violent patients had evidence of more severe neurological impairment, hostility, suspiciousness, and irritability than the other two groups. Canonical discriminant analyses identified two significant dimensions differentiated the groups. The first, characterized by positive psychotic symptoms, differentiated the violent patients from the controLsubjects;_the second,xharacterized by neurological impairment and high endpoint score for negative symptoms, differentiated the transiently from the persistently violent patients. Identification of certain symptoms associated with different forms of violence has important implications for the prediction and differential treatment of violent behavior in patients with schizophrenia.