151
|
Improvement in IAPT outcomes over time: are they driven by changes in clinical practice? COGNITIVE BEHAVIOUR THERAPIST 2021; 13:e16. [PMID: 33613689 PMCID: PMC7872157 DOI: 10.1017/s1754470x20000173] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/04/2020] [Accepted: 04/17/2020] [Indexed: 11/23/2022]
Abstract
Treatment outcomes across Improving Access to Psychological Therapies (IAPT) services in England have improved year-on-year, with the national average proportion of patients in recovery at the end of treatment now exceeding the 50% target. This is despite the number of referrals and numbers of treated patients also increasing year-on-year, suggesting that services have evolved local practices and treatment delivery to meet needs whilst improving performance. This study explores whether there have been changes in clinical practice with regard to: (1) the number of sessions and length of treatments; (2) the number of cancellations and non-attendance; and (3) the recording of problem descriptor information, and the association with treatment outcomes in IAPT. Routinely collected data from seven IAPT services involved in the North and Central East London (NCEL) IAPT Service Improvement and Research Network (SIRN) were brought together to form a dataset of nearly 88,000 patients who completed a course of IAPT treatment. Results showed that there was a slight increase in the average number of sessions, and decreases in the length of time in treatment, as well as decreases in both the number of non-attended appointments and the use of inappropriate problem descriptors. These findings highlight a number of areas where potentially small changes to clinical practice may have had positive effects on patient outcomes. The value of using IAPT data to inform service improvement evaluations is discussed.
Collapse
|
152
|
Inada K, Enomoto M, Yamato K, Marumoto T, Takeshima M, Mishima K. Effect of residual insomnia and use of hypnotics on relapse of depression: a retrospective cohort study using a health insurance claims database. J Affect Disord 2021; 281:539-546. [PMID: 33401142 DOI: 10.1016/j.jad.2020.12.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/03/2020] [Accepted: 12/11/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Residual insomnia is associated with a risk of depression recurrence. METHODS In this retrospective, longitudinal cohort study, the recurrence pattern of depression in patients with or without residual insomnia was assessed using a health insurance claims database. Patients who were diagnosed with major depressive disorder and prescribed antidepressants, between January 2006 and June 2017 in Japan, were enrolled in the study. Residual insomnia was defined by a prescription of hypnotics, and recurrence of depression by prescription of antidepressants. Main outcomes included time to recurrence and the 1-year recurrence rate. Factors associated with recurrence of depression were assessed by multivariate analyses. The effect of residual insomnia on the frequency of recurrence was assessed by Chi-square test. RESULTS Of the 30,381 patients analyzed, there were 4,166 and 26,215 patients with or without residual insomnia, respectively. Time to recurrence in patients with residual insomnia was significantly shorter compared with those without residual insomnia (p <0.001), with a 1-year recurrence rate (95% CI) of 43.4% (41.9-45.0) and 7.4% (7.1-7.7), respectively. The frequency of recurrence was significantly higher in patients with residual insomnia than in those without (p <0.0001). A higher risk of depression recurrence (odds ratio 9.98, 95% CI 9.22-10.81) was found for residual insomnia compared with other significant factors. LIMITATIONS The diagnosis stated in the receipt data may not accurately reflect the patient's condition, and medication adherence was unknown but assumed. CONCLUSIONS Residual insomnia is a significant risk factor for depression recurrence in Japanese patients.
Collapse
Affiliation(s)
- Ken Inada
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Minori Enomoto
- Department of Medical Technology, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
| | - Kentaro Yamato
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Tatsuro Marumoto
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Masahiro Takeshima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Kazuo Mishima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan; Department of Psychophysiology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan; International Institute for Integrative Sleep Medicine, Tsukuba, Japan.
| |
Collapse
|
153
|
Mikkelsen S, Coggon D, Andersen JH, Casey P, Flachs EM, Kolstad HA, Mors O, Bonde JP. Are depressive disorders caused by psychosocial stressors at work? A systematic review with metaanalysis. Eur J Epidemiol 2021; 36:479-496. [PMID: 33580479 PMCID: PMC8159794 DOI: 10.1007/s10654-021-00725-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 01/25/2021] [Indexed: 11/25/2022]
Abstract
In the last decade, many studies have examined associations between poor psychosocial work environment and depression. We aimed to assess the evidence for a causal association between psychosocial factors at work and depressive disorders. We conducted a systematic literature search from 1980 to March 2019. For all exposures other than night and shift work and long working hours, we limited our selection of studies to those with a longitudinal design. We extracted available risk estimates for each of 19 psychosocial exposures, from which we calculated summary risk estimates with 95% confidence intervals (PROSPERO, identifier CRD42019130266). 54 studies were included, addressing 19 exposures and 11 different measures of depression. Only data on depressive episodes were sufficient for evaluation. Heterogeneity of exposure definitions and ascertainment, outcome measures, risk parameterization and effect contrasts limited the validity of meta-analyses. Summary risk estimates were above unity for all but one exposure, and below 1.60 for all but another. Outcome measures were liable to high rates of false positives, control of relevant confounding was mostly inadequate, and common method bias was likely in a large proportion of studies. The combination of resulting biases is likely to have inflated observed effect estimates. When statistical uncertainties and the potential for bias and confounding are taken into account, it is not possible to conclude with confidence that any of the psychosocial exposures at work included in this review is either likely or unlikely to cause depressive episodes or recurrent depressive disorders.
Collapse
Affiliation(s)
- Sigurd Mikkelsen
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - David Coggon
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Johan Hviid Andersen
- Department of Occupational Medicine, Danish Ramazzini Centre, University Research Clinic, Herning, Denmark
| | - Patricia Casey
- Department of Psychiatry, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Esben Meulengracht Flachs
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Albert Kolstad
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Ole Mors
- Department of Psychosis, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
| | - Jens Peter Bonde
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
154
|
Litwińska-Bołtuć M, Święcicki Ł, Spreco A, Timpka T. Clinical effectiveness of the electrodermal orienting reactivity test for evaluating relapse and recurrence risk in patients hospitalized for depression. BMC Psychiatry 2021; 21:88. [PMID: 33568134 PMCID: PMC7877008 DOI: 10.1186/s12888-021-03088-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recurrence is a problem for many patients who have episodes of depression. In experimental settings, hyporeactivity in the Electrodermal Orienting Reactivity (EDOR) test has been observed to be more frequent in these patients. The aim of this study was to investigate the clinical value of this test with regard to a prognosis of episode recurrence in patients hospitalized for depression. METHODS The study was performed using a cohort design at a specialized psychiatric clinic in Warsaw, Poland. The primary endpoint measure was relapse or recurrence of depression. Data on electrodermal reactivity measured by the EDOR test, clinical status, and psychiatric history were collected at the clinic. Relapse and recurrence data were collected by clinical interviews 1 year after the EDOR test. The predictive (adjusting for confounders) and comparative (relative to other predictors) performance of electrodermal hyporeactivity was assessed using simple and multiple binary logistic regression. RESULTS The patient sample included 97 patients aged between 20 and 81 years (mean, 51.2 years). Twenty patients (20.6%) were hyporeactive in the EDOR test. The group of hyporeactive patients did not differ significantly from the reactive group with regard to background factors or clinical status on admission. Forty-seven patients (51.6%) had at least one depressive episode during the follow-up period. In the analysis including potential confounders, the likelihood of relapse or recurrence of depression was nearly five times higher among the hyporeactive patients than the reactive patients (odds ratio [OR], 4.7; 95% confidence interval (CI), 1.3-16.2; p = 0.015). In the comparative analysis, only hyporeactivity was found to be associated with recurring episodes (OR, 3.3; 95% CI, 1.1-10.2; p = 0.036). CONCLUSIONS Electrodermal hyporeactivity was associated with a higher risk of relapse or recurrence after discharge among patients hospitalized for depression. This finding warrants further clinical investigations that cover different types of depression and account for causal mechanisms. TRIAL REGISTRATION The study design was registered in the German Clinical Trials Register ( DRKS00010082 ).
Collapse
Affiliation(s)
- Marta Litwińska-Bołtuć
- grid.418955.40000 0001 2237 2890Second Clinic of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Łukasz Święcicki
- grid.418955.40000 0001 2237 2890Second Clinic of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Armin Spreco
- grid.5640.70000 0001 2162 9922Department of Health, Medicine, and Caring Sciences, Linköping University, Linköping, Sweden
| | - Toomas Timpka
- Department of Health, Medicine, and Caring Sciences, Linköping University, Linköping, Sweden.
| |
Collapse
|
155
|
Tomer N, Small A, Mirza O, Palese M. Evidence of Resilience in Kidney Donors: A New York Statewide Cohort Analysis. Transplant Proc 2021; 53:803-807. [PMID: 33551185 DOI: 10.1016/j.transproceed.2021.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/08/2020] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Donor nephrectomy (DN) is a procedure performed to provide recipients with a kidney to treat end-stage renal disease. The following analysis evaluated depression diagnosis in DN patients compared to controls. METHODS DN patients and matched controls were identified between 2000 and 2009 from the Statewide Planning and Research Cooperative System database. Cohorts were tracked for depression incidence. Multivariable logistic regression was used to determine independent predictors of a postoperative depression diagnosis. RESULTS The total study cohort included 2108 DN cases and 2108 controls. In both donors and controls, the baseline rate of depression was 0.95% (n = 20). The 5-year incidence of depression diagnosis after exposure increased in both cohorts (donors: 2.5%, n = 53; controls: 7.2%, n = 152; P < .001). The 5-year relative risk for developing depression was 2.65 (CI 1.59-4.42, P = .0002) in donors and 7.60 (CI 4.79-12.07, P < .001) in controls. On multivariable regression, being a donor was associated with reduced risk of developing postoperative depression (OR = 0.322, CI 0.233-0.445, P < .001), and the greatest risk factor for postoperative depression was a prior depressive diagnosis (OR = 7.811, CI 3.814-15.997, P < .001). CONCLUSION Our analysis shows that the strongest risk factor for depression was a prior diagnosis of depression. However, willingness to undergo donor nephrectomy is associated with less subsequent depression than the control population, suggesting that kidney donors may be a more resilient cohort.
Collapse
Affiliation(s)
- Nir Tomer
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alexander Small
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Omar Mirza
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michael Palese
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY.
| |
Collapse
|
156
|
Liu J, Fan Y, Ling-Li Zeng, Liu B, Ju Y, Wang M, Dong Q, Lu X, Sun J, Zhang L, Guo H, Futao Zhao, Weihui Li, Zhang L, Li Z, Liao M, Zhang Y, Hu D, Li L. The neuroprogressive nature of major depressive disorder: evidence from an intrinsic connectome analysis. Transl Psychiatry 2021; 11:102. [PMID: 33542206 PMCID: PMC7862649 DOI: 10.1038/s41398-021-01227-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 01/08/2021] [Accepted: 01/15/2021] [Indexed: 12/16/2022] Open
Abstract
Major depressive disorder (MDD) is a prevailing chronic mental disorder with lifetime recurring episodes. Recurrent depression (RD) has been reported to be associated with greater severity of depression, higher relapse rate and prominent functioning impairments than first-episode depression (FED), suggesting the progressive nature of depression. However, there is still little evidence regarding brain functional connectome. In this study, 95 medication-free MDD patients (35 with FED and 60 with RD) and 111 matched healthy controls (HCs) underwent resting-state functional magnetic resonance imaging (fMRI) scanning. After six months of treatment with paroxetine, 56 patients achieved clinical remission and finished their second scan. Network-based statistics analysis was used to explore the changes in functional connectivity. The results revealed that, compared with HCs, patients with FED exhibited hypoconnectivity in the somatomotor, default mode and dorsal attention networks, and RD exhibited hyperconnectivity in the somatomotor, salience, executive control, default mode and dorsal attention networks, as well as within and between salience and executive control networks. Moreover, the disrupted components in patients with current MDD did not change significantly when the patients achieved remission after treatment, and sub-hyperconnectivity and sub-hypoconnectivity were still found in those with remitted RD. Additionally, the hypoconnectivity in FED and hyperconnectivity in RD were associated with the number of episodes and total illness duration. This study provides initial evidence supporting that impairment of intrinsic functional connectivity across the course of depression is a progressive process.
Collapse
Affiliation(s)
- Jin Liu
- grid.216417.70000 0001 0379 7164Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan China ,grid.489086.bMental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan China
| | - Yiming Fan
- grid.412110.70000 0000 9548 2110College of Intelligence Science and Technology, National University of Defense Technology, Changsha, Hunan China
| | - Ling-Li Zeng
- grid.412110.70000 0000 9548 2110College of Intelligence Science and Technology, National University of Defense Technology, Changsha, Hunan China
| | - Bangshan Liu
- grid.216417.70000 0001 0379 7164Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan China ,grid.489086.bMental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan China
| | - Yumeng Ju
- grid.216417.70000 0001 0379 7164Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan China ,grid.489086.bMental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan China
| | - Mi Wang
- grid.216417.70000 0001 0379 7164Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan China ,grid.489086.bMental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan China
| | - Qiangli Dong
- grid.216417.70000 0001 0379 7164Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan China ,grid.489086.bMental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan China
| | - Xiaowen Lu
- grid.216417.70000 0001 0379 7164Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan China ,grid.489086.bMental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan China
| | - Jinrong Sun
- grid.216417.70000 0001 0379 7164Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan China ,grid.489086.bMental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan China
| | - Liang Zhang
- grid.216417.70000 0001 0379 7164Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan China ,grid.489086.bMental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan China
| | - Hua Guo
- Zhumadian Psychiatric Hospital, Zhumadian, Henan China
| | - Futao Zhao
- Zhumadian Psychiatric Hospital, Zhumadian, Henan China
| | - Weihui Li
- grid.216417.70000 0001 0379 7164Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan China ,grid.489086.bMental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan China
| | - Li Zhang
- grid.216417.70000 0001 0379 7164Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan China ,grid.489086.bMental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan China
| | - Zexuan Li
- grid.216417.70000 0001 0379 7164Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan China ,grid.489086.bMental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan China
| | - Mei Liao
- grid.216417.70000 0001 0379 7164Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan China ,grid.489086.bMental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan China
| | - Yan Zhang
- grid.216417.70000 0001 0379 7164Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan China ,grid.489086.bMental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan China
| | - Dewen Hu
- College of Intelligence Science and Technology, National University of Defense Technology, Changsha, Hunan, China.
| | - Lingjiang Li
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China. .,Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan, China.
| |
Collapse
|
157
|
Chatterjee S, Kar SK. Comments on "Benefits of Sexual Activity on Psychological, Relational, and Sexual Health During the COVID-19 Breakout". J Sex Med 2021; 18:430-431. [PMID: 33341420 PMCID: PMC10016841 DOI: 10.1016/j.jsxm.2020.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 01/29/2023]
Affiliation(s)
- Surobhi Chatterjee
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India.
| | - Sujita Kumar Kar
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
| |
Collapse
|
158
|
Yamato K, Inada K, Enomoto M, Marumoto T, Takeshima M, Mishima K. Patterns of hypnotic prescribing for residual insomnia and recurrence of major depressive disorder: a retrospective cohort study using a Japanese health insurance claims database. BMC Psychiatry 2021; 21:40. [PMID: 33441086 PMCID: PMC7807418 DOI: 10.1186/s12888-021-03046-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/05/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is highly prevalent in Japan and frequently accompanied by insomnia that may persist even with MDD remission. Hypnotics are used for the pharmacological treatment of insomnia, but their influence on MDD recurrence or residual insomnia following MDD remission is unclear. This retrospective, longitudinal, cohort study utilized a large Japanese health insurance claims database to investigate patterns of hypnotic prescriptions among patients with MDD, and the influence of hypnotic prescription pattern on MDD recurrence. METHODS Eligible patients (20-56 years) were those registered in the Japan Medical Data Center database between 1 January 2005 and 31 December 2018, and prescribed antidepressant and hypnotic therapy after being diagnosed with MDD. Patients who had ceased antidepressant therapy for > 180 days were followed for 1 year to evaluate depression recurrence, as assessed using Kaplan-Meier estimates. Logistic regression modelling was used to analyze the effect of hypnotic prescription pattern on MDD recurrence. RESULTS Of the 179,174 patients diagnosed with MDD who initiated antidepressant treatment between 1 January 2006 and 30 June 2017, complete prescription information was available for 2946 eligible patients who had been prescribed hypnotics. More patients were prescribed hypnotic monotherapy (70.8%) than combination therapy (29.2%). The most prescribed therapies were benzodiazepine monotherapy (26.2%), non-benzodiazepine monotherapy (28.9%), and combination therapy with two drugs (21.1%). Among patients prescribed multiple hypnotics, concomitant prescriptions for anxiolytics, antipsychotics, mood stabilizers and sedative antidepressants were more common. The 1-year recurrence rate for MDD was approximately 20%, irrespective of hypnotic mono- versus combination therapy or class of hypnotic therapy. Being a spouse (odds ratio [OR], 1.44; 95% confidence interval [CI], 1.03-2.02) or other family member (OR, 1.46, 95% CI, 0.99-2.16) of the insured individual, or being prescribed a sedative antidepressant (OR, 1.50, 95% CI, 1.24-1.82) conferred higher odds of MDD recurrence within 1 year of completing antidepressant therapy. CONCLUSIONS Benzodiazepines are the most prescribed hypnotic among Japanese patients with MDD, though combination hypnotic therapy is routinely prescribed. Hypnotic prescription pattern does not appear to influence real-world MDD recurrence, though hypnotics should be appropriately prescribed given class differences in efficacy and safety.
Collapse
Affiliation(s)
- Kentaro Yamato
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Ken Inada
- grid.410818.40000 0001 0720 6587Department of Psychiatry, Tokyo Women’s Medical University, Tokyo, Japan
| | - Minori Enomoto
- grid.412788.00000 0001 0536 8427Department of Medical Technology, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
| | - Tatsuro Marumoto
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Masahiro Takeshima
- grid.251924.90000 0001 0725 8504Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Kazuo Mishima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan. .,Department of Psychophysiology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan. .,International Institute for Integrative Sleep Medicine, Tsukuba, Japan.
| |
Collapse
|
159
|
The effects of intensive home treatment on self-efficacy in patients recovering from a psychiatric crisis. Int J Ment Health Syst 2021; 15:1. [PMID: 33407731 PMCID: PMC7789166 DOI: 10.1186/s13033-020-00426-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/29/2020] [Indexed: 02/02/2023] Open
Abstract
Background This study evaluated whether providing intensive home treatment (IHT) to patients experiencing a psychiatric crisis has more effect on self-efficacy when compared to care as usual (CAU). Self-efficacy is a psychological concept closely related to one of the aims of IHT. Additionally, differential effects on self-efficacy among patients with different mental disorders and associations between self-efficacy and symptomatic recovery or quality of life were examined. Methods Data stem from a Zelen double consent randomised controlled trial (RCT), which assesses the effects of IHT compared to CAU on patients who experienced a psychiatric crisis. Data were collected at baseline, 6 and 26 weeks follow-up. Self-efficacy was measured using the Mental Health Confidence Scale. The 5-dimensional EuroQol instrument and the Brief Psychiatric Rating Scale (BPRS) were used to measure quality of life and symptomatic recovery, respectively. We used linear mixed modelling to estimate the associations with self-efficacy. Results Data of 142 participants were used. Overall, no difference between IHT and CAU was found with respect to self-efficacy (B = − 0.08, SE = 0.15, p = 0.57), and self-efficacy did not change over the period of 26 weeks (B = − 0.01, SE = 0.12, t (103.95) = − 0.06, p = 0.95). However, differential effects on self-efficacy over time were found for patients with different mental disorders (F(8, 219.33) = 3.75, p < 0.001). Additionally, self-efficacy was strongly associated with symptomatic recovery (total BPRS B = − 0.10, SE = 0.02, p < 0.00) and quality of life (B = 0.14, SE = 0.01, p < 0.001). Conclusions Although self-efficacy was associated with symptomatic recovery and quality of life, IHT does not have a supplementary effect on self-efficacy when compared to CAU. This result raises the question whether, and how, crisis care could be adapted to enhance self-efficacy, keeping in mind the development of self-efficacy in depressive, bipolar, personality, and schizophrenia spectrum and other psychotic disorders. The findings should be considered with some caution. This study lacked sufficient power to test small changes in self-efficacy and some mental disorders had a small sample size. Trial registration This trial is registered at Trialregister.nl, number NL6020.
Collapse
|
160
|
Malhi GS, Bell E, Bassett D, Boyce P, Bryant R, Hazell P, Hopwood M, Lyndon B, Mulder R, Porter R, Singh AB, Murray G. The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry 2021; 55:7-117. [PMID: 33353391 DOI: 10.1177/0004867420979353] [Citation(s) in RCA: 246] [Impact Index Per Article: 82.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To provide advice and guidance regarding the management of mood disorders, derived from scientific evidence and supplemented by expert clinical consensus to formulate s that maximise clinical utility. METHODS Articles and information sourced from search engines including PubMed, EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (e.g. books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Relevant information was appraised and discussed in detail by members of the mood disorders committee, with a view to formulating and developing consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous consultation and external review involving: expert and clinical advisors, key stakeholders, professional bodies and specialist groups with interest in mood disorders. RESULTS The Royal Australian and New Zealand College of Psychiatrists mood disorders clinical practice guidelines 2020 (MDcpg2020) provide up-to-date guidance regarding the management of mood disorders that is informed by evidence and clinical experience. The guideline is intended for clinical use by psychiatrists, psychologists, primary care physicians and others with an interest in mental health care. CONCLUSION The MDcpg2020 builds on the previous 2015 guidelines and maintains its joint focus on both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. MOOD DISORDERS COMMITTEE Gin S Malhi (Chair), Erica Bell, Darryl Bassett, Philip Boyce, Richard Bryant, Philip Hazell, Malcolm Hopwood, Bill Lyndon, Roger Mulder, Richard Porter, Ajeet B Singh and Greg Murray.
Collapse
Affiliation(s)
- Gin S Malhi
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Erica Bell
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | | | - Philip Boyce
- Department of Psychiatry, Westmead Hospital and the Westmead Clinical School, Wentworthville, NSW, Australia.,Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Philip Hazell
- Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne and Professorial Psychiatry Unit, Albert Road Clinic, Melbourne, VIC, Australia
| | - Bill Lyndon
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Ajeet B Singh
- The Geelong Clinic Healthscope, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
| |
Collapse
|
161
|
Liu J, Liu B, Wang M, Ju Y, Dong Q, Lu X, Sun J, Zhang L, Guo H, Zhao F, Li W, Zhang L, Li Z, Zhang Y, Liao M, Li L. Evidence for Progressive Cognitive Deficits in Patients With Major Depressive Disorder. Front Psychiatry 2021; 12:627695. [PMID: 33664684 PMCID: PMC7921310 DOI: 10.3389/fpsyt.2021.627695] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/25/2021] [Indexed: 01/24/2023] Open
Abstract
Background: Cognitive deficits have shown progressive feature in major depressive disorder (MDD). However, it remains unknown which component of cognitive function is progressively impaired across episodes of MDD. Here we aim to identify the progressively impaired cognitive components in patients with MDD. Methods: A comprehensive neurocognitive test battery was used to assess the cognitive components (executive function, attention, processing speed, memory, working memory, inhibition, shifting, and verbal fluency) in 35 patients with first-episode MDD (FED), 60 patients with recurrent MDD (RD) and 111 matched healthy controls (HCs). After 6 months of treatment with antidepressant, 20 FED and 36 RD patients achieved clinical remission and completed their second-time neurocognitive tests. Statistical analyses were conducted to identify the impaired cognitive components in the FED and RD groups before and after treatment, and to assess the relationship between the cognitive components and the number of episodes and total illness duration in the MDD patient group. Results: At baseline, both the FED and RD groups showed impairments in all of the cognitive components; the FED and RD groups showed no significant difference in all of the components except for shifting. After remission, only shifting in the RD group showed no significant improvement and remained in an impaired status. Furthermore, shifting was the only component negatively correlated with the number of episodes as well as the total illness duration. Conclusions: Shifting may serve as the progressive cognitive deficit across episodes of MDD. Clinical Trials Registration: Registry name: HPA function and MRI study of trauma-related depression; Registration number: ChiCTR1800014591; URL: http://www.chictr.org.cn/edit.aspx?pid=24669&htm=4.
Collapse
Affiliation(s)
- Jin Liu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, China
| | - Bangshan Liu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, China
| | - Mi Wang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, China
| | - Yumeng Ju
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, China
| | - Qiangli Dong
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, China
| | - Xiaowen Lu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, China
| | - Jinrong Sun
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, China
| | - Liang Zhang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, China
| | - Hua Guo
- Zhumadian Psychiatric Hospital, Zhumadian, China
| | - Futao Zhao
- Zhumadian Psychiatric Hospital, Zhumadian, China
| | - Weihui Li
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, China
| | - Li Zhang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, China
| | - Zexuan Li
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, China
| | - Yan Zhang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, China
| | - Mei Liao
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, China
| | - Lingjiang Li
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, China
| |
Collapse
|
162
|
Adamo D, Calabria E, Coppola N, Pecoraro G, Mignogna MD. Vortioxetine as a new frontier in the treatment of chronic neuropathic pain: a review and update. Ther Adv Psychopharmacol 2021; 11:20451253211034320. [PMID: 34497709 PMCID: PMC8419528 DOI: 10.1177/20451253211034320] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 07/06/2021] [Indexed: 01/10/2023] Open
Abstract
Chronic neuropathic pain (CNP) is a disabling medical condition that impairs the health-related quality-of-life of affected patients. A high prevalence of anxiety, depression, sleep disturbance and cognitive impairment has frequently been reported in association with CNP, making the management of this disease complex and often multidisciplinary. Dual-acting agents such as selective serotonin and noradrenalin reuptake inhibitors (SNRIs) are considered particularly useful in the modulation of pain and in treatment of the mood disorders frequently associated with CNP. Recent evidence suggests that the top-down inhibitory control of pain involves the engagement and enhancement of descending endogenous opioidergic, cannabinoid and serotonergic systems, with the effect of serotonin being particularly related to the receptor subtypes that are preferentially activated; indeed serotonin induces analgesia via activation of 5-HT7 receptors and hyperalgesia via activation of 5-HT3 receptors. Vortioxetine (VO) is a novel multimodal serotonergic antidepressant with a unique mechanism of action. It has been demonstrated recently in experimental and clinical studies to have efficacy on pain hypersensitivity and on mood disorders. This drug inhibits the serotonin transporter with a high affinity, antagonises the 5-HT3, 5-HT1D and 5HT7 serotonin receptors, and activates the 5-HT1A and 5-HT1B receptors. In clinical studies, VO has proved effective at a dose of 10-20 mg/daily in short- and long-term treatment of patients with chronic orofacial pain, demonstrating a higher rate of clinical response and remission, a better acceptability, safety rate and tolerability, and a lower latency of action compared with other antidepressants. In the light of these recent findings, VO may be considered as a new pharmacological treatment also in relation to various types of CNP, particularly in elderly patients with concomitant mood disorders and cognitive impairment. The purpose of this review is to provide an up-to-date overview of the pharmacology and clinical applications of VO and to highlight its potential therapeutic properties and advantages in the management of CNP.
Collapse
Affiliation(s)
- Daniela Adamo
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Elena Calabria
- Department of Neuroscience, Reproductive Sciences and Dentistry, University Federico II of Naples, via Pansini no.5, Naples, 80131, Italy
| | - Noemi Coppola
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Giuseppe Pecoraro
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Michele Davide Mignogna
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| |
Collapse
|
163
|
Calabria E, Adamo D, Leuci S, Pecoraro G, Coppola N, Aria M, Mignogna MD. The health-related quality of life and psychological profile in patients with oropharyngeal Pemphigus Vulgaris in complete clinical remission: A case-control study. J Oral Pathol Med 2020; 50:510-519. [PMID: 33314320 DOI: 10.1111/jop.13150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/11/2020] [Accepted: 12/01/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pemphigus Vulgaris (PV) is a severe autoimmune blistering disease which may affect the patient's health-related quality of life (HR-QoL) and mood even during quiescent disease activity. We sought to evaluate HR-QoL, quality of sleep (QoS), anxiety and depression in oropharyngeal PV patients (OPV) in complete clinical remission on or off therapy (CCR-on, CCR-off). METHODS Thirty OPV patients and 30 healthy controls were enrolled. The Short Form 36 Health Survey Questionnaire (SF-36), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Hamilton Rating Scale for Depression (HAM-D) and Hamilton Rating Scale for Anxiety (HAM-A) were administered. Descriptive statistics, including the Mann-Whitney U test and hierarchical multiple linear regression analysis, were used. RESULTS The OPV patients had statistically lower scores in the majority of items of the SF-36 and higher scores in the PSQI, HAM-A and HAM-D than the healthy controls (P < .004; P < .001; and P < .001 respectively). Nine (30%) of the OPV patients were poor sleepers (PSQI > 5) with higher scores in the SF-36, HAM-A and HAM-D compared with the good sleepers (PSQI < 5). No statistically significant difference was detected in the OPV group when comparing patients in CCR-on and CCR-off, or in consideration of the cumulative time of the disease duration. CONCLUSIONS HR-QoL of OPV patients can be impaired even over periods of relatively well-being, therefore, clinicians should monitor periodically their HR-QoL, QoS and psychological profile in order to guide treatments also toward improving their HR-QoL.
Collapse
Affiliation(s)
- Elena Calabria
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Daniela Adamo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Stefania Leuci
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Giuseppe Pecoraro
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Noemi Coppola
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Massimo Aria
- Department of Economics and Statistics, Federico II University of Naples, Naples, Italy
| | - Michele D Mignogna
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| |
Collapse
|
164
|
Stress-induced sleep-like inactivity modulates stress susceptibility in mice. Sci Rep 2020; 10:19800. [PMID: 33188274 PMCID: PMC7666172 DOI: 10.1038/s41598-020-76717-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/28/2020] [Indexed: 11/09/2022] Open
Abstract
Severe environmental and social stress induces dysregulation of sleep along with mood and cognitive disturbances. However, the role and mechanism of this sleep dysregulation remain elusive. Here we evaluated sleep-like inactivity measured by voluntary movements and its relationship to social behaviors in mice without or with social defeat stress as well as the stressed mice with subsequent sleep deprivation. Social defeat stress immediately induced sleep-like inactivity with decreased body temperature. In the social interaction test, the control mice showed high social interest and its correlation with social sniffing intensity, the latter of which indicates positive valence of social sniffing. After the stress, these social characteristics were maintained in stress-resilient mice, but disrupted in stress-susceptible mice, leading to social avoidance. Sleep deprivation after the stress decreased social sniffing intensity along with reduced social interest, but enhanced the exploratory activity with the positive valence of social sniffing. We also found by c-Fos immunohistochemistry that the stress activated sleep-related brain regions, the dorsomedial hypothalamus and ventrolateral periaqueductal gray. Collectively, these findings show that stress activates sleep-related brain regions and induces sleep-like inactivity, contributing to multiple roles of stress-induced sleep for social behaviors.
Collapse
|
165
|
Cosci F, Mansueto G, Fava GA. Relapse prevention in recurrent major depressive disorder. A comparison of different treatment options based on clinical experience and a critical review of the literature. Int J Psychiatry Clin Pract 2020; 24:341-348. [PMID: 32716222 DOI: 10.1080/13651501.2020.1779308] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Reducing the risk of relapses is a critical component of major depressive disorders treatment. Guidelines suggest maintenance with antidepressant drugs in recurrent depression, but this solution has recently been questioned. OBJECTIVE The aim of this article is to provide a critical review of the literature of the main treatment options currently available to prevent relapse and recurrence in depression. METHODS We compared long-term antidepressant therapy (i.e., indefinite maintenance of antidepressant), intermittent antidepressant therapy (i.e., use of antidepressants mainly limited to the acute phases), use of psychotherapy in the sequential model (i.e., pharmacotherapy in the acute phase and psychotherapy in the residual phase). RESULTS We argue that the same solution may not apply to all patients and question the feasibility of a single course of treatment in the setting of complex disorders that are encountered in practice. The clinician should weigh advantages and disadvantages in the individual case. CONCLUSIONS The sequential model appears to be particularly indicated in recurrent depression. KEY POINTS Relapse is a major challenge of depressive disorders treatment Treatment options currently available include long-term antidepressants, intermittent antidepressants, addition of psychotherapy to pharmacotherapy in the sequential model Maintenance with antidepressants in recurrent depression has recently been questioned The sequential model appears to be particularly indicated in recurrent depression.
Collapse
Affiliation(s)
- Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy.,Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | - Giovanni Mansueto
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Giovanni Andrea Fava
- Department of Psychiatry, State University of New York at Buffalo, Buffalo, NY, USA
| |
Collapse
|
166
|
Tastevin M, Boyer L, Korchia T, Fond G, Lançon C, Richieri R, Guedj E. Brain SPECT perfusion and PET metabolism as discordant biomarkers in major depressive disorder. EJNMMI Res 2020; 10:121. [PMID: 33030615 PMCID: PMC7544792 DOI: 10.1186/s13550-020-00713-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/24/2020] [Indexed: 01/09/2023] Open
Abstract
Background Brain SPECT perfusion and PET metabolism have been, most often interchangeably, proposed to study the underlying pathological process in major depressive disorder (MDD). The objective of this study was to specify similarities and inconsistencies between these two biomarkers according to global characteristics of the disease. We conducted a retrospective study in 16 patients suffering from treatment-resistant MDD who underwent, during the same current episode, a cerebral perfusion SPECT with 99mTc-HMPAO and a metabolic PET with 18F-FDG. Whole-brain voxel-based SPM(T) maps were generated in correlation with the number of depressive episodes and in correlation with the depression duration, separately for the two exams (p-voxel < 0.001 uncorrected, k > 20). Results No significant correlations were found between brain metabolism and either the number of depressive episodes or the duration of the disease, even at an uncorrected p-voxel < 0.005. On the other hand, the increased number of depressive episodes was correlated with decreased perfusion of the right middle frontal cortex, the right anterior cingulum cortex, the right insula, the right medial temporal cortex and the left precuneus. The increased depression duration was correlated with decreased perfusion of the right anterior cingulum cortex. Conclusions This preliminary study demonstrates more significant results with brain perfusion compared with glucose metabolism in treatment-resistant MDD, highlighting the value of brain SPECT despite less favourable instrumentation detection compared to PET.
Collapse
Affiliation(s)
- Maud Tastevin
- Department of Psychiatry, Sainte Marguerite University Hospital, Assistance Publique- Hôpitaux de Marseille, Marseille, France
| | - Laurent Boyer
- CEReSS-Health Service Research and Quality of Life Centre, Aix Marseille University, Marseille, France.,Department of Medical Information and Public Health, APHM, Marseille, France.,Department of Epidemiology and Health Economics, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Theo Korchia
- Department of Psychiatry, Sainte Marguerite University Hospital, Assistance Publique- Hôpitaux de Marseille, Marseille, France
| | - Guillaume Fond
- Department of Psychiatry, Sainte Marguerite University Hospital, Assistance Publique- Hôpitaux de Marseille, Marseille, France.,CEReSS-Health Service Research and Quality of Life Centre, Aix Marseille University, Marseille, France.,Department of Medical Information and Public Health, APHM, Marseille, France
| | - Christophe Lançon
- Department of Psychiatry, Sainte Marguerite University Hospital, Assistance Publique- Hôpitaux de Marseille, Marseille, France.,CEReSS-Health Service Research and Quality of Life Centre, Aix Marseille University, Marseille, France
| | - Raphaëlle Richieri
- Department of Psychiatry, Sainte Marguerite University Hospital, Assistance Publique- Hôpitaux de Marseille, Marseille, France.,CNRS, Centrale Marseille, Institut Fresnel, Aix Marseille University, Marseille, France
| | - Eric Guedj
- Nuclear Medicine Department, APHM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, CERIMED, Aix Marseille University, Marseille, France.
| |
Collapse
|
167
|
Adamo D, Pecoraro G, Coppola N, Calabria E, Aria M, Mignogna M. Vortioxetine versus other antidepressants in the treatment of burning mouth syndrome: An open-label randomized trial. Oral Dis 2020; 27:1022-1041. [PMID: 32790904 DOI: 10.1111/odi.13602] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES This randomized open-label trial compared the efficacy and tolerability of vortioxetine (15 mg/daily) with different antidepressants in the treatment of patients with burning mouth syndrome (BMS). METHODS One and hundred fifty BMS patients were randomized into five groups and treated with either vortioxetine, paroxetine (20 mg/daily), sertraline (50 mg/daily), escitalopram (10 mg/daily) or duloxetine (60 mg/daily). The Visual Analogue Scale (VAS), Total Pain Rating Index (T-PRI), Hamilton Rating Scales for Depression (HAM-D) and Anxiety (HAM-A), and Clinical Global Impression Improvement (CGI-I) and Efficacy scales (CGI-E) were performed at baseline and after 2, 4, 6, and 12 months of treatment. Any adverse events (AEs) were tabulated for each group. Descriptive statistics, including the Kruskal-Wallis non-parametric test and the Friedman non-parametric test for median comparisons between different times, were used. RESULTS All the antidepressants (AD) were associated with a significant decrease in the VAS, T-PRI, HAM-A, HAM-D, CGI-I, and CGI-E scores in the long-term (p < .001). However, the response rate of the vortioxetine group showed a significant reduction after six months. The medians, after 6 months, were as follows: VAS 0.0; T-PRI 2.0; HAM-A 7.0; HAM-D 7.0; CGI-I 1.0; and CGI-E 1.0 with a lower incidence of AEs (p < .019). CONCLUSION Vortioxetine was efficacious with a shorter latency of action and fewer AEs compared with other ADs.
Collapse
Affiliation(s)
- Daniela Adamo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II of Naples, Naples, Italy
| | - Giuseppe Pecoraro
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II of Naples, Naples, Italy
| | - Noemi Coppola
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II of Naples, Naples, Italy
| | - Elena Calabria
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II of Naples, Naples, Italy
| | - Massimo Aria
- Department of Economics and Statistics, University Federico II of Naples, Naples, Italy
| | - Michele Mignogna
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II of Naples, Naples, Italy
| |
Collapse
|
168
|
Vittengl JR, Stutzman S, Atluru A, Jarrett RB. Do Cognitive Therapy Skills Neutralize Lifetime Stress to Improve Treatment Outcomes in Recurrent Depression? Behav Ther 2020; 51:739-752. [PMID: 32800302 PMCID: PMC7431681 DOI: 10.1016/j.beth.2019.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 10/22/2019] [Accepted: 10/22/2019] [Indexed: 11/27/2022]
Abstract
Cognitive therapy (CT) is an efficacious treatment for major depressive disorder (MDD), but not all patients respond. Past research suggests that stressful life events (SLE; e.g., childhood maltreatment, emotional and physical abuse, relationship discord, physical illness) sometimes reduce the efficacy of depression treatment, whereas greater acquisition and use of CT skills may improve patient outcomes. In a sample of 276 outpatient participants with recurrent MDD, we tested the hypothesis that patients with more SLE benefit more from CT skills in attaining response and remaining free of relapse/recurrence. Patients with more pretreatment SLE did not develop weaker CT skills, on average, but were significantly less likely to respond to CT. However, SLE predicted non-response only for patients with relatively weak skills, and not for those with stronger CT skills. Similarly, among acute-phase responders, SLE increased risk for MDD relapse/recurrence among patients with weaker CT skills. Thus, the combination of more SLE and weaker CT skills forecasted negative outcomes. These novel findings are discussed in the context of improving CT for depression among patients with greater lifetime history of SLE and require replication before clinical application.
Collapse
|
169
|
Shdaifat SA, Al Qadire M. Anxiety and Depression among Patients Admitted to Intensive Care. Nurs Crit Care 2020; 27:106-112. [PMID: 32844542 DOI: 10.1111/nicc.12536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 05/23/2020] [Accepted: 07/28/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Critically ill patients in intensive care units frequently experience high levels of anxiety and depression. These symptoms affect the patient's treatment plan and response to treatment. AIMS AND OBJECTIVES To identify the prevalence of anxiety and depression among patients admitted to intensive care units in Jordan and their correlation with quality of life. DESIGN A descriptive cross-sectional survey design was used. METHODS The sample for this study consisted of 108 patients admitted to intensive care units in seven governmental hospitals in Jordan. Three instruments were used to collect the data: the demographic data sheet, Hospital Anxiety and Depression Scale, and the World Health Organization Quality of Life tool. RESULTS More than half of the participants were female (56.5%), and the mean age was 44.6 years (SD 18.2); 84.3% had anxiety with a mean total score of 12.1 (SD 4.3), and 79.6% of the patients had depression with a mean total score of 11.5 (SD 4.5). A significant negative correlation was found between the mean total anxiety score (r = -0.541, P < .001), depression (r = -0.616, P < .001), and the mean total quality of life score. CONCLUSIONS Management programmes for anxiety and depression are highly recommended for intensive care units patients. Such programmes should focus on teaching health care providers correct assessment and management techniques. In addition, developing and implementing a psychiatric consultation support system for these patients might contribute to better management of anxiety and depression. RELEVANCE TO CLINICAL PRACTICE This study reveals high prevalence of anxiety and depression among critically ill patient in ICUs. So, regular assessment of anxiety and depression should be conducted by healthcare provider. This requires using a valid and reliable assessment tool. Early correct assessment would result in optimal management for anxiety and depression through patient referral to psychiatric care and the use of pharmacological and non-pharmacological interventions. Guidelines to assess and manage anxiety and depression should be adapted and implemented into clinical practice within the intensive care units. Regular psychiatric consultation for patients admitted to ICU might be helpful in detecting and managing anxiety and depression symptoms.
Collapse
Affiliation(s)
| | - Mohammad Al Qadire
- College of Nursing, Sultan Qaboos University, Muscat, Sultanate of Oman.,Faculty of Nursing, Al Al-Bayt University, Mafraq, Jordan
| |
Collapse
|
170
|
Abstract
Electroconvulsive therapy (ECT) is an important component in the treatment of depression and schizophrenia in Germany. For this intervention patients undergo short-term general anesthesia and muscle relaxation. Before anesthesia can be carried out patients are subject to a comprehensive examination. For general anesthesia all established hypnotics can be used, but differences with respect to the success of the ECT have been described. Short-acting or reversible relaxants should be preferentially used. The risks of general anesthesia during ECT are estimated to be low but a transient hemodynamic instability of patients can occur. Treatment can be performed as an inpatient but also as an outpatient procedure.
Collapse
Affiliation(s)
- T Ninke
- Klinik für Anaesthesiologie, Klinikum der Universität München, LMU München, München, Deutschland.
| | - S Bayerl
- Klinik für Anaesthesiologie, Klinikum der Universität München, LMU München, München, Deutschland
| | - P Groene
- Klinik für Anaesthesiologie, Klinikum der Universität München, LMU München, München, Deutschland
| |
Collapse
|
171
|
Cosci F, Guidi J, Mansueto G, Fava GA. Psychotherapy in recurrent depression: efficacy, pitfalls, and recommendations. Expert Rev Neurother 2020; 20:1169-1175. [DOI: 10.1080/14737175.2020.1804870] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Jenny Guidi
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Giovanni Mansueto
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Giovanni A. Fava
- Department of Psychiatry, University at Buffalo, State University of New York, Buffalo, NY, USA
| |
Collapse
|
172
|
Pahlevan T, Ung C, Segal Z. Cost-Utility Analysis of Mindfulness-Based Cognitive Therapy Versus Antidepressant Pharmacotherapy for Prevention of Depressive Relapse in a Canadian Context: Analyse coût-utilité de la thérapie cognitive basée sur la pleine conscience contre la pharmacothérapie antidépressive pour prévenir la rechute de la dépression en contexte canadien. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:568-576. [PMID: 32031000 PMCID: PMC7492890 DOI: 10.1177/0706743720904613] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Patients suffering from major depressive disorder (MDD) experience impaired functioning and reduced quality of life, including an elevated risk of episode return. MDD is associated with high societal burden due to increased healthcare utilization, productivity losses, and suicide-related costs, making the long-term management of this illness a priority. The purpose of this study is to evaluate the cost-effectiveness of mindfulness-based cognitive therapy (MBCT), a first-line preventative psychological treatment, compared to maintenance antidepressant medication (ADM), the current standard of care. METHOD A cost-utility analysis was conducted over a 24-month time horizon to model differences between MBCT and ADM in cost and quality-adjusted life years (QALY). The analysis was conducted using a decision tree analytic model. Intervention efficacy, utility, and costing data estimates were derived from published sources and expert consultation. RESULTS MBCT was found to be cost-effective compared to maintenance ADM over a 24-month time horizon. Antidepressant pharmacotherapy resulted in 1.10 QALY and $17,255.37 per patient on average, whereas MBCT resulted in 1.18 QALY and $15,030.70 per patient on average. This resulted in a cost difference of $2,224.67 and a QALY difference of 0.08, in favor of MBCT. Multiple sensitivity analyses supported these findings. CONCLUSIONS From both a societal and health system perspective, utilizing MBCT as a first-line relapse prevention treatment is potentially cost-effective in a Canadian setting. Future economic evaluations should consider combined treatment (e.g., ADM and psychotherapy) as a comparator and longer time horizons as the literature advances.
Collapse
Affiliation(s)
- Tina Pahlevan
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Christine Ung
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Zindel Segal
- Graduate Program in Psychological Clinical Science, University of Toronto Scarborough, Ontario, Canada
| |
Collapse
|
173
|
Ling C, Evans D, Zhang Y, Luo J, Hu Y, Ouyang Y, Tang J, Kuang Z. The effects of cognitive behavioural therapy on depression and quality of life in patients with maintenance haemodialysis: a systematic review. BMC Psychiatry 2020; 20:369. [PMID: 32664880 PMCID: PMC7362428 DOI: 10.1186/s12888-020-02754-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 06/23/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Depression is highly prevalent among Haemodialysis (HD) patients and is known to results in a series of adverse outcomes and poor quality of life (QoL). Although cognitive behavioural therapy (CBT) has been shown to improve depressive symptoms and QoL in other chronic illness, there is uncertainty in terms of the effectiveness of CBT in HD patients with depression or depressive symptoms. METHODS All randomised controlled trials relevant to the topic were retrieved from the following databases: CINHAL, MEDLINE, PubMed, PsycINFO and CENTRAL. The grey literature, specific journals, reference lists of included studies and trials registers website were also searched. Data was extracted or calculated from included studies that had measured depression and quality of life using valid and reliable tools -this included mean differences or standardised mean differences and 95% confidence intervals. The Cochrane risk of bias tool was used to identify the methodological quality of the included studies. RESULTS Six RCTs were included with varying methodological quality. Meta-analysis was undertaken for 3 studies that employed the CBT versus usual care. All studies showed that the depressive symptoms significantly improved after the CBT. Furthermore, CBT was more effective than usual care (MD = - 5.28, 95%CI - 7.9 to - 2.65, P = 0.37) and counselling (MD = - 2.39, 95%CI - 3.49 to - 1.29), while less effective than sertraline (MD = 2.2, 95%CI 0.43 to 3.97) in alleviating depressive symptoms. Additionally, the CBT seems to have a beneficial effect in improving QoL when compared with usual care, while no significant difference was found in QoL score when compared CBT with sertraline. CONCLUSIONS CBT may improve depressive symptoms and QoL in HD patients with comorbid depressive symptoms. However, more rigorous studies are needed in this field due to the small quantity and varied methodological quality in the identified studies.
Collapse
Affiliation(s)
- Chen Ling
- Department of Nephrology, Huadu Hospital, Southern Medical University (People's Hospital of Huadu District), 22 Baohua Road, Huadu District, Guangzhou, 510800, People's Republic of China. .,The Third School of Clinical Medicine, Southern Medical University, Guangzhou, People's Republic of China.
| | - Debra Evans
- grid.19822.300000 0001 2180 2449Birmingham City University, City South Campus, Faculty of Health, Education and Life Sciences, 15 Bartholomew Row, Birmingham, B5 5JU UK
| | - Yunfang Zhang
- grid.284723.80000 0000 8877 7471Department of Nephrology, Huadu Hospital, Southern Medical University (People’s Hospital of Huadu District), 22 Baohua Road, Huadu District, Guangzhou, 510800 People’s Republic of China ,grid.284723.80000 0000 8877 7471The Third School of Clinical Medicine, Southern Medical University, Guangzhou, People’s Republic of China
| | - Jianying Luo
- grid.284723.80000 0000 8877 7471Nursing Department, Huadu Hospital, Southern Medical University (People’s Hospital of Huadu District), 48 Xinhua Road, Huadu District, Guangzhou, 510800 People’s Republic of China
| | - Yanping Hu
- grid.284723.80000 0000 8877 7471Nursing Department, Huadu Hospital, Southern Medical University (People’s Hospital of Huadu District), 48 Xinhua Road, Huadu District, Guangzhou, 510800 People’s Republic of China
| | - Yuxia Ouyang
- grid.284723.80000 0000 8877 7471Nursing Department, Huadu Hospital, Southern Medical University (People’s Hospital of Huadu District), 48 Xinhua Road, Huadu District, Guangzhou, 510800 People’s Republic of China
| | - Jiamin Tang
- grid.284723.80000 0000 8877 7471Department of Nephrology, Huadu Hospital, Southern Medical University (People’s Hospital of Huadu District), 22 Baohua Road, Huadu District, Guangzhou, 510800 People’s Republic of China
| | - Ziqiao Kuang
- grid.284723.80000 0000 8877 7471Department of Breast Surgery, Huadu Hospital, Southern Medical University (People’s Hospital of Huadu District), 48 Xinhua Road, Huadu District, Guangzhou, 510800 People’s Republic of China
| |
Collapse
|
174
|
Nuggerud-Galeas S, Oliván Blázquez B, Perez Yus MC, Valle-Salazar B, Aguilar-Latorre A, Magallón Botaya R. Factors Associated With Depressive Episode Recurrences in Primary Care: A Retrospective, Descriptive Study. Front Psychol 2020; 11:1230. [PMID: 32581978 PMCID: PMC7290009 DOI: 10.3389/fpsyg.2020.01230] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 05/11/2020] [Indexed: 12/12/2022] Open
Abstract
Introduction and Objective The early identification of depressive patients having a poor evolution, with frequent relapses and/or recurrences, is one of the priority challenges in this study of high prevalence mental disorders, and specifically in depression. So, this study aims to analyze the factors that may be associated with an increased risk of recurrence of major depression episodes in patients treated in primary care. Methods A retrospective, descriptive study of cases-controls was proposed. The cases consisted of patients who had been diagnosed with major depression and who had presented recurrences (n = 101), in comparison with patients who had experienced a single major depression episode with no recurrence (n = 99). The variables of the study are age at first episode; number of episodes; perception of severity of the depression episode suffered prior to recurrence; number of residual symptoms; physical and psychiatric comorbidity; history of anxiety disorders; family psychiatric history; high incidence of stressful life events (SLEs); and experiences of physical, psychological, or sexual abuse in childhood. The differences of the variables were compared between the case subjects and the control subjects, using the Mann-Whitney, chi-square, and Fisher's U statistics. A multivariate analysis (ordinary logistic regression) was performed. Results The average age of those suffering more than one depressive episode is significantly older (5 years), and a higher percentage of subjects who have experienced more than one depressive episode have a history of anxiety disorders. In the multivariate analysis, the variables that obtained a significant value in the logistic regression analysis were age (OR: 1.03; value: 0.007) and having suffered sexual abuse during childhood (OR: 1.64; value: 0.072). Conclusion These indicators should be considered by primary care physicians when attending patients suffering from major depression.
Collapse
Affiliation(s)
- Shysset Nuggerud-Galeas
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain.,Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain
| | - Bárbara Oliván Blázquez
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain.,Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - María Cruz Perez Yus
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain.,Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Begoña Valle-Salazar
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain.,Primary Health Care, Aragón Health Service, Zaragoza, Spain
| | | | - Rosa Magallón Botaya
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain.,Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain.,Primary Health Care, Aragón Health Service, Zaragoza, Spain
| |
Collapse
|
175
|
Tor PC, Bin Abdin E. Mirror Readmission Study of the Association of Electroconvulsive Therapy With 1-Year Mood Disorder Readmissions in a Tertiary Mood Disorder Unit. J ECT 2020; 36:111-114. [PMID: 31652175 DOI: 10.1097/yct.0000000000000628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Electroconvulsive therapy (ECT) is one of the most effective treatments for severe mood disorders and may reduce psychiatric readmissions. However, the effect on ECT on mood disorder readmissions in Asia is unclear. We embarked to assess the relationship between inpatient ECT and 1-year psychiatric readmissions for patients with mood disorders. METHODS A retrospective database analysis of patients admitted to a tertiary Mood Disorders Unit in a developed Asian city was analyzed to investigate the association of inpatient ECT with psychiatric readmission using a 1-year mirror-image method with major depressive disorder and bipolar mania patients acting as their own controls. Covariates of age, sex, number of outpatient visits, and outpatient ECT were analyzed to account for confounders. t Tests were done to compare number and duration of psychiatric admissions and significance set at P < 0.05. RESULTS Patients with major depressive disorder and bipolar mania (N = 121) receiving inpatient ECT had a 35% mean reduction from the baseline mean of number of admissions in the 1-year after ECT. Maintenance ECT (between 30 days and 1 year after discharge) was associated with the protective effect (β = -0.116, t = -2.044, P = 0.043). In major depressive disorder, there was a trend association between the number of 1-year postdischarge outpatient visits and decreased 1-year readmissions with an opposite association seen in bipolar mania. CONCLUSIONS Electroconvulsive therapy may be associated with decreased 1-year readmissions for mood disorders in Asia, and this effect may be mediated by maintenance ECT.
Collapse
|
176
|
A plea for more attention to mental representations. J Behav Ther Exp Psychiatry 2020; 67:101510. [PMID: 31640848 DOI: 10.1016/j.jbtep.2019.101510] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/07/2019] [Accepted: 08/19/2019] [Indexed: 12/19/2022]
Abstract
In this invited essay I plead for a renewed attention to mental representations in research into psychopathology and its treatment. With the cognitive revolution in the second half of the previous century most psychological models of psychopathology were based on people's capacity to form mental representations of the world. However, much research effort was put into investigating cognitive biases instead of investigating mental representations, and attention shifted towards such biases, including claims that they are causal in psychopathology. Similar claims were made about emotion regulation difficulties. Moreover, in many treatment models that were developed the focus was more on cognitive biases and emotion regulation, than on underlying representations. In this essay I argue that the causal status of cognitive biases, emotion regulation, and similar phenomena is overestimated, and that in clinical reality such phenomena can be best conceptualized as output of activated mental representations. Moreover, I argue that the disappointing effectiveness and protection to relapse of many current psychological treatments are related to not addressing the underlying mental representation. Next I discuss aspects of mental representations that are important for understanding and treating psychopathology, after which I discuss the clinical implications. I sketch how better understanding the specificities of mental representations can help us to improve psychological treatments, and I make some suggestions for future research.
Collapse
|
177
|
Victory A, Letkiewicz A, Cochran AL. Digital solutions for shaping mood and behavior among individuals with mood disorders. CURRENT OPINION IN SYSTEMS BIOLOGY 2020; 21:25-31. [PMID: 32905495 PMCID: PMC7473040 DOI: 10.1016/j.coisb.2020.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Mood disorders present on-going challenges to the medical field, with difficulties ranging from establishing effective treatments to understanding complexities of one's mood. One solution is the use of mobile apps and wearables for measuring physiological symptoms and real-time mood in order to shape mood and behavior. Current digital research is focused on increasing engagement in monitoring mood, uncovering mood dynamics, predicting mood, and providing digital microinterventions. This review discusses the importance and risks of user engagement, as well as barriers to improving it. Research on mood dynamics highlights the possibility to reveal data-driven computational phenotypes that could guide treatment. Mobile apps are being used to track voice patterns, GPS, and phone usage for predicting mood and treatment response. Future directions include utilizing mobile apps to deliver and evaluate microinterventions. To continue these advances, standardized reporting and study designs should be considered to improve digital solutions for mood disorders.
Collapse
Affiliation(s)
- Amanda Victory
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, US
| | | | - Amy L Cochran
- Department of Population Health Sciences, Department of Math, University of Wisconsin, Madison, WI, US
| |
Collapse
|
178
|
Nuggerud-Galeas S, Sáez-Benito Suescun L, Berenguer Torrijo N, Sáez-Benito Suescun A, Aguilar-Latorre A, Magallón Botaya R, Oliván Blázquez B. Analysis of depressive episodes, their recurrence and pharmacologic treatment in primary care patients: A retrospective descriptive study. PLoS One 2020; 15:e0233454. [PMID: 32437398 PMCID: PMC7241802 DOI: 10.1371/journal.pone.0233454] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 05/05/2020] [Indexed: 11/29/2022] Open
Abstract
Background Depression is one of the most prevalent health problems, frequently being a medium- and long-term condition, with a high comorbidity rate and with frequent relapses and recurrences. Although numerous studies have compared the effectiveness of specific antidepressant therapy drugs and have assessed relapses, scientific evidence on the relationship between pharmacologic treatments and recurrence is scarce. The objective of this study is to describe depressive episodes in a primary care patient cohort, the percentage of depression recurrences and the administered pharmacologic treatment, from a naturalistic perspective. Methods Retrospective descriptive study. 957 subjects were included. The dependent variable was a depression diagnosis and independent variables were: gender, age at time of data collection; age of onset, first-episode treatment, number of recurrences, age at recurrences, treatment prescribed for recurrences using therapeutic groups categorization. Results Recurrences are frequent, affecting more than 40% of the population. In the first episode, 13.69% of the patients were not prescribed pharmacological treatment, but this percentage decreased over the following depression episodes. 80.9% of the patients who did not receive drug treatment in the first depression episode did not experience subsequent episodes. Monotherapy, and specifically, SSRIs were the most frequently prescribed treatment option for all depressive episodes. Regards the combined pharmacologic treatment, the most frequent drug combinations were SSRIs and benzodiazepines. Limitations In order to increase the power of results, the statistical analysis was performed using therapeutic groups categorization, not individually analyzing each drug and dose. Conclusions Depressive episode recurrence is frequent in primary care patients. Further studies having a prospective design are needed in order to expand on this issue.
Collapse
Affiliation(s)
| | | | | | | | | | - Rosa Magallón Botaya
- Institute for Health Research Aragón, Zaragoza, Spain
- Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain
- * E-mail: ,
| | - Bárbara Oliván Blázquez
- Institute for Health Research Aragón, Zaragoza, Spain
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| |
Collapse
|
179
|
ter Avest MJ, Greven CU, Huijbers MJ, Wilderjans TF, Speckens AEM, Spinhoven P. Prospective Associations Between Home Practice and Depressive Symptoms in Mindfulness-Based Cognitive Therapy for Recurrent Depression: A 15 Months Follow-Up Study. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-020-10108-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Abstract
Background
Home practice is considered a key element in increasing treatment effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) for depression. However, long-term longitudinal research into the associations between home practice and depression outcomes is scarce. The current study examined the prospective associations between the extent of formal home practice and subsequent depression severity during 15 months of follow-up.
Methods
Data from two randomized-controlled trials on MBCT for recurrent depression were used (n = 200). Depressive symptoms were assessed at 3-month intervals: 0 (baseline), 3 (posttreatment), 6, 9, 12, and 15 months. Formal home practice frequency was calculated for each 3-month period. Autoregressive latent trajectory (ALT) modelling was applied.
Results
Participants practiced formal exercises on 57% (SD = 0.22, range 0–1) of the days during MBCT, equivalent to an average of 4 days per week, which showed a rapid decline after MBCT. The level of depressive symptoms did not change over the full study period. A small positive association was found between formal home practice frequency during each three-month period on subsequent depressive symptoms, but sensitivity analyses did not confirm this. More robust, a small negative association was found between levels of depressive symptoms at each measurement point and formal home practice frequency during the subsequent three-month periods.
Conclusions
The hypothesis that more frequent home practice would lead to reductions in depressive symptoms was not confirmed in the current study. Rather, it seems that patients with higher levels of depression may subsequently practice less frequently at home. The interplay between home practice and outcome might not be as straightforward as expected. However, these results are preliminary and should be replicated first before recommendations for clinical practice can be formulated.
Collapse
|
180
|
Muscle-strengthening exercise and depressive symptom severity among a nationally representative sample of 23,635 german adults. J Affect Disord 2020; 266:282-287. [PMID: 32056889 DOI: 10.1016/j.jad.2020.01.172] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 01/21/2020] [Accepted: 01/28/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND There is strong epidemiological evidence that physical activity is associated with lower likelihood of depression. Yet, most existing large population studies have investigated aerobic physical activity (e.g. walking/running), with few epidemiological studies examining the association between muscle-strengthening exercise (MSE; push ups, using weight machines) with depression. The aim of this study is to examine associations between MSE and depressive symptoms among a representative sample of German adults. METHODS Cross-sectional analyses were conducted on the 2014 German Health Update. Validated questionnaires were used to assess MSE and depression symptom severity (eight-item Personal Health Questionnaire Depression Scale). Generalized linear models with Poisson regression with a robust error variance were used to assess prevalence ratios of depression symptom severity (mild, moderate, moderately severe/severe) across weekly MSE frequency (None [reference]; 1, 2, 3-4 and ≥5), adjusting for potential cofounders (e.g. age, sex, socioeconomic status, self-rated health, smoking, hazardous alcohol consumption, aerobic exercise). RESULTS Data were available on 23,635 adults (≥18 years). When compared with those reporting no MSE, for all levels of depressive symptom severity, there were reduced prevalence ratios across all MSE frequencies. Compared to the higher MSE frequency groups (3-≥5 times/week), the prevalence ratios (range: 0.53-0.85) were similar among lower frequency groups (1-2 times/week) (range: 0.46-0.85). All associations remained after adjustment for sociodemographic, lifestyle characteristics and aerobic physical activity. LIMITATIONS Findings may be biased by the self-reporting of MSE and depressive symptom severity. CONCLUSION Any increase in MSE at the population-level may be beneficial for the prevention and treatment of depression.
Collapse
|
181
|
Buckman JE, Saunders R, Cohen ZD, Clarke K, Ambler G, DeRubeis RJ, Gilbody S, Hollon SD, Kendrick T, Watkins E, White IR, Lewis G, Pilling S. What factors indicate prognosis for adults with depression in primary care? A protocol for meta-analyses of individual patient data using the Dep-GP database. Wellcome Open Res 2020; 4:69. [PMID: 31815189 PMCID: PMC6880263 DOI: 10.12688/wellcomeopenres.15225.3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Pre-treatment severity is a key indicator of prognosis for those with depression. Knowledge is limited on how best to encompass severity of disorders. A number of non-severity related factors such as social support and life events are also indicators of prognosis. It is not clear whether this holds true after adjusting for pre-treatment severity as a) a depressive symptom scale score, and b) a broader construct encompassing symptom severity and related indicators: "disorder severity". In order to investigate this, data from the individual participants of clinical trials which have measured a breadth of "disorder severity" related factors are needed. Aims: 1) To assess the association between outcomes for adults seeking treatment for depression and the severity of depression pre-treatment, considered both as i) depressive symptom severity only and ii) "disorder severity" which includes depressive symptom severity and comorbid anxiety, chronicity, history of depression, history of previous treatment, functional impairment and health-related quality of life. 2) To determine whether i) social support, ii) life events, iii) alcohol misuse, and iv) demographic factors (sex, age, ethnicity, marital status, employment status, level of educational attainment, and financial wellbeing) are prognostic indicators of outcomes, independent of baseline "disorder severity" and the type of treatment received. Methods: Databases were searched for randomised clinical trials (RCTs) that recruited adults seeking treatment for depression from their general practitioners and used the same diagnostic and screening instrument to measure severity at baseline - the Revised Clinical Interview Schedule; outcome measures could differ between studies. Chief investigators of all studies meeting inclusion criteria were contacted and individual patient data (IPD) were requested. Conclusions: In total 15 RCTs met inclusion criteria. The Dep-GP database will include the 6271 participants from the 13 studies that provided IPD. This protocol outlines how these data will be analysed. Registration: PROSPERO CRD42019129512 (01/04/2019).
Collapse
Affiliation(s)
- Joshua E.J. Buckman
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
| | - Rob Saunders
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
| | - Zachary D. Cohen
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Katherine Clarke
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
| | - Gareth Ambler
- Statistical Science, University College London, London, WC1E 7HB, UK
| | - Robert J. DeRubeis
- School of Arts and Sciences, Department of Psychology, University of Pennsylvania, Philadelphia, PA, 19104-60185, USA
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Steven D. Hollon
- Department of Psychology, Vanderbilt University, Nashville, TN, 407817, USA
| | - Tony Kendrick
- Primary Care & Population Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 5ST, UK
| | - Edward Watkins
- Department of Psychology, University of Exeter, Exeter, EX4 4QG, UK
| | - Ian R. White
- Institute of Clinical Trials and Methodology, MRC Clinical Trials Unit, University College London, London, WC1V 6LJ, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, W1T 7NF, UK
| | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
| |
Collapse
|
182
|
Abstract
A total of 201 patients with major depressive disorder from four hospitals in Malaysia were followed up for 5 years to determine the prognostic factors of recurrent major depressive disorder that could potentially contribute to improving the management of MDD patients. For each individual patient, at the time of recruitment as part of a case-control study, information was collected on recent threatening life events, personality and social and occupational functioning, while blood samples were collected to genotype single nucleotide polymorphisms of vitamin D receptor (VDR), zinc transporter-3 (ZnT3), dopamine transporter-1 (DAT1), brain-derived neurotropic factor (BDNF), serotonin receptor 1A (HT1A) and 2A (HT2A) genes. Kaplan-Meier and Cox-regression were used to estimate hazard functions for recurrence of major depressive disorder. Individuals with severe MDD in previous major depressive episodes had five and a half times higher hazard of developing recurrence compared to mild and moderate MDD (HR = 5.565, 95% CI = 1.631–18.994, p = 0.006). Individuals who scored higher on social avoidance had three and a half times higher hazard of recurrence of MDD (HR = 3.525, 95% CI = 1.349–9.209; p = 0.010). There was significant interaction between ApaI +64978C>A single nucleotide polymorphism and severity. The hazard ratio increased by 6.4 times from mild and moderate to severe MDD for A/A genotype while that for C/A genotype increased by 11.3 times. Social avoidance and severity of depression at first episode were prognostic of recurrence. Screening for personality factors at first encounter with MDD patients needs to be considered as part of the clinical practice. For those at risk of recurrence in relation to social avoidance, the psychological intervention prescribed should be customized to focus on this modifiable factor. Prompt and appropriate management of severe MDD is recommended to reduce risk of recurrence.
Collapse
|
183
|
Breedvelt JJF, Warren FC, Brouwer ME, Karyotaki E, Kuyken W, Cuijpers P, van Oppen P, Gilbody S, Bockting CLH. Individual participant data (IPD) meta-analysis of psychological relapse prevention interventions versus control for patients in remission from depression: a protocol. BMJ Open 2020; 10:e034158. [PMID: 32060157 PMCID: PMC7044815 DOI: 10.1136/bmjopen-2019-034158] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Psychological interventions and antidepressant medication can be effective interventions to prevent depressive relapse for patients currently in remission of depression. Less is known about overall factors that predict or moderate treatment response for patients receiving a psychological intervention for recurrent depression. This is a protocol for an individual participant data (IPD) meta-analysis which aims to assess predictors and moderators of relapse or recurrence for patients currently in remission from depression. METHODS AND ANALYSIS Searches of PubMed, PsycINFO, Embase and Cochrane Central Register of Controlled Trials were completed on 13 October 2019. Study extractions and risk of bias assessments have been completed. Study authors will be asked to contribute IPD. Standard aggregate meta-analysis and IPD analysis will be conducted, and the outcomes will be compared with assess whether results differ between studies supplying data and those that did not. IPD files of individual data will be merged and variables homogenised where possible for consistency. IPD will be analysed via Cox regression and one and two-stage analyses will be conducted. ETHICS AND DISSEMINATION The results will be published in peer review journals and shared in a policy briefing as well as accessible formats and shared with a range of stakeholders. The results will inform patients and clinicians and researchers about our current understanding of more personalised ways to prevent a depressive relapse. No local ethics approval was necessary following consultation with the legal department. Guidance on patient data storage and management will be adhered to. PROSPERO REGISTRATION NUMBER CRD42019127844.
Collapse
Affiliation(s)
- Josefien J F Breedvelt
- Department of Psychiatry and Amsterdam Public Health research institute, Amsterdam University Medical Centre - Location AMC, Amsterdam, The Netherlands
| | - Fiona C Warren
- Institute of Health Research, College of Medicine & Health, University of Exeter, Exeter, UK
| | - Marlies E Brouwer
- Department of Psychiatry and Amsterdam Public Health research institute, Amsterdam University Medical Centre - Location AMC, Amsterdam, The Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Willem Kuyken
- Department of Psychiatry, University of Oxford, Oxford, Oxfordshire, UK
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Patricia van Oppen
- Department of Psychiatry, Amsterdam Public Health research institute, Amsterdam University Medical Centre, location VUmc and GGZ InGeest, Amsterdam, Netherlands
| | - Simon Gilbody
- Mental Health and Addictions Research Group - Department of Health Sciences, The University of York, York, UK
| | - Claudi L H Bockting
- Department of Psychiatry and Amsterdam Public Health research institute, Amsterdam University Medical Centre - Location AMC, Amsterdam, The Netherlands
| |
Collapse
|
184
|
Bennie JA, De Cocker K, Biddle SJH, Teychenne MJ. Joint and dose-dependent associations between aerobic and muscle-strengthening activity with depression: A cross-sectional study of 1.48 million adults between 2011 and 2017. Depress Anxiety 2020; 37:166-178. [PMID: 31876971 DOI: 10.1002/da.22986] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/12/2019] [Accepted: 12/06/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Research has shown that regular physical activity is key for the prevention and/or treatment of depression. However, epidemiological studies describing the associations between different physical activity modes (i.e., aerobic vs. muscle-strengthening exercise) with depression are limited. METHODS Cross-sectional analyses were conducted on pooled data from four U.S. health surveillance surveys (2011-2017). Validated survey items assessed self-reported moderate-to-vigorous-intensity physical activity (MVPA) and muscle-strengthening activity (MSA). Twenty groups were created, ranging from (a) "inactive" (0 MVPA min/week & MSA 0 times/week) to (xx) "most active" (≥300 MVPA min/week & MSA ≥4 times/week). Poisson regression with a robust error variance was used to assess prevalence ratios (PRs) of self-reported clinically diagnosed depression (outcome variable) across physical activity groups (exposure variables). RESULTS The sample contained 1,477,981 adults (≥18 years), of which 286,325 (18.0%) had depression. Compared to the reference group (i.e., no MVPA and no MSA), almost all physical activity combinations were associated with lower depression prevalence. Lowest prevalence of depression was shown for those combining sufficient MVPA-MSA (MVPA ≧300 min/week and MSA ≥2 times/week; adjusted prevalence ratio range: 0.54-0.63). All associations remained after stratification and/or adjustment for sociodemographic (age, sex, income, education), lifestyle characteristics (body mass index, self-rated health, smoking, alcohol), comorbidities (e.g., arthritis, diabetes, hypertension), and year of survey. CONCLUSIONS A physical activity routine that includes both aerobic and MSA is likely to be optimal for the prevention of depression. Public health approaches targeting depression should endorse joint aerobic and MSA as key lifestyle modification strategy.
Collapse
Affiliation(s)
- Jason A Bennie
- Physically Active Lifestyles Research Group (USQ-PALs), Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Queensland, Australia
| | - Katrien De Cocker
- Physically Active Lifestyles Research Group (USQ-PALs), Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Queensland, Australia
| | - Stuart J H Biddle
- Physically Active Lifestyles Research Group (USQ-PALs), Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Queensland, Australia
| | - Megan J Teychenne
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| |
Collapse
|
185
|
|
186
|
Affiliation(s)
- Andrew MacLeod
- Department of Psychology, Royal Holloway, University of London, London, UK
| |
Collapse
|
187
|
Bickel KE, Kennedy R, Levy C, Burgio KL, Bailey FA. The Relationship of Post-traumatic Stress Disorder to End-of-life Care Received by Dying Veterans: a Secondary Data Analysis. J Gen Intern Med 2020; 35:505-513. [PMID: 31792872 PMCID: PMC7018872 DOI: 10.1007/s11606-019-05538-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 08/06/2019] [Accepted: 10/18/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) can be exacerbated by subsequent trauma, but it is unclear if symptoms are worsened by impending death. PTSD symptoms, including hyperarousal, negative mood and thoughts, and traumatic re-experiencing, can impact end-of-life symptoms, including pain, mood, and poor sleep. Thus, increased symptoms may lead to increased end-of-life healthcare utilization. OBJECTIVES To determine if veterans with PTSD have increased end-of-life healthcare utilization or medication use and to examine predictors of medication administration. DESIGN Secondary analysis of a stepped-wedge design implementation trial to improve end-of-life care for Veterans Affairs (VA) inpatients. Outcome variables were collected via direct chart review. Analyses included hierarchical, generalized estimating equation models, clustered by medical center. SUBJECTS Veterans, inpatient at one of six VA facilities, dying between 2005 and 2011. MAIN MEASURES Emergency room (ER) visits, hospitalizations, and medication administration in the last 7 days of life. KEY RESULTS Of 5341 veterans, 468 (8.76%) had PTSD. Of those, 21.4% (100/468) had major depression and 36.5% (171/468) had anxiety. Veterans with PTSD were younger (mean age 65.4 PTSD, 70.5 no PTSD, p < 0.0001) and had more VA hospitalizations and ER visits in the last 12 months of life (admissions: PTSD 2.8, no PTSD 2.4, p < 0.0001; ER visits: 3.2 vs 2.5, p < 0.0001). PTSD was associated with antipsychotic administration (OR 1.52, 95% CI 1.06-2.18). Major depression (333/5341, 6.2%) was associated with opioid administration (OR 1.348, 95% CI 1.129-1.609) and benzodiazepines (OR 1.489, 95% CI 1.141-1.943). Anxiety disorders (778/5341, 14.6%) were only associated with benzodiazepines (OR 1.598, 95% CI 1.194-2.138). CONCLUSIONS PTSD's association with increased end-of-life healthcare utilization and increased antipsychotic administration in the final days of life suggests increased symptom burden and potential for terminal delirium in individuals with PTSD. Understanding the burden of psychiatric illness and potential risks for delirium may facilitate the end-of-life care for these patients. TRIAL REGISTRATION NCT00234286.
Collapse
Affiliation(s)
- Kathleen E Bickel
- University of Colorado School of Medicine, Rocky Mountain VA Medical Center, Mail Stop B180, Academic Office One, 12631 E 17th Ave, Room 8407, Aurora, CO, 80045-2527, USA.
- Rocky Mountain Veterans Affairs Medical Center, Aurora, USA.
| | - Richard Kennedy
- The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Cari Levy
- University of Colorado School of Medicine, Rocky Mountain VA Medical Center, Mail Stop B180, Academic Office One, 12631 E 17th Ave, Room 8407, Aurora, CO, 80045-2527, USA
- Rocky Mountain Veterans Affairs Medical Center, Aurora, USA
| | - Kathryn L Burgio
- The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA
| | - F Amos Bailey
- University of Colorado School of Medicine, Rocky Mountain VA Medical Center, Mail Stop B180, Academic Office One, 12631 E 17th Ave, Room 8407, Aurora, CO, 80045-2527, USA
- Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA
| |
Collapse
|
188
|
Gaillard C, Guillod M, Ernst M, Federspiel A, Schoebi D, Recabarren RE, Ouyang X, Mueller-Pfeiffer C, Horsch A, Homan P, Wiest R, Hasler G, Martin-Soelch C. Striatal reactivity to reward under threat-of-shock and working memory load in adults at increased familial risk for major depression: A preliminary study. Neuroimage Clin 2020; 26:102193. [PMID: 32036303 PMCID: PMC7011085 DOI: 10.1016/j.nicl.2020.102193] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/27/2019] [Accepted: 01/20/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Anhedonia, a core symptom of Major Depressive Disorder (MDD), manifests as a lack or loss of motivation as reflected by decreased reward responsiveness, at both behavioral and neural (i.e., striatum) levels. Exposure to stressful life events is another important risk factor for MDD. However, the mechanisms linking reward-deficit and stress to MDD remain poorly understood. Here, we explore whether the effects of stress exposure on reward processing might differentiate between Healthy Vulnerable adults (HVul, i.e., positive familial MDD) from Healthy Controls (HCon). Furthermore, the well-described reduction in cognitive resources in MDD might facilitate the stress-induced decrease in reward responsiveness in HVul individuals. Accordingly, this study includes a manipulation of cognitive resources to address the latter possibility. METHODS 16 HVul (12 females) and 16 gender- and age-matched HCon completed an fMRI study, during which they performed a working memory reward task. Three factors were manipulated: reward (reward, no-reward), cognitive resources (working memory at low and high load), and stress level (no-shock, unpredictable threat-of-shock). Only the reward anticipation phase was analyzed. Imaging analyses focused on striatal function. RESULTS Compared to HCon, HVul showed lower activation in the caudate nucleus across all conditions. The HVul group also exhibited lower stress-related activation in the nucleus accumbens, but only in the low working memory (WM) load condition. Moreover, while stress potentiated putamen reactivity to reward cues in HVul when the task was more demanding (high WM load), stress blunted putamen reactivity in both groups when no reward was at stake. CONCLUSION Findings suggest that HVul might be at increased risk of developing anhedonic symptoms due to weaker encoding of reward value, higher difficulty to engage in goal-oriented behaviors and increased sensitivity to negative feedback, particularly in stressful contexts. These findings open new avenues for a better understanding of the mechanisms underlying how the complex interaction between the systems of stress and reward responsiveness contribute to the vulnerability to MDD, and how cognitive resources might modulate this interaction.
Collapse
Affiliation(s)
- Claudie Gaillard
- IReach Lab, Unit of Clinical and Health Psychology, Department of Psychology, University of Fribourg, Fribourg, Switzerland; Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, Maryland, USA.
| | - Matthias Guillod
- IReach Lab, Unit of Clinical and Health Psychology, Department of Psychology, University of Fribourg, Fribourg, Switzerland
| | - Monique Ernst
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, Maryland, USA
| | - Andrea Federspiel
- Psychiatric Neuroimaging Unit, Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Dominik Schoebi
- Unit of Clinical Family Psychology, Department of Psychology, University of Fribourg, Fribourg, Switzerland
| | - Romina Evelyn Recabarren
- IReach Lab, Unit of Clinical and Health Psychology, Department of Psychology, University of Fribourg, Fribourg, Switzerland
| | - Xinyi Ouyang
- iBM Lab, Department of Psychology, University of Fribourg, Fribourg, Switzerland
| | - Christoph Mueller-Pfeiffer
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Antje Horsch
- Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland; Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
| | - Philipp Homan
- Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, New York, New York, USA
| | - Roland Wiest
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bern, Bern, Switzerland
| | - Gregor Hasler
- Unit of Psychiatry Research, University of Fribourg, Fribourg, Switzerland
| | - Chantal Martin-Soelch
- IReach Lab, Unit of Clinical and Health Psychology, Department of Psychology, University of Fribourg, Fribourg, Switzerland
| |
Collapse
|
189
|
Brouwer ME, Molenaar NM, Burger H, Williams AD, Albers CJ, Lambregtse-van den Berg MP, Bockting CLH. Tapering Antidepressants While Receiving Digital Preventive Cognitive Therapy During Pregnancy: An Experience Sampling Methodology Trial. Front Psychiatry 2020; 11:574357. [PMID: 33192705 PMCID: PMC7641921 DOI: 10.3389/fpsyt.2020.574357] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/25/2020] [Indexed: 12/18/2022] Open
Abstract
Background: Previous studies indicated that affect fluctuations, the use of antidepressant medication (ADM), as well as depression during pregnancy might have adverse effects on offspring outcomes. The aim of the current proof-of-principle study is to explore the effect of tapering ADM while receiving online preventive cognitive therapy (PCT) on pregnant women and the offspring as compared to pregnant women continuing ADM. Objectives: We sought to compare positive and negative affect fluctuations in pregnant women receiving online PCT while tapering ADM vs. pregnant women continuing ADM, and to investigate if affect fluctuations in early pregnancy were related to offspring birth weight. Method: An experience sampling methodology (ESM)-trial ran alongside a Dutch randomized controlled trial (RCT) and prospective observational cohort of women using ADM at the start of pregnancy. In the ESM-trial fluctuations of positive and negative affect were assessed in the first 8 weeks after inclusion. Recurrences of depression were assessed up to 12 weeks post-partum, and birth records were used to assess offspring birth weight. The RCT has been registered at the Netherlands Trial Register (NTR4694, https://www.trialregister.nl/trial/4551). Results: In total, 19 pregnant women using ADM at start of their pregnancy participated in the ESM-trial. There were no significant differences in positive and negative affect fluctuations, nor recurrence rates between women receiving PCT while tapering ADM vs. women continuing ADM. We found no association between affect fluctuations, pre-natal depressive symptoms, and birth weight (all p > 0.05). Conclusion: This explorative study showed that tapering ADM while receiving online PCT may protect pregnant women against recurrences of depression and affect fluctuations, without affecting birth weight. There is a high need for more controlled studies focusing on tapering ADM with (online) psychological interventions during pregnancy.
Collapse
Affiliation(s)
- Marlies E Brouwer
- Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands.,Department of Psychiatry, Amsterdam University Medical Centres, Location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Nina M Molenaar
- Departments of Psychiatry and Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre Rotterdam, Rotterdam, Netherlands.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Huibert Burger
- Department of Psychiatry, Amsterdam University Medical Centres, Location AMC, University of Amsterdam, Amsterdam, Netherlands.,Department of General Practice, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Alishia D Williams
- Faculty of Science, School of Psychology, The University of New South Wales, Sydney, NSW, Australia
| | - Casper J Albers
- Heymans Institute for Psychological Research, University of Groningen, Groningen, Netherlands
| | - Mijke P Lambregtse-van den Berg
- Departments of Psychiatry and Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Claudi L H Bockting
- Department of Psychiatry, Amsterdam University Medical Centres, Location AMC, University of Amsterdam, Amsterdam, Netherlands.,Institute for Advanced Study, Netherlands Institute for Advanced Study in the Humanities and Social Sciences, Royal Netherlands Academy of Arts and Sciences, University of Amsterdam, Amsterdam, Netherlands.,Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
190
|
Saunders R, Buckman JEJ, Pilling S. Latent variable mixture modelling and individual treatment prediction. Behav Res Ther 2020; 124:103505. [PMID: 31841709 PMCID: PMC7417810 DOI: 10.1016/j.brat.2019.103505] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 10/08/2019] [Accepted: 10/25/2019] [Indexed: 01/10/2023]
Abstract
Understanding which groups of patients are more or less likely to benefit from specific treatments has important implications for healthcare. Many personalised medicine approaches in mental health employ variable-centred approaches to predicting treatment response, yet person-centred approaches that identify clinical profiles of patients can provide information on the likelihood of a range of important outcomes. In this paper, we discuss the use of latent variable mixture modelling and demonstrate its use in the application of a patient profiling algorithm using routinely collected patient data to predict outcomes from psychological treatments. This validation study analysed data from two services, which included n = 44,905 patients entering treatment. There were different patterns of reliable recovery, improvement and clinical deterioration from therapy, across the eight profiles which were consistent over time. Outcomes varied between different types of therapy within the profiles: there were significantly higher odds of reliable recovery with High Intensity therapies in two profiles (32.5% of patients) and of reliable improvement in three profiles (32.2% of patients) compared with Low Intensity treatments. In three profiles (37.4% of patients) reliable recovery was significantly more likely if patients had CBT vs Counselling. The developments and potential application of latent variable mixture approaches are further discussed.
Collapse
Affiliation(s)
- Rob Saunders
- Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 7HB, UK
| | - Joshua E J Buckman
- Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 7HB, UK
| | - Stephen Pilling
- Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 7HB, UK.
| |
Collapse
|
191
|
van Kleef RS, Bockting CLH, van Valen E, Aleman A, Marsman JBC, van Tol MJ. Neurocognitive working mechanisms of the prevention of relapse in remitted recurrent depression (NEWPRIDE): protocol of a randomized controlled neuroimaging trial of preventive cognitive therapy. BMC Psychiatry 2019; 19:409. [PMID: 31856771 PMCID: PMC6921462 DOI: 10.1186/s12888-019-2384-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 11/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Major Depressive Disorder (MDD) is a psychiatric disorder with a highly recurrent character, making prevention of relapse an important clinical goal. Preventive Cognitive Therapy (PCT) has been proven effective in preventing relapse, though not for every patient. A better understanding of relapse vulnerability and working mechanisms of preventive treatment may inform effective personalized intervention strategies. Neurocognitive models of MDD suggest that abnormalities in prefrontal control over limbic emotion-processing areas during emotional processing and regulation are important in understanding relapse vulnerability. Whether changes in these neurocognitive abnormalities are induced by PCT and thus play an important role in mediating the risk for recurrent depression, is currently unclear. In the Neurocognitive Working Mechanisms of the Prevention of Relapse In Depression (NEWPRIDE) study, we aim to 1) study neurocognitive factors underpinning the vulnerability for relapse, 2) understand the neurocognitive working mechanisms of PCT, 3) predict longitudinal treatment effects based on pre-treatment neurocognitive characteristics, and 4) validate the pupil dilation response as a marker for prefrontal activity, reflecting emotion regulation capacity and therapy success. METHODS In this randomized controlled trial, 75 remitted recurrent MDD (rrMDD) patients will be included. Detailed clinical and cognitive measurements, fMRI scanning and pupillometry will be performed at baseline and three-month follow-up. In the interval, 50 rrMDD patients will be randomized to eight sessions of PCT and 25 rrMDD patients to a waiting list. At baseline, 25 healthy control participants will be additionally included to objectify cross-sectional residual neurocognitive abnormalities in rrMDD. After 18 months, clinical assessments of relapse status are performed to investigate which therapy induced changes predict relapse in the 50 patients allocated to PCT. DISCUSSION The present trial is the first to study the neurocognitive vulnerability factors underlying relapse and mediating relapse prevention, their value for predicting PCT success and whether pupil dilation acts as a valuable marker in this regard. Ultimately, a deeper understanding of relapse prevention could contribute to the development of better targeted preventive interventions. TRIAL REGISTRATION Trial registration: Netherlands Trial Register, August 18, 2015, trial number NL5219.
Collapse
Affiliation(s)
- Rozemarijn S. van Kleef
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 2, 9713 AW Groningen, The Netherlands
| | - Claudi L. H. Bockting
- 0000000084992262grid.7177.6Department of Psychiatry and Urban Mental Health Institute, Amsterdam University Medical Center, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Evelien van Valen
- 0000000090126352grid.7692.aDepartment of Geriatrics, Heidelberglaan 100, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - André Aleman
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 2, 9713 AW Groningen, The Netherlands
| | - Jan-Bernard C. Marsman
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 2, 9713 AW Groningen, The Netherlands
| | - Marie-José van Tol
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 2, 9713 AW Groningen, The Netherlands
| |
Collapse
|
192
|
Course of depressive symptoms in men and women: differential effects of social, psychological, behavioral and somatic predictors. Sci Rep 2019; 9:18929. [PMID: 31831794 PMCID: PMC6908702 DOI: 10.1038/s41598-019-55342-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 11/27/2019] [Indexed: 11/08/2022] Open
Abstract
In this study, we aimed to identify the most important and sex-specific social, psychological, behavioral and somatic predictors of recurrent depressive symptoms. Data was obtained at two measurement points within five years by the Gutenberg Health Study (GHS). Out of N = 12,061 individuals, a sample of 877 (age 52.3 ± 9.9) who reported clinically relevant depressive symptoms at baseline was analyzed. Univariate analyses and multiple logistic regression analyses were conducted. Almost half of participants depressed at baseline also reported depressive symptoms five years later. Sex-stratified multivariate analyses revealed that solely social support remained a significant protective predictor against recurrence of depression in men (OR = 0.93; CI95% = 0.87-0.99), whereas in women smoking (OR = 1.97; CI95% = 1.23-3.22), and Type D personality (OR = 1.65; CI95% = 1.10-2.49) were significant risk factors. However, when analyzing the entire sample, no interaction effect between sex and each predictor turned out to be significant. Only social support was retained as an overall predictive factor. As depressive symptoms recur, depressive vulnerability is established involving personality, health behavior and social factors. Although no significant sex-specific interactions were observed, sex-stratified analyses point out different patterns for relevant predictors of recurrent depressive symptoms in men and women.
Collapse
|
193
|
Moriarty AS, Meader N, Gilbody S, Chew-Graham CA, Churchill R, Ali S, Phillips RS, Riley RD, McMillan D. Prognostic models for predicting relapse or recurrence of depression. Hippokratia 2019. [DOI: 10.1002/14651858.cd013491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Andrew S Moriarty
- University of York; Mental Health and Addiction Research Group, Department of Health Sciences; York UK
- University of York; Hull York Medical School; York UK
| | - Nicholas Meader
- University of York; Centre for Reviews and Dissemination; York UK YO10 5DD
- University of York; Cochrane Common Mental Disorders; York UK
| | - Simon Gilbody
- University of York; Mental Health and Addiction Research Group, Department of Health Sciences; York UK
- University of York; Hull York Medical School; York UK
| | | | - Rachel Churchill
- University of York; Centre for Reviews and Dissemination; York UK YO10 5DD
- University of York; Cochrane Common Mental Disorders; York UK
| | - Shehzad Ali
- University of York; Mental Health and Addiction Research Group, Department of Health Sciences; York UK
- Western University; Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry; London ON Canada
| | - Robert S Phillips
- University of York; Centre for Reviews and Dissemination; York UK YO10 5DD
| | - Richard D Riley
- Keele University; School of Primary, Community and Social Care; Keele UK
| | - Dean McMillan
- University of York; Mental Health and Addiction Research Group, Department of Health Sciences; York UK
- University of York; Hull York Medical School; York UK
| |
Collapse
|
194
|
Brouwer ME, Williams AD, Kennis M, Fu Z, Klein NS, Cuijpers P, Bockting CLH. Psychological theories of depressive relapse and recurrence: A systematic review and meta-analysis of prospective studies. Clin Psychol Rev 2019; 74:101773. [PMID: 31756681 DOI: 10.1016/j.cpr.2019.101773] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 05/18/2019] [Accepted: 09/14/2019] [Indexed: 01/05/2023]
Abstract
Psychological factors hypothesized to account for relapse of major depressive disorder (MDD) roughly originate from five main theories: Cognitive, diathesis-stress, behavioural, psychodynamic, and personality-based. In a meta-analysis we investigated prospective, longitudinal evidence for these leading psychological theories and their factors in relation to depressive relapse. Included studies needed to establish history of MDD and prospective depressive relapse through a clinical interview, have a longitudinal and prospective design, and measure at least one theory-derived factor before relapse. We identified 66 eligible articles out of 43,586 records published up to November 2018. Pooled odds ratios (OR) indicated a significant relationship between the cognitive, behavioural, and personality-based theories and depressive relapse (cognitive: k = 17, OR = 1.24, 95% CI = 1.10-1.40; behavioural, k = 8, OR = 1.15, 95% CI = 1.05-1.25; personality: k = 12, OR = 1.26, 95% CI = 1.02-1.54), but not for the psychodynamic theories (k = 4, OR = 1.29, 95% CI = 0.83-1.99). Pooled hazard ratios of the theories were not significant. There were no articles identified for the diathesis-stress theories. To conclude, there is a restricted number of prospective studies, and some evidence that the cognitive, behavioural, and personality-based theories indeed partially account for depressive relapse.
Collapse
Affiliation(s)
- Marlies E Brouwer
- Department of Psychiatry, Amsterdam University Medical Centres, location AMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands.
| | - Alishia D Williams
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands; Faculty of Science, School of Psychology, The University of New South Wales, Sydney, Australia.
| | - Mitzy Kennis
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands.
| | - Zhongfang Fu
- Department of Psychiatry, Amsterdam University Medical Centres, location AMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands.
| | - Nicola S Klein
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands; Department of Early Detection and Intervention in Psychosis, GGZ Drenthe, Assen, the Netherlands.
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Claudi L H Bockting
- Department of Psychiatry, Amsterdam University Medical Centres, location AMC, University of Amsterdam, Amsterdam, the Netherlands; Institute for Advanced Study, University of Amsterdam, Netherlands Institute for Advanced Study in the Humanities and Social Sciences, Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands.
| |
Collapse
|
195
|
Buckman JE, Saunders R, Cohen ZD, Clarke K, Ambler G, DeRubeis RJ, Gilbody S, Hollon SD, Kendrick T, Watkins E, White IR, Lewis G, Pilling S. What factors indicate prognosis for adults with depression in primary care? A protocol for meta-analyses of individual patient data using the Dep-GP database. Wellcome Open Res 2019; 4:69. [PMID: 31815189 PMCID: PMC6880263 DOI: 10.12688/wellcomeopenres.15225.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2019] [Indexed: 02/15/2024] Open
Abstract
Background: Pre-treatment severity is a key indicator of prognosis for those with depression. Knowledge is limited on how best to encompass severity of disorders. A number of non-severity related factors such as social support and life events are also indicators of prognosis. It is not clear whether this holds true after adjusting for pre-treatment severity as a) a depressive symptom scale score, and b) a broader construct encompassing symptom severity and related indicators: "disorder severity". In order to investigate this, data from the individual participants of clinical trials which have measured a breadth of "disorder severity" related factors are needed. Aims: 1) To assess the association between outcomes for adults seeking treatment for depression and the severity of depression pre-treatment, considered both as i) depressive symptom severity only and ii) "disorder severity" which includes depressive symptom severity and comorbid anxiety, chronicity, history of depression, history of previous treatment, functional impairment and health-related quality of life. 2) To determine whether i) social support, ii) life events, iii) alcohol misuse, and iv) demographic factors (sex, age, ethnicity, marital status, employment status, level of educational attainment, and financial wellbeing) are prognostic indicators of outcomes, independent of baseline "disorder severity" and the type of treatment received. Methods: Databases were searched for randomised clinical trials (RCTs) that recruited adults seeking treatment for depression from their general practitioners and used the same diagnostic and screening instrument to measure severity at baseline - the Revised Clinical Interview Schedule; outcome measures could differ between studies. Chief investigators of all studies meeting inclusion criteria were contacted and individual patient data (IPD) were requested. Conclusions: In total 15 RCTs met inclusion criteria. The Dep-GP database will include the 6271 participants from the 13 studies that provided IPD. This protocol outlines how these data will be analysed. Registration: PROSPERO CRD42019129512 (01/04/2019).
Collapse
Affiliation(s)
- Joshua E.J. Buckman
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
| | - Rob Saunders
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
| | - Zachary D. Cohen
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Katherine Clarke
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
| | - Gareth Ambler
- Statistical Science, University College London, London, WC1E 7HB, UK
| | - Robert J. DeRubeis
- School of Arts and Sciences, Department of Psychology, University of Pennsylvania, Philadelphia, PA, 19104-60185, USA
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Steven D. Hollon
- Department of Psychology, Vanderbilt University, Nashville, TN, 407817, USA
| | - Tony Kendrick
- Primary Care & Population Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 5ST, UK
| | - Edward Watkins
- Department of Psychology, University of Exeter, Exeter, EX4 4QG, UK
| | - Ian R. White
- Institute of Clinical Trials and Methodology, MRC Clinical Trials Unit, University College London, London, WC1V 6LJ, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, W1T 7NF, UK
| | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
| |
Collapse
|
196
|
Atique-Ur-Rehman H, Neill JC. Cognitive dysfunction in major depression: From assessment to novel therapies. Pharmacol Ther 2019; 202:53-71. [DOI: 10.1016/j.pharmthera.2019.05.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/24/2019] [Indexed: 02/07/2023]
|
197
|
Rao AS, Lemma A, Fonagy P, Sosnowska M, Constantinou MP, Fijak-Koch M, Gelberg G. Development of dynamic interpersonal therapy in complex care (DITCC): a pilot study. PSYCHOANALYTIC PSYCHOTHERAPY 2019. [DOI: 10.1080/02668734.2019.1622147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Amra S Rao
- East London Foundation Trust, London, UK
| | | | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Anna Freud Centre, London, UK
| | | | - Matthew P Constantinou
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | | | | |
Collapse
|
198
|
Buckman J, Saunders R, Fearon P, Leibowitz J, Pilling S. Attentional Control as a Predictor of Response to Psychological Treatment for Depression and Relapse up to 1 year After Treatment: A Pilot Cohort Study. Behav Cogn Psychother 2019; 47:318-331. [PMID: 30352633 PMCID: PMC6372070 DOI: 10.1017/s1352465818000590] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Identifying depressed patients unlikely to reach remission and those likely to relapse after reaching remission is of great importance, but there are few pre-treatment factors that can help clinicians predict prognosis and together these explain relatively little variance in treatment outcomes. Attentional control has shown promise in studies to date, but has not been investigated prospectively in routine clinical settings with depressed patients. AIMS This study aimed to pilot the use of a brief self-report measure of attentional control in routine care and investigate the associations between attentional control, psychological treatment response and relapse to depression up to 1 year post-treatment. METHOD Depressed patients were recruited from two primary care psychological treatment (IAPT) services and completed the Attentional Control Scale (ACS) alongside routine symptom measures at every therapy session. Participants were tracked and followed up for 1 year post-treatment. RESULTS Baseline ACS scores were associated with remission and residual depressive symptoms post-treatment, and relapse within 12 months of ending treatment, all independent of pre-treatment depressive symptom severity, and the latter also independent of residual symptoms. CONCLUSION A self-report measure of attentional control can potentially be used to predict levels of depressive symptoms post-treatment and can contribute to predicting risk of relapse to depression in IAPT services, without affecting rates of therapy completion/drop-out or data completion of standard IAPT measures. However, this pilot study had a small overall sample size and a very small number of observed relapses, so replication in a larger study is needed before firm conclusions can be made.
Collapse
Affiliation(s)
- J.E.J. Buckman
- Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London WC1E 6BT
- iCope – Camden and Islington Psychological Therapies Services, Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London NW1 0PE
| | - R. Saunders
- Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London WC1E 6BT
| | - P. Fearon
- Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London WC1E 6BT
| | - J. Leibowitz
- iCope – Camden and Islington Psychological Therapies Services, Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London NW1 0PE
| | - S. Pilling
- Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London WC1E 6BT
- iCope – Camden and Islington Psychological Therapies Services, Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London NW1 0PE
| |
Collapse
|
199
|
Hur J, Stockbridge MD, Fox AS, Shackman AJ. Dispositional negativity, cognition, and anxiety disorders: An integrative translational neuroscience framework. PROGRESS IN BRAIN RESEARCH 2019; 247:375-436. [PMID: 31196442 PMCID: PMC6578598 DOI: 10.1016/bs.pbr.2019.03.012] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
When extreme, anxiety can become debilitating. Anxiety disorders, which often first emerge early in development, are common and challenging to treat, yet the underlying mechanisms have only recently begun to come into focus. Here, we review new insights into the nature and biological bases of dispositional negativity, a fundamental dimension of childhood temperament and adult personality and a prominent risk factor for the development of pediatric and adult anxiety disorders. Converging lines of epidemiological, neurobiological, and mechanistic evidence suggest that dispositional negativity increases the likelihood of psychopathology via specific neurocognitive mechanisms, including attentional biases to threat and deficits in executive control. Collectively, these observations provide an integrative translational framework for understanding the development and maintenance of anxiety disorders in adults and youth and set the stage for developing improved intervention strategies.
Collapse
Affiliation(s)
- Juyoen Hur
- Department of Psychology, University of Maryland, College Park, MD, United States.
| | | | - Andrew S Fox
- Department of Psychology, University of California, Davis, CA, United States; California National Primate Research Center, University of California, Davis, CA, United States
| | - Alexander J Shackman
- Department of Psychology, University of Maryland, College Park, MD, United States; Neuroscience and Cognitive Science Program, University of Maryland, College Park, MD, United States; Maryland Neuroimaging Center, University of Maryland, College Park, MD, United States.
| |
Collapse
|
200
|
Buckman JE, Saunders R, Cohen ZD, Clarke K, Ambler G, DeRubeis RJ, Gilbody S, Hollon SD, Kendrick T, Watkins E, White IR, Lewis G, Pilling S. What factors indicate prognosis for adults with depression in primary care? A protocol for meta-analyses of individual patient data using the Dep-GP database. Wellcome Open Res 2019; 4:69. [PMID: 31815189 PMCID: PMC6880263 DOI: 10.12688/wellcomeopenres.15225.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2019] [Indexed: 02/15/2024] Open
Abstract
Background: Pre-treatment severity is a key indicator of prognosis for those with depression. Knowledge is limited on how best to encompass severity of disorders. A number of non-severity related factors such as social support and life events are also indicators of prognosis. It is not clear whether this holds true after adjusting for pre-treatment severity as a) a depressive symptom scale score, and b) a broader construct encompassing symptom severity and related indicators: "disorder severity". In order to investigate this, data from the individual participants of clinical trials which have measured a breadth of "disorder severity" related factors are needed. Aims: 1) To assess the association between outcomes for adults seeking treatment for depression and the severity of depression pre-treatment, considered both as i) depressive symptom severity only and ii) "disorder severity" which includes depressive symptom severity and comorbid anxiety, chronicity, history of depression, history of previous treatment, functional impairment and health-related quality of life. 2) To determine whether i) social support, ii) life events, iii) alcohol misuse, and iv) demographic factors (sex, age, ethnicity, marital status, employment status, level of educational attainment, and financial wellbeing) are prognostic indicators of outcomes, independent of baseline "disorder severity" and the type of treatment received. Methods: Databases were searched for randomised clinical trials (RCTs) that recruited adults seeking treatment for depression from their general practitioners and used the same diagnostic and screening instrument to measure severity at baseline - the Revised Clinical Interview Schedule; outcome measures could differ between studies. Chief investigators of all studies meeting inclusion criteria were contacted and individual patient data (IPD) were requested. Conclusions: In total 13 RCTs were found to meet inclusion criteria. The Dep-GP database was formed from the 6271 participants. This protocol outlines how these data will be analysed. Registration: PROSPERO CRD42019129512 (01/04/2019).
Collapse
Affiliation(s)
- Joshua E.J. Buckman
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
| | - Rob Saunders
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
| | - Zachary D. Cohen
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Katherine Clarke
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
| | - Gareth Ambler
- Statistical Science, University College London, London, WC1E 7HB, UK
| | - Robert J. DeRubeis
- School of Arts and Sciences, Department of Psychology, University of Pennsylvania, Philadelphia, PA, 19104-60185, USA
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Steven D. Hollon
- Department of Psychology, Vanderbilt University, Nashville, TN, 407817, USA
| | - Tony Kendrick
- Primary Care & Population Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 5ST, UK
| | - Edward Watkins
- Department of Psychology, University of Exeter, Exeter, EX4 4QG, UK
| | - Ian R. White
- Institute of Clinical Trials and Methodology, MRC Clinical Trials Unit, University College London, London, WC1V 6LJ, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, W1T 7NF, UK
| | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
| |
Collapse
|