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Castelnovo V, Canu E, Aiello EN, Curti B, Sibilla E, Torre S, Freri F, Tripodi C, Lumaca L, Spinelli EG, Schito P, Russo T, Falzone Y, Verde F, Silani V, Ticozzi N, Sturm VE, Rankin KP, Gorno-Tempini ML, Poletti B, Filippi M, Agosta F. How to detect affect recognition alterations in amyotrophic lateral sclerosis. J Neurol 2024:10.1007/s00415-024-12686-6. [PMID: 39287680 DOI: 10.1007/s00415-024-12686-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 09/02/2024] [Accepted: 09/05/2024] [Indexed: 09/19/2024]
Abstract
OBJECTIVE To define the clinical usability of an affect recognition (AR) battery-the Comprehensive Affect Testing System (CATS)-in an Italian sample of patients with amyotrophic lateral sclerosis (ALS). METHODS 96 ALS patients and 116 healthy controls underwent a neuropsychological assessment including the AR subtests of the abbreviated version of the CATS (CATS-A). CATS-A AR subtests and their global score (CATS-A AR Quotient, ARQ) were assessed for their factorial, convergent, and divergent validity. The diagnostic accuracy of each CATS-A AR measure in discriminating ALS patients with cognitive impairment from cognitively normal controls and patients was tested via receiver-operating characteristics analyses. Optimal cut-offs were identified for CATS-A AR measures yielding an acceptable AUC value (≥ .70). The ability of CATS-A ARQ to discriminate between different ALS cognitive phenotypes was also tested. Gray-matter (GM) volumes of controls, ALS with normal (ALS-nARQ), and impaired ARQ score (ALS-iARQ) were compared using ANCOVA models. RESULTS CATS-A AR subtests and ARQ proved to have moderate-to-strong convergent and divergent validity. Almost all considered CATS-A measures reached acceptable accuracy and diagnostic power (AUC range = .79-.83). ARQ showed to be the best diagnostic measure (sensitivity = .80; specificity = .75) and discriminated between different ALS cognitive phenotypes. Compared to ALS-nARQ, ALS-iARQ patients showed reduced GM volumes in the right anterior cingulate, right middle frontal, left inferior temporal, and superior occipital regions. CONCLUSIONS The AR subtests of the CATS-A, and in particular the CATS-A ARQ, are sound measures of AR in ALS. AR deficits may be a valid marker of frontotemporal involvement in these patients.
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Affiliation(s)
- Veronica Castelnovo
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisa Canu
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Edoardo Nicolò Aiello
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Beatrice Curti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Elisa Sibilla
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Torre
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Fabiola Freri
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Chiara Tripodi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Laura Lumaca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Edoardo Gioele Spinelli
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Paride Schito
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Tommaso Russo
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Yuri Falzone
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federico Verde
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi Di Milano, Milan, Italy
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi Di Milano, Milan, Italy
| | - Nicola Ticozzi
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi Di Milano, Milan, Italy
| | - Virginia E Sturm
- Memory and Aging Center, University of California, San Francisco, CA, USA
| | - Katherine P Rankin
- Memory and Aging Center, University of California, San Francisco, CA, USA
| | - Maria Luisa Gorno-Tempini
- Memory and Aging Center, University of California, San Francisco, CA, USA
- Global Brain Health Institute, University of California, San Francisco, CA, USA
| | - Barbara Poletti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Oncology and Hemato-Oncology, Università degli Studi Di Milano, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
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Long F, Chen Y, Zhang Q, Li Q, Wang Y, Wang Y, Li H, Zhao Y, McNamara RK, DelBello MP, Sweeney JA, Gong Q, Li F. Predicting treatment outcomes in major depressive disorder using brain magnetic resonance imaging: a meta-analysis. Mol Psychiatry 2024:10.1038/s41380-024-02710-6. [PMID: 39187625 DOI: 10.1038/s41380-024-02710-6] [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: 01/18/2024] [Revised: 08/18/2024] [Accepted: 08/19/2024] [Indexed: 08/28/2024]
Abstract
Recent studies have provided promising evidence that neuroimaging data can predict treatment outcomes for patients with major depressive disorder (MDD). As most of these studies had small sample sizes, a meta-analysis is warranted to identify the most robust findings and imaging modalities, and to compare predictive outcomes obtained in magnetic resonance imaging (MRI) and studies using clinical and demographic features. We conducted a literature search from database inception to July 22, 2023, to identify studies using pretreatment clinical or brain MRI features to predict treatment outcomes in patients with MDD. Two meta-analyses were conducted on clinical and MRI studies, respectively. The meta-regression was employed to explore the effects of covariates and compare the predictive performance between clinical and MRI groups, as well as across MRI modalities and intervention subgroups. Meta-analysis of 13 clinical studies yielded an area under the curve (AUC) of 0.73, while in 44 MRI studies, the AUC was 0.89. MRI studies showed a higher sensitivity than clinical studies (0.78 vs. 0.62, Z = 3.42, P = 0.001). In MRI studies, resting-state functional MRI (rsfMRI) exhibited a higher specificity than task-based fMRI (tbfMRI) (0.79 vs. 0.69, Z = -2.86, P = 0.004). No significant differences in predictive performance were found between structural and functional MRI, nor between different interventions. Of note, predictive MRI features for treatment outcomes in studies using antidepressants were predominantly located in the limbic and default mode networks, while studies of electroconvulsive therapy (ECT) were restricted mainly to the limbic network. Our findings suggest a promise for pretreatment brain MRI features to predict MDD treatment outcomes, outperforming clinical features. While tasks in tbfMRI studies differed, those studies overall had less predictive utility than rsfMRI data. Overlapping but distinct network-level measures predicted antidepressants and ECT outcomes. Future studies are needed to predict outcomes using multiple MRI features, and to clarify whether imaging features predict outcomes generally or differ depending on treatments.
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Affiliation(s)
- Fenghua Long
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, PR China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, 610041, Sichuan, PR China
| | - Yufei Chen
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, PR China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, 610041, Sichuan, PR China
| | - Qian Zhang
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, PR China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, 610041, Sichuan, PR China
| | - Qian Li
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, PR China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, 610041, Sichuan, PR China
| | - Yaxuan Wang
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, PR China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, 610041, Sichuan, PR China
| | - Yitian Wang
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, PR China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, 610041, Sichuan, PR China
| | - Haoran Li
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, PR China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, 610041, Sichuan, PR China
| | - Youjin Zhao
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, PR China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, 610041, Sichuan, PR China
| | - Robert K McNamara
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, 45219, USA
| | - Melissa P DelBello
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, 45219, USA
| | - John A Sweeney
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, PR China
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, 45219, USA
| | - Qiyong Gong
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, PR China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, 610041, Sichuan, PR China
| | - Fei Li
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, PR China.
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, 610041, Sichuan, PR China.
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Ciharova M, Karyotaki E, Miguel C, Walsh E, de Ponti N, Amarnath A, van Ballegooijen W, Riper H, Arroll B, Cuijpers P. Amount and frequency of psychotherapy as predictors of treatment outcome for adult depression: A meta-regression analysis. J Affect Disord 2024; 359:92-99. [PMID: 38777269 DOI: 10.1016/j.jad.2024.05.070] [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] [Received: 01/22/2024] [Revised: 05/14/2024] [Accepted: 05/17/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND It is not clear whether the amount and frequency of psychotherapy is associated with treatment effects for adult depression. We investigated whether a number of indicators of the amount and frequency of psychotherapy were related to the treatment effects in randomized controlled trials (RCTs) comparing individual, face-to-face psychotherapy to a control group (e.g., care-as-usual [CAU] or waitlist condition [WL]). METHODS Four databases were systematically searched, and meta-regression analyses conducted to assess the relationship between the effect size (Hedges' g) of the treatment and number of sessions, duration of psychotherapy, total contact time with the therapist, and number of sessions per week. RESULTS We included 176 studies (210 comparisons) with 15,158 participants. We did not find a relationship between the effect size, and number of sessions, or total contact time. There was a small negative association between duration of treatment and the effect size, an additional week of treatment was related to a 0.014 decrease in the effect size. In addition, there was a strong association between number of sessions per week and the effect size, an increase from one to two sessions per week was related to an effect size higher by 0.596. Both associations were no longer significant when controlling for characteristics of studies. LIMITATIONS The current findings are correlational, future research should thus address this question in an RCT. CONCLUSIONS We should deliver brief therapies, and thus shorten waiting lists. More sessions, if necessary, should be delivered with higher frequency and over a shorter period of time.
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Affiliation(s)
- Marketa Ciharova
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Black Dog Institute, University of New South Wales, Sydney, Australia.
| | - Eirini Karyotaki
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; WHO Collaborating Center for Research and Dissemination of Psychological Interventions, the Netherlands
| | - Clara Miguel
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Esther Walsh
- Department of General Practice and Primary Health Care, University of Auckland, New Zealand
| | - Nino de Ponti
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Arpana Amarnath
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Wouter van Ballegooijen
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Bruce Arroll
- Department of General Practice and Primary Health Care, University of Auckland, New Zealand
| | - Pim Cuijpers
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; WHO Collaborating Center for Research and Dissemination of Psychological Interventions, the Netherlands
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Zhang Y, Peng Z, Tang N, Zhang Y, Liu N, Lv R, Meng Y, Cai M, Wang H. Efficacy of MRI-guided rTMS for post-traumatic stress disorder by modulating amygdala activity: study protocol for a randomised controlled trial. BMJ Open 2024; 14:e081751. [PMID: 38960463 PMCID: PMC11227799 DOI: 10.1136/bmjopen-2023-081751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 06/17/2024] [Indexed: 07/05/2024] Open
Abstract
INTRODUCTION Post-traumatic stress disorder (PTSD) is a prevalent and severe psychiatric disorder. Repetitive transcranial magnetic stimulation (rTMS) targeting the dorsolateral prefrontal cortex provides limited relief for symptoms of PTSD. This study will be conducted to validate the efficacy of MRI-guided rTMS in targeting the sites most closely associated with the amygdala for patients with PTSD. We hypothesise that the intervention will improve clinical symptoms by decreasing amygdala activity in patients. METHODS AND ANALYSIS A randomised, double-blind, sham-controlled trial will be conducted. Forty-eight eligible patients with PTSD will be randomly assigned to receive either active or sham MRI-guided rTMS for 10 consecutive days after the initial MRI scans. MRI scans will be recollected at the end of the intervention. Clinical assessments will be performed at baseline, treatment day 5, treatment day 10, and 2 weeks, 4 weeks, 8 weeks after completion of the intervention to monitor changes in clinical symptoms. The primary assessment outcome is the change in PTSD symptoms between baseline and treatment day 10, as measured by the PTSD Checklist for DSM-5. Repeated measures analysis of variance will be performed using statistical software SPSS V.26.0. The significance level will be set at 0.05. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Ethics Committee of Xijing Hospital in Xi'an, China (KY20222176-X-1), and the trial has been registered on ClinicalTrials.gov. The findings of this trial will be disseminated at academic conferences or published in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER NCT05544110.
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Affiliation(s)
- Yaochi Zhang
- Department of Psychiatry, Xijing Hospital of Air Force Military Medical University, Xian, Shaanxi, China
| | - Zhengwu Peng
- Department of Psychiatry, Xijing Hospital of Air Force Military Medical University, Xian, Shaanxi, China
| | - Nailong Tang
- Department of Psychiatry, Xijing Hospital of Air Force Military Medical University, Xian, Shaanxi, China
| | - Yuyu Zhang
- Department of Psychiatry, Xijing Hospital of Air Force Military Medical University, Xian, Shaanxi, China
| | - Nian Liu
- Department of Psychiatry, Xijing Hospital of Air Force Military Medical University, Xian, Shaanxi, China
| | - Runxin Lv
- Department of Psychiatry, Xijing Hospital of Air Force Military Medical University, Xian, Shaanxi, China
| | - Yumeng Meng
- Department of Psychiatry, Xijing Hospital of Air Force Military Medical University, Xian, Shaanxi, China
| | - Min Cai
- Department of Psychiatry, Xijing Hospital of Air Force Military Medical University, Xian, Shaanxi, China
| | - Huaning Wang
- Department of Psychiatry, Xijing Hospital of Air Force Military Medical University, Xian, Shaanxi, China
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Wang X, Chen H, Wen R, Ou P, Huang Y, Deng L, Shi L, Chen W, Chen H, Wang J, He C, Liu C. Exploring functional and structural connectivity disruptions in spinocerebellar ataxia type 3: Insights from gradient analysis. CNS Neurosci Ther 2024; 30:e14842. [PMID: 39014518 PMCID: PMC11251871 DOI: 10.1111/cns.14842] [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: 02/27/2024] [Revised: 05/30/2024] [Accepted: 06/23/2024] [Indexed: 07/18/2024] Open
Abstract
AIMS Spinocerebellar Ataxia Type 3 (SCA3) is a rare genetic ataxia that impacts the entire brain and is characterized as a neurodegenerative disorder affecting the neural network. This study explores how alterations in the functional hierarchy, connectivity, and structural changes within specific brain regions significantly contribute to the heterogeneity of symptom manifestations in patients with SCA3. METHODS We prospectively recruited 51 patients with SCA3 and 59 age-and sex-matched healthy controls. All participants underwent comprehensive multimodal neuroimaging and clinical assessments. In SCA3 patients, an innovative approach utilizing gradients in resting-state functional connectivity (FC) was employed to examine atypical patterns of hierarchical processing topology from sensorimotor to supramodal regions in the cerebellum and cerebrum. Coupling analyses of abnormal FC and structural connectivity among regions of interest (ROIs) in the brain were also performed to characterize connectivity alterations. Additionally, relationships between quantitative ROI values and clinical variables were explored. RESULTS Patients with SCA3 exhibited either compression or expansion within the primary sensorimotor-to-supramodal gradient through four distinct calculation methods, along with disruptions in FC and structural connectivity coupling. A comprehensive correlation was identified between the altered gradients and the clinical manifestations observed in patients. Notably, altered fractional anisotropy values were not significantly correlated with clinical variables. CONCLUSION Abnormal gradients and connectivity in the cerebellar and cerebral cortices in SCA3 patients may contribute to disrupted motor-to-supramodal functions. Moreover, these findings support the potential utility of FCG analysis as a biomarker for diagnosing SCA3 and assessing treatment efficacy.
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Affiliation(s)
- Xingang Wang
- Department of Radiology, 7T Magnetic Resonance Translational Medicine Research Center, Southwest HospitalArmy Medical University (Third Military Medical University)ChongqingChina
| | - Hui Chen
- Department of Radiology, 7T Magnetic Resonance Translational Medicine Research Center, Southwest HospitalArmy Medical University (Third Military Medical University)ChongqingChina
| | - Ru Wen
- Department of Radiology, 7T Magnetic Resonance Translational Medicine Research Center, Southwest HospitalArmy Medical University (Third Military Medical University)ChongqingChina
| | - Peiling Ou
- Department of Radiology, 7T Magnetic Resonance Translational Medicine Research Center, Southwest HospitalArmy Medical University (Third Military Medical University)ChongqingChina
| | - Yonghua Huang
- Department of Radiology, 7T Magnetic Resonance Translational Medicine Research Center, Southwest HospitalArmy Medical University (Third Military Medical University)ChongqingChina
| | - Lihua Deng
- Department of Radiology, 7T Magnetic Resonance Translational Medicine Research Center, Southwest HospitalArmy Medical University (Third Military Medical University)ChongqingChina
| | - Linfeng Shi
- Department of Radiology, 7T Magnetic Resonance Translational Medicine Research Center, Southwest HospitalArmy Medical University (Third Military Medical University)ChongqingChina
| | - Wei Chen
- MR Research Collaboration TeamSiemens Healthineers Ltd.WuhanChina
| | - Huafu Chen
- Department of Radiology, 7T Magnetic Resonance Translational Medicine Research Center, Southwest HospitalArmy Medical University (Third Military Medical University)ChongqingChina
- Biomedical EngineeringUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Jian Wang
- Department of Radiology, 7T Magnetic Resonance Translational Medicine Research Center, Southwest HospitalArmy Medical University (Third Military Medical University)ChongqingChina
| | - Changchun He
- College of Blockchain IndustryChengdu University of Information TechnologyChengduChina
| | - Chen Liu
- Department of Radiology, 7T Magnetic Resonance Translational Medicine Research Center, Southwest HospitalArmy Medical University (Third Military Medical University)ChongqingChina
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Lin HL, Lee WY, Liu CH, Chiang WY, Hsu YT, Hsiao CF, Tsou HH, Liu CY. The Clinical Characteristics and Manifestation of Anxious Depression Among Patients With Major Depressive Disorders-Results From a Taiwan Multicenter Study. Psychiatry Investig 2024; 21:561-572. [PMID: 38960433 PMCID: PMC11222076 DOI: 10.30773/pi.2023.0419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/22/2024] [Accepted: 02/26/2024] [Indexed: 07/05/2024] Open
Abstract
OBJECTIVE Anxious depression is a prevalent characteristic observed in Asian psychiatric patients diagnosed with major depressive disorder (MDD). This study aims to investigate the prevalence and clinical presentation of anxious depression in Taiwanese individuals diagnosed with MDD. METHODS We recruited psychiatric outpatients aged over 18 who had been diagnosed with MDD through clinical interviews. This recruitment took place at five hospitals located in northern Taiwan. We gathered baseline clinical and demographic information from the participants. Anxious depression was identified using a threshold of an anxiety/somatization factor score ≥7 on the 21-item Hamilton Rating Scale for Depression (HAM-D). RESULTS In our study of 399 patients (84.21% female), 64.16% met the criteria for anxious depression. They tended to be older, married, less educated, with more children, and an older age of onset. Anxious depression patients had higher HAM-D and Clinical Global Impression-Severity scale score, more panic disorder (without agoraphobia), and exhibited symptoms like agitation, irritability, concentration difficulties, psychological and somatic anxiety, somatic complaints, hypochondriasis, weight loss, and increased insight. Surprisingly, their suicide rates did not significantly differ from non-anxious depression patients. This highlights the importance of recognizing and addressing these unique characteristics. CONCLUSION Our study findings unveiled that the prevalence of anxious depression among Taiwanese outpatients diagnosed with MDD was lower compared to inpatients but substantially higher than the reported rates in European countries and the United States. Furthermore, patients with anxious depression exhibited a greater occurrence of somatic symptoms.
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Affiliation(s)
- Huang-Li Lin
- Department of Psychiatry, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Yang Lee
- Department of Psychiatry, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan
| | - Chun-Hao Liu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Child and Adolescent Psychiatry, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan
| | - Wei-Yu Chiang
- Department of Medical Education, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan
| | - Ya-Ting Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli, Taiwan
| | - Chin-Fu Hsiao
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli, Taiwan
| | - Hsiao-Hui Tsou
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli, Taiwan
- Graduate Institute of Biostatistics, College of Public Health, China Medical University, Taichung, Taiwan
| | - Chia-Yih Liu
- Department of Psychiatry, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan
- Department of Psychiatry, New Taipei City Tucheng Hospital, New Taipei City, Taiwan
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7
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Zhao X, Wu S, Li X, Liu Z, Lu W, Lin K, Shao R. Common neural deficits across reward functions in major depression: a meta-analysis of fMRI studies. Psychol Med 2024:1-13. [PMID: 38777630 DOI: 10.1017/s0033291724001235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Major depressive disorder (MDD) is characterized by deficient reward functions in the brain. However, existing findings on functional alterations during reward anticipation, reward processing, and learning among MDD patients are inconsistent, and it was unclear whether a common reward system implicated in multiple reward functions is altered in MDD. Here we meta-analyzed 18 past studies that compared brain reward functions between adult MDD patients (N = 477, mean age = 26.50 years, female = 59.40%) and healthy controls (N = 506, mean age = 28.11 years, females = 55.58%), and particularly examined group differences across multiple reward functions. Jack-knife sensitivity and subgroup meta-analyses were conducted to test robustness of findings across patient comorbidity, task paradigm, and reward nature. Meta-regression analyses assessed the moderating effect of patient symptom severity and anhedonia scores. We found during reward anticipation, MDD patients showed lower activities in the lateral prefrontal-thalamus circuitry. During reward processing, patients displayed reduced activities in the right striatum and prefrontal cortex, but increased activities in the left temporal cortex. During reward learning, patients showed reduced activity in the lateral prefrontal-thalamic-striatal circuitry and the right parahippocampal-occipital circuitry but higher activities in bilateral cerebellum and the left visual cortex. MDD patients showed decreased activity in the right thalamus during both reward anticipation and learning, and in the right caudate during both reward processing and learning. Larger functional changes in MDD were observed among patients with more severe symptoms and higher anhedonia levels. The thalamic-striatal circuitry functional alterations could be the key neural mechanism underlying MDD patients overarching reward function deficiencies.
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Affiliation(s)
- Xuanhao Zhao
- Department of Affective Disorder, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, P.R. China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, P.R. China
| | - Shiyun Wu
- Department of Affective Disorder, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, P.R. China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, P.R. China
| | - Xian Li
- Department of Affective Disorder, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, P.R. China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, P.R. China
| | - Zhongwan Liu
- Department of Affective Disorder, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, P.R. China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, P.R. China
| | - Weicong Lu
- Department of Affective Disorder, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, P.R. China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, P.R. China
| | - Kangguang Lin
- Department of Affective Disorder, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, P.R. China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, P.R. China
| | - Robin Shao
- Department of Affective Disorder, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, P.R. China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, P.R. China
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Cluxton-Keller F, Hegel MT, Donnelly CL, Bruce ML. Video-Delivered Family Therapy for Perinatal Women With Depressive Symptoms and Family Conflict: Feasibility, Acceptability, Safety, and Tolerability Results From a Pilot Randomized Trial. JMIR Form Res 2023; 7:e51824. [PMID: 37921846 PMCID: PMC10656661 DOI: 10.2196/51824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/14/2023] [Accepted: 09/27/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Although individual-level treatments exist for pregnant and postpartum women with depression, family conflict is a significant factor that can contribute to the development and severity of perinatal depressive symptoms. Yet, there is a lack of research on family therapy for perinatal women with moderate to severe depressive symptoms and family conflict. Further, research is needed on the feasibility, acceptability, safety, and tolerability of family therapies for perinatal depression that are delivered using Health Insurance Portability and Accountability Act-compliant videoconferencing technology (VCT). OBJECTIVE This paper describes the feasibility, acceptability, safety, and tolerability of a VCT-based family therapeutic intervention, Resilience Enhancement Skills Training (REST), for perinatal women with moderate to severe depressive symptoms and moderate to high conflict with their family members. METHODS This paper includes data from an ongoing randomized trial that compares an experimental family therapeutic intervention (REST) to standard of care (VCT-based problem-solving individual therapy) for the treatment of moderate to severe depressive symptoms in perinatal women with moderate to high family conflict. Both interventions were delivered by masters-level therapists using VCT. A total of 83 perinatal women and their adult family members (N=166 individuals) were recruited for participation in the study. Feasibility, defined as therapist adherence to ≥80% of REST session content, was assessed in audio-recorded sessions by 2 expert raters. Acceptability was defined as ≥80% of families completing REST, including completion of ≥80% homework assignments and family report of satisfaction with REST. Completion of REST was assessed by review of therapist session notes, and satisfaction was assessed by participant completion of a web-based questionnaire. The Beck Depression Inventory-Second Edition was administered to perinatal women by research assistants (blind to study group assignment) to assess safety, defined as a reduction in depressive symptoms during the treatment phase. The Family Environment Scale-Family Conflict subscale was administered by therapists to participants during the treatment phase to assess tolerability, defined as a reduction in family conflict during the treatment phase. RESULTS On average, the therapists achieved 90% adherence to REST session content. Of the families who started REST, 84% (32/38) of them completed REST, and on average, they completed 89% (8/9) of the homework assignments. Families reported satisfaction with REST. The results showed that REST is safe for perinatal women with moderate to severe depressive symptoms, and none discontinued due to worsened depressive symptoms. The results showed that REST is well tolerated by families, and no families discontinued due to sustained family conflict. CONCLUSIONS The results show that REST is feasible, acceptable, safe, and tolerable for families. These findings will guide our interpretation of REST's preliminary effectiveness upon completion of outcome data collection. TRIAL REGISTRATION ClinicalTrials.gov NCT04741776; https://clinicaltrials.gov/ct2/show/NCT04741776.
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Affiliation(s)
- Fallon Cluxton-Keller
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Mark T Hegel
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Craig L Donnelly
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Martha L Bruce
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
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Chen Y, Zhao W, Yi S, Liu J. The diagnostic performance of machine learning based on resting-state functional magnetic resonance imaging data for major depressive disorders: a systematic review and meta-analysis. Front Neurosci 2023; 17:1174080. [PMID: 37811326 PMCID: PMC10559726 DOI: 10.3389/fnins.2023.1174080] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 08/11/2023] [Indexed: 10/10/2023] Open
Abstract
Objective Machine learning (ML) has been widely used to detect and evaluate major depressive disorder (MDD) using neuroimaging data, i.e., resting-state functional magnetic resonance imaging (rs-fMRI). However, the diagnostic efficiency is unknown. The aim of the study is to conduct an updated meta-analysis to evaluate the diagnostic performance of ML based on rs-fMRI data for MDD. Methods English databases were searched for relevant studies. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used to assess the methodological quality of the included studies. A random-effects meta-analytic model was implemented to investigate the diagnostic efficiency, including sensitivity, specificity, diagnostic odds ratio (DOR), and area under the curve (AUC). Regression meta-analysis and subgroup analysis were performed to investigate the cause of heterogeneity. Results Thirty-one studies were included in this meta-analysis. The pooled sensitivity, specificity, DOR, and AUC with 95% confidence intervals were 0.80 (0.75, 0.83), 0.83 (0.74, 0.82), 14.00 (9, 22.00), and 0.86 (0.83, 0.89), respectively. Substantial heterogeneity was observed among the studies included. The meta-regression showed that the leave-one-out cross-validation (loocv) (sensitivity: p < 0.01, specificity: p < 0.001), graph theory (sensitivity: p < 0.05, specificity: p < 0.01), n > 100 (sensitivity: p < 0.001, specificity: p < 0.001), simens equipment (sensitivity: p < 0.01, specificity: p < 0.001), 3.0T field strength (Sensitivity: p < 0.001, specificity: p = 0.04), and Beck Depression Inventory (BDI) (sensitivity: p = 0.04, specificity: p = 0.06) might be the sources of heterogeneity. Furthermore, the subgroup analysis showed that the sample size (n > 100: sensitivity: 0.71, specificity: 0.72, n < 100: sensitivity: 0.81, specificity: 0.79), the different levels of disease evaluated by the Hamilton Depression Rating Scale (HDRS/HAMD) (mild vs. moderate vs. severe: sensitivity: 0.52 vs. 0.86 vs. 0.89, specificity: 0.62 vs. 0.78 vs. 0.82, respectively), the depression scales in patients with comparable levels of severity. (BDI vs. HDRS/HAMD: sensitivity: 0.86 vs. 0.87, specificity: 0.78 vs. 0.80, respectively), and the features (graph vs. functional connectivity: sensitivity: 0.84 vs. 0.86, specificity: 0.76 vs. 0.78, respectively) selected might be the causes of heterogeneity. Conclusion ML showed high accuracy for the automatic diagnosis of MDD. Future studies are warranted to promote the potential use of these classification algorithms in clinical settings.
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Affiliation(s)
- Yanjing Chen
- Department of Radiology, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wei Zhao
- Department of Radiology, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Clinical Research Center for Medical Imaging in Hunan Province, Changsha, Hunan, China
| | - Sijie Yi
- Department of Radiology, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jun Liu
- Department of Radiology, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Clinical Research Center for Medical Imaging in Hunan Province, Changsha, Hunan, China
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10
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Cuijpers P, Miguel C, Harrer M, Ciharova M, Karyotaki E. Does the use of pharmacotherapy interact with the effects of psychotherapy? A meta-analytic review. Eur Psychiatry 2023; 66:e63. [PMID: 37534407 PMCID: PMC10594340 DOI: 10.1192/j.eurpsy.2023.2437] [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] [Received: 05/12/2023] [Revised: 06/20/2023] [Accepted: 07/03/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND It is not clear if there is an interaction between psychotherapy and pharmacotherapy. First, there may be no interaction at all, meaning that the effects of both are independent of each other. Second, antidepressants may reduce the effects of psychotherapy, and third, antidepressants may increase the effects of psychotherapy. We examined which of the three is correct. METHODS We conducted random effects meta-analyses of randomized trials comparing psychotherapies for adult depression with control conditions. The proportion of users of antidepressants was used as a predictor of the effect size in a series of meta-regression analyses, while adjusting for relevant moderators, such as type of control group and baseline severity. RESULTS We included 300 randomized controlled trials (353 comparisons between treatment and control; 32,852 participants). The main effect size of psychotherapy was g = 0.71 (95% CI: 0.64; 0.79) with high heterogeneity (I2 = 82; 95% CI: 80; 84). We found no significant association between the proportion of antidepressants users and effect size (p = .07). We did find a significant association with some other predictors, including the type of control group and risk of bias. The use of antidepressants was associated with higher response rates within the control conditions, but not with the relative effects of the treatments compared to the control groups. DISCUSSION We found support for the independent effects of psychotherapy and pharmacotherapy, which is good news from a clinical perspective. Apparently, patients can start with psychotherapy and do not have to be afraid that this will reduce the effects of the therapy.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- International Institute for Psychotherapy, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mathias Harrer
- Psychology & Digital Mental Health Care, Department of Health Sciences, Technical University Munich, Munich, Germany
- Department of Clinical Psychology & Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Marketa Ciharova
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Askaryzadeh Mahani M, Ghasemi M, Arab M, Baniasadi Z, Omidi A, Irani PS. The correlation between caregiver burden with depression and quality of life among informal caregivers of hemodialysis and thalassemia patients during the COVID-19 pandemic: a cross-sectional study. BMC Nurs 2023; 22:183. [PMID: 37246222 PMCID: PMC10225281 DOI: 10.1186/s12912-023-01351-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/23/2023] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Lifelong provision of care to chronically ill patients increase the risk of physical and mental diseases in informal caregivers and adversely affects their quality of life. The present study examined the correlation between caregiver burden, depression, and quality of life among the informal caregivers of thalassemia and hemodialysis patients during the COVID-19 pandemic in southeastern Iran. METHODS This cross-sectional correlational study used convenience sampling to select 200 informal caregivers involved in providing direct care for patients undergoing hemodialysis (n = 70) and patients with thalassemia (130) for at least 6 months. A demographic questionnaire, Beck's Depression Inventory (BDI), the Quality-Of-Life Questionnaire (SF-36), and the Zarit Burden Interview were used to collect data in 2021. The data were analyzed with SPSS software (version 19) using frequency, percentage, independent samples t-test, ANOVA, and multivariate regression analysis. RESULTS Most of the informal caregivers of the thalassemia and hemodialysis patients (58% and 43%) reported moderate levels of caregiver burden. There were significant correlations between the caregiver burden and depression (P < 0.0001) and between the caregiver burden and the quality of life (P < 0.009). The level of depression in informal caregivers of patients undergoing hemodialysis was higher than that of the informal caregivers of patients with thalassemia, but the quality of life in the informal caregivers of the patient's undergoing hemodialysis was higher than that of the informal caregivers of the patients with thalassemia. CONCLUSION Considering the significant correlations between caregiver burden, depression, and quality of life in this study, healthcare providers are recommended to develop educational and supportive interventions to meet informal caregivers' needs, mitigate their emotional distress, fears, and concerns, and prevent caregiver burden in times of greater uncertainty.
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Affiliation(s)
- Maryam Askaryzadeh Mahani
- Student Research Committee, Razi faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran.
| | | | | | | | - Ali Omidi
- School of Nursing ad Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parichehr Sabaghzadeh Irani
- Student Research Committee, Razi faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
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Borroni E, Pesatori AC, Nosari G, Monti P, Ceresa A, Fedrizzi L, Bollati V, Buoli M, Carugno M. Understanding the Interplay between Air Pollution, Biological Variables, and Major Depressive Disorder: Rationale and Study Protocol of the DeprAir Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20065196. [PMID: 36982103 PMCID: PMC10049152 DOI: 10.3390/ijerph20065196] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 05/27/2023]
Abstract
Major depressive disorder (MDD) is a serious and disabling condition, whose etiological mechanisms are not fully understood. The aim of the DeprAir study is to verify the hypothesis that air pollution exposure may exacerbate neuroinflammation with consequent alterations in DNA methylation of genes involved in circadian rhythms and hormonal dysregulation, resulting in the worsening of depressive symptoms. The study population consists of 420 depressed patients accessing the psychiatry unit of the Policlinico Hospital (Milan, Italy), from September 2020 to December 2022. Data collection is still ongoing for about 100 subjects. For each participant demographic and lifestyle information, depression history and characteristics, as well as blood samples, were collected. MDD severity was assessed through five rating scales commonly used in clinical practice to assess the severity of affective symptoms. Exposure to particulate and gaseous air pollutants is assigned to each subject using both air pollution monitoring station measurements and estimates derived from a chemical transport model. DeprAir is the first study investigating in a comprehensive picture whether air pollution exposure could be an important modifiable environmental factor associated with MDD severity and which biological mechanisms mediate the negative effect of air pollution on mental health. Its results will represent an opportunity for preventive strategies, thus entailing a tremendous impact on public health.
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Affiliation(s)
- Elisa Borroni
- EPIGET Lab, Department of Clinical Sciences and Community Health, University of Milan, Via San Barnaba 8, 20122 Milan, Italy; (E.B.); (A.C.P.); (P.M.); (V.B.)
| | - Angela Cecilia Pesatori
- EPIGET Lab, Department of Clinical Sciences and Community Health, University of Milan, Via San Barnaba 8, 20122 Milan, Italy; (E.B.); (A.C.P.); (P.M.); (V.B.)
- Occupational Health Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via san Barnaba 8, 20122 Milan, Italy;
| | - Guido Nosari
- Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza 35, 20122 Milan, Italy; (G.N.); (A.C.); (M.B.)
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Paola Monti
- EPIGET Lab, Department of Clinical Sciences and Community Health, University of Milan, Via San Barnaba 8, 20122 Milan, Italy; (E.B.); (A.C.P.); (P.M.); (V.B.)
| | - Alessandro Ceresa
- Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza 35, 20122 Milan, Italy; (G.N.); (A.C.); (M.B.)
| | - Luca Fedrizzi
- Occupational Health Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via san Barnaba 8, 20122 Milan, Italy;
| | - Valentina Bollati
- EPIGET Lab, Department of Clinical Sciences and Community Health, University of Milan, Via San Barnaba 8, 20122 Milan, Italy; (E.B.); (A.C.P.); (P.M.); (V.B.)
- Occupational Health Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via san Barnaba 8, 20122 Milan, Italy;
| | - Massimiliano Buoli
- Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza 35, 20122 Milan, Italy; (G.N.); (A.C.); (M.B.)
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Michele Carugno
- EPIGET Lab, Department of Clinical Sciences and Community Health, University of Milan, Via San Barnaba 8, 20122 Milan, Italy; (E.B.); (A.C.P.); (P.M.); (V.B.)
- Occupational Health Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via san Barnaba 8, 20122 Milan, Italy;
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13
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Wilken J, Traboulsee A, Nelson F, Ionete C, Kolind S, Fratto T, Kane R, Gandhi R, Rawlings AM, Roesch N, Ozog MA, DeLuca J. Longitudinal assessment of neurocognitive function in people with relapsing multiple sclerosis initiating alemtuzumab in routine clinical practice: LEM-COG study results. Mult Scler Relat Disord 2023; 73:104677. [PMID: 37028124 DOI: 10.1016/j.msard.2023.104677] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/21/2023] [Accepted: 03/26/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Alemtuzumab is effective in reducing relapse rate and disability, but limited data exist on its effect on cognitive function in relapsing multiple sclerosis (RMS). The present study assessed neurocognitive function and safety associated with alemtuzumab treatment in RMS. METHODS This longitudinal, single-arm, prospective study included people with RMS (aged 25-55 years) who were treated with alemtuzumab in clinical practice in the United States of America and Canada. The first participant was enrolled in December 2016. The primary endpoint was the change from baseline to post-baseline (month [M] 12/24) in MS-COGnitive (MS-COG) composite score. Secondary endpoints included Paced Auditory Serial Addition Test (PASAT), Symbol Digit Modalities Test (SDMT), Brief Visuospatial Memory Test-Revised (BVMT-R), Selective Reminding Test (SRT), Controlled Oral Word Association Test (COWAT), and Automated Neuropsychological Assessment Metrics (ANAM) scores. Depression and fatigue were assessed using Hamilton Rating Scale-Depression (HAM-D) and Fatigue Severity Scale (FSS)/Modified Fatigue Impact Scale (MFIS), respectively. Magnetic resonance imaging (MRI) parameters were assessed when available. Safety was assessed throughout the study. Descriptive statistics were used for the pre-specified statistical analyses. Since the study was terminated early (November 2019) because of operational and resource difficulties, post hoc analyses for statistical inference were performed among participants who had a baseline value and at least one complete post-baseline assessment for cognitive parameters, fatigue, or depression. RESULTS Of the 112 participants enrolled, 39 were considered as the primary analysis population at M12. At M12, a mean change of 0.25 (95% confidence interval [CI]: 0.04, 0.45; p = 0.0049; effect size [ES]: 0.39) was observed in the MS-COG composite score. Improvements were observed in processing speed (based on PASAT and SDMT; p < 0.0001; ES: 0.62), as well as in individual PASAT, SDMT and COWAT scores. An improvement was also noted in HAM-D (p = 0.0054; ES: -0.44), but not in fatigue scores. Among MRI parameters, decreases in burden of disease volume (BDV; ES: -0.12), new gadolinium-enhancing lesions (ES: -0.41) and newly active lesions (ES: -0.07) were observed at M12. About 92% of participants showed stable or improved cognitive status at M12. There were no new safety signals reported in the study. The most common adverse events (≥10% of participants) were headache, fatigue, nausea, insomnia, urinary tract infection, pain in extremity, chest discomfort, anxiety, dizziness, arthralgia, flushing, and rash. Hypothyroidism (3.7%) was the most frequent adverse event of special interest. CONCLUSION The findings from this study suggest that alemtuzumab has a positive impact on cognitive function with significant improvements in processing speed and depression in people with RMS over a period of 12 months. The safety profile of alemtuzumab was consistent with previous studies.
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Dar R, Sarna N, Yardeni G, Lazarov A. Are people with obsessive-compulsive disorder under-confident in their memory and perception? A review and meta-analysis. Psychol Med 2022; 52:2404-2412. [PMID: 35848286 PMCID: PMC9647546 DOI: 10.1017/s0033291722001908] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 05/10/2022] [Accepted: 06/01/2022] [Indexed: 12/24/2022]
Abstract
People with obsessive-compulsive disorder (OCD) tend to distrust their memory, perception, and other cognitive functions, and many OCD symptoms can be traced to diminished confidence in one's cognitive processes. For example, poor confidence in recall accuracy can cause doubt about one's memory and motivate repeated checking. At the same time, people with OCD also display performance deficits in a variety of cognitive tasks, so their reduced confidence must be evaluated in relation to their actual performance. To that end, we conducted an exhaustive review and meta-analysis of studies in which OCD participants and non-clinical control participants performed cognitive tasks and reported their confidence in their performance. Our search resulted in 19 studies that met criteria for inclusion in the quantitative analysis, with all studies addressing either memory or perception. We found that both performance and reported confidence were lower in OCD than in control participants. Importantly, however, confidence was more impaired than performance in participants with OCD. These findings suggest that people with OCD are less confident in their memory and perception than they should be, indicating a genuine under-confidence in this population. We discuss potential mechanisms that might account for this finding and suggest avenues for further research into under-confidence and related meta-cognitive characteristics of OCD.
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Affiliation(s)
- Reuven Dar
- School of Psychological Sciences, Tel Aviv University, Tel Aviv 69978, Israel
| | - Noam Sarna
- School of Psychological Sciences, Tel Aviv University, Tel Aviv 69978, Israel
| | - Gal Yardeni
- School of Psychological Sciences, Tel Aviv University, Tel Aviv 69978, Israel
| | - Amit Lazarov
- School of Psychological Sciences, Tel Aviv University, Tel Aviv 69978, Israel
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A systematic review of digital and face-to-face cognitive behavioral therapy for depression. NPJ Digit Med 2022; 5:144. [PMID: 36109583 PMCID: PMC9476400 DOI: 10.1038/s41746-022-00677-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/12/2022] [Indexed: 11/08/2022] Open
Abstract
AbstractCognitive behavioral therapy (CBT) represents one of the major treatment options for depressive disorders besides pharmacological interventions. While newly developed digital CBT approaches hold important advantages due to higher accessibility, their relative effectiveness compared to traditional CBT remains unclear. We conducted a systematic literature search to identify all studies that conducted a CBT-based intervention (face-to-face or digital) in patients with major depression. Random-effects meta-analytic models of the standardized mean change using raw score standardization (SMCR) were computed. In 106 studies including n = 11854 patients face-to-face CBT shows superior clinical effectiveness compared to digital CBT when investigating depressive symptoms (p < 0.001, face-to-face CBT: SMCR = 1.97, 95%-CI: 1.74–2.13, digital CBT: SMCR = 1.20, 95%-CI: 1.08–1.32) and adherence (p = 0.014, face-to-face CBT: 82.4%, digital CBT: 72.9%). However, after accounting for differences between face-to-face and digital CBT studies, both approaches indicate similar effectiveness. Important variables with significant moderation effects include duration of the intervention, baseline severity, adherence and the level of human guidance in digital CBT interventions. After accounting for potential confounders our analysis indicates comparable effectiveness of face-to-face and digital CBT approaches. These findings underline the importance of moderators of clinical effects and provide a basis for the future personalization of CBT treatment in depression.
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Chevance A, Ravaud P, Cornelius V, Mayo-Wilson E, Furukawa TA. Designing clinically useful psychopharmacological trials: challenges and ways forward. Lancet Psychiatry 2022; 9:584-594. [PMID: 35525252 DOI: 10.1016/s2215-0366(22)00041-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 01/15/2022] [Accepted: 02/01/2022] [Indexed: 12/23/2022]
Abstract
The clinical guidelines that underpin the use of drugs for mental disorders are informed by evidence from randomised controlled trials (RCTs). RCTs are performed to obtain marketing authorisation from regulators. The methods used in these RCTs could be appropriate for early phases of drug development because they identify drugs with important harms and drugs that are efficacious for specific health problems and populations. RCTs done before marketing authorisation do not tend to address clinical questions that concern the effectiveness of a drug in heterogeneous and comorbid populations, the optimisation of drug sequencing and discontinuation, or the comparative benefits and harms of different drugs that could be used for the same health problem. This Review proposes an overview of some shortcomings of RCTs, at an individual level and at the whole portfolio level, and identifies some methods in planning, conducting, and carrying out analyses in RCTs that could enhance their ability to support therapeutic decisions. These suggestions include: identifying patient-important questions to be investigated by psychopharmacological RCTs; embedding pragmatic RCTs within clinical practice to improve generalisability to target populations; collecting evidence about drugs in overlooked populations; developing methods to facilitate the recruitment of patients with mental disorders and to reduce the number of patients who drop out, using specific methods; using core outcome sets to standardise the assessment of benefits and harms; and recording systematically serious objective outcomes, such as suicide or hospitalisation, to be evaluated in meta-analyses. This work is a call to address questions relevant to patients using diverse design of RCTs, thus contributing to the development of a patient-centred, evidence-based psychiatry.
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Affiliation(s)
- Astrid Chevance
- Université Paris Cité, CRESS, INSERM, INRAE, Paris, France; Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, AP-HP, Paris, France.
| | - Philippe Ravaud
- Université Paris Cité, CRESS, INSERM, INRAE, Paris, France; Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, AP-HP, Paris, France
| | - Victoria Cornelius
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, UK
| | - Evan Mayo-Wilson
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior and Department of Clinical Epidemiology, School of Public Health, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Glabellar Botulinum Toxin Injection Improves Depression Scores: A Systematic Review and Meta-Analysis. Plast Reconstr Surg 2022; 150:211e-220e. [PMID: 35588104 DOI: 10.1097/prs.0000000000009240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Depression is a leading cause of disability worldwide. Preliminary evidence suggests that glabellar onabotulinumtoxinA injections improve depression scores with few side effects compared to current first-line antidepressant medications. The authors' review reports on these studies, hypothesizing that glabellar onabotulinumtoxinA injections can be an alternative safe and effective treatment for depression. METHODS A systematic review and meta-analysis of the relevant literature was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The PubMed, Cochrane Library, Embase, and Scopus databases were searched in August of 2020 using the keywords ["botox" OR "botulinum"] AND ["mood" OR "depression"] for articles published between 1980 and 2020. Prospective studies and randomized controlled trials on the use of glabellar onabotulinumtoxinA injections for the primary purpose of treating depression were considered. The primary endpoint for the meta-analysis was the mean difference in primary depression scores after treatment, along with a second endpoint of the standardized mean difference in depression scores among treated patients including all nine studies. RESULTS Of the 499 reviewed articles, nine studies were included that reported improvement in mean depression scores from baseline. All five randomized controlled trials reported an improvement in mean depression scores at 6 weeks after treatment, with a weighted average change of -8.39 points ( p < 0.0001). The aggregate standardized mean difference from baseline to the primary endpoint across all nine prospective studies was -1.61 SD ( p < 0.0001). CONCLUSION Meta-analysis and systematic review of the included studies provide support for an antidepressant effect of glabellar onabotulinumtoxinA injections.
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18
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Fried EI, Flake JK, Robinaugh DJ. Revisiting the theoretical and methodological foundations of depression measurement. NATURE REVIEWS PSYCHOLOGY 2022; 1:358-368. [PMID: 38107751 PMCID: PMC10723193 DOI: 10.1038/s44159-022-00050-2] [Citation(s) in RCA: 97] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 12/19/2023]
Abstract
Depressive disorders are among the leading causes of global disease burden, but there has been limited progress in understanding the causes and treatments for these disorders. In this Perspective, we suggest that such progress crucially depends on our ability to measure depression. We review the many problems with depression measurement, including limited evidence of validity and reliability. These issues raise grave concerns about common uses of depression measures, such as diagnosis or tracking treatment progress. We argue that shortcomings arise because depression measurement rests on shaky methodological and theoretical foundations. Moving forward, we need to break with the field's tradition that has, for decades, divorced theories about depression from how we measure it. Instead, we suggest that epistemic iteration, an iterative exchange between theory and measurement, provides a crucial avenue for depression measurement to progress.
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Affiliation(s)
- Eiko I. Fried
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
| | - Jessica K. Flake
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Donald J. Robinaugh
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, US
- Department of Applied Psychology, Northeastern University, Boston, Massachusetts, US
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19
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Karyotaki E, Araya R, Kessler RC, Waqas A, Bhana A, Rahman A, Matsuzaka CT, Miguel C, Lund C, Garman EC, Nakimuli-Mpungu E, Petersen I, Naslund JA, Schneider M, Sikander S, Jordans MJD, Abas M, Slade P, Walters S, Brugha TS, Furukawa TA, Amanvermez Y, Mello MF, Wainberg ML, Cuijpers P, Patel V. Association of Task-Shared Psychological Interventions With Depression Outcomes in Low- and Middle-Income Countries: A Systematic Review and Individual Patient Data Meta-analysis. JAMA Psychiatry 2022; 79:430-443. [PMID: 35319740 PMCID: PMC8943620 DOI: 10.1001/jamapsychiatry.2022.0301] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/02/2022] [Indexed: 01/14/2023]
Abstract
Importance Task sharing, the training of nonspecialist workers with no formal experience in counseling, is a promising strategy for addressing the large gap in treatment for depression in low- and middle-income countries (LMICs). Objective To examine the outcomes and moderators of task-shared psychological interventions associated with depression severity, response, and remission. Data Sources Systematic literature searches in PubMed, Embase, PsycINFO, and Cochrane Library up to January 1, 2021. Study Selection Randomized clinical trials (RCTs) of task-shared psychological interventions compared with control conditions for adults with depressive symptoms in LMICs were included. Data Extraction and Synthesis Two researchers independently reviewed the titles, abstracts, and full text of articles from an existing generic meta-analytic database that includes all RCTs on psychotherapy for depression. A systematic review and individual patient data (IPD) meta-analysis was used to estimate the outcomes of task-shared psychological interventions across patient characteristics using mixed-effects models. Procedures for abstracting data and assessing data quality and validity followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline. Main Outcomes and Measures Primary outcome was reduction in depression symptom severity measured by the 9-item Patient Health Questionnaire (PHQ-9). Response and remission rates were also estimated. Results Of 13 eligible trials, 11 (4145 participants) contributed IPD. Task-shared psychological interventions were associated with a greater decrease in depressive symptom severity than control conditions (Hedges g, 0.32; 95% CI, -0.26 to -0.38). Participants in the intervention groups had a higher chance of responding (odds ratio, 2.11; 95% CI, 1.60 to 2.80) and remitting (odds ratio, 1.87; 95% CI, 1.20 to 1.99). The presence of psychomotor symptoms was significantly associated with the outcomes of task-shared psychological interventions (β [SE], -1.21 [0.39]; P = .002). No other significant associations were identified. Heterogeneity among the trials with IPD was 74% (95% CI, 53%-86%). Conclusions and Relevance In this meta-analysis of IPD, task-shared psychological interventions were associated with a larger reduction in depressive symptom severity and a greater chance of response and remission than control conditions. These findings show potential for the use of task-sharing of psychological interventions across different groups of patients with depression. Further research would help identify which people are most likely to benefit and strengthen larger-scale implementation of this strategy to address the burden of depression in LMICs.
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Affiliation(s)
- Eirini Karyotaki
- Department of Clinical Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
| | - Ricardo Araya
- Center for Global Mental Health and Primary Care Research, Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Ahmed Waqas
- Institute of Population Health Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Arvin Bhana
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Atif Rahman
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Camila T. Matsuzaka
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Clara Miguel
- Department of Clinical Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
| | - Crick Lund
- Center for Global Mental Health and Primary Care Research, Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Emily C. Garman
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Inge Petersen
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Marguerite Schneider
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Siham Sikander
- Human Development Research Foundation, Islamabad, Pakistan
- Health Services Academy, Islamabad, Pakistan
| | - Mark J. D. Jordans
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Melanie Abas
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Pauline Slade
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Stephen Walters
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
| | - Traolach S. Brugha
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Toshi A. Furukawa
- Departments of Health Promotion and Human Behaviour and of Clinical Epidemiology, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | - Yagmur Amanvermez
- Department of Clinical Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
| | - Marcelo F. Mello
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
- Albert Einstein Israelite Hospital, Medicine School, São Paulo, Brazil
| | - Milton L. Wainberg
- Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York
| | - Pim Cuijpers
- Department of Clinical Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
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20
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Rabin EE, Kim M, Mozny A, Cardoza K, Bell AC, Zhai L, Bommi P, Lauing KL, King AL, Armstrong TS, Walunas TL, Fang D, Roy I, Peipert JD, Sieg E, Mi X, Amidei C, Lukas RV, Wainwright DA. A systematic review of pharmacologic treatment efficacy for depression in older patients with cancer. Brain Behav Immun Health 2022; 21:100449. [PMID: 35368609 PMCID: PMC8968450 DOI: 10.1016/j.bbih.2022.100449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 03/03/2022] [Accepted: 03/12/2022] [Indexed: 12/19/2022] Open
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21
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Hengartner MP, Plöderl M. Estimates of the minimal important difference to evaluate the clinical significance of antidepressants in the acute treatment of moderate-to-severe depression. BMJ Evid Based Med 2022; 27:69-73. [PMID: 33593736 DOI: 10.1136/bmjebm-2020-111600] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2021] [Indexed: 12/27/2022]
Abstract
The efficacy of antidepressants in the acute treatment of moderate-to-severe depression remains a controversial issue. The minimal important difference (MID) is relevant to judge the clinical significance of treatment effects. In this analysis paper, we discuss estimates of the MID for common depression outcome measures.For the Hamilton Depression Rating Scale 17-item Version (HDRS-17), according to both anchor-based and distribution-based approaches, MID estimates range from 3 to 8 points, and the most accurate values are likely between 3 and 5 points. For the 6-item version (HDRS-6), MID estimates range between 2 and 4 points. For both the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Beck Depression Inventory II (BDI-II), MID estimates range between 3 and 9 points, with estimates of 3-6 points likely being the most accurate. Quality of life appears to be more important to patients than core depression symptoms. We thus also evaluated the Short-Form 36 (SF-36) mental component score, a popular mental-health-related quality of life measure. Its MID estimate is likely about 5 points. By contrast, the average treatment effects of antidepressants on the HDRS-17, HDRS-6, MADRS, BDI-II and SF-36 are 2 points, 1.5 points, 3 points, 2 points and 3-5 points, respectively.In conclusion, the efficacy of antidepressants in the acute treatment of moderate-to-severe depression consistently fails to exceed the lower bound of the MID estimates for common depression outcome measures. The clinical significance of antidepressants thus remains uncertain and we call for more research on quality of life measures, which are the patients' most valued outcome domains.
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Affiliation(s)
- Michael P Hengartner
- Department of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland
| | - Martin Plöderl
- Department of Crisis Intervention and Suicide Prevention, Paracelsus Medical University Salzburg, Salzburg, Salzburg, Austria
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22
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Chen GW, Hsu TW, Ching PY, Pan CC, Chou PH, Chu CS. Efficacy and Tolerability of Repetitive Transcranial Magnetic Stimulation on Suicidal Ideation: A Systemic Review and Meta-Analysis. Front Psychiatry 2022; 13:884390. [PMID: 35599760 PMCID: PMC9120615 DOI: 10.3389/fpsyt.2022.884390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 04/14/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the efficacy of repetitive transcranial magnetic stimulation (rTMS) in treating suicidal ideation in patients with mental illness. METHOD We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Major electronic databases were systematically searched from the time of their inception until July 22, 2021. The primary outcome was the mean change in the scores for suicidal ideation. The secondary outcome was the mean change in depression severity. RESULTS Ten randomized controlled trials were eligible with 415 participants in the active treatment group (mean age = 53.78 years; mean proportion of women = 54.5%) and 387 participants in the control group (mean age = 55.52 years; mean proportion of women = 51.78%). rTMS significantly reduced suicidal ideation (k = 10, n = 802, Hedges' g = -0.390, 95% confidence interval [CI] = -0.193 to -0.588, p <.001) and severity of depressive symptoms (k = 9, n = 761, Hedges' g = -0.698, 95% CI = -1.023 to -0.372, p < 0.001) in patients with major mental disorders. In the subgroup analysis, rTMS reduced suicidal ideation among patients with non-treatment-resistant depression (non-TRD) (-0.208) but not in those with TRD. rTMS as combination therapy had a larger effect than did monotherapy (-0.500 vs. -0.210). Suicidal ideation significantly reduced in patients receiving more than ten treatment sessions (-0.255). Importantly, the rTMS group showed favorable tolerability without major adverse events. CONCLUSION The study showed that rTMS was effective and well-tolerated in reducing suicidal ideation and depression severity in patients with major mental disorders.
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Affiliation(s)
- Guan-Wei Chen
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Tien-Wei Hsu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Pao-Yuan Ching
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chih-Chuan Pan
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Po-Han Chou
- Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Hsinchu, Taiwan
| | - Che-Sheng Chu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Non-invasive Neuromodulation Consortium for Mental Disorders, Society of Psychophysiology, Taipei, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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23
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Domhardt M, Grund S, Mayer A, Büscher R, Ebert DD, Sander LB, Karyotaki E, Cuijpers P, Baumeister H. Unveiling mechanisms of change in digital interventions for depression: Study protocol for a systematic review and individual participant data meta-analysis. Front Psychiatry 2022; 13:899115. [PMID: 36262633 PMCID: PMC9574035 DOI: 10.3389/fpsyt.2022.899115] [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: 03/18/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The efficacy and effectiveness of digital interventions for depression are both well-established. However, precise effect size estimates for mediators transmitting the effects of digital interventions are not available; and integrative insights on the specific mechanisms of change in internet- and mobile-based interventions (IMIs)-as related to key features like delivery type, accompanying support and theoretical foundation-are largely pending. OBJECTIVE We will conduct a systematic review and individual participant data meta-analysis (IPD-MA) evaluating the mediators associated with therapeutic change in various IMIs for depression in adults. METHODS We will use three electronic databases (i.e., Embase, Medline/PubMed, PsycINFO) as well as an already established database of IPD to identify relevant published and unpublished studies. We will include (1) randomized controlled trials that examine (2) mediators of (3) guided and unguided (4) IMIs with (5) various theoretical orientations for (6) adults with (7) clinically relevant symptoms of depression (8) compared to an active or passive control condition (9) with depression symptom severity as primary outcome. Study selection, data extraction, as well as quality and risk of bias (RoB) assessment will be done independently by two reviewers. Corresponding authors of eligible primary studies will be invited to share their IPD for this meta-analytic study. In a 1-stage IPD-MA, mediation analyses (e.g., on potential mediators like self-efficacy, emotion regulation or problem solving) will be performed using a multilevel structural equation modeling approach within a random-effects framework. Indirect effects will be estimated, with multiple imputation for missing data; the overall model fit will be evaluated and statistical heterogeneity will be assessed. Furthermore, we will investigate if indirect effects are moderated by different variables on participant- (e.g., age, sex/gender, symptom severity), study- (e.g., quality, studies evaluating the temporal ordering of changes in mediators and outcomes), and intervention-level (e.g., theoretical foundation, delivery type, guidance). DISCUSSION This systematic review and IPD-MA will generate comprehensive information on the differential strength of mediators and associated therapeutic processes in digital interventions for depression. The findings might contribute to the empirically-informed advancement of psychotherapeutic interventions, leading to more effective interventions and improved treatment outcomes in digital mental health. Besides, with our novel approach to mediation analyses with IPD-MA, we might also add to a methodological progression of evidence-synthesis in psychotherapy process research. STUDY REGISTRATION WITH OPEN SCIENCE FRAMEWORK OSF https://osf.io/md7pq/.
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Affiliation(s)
- Matthias Domhardt
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Simon Grund
- Department of Quantitative Psychology, University of Hamburg, Hamburg, Germany
| | - Axel Mayer
- Department of Psychological Methods and Evaluation, Bielefeld University, Bielefeld, Germany
| | - Rebekka Büscher
- Department of Rehabilitation Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany.,Medical Psychology and Medical Sociology, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - David D Ebert
- Department of Psychology and Digital Mental Health Care, Technical University Munich, Munich, Germany
| | - Lasse B Sander
- Department of Rehabilitation Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany.,Medical Psychology and Medical Sociology, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Eirini Karyotaki
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
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24
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Musazadeh V, Zarezadeh M, Faghfouri AH, Keramati M, Ghoreishi Z, Farnam A. Saffron, as an adjunct therapy, contributes to relieve depression symptoms: An umbrella meta-analysis. Pharmacol Res 2021; 175:105963. [PMID: 34757208 DOI: 10.1016/j.phrs.2021.105963] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Saffron is a traditional herbal medicine that has been used to treat various ailments such as depressive mood. However, the findings of several meta-analyses regarding anti-depressive properties of saffron (Crocus sativus L.) are controversial. The current umbrella meta-analysis was carried out to determine the magnitude and direction of saffron administration on depression. METHODS Relevant studies were searched in international databases including PubMed, Scopus, EMBASE, Web of Science, and Cochrane Central Library up to June 2021. Meta-analysis studies investigating the effects of saffron on depression were considered to include in the study. Random-effects model was used to perform the meta-analysis. Additional analyses including subgroup and sensitivity analyses were carried out. RESULTS Overall, 7 meta-analyses were included in the study. The results demonstrated that the consumption of saffron resulted in a significant reduction in BDI scores (ES: -3.87; 95% CI: -5.27, -2.46). However, saffron did not change the HAMD scores (ES: -2.10; 95% CI: -5.05, 0.86, p = 0.164) and mixed scores (HAM-D/BDI/DASS) (ES: 0.02; 95% CI: -0.39, 0.43,p = 0.941). CONCLUSION Present umbrella meta-analysis demonstrated that saffron intake might contribute to alleviation of depression disorder, however, it cannot be considered as a single therapeutic approach to treat depression.
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Affiliation(s)
- Vali Musazadeh
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Community Nutrition, School of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Meysam Zarezadeh
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; Nutrition Research Center, Department of Clinical Nutrition, School of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Amir Hossein Faghfouri
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Community Nutrition, School of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Majid Keramati
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Community Nutrition, School of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zohreh Ghoreishi
- Nutrition Research Center, Department of Clinical Nutrition, School of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Farnam
- Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.
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25
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Leichsenring F, Jaeger U, Masuhr O, Dally A, Dümpelmann M, Fricke-Neef C, Spitzer C, Steinert C. To Be or Not to Be Improved: Patients' Perception of Symptom Improvement - Linking the SCL-90-R to Patient-Rated Global Improvement in a Large Real-World Treatment Sample. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 89:357-362. [PMID: 32731248 DOI: 10.1159/000509213] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 05/27/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION From both a clinical and research perspective, it is important to determine what constitutes a perceivable change in commonly used outcome measures. OBJECTIVE We aimed to do so for the Symptom Checklist-90-Revised (SCL-90-R). METHODS Patients from a large real-world sample treated with inpatient psychotherapy (n = 4,791) rated improvements in symptoms on a global 5-point Likert scale at discharge. These ratings were related to pre-post changes in the Global Severity Index (GSI) of the SCL-90-R by use of equipercentile linking. RESULTS A patient rating of 5 ("clearly improved") was found to be equivalent to an absolute pre-post difference in the GSI of 0.67 or to a percentage improvement of 54%, with the latter corresponding to the common definition of response as a 50% reduction in symptoms. A rating of 1 ("clearly worse") was equivalent to an increase in the GSI >0.50 and to a percentage worsening >55%. "Slightly improved" or "slightly worse" (ratings of 4 or 2) corresponded to pre-post changes in the GSI of 0.07 and 0.50. For severely disordered patients, larger changes were required for ratings of improvement, and for less severely disordered patients, larger changes were required for ratings of worsening. Results for depressive, anxiety, and personality disorders were widely consistent with those of the total sample. CONCLUSIONS This study is the first to link patient ratings of improvement or worsening to changes in the SCL-90-R. Results are relevant to both the interpretation of changes in individual patients and of effect sizes in outcome research. Results require replication.
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Affiliation(s)
- Falk Leichsenring
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany, .,Department of Psychosomatics and Psychotherapeutic Medicine, University of Rostock, Rostock, Germany,
| | | | | | | | | | | | - Carsten Spitzer
- Asklepios Clinic Tiefenbrunn, Tiefenbrunn, Germany.,Department of Psychosomatics and Psychotherapeutic Medicine, University of Rostock, Rostock, Germany
| | - Christiane Steinert
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany.,International Psychoanalytic University, Berlin, Germany
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26
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Furukawa TA, Suganuma A, Ostinelli EG, Andersson G, Beevers CG, Shumake J, Berger T, Boele FW, Buntrock C, Carlbring P, Choi I, Christensen H, Mackinnon A, Dahne J, Huibers MJH, Ebert DD, Farrer L, Forand NR, Strunk DR, Ezawa ID, Forsell E, Kaldo V, Geraedts A, Gilbody S, Littlewood E, Brabyn S, Hadjistavropoulos HD, Schneider LH, Johansson R, Kenter R, Kivi M, Björkelund C, Kleiboer A, Riper H, Klein JP, Schröder J, Meyer B, Moritz S, Bücker L, Lintvedt O, Johansson P, Lundgren J, Milgrom J, Gemmill AW, Mohr DC, Montero-Marin J, Garcia-Campayo J, Nobis S, Zarski AC, O'Moore K, Williams AD, Newby JM, Perini S, Phillips R, Schneider J, Pots W, Pugh NE, Richards D, Rosso IM, Rauch SL, Sheeber LB, Smith J, Spek V, Pop VJ, Ünlü B, van Bastelaar KMP, van Luenen S, Garnefski N, Kraaij V, Vernmark K, Warmerdam L, van Straten A, Zagorscak P, Knaevelsrud C, Heinrich M, Miguel C, Cipriani A, Efthimiou O, Karyotaki E, Cuijpers P. Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data. Lancet Psychiatry 2021; 8:500-511. [PMID: 33957075 PMCID: PMC8838916 DOI: 10.1016/s2215-0366(21)00077-8] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/12/2021] [Accepted: 02/17/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Internet cognitive behavioural therapy (iCBT) is a viable delivery format of CBT for depression. However, iCBT programmes include training in a wide array of cognitive and behavioural skills via different delivery methods, and it remains unclear which of these components are more efficacious and for whom. METHODS We did a systematic review and individual participant data component network meta-analysis (cNMA) of iCBT trials for depression. We searched PubMed, PsycINFO, Embase, and the Cochrane Library for randomised controlled trials (RCTs) published from database inception to Jan 1, 2019, that compared any form of iCBT against another or a control condition in the acute treatment of adults (aged ≥18 years) with depression. Studies with inpatients or patients with bipolar depression were excluded. We sought individual participant data from the original authors. When these data were unavailable, we used aggregate data. Two independent researchers identified the included components. The primary outcome was depression severity, expressed as incremental mean difference (iMD) in the Patient Health Questionnaire-9 (PHQ-9) scores when a component is added to a treatment. We developed a web app that estimates relative efficacies between any two combinations of components, given baseline patient characteristics. This study is registered in PROSPERO, CRD42018104683. FINDINGS We identified 76 RCTs, including 48 trials contributing individual participant data (11 704 participants) and 28 trials with aggregate data (6474 participants). The participants' weighted mean age was 42·0 years and 12 406 (71%) of 17 521 reported were women. There was suggestive evidence that behavioural activation might be beneficial (iMD -1·83 [95% credible interval (CrI) -2·90 to -0·80]) and that relaxation might be harmful (1·20 [95% CrI 0·17 to 2·27]). Baseline severity emerged as the strongest prognostic factor for endpoint depression. Combining human and automated encouragement reduced dropouts from treatment (incremental odds ratio, 0·32 [95% CrI 0·13 to 0·93]). The risk of bias was low for the randomisation process, missing outcome data, or selection of reported results in most of the included studies, uncertain for deviation from intended interventions, and high for measurement of outcomes. There was moderate to high heterogeneity among the studies and their components. INTERPRETATION The individual patient data cNMA revealed potentially helpful, less helpful, or harmful components and delivery formats for iCBT packages. iCBT packages aiming to be effective and efficient might choose to include beneficial components and exclude ones that are potentially detrimental. Our web app can facilitate shared decision making by therapist and patient in choosing their preferred iCBT package. FUNDING Japan Society for the Promotion of Science.
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Affiliation(s)
- Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan.
| | - Aya Suganuma
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Edoardo G Ostinelli
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Gerhard Andersson
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden; Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | - Christopher G Beevers
- Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, Austin, TX, USA
| | - Jason Shumake
- Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, Austin, TX, USA
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Florien Willemijn Boele
- Patient Centred Outcomes Research Group, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Claudia Buntrock
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Isabella Choi
- Central Clinical School, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Helen Christensen
- Black Dog Institute and University of New South Wales, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Andrew Mackinnon
- Black Dog Institute and University of New South Wales, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Jennifer Dahne
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Marcus J H Huibers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - David D Ebert
- Department for Sport and Health Sciences, Chair for Psychology & Digital Mental Health Care, Technical University Munich, Germany
| | - Louise Farrer
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Nicholas R Forand
- Department of Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Daniel R Strunk
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Iony D Ezawa
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Erik Forsell
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Viktor Kaldo
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden; Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | | | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
| | | | - Sally Brabyn
- Department of Health Sciences, University of York, York, UK
| | | | - Luke H Schneider
- Anxiety Treatment and Research Clinic, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Robert Johansson
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Robin Kenter
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Marie Kivi
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Cecilia Björkelund
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Annet Kleiboer
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jan Philipp Klein
- Department of Psychiatry and Psychotherapy, Luebeck University, Luebeck, Germany
| | - Johanna Schröder
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Björn Meyer
- Research Department, GAIA AG, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lara Bücker
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ove Lintvedt
- Norwegian Center for E-health research, Tromsø, Norway
| | - Peter Johansson
- Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Johan Lundgren
- Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Jeannette Milgrom
- Parent-Infant Research Institute and Austin Health, Melbourne School of Psychological Sciences, University of Melbourne, VIC, Australia
| | - Alan W Gemmill
- Parent-Infant Research Institute and Austin Health, Melbourne School of Psychological Sciences, University of Melbourne, VIC, Australia
| | - David C Mohr
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Jesus Montero-Marin
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Javier Garcia-Campayo
- Aragon Institute for Health Research, Miguel Servet University Hospital, Zaragoza, Spain; Primary Care Prevention and Health Promotion Research Network, RedIAPP, Madrid, Spain
| | | | - Anna-Carlotta Zarski
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Kathleen O'Moore
- Black Dog Institute and University of New South Wales, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Alishia D Williams
- Department of Psychology, Faculty of Science, The University of New South Wales, Sydney, NSW, Australia
| | - Jill M Newby
- School of Psychology, University of New South Wales at the Black Dog Institute, Sydney, NSW, Australia
| | - Sarah Perini
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW, Australia
| | - Rachel Phillips
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Justine Schneider
- School of Sociology & Social Policy and Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Wendy Pots
- Department of Psychology, Health & Technology, University of Twente, Enschede, Netherlands
| | | | - Derek Richards
- University of Dublin, Trinity College, School of Psychology, E-mental Health Research Group, Dublin, Ireland; SilverCloud Health, Clinical Research & Innovation, Dublin, Ireland
| | | | | | | | - Jessica Smith
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - Viola Spek
- School of Applied Psychology, Fontys University of Applied Science, Eindhoven, Netherlands
| | - Victor J Pop
- Department of Medical & Clinical Psychology, Tilburg University, Tilburg, Netherlands
| | | | | | - Sanne van Luenen
- Department of Clinical Psychology, Leiden University, Leiden, Netherlands
| | - Nadia Garnefski
- Department of Clinical Psychology, Leiden University, Leiden, Netherlands
| | - Vivian Kraaij
- Department of Clinical Psychology, Leiden University, Leiden, Netherlands
| | - Kristofer Vernmark
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | | | - Annemieke van Straten
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Pavle Zagorscak
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | | | - Manuel Heinrich
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Andrea Cipriani
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Orestis Efthimiou
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Eirini Karyotaki
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Furukawa TA, Levine SZ, Buntrock C, Ebert DD, Gilbody S, Brabyn S, Kessler D, Björkelund C, Eriksson M, Kleiboer A, van Straten A, Riper H, Montero-Marin J, Garcia-Campayo J, Phillips R, Schneider J, Cuijpers P, Karyotaki E. How can we estimate QALYs based on PHQ-9 scores? Equipercentile linking analysis of PHQ-9 and EQ-5D. EVIDENCE-BASED MENTAL HEALTH 2021; 24:ebmental-2020-300240. [PMID: 33653738 PMCID: PMC8311092 DOI: 10.1136/ebmental-2020-300240] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/26/2021] [Accepted: 01/30/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Quality-adjusted life years (QALYs) are widely used to measure the impact of various diseases on both the quality and quantity of life and in their economic valuations. It will be clinically important and informative if we can estimate QALYs based on measurements of depression severity. OBJECTIVE To construct a conversion table from the Patient Health Questionnaire-9 (PHQ-9), the most frequently used depression scale in recent years, to the Euro-Qol Five Dimensions Three Levels (EQ-5D-3L), one of the most commonly used instruments to assess QALYs. METHODS We obtained individual participant data of randomised controlled trials of internet cognitive-behavioural therapy which had administered depression severity scales and the EQ-5D-3L at baseline and at end of treatment. Scores from depression scales were all converted into the PHQ-9 according to the validated algorithms. We used equipercentile linking to establish correspondences between the PHQ-9 and the EQ-5D-3L. FINDINGS Individual-level data from five trials (total N=2457) were available. Subthreshold depression (PHQ-9 scores between 5 and 10) corresponded with EQ-5D-3L index values of 0.9-0.8, mild major depression (10-15) with 0.8-0.7, moderate depression (15-20) with 0.7-0.5 and severe depression (20 or higher) with 0.6-0.0. A five-point improvement in PHQ-9 corresponded approximately with an increase in EQ-5D-3L score by 0.03 and a ten-point improvement by approximately 0.25. CONCLUSIONS AND CLINICAL IMPLICATIONS The conversion table between the PHQ-9 and the EQ-5D-3L scores will enable fine-grained assessment of burden of depression at its various levels of severity and of impacts of its various treatments.
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Affiliation(s)
- Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
| | - Stephen Z Levine
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Claudia Buntrock
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - David D Ebert
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
| | - Sally Brabyn
- Department of Health Sciences, University of York, York, UK
| | - David Kessler
- Population Health Sciences & National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Cecilia Björkelund
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Maria Eriksson
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Annet Kleiboer
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Annemieke van Straten
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jesus Montero-Marin
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Javier Garcia-Campayo
- Aragon Institute for Health Research (IIS Aragón), Miguel Servet University Hospital, Zaragoza, Spain
- Primary Care Prevention and Health Promotion Research Network, RedIAPP, Madrid, Spain
| | - Rachel Phillips
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Justine Schneider
- School of Sociology & Social Policy and Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Driessen E, Cohen ZD, Weissman MM, Markowitz JC, Weitz ES, Hollon SD, Browne DT, Rucci P, Corda C, Menchetti M, Bagby RM, Quilty LC, O'Hara MW, Zlotnick C, Pearlstein T, Blom MBJ, Altamura M, Gois C, Schneider LS, Twisk JWR, Cuijpers P. The efficacy of antidepressant medication and interpersonal psychotherapy for adult acute-phase depression: study protocol of a systematic review and meta-analysis of individual participant data. BJPsych Open 2021; 7:e56. [PMID: 33602371 PMCID: PMC8058821 DOI: 10.1192/bjo.2021.4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Antidepressant medication and interpersonal psychotherapy (IPT) are both recommended interventions in depression treatment guidelines based on literature reviews and meta-analyses. However, 'conventional' meta-analyses comparing their efficacy are limited by their reliance on reported study-level information and a narrow focus on depression outcome measures assessed at treatment completion. Individual participant data (IPD) meta-analysis, considered the gold standard in evidence synthesis, can improve the quality of the analyses when compared with conventional meta-analysis. AIMS We describe the protocol for a systematic review and IPD meta-analysis comparing the efficacy of antidepressants and IPT for adult acute-phase depression across a range of outcome measures, including depressive symptom severity as well as functioning and well-being, at both post-treatment and follow-up (PROSPERO: CRD42020219891). METHOD We will conduct a systematic literature search in PubMed, PsycINFO, Embase and the Cochrane Library to identify randomised clinical trials comparing antidepressants and IPT in the acute-phase treatment of adults with depression. We will invite the authors of these studies to share the participant-level data of their trials. One-stage IPD meta-analyses will be conducted using mixed-effects models to assess treatment effects at post-treatment and follow-up for all outcome measures that are assessed in at least two studies. CONCLUSIONS This will be the first IPD meta-analysis examining antidepressants versus IPT efficacy. This study has the potential to enhance our knowledge of depression treatment by comparing the short- and long-term effects of two widely used interventions across a range of outcome measures using state-of-the-art statistical techniques.
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Affiliation(s)
- Ellen Driessen
- Department of Clinical Psychology, Behavioural Science Institute, Radboud University, the Netherlands; and Depression Expertise Center, Pro Persona Mental Health Care, the Netherlands
| | - Zachary D Cohen
- Department of Psychiatry, University of California Los Angeles, USA
| | - Myrna M Weissman
- Columbia University Vagelos College of Physicians & Surgeons, New York State Psychiatric Institute, USA
| | - John C Markowitz
- Columbia University Vagelos College of Physicians & Surgeons, New York State Psychiatric Institute, USA
| | - Erica S Weitz
- Department of Psychology, University of Pennsylvania, USA
| | | | | | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Carolina Corda
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Marco Menchetti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - R Michael Bagby
- Departments of Psychology and Psychiatry, and Graduate Department of Psychological Clinical Science, University of Toronto Scarborough, Canada
| | - Lena C Quilty
- Department of Psychiatry, University of Toronto, Canada
| | - Michael W O'Hara
- Department of Psychological and Brain Sciences, University of Iowa, USA
| | - Caron Zlotnick
- Departments of Psychiatry and Human Behavior, Medicine, and Obstetrics and Gynecology, Brown University, USA; and Butler Hospital, USA
| | | | | | - Mario Altamura
- Department of Clinical and Experimental Medicine, University of Foggia, Italy
| | - Carlos Gois
- Department of Psychiatry, University of Lisbon, Portugal
| | - Lon S Schneider
- Department of Psychiatry and Neuroscience, Keck School of Medicine of USC, USA
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Centers, the Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
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Updated Review and Meta-Analysis of Probiotics for the Treatment of Clinical Depression: Adjunctive vs. Stand-Alone Treatment. J Clin Med 2021; 10:jcm10040647. [PMID: 33567631 PMCID: PMC7915600 DOI: 10.3390/jcm10040647] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 01/07/2023] Open
Abstract
Recent years have seen a rapid increase in the use of gut microbiota-targeting interventions, such as probiotics, for the treatment of psychiatric disorders. The objective of this update review was to evaluate all randomised controlled clinical trial evidence on the efficacy of probiotics for clinical depression. Cochrane guidelines for updated reviews were followed. By searching PubMed and Web of Science databases, we identified 546 new records since our previous review. A total of seven studies met selection criteria, capturing 404 people with depression. A random effects meta-analysis using treatment type (stand-alone vs. adjunctive) as subgroup was performed. The results demonstrated that probiotics are effective in reducing depressive symptoms when administered in addition to antidepressants (SMD = 0.83, 95%CI 0.49-1.17), however, they do not seem to offer significant benefits when used as stand-alone treatment (SMD = -0.02, 95%CI -0.34-0.30). Potential mechanisms of action may be via increases in brain-derived neurotrophic factor (BDNF) and decreases in C-reactive protein (CRP), although limited evidence is available at present. This review offers stronger evidence to support the clinical use of probiotics in depressed populations and provides an insight into the mode of administration more likely to yield antidepressant effects.
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Chopra P, Ayers CK, Antick JR, Kansagara D, Kondo K. The Effectiveness of Depression Treatment for Adults with ESKD: A Systematic Review. KIDNEY360 2021; 2:558-585. [PMID: 35369008 PMCID: PMC8785990 DOI: 10.34067/kid.0003142020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 01/04/2021] [Indexed: 02/04/2023]
Abstract
Adults with dialysis-dependent ESKD experience higher rates of depression than the general population, yet efficacy of depression treatments in this population is not well understood. We conducted a systematic review of the benefits and harms of depression treatment in adults with ESKD. We searched multiple data sources through June 2020 for English-language, controlled trials that compared interventions for depression in adults with ESKD to another intervention, placebo, or usual care, and reported depression treatment-related outcomes. Observational studies were included for harms. Two investigators independently screened all studies using prespecified criteria. One reviewer abstracted data on study design, interventions, implementation characteristics, and outcomes, and a second reviewer provided confirmation. Two reviewers independently assessed study quality and resolved any discords through discussion or a third reviewer. Strength of evidence (SOE) was assessed and agreed upon by review-team consensus. We qualitatively analyzed the data and present syntheses in text and tables. We included 26 RCTs and three observational studies. SSRIs were the most studied type of drug and the evidence was largely insufficient. We found moderate SOE that long-term, high-dose vitamin D3 is ineffective for reducing depression severity. Cognitive behavioral therapy is more effective than (undefined) psychotherapy and placebo for depression improvement and quality of life (low SOE), and acupressure is more effective than usual care or sham acupressure in reducing depression severity (low SOE). There is limited research evaluating treatment for depression in adults with ESKD, and existing studies may not be generalizable to adults in the United States. Studies suffer from limitations related to methodologic quality or reporting. More research replicating studies of promising interventions in US populations, with larger samples, is needed. Systematic Review registry name and registration number: PROSPERO, CRD42020140227.
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Affiliation(s)
- Pavan Chopra
- Department of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Chelsea K. Ayers
- Evidence Synthesis Program, Veterans Affairs Portland Health Care System, Portland, Oregon
| | - Jennifer R. Antick
- School of Graduate Psychology, Pacific University, Hillsboro, Oregon,Legacy Good Samaritan Medical Center, Portland, Oregon
| | - Devan Kansagara
- Department of Medicine, Oregon Health and Science University, Portland, Oregon,Evidence Synthesis Program, Veterans Affairs Portland Health Care System, Portland, Oregon,Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Portland, Oregon
| | - Karli Kondo
- Evidence Synthesis Program, Veterans Affairs Portland Health Care System, Portland, Oregon,Research Integrity Office, Oregon Health and Science University, Portland, Oregon
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Kinjo M, Wada M, Nakajima S, Tsugawa S, Nakahara T, Blumberger DM, Mimura M, Noda Y. Transcranial magnetic stimulation neurophysiology of patients with major depressive disorder: a systematic review and meta-analysis. Psychol Med 2021; 51:1-10. [PMID: 33267920 PMCID: PMC7856413 DOI: 10.1017/s0033291720004729] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/27/2020] [Accepted: 11/09/2020] [Indexed: 12/16/2022]
Abstract
Major depressive disorder (MDD) is a mental illness with high socio-economic burden, but its pathophysiology has not been fully elucidated. Recently, the cortical excitatory and inhibitory imbalance hypothesis and neuroplasticity hypothesis have been proposed for MDD. Although several studies have examined the neurophysiological profiles in MDD using transcranial magnetic stimulation (TMS), a meta-analysis of TMS neurophysiology has not been performed. The objective of this study was to compare TMS-electromyogram (TMS-EMG) findings between patients with MDD and healthy controls (HCs). To this end, we examined whether patients with MDD have lower short-interval cortical inhibition (SICI) which reflects gamma-aminobutyric acid (GABA)A receptor-mediated activity, lower cortical silent period (CSP) which represents GABAB receptor-mediated activity, higher intracortical facilitation (ICF) which reflects glutamate N-methyl-D-aspartate receptor-mediated activity, and the lower result of paired associative stimulation (PAS) paradigm which shows the level of neuroplasticity in comparison with HC. Further, we explored the effect of clinical and demographic factors that may influence TMS neurophysiological indices. We first searched and identified research articles that conducted single- or paired-pulse TMS-EMG on patients with MDD and HC. Subsequently, we extracted the data from the included studies and meta-analyzed the data with the comprehensive meta-analysis software. Patients with MDD were associated with lower SICI, lower CSP, potentially higher ICF, and lower PAS compared with HC. Our results confirmed the proposed hypotheses, suggesting the usefulness of TMS neurophysiology as potential diagnostic markers of MDD.
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Affiliation(s)
- Megumi Kinjo
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Masataka Wada
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Shinichiro Nakajima
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Sakiko Tsugawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Tomomi Nakahara
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Daniel M. Blumberger
- Department of Psychiatry, Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Yoshihiro Noda
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
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Flowers M, Leung A, Schiehser DM, Metzger-Smith V, Delano-Wood L, Sorg S, Kunnel A, Wong A, Vaninetti M, Golshan S, Lee R. Severities in persistent mild traumatic brain injury related headache is associated with changes in supraspinal pain modulatory functions. Mol Pain 2021; 17:17448069211037881. [PMID: 34365850 PMCID: PMC8358489 DOI: 10.1177/17448069211037881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/04/2021] [Accepted: 07/19/2021] [Indexed: 11/17/2022] Open
Abstract
Emerging evidence suggests mild traumatic brain injury related headache (MTBI-HA) is a form of neuropathic pain state. Previous supraspinal mechanistic studies indicate patients with MTBI-HA demonstrate a dissociative state with diminished levels of supraspinal prefrontal pain modulatory functions and enhanced supraspinal sensory response to pain in comparison to healthy controls. However, the relationship between supraspinal pain modulatory functional deficit and severity of MTBI-HA is largely unknown. Understanding this relationship may provide enhanced levels of insight about MTBI-HA and facilitate the development of treatments. This study assessed pain related supraspinal resting states among MTBI-HA patients with various headache intensity phenotypes with comparisons to controls via functional magnetic resonance imaging (fMRI). Resting state fMRI data was analyzed with self-organizing-group-independent-component-analysis in three MTBI-HA intensity groups (mild, moderate, and severe) and one control group (n = 16 per group) within a pre-defined supraspinal pain network based on prior studies. In the mild-headache group, significant increases in supraspinal function were observed in the right premotor cortex (T = 3.53, p < 0.001) and the left premotor cortex (T = 3.99, p < 0.0001) when compared to the control group. In the moderate-headache group, a significant (T = -3.05, p < 0.01) decrease in resting state activity was observed in the left superior parietal cortex when compared to the mild-headache group. In the severe-headache group, significant decreases in resting state supraspinal activities in the right insula (T = -3.46, p < 0.001), right premotor cortex (T = -3.30, p < 0.01), left premotor cortex (T = -3.84, p < 0.001), and left parietal cortex (T = -3.94, p < 0.0001), and an increase in activity in the right secondary somatosensory cortex (T = 4.05, p < 0.0001) were observed when compared to the moderate-headache group. The results of the study suggest that the increase in MTBI-HA severity may be associated with an imbalance in the supraspinal pain network with decline in supraspinal pain modulatory function and enhancement of sensory/pain decoding.
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Affiliation(s)
- Matthew Flowers
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Albert Leung
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Anesthesiology, The University of California, San Diego, La Jolla, CA, USA
| | - Dawn M Schiehser
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, The University of California, San Diego, La Jolla, CA, USA
| | - Valerie Metzger-Smith
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Lisa Delano-Wood
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, The University of California, San Diego, La Jolla, CA, USA
| | - Scott Sorg
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, The University of California, San Diego, La Jolla, CA, USA
| | - Alphonsa Kunnel
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Angeline Wong
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Michael Vaninetti
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Anesthesiology, The University of California, San Diego, La Jolla, CA, USA
| | - Shahrokh Golshan
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Roland Lee
- Department of Radiology, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
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Carneiro L, Afonso J, Ramirez-Campillo R, Murawska-Ciałowciz E, Marques A, Clemente FM. The Effects of Exclusively Resistance Training-Based Supervised Programs in People with Depression: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186715. [PMID: 32942633 PMCID: PMC7560016 DOI: 10.3390/ijerph17186715] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/09/2020] [Accepted: 09/12/2020] [Indexed: 12/20/2022]
Abstract
The purpose of this study was to systematically review the effects of supervised resistance training (RT) programs in people diagnosed with depression or depressive symptoms. The following databases were used to search and retrieve the articles: Cochrane Library, EBSCO, PEDro, PubMed, Scopus and Web of Science. The search was conducted in late June 2020. Search protocol required the title to contain the words depression or depressive or dysthymia. Furthermore, the title, abstract or keywords had to contain the words or expressions: "randomized controlled trial"; and "strength training" or "resistance training" or "resisted training" or "weight training". The screening provided 136 results. After the removal of duplicates, 70 records remained. Further screening of titles and abstracts resulted in the elimination of 57 papers. Therefore, 13 records were eligible for further scrutiny. Of the 13 records, nine were excluded, and the final sample consisted of four articles. Results were highly heterogeneous, with half of the studies showing positive effects of resistance training and half showing no effects. In two of the four combinations, the meta-analysis revealed significant benefits of RT in improving depressive symptoms (p ≤ 0.05). However, considering significant differences with moderate (Effect Size = 0.62) and small (ES = 0.53) effects, the heterogeneity was above 50%, thus suggesting a substantial level. To draw meaningful conclusions, future well-designed randomized controlled trials (RCTs) are needed that focus on understudied RT as a treatment for depression.
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Affiliation(s)
- Lara Carneiro
- Department of Sport and Physical Education, University Institute of Maia (ISMAI), Castêlo da Maia, 4475-690 Maia, Portugal;
- Research Centre in Sports Sciences, Health Sciences and Human Development, CIDESD, GERON Research Community, 5001-801 Vila Real, Portugal
| | - José Afonso
- Centre for Research, Education, Innovation and Intervention in Sport (CIFI2D), Faculty of Sport of the University of Porto (FADEUP), 4200-450 Porto, Portugal;
| | - Rodrigo Ramirez-Campillo
- Human Performance Laboratory, Quality of Life and Wellness Research Group, Department of Physical Activity Sciences, Universidad de Los Lagos, Lord Cochrane, 1046 Osorno, Chile;
| | - Eugenia Murawska-Ciałowciz
- Department of Physiology and Biochemistry, University School of Physical Education, 51-612 Wroclaw, Poland;
| | - Adilson Marques
- Faculty of Human Kinetics, University of Lisboa, Cruz Quebrada, 1499-002 Lisboa, Portugal;
| | - Filipe Manuel Clemente
- Escola Superior Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Rua Escola Industrial e Comercial de Nun’Álvares, 4900-347 Viana do Castelo, Portugal
- Instituto de Telecomunicações, Delegação da Covilhã, 1049-001 Lisboa, Portugal
- Correspondence:
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Vittengl JR, Clark LA, Thase ME, Jarrett RB. Psychometric properties of the Marital Adjustment Scale during cognitive therapy for depression: New research opportunities. Psychol Assess 2020; 32:1028-1036. [PMID: 32853004 DOI: 10.1037/pas0000944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Poor dyadic adjustment in marital or similar relationships is common among patients seeking individual cognitive therapy (CT) for major depressive disorder (MDD). Here we examined the psychometric properties of the marital adjustment subscale (MAS) of the Social Adjustment Scale-Self-report (SAS-SR; Weissman & Bothwell, 1976). Among married or cohabiting patients receiving individual CT for recurrent MDD (N = 306) in the context of two randomized controlled trials, the MAS demonstrated moderate internal consistency and test-retest reliability, strong convergence with the Dyadic Adjustment Scale (Spanier, 1976), and moderate relations with interpersonal problems and depressive symptoms. Controlling baseline depressive symptom severity, greater pre-CT relationship discord on the MAS predicted less reduction in depressive symptom severity and lower odds of depression remission during CT. These results support the reliability, validity, and potential utility of the MAS. Using the MAS may help investigators "mine" existing data sets including the SAS-SR to further understanding of dyadic functioning and its potential impact on depression treatment and other health outcomes. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Bora E. Meta-analysis of neurocognitive deficits in unaffected relatives of obsessive-compulsive disorder (OCD): comparison with healthy controls and patients with OCD. Psychol Med 2020; 50:1257-1266. [PMID: 32476632 DOI: 10.1017/s0033291720001634] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) has been associated with cognitive deficits, particularly with executive functions. These findings support fronto-striatal dysfunction in OCD. However, it is not certain whether these findings are trait features of OCD. In recent years, a number of studies have investigated cognitive functions in unaffected relatives of OCD (OCDrel) but the findings of these studies are contradictory. METHODS A systematic review in Pubmed and Scopus databases was performed until 18 March 2019, to locate the studies comparing cognitive functions of OCDrel with healthy controls and OCD patients (OCDpt). A random-effects meta-analysis was conducted. RESULTS Current meta-analysis included 16 studies including 527 OCDrel, 445 OCDpt and 639 healthy controls. Healthy controls overperformed OCDpt in all cognitive domains (d = 0.36-0.86). OCDrel underperformed healthy controls in inhibition (d = 0.58, CI = 0.29-0.86), planning (d = 0.45, CI = 0.28-0.63), decision-making (d = 0.58, CI = 0.19-0.98). OCDrel also had small-sized deficits in set-shifting (d = 0.37, CI = 0.04-0.69) and visual memory (d = 0.28, CI = 0.08-0.49). OCDpt underperformed OCDrel in visual memory (d = 0.45, CI = 0.22-0.67) and set-shifting (d = 0.23, CI = 0.04-0.42). CONCLUSIONS Current findings suggest that abnormalities in inhibition, planning/problem solving and reward-based decision-making are shared features of OCDrel and OCDpt and might be trait markers related to vulnerability for developing OCD. Visual memory and set-shifting deficits might potentially be biomarkers of incipient illness or subthreshold OCD presentation among OCDrel. Further exploration of cognitive heterogeneity in OCDrel and investigating the effects of the subtypes of OCD in probands on cognitive impairment in OCDrel are needed.
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Affiliation(s)
- Emre Bora
- Department of Psychiatry, Dokuz Eylul University Medical School, Izmir35340, Turkey
- Department of Neuroscience, Dokuz Eylul University, Izmir35340, Turkey
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria3053, Australia
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