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Cavanah LR, Ray P, Goldhirsh JL, Huey LY, Piper BJ. Rise of escitalopram and the fall of citalopram. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.07.23289632. [PMID: 37214883 PMCID: PMC10197723 DOI: 10.1101/2023.05.07.23289632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Introduction Citalopram and escitalopram are among the most used medications and are key treatments for many psychiatric disorders. Previous findings suggest citalopram and escitalopram prescription rates are changing because of the patent for citalopram ending as opposed to evidence of a clear therapeutic advantage, which is called evergreening. This retrospective study focuses on characterizing the chronologic and geographic variation in the use of citalopram and escitalopram among US Medicaid and Medicare patients. We hypothesized that prescription rates of citalopram will decrease with a concurrent increase in escitalopram, consistent with evergreening. Methods Citalopram and escitalopram prescription rates and costs per state were obtained from the Medicaid State Drug Utilization Database and Medicare Provider Utilization and Payment Data. Annual prescription rates outside a 95% confidence interval were considered significantly different from the average. Results Overall, a decreasing trend for citalopram and an increasing trend for escitalopram prescription rates were noted in both Medicare and Medicaid patients. Cost differences between generic and brand were noted for both drugs, with generic forms being cheaper compared to the brand-name version. Discussion Despite limited evidence suggesting that citalopram and escitalopram have any meaningful differences in therapeutic or adverse effects, there exists a noticeable decline in the use of citalopram that cooccurred with an increase in escitalopram prescribing, consistent with our hypothesis. Moreover, among these general pharmacoepidemiologic trends exists significant geographic variability. There was disproportionate spending (relative to their use) on the brand versions of these medicines compared to their generic forms.
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Affiliation(s)
| | - Parita Ray
- Geisinger Commonwealth School of Medicine, Scranton, PA
| | - Jessica L. Goldhirsh
- Geisinger Commonwealth School of Medicine, Scranton, PA
- Behavioral Health Initiative, Scranton, PA
| | - Leighton Y. Huey
- Geisinger Commonwealth School of Medicine, Scranton, PA
- Behavioral Health Initiative, Scranton, PA
| | - Brian J. Piper
- Geisinger Commonwealth School of Medicine, Scranton, PA
- Center for Pharmacy Innovation and Outcomes, Forty Fort, PA
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Berghs M, Prick AEJC, Vissers C, van Hooren S. Drama Therapy for Children and Adolescents with Psychosocial Problems: A Systemic Review on Effects, Means, Therapeutic Attitude, and Supposed Mechanisms of Change. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1358. [PMID: 36138667 PMCID: PMC9497558 DOI: 10.3390/children9091358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/16/2022]
Abstract
Drama therapy is applied to children and adolescents with psychosocial problems. Drama therapy is an experimental form of treatment which methodologically uses drama and theatre processes to achieve psychological growth. Although in clinical practice, drama therapy has been applied successfully, little is known about how and why drama therapy contributes to a decrease in psychosocial problems. A systematic narrative review was performed to obtain more insight into this issue. Eight databases were systematically searched. Ten out of 3742 studies were included, of which there were four random controlled trails, three non-controlled trials, and three pre-and post-test design studies. We identified the results, drama therapeutic means, attitude, and mechanism of change. Positive effects were found on overall psychosocial problems, internalizing and externalizing problems, social functioning, coping and regulation processes, social identity, and cognitive development. An adaptive approach was mentioned as the therapeutic attitude. The means established contribute to a dramatic reality, which triggers the mechanisms of change. These are processes that arise during treatment and which facilitate therapeutic change. We found ten supposed mechanisms of change to be frequently used in all studies. No direct relations were found between the results, drama therapeutic attitude, means, and mechanisms of change.
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Affiliation(s)
- Marij Berghs
- Royal Dutch Kentalis, 5271 GD Sint-Michielsgestel, The Netherlands
- KenVak, School of Arts Therapies, Zuyd University of Applied Science, 6419 DJ Heerlen, The Netherlands
- Department of Clinical Psychology, Faculty of Psychology, Open University of the Netherlands, 6419 AT Heerlen, The Netherlands
| | - Anna-Eva J. C. Prick
- KenVak, School of Arts Therapies, Zuyd University of Applied Science, 6419 DJ Heerlen, The Netherlands
- Department of Clinical Psychology, Faculty of Psychology, Open University of the Netherlands, 6419 AT Heerlen, The Netherlands
| | - Constance Vissers
- KenVak, School of Arts Therapies, Zuyd University of Applied Science, 6419 DJ Heerlen, The Netherlands
- Behavioural Science Institute, Radboud University, 6525 XZ Nijmegen, The Netherlands
| | - Susan van Hooren
- Department of Clinical Psychology, Faculty of Psychology, Open University of the Netherlands, 6419 AT Heerlen, The Netherlands
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Yang YJ, Chung KM. Pilot Randomized Control Trial of an App-Based CBT Program for Reducing Anxiety in Individuals with ASD without Intellectual Disability. J Autism Dev Disord 2022; 53:1331-1346. [PMID: 35689137 DOI: 10.1007/s10803-022-05617-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2022] [Indexed: 10/18/2022]
Abstract
This study developed and tested the effectiveness of an app-based cognitive behavioral therapy (CBT) program in alleviating anxiety among adolescents and adults with autism without co-occurring intellectual disability. Thirty participants from 15 to 35 years old were randomly assigned to either the intervention or waitlist control group, and self- and caregiver proxy report questionnaires were administered, accompanied by direct behavior observation before and after the intervention period. There was a significant decrease in anxiety level, an increase in positive affect, and a decline in stereotypic behaviors, hyperactivity, noncompliance, and inappropriate speech in proxy reports for the intervention group, compared to the control group. A significant rise in passive response in the direct observation was also seen in the intervention group.
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Affiliation(s)
- Yoon Jung Yang
- Department of Psychology, College of Arts and Science, Yonsei University, Seoul, Korea
| | - Kyong-Mee Chung
- Department of Psychology, College of Arts and Science, Yonsei University, Seoul, Korea.
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Atkinson C, Kenneally O. A model for therapeutic educational psychology practice. EDUCATIONAL PSYCHOLOGY IN PRACTICE 2021. [DOI: 10.1080/02667363.2021.1933393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Cathy Atkinson
- Manchester Institute of Education, Ellen Wilkinson Building, University of Manchester, Manchester, UK
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Kendall PC, Norris LA, Rabner JC, Crane ME, Rifkin LS. Intolerance of Uncertainty and Parental Accommodation: Promising Targets for Personalized Intervention for Youth Anxiety. Curr Psychiatry Rep 2020; 22:49. [PMID: 32666277 PMCID: PMC8098646 DOI: 10.1007/s11920-020-01170-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE OF REVIEW After reviewing predictors of differential outcomes of cognitive behavioral therapy (CBT) for pediatric anxiety, we identify and discuss recent evidence for the role of (a) intolerance of uncertainty (IU) and (b) parental accommodation as meaningful targets for personalized intervention. RECENT FINDINGS Few studies to date have identified promising, theory-driven predictors of differential CBT outcomes. Recent findings suggest that increased IU and high levels of parental accommodation are associated with a poorer response to CBT. Several adaptations of CBT and new interventions targeting either IU or parental accommodation have been developed and found to be efficacious in preliminary studies. IU and parental accommodation are promising constructs for personalizing intervention, both in the identification of who will respond to treatment and in the development of targeted intervention. We recommend that future work test if individuals high in IU and/or parental accommodation will respond more optimally to treatments that specifically target these constructs. The results of this future work may help to move the field closer to personalized intervention.
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Affiliation(s)
- Philip C Kendall
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA, 19122, USA.
| | - Lesley A Norris
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA, 19122, USA
| | - Jonathan C Rabner
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA, 19122, USA
| | - Margaret E Crane
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA, 19122, USA
| | - Lara S Rifkin
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA, 19122, USA
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Tozzi F, Nicolaidou I, Galani A, Antoniades A. eHealth Interventions for Anxiety Management Targeting Young Children and Adolescents: Exploratory Review. JMIR Pediatr Parent 2018; 1:e5. [PMID: 31518330 PMCID: PMC6716078 DOI: 10.2196/pediatrics.7248] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 04/22/2018] [Accepted: 04/24/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Advances in technology are progressively more relevant to the clinical practice of psychology and mental health services generally. Studies indicate that technology facilitates the delivery of interventions, such as cognitive behavioral therapy, in the treatment of psychological disorders in adults, such as depression, anxiety, obsessive-compulsive disorder, panic symptoms, and eating disorders. Fewer data exist for computer-based (stand-alone, self-help) and computer-assisted (in combination with face-to-face therapy, or therapist guided) programs for youth. OBJECTIVE Our objective was to summarize and critically review the literature evaluating the acceptability and efficacy of using technology with treatment and prevention programs for anxiety in young children and adolescents. The aim was to improve the understanding of what would be critical for future development of effective technology-based interventions. METHODS We conducted an exploratory review of the literature through searches in 3 scientific electronic databases (PsycINFO, ScienceDirect, and PubMed). We used keywords in various combinations: child or children, adolescent, preschool children, anxiety, intervention or treatment or program, smartphone applications or apps, online or Web-based tool, computer-based tool, internet-based tool, serious games, cognitive behavioral therapy or CBT, biofeedback, and mindfulness. For inclusion, articles had to (1) employ a technological therapeutic tool with or without the guidance of a therapist; (2) be specific for treatment or prevention of anxiety disorders in children or adolescents; (3) be published between 2000 and 2018; and (4) be published in English and in scientific peer-reviewed journals. RESULTS We identified and examined 197 articles deemed to be relevant. Of these, we excluded 164 because they did not satisfy 1 or more of the requirements. The final review comprised 19 programs. Published studies demonstrated promising results in reducing anxiety, especially relative to the application of cognitive behavioral therapy with technology. For those programs demonstrating efficacy, no difference was noted when compared with traditional interventions. Other approaches have been applied to technology-based interventions with inconclusive results. Most programs were developed to be used concurrently with traditional treatments and lacked long-term evaluation. Very little has been done in terms of prevention interventions. CONCLUSIONS Future development of eHealth programs for anxiety management in children will have to address several unmet needs and overcome key challenges. Although developmental stages may limit the applicability to preschool children, prevention should start in early ages. Self-help formats and personalization are highly relevant for large-scale dissemination. Automated data collection should be built in for program evaluation and effectiveness assessment. And finally, a strategy to stimulate motivation to play and maintain high adherence should be carefully considered.
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Affiliation(s)
| | - Iolie Nicolaidou
- Department of Communication and Internet Studies, Cyprus University of Technology, Limassol, Cyprus
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Conaughton RJ, Donovan CL, March S. Efficacy of an internet-based CBT program for children with comorbid High Functioning Autism Spectrum Disorder and anxiety: A randomised controlled trial. J Affect Disord 2017; 218:260-268. [PMID: 28477505 DOI: 10.1016/j.jad.2017.04.032] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 02/21/2017] [Accepted: 04/19/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND All trials conducted to date on BRAVE-ONLINE for youth anxiety disorders have excluded children with High Functioning Autism Spectrum Disorder (HFASD) and therefore it is unknown whether these programs might be beneficial to HFASD children. The aim of this study was to evaluate the efficacy of BRAVE-ONLINE in HFASD children with an anxiety disorder. METHODS Forty-two HFASD children, aged 8-12 years, with an anxiety disorder, and their parents, were randomly assigned to either the BRAVE-ONLINE condition (NET) or a waitlist control (WLC). Diagnostic interviews and parent/child questionnaires were completed at pre-treatment, post-treatment and 3-month follow-up. RESULTS At post- assessment, compared to children in the WLC condition, children in the NET condition demonstrated a significantly greater reduction in number of anxiety diagnoses, clinical severity of diagnosis, and self and parent reported anxiety symptoms, as well as significantly greater increases in overall functioning. However, loss of primary diagnosis in this sample was lower than in previous studies. LIMITATIONS The small sample size, coupled with attrition rates, makes it difficult to generalise the findings of the study to HFASD population and to conduct analyses regarding mediators, moderators and predictors of outcomes. CONCLUSIONS The BRAVE-ONLINE program may be useful in reducing anxiety symptoms in HFASD children, although the effects are less strong than those found in neurotypical children for a variety of reasons.
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Affiliation(s)
- Rebecca J Conaughton
- School of Applied Psychology, Menzies Health Institute Queensland, Mount Gravatt Campus, Mount Gravatt, QLD 4122, Australia.
| | - Caroline L Donovan
- School of Applied Psychology, Menzies Health Institute Queensland, Mount Gravatt Campus, Mount Gravatt, QLD 4122, Australia.
| | - Sonja March
- School of Psychology and Counselling, Institute for Resilient Regions, University of Southern Queensland, Springfield Campus, Springfield, Qld 4432, Australia
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Patterson B, Boyle MH, Kivlenieks M, Van Ameringen M. The use of waitlists as control conditions in anxiety disorders research. J Psychiatr Res 2016; 83:112-120. [PMID: 27585425 DOI: 10.1016/j.jpsychires.2016.08.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/15/2016] [Accepted: 08/18/2016] [Indexed: 01/04/2023]
Abstract
Current evidence suggests that the strength of the psychological control condition greatly impacts treatment outcomes. Psychological controls can be grouped into three general classes: no-treatment or waitlist (delayed treatment), attention placebo or the best available treatment comparison. Of these three, the use of the waitlist condition is the most common and is used in up to 73% of published psychological treatment studies. Many psychological interventions are in use today based on the efficacy demonstrated in waitlist controlled trials. In the field of anxiety disorders, cognitive behavioural therapy (CBT) is considered a first-line treatment. Meta-analyses in anxiety disorders have revealed that effect sizes for CBT compared to waitlist controls are much higher than those found using psychological placebos as comparators. Furthermore, waitlists have been associated with deleterious effects and have been described as "no-cebos" in related conditions such as major depressive disorder. Despite these findings, the use of waitlist controls continues to be a mainstay in the psychological anxiety disorders literature. The purpose of this paper is to examine the use of waitlists with a focus on the anxiety disorders. Methodological and ethical issues associated with waitlist controls will be explored, as well the use of alternative psychological placebos.
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Affiliation(s)
- Beth Patterson
- MacAnxiety Research Centre, McMaster University, Hamilton, ON, Canada; Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, ON, Canada.
| | - Michael H Boyle
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, ON, Canada
| | | | - Michael Van Ameringen
- MacAnxiety Research Centre, McMaster University, Hamilton, ON, Canada; Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, ON, Canada; Hamilton Health Sciences, Hamilton, ON, Canada
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‘Pesky gNATs’: investigating the feasibility of a novel computerized CBT intervention for adolescents with anxiety and/or depression in a Tier 3 CAMHS setting. COGNITIVE BEHAVIOUR THERAPIST 2016. [DOI: 10.1017/s1754470x16000222] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractIncreasingly, evidence suggests that computerized Cognitive Behavioural Therapy (cCBT) is effective at reducing adolescent anxiety and depression for young people in the general population or those ‘at risk’. However, less is known about the acceptability, feasibility and effectiveness of cCBT for adolescents with clinically significant levels of impairment. This study aimed to investigate the feasibility of using a novel cCBT intervention, ‘Pesky gNATs’, with adolescents aged between 13–18 years with anxiety and/or depression who met the criteria for specialist mental health services. Eleven participants were recruited from a Tier 3 child and adolescent mental health service (CAMHS). Recruitment, attendance and retention rates were recorded and qualitative feedback about the benefits and disadvantages of completing cCBT were obtained during the final session. In addition, a number of outcome measures were completed pre- and post- intervention to assess reliable and clinically significant change. The intervention was very brief comprising of just seven sessions. Participants showed high recruitment and retention rates. All participants who started the intervention completed it. All described the programme as useful and the majority identified several benefits. Four of 11 participants demonstrated reliable reductions in symptoms of depression and anxiety and six of 11 showed decreases in parent-reported symptoms of anxiety and depression following the seven-session intervention. This study demonstrates the acceptability and feasibility of using cCBT in a Tier 3 CAMHS setting. Further research is required to investigate the effect of Pesky gNATs on anxiety and depression in other Tier 3 settings.
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A Disorder-Specific, Cognitively Focused Group Treatment for Childhood Generalized Anxiety Disorder: Development and Case Illustration of the No Worries! Program. J Cogn Psychother 2015; 29:275-301. [PMID: 32755939 DOI: 10.1891/0889-8391.29.4.275] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Generalized anxiety disorder (GAD) is a highly prevalent, chronic, and costly mental disorder in children, and there is a comparative lack of research on specific treatments for GAD, relative to other anxiety disorders. Furthermore, treatment programs for child GAD, unlike those for adults, are almost uniformly transdiagnostic in nature and do not specifically target the cognitive variables (e.g., intolerance of uncertainty, negative beliefs about worry, cognitive avoidance, and negative problem orientation) demonstrated to be correlated with the disorder. However, helping children to understand and address these rather complex cognitive factors is difficult. This article describes the development of a disorder-specific, cognitively focused group treatment program for child GAD (the No Worries! Program) that aims to target the cognitive variables and symptoms correlated with the GAD. It provides a detailed discussion of the strategies taught to children and highlights some of the challenges involved. A case study is presented to demonstrate the feasibility of achieving successful outcomes with complex presentations.
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Waters AM, Kershaw R. Direction of attention bias to threat relates to differences in fear acquisition and extinction in anxious children. Behav Res Ther 2015; 64:56-65. [DOI: 10.1016/j.brat.2014.11.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 11/04/2014] [Accepted: 11/30/2014] [Indexed: 10/24/2022]
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Holmes MC, Donovan CL, Farrell LJ, March S. The efficacy of a group-based, disorder-specific treatment program for childhood GAD--a randomized controlled trial. Behav Res Ther 2014; 61:122-35. [PMID: 25193003 DOI: 10.1016/j.brat.2014.08.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 07/19/2014] [Accepted: 08/01/2014] [Indexed: 02/08/2023]
Abstract
The aim of this study was to provide a preliminary examination of a disorder-specific treatment program for children with generalised anxiety disorder (GAD) that employed strategies targeting underlying cognitive factors. Forty-two children with a primary diagnosis of GAD, aged between 7 and 12 years, were randomly assigned to either a treatment (TX) or waitlist (WLC) condition. Clinical diagnostic interviews as well as parent and child questionnaires were completed at pre- and post-assessment for both conditions, and at 3-month follow-up for the TX group. For the completer analyses at post-treatment, 52.9 % of children in the TX group (0% in the WLC group) were free of their primary GAD diagnosis. By 3-month follow-up, 100% of children in the TX group were free of their GAD diagnosis, 50% were free of all diagnoses. Overall, there is preliminary evidence that a disorder-specific treatment program for children with GAD is effective in treating this chronic and disabling disorder.
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Affiliation(s)
- Monique C Holmes
- School of Applied Psychology and the Behavioural Basis of Health, Griffith University, Mount Gravatt Campus, Mount Gravatt, QLD, 4122, Australia.
| | - Caroline L Donovan
- School of Applied Psychology and the Behavioural Basis of Health, Griffith University, Mount Gravatt Campus, Mount Gravatt, QLD, 4122, Australia.
| | - Lara J Farrell
- School of Applied Psychology and the Behavioural Basis of Health, Griffith University, Gold Coast Campus, Southport, QLD, 4222, Australia.
| | - Sonja March
- School of Psychology, Counselling and Community, University of Southern Queensland, Springfield, QLD, 4300, Australia.
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Stallard P. School-based interventions for depression and anxiety in children and adolescents. EVIDENCE-BASED MENTAL HEALTH 2013; 16:60-1. [PMID: 23580540 DOI: 10.1136/eb-2013-101242] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Paul Stallard
- Department of Health, University of Bath and Head of Psychological Therapies Oxford Health NHS Foundation Trust, Bath BA2 7AY, UK.
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