Academic Appointments

Administrative Appointments

  • Staff Psychiatrist and Research Associate, Hillside Hospital, Glen Oaks, New York (1965 - 1966)
  • Instructor & Assistant Attending Psychiatrist, New York State Psychiatric Institute, College of Physicians and Surgeons, Columbia University (1965 - 1968)
  • Assistant Clinical Professor of Psychiatry, Medical College of Georgia (1966 - 1968)
  • Captain, Army of the United States, Chief, Psychiatry Service, U.S.Army Hospital Specialized Treatment Center, Fort Gordon, Georgia (1966 - 1968)
  • Assistant Clinical Professor of Psychiatry and of Obstetrics & Gynecology, School of Medicine, University of California, San Francisco (UCSF) (1968 - 1972)
  • Chief, Clinical Research Ward, Langley Porter Neuropsychiatric Institute and Dept. of Psychiatry (1968 - 1978)
  • Career Teacher in Psychiatry, School of Medicine, University of California, San Francisco (UCSF) (1971 - 1973)
  • Associate Clinical Professor, School of Medicine, University of California, San Francisco (UCSF) (1972 - 1976)
  • Director, Medical Student Education, Langley Porter Neuropsychiatric Institute and Dept. of Psychiatry (1975 - 1978)
  • Professor of Psychiatry in Residence, School of Medicine, School of Medicine, University of California, San Francisco (UCSF) (1976 - 1978)
  • Professor of Psychiatry, Cornell University Medical College, New York, NY (1978 - 1993)
  • Associate Medical Director, , Payne Whitney Clinic, Dept. of Psychiatry, The New York Hospital- Cornell Medical Center (1978 - 1993)
  • Associate Medical Director, Payne Whitney Clinic, Dept. of Psychiatry, The New York Hospital- Cornell Medical Center (1978 - 1993)
  • Senior Science Advisor to the Director, National Institute of Mental Health, Rockville, MD, 80% (1988 - 1990)
  • Professor of Psychiatry & Behavioral Sciences, Stanford University School of Medicine (1993 - Present)
  • Director, Schizophrenia Research Clinic, Stanford University School of Medicine & Stanford University Hospital (1993 - Present)
  • Director of Inpatient & Partial Hospitalization Services, Stanford University School of Medicine & Stanford University Hospital (1993 - 2000)
  • Acting Deputy Chief of Staff and Chief of Psychiatry, Palo Alto Veterans, Stanford University School of Medicine & Stanford University Hospital (1995 - 1996)

Honors & Awards

  • Fulbright Lecturing Award, India (2003)
  • 2003 Metzger-Conway Fellow, Clarke Center, Dickinson College, Carlisle, PA (2003)
  • 2002 Rockefeller Foundation Award, Residence at Bellagio, Italy (2002)
  • Distinguished Contribution to Family Systems Research Award, Annual AFTA award (2001)
  • Annual Outstanding Achievement Award of the Northern California Psychiatric Society, APA (2000)
  • Association for Academic Psychiatry Annual 1997 Education Award, . (1996)
  • The Gralnick Award, American Psychological Foundation (1994)
  • The Van Ameringen Award in Psychiatric Rehabilitation, American Psychiatric Association (1993)
  • MacArthur Foundation Research Network on Depression, . (1991-1994)
  • Runner-up for The American Academy of Clinical Psychiatrists Clinical Research Award, . (1991)
  • Alumni Achievement Awards, New York Medical College (1991)
  • Model Curriculum in Psychopharmacology, The Association for Academic Psychiatry Psychiatric Education Award, Honorable Mention (1991)
  • Director's Award, National Institute of Mental Health (1990)
  • The Seymour D. Vestermark Award, American Psychiatric Association (1990)
  • The Best Doctors in America, . (1986-1997)
  • The American Psychiatric Association and PIA Award for Hospital Psychiatric Research, Research in the field of hospital psychiatric treatment. (1987)
  • Research Fellowship, Japanese National Institute of Mental Health, Itchikawa, Japan (1987)
  • Fulbright Research Scholar, Japan (1987)
  • Member, Special Review Committee on Depression, ADAMHA, NIMH (July) (1982)
  • Ad Hoc Reviewer for the Psychosocial & Biobehavioral Treatments Subcommittee, Treatment Development and Assessment Research Review Committee, NIMH (1979-1980)
  • Consultant, Psychiatric Education Branch of the National Institute of Mental Health (1974-1978)
  • American Journal of Nursing, 1979, Books of the Year Award, "Psychiatric Hospital Treatment for the 1980's" (1979)
  • Kaiser Award for Excellence in Teaching, Dept. of Psychiatry Nominee (1974-1975)
  • Career Teacher in Psychiatry, National Institute of Mental Health, MH-12450 (1971-1973)
  • Army Commendation Medal, U.S. Army Hospital, Ft. Gordon, Georgia (1968)
  • Stephen P. Jewett Award ., Dept. of Psychiatry, New York Medical College (1961)
  • Dept. of Psychiatry, New York Medical College (Summer), National Institute of Mental Health Research Training Grant (1960)
  • National Foundation Medical Student Fellowship, Dept. of Physical Medicine & Rehabilitation, New York Medical College (Summer) (1959)
  • Skull & Key Award, Dickinson College (1953-1954)

Professional Education

  • B.S, Dickinson College, Carlisle,, . (1957)
  • M.D, New York Medical College (1961)
  • Rotating Internship, Beth Israel Hospital, New York, (1962)
  • Psychiatry Residency, Hillside Hospital, Glen Oaks,NY (1963)
  • Psychiatry Residency, Mt. Zion Hospital, San Francisco (1964)
  • Psychiatry Residency, Hillside Hospital (1964)
  • Candidate, NY Psychoanalytic Institute (1965)

Research & Scholarship

Current Research and Scholarly Interests

Schizophrenia is one of the major public health problems in American medicine. Treatment is partially efficacious but unsatisfactory. Accordingly, our research focuses on treatment outcome in two areas; finding more effective medications which have less side effects than current medications, and in the effects of combining medication with psychosocial interventions.



All Publications

  • The Maristan "Sidi Fredj" in Fez, Morocco. American journal of psychiatry Moussaoui, D., Glick, I. D. 2015; 172 (9): 838-839

    View details for DOI 10.1176/appi.ajp.2015.15010051

    View details for PubMedID 26324302

  • Teaching the Teachers of Clinical Psychopharmacology ACADEMIC PSYCHIATRY Salzman, C., Glick, I. D. 2015; 39 (4): 475-481


    This commentary focuses on psychopharmacology teachers and their teaching. The authors offer broadly based pedagogic suggestions on how to deliver evidence-based and neurobiologically informed prescribing information to clinicians at all levels of experience. They argue that teaching essential psychopharmacology knowledge and practice must be up-to-date, accurate, and consistent with the reality of an individual patient's life experience and beliefs. They stress that educators must teach that nonpsychopharmacological factors in a patient's life may be as relevant to the treatment setting as the actual pharmacological basis of psychotropic drug therapeutics.

    View details for DOI 10.1007/s40596-014-0263-z

    View details for Web of Science ID 000361093500027

    View details for PubMedID 25472420

  • Can you treat the cheat in sports? Physician and sportsmedicine Glick, I. D., Begel, D. 2015; 43 (3): 285-286


    This editorial examines the issue of "cheating" (broadly defined) in sports from youth through professional sports. We describe possible underlying causes focusing on the development of a "personality disorder" and psychiatric/psychodynamic needs (e.g. a pathological need to be the best). We detail treatment and management from a medical-psychiatric perspective as well as implications for coaches, teams, leagues and professional organizations (e.g. soccer, bicycling, etc). Cheating behavior exists in other fields, for example, politics, law among others and some of the management principles mentioned here may apply there.

    View details for DOI 10.1080/00913847.2015.1066230

    View details for PubMedID 26205610

  • Improving the practice of clinical psychopharmacotherapy: the process of long-term management for patients and caregivers. journal of clinical psychiatry Glick, I. D., Ellison, J. M. 2015; 76 (6): 735-736


    In the care of psychiatric patients, many of whom will require prolonged medication treatment and monitoring, the pharmacotherapy visit is one place where "the rubber meets the road." Complex clinical and administrative needs must be addressed, often with incomplete clinical information during encounters that are abbreviated due to packed schedules and late arrivals. Clinician engagement is undermined by growing caseloads, increasing documentation requirements, coverage limitations, and the need to keep abreast of a growing body of knowledge that defines evidence-based practices.

    View details for DOI 10.4088/JCP.15ac10034

    View details for PubMedID 26132674

  • Switching to iloperidone. Clinical schizophrenia & related psychoses Citrome, L., Weiden, P. J., Alva, G., Glick, I. D., Jackson, R., Mattingly, G., Kianifard, F., Meng, X., Winseck, A. 2015; 8 (4): 183-195


    To describe secondary analyses from a 12-week, randomized, open-label trial where adult schizophrenia outpatients receiving risperidone, olanzapine, or aripiprazole were switched to iloperidone.Patients were randomized into two groups: one where the antecedent antipsychotic dose was titrated downwards to zero over 2 weeks (n=240), and the other group where the antecedent antipsychotic was abruptly stopped (n=260). Adaptations of the Clinical Global Impression scale were used to evaluate clinical changes. Other assessments included the reporting of adverse events (AEs), study discontinuation, body weight, and metabolic variables.Improvement was steady throughout the study for both gradual- and immediate-switch groups starting at Week 1 and continuing through Week 12. Discontinuations due to AEs in the first 2 weeks of treatment were higher for the immediate-switch group compared with the gradual-switch group (10.8% vs. 5.4%, NNT 19, 95% CI 10-151). Fewer patients in the gradual-switch group experienced dizziness as an AE, whereas a higher percentage of patients in the immediate-switch group exhibited earlier onset of a therapeutic response within the first 2 weeks; both groups were comparable thereafter with low rates of dizziness and similar efficacy outcomes.Switching to iloperidone can be accomplished either with a gradual crossover or immediate discontinuation of the prior antipsychotic; however, the immediate-switch method is associated with greater proportion of initial dizziness. The observed outcomes are consistent with what has been previously reported regarding iloperidone's favorable akathisia/EPS profile and modest impact on somnolence/sedation, body weight, and metabolic variables.

    View details for DOI 10.3371/CSRP.CIWE.103114

    View details for PubMedID 25367165

  • Industry withdrawal from psychiatric medication development. Revista brasileira de psiquiatria Klein, D. F., Glick, I. D. 2014; 36 (3): 259-261


    Between 1950 and 1969, on a serendipitous basis, psychiatric drug development flourished. However, there has been a steep decline in the development of new medication classes. Instead of new molecular entities, slight molecular modifications producing "me-too" drugs attempted to garner market share. With failing profitability, industry is now withdrawing from psychiatric medication development. Managed care drastically shortened contact between patients and clinicians, so the possible observation of unexpected benefits has been nullified. The randomized, parallel-groups design met FDA requirements for specific pharmacological efficacy. However, it does not determine whether a patient who improved while drug-treated required the drug or would have gotten better on his own. Further, pathophysiology benefit remains obscure. The major psychotropic drugs have no benefits for normal subjects. Their remarkable benefits must stem from a necessary interaction with a pathophysiological state. Therefore, understanding therapeutic benefit by treating normal subjects becomes unlikely. The claim that therapeutic knowledge in psychiatry proceeds from bench to bedside has proven vacuous, primarily because of our limited understanding of brain pathophysiology. The utility of the alternative intensive design for understanding diagnosis, therapeutic benefit, and pathophysiology is emphasized.

    View details for PubMedID 24918522

  • A trial evaluating gradual- or immediate-switch strategies from risperidone, olanzapine, or aripiprazole to iloperidone in patients with schizophrenia. Schizophrenia research Weiden, P. J., Citrome, L., Alva, G., Brams, M., Glick, I. D., Jackson, R., Mattingly, G., Kianifard, F., Meng, X., Pestreich, L., Hochfeld, M., Winseck, A. 2014; 153 (1-3): 160-168


    In a 12-week randomized open-label trial, adults diagnosed with schizophrenia experiencing inadequate efficacy and/or poor tolerability on risperidone, olanzapine, or aripiprazole were randomized to switch to iloperidone either gradually (ie, down-titration of current therapy over the first 2weeks [to 50% on Day 1, 25% by Week 1, 0% by Week 2]) or immediately. All patients were titrated on iloperidone to 6mg BID by Day 4, then flexibly dosing between 6 and 12mg BID, as needed. The primary variable was the Integrated Clinical Global Impression of Change (I-CGI-C) and the primary analysis time point was Week 12. A total of 500 patients were randomized and received iloperidone (gradual switch, 240; immediate switch, 260), with 175, 155, and 170 patients switched from risperidone, olanzapine, and aripiprazole, respectively. I-CGI-C Results confirmed improved outcomes at Week 12, with scores that were similar between the gradual- and immediate-switch groups, respectively, for risperidone, 2.82 and 2.67 (95% CI: -0.229, 0.511); olanzapine, 2.87 and 3.03 (95% CI: -0.548, 0.235); and aripiprazole, 2.79 and 2.81 (95% CI: -0.405, 0.368). Incidence of adverse events (AEs) was similar in both switch groups, with the most frequently reported (≥10%) being dizziness, dry mouth, somnolence, and weight increase. In conclusion, switching to iloperidone by either a gradual or an immediate method did not reveal any clinically significant differences in ratings of overall efficacy and safety/tolerability outcomes, based on the I-CGI-C at 12weeks. Similar overall safety/AE profiles were observed regardless of the specific agent from which patients were switched.

    View details for DOI 10.1016/j.schres.2013.11.042

    View details for PubMedID 24529610

  • Effects of switching from olanzapine, quetiapine, and risperidone to aripiprazole on 10-year coronary heart disease risk and metabolic syndrome status: Results from a randomized controlled trial SCHIZOPHRENIA RESEARCH Stroup, T. S., Byerly, M. J., Nasrallah, H. A., Ray, N., Khan, A. Y., Lamberti, J. S., Glick, I. D., Steinbook, R. M., McEvoy, J. P., Hamer, R. M. 2013; 146 (1-3): 190-195


    This study examined the clinical significance of switching from olanzapine, quetiapine, or risperidone to aripiprazole by examining changes in predicted risk of cardiovascular disease (CVD) according to the Framingham Risk Score (FRS) and metabolic syndrome status. FRS estimates 10-year risk of "hard" coronary heart disease (CHD) outcomes (myocardial infarction and coronary death) while metabolic syndrome is associated with increased risk of CVD, stroke, and diabetes mellitus.Changes in FRS and metabolic syndrome status were compared between patients with BMI ≥ 27 and non-HDL-C ≥ 130 mg/dL randomly assigned to stay on stable current treatment (olanzapine, quetiapine, or risperidone) or switch to treatment with aripiprazole with 24 weeks of follow-up. All study participants were enrolled in a behavioral program that promoted healthy diet and exercise.The pre-specified analyses included 89 switchers and 98 stayers who had post-baseline measurements needed to assess changes. Least squares mean estimates of 10-year CHD risk decreased more for the switch (from 7.0% to 5.2%) than the stay group (from 7.4% to 6.4%) (p = 0.0429). The odds ratio for having metabolic syndrome (stay vs. switch) at the last observation was 1.748 (95% CI 0.919, 3.324, p = 0.0885).Switching from olanzapine, quetiapine, or risperidone to aripiprazole was associated with larger reductions in predicted 10-year risk of CHD than the behavioral program alone. The advantage of switching on metabolic syndrome was not statistically significant. The benefits of switching must be balanced against its risks, which in this study included more discontinuations of the study treatment but no significant increase in symptoms or hospitalizations.

    View details for DOI 10.1016/j.schres.2013.01.013

    View details for Web of Science ID 000317336500028

    View details for PubMedID 23434503

  • Teaching the teacher: a report from the third annual American Society of Clinical Psychopharmacology teaching session. journal of clinical psychiatry Glick, I. D., Zisook, S., Rapaport, M. H. 2013; 74 (3): 262-264

    View details for DOI 10.4088/JCP.12com08243

    View details for PubMedID 23561232

  • Can Long-Term Outcomes Be Improved by Shortening the Duration of Untreated Illness in Psychiatric Disorders? A Conceptual Framework PSYCHOPATHOLOGY Dell'Osso, B., Glick, I. D., Baldwin, D. S., Altamura, A. C. 2013; 46 (1): 14-21


    The duration of untreated illness (DUI), meaning the latency to the pharmacological treatment, has been increasingly investigated in the last decade as a predictor of outcome across different psychiatric conditions, particularly in psychotic disorders. DUI is essentially computed by subtracting the age of onset of a specific disorder from the age at which the first adequate pharmacological treatment is administered. Assessment of the latency to treatment represents one of the first steps in planning early interventions. This review examines the role of the DUI in psychotic and affective disorders, focusing on neuropathological, epidemiologic, clinical and prognostic factors related to a longer latency to treatment. Through a Medline and Cochrane Library search, relevant studies up to June 2011 and other pertinent articles including meta-analyses, randomized controlled trials, naturalistic studies and clinical reviews were identified. Converging evidence indicates that a prolonged DUI negatively influences the outcome of first-episode psychosis and schizophrenia in different ways, and increasing data point toward a similar conclusion in affective disorders. Even though methodological limitations related to investigation of the DUI need to be considered, research and interventions aimed to reduce latency to treatments are object of increasing implementation worldwide. The assessment of the DUI represents one of the most important parameters to consider in this perspective, in order to quantify different latency to treatment in specific disorders and to plan related, targeted interventions.

    View details for DOI 10.1159/000338608

    View details for Web of Science ID 000311492800002

    View details for PubMedID 22890286

  • Obsessive-compulsive symptoms in schizophrenia: implications for future psychiatric classifications COMPREHENSIVE PSYCHIATRY Poyurovsky, M., Zohar, J., Glick, I., Koran, L. M., Weizman, R., Tandon, R., Weizman, A. 2012; 53 (5): 480-483


    Although obsessive-compulsive symptoms are not considered primary features, they are prevalent, independent of psychosis, and substantially modify clinical characteristics, course, treatment and prognosis of schizophrenia. The authors highlight the clinical significance of obsessive-compulsive symptoms in schizophrenia, provide diagnostic criteria for "schizo-obsessive" patients and address future directions for research.

    View details for DOI 10.1016/j.comppsych.2011.08.009

    View details for Web of Science ID 000305769000010

    View details for PubMedID 22036006

  • Managing Psychiatric Issues in Elite Athletes JOURNAL OF CLINICAL PSYCHIATRY Glick, I. D., Stillman, M. A., Reardon, C. L., Ritvo, E. C. 2012; 73 (5): 640-644


    Providing psychiatric consultation to elite athletes presents unique and complex issues. These patients present with multifaceted medical, psychological, and performance concerns. We provide the first report of professional and ethical quandaries that arise in treating elite athletes and ways to address them.We identified studies through a MEDLINE search. Search terms included the following, individually and in combination: psychiatry, athletes, elite athletes, professional athletes, sports, sport psychiatry, mental illness, major depressive disorder, depression, bipolar disorder, suicide, anxiety, generalized anxiety disorder, obsessive compulsive disorder, social phobia, social anxiety disorder, panic disorder, post traumatic stress disorder, specific phobia, psychosis, eating disorders, anorexia nervosa, bulimia nervosa, attention deficit hyperactivity disorder, substance abuse, substance dependence, addiction, alcohol, anabolic steroids, stimulants, antidepressants, mood stabilizers, anxiolytics, antipsychotics, sedative-hypnotics, psychotropics, medications, and psychiatric medications. We restricted results to the English language and used no date restrictions. We retrieved all articles discussing psychiatric diagnosis or psychiatric treatment of athletes. We reviewed each article's findings to see if they applied to elite athletes and reviewed the references of each article for additional articles that had been missed in the initial search and that might include findings relevant to the scope of our article. Our search found no controlled data to guide treatment in working with elite athletes. We describe the literature that does exist and present 4 case examples to illustrate diagnostic and treatment issues with elite athletes.Patient and family characteristics are described as they bear on treatment context. The key pitfalls that interfere with treatment are listed, and clinical guidelines to improve outcomes are suggested. Specific key pitfalls that interfere with treatment include elite athletes' expecting "special treatment," issues of flexibility in treatment to accommodate travel schedules and the need for privacy, and inclusion of coaches and significant others in treatment. Recommendations for working with this population include being flexible within reason about timing of sessions, involving family members when relationship issues are involved, and not compromising on delivering the appropriate treatment, including medications and hospitalizations as necessary.The challenges of treating the elite athlete are great, but successful treatment is possible.

    View details for DOI 10.4088/JCP.11r07381

    View details for Web of Science ID 000314999900006

    View details for PubMedID 22697190

  • Mid-Term and Long-Term Efficacy and Effectiveness of Antipsychotic Medications for Schizophrenia: A Data-Driven, Personalized Clinical Approach JOURNAL OF CLINICAL PSYCHIATRY Glick, I. D., Correll, C. U., Altamura, C., Marder, S. R., Csernansky, J. G., Weiden, P. J., Leucht, S., Davis, J. M. 2011; 72 (12): 1616-1627


    Our aim in this article is 2-fold: first, to examine the mid-term to long-term data on efficacy, from controlled and naturalistic and other studies, in order to determine if they are consistent with the quantitative meta-analyses of mostly short-term, randomized controlled trials Our second (and most important) aim is to use these and other data to provide guidance about the potential relationship of these differences among antipsychotics to the individual patient's own experience with antipsychotic drugs in the process of shared decision-making with the patients and their significant others.A search of PubMed, Embase, and PsychINFO was conducted for articles published in English between January 1, 1999, and April 2011, using the search terms double-blind AND randomized AND olanzapine AND (ziprasidone OR risperidone OR quetiapine OR haloperidol OR fluphenazine OR perphenazine OR aripiprazole).Studies with a duration 3 months or longer, including patients with schizophrenia or schizoaffective disorder, reporting survival analysis for all-cause discontinuation and relapse or dropout due to poor efficacy were selected.We extracted the number of patients relapsed due to poor efficacy and hazard rates for relapses.Overall, the efficacy patterns of both controlled effectiveness and observational long-term studies closely parallel the efficacy observed in the short-term, controlled studies. The results of Phase 1 Clinical Antipsychotic Trials of Intervention Effectiveness are very similar to, but not identical with, the controlled short-term efficacy studies, the European First-Episode Schizophrenia Trial, and naturalistic studies. The mid-term and long-term data suggest that olanzapine is more effective than risperidone and that both of these are better than the other first- and second-generation antipsychotics except for clozapine, which is the most efficacious of all. Further large differences emerged regarding the specific mid-term and long-term safety profiles of individual antipsychotics.Despite intraclass differences and the complexities of antipsychotic choice, the second-generation antipsychotics are important contributions not only to the acute phase but, more importantly, to the maintenance treatment of schizophrenia.

    View details for DOI 10.4088/JCP.11r06927

    View details for Web of Science ID 000298778500007

    View details for PubMedID 22244023

  • Central Nervous System Drug Development, Basic, and Clinical Research Thinking Outside the Box JOURNAL OF CLINICAL PSYCHOPHARMACOLOGY Klein, D. F., Glick, I. D., Shader, R. I. 2011; 31 (5): 553-554

    View details for DOI 10.1097/JCP.0b013e3182305656

    View details for Web of Science ID 000294467300001

    View details for PubMedID 21869701

  • An epidemiologic and clinical overview of medical and psychopathological comorbidities in major psychoses EUROPEAN ARCHIVES OF PSYCHIATRY AND CLINICAL NEUROSCIENCE Altamura, A. C., Serati, M., Albano, A., Paoli, R. A., Glick, I. D., Dell'Osso, B. 2011; 261 (7): 489-508


    The presence of comorbidity in major psychoses (e.g., schizophrenia and psychotic subtypes of bipolar disorder and major depressive disorder) seems to be the rule rather than the exception in both DSM-IV and ICD-10. Examining comorbidity in major psychoses, however, requires an investigation into the different levels of comorbidity (either full-blown and subsyndromal) which should be analyzed in both psychopathological and medical fields. On one hand, the high prevalence of psychiatric comorbidity in major psychoses may be the result of the current nosographic systems. On the other hand, it may stem from a common neurobiological substrate. In fact, comorbid psychopathological conditions may share a biological vulnerability, given that dysfunction in specific brain areas may be responsible for different symptoms and syndromes. The high rates of comorbidity in major psychoses require targeted pharmacological treatments in order to effectively act on both the primary diagnosis and comorbid conditions. Nevertheless, few controlled trials in comorbid major psychoses had been carried out and treatment recommendations in this field have mostly an empirical basis. The aim of the present article is to provide a comprehensive and updated overview in relation to epidemiological and clinical issues of comorbidity in major psychoses.

    View details for DOI 10.1007/s00406-011-0196-4

    View details for Web of Science ID 000297619700006

    View details for PubMedID 21331479

  • The Role of the Family and Improvement in Treatment Maintenance, Adherence, and Outcome for Schizophrenia JOURNAL OF CLINICAL PSYCHOPHARMACOLOGY Glick, I. D., Stekoll, A. H., Hays, S. 2011; 31 (1): 82-85


    In the context of a large, random assignment, controlled study evaluating the relative effectiveness and safety of antipsychotic medication (CATIE), we examined the relationship between treatment outcome and 2 family variables: their presence and their ability to support treatment adherence.Post hoc, we assessed the 50 study patients (40 of whom had families) and their families by dividing them into 2 groups. The first had a family/significant other, available and mostly supportive, to work collaboratively on adherence with the treatment team (n = 27). The second group either did not have the family/significant other or, if they did, lacked support for long-term maintenance (n = 23). Next, we examined outcome on 2 measures: study completion (vs discontinuation) and global outcome.Of 27 patients with available/supportive families, 23 remained in treatment for the full study course. In contrast, 13 of 23 patients, who were discontinued or dropped out, either did not have families or, if they had them, were unable to support adherence (P < 0.01). As to global outcome, 24 of the 27 patients who had supportive families improved, compared with only 9 of the 23 of the other group (P < 0.001).In summary, in the context of a large medication efficacy-effectiveness trial, we present data suggesting that having a "family" available and supportive (regardless of the interpersonal issues between patient and family) improves outcome mediated by improving long-term adherence.

    View details for DOI 10.1097/JCP.0b013e31820597fa

    View details for Web of Science ID 000285771000014

    View details for PubMedID 21192148

  • Inpatient Psychiatric Care in the 21st Century: The Need for Reform PSYCHIATRIC SERVICES Glick, I. D., Sharfstein, S. S., Schwartz, H. I. 2011; 62 (2): 206-209


    Driven by financial pressures, the sole focus of psychiatric inpatient treatment has become safety and crisis stabilization. Data are lacking on outcomes of ultrashort-stay hospitalizations; however, such stays may diminish opportunities for a sustained recovery. In the absence of an evidence base to guide clinicians and policy makers, mental health professionals have an ethical obligation to promote what they consider to be best practice. This Open Forum focuses on the need to reconsider the current model of inpatient hospitalization in order to maximize positive outcomes and emphasize appropriate transition to the community and less intensive levels of care. A model of care is presented based on rapid formulation of diagnosis, goals, and treatment modalities before treatment begins. Three phases are described--assessment, implementation, and resolution--with specific principles to guide length-of-stay decisions and requirements for staffing.

    View details for Web of Science ID 000286809500015

    View details for PubMedID 21285100

  • What Have We Learned about Trial Design From NIMH-Funded Pragmatic Trials? NEUROPSYCHOPHARMACOLOGY March, J., Kraemer, H. C., Trivedi, M., Csernansky, J., Davis, J., Ketter, T. A., Glick, I. D. 2010; 35 (13): 2491-2501


    At the 2008 annual meeting of the American College of Neuropsychopharmacology (ACNP), a symposium was devoted to the following question: 'what have we learned about the design of pragmatic clinical trials (PCTs) from the recent costly long-term, large-scale trials of psychiatric treatments?' in order to inform the design of future trials. In all, 10 recommendations were generated placing emphasis on (1) appropriate conduct of pragmatic trials; (2) clinical, rather than, merely statistical significance; (3) sampling from the population clinicians are called upon to treat; (4) clinical outcomes of patients, rather than, on outcome measures; (5) use of stratification, controlling, or adjusting when necessary and not otherwise; (6) appropriate consideration of site differences in multisite studies; (7) encouragement of 'post hoc' exploration to generate (not test) hypotheses; (8) precise articulation of the treatment strategy to be tested and use of the corresponding appropriate design; (9) expanded opportunity for training of researchers and reviewers in RCT principles; and (10) greater emphasis on data sharing.

    View details for DOI 10.1038/npp.2010.115

    View details for Web of Science ID 000284104400002

    View details for PubMedID 20736990

    View details for PubMedCentralID PMC3055577

  • Designing outcome studies to determine efficacy and safety of antipsychotics for 'real world' treatment of schizophrenia INTERNATIONAL JOURNAL OF NEUROPSYCHOPHARMACOLOGY Altamura, A. C., Glick, I. D. 2010; 13 (7): 971-973


    Over the last 5 years, some studies have questioned the efficacy of second-generation antipsychotics over first-generation neuroleptics in the treatment of schizophrenia. At the same time, these study results have led to re-examination of their design--particularly CATIE and CUtLASS--which essentially measured relatively short-/mid-term outcome and did not always take into account real-world clinical practice and outcome measures (e.g. prevalence of positive acute symptoms, exclusion of comorbidity with substance abuse, predominance of chronic patients, lack of quality of life/wellbeing measures, etc.). In fact, one of the greatest challenges to treatment of schizophrenia is its life-long, multifaceted, functional disability associated with progressive cognitive deterioration after each acute episode. As such, the most important goal of the treatment is not just to deal with acute episodes, but rather to improve long-term outcome. Specifically, we aim for modest improvement and then stabilization of the different clinical dimensions involved in the overall symptomatology (i.e. negative/anergic, impulsive, positive, mood and cognitive impairments), and to achieve 'clinical stabilization' after obtaining a partial or full remission of acute symptoms, thus reducing the risk of a progressive cognitive deterioration. All these aspects need to be properly evaluated in a long-run perspective.

    View details for DOI 10.1017/S1461145709991271

    View details for Web of Science ID 000280934600014

    View details for PubMedID 20128954

  • Lamotrigine augmentation in schizophrenia and schizoaffective patients with obsessive-compulsive symptoms JOURNAL OF PSYCHOPHARMACOLOGY Poyurovsky, M., Glick, I., Koran, L. M. 2010; 24 (6): 861-866


    Obsessive-compulsive symptoms (OCS) are clinically important phenomena in schizophrenia patients. Lamotrigine has a modulating effect on glutamatergic neurotransmission relevant to pathophysiology of both schizophrenia and OCD. Efficacy and tolerability of lamotrigine in schizophrenia and schizoaffective patients with comorbid OCS were evaluated. In an 8-week, open-label trial, lamotrigine (25 mg/day for 1 week, 50 mg for 2 weeks, 100 mg for 2 weeks, 200 mg for 3 weeks) was added to ongoing psychotropic drug regimens in schizophrenia (N = 5) and schizoaffective disorder (N = 6) patients with clinically significant OCS [Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score > 16]. The Y-BOCS score for nine completers decreased significantly from baseline to week 8 (22.9 +/- 6.1 vs 17.4 +/- 3.6; t = 2.33, df = 1, P = 0.033). Five patients, all with schizoaffective disorder, were responders (>or=35% decrease in Y-BOCS score). No significant changes were detected in schizophrenia symptom severity. Depressive symptoms, assessed with the Calgary Depression Rating Scale, improved significantly (6.4 +/- 1.5 vs 4.0 +/- 2.5; t = 3.19, df = 1, P = 0.013); this change positively correlated with OCS improvement (r = 0.69, P = 0.04). Lamotrigine was safe and well tolerated. Explicit evaluation of therapeutic efficacy of adjunctive lamotrigine in schizoaffective disorder patients with comorbid OCS merits further investigation.

    View details for DOI 10.1177/0269881108099215

    View details for Web of Science ID 000278089200008

    View details for PubMedID 19074541

  • Onset and Persistence of Antipsychotic Response in Patients With Schizophrenia JOURNAL OF CLINICAL PSYCHOPHARMACOLOGY Glick, I. D., Bossie, C. A., Alphs, L., Canuso, C. M. 2009; 29 (6): 542-547


    In daily practice, clinicians are interested in knowing when to expect treatment response after initiating a new antipsychotic medication. This analysis examined whether response onset and persistence can distinguish true drug from placebo responses. The methodology proposed by Quitkin et al (1984) was applied to data from three 6-week double-blind placebo-controlled trials in schizophrenia to examine response (> or =30% Positive and Negative Syndrome Scale total score reduction from baseline) here using the antipsychotic paliperidone extended release (3-12 mg/d) versus placebo. Response patterns were categorized by persistence (persistent: response at every time point from first response to end point for > or =2 time points; nonpersistent: other patterns) and onset (early: first response at day 4 to week 2; later: week 3 to end point). Persistent responses occurred in 39.8% of antipsychotic-treated patients and in 20.2% of subjects receiving placebo (P < 0.001). An early persistent response was achieved in 23.5% of those who received antipsychotic medication and by 14.2% of the subjects who received placebo, and a later persistent response was achieved in 16.3% and in 6.0%, respectively (P < 0.001 for both comparisons). A nonpersistent response occurred in 16.9% and in 18.1%, respectively (P = 0.631). No response occurred in 37.1% of the antipsychotic-treated patients and in 58.6% of the placebo-treated subjects over 6 weeks (P < 0.001). In conclusion, persistent response (occurring either early or later) is more likely achieved with antipsychotic medication than with placebo, and response patterns may be useful in assessing true drug response. Results suggest that persistent response requires continuing antipsychotic treatment beyond 2 weeks in some patients. These results may be useful for clinical decision making and patient education.

    View details for DOI 10.1097/JCP.0b013e3181befa2a

    View details for Web of Science ID 000272004300005

    View details for PubMedID 19910718

  • Clinical Trials Design Lessons From the CATIE Study AMERICAN JOURNAL OF PSYCHIATRY Kraemer, H. C., Glick, I. D., Klein, D. F. 2009; 166 (11): 1222-1228


    The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study was funded by the National Institute of Mental Health to compare the effectiveness of drugs for schizophrenia. The focus here is not on its conclusions but on the knotty issues of design and methods, in order to support appropriate clinical interpretation of the conclusions, and on using the CATIE experience to indicate directions for improvement of future clinical trials. While many of the CATIE design and implementation decisions are excellent and serve as models for future research, other decisions resulted in a study with a large study group but inadequate power. Multiple treatment interventions, unbalanced randomization within and across clinical sites, and multiple secondary outcomes are among the issues that require even more serious consideration in future large multisite clinical trials. Moreover, it is crucial to clarify whether the intent of a study is to establish superiority of some treatments or to establish equivalence, for the appropriate designs and analyses differ in these situations. If the study is designed, as was CATIE, to demonstrate some treatments' superiority, statistically nonsignificant results should not be misinterpreted as evidence of "equivalence." For establishing either superiority or equivalence, future treatment comparisons might better be designed with fewer sites, more subjects per site, fewer treatments, and fewer outcomes, in order to have the power for definitively establishing superiority or equivalence at a lower cost.

    View details for DOI 10.1176/appi.ajp.2009.08121809

    View details for Web of Science ID 000271429600008

    View details for PubMedID 19797435

  • Psychiatric Conditions in Sports: Diagnosis, Treatment, and Quality of Life PHYSICIAN AND SPORTSMEDICINE Glick, I. D., Horsfall, J. L. 2009; 37 (3): 29-34


    The social stigma surrounding psychiatric illness may prevent athletes from seeking counseling, psychotherapy, medication, or other treatment when needed. Few controlled studies on athletes exist to guide the team physician, clinician, or psychiatrist who must deal with diagnostic issues. Management involves setting realistic goals, educating as well as inducing the patient into treatment, soliciting support from family or significant others, and delivering appropriate treatment (the most difficult task). The objective is to improve performance and quality of life. Confidentiality issues are paramount during diagnosis and treatment. Physicians who understand sports and team dynamics may have more success in helping patients follow through with treatment.

    View details for Web of Science ID 000207931000003

    View details for PubMedID 20058398

  • Teaching Pearls from the Lost Art of Psychopharmacology JOURNAL OF PSYCHIATRIC PRACTICE Glick, I. D., Balon, R. J., Ballon, J., Rovine, D. 2009; 15 (5): 423-426


    Rapid advances in neuroscience and clinical research have made the practice of quality clinical psychopharmacology increasingly difficult. While practice guidelines, model psychopharmacology curricula, and clinical algorithms have helped "the science" of psychopharmacology, they often fail to provide guidance for clinicians in specific clinical situations with individual patients. Quality psychopharmacology practice is based on a combination of knowledge, experience, judgment, and luck. In this article, the authors present their collection of psychopharmacology "pearls" for trainees as well as experienced clinicians. (Journal of Psychiatric Practice 2009;15:423-426).

    View details for Web of Science ID 000270282500009

    View details for PubMedID 19820559

  • A Double-Blind Randomized Trial of Mood Stabilizer Augmentation Using Lamotrigine and Valproate for Patients With Schizophrenia Who Are Stabilized and Partially Responsive JOURNAL OF CLINICAL PSYCHOPHARMACOLOGY Glick, I. D., Bosch, J., Casey, D. E. 2009; 29 (3): 267-271


    To compare the efficacy of mood stabilizer augmentation of an antipsychotic for patients with schizophrenia who are both stabilized and partially responsive.Adult patients who met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for schizophrenia or schizoaffective disorder were enrolled in a 12-week, double-blind randomized trial. Patients were stabilized on an antipsychotic, and dose remained constant. Patients were randomly assigned to 1 of 3 adjunctive treatments: (1) with lamotrigine, (2) with divalproex sodium, or (3) with placebo. Efficacy assessments included the Positive and Negative Syndrome Scale, the Calgary Depression Scale for Schizophrenia, a Demoralization Scale, and the Clinical Global Impression severity and improvement scores. The Lehman quality of life improvement scale was used to assess quality of life and social functioning. Ratings were done at each study visit, including the last visit when they had been tapered off the adjunctive treatment.There were no differences in global outcomes, symptoms, quality of life, or demoralization among the 3 groups. Short-term adverse effects were minimal.Augmenting antipsychotics with the mood stabilizers of lamotrigine or divalproex sodium for most partially responsive patients with chronic schizophrenia did not seem to be a useful treatment strategy for improving the residual symptoms. The small sample size limits firm conclusions.

    View details for DOI 10.1097/JCP.0b013e3181a443d0

    View details for Web of Science ID 000266078900012

    View details for PubMedID 19440081

  • The efficacy, safety, and tolerability of aripiprazole for the treatment of schizoaffective disorder: Results from a pooled analysis of a sub-population of subjects from two randomized, double-blind, placebo-controlled, pivotal trials JOURNAL OF AFFECTIVE DISORDERS Glick, I. D., Mankoski, R., Eudicone, J. M., Marcus, R. N., Tran, Q., Assuncao-Talbott, S. 2009; 115 (1-2): 18-26


    Schizoaffective disorder shares clinical characteristics with schizophrenia and affective disorders, with patients experiencing concurrent manic, mixed, or depressive episodes during psychosis. Because efficacy may be better in schizoaffective disorder than schizophrenia, this post-hoc analysis examines the efficacy, safety, and tolerability of aripiprazole in patients with schizoaffective disorder.Data were obtained from a sub-sample of subjects with schizoaffective disorder (randomized: aripiprazole n=123, placebo n=56) who participated in two 4-week, multicenter, double-blind trials of subjects with schizophrenia or schizoaffective disorder. Aripiprazole was administered at fixed doses of 15 mg/day, 20 mg/day, or 30 mg/day. Efficacy assessments included the Positive and Negative Syndrome Scale (PANSS) Total score, and the Positive, Negative, and General Psychopathology subscale scores. Safety and tolerability evaluations included incidence of treatment-emergent adverse events and extrapyramidal symptom assessments (SAS, BARS, and AIMS), and metabolic profile changes including weight and BMI.A significantly greater improvement from baseline to endpoint was observed with aripiprazole compared with placebo on the PANSS Total (-15.9 vs. -3.4; p=0.038) and PANSS Positive subscale (-4.6 vs. -1.0; p=0.027). Differences between treatments were not significant for the PANSS Negative subscale score (-3.7 vs. -1.2; p=0.15) or PANSS General Psychopathology subscale score (-8.3 vs. -3.1; p=0.06). There were no statistically significant differences at endpoint between groups in the mean change from baseline to endpoint in weight, glucose, or total cholesterol, or on SAS, BARS, or AIMS scores. There was a statistically significant decrease in prolactin in subjects treated with aripiprazole compared with placebo (-5.6 vs. -1.3, p<0.001).Aripiprazole was efficacious and well tolerated in patients with schizoaffective disorder.

    View details for DOI 10.1016/j.jad.2008.12.017

    View details for Web of Science ID 000265319900003

    View details for PubMedID 19230981

  • The Evolution of Sport Psychiatry, Circa 2009 SPORTS MEDICINE Glick, I. D., Kamn, R., Morse, E. 2009; 39 (8): 607-613


    Over the past three decades, the world of both amateur and professional sports has expanded greatly and become more complex. In part related to these changes - and relatively unknown to sports medicine practitioners - the field of sport psychiatry has steadily evolved and grown. This paper focuses on what these changes have been. A sport psychiatrist is a physician-psychiatrist who diagnoses and treats problems, symptoms and/or disorders associated with an athlete, with their family/significant others, with their team, or with their sport, including spectators/fans. The primary aims of the specialty are to (i) optimize health, (ii) improve athletic performance, and (iii) manage psychiatric symptoms or disorders. The training includes medical training to provide knowledge and skills unique to physicians; psychiatric training to provide knowledge and skills inherent in that field, and training and/or experience in sport psychiatry to provide knowledge and skills about psychiatric aspects of sports. The sport psychiatrist first makes an individual, family-systems and phenomenological diagnosis of the clinical situation. Based on this evaluation, he sets goals for not only the athlete, but also for significant others involved. He delivers treatment based on the psychiatric disorder or problem using a combination of medication, psychotherapy or self-help group interventions plus strategies targeted to specific sport performance issues. Evolution of the International Society of Sport Psychiatry as well as the field, including incorporation into school and professional team sports, is described along with a 'typical day' for a sport psychiatrist. Case examples, a training curriculum and core literature are included.

    View details for Web of Science ID 000269567900001

    View details for PubMedID 19769412

  • The Acute Efficacy of Aripiprazole Across the Symptom Spectrum of Schizophrenia: A Pooled Post Hoc Analysis From 5 Short-Term Studies JOURNAL OF CLINICAL PSYCHIATRY Janicak, P. G., Glick, I. D., Marder, S. R., Crandall, D. T., McQuade, R. D., Marcus, R. N., Eudicone, J. M., Assuncao-Talbott, S. 2009; 70 (1): 25-35


    To evaluate the efficacy of aripiprazole across a range of symptoms-positive, negative, disorganized thought, depression/anxiety, and hostility-in schizophrenia and schizoaffective disorder.Pooled data were analyzed from 5 short-term, double-blind, multicenter studies (published between 1997 and 2007) involving patients hospitalized with acute exacerbation of schizophrenia (5 studies) or schizoaffective disorder (2 studies) and randomly assigned to aripiprazole (N = 875), haloperidol (N = 193), risperidone (N = 95), or placebo (N = 406). Aripiprazole doses ranged from 2 to 30 mg/day. Patients receiving the ineffective 2-mg dose were excluded from the primary analyses presented here. Factor analysis of Positive and Negative Syndrome Scale (PANSS) data was used to evaluate changes from baseline with aripiprazole on 5 symptom factors-positive, negative, disorganized thought, depression/anxiety, and hostility-in 2 population subsets-schizophrenia and schizoaffective disorder. Pairwise comparisons were made as follows for schizophrenia: aripiprazole versus placebo in all 5 studies; aripiprazole, haloperidol, and placebo in 3 studies; and aripiprazole, risperidone, and placebo in 1 study. Patients with schizoaffective disorder in 2 studies were included in the comparison of aripiprazole and placebo.Aripiprazole was significantly better than placebo in improving all 5 PANSS factor scores from baseline (each p < .001) in the schizophrenia dataset. In schizoaffective disorder, aripiprazole was significantly better than placebo for the improvement of positive (p

    View details for Web of Science ID 000262819800005

    View details for PubMedID 19192472

  • Aripiprazole in Schizophrenia Patients With Comorbid Obsessive-Compulsive Symptoms: An Open-Label Study of 15 Patients JOURNAL OF CLINICAL PSYCHIATRY Glick, I. D., Poyurovsky, M., Ivanova, O., Koran, L. M. 2008; 69 (12): 1856-1859


    Approximately 15% of patients with schizophrenia also meet DSM-IV criteria for obsessive-compulsive disorder (OCD) at some point in their illness, a rate considerably higher than in the general population. This study examined aripiprazole treatment of patients with comorbid schizophrenia and obsessive-compulsive symptoms (OCS) that did not meet full criteria for OCD.Physically healthy adults aged 18 to 65 years with DSM-IV schizophrenia and a minimum score of 16 on the Yale-Brown Obsessive Compulsive Scale (YBOCS) were eligible to participate in this 6-week, open-label, flexible-dose trial of aripiprazole monotherapy. Patients currently taking another antipsychotic medication were concurrently down-titrated from their current antipsychotic and up-titrated with aripiprazole, starting with 15 mg/day. Coadministration of the 2 medications lasted from 7 to 14 days, until a stable therapeutic dose of 10 to 30 mg/day was reached. Subjects were recruited into the study, which was conducted at the Schizophrenia Clinic of Stanford University School of Medicine, between January 2005 and December 2006.Of 15 eligible patients, 7 completed the trial. All 7 had at least minimal improvement on the YBOCS, the Clinical Global Impressions (CGI) scale, and the Positive and Negative Syndrome Scale (PANSS). At week 6, the mean CGI-Improvement scale score was 2.3 (much improved). Mean PANSS scores decreased from 75 to 56, a mean decrease of 21%, (p < .05). On the YBOCS, 6 of 7 completers showed a change of greater than 35% from baseline to week 6.These results suggest that aripiprazole monotherapy can modestly improve the outcome for some schizophrenia patients with obsessive-compulsive symptoms. Further studies with aripiprazole under controlled conditions are indicated for this population of patients. Overall, even modest improvement in global functioning due to an improvement in an OCS component may be clinically meaningful for this difficult-to-treat subset of schizophrenia patients.

    View details for Web of Science ID 000262059700002

    View details for PubMedID 19026264

  • Issues that may determine the outcome of antipsychotic trials: Industry sponsorship and extrapyramidal side effect NEUROPSYCHOPHARMACOLOGY Davis, J. M., Chen, N., Glick, I. D. 2008; 33 (5): 971-975


    This study presents a meta-analysis of the influence of several potentially biasing factors (eg industry support, extrapyramidal side effects) on efficacy of studies comparing second-generation antipsychotic (SGA) with first-generation antipsychotic (FGA) medications. We used the dataset from our previously published meta-analysis of 124 randomized controlled trials (RCTs) comparing SGAs with FGAs, to evaluate whether certain possible biases could influence the actual outcome on the total score of the Positive and Negative Syndrome Scale (PANSS), Brief Psychiatric Rating Scale (BPRS), and Clinical Global Impressions (CGI) scores. Industry sponsorship was determined by contact with authors or publication statement. We calculated whether (1) industry sponsorship, (2) study quality, (3) extrapyramidal symptoms (EPS) properties, or (4) prophylactic antiparkinsonian medications influenced SGA vs FGA efficacy for each drug and averaged overall by two Hedges and Olkin-based meta-analyses. The analysis found that none of the factors was significantly associated with a particular outcome. While industry-sponsored articles may conclude their medication to be more favorable than that of a competitor in an RCT, we found that the observed efficacy was not influenced by sponsorship. Many attribute the finding that SGAs appears to be more efficacious than FGAs to be a result of EPS-decreasing efficacy (or its measurement). We were unable to confirm that the drug's EPS properties or antiparkinsonian management altered actual efficacy.

    View details for DOI 10.1038/sj.npp.1301493

    View details for Web of Science ID 000253957600002

    View details for PubMedID 17609679

  • A model for reintegrating couples and family therapy training in psychiatric residency programs ACADEMIC PSYCHIATRY Rait, D., Glick, I. 2008; 32 (2): 81-86


    The authors propose a family-systems training model for general residency training programs in psychiatry based on the couples and family therapy training program in Stanford's Department of Psychiatry and Behavioral Sciences.The authors review key elements in couples and family therapy training. Examples are drawn from the family therapy training curriculum in a general psychiatric residency program.Conceptual and practical skills taught over the span of a psychiatric residency training program are described, focusing on: joining with the couple or family; seeing systemic patterns, recognizing the family's developmental stage, history, and culture; identifying family structure; and intervening systemically.This family-systems training model can serve as a resource for residency programs interested in integrating the couples and family therapy model more fully into their curricula.

    View details for Web of Science ID 000253907100005

    View details for PubMedID 18349325

  • The effectiveness of antipsychotic medications in patients who use or avoid illicit substances: Results from the CATIE study SCHIZOPHRENIA RESEARCH Swartz, M. S., Wagner, H. R., Swanson, J. W., Stroup, I. S., McEvoy, J. P., Reimherr, F., Miller, D. D., McGee, M., Khan, A., Canive, J. M., Davis, S. M., Hsiao, J. K., Lieberman, J. A., Adler, L., Bari, M., Belz, I., Bland, R., Blocher, T., Bolyard, B., Buffenstein, A., Burruss, J., Byerly, M., Canive, J., Caroff, S., Casat, C., Chavez-Rice, E., Csernansky, J., Delgado, P., Douyon, R., D'Souza, C., Glick, I., Goff, D., Gratz, S., Grossberg, G. T., Hale, M., Hamner, M., Jaffe, R., Jeste, D., Kablinger, A., Khan, A., Lamberti, S., Levy, M. T., Lieberman, J., Maguire, G., Manschreck, T., McEvoy, J., McGee, M., Meltzer, H., Miller, A., Miller, D. D., Nasrallah, H., Nemeroff, C., Olson, S., Oxenkrug, G. F., Patel, J., Reimher, F., Riggio, S., Risch, S., Saltz, B., Simpatico, T., Simpson, G., Smith, M., Sommi, R., Steinbook, R. M., Stevens, M., Torres, R., Weiden, P., Wolberg, J. 2008; 100 (1-3): 39-52


    This double-blind study compared a second generation (atypical) antipsychotic drugs compared to a representative older agent for patients with schizophrenia who use or avoid illicit substances.Schizophrenic subjects were recruited at 57 U.S. sites and randomly assigned to olanzapine, perphenazine, quetiapine, risperidone or ziprasidone for up to 18 months. The primary aim of this analysis was to delineate differences between the overall effectiveness of these five treatments among patients who used or did not use illicit substances.There were no significant differences between treatment groups in time to all-cause treatment discontinuation among patients who use illicit drugs (median 3.3 to 6.8 months). Among non-users time to treatment discontinuation was significantly longer for patients treated with olanzapine (median 13.0 months) than perphenazine ( 5.9 months), risperidone (5.6 months), or quetiapine (5.0 months); time to discontinuation for ziprasidone (4.3 months) was even shorter, although the latter difference was not significant. The difference between risperidone and quetiapine, although small, was significant. All remaining differences were non-significant. Similar results were found for discontinuation due to inefficacy. There were no differences between illicit users and non-users in symptom reduction and global improvement, after adjustment for differential duration of treatment. Differences in discontinuation results were attenuated by non-compliance, but the trends persisted after controlling for treatment compliance.Among patients with chronic schizophrenia who avoid use of illicit drugs, olanzapine was more effective than other antipsychotics as reflected by longer time to all-cause discontinuation, but illicit substance abuse attenuated this advantage, reinforcing the need for concurrent substance abuse treatment.

    View details for DOI 10.1016/j.schres.2007.11.034

    View details for Web of Science ID 000254722400004

    View details for PubMedID 18191383

  • Reintegrating family therapy training in psychiatric residency programs: Making the case ACADEMIC PSYCHIATRY Rait, D., Glick, I. 2008; 32 (2): 76-80


    Given the marginalization of couples and family therapy in psychiatric residency programs over the past two decades, the authors propose a rationale for the reintegration of these important psychosocial treatments into the mainstream of general psychiatric residency education.After reviewing recent trends in the field that call for a more prominent role for couples and family therapy in residency training, the authors summarize the literature on family therapy training in psychiatry over the past four decades.Because biopsychosocial systemic thinking provides a powerful framework for looking at multiple levels of systems and their interrelationships, developing a strong family-systems perspective and acquiring basic "family skills" represent the minimum requirement for general psychiatric training. The authors argue for the addition of couples and family therapy to the five required psychotherapy competencies defined by the residency review committee in psychiatry.A rationale for a family-systems training model is proposed with the objective of encouraging residency programs to integrate the family-systems model more fully into their curricula.

    View details for Web of Science ID 000253907100004

    View details for PubMedID 18349324

  • Teaching psychopharmacology - What works and what doesn't JOURNAL OF CLINICAL PSYCHOPHARMACOLOGY Zisook, S., Glick, I. D., Jefferson, J. W., Wagner, K. D., Salzman, C., Peselow, E. D., Stahl, S. 2008; 28 (1): 96-100


    How do we best teach clinical psychopharmacology to trainees and clinicians, so they not only increase their knowledge base, but even more importantly also learn to practice the most informed, evidence-based practice possible? This article attempts to answer this elusive question by compiling the individual and combined wisdom of 5 expert psychopharmacology teachers, each of whom draws on years of their own experiences as master educators. The topics covered include teaching clinical psychopharmacological competence in adult psychiatry residency training and in issues specific to both pediatric and geriatric populations, teaching physicians to improve clinical outcomes through continuing medical education, and new developments in adult-centered pedagogy and assessment. Although the focus of this article is on practical pearls found useful in teaching psychiatric residents and practicing physicians, the lessons learned are applicable to other groups of learners such as medical students, other trainees, and nonmedical clinicians. Our goal is to help educators produce competent psychopharmacology clinicians schooled in the latest evidence, capable of keeping up with new knowledge as it becomes available, and practicing both the art and science of expert clinical care.

    View details for DOI 10.1097/jcp.0b013e3181603f6b

    View details for Web of Science ID 000252481100018

    View details for PubMedID 18204350

  • Metabolic impact of switching antipsychotic therapy to aripiprazole after weight gain - A pilot study JOURNAL OF CLINICAL PSYCHOPHARMACOLOGY Kim, S. H., Ivanova, O., Abbasi, F. A., Lamendola, C. A., Reaven, G. M., Glick, I. D. 2007; 27 (4): 365-368


    Switching antipsychotic regimen to agents with low weight gain potential has been suggested in patients who gain excessive weight on their antipsychotic therapy. In an open-label pilot study, we evaluated the metabolic and psychiatric efficacy of switching to aripiprazole in 15 (9 men, 6 women) outpatients with schizophrenia who had gained at least 10 kg on their previous antipsychotic regimen. Individuals had evaluation of glucose tolerance, insulin resistance (insulin suppression test), lipid concentrations, and psychiatric status before and after switching to aripiprazole for 4 months. A third of the individuals could not psychiatrically tolerate switching to aripiprazole. In the remaining individuals, psychiatric symptoms significantly improved with decline in Clinical Global Impression Scale (by 26%, P = 0.015) and Positive and Negative Syndrome Scale (by 22%, P = 0.023). Switching to aripiprazole did not alter weight or metabolic outcomes (fasting glucose, insulin resistance, and lipid concentrations) in the patients of whom 73% were insulin resistant and 47% had impaired or diabetic glucose tolerance at baseline. In conclusion, switching to aripiprazole alone does not ameliorate the highly prevalent metabolic abnormalities in the schizophrenia population who have gained weight on other second generation antipsychotic medications.

    View details for DOI 10.1097/JCP.0b013e3180a9076c

    View details for Web of Science ID 000248062400007

    View details for PubMedID 17632220

  • Improving the pedagogy associated with the teaching of psychopharmacology ACADEMIC PSYCHIATRY Glick, I. D., Salzman, C., Cohen, B. M., Klein, D. F., Moutier, C., Nasrallah, H. A., Ongur, D., Wang, P., Zisook, S. 2007; 31 (3): 211-217


    The authors summarize two special sessions focused on the teaching of psychopharmacology at the 2003 and 2004 annual meeting of the American College of Neuropsychopharmacology (ACNP). The focus was on whether "improving the teaching-learning process" in psychiatric residency programs could improve clinical practice.Problems of strategies and pedagogic techniques that have been used were presented from multiple perspectives (e.g., from a dean, department chair, training director, and former students).There was a consensus that action involving psychopharmacology organizations and the American Association of Directors of Residency Training in Psychiatry (AADPRT) was necessary to improve "evidence-based" competencies before graduation and to follow prescribing patterns into clinical practice to determine whether the standards of care could be improved.

    View details for Web of Science ID 000246445500009

    View details for PubMedID 17496178

  • The ACNP and me ACADEMIC PSYCHIATRY Glick, I. D. 2007; 31 (2): 125-126

    View details for Web of Science ID 000244766300016

    View details for PubMedID 17344450

  • Combining pharmacotherapy with psychotherapeutic management: Guidelines for integration JOURNAL OF CLINICAL PSYCHIATRY Glick, I. D. 2006; 67 (10): 1645-1646

    View details for Web of Science ID 000241964300022

    View details for PubMedID 17107259

  • Insight in first-episode psychosis PSYCHOLOGICAL MEDICINE McEvoy, J. P., Johnson, J., Perkins, D., Lieberman, J. A., Hamer, R. M., Keefe, R. S., Tohen, M., Glick, I. D., Sharma, T. 2006; 36 (10): 1385-1393


    We report here a study examining the relationships between insight and psychopathology, cognitive performance, brain volume and co-morbid depression in 251 patients experiencing a first episode of psychosis, who were then randomly assigned to 2 years of double-blind treatment with either olanzapine or haloperidol.Repeated measures of insight were obtained at baseline and 12, 24, 52 and 104 weeks by the Insight and Treatment Attitudes Questionnaire (ITAQ).Older age, female gender and white ethnicity were associated with more insight. Higher total, positive, negative and general psychopathology scores on the Positive and Negative Syndromes Scale (PANSS) were associated with less insight. Higher depression scores were associated with more insight. Better neurocognitive function and large brain volumes were associated with more insight. More insight throughout the study was associated with longer time to medication non-adherence. However, baseline insight was not significantly related to the probability of discontinuing the study before 2 years. Insight improved significantly over the course of the study, but the improvement in insight was not significantly different between the two antipsychotic treatment groups.Multiple factors contribute to insight. Patients experiencing a first episode of psychosis who have little insight are at increased risk of discontinuing their medication.

    View details for DOI 10.1017/S0033291706007793

    View details for Web of Science ID 000241671800005

    View details for PubMedID 16740175

  • Differential early onset of therapeutic response with risperidone vs conventional antipsychotics in patients with chronic schizophrenia INTERNATIONAL CLINICAL PSYCHOPHARMACOLOGY Glick, I. D., Shkedy, Z., Schreiner, A. 2006; 21 (5): 261-266


    The present post-hoc analysis investigated the speed of onset of therapeutic effect of the atypical antipsychotic, risperidone, in direct comparison with conventional antipsychotics. Data were pooled from four double-blind active comparator-controlled clinical trials involving 757 patients with schizophrenia treated for up to 8 weeks with either risperidone (4-6 mg/day) or a conventional antipsychotic such as haloperidol (10 or 20 mg/day), perphenazine (mean dose 28 mg/day), or zuclopenthixol (mean dose 38 mg/day). Primary outcome was assessed using the Positive and Negative Syndrome Scale. A significantly greater proportion of patients treated with risperidone achieved > or =20% reduction from baseline Positive and Negative Syndrome Scale total score at weeks 1, 2, 6, and at end point (last observation carried forward: P< or =0.04). A significant difference exists in mean reduction from baseline to end point in Positive and Negative Syndrome Scale total scores in favor of patients treated with risperidone compared with those treated with conventional antipsychotics (-18.4 vs -13.5; P=0.0013). The mean time to response was 23.8 days with risperidone and 28.2 days with conventional drugs (hazard ratio 1.3; 95% confidence interval 1.1-1.5). These findings are clinically relevant because the faster onset of therapeutic effect with atypical antipsychotics can be important in the acute setting and have a considerable impact on healthcare systems.

    View details for Web of Science ID 000240253400003

    View details for PubMedID 16877896

  • Olanzapine and haloperidol in first episode psychosis: Two-year data SCHIZOPHRENIA RESEARCH Green, A. I., Lieberman, J. A., Hamer, R. M., Glick, I. D., Gur, R. E., Kahn, R. S., McEvoy, J. P., Perkins, D. O., Rothschild, A. J., Sharma, T., Tohen, M. F., Woolson, S., Zipursky, R. B. 2006; 86 (1-3): 234-243


    Few studies have assessed the comparative efficacy and safety of atypical and typical antipsychotic medications in patients within their first episode of psychosis. This study examined the effectiveness of the atypical antipsychotic olanzapine and the typical antipsychotic haloperidol in patients experiencing their first episode of a schizophrenia-related psychotic disorder over a 2-year treatment period. Two hundred and sixty-three patients were randomized to olanzapine or haloperidol in a doubleblind, multisite, international 2-year study. Clinical symptoms and side effects were assessed at baseline and longitudinally following randomization for the duration of the study. Olanzapine and haloperidol treatment were both associated with substantial and comparable reductions in symptom severity (the primary outcome measure) over the course of the study. However, the treatment groups differed on two secondary efficacy measures. Patients were less likely to discontinue treatment with olanzapine than with haloperidol: mean time (in days) in the study was significantly greater for those treated with olanzapine compared to haloperidol (322.09 vs. 230.38, p<0.0085). Moreover, remission rates were greater in patients treated with olanzapine as compared to those treated with haloperidol (57.25% vs. 43.94%, p<0.036). While extrapyramidal side effects were greater in those treated with haloperidol, weight gain, cholesterol level and liver function values were greater in patients treated with olanzapine. The data from this study suggest some clinical benefits for olanzapine as compared to haloperidol in first episode patients, which must be weighed against those adverse effects that are more likely with olanzapine.

    View details for DOI 10.1016/j.schres.2006.06.021

    View details for Web of Science ID 000243775100030

    View details for PubMedID 16887334

  • Through the golden chalkboard: Twelve teaching pearls on the teaching-learning process in psychiatry ACADEMIC PSYCHIATRY Glick, I. D., Borus, J. F. 2006; 30 (5): 422-423

    View details for Web of Science ID 000241026900011

    View details for PubMedID 17021152

  • Concomitant medications may not improve outcome of antipsychotic monotherapy for stabilized patients with nonacute schizophrenia JOURNAL OF CLINICAL PSYCHIATRY Glick, I. D., Pham, D., Davis, J. M. 2006; 67 (8): 1261-1265


    There are virtually no controlled data suggesting that concomitant psychotropic medications (CPMs) improve outcome in schizophrenia after the acute phase. Despite that, polypharmacy (with all of its disadvantages) is far more common than monotherapy. To our knowledge, there have been no published reports of prospective systematic investigations of the efficacy of unrestricted CPM use in nonacute schizophrenia.This was a naturalistic, systematic study using a sample of 53 stabilized patients with DSM-IV-TR schizophrenia from 1 clinical practice setting including both private patients and patients from controlled research studies of the effectiveness of antipsychotics. Since there are meager controlled or systematic data on the effectiveness of CPM use with antipsychotics in nonacute schizophrenia, we tested the clinical strategy of CPM use by gradually tapering all CPMs (except antianxiety agents). The aim was to determine if the CPM improved outcome, had no effect, or worsened outcome using the Clinical Global Impressions-Improvement scale before and after taper, over at least 3 months and in some cases up to 18 months after discontinuation. Data were gathered from July 2002 to June 2005.For 21 patients undergoing 22 antidepressant tapers, no change was noted in 18 of 22 tapers, while in 3 improvement was noted and in 1 worsening was noted. For the 12 patients on treatment with mood stabilizers, no change was noted in 10 of 13 discontinuations, while in 3 mild worsening was noted. One patient was on treatment with both modafinil and trazodone and reported no change after tapering each in separate discontinuation trials, while another 3 patients were taking sleeping medications and also noted no change after discontinuation.For most stabilized, chronic patients with schizophrenia, tapering adjunctive medications did not change outcome. This naturalistic study further defines the limits of efficacy of some concomitant classes of medications in patients with chronic schizophrenia who are already receiving adequate antipsychotic therapy.

    View details for Web of Science ID 000240252400013

    View details for PubMedID 16965205

  • Baseline use of concomitant psychotropic medications to treat schizophrenia in the CATIE trial PSYCHIATRIC SERVICES Chakos, M. H., Glick, I. D., Miller, A. L., Hamner, M. B., Miller, D. D., Patel, J. K., Tapp, A., Keefe, R. S., Rosenheck, R. A. 2006; 57 (8): 1094-1101


    This study examined the prevalence and correlates of concomitant psychotropic medications and use of anticholinergic drugs to treat schizophrenia.Concomitant medication use was studied at baseline for participants in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) trial.Of the 1,380 patients with baseline medication data, 82 percent were taking psychotropic medications. Of this group, 6 percent were taking two antipsychotics (one first generation and one second generation); 38 percent, antidepressants; 22 percent, anxiolytics; 4 percent, lithium, and 15 percent, other mood stabilizers. The strongest predictors of taking several medications were having anxiety or depression, being female, and taking second-generation antipsychotics. Conversely, African Americans and those with better neurocognitive functioning were less likely to be taking several concomitant psychotropic medications. In some cases symptoms that were likely targets of polypharmacy, such as depression, remained prominent, suggesting only partial response.Concomitant use of psychotropic medications to treat people with schizophrenia is common. Empirical data demonstrating the effectiveness of many of these agents for this population are lacking.

    View details for Web of Science ID 000239309200005

    View details for PubMedID 16870959

  • Understanding the results of CATIE in the context of the field CNS SPECTRUMS Glick, I. D. 2006; 11 (7): 40-47


    The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study was undertaken to provide a valid assessment of the differences between conventional and atypical antipsychotics and among the atypicals themselves in patients with schizophrenia. The CATIE investigators reported that while none of the study medications were ideal, olanzapine was the most effective in terms of treatment discontinuation, and there were no significant differences in effectiveness between the conventional antipsychotic perphenazine and the atypicals quetiapine, risperidone, and ziprasidone. Each drug differed slightly in rates of side effects, with more patients discontinuing perphenazine due to extrapyramidal side effects and more patients discontinuing olanzapine due to weight gain and metabolic effects. In order for data from phase 1 of the CATIE study to be interpreted within the appropriate context, physicians must understand how aspects of study design and statistical methods affect interpretation, and how this trial weighs against other data in the literature. This article enumerates the factors that complicate our understanding of the CATIE results and compares these findings with those from previously published meta-analyses. It is clear that therapeutic and side effects of antipsychotics vary from person to person. The goal of schizophrenia management is to maintain pharmacotherapeutic efficacy and tolerability over the long-term in order to maximize treatment adherence and benefits. What should emerge from CATIE is a renewed commitment to tailor schizophrenia treatment to the individual patient for long-term management.

    View details for Web of Science ID 000239335300006

    View details for PubMedID 16816799

  • Predictors of antipsychotic medication adherence in patients recovering from a first psychotic episode SCHIZOPHRENIA RESEARCH Perkins, D. O., Johnson, J. L., Hamer, R. M., Zipursky, R. B., Keefe, R. S., Centorrhino, F., Green, A. I., Glick, I. B., Kahn, R. S., Sharma, T., Tohen, M., McEvoy, J. P., Welden, P. J., Lieberman, J. A. 2006; 83 (1): 53-63


    Many patients recovering from a first psychotic episode will discontinue medication against medical advice, even before a 1-year treatment course is completed. Factors associated with treatment adherence in patients with chronic schizophrenia include beliefs about severity of illness and need for treatment, treatment with typical versus atypical antipsychotic and medication side effects.In this 2-year prospective study of 254 patients recovering from a first episode of schizophrenia, schizophreniform, or schizoaffective disorder we examined the relationship between antipsychotic medication non-adherence and patient beliefs about: need for treatment, antipsychotic medication benefits, and negative aspects of antipsychotic medication treatment. We also examined the relationship between medication non-adherence and treatment with either haloperidol or olanzapine, and objective measures of symptom response and side effects.The likelihood of becoming medication non-adherent for 1 week or longer was greater in subjects whose belief in need for treatment was less (HR=1.75, 95% CI 1.16, 2.65, p=0.0077) or who believed medications were of low benefit (HR=2.88, 95 CI 1.79-4.65, p<0.0001). Subjects randomized to haloperidol were more likely to become medication non-adherent for >or=1 week than subjects randomized to olanzapine (HR-1.51, 95% CI 1.01, 2.27, p=0.045).Beliefs about need for treatment and the benefits of antipsychotic medication may be intervention targets to improve likelihood of long-term medication adherence in patients recovering from a first episode of schizophrenia, schizoaffective, or schizophreniform disorder.

    View details for DOI 10.1016/j.schres.2005.10.016

    View details for Web of Science ID 000236789000006

    View details for PubMedID 16529910

  • Aripiprazole as a dopamine partial agonist - Positive and negative effects JOURNAL OF CLINICAL PSYCHOPHARMACOLOGY Glick, I. D., Duggal, V., Hodulik, C. 2006; 26 (1): 101-103

    View details for Web of Science ID 000234773700028

    View details for PubMedID 16415723

  • Quality of life during treatment with haloperidol or olanzapine in the year following a first psychotic episode SCHIZOPHRENIA RESEARCH Strakowski, S. M., Johnson, J. L., Delbello, M. P., Hamer, R. M., Green, A. I., Tohen, M., Lieberman, J. A., Glick, I., Patel, J. K. 2005; 78 (2-3): 161-169


    Schizophrenia causes significant impairments of quality of life. As treatment approaches have advanced, more attention has been given to re-integrating patients into their psychosocial environments, rather than simply monitoring psychotic symptoms. The development of the second-generation antipsychotics raised hope that these medications would provide better quality of life improvement than conventional antipsychotics. This improvement is particularly relevant early in the course of schizophrenia.To address these considerations, improvements in measures of general health and social function (determined using the SF-36) were assessed in 195 patients with first-episode schizophrenia for up to one year following randomization to either olanzapine or haloperidol in a double blind clinical trial. We hypothesized that olanzapine would demonstrate better improvement on these measures than haloperidol. In order to test this hypothesis, we used a repeated measure model with SF-36 scores as the outcome, and treatment group, time, time2, time-by-treatment group interaction, and time2-by-treatment group interaction as fixed effects.Both treatments demonstrated similar changes on the SF-36. Independent of treatment, patients demonstrated significant improvements in most of the SF-36 subscales, which approached normative scores by the end of one year of treatment. Forty-six of 100 olanzapine-treated patients and 37 of 95 haloperidol-treated patients completed the one year of this study (p<.4).These results suggest an important initial treatment goal for patients with new onset schizophrenic disorders, namely that they can expect to recover significant quality of life and social function at least initially in treatment.

    View details for DOI 10.1016/j.schres.2005.04.017

    View details for Web of Science ID 000232174100007

    View details for PubMedID 15950436

  • Diagnosis and psychiatric treatment of athletes CLINICS IN SPORTS MEDICINE Glick, I. D., Horsfall, J. L. 2005; 24 (4): 771-?


    Although enormous amounts of time and money have been invested in enhancing performance for college and professional athletes, their psychiatric needs have been minimally addressed. Given the virtual absence of controlled scientific literature, in this article the authors detail the diagnostic issues and delineate treatment principles, including: (1) making an accurate diagnosis; (2) setting realistic goals; (3) delivering psycho-education; (4) inducing the patient to undergo treatment, including involving the family and significant others; and (5) delivering appropriate treatment (the most difficult task). The objective is to improve performance and quality of life by treating the problem or psychiatric illness. A special concern is minimizing countertransference feelings and avoiding undertreatment, because by definition the athlete needs to perform.

    View details for DOI 10.1016/j.csm.2005.03.007

    View details for Web of Science ID 000232407000004

    View details for PubMedID 16169445

  • Family problems and sports performance - The role of couple's therapy in treating athletes and their families PHYSICIAN AND SPORTSMEDICINE Ritvo, E. C., Glick, I. D. 2005; 33 (9): 37-41


    The incidence of psychiatric disorders and family problems in elite athletes is probably similar to that of the general population, yet, for a variety of reasons, athletes and their families rarely seek treatment. Athletic performance may be affected by problems in a marriage or home life, as in this case of a high-profile athlete whose wife abused medications and alcohol to cope with a depressive disorder and anxiety. Clinicians who treat athletes should be aware of family dynamics that may affect performance and be willing to suggest interventions, such as individual and marital psychotherapy, medication, or both.

    View details for Web of Science ID 000231862500011

    View details for PubMedID 20086379

  • Challenges and opportunities in teaching psychopharmacology during residency training JOURNAL OF CLINICAL PSYCHIATRY Zisook, S., Glick, I., Goldberg, D. A. 2005; 66 (7): 948-948

    View details for Web of Science ID 000230663800021

    View details for PubMedID 16013914

  • The challenge of teaching psychopharmacology and improving clinical practice JOURNAL OF CLINICAL PSYCHOPHARMACOLOGY Glick, I. D., Zisook, S., Shader, R. I. 2005; 25 (3): 203-205
  • Long-term maintenance therapy with quetiapine versus haloperidol decanoate in patients with schizophrenia or schizoaffective disorder JOURNAL OF CLINICAL PSYCHIATRY Glick, I. D., Marder, S. R. 2005; 66 (5): 638-641


    To compare the long-term efficacy and tolerability of oral quetiapine with those of intramuscular haloperidol.Patients with DSM-IV-diagnosed schizophrenia or schizoaffective disorder requiring long-term antipsychotic treatment were randomly assigned to open-label oral quetiapine or intramuscular haloperidol decanoate for 48 weeks. Clinicians were instructed to target dosing at 500 mg/day of quetiapine or 200 mg of haloperidol decanoate every 4 weeks. The Positive and Negative Syndrome Scale was used to assess efficacy; the Simpson-Angus Scale and the Barnes Akathisia Scale were used to assess safety and tolerability. For statistical analyses, a general linear mixed-model repeated-measures analysis of covariance was used, with change scores for dependent variables computed with the baseline score as covariate. Data were collected from 1998 to 2001.Thirty-five patients were enrolled, but 6 did not participate after being informed of their treatment assignment; 4 of the 6 withdrawals were assigned to haloperidol decanoate. Mean doses at week 48 were 493 mg/day of quetiapine (N = 16) and 170 mg/28 days of haloperidol decanoate (N = 9). Survival analysis showed no between-group differences in estimates of the number of patients remaining exacerbation-free over time. Both drugs were efficacious, but quetiapine was significantly better than haloperidol decanoate in controlling negative symptoms (p < .05). The incidence of extrapyramidal symptoms was low in both groups; patients receiving quetiapine showed significantly greater improvement in rigidity and akathisia (p < .05).Oral quetiapine was as efficacious as intramuscular haloperidol in preventing symptom exacerbation over 48 weeks in patients with schizophrenia or schizoaffective disorder, with fewer extrapyramidal symptoms, especially rigidity and akathisia. Quetiapine was more efficacious than haloperidol decanoate in treating negative symptoms.

    View details for Web of Science ID 000229302900015

    View details for PubMedID 15889952

  • Alternate methods of teaching psychopharmacology ACADEMIC PSYCHIATRY Zisook, S., Benjamin, S., Balon, R., Glick, I., Louie, A., MOUTIER, C., Moyer, T., Santos, C., Servis, M. 2005; 29 (2): 141-154


    This article reviews methods used to teach psychopharmacology to psychiatry residents that utilize principles of adult learning, enlist active participation of residents, and provide faculty with skills to seek, analyze, and use new information over the course of their careers.The pros and cons of five "nonlecture" methods of teaching are reviewed: 1) journal clubs, 2) problem-based learning, 3) formalized patient-centered training, 4) games, and 5) the use of modern technology.Several programs are beginning to find novel methods of teaching psychopharmacology that are effective and well received by trainees and faculty.Programs need to go beyond the traditional lecture and apprenticeship model of psychopharmacology education to help make learning more fun, useful, relevant and self-sustaining.

    View details for Web of Science ID 000229541100007

    View details for PubMedID 15937260

  • The challenge of teaching psychopharmacology in the new millennium: The role of curricula ACADEMIC PSYCHIATRY Glick, I. D., Zisook, S. 2005; 29 (2): 134-140


    For a variety of pedagogical, political and financial reasons, there are major problems in achieving effective teaching of cutting-edge psychopharmacology for psychiatric residents. This article focuses on ways to improve the teaching/learning process, in part through the use of structured curricula. The authors review 1) attempted solutions to the educational problems, including use of the 1980s American College of Neuropsychopharmacology (ACNP) and 1990s American Society of Clinical Psychopharmacology (ASCP) model curriculums; 2) evaluation of and obstacles to change; and 3) suggestions of what to do now.A psychopharmacology curriculum was prepared in the early 1980s under the auspices of the ACNP and in the 1990s and early 2000s by the ASCP in three editions. Three separate surveys of training directors and Chairs of departments using the curriculum, informal feedback from a variety of psychopharmacology experts, interactive presentations at national meetings (e.g., ACNP and AADPRT) served to guide development and revisions of the curriculum.Three formal follow up evaluations over two decades of users of the curriculum have suggested that it is not enough to have a strong content of what needs to be taught. In addition, a successful psychopharmacology curriculum must have 1) the pedagogy, (i.e., features like pre-post questions, teaching points, etc.) to facilitate use of the many facets and considerable amounts of information; 2) advanced technology to make the content current, adaptable, and both teacher- and student-friendly; 3) accompanying strategies to allow buy-in from training directors and teachers who have had no role in development; 4) reasonable cost to allow wide-spread dissemination while covering preparation expense (preferably without industry support); and, finally 5) evaluation of competence both at the end of training and post-residency in actual practice.The long-term objective of improving the teaching/learning process is to improve the clinical practice of psychopharmacology.

    View details for Web of Science ID 000229541100006

    View details for PubMedID 15937259

  • Randomized, controlled, double-blind multicenter comparison of the efficacy and tolerability of ziprasidone and olanzapine in acutely ill inpatients with schizophrenia or schizoaffective disorder 53rd Annual Meeting of the Institute-on-Psychiatric-Services Simpson, G. M., Glick, I. D., Weiden, P. J., Romano, S. J., Siu, C. O. AMER PSYCHIATRIC PUBLISHING, INC. 2004: 1837–47


    Limited randomized, controlled trial data exist on possible differences between atypical antipsychotics in efficacy, overall tolerability, and important indices of health status. The authors compared the efficacy and tolerability of ziprasidone and olanzapine in the treatment of acutely ill inpatients with schizophrenia or schizoaffective disorder.In this 6-week, multicenter, double-blind, parallel-design, flexible-dose trial, patients were randomly assigned to receive ziprasidone (N=136) or olanzapine (N=133). Primary efficacy measures were improvement in Brief Psychiatric Rating Scale and Clinical Global Impression (CGI) severity scale scores; secondary measures were scores on the CGI improvement scale, Positive and Negative Syndrome Scale, and Calgary Depression Scale for Schizophrenia. Tolerability assessments included fasting lipid profiles, fasting glucose and insulin measurements, electrocardiography, and monitoring of vital signs and body weight.The overall mean daily doses were 129.9 mg (SD=27.3) for ziprasidone and 11.3 mg (SD=2.8) for olanzapine. Both antipsychotics were efficacious in improving symptoms and global illness severity. The two treatment groups did not differ significantly in primary or secondary efficacy measures at endpoint or in by-visit analysis. Both agents were well tolerated. Body weight, total cholesterol, triglycerides, and low-density lipoprotein cholesterol significantly increased with olanzapine but not with ziprasidone; all between-group comparisons of these variables were significant and favored ziprasidone. Olanzapine, but not ziprasidone, was associated with significant increases in fasting insulin level. No patient in either group exhibited a corrected QT interval >/=500 msec.During 6 weeks' treatment, ziprasidone and olanzapine demonstrated comparable antipsychotic efficacy. Differences favoring ziprasidone were observed in metabolic parameters.

    View details for Web of Science ID 000224279000018

    View details for PubMedID 15465981

  • Patterns of concomitant psychotropic medication use during a 2-year study comparing clozapine and olanzapine for the prevention of suicidal behavior JOURNAL OF CLINICAL PSYCHIATRY Glick, I. D., Zaninelli, R., Hsu, C., Young, F. K., Weiss, L., Gunay, I. 2004; 65 (5): 679-685


    Results from the International Suicide Prevention Trial (InterSePT) indicate that clozapine is more effective than olanzapine in reducing suicidal behavior in schizophrenic and schizoaffective patients. However, because InterSePT allowed the uncontrolled use of concomitant psychotropic medications (CPMs), it is possible that the antisuicidal effect of clozapine may have been influenced by greater use of such agents. This article describes the use patterns of CPMs during InterSePT and examines whether CPM use may have affected study outcome.In this study, 479 patients received clozapine and 477 patients received olanzapine. Concomitant psychotropic medications were grouped into 4 classes: antipsychotics, antidepressants, sedatives/anxiolytics, and mood stabilizers. The doses of each CPM were converted into dosage equivalents of standard reference drugs. An analysis of covariance was performed to compare mean daily doses of CPMs between the 2 groups over the 2-year treatment period. The duration of treatment for each patient was 2 years, with the first patient entering the study in March 1998 and the last patient completing treatment in February 2001.Approximately 90% of patients in both treatment groups received at least 1 CPM. The mean +/- SD number of CPMs per patient was 3.8 +/- 2.90 in the clozapine group and 4.2 +/- 3.16 in the olanzapine group. For each CPM class, the mean daily dose was statistically significantly lower in the clozapine group (antipsychotics, p <.001; antidepressants, p <.01; sedatives/anxiolytics, p <.001; mood stabilizers, p <.05). Analyses of CPM use by study intervals, suicide attempters versus nonattempters, study completers versus noncompleters, and geographic region resulted in similar findings.The results support the conclusion that the effects of clozapine in reducing the risk of suicidal behavior derive from its intrinsic pharmacology and not from the influence of concomitant psychotropic medications.

    View details for Web of Science ID 000221887100013

    View details for PubMedID 15163255

  • First episode schizophrenia-related psychosis and substance use disorders: acute response to olanzapine and haloperidol SCHIZOPHRENIA RESEARCH Green, A. I., Tohen, M. F., Hamer, R. M., Strakowski, S. M., Lieberman, J. A., Glick, I., Clark, W. S. 2004; 66 (2-3): 125-135


    Co-occurring substance use disorders, mostly involving alcohol, cannabis or cocaine, occur commonly in patients with schizophrenia and are associated with increased morbidity and mortality. Available but limited data suggest that substance use disorders (especially cannabis use disorders) may also be common in first-episode patients and appear linked to a poor outcome in these patients. Strategies to curtail substance use form an important dimension of the treatment program for both first-episode and chronic patients. We report on rates of co-occurring substance use disorders in patients within their first episode of schizophrenia-related psychosis from a multicenter, international treatment trial of olanzapine vs. haloperidol.The study involved 262 patients (of 263 who were randomized and who returned for a post-randomization evaluation) within their first episode of psychosis (schizophrenia, schizoaffective disorder or schizophreniform disorder) recruited from 14 academic medical centers in North America and Western Europe. Patients with a history of substance dependence within 1 month prior to entry were excluded.Of this sample, 97 (37%) had a lifetime diagnosis of substance use disorder (SUD); of these 74 (28% of the total) had a lifetime cannabis use disorder (CUD) and 54 (21%) had a lifetime diagnosis of alcohol use disorder (AUD). Patients with SUD were more likely to be men. Those with CUD had a lower age of onset than those without. Patients with SUD had more positive symptoms and fewer negative symptoms than those without SUD, and they had a longer duration of untreated psychosis. The 12-week response data indicated that 27% of patients with SUD were responders compared to 35% of those without SUD. Patients with AUD were less likely to respond to olanzapine than those without AUD.These data suggest that first-episode patients are quite likely to have comorbid substance use disorders, and that the presence of these disorders may negatively influence response to antipsychotic medications, both typical and atypical antipsychotics, over the first 12 weeks of treatment.

    View details for DOI 10.1016/j.schres.2003.08.001

    View details for Web of Science ID 000188064000005

    View details for PubMedID 15061244

  • Adding psychotherapy to pharmacotherapy: data, benefits, and guidelines for integration. American journal of psychotherapy Glick, I. D. 2004; 58 (2): 186-208

    View details for PubMedID 15373281

  • Undiagnosed Bipolar Disorder: New Syndromes and New Treatments. Primary care companion to the Journal of clinical psychiatry Glick, I. D. 2004; 6 (1): 27–33


    Recent studies have indicated that bipolar disorder is more common than previously believed. The socioeconomic and personal burdens of this illness are significant, and the lifetime risk of suicide attempts by patients with bipolar II disorder is high. It is not uncommon for patients with bipolar disorder, especially those presenting with depression, to be seen first in a primary care setting; therefore, primary care physicians need to be ready to diagnose and manage patients with these mental illnesses. The diagnosis of bipolar disorder or bipolar spectrum disorder is easily missed, or these illnesses may be misdiagnosed. A systematic and detailed initial history from the patient and a reliable family member is essential to making the correct diagnosis. The Mood Disorder Questionnaire, a validated screening instrument for bipolar disorder, may help primary care physicians make an appropriate diagnosis. Long-term management of patients with bipolar disorder should involve close liaison with a psychiatrist.

    View details for PubMedID 15486598

  • Dr. Glick Replies. Primary care companion to the Journal of clinical psychiatry Glick, I. D. 2004; 6 (5): 223

    View details for PubMedID 15514696

  • A paradigm for treatment of inpatient psychiatric disorders: from asylum to intensive care. Journal of psychiatric practice Glick, I. D., Carter, W. G., Tandon, R. 2003; 9 (5): 395-402


    No articles, chapters, or texts have been published in the last 5 years that detail a workable model of inpatient psychiatric treatment based on current, drastically changed realities.We reviewed controlled studies on inpatient psychiatric care and pooled our clinical experience from two academic inpatient units and a Veterans Affairs inpatient unit.Major changes in systems of care, the population now being hospitalized, the emphasis on practicing evidence-based medicine, and decreased funding of inpatient psychiatric units have necessitated changes in the traditional paradigm of inpatient treatment. We describe the functions that an inpatient unit performs best and detail 1) objectives of treatment with an emphasis on the "focal problem", and 2) the specific treatment interventions, treatment team members, and outpatient links necessary to maximize post-hospital outcome for patient and family.Given current realities, the treatment paradigm that we recommend has evolved from an asylum-like long-stay model to one that is more like a medical-surgical intensive care unit with an emphasis on rapid diagnosis, psychopharmacological intervention, and laying the groundwork for effective outpatient management. In consequence, the expected clinical outcomes from an episode of inpatient psychiatric treatment are quite different from those of the recent past.

    View details for PubMedID 15985960

  • A meta-analysis of the efficacy of second-generation antipsychotics ARCHIVES OF GENERAL PSYCHIATRY Davis, J. M., Chen, N., Glick, I. D. 2003; 60 (6): 553-564


    Consensus panel recommendations regarding choice of an antipsychotic agent for schizophrenia differ markedly, but most consider second-generation antipsychotics (SGAs) as a homogeneous group. It has been suggested that SGAs seem falsely more efficacious than first-generation antipsychotics (FGAs) as a result of reduced efficacy due to use of a high-dose comparator, haloperidol. We performed (1) a meta-analysis of randomized efficacy trials comparing SGAs and FGAs, (2) comparisons between SGAs, (3) a dose-response analysis of FGAs and SGAs, and (4) an analysis of the effect on efficacy of an overly high dose of an FGA comparator.Literature search of clinical trials between January 1953 and May 2002 of patients with schizophrenia from electronic databases, reference lists, posters, the Food and Drug Administration, and other unpublished data. We included 124 randomized controlled trials with efficacy data on 10 SGAs vs FGAs and 18 studies of comparisons between SGAs. Two of us independently extracted the sample sizes, means, and standard deviation of the efficacy data.Using the Hedges-Olkin algorithm, the effect sizes of clozapine, amisulpride, risperidone, and olanzapine were 0.49, 0.29, 0.25, and 0.21 greater than those of FGAs, with P values of 2 x 10-8, 3 x 10-7, 2 x 10-12, and 3 x 10-9, respectively. The remaining 6 SGAs were not significantly different from FGAs, although zotepine was marginally different. No efficacy difference was detected among amisulpride, risperidone, and olanzapine. We found no evidence that the haloperidol dose (or all FGA comparators converted to haloperidol-equivalent doses) affected these results when we examined its effect by drug or in a 2-way analysis of variance model in which SGA effectiveness is entered as a second factor.Some SGAs are more efficacious than FGAs, and, therefore, SGAs are not a homogeneous group.

    View details for Web of Science ID 000183424900002

    View details for PubMedID 12796218

  • The National Institute of Mental Health Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) project: Schizophrenia trial design and protocol development SCHIZOPHRENIA BULLETIN Stroup, T. S., McEvoy, J. P., Swartz, M. S., Byerly, M. J., Glick, I. D., Canive, J. M., McGee, M. F., Simpson, G. M., Stevens, M. C., Lieberman, J. A. 2003; 29 (1): 15-31


    The National Institute of Mental Health initiated the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) program to evaluate the effectiveness of antipsychotic drugs in typical settings and populations so that the study results will be maximally useful in routine clinical situations. The CATIE schizophrenia trial blends features of efficacy studies and large, simple trials to create a pragmatic trial that will provide extensive information about antipsychotic drug effectiveness over at least 18 months. The protocol allows for subjects who receive a study drug that is not effective to receive subsequent treatments within the context of the study. Medication dosages are adjusted within a defined range according to clinical judgment. The primary outcome is all-cause treatment discontinuation because it represents an important clinical endpoint that reflects both clinician and patient judgments about efficacy and tolerability. Secondary outcomes include symptoms, side effects, neurocognitive functioning, and cost-effectiveness. Approximately 50 clinical sites across the United States are seeking to enroll a total of 1,500 persons with schizophrenia. Phase 1 is a double-blinded randomized clinical trial comparing treatment with the second generation antipsychotics olanzapine, quetiapine, risperidone, and ziprasidone to perphenazine, a midpotency first generation antipsychotic. If the initially assigned medication is not effective, subjects may choose one of the following phase 2 trials: (1) randomization to open-label clozapine or a double-blinded second generation drug that was available but not assigned in phase 1; or (2) double-blinded randomization to ziprasidone or another second generation drug that was available but not assigned in phase 1. If the phase 2 study drug is discontinued, subjects may enter phase 3, in which clinicians help subjects select an open-label treatment based on individuals' experiences in phases 1 and 2.

    View details for Web of Science ID 000184166500003

    View details for PubMedID 12908658

  • Patient and family support organization services should be included as part of treatment for the severely mentally ill. Journal of psychiatric practice Glick, I. D., Dixon, L. 2002; 8 (2): 63-69


    Patient and family support organizations for Axis I disorders have grown exponentially and expanded their services over the past two decades. However, psychiatrists generally have not referred patients and families to these organizations. The goal of this paper is to change clinicians' behavior so that they more commonly include support organization services in treatment plans for patients and families. We performed a literature review focusing on the changing needs of patients and their families as they relate to mental health teams, changes in the family therapy field, and concerns of both healthcare providers and related organizations about referral. Abundant anecdotal evidence and some scientific data suggest that patients and families are satisfied with these support organizations and the services they provide. However, support organizations need clinician referrals in order for their services to be integrated into a multi-modal quality treatment plan to achieve full treatment efficacy.

    View details for PubMedID 15985859

  • Improving clinical trials - American Society of Clinical Psychopharmacology recommendations ARCHIVES OF GENERAL PSYCHIATRY Klein, D. F., Thase, M. E., Endicott, J., Adler, L., Glick, I., Kalali, A., Leventer, S., Mattes, J., Ross, P., Bystritsky, A. 2002; 59 (3): 272-278


    The major purpose of this American Society of Clinical Psychopharmacology-sponsored meeting was to identify strategies for more efficiently detecting clinical drug effects, thus reducing the economic and scientific risks of investigating new chemical entities in psychiatric disorders. The meeting consisted of presentations and discussions by experts who repeatedly had difficulty pursuing scientific, public health--relevant goals. Many approaches to improving the detection of potentially beneficial agents were reviewed. In this article, we discuss technically feasible study improvements. The scope of inquiry included identifying means of shifting institutional and regulatory assumptions and processes, even to the point of seeking appropriate national incentives.

    View details for Web of Science ID 000174300800008

    View details for PubMedID 11879165

  • Time to study discontinuation, relapse, and compliance with atypical or conventional antipsychotics in schizophrenia and related disorders INTERNATIONAL CLINICAL PSYCHOPHARMACOLOGY Glick, I. D., Berg, P. H. 2002; 17 (2): 65-68


    To more clearly clarify the efficacy of the atypical antipsychotics compared to conventional antipsychotics, we add data on the outcome of patients diagnosed with schizophrenia from two large, international clinical trials comparing olanzapine with haloperidol (n = 1996) and olanzapine with risperidone (n = 339). Both studies comprised double-blinded, placebo controlled, random assignment trials. Health outcomes reported include: (i) time to discontinuation in the trial; (ii) clinical relapse; and (iii) time to drug non-compliance. When outcome was measured as time to discontinuation due to adverse events or lack of efficacy, olanzapine showed superiority over haloperidol and no difference compared to risperidone. Of those patients who had an initial response, there was no significant difference between olanzapine and haloperidol when outcome was measured using either: (i) 52-week relapse rates or (ii) time to first non-compliance. Using the measures of study discontinuation, relapse and non-compliance, in one trial the atypical antipsychotic olanzapine was superior to haloperidol, while in a second trial there were no differences between olanzapine and risperidone.

    View details for Web of Science ID 000174080700004

    View details for PubMedID 11890188

  • Treatment of the symptoms of schizophrenia: a combined analysis of double-blind studies comparing risperidone with haloperidol and other antipsychotic agents INTERNATIONAL CLINICAL PSYCHOPHARMACOLOGY Glick, I. D., Lemmens, P., Vester-Blokland, E. 2001; 16 (5): 265-274


    Combined data on efficacy were available from 12 double-blind short-term (maximum 8 weeks) trials comparing risperidone and other antipsychotics in patients with chronic schizophrenia. Patients received risperidone (n = 1056) or other antipsychotics (n = 703). Haloperidol (n = 473) was the most frequently prescribed other antipsychotic. Efficacy assessments include the Positive and Negative Syndrome Scale (PANSS) total, subscale (positive symptoms, negative symptoms and general psychopathology), cluster (cognitive and affective symptoms) and item (anxiety and hostility) scores. At endpoint, the mean decrease from baseline in PANSS total scores was significantly greater for patients receiving risperidone (-20.9) than other antipsychotics (-16.2; P < 0.001), or the subset receiving haloperidol (-14.3; P < 0.001). Risperidone-treated patients showed a significantly greater decrease in the positive (P < 0.01), negative (P < 0.05) and general psychopathology (P < 0.001) scores than patients receiving other antipsychotics or haloperidol. Scores for cognition, affective symptoms, anxiety and hostility each improved significantly (P < 0.05) more for patients receiving risperidone than those receiving other antipsychotics or haloperidol. Efficacy data on patients with an acute exacerbation were available from seven trials (risperidone n = 372, other antipsychotics n = 285, including haloperidol n = 120). At endpoint, the mean decrease from baseline in PANSS total scores was significantly greater for patients receiving risperidone (-24.7) than other antipsychotics (-19.8, P < 0.01) including haloperidol (-19.8, P < 0.05). Risperidone-treated patients also showed a greater decrease in positive symptom scores (-7.8) than those receiving other antipsychotics (-6.3; P < 0.01) or haloperidol (-7.1). A > or = 20% reduction in PANSS total score with risperidone, haloperidol and other antipsychotics was achieved by 65.9%, 54.3% and 54.9%, respectively; a > or = 30% PANSS reduction by 54.0%, 46.6% and 46.5% of patients, respectively; and a > or = 40% reduction by 43.8%, 33.7% and 34.4% of patients, respectively. These findings are consistent with earlier findings that show risperidone is more efficacious than haloperidol for reducing the symptoms of schizophrenia.

    View details for Web of Science ID 000170745800003

    View details for PubMedID 11552769

  • Psychiatric conditions in sports - Diagnosis, treatment, and quality of life PHYSICIAN AND SPORTSMEDICINE Glick, I. D., Horsfall, J. L. 2001; 29 (8): 44-?


    The social stigma surrounding psychiatric illness may prevent athletes from seeking counseling, psychotherapy, medication, or other treatment when needed. Few controlled studies on athletes exist to guide the team physician, clinician, or psychiatrist who must deal with diagnostic issues. Management involves setting realistic goals, educating as well as inducing the patient into treatment, soliciting support from family or significant others, and delivering appropriate treatment (the most difficult task). The objective is to improve performance and quality of life. Confidentiality issues are paramount during diagnosis and treatment. Physicians who understand sports and team dynamics may have more success in helping patients follow through with treatment.

    View details for Web of Science ID 000170370700006

    View details for PubMedID 20086585

  • How should we teach psychopharmacology to residents? Results of the initial experience with the ASCP model Curriculum ACADEMIC PSYCHIATRY Glick, I. D., Janowsky, D. S., Zisook, S., Lydiard, R. B., Oesterheld, J. R., WARD, N. G., Ellison, J., Halper, J., Doraiswamy, P. M., PREVEN, D. W., Ross, R., Klein, D. E. 2001; 25 (2): 90-97
  • Treatment with atypical antipsychotics: new indications and new populations 153rd Annual Meeting of the American-Psychiatric-Association Glick, I. D., Murray, S. R., Vasudevan, P., Marder, S. R., Hu, R. J. PERGAMON-ELSEVIER SCIENCE LTD. 2001: 187–91


    Atypical antipsychotics have revolutionized the treatment of schizophrenia, becoming the treatment of choice for patients not only during their first episode, but also throughout their life course. Of note, as of 1999 more than 70% of prescriptions for these drugs are being prescribed for conditions other than schizophrenia, such as bipolar disorder and geriatric agitation. While there have been very few controlled trials that have established the efficacy of the atypical antipsychotics for these "off-label" uses, there have been a large number of open trials and case reports. The few controlled trials suggest that the atypical antipsychotics may be useful for affective disorders (both mania and depression), geriatric conditions such as senile dementia and aggression, as well as a variety of other disorders. Atypical agents may be particularly helpful for elderly, child, or adolescent patients who are especially susceptible to the side effects of medications and whose risk of tardive dyskinesia is high but further controlled studies are necessary.

    View details for Web of Science ID 000169978600007

    View details for PubMedID 11461715

  • Family treatment and medication dosage reduction in schizophrenia: Effects on patient social functioning, family attitudes, and burden JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Mueser, K. T., Sengupta, A., Schooler, N. R., Bellack, A. S., Xei, H. Y., Glick, I. D., Keith, S. J. 2001; 69 (1): 3-12


    The effects of 2 family intervention programs (supportive family management [SFM], including monthly support groups for 2 years; or applied family management [AFM], including 1 year of behavioral family therapy plus support groups for 2 years), and 3 different neuroleptic dosage strategies (standard, low, targeted) on social functioning of patients with schizophrenia. their relatives' attitudes, and family burden were examined. AFM was associated with lower rejecting attitudes by relatives toward patients and less friction in the family perceived by patients. Patients in both AFM and SFM improved in social functioning but did not differ, whereas family burden was unchanged. Medication strategy had few effects, nor did it interact with family intervention. The addition of time-limited behavioral family therapy to monthly support groups improved family atmosphere, but did not influence patient social functioning or family burden.

    View details for DOI 10.1037//0022-006X.69.1.3

    View details for Web of Science ID 000170876300001

    View details for PubMedID 11302274

  • Psychopharmacologic treatment strategies for depression, bipolar disorder, and schizophrenia ANNALS OF INTERNAL MEDICINE Glick, I. D., Suppes, T., Debattista, C., Hu, R. J., Marder, S. 2001; 134 (1): 47-60


    Patients with serious psychiatric disorders are frequently treated by primary care physicians, who may have difficulty keeping up with recent advances in psychiatry. This paper presents an updated synopsis for three major psychiatric illnesses: major depression, bipolar disorder, and schizophrenia. Current definitions, updated diagnostic criteria, short- and long-term treatment strategies with algorithms, and special challenges for the clinician are discussed for each of these illnesses. On the basis of each illness's distinct characteristics, five treatment principles are emphasized: 1) Treatment strategies should be long-term and should emphasize adherence, 2) treatment choice should be empirical, 3) combinations of medications may be helpful, 4) a combination of psychosocial and pharmacologic treatments may be more useful than either alone, and 5) the family or "significant others" as well as a consumer organization need to be involved. Some of the new directions in dinical research to refine these strategies and meet these challenges are also described.

    View details for Web of Science ID 000166043300007

    View details for PubMedID 11187420

  • Divalproex for the treatment of geriatric bipolar disorder INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY Mordecai, D. J., Sheikh, J. I., Glick, I. D. 1999; 14 (6): 494-496


    Divalproex is now commonly used to treat bipolar disorder in older patients. However, it has yet to be systematically studied in this population. This report describes six older bipolar patients treated with divalproex. Of the six, five showed some improvement with divalproex alone or in combination with other agents. Clearly, a double-blind, placebo-controlled study is an important next step to assess this promising medication.

    View details for Web of Science ID 000081209700012

    View details for PubMedID 10398360

  • Lithium augmentation fails to reduce symptoms in poorly responsive schizophrenic outpatients JOURNAL OF CLINICAL PSYCHIATRY Schulz, S. C., Thompson, P. A., Jacobs, M., Ninan, P. T., Robinson, D., Weiden, P. J., Yadalam, K., Glick, I. D., Odbert, C. L. 1999; 60 (6): 366-372


    Nearly one third of patients suffering from schizophrenia do not fully respond to antipsychotic medication. Safe, effective, and cost-efficient methods to reduce symptoms are clearly needed; therefore, lithium as an adjunct to fluphenazine decanoate was tested in a placebo-controlled trial in outpatients who were part of the Treatment Strategies of Schizophrenia (TSS) study.Forty-one patients with DSM-III schizophrenia or schizoaffective disorder were assigned to either adjunctive lithium or placebo after at least 6 months of fluphenazine decanoate treatment to stabilize symptoms had failed. The trial was designed for 8 weeks of treatment, and patients assigned to placebo could afterward be administered lithium in an 8-week, open-label study.Assessment of the intent-to-treat analysis revealed no significant differences in demographic variables between the lithium and placebo groups. Although both groups showed significant (p = .00135) improvement as measured by total scores on the Brief Psychiatric Rating Scale (BPRS), there were no significant differences in response between the lithium and placebo groups. Patients originally treated with placebo added to neuroleptic did not have significantly greater improvement when receiving open-label adjunctive lithium.Although success with lithium augmentation therapy for persistent psychosis has been reported in the past, this study of well-characterized patients showed no benefit for this common strategy, thus indicating that care be used in utilizing lithium augmentation.

    View details for Web of Science ID 000081187300003

    View details for PubMedID 10401914

  • Multicenter open-label sertraline study in adolescent outpatients with major depression 44th Annual Meeting of the American-Academy-of-Child-and-Adolescent-Psychiatry Ambrosini, P. J., Wagner, K. D., Biederman, J., Glick, I., Tan, C., Elia, J., Hebeler, J. R., Rabinovich, H., Lock, J., Geller, D. LIPPINCOTT WILLIAMS & WILKINS. 1999: 566–72


    The aim of this multicenter outpatient study was to assess the therapeutic benefits, response patterns, and safety of sertraline in adolescent major depressive disorder (MDD).Fifty-three adolescent outpatients with MDD were treated in an open-label, 10-week, acute-phase trial with sertraline and, if responders, for an additional 12-week continuation phase. Diagnostic and response assessments included the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS), 17-item K-SADS-derived depression severity score, Hamilton Depression Rating Scale, Beck Depression Inventory, and Clinical Global Impression Scale.By 2 weeks, when analyzed as continuous variables, all severity scores showed significant differences from baseline. This pattern persisted through 10 weeks, with a significantly greater response occurring when treatment was extended from 6 to 10 weeks. Both clinician- and patient-rated improvement was maintained during continuation treatment. Response rates varied considerably when depression rating scales were analyzed categorically. Sertraline was generally well tolerated and did not induce manic symptoms.In open treatment of adolescent MDD with sertraline, significant improvement occurred early on and was maintained for 22 weeks. Absolute response rates varied depending on the rating scales used, definition of response, and length of treatment. Maximal response rates were obtained by clinician-defined ratings after 10 weeks of treatment.

    View details for Web of Science ID 000079956100018

    View details for PubMedID 10230188

  • Family therapies - Efficacy, indications, and treatment outcomes 86th Annual Meeting of the American-Psychopathological-Association Glick, I. D. AMER PSYCHIATRIC PRESS, INC. 1999: 303–321
  • Effects of psychoeducational intervention for married patients with bipolar disorder and their spouses PSYCHIATRIC SERVICES Clarkin, J. F., Carpenter, D., Hull, J., Wilner, P., Glick, I. 1998; 49 (4): 531-533


    The relative benefit of adding a structured psychoeducational intervention to standard medication treatment for married patients with bipolar disorder and their spouses was assessed. Patients were randomly assigned to receive either medication management or medication management plus a marital intervention with their spouses for an 11-month period. Patients' symptoms, functioning, and adherence to their medication regimens were measured at study entry and at 11 months. Significant effects favoring the combined treatments were observed for overall patient functioning but not for symptom levels. The marital intervention was associated with improved medication adherence. Combined psychosocial and medication treatment does not affect patients' symptom levels beyond the effects of medication alone, but it does result in significant incremental gains in overall patient functioning.

    View details for Web of Science ID 000072790200019

    View details for PubMedID 9550248

  • A new algorithm for treating schizophrenia PSYCHOPHARMACOLOGY BULLETIN Pearsall, R., Glick, I. D., Pickard, D., Suppes, T., Tauscher, J., Jobson, K. O. 1998; 34 (3): 349-353


    This article presents two algorithms dealing with the management of schizophrenia. One provides a strategy for initiating pharmacologic treatment of schizophrenia and for ongoing medication management. The other covers suggestions for managing several common comorbid psychiatric conditions and some common side effects. The major change from previous algorithms is the suggestion that the newer atypical antipsychotic agents may now be the treatment of choice for initiating therapy in most clinical situations.

    View details for Web of Science ID 000078297300024

    View details for PubMedID 9803768

  • Relapse and rehospitalization during maintenance treatment of schizophrenia - The effects of dose reduction and family treatment ARCHIVES OF GENERAL PSYCHIATRY Schooler, N. R., Keith, S. J., Severe, J. B., Matthews, S. M., Bellack, A. S., Glick, I. D., Hargreaves, W. A., Kane, J. M., Ninan, P. T., Frances, A., Jacobs, M., Lieberman, J. A., Mance, R., Simpson, G. M., Woerner, M. G. 1997; 54 (5): 453-463


    Previous studies have examined dose reduction and family treatment in schizophrenia, but none has examined their interaction. This study assessed the impact of dose reduction of antipsychotic medication and family treatment on relapse and rehospitalization during maintenance treatment.Subjects were 313 male and female outpatients at 5 centers with a DSM-III-R diagnosis of schizophrenia or schizoaffective disorder. In a 3 x 2 design, subjects were randomized to 1 of 3 medication strategies using fluphenazine decanoate under double-blind conditions: continuous moderate dose (standard) (12.5-50 mg every 2 weeks); continuous low dose (2.5-10 mg every 2 weeks); or targeted, early intervention (fluphenazine only when symptomatic). Subjects also were randomized to 1 of 2 family treatment strategies (supportive or applied). Supportive family management involved monthly group meetings. The more intensive applied family management involved monthly group meetings and home visits where communication and problem-solving skills were taught. Patients and families were treated and assessed for 2 years.Both continuous low-dose and targeted treatment increased use of rescue medication and relapse; only targeted treatment increased rehospitalization. This pattern was consistent across both family treatments; there were no differences between family treatments.These findings reaffirm the value of antipsychotic medication in preventing relapse and rehospitalization. The absence of family treatment differences may be because both conditions engaged families.

    View details for Web of Science ID A1997WY63300008

    View details for PubMedID 9152099

  • Efficacious and safe psychotropics not available in the United States PSYCHIATRIC ANNALS Glick, I. D., Lecrubier, Y., Montgomery, S. A., Vinar, O., Klein, D. F. 1996; 26 (6): 354-361
  • Transition from acute to maintenance treatment: Prediction of stabilization Lundbeck Symposium on the Acute Episode in Schizophrenia - Diagnosis, Prognosis and Treatment Schooler, N. R., Severe, J. B., Glick, I. D., Hargreaves, W. A., Keith, S. J., Weiden, P., Matthews, S. M., SCHULTZ, S. C., Odbert, C. L., Kane, J. M., Lieberman, J. A., Woerner, M., Bellack, A. S., Simpson, G. M., Frances, A. J., Jacobs, M., Ninan, P. T., MANCE, R. M., Falloon, I. R., MCGILL, C. W. LIPPINCOTT WILLIAMS & WILKINS. 1996: 85–91


    The stabilization period that follows the exacerbation of a schizophrenic illness represents a critical point in the course of the illness. Successful stabilization is a prerequisite to long-term tenure in the community and the possibility of improvement in functional outcome. In this paper we present an operational definition of stabilization, developed in the context of a study of long-term maintenance treatment that incorporates time, symptomatic equilibrium and consistency of medication dosage. Patients were identified at the time of hospitalization and followed prospectively to determine whether or not they met stabilization criteria. Characteristics that predicted successful stabilization included measures drawn from the domains of patient personal characteristics and psychiatric history, symptoms of psychopathology and side effects in response to initial treatment and family judgments. These patients were treated primarily with fluphenazine decanoate, and five distinct dosing strategies with this agent were identified retrospectively. The dosing strategies distinguished the length of time to subsequent stabilization. The implications of these findings for clinical management of schizophrenia are discussed.

    View details for Web of Science ID A1996UR52700014

    View details for PubMedID 8803666

  • Improving outpatient treatment for severely mentally ill persons: Doing the right thing ADMINISTRATION AND POLICY IN MENTAL HEALTH Hanrahan, M., Glick, I. D. 1996; 23 (5): 459-463
  • Administrative intervention to increase the efficacy of outpatient treatment for the severely mentally ill. Administration Policy in Mental Health. - Glick ID, Hanrahan M 1996: 459-463
  • Efficacious and safe psychotropics not available in the US. Psych. Annals. Glick ID, Lecrubier Y, Montgomery S, Vinar O, Klein DF. 1996: 354-361


    The comorbidity of DSM-III-R axis II personality disorders in patients with bipolar disorder has received less attention than for unipolar depression perhaps because of the potential confounding of state vs. trait qualities. The current study took steps to separate pathological traits of personality from behaviors evidenced during discrete affective episodes in a sample of married, outpatient bipolar patients. Data indicated that 22% of our patients met criteria for a categorical diagnosis of personality disorder. Axis II pathology as represented by both categorical and dimensional scores was associated with increased psychiatric symptoms during subsequent treatment and poorer social adjustment.

    View details for Web of Science ID A1995RR59100002

    View details for PubMedID 8550952

  • The family, family therapy, and borderline personality disorder. The Journal of psychotherapy practice and research Glick, I. D., DULIT, R. A., Wachter, E., Clarkin, J. F. 1995; 4 (3): 237-246


    The authors review recent controlled studies on the interrelationship of the family and its members with borderline disorder and propose a new model for understanding and managing this relationship. The focus of the model is on psychopathology, evaluation, and treatment of patient and family as they influence each other. In the authors' view this illness originates in cerebral dysfunction, in the patient in combination with impaired relationships among family members. When the family is available, we believe that the treatment of choice is a multimodal approach involving family psychoeducation and family systems or dynamic intervention where possible, in combination with medications, individual psychotherapy, or both.

    View details for PubMedID 22700254

  • A model for the classification and diagnosis of relational disorders. J. Psych. Serv. Glick ID, Guttman HA, Beavers WR, Berman E, Combrinck-Graham L 1995: 926-932
  • Unbundling the function of an inpatient unit. New directions for mental health services Glick, I. D. 1994: 35-43

    View details for PubMedID 7823886



    This hypothesis-generating study had the objective of dissecting the process of psychiatric care in an attempt to understand outcomes for patients and their families. In all, 24 patients who carried a DSM-III diagnosis of major affective disorder were identified 12-18 months after hospital admission. The patients, their families, and their doctors were interviewed using instruments measuring delivery of treatment and achievement of treatment goals; findings were then correlated with resolution of the index episode and patient global outcome. Delivery of patient and family psychoeducation was associated with better resolution of the index episode and better global outcome.

    View details for Web of Science ID A1994MT67200017

    View details for PubMedID 8137088

  • Combining Medication and Family Psychotherapy. In: Beitman B (ed.), Combined Treatments, the American Psychiatry Press Review of Psychiatry, Washington, D.C. American Psychiatric Press, Inc. Glick ID, Clarkin JF, Goldsmith SJ. 1993; 12: 585-610


    Although effective medications for the treatment of Axis I disorders have been developed, achieving adequate, let alone, optimal medication regimens has been difficult. This hypothesis-generating study had the objective of dissecting the process of medication-management among 24 previously hospitalized affective disorder patients, their families, and their doctors in Italy, Japan, and the United States as well as identifying their outcomes. The data demonstrated significant positive associations between outcome and delivery of adequate medication as well as psychoeducation (about the illness and its treatment) to both patient and family. These results suggested that, regardless of country, medication was necessary but insufficient without the practitioner delivering a family intervention and psychoeducation.

    View details for Web of Science ID A1992JY72100011

    View details for PubMedID 1480729


    View details for Web of Science ID A1989CJ20200010

    View details for PubMedID 2626513