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Kalungi A, Kinyanda E, Akena DH, Gelaye B, Ssembajjwe W, Mpango RS, Ongaria T, Mugisha J, Makanga R, Kakande A, Kimono B, Amanyire P, Kirumira F, Lewis CM, McIntosh AM, Kuchenbaecker K, Nyirenda M, Kaleebu P, Fatumo S. Prevalence and correlates of common mental disorders among participants of the Uganda Genome Resource: Opportunities for psychiatric genetics research. Mol Psychiatry 2024:10.1038/s41380-024-02665-8. [PMID: 39003415 DOI: 10.1038/s41380-024-02665-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 06/27/2024] [Accepted: 07/04/2024] [Indexed: 07/15/2024]
Abstract
Genetics research has potential to alleviate the burden of mental disorders in low- and middle-income-countries through identification of new mechanistic pathways which can lead to efficacious drugs or new drug targets. However, there is currently limited genetics data from Africa. The Uganda Genome Resource provides opportunity for psychiatric genetics research among underrepresented people from Africa. We aimed at determining the prevalence and correlates of major depressive disorder (MDD), suicidality, post-traumatic stress disorder (PTSD), alcohol abuse, generalised anxiety disorder (GAD) and probable attention-deficit hyperactivity disorder (ADHD) among participants of the Uganda Genome Resource. Standardised tools assessed for each mental disorder. Prevalence of each disorder was calculated with 95% confidence intervals. Multivariate logistic regression models evaluated the association between each mental disorder and associated demographic and clinical factors. Among 985 participants, prevalence of the disorders were: current MDD 19.3%, life-time MDD 23.3%, suicidality 10.6%, PTSD 3.1%, alcohol abuse 5.7%, GAD 12.9% and probable ADHD 9.2%. This is the first study to determine the prevalence of probable ADHD among adult Ugandans from a general population. We found significant association between sex and alcohol abuse (adjusted odds ratio [AOR] = 0.26 [0.14,0.45], p < 0.001) and GAD (AOR = 1.78 [1.09,2.49], p = 0.019) respectively. We also found significant association between body mass index and suicidality (AOR = 0.85 [0.73,0.99], p = 0.041), alcohol abuse (AOR = 0.86 [0.78,0.94], p = 0.003) and GAD (AOR = 0.93 [0.87,0.98], p = 0.008) respectively. We also found a significant association between high blood pressure and life-time MDD (AOR = 2.87 [1.08,7.66], p = 0.035) and probable ADHD (AOR = 1.99 [1.00,3.97], p = 0.050) respectively. We also found a statistically significant association between tobacco smoking and alcohol abuse (AOR = 3.2 [1.56,6.67], p = 0.002). We also found ever been married to be a risk factor for probable ADHD (AOR = 2.12 [0.88,5.14], p = 0.049). The Uganda Genome Resource presents opportunity for psychiatric genetics research among underrepresented people from Africa.
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Affiliation(s)
- Allan Kalungi
- The African Computational Genomics (TACG) Research Group, Medical Research Council/ Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda.
- Department of Medical Biochemistry, College of Health Sciences, Makerere University, Kampala, Uganda.
- The Department of Non-communicable Diseases Epidemiology, London School of Hygiene and Tropical Medicine London, London, UK.
| | - Eugene Kinyanda
- Mental Health Section, Medical Research Council/ Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Dickens Howard Akena
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave Room 505F, Boston, MA, 02115, USA
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Wilber Ssembajjwe
- Mental Health Section, Medical Research Council/ Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Richard Steven Mpango
- The African Computational Genomics (TACG) Research Group, Medical Research Council/ Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
- Mental Health Section, Medical Research Council/ Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Terry Ongaria
- Medical Research Council/ Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Joseph Mugisha
- Medical Research Council/ Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Ronald Makanga
- Medical Research Council/ Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Ayoub Kakande
- Medical Research Council/ Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Beatrice Kimono
- Medical Research Council/ Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Philip Amanyire
- Mental Health Section, Medical Research Council/ Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Fred Kirumira
- Medical Research Council/ Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Cathryn M Lewis
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, de Crespigny Park, London, SE5 8AF, UK
| | - Andrew M McIntosh
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
| | | | - Moffat Nyirenda
- The Department of Non-communicable Diseases Epidemiology, London School of Hygiene and Tropical Medicine London, London, UK
- Medical Research Council/ Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Pontiano Kaleebu
- Medical Research Council/ Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Segun Fatumo
- The African Computational Genomics (TACG) Research Group, Medical Research Council/ Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda.
- Precision Healthcare University Research Institute, Queen Mary University of London, London, UK.
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Merza Mohammad TA, Merza Mohammad TA, Salman DM, Jaafar HM. Pentoxifylline as a Novel Add-on Therapy for Major Depressive Disorder in Adult Patients: A Randomized, Double-Blind, Placebo-Controlled Trial. PHARMACOPSYCHIATRY 2024; 57:205-214. [PMID: 38710206 DOI: 10.1055/a-2291-7204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
BACKGROUND Evidence indicates an association between immune dysregulation and major depressive disorder (MDD). Pentoxifylline (PTX), a phosphodiesterase inhibitor, has been shown to reduce pro-inflammatory activities. The aim of this study was to evaluate changes in depressive symptoms and pro-inflammatory markers after administration of PTX as an adjunctive agent to citalopram in patients with MDD. METHODS One hundred patients were randomly assigned to either citalopram (20 mg/day) plus placebo (twice daily) (n=50) or citalopram (20 mg/day) plus PTX (400 mg) (twice daily) (n=50). The Hamilton Depression Rating Scale-17 (HAM-D-17) scores at baseline, weeks 2, 4, 6, 8, 10, and 12 and serum levels of interleukin1-β (IL-1-β), tumor necrosis factor-α, C-reactive protein, IL-6, serotonin, IL-10, and brain-derived neurotrophic factor (BDNF) at baseline and week 12 were evaluated. RESULTS HAM-D-17 score in the PTX group significantly reduced in comparison to the control group after weeks 4, 6, 8,10, and 12 ((LSMD): - 2.193, p=0.021; - 2.597, p=0.036; - 2.916, p=0.019; - 4.336, p=0.005; and - 4.087, p=0.008, respectively). Patients who received PTX had a better response (83%) and remission rate (79%) compared to the placebo group (49% and 40%, p=0.006 and p=0.01, respectively). Moreover, the reduction in serum concentrations of pro-inflammatory factors and increase in serotonin and BDNF in the PTX group was significantly greater than in the placebo group (p<0.001). CONCLUSION These findings support the safety and efficacy of PTX as an adjunctive antidepressant agent with anti-inflammatory effects in patients with MDD.
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Affiliation(s)
- Talar A Merza Mohammad
- Department of Clinical Pharmacy, College of Pharmacy, Hawler Medical University, Kurdistan Region-Erbil, Iraq
| | - Tavgah A Merza Mohammad
- University of Sulaimani, College of Nursing, Department of Community Health Nursing, Kurdistan Region-Erbil, Iraq
| | - Dyar M Salman
- Department of Clinical Pharmacy, College of Pharmacy, Hawler Medical University, Kurdistan Region-Erbil, Iraq
- Tishk International University, Faculty of Pharmacy, Kurdistan Region-Erbil, Iraq
| | - Halmat M Jaafar
- Department of Clinical Pharmacy, College of Pharmacy, Hawler Medical University, Kurdistan Region-Erbil, Iraq
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Ćosić K, Popović S, Wiederhold BK. Enhancing Aviation Safety through AI-Driven Mental Health Management for Pilots and Air Traffic Controllers. CYBERPSYCHOLOGY, BEHAVIOR AND SOCIAL NETWORKING 2024. [PMID: 38916063 DOI: 10.1089/cyber.2023.0737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
This article provides an overview of the mental health challenges faced by pilots and air traffic controllers (ATCs), whose stressful professional lives may negatively impact global flight safety and security. The adverse effects of mental health disorders on their flight performance pose a particular safety risk, especially in sudden unexpected startle situations. Therefore, the early detection, prediction and prevention of mental health deterioration in pilots and ATCs, particularly among those at high risk, are crucial to minimize potential air crash incidents caused by human factors. Recent research in artificial intelligence (AI) demonstrates the potential of machine and deep learning, edge and cloud computing, virtual reality and wearable multimodal physiological sensors for monitoring and predicting mental health disorders. Longitudinal monitoring and analysis of pilots' and ATCs physiological, cognitive and behavioral states could help predict individuals at risk of undisclosed or emerging mental health disorders. Utilizing AI tools and methodologies to identify and select these individuals for preventive mental health training and interventions could be a promising and effective approach to preventing potential air crash accidents attributed to human factors and related mental health problems. Based on these insights, the article advocates for the design of a multidisciplinary mental healthcare ecosystem in modern aviation using AI tools and technologies, to foster more efficient and effective mental health management, thereby enhancing flight safety and security standards. This proposed ecosystem requires the collaboration of multidisciplinary experts, including psychologists, neuroscientists, physiologists, psychiatrists, etc. to address these challenges in modern aviation.
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Affiliation(s)
- Krešimir Ćosić
- Faculty of Electrical Engineering and Computing, University of Zagreb, Zagreb, Croatia
| | - Siniša Popović
- Faculty of Electrical Engineering and Computing, University of Zagreb, Zagreb, Croatia
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Varela-Moreno E, Anarte-Ortiz MT, Jodar-Sanchez F, Garcia-Palacios A, Monreal-Bartolomé A, Gili M, García-Campayo J, Mayoral-Cleries F. Economic Evaluation of a Web Application Implemented in Primary Care for the Treatment of Depression in Patients With Type 2 Diabetes Mellitus: Multicenter Randomized Controlled Trial. JMIR Mhealth Uhealth 2024; 12:e55483. [PMID: 38754101 PMCID: PMC11140277 DOI: 10.2196/55483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 03/04/2024] [Accepted: 03/14/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Depressive disorder and type 2 diabetes mellitus (T2DM) are prevalent in primary care (PC). Pharmacological treatment, despite controversy, is commonly chosen due to resource limitations and difficulties in accessing face-to-face interventions. Depression significantly impacts various aspects of a person's life, affecting adherence to medical prescriptions and glycemic control and leading to future complications and increased health care costs. To address these challenges, information and communication technologies (eg, eHealth) have been introduced, showing promise in improving treatment continuity and accessibility. However, while eHealth programs have demonstrated effectiveness in alleviating depressive symptoms, evidence regarding glycemic control remains inconclusive. This randomized controlled trial aimed to test the efficacy of a low-intensity psychological intervention via a web app for mild-moderate depressive symptoms in individuals with T2DM compared with treatment as usual (TAU) in PC. OBJECTIVE This study aimed to analyze the cost-effectiveness and cost-utility of a web-based psychological intervention to treat depressive symptomatology in people with T2DM compared with TAU in a PC setting. METHODS A multicenter randomized controlled trial was conducted with 49 patients with T2DM, depressive symptoms of moderate severity, and glycosylated hemoglobin (HbA1c) of 7.47% in PC settings. Patients were randomized to TAU (n=27) or a web-based psychological treatment group (n=22). This web-based treatment consisted of cognitive behavioral therapy, improvement of diabetes self-care behaviors, and mindfulness. Cost-effectiveness analysis for the improvement of depressive symptomatology was conducted based on reductions in 3, 5, or 50 points on the Patient Health Questionnaire-9 (PHQ-9). The efficacy of diabetes control was estimated based on a 0.5% reduction in HbA1c levels. Follow-up was performed at 3 and 6 months. The cost-utility analysis was performed based on quality-adjusted life years. RESULTS Efficacy analysis showed that the web-based treatment program was more effective in improving depressive symptoms than TAU but showed only a slight improvement in HbA1c. Incremental cost-effectiveness ratios of 186.76 for a 3-point reduction in PHQ-9 and 206.31 for reductions of 5 and 50 percentage points were obtained. In contrast, the incremental cost-effectiveness ratio for improving HbA1c levels amounted to €1510.90 (€1=US $1.18 in 2018) per participant. The incremental cost-utility ratio resulted in €4119.33 per quality-adjusted life year gained. CONCLUSIONS The intervention, using web-based modules incorporating cognitive behavioral therapy tools, diabetes self-care promotion, and mindfulness, effectively reduced depressive symptoms and enhanced glycemic control in patients with T2DM. Notably, it demonstrated clinical efficacy and economic efficiency. This supports the idea that eHealth interventions not only benefit patients clinically but also offer cost-effectiveness for health care systems. The study emphasizes the importance of including specific modules to enhance diabetes self-care behaviors in future web-based psychological interventions, emphasizing personalization and adaptation for this population. TRIAL REGISTRATION ClinicalTrials.gov NCT03426709; https://clinicaltrials.gov/study/NCT03426709. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/S12888-019-2037-3.
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Affiliation(s)
- Esperanza Varela-Moreno
- Research and Innovation Unit, Costa del Sol University Hospital, Marbella, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Málaga, Spain
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Málaga, Málaga, Spain
- Biomedical Research Institute of Malaga, Malaga, Spain
| | - Maria Teresa Anarte-Ortiz
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Málaga, Málaga, Spain
- Biomedical Research Institute of Malaga, Malaga, Spain
| | - Francisco Jodar-Sanchez
- Department of Applied Economics, Faculty of Economics and Business Administration, University of Malaga, Malaga, Spain
- Pharmacoeconomics: Clinical and Economic Evaluation of Medications and Palliative Care, Malaga, Spain
| | - Azucena Garcia-Palacios
- Network Biomedical Research Center. Physiopathology Obesity and Nutrition (CIBERobn), Carlos III Health Institute, Madrid, Spain
- Department of Clinical and Basic Psychology and Biopsychology, Faculty of Health Sciences, University Jaume I, Castellon, Spain
| | - Alicia Monreal-Bartolomé
- Institute of Health Research of Aragon, Zaragoza, Spain
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Margalida Gili
- Research Network on Preventive Activities and Health Promotion in Primary Health Care (RedIAPP), Madrid, Spain
- Institut Universitari d'Investigació en Ciències de la Salut, University Institute for Research in Health Sciences (IUNICS)- Palma Health Research Institute (IDISPA), University of the Balearic Islands, Palma, Spain
| | - Javier García-Campayo
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Málaga, Spain
- Institute of Health Research of Aragon, Zaragoza, Spain
| | - Fermin Mayoral-Cleries
- Biomedical Research Institute of Malaga, Malaga, Spain
- Mental Health Clinical Management Unit, University Regional Hospital of Malaga, Malaga, Spain
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Opoku P, Osei-Tutu A, Oti-Boadi M. Psychosocial impacts of caring for a child with a genetic disorder in Accra, Ghana. J Community Genet 2023; 14:565-574. [PMID: 37581869 PMCID: PMC10725383 DOI: 10.1007/s12687-023-00662-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 08/08/2023] [Indexed: 08/16/2023] Open
Abstract
Caregivers caring for a child with a genetic condition may experience psychosocial distress, which may be compounded by the context in which the caring takes place. Few studies have examined psychosocial distress and support among caregivers caring for a child with a genetic disorder in low-middle-income countries such as Ghana. The purpose of the current study was to investigate the psychosocial impacts of caring for a child with a genetic disorder in an urban setting in Ghana's capital, Accra. We conducted individual interviews among 17 caregivers who were taking care of children with various genetic disorders including, albinism, Edward's syndrome, osteogenesis imperfecta, sickle cell disease, and spondyloepiphyseal dysplasia congenita. Thematic analysis of the data revealed three main themes on the psychosocial impacts, including: (1) self-blame, guilt, and shame; (2) sleep and mood disturbances; and (3) discrimination and stigmatization. We observed three themes about support: (1) psychological support; (2) family and community support; and (3) institutional support. Participants reported limited support from professionals such as psychologists. Discussion focuses on the supportive care needs of caregivers and implications for genetic counselling awareness, advocacy, and training.
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Affiliation(s)
- Paul Opoku
- Department of Psychology, University of Ghana, Accra, Ghana
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Abraham J, Meng A, Baumann A, Holzer KJ, Lenard E, Freedland KE, Lenze EJ, Avidan MS, Politi MC. A multi- and mixed-method adaptation study of a patient-centered perioperative mental health intervention bundle. BMC Health Serv Res 2023; 23:1175. [PMID: 37891574 PMCID: PMC10612159 DOI: 10.1186/s12913-023-10186-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Anxiety and depression are common among older adults and can intensify during perioperative periods, but few mental health interventions are designed for older surgical patients' unique needs. As part of the feasibility trial, we developed and adapted a perioperative mental health (PMH) bundle for older patients comprised of behavioral activation (BA) and medication optimization (MO) to ameliorate anxiety and depressive symptoms before, during, and after cardiac, orthopedic, and oncologic surgery. METHODS We used mixed-methods including workshop studios with patients, caregivers, clinicians, researchers, and interventionists; intervention refinement and reflection meetings; patient case review meetings; intervention session audio-recordings and documentation forms; and patient and caregiver semi-structured interviews. We used the results to refine our PMH bundle. We used multiple analytical approaches to report the nature of adaptations, including hybrid thematic analysis and content analysis informed by the Framework for Reporting Adaptations and Modifications - Expanded. RESULTS Adaptations were categorized by content (intervention components), context (how the intervention is delivered, based on the study, target population, intervention format, intervention delivery mode, study setting, study personnel), training, and evaluation. Of 51 adaptations, 43.1% involved content, 41.2% involved context, and 15.7% involved training and evaluation. Several key adaptations were noted: (1) Intervention content was tailored to patient preferences and needs (e.g., rewording elements to prevent stigmatization of mental health needs; adjusting BA techniques and documentation forms to improve patient buy-in and motivation). (2) Cohort-specific adaptations were recommended based on differing patient needs. (3) Compassion was identified by patients as the most important element. CONCLUSIONS We identified evidence-based mental health intervention components from other settings and adapted them to the perioperative setting for older adults. Informed by mixed-methods, we created an innovative and pragmatic patient-centered intervention bundle that is acceptable, feasible, and responsive to the needs of older surgical populations. This approach allowed us to identify implementation strategies to improve the reach, scalability, and sustainability of our bundle, and can guide future patient-centered intervention adaptations. CLINICAL TRIALS REGISTRATION NCT05110690 (11/08/2021).
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Affiliation(s)
- Joanna Abraham
- Department of Anesthesiology, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA.
- Institute for Informatics, Data Science and Biostatistics, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA.
- Division of Biology and Biomedical Sciences, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA.
| | - Alicia Meng
- Department of Anesthesiology, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Ana Baumann
- Division of Public Health Sciences, Department of Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Katherine J Holzer
- Department of Anesthesiology, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Emily Lenard
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Kenneth E Freedland
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Eric J Lenze
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Michael S Avidan
- Department of Anesthesiology, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Mary C Politi
- Division of Public Health Sciences, Department of Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
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Lewandowska K, Węziak-Białowolska D. The impact of theatre on social competencies: a meta-analytic evaluation. Arts Health 2023; 15:306-337. [PMID: 36203325 DOI: 10.1080/17533015.2022.2130947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/15/2022] [Accepted: 09/14/2022] [Indexed: 10/10/2022]
Abstract
BACKGROUND There has been agrowing interest in using artistic interventions as a method of developing interpersonal competence. This paper presents a meta-analysis evaluating the impact of theatre interventions on social competencies. METHODS Twenty-one primary studies totaling 4064 participants were included, presenting evidence available since 1983. Included studies were assessed in terms of quality, heterogeneity, and publication bias. RESULTS Our findings indicated that active theatre participation significantly improved participants' empathic abilities, social communication, tolerance, and social interactions, with the largest pooled effect size for social communication (0.698) and the smallest for tolerance (0.156). Our findings did not corroborate the impact of theatre on self-concept. CONCLUSIONS This paper shows that theatre interventions have a positive impact on social competencies. The paper makes a methodological contribution by showing that randomized and non-randomized studies yielded comparably valid results.
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Affiliation(s)
- Kamila Lewandowska
- Aleksander Zelwerowicz National Academy of Dramatic Art in Warsaw, Warsaw, Poland
| | - Dorota Węziak-Białowolska
- Sustainability and Health Initiative (Shine), Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
- Centre for Evaluation and Analysis of Public Policies, Faculty of Philosophy, Jagiellonian University, Cracow, Poland
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Chen S, Lee A, Wang W. A Meta-Research of Randomized Controlled Trials in the Field of Mental Health: Comparing Pharmacological to Non-Pharmacological Interventions from 1955 to 2020. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:639-648. [PMID: 36744373 PMCID: PMC10585133 DOI: 10.1177/07067437231154993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This study aimed to provide a general overview of mental health randomized controlled trials (RCTs) and summarize the temporal trends in terms of the number of studies, median sample sizes, and median effect sizes using data collected from the Cochrane Database of Systematic Reviews (CDSR). METHODS Using data collected from the CDSR, the temporal trends are compared in terms of the number of studies, median sample sizes, and median effect sizes between two broad categories of interventions: pharmacological RCT (ph-RCT) and non-pharmacological RCT (nph-RCT), and in conjunction with major mental disorder categories. RESULTS Chronologically, the number of mental health RCTs reported in publications has increased exponentially from 1955 to 2020. While ph-RCT comprised a majority of mental health RCTs in the earlier years, the proportion of nph-RCTs increased more quickly over time and markedly exceeded ph-RCT after 2010. The median sample size for all 6,652 mental health RCTs was 61, with 61 for ph-RCT and 60 for nph-RCT. Over time, the median fluctuated but an increasing trend was observed over the past 60+ years. The median of the effect size, measured by Pearson's r, for overall RCTs was 0.18, and nph-RCT (0.19) had a larger median effect size compared to ph-RCT (0.16). Over the years, the nph-RCT had a larger median effect size than the ph-RCT. Differences in the median effect sizes among the categories of mental disorders were also noted. Schizophrenia had the most RCTs, with a median Pearson's r value of 0.17. Mood disorder had the second largest number of RCTs and a median Pearson's r value of 0.15. Neurotic/stress-related mental disorder had the third largest number of RCTs with the highest median Pearson's r being 0.23. CONCLUSIONS This study provides meaningful information and filled the knowledge gap in mental health RCTs.
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Affiliation(s)
- Sheng Chen
- Biostatistics Core, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Center for Complex Interventions, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Alina Lee
- Center for Complex Interventions, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Wei Wang
- Biostatistics Core, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Center for Complex Interventions, Centre for Addiction and Mental Health, Toronto, ON, Canada
- College of Public Health, University of South Florida, Tampa, FL, USA
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Treatment and Management of Mental Health Conditions During Pregnancy and Postpartum: ACOG Clinical Practice Guideline No. 5. Obstet Gynecol 2023; 141:1262-1288. [PMID: 37486661 DOI: 10.1097/aog.0000000000005202] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
PURPOSE To assess the evidence regarding safety and efficacy of psychiatric medications to treat mental health conditions during pregnancy and lactation. The conditions reviewed include depression, anxiety and anxiety-related disorders, bipolar disorder, and acute psychosis. For information on screening and diagnosis, refer to American College of Obstetricians and Gynecologists (ACOG) Clinical Practice Guideline Number 4, "Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum" (1). TARGET POPULATION Pregnant or postpartum individuals with mental health conditions with onset that may have predated the perinatal period or may have occurred for the first time in pregnancy or the first year postpartum or may have been exacerbated in that time. METHODS This guideline was developed using an a priori protocol in conjunction with a writing team consisting of one specialist in obstetrics and gynecology and one maternal-fetal medicine subspecialist appointed by the ACOG Committee on Clinical Practice Guidelines-Obstetrics and two external subject matter experts. ACOG medical librarians completed a comprehensive literature search for primary literature within Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE. Studies that moved forward to the full-text screening stage were assessed by two authors from the writing team based on standardized inclusion and exclusion criteria. Included studies underwent quality assessment, and a modified GRADE (Grading of Recommendations Assessment, Development and Evaluation) evidence-to-decision framework was applied to interpret and translate the evidence into recommendation statements. RECOMMENDATIONS This Clinical Practice Guideline includes recommendations on treatment and management of perinatal mental health conditions including depression, anxiety, bipolar disorders, and acute postpartum psychosis, with a focus on psychopharmacotherapy. Recommendations are classified by strength and evidence quality. Ungraded Good Practice Points are included to provide guidance when a formal recommendation could not be made because of inadequate or nonexistent evidence.
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Jones AC, Robinson WD, Delbridge EJ, Brown BJ, McPhee DP. Psychopharmacology attitudes, beliefs, and practices among systemic family therapists and supervisors. JOURNAL OF MARITAL AND FAMILY THERAPY 2023. [PMID: 37036303 DOI: 10.1111/jmft.12639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 03/15/2023] [Accepted: 03/15/2023] [Indexed: 06/19/2023]
Abstract
Many aspects of systemic family therapist (SFT) training and competence play a vital role in effective treatment and professional satisfaction. One area that has been significantly overlooked by many SFTs is the role of psychotropic medication (PM) in conjunction with talk therapy for optimal mental health outcomes. This study explores the current status of PM in SFT training and clinical practice. Our findings highlight the continued struggle of SFTs in their comfort level with addressing the PM needs of their clients. We identified a perceived inadequacy of SFT training and supervision regarding PM use. SFTs around the world need to find educational opportunities to improve their competence in working with their clients and their prescribed medications. Additional studies need to be conducted on strategies and mechanisms to improve client care. If SFTs are ignorant of PM, their treatment of clients-who often use PM-will be compromised.
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Affiliation(s)
- Adam C Jones
- Department of Human Development, Family Studies, and Counseling, Texas Woman's University, Denton, Texas, USA
| | - W David Robinson
- Human Development and Family Studies Department, Utah State University, Logan, Utah, USA
| | - Emilee J Delbridge
- Department of Family Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Braden J Brown
- Department of Family Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Douglas P McPhee
- Department of Marriage and Family Therapy, Mount Mercy University, Cedar Rapids, Iowa, USA
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Cheng C, Ebrahimi OV. A meta-analytic review of gamified interventions in mental health enhancement. COMPUTERS IN HUMAN BEHAVIOR 2023. [DOI: 10.1016/j.chb.2022.107621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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12
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Tjokrowijoto P, Stolwyk RJ, Ung D, Kilkenny MF, Kim J, Dalli LL, Cadilhac DA, Andrew NE. Factors associated with mental health service access among Australian community-dwelling survivors of stroke. Disabil Rehabil 2023; 45:504-511. [PMID: 35139002 DOI: 10.1080/09638288.2022.2032413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE To describe types of mental health treatment accessed by community-based stroke survivors and factors associated with access. METHODS A sub-group of registrants from the Australian Stroke Clinical Registry completed a supplementary survey 2.5 years post-stroke. Self-reported information about depression/anxiety and treatment access were collected. Demographic and clinical data were obtained through linkages with registry and government data. Staged multivariable logistic regression was conducted to examine factors associated with treatment access. RESULTS Among 623 registrants surveyed (37% female, median age 69 years), 26% self-reported a medical diagnosis of depression/anxiety at 2.5 years post-stroke. Of these, only 30% reported having accessed mental health services, mostly through government-funded Medicare schemes. Younger age (odds ratio (OR) 0.95, 95% CI 0.93, 0.98), history of mental health treatment (OR 3.38, 95% CI 1.35, 8.48), feeling socially isolated (OR 2.32, 95% CI 1.16, 4.66), self-reported medical diagnosis of depression/anxiety (OR 4.85, 95% CI 2.32, 10.14), and government-subsidised team care plan arrangement (OR 4.05, 95% CI 1.96, 8.37) were associated with receiving treatment. CONCLUSIONS Many stroke survivors have untreated depression/anxiety. Primary care practitioners should be supported in undertaking effective detection and management. Older and newly diagnosed individuals should be educated about depression/anxiety and available supports.Implications for rehabilitationPrimary care providers play a pivotal role in the pathway to mental health care, and therefore should always screen for depression/anxiety and provide comprehensive assessment and referral to specialist services where necessary.Targeted psychoeducation should be provided to survivors of stroke who are older and newly diagnosed with depression/anxiety, to increase awareness about mood problems following stroke.Primary care providers should collaborate with other health professionals (e.g., through coordinating a team care arrangement plan), to address patients' multiple and complex rehabilitation needs.Rehabilitation professionals should remain informed about current evidence-based treatments for post-stroke depression/anxiety and pathways that enable their patients to access these services.
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Affiliation(s)
- Priscilla Tjokrowijoto
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- Stroke and Telehealth Research, Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
| | - Renerus J Stolwyk
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- Stroke and Telehealth Research, Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
| | - David Ung
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Australia
| | - Monique F Kilkenny
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
- Stroke Division, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Australia
| | - Joosup Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
- Stroke Division, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Australia
| | - Lachlan L Dalli
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
- Stroke Division, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Australia
| | - Nadine E Andrew
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Australia
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Abraham J, Meng A, Baumann-Walker A, Holzer K, Lenard E, Freedland KE, Lenze EJ, Avidan MS, Politi MC. A Patient-Centered Perioperative Mental Health Intervention Bundle: A Multi- and Mixed-Method Adaptation Study. RESEARCH SQUARE 2023:rs.3.rs-2451723. [PMID: 36711989 PMCID: PMC9882664 DOI: 10.21203/rs.3.rs-2451723/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background Anxiety and depression are common among older adults and can intensify during perioperative periods, but few mental health interventions are designed for older surgical patients' unique needs. We developed and adapted a perioperative mental health (PMH) bundle for older patients comprised of behavioral activation (BA) and medication optimization (MO) to ameliorate anxiety and depressive symptoms before, during, and after cardiac, orthopedic, and oncologic surgery. Methods We used mixed-methods including workshop studios with patients, caregivers, clinicians, researchers, and interventionists; intervention refinement and reflection meetings; patient case review meetings; intervention session audio-recordings and documentation forms; and patient and caregiver semi-structured interviews. We used the results to refine our PMH bundle. We used multiple analytical approaches to report the nature of adaptations, including hybrid thematic analysis and content analysis informed by the Framework for Reporting Adaptations and Modifications - Expanded. Results Adaptations were categorized by content (intervention components), context (how the intervention is delivered, based on the study, target population, intervention format, intervention delivery mode, study setting, study personnel), training, and evaluation. Of 51 adaptations, 43.1% involved content, 41.2% involved context, and 15.7% involved training and evaluation. Several key adaptations were noted: 1) Intervention content was tailored to patient preferences and needs (e.g., rewording elements to prevent stigmatization of mental health needs; adjusting BA techniques and documentation forms to improve patient buy-in and motivation). 2) Cohort-specific adaptations were recommended based on differing patient needs. 3) Compassion was identified by patients as the most important element. Conclusions We identified evidence-based mental health intervention components from other settings and adapted them to the perioperative setting for older adults. Informed by mixed-methods, we created an innovative and pragmatic patient-centered intervention bundle that is acceptable, feasible, and responsive to the needs of older surgical populations. This approach allowed us to identify implementation strategies to improve the reach, scalability, and sustainability of our bundle, and can guide future patient-centered intervention adaptations.
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Asefa KZ, Bedada TD, Fufa JA, Gari FS, Gelcho GN, Akessa GM. Predictors of time to first symptomatic recovery of major depressive disordered patients: a case study at Jimma University Medical Center. BMC Psychiatry 2023; 23:37. [PMID: 36639751 PMCID: PMC9840281 DOI: 10.1186/s12888-022-04443-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 11/30/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Major Depressive Disorder is one of the most common mental disorders, and it is the main cause of disability worldwide with a prevalence ranging from 7 to 21%. OBJECTIVE The goal of this study was to predict the time it took for patients with severe depressive disorders at Jimma University Medical Center to experience their initial symptomatic recovery. STUDY DESIGN The researchers utilized a prospective study design. METHODS Patients with major depressive disorder were followed up on at Jimma University Medical Center from September 2018 to August 2020 for this study. The Gamma and Inverse Gaussian frailty distributions were employed with Weibull, Log-logistic, and Log-normal as baseline hazard functions. Akaike Information Criteria were used to choose the best model for describing the data. RESULTS This study comprised 366 patients, with 54.1% of them experiencing their first symptomatic recovery from a severe depressive disorder. The median time from the onset of symptoms to symptomatic recovery was 7 months. In the study area, there was a clustering effect in terms of time to first symptomatic recovery from major depressive disorder. According to the Log-normal Inverse-Gaussian frailty model, marital status, chewing khat, educational status, work status, substance addiction, and other co-variables were significant predictors of major depressive disorder (p-value < 0.05). CONCLUSION The best model for describing the time to the first symptomatic recovery of major depressive disorder is the log-normal Inverse-Gaussian frailty model. Being educated and working considerably were the variables that reduces the time to first symptomatic recovery from major depressive disorder; whereas being divorced, chewing khat, substance abused and other co-factors were the variables that significantly extends the time to first symptomatic recovery.
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Affiliation(s)
- Ketema Zerihun Asefa
- Department of Statistics, College of Natural and Computational Science, Madda Walabu University, Bale-Robe, Oromia Ethiopia
| | - Tadele Degefa Bedada
- Department of Statistics, College of Natural and Computational Science, Madda Walabu University, Bale-Robe, Oromia Ethiopia
| | - Jaleta Abdisa Fufa
- grid.411903.e0000 0001 2034 9160Department of Statistics, College of Natural Science, Jimma University, Jimma, Oromia Ethiopia
| | - Firomsa Shewa Gari
- grid.472250.60000 0004 6023 9726Department of Statistics, College of Natural and Computational Science, Assosa University, Assosa, Benishangul Gumuz Ethiopia
| | - Gurmessa Nugussu Gelcho
- Department of Statistics, College of Natural Science, Jimma University, Jimma, Oromia, Ethiopia.
| | - Geremew Muleta Akessa
- grid.411903.e0000 0001 2034 9160Department of Statistics, College of Natural Science, Jimma University, Jimma, Oromia Ethiopia
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Anderson DJ, Vazirnia P, Loehr C, Sternfels W, Hasoon J, Viswanath O, Kaye AD, Urits I. Testosterone Replacement Therapy in the Treatment of Depression. Health Psychol Res 2022; 10:38956. [PMID: 36452903 PMCID: PMC9704723 DOI: 10.52965/001c.38956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Depression is a common disorder that affects millions globally and is linked to reduced quality of life and mortality. Its pathophysiology is complex and there are several forms of treatment proposed in the literature with differing side effect profiles. Many patients do not respond to treatment which warrants augmentation with other treatments and the investigation of novel treatments. One of these treatments includes testosterone therapy which evidence suggests might improve depressed mood in older patients with low levels of testosterone and helps restore physical impairments caused by age-related hormonal changes. OBJECTIVE The objective of this review is to synthesize information regarding clinical depression, its treatment options, and the efficacy and safety of testosterone treatment for the treatment of depression. METHODS This review utilized comprehensive secondary and tertiary data analysis across many academic databases and published work pertaining to the topic of interest. RESULTS Within some subpopulations such as men with dysthymic disorder, treatment resistant depression, or low testosterone levels, testosterone administration yielded positive results in the treatment of depression. Additionally, rodent models have shown that administering testosterone to gonadectomized male animals reduces symptoms of depression. Conversely, some studies have found no difference in depressive symptoms after treatment with testosterone when compared with placebo. It was also noted that over administration of testosterone is associated with multiple adverse effects and complications. CONCLUSION The current evidence provides mixed conclusions on the effectiveness of testosterone therapy for treating depression. More research is needed in adult men to see if declining testosterone levels directly influence the development of depression.
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Affiliation(s)
| | | | - Catherine Loehr
- School of Medicine, Louisiana State University Health Sciences Center
| | - Whitney Sternfels
- School of Medicine, Louisiana State University Health Sciences Center
| | - Jamal Hasoon
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Omar Viswanath
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School; Valley Anesthesiology and Pain Consultants, Envision Physician Services; Department of Anesthesiology, University of Arizona College of Medicine Phoenix; Department of Anesthesiology, Creighton University School of Medicine
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center
| | - Ivan Urits
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School; Department of Anesthesiology, Louisiana State University Health Shreveport
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Flores-Plata LA, De la Rosa-Gómez A, Díaz-Sosa D, Valencia-Meléndez P, Hernández-Posadas A. Commentary: The psychological and social impact of COVID-19: New perspectives of well-being. Front Psychol 2022; 13:953147. [PMID: 36211845 PMCID: PMC9542049 DOI: 10.3389/fpsyg.2022.953147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/30/2022] [Indexed: 11/26/2022] Open
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Saji Parel N, Krishna PV, Gupta A, Uthayaseelan K, Uthayaseelan K, Kadari M, Subhan M, Kasire SP. Depression and Vitamin D: A Peculiar Relationship. Cureus 2022; 14:e24363. [PMID: 35637805 PMCID: PMC9132221 DOI: 10.7759/cureus.24363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2022] [Indexed: 12/03/2022] Open
Abstract
Depression is a psychiatric disorder characterized by various symptoms that can impact one's quality of life. Vitamin D, a fat-soluble vitamin, is well-known for its role in bone health, and research on its effects on mental health has only recently emerged. Vitamin D deficiency is widespread worldwide, and it has been linked to an increased risk of depression. In this article, we have discussed different hypotheses that explain the role of vitamin D in gene expression and its effects on neurotransmitters and different brain functions. We have reviewed literature that shows us that Vitamin D deficiency is a risk factor for depression and explored studies that show us the effects of using or supplementing Vitamin D in preventing depression among various populations.
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Anderson JR, Schrift M. Medication Management of Neuropsychiatric Symptoms in Neurological Conditions: A Dimensional Transdiagnostic Approach. Semin Neurol 2022; 42:225-236. [PMID: 35139549 DOI: 10.1055/s-0041-1742144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Neuropsychiatric symptoms are prevalent in neurologic practice, but their complexity makes them challenging to manage. Many cognitive, affective, behavioral, and perceptual symptoms span multiple neurologic diagnoses-and there is prominent variability in neuropsychiatric symptom burden for a given condition. There is also a relative lack of robust controlled clinical trial evidence and expert consensus recommendations for a range of neuropsychiatric symptom presentations. Thus, the categorical approach (e.g., a discrete diagnosis equals a specific set of medication interventions) used in many other medical conditions can sometimes have limited utility in commonly encountered neuropsychiatric clinical scenarios. In this review, we explore medication management for a range of neuropsychiatric symptoms using a dimensional transdiagnostic approach applied to the neurological patient. This approach allows the clinician to think beyond the boundaries of a discrete diagnosis and treat specific symptom domains (e.g., apathy, impulsivity). Pharmacologic considerations, including mechanisms of action and their application to various neurotransmitter systems and brain networks, are discussed, as well as general recommendations to optimize medication adherence and rapport with the patient. The dimensional, transdiagnostic approach to pharmacological management of patients with neurological conditions will help the clinician treat neuropsychiatric symptoms safely, effectively, and confidently.
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Affiliation(s)
- Jordan R Anderson
- Department of Psychiatry and Neurology, Oregon Health and Science University, Unity Center for Behavioral Health, VA Portland Healthcare System, Portland, Oregon
| | - Michael Schrift
- Department of Psychiatry and Behavioral Sciences, University of Washington, Harborview Medical Center, Seattle, Washington
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Wijekoon Mudiyanselage KW, Bastiaansen JA, Stewart R, Wardenaar KJ, Penninx BWJH, Schoevers RA, van Hemert AM, Jörg F. Identifying mismatch and match between clinical needs and mental healthcare use trajectories in people with anxiety and depression: Results of a longitudinal study. J Affect Disord 2022; 297:657-670. [PMID: 34763294 DOI: 10.1016/j.jad.2021.09.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/27/2021] [Accepted: 09/16/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mismatch between need and mental healthcare (MHC) use (under-and overuse) has mainly been studied with cross-sectional designs, not accurately capturing patterns of persistence or change in clinical burden and MHC-use among persons with depressive and/or anxiety disorders. AIMS Determining and describing [mis]match of longitudinal trajectories of clinical burden and MHC-use. METHODS Six-year longitudinal burden and MHC-use data came from the Netherlands Study of Depression and Anxiety (n=2981). The sample was split into four subgroups: I) no clinical burden but constant MHC use, II) constant clinical burden but no MHC-use, III) changing clinical burden and MHC-use, and IV) healthy non-users. Within subgroups I)-III), specific clinical burden and MHC trajectories were identified (growth mixture modeling). The resulting classes' associations with predisposing, enabling, and need factors were investigated (regression analysis). RESULTS Subgroups I-III revealed different trajectories. I) increasing MHC without burden (4.1%). II) slightly increasing (1.9%), strongly increasing (2.4%), and decreasing (9.5%) burden without MHC. III) increasing (41.4%) or decreasing (19.4%) burden and concurrently increasing MHC use (first underuse, then matched care), thus revealing delayed MHC-use. Only having suicidal ideation (p<.001, Cohen's d= .6-1.5) was a significant determinant of being in latter classes compared to underusers (strongly increasing burden without MHC-use). LIMITATIONS More explanatory factors are needed to explain [mis]match. CONCLUSION Mismatch occurred as constant underuse or as delayed MHC-use in a high-income country (Netherlands). Additionally, no meaningful class revealed constantly matched care on average. Presence of suicidal ideation could influence the probability of symptomatic individuals receiving matched MHC or not.
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Affiliation(s)
- Kalpani Wijekoon Wijekoon Mudiyanselage
- Leibniz Institute for Prevention Research and Epidemiology - BIPS. Department of Prevention and Evaluation, Achterstr. 30, 28359 Bremen, Germany; Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, University Medical Center Groningen, the Netherlands.
| | - Jojanneke A Bastiaansen
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, University Medical Center Groningen, the Netherlands; Department of Education and Research, Friesland Mental Health Care Services, Leeuwarden, the Netherlands.
| | - Roy Stewart
- Department of Health Sciences, Community & Occupational Medicine, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Klaas J Wardenaar
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Brenda W J H Penninx
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, University Medical Center Groningen, the Netherlands; Department of Psychiatry/EMGO Institute/Institute for Neurosciences, VU University Medical Center, Amsterdam, the Netherlands; Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
| | - Robert A Schoevers
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Albert M van Hemert
- Department of Psychiatry/EMGO Institute/Institute for Neurosciences, VU University Medical Center, Amsterdam, the Netherlands; Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
| | - Frederike Jörg
- Leibniz Institute for Prevention Research and Epidemiology - BIPS. Department of Prevention and Evaluation, Achterstr. 30, 28359 Bremen, Germany; Department of Education and Research, Friesland Mental Health Care Services, Leeuwarden, the Netherlands.
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Ehsan A, Re A, Rivera Perla K, Aghagoli G, Bellam K, Sellke F. Trends and outcomes of coronary artery bypass grafting in patients with major depressive disorder: A perspective from the national inpatient sample. HEART AND MIND 2022. [DOI: 10.4103/hm.hm_62_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Edinoff AN, Hegefeld TL, Petersen M, Patterson JC, Yossi C, Slizewski J, Osumi A, Cornett EM, Kaye A, Kaye JS, Javalkar V, Viswanath O, Urits I, Kaye AD. Transcranial Magnetic Stimulation for Post-traumatic Stress Disorder. Front Psychiatry 2022; 13:701348. [PMID: 35711594 PMCID: PMC9193572 DOI: 10.3389/fpsyt.2022.701348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/13/2022] [Indexed: 11/17/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) is a psychiatric disorder that causes significant functional impairment and is related to altered stress response and reinforced learned fear behavior. PTSD has been found to impact three functional networks in the brain: default mode, executive control, and salience. The executive control network includes the dorsolateral prefrontal cortex (DLPFC) and lateral PPC. The salience network involves the anterior cingulate cortex, anterior insula, and amygdala. This latter network has been found to have increased functional connectivity in PTSD. Transcranial Magnetic Stimulation (TMS) is a technique used in treating PTSD and involves stimulating specific portions of the brain through electromagnetic induction. Currently, high-frequency TMS applied to the left dorsolateral prefrontal cortex (DLPFC) is approved for use in treating major depressive disorder (MDD) in patients who have failed at least one medication trial. In current studies, high-frequency stimulation has been shown to be more effective in PTSD rating scales posttreatment than low-frequency stimulation. The most common side effect is headache and scalp pain treated by mild analgesics. Seizures are a rare side effect and are usually due to predisposing factors. Studies have been done to assess the overall efficacy of TMS. However, results have been conflicting, and sample sizes were small. More research should be done with larger sample sizes to test the efficacy of TMS in the treatment of PTSD. Overall, TMS is a relatively safe treatment. Currently, the only FDA- approved to treat refractory depression, but with the potential to treat many other conditions.
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Affiliation(s)
- Amber N Edinoff
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA, United States
| | - Tanner L Hegefeld
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA, United States
| | - Murray Petersen
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA, United States
| | - James C Patterson
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA, United States
| | | | - Jacob Slizewski
- Creighton University School of Medicine, Omaha, NE, United States
| | - Ashley Osumi
- Creighton University School of Medicine, Omaha, NE, United States
| | - Elyse M Cornett
- Department of Anesthesiology, Louisiana State University Shreveport, Shreveport, LA, United States
| | - Adam Kaye
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA, United States
| | - Jessica S Kaye
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA, United States
| | - Vijayakumar Javalkar
- Department of Neurology, Louisiana State University Shreveport, Shreveport, LA, United States
| | - Omar Viswanath
- College of Medicine-Phoenix, University of Arizona, Phoenix, AZ, United States.,Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, United States.,Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ, United States
| | - Ivan Urits
- Department of Anesthesiology, Louisiana State University Shreveport, Shreveport, LA, United States.,Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA, United States
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Shreveport, Shreveport, LA, United States
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Pearson C, Siegel J, Gold JA. Psilocybin-assisted psychotherapy for depression: Emerging research on a psychedelic compound with a rich history. J Neurol Sci 2021; 434:120096. [PMID: 34942586 DOI: 10.1016/j.jns.2021.120096] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/22/2021] [Accepted: 12/12/2021] [Indexed: 12/13/2022]
Abstract
There is a serious need for novel therapies that treat individuals with depression, including major depressive disorder (MDD) and treatment-resistant depression (TRD). An emerging body of research has demonstrated that psychedelic drugs such as psilocybin, combined with supportive psychotherapy, exert rapid and sustained antidepressant effects. The use of psychedelics is not new: they have a rich history with evidence of their use in ritual and medical settings. However, due to political, social, and cultural pressures, their use was limited until modern clinical trials began to emerge in the 2010s. This review provides a comprehensive look at the potential use of psilocybin in the treatment of depression and TRD. It includes an overview of the history, pharmacology, and proposed mechanism of psilocybin, and describes several published studies in the last decade which have provided evidence of the efficacy and safety of psilocybin-assisted psychotherapy for individuals with depression. It also includes a discussion of the limitations and barriers of current research on psychedelics. The results of these studies are contextualized within the current treatment landscape through an overview of the pathophysiology of depression and the treatments currently in use, as well as the clinical needs these novel therapies have the promise to fulfill.
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Affiliation(s)
- Craig Pearson
- Washington University School of Medicine, St. Louis, MO 63108, United States of America
| | - Joshua Siegel
- Washington University School of Medicine, St. Louis, MO 63108, United States of America
| | - Jessica A Gold
- Washington University School of Medicine, St. Louis, MO 63108, United States of America.
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24
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Association of functional disability and treatment modalities with perceived effectiveness of treatment among adults with depression: a cross-sectional study. Disabil Health J 2021; 15:101264. [DOI: 10.1016/j.dhjo.2021.101264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 11/19/2022]
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25
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Juul S, Siddiqui F, Barbateskovic M, Jørgensen CK, Hengartner MP, Kirsch I, Gluud C, Jakobsen JC. Beneficial and harmful effects of antidepressants versus placebo, 'active placebo', or no intervention for adults with major depressive disorder: a protocol for a systematic review of published and unpublished data with meta-analyses and trial sequential analyses. Syst Rev 2021; 10:154. [PMID: 34034811 PMCID: PMC8152051 DOI: 10.1186/s13643-021-01705-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 05/14/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Major depressive disorder is one of the most common, burdensome, and costly psychiatric disorders worldwide. Antidepressants are frequently used to treat major depressive disorder. It has been shown repeatedly that antidepressants seem to reduce depressive symptoms with a statistically significant effect, but the clinical importance of the effect sizes seems questionable. Both beneficial and harmful effects of antidepressants have not previously been sufficiently assessed. The main objective of this review will be to evaluate the beneficial and harmful effects of antidepressants versus placebo, 'active placebo', or no intervention for adults with major depressive disorder. METHODS/DESIGN A systematic review with meta-analysis will be reported as recommended by Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), bias will be assessed with the Cochrane Risk of Bias tool-version 2 (ROB2), our eight-step procedure will be used to assess if the thresholds for clinical significance are crossed, Trial Sequential Analysis will be conducted to control for random errors, and the certainty of the evidence will be assessed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. To identify relevant trials, we will search both for published and unpublished trials in major medical databases from their inception to the present. Clinical study reports will be obtained from regulatory authorities and pharmaceutical companies. Two review authors will independently screen the results of the literature searches, extract data, and perform risk of bias assessment. We will include any published or unpublished randomised clinical trial comparing one or more antidepressants with placebo, 'active placebo', or no intervention for adults with major depressive disorder. The following active agents will be included: agomelatine, amineptine, amitriptyline, bupropion, butriptyline, cianopramine, citalopram, clomipramine, dapoxetine, demexiptiline, desipramine, desvenlafaxine, dibenzepin, dosulepin, dothiepin, doxepin, duloxetine, escitalopram, fluoxetine, fluvoxamine, imipramine, iprindole, levomilnacipran, lofepramine, maprotiline, melitracen, metapramine, milnacipran, mirtazapine, nefazodone, nortriptyline, noxiptiline, opipramol, paroxetine, protriptyline, quinupramine, reboxetine, sertraline, trazodone, tianeptine, trimipramine, venlafaxine, vilazodone, and vortioxetine. Primary outcomes will be depressive symptoms, serious adverse events, and quality of life. Secondary outcomes will be suicide or suicide attempt, suicidal ideation, and non-serious adverse events. DISCUSSION As antidepressants are commonly used to treat major depressive disorder in adults, a systematic review evaluating their beneficial and harmful effects is urgently needed. This review will inform best practice in treatment and clinical research of this highly prevalent and burdensome disorder. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020220279.
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Affiliation(s)
- Sophie Juul
- Stolpegaard Psychotherapy Centre, Mental Health Services in the Capital Region of Denmark, Stolpegaardsvej 28, 2820, Gentofte, Denmark. .,Department of Psychology, University of Copenhagen, Østre Farimagsgade 2A, København K, 1353, Copenhagen, Denmark. .,Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital -- Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Faiza Siddiqui
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital -- Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Marija Barbateskovic
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital -- Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Caroline Kamp Jørgensen
- Stolpegaard Psychotherapy Centre, Mental Health Services in the Capital Region of Denmark, Stolpegaardsvej 28, 2820, Gentofte, Denmark.,Department of Psychology, University of Copenhagen, Østre Farimagsgade 2A, København K, 1353, Copenhagen, Denmark.,Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital -- Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Michael Pascal Hengartner
- Department of Applied Psychology, Zurich University of Applied Sciences, Pfingstweidstrasse 96, 8005, Zurich, Switzerland
| | - Irving Kirsch
- Program in Placebo Studies, Harvard Medical School, 330 Brookline Avenue, Boston, Massachusetts, 02215, USA
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital -- Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, J.B. Winsløws Vej 19, 3, 5000, Odense C, Denmark
| | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital -- Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, J.B. Winsløws Vej 19, 3, 5000, Odense C, Denmark
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Lew SY, Teoh SL, Lim SH, Lim LW, Wong KH. Discovering the Potentials of Medicinal Mushrooms in Combating Depression - A Review. Mini Rev Med Chem 2021; 20:1518-1531. [PMID: 32452327 DOI: 10.2174/1389557520666200526125534] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/23/2020] [Accepted: 03/23/2020] [Indexed: 01/21/2023]
Abstract
Depression is the most common form of mental illness and the major cause of disability worldwide. Symptoms of depression, including feelings of intense sadness and hopelessness, may occur after a specific event or in response to a gradual decline in health and functional status, often associated with aging. Current therapies for treating these symptoms include antidepressant drugs, counseling and behavioral therapy. However, antidepressant drugs are associated with mild to severe adverse effects, which has prompted the need for better treatment options. Medicinal mushrooms are valuable sources of food and medicine and are increasingly being used as supplements or as alternative medicines in standard healthcare. Numerous studies have provided insights into the neuroprotective effects of medicinal mushrooms, which are attributed to their antioxidant, anti-neuroinflammatory, cholinesterase inhibitory and neuroprotective properties. In this review, we comprehensively examine the role of these medicinal mushrooms in the treatment of depression. However, to apply these natural products in clinical settings, the therapeutic agent needs to be properly evaluated, including the active ingredients, the presence of synergistic effects, efficient extraction methods, and stabilization of the active ingredients for delivery into the body as well as crossing the blood-brain barrier.
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Affiliation(s)
- Sze Yuen Lew
- Department of Anatomy, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Seong Lin Teoh
- Department of Anatomy, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
| | - Siew Huah Lim
- Department of Chemistry, Faculty of Science, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Lee Wei Lim
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Kah Hui Wong
- Department of Anatomy, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
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Raevuori A, Vahlberg T, Korhonen T, Hilgert O, Aittakumpu-Hyden R, Forman-Hoffman V. A therapist-guided smartphone app for major depression in young adults: A randomized clinical trial. J Affect Disord 2021; 286:228-238. [PMID: 33743385 DOI: 10.1016/j.jad.2021.02.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/14/2021] [Accepted: 02/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Meru Health Program (MHP) is a therapist-guided, 8-week intervention for depression delivered via smartphone. The aim was to test its efficacy in patients with clinical depression in a Finnish university student health service. METHODS Patients (n=124, women 72.6%, mean age 25y) were stratified based on antidepressant status, and randomized into intervention group receiving MHP plus treatment as usual (TAU), and control group receiving TAU only. Depression, measured by the Patient Health Questionnaire-9 (PHQ-9) scale, was the primary outcome. After baseline (T0), follow-ups were at mid-intervention (T4), immediately post-intervention (T8); 3 months (T20), and 6 months (T32) post-intervention. RESULTS The intervention group and control group did not have significant differences in depression outcomes throughout end of treatment and follow-up. Among secondary outcomes, increase in resilience (d=0.32, p=0.03) and mindfulness (d=0.57, p=0.002), and reduction in perceived stress (d=-0.52, p=0.008) were greater in MHP+TAU versus TAU at T32; no differences were found in anxiety, sleep disturbances, and quality of life between groups. Post-hoc comparisons of patients on antidepressants showed significantly greater reduction in depression at T32 for MHP+TAU versus TAU (d=-0.73, p=0.01); patients not on antidepressants showed no between-group differences. LIMITATIONS Limitations include unknown characteristics of TAU, potential bias from patients and providers not being blinded to treatment group, and failure to specify examination of differences by antidepressant status in the protocol. CONCLUSIONS Most outcomes, including depression, did not significantly differ between MHP+TAU and TAU. Exploratory analysis revealed intervention effect at the end of the 6-month follow-up among patients on antidepressant medication.
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Affiliation(s)
- Anu Raevuori
- Department of Adolescent Psychiatry, Helsinki University Hospital, Helsinki, Finland; Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland.
| | - Tero Vahlberg
- Department of Biostatistics, University of Turku, Turku, Finland
| | - Tellervo Korhonen
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Finland
| | - Outi Hilgert
- Meru Health Inc. Palo Alto, The United States & Helsinki, Finland
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28
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Fernandes S, Fond G, Zendjidjian X, Michel P, Lançon C, Berna F, Schurhoff F, Aouizerate B, Henry C, Etain B, Samalin L, Leboyer M, Misdrahi D, Llorca PM, Coldefy M, Auquier P, Baumstarck K, Boyer L. A conceptual framework to develop a patient-reported experience measure of the quality of mental health care: a qualitative study of the PREMIUM project in France. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2021; 9:1885789. [PMID: 33680364 PMCID: PMC7906613 DOI: 10.1080/20016689.2021.1885789] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Background: The objective of this study was to develop a conceptual framework to define a domain map describing the experience of patients with severe mental illnesses (SMIs) on the quality of mental health care. Methods: This study used an exploratory qualitative approach to examine the subjective experience of adult patients (18-65 years old) with SMIs, including schizophrenia (SZ), bipolar disorder (BD) and major depressive disorder (MDD). Participants were selected using a purposeful sampling method. Semistructured interviews were conducted with 37 psychiatric inpatients and outpatients recruited from the largest public hospital in southeastern France. Transcripts were subjected to an inductive analysis by using two complementary approaches (thematic analysis and computerized text analysis) to identify themes and subthemes. Results: Our analysis generated a conceptual model composed of 7 main themes, ranked from most important to least important as follows: interpersonal relationships, care environment, drug therapy, access and care coordination, respect and dignity, information and psychological care. The interpersonal relationships theme was divided into 3 subthemes: patient-staff relationships, relations with other patients and involvement of family and friends. All themes were spontaneously raised by respondents. Conclusion: This work provides a conceptual framework that will inform the subsequent development of a patient-reported experience measure to monitor and improve the performance of the mental health care system in France. The findings showed that patients with SMIs place an emphasis on the interpersonal component, which is one of the important predictors of therapeutic alliance. Trial registration: NCT02491866.
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Affiliation(s)
- S Fernandes
- Aix-Marseille Univ, School of Medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, Marseille, France
- CONTACT S Fernandes
| | - G Fond
- Aix-Marseille Univ, School of Medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, Marseille, France
| | - X Zendjidjian
- Aix-Marseille Univ, School of Medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, Marseille, France
| | - P Michel
- Aix-Marseille Univ, School of Medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, Marseille, France
| | - C Lançon
- Aix-Marseille Univ, School of Medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, Marseille, France
| | - F Berna
- FondaMental Foundation, Créteil, France
| | | | | | - C Henry
- FondaMental Foundation, Créteil, France
| | - B Etain
- FondaMental Foundation, Créteil, France
| | - L Samalin
- FondaMental Foundation, Créteil, France
| | - M Leboyer
- FondaMental Foundation, Créteil, France
| | | | - PM Llorca
- FondaMental Foundation, Créteil, France
| | - M Coldefy
- Institute for Research and Information in Health Economics (IRDES), Paris, France
| | - P Auquier
- Aix-Marseille Univ, School of Medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, Marseille, France
| | - K Baumstarck
- Aix-Marseille Univ, School of Medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, Marseille, France
| | - L Boyer
- Aix-Marseille Univ, School of Medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, Marseille, France
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29
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Høstmaelingen A, Ulvenes P, Nissen-Lie HA, Eielsen M, Wampold BE. Comparing outcomes in chronic depression following inpatient psychotherapy for patients continuing versus discontinuing antidepressant medication. Clin Psychol Psychother 2021; 28:1111-1127. [PMID: 33527551 DOI: 10.1002/cpp.2561] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 01/24/2021] [Indexed: 11/09/2022]
Abstract
Research indicates that combination of psychotherapy and antidepressant medication (ADM) provides cumulative effects and thus outperforms monotherapy in treating chronic depression. In this quasi-experimental study, we explored symptom change for patients with chronic depression treated with ADM when presenting for a 12-week psychotherapeutic inpatient treatment programme. We compared outcomes through treatment and follow-up of patients who continued medication with those who discontinued. We also tested possible moderator effects of initial depression severity on change between the groups. Based on prior research, we hypothesized that combination treatment would yield better results (i.e., more reduction in depression). Patients (N = 112) were referred from general practitioners or local secondary health care. Outcome was measured by Beck Depression Inventory-II (BDI-II), and comparisons were carried out using multilevel modelling. Although 35 patients discontinued ADM during treatment, 77 continued. Both continuers and discontinuers had a significant treatment effect that was maintained at 1-year follow-up. There was no difference in outcome between continuers and discontinuers of ADM. Patients with severe depression had significantly more symptom improvement than patients with moderate depression, but depression severity did not affect outcomes across continuers and discontinuers of ADM differently. The results could indicate that patients had developed resistance and/or tolerance to the prophylactic effects of medication and that ADM did not contribute to the reduction of depressive symptoms. The findings may also indicate that psychotherapy alone in some instances can be a viable alternative to continued combined treatment. Clinicians should carefully assess benefits of patients' ongoing use of antidepressant medication when entering psychotherapy.
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Affiliation(s)
| | - Pål Ulvenes
- Department of Psychology, University of Oslo, Oslo, Norway.,Modum Bad Research Institute, Modum Bad, Vikersund, Norway
| | | | - Mikkel Eielsen
- Modum Bad Research Institute, Modum Bad, Vikersund, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Bruce E Wampold
- Modum Bad Research Institute, Modum Bad, Vikersund, Norway.,Department of Counseling Psychology, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Díaz-García A, González-Robles A, García-Palacios A, Fernández-Álvarez J, Castilla D, Bretón JM, Baños RM, Quero S, Botella C. Negative and Positive Affect Regulation in a Transdiagnostic Internet-Based Protocol for Emotional Disorders: Randomized Controlled Trial. J Med Internet Res 2021; 23:e21335. [PMID: 33522977 PMCID: PMC7884218 DOI: 10.2196/21335] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/10/2020] [Accepted: 12/01/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Emotional disorders (EDs) are among the most prevalent mental disorders. Existing evidence-based psychological treatments are not sufficient to reduce the disease burden of mental disorders. It is therefore essential to implement innovative solutions to achieve a successful dissemination of psychological treatment protocols, and in this regard, the use of information and communication technologies such as the internet can be very useful. Furthermore, the literature suggests that not everyone with an ED receives the appropriate treatment. This situation has led to the development of new intervention proposals based on the transdiagnostic perspective, which attempts to address the underlying processes common to EDs. Most of these transdiagnostic interventions focus primarily on downregulating negative affectivity (NA), and less attention has been paid to strengths and the upregulation of positive affectivity, despite its importance for well-being and mental health. OBJECTIVE This study aims to evaluate the efficacy of a transdiagnostic internet-based treatment for EDs in a community sample. METHODS A 3-armed randomized controlled trial was conducted. A total of 216 participants were randomly assigned to a transdiagnostic internet-based protocol (TIBP), a TIBP+ positive affect (PA) component, or a waiting list (WL) control group. The treatment protocol contained core components mainly addressed to downregulate NA (ie, present-focused emotional awareness and acceptance, cognitive flexibility, behavioral and emotional avoidance patterns, and interoceptive and situational exposure) as well as a PA regulation component to promote psychological strengths and enhance well-being. Data on depression, anxiety, quality of life, neuroticism and extraversion, and PA/NA before and after treatment were analyzed. Expectations and opinions of treatment were also analyzed. RESULTS Within-group comparisons indicated significant pre-post reductions in the two experimental conditions. In the TIBP+PA condition, the effect sizes were large for all primary outcomes (d=1.42, Beck Depression Inventory [BDI-II]; d=0.91, Beck Anxiety Inventory [BAI]; d=1.27, Positive and Negative Affect Schedule-Positive [PANAS-P]; d=1.26, Positive and Negative Affect Schedule-Negative [PANAS-N]), whereas the TIBP condition yielded large effect sizes for BDI-II (d=1.19) and PANAS-N (d=1.28) and medium effect sizes for BAI (d=0.63) and PANAS-P (d=0.69). Between-group comparisons revealed that participants who received one of the two active treatments scored better at posttreatment than WL participants. Although there were no statistically significant differences between the two intervention groups on the PA measure, effect sizes were consistently larger in the TIBP+PA condition than in the standard transdiagnostic protocol. CONCLUSIONS Overall, the findings indicate that EDs can be effectively treated with a transdiagnostic intervention via the internet, as significant improvements in depression, anxiety, and quality of life measures were observed. Regarding PA measures, promising effects were found, but more research is needed to study the role of PA as a therapeutic component. TRIAL REGISTRATION ClinicalTrials.gov NCT02578758; https://clinicaltrials.gov/ct2/show/NCT02578758. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12888-017-1297-z.
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Affiliation(s)
- Amanda Díaz-García
- Department of Psychology and Sociology, Universidad de Zaragoza, Teruel, Spain
| | | | - Azucena García-Palacios
- Universitat Jaume I, Castellón de la Plana, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Carlos III, Madrid, Spain
| | | | - Diana Castilla
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Carlos III, Madrid, Spain
- Department of Personality, Evaluation and Psychological Treatments, Universidad de Valencia, Valencia, Spain
| | | | - Rosa María Baños
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Carlos III, Madrid, Spain
- Department of Personality, Evaluation and Psychological Treatments, Universidad de Valencia, Valencia, Spain
| | | | - Cristina Botella
- Universitat Jaume I, Castellón de la Plana, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Carlos III, Madrid, Spain
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Görgülü E, Bieber M, Engeroff T, Zabel K, Etyemez S, Prvulovic D, Reif A, Oertel V. Physical activity, physical self-perception and depression symptoms in patients with major depressive disorder: a mediation analysis. Eur Arch Psychiatry Clin Neurosci 2021; 271:1205-1215. [PMID: 34282468 PMCID: PMC8429392 DOI: 10.1007/s00406-021-01299-z] [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: 07/04/2021] [Indexed: 11/21/2022]
Abstract
Physical inactivity is discussed as one of the most detrimental influences for lifestyle-related medical complications such as obesity, heart disease, hypertension, diabetes and premature mortality in in- and outpatients with major depressive disorder (MDD). In contrast, intervention studies indicate that moderate-to-vigorous-intensity physical activity (MVPA) might reduce complications and depression symptoms itself. Self-reported data on depression [Beck-Depression-Inventory-II (BDI-II)], general habitual well-being (FAHW), self-esteem and physical self-perception (FAHW, MSWS) were administrated in a cross-sectional study with 76 in- and outpatients with MDD. MVPA was documented using ActiGraph wGT3X + ® accelerometers and fitness was measured using cardiopulmonary exercise testing (CPET). Subgroups were built according to activity level (low PA defined as MVPA < 30 min/day, moderate PA defined as MVPA 30-45 min/day, high PA defined as MVPA > 45 min/day). Statistical analysis was performed using a Mann-Whitney U and Kruskal-Wallis test, Spearman correlation and mediation analysis. BDI-II scores and MVPA values of in- and outpatients were comparable, but fitness differed between the two groups. Analysis of the outpatient group showed a negative correlation between BDI-II and MVPA. No association of inpatient MVPA and psychopathology was found. General habitual well-being and self-esteem mediated the relationship between outpatient MVPA and BDI-II. The level of depression determined by the BDI-II score was significantly higher in the outpatient low- and moderate PA subgroups compared to outpatients with high PA. Fitness showed no association to depression symptoms or well-being. To ameliorate depressive symptoms of MDD outpatients, intervention strategies should promote habitual MVPA and exercise exceeding the duration recommended for general health (≥ 30 min/day). Further studies need to investigate sufficient MVPA strategies to impact MDD symptoms in inpatient settings. Exercise effects seem to be driven by changes of well-being rather than increased physical fitness.
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Affiliation(s)
- Esra Görgülü
- Institute of Occupational, Social and Environmental Medicine, University Hospital of Frankfurt, Frankfurt am Main, Germany.
| | - Miriam Bieber
- grid.411088.40000 0004 0578 8220Institute of Occupational, Social and Environmental Medicine, University Hospital of Frankfurt, Frankfurt am Main, Germany
| | - Tobias Engeroff
- grid.7839.50000 0004 1936 9721Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
| | - Kirsten Zabel
- grid.411088.40000 0004 0578 8220Institute of Occupational, Social and Environmental Medicine, University Hospital of Frankfurt, Frankfurt am Main, Germany
| | - Semra Etyemez
- grid.21107.350000 0001 2171 9311Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - David Prvulovic
- grid.411088.40000 0004 0578 8220Institute of Occupational, Social and Environmental Medicine, University Hospital of Frankfurt, Frankfurt am Main, Germany
| | - Andreas Reif
- grid.411088.40000 0004 0578 8220Institute of Occupational, Social and Environmental Medicine, University Hospital of Frankfurt, Frankfurt am Main, Germany
| | - Viola Oertel
- grid.411088.40000 0004 0578 8220Institute of Occupational, Social and Environmental Medicine, University Hospital of Frankfurt, Frankfurt am Main, Germany
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Management of Mental Health Disorders, Substance Use Disorders, and Suicide in Adults with Spinal Cord Injury. J Spinal Cord Med 2021; 44:102-162. [PMID: 33630722 PMCID: PMC7993020 DOI: 10.1080/10790268.2021.1863738] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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33
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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: 236] [Impact Index Per Article: 78.7] [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.
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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
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Bombardier CH, Azuero CB, Fann JR, Kautz DD, Richards JS, Sabharwal S. Management of Mental Health Disorders, Substance Use Disorders, and Suicide in Adults with Spinal Cord Injury: Clinical Practice Guideline for Healthcare Providers. Top Spinal Cord Inj Rehabil 2021; 27:152-224. [PMID: 34108836 PMCID: PMC8152173 DOI: 10.46292/sci2702-152] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | - Casey B. Azuero
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jesse R. Fann
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Donald D. Kautz
- School of Nursing, University of North Carolina Greensboro, Greensboro, NC, USA
| | - J. Scott Richards
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sunil Sabharwal
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
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Matthews EB, Savoy M, Paranjape A, Washington D, Hackney T, Galis D, Zisman-Ilani Y. Shared Decision Making in Primary Care Based Depression Treatment: Communication and Decision-Making Preferences Among an Underserved Patient Population. Front Psychiatry 2021; 12:681165. [PMID: 34322040 PMCID: PMC8310927 DOI: 10.3389/fpsyt.2021.681165] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/15/2021] [Indexed: 12/19/2022] Open
Abstract
Objectives: Although depression is a significant public health issue, many individuals experiencing depressive symptoms are not effectively linked to treatment by their primary care provider, with underserved populations have disproportionately lower rates of engagement in depression care. Shared decision making (SDM) is an evidence-based health communication framework that can improve collaboration and optimize treatment for patients, but there is much unknown about how to translate SDM into primary care depression treatment among underserved communities. This study seeks to explore patients' experiences of SDM, and articulate communication and decision-making preferences among an underserved patient population receiving depression treatment in an urban, safety net primary care clinic. Methods: Twenty-seven patients with a depressive disorder completed a brief, quantitative survey and an in-depth semi-structured interview. Surveys measured patient demographics and their subjective experience of SDM. Qualitative interview probed for patients' communication preferences, including ideal decision-making processes around depression care. Interviews were transcribed verbatim and analyzed using thematic analysis. Univariate statistics report quantitative findings. Results: Overall qualitative and quantitative findings indicate high levels of SDM. Stigma related to depression negatively affected patients' initial attitude toward seeking treatment, and underscored the importance of patient-provider rapport. In terms of communication and decision-making preferences, patients preferred collaboration with doctors during the information sharing process, but desired control over the final, decisional outcome. Trust between patients and providers emerged as a critical precondition to effective SDM. Respondents highlighted several provider behaviors that helped facilitated such an optimal environment for SDM to occur. Conclusion: Underserved patients with depression preferred taking an active role in their depression care, but looked for providers as partner in this process. Due to the stigma of depression, effective SDM first requires primary care providers to ensure that they have created a safe and trusting environment where patients are able to discuss their depression openly.
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Affiliation(s)
- Elizabeth B Matthews
- Graduate School of Social Service, Fordham University, New York, NY, United States
| | - Margot Savoy
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Anuradha Paranjape
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Diana Washington
- College of Public Health, Temple University, Philadelphia, PA, United States
| | - Treanna Hackney
- College of Public Health, Temple University, Philadelphia, PA, United States
| | - Danielle Galis
- Graduate School of Social Service, Fordham University, New York, NY, United States
| | - Yaara Zisman-Ilani
- College of Public Health, Temple University, Philadelphia, PA, United States
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Gajendran M, Sifuentes J, Bashashati M, McCallum R. Cannabinoid hyperemesis syndrome: definition, pathophysiology, clinical spectrum, insights into acute and long-term management. J Investig Med 2020; 68:1309-1316. [PMID: 33115959 DOI: 10.1136/jim-2020-001564] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2020] [Indexed: 12/15/2022]
Abstract
Although cannabinoid hyperemesis syndrome (CHS) was first reported more than 15 years ago, it still remains an unfamiliar clinical entity among physicians worldwide. CHS is categorized by Rome IV classification as a functional gastroduodenal disorder. It is characterized by stereotypical episodic vomiting in the setting of chronic, daily cannabis use, with cycles decreasing by the cessation of cannabis. CHS is also associated with abdominal pain reduced by hot baths and showers with comparative well-being between attacks. Thus, its clinical presentation resembles 'classic' cyclic vomiting syndrome, but eliciting a cannabis history is crucial in diagnosing this entity. In acute attacks, parenteral benzodiazepines are very effective. For prevention and long-term management, tricyclic antidepressants such as amitriptyline are the mainstay of therapy requiring doses in the range of 50-200 mg/d to achieve symptom control. In addition, counseling to achieve marijuana cessation, accompanied by antianxiety medications, is necessary for sustaining clinical outcomes. Once the patient is in remission and off marijuana for a period of 6-12 months, then tapering the dose of amitriptyline can be implemented, with the goal of no therapy being achieved in the majority of patients over time. With the legalization of marijuana in many states, CHS will become an increasingly prevalent clinical entity, so educating about CHS is an important goal, particularly for emergency department physicians who generally first encounter these patients.
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Affiliation(s)
- Mahesh Gajendran
- Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, Paul L Foster School of Medicine, El Paso, Texas, USA
| | - Joshua Sifuentes
- Department of Gastroenterology, Texas Tech University Health Sciences Center El Paso, Paul L Foster School of Medicine, El Paso, Texas, USA
| | - Mohammad Bashashati
- Department of Gastroenterology, Texas Tech University Health Sciences Center El Paso, Paul L Foster School of Medicine, El Paso, Texas, USA
| | - Richard McCallum
- Department of Gastroenterology, Center for Neurogastroenterology and GI Motility, Texas Tech University Health Sciences Center El Paso, Paul L Foster School of Medicine, El Paso, Texas, USA
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Lewandowska K, Węziak-Białowolska D. The impact of theatre on empathy and self-esteem: a meta-analysis. CREATIVITY RESEARCH JOURNAL 2020. [DOI: 10.1080/10400419.2020.1821553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
BACKGROUND Major depressive disorder is estimated by the WHO to affect more than 300 million people globally, making depression the leading cause of disability worldwide. Antidepressants are commonly used to treat depression. OBJECTIVE The study aimed to provide an update on the evidence on the effects of antidepressants compared with placebo. Should antidepressants be used for adults with major depressive disorder? STUDY SELECTION We searched the Cochrane Library, BMJ Best Practice and PubMed up to June 2019 with the search terms 'depression' and 'antidepressants' targeting reviews published in English since 1990. FINDINGS Several reviews have assessed the effects of antidepressants compared with placebo for depression. Generally, all the previous reviews show that antidepressants seem to have statistically significant effects on depressive symptoms, but the size of the effect has questionable importance to most patients. Antidepressants seem to have minimal beneficial effects on depressive symptoms and increase the risk of both serious and non-serious adverse events. CONCLUSIONS The benefits of antidepressants seem to be minimal and possibly without any importance to the average patient with major depressive disorder. Antidepressants should not be used for adults with major depressive disorder before valid evidence has shown that the potential beneficial effects outweigh the harmful effects.
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Affiliation(s)
- Janus Christian Jakobsen
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Cardiology, Holbaek Hospital, Holbaek, Denmark
- Department of Regional Health Research, The Faculty of Heath Sciences, University of Southern Denmark, Denmark
| | - Christian Gluud
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Irving Kirsch
- Program in Placebo Studies, Harvard Medical School, Boston, Massachusetts, USA
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Kligerman MP, Devine EE, Bentzley JP, Megwalu UC. Cost-Effectiveness of Depression Screening for Otolaryngology-Head and Neck Surgery Residents. Laryngoscope 2020; 131:502-508. [PMID: 32510589 DOI: 10.1002/lary.28780] [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: 03/31/2020] [Revised: 04/29/2020] [Accepted: 05/10/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES This study aims to determine the cost-effectiveness of screening and treating otolaryngology-head and neck surgery residents for depression. METHODS A Markov model was built using TreeAgePro, version 2019 (TreeAge Software Inc.; Williamstown, MA) to assess the cost-effectiveness of five potential treatment algorithms: 1) treat all residents with psychotherapy, 2) screen and treat depressed residents with psychotherapy, 3) screen and treat depressed residents with pharmacotherapy, 4) screen and treat depressed residents with combination psychotherapy/pharmacotherapy, and 5) no intervention. A Monte Carlo probabilistic sensitivity analysis (PSA), consisting of 1 thousand simulations over a cumulative 5-year period, was performed to evaluate both base case values and a range of values for model variables. RESULTS Screening residents for depression and treating with combination psychotherapy/pharmacotherapy was cost-effective and the optimal strategy at a willingness-to-pay threshold of $50 thousand per quality-adjusted life year (QALY). This option demonstrated an incremental cost-effectiveness ratio of $27,578 per QALY for base case values. PSA confirmed these results and demonstrated that screening residents for depression and treating with either combination pharmacotherapy/psychotherapy, pharmacotherapy alone, or psychotherapy alone were cost-effective options in 94.9% of simulations. CONCLUSION Depression and burnout remain crucial issues among resident physicians. This study demonstrates that actively screening residents for depression is cost-effective. Based on these results, residency programs may consider trialing standardized depression screening protocols. LEVEL OF EVIDENCE I and II. Laryngoscope, 131:502-508, 2021.
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Affiliation(s)
- Maxwell P Kligerman
- Department of Otolaryngology, School of Medicine, Stanford University, Stanford, California, USA
| | - Erin E Devine
- Department of Otolaryngology, School of Medicine, Stanford University, Stanford, California, USA
| | - Jessica P Bentzley
- Department of Psychiatry, School of Medicine, Stanford University, Stanford, California, U.S.A
| | - Uchechukwu C Megwalu
- Department of Otolaryngology, School of Medicine, Stanford University, Stanford, California, USA
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Abstract
In major depression, remission rate in response to monoaminergic antidepressant is around 50%. The lack of strong synergies between classical antidepressants and psychotherapy may be due to the molecular effects of classical antidepressants. They modulate synapses but they do not substantially influence synaptogenesis. They also increase brain-derived neurotrophic factor (BDNF). However, for activity-dependent plasticity, BDNF release has to work in concert with activation of synaptogenesis. There has been considerable excitement about ketamine's antidepressant effect. Ketamine leads to fast changes in synaptic function and plasticity that go well beyond effects of classical antidepressants. As a result, ketamine may turn out to have the capacity to considerably enhance the effects of psychotherapy. Such enhancing effects may become an important clinical indication for ketamine since its purely pharmacological effect is transient. This editorial outlines some mechanistic hypotheses, how Behavioral Activation, Trauma-Focused Psychotherapies and Humanistic Psychotherapy may specifically prolong ketamine's antidepressant effects.
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DeRubeis RJ, Zajecka J, Shelton RC, Amsterdam JD, Fawcett J, Xu C, Young PR, Gallop R, Hollon SD. Prevention of Recurrence After Recovery From a Major Depressive Episode With Antidepressant Medication Alone or in Combination With Cognitive Behavioral Therapy: Phase 2 of a 2-Phase Randomized Clinical Trial. JAMA Psychiatry 2020; 77:237-245. [PMID: 31799993 PMCID: PMC6902236 DOI: 10.1001/jamapsychiatry.2019.3900] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
IMPORTANCE Antidepressant medication (ADM) maintenance treatment is associated with the prevention of depressive recurrence in patients with major depressive disorder (MDD), but whether cognitive behavioral therapy (CBT) treatment is associated with recurrence prevention remains unclear. OBJECTIVE To determine the effects of combining CBT with ADM on the prevention of depressive recurrence when ADMs are withdrawn or maintained after recovery in patients with MDD. DESIGN, SETTING, AND PARTICIPANTS A total of 292 adult outpatients with chronic or recurrent MDD who participated in the second phase of a 2-phase trial. Participants had recovered in the first phase of the trial receiving ADM, either alone or in combination with CBT. The trial was conducted in research clinics in 3 university medical centers in the United States. Patients in phase 2 were randomized to receive maintenance of or withdrawal from ADM and were followed up for 3 years. The first and last patients entered phase 2 in August 2003 and October 2009, respectively. The last patient completed phase 2 in August 2012. Data were analyzed from December 2013 to December 2018. INTERVENTIONS Maintenance of or withdrawal from treatment with ADM. MAIN OUTCOMES AND MEASURES Recurrence of an MDD episode using longitudinal interval follow-up evaluations; sustained recovery across both phases. RESULTS A total of 292 participants (171 women, 121 men; mean [SD] age 45.1 [12.9] years) were included in analyses of depressive recurrence. Maintenance ADM yielded lower rates of recurrence compared with ADM withdrawal regardless of whether patients had achieved recovery in phase 1 with ADM alone (48.5% vs 74.8%; z = -3.16; P = .002; number needed to treat [NNT], 2.8; 95% CI, 1.8-7.0) or ADM plus CBT (48.5% vs 76.7%; z = -3.49; P < .001; NNT, 2.7; 95% CI, 1.9-5.9). Sustained recovery rates differed as a function of phase 2 condition, with maintenance ADM superior to ADM withdrawal (z = 2.90; P = .004; OR, 2.54; 95% CI, 1.37-4.84; NNT, 2.3; 95% CI, 1.5-6.4). Phase 1 condition was not associated with differential rates of sustained recovery (ADM alone vs ADM plus CBT; z = 0.22; P = .83; OR, 1.08; 95% CI, 0.52-2.11; NNT, 26.0; 95% CI, number needed to harm 3.2 to NNT 2.8), nor was there a significant interaction of phase 1 condition and phase 2 condition (z = 0.30; P = .77; OR, 1.14; 95% CI, 0.49-2.88). CONCLUSIONS AND RELEVANCE Maintenance ADM treatment, but not previous exposure to CBT, was associated with reduced rates of depressive recurrence. In previous studies, when CBT has been provided without ADM, CBT has shown a preventive effect on depressive relapse. Whether CBT also has a preventive effect on depressive recurrence, or if adding ADM interferes with any such preventive effect, remains unclear. TRIAL REGISTRATION ClinicalTrial.gov identifier: NCT00057577.
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Affiliation(s)
| | - John Zajecka
- Department of Psychiatry, Rush University, Chicago, Illinois
| | - Richard C. Shelton
- Department of Psychiatry, Vanderbilt University, Nashville, Tennessee,Department of Psychiatry, University of Alabama at Birmingham, Birmingham
| | - Jay D. Amsterdam
- Department of Psychiatry, University of Pennsylvania, Philadelphia
| | - Jan Fawcett
- Department of Psychiatry, University of New Mexico, Albuquerque
| | - Colin Xu
- Department of Psychology, University of Pennsylvania, Philadelphia
| | - Paula R. Young
- Department of Psychiatry, Rush University, Chicago, Illinois
| | - Robert Gallop
- Department of Mathematics and Applied Statistics, West Chester University, West Chester, Pennsylvania
| | - Steven D. Hollon
- Department of Psychology, Vanderbilt University, Nashville, Tennessee
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Duan L, Gao Y, Shao X, Tian C, Fu C, Zhu G. Research on the Development of Theme Trends and Changes of Knowledge Structures of Drug Therapy Studies on Major Depressive Disorder Since the 21 st Century: A Bibliometric Analysis. Front Psychiatry 2020; 11:647. [PMID: 32754061 PMCID: PMC7367417 DOI: 10.3389/fpsyt.2020.00647] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/22/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Antidepressant treatment is one of the most effective ways of relieving or curing depressive symptoms in patients with major depressive disorder (MDD). Although many studies have explored the efficacy, tolerability, adverse reactions, and functional mechanism of the disease, there has been no systematic evaluation of the relevant results in this field. AIM This paper aims to analyze the theme trends and knowledge structure of drug therapy studies on MDD since the 21st century by employing bibliometric analysis. METHODS Literature published in PubMed and related to drug therapy studies on MDD were retrieved between 2001 and 2018 in 6-year increments. After extracting major Medical Subject Headings (MeSH) terms/MeSH subheadings, bi-clustering analysis, social network analysis, and strategic diagrams were employed to complete bibliometric analysis. RESULTS Overall, 1,577, 2,680, 2,848 relevant research articles were retrieved for the periods during 2001-2006, 2007-2012, and 2013-2018, respectively. In line with strategic diagrams, the main undeveloped and peripheral theme clusters during 2001-2006 were functional mechanisms of antidepressants in pathophysiology, neuroendocrinology and neural biochemistry. These themes were replaced during 2007-2012 by clinical efficacy and influencing factors of antidepressants with or without psychotherapy, mechanisms of adverse reactions of antidepressants, and predictive studies of clinical therapeutic effects of antidepressants based on brain imaging. During 2013-2018 application and evaluation of new antidepressant agents, early identification and prevention of suicide of patients with MDD, as well as genetic- or bio-markers affecting the response and efficacy of antidepressants were the primary themes. Based on social network analyses, emerging hotspots, such as antidepressive agents, second-generation/adverse effects, depressive disorder, major/metabolism, psychotherapy/methods, and brain/drug effects could be identified during 2007-2012 and 2013-2018. CONCLUSIONS These undeveloped theme clusters and emerging hotspots can be helpful for researchers to clarify the current status of their respective fields and future trends, and to generate novel ideas that may launch new research directions.
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Affiliation(s)
- Li Duan
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China.,School of Nursing, Chengde Medical University, Chengde, China
| | - Yunfeng Gao
- Department of Hand and Foot Surgery, The Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Xiaojun Shao
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - ChunSheng Tian
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Chunfeng Fu
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Gang Zhu
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China.,Central Laboratory, The First Affiliated Hospital of China Medical University, Shenyang, China
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Whiston A, Bockting CLH, Semkovska M. Towards personalising treatment: a systematic review and meta-analysis of face-to-face efficacy moderators of cognitive-behavioral therapy and interpersonal psychotherapy for major depressive disorder. Psychol Med 2019; 49:2657-2668. [PMID: 31615583 DOI: 10.1017/s0033291719002812] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Consistent evidence suggests that face-to-face cognitive-behavioural therapy (CBT) and interpersonal psychotherapy (IPT) may be equally effective depression treatments. Current clinical research focuses on detecting the best predictors-moderators of efficacy to guide treatment personalisation. However, individual moderator studies show inconsistent findings. This systematic review and meta-analysis aimed to compare the efficacy of CBT and IPT, including combined treatment with antidepressants for depression, and evaluate the predictive power of demographic, clinical presentation and treatment characteristics moderators for both therapies. METHODS PsycArticles, PsycINFO, PubMed and Cochrane Library were systematically searched through December 2017 for studies that have assessed individuals with major depression receiving either CBT or IPT in a face-to-face format both at pre- and post-treatment. Random-effects moderator meta-analyses were conducted. RESULTS In total 168 samples from 137 studies including 11 374 participants qualified for the meta-analytic review. CBT and IPT were equally effective across all but one prespecified moderators. For psychotherapy delivered without concomitant antidepressant treatment [antidepressant medications (ADMs)], CBT was superior to IPT (g = 1.68, Qbetweenp = 0.037). Within-CBT moderator analyses showed that increased CBT efficacy was associated with lower age, high initial depression severity, individual format of administration and no adjunctive ADMs. Within-IPT analyses showed comparable efficacy across all moderators. CONCLUSIONS Clinical guidance around combined treatment (psychotherapy plus ADMs) should be reconsidered. CBT alone is superior to IPT alone and to combined treatment, while IPT alone is non-inferior to combined treatment. More research is needed to assess the moderating effect of older age and number of previous episodes on IPT efficacy.
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Affiliation(s)
- Aoife Whiston
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Claudi L H Bockting
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Maria Semkovska
- Department of Psychology, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
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Shirazian S. Depression in patients undergoing hemodialysis: time to treat. Kidney Int 2019; 96:1264-1266. [PMID: 31420195 DOI: 10.1016/j.kint.2019.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 05/20/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Shayan Shirazian
- Columbia University Medical Center, Division of Nephrology, Department of Medicine, College of Physicians and Surgeons at Columbia University, New York, New York, USA.
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45
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A Retrospective Examination of Symptom Improvements in Primary Care Patients Receiving Behavior Therapy With and Without Concurrent Pharmacotherapy. J Clin Psychol Med Settings 2019; 27:582-592. [DOI: 10.1007/s10880-019-09642-2] [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]
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Kelly JR, Cosgrove M, Judd C, Scott K, Loughlin AM, O’Keane V. Mood matters: a national survey on attitudes to depression. Ir J Med Sci 2019; 188:1317-1327. [DOI: 10.1007/s11845-019-02014-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 03/22/2019] [Indexed: 12/28/2022]
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Tapper C, Arnold R, Pruskowski J. Non-Oral Pharmacotherapy Options for Depression #372. J Palliat Med 2019; 22:454-455. [DOI: 10.1089/jpm.2019.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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A methodological review of meta-analyses of the effectiveness of clinical psychology treatments. Behav Res Methods 2019; 50:2057-2073. [PMID: 29052165 DOI: 10.3758/s13428-017-0973-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This article presents a methodological review of 54 meta-analyses of the effectiveness of clinical psychological treatments, using standardized mean differences as the effect size index. We statistically analyzed the distribution of the number of studies of the meta-analyses, the distribution of the sample sizes in the studies of each meta-analysis, the distribution of the effect sizes in each of the meta-analyses, the distribution of the between-studies variance values, and the Pearson correlations between effect size and sample size in each meta-analysis. The results are presented as a function of the type of standardized mean difference: posttest standardized mean difference, standardized mean change from pretest to posttest, and standardized mean change difference between groups. These findings will help researchers design future Monte Carlo and theoretical studies on the performance of meta-analytic procedures, based on the manipulation of realistic model assumptions and parameters of the meta-analyses. Furthermore, the analysis of the distribution of the mean effect sizes through the meta-analyses provides a specific guide for the interpretation of the clinical significance of the different types of standardized mean differences within the field of the evaluation of clinical psychological interventions.
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Minelli A, Zampieri E, Sacco C, Bazzanella R, Mezzetti N, Tessari E, Barlati S, Bortolomasi M. Clinical efficacy of trauma-focused psychotherapies in treatment-resistant depression (TRD) in-patients: A randomized, controlled pilot-study. Psychiatry Res 2019; 273:567-574. [PMID: 30711853 DOI: 10.1016/j.psychres.2019.01.070] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/23/2019] [Accepted: 01/23/2019] [Indexed: 02/06/2023]
Abstract
In major depressive disorder (MDD) patients, life stress events represent a risk factor for a severe, early-onset, treatment-resistant and chronic endophenotype. Treatment-resistant depression (TRD) patients who have experienced traumatic events could benefit from evidence-based trauma-focused psychotherapies. Because this topic has never been investigated, the aim of this pilot trial was to evaluate whether trauma-focused cognitive-behavioural therapy (TF-CBT) and/or eye movement desensitization and reprocessing (EMDR) can help achieve depressive symptom remission in TRD patients. We carried out a single-blind randomized controlled trial with TRD patients and we compared EMDR (N = 12) with TF-CBT (N = 10). Patients received 3 individual sessions per week over a period of 8 weeks. The symptomatological assessments were performed at 4 timepoints: baseline (T0), 4 (T4), 8 (T8) and 12 (T12) weeks. After 24 weeks, a clinical interview was carried out by phone. All TRD patients showed a significant improvement in depressive symptomatology; however, post hoc comparisons showed a significant difference between the two treatment groups, with lower depressive symptom scores in the EMDR than in the TF-CBT group at the follow-up (T12). This effect was partly maintained at 24 weeks. This pilot study suggests that evidence-based trauma-focused psychotherapies, particularly EMDR, can represent effective interventions to treat TRD patients.
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Affiliation(s)
- Alessandra Minelli
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.
| | - Elisa Zampieri
- Psychiatric Hospital "Villa Santa Chiara", Verona, Italy
| | - Chiara Sacco
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | | | | | | | - Stefano Barlati
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Department of Mental Health and Addiction Services, ASST Spedali Civili, Brescia, Italy
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Abstract
The issue of placebo response and the extent of its effect on psychotherapy is complex for two specific reasons: i) Current standards for drug trials, e.g., true placebo interventions, double-blinding, cannot be applied to most psychotherapy techniques, and ii) some of the "nonspecific effects" in drug therapy have very specific effects in psychotherapy, such as the frequency and intensity of patient-therapist interaction. In addition, different psychotherapy approaches share many such specific effects (the "dodo bird verdict") and lack specificity with respect to therapy outcome. Here, we discuss the placebo effect in psychotherapy under four aspects: a) nonspecific factors shared with drug therapy (context factors); b) nonspecific factors shared among all psychotherapy traditions (common factors); c) specific placebo-controlled options with different psychotherapy modalities; and d) nonspecific control options for the specific placebo effect in psychotherapy. The resulting framework proposes that the exploration and enumeration of context factors, common factors, and specific factors contributes to the placebo effects in psychotherapy.
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Affiliation(s)
- Paul Enck
- Psychosomatic Medicine and Psychotherapy, Department of Internal Medicine VI, University Hospital Tübingen, Tübingen, Germany
| | - Stephan Zipfel
- Psychosomatic Medicine and Psychotherapy, Department of Internal Medicine VI, University Hospital Tübingen, Tübingen, Germany
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