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Mathias L, Quagliato LA, Carta MG, Nardi AE, Cheniaux E. Challenges in the treatment of dysthymia: a narrative review. Expert Rev Neurother 2024; 24:633-642. [PMID: 38805342 DOI: 10.1080/14737175.2024.2360671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 05/23/2024] [Indexed: 05/30/2024]
Abstract
INTRODUCTION Despite its milder severity, the chronic nature of dysthymia leads to significant impairments and functional limitations. The treatment of dysthymia has received considerably less research attention compared to major depressive disorder (MDD). AREAS COVERED The authors have conducted a comprehensive review on the treatment of dysthymia. Their primary objective was to identify therapeutic options that have demonstrated genuine efficacy. To do this, they searched the PubMed database, without any time restrictions, to retrieve original studies. The samples were exclusively comprised individuals diagnosed with dysthymia according to the diagnostic criteria outlined in DSM-III, DSM-III-R, DSM-IV, or DSM-IV-TR. EXPERT OPINION Within the realm of dysthymia treatment, several antidepressants, including imipramine, sertraline, paroxetine, minaprine, moclobemide, and amineptine, in addition to the antipsychotic agent amisulpride, have demonstrated superiority over placebo. In certain studies, psychotherapeutic interventions did not distinguish themselves significantly from pharmacological treatments and failed to exhibit greater efficacy than a placebo. However, these findings remain inconclusive due to the limited number of studies and substantial methodological limitations prevalent in a significant proportion of them. Limitations include factors like small sample sizes, the absence of placebo comparisons, and a lack of study blinding.
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Affiliation(s)
- Livia Mathias
- Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Laiana A Quagliato
- Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Mauro G Carta
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonio E Nardi
- Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Elie Cheniaux
- Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
- Laboratory of Panic and Respiration, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
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Xu YE, Barron DA, Sudol K, Zisook S, Oquendo MA. Suicidal behavior across a broad range of psychiatric disorders. Mol Psychiatry 2023; 28:2764-2810. [PMID: 36653675 PMCID: PMC10354222 DOI: 10.1038/s41380-022-01935-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 12/12/2022] [Accepted: 12/16/2022] [Indexed: 01/20/2023]
Abstract
Suicide is a leading cause of death worldwide. In 2020, some 12.2 million Americans seriously contemplated suicide, 3.2 million planned suicide attempts, and 1.2 million attempted suicide. Traditionally, the approach to treating suicidal behavior (SB) has been to treat the "underlying" psychiatric disorder. However, the number of diagnoses associated with SB is considerable. We could find no studies describing the range of disorders reported to be comorbid with SB. This narrative review summarizes literature documenting the occurrence of SB across the lifespan and the full range of psychiatric diagnoses, not only BPD and those that comprise MDE, It also describes the relevance of these observations to clinical practice, research, and nosology. The literature searches contained the terms "suicid*" and each individual psychiatric diagnosis and identified 587 studies. We did not include case reports, case series, studies only addressing suicidal ideation or non-suicidal self-injury (NSSI), studies on self-harm, not distinguishing between SB and NSSI and studies that did not include any individuals that met criteria for a specific DSM-5 diagnosis (n = 366). We found that SB (suicide and/or suicide attempt) was reported to be associated with 72 out of 145 diagnoses, although data quality varied. Thus, SB is not exclusively germane to Major Depressive Episode (MDE) and Borderline Personality Disorder (BPD), the only conditions for which it is a diagnostic criterion. That SB co-occurs with so many diagnoses reinforces the need to assess current and past SB regardless of diagnosis, and supports the addition of charting codes to the DSM-5 to indicate current or past SB. It also comports with new data that specific genes are associated with SB independent of psychiatric diagnoses, and suggests that SB should be managed with specific suicide prevention interventions in addition to treatments indicated for co-occurring diagnoses. SB diagnostic codes would help researchers and clinicians document and measure SB's trajectory and response to treatment over time, and, ultimately, help develop secondary and tertiary prevention strategies. As a separate diagnosis, SB would preclude situations in which a potentially life-threatening behavior is not accounted for by a diagnosis, a problem that is particularly salient when no mental disorder is present, as is sometimes the case.
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Affiliation(s)
- Yingcheng E Xu
- Department of Psychiatry and Behavioral Health, Cooper Medical School of Rowan University and Cooper University Health Care, Camden, NJ, 08103, US
| | - Daniel A Barron
- Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, PA, 19104, USA
| | - Katherin Sudol
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, 37212, USA
| | - Sidney Zisook
- Department of Psychiatry, University of California San Diego School of Medicine, San Diego, CA, 92103, USA
| | - Maria A Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
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Charlton CE, Karvelis P, McIntyre RS, Diaconescu AO. Suicide prevention and ketamine: insights from computational modeling. Front Psychiatry 2023; 14:1214018. [PMID: 37457775 PMCID: PMC10342546 DOI: 10.3389/fpsyt.2023.1214018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Suicide is a pressing public health issue, with over 700,000 individuals dying each year. Ketamine has emerged as a promising treatment for suicidal thoughts and behaviors (STBs), yet the complex mechanisms underlying ketamine's anti-suicidal effect are not fully understood. Computational psychiatry provides a promising framework for exploring the dynamic interactions underlying suicidality and ketamine's therapeutic action, offering insight into potential biomarkers, treatment targets, and the underlying mechanisms of both. This paper provides an overview of current computational theories of suicidality and ketamine's mechanism of action, and discusses various computational modeling approaches that attempt to explain ketamine's anti-suicidal effect. More specifically, the therapeutic potential of ketamine is explored in the context of the mismatch negativity and the predictive coding framework, by considering neurocircuits involved in learning and decision-making, and investigating altered connectivity strengths and receptor densities targeted by ketamine. Theory-driven computational models offer a promising approach to integrate existing knowledge of suicidality and ketamine, and for the extraction of model-derived mechanistic parameters that can be used to identify patient subgroups and personalized treatment approaches. Future computational studies on ketamine's mechanism of action should optimize task design and modeling approaches to ensure parameter reliability, and external factors such as set and setting, as well as psychedelic-assisted therapy should be evaluated for their additional therapeutic value.
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Affiliation(s)
- Colleen E. Charlton
- Krembil Center for Neuroinformatics, Center for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Povilas Karvelis
- Krembil Center for Neuroinformatics, Center for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Roger S. McIntyre
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Andreea O. Diaconescu
- Krembil Center for Neuroinformatics, Center for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Department of Psychology, University of Toronto, Toronto, ON, Canada
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Cai H, Xie XM, Zhang Q, Cui X, Lin JX, Sim K, Ungvari GS, Zhang L, Xiang YT. Prevalence of Suicidality in Major Depressive Disorder: A Systematic Review and Meta-Analysis of Comparative Studies. Front Psychiatry 2021; 12:690130. [PMID: 34603096 PMCID: PMC8481605 DOI: 10.3389/fpsyt.2021.690130] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 07/13/2021] [Indexed: 12/31/2022] Open
Abstract
Background: Suicidality is common in major depressive disorder (MDD), but there has been no systematic review published about all aspects of suicidality. This meta-analysis and systematic review compared the prevalence of the whole range of suicidality comprising suicidal ideation (SI), suicide plan (SP), suicide attempt (SA), and completed suicide (CS), between patients with MDD and non-MDD controls. Methods: Major international (PubMed, PsycINFO, Web of Science, EMBASE) and Chinese (Chinese Nation Knowledge Infrastructure and WANFANG) databases were systematically and independently searched from their inception until January 12, 2021. Results: Fifteen studies covering 85,768 patients (12,668 in the MDD group and 73,100 in the non-MDD group) were included in the analyses. Compared to non-MDD controls, the odds ratios (ORs) for lifetime, past month, past year, and 2-week prevalence of SI in MDD were 2.88 [95% confidence interval (CI) = 0.30-27.22, p = 0.36], 49.88 (95% CI = 2-8.63, p < 0.001), 13.97 (95% CI = 12.67-15.41, p < 0.001), and 24.81 (95% CI = 15.70-39.22, p < 0.001), respectively. Compared to non-MDD controls, the OR for lifetime SP in MDD was 9.51 (95% CI = 7.62-11.88, p < 0.001). Compared to non-MDD controls, the ORs of lifetime and past-year prevalence of SA were 3.45 (95% CI = 1.58-7.52, p = 0.002), and 7.34 (95% CI = 2.14-25.16, p = 0.002), respectively, in MDD patients. No difference in the prevalence of CS between MDD and controls was found (OR = 0.69, 95% CI = 0.23-2.02, p = 0.50). Conclusions: MDD patients are at a higher risk of suicidality, compared to non-MDD controls. Routine screening for a range of suicidality should be included in the management of MDD, followed by timely treatment for suicidal patients. Systematic Review Registration: Identifier [INPLASY202120078].
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Affiliation(s)
- Hong Cai
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Faculty of Health Sciences, Institute of Translational Medicine, University of Macau, Macao, Macao, SAR China.,Centre for Cognitive and Brain Sciences, University of Macau, Macao, Macao, SAR China.,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao, Macao, SAR China
| | - Xiao-Meng Xie
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Macao, Macao, SAR China
| | - Qinge Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Macao, Macao, SAR China
| | - Xiling Cui
- Department of Business Administration, Hong Kong Shue Yan University, Hong Kong, Hong Kong, SAR China
| | - Jing-Xia Lin
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong, Hong Kong, SAR China
| | - Kang Sim
- West Region, Institute of Mental Health, Buangkok Green Medical Park, Singapore, Singapore
| | - Gabor S Ungvari
- University of Notre Dame Australia, Fremantle, WA, Australia.,Division of Psychiatry, School of Medicine, University of Western Australia/Graylands Hospital, Perth, WA, Australia
| | - Ling Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Macao, Macao, SAR China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Faculty of Health Sciences, Institute of Translational Medicine, University of Macau, Macao, Macao, SAR China.,Centre for Cognitive and Brain Sciences, University of Macau, Macao, Macao, SAR China.,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao, Macao, SAR China
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Smirnova D, Cumming P, Sloeva E, Kuvshinova N, Romanov D, Nosachev G. Language Patterns Discriminate Mild Depression From Normal Sadness and Euthymic State. Front Psychiatry 2018; 9:105. [PMID: 29692740 PMCID: PMC5902561 DOI: 10.3389/fpsyt.2018.00105] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 03/15/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Deviations from typical word use have been previously reported in clinical depression, but language patterns of mild depression (MD), as distinct from normal sadness (NS) and euthymic state, are unknown. In this study, we aimed to apply the linguistic approach as an additional diagnostic key for understanding clinical variability along the continuum of affective states. METHODS We studied 402 written reports from 124 Russian-speaking patients and 77 healthy controls (HC), including 35 cases of NS, using hand-coding procedures. The focus of our psycholinguistic methods was on lexico-semantic [e.g., rhetorical figures (metaphors, similes)], syntactic [e.g., predominant sentence type (single-clause and multi-clause)], and lexico-grammatical [e.g., pronouns (indefinite, personal)] variables. Statistical evaluations included Cohen's kappa for inter-rater reliability measures, a non-parametric approach (Mann-Whitney U-test and Pearson chi-square test), one-way ANOVA for between-group differences, Spearman's and point-biserial correlations to analyze relationships between linguistic and gender variables, discriminant analysis (Wilks' λ) of linguistic variables in relation to the affective diagnostic types, all using SPSS-22 (significant, p < 0.05). RESULTS In MD, as compared with healthy individuals, written responses were longer, demonstrated descriptive rather than analytic style, showed signs of spoken and figurative language, single-clause sentences domination over multi-clause, atypical word order, increased use of personal and indefinite pronouns, and verb use in continuous/imperfective and past tenses. In NS, as compared with HC, we found greater use of lexical repetitions, omission of words, and verbs in continuous and present tenses. MD was significantly differentiated from NS and euthymic state by linguistic variables [98.6%; Wilks' λ(40) = 0.009; p < 0.001; r = 0.992]. The highest predictors in discrimination between MD, NS, and euthymic state groups were the variables of word order (typical/atypical) (r = -0.405), ellipses (omission of words) (r = 0.583), colloquialisms (informal words/phrases) (r = 0.534), verb tense (past/present/future) (r = -0.460), verbs form (continuous/perfect) (r = 0.345), amount of reflexive (e.g., myself)/personal (r = 0.344), and negative (e.g., nobody)/indefinite (r = 0.451) pronouns. The most significant between-group differences were observed in MD as compared with both NS and euthymic state. CONCLUSION MD is characterized by patterns of atypical language use distinguishing depression from NS and euthymic state, which points to a potential role of linguistic indicators in diagnosing affective states.
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Affiliation(s)
- Daria Smirnova
- Department of Psychiatry, Addictology, Psychotherapy and Clinical Psychology, Samara State Medical University, Samara, Russia.,Centre for Clinical Research in Neuropsychiatry, University of Western Australia, Perth, WA, Australia
| | - Paul Cumming
- School of Psychology and Counselling, Queensland University of Technology, QIMR Berghofer Institute, Brisbane, QLD, Australia
| | - Elena Sloeva
- Department of Pedagogy, Psychology and Psycholinguistics, Samara State Medical University, Samara, Russia
| | - Natalia Kuvshinova
- Department of Pedagogy, Psychology and Psycholinguistics, Samara State Medical University, Samara, Russia
| | - Dmitry Romanov
- Department of Psychiatry, Addictology, Psychotherapy and Clinical Psychology, Samara State Medical University, Samara, Russia
| | - Gennadii Nosachev
- Department of Psychiatry, Addictology, Psychotherapy and Clinical Psychology, Samara State Medical University, Samara, Russia
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Renner F, Arntz A, Peeters FPML, Lobbestael J, Huibers MJH. Schema therapy for chronic depression: Results of a multiple single case series. J Behav Ther Exp Psychiatry 2016; 51:66-73. [PMID: 26780673 DOI: 10.1016/j.jbtep.2015.12.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 10/26/2015] [Accepted: 12/01/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of this study was to test the effects of individual schema therapy (ST) for patients with chronic depression. METHODS Using a multiple-baseline single case series design, patients with chronic major depressive disorder (N = 25) first entered a 6-24 weeks baseline phase; this phase functioned as a no-treatment control condition. Then, patients started a 12 week exploration phase during which symptoms and underlying schemas were explored; this phase functioned as an attention control condition. Next, patients received up to 65 sessions of individual ST. The Beck Depression Inventory II (BDI-II) and the Quick Inventory of Depressive Symptomatology (QIDS) were the primary outcome measures. The BDI-II was assessed once a week during all phases of the study resulting in 100 repeated assessments per participant on average. Mixed regression analysis was used to contrast change in symptoms during the intervention with change in symptoms during the baseline and exploration control phases. RESULTS When compared to the no-treatment control period, the intervention had a significant, large effect on depressive symptoms (Cohen's d BDI-II = 1.30; Cohen's d QIDS = 1.22). Effects on secondary continuous outcomes were moderate to large. LIMITATIONS The small sample size and lack of a control group. CONCLUSIONS These findings provide evidence that ST might be an effective treatment for patients with chronic depression.
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Affiliation(s)
- Fritz Renner
- MRC Cognition and Brain Sciences Unit, Cambridge, United Kingdom; Department of Clinical Psychological Science, Maastricht University, The Netherlands.
| | - Arnoud Arntz
- Department of Clinical Psychological Science, Maastricht University, The Netherlands; Department of Clinical Psychology, University of Amsterdam, The Netherlands
| | - Frenk P M L Peeters
- Department of Psychiatry and Neuropsychology, University Hospital Maastricht, The Netherlands. School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life sciences, Maastricht University, The Netherlands
| | - Jill Lobbestael
- Department of Clinical Psychological Science, Maastricht University, The Netherlands
| | - Marcus J H Huibers
- Department of Clinical Psychology, VU University Amsterdam, The Netherlands; Department of Clinical Psychological Science, Maastricht University, The Netherlands
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Renner F, Arntz A, Leeuw I, Huibers M. Schematherapie für chronische Depressionen. VERHALTENSTHERAPIE 2014. [DOI: 10.1159/000365472] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Renner F, Arntz A, Leeuw I, Huibers M. Treatment for chronic depression using schema therapy. ACTA ACUST UNITED AC 2013. [DOI: 10.1111/cpsp.12032] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Blasco-Fontecilla H, Alegria AA, Delgado-Gomez D, Legido-Gil T, Saiz-Ruiz J, Oquendo MA, Baca-Garcia E. Age of first suicide attempt in men and women: an admixture analysis. ScientificWorldJournal 2012; 2012:825189. [PMID: 22654633 PMCID: PMC3354661 DOI: 10.1100/2012/825189] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2011] [Accepted: 12/18/2011] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES To define different subgroups of suicide attempters according to age at onset of suicide attempts. METHODS Participants were 229 suicide attempters (147 females; 82 males) admitted to a general hospital in Madrid, Spain. We used admixture analysis to determine the best-fitting model for the age at onset of suicide attempts separated by sex. RESULTS The best fitted model for the age at onset of suicide attempts was a mixture of two gaussian distributions. Females showed an earlier age at onset of suicide attempts in both Gaussian distributions (mean ± S.D.) (26.98 ± 5.69 and 47.98 ± 14.13) than males (32.77 ± 8.11 and 61.31 ± 14.61). Early-onset female attempters were more likely to show borderline personality disorder than late-onset female attempters (OR = 11.11; 95% CI = 2.43-50.0). CONCLUSIONS Age at onset of suicide attempts characterizes different subpopulations of suicide attempters.
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Affiliation(s)
- Hilario Blasco-Fontecilla
- Department of Psychiatry, Fundacion Jimenez Diaz, IIS, CIBERSAM, Autonoma University, 28040 Madrid, Spain.
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Hesse M, Guldager S, Holm Linneberg I. Convergent validity of MCMI-III clinical syndrome scales. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2011; 51:172-84. [DOI: 10.1111/j.2044-8260.2011.02019.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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