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Michel K, Lutz-Beck D, Engeroff S. Improving the Therapeutic Relationship When Prescribing Antidepressants: A Pilot Study. Healthcare (Basel) 2023; 11:2825. [PMID: 37957970 PMCID: PMC10650839 DOI: 10.3390/healthcare11212825] [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: 08/27/2023] [Revised: 10/22/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
Studies indicate that the quality of the doctor-patient relationship moderates the effect of pharmacotherapy. To enhance the quality of the therapeutic relationship in the pharmacotherapy of depression, we developed a brief manual with interactive materials for residents in psychiatry and their patients. In a pilot study at a psychiatric university hospital's outpatient department, we compared patient-centered treatment parameters of a first patient group treated as usual and a second patient group treated using the manual. The study had no influence on the choice of medication. In the manual group, patient satisfaction with the doctor-patient relationship increased significantly at the three-month follow-up. Depression parameters declined in both groups, without group differences. Continuation of antidepressant medication at six months was higher in the manual group. In conclusion, a simple intervention using written materials for doctors prescribing antidepressants improved doctors' and patients' satisfaction with treatment.
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Affiliation(s)
- Konrad Michel
- University Hospital of Psychiatry, University of Bern, CH-3008 Bern, Switzerland
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2
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Booij MM, van Noorden MS, van Vliet IM, Ottenheim NR, van der Wee NJA, Van Hemert AM, Giltay EJ. Dynamic time warp analysis of individual symptom trajectories in depressed patients treated with electroconvulsive therapy. J Affect Disord 2021; 293:435-443. [PMID: 34252687 DOI: 10.1016/j.jad.2021.06.068] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 06/20/2021] [Accepted: 06/27/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Although electroconvulsive therapy (ECT) effectively improves severity scores of depression, its effects on its individual symptoms has scarcely been studied. We aimed to study which depressive symptom trajectories dynamically cluster together in individuals as well as groups of patients during ECT using Dynamic Time Warp (DTW) analysis. METHODS We analysed the standardized weekly scores on the 25-item abbreviated version of the Comprehensive Psychopathological Rating Scale (CPRS) in depressed patients before and during their first six weeks of ECT treatment. DTW analysis was used to analyse the (dis)similarity of time series of items scores at the patient level (300 'DTW distances' per patient) as well as on the group level. Hierarchical cluster, network, and Distatis analyses yielded symptom dimensions. RESULTS We included 133 patients, 64.7% female, with an average age of 60.4 years (SD 15.1). Individual DTW distance matrices and networks revealed marked differences in hierarchical and network clusters among patients. Based on cluster analyses of the aggregated matrices, four symptom clusters emerged. In patients who reached remission, the average DTW distance between their symptoms was significantly smaller than non-remitters, reflecting denser symptom networks in remitters than non-remitters (p=0.04). LIMITATIONS The assessments were done only weekly during the first six weeks of ECT treatment. The use of individual items of the abbreviated CPRS may have led to measurement error as well as floor and ceiling effects. CONCLUSION DTW offers an efficient new approach to analyse symptom trajectories within individuals as well as groups of patients, aiding personalized medicine of psychopathology.
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Affiliation(s)
- Marijke M Booij
- Department of Psychiatry, Leiden University Medical Center (LUMC), the Netherlands
| | | | - Irene M van Vliet
- Department of Psychiatry, Leiden University Medical Center (LUMC), the Netherlands
| | | | - Nic J A van der Wee
- Department of Psychiatry, Leiden University Medical Center (LUMC), the Netherlands
| | - Albert M Van Hemert
- Department of Psychiatry, Leiden University Medical Center (LUMC), the Netherlands
| | - Erik J Giltay
- Department of Psychiatry, Leiden University Medical Center (LUMC), the Netherlands.
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3
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Slofstra C, Booij SH, Rogier Hoenders HJ, Castelein S. Redefining Therapeutic Outcomes of Depression Treatment. J Pers Oriented Res 2019; 5:1-8. [PMID: 33569141 PMCID: PMC7842646 DOI: 10.17505/jpor.2019.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Responses to evidence-based interventions for depression are divergent: Some patients benefit more than others during treatment and some do not benefit at all or even deteriorate. Tailoring interventions to the individual may improve outcomes. However, such personalization of evidence-based treatment in depression requires investigation of individual outcomes and the individual trajectories towards these outcomes. This theoretical paper provides a critical reflection on individual outcomes of depression treatment. First, it is argued that outcomes should be broadened, from a focus on mainly depressive symptomatology to recovery in different domains. It is acknowledged that recovery from depression reflects a personal journey that differs from person to person. Second, outcome measures should be lengthened beyond the acute treatment phase, taking a lifetime perspective on depression. The challenge then is to discover which trajectories of what measures during what interventions result in personalized sustainable recovery and for whom. Routine outcome monitoring systems may be used to inform this quest towards assessment of personalized sustainable therapeutic outcomes. Adaptations to broaden and lengthen measurements in routine outcome monitoring systems are proposed to identify predictors of personalized sustainable recovery. Routine outcome monitoring systems may eventually be used to implement personalized treatments for depression that result in personalized sustainable recovery.
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Affiliation(s)
- Christien Slofstra
- Lentis Research, Groningen, Hereweg 80, 9700 AB Groningen, The Netherlands
| | - Sanne H Booij
- Lentis Psychiatric Institute, Center for Integrative Psychiatry, Hereweg 76, 9700 AB Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, CC72, Hanzeplein 1, 9700 RB Groningen, The Netherlands
| | - H J Rogier Hoenders
- Lentis Psychiatric Institute, Center for Integrative Psychiatry, Hereweg 76, 9700 AB Groningen, The Netherlands
| | - Stynke Castelein
- Lentis Research, Groningen, Hereweg 80, 9700 AB Groningen, The Netherlands.,Lentis Psychiatric Institute, Center for Integrative Psychiatry, Hereweg 76, 9700 AB Groningen, The Netherlands.,University of Groningen, Faculty of Behavioral and Social Sciences, Department of Clinical Psychology and Experimental Psychopathology, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands
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4
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Carhart-Harris RL, Roseman L, Haijen E, Erritzoe D, Watts R, Branchi I, Kaelen M. Psychedelics and the essential importance of context. J Psychopharmacol 2018; 32:725-731. [PMID: 29446697 DOI: 10.1177/0269881118754710] [Citation(s) in RCA: 274] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Psychedelic drugs are making waves as modern trials support their therapeutic potential and various media continue to pique public interest. In this opinion piece, we draw attention to a long-recognised component of the psychedelic treatment model, namely ‘set’ and ‘setting’ – subsumed here under the umbrella term ‘context’. We highlight: (a) the pharmacological mechanisms of classic psychedelics (5-HT2A receptor agonism and associated plasticity) that we believe render their effects exceptionally sensitive to context, (b) a study design for testing assumptions regarding positive interactions between psychedelics and context, and (c) new findings from our group regarding contextual determinants of the quality of a psychedelic experience and how acute experience predicts subsequent long-term mental health outcomes. We hope that this article can: (a) inform on good practice in psychedelic research, (b) provide a roadmap for optimising treatment models, and (c) help tackle unhelpful stigma still surrounding these compounds, while developing an evidence base for long-held assumptions about the critical importance of context in relation to psychedelic use that can help minimise harms and maximise potential benefits.
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Affiliation(s)
- Robin L Carhart-Harris
- 1 Psychedelic Research Group, Neuropsychopharmacology Unit, Centre for Psychiatry, Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - Leor Roseman
- 1 Psychedelic Research Group, Neuropsychopharmacology Unit, Centre for Psychiatry, Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - Eline Haijen
- 1 Psychedelic Research Group, Neuropsychopharmacology Unit, Centre for Psychiatry, Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - David Erritzoe
- 1 Psychedelic Research Group, Neuropsychopharmacology Unit, Centre for Psychiatry, Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - Rosalind Watts
- 1 Psychedelic Research Group, Neuropsychopharmacology Unit, Centre for Psychiatry, Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - Igor Branchi
- 2 Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena, Roma, Italy
| | - Mendel Kaelen
- 1 Psychedelic Research Group, Neuropsychopharmacology Unit, Centre for Psychiatry, Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
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5
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Fiorillo A, Carpiniello B, De Giorgi S, La Pia S, Maina G, Sampogna G, Spina E, Tortorella A, Vita A. Assessment and Management of Cognitive and Psychosocial Dysfunctions in Patients With Major Depressive Disorder: A Clinical Review. Front Psychiatry 2018; 9:493. [PMID: 30364225 PMCID: PMC6193102 DOI: 10.3389/fpsyt.2018.00493] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 09/20/2018] [Indexed: 12/20/2022] Open
Abstract
Background: Full functional recovery is defined as a state in which patients are again able to enjoy their usual activities, return to work, and take care of themselves, and it should represent the end goal of treatment in patients with major depressive disorder (MDD). Patients with MDD report many unmet needs, including residual cognitive symptoms, lack of improvement in psychosocial functioning and life satisfaction, even during mood symptom remission. In this paper, we aim to: (a) identify the available assessment tools for evaluating cognitive and psychosocial functioning in patients with MDD; (b) provide an overview of therapeutic options that can improve full functional recovery in MDD also by improving cognitive symptoms. Methods: The relevant databases MEDLINE, ISI Web of Knowledge - Web of Science Index, Cochrane Reviews Library and PsychoINFO were searched for identifying papers on validated tools for the assessment of cognitive and personal functioning in patients with MDD. Results: New assessment tools (such as the THINC-it TOOL, the COBRA, the SCIP-D, and the UPSA-D) have been developed for evaluating the cognitive dysfunction in MDD patients. Adopting these tools in the clinical routine practice is useful to evaluate the improvement in cognitive functioning and, therefore, the achievement of full functioning recovery. The optimal management of patients with MDD include the combination of pharmacological compounds and psychosocial interventions for achieving full functional recovery in patients with MDD. Conclusions: Full functional recovery must be the target of any treatment programme for patients with MDD. In order to achieve this goal, it is necessary to develop personalized treatment and integrate psychosocial and psychopharmacological interventions.
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Affiliation(s)
- Andrea Fiorillo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Bernardo Carpiniello
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | | | | | - Giuseppe Maina
- AOU San Luigi Gonzaga, University of Turin, Turin, Italy
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Edoardo Spina
- Department of Clinical and Experimental Pharmacology, University of Messina, Messina, Italy
| | | | - Antonio Vita
- Neuroscience Section, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Department of Mental Health, Spedali Civili Hospital, Brescia, Italy
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Bousman CA, Forbes M, Jayaram M, Eyre H, Reynolds CF, Berk M, Hopwood M, Ng C. Antidepressant prescribing in the precision medicine era: a prescriber's primer on pharmacogenetic tools. BMC Psychiatry 2017; 17:60. [PMID: 28178974 PMCID: PMC5299682 DOI: 10.1186/s12888-017-1230-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 02/04/2017] [Indexed: 12/25/2022] Open
Abstract
About half of people who take antidepressants do not respond and many experience adverse effects. These detrimental outcomes are in part a result of the impact of an individual's genetic profile on pharmacokinetics and pharmcodynamics. If known and made available to clinicians, this could improve decision-making and antidepressant therapy outcomes. This has spurred the development of numerous pharmacogenetic-based decision support tools. In this article, we provide an overview of pharmacogenetic decision support tools, with particular focus on tools relevant to antidepressants. We briefly describe the evolution and current state of antidepressant pharmacogenetic decision support tools in clinical practice, followed by the evidence-base for their use. Finally, we present a series of considerations for clinicians contemplating use of these tools and discuss the future of antidepressant pharmacogenetic decision support tools.
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Affiliation(s)
- Chad A Bousman
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne, 161 Barry Street, Level 3, Parkville, VIC, 3053, Australia.
- Department of General Practice, The University of Melbourne, Parkville, VIC, Australia.
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorne, VIC, Australia.
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Malcolm Forbes
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne, 161 Barry Street, Level 3, Parkville, VIC, 3053, Australia
| | - Mahesh Jayaram
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne, 161 Barry Street, Level 3, Parkville, VIC, 3053, Australia
| | - Harris Eyre
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne, 161 Barry Street, Level 3, Parkville, VIC, 3053, Australia
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Geelong, Australia
- Discipline of Psychiatry, The University of Adelaide, Adelaide, South Australia, Australia
| | | | - Michael Berk
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne, 161 Barry Street, Level 3, Parkville, VIC, 3053, Australia
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Geelong, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne, 161 Barry Street, Level 3, Parkville, VIC, 3053, Australia
| | - Chee Ng
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne, 161 Barry Street, Level 3, Parkville, VIC, 3053, Australia
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