1
|
Correll CU, Dombi ZB, Barabássy Á, Németh G, Brevig T, McIntyre RS. The Transdiagnostic Global Impression - Psychopathology scale (TGI-P): Initial development of a novel transdiagnostic tool for assessing, tracking, and visualising psychiatric symptom severity in everyday practice. Eur Neuropsychopharmacol 2024; 88:31-39. [PMID: 39121713 DOI: 10.1016/j.euroneuro.2024.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 07/23/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024]
Abstract
Lacking biomarkers in psychiatry calls for a valid and reliable assessment of psychopathology across mental disorders that is easy to use, bridges research and clinical care, and that can capture clinician and patient perspectives. Herein we propose, a novel, brief, transdiagnostic tool to assess and visualize symptom severity in different psychiatric disorders. The Transdiagnostic Global Impression - Psychopathology scale (TGI-P) is based on the Clinical Global Impression - Severity scale (CGI-S), which was originally designed to measure global illness severity in one score. The TGI-P covers 10 transdiagnostic symptom domains and similar to the CGI-S, it is rated on a 7-point Likert-scale from 1 (normal) to 7 (extreme). These ten domains include positive symptoms, negative symptoms, manic symptoms, depressive symptoms, addiction symptoms, cognitive symptoms, anxiety symptoms, sleep symptoms, hostility symptoms, and self-harm symptoms. The results are visually presented, thus simplifying the monitoring of symptoms, and facilitating discussion with patients and caregivers. As part of the development process, the TGI-P was surveyed among 36 psychiatrists from 3 countries. Importantly, over 80 % of them was "very positive" or "positive" about the concept of the tool, and most of them (70 %) reported willingness to use it in their everyday practice. Further psychometric development and testing of the TGI-P is underway alongside future TGI scales covering adverse events, functioning and satisfaction.
Collapse
Affiliation(s)
- Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA; Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany; German Center for Mental Health (DZPG), partner site Berlin, Germany; Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Northwell Health, New Hyde Park, NY, US
| | - Zsófia B Dombi
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom; Global Medical Division, Gedeon Richter Plc., Budapest, Hungary.
| | - Ágota Barabássy
- Global Medical Division, Gedeon Richter Plc., Budapest, Hungary
| | - György Németh
- Global Medical Division, Gedeon Richter Plc., Budapest, Hungary
| | - Thomas Brevig
- Global Medical Division, Gedeon Richter Plc., Budapest, Hungary
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
2
|
Rodrigues A, Santos HC, Ferreira S, Diogo V, Costa M, Brissos S, Marques JG, Prata D. An exploration of blood-based biomarkers of negative symptoms of psychosis in men. J Psychiatr Res 2024; 177:256-263. [PMID: 39047549 DOI: 10.1016/j.jpsychires.2024.06.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 05/31/2024] [Accepted: 06/28/2024] [Indexed: 07/27/2024]
Abstract
Negative symptoms in the context of psychosis are still poorly understood and diagnosed, which impairs the treatment efficacy of current therapies and patient's integration in society. In this study, we aimed to test hypothesis-based and exploratory associations of negative symptom domains, as defined by the Brief Negative Symptom Scale (BNSS), with hormonal and hematological variables, and, complementarily, with standard psychological/cognitive and psychopathological measures. Fifty-one male patients diagnosed with a psychotic disorder underwent a structured interview and blood collection. Standard Spearmen bivariate correlations were used for data analysis. We obtained evidence of hypothesis-based associations between specific negative symptoms and oxytocin, thyroid stimulating hormone levels and neutrophil-to-lymphocyte ratio; as well as novel and hypothesis-free associations with erythrocyte and lymphocyte count, mean corpuscular volume and red cell distribution width. Complementarily, we also obtained some validation of previous associations of negative symptoms with illness resolution, cognitive symptom severity and social performance, and a novel association with anger contagion. We hope our results can generate new hypotheses in psychosis research. Our work suggests further avenues in research on erythrocytic, inflammatory, thyroid and oxytocin-related markers and abnormalities in psychosis, especially in regards to specific negative symptoms, towards more precise and comprehensive etiological, diagnostic and therapeutic models.
Collapse
Affiliation(s)
- Alexandra Rodrigues
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências da Universidade de Lisboa, Lisboa, Portugal; Neuroradiology Department, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal; Unidade de Neurorradiologia, Hospital Central do Funchal, Funchal, Portugal
| | - Henrique Castro Santos
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências da Universidade de Lisboa, Lisboa, Portugal; Unidade Local de Saúde de São José - Polo Júlio de Matos, Centro Hospitalar Psiquiátrico de Lisboa, Lisboa, Portugal
| | - Sara Ferreira
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências da Universidade de Lisboa, Lisboa, Portugal
| | - Vasco Diogo
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências da Universidade de Lisboa, Lisboa, Portugal
| | - Marco Costa
- Departamento de Imagiologia, Hospital CUF Tejo, Lisboa, Portugal
| | - Sofia Brissos
- Unidade Local de Saúde de São José - Polo Júlio de Matos, Centro Hospitalar Psiquiátrico de Lisboa, Lisboa, Portugal
| | - João Gama Marques
- Unidade Local de Saúde de São José - Polo Júlio de Matos, Centro Hospitalar Psiquiátrico de Lisboa, Lisboa, Portugal; Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Diana Prata
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências da Universidade de Lisboa, Lisboa, Portugal; Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| |
Collapse
|
3
|
Humayun MM, Brouillette MJ, Fellows LK, Mayo NE. The Patient Generated Index (PGI) as an early-warning system for predicting brain health challenges: a prospective cohort study for people living with Human Immunodeficiency Virus (HIV). Qual Life Res 2023; 32:3439-3452. [PMID: 37428407 DOI: 10.1007/s11136-023-03475-1] [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] [Accepted: 06/28/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE In research people are often asked to fill out questionnaires about their health and functioning and some of the questions refer to serious health concerns. Typically, these concerns are not identified until the statistician analyses the data. An alternative is to use an individualized measure, the Patient Generated Index (PGI) where people are asked to self-nominate areas of concern which can then be dealt with in real-time. This study estimates the extent to which self-nominated areas of concern related to mood, anxiety and cognition predict the presence or occurrence of brain health outcomes such as depression, anxiety, psychological distress, or cognitive impairment among people aging with HIV at study entry and for successive assessments over 27 months. METHODS The data comes from participants enrolled in the Positive Brain Health Now (+ BHN) cohort (n = 856). We analyzed the self-nominated areas that participants wrote on the PGI and classified them into seven sentiment groups according to the type of sentiment expressed: emotional, interpersonal, anxiety, depressogenic, somatic, cognitive and positive sentiments. Tokenization was used to convert qualitative data into quantifiable tokens. A longitudinal design was used to link these sentiment groups to the presence or emergence of brain health outcomes as assessed using standardized measures of these constructs: the Hospital Anxiety and Depression Scale (HADS), the Mental Health Index (MHI) of the RAND-36, the Communicating Cognitive Concerns Questionnaire (C3Q) and the Brief Cognitive Ability Measure (B-CAM). Logistic regressions were used to estimate the goodness of fit of each model using the c-statistic. RESULTS Emotional sentiments predicted all of the brain health outcomes at all visits with adjusted odds ratios (OR) ranging from 1.61 to 2.00 and c-statistics > 0.73 (good to excellent prediction). Nominating an anxiety sentiment was specific to predicting anxiety and psychological distress (OR 1.65 & 1.52); nominating a cognitive concern was specific to predicting self-reported cognitive ability (OR 4.78). Positive sentiments were predictive of good cognitive function (OR 0.36) and protective of depressive symptoms (OR 0.55). CONCLUSIONS This study indicates the value of using this semi-qualitative approach as an early-warning system in predicting brain health outcomes.
Collapse
Affiliation(s)
- Muhammad Mustafa Humayun
- Division of Experimental Medicine, Faculty of Medicine and Health Sciences, McGill University, 5252 de Maisonneuve, Montreal, QC, H4A 3S5, Canada.
- Center for Outcome Research and Evaluation (CORE), Research Institute of the McGill University Health Center, Montreal, QC, Canada.
| | - Marie-Josée Brouillette
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Lesley K Fellows
- Department of Neurology and Neurosurgery, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Nancy E Mayo
- Center for Outcome Research and Evaluation (CORE), Research Institute of the McGill University Health Center, Montreal, QC, Canada
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada
| |
Collapse
|
4
|
Kolc KL, Tan YXK, Lo AZY, Shvetcov A, Mitchell PB, Perkes IE. Measuring psychiatric symptoms online: A systematic review of the use of inventories on Amazon Mechanical Turk (mTurk). J Psychiatr Res 2023; 163:118-126. [PMID: 37209617 DOI: 10.1016/j.jpsychires.2023.05.027] [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: 12/07/2022] [Revised: 02/20/2023] [Accepted: 05/01/2023] [Indexed: 05/22/2023]
Abstract
Symptom measurement in psychiatric research increasingly uses digitized self-report inventories and is turning to crowdsourcing platforms for recruitment, e.g., Amazon Mechanical Turk (mTurk). The impact of digitizing pencil-and-paper inventories on the psychometric properties is underexplored in mental health research. Against this background, numerous studies report high prevalence estimates of psychiatric symptoms in mTurk samples. Here we develop a framework to evaluate the online implementation of psychiatric symptom inventories relative to two domains, that is, the adherence to (i) validated scoring and (ii) standardized administration. We apply this new framework to the online use of the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Alcohol Use Disorder Identification Test (AUDIT). Our systematic review of the literature identified 36 implementations of these three inventories on mTurk across 27 publications. We also evaluated methodological approaches to enhance data quality, e.g., the use of bot detection and attention check items. Of the 36 implementations, 23 reported the applied diagnostic scoring criteria and only 18 reported the specified symptom timeframe. None of the 36 implementations reported adaptations made in their digitization of the inventories. While recent reports attribute higher rates of mood, anxiety, and alcohol use disorders on mTurk to data quality, our findings indicate that this inflation may also relate to the assessment methods. We provide recommendations to enhance both data quality and fidelity to validated administration and scoring methods.
Collapse
Affiliation(s)
- Kristy L Kolc
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, Australia; Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia.
| | - Yue Xuan Karen Tan
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Alys Z Y Lo
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Artur Shvetcov
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia
| | - Philip B Mitchell
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Iain E Perkes
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, Australia; Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Discipline of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Department of Psychological Medicine, Sydney Children's Hospital Network, Sydney, Australia
| |
Collapse
|
5
|
The Association of the Oral Microbiota with the Effects of Acid Stress Induced by an Increase of Brain Lactate in Schizophrenia Patients. Biomedicines 2023; 11:biomedicines11020240. [PMID: 36830777 PMCID: PMC9953675 DOI: 10.3390/biomedicines11020240] [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: 12/07/2022] [Revised: 12/28/2022] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
The altered cerebral energy metabolism central to schizophrenia can be linked to lactate accumulation. Lactic acid is produced by gastrointestinal bacteria, among others, and readily crosses the blood-brain barrier, leading to the brain acidity. This study aimed to examine the association of the oral microbiota with the effects of acid stress induced by an increase of brain lactate in schizophrenia patients. The study included patients with a diagnosis of acute polyphasic psychotic disorder meeting criteria for schizophrenia at 3-month follow-up. Results: Individuals with a significantly higher total score on the Positive and Negative Syndrome Scale had statistically significantly lower lactate concentrations compared to those with a lower total score and higher brain lactate. We observed a positive correlation between Actinomyces and lactate levels in the anterior cingulate cap and a negative correlation between bacteria associated with lactate metabolism and some clinical assessment scales. Conclusions: Shifts in the oral microbiota in favour of lactate-utilising bacterial genera may represent a compensatory mechanism in response to increased lactate production in the brain. Assessment of neuronal function mediated by ALA-LAC-dependent NMDA regulatory mechanisms may, thus, support new therapies for schizophrenia, for which acidosis has become a differentiating feature of individuals with schizophrenia endophenotypes.
Collapse
|
6
|
Hofmann AB, Schmid HM, Jabat M, Brackmann N, Noboa V, Bobes J, Garcia-Portilla MP, Seifritz E, Vetter S, Egger ST. Utility and validity of the Brief Psychiatric Rating Scale (BPRS) as a transdiagnostic scale. Psychiatry Res 2022; 314:114659. [PMID: 35709637 DOI: 10.1016/j.psychres.2022.114659] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 05/15/2022] [Accepted: 05/30/2022] [Indexed: 10/18/2022]
Abstract
The Brief Psychiatric Rating Scale (BPRS) was originally conceived to assess psychopathology in several psychiatric disorders, making it an appropriate candidate to be used as a transdiagnostic instrument. We analyzed the utility and validity of the BPRS in a diagnostically heterogeneous sample of 600 psychiatric inpatients. As a comparator, we chose the mini-ICF-APP, a scale used to measure functioning and impairment across the diagnostic spectrum. Both scales had good internal consistency. The BPRS and the mini-ICF-APP showed a moderate correlation, with good levels of agreement. We were able to identify general symptoms present across the diagnostic spectrum, influencing severity and a cluster of symptoms specific for each diagnosis. Our results show the utility and validity of the BPRS as a transdiagnostic assessment tool that could easily be introduced in routine clinical work.
Collapse
Affiliation(s)
- Andreas B Hofmann
- University of Zurich, Faculty of Medicine, Psychiatric University Hospital of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland
| | - Hanna M Schmid
- University of Zurich, Faculty of Medicine, Psychiatric University Hospital of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland
| | - Mounira Jabat
- University of Zurich, Faculty of Medicine, Psychiatric University Hospital of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland
| | - Nathalie Brackmann
- University of Zurich, Faculty of Medicine, Psychiatric University Hospital of Zurich, Department of Forensic Psychiatry, Zurich, Switzerland
| | - Vanessa Noboa
- University of Zurich, Faculty of Medicine, Psychiatric University Hospital of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland; University San Francisco de Quito, Faculty of Medicine, Quito, Ecuador
| | - Julio Bobes
- University of Oviedo, Faculty of Medicine, Department of Psychiatry, ISPA, INEUROPA, CIBERSAM, Oviedo, Spain
| | - Maria Paz Garcia-Portilla
- University of Oviedo, Faculty of Medicine, Department of Psychiatry, ISPA, INEUROPA, CIBERSAM, Oviedo, Spain
| | - Erich Seifritz
- University of Zurich, Faculty of Medicine, Psychiatric University Hospital of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland
| | - Stefan Vetter
- University of Zurich, Faculty of Medicine, Psychiatric University Hospital of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland
| | - Stephan T Egger
- University of Zurich, Faculty of Medicine, Psychiatric University Hospital of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland; University of Oviedo, Faculty of Medicine, Department of Psychiatry, ISPA, INEUROPA, CIBERSAM, Oviedo, Spain.
| |
Collapse
|
7
|
de Leon-Martinez S, Ruiz M, Parra-Vargas E, Chicchi-Giglioli I, Courtet P, Lopez-Castroman J, Artes A, Baca-Garcia E, Porras-Segovia AA, Barrigon ML. Virtual reality and speech analysis for the assessment of impulsivity and decision-making: protocol for a comparison with neuropsychological tasks and self-administered questionnaires. BMJ Open 2022; 12:e058486. [PMID: 35831051 PMCID: PMC9280903 DOI: 10.1136/bmjopen-2021-058486] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Impulsivity is present in a range of mental disorders and has been associated with suicide. Traditional measures of impulsivity have certain limitations, such as the lack of ecological validity. Virtual reality (VR) may overcome these issues. This study aims to validate the VR assessment tool 'Spheres & Shield Maze Task' and speech analysis by comparing them with traditional measures. We hypothesise that these innovative tools will be reliable and acceptable by patients, potentially improving the simultaneous assessment of impulsivity and decision-making. METHODS AND ANALYSIS This study will be carried out at the University Hospital Fundación Jiménez Díaz (Madrid, Spain). Our sample will consist of adults divided into three groups: psychiatric outpatients with a history of suicidal thoughts and/or behaviours, psychiatric outpatients without such a history and healthy volunteers. The target sample size was established at 300 participants (100 per group). Participants will complete the Barratt Impulsiveness Scale 11; the Urgency, Premeditation, Perseverance, Sensation Seeking, Positive Urgency, Impulsive Behaviour Scale; Iowa Gambling Task; Continuous Performance Test; Stop signal Task, and Go/no-go task, three questions of emotional affect, the Spheres & Shield Maze Task and two satisfaction surveys. During these tasks, participant speech will be recorded. Construct validity of the VR environment will be calculated. We will also explore the association between VR-assessed impulsivity and history of suicidal thoughts and/or behaviour, and the association between speech and impulsivity and decision-making. ETHICS AND DISSEMINATION This study was approved by the Ethics Committee of the University Hospital Fundación Jiménez Díaz (PIC128-21_FJD). Participants will be required to provide written informed consent. The findings will be presented in a series of manuscripts that will be submitted to peer-reviewed journals for publication. TRIAL REGISTRATION NUMBER NCT05109845; Pre-results.
Collapse
Affiliation(s)
| | - Marta Ruiz
- Department of Psychiatry, Hospital Universitario Rey Juan Carlos, Mostoles, Spain
| | - Elena Parra-Vargas
- Laboratory of Immersive Neurotechnologies (LabLENI), Universidad Politécnica de Valencia, Valencia, Spain
| | - Irene Chicchi-Giglioli
- Department of Signal Theory and Communications, Universidad Carlos III de Madrid, Getafe, Spain
| | - Philippe Courtet
- Unité de recherche U1061, Institut national de la santé et de la recherche médicale, Paris, France
- Department of Emergency Psychiatry and Acute Care, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | | | - Antonio Artes
- Department of Signal Theory and Communications, Universidad Carlos III de Madrid, Leganés, Spain
| | - Enrique Baca-Garcia
- Department of Psychiatry, Hospital Universitario Rey Juan Carlos, Mostoles, Spain
- Department of Psychiatry, University Hospital Centre Nimes, Nimes, France
- Grupo de Investigación en Psiquiatría Translacional, Instituto de Investigacion Sanitaria de la Fundacion Jimenez Diaz, Madrid, Spain
- Department of Psychiatry, Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain
- Universidad Catolica del Maule, Talca, Chile
- Department of Psychiatry, Madrid Autonomous University, Madrid, Spain
- Department of Psychiatry, General Hospital of Villalba, Villaba, Madrid, Spain
- CIBERSAM (Centro de Investigacion en Salud Mental), Carlos III Institute of Health, Madrid, Spain
- Department of Psychiatry, University Hospital Infanta Elena, Valdemoro, Madrid, Spain
| | - Alejandro Albán Porras-Segovia
- Grupo de Investigación en Psiquiatría Translacional, Instituto de Investigacion Sanitaria de la Fundacion Jimenez Diaz, Madrid, Spain
- Division of Psychiatry, Imperial College London, London, UK
| | - Maria Luisa Barrigon
- Department of Psychiatry, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| |
Collapse
|
8
|
Borrione L, Cirillo PC, Aparicio LVM, Cavendish BA, Valiengo L, Moura DO, de Souza JP, Luethi MS, Klein I, Bariani B, Gallucci-Neto J, Suen P, Padberg F, Goerigk S, Vanderhasselt MA, De Deng Z, O’Shea J, Lotufo PA, Bensenor IM, Brunoni AR. A study protocol for an ongoing multi-arm, randomized, double-blind, sham-controlled clinical trial with digital features, using portable transcranial electrical stimulation and internet-based behavioral therapy for major depression disorders: The PSYLECT study. Expert Rev Neurother 2022; 22:513-523. [PMID: 35642516 PMCID: PMC10627342 DOI: 10.1080/14737175.2022.2083959] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/26/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Transcranial electrical stimulation (tES) is considered effective and safe for depression, albeit modestly, and prone to logistical burdens when performed in external facilities. Investigation of portable tES (ptES), and potentiation of ptES with remote psychological interventions have shown positive, but preliminary, results. RESEARCH DESIGN We report the rationale and design of an ongoing multi-arm, randomized, double-blind, sham-controlled clinical trial with digital features, using ptES and internet-based behavioral therapy (iBT) for major depressive disorder (MDD) (NCT04889976). METHODS We will evaluate the efficacy, safety, tolerability and usability of (1) active ptES + active iBT ('double-active'), (2) active ptES + sham iBT ('ptES-only'), and (3) sham ptES + sham iBT ('double-sham'), in adults with MDD, with a Hamilton Depression Rating Scale - 17 item version (HDRS-17) score ≥ 17 at baseline, during 6 weeks. Antidepressants are allowed in stable doses during the trial. RESULTS We primarily co-hypothesize changes in HDRS-17 will be greater in (1) 'double-active' compared to 'ptES-only,' (2) 'double-active' compared to 'double-sham,' and (3) 'ptES-only' compared to 'double-sham.' We aim to enroll 210 patients (70 per arm). CONCLUSIONS Our results should offer new insights regarding the efficacy and scalability of combined ptES and iBT for MDD, in digital mental health.
Collapse
Affiliation(s)
- Lucas Borrione
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
- Laboratory of Neuroscience and National Institute of Biomarkers in Psychiatry, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Patricia C Cirillo
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
- Laboratory of Neuroscience and National Institute of Biomarkers in Psychiatry, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Luana VM Aparicio
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
- Laboratory of Neuroscience and National Institute of Biomarkers in Psychiatry, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Beatriz A Cavendish
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
- Laboratory of Neuroscience and National Institute of Biomarkers in Psychiatry, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Leandro Valiengo
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
- Laboratory of Neuroscience and National Institute of Biomarkers in Psychiatry, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Darin O Moura
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
- Laboratory of Neuroscience and National Institute of Biomarkers in Psychiatry, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Juliana P de Souza
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
- Laboratory of Neuroscience and National Institute of Biomarkers in Psychiatry, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Matthias S Luethi
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
- Laboratory of Neuroscience and National Institute of Biomarkers in Psychiatry, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Izio Klein
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
- Laboratory of Neuroscience and National Institute of Biomarkers in Psychiatry, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Bruna Bariani
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
- Laboratory of Neuroscience and National Institute of Biomarkers in Psychiatry, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - José Gallucci-Neto
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
- Laboratory of Neuroscience and National Institute of Biomarkers in Psychiatry, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Paulo Suen
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
- Laboratory of Neuroscience and National Institute of Biomarkers in Psychiatry, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Stephan Goerigk
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Marie-Anne Vanderhasselt
- Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Ghent Experimental Psychiatry (GHEP) lab, Ghent University, Ghent, Belgium
- Department of Experimental Clinical and Health Psychology, Psychopathology and Affective Neuroscience Lab, Ghent University, Ghent, Belgium
| | - Zhi De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutic & Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jacinta O’Shea
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Human Brain Activity, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Paulo A Lotufo
- Center for Clinical and Epidemiological Research & Interdisciplinary Center for Applied Neuromodulation, University Hospital, University of São Paulo, São Paulo, Brazil
| | - Isabela M Bensenor
- Center for Clinical and Epidemiological Research & Interdisciplinary Center for Applied Neuromodulation, University Hospital, University of São Paulo, São Paulo, Brazil
| | - Andre R Brunoni
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
- Laboratory of Neuroscience and National Institute of Biomarkers in Psychiatry, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
- Center for Clinical and Epidemiological Research & Interdisciplinary Center for Applied Neuromodulation, University Hospital, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
9
|
Universal healthcare coverage for first episode of schizophrenia-spectrum disorders in Chile: analysis of the administrative database. Eur Arch Psychiatry Clin Neurosci 2022; 272:129-138. [PMID: 33772320 DOI: 10.1007/s00406-021-01254-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
Aim of the study was to analyse the Ministry of Health's (MINSAL) administrative database of the Universal Health Coverage (UHC) program for First Episode of Schizophrenia Spectrum Disorders (FEP-SSD). The database included every case registered in the program between 2004 and 2017. According to the timeframes established for permanence in the program, cases were defined as Suspected, FEP in diagnostic observation and FEP-SSD. Only first registers were analysed. We compared gender, age at entry, level of care and region where the case was registered. Denominator data for estimation of incidence rates were obtained from the last census. We adjusted incidence rate ratios by age, gender, and region. During the studied period, 33.207 suspected cases were registered. 27.006 (81%) were confirmed as FEP and after 6-month follow-up, 22.701 (68%) were confirmed as FEP-SSD. The median age at entry was 24 years, males entering at younger age. Male proportion was higher than female in all groups. 46.9% of all cases were detected in primary care. FEP-SSD cases were six years younger and had a higher proportion of males than discarded cases (62.6 vs 53.2%). During 169.4 million person-years at risk, crude incidence for suspected cases was 19.58 per 100.000 person-years; for FEP, 15.92 per 100.000 person-years and for FEP-SSD, 13.38 per 100.000 person-years. Chile has lower incidence of FEP-SSD compared to current world estimations but gender proportions are comparable. This UHC program has allowed early access through the integration of mental health to the health network at all levels of care.
Collapse
|
10
|
Choi YH, Yook V, Yang K, Cho Y, Lee DH, Lee HJ, Lee DH, Jeon HJ. Development and validation study of the suicide screening questionnaire-observer rating (SSQ-OR). Front Psychiatry 2022; 13:945051. [PMID: 36032221 PMCID: PMC9411983 DOI: 10.3389/fpsyt.2022.945051] [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: 05/16/2022] [Accepted: 07/18/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Observer rating scales are necessary to evaluate the risk of suicide because individuals at risk for suicide are often unwilling to seek help on their own. Reliability and validity were evaluated for the newly developed Suicide Screening Questionnaire-Observer Rating (SSQ-OR). METHODS Preliminary items were assessed by 251 experts online and 25 questions were selected. 328 individuals at high-risk and 661 controls from 12 Crisis Response Centers and 5 university counseling centers were recruited to complete SSQ-OR, Beck Scale for Suicide Ideation (BSSI) and Patient Health Questionnaire-9 (PHQ-9). In a 6 months follow-up, we reached out to 176 participants to ask whether they had experienced a suicidal thought, plan, or attempt since the baseline assessment. Cronbach's α, Mann-Whitney U test, Spearman's correlation, factor analyses, Receiver operating characteristic (ROC) analysis and logistic regression analysis were used to verify the SSQ-OR. RESULTS Structural validity was supported by a two-factor solution using exploratory and confirmatory factor analyses. Excellent model fit indices for the two-factor structure using exploratory factor analysis were confirmed (RMSEA = 0.033, TLI = 0.980, CFI = 0.983). The SSQ-OR demonstrated strong internal consistency. The concurrent validity based on the correlations with other self-reported indicators of suicidal potential-BSSI and PHQ-9- revealed substantial relationships. The high-risk group was effectively characterized by a cut-off point of 4, with a sensitivity of 0.73 and a specificity of 0.79. The SSQ-OR scores were significant predictors of suicidal thoughts and behaviors within 6 months. CONCLUSIONS The SSQ-OR exhibits sound psychometric properties, and could be used as a complement to a self-report or clinical-administered scale to screen suicide risk comprehensively.
Collapse
Affiliation(s)
- Young-Hwan Choi
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Vidal Yook
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyojin Yang
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yaehee Cho
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Deok Hee Lee
- Department of Education, Traumatic Stress Center, Sungkyunkwan University College of Education, Seoul, South Korea
| | - Hwa Jung Lee
- Department of Education, Traumatic Stress Center, Sungkyunkwan University College of Education, Seoul, South Korea
| | - Dong Hun Lee
- Department of Education, Traumatic Stress Center, Sungkyunkwan University College of Education, Seoul, South Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea
| |
Collapse
|
11
|
Das A, Padala KP, Crawford CG, Teo A, Mendez DM, Phillips OA, Wright BC, House S, Padala PR. A systematic review of loneliness and social isolation scales used in epidemics and pandemics. Psychiatry Res 2021; 306:114217. [PMID: 34644661 PMCID: PMC8502233 DOI: 10.1016/j.psychres.2021.114217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 09/15/2021] [Accepted: 09/19/2021] [Indexed: 12/30/2022]
Abstract
The COVID-19 pandemic has heightened social isolation and loneliness. There is a lack of consensus on rating scales to measure these constructs. Our objectives were to identify commonly used loneliness and social isolation scales over the last two decades and test their user characteristics. 7928 articles were searched in PubMed/MEDLINE, CINAHL, Web of Science, and APA PsychINFO databases. 41 articles were included based on study criteria. Among fourteen scales reported, UCLA 3-item loneliness scale was found to be most commonly used. The scale is specifically developed for telephone use and is the fastest taking less than a minute for self-administration.
Collapse
Affiliation(s)
- Aparna Das
- Department of Psychiatry, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA; Geriatric Research Education, and Clinical Center (GRECC), Central Arkansas Veterans Healthcare System (CAVHS), Little Rock, AR, USA
| | - Kalpana P Padala
- Geriatric Research Education, and Clinical Center (GRECC), Central Arkansas Veterans Healthcare System (CAVHS), Little Rock, AR, USA; Department of Geriatrics, UAMS, Little Rock, AR, USA
| | - Christina G Crawford
- Geriatric Research Education, and Clinical Center (GRECC), Central Arkansas Veterans Healthcare System (CAVHS), Little Rock, AR, USA
| | - Alan Teo
- Center to Improve Veteran Involvement in Care, Portland, OR USA; Oregon Health & Science University, Portland, OR USA
| | - Diana M Mendez
- Orlando VA Health Care System, Orlando, FL USA; University of Central Florida College of Medicine, Orlando, FL USA
| | - Olive A Phillips
- Geriatric Research Education, and Clinical Center (GRECC), Central Arkansas Veterans Healthcare System (CAVHS), Little Rock, AR, USA
| | - Benjamin C Wright
- Geriatric Research Education, and Clinical Center (GRECC), Central Arkansas Veterans Healthcare System (CAVHS), Little Rock, AR, USA
| | - Samuel House
- Geriatric Research Education, and Clinical Center (GRECC), Central Arkansas Veterans Healthcare System (CAVHS), Little Rock, AR, USA
| | - Prasad R Padala
- Department of Psychiatry, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA; Geriatric Research Education, and Clinical Center (GRECC), Central Arkansas Veterans Healthcare System (CAVHS), Little Rock, AR, USA; Department of Geriatrics, UAMS, Little Rock, AR, USA.
| |
Collapse
|
12
|
Maß R, Schottke ML, Müller M, Lübbers F, Müller-Alcazar A, Kolbeck S, Morgenroth O. [Self-Responsibility: Relationship with Depression and Anxiety and Relevance for the Treatment Outcome of Inpatients with Major Depression]. Psychother Psychosom Med Psychol 2021; 72:78-86. [PMID: 34500480 DOI: 10.1055/a-1559-4251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Though in most psychotherapy schools a high self-responsibility (SR) of patients is considered as the basis necessary for the success of psychological treatment, there is neither a uniform definition nor a psychometric operationalisation of SR. Hence, there is no empirical evidence for the actual importance of SR in psychotherapy. This work aims (1) to introduce a definition of SR as well as to develop a questionnaire for its measurement and (2) to evaluate SR in the treatment of depression. METHODS In two studies with samples of healthy adults (n=233, n=301), the "Self-Responsibility Inventory" (German: "Selbstverantwortungs-Inventar", SV-I) was developed. In a third study, the SV-I was administered to n=231 psychiatric inpatients with major depression according to the ICD-10 diagnostic criteria. Patients were mainly treated with psychotherapy. RESULTS The final SV-I version consisted of three scales with 10 items each: "Being determined by others", "Self-determination", "Orientation towards the expectations of others". In healthy adults, poor SR was accompanied by high levels of depression, and high trait anxiety. Inpatients with mental disorders show less SR than healthy individuals. During treatment, SR increased from admission to discharge. It was found that the higher the SR at discharge, the stronger the decrease of depression from admission to discharge. DISCUSSION The SV-I appears to be suitable for use in healthy individuals and in clinical groups. Our findings suggest that low SR is related to the development of psychological symptoms and illnesses. CONCLUSIONS SR may be a critical factor for outcome in the psychotherapy of major depression. The SV-I could be a useful tool for understanding psychotherapeutic processes.
Collapse
Affiliation(s)
- Reinhard Maß
- Zentrum für Seelische Gesundheit Marienheide, Allgemeinpsychiatrie und Psychotherapie, Marienheide, Deutschland
| | - Marie-Lene Schottke
- MSH Medical School Hamburg, Fakultät für Humanwissenschaften, Hamburg, Deutschland
| | - Maria Müller
- MSH Medical School Hamburg, Fakultät für Humanwissenschaften, Hamburg, Deutschland
| | - Frederik Lübbers
- MSH Medical School Hamburg, Fakultät für Humanwissenschaften, Hamburg, Deutschland
| | - Anett Müller-Alcazar
- MSH Medical School Hamburg, Fakultät für Humanwissenschaften, Hamburg, Deutschland
| | - Sabine Kolbeck
- MSH Medical School Hamburg, Fakultät für Humanwissenschaften, Hamburg, Deutschland
| | - Olaf Morgenroth
- MSH Medical School Hamburg, Fakultät für Humanwissenschaften, Hamburg, Deutschland
| |
Collapse
|
13
|
Abstract
BACKGROUND The Leuven Affect and Pleasure Scale (LAPS) is a depression outcome measure aiming to better reflect patient treatment expectations. We investigated the evolution of the LAPS and some comparator scales during antidepressant treatment and compared scores of remitters with scores of healthy controls. METHODS A total of 109 outpatients with Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) major depressive disorder were assessed over 8 weeks of antidepressant treatment. At baseline and after 2, 4, and 8 weeks, the LAPS as well as the Hamilton Depression Rating Scale (HAMD), the Snaith-Hamilton Pleasure Scale (SHAPS), the Positive and Negative Affect Scale (PANAS), and the Sheehan Disability Scale (SDS) were administered. Healthy controls consisted of 38 Italian adults and 111 Belgian students. RESULTS Correlations between baseline positive and negative affect were only moderate (R between -0.20 and -0.41). LAPS positive affect and hedonic tone showed higher correlations with LAPS cognitive functioning, overall functioning, meaningfulness of life, and happiness than HAMD scores or PANAS negative affect. HAMD remission was associated with normal levels of LAPS negative affect but with significantly lower levels of LAPS positive affect, hedonic tone, cognitive functioning, overall functioning, meaningfulness of life, and happiness. The scores on the latter subscales only reached healthy control scores when the HAMD approached a score of 0 or 1. CONCLUSIONS The standard definition of remission (HAMD cutoff of 7) is probably adequate for remitting negative mood, but not good enough for recovering positive mood, hedonic tone, functioning, or meaningfulness of life.
Collapse
|
14
|
Hajj A, Hallit S, Chamoun K, Sacre H, Obeid S, Haddad C, Dollfus S, Khabbaz LR. Negative symptoms in schizophrenia: correlation with clinical and genetic factors. Pharmacogenomics 2021; 22:389-399. [PMID: 33858192 DOI: 10.2217/pgs-2020-0171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Explore the possible association between clinical factors and genetic variants of the dopamine pathways and negative symptoms. Materials & methods: Negative symptoms were assessed in 206 patients with schizophrenia using the Arabic version of the self-evaluation of negative symptoms scale and the Positive and Negative Syndrome Scale. Genotyping for COMT, DRD2, MTHFR and OPRM1 genes was performed. Results: Multivariable analysis showed that higher self-evaluation of negative symptoms scale scores were significantly associated with higher age, higher chlorpromazine-equivalent daily dose for typical antipsychotics and in married patients. Higher negative Positive and Negative Syndrome Scale scores were significantly associated with women and having the CT genotype for MTHFR c.677C>T (β = 4.25; p = 0.008) compared with CC patients. Conclusion: Understanding both clinical/genetic factors could help improve the treatment of patients.
Collapse
Affiliation(s)
- Aline Hajj
- Faculty of Pharmacy, Saint-Joseph University, Beirut, Lebanon.,Laboratoire de Pharmacologie, Pharmacie Clinique et Contrôle de Qualité des Médicaments, Saint-Joseph University, Beirut, Lebanon
| | - Souheil Hallit
- Faculty of Medicine & Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.,INSPECT-LB: Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon
| | - Karam Chamoun
- Faculty of Pharmacy, Saint-Joseph University, Beirut, Lebanon
| | - Hala Sacre
- INSPECT-LB: Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon
| | - Sahar Obeid
- INSPECT-LB: Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon.,Research Department, Psychiatric Hospital of the Cross, PO Box 60096, Jal Eddib, Lebanon.,Faculty of Art and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Chadia Haddad
- INSPECT-LB: Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon.,Research Department, Psychiatric Hospital of the Cross, PO Box 60096, Jal Eddib, Lebanon.,INSERM, Univ. Limoges, CH Esquirol Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Sonia Dollfus
- CHU de Caen, Service de Psychiatrie, 14000, Caen, France.,Normandie University, UNICAEN, ISTS, GIP Cyceron, 14000, Caen, France
| | - Lydia Rabbaa Khabbaz
- Faculty of Pharmacy, Saint-Joseph University, Beirut, Lebanon.,Laboratoire de Pharmacologie, Pharmacie Clinique et Contrôle de Qualité des Médicaments, Saint-Joseph University, Beirut, Lebanon
| |
Collapse
|
15
|
Zinchuk M, Kustov G, Pashnin E, Pochigaeva K, Rider F, Yakovlev A, Hesdorffer D, Hauser WA, Guekht A. Interictal dysphoric disorder in people with and without epilepsy. Epilepsia 2021; 62:1382-1390. [PMID: 33856044 DOI: 10.1111/epi.16902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/25/2021] [Accepted: 03/25/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Interictal dysphoric disorder (IDD) has been regarded as an affective disorder occurring only in people with epilepsy (PWE). Data showing similar characteristics and similar prevalence of IDD in patients with migraine and with psychogenic nonepileptic seizures question the epilepsy-specific nature of IDD. The aim of the study was to investigate the nature of IDD in people with prevalent epilepsy with mood disorders and people with mood disorders who are free of neurological disease. METHODS This is a case-control study, with 142 patients with a confirmed diagnosis of epilepsy and major depressive disorder (MDD; cases) and 222 patients with MDD only (controls). MDD diagnosis was confirmed by a structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders, 4th edition (SCID-I-RV). We used the Beck Depression Inventory and the Beck Anxiety Inventory to estimate anxiety and depression levels and the Interictal Dysphoric Disorder Inventory (IDDI) to confirm the presence of IDD. Mann-Whitney U test, Pearson chi-squared, Spearman correlation, and logistic regression were used. RESULTS No differences were found in the prevalence of IDD between PWE with MDD and people with MDD alone (88.73% vs. 85.13%, χ2 = .96, p = .32). There were no differences between the groups overall or for any IDDI subscales (all p > .05). In both groups, IDD symptoms were grouped with the same incidence and had the same duration and periodicity. IDD was not associated with epilepsy (odds ratio = .84, 95% confidence interval = .40-1.98, p = .72). No significant correlation was found between epilepsy, demographic characteristics, and all IDDI subscales (all p > .05). Notably, patients with IDD suffered from affective disorders longer (6.68 ± 6.82 years vs. 3.7 ± 3.97 years, p = .001) and also received higher scores on all psychometric scales (all p < .05). SIGNIFICANCE This study does not confirm the specificity of IDD for epilepsy. The presence of IDD symptoms may be associated with a more severe course of MDD and significant anxiety distress.
Collapse
Affiliation(s)
- Mikhail Zinchuk
- Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation
| | - Georgii Kustov
- Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation
| | - Evgenii Pashnin
- Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation
| | - Ksenia Pochigaeva
- Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation
| | - Flora Rider
- Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation
| | - Alexander Yakovlev
- Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation.,Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Moscow, Russian Federation
| | - Dale Hesdorffer
- G. H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - W Allen Hauser
- G. H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Alla Guekht
- Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation.,Pirogov Russian National Research Medical University, Moscow, Russian Federation
| |
Collapse
|
16
|
Alves P, Faísca L, Sales CMD, Ashworth M. Personalising Outcome Measurement in Substance Misuse Treatment: the Feasibility and Psychometrics of Two Individualised Outcome Measures. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-020-00396-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
AbstractIndividualised information in substance misuse treatment complements standardised outcome measures. However, few studies investigate the use of individualised measures and their robustness in terms of quantifying outcomes. In this study, we analysed the psychometrics and feasibility of two individualised outcome measures (PQ and PSYCHLOPS). We followed a cross-sectional methodology, administering the individualised measures and three additional standardised measures (TOP, a measure of psychological health within addiction services; PHQ-9; CORE-OM) to a sample of 93 patients entering substance misuse treatment in four clinical services. The results showed high levels of patient acceptability of the two individualised measures (response rates > 95%). The internal reliability was good for both PQ and PSYCHLOPS (Cronbach’s alpha, .79 and .72, respectively). Convergent validity of PQ with standardised measures was weak: Pearson’s r values for TOP (psychological health), PHQ-9 and CORE-OM were .21, .22 and .27, respectively. In contrast, convergent validity of PSYCHLOPS was moderate: r = .40, .39 and .50, respectively. Convergence between PQ and PSYCHLOPS was weak (r = .28). Experience of previous treatment episodes was associated with higher PQ and PSYCHLOPS scores; PSYCHLOPS but not PQ scores were higher among those opting to complete the questionnaires in written rather than verbal format. Our findings demonstrated that PQ and PSYCHLOPS are reliable and feasible individualised outcome measures for use in substance misuse treatment units, although the lack of strong convergent validity indicates that they may be measuring different underlying constructs. Optimal outcome measurement may involve combining individualised and standardised measures.
Collapse
|
17
|
Hajj A, Hallit S, Chamoun K, Sacre H, Obeid S, Haddad C, Dollfus S, Rabbaa Khabbaz L. Validation of the Arabic version of the "self-evaluation of negative symptoms" scale (SNS). BMC Psychiatry 2020; 20:240. [PMID: 32408876 PMCID: PMC7227103 DOI: 10.1186/s12888-020-02647-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/03/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The self-evaluation of negative symptoms scale (SNS) is a new easy-to-use self-administered questionnaire allowing clinicians to understand the clinical and genetic factors affecting the negative symptoms in patients with schizophrenia. There was a need to translate and validate this scale in Arabic so that Arab-speaking patients benefit from it. Therefore, the aim of our study was to validate the Arabic version of the SNS in a sample of Lebanese patients with schizophrenia. METHODS The Arabic SNS was used to quantify the disability associated with negative symptoms in patients with schizophrenia (n = 206). Six weeks after completing the SNS, the participants were interviewed again to assess test-retest reproducibility. The validity was confirmed by factor analyses using the principal component analysis technique with a varimax rotation. The Positive and Negative Syndrome Scale (PANSS) was also assessed. RESULTS None of the items of the SNS scale were removed; all items converged over a solution of five factors that had an eigenvalue > 1, explaining a total of 66.01% of the variance (Cronbach's alpha = 0.879; test part). The mean total SNS score was 17.33 ± 8.43 for the "test", and 16.35 ± 7.50 for the "retest". The correlation coefficients between the SNS total score and the PANSS scale and subscales were as follows: total PANSS (r = 0.044; p = 0.530), positive PANSS score (r = - 0.106; p = 0.131), negative PANSS score (r = 0.204; p = 0.003), and general psychopathological PANSS score (r = 0.03; p = 0.530). CONCLUSION This study is the first to validate the Arabic version of the SNS in patients with schizophrenia. Using this scale would help improve treatment by correctly assessing negative symptoms, thus optimizing treatment options.
Collapse
Affiliation(s)
- Aline Hajj
- Faculty of Pharmacy, Saint-Joseph University, Beirut, Lebanon. .,Laboratoire de Pharmacologie, Pharmacie Clinique et Contrôle de Qualité des Médicaments, Saint-Joseph University, Beirut, Lebanon.
| | - Souheil Hallit
- grid.444434.70000 0001 2106 3658Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon ,INSPECT-LB: Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie, Beirut, Lebanon
| | - Karam Chamoun
- grid.42271.320000 0001 2149 479XFaculty of Pharmacy, Saint-Joseph University, Beirut, Lebanon
| | - Hala Sacre
- INSPECT-LB: Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie, Beirut, Lebanon ,Drug Information Center, Order of Pharmacists of Lebanon, Beirut, Lebanon
| | - Sahar Obeid
- INSPECT-LB: Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie, Beirut, Lebanon ,Research Department, Psychiatric Hospital of the Cross, P.O Box 60096, Jal Eddib, Lebanon ,grid.444434.70000 0001 2106 3658Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Chadia Haddad
- Research Department, Psychiatric Hospital of the Cross, P.O Box 60096, Jal Eddib, Lebanon
| | - Sonia Dollfus
- grid.411149.80000 0004 0472 0160CHU de Caen, Service de Psychiatrie, 14000 Caen, France ,grid.412043.00000 0001 2186 4076Normandie Univ, UNICAEN, ISTS, GIP Cyceron, 14000 Caen, France
| | - Lydia Rabbaa Khabbaz
- grid.42271.320000 0001 2149 479XFaculty of Pharmacy, Saint-Joseph University, Beirut, Lebanon ,grid.42271.320000 0001 2149 479XLaboratoire de Pharmacologie, Pharmacie Clinique et Contrôle de Qualité des Médicaments, Saint-Joseph University, Beirut, Lebanon
| |
Collapse
|
18
|
Möller HJ, Bitter I, Bobes J, Fountoulakis K, Höschl C, Kasper S. Position statement of the European Psychiatric Association (EPA) on the value of antidepressants in the treatment of unipolar depression. Eur Psychiatry 2020; 27:114-28. [DOI: 10.1016/j.eurpsy.2011.08.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 08/24/2011] [Accepted: 08/25/2011] [Indexed: 12/28/2022] Open
Abstract
AbstractThis position statement will address in an evidence-based approach some of the important issues and controversies of current drug treatment of depression such as the efficacy of antidepressants, their effect on suicidality and their place in a complex psychiatric treatment strategy including psychotherapy. The efficacy of antidepressants is clinically relevant. The highest effect size was demonstrated for severe depression. Based on responder rates and based on double-blind placebo-controlled studies, the number needed to treat (NNT) is 5–7 for acute treatment and four for maintenance treatment. Monotherapy with one drug is often not sufficient and has to be followed by other antidepressants or by comedication/augmentation therapy approaches. Generally, antidepressants reduce suicidality, but under special conditions like young age or personality disorder, they can also increase suicidality. However, under the conditions of good clinical practice, the risk–benefit relationship of treatment with antidepressants can be judged as favourable also in this respect. The capacity of psychiatrists to individualise and optimise treatment decisions in terms of ‘the right drug/treatment for the right patient’ is still restricted since currently there are no sufficient powerful clinical or biological predictors which could help to achieve this goal. There is hope that in future pharmacogenetics will contribute significantly to a personalised treatment. With regard to plasma concentration, therapeutic drug monitoring (TDM) is a useful tool to optimize plasma levels therapeutic outcome. The ideal that all steps of clinical decision-making can be based on the strict rules of evidence-based medicine is far away from reality. Clinical experience so far still has a great impact.
Collapse
|
19
|
Inpatient treatment decreases depression but antidepressants may not contribute. A prospective quasi-experimental study. Compr Psychiatry 2019; 94:152124. [PMID: 31518849 DOI: 10.1016/j.comppsych.2019.152124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 07/14/2019] [Accepted: 08/28/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The aim of the study is the evaluation of psychiatric-psychotherapeutic inpatient treatment utilizing a naturalistic design. METHODS In a sample of 574 consecutively admitted patients, depression (64.5%), personality disorders (19.5%), schizophrenia (4.2%), bipolar disorder (3.3%), obsessive-compulsive disorder (2.3%) or other mental disorders (6.4%) were diagnosed. All patients were treated with psychotherapy, most with antidepressants. Depression was measured using the Beck Depression Inventory-II (BDI-II). 180 patients formed a waiting list control group. The regularly discharged patients (N = 489) were asked to participate in a six-month follow-up, with 62.6% taking part. RESULTS From the time of admission to discharge, there was a strong decline in depression (31.5 vs. 13.2 points on the BDI-II), as well as from admission to follow-up (31.2 vs. 18.3 points). In the control group, there was a weak symptom decline (34.6 vs. 32.1 points) until admission, which was independent of the waiting period duration. For the success of treatment, it did not matter whether the patients received antidepressants. In the follow-up, 81.0% of patients retrospectively considered psychotherapy to be important for treatment outcome, only 2.3% considered medications to be important. CONCLUSIONS Psychiatric inpatient treatment reduces depression significantly at discharge and follow-up; the decrease in depression is rather due to psychotherapy than to antidepressants.
Collapse
|
20
|
Interictal dysphoric disorder of epilepsy: A continuing diagnostic challenge. Epilepsy Behav 2019; 95:34-38. [PMID: 31022662 DOI: 10.1016/j.yebeh.2019.03.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/11/2019] [Accepted: 03/18/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The interictal dysphoric disorder (IDD) is a proposed epilepsy-specific mood disorder characterized by a cluster of symptoms such as depressed mood, irritability, euphoria, and anxiety. Since its introduction, the concept of IDD has been a matter of debate. This study aimed to evaluate the frequency of the IDD and the association between psychiatric disorders and IDD. We also analyzed potential associations between IDD symptoms and epilepsy-related variables. METHODS A consecutive group of 118 outpatients with epilepsy were screened. Ninety-six patients met inclusion criteria and examined by a trained psychiatrist using Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders fourth edition Text Revision (DSM-IV-TR) (SCID-I). In order to diagnose IDD, all participants completed the self-rating questionnaire consisting of a set of questions aimed to assess the eight key symptoms of IDD. On completion of the questionnaire, the psychiatrist reviewed all the data for completeness and accuracy with the patient. RESULTS In our group with epilepsy, we observed IDD in 49.0% (47 of 96) of people with epilepsy (PWE) with substantial overlap (85%) of IDD with depressive and anxiety disorders. The frequency of depressive mood, anergia, and irritability was significantly higher in patients with IDD diagnosis. Older age at epilepsy onset was associated with IDD. STUDY LIMITATIONS The cross-sectional study design, a consecutive sample of patients presenting to a tertiary referral center, a small sample size of the population, and applied methodology could have affected the results. CONCLUSIONS The present study indicates that IDD occurs in high frequency in PWE with a substantial overlap of IDD with depressive and anxiety disorders. The study highlights the importance of the observer-based systematic approach for diagnosing IDD and the usage of operationalized diagnostic criteria for psychiatric comorbidities in PWE. Future research should be directed at validating whether IDD is nosologically independent of other psychiatric conditions.
Collapse
|
21
|
Townsend ML, Kelly MA, Pickard JA, Larkin TA, Flood VM, Caputi P, Wright IM, Jones A, Grenyer BFS. Illawarra Born cross-generational health study: feasibility of a multi-generational birth cohort study. Pilot Feasibility Stud 2019; 5:32. [PMID: 30834141 PMCID: PMC6390311 DOI: 10.1186/s40814-019-0418-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 02/13/2019] [Indexed: 12/18/2022] Open
Abstract
Background There is a strong interest in the concept of developmental origins of health and disease and their influence on various factors “from cradle to grave”. Despite the increasing appreciation of this lifelong legacy across the human life course, many gaps remain in the scientific understanding of mechanisms influencing these formative phases. Cross-generational susceptibility to health problems is emerging as a focus of research in the context of birth cohort studies. The primary aim of the Illawarra Born study is to make scientific discoveries associated with improving health and wellbeing across the lifespan, with a particular focus on preventable chronic diseases, especially mental health. This birth cohort study will follow and collect data from three cohorts representing different stages across the lifespan: infants, adults (parents) and older adults (grandparents). The multi-generational, cross-sectional and longitudinal design of this birth cohort study supports a focus on the contributions of genetics, environment and lifestyle on health and wellbeing. The feasibility of conducting a multi-generational longitudinal birth cohort project was conducted through a small pilot study. Methods/design The purpose of this paper is to report on the feasibility and acceptability of the research protocol for a collaborative cross-generation health study in the community and test recruitment and outcome measures for the main study. This feasibility study included pregnant women who were intending to give birth in the Illawarra-Shoalhaven region in Eastern Australia. The area includes a large, regional referral hospital, with capacity to treat specialist and complex cases. Pregnant women were asked to participate in five data collection waves beginning at 22 weeks gestation and ending with a 6-month post-partum appointment. Recruitment was then extended, via the pregnant women, to also include fathers and maternal grandmothers. Discussion This feasibility study focused on the perinatal period and collected data across three multi-disciplinary domains including mental health, diet, exposures to toxins and the role of these in maternal and infant outcomes. Forty-one families participated in extensive data collection from 22 weeks gestation to 6-months post-partum. Factors impacting on viability and feasibility including recruitment solutions provide the basis for a large-scale study.
Collapse
Affiliation(s)
- Michelle L Townsend
- 1Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2522 Australia.,2School of Psychology, University of Wollongong, Wollongong, NSW 2522 Australia
| | - Megan A Kelly
- 1Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2522 Australia.,7School of Chemistry and Molecular Biosciences, University of Wollongong, Wollongong, NSW 2522 Australia
| | - Judy A Pickard
- 1Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2522 Australia.,2School of Psychology, University of Wollongong, Wollongong, NSW 2522 Australia
| | - Theresa A Larkin
- 1Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2522 Australia.,3Graduate School of Medicine, University of Wollongong, Wollongong, NSW 2522 Australia
| | - Victoria M Flood
- 5Faculty of Health Sciences, University of Sydney, PO Box 170, Lidcombe, NSW 1825 Australia.,6St Vincent's Hospital, 390 Victoria Street, Darlinghurst, NSW 2010 Australia
| | - Peter Caputi
- 1Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2522 Australia.,2School of Psychology, University of Wollongong, Wollongong, NSW 2522 Australia
| | - Ian M Wright
- 1Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2522 Australia.,3Graduate School of Medicine, University of Wollongong, Wollongong, NSW 2522 Australia.,4Illawarra Shoalhaven Local Health District, NSW Health, Locked Mail Bag 8808, South Coast Mail Centre, North Sydney, NSW 2521 Australia
| | - Alison Jones
- 1Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2522 Australia.,3Graduate School of Medicine, University of Wollongong, Wollongong, NSW 2522 Australia
| | - Brin F S Grenyer
- 1Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2522 Australia.,2School of Psychology, University of Wollongong, Wollongong, NSW 2522 Australia
| |
Collapse
|
22
|
Hagen E, Sømhovd M, Hesse M, Arnevik EA, Erga AH. Measuring cognitive impairment in young adults with polysubstance use disorder with MoCA or BRIEF-A – The significance of psychiatric symptoms. J Subst Abuse Treat 2019; 97:21-27. [DOI: 10.1016/j.jsat.2018.11.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/21/2018] [Accepted: 11/21/2018] [Indexed: 11/25/2022]
|
23
|
Kuga A, Otsubo T, Tsuji T, Hayashi S, Imagawa H, Fujikoshi S, Escobar R. Analysis of HAM-D scores and working ability in an observational study of Japanese patients with major depressive disorder and painful physical symptoms treated with duloxetine or SSRI monotherapy. Neuropsychiatr Dis Treat 2019; 15:809-817. [PMID: 31040680 PMCID: PMC6455004 DOI: 10.2147/ndt.s195445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To investigate the relationship between Hamilton Depression Rating Scale (HAM-D) score and psychiatrists' judgment of working ability in patients with major depressive disorder (MDD) and painful physical symptoms. METHODS This was a prospective, observational, 12-week study in patients who received duloxetine or a selective serotonin reuptake inhibitor. Patients were ≥20 years old, resided in Japan, and had at least moderate depression (Quick Inventory of Depressive Symptomatology ≥16) and at least moderate painful physical symptoms (Brief Pain Inventory-Short Form average pain ≥3). The main outcome in this post-hoc analysis was the HAM-D17 cutoff best corresponding with patients' working ability according to the investigator's judgment. Area under the receiver-operator curve was used to determine the time point with the strongest relationship between HAM-D17 and working ability. The optimal HAM-D17 cutoff was determined based on the maximum of sensitivity (true positive rate) minus ([1 minus specificity] [true negative rate]). For the evaluation of binary data, a mixed effects model with repeated measures analysis was used. RESULTS For the estimation of the HAM-D17 cutoff, the area under the receiver-operator curve was maximal at 12 weeks, when a HAM-D17 score of 6 resulted in the best correspondence with working ability in the combined study population. At 12 weeks, a HAM-D17 score of 6 also resulted in the maximum predictive ability in each of the two treatment groups separately. For predicted working ability at 12 weeks, 52.7% of duloxetine-treated patients achieved the HAM-D17 cutoff of ≤6, whereas 48.5% of SSRIs-treated patients achieved HAM-D17 ≤6 (P=0.477). CONCLUSION In this study of patients with major depressive disorder and painful physical symptoms, a HAM-D17 score ≤6 corresponded best with patients' working ability. This finding is consistent with previous studies showing that a HAM-D17 cutoff of ≤7 may overestimate functional recovery from MDD.
Collapse
Affiliation(s)
- Atsushi Kuga
- Medicines Development Unit Japan, Eli Lilly Japan K.K., Kobe, Japan,
| | - Tempei Otsubo
- Department of Psychiatry, Tokyo Women's Medical University, Medical Center East, Tokyo, Japan
| | - Toshinaga Tsuji
- Medical Affairs Department, Shionogi & Co., Ltd., Osaka, Japan
| | - Shinji Hayashi
- Medical Affairs Department, Shionogi & Co., Ltd., Osaka, Japan
| | - Hideyuki Imagawa
- Medicines Development Unit Japan, Eli Lilly Japan K.K., Kobe, Japan,
| | - Shinji Fujikoshi
- Medicines Development Unit Japan, Eli Lilly Japan K.K., Kobe, Japan,
| | - Rodrigo Escobar
- Bio-Medicines Global Team, Eli Lilly and Company, Madrid, Spain
| |
Collapse
|
24
|
Nilsson KW, Åslund C, Comasco E, Oreland L. Gene-environment interaction of monoamine oxidase A in relation to antisocial behaviour: current and future directions. J Neural Transm (Vienna) 2018; 125:1601-1626. [PMID: 29881923 PMCID: PMC6224008 DOI: 10.1007/s00702-018-1892-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 05/29/2018] [Indexed: 12/24/2022]
Abstract
Since the pioneering finding of Caspi and co-workers in 2002 that exposure to childhood maltreatment predicted later antisocial behaviour (ASB) in male carriers of the low-activity MAOA-uVNTR allele, frequent replication studies have been published. Two meta-analyses, one in 2006 and the other in 2014, confirmed the original findings by Caspi and co-workers. In the present paper, we review the literature, note some methodological aspects of candidate gene–environment interaction (cG×E) studies and suggest some future directions. Our conclusions are as follows. (1) The direction of the effect in a cG×E model may differ according to the positive and negative environmental background of the population. (2) There is a predictor-intersection problem such that when measuring one type of maltreatment in a person, other kinds of maltreatment often co-occur. Other forms of abuse are implicitly considered in statistical models; therefore, it is difficult to draw conclusions about the effects of timing and the severity of different forms of stressful life events in relation to ASB. (3) There is also an outcome-intersection problem because of the major intersection of ASB and other forms of mental health problems. It is likely that the G×E with MAOA is related to a common unmeasured factor. (4) For the G×E model, in which the effect of the gene on the outcome variable is dependent on other predictor variables, theoretically, hypothesis-driven statistical modelling is needed.
Collapse
Affiliation(s)
- Kent W Nilsson
- Centre for Clinical Research, Uppsala University, County Hospital, Västerås, Sweden.
| | - Cecilia Åslund
- Centre for Clinical Research, Uppsala University, County Hospital, Västerås, Sweden
| | - Erika Comasco
- Department of Neuroscience, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Lars Oreland
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| |
Collapse
|
25
|
van Bennekom MJ, Kasanmoentalib MS, de Koning PP, Denys D. A Virtual Reality Game to Assess Obsessive-Compulsive Disorder. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2018; 20:718-722. [PMID: 29125791 DOI: 10.1089/cyber.2017.0107] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The retrospective and subjective nature of clinical interviews is an important shortcoming of current psychiatric diagnosis. Consequently, there is a clear need for objective and standardized tools. Virtual reality (VR) can be used to achieve controlled symptom provocation, which allows direct assessment for the clinician. We developed a video VR game to provoke and assess obsessive-compulsive disorder (OCD) symptoms in a standardized and controlled environment. The first objective was to evaluate if the VR game is capable of provoking symptoms in OCD patients as opposed to healthy controls. The second objective was to evaluate the tolerability of the VR game in OCD patients. The VR game was created using a first-person perspective and confronted patients with 15 OCD-specific items, while simultaneously measuring OCD symptoms, including the number of compulsions, anxiety, tension, uncertainty, and urge to control. In this pilot study, eight patients and eight healthy controls performed the VR game. OCD patients performed significantly more compulsions (U = 5, p = 0.003) during the VR game. The anxiety, tension, uncertainty, and urge to control in response to the specific items were also higher for OCD patients, although significance was not yet reached because of the small sample. There were no substantial adverse effects. The results of this pilot study indicate that the VR game is capable of provoking a variety of OCD symptoms in OCD patients, as opposed to healthy controls, and is a potential valuable tool to objectify and standardize an OCD diagnosis.
Collapse
Affiliation(s)
- Martine J van Bennekom
- 1 Department of Psychiatry, Academical Medical Center, University of Amsterdam , Amsterdam, The Netherlands
| | - M Soemiati Kasanmoentalib
- 1 Department of Psychiatry, Academical Medical Center, University of Amsterdam , Amsterdam, The Netherlands
| | - Pelle P de Koning
- 1 Department of Psychiatry, Academical Medical Center, University of Amsterdam , Amsterdam, The Netherlands
| | - Damiaan Denys
- 1 Department of Psychiatry, Academical Medical Center, University of Amsterdam , Amsterdam, The Netherlands .,2 The Netherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences , Amsterdam, The Netherlands
| |
Collapse
|
26
|
Validation of Bangla Montgomery Asberg Depression Rating Scale (MADRSB). Asian J Psychiatr 2017; 28:41-46. [PMID: 28784395 DOI: 10.1016/j.ajp.2017.03.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 02/14/2017] [Accepted: 03/13/2017] [Indexed: 11/22/2022]
Abstract
Depression is escalating among Bangla speaking people. About 300 million people speak in Bangla. However, a valid Bangla Depression rating scale is missing to assess their depression. Montgomery Asberg Depression Rating Scale (MADRS) is a clinician rated 10 item scale widely used for depression assessment. This study aimed to validate this scale in Bangla. The study was conducted from July 2013 to August 2015 at outpatient department of Psychiatry of Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh. Bangla MADRS scale development process started with the development of conceptional definition of each items of the original scale followed by forward, backward and committee translation. This translated Bangla MADRS was pretested and necessary correction was made for better understating and acceptance. Then its psychometric properties were assessed from consecutive randomly selected 111 depressed patients. The Bangla MADRS exhibited excellent internal consistency (Cronbach's Alpha=0.87), inter rater reliability and test retest reliability (Pearson coefficient r=0.77). To assess the concurrent validity the correlation between the findings of MADRS was evaluated with that of Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) that revealed a significant correlation (r=0.73). Moreover, the Factor analysis showed 56% of the variance can be explained by apparent sadness and reported sadness. This Bangla MADRS can have a long and wide spread impact and implication in depression assessment, management and future research for Bangla speaking people.
Collapse
|
27
|
Herniman SE, Allott KA, Killackey E, Hester R, Cotton SM. The psychometric validity of the Center for Epidemiological Studies - Depression Scale (CES-D) in first episode schizophrenia spectrum. Psychiatry Res 2017; 252:16-22. [PMID: 28237759 DOI: 10.1016/j.psychres.2017.02.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 01/21/2017] [Accepted: 02/10/2017] [Indexed: 02/02/2023]
Abstract
Depressive pathology is common in first-episode schizophrenia spectrum disorders (FES), and is frequently assessed using the Center for Epidemiological Studies - Depression Scale (CES-D), an instrument designed for use in community samples. Despite its widespread use, no prior study has examined the psychometric validity of the CES-D in assessing depressive pathology in FES. The aim of this study was to examine the psychometric validity of the CES-D in FES. This study involved secondary analysis of baseline data from a single blind, randomized controlled trial of vocational intervention for individuals with FES (N=91; age range: 15-25 years). Measures used were: CES-D, Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Negative Symptoms (SANS), and Structured Clinical Interview for DSM-IV-TR (SCID-I/P). The CES-D strongly correlated with the depression subscale of the BPRS, and with the presence of full-threshold depressive disorder on the SCID-I/P. There was minimal overlap between the CES-D and SANS, with weak correlations emerging for avolition and anhedonia, and not for affective flattening, alogia, and attention. The CES-D cut-off of ≥23 produced high sensitivity and specificity values for determining full-threshold comorbid depressive disorder. Such findings indicate that the CES-D is effective for assessing and measuring depressive pathology in FES.
Collapse
Affiliation(s)
- Sarah E Herniman
- Orygen, The National Centre of Excellence in Youth Mental Health, Australia; Centre for Youth Mental Health, University of Melbourne, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Australia.
| | - Kelly A Allott
- Orygen, The National Centre of Excellence in Youth Mental Health, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - Eóin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - Robert Hester
- Melbourne School of Psychological Sciences, University of Melbourne, Australia
| | - Sue M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| |
Collapse
|
28
|
Möller HJ. Why are new antidepressants failing to make the grade for approval? Expert Opin Pharmacother 2017; 18:641-643. [DOI: 10.1080/14656566.2017.1311324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
29
|
Zhou XY, Chu CL. Importance of diagnosis and management of psychological disorders in patients with refractory gastroesophageal reflux disease. Shijie Huaren Xiaohua Zazhi 2017; 25:1-6. [DOI: 10.11569/wcjd.v25.i1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Psychological factors are closely related to the pathogenesis of gastroesophageal reflux disease, irritable bowel syndrome, functional dyspepsia, and other gastrointestinal diseases. It has been widely accepted that psychological factors play a very important role in refractory gastroesophageal reflux disease (RGERD). This article reviews the role of psychological factors in the epidemiology, pathogenesis, assessment, and management of RGERD.
Collapse
|
30
|
Nicholson WC, Kempf MC, Moneyham L, Vance DE. The potential role of vagus-nerve stimulation in the treatment of HIV-associated depression: a review of literature. Neuropsychiatr Dis Treat 2017; 13:1677-1689. [PMID: 28721049 PMCID: PMC5499939 DOI: 10.2147/ndt.s136065] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Depression is the most common comorbidity and neuropsychiatric complication in HIV. Estimates suggest that the prevalence rate for depression among HIV-infected individuals is three times that of the general population. The association between HIV and clinical depression is complex; however, chronic activation of inflammatory mechanisms, which disrupt central nervous system (CNS) function, may contribute to this association. Disruptions in CNS function can result in cognitive disorders, social withdrawal, fatigue, apathy, psychomotor impairment, and sleep disturbances, which are common manifestations in depression and HIV alike. Interestingly, the parasympathetic system-associated vagus nerve (VN) has primary homeostatic properties that restore CNS function following a stress or inflammatory response. Unfortunately, about 30% of adults with HIV are resistant to standard psychotherapeutic and psychopharmacological treatments for depression, thus suggesting the need for alternative treatment approaches. VN stimulation (VNS) and its benefits as a treatment for depression have been well documented, but remain unexplored in the HIV population. Historically, VNS has been delivered using a surgically implanted device; however, transcutanous VNS (tVNS) with nonsurgical auricular technology is now available. Although it currently lacks Food and Drug Administration approval in the US, evidence suggests several advantages of tVNS, including a reduced side-effect profile when compared to standard treatments and comparable results to implantable VNS in treating depression. Therefore, tVNS could offer an alternative for managing depression in HIV via regulating CNS function; moreover, tVNS may be useful for treatment of other symptoms common in HIV. From this, implications for nursing research and practice are provided.
Collapse
Affiliation(s)
| | | | - Linda Moneyham
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David E Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
31
|
Conijn JM, Emons WHM, Page BF, Sijtsma K, Van der Does W, Carlier IVE, Giltay EJ. Response Inconsistency of Patient-Reported Symptoms as a Predictor of Discrepancy Between Patient and Clinician-Reported Depression Severity. Assessment 2016; 25:917-928. [PMID: 27630204 DOI: 10.1177/1073191116666949] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to assess the extent to which discrepancy between self-reported and clinician-rated severity of depression are due to inconsistent self-reports. Response inconsistency threatens the validity of the test score. We used data from a large sample of outpatients ( N = 5,959) who completed the self-report Beck Depression Inventory-II (BDI-II) and the clinician-rated Montgomery-Åsberg Depression Rating Scale (MADRS). We used item response theory based person-fit analysis to quantify the inconsistency of the self-report item scores. Inconsistency was weakly positively related to patient-clinician discrepancy (i.e., higher BDI-II scores relative to MADRS scores). The mediating effect of response inconsistency in the relationship between discrepancy and demographic (e.g., ethnic origin) and clinical variables (e.g., cognitive problems) was negligible. The small direct and mediating effects of response inconsistency suggest that inaccurate patient self-reports are not a major cause of patient-clinician discrepancy in outpatient samples. Future research should investigate the role of clinician biases in explaining clinician-patient discrepancy.
Collapse
Affiliation(s)
- Judith M Conijn
- 1 University of Amsterdam, Amsterdam, The Netherlands.,2 Leiden University, Leiden, The Netherlands
| | | | | | | | | | | | - Erik J Giltay
- 4 Leiden University Medical Centre, Leiden, The Netherlands
| |
Collapse
|
32
|
Assessment of Executive Function in Patients With Substance Use Disorder: A Comparison of Inventory- and Performance-Based Assessment. J Subst Abuse Treat 2016; 66:1-8. [DOI: 10.1016/j.jsat.2016.02.010] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 02/15/2016] [Accepted: 02/28/2016] [Indexed: 11/23/2022]
|
33
|
Abstract
Many patients with schizophrenia have negative symptoms, but their evaluation is a challenge. Thus, standardized assessments are needed to facilitate identification of these symptoms. Many tools have been developed, but most are based on observer ratings. Self-evaluation can provide an additional outcome measure and allow patients to be more engaged in their treatment. The aim of this study was to present a novel tool, Self-evaluation of Negative Symptoms (SNS), and demonstrate its validity. Forty-nine patients with schizophrenia and schizoaffective disorders according to DSM-5 were evaluated. Cronbach's coefficient (α = 0.867) showed good internal consistency. Factor analysis extracted 2 factors (apathy and emotional) that accounted for 75.2% of the variance. The SNS significantly correlated with the Scale of Assessment of Negative Symptoms (r= 0.628) and the Clinician Global Impression on the severity of negative symptoms (r= 0.599), supporting good convergent validity. SNS scores did not correlate with level of insight (r= 0.008), Parkinsonism (r= 0.175) or Brief Psychiatric Rating Scale positive subscores (r= 0.253), which indicates good discriminant validity. The intrasubject reliability of the SNS revealed excellent intraclass correlation coefficients (ICC = 0.942). Taken together, the results show that the SNS has good psychometric properties and satisfactory acceptance by patients. The study also demonstrates the ability of patients with schizophrenia to accurately report their own experiences. Self-assessments of negative symptoms should be more widely employed in clinical practice because they may allow patients with schizophrenia to develop appropriate coping strategies.
Collapse
Affiliation(s)
- Sonia Dollfus
- CHU de Caen, Service de psychiatrie, Centre Esquirol, F-14000 Caen, France; UNICAEN, UFR de Médecine, F-14000 Caen, France; CNRS, UMR 6301, ISTCT, ISTS group, GIP Cyceron, F-14074 Caen, France;
| | - Cyril Mach
- CHU de Caen, Service de psychiatrie, Centre Esquirol, F-14000 Caen, France
| | - Rémy Morello
- CHU de Caen, Unité de biostatistiques et recherche Clinique, F-14000 Caen, France
| |
Collapse
|
34
|
Mach C, Dollfus S. Symptômes négatifs de la schizophrénie : une revue des instruments d’évaluation. Encephale 2016; 42:165-71. [DOI: 10.1016/j.encep.2015.12.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 12/01/2014] [Indexed: 10/22/2022]
|
35
|
Bukumiric Z, Starcevic V, Stanisavljevic D, Marinkovic J, Milic N, Djukic-Dejanovic S, Janjic V, Corac A, Ilic A, Kostic M, Nikolic I, Trajkovic G. Meta-analysis of the changes in correlations between depression instruments used in longitudinal studies. J Affect Disord 2016; 190:733-743. [PMID: 26606717 DOI: 10.1016/j.jad.2015.10.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 10/01/2015] [Accepted: 10/15/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Correlations between instruments measuring the same construct reflect their concurrent validity. Little is known about changes in correlations between such instruments employed in studies with repeated assessment. The aim of this meta-analysis was to examine the changes in correlations between depression instruments in the course of longitudinal studies. METHODS A literature search was conducted using MEDLINE and PsycINFO for the period from 1960 to 2013. The total number of collected articles was 3723, of which 61 were included. Three meta-analyses were performed for the changes in correlations between each pair of the three depression scales: Hamilton Rating Scale for Depression (HAMD), Montgomery-Asberg Depression Rating Scale (MADRS) and Beck Depression Inventory (BDI). The effect size in these meta-analyses was obtained by the z-transformation of correlation coefficients. RESULTS Correlations between depression scales increased over time in 52 studies. Significant changes in correlation coefficients were found for correlations between HAMD and BDI (p<0.001) and for correlations between HAMD and MADRS (p<0.001). An increase in correlations between the scales was associated with a decrease in depression scores and increase in their variability. LIMITATIONS Univariable and multivariable meta-regression models were not obtained in all three meta-analyses because of the lack of data. CONCLUSIONS A finding that correlations between depression instruments tended to increase over time has significant implications for assessment of the concurrent validity of these instruments. In longitudinal designs it is important to estimate correlations between depression scales over time because different thresholds for scale correlations indicate acceptable concurrent validity at different times.
Collapse
Affiliation(s)
- Zoran Bukumiric
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Serbia.
| | - Vladan Starcevic
- University of Sydney, Sydney Medical School - Nepean, Discipline of Psychiatry, Sydney, Australia
| | - Dejana Stanisavljevic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Serbia
| | - Jelena Marinkovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Serbia
| | - Natasa Milic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Serbia
| | | | - Vladimir Janjic
- Department of Psychiatry, Faculty of Medical Sciences, University of Kragujevac, Serbia
| | - Aleksandar Corac
- Department of Public Health, Medical Faculty, University of Pristina, Kosovska Mitrovica, Serbia
| | - Aleksandra Ilic
- Department of Public Health, Medical Faculty, University of Pristina, Kosovska Mitrovica, Serbia
| | - Mirjana Kostic
- Department of Public Health, Medical Faculty, University of Pristina, Kosovska Mitrovica, Serbia
| | - Ivan Nikolic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Serbia
| | - Goran Trajkovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Serbia
| |
Collapse
|
36
|
Abstract
The Continuous Performance Test (CPT) is a widely used computerized test to assess impulsivity. This article proposes the use of a CPT variant based on movement recognition to obtain more accurate measurements of impulsivity. In this pilot study, 22 volunteers participated in a CPT experiment responding to the stimuli by raising his or her dominant hand instead of pressing the space bar in a keyboard. Using this method, correlations of self-reported impulsivity with number of commission errors and average reaction time improved those obtained with standard CPT.
Collapse
|
37
|
Depression Symptom Severity and Cardiorespiratory Fitness in Healthy and Depressed Adults: A Systematic Review and Meta-Analysis. Sports Med 2015; 46:219-30. [DOI: 10.1007/s40279-015-0409-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
38
|
Möller HJ, Bandelow B, Bauer M, Hampel H, Herpertz SC, Soyka M, Barnikol UB, Lista S, Severus E, Maier W. DSM-5 reviewed from different angles: goal attainment, rationality, use of evidence, consequences--part 1: general aspects and paradigmatic discussion of depressive disorders. Eur Arch Psychiatry Clin Neurosci 2015; 265:5-18. [PMID: 25119146 DOI: 10.1007/s00406-014-0520-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 08/01/2014] [Indexed: 01/01/2023]
Abstract
DSM-5 was published in 2013 after about 10 years of preparation. Part 1 of this paper discusses several more general aspects of DSM-5 and offers a detailed, paradigmatic analysis of changes made to the chapter on depressive disorders. The background for the changes is analysed on the basis of a PubMed search and review papers on the classification of mental disorders in general and on empirical knowledge about individual disorders. Contrary to the original plans, DSM-5 has not introduced a primarily dimensional diagnostic system but has widely preserved the categorical system of disorders. Also, it has not adopted a more neurobiological approach to disorders by including biological markers to increase the objectivity of psychiatric diagnoses but has maintained the primarily symptom-based, descriptive approach. The criteria for some disorders have been changed, including affective, schizophrenic and addiction disorders, and a few new disorders have been added. A minimal version of the dimensional approach was realised through the introduction of several transnosological specifiers and the option to make symptom- or syndrome-related severity and dimensional assessments. These specifiers and assessments might allow a more individualised description of a patient's psychopathological state and more personalised treatment. However, most of the symptom- and syndrome-related assessments are not mandatory and therefore may not be used in clinical practice.
Collapse
Affiliation(s)
- Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany,
| | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Comparison of physician-rating and self-rating scales for patients with major depressive disorder. J Clin Psychopharmacol 2014; 34:716-21. [PMID: 25310200 DOI: 10.1097/jcp.0000000000000229] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Physician-rating scales remain the standard in antidepressant clinical trials. The current study aimed to examine the discrepancies between physician-rating scales and self-rating scales for symptoms and functioning, before and after treatment, in newly hospitalized patients. A total of 131 acutely ill inpatients with major depressive disorder were enrolled to receive 20 mg of fluoxetine daily for 6 weeks. Symptom severity and functioning were assessed at baseline and again at week 6. Symptom severity was rated using the 17-item Hamilton Depression Rating Scale (HDRS-17) and the Zung Self-rating Depression Scale (ZDS). Functioning was measured by the Global Assessment of Functioning (GAF) and the Work and Social Adjustment Scale (WSAS). Pearson correlation coefficients (r) between HDRS-17 and ZDS and between GAF and WSAS were calculated at week 0 and week 6. Sensitivity to change was measured using effect sizes. One-hundred twelve patients completed the 6-week trial. After 6 weeks of treatment, correlations between HDRS-17 and ZDS or correlations between GAF and WSAS became larger from baseline to end point. All correlations were statistically significant (P < 0.001). Effect sizes measured by physician-rating scales (ie, HDRS-17 and GAF) were larger than by self-rating scales (ie, ZDS and WSAS). Correlations between baseline physician-rating scale scores and self-rating scale scores improved after 6 weeks of treatment. Physician-rating scales had larger effect sizes than self-rating scales. Physician-rating scales were more sensitive in detecting symptom or functional changes than self-rating scales.
Collapse
|
40
|
Lako IM, Wigman JTW, Klaassen RMC, Slooff CJ, Taxis K, Bartels-Velthuis AA. Psychometric properties of the self-report version of the Quick Inventory of Depressive Symptoms (QIDS-SR₁₆) questionnaire in patients with schizophrenia. BMC Psychiatry 2014; 14:247. [PMID: 25178310 PMCID: PMC4159524 DOI: 10.1186/s12888-014-0247-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 08/19/2014] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Self-report instruments for the assessment of depressive symptoms in patients with psychotic disorders are scarce. The Quick Inventory of Depressive Symptoms (QIDS-SR16) may be a useful self-report instrument, but has received little attention in this field. This paper aimed to test the psychometric properties of the QIDS-SR16 questionnaire in patients with a psychotic disorder. METHODS Patients diagnosed with a psychotic disorder from health care institutions in The Netherlands were included in the study. Depressive symptoms were assessed with the QIDS-SR16 and the Calgary Depression Scale for Schizophrenia (CDSS). Psychotic symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS) and extrapyramidal symptoms (EPS) with three EPS rating scales. Spearman's correlation coefficients were used to compare the total score of the QIDS-SR16 with the total scores of the CDSS, PANSS-subscales and EPS rating scales. RESULTS In a sample of 621 patients with psychotic disorders, the QIDS-SR16 showed good internal consistency (α = 0.87). The QIDS-SR16 correlated moderately with the CDSS (r = 0.44) and the PANSS subscale for emotional distress (r = 0.47). The QIDS-SR16 showed weak correlation with the PANSS subscale for negative symptoms (r = 0.28) and minimal correlation with EPS rating scales (r = 0.09-0.16). CONCLUSIONS The QIDS-SR16 may reliably assess depressive symptoms in patients with psychotic disorders, but its concurrent validity with the CDSS was rather poor in this population. We would recommend developing a new self-report questionnaire for the assessment of depressive symptoms in patients with psychotic disorders.
Collapse
Affiliation(s)
- Irene M Lako
- Division of Pharmacotherapy and Pharmaceutical Care, Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Johanna TW Wigman
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Groningen, The Netherlands ,Department of Psychiatry and Psychology, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Cees J Slooff
- Department of Psychotic Disorders, Mental Health Center Assen (GGZ Drenthe), Assen, Netherlands
| | - Katja Taxis
- Division of Pharmacotherapy and Pharmaceutical Care, Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Agna A Bartels-Velthuis
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Groningen, The Netherlands.
| | | |
Collapse
|
41
|
Kleimann A, Toto S, Eberlein CK, Kielstein JT, Bleich S, Frieling H, Sieberer M. Psychiatric symptoms in patients with Shiga toxin-producing E. coli O104:H4 induced haemolytic-uraemic syndrome. PLoS One 2014; 9:e101839. [PMID: 25007072 PMCID: PMC4090208 DOI: 10.1371/journal.pone.0101839] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 06/12/2014] [Indexed: 01/22/2023] Open
Abstract
Background In May 2011 an outbreak of Shiga toxin-producing enterohaemorrhagic E. coli (STEC) O104:H4 in Northern Germany led to a high number of in-patients, suffering from post-enteritis haemolytic-uraemic syndrome (HUS) and often severe affection of the central nervous system. To our knowledge so far only neurological manifestations have been described systematically in literature. Aim To examine psychiatric symptoms over time and search for specific symptom clusters in affected patients. Methods 31 in-patients suffering from E. coli O104:H4 associated HUS, were examined and followed up a week during the acute hospital stay. Psychopathology was assessed by clinical interview based on the AMDP Scale, the Brief Symptom Inventory and the Clinical Global Impressions Scale. Results At baseline mental disorder due to known physiological condition (ICD-10 F06.8) was present in 58% of the examined patients. Patients suffered from various manifestations of cognitive impairment (n = 27) and hallucinations (n = 4). Disturbances of affect (n = 28) included severe panic attacks (n = 9). Psychiatric disorder was significantly associated with higher age (p<0.0001), higher levels of C-reactive protein (p<0.05), and positive family history of heart disease (p<0.05). Even within the acute hospital stay with a median follow up of 7 days, symptoms improved markedly over time (p <0.0001). Conclusions Aside from severe neurological symptoms the pathology in E.coli O104:H4 associated HUS frequently includes particular psychiatric disturbances. Long term follow up has to clarify whether or not these symptoms subside.
Collapse
Affiliation(s)
- Alexandra Kleimann
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
- * E-mail:
| | - Sermin Toto
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Christian K. Eberlein
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Jan T. Kielstein
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Helge Frieling
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Marcel Sieberer
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| |
Collapse
|
42
|
Abstract
OBJECTIVE After 10 years of preparation, DSM-5 was published in 2013. This paper will examine the possible effects of DSM-5 on psychiatric diagnosis and psychopharmacotherapy. METHODS DSM-5 was compared with DSM-IV to identify the important changes in psychiatric diagnosis and possible consequences for psychopharmacotherapy. RESULTS Contrary to the original plans, DSM-5 did not make radical changes and move towards dimensional diagnosis but preserved the previous categorical system of disorders and a primarily symptom-based descriptive approach. The dimensional approach was only adopted through the introduction of several transnosological specifiers and the option to make symptom- or syndrome-related assessments. The criteria for some disorders were changed, including affective, dependence and schizophrenic disorders, and a few new disorders were added. CONCLUSION The DSM-IV diagnostic system was largely preserved, although some changes were made, primarily in the field of affective disorder and in several criteria sets. The new transnosological specifiers, severity assessments and cross-cutting dimensional assessments may help to individualise treatment.
Collapse
Affiliation(s)
- Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University , Munich , Germany
| |
Collapse
|
43
|
McAdams CJ, Krawczyk DC. Neural Responses during Social and Self-Knowledge Tasks in Bulimia Nervosa. Front Psychiatry 2013; 4:103. [PMID: 24065928 PMCID: PMC3770922 DOI: 10.3389/fpsyt.2013.00103] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 08/28/2013] [Indexed: 11/24/2022] Open
Abstract
Self-evaluation closely dependent upon body shape and weight is one of the defining criteria for bulimia nervosa (BN). We studied 53 adult women, 17 with BN, 18 with a recent history of anorexia nervosa (AN), and 18 healthy comparison women, using three different fMRI tasks that required thinking about self-knowledge and social interactions: the Social Identity task, the Physical Identity task, and the Social Attribution task. Previously, we identified regions of interest (ROI) in the same tasks using whole-brain voxel-wise comparisons of the healthy comparison women and women with a recent history of AN. Here, we report on the neural activations in those ROIs in subjects with BN. In the Social Attribution task, we examined activity in the right temporoparietal junction (RTPJ), an area frequently associated with mentalization. In the Social Identity task, we examined activity in the precuneus (PreC) and dorsal anterior cingulate (dACC). In the Physical Identity task, we examined activity in a ventral region of the dACC. Interestingly, in all tested regions, the average activation in subjects with bulimia was more than the average activation levels seen in the subjects with a history of anorexia but less than that seen in healthy subjects. In three regions, the RTPJ, the PreC, and the dACC, group responses in the subjects with bulimia were significantly different from healthy subjects but not subjects with anorexia. The neural activations of people with BN performing fMRI tasks engaging social processing are more similar to people with AN than healthy people. This suggests biological measures of social processes may be helpful in characterizing individuals with eating disorders.
Collapse
Affiliation(s)
- Carrie J McAdams
- Department of Psychiatry, The University of Texas Southwestern Medical Center , Dallas, TX , USA
| | | |
Collapse
|
44
|
Uher R, Carver S, Power RA, Mors O, Maier W, Rietschel M, Hauser J, Dernovsek MZ, Henigsberg N, Souery D, Placentino A, Farmer A, McGuffin P. Non-steroidal anti-inflammatory drugs and efficacy of antidepressants in major depressive disorder. Psychol Med 2012; 42:2027-2035. [PMID: 22391106 DOI: 10.1017/s0033291712000190] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND It has been proposed that non-steroidal anti-inflammatory drugs (NSAIDs) may interfere with the efficacy of antidepressants and contribute to treatment resistance in major depressive disorder (MDD). This effect requires replication and a test of whether it is specific to serotonin-reuptake inhibiting (SRI) antidepressants. METHOD We tested the effect of concomitant medication with NSAIDs on the efficacy of escitalopram, a SRI antidepressant, and nortriptyline, a tricyclic antidepressant, among 811 subjects with MDD treated for up to 12 weeks in the GENDEP study. Effects of NSAIDs on improvement of depressive symptoms were tested in mixed-effect linear models. Effects on remission were tested in logistic regression. Age, sex, baseline severity and centre of recruitment were considered as potential confounding factors. RESULTS Ten percent (n=78) of subjects were taking NSAIDs during the antidepressant treatment. Older subjects were significantly more likely to take NSAIDs. After controlling for age, sex, centre of recruitment and baseline severity, concomitant medication with NSAIDs did not significantly influence the efficacy of escitalopram [β=0.035, 95% confidence interval (CI) -0.145 to 0.215, p=0.704] or nortriptyline (β=0.075, 95% CI -0.131 to 0.281, p=0.476). Although slightly fewer subjects who took NSAIDs reached remission [odds ratio (OR) 0.80, 95% CI 0.49-1.31, p=0.383], this non-significant effect was reversed after controlling for age, sex, baseline severity and recruitment centre effects (OR 1.04, 95% CI 0.61-1.77, p=0.882). CONCLUSIONS NSAIDs are unlikely to affect the efficacy of SRI or other antidepressants. Concurrent use of NSAIDs and antidepressants does not need to be avoided.
Collapse
Affiliation(s)
- R Uher
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Lako IM, Bruggeman R, Knegtering H, Wiersma D, Schoevers RA, Slooff CJ, Taxis K. A systematic review of instruments to measure depressive symptoms in patients with schizophrenia. J Affect Disord 2012; 140:38-47. [PMID: 22099566 DOI: 10.1016/j.jad.2011.10.014] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Revised: 10/11/2011] [Accepted: 10/11/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND Depressive symptoms require accurate recognition and monitoring in clinical practice of patients with schizophrenia. Depression instruments developed for use in depressed patients may not discriminate depressive symptoms from negative psychotic symptoms. OBJECTIVE We reviewed depression instruments on their reliability and validity in patients with schizophrenia. METHODOLOGY A systematic literature search was carried out in three electronic databases. Psychometric properties were extracted for those instruments of which reliability, divergent, concurrent and predictive validity were reported in one or more publications. RESULTS Forty-eight publications described the reliability and validity of six depression instruments in patients with schizophrenia. The only self-report was the Beck Depression Inventory (BDI). The Brief Psychiatric Rating Scale-Depression subscale (BPRS-D), Positive and Negative Syndrome Scale-Depression subscale (PANSS-D), Hamilton Rating Scale for Depression (HAMD), Montgomery Asberg Depression Rating Scale (MADRS) and Calgary Depression Scale for Schizophrenia (CDSS) were clinician rated. All instruments were reliable for the measurement of depressive symptoms in patients with schizophrenia. The CDSS most accurately differentiated depressive symptoms from other symptoms of schizophrenia (divergent validity), correlated well with other depression instruments (concurrent validity), and was least likely to miss cases of depression or misdiagnose depression (predictive validity). CONCLUSIONS We would recommend to use the CDSS for the measurement of depressive symptoms in research and in daily clinical practice of patients with schizophrenia. A valid self-report instrument is to be developed for the use in clinical practice.
Collapse
Affiliation(s)
- Irene M Lako
- Rob Giel Research Center (RGOc), Department of Psychiatry (UCP), University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
46
|
Standardized diagnostic interviews, criteria, and algorithms for mental disorders: garbage in, garbage out. Eur Arch Psychiatry Clin Neurosci 2012; 262:535-44. [PMID: 22274737 DOI: 10.1007/s00406-012-0293-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Accepted: 01/10/2012] [Indexed: 10/14/2022]
Abstract
There is a general consensus that diagnoses for mental disorders should be based on criteria and algorithms as given in ICD or DSM. Standardized clinical interviews are recommended as diagnostic methods. In ICD and DSM, much emphasis is put on algorithms, while the underlying criteria get much less attention. The question is how valid are the criteria that are collected by structured diagnostic interviews. 209 patients from a cardiology inpatient unit were interviewed with the Mini International Neuropsychiatric Interview (MINI). 32 (15.3%) were diagnosed as suffering from a major depressive episode or dysthymia. Additionally, a thorough clinical examination was done by a psychiatric expert in 15 patients. The standardized diagnosis of present major depression was reaffirmed in one. In total, four patients were suffering from some kind of depressive disorder presently or life time. Two patients were suffering from anxiety disorders, two from adjustment disorders, and four from different types of organic brain disorders. Most important, there are 3 out of 15 who are not mentally ill. Our observations show that standardized diagnostic interviews cannot be used to make specific differential diagnoses, but rather catch unspecific syndromes. This is partly due to the fact that the wording, definition, and understanding of the underlying criteria is rather vague. This is an even greater problem if there is any somatic comorbidity. In the revision of ICD and DSM, a glossary of psychopathological terms and guidelines for the training of clinicians should be included.
Collapse
|
47
|
Schaefer B, Schaefer F, Wittmer D, Engelmann G, Wenning D, Schmitt CP. Molecular Adsorbents Recirculating System dialysis in children with cholestatic pruritus. Pediatr Nephrol 2012; 27:829-34. [PMID: 22083365 DOI: 10.1007/s00467-011-2058-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 08/28/2011] [Accepted: 08/30/2011] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cholestatic pruritus may severely compromise quality of life. The Molecular Adsorbents Recirculating System (MARS) allows removal of pruritogenic substances without exposure to foreign proteins. Pediatric data, however, are scant. METHODS We retrospectively analyzed the efficacy of MARS in three boys with severe cholestatic pruritus. They received a total of 135 MARS sessions during 8, 4, and 13 months prior to liver transplantation. Total serum bilirubin and bile acids were monitored, and pruritus was assessed by a numerical rating scale (NRS 0 = no pruritus, 10 = maximal pruritus). RESULTS MARS sessions were initially performed three times weekly at a mean duration of 6.3 ± 1.4 h. Sessions could be reduced to once weekly and once every other week in two patients. Pre-MARS plasma bile acid concentrations averaged 207 ± 67 μmol/l. They declined to 67 ± 9%, 48 ± 3%, 38 ± 14%, and 37 ± 5% of baseline within 2, 4, 6 and 8 h of therapy, respectively (all p < 0.05). The average interdialytic increase of plasma bile acids was 34 ± 33 μmol/l per day. Mean NRS score decreased from 6.5 ± 2.3 to 3.3 ± 2.9 (p < 0.01). Skin lesions from itching disappeared. All MARS treatments were well tolerated. CONCLUSION MARS dialysis substantially reduces cholestatic pruritus in children refractory to pharmacological treatment.
Collapse
Affiliation(s)
- Betti Schaefer
- Center for Pediatric and Adolescent Medicine Heidelberg, University of Heidelberg, INF 430, 69120 Heidelberg, Germany
| | | | | | | | | | | |
Collapse
|
48
|
Critical trial-related criteria in acute schizophrenia studies. Eur Arch Psychiatry Clin Neurosci 2012; 262:151-5. [PMID: 21789700 DOI: 10.1007/s00406-011-0225-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2011] [Accepted: 07/09/2011] [Indexed: 10/18/2022]
Abstract
The Trial Criteria in Schizophrenia Working Group was convened in November 2007 to define consensus criteria for clinical trials in patients suffering from acute schizophrenia with special focus on placebo-controlled trials and withdrawal conditions. Clinical trials involving patients give rise to ethical and medico-legal dilemmas. Essential research of new drugs may potentially expose patients to ineffective treatment regimens or placebo. The complexity of the problem increases when dealing with mentally ill patients. The Working Group's criteria are thought to cover different aspects important in conducting clinical trials namely to ensure the patient's safety, to present criteria that would allow the ethics committees to agree to the proposed criteria and to enable the possibility to reasonably conduct and ensure comparable quality of clinical studies in acutely ill patients with schizophrenia. To furthermore counteract current inconsistencies, these criteria should be evaluated using standardized rating scales applying established cut-off criteria. The developed trial criteria cover inclusion and exclusion criteria as well as withdrawal criteria due to non-response or worsening of symptoms.
Collapse
|
49
|
Impaired neural processing of social attribution in anorexia nervosa. Psychiatry Res 2011; 194:54-63. [PMID: 21872451 DOI: 10.1016/j.pscychresns.2011.06.016] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 06/23/2011] [Accepted: 06/24/2011] [Indexed: 11/21/2022]
Abstract
Anorexia nervosa (AN) patients have been found to have problems in social cognition, including the process of thinking about other people's thoughts and feelings, often referred to as Theory of Mind (ToM). We examined neural correlates relating to thinking about social relationships in 17 women in recovery from anorexia (RAN) and 17 healthy women (CON) using a functional magnetic resonance imaging (fMRI) task. The task consisted of short videos of moving shapes that subjects viewed either in the context of performing a social decision related to how the shapes interacted: "People: All friends?" or in the context of performing a visuospatial task related to how the shapes moved after bumping into each other: "Bumper cars: Same weight?". The RAN participants showed reduced activation in the social cognition network, with the most robust differences in the right temporoparietal junction (RTPJ). There were no significant differences between the CON and RAN groups in regions more active during the visuospatial task. These neural correlates show differences in the processing of social knowledge in RAN subjects suggesting that biological impairments in social cognition may contribute to pathology in AN.
Collapse
|
50
|
Abstract
In recent years, so-called “effectiveness studies,” also called “real-world studies” or “pragmatic trials, ” have gained increasing importance in the context of evidencebased medicine. These studies follow less restrictive methodological standards than phase III studies in terms of patient selection, comedication, and other design issues, and their results should therefore be better generalizable than those of phase III trials. Effectiveness studies, like other types of phase IV studies, can therefore contribute to knowledge about medications and supply relevant information in addition to that gained from phase III trials. However, the less restrictive design and inherent methodological problems of phase IV studies have to be carefully considered. For example, the greater variance caused by the different kinds of confounders as well as problematic design issues, such as insensitive primary outcome criteria, unblinded treatment conditions, inclusion of chronic refractory patients, etc, can lead to wrong conclusions. Due to these methodological problems, effectiveness studies are on a principally lower level of evidence, adding only a complementary view to the results of phase III trials without falsifying their results.
Collapse
Affiliation(s)
- Hans-Jürgen Möller
- Department of Psychiatry, Ludwig-Maximilians-University München, Munich, Germany.
| |
Collapse
|