Bio

Academic Appointments


Administrative Appointments


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

Honors & Awards


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

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.

Teaching

2010-11 Courses


Publications

Journal Articles


  • 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 Web of Science ID 000316925700006

    View details for PubMedID 23561232

  • 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

    Abstract

    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

    Abstract

    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

  • 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

    Abstract

    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

    Abstract

    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

  • 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

    Abstract

    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

    Abstract

    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

    Abstract

    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

    Abstract

    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

    Abstract

    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

    Abstract

    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

    Abstract

    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

  • 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

    Abstract

    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

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

    Abstract

    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

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

    Abstract

    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

    Abstract

    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

    Abstract

    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

    Abstract

    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

  • 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

    Abstract

    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

  • 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

    Abstract

    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

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

    Abstract

    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

  • 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

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

    Abstract

    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

  • 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

    Abstract

    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

  • 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

    Abstract

    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

  • 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

    Abstract

    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

  • 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

    Abstract

    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

    Abstract

    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

  • 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

    Abstract

    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

  • 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

    Abstract

    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

    Abstract

    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-?

    Abstract

    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

  • 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

    Abstract

    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

    Abstract

    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

  • 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

    Abstract

    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

  • 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
  • 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

  • EFFECTIVENESS IN PSYCHIATRIC-CARE .3. PSYCHOEDUCATION AND OUTCOME FOR PATIENTS WITH MAJOR AFFECTIVE-DISORDER AND THEIR FAMILIES BRITISH JOURNAL OF PSYCHIATRY Glick, I. D., Burti, L., Okonogi, K., Sacks, M. 1994; 164: 104-106

    Abstract

    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

Conference Proceedings


  • Treatment with atypical antipsychotics: new indications and new populations Glick, I. D., Murray, S. R., Vasudevan, P., Marder, S. R., Hu, R. J. PERGAMON-ELSEVIER SCIENCE LTD. 2001: 187-191

    Abstract

    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

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