1
|
Dam S, Batail JM, Robert GH, Drapier D, Maurel P, Coloigner J. Structural Brain Connectivity and Treatment Improvement in Mood Disorder. Brain Connect 2024; 14:239-251. [PMID: 38534988 DOI: 10.1089/brain.2023.0063] [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] [Indexed: 04/25/2024] Open
Abstract
Background: The treatment of depressive episodes is well established, with clearly demonstrated effectiveness of antidepressants and psychotherapies. However, more than one-third of depressed patients do not respond to treatment. Identifying the brain structural basis of treatment-resistant depression could prevent useless pharmacological prescriptions, adverse events, and lost therapeutic opportunities. Methods: Using diffusion magnetic resonance imaging, we performed structural connectivity analyses on a cohort of 154 patients with mood disorder (MD) and 77 sex- and age-matched healthy control (HC) participants. To assess illness improvement, the patients with MD went through two clinical interviews at baseline and at 6-month follow-up and were classified based on the Clinical Global Impression-Improvement score into improved or not-improved (NI). First, the threshold-free network-based statistics (NBS) was conducted to measure the differences in regional network architecture. Second, nonparametric permutations tests were performed on topological metrics based on graph theory to examine differences in connectome organization. Results: The threshold-free NBS revealed impaired connections involving regions of the basal ganglia in patients with MD compared with HC. Significant increase of local efficiency and clustering coefficient was found in the lingual gyrus, insula, and amygdala in the MD group. Compared with the NI, the improved displayed significantly reduced network integration and segregation, predominately in the default-mode regions, including the precuneus, middle temporal lobe, and rostral anterior cingulate. Conclusions: This study highlights the involvement of regions belonging to the basal ganglia, the fronto-limbic network, and the default mode network, leading to a better understanding of MD disease and its unfavorable outcome.
Collapse
Affiliation(s)
- Sébastien Dam
- Univ Rennes, Inria, CNRS, IRISA, INSERM, Empenn U1228 ERL, Rennes, France
| | - Jean-Marie Batail
- Academic Psychiatry Department, Centre Hospitalier Guillaume Régnier, Rennes, France
- CIC 1414, CHU de Rennes, INSERM, Rennes, France
| | - Gabriel H Robert
- Univ Rennes, Inria, CNRS, IRISA, INSERM, Empenn U1228 ERL, Rennes, France
- Academic Psychiatry Department, Centre Hospitalier Guillaume Régnier, Rennes, France
- CIC 1414, CHU de Rennes, INSERM, Rennes, France
| | - Dominique Drapier
- Academic Psychiatry Department, Centre Hospitalier Guillaume Régnier, Rennes, France
- CIC 1414, CHU de Rennes, INSERM, Rennes, France
| | - Pierre Maurel
- Univ Rennes, Inria, CNRS, IRISA, INSERM, Empenn U1228 ERL, Rennes, France
| | - Julie Coloigner
- Univ Rennes, Inria, CNRS, IRISA, INSERM, Empenn U1228 ERL, Rennes, France
| |
Collapse
|
2
|
Yoon IY, Ryu JH, Do SH, Min B, Koo CH. Etomidate versus Propofol for Electroconvulsive Therapy in Patients with Major Depressive Disorders in Terms of Clinical Responses to Treatment: A Retrospective Analysis. Brain Sci 2023; 13:1023. [PMID: 37508956 PMCID: PMC10377494 DOI: 10.3390/brainsci13071023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 06/25/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023] Open
Abstract
General anesthetic agents may be associated with the clinical efficacy of electroconvulsive therapy (ECT), as they may influence seizure quality and duration. Hence, a retrospective study was conducted to compare the clinical effects and seizure variables of etomidate and propofol during ECT. Patients treated with ECT under anesthesia with etomidate (n = 43) or propofol (n = 12) were retrospectively analyzed. Seizure variables (seizure duration, intensity, and threshold) and hemodynamic changes during ECT were assessed and recorded. Clinical responses to treatment were evaluated using the Clinical Global Impression scale and mood at discharge after the course of ECT. Adverse effects were also recorded. The demographic characteristics were similar between the two groups. There were no significant differences in the Clinical Global Impression scale scores, mood at discharge, and adverse effects between the two groups (p > 0.05); however, etomidate was associated with a significantly longer motor (42.0 vs. 23.65 s, p < 0.001) and electroencephalogram (51.8 vs. 33.5 s, p < 0.001) seizure duration than propofol. In conclusion, etomidate showed more favorable seizure profiles than propofol during ECT; however, both agents (etomidate and propofol) were associated with similar clinical efficacy profiles at discharge.
Collapse
Affiliation(s)
- In-Young Yoon
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Jung-Hee Ryu
- Department of Anesthesia and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea
- Department of Anesthesia and Pain Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Sang-Hwan Do
- Department of Anesthesia and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea
- Department of Anesthesia and Pain Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Beomjun Min
- Chung Psychiatric Clinic, Seoul 06614, Republic of Korea
| | - Chang-Hoon Koo
- Department of Anesthesia and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea
- Department of Anesthesia and Pain Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| |
Collapse
|
3
|
Kyrillos V, Bosqui T, Moghames P, Chehade N, Saad S, Abdul Rahman D, Karam E, Karam G, Saab D, Pluess M, McEwen FS. The culturally and contextually sensitive assessment of mental health using a structured diagnostic interview (MINI Kid) for Syrian refugee children and adolescents in Lebanon: Challenges and solutions. Transcult Psychiatry 2023; 60:125-141. [PMID: 35818837 PMCID: PMC9834432 DOI: 10.1177/13634615221105114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Elevated rates of mental health difficulties are frequently reported in conflict-affected and displaced populations. Even with advances in improving the validity and reliability of measures, our knowledge of the performance of assessment tools is often limited by a lack of contextualization to specific populations and socio-political settings. This reflective article aimed to review challenges and share lessons learned from the process of administering and supervising a structured clinical interview. We administered the MINI International Neuropsychiatric Interview for Children and Adolescents (MINI Kid) and used the Clinical Global Impression (CGI) severity scale with N = 119 Syrian refugee children (aged 8-17) resident in ITSs in Lebanon. Qualitative data were derived from supervision process notes on challenges that arose during assessments, analyzed for thematic content. Five themes were identified: (1) practical and logistical challenges (changeable nature of daily life, competing demands, access to phones, temporary locations, limited referral options); (2) validity (lack of privacy, trust, perceptions of mental health, stigma, false positive answers); (3) cultural norms and meaning (impact of different meanings on answers); (4) contextual norms (reactive and adaptive emotional and behavioral responses to contextual stress); and (5) co-morbidity and formulation (interconnected and complex presentations). The findings suggest that while structured assessments have major advantages, cultural and contextual sensitivity during assessments, addressing practical barriers to improving accessibility, and consideration for inter-connected formulations are essential to help inform prevalence rates, treatment plans, and public health strategies.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Elie Karam
- Institute for Development, Research, Advocacy and Applied Care
- Saint George Hospital University Medical Center
- Balamand University
| | | | - Dahlia Saab
- Institute for Development, Research, Advocacy and Applied Care
| | | | | |
Collapse
|
4
|
Morcos N, Strominger J. Electroconvulsive Therapy for Unipolar Depression in Older Adults: Overall Outcomes and Clinical Trajectories of Nonresponders. J ECT 2022; 38:224-229. [PMID: 35462391 DOI: 10.1097/yct.0000000000000853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Electroconvulsive therapy (ECT) is a safe and effective procedure in unipolar depression in older adults; however, less is known about clinical features and trajectories among patients who do not respond. In this retrospective, naturalistic study, we examine characteristics associated with ECT response among older adults with unipolar depression who received ECT over an 8-year period and describe long-term outcomes for nonresponders. METHODS We retrospectively identified patients 65 years or older with major depressive disorder who were treated with ECT during an 8-year period. We reviewed demographic and clinical factors among patients who responded to ECT and those who did not. Clinic notes were reviewed for ECT nonresponders to determine Clinical Global Impressions scores in the 24 months after ECT treatment. RESULTS We identified 140 patients meeting the inclusion criteria. Most patients (65%) responded to ECT. Fewer previous antidepressant trials, lower baseline Montreal Cognitive Assessment scores, and lower baseline Montgomery-Asberg Depression Rating Scale scores were associated with an increased likelihood of ECT response. Among the 49 (35%) nonresponders, another 12 (24.5%) responded to a variety of treatments within 2 years after ECT. There were no serious adverse effects of treatment. CONCLUSIONS Most patients responded to ECT, many of whom had severe illness that had been refractory to numerous medication trials. Among nonresponders, a subset improved over time through a variety of treatments. However, most patients who did not respond to ECT had persistent depression after 2 years.
Collapse
Affiliation(s)
- Nicholas Morcos
- From the Department of Psychiatry, The University of Michigan, Michigan Medicine
| | - Julie Strominger
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
| |
Collapse
|
5
|
Exploring the factor structure of the mini-ICF-APP in an inpatient clinical sample, according to the psychiatric diagnosis. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2021; 14:186-195. [PMID: 34861928 DOI: 10.1016/j.rpsmen.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 05/16/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Psychosocial functioning is a key factor determining prognosis, severity, impairment and quality of life in people who have a mental disorder. The mini-ICF-APP was developed to provide a standardised classification of functioning and disability. However, despite its gaining popularity little is known about its structure and performance. This paper examines the structure of the mini-ICF-APP using factor analysis techniques. MATERIALS AND METHODS In a clinical sample of 3178 patients, with psychiatric diagnoses from several ICD-10 categories, we analysed internal consistency, item inter-correlations and the factorial structure of the data, with reference to ICD-10 diagnostic categories; Neurocognitive Disorders; Alcohol Use Disorders; Substance Use Disorders; Schizophrenia and Psychotic Disorders; Bipolar Disorder; Major Depressive Disorder; Anxiety Disorders; Personality Disorders; and Neurodevelopmental Disorders. RESULTS We found good internal consistency and item inter-correlations (Cronbach alpha=0.92) for the mini-ICF-APP. We were able to identify pivotal domains (flexibility, assertiveness and intimate relationships), which demonstrate sub-threshold influences on other domains. The factor analysis yielded a one-factor model as ideal for the whole sample and for all diagnostic categories. For some diagnostic categories the data suggested a two or three-factor model, however, with poorer fit indices. CONCLUSIONS The factor structure of the mini-ICF-APP appears to modify according to the main diagnosis. However, a one-factor model demonstrates better fit regardless of diagnostic category. Consequently, we consider the mini-ICF-APP to be a trans-diagnostic measurement instrument for the assessment and grading of psychosocial functioning. The use of the mini-ICF-APP sum score seems to best reflect the degree of impairment in an individual, even taking into account that affected domains may lead to sub-threshold effects on other domains.
Collapse
|
6
|
Bond L, Power P. The young adult service: An evaluation of a youth mental health service in the independent sector in Ireland. Early Interv Psychiatry 2021; 15:1349-1361. [PMID: 33145989 DOI: 10.1111/eip.13065] [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: 08/26/2019] [Revised: 10/05/2020] [Accepted: 10/18/2020] [Indexed: 11/28/2022]
Abstract
AIMS Increasing concerns about the specific needs and rates of mental illness among young adults have spurred the development of youth mental health services. Yet few outcome studies exist. This study aims to evaluate a young adult service in an independent mental health sector in Ireland. METHODS This is a service evaluation using a retrospective, descriptive and naturalistic study design. Routine demographic, diagnostic and service usage data were collected at entry into the service. Outcomes were recorded at discharge from the service using the Clinical Global Impression (CGI) improvement scores. Factors associated with better or worse outcomes were analyzed. RESULTS Five hundred and sixty-seven young adults were assessed and managed during a 3-year period by the Young Adult Service. Their characteristics fell midway between adolescent and adult mental health service populations. They had high levels of Axis I & II co-morbidities reflecting the complex and fluid nature of emerging conditions in this age group. The majority (62.8%) had clinically improved by the end of follow-up. Outcomes were significantly better in those who were hospitalized, prescribed psychotropic medication, received 1:1 psychology sessions and attended a group-based psychology program or group program for specific disorders. One hundred and sixty-six patients (29.3%) dropped out of follow-up. Drop out was associated with longer time spent in the service, being treated solely in the community, without medication, not having a developmental disorder and not transferring from CAMHS. CONCLUSIONS This study demonstrates that it is possible to establish an effective youth mental health service with favourable outcomes within a broader mental health system. It provides a benchmark for similar services, bridging the gap between adolescent and adult mental health services.
Collapse
Affiliation(s)
- Laura Bond
- St. Patrick's Mental Health Services, Dublin, Ireland
| | - Paddy Power
- St. Patrick's Mental Health Services, Dublin, Ireland.,Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
7
|
Abstract
OBJECTIVES Electroconvulsive therapy (ECT) is a well-established treatment for mood disorders in younger adults and has been consistently shown to be safe and effective in unipolar depression in older adults. However, data on this treatment in older adults with bipolar disorder are limited. In this retrospective study, we report outcomes from all cases of older adults with bipolar depression who received ECT from a large academic institution over a 7-year period. METHODS We retrospectively identified all patients 65 years and older with bipolar depression who were treated with ECT over a 7-year period. Patients receiving ECT for an episode of bipolar depression were included in the study based on chart review and availability of documented outcome measures. Primary outcomes were changes in Montreal Cognitive Assessment and Clinical Global Impressions scores. RESULTS We identified 34 patients meeting inclusion criteria. Collectively, patients had statistically significant improvement in Montreal Cognitive Assessment scores and reductions in Clinical Global Impressions severity scores after treatment. Pre- and posttreatment Montgomery-Asberg Depression Rating Scale scores were also available for a subset of 20 patients and demonstrated a similarly significant reduction in severity with treatment. There were no serious adverse effects of treatment, and no patients discontinued treatment. CONCLUSIONS Electroconvulsive therapy was well tolerated and effective in treating bipolar depression in older adults. Importantly, these findings challenge commonly held worries about cognitive decline in older adults receiving ECT. It should be a regular consideration for management of this challenging illness in a population that may otherwise not respond to pharmacotherapy.
Collapse
Affiliation(s)
- Nicholas Morcos
- From the Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | | | | |
Collapse
|
8
|
Kolevzon A, Ventola P, Keary CJ, Heimer G, Neul JL, Adera M, Jaeger J. Development of an adapted Clinical Global Impression scale for use in Angelman syndrome. J Neurodev Disord 2021; 13:3. [PMID: 33397286 PMCID: PMC7784030 DOI: 10.1186/s11689-020-09349-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 12/01/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The Clinical Global Impression-Severity (CGI-S) and CGI-Improvement (CGI-I) scales are widely accepted tools that measure overall disease severity and change, synthesizing the clinician's impression of the global state of an individual. Frequently employed in clinical trials for neuropsychiatric disorders, the CGI scales are typically used in conjunction with disease-specific rating scales. When no disease-specific rating scale is available, the CGI scales can be adapted to reflect the specific symptom domains that are relevant to the disorder. Angelman syndrome (AS) is a rare, clinically heterogeneous condition for which there is no disease-specific rating scale. This paper describes efforts to develop standardized, adapted CGI scales specific to AS for use in clinical trials. METHODS In order to develop adapted CGI scales specific to AS, we (1) reviewed literature and interviewed caregivers and clinicians to determine the most impactful symptoms, (2) engaged expert panels to define and operationalize the symptom domains identified, (3) developed detailed rating anchors for each domain and for global severity and improvement ratings, (4) reviewed the anchors with expert clinicians and established minimally clinically meaningful change for each symptom domain, and (5) generated mock patient vignettes to test the reliability of the resulting scales and to standardize rater training. This systematic approach to developing, validating, and training raters on a standardized, adapted CGI scale specifically for AS is described herein. RESULTS The resulting CGI-S/I-AS scales capture six critical domains (behavior, gross and fine motor function, expressive and receptive communication, and sleep) defined by caregivers and expert clinicians as the most challenging for patients with AS and their families. CONCLUSIONS Rigorous training and careful calibration for clinicians will allow the CGI-S/-I-AS scales to be reliable in the context of randomized controlled trials. The CGI-S/-I-AS scales are being utilized in a Phase 3 trial of gaboxadol for the treatment of AS.
Collapse
Affiliation(s)
- Alexander Kolevzon
- Seaver Autism Center for Research and Treatment, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pamela Ventola
- Yale University Child Study Center, New Haven, CT, USA
- Cogstate, New Haven, CT, USA
| | - Christopher J Keary
- Angelman Syndrome Program, Massachusetts General Hospital for Children, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Gali Heimer
- Pediatric Neurology Unit, Safra Children Hospital, Sheba Medical Center, Tel Hashomer and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jeffrey L Neul
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Judith Jaeger
- CognitionMetrics, LLC, Wilmington, DE, USA.
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA.
| |
Collapse
|
9
|
Egger ST, Weniger G, Bobes J, Seifritz E, Vetter S. Exploring the factor structure of the mini-ICF-APP in an inpatient clinical sample, according to the psychiatric diagnosis. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2020; 14:S1888-9891(20)30066-5. [PMID: 32712046 DOI: 10.1016/j.rpsm.2020.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 04/14/2020] [Accepted: 05/16/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Psychosocial functioning is a key factor determining prognosis, severity, impairment and quality of life in people who have a mental disorder. The mini-ICF-APP was developed to provide a standardised classification of functioning and disability. However, despite its gaining popularity little is known about its structure and performance. This paper examines the structure of the mini-ICF-APP using factor analysis techniques. MATERIALS AND METHODS In a clinical sample of 3178 patients, with psychiatric diagnoses from several ICD-10 categories, we analysed internal consistency, item inter-correlations and the factorial structure of the data, with reference to ICD-10 diagnostic categories; Neurocognitive Disorders; Alcohol Use Disorders; Substance Use Disorders; Schizophrenia and Psychotic Disorders; Bipolar Disorder; Major Depressive Disorder; Anxiety Disorders; Personality Disorders; and Neurodevelopmental Disorders. RESULTS We found good internal consistency and item inter-correlations (Cronbach alpha=0.92) for the mini-ICF-APP. We were able to identify pivotal domains (flexibility, assertiveness and intimate relationships), which demonstrate sub-threshold influences on other domains. The factor analysis yielded a one-factor model as ideal for the whole sample and for all diagnostic categories. For some diagnostic categories the data suggested a two or three-factor model, however, with poorer fit indices. CONCLUSIONS The factor structure of the mini-ICF-APP appears to modify according to the main diagnosis. However, a one-factor model demonstrates better fit regardless of diagnostic category. Consequently, we consider the mini-ICF-APP to be a trans-diagnostic measurement instrument for the assessment and grading of psychosocial functioning. The use of the mini-ICF-APP sum score seems to best reflect the degree of impairment in an individual, even taking into account that affected domains may lead to sub-threshold effects on other domains.
Collapse
Affiliation(s)
- Stephan T Egger
- Centre for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland; Department of Psychiatry, Faculty of Medicine, University of Oviedo, CIBERSAM, Oviedo. Spain.
| | - Godehard Weniger
- Centre for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Julio Bobes
- Department of Psychiatry, Faculty of Medicine, University of Oviedo, CIBERSAM, Oviedo. Spain
| | - Erich Seifritz
- Centre for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Stefan Vetter
- Centre for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| |
Collapse
|
10
|
Benraad CEM, Disselhorst L, Laurenssen NCW, Hilderink PH, Melis RJF, Spijker J, Olde Rikkert MGM. Frailty, multimorbidity and functional status as predictors for health outcomes of acute psychiatric hospitalisation in older adults. Aging Ment Health 2020; 24:119-128. [PMID: 30450946 DOI: 10.1080/13607863.2018.1515888] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Objectives: Frailty, multimorbidity and functional decline predict adverse health outcomes in community dwelling older people and older patients in general hospitals. This study investigates whether these characteristics separately are independent predictors of health outcomes of acute psychiatric hospitalization.Methods: Observational study in a prospectively sampled cohort of older patients, consecutively admitted to a psychiatric hospital. On admission we assessed frailty (Frailty Index and walking speed); multimorbidity (Cumulative Index Rating Scale Geriatrics (CIRS-G)) and functional status (Barthel Index). We used the Clinical Global Impressions of Improvement scale (CGI-I) as the psychiatric outcome measure, and dichotomized discharge destination as overall outcome measure: favourable (able to return home or previous care level) or adverse (death, or move to higher level of residential care).Results: We included 120 patients, 74.6 years (±7.8). 52.5% of the patients was frail (FI ≥0.25). The mean level of the CIRS-G was 13.5 (5.4). Mean CGI-I at discharge was 2.8 (± 1.0), indicating moderate improvement in the psychiatric outcome. Neither FI, CIRS-G, nor Barthel scores were, independent of age, sex and diagnosis, associated with the CGI-I. FI was predictive for adverse discharge destination (OR 1.91, 95%CI 1.09-3.37 per 0.1), as were higher CIRS-G (OR 1.19 95%CI 1.06-1.34, per point) and lower walking speed (OR 1.35 95%CI 1.06-1.72 per 0.1 m/s).Conclusions: Half of our patients were frail and had a high level of multimorbidity. The FI, walking speed and multimorbidity did not predict improvement of psychiatric symptoms at discharge, but independently helped to predict adverse discharge destination.
Collapse
Affiliation(s)
- Carolien E M Benraad
- Department of Geriatric Medicine/Radboudumc Alzheimer Centre, Donders Institute for Medical Neurosciences, Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Geriatric Psychiatry, Pro Persona Mental Health Care, Nijmegen, The Netherlands
| | - Luc Disselhorst
- Department of Geriatric Psychiatry, Pro Persona Mental Health Care, Nijmegen, The Netherlands
| | - Nicky C W Laurenssen
- Department of Geriatric Psychiatry, Pro Persona Mental Health Care, Nijmegen, The Netherlands
| | - Peter H Hilderink
- SeniorBeter, Practice for Old Age Psychiatry, Gendt, The Netherlands
| | - René J F Melis
- Department of Geriatric Medicine/Radboudumc Alzheimer Centre, Donders Institute for Medical Neurosciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jan Spijker
- Depression Expertise Centre, Pro Persona Mental Health Care, Nijmegen, The Netherlands.,Behavioral Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Marcel G M Olde Rikkert
- Department of Geriatric Medicine/Radboudumc Alzheimer Centre, Donders Institute for Medical Neurosciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| |
Collapse
|
11
|
Abstract
Although functional impairment is very common among patients with major depressive disorder (MDD) and is a necessary diagnostic criterion for MDD, clinicians have not directed their attention beyond the mood symptoms of MDD. We aimed to multi-dimensionally assess the functional abilities of patients with MDD using a standardized scale of adaptive function reported by caregivers or parents to identify the nature and degree of functional impairment in patients with MDD.This study was conducted in 40 depressive patients aged 19 to 60 years. Patients were screened according to the DSM-IV-TR and a Hamilton Depression Rating Scale score ≥8. We administered the parent/caregiver rating form of the Korean Vineland Adaptive Behavior Scale to assess functional outcomes in the patients.Patients with MDD showed significant differences in both global and domain-specific functional abilities compared to those of the normal group (all t > -6.35, P < .05) and the patients' premorbid IQ (all t > 4.30, P < .001). The number of episodes among clinical factors was negatively correlated with overall adaptive functioning (r = -0.32, P < .05) and expressive communication (r = -0.42, P < .01).Our present study replicates existing evidence showing impairment in both broad and various functional areas in patients with MDD, suggesting the importance of quantitatively assessing functional outcomes and acquiring information about functioning from informants other than patients.
Collapse
|
12
|
Egger ST, Weniger G, Müller M, Bobes J, Seifritz E, Vetter S. Assessing the severity of functional impairment of psychiatric disorders: equipercentile linking the mini-ICF-APP and CGI. Health Qual Life Outcomes 2019; 17:174. [PMID: 31744498 PMCID: PMC6862821 DOI: 10.1186/s12955-019-1235-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 10/18/2019] [Indexed: 12/02/2022] Open
Abstract
Background The assessment of functioning and impairment due to psychiatric illness has been acknowledged to be crucial for research and practice. This led to the development of the mini-ICF-APP, which provides a reliable and time-efficient measure of functioning and impairment. Although its use is increasing, it remains unclear how it reflects severity and how change might be interpreted from a clinical perspective. Methods In a clinical sample of 3067 individuals hospitalized for mental health treatment, we used an equipercentile approach to link the mini-ICF-APP with the Clinical Global Impression scale (CGI) at admission and discharge. We linked the mini-ICF-APP sum score to the CGI-S scale and the mini-ICF-APP proportional change between admission and discharge to the CGI-I scale. Results The mini-ICF-APP and CGI scales showed a Spearman correlation of 0.50 (p < .000). CGI-S: “borderline-ill” corresponded to a mini-ICF-APP score 1–2; “mildly-ill” to 3–7; “moderately-ill” to 8–15; “markedly-ill” to 16–24; “severely-ill” to 25–37; and “extremely-ill” to a score ≥ 38. The Spearman correlation between the percentage change of mini-ICF-APP sum score and the CGI-I was 0.32 (p > .000); “no-change” in the CGI-I corresponded to an increase or decrease of 2%; “minimally-improved” to a mini-ICF-APP reduction of 3–30%; “much-improved” to a reduction of 31–63%; “very-much-improved” to a reduction of ≥64% “minimally-worse” to an increase of 3–34% “much-worse” to an increase of 35–67%; and finally “very-much-worse” with an increase of ≥68%. Conclusions Our findings improve understanding of the clinical meaning of the mini-ICF-APP sum score and percentage change in patients hospitalized for treatment.
Collapse
Affiliation(s)
- Stephan T Egger
- Centre for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland. .,Department of Psychiatry, Faculty of Medicine, University of Oviedo, CIBERSAM, Oviedo, Spain.
| | - Godehard Weniger
- Centre for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland
| | - Mario Müller
- Centre for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland
| | - Julio Bobes
- Department of Psychiatry, Faculty of Medicine, University of Oviedo, CIBERSAM, Oviedo, Spain
| | - Erich Seifritz
- Centre for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland
| | - Stefan Vetter
- Centre for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland
| |
Collapse
|
13
|
Heussler H, Cohen J, Silove N, Tich N, Bonn-Miller MO, Du W, O'Neill C, Sebree T. A phase 1/2, open-label assessment of the safety, tolerability, and efficacy of transdermal cannabidiol (ZYN002) for the treatment of pediatric fragile X syndrome. J Neurodev Disord 2019; 11:16. [PMID: 31370779 PMCID: PMC6676516 DOI: 10.1186/s11689-019-9277-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 07/18/2019] [Indexed: 12/23/2022] Open
Abstract
Background Fragile X syndrome (FXS) is characterized by a range of developmental, neuropsychiatric, and behavioral symptoms that cause significant impairment in those with the disorder. Cannabidiol (CBD) holds promise as a potential treatment for FXS symptoms due to its safety profile and positive effects on a number of emotional and behavioral symptoms associated with FXS. The aim of the current study was to evaluate the safety, tolerability, and initial efficacy of ZYN002, a transdermal CBD gel, in a pediatric population with FXS. Methods Twenty children and adolescents (aged 6–17 years) with a diagnosis of FXS (confirmed through molecular documentation of FMR1 full mutation) were enrolled in an open-label, multi-site, trial of ZYN002. Transdermal CBD gel was administered twice daily for 12 weeks, titrated from 50 mg to a maximum daily dose of 250 mg. The primary efficacy endpoint was change from screening to week 12 on the Anxiety, Depression, and Mood Scale (ADAMS). Secondary endpoint measures included the Aberrant Behavior Checklist—Community for FXS (ABC-CFXS), Pediatric Anxiety Rating Scale (PARS-R), Pediatric Quality of Life Inventory (PedsQL™), three Visual Analogue Scales (VAS), and the Clinical Global Impression Scale—Severity (CGI-S) and Improvement (CGI-I). Results The majority of treatment-emergent AEs (reported by 85% of participants) were mild in severity (70%), and no serious adverse events were reported. There was a statistically significant reduction in ADAMS total score from screening to week 12 and significant reductions on nearly all other secondary endpoints, including all ADAMS subscales (except depressed mood), all ABC-CFXS subscale scores (e.g., social avoidance, irritability), PARS-R total severity score, and PedsQL total score. Conclusions ZYN002 was well tolerated and produced clinically meaningful reductions in anxiety and behavioral symptoms in children and adolescents with FXS. These findings support further study of ZYN002 in a randomized, well-controlled trial for the treatment of behavioral symptoms of FXS. Trial registration ANZCTR, ACTRN12617000150347 Registered 27 January 2017
Collapse
Affiliation(s)
- Helen Heussler
- Centre for Clinical Trials in Rare Neurodevelopmental Disorders, Children's Health Queensland, Brisbane, Australia.,Centre for Child Health Research, University of Queensland, Brisbane, Australia
| | - Jonathan Cohen
- Fragile X Alliance Inc. and Genetic Clinics Australia, Melbourne, Australia
| | | | - Nancy Tich
- Zynerba Pharmaceuticals, Devon, PA, 19333, USA.
| | | | - Wei Du
- Clinical Statistics Consulting, Blue Bell, PA, 19422, USA
| | | | | |
Collapse
|
14
|
Oud M, de Winter L, Vermeulen-Smit E, Bodden D, Nauta M, Stone L, van den Heuvel M, Taher RA, de Graaf I, Kendall T, Engels R, Stikkelbroek Y. Effectiveness of CBT for children and adolescents with depression: A systematic review and meta-regression analysis. Eur Psychiatry 2019; 57:33-45. [DOI: 10.1016/j.eurpsy.2018.12.008] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/27/2018] [Accepted: 12/28/2018] [Indexed: 12/19/2022] Open
Abstract
AbstractBackground:Cognitive-behavioral therapy (CBT) is first choice of treatment for depressive symptoms and disorders in adolescents, however improvements are necessary because overall efficacy is low. Insights on CBT components and contextual and structural characteristics might increase the efficacy. The aim of our approach is to evaluate the efficacy of CBT for youth with depression and investigate the influence of specific components, contextual and structural factors that could improve effects.Methods:A systematic review of randomized controlled trials was conducted, searches were undertaken in CINAHL, CENTRAL, EMBASE, MEDLINE/PubMed and PsycINFO. Outcomes were meta-analyzed and confidence in results was assessed using the GRADE-method. Meta-regression was used to pinpoint components or other factors that were associated with an in- or decrease of effects of CBT.Results:We included 31 trials with 4335 participants. Moderate-quality evidence was found for CBT reducing depressive symptoms at the end of treatment and at follow-up, and CBT as indicated prevention resulted in 63% less risk of being depressed at follow-up. CBT containing a combination of behavioral activation and challenging thoughts component (as part of cognitive restructuring) or the involvement of caregiver(s) in intervention were associated with better outcomes for youth on the long term.Conclusions:There is evidence that CBT is effective for youth with a (subclinical) depression. Our analyses show that effects might improve when CBT contains the components behavioral activation and challenging thoughts and also when the caregiver(s) are involved. However, the influential effects of these three moderators should be further tested in RCTs.
Collapse
|
15
|
Curto M, Pompili E, Silvestrini C, Bellizzi P, Navari S, Pompili P, Manzi A, Bianchini V, Carlone C, Ferracuti S, Nicolò G, Baldessarini RJ. A novel SCL-90-R six-item factor identifies subjects at risk of early adverse outcomes in public mental health settings. Psychiatry Res 2018; 267:376-381. [PMID: 29957556 DOI: 10.1016/j.psychres.2018.06.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 05/28/2018] [Accepted: 06/13/2018] [Indexed: 11/29/2022]
Abstract
To increase access to treatment, Italy made assessment at community mental health centers (CMHCs) independent of medical referral, resulting in increased numbers of patients to be triaged efficiently. To support this process, we evaluated SCL-90-R item-ratings to identify factors that best predicted adverse early outcomes among persons seeking first-time CMHC care in a 24-month period in Rome. A psychiatric nurse screened subjects with a brief interview and self-administered SCL-90-R and psychiatrists provided CGI ratings and ICD-9 diagnosis. Of 832 screened subjects, 32 (3.85%) were hospitalized or attempted suicide within 90 days. Six SCL-90 items (15,41,55,57,78,88) scored much higher with than without such adverse outcomes; their sum is proposed as a predictive measure ("SCL-6″). In binary multivariable logistic modeling, this factor, but not age, sex, diagnosis, or other SCL-90-derived subscales strongly predicted adverse outcomes. A ROC curve for SCL-6 reflected a strong separation between subjects with versus without adverse outcomes (AUC = 0.76). This simple screening tool may support timely identification of patients at risk of early adverse clinical outcome who require especially close follow-up.
Collapse
Affiliation(s)
- Martina Curto
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, Rome 00185, Italy; Department of Mental Health, ASL Roma 5, Via degli Esplosivi 9, Colleferro (RM) 00034, Italy; International Mood & Psychotic Disorders Research Consortium, Mailman Research Center, McLean Hospital, 15 Mill Street, Belmont, MA 02478-9106, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Enrico Pompili
- Department of Mental Health, ASL Roma 5, Via degli Esplosivi 9, Colleferro (RM) 00034, Italy
| | - Cristiana Silvestrini
- Department of Mental Health, ASL Roma 5, Via degli Esplosivi 9, Colleferro (RM) 00034, Italy
| | - Pina Bellizzi
- Department of Mental Health, ASL Roma 5, Via degli Esplosivi 9, Colleferro (RM) 00034, Italy
| | - Serena Navari
- Department of Mental Health, ASL Roma 5, Via degli Esplosivi 9, Colleferro (RM) 00034, Italy
| | - Pieritalo Pompili
- Department of Mental Health, ASL Roma 5, Via degli Esplosivi 9, Colleferro (RM) 00034, Italy
| | - Agostino Manzi
- Department of Mental Health, ASL Roma 5, Via degli Esplosivi 9, Colleferro (RM) 00034, Italy
| | - Valeria Bianchini
- Department of Mental Health, ASL Roma 5, Via degli Esplosivi 9, Colleferro (RM) 00034, Italy
| | - Cristiano Carlone
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, Rome 00185, Italy
| | - Stefano Ferracuti
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, Rome 00185, Italy
| | - Giuseppe Nicolò
- Department of Mental Health, ASL Roma 5, Via degli Esplosivi 9, Colleferro (RM) 00034, Italy
| | - Ross J Baldessarini
- International Mood & Psychotic Disorders Research Consortium, Mailman Research Center, McLean Hospital, 15 Mill Street, Belmont, MA 02478-9106, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
16
|
Stefanovics EA, Rosenheck RA, Jones KM, Huang G, Krystal JH. Minimal Clinically Important Differences (MCID) in Assessing Outcomes of Post-Traumatic Stress Disorder. Psychiatr Q 2018. [PMID: 28634644 DOI: 10.1007/s11126-017-9522-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study sought to determine the minimal clinically important difference (MCID) for two frequently used measures of symptom severity in Post-Traumatic Stress Disorder: the Clinician Administered PTSD Scale (CAPS) and the PTSD Symptom Checklist (PCL). Data from a randomized clinical trial of antipsychotic medication in military-related treatment-resistant PTSD (N= 267) included assessments 4 times over 26 weeks. Methods for estimating the MCID were based on both the anchor-based approach, using the Clinical Global Impressions (CGI) severity and improvement scales, rated by both clinicians and patients; and the distribution-based approach (based on standardized z-scores). Severity and change scores on the CAPS and PCL were converted to z-scores and compared across CGI levels using analysis of variance. The average difference in CAPS z-scores between each of three CGI levels between "moderate" to "severe" and from "no change" to "much improved" was 0.758 for clinician CGI ratings and 0.525 for patient CGI ratings and were similar for the PCL (0.483 and 0.471) with all differences significant at p<.0001). Clinically meaningful CAPS and PCL severity and change z-scores range between 0.5-0.8 standard deviations. The MCID estimates suggested here provide an empirical basis for determining whether statistically significant changes in CAPS and PCL scores are clinically meaningful.
Collapse
Affiliation(s)
- Elina A Stefanovics
- VA New England Mental Illness Research and Education Center, VA Connecticut Healthcare System (116A-4), 950 Campbell Avenue, Building 36, West Haven, CT, 06516, USA. .,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
| | - Robert A Rosenheck
- VA New England Mental Illness Research and Education Center, VA Connecticut Healthcare System (116A-4), 950 Campbell Avenue, Building 36, West Haven, CT, 06516, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Karen M Jones
- VA Cooperative Studies Coordinating Center, Point, Perry, MD, USA
| | - Grant Huang
- VA Cooperative Studies Program Central Office, Washington, D.C, USA
| | - John H Krystal
- VA New England Mental Illness Research and Education Center, VA Connecticut Healthcare System (116A-4), 950 Campbell Avenue, Building 36, West Haven, CT, 06516, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.,Clinical Neuroscience Division, Department of Veterans Affairs National Center for PTSD, West Haven, CT, USA
| |
Collapse
|
17
|
Yang J, Kang C, Li J, Li P, Zhao X. A three-decade repeated cross-sectional survey on mental health of the Chinese Jino minority. Aust N Z J Psychiatry 2017; 51:1134-1141. [PMID: 29087228 DOI: 10.1177/0004867416682599] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE As there is growing evidence outlining varying degrees of social, economic and cultural changes among minority groups in China, there was a need to undertake research to determine whether modernization and urbanization of China has had an impact on the mental health of individuals from minority groups. In 1979, the Jino ethnic minority group was the last minority group to be designated a minority by the Chinese Central Government. As a direct result of the Chinese Government intervention, the Jino society began transitioning from a traditional rural lifestyle existence to that of a more modern urban lifestyle. Our objective was to explore whether changing social and economic influences had impacted the mental health of the Jino people. METHODS A longitudinal study over three decades was undertaken to determine the mental health of the Jino People. RESULTS From our initial study in 1979 and subsequent follow-up studies in 1989, 1999 and 2009, there were no significant changes found for 1-month prevalence, lifetime prevalence and prognosis for schizophrenia and mental retardation among the Jino population researched. For major depressive disorders, there were significant differences, suggesting a rising trend not only in 1-month prevalence but also in lifetime prevalence. We found significant differences had occurred over the three decades for alcohol abuse, alcohol dependence and Korsakov's psychosis. At the same time, the annual suicide incidence had increased at least three times in 2009 compared to that of 1989. CONCLUSION Results from our three-decade longitudinal repeated cross-sectional survey show that due to rapid social, economic and cultural changes among the Jino people, serious social and mental health problems such as alcohol-related disorder, suicide and major depressive disorders have increased.
Collapse
Affiliation(s)
- JianZhong Yang
- 1 Department of Psychiatry, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - ChuanYuan Kang
- 2 Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - JianHua Li
- 3 Yunnan Institute for Drug Abuse, Kunming, China
| | - PeiKai Li
- 3 Yunnan Institute for Drug Abuse, Kunming, China
| | - XuDong Zhao
- 2 Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| |
Collapse
|
18
|
Houghton DC, Capriotti MR, Scahill LD, Wilhelm S, Peterson AL, Walkup JT, Piacentini J, Woods DW. Investigating Habituation to Premonitory Urges in Behavior Therapy for Tic Disorders. Behav Ther 2017; 48:834-846. [PMID: 29029679 PMCID: PMC5679290 DOI: 10.1016/j.beth.2017.08.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 06/26/2017] [Accepted: 08/02/2017] [Indexed: 11/24/2022]
Abstract
Behavior therapy is effective for Persistent Tic Disorders (PTDs), but behavioral processes facilitating tic reduction are not well understood. One process, habituation, is thought to create tic reduction through decreases in premonitory urge severity. The current study tested whether premonitory urges decreased in youth with PTDs (N = 126) and adults with PTDs (N = 122) who participated in parallel randomized clinical trials comparing behavior therapy to psychoeducation and supportive therapy (PST). Trends in premonitory urges, tic severity, and treatment outcome were analyzed according to the predictions of a habituation model, whereby urge severity would be expected to decrease in those who responded to behavior therapy. Although adults who responded to behavior therapy showed a significant trend of declining premonitory urge severity across treatment, results failed to demonstrate that behavior therapy specifically caused changes in premonitory urge severity. In addition, reductions in premonitory urge severity in those who responded to behavior therapy were significant greater than those who did not respond to behavior therapy but no different than those who responded or did not respond to PST. Children with PTDs failed to show any significant changes in premonitory urges. Reductions in premonitory urge severity did not mediate the relationship between treatment and outcome in either adults or children. These results cast doubt on the notion that habituation is the therapeutic process underlying the effectiveness of behavior therapy, which has immediate implications for the psychoeducation and therapeutic rationale presented in clinical practice. Moreover, there may be important developmental changes in premonitory urges in PTDs, and alternative models of therapeutic change warrant investigation.
Collapse
Affiliation(s)
- David C. Houghton
- Texas A&M University, Department of Psychology, 4235 TAMU, College Station, TX, 77843-4235, USA,
| | - Matthew R. Capriotti
- San Jose State University, Department of Psychology, One Washington Square, San José, CA, 95192-0120,University of California San Francisco, Department of Medicine, 533 Parnassus Ave, San Francisco, CA 94143
| | - Lawrence D. Scahill
- Emory University, Marcus Center, 1920 Briarcliff Road, Atlanta, GA, 30329, USA
| | - Sabine Wilhelm
- Massachusetts General Hospital/Harvard Medical School, Department of Psychiatry, 185 Cambridge Street, Suite 2000, Boston, MA 0214, USA
| | - Alan L. Peterson
- University of Texas Health Science Center at San Antonio, Department of Psychiatry, 7550 IH 10 West, Suite 1325, San Antonio, TX 78229, USA
| | - John T. Walkup
- Weill Cornell Medical College of Cornell University, Department of Psychiatry, 525 East 68th St. #140, New York, NY 10065, USA
| | - John Piacentini
- University of California Los Angeles, Semel Institute of Neuroscience and Human Behavior, 760 Westwood Plaza, Los Angeles, CA 90095, USA
| | - Douglas W. Woods
- Marquette University, Department of Psychology, P.O. Box 1881, Milwaukee, WI 53201-0327, USA
| |
Collapse
|
19
|
Treatment of Premenstrual Breakthrough of Depression With Adjunctive Oral Contraceptive Pills Compared With Placebo. J Clin Psychopharmacol 2017; 37:609-614. [PMID: 28816924 DOI: 10.1097/jcp.0000000000000761] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE/BACKGROUND Two-thirds of women with depressive disorders report reemergence of depression premenstrually, or premenstrual exacerbation (PME), despite effective treatment of the underlying mood disorder during the remainder of the cycle. There is a paucity of studies that rigorously assess treatments targeting PME. Open-label data suggest that augmentation of antidepressants with the oral contraceptive pill (OCP) drospirenone and ethinyl estradiol (DRSP/EE) improves depressive symptoms that break through treatment premenstrually. We now report results of a randomized placebo-controlled OCP augmentation trial. METHODS Women with unipolar depressive disorders in remission on stable antidepressant doses with a 30% increase in Montgomery-Åsberg Depression Rating Scale (MADRS) scores from the follicular to luteal phase were randomized to double-blind augmentation of antidepressant with either DRSP/EE or placebo for 2 months. The MADRS and Daily Record of Severity of Problems (DRSP) measures were anchored to the menstrual cycle phase. FINDINGS/RESULTS Of 32 women randomized, 25 (n = 12 DRSP/EE, n = 13 placebo) completed the trial. Premenstrual MADRS scores declined by a median of 43.6% and 38.9% (P = 0.59), and premenstrual DRSP scores declined by a median of 23.5% and 20.9% (P = 0.62) in the DRSP/EE and placebo groups, respectively. There was a trend toward greater improvement in premenstrual DRSP scores for women with fewer lifetime depressive episodes (r = -0.40, P = 0.06). IMPLICATIONS/CONCLUSIONS Findings from this small randomized trial suggest that OCP augmentation of antidepressants may not be effective for treating premenstrual breakthrough of depression. Future studies should target women established to have hormonal sensitivity prior to antidepressant therapy and those with fewer lifetime depressive episodes.
Collapse
|
20
|
Hom MA, Stanley IH, Vazquez A, Belz M, Joiner TE. Gains in Cognitive Behavioral Analysis System of Psychotherapy: Examining Treatment Progress and Processes of Change in a Psychiatric Outpatient Sample. Int J Cogn Ther 2017. [DOI: 10.1521/ijct.2017.10.3.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Melanie A. Hom
- Department of Psychology, Florida State University, Tallahassee, Florida
| | - Ian H. Stanley
- Department of Psychology, Florida State University, Tallahassee, Florida
| | - Ana Vazquez
- Department of Psychology, Florida State University, Tallahassee, Florida
| | - Martina Belz
- Department of Psychology, University of Bern, Switzerland
| | - Thomas E. Joiner
- Department of Psychology, Florida State University, Tallahassee, Florida
| |
Collapse
|
21
|
Dunlop BW, Gray J, Rapaport MH. Transdiagnostic Clinical Global Impression Scoring for Routine Clinical Settings. Behav Sci (Basel) 2017; 7:E40. [PMID: 28653978 PMCID: PMC5618048 DOI: 10.3390/bs7030040] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 06/05/2017] [Accepted: 06/21/2017] [Indexed: 11/17/2022] Open
Abstract
Although there is great interest in the improving the ability to track patients' change over time in routine clinical care settings, no standardized transdiagnostic measure is currently available for busy clinicians to apply. The Clinical Global Impression (CGI) scales are simple measures widely used as outcomes in psychiatric clinical trials. However, the CGI suffers from poorly defined scoring anchors. Efforts to improve the anchors by enhancing the anchor descriptions have proven useful but are limited by being disease-specific, thereby acting as a barrier to the routine clinical adoption of the CGI. To inform the development of more broadly applicable CGI scoring anchors, we surveyed 24 clinical trial investigators, asking them to rank-order seven elements that inform their CGI-Severity (CGI-S) scoring. Symptom severity emerged as the most important element in determining CGI-S scores; the functional status of the patient emerged as a second element. Less importance was given to self-report symptom scores, staff observations, or side effects. Relative rankings of the elements' importance did not differ by investigators' experience nor time usually spent with patients. We integrated these results with published illness-specific CGI anchors to develop the Transdiagnostic CGI (T-CGI), which employs standardized scoring anchors applicable across psychiatric illnesses. Pending validity and reliability evaluations, the T-CGI may prove well-suited for inclusion in routine clinical settings and for incorporation into electronic medical records as a simple and useful measure of treatment efficacy.
Collapse
Affiliation(s)
- Boadie W Dunlop
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Drive, 3rd Floor, Atlanta, GA 30329, USA.
| | - Jaclyn Gray
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Drive, 3rd Floor, Atlanta, GA 30329, USA.
| | - Mark H Rapaport
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Drive, 3rd Floor, Atlanta, GA 30329, USA.
| |
Collapse
|
22
|
Leucht S, Fennema H, Engel RR, Kaspers-Janssen M, Lepping P, Szegedi A. What does the MADRS mean? Equipercentile linking with the CGI using a company database of mirtazapine studies. J Affect Disord 2017; 210:287-293. [PMID: 28068617 DOI: 10.1016/j.jad.2016.12.041] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 11/07/2016] [Accepted: 12/22/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Little is known about the clinical relevance of the Montgomery Asberg Depression Rating Scale (MADRS) total scores. It is unclear how total scores translate into clinical severity, or how commonly used measures for response (reduction from baseline of ≥50% in the total score) translate into clinical relevance. Moreover, MADRS based definitions of remission vary. METHODS We therefore compared: a/ the MADRS total score with the Clinical Global Impression - Severity Score (CGI-S) b/ the percentage and absolute change in the MADRS total scores with Clinical Global Impression - Improvement (CGI-I); c/ the absolute and percentage change in the MADRS total scores with CGI-S absolute change. The method used was equipercentile linking of MADRS and CGI ratings from 22 drug trials in patients with Major Depressive Disorder (MDD) (n=3288). RESULTS Our results confirm the validity of the commonly used measures for response in MDD trials: a CGI-I score of 2 ('much improved') corresponded to a percentage MADRS reduction from baseline of 48-57%, and a CGI-I score of 1 ('very much improved') to a reduction of 80-84%. If a state of almost complete absence of symptoms were required for a definition of remission, a MADRS total score would be <8, because such scores corresponded to a CGI-S score of 2 ('borderline mentally ill'). LIMITATIONS Although our analysis is based on a large number of patients, the original trials were not specifically designed to examine our research question. CONCLUSIONS The results might contribute to a better understanding and improved interpretation of clinical trial results in MDD.
Collapse
Affiliation(s)
- Stefan Leucht
- Department of Psychiatry and Psychotherapy, Technische Universität München, Klinikum rechts der Isar, Ismaningerstr 22, 81675 München, Germany.
| | | | - Rolf R Engel
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians Universität München, Germany
| | | | - Peter Lepping
- Betsi Cadwaladr University Health Board, Centre for Mental Health and Society, Bangor University, UK; Mysore Medical College and Research Institute, India
| | | |
Collapse
|
23
|
Watanabe Y, Hongo S. Long-term efficacy and safety of lamotrigine for all types of bipolar disorder. Neuropsychiatr Dis Treat 2017; 13:843-854. [PMID: 28360522 PMCID: PMC5365320 DOI: 10.2147/ndt.s128653] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND We investigated whether the long-term efficacy and safety of lamotrigine (LTG) for bipolar disorder (BP) differs between disease types (BP-I, BP-II, or BP not otherwise specified [BP-NOS]), and the efficacy of the concomitant use of antidepressants (ADs). METHODS For >1 year, we observed 445 outpatients with BP (diagnosed by DSM-IV criteria) who initiated LTG treatment between July 1 and October 31, 2011, using the Himorogi Self-rating Depression (HSDS) and Anxiety Scales and the Clinical Global Impression-Improvement scale and also recorded adverse events. RESULTS Treatment efficacy was observed at week 4, with the improved HSDS scores sustained until week 52 for all types of BP; 50% of the patients with any type of BP could be treated with LTG for 1 year, whereas ~40% could be treated for >1.5 years. However, 25% of the patients were withdrawn within the first 4 weeks. The overall incidence of adverse events was 22.9% (104/455): 34.1% (14/41) for BP-I, 22.7% (15/66) for BP-II, and 22.2% (75/338) for BP-NOS. The most common adverse event was skin rash: 22.0% for BP-I, 16.7% for BP-II, and 12.1% for BP-NOS. LIMITATIONS There was no control group. Data were collected retrospectively. CONCLUSION With careful and adequate titration, long-term treatment with LTG is possible for any type of BP, with BP-NOS patients, the largest population in clinical practice, responding particularly well. Symptoms can improve with or without ADs. Large-scale prospective studies of the efficacy of ADs in bipolar treatment are warranted.
Collapse
Affiliation(s)
- Yoshinori Watanabe
- Himorogi Psychiatric Institute, Tokyo; Nanko Clinic of Psychiatry, Shirakawa city, Fukushima, Japan
| | - Seiji Hongo
- Nanko Clinic of Psychiatry, Shirakawa city, Fukushima, Japan
| |
Collapse
|
24
|
Affiliation(s)
- Ömer Aydemir
- Celal Bayar Üniversitesi Tıp Fakültesi Psikiyatri Anabilim Dalı, Manisa-Türkiye
| |
Collapse
|
25
|
Müller M, Vandeleur C, Weniger G, Prinz S, Vetter S, Egger ST. The performance of the Health of the Nation Outcome Scales as measures of clinical severity. Psychiatry Res 2016; 239:20-7. [PMID: 27137958 DOI: 10.1016/j.psychres.2016.02.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 02/12/2016] [Accepted: 02/27/2016] [Indexed: 11/26/2022]
Abstract
The aim of this study was to examine the performance of the Health of the Nation Outcome Scales (HoNOS) against other measures of functioning and mental health in a full three-year cohort of admissions to a psychiatric hospital. A sample of N=1719 patients (35.3% females, aged 17-78 years) was assessed using observer-rated measures and self-reports of psychopathology at admission. Self-reports were available from 51.7% of the sample (34.4% females, aged 17-76 years). Functioning and psychopathology were compared across five ICD-10 diagnostic groups: substance use disorders, schizophrenia and psychotic disorders, affective disorders, anxiety/somatoform disorders and personality disorders. Associations between the measures were examined, stratifying by diagnostic subgroup. The HoNOS were strongly linked to other measures primarily in psychotic disorders (except for the behavioral subscale), while those with substance use disorders showed rather poor links. Those with anxiety/somatoform disorders showed null or only small associations. This study raises questions about the overall validity of the HoNOS. It seems to entail different levels of validity when applied to different diagnostic groups. In clinical practice the HoNOS should not be used as a stand-alone instrument to assess outcome but rather as part of a more comprehensive battery including diagnosis-specific measures.
Collapse
Affiliation(s)
- Mario Müller
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland.
| | | | - Godehard Weniger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland
| | - Susanne Prinz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland
| | - Stefan Vetter
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland
| | - Stephan T Egger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland
| |
Collapse
|
26
|
Bobo WV, Angleró GC, Jenkins G, Hall-Flavin DK, Weinshilboum R, Biernacka JM. Validation of the 17-item Hamilton Depression Rating Scale definition of response for adults with major depressive disorder using equipercentile linking to Clinical Global Impression scale ratings: analysis of Pharmacogenomic Research Network Antidepressant Medication Pharmacogenomic Study (PGRN-AMPS) data. Hum Psychopharmacol 2016; 31:185-92. [PMID: 26999588 PMCID: PMC5008690 DOI: 10.1002/hup.2526] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 01/15/2016] [Accepted: 01/31/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The study aimed to define thresholds of clinically significant change in 17-item Hamilton Depression Rating Scale (HDRS-17) scores using the Clinical Global Impression-Improvement (CGI-I) Scale as a gold standard. METHODS We conducted a secondary analysis of individual patient data from the Pharmacogenomic Research Network Antidepressant Medication Pharmacogenomic Study, an 8-week, single-arm clinical trial of citalopram or escitalopram treatment of adults with major depression. We used equipercentile linking to identify levels of absolute and percent change in HDRS-17 scores that equated with scores on the CGI-I at 4 and 8 weeks. Additional analyses equated changes in the HDRS-7 and Bech-6 scale scores with CGI-I scores. RESULTS A CGI-I score of 2 (much improved) corresponded to an absolute decrease (improvement) in HDRS-17 total score of 11 points and a percent decrease of 50-57%, from baseline values. Similar results were observed for percent change in HDRS-7 and Bech-6 scores. Larger absolute (but not percent) decreases in HDRS-17 scores equated with CGI-I scores of 2 in persons with higher baseline depression severity. CONCLUSIONS Our results support the consensus definition of response based on HDRS-17 scores (>50% decrease from baseline). A similar definition of response may apply to the HDRS-7 and Bech-6. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- William V. Bobo
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA,Correspondence to: William V. Bobo, MD, MPH, 200 First Street SW, Generose 2A, Rochester, MN 55905, USA, , Telephone: 507-255-9412
| | - Gabriela C. Angleró
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA,School of Medicine, University of Puerto Rico, San Juan, Puerto Rico
| | - Gregory Jenkins
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - Richard Weinshilboum
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | - Joanna M. Biernacka
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA,Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
27
|
Houghton DC, Capriotti MR, De Nadai AS, Compton SN, Twohig MP, Neal-Barnett AM, Saunders SM, Franklin ME, Woods DW. Defining treatment response in trichotillomania: a signal detection analysis. J Anxiety Disord 2015; 36:44-51. [PMID: 26422605 PMCID: PMC4658278 DOI: 10.1016/j.janxdis.2015.09.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 09/07/2015] [Accepted: 09/14/2015] [Indexed: 12/25/2022]
Abstract
The Massachusetts General Hospital Hairpulling Scale (MGH-HPS) and the NIMH Trichotillomania Severity Scale (NIMH-TSS) are two widely used measures of trichotillomania severity. Despite their popular use, currently no empirically-supported guidelines exist to determine the degrees of change on these scales that best indicate treatment response. Determination of such criteria could aid in clinical decision-making by defining clinically significant treatment response/recovery and producing accurate power analyses for use in clinical trials research. Adults with trichotillomania (N=69) participated in a randomized controlled trial of psychotherapy and were assessed before and after treatment. Response status was measured via the Clinical Global Impressions-Improvement Scale, and remission status was measured via the Clinical Global Impressions-Severity Scale. For treatment response, a 45% reduction or 7-point raw score change on the MGH-HPS was the best indicator of clinically significant treatment response, and on the NIMH-TSS, a 30-40% reduction or 6-point raw score difference was most effective cutoff. For disorder remission, a 55-60% reduction or 7-point raw score change on the MGH-HPS was the best predictor, and on the NIMH-TSS, a 65% reduction or 6-point raw score change was the best indicator of disorder remission. Implications of these findings are discussed.
Collapse
Affiliation(s)
- David C. Houghton
- Texas A&M University – Department of Psychology, 4235 TAMU, College Station, TX, 77843, USA, D.C.H.
| | - Matthew R. Capriotti
- University of California San Francisco – Department of Psychiatry, 401 Parnassus Ave., Box 0984, San Francisco, CA, 94143, USA,
| | - Alessandro S. De Nadai
- University of South Florida – Department of Psychology, 4202 East Fowler Ave., PCD4118G, Tampa, FL, 33620, USA,
| | - Scott N. Compton
- Duke University School of Medicine – Department of Psychiatry and Behavioral Sciences, 2213 Elba St., Durham, NC, 27705, USA,
| | - Michael P. Twohig
- Utah State University – Department of Psychology, 2810 Old Main Hill, Logan, UT, 84322, USA,
| | - Angela M. Neal-Barnett
- Kent State University – Department of Psychological Sciences, 600 Hilltop Drive, Kent, OH, 44242, USA,
| | - Stephen M. Saunders
- Marquette University – Department of Psychology, 317 Cramer Hall, Milwaukee, WI, 53233, USA,
| | - Martin E. Franklin
- University of Pennsylvania School of Medicine – Department of Psychiatry, 3535 Market St., Philadelphia, PA, 19104, USA,
| | - Douglas W. Woods
- Texas A&M University – Department of Psychology, 4235 TAMU, College Station, TX, 77843, USA, D.C.H. ,D.W.W. , D.W.W. phone: 1-(979)845-2540, D.W.W. fax: 1-(979)-845-4727
| |
Collapse
|
28
|
Helmreich I, Wagner S, König J, Kohnen R, Szegedi A, Hiemke C, Tadić A. Hamilton depression rating subscales to predict antidepressant treatment outcome in the early course of treatment. J Affect Disord 2015; 175:199-208. [PMID: 25638793 DOI: 10.1016/j.jad.2014.12.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 12/02/2014] [Accepted: 12/16/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hamilton depression rating scale (HAMD) subscales provide an economic alternative for the full scale; however, their ability to detect onset of improvement in the early course of treatment (EI) has not yet been researched. The present study investigated in patients with major depression (MD) whether the subscales are a comparable option to predict treatment remission in the early course of treatment. METHODS Based on data from 210 MD patients of a 6-week randomised, placebo-controlled trial comparing mirtazapine (MIR) and paroxetine (PAR), the discriminative and predictive validity of EI for (stable) remission at treatment end was evaluated for seven subscales and the HAMD17 in the total and in treatment subgroups (MIR vs. PAR). Receiver operating characteristics (ROC) curves (at week 2) and the Clinical Global Impression scales (CGI) (at study endpoint) were used to validate the 20% EI criterion for the subscales. RESULTS Only the Evans6 and Toronto7 subscale had almost the same predictive value as the HAMD17 (e.g., sensitivities stable remission Evans6/Toronto7: 96/95% vs. 96% HAMD17). The optimal cut-off for EI to predict remission was just below 20% for most subscales and slightly over 20% for stable remission. LIMITATIONS Study sample representativeness, non-independence of subscales, missing external validation criterion, lack of control group. CONCLUSIONS The Evans6 and Toronto7 subscales are valuable alternatives in situations, where economic aspects play a larger role. A sum score reduction of ≥20% as definition for EI seems also appropriate for the HAMD subscales, in the total as well as in the antidepressant subgroups.
Collapse
Affiliation(s)
- Isabella Helmreich
- Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Mainz, Germany.
| | - Stefanie Wagner
- Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Mainz, Germany
| | - Jochem König
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Mainz, Germany
| | - Ralf Kohnen
- Psychology Department, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Armin Szegedi
- Employee of Merck, Rahway, NJ, USA (at the time of manuscript preparation)
| | - Christoph Hiemke
- Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Mainz, Germany
| | - André Tadić
- Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Mainz, Germany
| |
Collapse
|
29
|
Egger ST, Weniger G, Prinz S, Vetter S, Müller M. Health of the Nation Outcome Scales in a psychiatric inpatient setting: assessing clinical change. J Eval Clin Pract 2015; 21:236-41. [PMID: 25644710 DOI: 10.1111/jep.12296] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2014] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES The aim of this study was to examine the validity of the Health of the Nation Outcome Scales (HoNOS) in terms of change in relation to sex, clinical characteristics and level of clinical change as assessed using other measures. METHODS The sample consisted of N = 690 admissions from one Swiss psychiatric hospital who were assessed at admission and discharge using the HoNOS and the clinical global impression (CGI) scale. Repeated measures analyses of variance were conducted to compare changes in HoNOS scores over time stratified by sex, diagnostic category and CGI level of change, controlled for age and previous hospitalizations. Two-way interactions between time and these factors were calculated and post hoc t-tests were conducted to compare changes in HoNOS scores between admission and discharge at factor levels. RESULTS HoNOS scores significantly decreased from admission to discharge in bivariate analyses although no main effect of time was found in multivariate models. Sex was found to moderate change in HoNOS behavioural subscale scores; primary diagnosis at admission moderated change in HoNOS total scores, the behavioural subscale and the social subscale; and CGI level of change moderated the change in all HoNOS scales. CONCLUSIONS Our findings confirmed the sensitivity to change of the HoNOS in psychiatric settings from admission to discharge. Furthermore, we found that this change reflected similar changes in the CGI, a well-established measure for the evaluation of clinical outcomes, which, in turn supports the validity of the HoNOS.
Collapse
Affiliation(s)
- Stephan T Egger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland
| | | | | | | | | |
Collapse
|
30
|
Driessen E, Van Henricus L, Peen J, Don FJ, Kool S, Westra D, Hendriksen M, Cuijpers P, Twisk JWR, Dekker JJM. Therapist-rated outcomes in a randomized clinical trial comparing cognitive behavioral therapy and psychodynamic therapy for major depression. J Affect Disord 2015; 170:112-8. [PMID: 25240140 DOI: 10.1016/j.jad.2014.08.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 08/13/2014] [Accepted: 08/15/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The efficacy of psychodynamic therapy (PDT) for depression is debated due to a paucity of high-quality studies. We compared short psychodynamic supportive psychotherapy (SPSP) to cognitive behavioral therapy (CBT) in a randomized clinical trial. We used therapist-rated outcomes to examine how the course of change during treatment could be best represented and to compare treatment efficacy, hypothesizing non-significant differences. METHODS Three hundred and forty-one adults meeting DSM-IV criteria for a depressive episode and with Hamilton Depression Rating Scale (HAM-D) scores ≥14 were randomized to 16 sessions of individual manualized CBT or SPSP. Severely depressed patients (HAM-D>24) received additional antidepressant medication. After each session, therapists rated the Clinical Global Impression Scale subscales 'Severity of Illness' (CGI-S) and 'Global Improvement' (CGI-I), and the DSM-IV Axis V Global Assessment of Functioning Scale (GAF). We fitted growth curves using mixed model analyses with intention-to-treat samples. RESULTS CGI-S and GAF scores during treatment were best represented by a linear symptom decrease. CGI-I scores were best represented by an S-shaped curve with relative more improvement in the first and last phases than in the middle phase of treatment. No significant post-treatment treatment differences were found. A non-significant trend for a treatment effect on CGI-S scores vanished when controlling for therapist gender and profession. LIMITATIONS Therapists were not specifically trained for CGI and GAF assessments. CONCLUSIONS These findings add to the evidence-base of PDT for depression. Therapist characteristics and differences between severity and improvement measures might influence ratings and need to be taken into account when using therapist-rated outcome measures.
Collapse
Affiliation(s)
- Ellen Driessen
- VU University Amsterdam, Department of Clinical Psychology, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University and VU University Medical Center Amsterdam, The Netherlands.
| | | | - Jaap Peen
- Arkin Mental Health Care, Amsterdam, The Netherlands
| | - Frank J Don
- Arkin Mental Health Care, Amsterdam, The Netherlands; ProPersona Mental Health, Nijmegen, The Netherlands
| | - Simone Kool
- Arkin Mental Health Care, Amsterdam, The Netherlands
| | | | | | - Pim Cuijpers
- VU University Amsterdam, Department of Clinical Psychology, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University and VU University Medical Center Amsterdam, The Netherlands
| | - Jos W R Twisk
- VU University Amsterdam, Department of Health Sciences, Amsterdam, The Netherlands; VU University Medical Center Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam, The Netherlands
| | - Jack J M Dekker
- VU University Amsterdam, Department of Clinical Psychology, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University and VU University Medical Center Amsterdam, The Netherlands; Arkin Mental Health Care, Amsterdam, The Netherlands
| |
Collapse
|
31
|
Yang J, Kang C, Zeng Y, Li J, Li P, Wan W, Zhao X, Guo W, Xu X, Yang X, Li Q, Liu X, Pauline SC. Prevalence and prognosis of schizophrenia in Jinuo people in China: a prospective 30-year follow-up study. Int J Soc Psychiatry 2014; 60:482-8. [PMID: 23941834 DOI: 10.1177/0020764013498987] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There are few studies investigating the influence of the development on mental health of minorities in China. AIMS To follow up the prevalence, natural course and prognosis of schizophrenia in Jinuo people, the last group to be recognized as a 'national minority' in China, every 10 years since 1979. METHODS From 1979 to 2009, 15%-19% of Jinuo residents were evaluated by random cluster sampling and followed up every 10 years using the Chinese version of the Composite International Diagnostic Interview (CIDI) as the screening tool and the International Classification of Diseases (ICD) as diagnostic criteria tool. RESULTS There were no significant differences for the lifetime prevalence and current prevalence of schizophrenia across the three decades. Neither were there any significant differences for the prognosis of schizophrenia; however, at least half the patients had deteriorated or had residual symptoms in the follow-up. PANSS symptoms were significantly different according to different illness duration. CONCLUSIONS During the three decades, there was no increasing trend for schizophrenia prevalence in Jinuo society; however, the prognosis of schizophrenia was not optimistic. In the natural, untreated status, schizophrenia patients with an illness duration of more than 20 years had more serious symptoms.
Collapse
Affiliation(s)
- JianZhong Yang
- Department of Clinical Psychology, The Second People's Hospital of Yunnan Province, Kunming Yunnan, China Department of Psychiatry, The First Affiliate Hospital of Kunming Medical University, Kunming Yunnan, China Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - ChuanYuan Kang
- Department of Psychiatry, The First Affiliate Hospital of Kunming Medical University, Kunming Yunnan, China
| | - Yong Zeng
- Department of Psychiatry, The First Affiliate Hospital of Kunming Medical University, Kunming Yunnan, China
| | - JianHua Li
- Yunnan Institute of Drug Abuse, Kunming Yunnan, China
| | - PeiKai Li
- Department of Clinical Psychology, The Second People's Hospital of Yunnan Province, Kunming Yunnan, China
| | - WenPeng Wan
- Yunnan Institute of Drug Abuse, Kunming Yunnan, China
| | - XuDong Zhao
- Department of Psychiatry, The First Affiliate Hospital of Kunming Medical University, Kunming Yunnan, China
| | - WanJun Guo
- Department of Psychiatry, The First Affiliate Hospital of Kunming Medical University, Kunming Yunnan, China
| | - XiuFeng Xu
- Department of Psychiatry, The First Affiliate Hospital of Kunming Medical University, Kunming Yunnan, China
| | - XiaoBin Yang
- Department of Clinical Psychology, The Second People's Hospital of Yunnan Province, Kunming Yunnan, China
| | - QiuYuan Li
- Department of Psychiatry, The First Affiliate Hospital of Kunming Medical University, Kunming Yunnan, China
| | - XiaoYan Liu
- Department of Clinical Psychology, The Second People's Hospital of Yunnan Province, Kunming Yunnan, China
| | - Sung-Chan Pauline
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| |
Collapse
|
32
|
Kim Y, Kim B, Chang JS, Kim BN, Cho SC, Hwang JW. Parental quality of life and depressive mood following methylphenidate treatment of children with attention-deficit hyperactivity disorder. Psychiatry Clin Neurosci 2014; 68:506-14. [PMID: 24417707 DOI: 10.1111/pcn.12155] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Revised: 12/05/2013] [Accepted: 12/20/2013] [Indexed: 11/29/2022]
Abstract
AIM This naturalistic study investigated the associations between quality of life and depressive mood in parents and symptom changes in attention-deficit hyperactivity disorder (ADHD) children. METHODS At baseline and at weeks 4 and 8, the parents evaluated their children, who were receiving treatment with osmotic-release oral system methylphenidate (mean dosage 36.3 ± 15.5 mg/day), using the Swanson, Nolan, and Pelham - Fourth Edition (SNAP-IV-18) scale. The parents evaluated themselves using the Beck Depression Inventory (BDI) and the World Health Organization Quality of Life Assessment, Brief Version (WHOQOL-BREF). RESULTS A significant reduction in SNAP-IV-18 scores and improvements in parental BDI scores and parental WHOQOL-BREF scores were observed. The decrease in BDI scores from baseline to 8 weeks was significantly associated with increases in WHOQOL-BREF sub-domain scores from baseline to 8 weeks, with a greater decrease at 4 weeks and after. The decrease in the SNAP-IV-18 hyperactivity-impulsivity score was significantly associated with increases in WHOQOL social sub-domain scores from baseline to 8 weeks. For those patients who showed a 25% or greater decrease in the SNAP-IV-18 total scores from baseline to 8 weeks, the decreases in the SNAP-IV-18 total score and in the inattention and hyperactivity-impulsivity scores were significantly associated with a decrease in BDI scores from baseline to 8 weeks. CONCLUSION Methylphenidate treatment for ADHD was associated with both symptom alleviation in children with ADHD and improvement in parental depressive mood and quality of life, suggesting that the effects of treatment could go beyond symptom improvement in ADHD.
Collapse
Affiliation(s)
- Yeni Kim
- Department of Child Psychiatry, Center for Child and Adolescent Psychiatry, Seoul National Hospital, Seoul, Korea
| | | | | | | | | | | |
Collapse
|
33
|
Abstract
Data on the efficacy and safety of psychiatric medicines should form the foundation of evidence-based treatment practices. The US Food and Drug Administration (FDA) reviews such data in determining whether to approve new treatments, and the published literature serves as a repository for evidence on treatment benefits and harms. We describe the FDA review of clinical trials, examining the underlying logic and legal guidelines. Several FDA reviews provide evidence that the agency requires only minimal efficacy for psychiatric drugs. Further, in some instances, the FDA has relied on secondary rather than primary outcomes and has discounted the findings of negative studies in its review of antidepressant and antipsychotic medications. The published literature provides another lens into the safety and efficacy of treatments. We describe how treatment efficacy is systematically overstated and treatment-related harms are understated in the scientific literature. Suggestions are provided to improve public access to underlying safety and efficacy data and for the FDA to potentially improve its review process.
Collapse
Affiliation(s)
- Glen I Spielmans
- Department of Psychology, Metropolitan State University, Saint Paul, Minnesota 55108
| | | |
Collapse
|
34
|
Using the unbiased perspectives of people living with a spinal cord injury in assessments of mobility. Spinal Cord 2013; 51:843-6. [PMID: 24042995 DOI: 10.1038/sc.2013.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 07/29/2013] [Accepted: 08/01/2013] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Clinometrics study. OBJECTIVE To devise a way of capturing the unbiased perspectives of people living with a spinal cord injury (SCI) in assessments of mobility. SETTING SCI unit and community. METHODS Three groups of raters used the Global Impression of Change Scale (GICS) to rate change in mobility of a cohort of patients with a recent SCI. The three groups of raters were as follows: 10 people with a recent SCI, 10 people with an established SCI and 10 physiotherapists. The ratings were done after viewing 51 pairs of videos depicting one of three motor tasks: sitting unsupported, transferring and walking. Each pair of videos showed the same person performing the same motor task on two occasions. The videos were taken between 1 h and 5 months apart and presented side by side, randomly left or right, on the screen. Raters were asked to score the amount of change in performance between the two videos on a 7-point Global Impression of Change Scale (GICS). Intra-rater reliability for the three motor tasks and three groups of raters was determined using intra-class correlation coefficients. RESULTS People with an SCI were reliable at rating change in patients' abilities to transfer and walk with ICC's ranging from 0.66 to 0.81 (95% Confidence interval bounds ranging from 0.51 to 0.94). Physiotherapists were consistently but only marginally more reliable at rating than people with an SCI. CONCLUSIONS Videos and the GICS may provide a way of using the unbiased perspectives of people living with spinal cord injury in assessments of mobility.
Collapse
|
35
|
Leucht S, Fennema H, Engel R, Kaspers-Janssen M, Lepping P, Szegedi A. What does the HAMD mean? J Affect Disord 2013; 148:243-8. [PMID: 23357658 DOI: 10.1016/j.jad.2012.12.001] [Citation(s) in RCA: 137] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 11/30/2012] [Accepted: 12/01/2012] [Indexed: 11/25/2022]
Abstract
Little is known about the clinical relevance of the Hamilton Rating Scale for Depression (HAMD-17) total scores. It is unclear how total scores translate into clinical severity, or what commonly used measures for response (reduction from baseline of ≥ 50% in the total score) and remission (total HAMD-17 score ≤ 7) mean from a clinical perspective. We therefore compared: (a) the percentage and absolute change in the HAMD-17 total scores with Clinical Global Impression-Improvement (CGI-I); (b) the absolute and percentage change in the HAMD-17 total scores with Clinical Global Impression-Severity (CGI-S) absolute change; and (c) the percentage and absolute change in the HAMD-17 total scores with CGI-I in the subgroups of patients with ≤ median and > median HAMD-17 total scores at baseline. The method used was equipercentile linking of HAMD-17 and CGI ratings from 43 drug trials in patients with Major Depressive Disorder (MDD) (n = 7131). Our results confirm the validity of the commonly used measures for remission and response in MDD trials: a CGI-I score of 2 ('much improved') corresponded to a reduction from baseline of > 50% and < 60%, and a CGI-I score of 1 ('very much improved') to a reduction of > 75% and < 85%. The CGI-S score of 1 ('normal., not at all ill') corresponded to the HAMD-17 total score of < 5 and the CGI-S score of 2 ('borderline mentally ill') to the score between 6 and 8. An effect of baseline illness severity was observed.
Collapse
Affiliation(s)
- Stefan Leucht
- Klinik für Psychiatrie und Psychotherapie der TU-München Klinikum rechts der Isar Ismaningerstr. 22, 81675 München, Germany.
| | | | | | | | | | | |
Collapse
|
36
|
Min JA, Lee NB, Lee CU, Lee C, Chae JH. Low trait anxiety, high resilience, and their interaction as possible predictors for treatment response in patients with depression. J Affect Disord 2012; 137:61-9. [PMID: 22244377 DOI: 10.1016/j.jad.2011.12.026] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 12/12/2011] [Accepted: 12/12/2011] [Indexed: 12/25/2022]
Abstract
BACKGROUND Although many demographic and clinical characteristics have been suggested to predict treatment outcome of depression, they provide only a weak prediction for clinical response. Based on the predictive values of trauma and biological markers involved in stress response, we investigated the roles of baseline trait anxiety and resilience, which were assumed as vulnerability and resilience factors, respectively, in predicting treatment response in naturalistically treated outpatients with depressive disorders. METHODS A total of 178 outpatients with depressive disorders were consecutively recruited and completed measures of trauma experiences, psychological symptoms, and resilience at baseline. Response was defined by Clinical Global Impression (CGI)-Improvement score ≤2 at last visit during a 6month-treatment period. Univariate analyses and multiple logistic regression analysis were performed to determine predictors of treatment response. RESULTS Among demographic and clinical variables, treatment response was associated with increased age, longer treatment duration, higher resilience, and lower trait anxiety. In logistic regression analysis, resilience, trait anxiety, and their interaction significantly predicted treatment response after adjusting for age and treatment duration. Interaction between resilience and trait anxiety remained significant in the final model. Examining the interaction between the two, patients with low trait anxiety were only significantly affected by the level of resilience in response rate. CONCLUSIONS Low trait anxiety, high resilience, and their interaction might contribute to better treatment response in depressed patients. Our result suggested that individual differences in responding to stress might be important in predicting treatment outcome of depression in addition to other demographic and clinical factors.
Collapse
Affiliation(s)
- Jung-Ah Min
- Department of Psychiatry, Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea
| | | | | | | | | |
Collapse
|
37
|
Reward-related brain function as a predictor of treatment response in adolescents with major depressive disorder. COGNITIVE AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2010; 10:107-18. [PMID: 20233959 DOI: 10.3758/cabn.10.1.107] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The present study provides preliminary evidence that pretreatment reward-related brain function in the striatum and medial prefrontal cortex (PFC) could have relevance for predicting both final level and rate of change of clinical characteristics in adolescents with major depressive disorder. Adolescents with depression underwent a functional MRI scan during a monetary reward task, participated in an 8-week open trial of cognitive behavioral therapy (CBT) or CBT plus selective serotonin reuptake inhibitor, and completed reports of anxiety and depressive symptoms before, during, and after treatment. Clinicians rated adolescents' improvement and severity at the same time points. Growth models were used to examine change in clinical characteristics and its association with brain function. Severity, anxiety symptoms, and depressive symptoms decreased over treatment. Final levels of severity and anxiety symptoms were associated with pretreatment striatal reactivity, and rate of anxiety symptom reduction was associated with greater striatal reactivity and lower medial PFC reactivity.
Collapse
|
38
|
Furukawa TA. Assessment of mood: guides for clinicians. J Psychosom Res 2010; 68:581-9. [PMID: 20488276 DOI: 10.1016/j.jpsychores.2009.05.003] [Citation(s) in RCA: 119] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Revised: 04/12/2009] [Accepted: 05/07/2009] [Indexed: 01/30/2023]
Abstract
OBJECTIVE This article is one of the series of review articles aiming to present a convenient guideline for practicing clinicians in their selection of scales for clinical and research purposes. This article focuses on assessment scales for mood (depression, mania). METHODS After reviewing the basic principles of clinical psychometrics, we present a selective review of representative scales measuring depressed or manic mood. RESULTS We reviewed and reported on reliability, validity, interpretability, and feasibility of the following rating scales: Patient Health Questionnaire-9 (PHQ-9), K6, Beck Depression Inventory II (BDI-II), and Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR) as self-report scales for depressed mood; Hamilton Rating Scale for Depression (HAM-D) and Montgomery-Asberg Depression Rating Scale (MADRS) as clinician-administered measure for depression; and Young Mania Rating Scale (YMRS) as a clinician-administered instrument for mania. CONCLUSION Although the rating scales for mood represent a well-trodden terrain, this brief review of the most frequently used scales in the literature revealed there is still some room for improvement and for further research, especially with regard to their clinical interpretability.
Collapse
Affiliation(s)
- Toshi A Furukawa
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
| |
Collapse
|
39
|
McKnight PE, Kashdan TB. The importance of functional impairment to mental health outcomes: a case for reassessing our goals in depression treatment research. Clin Psychol Rev 2009; 29:243-59. [PMID: 19269076 PMCID: PMC2814224 DOI: 10.1016/j.cpr.2009.01.005] [Citation(s) in RCA: 243] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Revised: 12/12/2008] [Accepted: 01/21/2009] [Indexed: 11/22/2022]
Abstract
Outcomes in depression treatment research include both changes in symptom severity and functional impairment. Symptom measures tend to be the standard outcome but we argue that there are benefits to considering functional outcomes. An exhaustive literature review shows that the relationship between symptoms and functioning remains unexpectedly weak and often bidirectional. Changes in functioning often lag symptom changes. As a result, functional outcomes might offer depression researchers more critical feedback and better guidance when studying depression treatment outcomes. The paper presents a case for the necessity of both functional and symptom outcomes in depression treatment research by addressing three aims-1) review the research relating symptoms and functioning, 2) provide a rationale for measuring both outcomes, and 3) discuss potential artifacts in measuring functional outcomes. The three aims are supported by an empirical review of the treatment outcome and epidemiological literatures.
Collapse
Affiliation(s)
- Patrick E McKnight
- Department of Psychology, George Mason University, MSN 3F5, 4400 University Drive, Fairfax, VA 22030-4400, United States.
| | | |
Collapse
|
40
|
Confounding influence of extraneous symptoms on clinical global impression ratings for depression. J Clin Psychopharmacol 2008; 28:587-9. [PMID: 18794667 DOI: 10.1097/jcp.0b013e318184259e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
41
|
Targum SD, Busner J, Young AH. Targeted scoring criteria reduce variance in global impressions. Hum Psychopharmacol 2008; 23:629-33. [PMID: 18666094 DOI: 10.1002/hup.966] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study examined the confounding effect of treatment emergent physical or psychic symptoms on clinical global impression (CGI) ratings in CNS trials and examined the benefit of targeted scoring criteria on clarifying ratings and reducing scoring variance. METHODS Twenty-four raters participating in an investigator meeting training session scored a series of scripted CGI scenarios that included treatment emergent symptoms. RESULTS The addition of treatment emergent gastrointestinal (GI) symptoms or anxiety symptoms significantly changed the rating of clinical global improvement and caused a broad CGI-improvement (CGI-I) scoring variance reflecting scoring ambiguity amongst these raters. Re-rating after a presentation of well-defined criteria that addressed these scoring issues narrowed the variance and significantly improved inter-rater reliability. CONCLUSIONS It is clear that CNS trials must define scoring criteria for global ratings prior to the initiation of a study to assure ratings consistency. The actual definition of global must be study-specific and may depend upon the targeted symptoms of interest and mechanism of drug action. The targeted criteria that define global must be included in all published reports about the trial.
Collapse
|
42
|
Dekker JJM, Koelen JA, Van HL, Schoevers RA, Peen J, Hendriksen M, Kool S, Van Aalst G, De Jonghe F. Speed of action: the relative efficacy of short psychodynamic supportive psychotherapy and pharmacotherapy in the first 8 weeks of a treatment algorithm for depression. J Affect Disord 2008; 109:183-8. [PMID: 18061276 DOI: 10.1016/j.jad.2007.10.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Revised: 10/18/2007] [Accepted: 10/19/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine the efficacy and speed of action of short-term psychodynamic supportive psychotherapy (SPSP) in comparison to pharmacotherapy (PhT) in the acute treatment of depression. METHOD This study reported on the first 8 weeks of a treatment algorithm for depression. 70 patients with a depressive episode according to DSM-IV were randomized to PhT, 71 patients were randomized to SPSP. The acceptability of the psychotherapy was greater than pharmacotherapy. RESULTS At the end of the first 8 weeks of treatment, attrition rates were similar in both conditions. PhT-patients were better off at 4 weeks according to two of the four measures The superiority of PhT was clearer on the self-report than on the independent measure. CONCLUSIONS There are signs that the benefits of PhT over SPSP--where detected--are short-lived and cover mostly the first month of treatment. The progression of these patients through the rest of their treatments, and afterwards, will be reported in further contributions.
Collapse
Affiliation(s)
- J J M Dekker
- Clinical Psychology, Vrije Universiteit, Amsterdam, The Netherlands.
| | | | | | | | | | | | | | | | | |
Collapse
|
43
|
An open-label pilot study to evaluate the efficacy of sildenafil citrate in middle-aged men with late-onset dysthymia. J Nerv Ment Dis 2008; 196:496-500. [PMID: 18552628 DOI: 10.1097/nmd.0b013e3181773913] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Late onset dysthymic disorder (DD) in middle-aged and elderly men responds poorly to established antidepressants. Previous studies noted an improvement in mood accompanying sildenafil citrate treatment for erectile dysfunction. We sought to evaluate whether sildenafil's mood effects were independent of the effect on erectile function. A 6-week open label study was conducted with 20 male participants, aged 41-60 who were diagnosed with DD and who had normal erectile function. Participants were treated with sildenafil citrate 25 mg per day for 6 weeks. The primary outcome measure was the 21-item Hamilton Depression Rating Scale. Depressive and sexual symptoms were also evaluated using self-report questionnaires. Treatment with sildenafil resulted in a significant reduction in Hamilton Depression Rating Scale mean scores: from 14.61 +/- 3.5 at baseline to 6.39 +/- 5.13 at end of study (F(3,51) = 32.52, p </= 0.001). No changes in sexual functioning were detected. Significant improvement was also noted on the self-report measures of depressive symptoms. Sildenafil citrate might have an antidepressant effect on late onset DD, that is not attributable to improvement in erectile function. Possible explanations for this effect are offered. Larger placebo controlled studies are warranted.
Collapse
|
44
|
Usala T, Clavenna A, Zuddas A, Bonati M. Randomised controlled trials of selective serotonin reuptake inhibitors in treating depression in children and adolescents: a systematic review and meta-analysis. Eur Neuropsychopharmacol 2008; 18:62-73. [PMID: 17662579 DOI: 10.1016/j.euroneuro.2007.06.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Revised: 05/30/2007] [Accepted: 06/07/2007] [Indexed: 10/23/2022]
Abstract
To evaluate the efficacy of selective serotonin reuptake inhibitors (SSRIs) in children and adolescents with depressive disorder, the main electronic databases and the reference lists of retrieved articles and reviews were searched up to January 2007. Randomized controlled studies (RCT) were assessed for methodological quality, taking into consideration the specific diagnostic and severity evaluation tools used, and a meta-analysis on the efficacy of SSRIs compared placebo was undertaken. In all, 13 studies were included, covering a total of 2530 children and adolescents. Eleven studies met the criteria for inclusion in the meta-analysis. The pooled odds ratio was 1.57 (95% C.I. 1.29-1.91). Only fluoxetine appeared to offer a moderately significant benefit profile (OR=2.39). All studies differed in diagnostic tools and primary efficacy measures. SSRI treatment, especially with fluoxetine, may be effective on child and adolescent depression. Nevertheless, additional RCTs with sound methodological designs, validated diagnostic instruments, large sample sizes, and consistent outcomes are necessary to determine the role of SSRIs, alone or in combination with psychological interventions in the treatment of depression in children and adolescents.
Collapse
Affiliation(s)
- Tatiana Usala
- Child NeuroPsychiatry, Department of Neurosciences, University of Cagliari Via Ospedale 119, 09124 Cagliari, Italy
| | | | | | | |
Collapse
|
45
|
Furukawa TA, Akechi T, Azuma H, Okuyama T, Higuchi T. Evidence-based guidelines for interpretation of the Hamilton Rating Scale for Depression. J Clin Psychopharmacol 2007; 27:531-4. [PMID: 17873700 DOI: 10.1097/jcp.0b013e31814f30b1] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
46
|
Spielmans GI, Pasek LF, McFall JP. What are the active ingredients in cognitive and behavioral psychotherapy for anxious and depressed children? A meta-analytic review. Clin Psychol Rev 2007; 27:642-54. [PMID: 17368886 DOI: 10.1016/j.cpr.2006.06.001] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2005] [Revised: 05/01/2006] [Accepted: 06/07/2006] [Indexed: 11/17/2022]
Abstract
Prior meta-analytic reviews have indicated that cognitive and behavioral treatments are efficacious in treating child and adolescent depression and anxiety. Further, a meta-analysis has suggested that behavioral treatments are superior to nonbehavioral treatments for treating anxiety and depression in youth. However, the prior meta-analysis did not examine direct comparisons between cognitive and behavioral treatments (CBT) and non-CBT treatments, leaving open the possibility that their results were artifactual. The present meta-analysis aggregated results of studies in which CBT treatments were compared with either other bona fide treatments (including other CBT therapies) or non-bona fide therapies. The heterogeneity of the distribution of differences between bona fide treatments as well as a comparison of full (e.g. CBT+Parent training) versus component treatments (e.g., CBT only) were examined. The results indicated that: (a) CBT was more efficacious than non-bona fide therapies; (b) CBT was no more efficacious than bona fide non-CBT treatments (c) the differences between bona fide treatments were homogenously distributed around zero; and (d) full CBT treatments offered no significant benefit over their components. The results strongly suggest that the theoretically purported critical ingredients of CBT are not specifically ameliorative for child and adolescent depression and anxiety.
Collapse
|