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Yang K, Tiwari S, Liu D, Xu Q, Qi L, Zhu Y, Jiang L, Zouqin H, Wong J, Chen J, Han Z. Acupuncture and Escitalopram for Treating Major Depression Clinical Study (AE-TMDCS): protocol for a factorial randomised controlled trial. BMJ Open 2024; 14:e091214. [PMID: 39260834 DOI: 10.1136/bmjopen-2024-091214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2024] Open
Abstract
INTRODUCTION Major depressive disorder (MDD), the second leading cause of disability globally, is considered to be associated with a consequent deterioration in the quality of life and can lead to a major economic burden on medical service and suicide-related costs. Previous research has shown that acupuncture may be beneficial for treating MDD. However, there is a lack of rigorous evidence from previous studies comparing acupuncture with antidepressant medications. This study aims to assess the therapeutic potential of acupuncture in the management of depressive disorders. METHODS AND ANALYSIS A multicentre, randomised, participant-blind, sham-controlled, 2×2 factorial clinical trial, Acupuncture and Escitalopram for Treating Major Depression Clinical Study, aims to compare the efficacy of acupuncture versus escitalopram in treating depression. This study will be conducted at three hospitals in China, enrolling 260 patients with moderate-to-severe major depression, as defined by DSM-5 criteria and Hamilton Depression Rating Scale (HDRS-17) Scores above 17. Participants will be randomly assigned in equal proportions to one of four groups (acupuncture/escitalopram, sham acupuncture/escitalopram, acupuncture/placebo and sham acupuncture/placebo) and undergo 30 sessions across 10 weeks. The primary outcome is change in HDRS-17 Score and secondary outcomes include BDI, Clinical Global Impression, Generalised Anxiety Disorder-7 and Mini-Mental State Examination Scores, alongside potential biological markers. ETHICS AND DISSEMINATION Ethical approval for the study was granted by the Ethics Committees of the Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine (2023-7th-HIRB-020), Shanghai Mental Health Centre (2022-86) and Shanghai Pudong New Area Hospital of Traditional Chinese Medicine (2023-003). Informed consent will be obtained from all participants. The study's findings are intended for publication in a scholarly journal. TRIAL REGISTRATION NCT05901571.
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Affiliation(s)
- Kaiqi Yang
- Department of Neurology and Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Sagun Tiwari
- Shenzhen Institute of Advanced Technology,Chinese Academy of Sciences, University of Chinese Academy of Sciences, Beijing, China
| | - Dezhi Liu
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qinfeng Xu
- Department of Statistics and Data Science, Fudan University, Shanghai, Shanghai, China
| | - Lili Qi
- Department of Emergency, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of TCM, Shanghai, China
| | - Yue Zhu
- Jiangsu Key Laboratory for High Technology Research of Traditional Chinese Medicine Formulae and Jangsu Collaborative Innovation Center of Chinese Medicine Resource Industrialization, Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Liling Jiang
- Department of Neurology and Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Huang Zouqin
- Shanghai Pudong New Area Hospital of Traditional Chinese Medicine, Shanghai, China
| | - John Wong
- School of Nursing and Department of Occupational Therapy, MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Jianhua Chen
- Department of Acupuncture, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of TCM, Shanghai, China
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, Shanghai, China
| | - Zhenxiang Han
- Department of Neurology and Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Forsdike K, Pirotta M. St John's wort for depression: scoping review about perceptions and use by general practitioners in clinical practice. ACTA ACUST UNITED AC 2017; 71:117-128. [PMID: 28653745 DOI: 10.1111/jphp.12775] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 05/28/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Extracts of Hypericum perforatum, more commonly known as St John's wort (SJW), have good evidence for treating depression. The herb is easily accessible and widely used by consumers, although it has potential for interaction with other medicines. Consumers' use of SJW is often not discussed with their general practitioners (GPs). It is unclear how GPs perceive use of SJW in practice and the implications for consumers and pharmacists. OBJECTIVE Explore GPs' perception of SJW use in practice. METHODS Scoping review. KEY FINDINGS Few studies explore GPs' perceptions of SJW for depression, but they appear to recommend it infrequently, except in Germany. Reasons for limited use in practice include lack of knowledge, particularly regarding which preparations and dosages have trial evidence, and lack of standardisation of active ingredients. Guidelines either do not mention SJW or advise against its use. CONCLUSIONS Consumers drive SJW use but often do not disclose to their GPs, which is concerning due to issues about safety. Pharmacists could play an important role here. Improved education about SJW is required for both GPs and consumers, including the need for communication between them and their pharmacists. Lack of adoption of evidence-based therapy for depression should be explored further.
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Affiliation(s)
- Kirsty Forsdike
- Department of General Practice, The University of Melbourne, Carlton, Vic., Australia
| | - Marie Pirotta
- Department of General Practice, The University of Melbourne, Carlton, Vic., Australia
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Yrondi A, Bennabi D, Haffen E, Garnier M, Bellivier F, Bourgerol T, Camus V, D'Amato T, Doumy O, Haesebaert F, Holtzmann J, Lançon C, Vignaud P, Moliere F, Nieto I, Richieri RM, Domenech P, Rabu C, Mallet L, Yon L, Schmitt L, Stephan F, Vaiva G, Walter M, Llorca PM, Courtet P, Leboyer M, El-Hage W, Aouizerate B. Significant Need for a French Network of Expert Centers Enabling a Better Characterization and Management of Treatment-Resistant Depression (Fondation FondaMental). Front Psychiatry 2017; 8:244. [PMID: 29225582 PMCID: PMC5706526 DOI: 10.3389/fpsyt.2017.00244] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 11/06/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Major depression is characterized by (i) a high lifetime prevalence of 16-17% in the general population; (ii) a high frequency of treatment resistance in around 20-30% of cases; (iii) a recurrent or chronic course; (iv) a negative impact on the general functioning and quality of life; and (v) a high level of comorbidity with various psychiatric and non-psychiatric disorders, high occurrence of completed suicide, significant burden along with the personal, societal, and economic costs. In this context, there is an important need for the development of a network of expert centers for treatment-resistant depression (TRD), as performed under the leadership of the Fondation FondaMental. METHODS The principal mission of this national network is to establish a genuine prevention, screening, and diagnosis policy for TRD to offer a systematic, comprehensive, longitudinal, and multidimensional evaluation of cases. A shared electronic medical file is used referring to a common exhaustive and standardized set of assessment tools exploring psychiatric, non-psychiatric, metabolic, biological, and cognitive dimensions of TRD. This is paralleled by a medico-economic evaluation to examine the global economic burden of the disease and related health-care resource utilization. In addition, an integrated biobank has been built by the collection of serum and DNA samples for the measurement of several biomarkers that could further be associated with the treatment resistance in the recruited depressed patients. A French observational long-term follow-up cohort study is currently in progress enabling the extensive assessment of resistant depressed patients. In those unresponsive cases, each expert center proposes relevant therapeutic options that are classically aligned to the international guidelines referring to recognized scientific societies. DISCUSSION This approach is expected to improve the overall clinical assessments and to provide evidence-based information to those clinicians most closely involved in the management of TRD thereby facilitating treatment decisions and choice in everyday clinical practice. This could contribute to significantly improve the poor prognosis, the relapsing course, daily functioning and heavy burden of TRD. Moreover, the newly created French network of expert centers for TRD will be particularly helpful for a better characterization of sociodemographic, clinical, neuropsychological, and biological markers of treatment resistance required for the further development of personalized therapeutic strategies in TRD.
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Affiliation(s)
- Antoine Yrondi
- Service de Psychiatrie et de Psychologie Médicale de l'adulte, Centre Expert Dépression Résistante FondaMental, CHRU de Toulouse, Hôpital Purpan, Toulouse, France
| | - Djamila Bennabi
- Service de Psychiatrie clinique, Centre Expert Dépression Résistante FondaMental, EA 481 Neurosciences, Université de Bourgogne Franche Comté, Besançon, France
| | - Emmanuel Haffen
- Service de Psychiatrie clinique, Centre Expert Dépression Résistante FondaMental, Centre Investigation Clinique 1431-INSERM, EA 481 Neurosciences, Université de Bourgogne Franche Comté, Besançon, France
| | - Marion Garnier
- Service de Psychiatrie de l'adulte B, Centre Expert Dépression Résistante FondaMental, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Frank Bellivier
- Service de Psychiatrie adulte, Centre Expert Dépression Résistante FondaMental, Hôpital Fernand-Widal, Paris, France
| | - Thierry Bourgerol
- Service de Psychiatrie de l'adulte, CS 10217, Centre Expert Dépression Résistante FondaMental, CHU de Grenoble, Hôpital Nord, Grenoble, France
| | - Vincent Camus
- Clinique Psychiatrique Universitaire, Centre Expert Dépression Résistante FondaMental, Inserm U1253 imaging and Brain:iBrain, CHRU de Tours, Tours, France
| | - Thierry D'Amato
- Service Universitaire de Psychiatrie adulte, Centre Expert Dépression Résistante FondaMental, Centre Hospitalier Le Vinatier, Bron cedex, France
| | - Olivier Doumy
- Pôle de Psychiatrie Générale et Universitaire, Centre Expert Dépression Résistante FondaMental, CH Charles Perrens, Bordeaux, France
| | - Frédéric Haesebaert
- Service Universitaire de Psychiatrie adulte, Centre Expert Dépression Résistante FondaMental, Centre Hospitalier Le Vinatier, Bron cedex, France
| | - Jérôme Holtzmann
- Service de Psychiatrie de l'adulte, CS 10217, Centre Expert Dépression Résistante FondaMental, CHU de Grenoble, Hôpital Nord, Grenoble, France
| | - Christophe Lançon
- Pôle Psychiatrie, Centre Expert Dépression Résistante FondaMental, CHU La Conception, Marseille, France
| | - Philippe Vignaud
- Service Universitaire de Psychiatrie adulte, Centre Expert Dépression Résistante FondaMental, Centre Hospitalier Le Vinatier, Bron cedex, France
| | - Fanny Moliere
- Département des Urgences et Post-Urgences Psychiatriques, Centre Expert Dépression Résistante FondaMental, CHRU Lapeyronie, Montpellier, France
| | - Isabel Nieto
- Service de Psychiatrie adulte, Centre Expert Dépression Résistante FondaMental, Hôpital Fernand-Widal, Paris, France
| | - Raphaëlle Marie Richieri
- Pôle Psychiatrie, Centre Expert Dépression Résistante FondaMental, CHU La Conception, Marseille, France
| | - Philippe Domenech
- Pôle de Psychiatrie des Hôpitaux Universitaires, Centre Expert Dépression Résistante FondaMental, Hôpital Henri Mondor, Créteil, France
| | - Corentin Rabu
- Pôle de Psychiatrie des Hôpitaux Universitaires, Centre Expert Dépression Résistante FondaMental, Hôpital Henri Mondor, Créteil, France
| | - Luc Mallet
- Pôle de Psychiatrie des Hôpitaux Universitaires, Centre Expert Dépression Résistante FondaMental, Hôpital Henri Mondor, Créteil, France
| | - Liova Yon
- Pôle de Psychiatrie des Hôpitaux Universitaires, Centre Expert Dépression Résistante FondaMental, Hôpital Henri Mondor, Créteil, France
| | - Laurent Schmitt
- Service de Psychiatrie et de Psychologie Médicale de l'adulte, Centre Expert Dépression Résistante FondaMental, CHRU de Toulouse, Hôpital Purpan, Toulouse, France
| | - Florian Stephan
- Service de Psychiatrie de l'adulte, Centre Expert Dépression Résistante FondaMental, CHU de Brest, Hôpital de Bohars, Bohars, France
| | - Guillaume Vaiva
- Service de Psychiatrie adulte, Centre Expert Dépression Résistante FondaMental, CHRU de Lille, Hôpital Fontan 1, Lille, France
| | - Michel Walter
- Service de Psychiatrie de l'adulte, Centre Expert Dépression Résistante FondaMental, CHU de Brest, Hôpital de Bohars, Bohars, France
| | - Pierre-Michel Llorca
- Service de Psychiatrie de l'adulte B, Centre Expert Dépression Résistante FondaMental, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Philippe Courtet
- Département des Urgences et Post-Urgences Psychiatriques, Centre Expert Dépression Résistante FondaMental, CHRU Lapeyronie, Montpellier, France
| | - Marion Leboyer
- Pôle de Psychiatrie des Hôpitaux Universitaires, Centre Expert Dépression Résistante FondaMental, Hôpital Henri Mondor, Créteil, France
| | - Wissam El-Hage
- Clinique Psychiatrique Universitaire, Centre Expert Dépression Résistante FondaMental, Inserm U1253 imaging and Brain:iBrain, CHRU de Tours, Tours, France
| | - Bruno Aouizerate
- Pôle de Psychiatrie Générale et Universitaire, Centre Expert Dépression Résistante FondaMental, CH Charles Perrens, Bordeaux, France
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Smits FT, Brouwer HJ, Zwinderman AH, Mohrs J, Schene AH, van Weert HCPM, ter Riet G. Why do they keep coming back? Psychosocial etiology of persistence of frequent attendance in primary care: a prospective cohort study. J Psychosom Res 2014; 77:492-503. [PMID: 25217448 DOI: 10.1016/j.jpsychores.2014.08.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 07/21/2014] [Accepted: 08/12/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients who visit their General Practitioner (GP) very frequently over extended periods of time often have multimorbidity and are costly in primary and specialist healthcare. We investigated the impact of patient-level psychosocial and GP-level factors on the persistence of frequent attendance (FA) in primary care. METHODS Two-year prospective cohort study in 623 incident adult frequent attenders (>90th attendance centile; age and sex-adjusted) in 2009. Information was collected through questionnaires (patients, GPs) and GPs' patient data. We used multilevel, ordinal logistic regression analysis, controlling for somatic illness and demographic factors with FA in 2010 and/or 2011 as the outcome. RESULTS Other anxiety (odds ratio (OR) 2.00; 95% confidence interval from 1.29 to 3.10) over 3years and the number of life events in 3years (OR 1.06; 1.01-1.10 per event; range of 0 to 12) and, at baseline, panic disorder (OR 5.40; 1.67-17.48), other anxiety (OR 2.78; 1.04-7.46), illness behavior (OR 1.13; 1.05-1.20 per point; 28-point scale) and lack of mastery (OR 1.08; 1.01-1.15 per point; 28-point scale) were associated with persistence of FA. We found no evidence of synergistic effects of somatic, psychological and social problems. We found no strong evidence of effects of GP characteristics. CONCLUSION Panic disorder, other anxiety, negative life events, illness behavior and lack of mastery are independently associated with persistence of frequent attendance. Effective intervention at these factors, apart from their intrinsic benefits to these patients, may reduce attendance rates, and healthcare expenditures in primary and specialist care.
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Affiliation(s)
- Frans T Smits
- Department of General Practice, Academic Medical Center, University of Amsterdam, 1100 DD Amsterdam, The Netherlands.
| | - Henk J Brouwer
- Department of General Practice, Academic Medical Center, University of Amsterdam, 1100 DD Amsterdam, The Netherlands
| | - Aeilko H Zwinderman
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, 1100 DD Amsterdam, The Netherlands
| | - Jacob Mohrs
- Department of General Practice, Academic Medical Center, University of Amsterdam, 1100 DD Amsterdam, The Netherlands
| | - Aart H Schene
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, 1100 DD Amsterdam, The Netherlands; Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henk C P M van Weert
- Department of General Practice, Academic Medical Center, University of Amsterdam, 1100 DD Amsterdam, The Netherlands
| | - Gerben ter Riet
- Department of General Practice, Academic Medical Center, University of Amsterdam, 1100 DD Amsterdam, The Netherlands
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Jordan J, Carter JD, McIntosh VVW, Fernando K, Frampton CMA, Porter RJ, Mulder RT, Lacey C, Joyce PR. Metacognitive therapy versus cognitive behavioural therapy for depression: a randomized pilot study. Aust N Z J Psychiatry 2014; 48:932-43. [PMID: 24810871 DOI: 10.1177/0004867414533015] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Metacognitive therapy (MCT) is one of the newer developments within cognitive therapy. This randomized controlled pilot study compared independently applied MCT with cognitive behavioural therapy (CBT) in outpatients with depression to explore the relative speed and efficacy of MCT, ahead of a planned randomized controlled trial. METHOD A total of 48 participants referred for outpatient therapy were randomized to up to 12 weeks of MCT or CBT. Key outcomes were reduction in depressive symptoms at week 4 and week 12, measured using the independent-clinician-rated Quick Inventory of Depressive Symptomatology16. Intention-to-treat and completer analyses as well as additional methods of reporting outcome of depression are presented. RESULTS Both therapies were effective in producing clinically significant change in depressive symptoms, with moderate-to-large effect sizes obtained. No differences were detected between therapies in overall outcome or early change on clinician-rated or self-reported measures. Post-hoc analyses suggest that MCT may have been adversely affected by greater comorbidity. CONCLUSIONS In this large pilot study conducted independently of MCT's developers, MCT was an effective treatment for outpatients with depression, with similar results overall to CBT. Insufficient power and imbalanced comorbidity limit conclusions regarding comparative efficacy so further studies of MCT and CBT are required.
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Affiliation(s)
- Jennifer Jordan
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand Clinical Research Unit, Canterbury District Health Board, Christchurch, New Zealand
| | - Janet D Carter
- Psychology Department, University of Canterbury, Christchurch, New Zealand
| | - Virginia V W McIntosh
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand Clinical Research Unit, Canterbury District Health Board, Christchurch, New Zealand
| | - Kumari Fernando
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | | | - Richard J Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Roger T Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Cameron Lacey
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand Maori Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Peter R Joyce
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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Wang HR, Bahk WM, Park YM, Lee HB, Song HR, Jeong JH, Seo JS, Lim ES, Hong JW, Kim W, Jon DI, Hong JP, Woo YS, Min KJ. Korean medication algorithm for depressive disorder: comparisons with other treatment guidelines. Psychiatry Investig 2014; 11:1-11. [PMID: 24605117 PMCID: PMC3942544 DOI: 10.4306/pi.2014.11.1.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 04/19/2013] [Accepted: 04/25/2013] [Indexed: 01/10/2023] Open
Abstract
We aimed to compare the recommendations of the Korean Medication Algorithm Project for Depressive Disorder 2012 (KMAP-DD 2012) with other recently published treatment guidelines for depressive disorder. We reviewed a total of five recently published global treatment guidelines and compared each treatment recommendation of the KMAP-DD 2012 with those in other guidelines. For initial treatment recommendations, there were no significant major differences across guidelines. However, in the case of nonresponse or incomplete response to initial treatment, the second recommended treatment step varied across guidelines. For maintenance therapy, medication dose and duration differed among treatment guidelines. Further, there were several discrepancies in the recommendations for each subtype of depressive disorder across guidelines. For treatment in special populations, there were no significant differences in overall recommendations. This comparison identifies that, by and large, the treatment recommendations of the KMAP-DD 2012 are similar to those of other treatment guidelines and reflect current changes in prescription pattern for depression based on accumulated research data. Further studies will be needed to address several issues identified in our review.
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Affiliation(s)
- Hee Ryung Wang
- Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Won-Myong Bahk
- Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young-Min Park
- Department of Psychiatry, Ilsan Paik Hospital, College of Medicine, Inje University, Goyang, Republic of Korea
| | - Hwang Bin Lee
- Department of Psychiatry, Seoul National Hospital, Seoul, Republic of Korea
| | - Hoo Rim Song
- Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong-Hyun Jeong
- Department of Psychiatry, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea
| | - Jeong Seok Seo
- Department of Psychiatry, School of Medicine, Konkuk University, Chungju, Republic of Korea
| | | | - Jeong-Wan Hong
- Namwon Sungil Mental Hospital, Namwon, Republic of Korea
| | - Won Kim
- Department of Psychiatry, Stress Research Institute, Inje University College of Medicine, Seoul Paik Hospital, Seoul, Republic of Korea
| | - Duk-In Jon
- Department of Psychiatry, College of Medicine, Hallym University, Anyang, Republic of Korea
| | - Jin-Pyo Hong
- Department of Psychiatry, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Young Sup Woo
- Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung Joon Min
- Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
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Brief psychoeducation for schizophrenia primarily intended to change the cognition of auditory hallucinations: an exploratory study. J Nerv Ment Dis 2014; 202:35-9. [PMID: 24375210 DOI: 10.1097/nmd.0000000000000064] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Auditory hallucinations and delusions are core symptoms of schizophrenia, which interact with each other. The attribution of auditory hallucinations to other people is considered to lead to secondary delusions. This study examined whether brief psychoeducation can change the cognition of auditory hallucinations, particularly, their attribution, and thus alleviate secondary delusions. Twenty-two schizophrenic patients with auditory hallucinations were recruited in this open study. The intervention consisted of five sessions during the course of 4 weeks. Outcome measures were used to assess delusions, beliefs about auditory hallucinations, and depression. At the end of the intervention, statistically significant reduction was observed in both delusions and depression. Beliefs about hallucinations showed statistically significant improvement in terms of malevolence, omnipotence, and resistance but not in terms of benevolence and engagement. In conclusion, the present study suggests that psychoeducation might be useful in reducing secondary delusions without exacerbating a depressive state.
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Apil SRA, Hoencamp E, Judith Haffmans PM, Spinhoven P. A stepped care relapse prevention program for depression in older people: a randomized controlled trial. Int J Geriatr Psychiatry 2012; 27:583-91. [PMID: 21766336 DOI: 10.1002/gps.2756] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 05/15/2011] [Accepted: 05/16/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND This study aimed to determine the feasibility and the effectiveness of a Stepped Care Program (SCP) for preventing relapse of depression in older people. Stepped care consisted of (1) watchful waiting; (2) bibliotherapy; (3) individual cognitive behavioral therapy; and (4) indicated treatment. METHODS In a randomized controlled trial, persons 55 years and older (n = 136) who had suffered at least one episode of major depression in the past received a SCP or Care As Usual (CAU). The primary outcome measure was incidence of a new depressive episode. RESULTS Of 1725 previously depressed persons, 175 were willing to partake in the study, 136 of whom were eligible. Treatment satisfaction for stepped care was high. At 12-month follow-up, no difference in incidence of depression between SCP and CAU was found. Medical patient records showed that missing data were often related to relapse. CONCLUSIONS In this study, SCP was not more effective in preventing relapse than CAU. Watchful waiting may harmfully delay actual preventive treatment. Prevention as an integral part of regular treatment might lead to higher participation rates.
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Affiliation(s)
- Sachlan R A Apil
- Leiden University Institute of Psychology, Leiden, the Netherlands.
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The Outcome Questionnaire 45.2. Italian validation of an instrument for the assessment of phychological treatments. ACTA ACUST UNITED AC 2011. [DOI: 10.1017/s1121189x00002852] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
SummaryAims– The Outcome Questionnaire (OQ-45.2; Lambertet al., 2004) was designed to measure important areas of functioning (symptoms, interpersonal problems and social role functioning) that are of central interest in mental health. The crosscultural validity of the OQ-45.2 in the Italian population has been examined by comparing the psychometric properties and equivalence in factor structure and normative scores of the Italian OQ with the original American version.Method– Data were collected at university (N=461), in community (N=61) and in three mental health care organisations (N=301).Results– Results showed that the psychometric properties of the Italian OQ were adequate and similar to the original instrument. The CFA supported the multidimentional construct system of the instrument. Furthermore, normative scores were different for the Italian and American samples and this resulted in different cutoff scores for estimating clinically significant change in the Italian population.Conclusions– The Italian version of the OQ-45.2 appears promising as a measure of general psychological distress, and it could be used to measure the psychotherapy outcome in routine clinical practice.Declaration of Interest:
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Mood and anxiety disorders, the association with presenteeism in employed members of a general population sample. ACTA ACUST UNITED AC 2008; 16:231-7. [PMID: 18020197 DOI: 10.1017/s1121189x00002335] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AIMS The term "presenteeism" is used to describe workers who are present in the workforce, but who are not functioning at full capacity. The objective of the study was to describe the impact of mood and anxiety disorders on presenteeism in a population sample. METHODS Random digit dialing was used to select a sample of n=3345 subjects between the ages of 18 and 64. A computer assisted telephone interview that included the Mini Neuropsychiatric Diagnostic Interview (MINI), the Stanford Presenteeism Scale 6 (SPS-6) and a pharmacoepidemiology module was administered. RESULTS Among subjects with comorbid mood and anxiety disorders 75.0% reported interference with their work compared with only 13.3% of subjects without mood or anxiety disorders. Mood and anxiety disorders were associated with lower presenteeism ratings. Regression analysis uncovered a significant gender by anxiety disorder interaction, indicating that the effect of anxiety disorders was greater in men than women. CONCLUSIONS This is the first study to report the impact of mental disorders on presenteeism in a general population sample. The results confirm that the problem of presenteeism is not restricted to specific occupational groups, but is instead a widespread problem in the general population.
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Rossi A, Amaddeo F, Sandri M, Marsilio A, Bianco M, Tansella M. What happens to patients seen only once by psychiatric services? Findings from a follow-up study. Psychiatry Res 2008; 157:53-65. [PMID: 17904228 DOI: 10.1016/j.psychres.2006.05.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2005] [Revised: 03/20/2006] [Accepted: 05/15/2006] [Indexed: 11/29/2022]
Abstract
The aim of this study was to identify patient characteristics associated with once-only contact with a community-based mental health service (CMHS) and to re-evaluate these patients 3 months after the contact. A 33-month cohort of new episodes of care was followed up to identify and interview once-only contact patients. Of the 1101 patients who met the study criteria, 165 (15%) were discharged after the first contact, 87 (8%) dropped out after the first contact, 440 (40%) were low users and 409 (37%) were high users of the CMHS in the 90 days after the first contact. A higher score on the Global Assessment of Functioning scale, less severe psychiatric diagnoses and lower socioeconomic status were the factors most associated with once-only contact at baseline. At follow-up clinical conditions of patients who had only one contact (both discharged patients and drop-outs) had improved and, in most cases, they were in contact with other services. Drop-out patients, however, were more unwell and less satisfied with the initial contact. This dissatisfaction may have led these patients to seek help elsewhere. It is possible that some of these extremely low users are in need of a different or more specialized clinical treatment approach.
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Affiliation(s)
- Alberto Rossi
- Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy.
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