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de Leon J. Promoting safer and wider worldwide use of clozapine. Schizophr Res 2024; 268:1-6. [PMID: 38519290 DOI: 10.1016/j.schres.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 03/10/2024] [Indexed: 03/24/2024]
Abstract
This issue focuses on the past, the present and the future of clozapine. Of the 43 clozapine articles, nine are historical articles dealing with the past, 29 deal with the present and five with laboratory assays which may influence its future use. These 43 articles include 219 different authors from 56 countries/regions and five continents.
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Affiliation(s)
- Jose de Leon
- Department of Psychiatry, University of Kentucky, Lexington, KY, USA; Mental Health Research Center, Eastern State Hospital, Lexington, KY, USA; Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apóstol Hospital, University of the Basque Country, Vitoria, Spain.
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2
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Berwian IM, Tröndle M, de Miquel C, Ziogas A, Stefanics G, Walter H, Stephan KE, Huys QJM. Emotion-induced frontal α asymmetry as a candidate predictor of relapse after discontinuation of antidepressant medication. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024:S2451-9022(24)00134-4. [PMID: 38735534 DOI: 10.1016/j.bpsc.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 02/13/2024] [Accepted: 05/03/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND One in three patients relapse after antidepressant discontinuation. Thus, the prevention of relapse after achieving remission is an important component in the long-term management of Major Depressive Disorder (MDD). However, no clinical or other predictors are established. Frontal reactivity to sad mood as measured by fMRI has been reported to relate to relapse independently of antidepressant discontinuation and is an interesting candidate predictor. METHODS Patients (n=56) who had remitted from a depressive episode while taking antidepressants underwent EEG recording during a sad mood induction procedure prior to gradually discontinuing their medication. Relapse was assessed over a six-months follow-up period. 35 healthy controls were also tested. Current source density of the EEG power in the α band (8-13Hz) was extracted and alpha-asymmetry was computed by comparing the power across two hemispheres at frontal electrodes (F5 and F6). OUTCOMES Sad mood induction was robust across all groups. Reactivity of α-asymmetry to sad mood did not distinguish healthy controls from patients with remitted MDD on medication. However, the 14 (25%) patients who relapsed during the follow-up period after discontinuing medication showed significantly reduced reactivity in α- asymmetry compared to patients who remained well. This EEG signal provided predictive power (69% out-of-sample balanced accuracy and a positive predictive value of 0.75). INTERPRETATION A simple EEG-based measure of emotional reactivity may have potential to contribute to clinical prediction models of antidepressant discontinuation. Given the very small sample size, this finding must be interpreted with caution and requires replication in a larger study.
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Affiliation(s)
- Isabel M Berwian
- Princeton Neuroscience Institute & Psychology Department, Princeton University, Princeton, USA; Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland.
| | - Marius Tröndle
- Methods of Plasticity Research, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Carlota de Miquel
- Research Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | | | - Gabor Stefanics
- Semmelweis University, Department of Psychiatry and Psychotherapy, Budapest, Hungary
| | - Henrik Walter
- Charité Universitätsmedizin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Psychiatry and Psychotherapy, Berlin, Germany
| | - Klaas Enno Stephan
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland; Max Planck Institute for Metabolism Research, Cologne, Germany
| | - Quentin J M Huys
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland; Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland; Division of Psychiatry and Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, United Kingdom
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3
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Fava GA. Forty Years of Clinimetrics. PSYCHOTHERAPY AND PSYCHOSOMATICS 2022; 91:1-7. [PMID: 34839291 DOI: 10.1159/000520251] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 10/17/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Giovanni A Fava
- Department of Psychiatry, University at Buffalo, State University of New York, Buffalo, New York, USA
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4
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Carrozzino D, Patierno C, Guidi J, Berrocal Montiel C, Cao J, Charlson ME, Christensen KS, Concato J, De Las Cuevas C, de Leon J, Eöry A, Fleck MP, Furukawa TA, Horwitz RI, Nierenberg AA, Rafanelli C, Wang H, Wise TN, Sonino N, Fava GA. Clinimetric Criteria for Patient-Reported Outcome Measures. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 90:222-232. [PMID: 34038901 DOI: 10.1159/000516599] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/19/2021] [Indexed: 11/19/2022]
Abstract
Patient-reported outcome measures (PROMs) are self-rated scales and indices developed to improve the detection of the patients' subjective experience. Given that a considerable number of PROMs are available, it is important to evaluate their validity and usefulness in a specific research or clinical setting. Published guidelines, based on psychometric criteria, do not fit in with the complexity of clinical challenges, because of their quest for homogeneity of components and inadequate attention to sensitivity. Psychometric theory has stifled the field and led to the routine use of scales widely accepted yet with a history of poor performance. Clinimetrics, the science of clinical measurements, may provide a more suitable conceptual and methodological framework. The aims of this paper are to outline the major limitations of the psychometric model and to provide criteria for clinimetric patient-reported outcome measures (CLIPROMs). The characteristics related to reliability, sensitivity, validity, and clinical utility of instruments are critically reviewed, with particular reference to the differences between clinimetric and psychometric approaches. Of note is the fact that PROMs, rating scales, and indices developed according to psychometric criteria may display relevant clinimetric properties. The present paper underpins the importance of the clini-metric methodology in choosing the appropriate PROMs. CLIPROM criteria may also guide the development of new indices and the validation of existing PROMs to be employed in clinical settings.
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Affiliation(s)
- Danilo Carrozzino
- Department of Psychology Renzo Canestrari, University of Bologna, Bologna, Italy
| | - Chiara Patierno
- Department of Psychology Renzo Canestrari, University of Bologna, Bologna, Italy
| | - Jenny Guidi
- Department of Psychology Renzo Canestrari, University of Bologna, Bologna, Italy
| | - Carmen Berrocal Montiel
- Department of Surgical, Medical and Molecular Pathology, and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Jianxin Cao
- Changzhou First People's Hospital and Psychosomatic Gastroenterology Institute, Soochow University, Changzhou, China
| | - Mary E Charlson
- Division of Clinical Epidemiology and Evaluative Sciences Research, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Kaj Sparle Christensen
- Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - John Concato
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA.,Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Carlos De Las Cuevas
- Department of Internal Medicine, Dermatology and Psychiatry, Universidad de La Laguna, Canary Islands, Spain
| | - Jose de Leon
- University of Kentucky Mental Health Research Center at Eastern State Hospital, Lexington, Kentucky, USA
| | - Ajandek Eöry
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Marcelo Pio Fleck
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Ralph I Horwitz
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Andrew A Nierenberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Chiara Rafanelli
- Department of Psychology Renzo Canestrari, University of Bologna, Bologna, Italy
| | - Hongxing Wang
- Division of Neuropsychiatry and Psychosomatics, Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Psychosomatic Disease Consultation Center, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Thomas N Wise
- Department of Psychiatry, Inova Health Systems, Falls Church, Virginia, USA.,Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Psychiatry and Behavioral Sciences, George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Nicoletta Sonino
- Department of Statistical Sciences, University of Padova, Padova, Italy.,Department of Psychiatry, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Giovanni A Fava
- Department of Psychiatry, University at Buffalo, State University of New York, Buffalo, New York, USA
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Pelke S, Wager J, Claus BB, Stening K, Zernikow B, Reuther M. Validation of the FACETS-OF-PPC as an Outcome Measure for Children with Severe Neurological Impairment and Their Families-A Multicenter Prospective Longitudinal Study. CHILDREN-BASEL 2021; 8:children8100905. [PMID: 34682170 PMCID: PMC8535047 DOI: 10.3390/children8100905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/03/2021] [Accepted: 10/07/2021] [Indexed: 11/16/2022]
Abstract
Outcome measurement in pediatric palliative care (PPC) is receiving increasing attention. The FACETS-OF-PPC, a multidimensional outcome measure for children with severe neurological impairment, has been developed and partly validated. This study aimed to conclude the validity of the German version of the FACETS-OF-PPC. A multicenter prospective study with two points of measurement has been conducted, employing confirmatory factor analyses, reliability analyses, and analyses to evaluate the tool's sensitivity to change. Overall, 25 inpatient and outpatient teams throughout Germany recruited N = 227 parents of affected children and N = 238 professional caregivers. Participants filled out the FACETS-OF-PPC on the admission of a child to a palliative care service and at discharge from inpatient settings or two months after admission to outpatient services. The analyses revealed the questionnaire needing further adaption. Now, 17 of the original 34 items contribute to the construction of the questionnaire scales. The other items remain part of the questionnaire and may be evaluated descriptively. Furthermore, the FACETS-OF-PPC has moderate to appropriate internal consistency and is sensitive to change. Creating an outcome measure with good psychometric properties for the vulnerable population of children with severe neurological impairment appears extremely difficult. Considering these challenges, the FACETS-OF-PPC demonstrates adequate psychometric properties.
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Affiliation(s)
- Sophie Pelke
- Pediatric Palliative Care Center Datteln, Children’s and Adolescents’ Hospital Datteln, 45711 Datteln, Germany; (J.W.); (B.B.C.); (K.S.); (B.Z.); (M.R.)
- Department of Children’s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany
- Correspondence: ; Tel.: +49-2363-975-2014
| | - Julia Wager
- Pediatric Palliative Care Center Datteln, Children’s and Adolescents’ Hospital Datteln, 45711 Datteln, Germany; (J.W.); (B.B.C.); (K.S.); (B.Z.); (M.R.)
- Department of Children’s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany
- PedScience Research Institute, 45711 Datteln, Germany
| | - Benedikt B. Claus
- Pediatric Palliative Care Center Datteln, Children’s and Adolescents’ Hospital Datteln, 45711 Datteln, Germany; (J.W.); (B.B.C.); (K.S.); (B.Z.); (M.R.)
- PedScience Research Institute, 45711 Datteln, Germany
| | - Kathrin Stening
- Pediatric Palliative Care Center Datteln, Children’s and Adolescents’ Hospital Datteln, 45711 Datteln, Germany; (J.W.); (B.B.C.); (K.S.); (B.Z.); (M.R.)
| | - Boris Zernikow
- Pediatric Palliative Care Center Datteln, Children’s and Adolescents’ Hospital Datteln, 45711 Datteln, Germany; (J.W.); (B.B.C.); (K.S.); (B.Z.); (M.R.)
- Department of Children’s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany
- PedScience Research Institute, 45711 Datteln, Germany
| | - Mandira Reuther
- Pediatric Palliative Care Center Datteln, Children’s and Adolescents’ Hospital Datteln, 45711 Datteln, Germany; (J.W.); (B.B.C.); (K.S.); (B.Z.); (M.R.)
- Department of Children’s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany
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Pardiñas AF, Owen MJ, Walters JTR. Pharmacogenomics: A road ahead for precision medicine in psychiatry. Neuron 2021; 109:3914-3929. [PMID: 34619094 DOI: 10.1016/j.neuron.2021.09.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/05/2021] [Accepted: 09/09/2021] [Indexed: 12/11/2022]
Abstract
Psychiatric genomics is providing insights into the nature of psychiatric conditions that in time should identify new drug targets and improve patient care. Less attention has been paid to psychiatric pharmacogenomics research, despite its potential to deliver more rapid change in clinical practice and patient outcomes. The pharmacogenomics of treatment response encapsulates both pharmacokinetic ("what the body does to a drug") and pharmacodynamic ("what the drug does to the body") effects. Despite early optimism and substantial research in both these areas, they have to date made little impact on clinical management in psychiatry. A number of bottlenecks have hampered progress, including a lack of large-scale replication studies, inconsistencies in defining valid treatment outcomes across experiments, a failure to routinely incorporate adverse drug reactions and serum metabolite monitoring in study designs, and inadequate investment in the longitudinal data collections required to demonstrate clinical utility. Nonetheless, advances in genomics and health informatics present distinct opportunities for psychiatric pharmacogenomics to enter a new and productive phase of research discovery and translation.
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Affiliation(s)
- Antonio F Pardiñas
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK
| | - Michael J Owen
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK.
| | - James T R Walters
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK
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Cosci F. Clinimetric Perspectives in Clinical Psychology and Psychiatry. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 90:217-221. [PMID: 34052804 DOI: 10.1159/000517028] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/04/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy.,Clinical Pharmacopsychology Lab, University of Florence, Florence, Italy.,Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
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Cosci F, Chouinard G. Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 89:283-306. [PMID: 32259826 DOI: 10.1159/000506868] [Citation(s) in RCA: 110] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 02/27/2020] [Indexed: 11/19/2022]
Abstract
Studies on psychotropic medications decrease, discontinuation, or switch have uncovered withdrawal syndromes. The present overview aimed at analyzing the literature to illustrate withdrawal after decrease, discontinuation, or switch of psychotropic medications based on the drug class (i.e., benzodiazepines, nonbenzodiazepine benzodiazepine receptor agonists, antidepressants, ketamine, antipsychotics, lithium, mood stabilizers) according to the diagnostic criteria of Chouinard and Chouinard [Psychother Psychosom. 2015;84(2):63-71], which encompass new withdrawal symptoms, rebound symptoms, and persistent post-withdrawal disorders. All these drugs may induce withdrawal syndromes and rebound upon discontinuation, even with slow tapering. However, only selective serotonin reuptake inhibitors, serotonin noradrenaline reuptake inhibitors, and antipsychotics were consistently also associated with persistent post-withdrawal disorders and potential high severity of symptoms, including alterations of clinical course, whereas the distress associated with benzodiazepines discontinuation appears to be short-lived. As a result, the common belief that benzodiazepines should be substituted by medications that cause less dependence such as antidepressants and antipsychotics runs counter the available literature. Ketamine, and probably its derivatives, may be classified as at high risk for dependence and addiction. Because of the lag phase that has taken place between the introduction of a drug into the market and the description of withdrawal symptoms, caution is needed with the use of newer antidepressants and antipsychotics. Within medication classes, alprazolam, lorazepam, triazolam, paroxetine, venlafaxine, fluphenazine, perphenazine, clozapine, and quetiapine are more likely to induce withdrawal. The likelihood of withdrawal manifestations that may be severe and persistent should thus be taken into account in clinical practice and also in children and adolescents.
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Affiliation(s)
- Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy, .,Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands,
| | - Guy Chouinard
- Clinical Pharmacology and Toxicology Program, McGill University and Mental Health Institute of Montreal Fernand Seguin Research Centre, University of Montreal, Montreal, Québec, Canada
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Carrozzino D, Patierno C, Fava GA, Guidi J. The Hamilton Rating Scales for Depression: A Critical Review of Clinimetric Properties of Different Versions. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 89:133-150. [PMID: 32289809 DOI: 10.1159/000506879] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 02/27/2020] [Indexed: 11/19/2022]
Abstract
The format of the original Hamilton Rating Scale for Depression (HAM-D) was unstructured: only general instructions were provided for rating individual items. Over the years, a number of modified versions of the HAM-D have been proposed. They differ not only in the number of items, but also in modalities of administration. Structured versions, including item definitions, anchor points and semi-structured or structured interview questions, were developed. This comprehensive review was conducted to examine the clinimetric properties of the different versions of the HAM-D. The aim was to identify the HAM-D versions that best display the clinimetric properties of reliability, validity, and sensitivity to change. The search was conducted on MEDLINE, Scopus, Web of Science, and PubMed, and yielded a total of 35,473 citations, but only the most representative studies were included. The structured versions of the HAM-D were found to display the highest inter-rater and test-retest reliability. The Clinical Interview for Depression and the 6-item HAM-D showed the highest sensitivity in differentiating active treatment from placebo. The findings indicate that the HAM-D is a valid and sensitive clinimetric index, which should not be discarded in view of obsolete and not clinically relevant psychometric criteria. The HAM-D, however, requires an informed use: unstructured forms should be avoided and the type of HAM-D version that is selected should be specified in the registration of the study protocol and in the methods of the trial.
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Affiliation(s)
| | - Chiara Patierno
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Giovanni A Fava
- Department of Psychiatry, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Jenny Guidi
- Department of Psychology, University of Bologna, Bologna, Italy
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Benasi G, Fava GA, Rafanelli C. Kellner's Symptom Questionnaire, a Highly Sensitive Patient-Reported Outcome Measure: Systematic Review of Clinimetric Properties. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 89:74-89. [PMID: 32050199 DOI: 10.1159/000506110] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 01/23/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Patient-reported outcomes (PROs) are of increasing importance in clinical medicine. However, their evaluation by classic psychometric methods carries considerable limitations. The clinimetric approach provides a viable framework for their assessment. OBJECTIVE The aim of this paper was to provide a systematic review of clinimetric properties of the Symptom Questionnaire (SQ), a simple, self-rated instrument for the assessment of psychological symptoms (depression, anxiety, hostility, and somatization) and well-being (contentment, relaxation, friendliness, and physical well-being). METHODS The PRISMA guidelines were used. Electronic databases were searched from inception up to March 2019. Only original research articles, published in English, reporting data about the clinimetric properties of the SQ, were included. RESULTS A total of 284 studies was selected. The SQ has been used in populations of adults, adolescents, and older individuals. The scale significantly discriminated between subgroups of subjects in both clinical and nonclinical settings, and differentiated medical and psychiatric patients from healthy controls. In longitudinal studies and in controlled pharmacological and psychotherapy trials, it was highly sensitive to symptoms and well-being changes and discriminated between the effects of psychotropic drugs and placebo. CONCLUSIONS The SQ is a highly sensitive clinimetric index. It may yield clinical information that similar scales would fail to provide and has a unique position among the PROs that are available. Its use in clinical trials is strongly recommended.
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Affiliation(s)
- Giada Benasi
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Giovanni A Fava
- Department of Psychiatry, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Chiara Rafanelli
- Department of Psychology, University of Bologna, Bologna, Italy,
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Hui A. Exploring the utility of RDoC in differentiating effectiveness amongst antidepressants: A systematic review using proposed psychometrics as the unit of analysis for the Negative Valence Systems domain. PLoS One 2020; 15:e0243057. [PMID: 33326436 PMCID: PMC7743972 DOI: 10.1371/journal.pone.0243057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 11/14/2020] [Indexed: 01/26/2023] Open
Abstract
Background RDoC conceptualises psychopathology as neurobiologically-rooted behavioural psychological “constructs” that span dimensionally from normality to pathology, but its clinical utility remains controversial. Aim To explore RDoC’s potential clinical utility by examining antidepressant effectiveness through Negative Valence Systems (NVS) domain constructs. Method A systematic review was conducted on Web of Science, MEDLINE, EMBASE and PsycINFO for antidepressant trials that included psychometric instruments assessed by Watson, Stanton & Clark (2017) to represent NVS constructs of Acute Threat, Potential Threat and Loss. Results 221 citations were identified; 13 were included in qualitative synthesis, none for quantitative analysis. All suffered from significant bias risks. 9 antidepressants were investigated, most within 1 construct, and most were found to be effective. Paroxetine, citalopram and fluvoxamine were found to be effective for Acute Threat, fluoxetine, desvenlafaxine and sertraline for Potential Threat, and sertraline, fluvoxamine, fluoxetine and desvenlafaxine effective for Loss. Nefazodone was found to be ineffective for acute fear. Conclusion Preliminary evidence supports RDoC NVS constructs’ clinical utility in assessing antidepressant effectiveness, but lack of discriminant validity between Potential Threat and Loss supports their recombination into a single Distress construct. Finding of effectiveness within “normal” construct levels support the utility of a dimensional approach. Testable hypotheses were generated that can further test RDoC’s clinical utility.
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Affiliation(s)
- Andrew Hui
- NorthWestern Mental Health, The Royal Melbourne Hospital, Melbourne, Australia
- * E-mail:
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12
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A Paradigmatic Case of Postselective Serotonin Reuptake Inhibitors Sexual Dysfunction or Withdrawal After Discontinuation of Selective Serotonin Reuptake Inhibitors? J Clin Psychopharmacol 2020; 40:93-95. [PMID: 31834096 DOI: 10.1097/jcp.0000000000001154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Fava GA, Tomba E, Brakemeier EL, Carrozzino D, Cosci F, Eöry A, Leonardi T, Schamong I, Guidi J. Mental Pain as a Transdiagnostic Patient-Reported Outcome Measure. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 88:341-349. [PMID: 31665739 DOI: 10.1159/000504024] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 10/10/2019] [Indexed: 11/19/2022]
Abstract
Patient-reported outcomes (PROs) refer to any report coming directly from patients about how they function or feel in relation to a health condition or its therapy. PROs have been applied in medicine for the assessment of the impact of clinical phenomena. Self-report scales and procedures for assessing physical pain in adults have been developed and used in clinical trials. However, insufficient attention has been dedicated to the assessment of mental pain. The aim of this paper is to outline the implications that assessment of mental pain may entail in psychiatry and medicine, with particular reference to a clinimetric index. A simple 10-item self-rating questionnaire, the Mental Pain Questionnaire (MPQ), encompasses the specific clinical features of mental pain and shows good clinimetric properties (i.e., sensitivity, discriminant and incremental validity). The preliminary data suggest that the MPQ may qualify as a PRO measure to be included in clinical trials. Assessment of mental pain may have important clinical implications in intervention research, both in psychopharmacology and psychotherapy. The transdiagnostic features of mental pain are supported by its association with a number of psychiatric disorders, such as depression, anxiety, eating disorders, as well as borderline personality disorder. Further, addressing mental pain may be an important pathway to prevent and diminish the opioid epidemic. The data summarized here indicate that mental pain can be incorporated into current psychiatric assessment and included as a PRO measure in treatment outcome studies.
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Affiliation(s)
- Giovanni A Fava
- Department of Psychiatry, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Elena Tomba
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Eva-Lotta Brakemeier
- Department of Clinical Psychology and Psychotherapy, Universitat Greifswald, Greifswald, Germany.,Department of Clinical Psychology and Psychotherapy and Center for Mind, Brain and Behavior (CMBB), Phillips Universität Marburg, Marburg, Germany
| | - Danilo Carrozzino
- Department of Psychological, Health and Territorial Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Ajándék Eöry
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Tommaso Leonardi
- Clinical Trials Network and Institute (CTNI), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Isabel Schamong
- Department of Clinical Psychology and Psychotherapy and Center for Mind, Brain and Behavior (CMBB), Phillips Universität Marburg, Marburg, Germany
| | - Jenny Guidi
- Department of Psychology, University of Bologna, Bologna, Italy,
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de Leon J, Ruan CJ, Schoretsanitis G, De las Cuevas C. A Rational Use of Clozapine Based on Adverse Drug Reactions, Pharmacokinetics, and Clinical Pharmacopsychology. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 89:200-214. [PMID: 32289791 PMCID: PMC7206357 DOI: 10.1159/000507638] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/30/2020] [Indexed: 12/11/2022]
Abstract
Using Richardson and Davidson's model and the sciences of pharmacokinetics and clinical pharmacopsychology, this article reviewed the: (1) poor life expectancy associated with treatment-resistant schizophrenia (TRS), which may be improved in patients who adhere to clozapine; (2) findings that clozapine is the best treatment for TRS (according to efficacy, effectiveness and well-being); and (3) potential for clozapine to cause vulnerabilities, including potentially lethal adverse drug reactions such as agranulocytosis, pneumonia, and myocarditis. Rational use requires: (1) modification of the clozapine package insert worldwide to include lower doses for Asians and to avoid the lethality associated with pneumonia, (2) the use of clozapine levels for personalizing dosing, and (3) the use of slow and personalized titration. This may make clozapine as safe as possible and contribute to increased life expectancy and well-being. In the absence of data on COVID-19 in clozapine patients, clozapine possibly impairs immunological mechanisms and may increase pneumonia risk in infected patients. Psychiatrists should call their clozapine patients and families and explain to them that if the patient develops fever or flu-like symptoms, the psychiatrist should be called and should consider halving the clozapine dose. If the patient is hospitalized with pneumonia, the treating physician needs to assess for symptoms of clozapine intoxication since halving the dose may not be enough for all patients; consider decreasing it to one-third or even stopping it. Once the signs of inflammation and fever have disappeared, the clozapine dose can be slowly increased to the prior dosage level.
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Affiliation(s)
- Jose de Leon
- Mental Health Research Center at Eastern State Hospital, Lexington, Kentucky, USA, .,Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada, Spain, .,Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apóstol Hospital, University of the Basque Country, Vitoria, Spain,
| | - Can-Jun Ruan
- The National Clinical Research Centre for Mental Disorders, Beijing Key Laboratory of Mental Disorders, and Laboratory of Clinical Psychopharmacology, Beijing Anding Hospital, Capital Medical University, Beijing, China,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Georgios Schoretsanitis
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York, USA
| | - Carlos De las Cuevas
- Department of Internal Medicine, Dermatology and Psychiatry, University of La Laguna, San Cristóbal de La Laguna, Spain
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15
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Fava GA, Rafanelli C. Iatrogenic Factors in Psychopathology. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 88:129-140. [PMID: 31085917 DOI: 10.1159/000500151] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 04/04/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Giovanni A Fava
- Department of Psychiatry, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Chiara Rafanelli
- Department of Psychology, University of Bologna, Bologna, Italy,
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16
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Abstract
Psychiatrists often consider the positive characteristics displayed by a patient in their clinical judgment, yet current assessment and treatment strategies are shifted on the side of psychological dysfunction. Euthymia is a transdiagnostic construct referring to the presence of positive affects and psychological well-being, i.e., balance and integration of psychic forces (flexibility), a unifying outlook on life which guides actions and feelings for shaping future accordingly (consistency), and resistance to stress (resilience and tolerance to anxiety or frustration). There is increasing evidence that the evaluation of euthymia and its components has major clinical implications. Specific instruments (clinical interviews and questionnaires) may be included in a clinimetric assessment strategy encompassing macro-analysis and staging. The pursuit of euthymia cannot be conceived as a therapeutic intervention for specific mental disorders, but as a transdiagnostic strategy to be incorporated in an individualized therapeutic plan. A number of psychotherapeutic techniques aiming to enhance positive affects and psychological well-being (such as well-being therapy, mindfulness-based cognitive therapy, and acceptance and commitment therapy) have been developed and validated in randomized controlled clinical trials. The findings indicate that flourishing and resilience can be promoted by specific interventions leading to a positive evaluation of one's self, a sense of continuing growth and development, the belief that life is purposeful and meaningful, satisfaction with one's relations with others, the capacity to manage effectively one's life, and a sense of self-determination.
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Affiliation(s)
- Giovanni A Fava
- Department of Psychiatry, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Jenny Guidi
- Department of Psychology, University of Bologna, Bologna, Italy
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Herzog P, Lauff S, Rief W, Brakemeier EL. Assessing the unwanted: A systematic review of instruments used to assess negative effects of psychotherapy. Brain Behav 2019; 9:e01447. [PMID: 31647202 PMCID: PMC6908878 DOI: 10.1002/brb3.1447] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/04/2019] [Accepted: 09/14/2019] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE While the efficacy of psychotherapy in the treatment of mental disorders is well examined, systematic research into negative effects of psychotherapy seems comparatively rare. Therefore, this review evaluates instruments for assessing negative effects of psychotherapy in order to create a consensus framework and make recommendations for their assessment. METHODS The study selection procedure follows current best-practice guidelines for conducting systematic reviews, with 10 included studies in three databases (PsycINFO, PubMed, and Web of Science). The nine instruments identified were each critically reviewed concerning the theoretical orientation, including the assessed domains of negative effects, psychometric properties, and diagnostic characteristics. RESULTS Seventeen domains of negative effects of psychotherapy were identified but inconsistently assessed by the nine instruments. Most instruments provide some initial data on their psychometric properties. Regarding diagnostic characteristics, different item-response formats are used but often with reference to "attribution to therapy." CONCLUSION This review indicates that the existing instruments for assessing negative effects of psychotherapy cover a wide range of relevant domains without any consensus on the most important ones and their psychometric properties are usually unsatisfactory. A framework for consensus, building on the definition and conceptualization of negative effects, is synthesized, and recommendations for improving the assessment are derived.
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Affiliation(s)
- Philipp Herzog
- Department of Clinical Psychology and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
| | - Sören Lauff
- Department of Clinical Psychology and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
| | - Eva-Lotta Brakemeier
- Department of Clinical Psychology and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany.,Marburg Center for Mind, Brain and Behavior (MCMBB), Marburg, Germany
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18
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Fleck MP, Carrozzino D, Fava GA. The challenge of measurement in psychiatry: the lifetime accomplishments of Per Bech (1942-2018). REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2019; 41:369-372. [PMID: 31269098 PMCID: PMC6796809 DOI: 10.1590/1516-4446-2019-0509] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Marcelo P. Fleck
- Departamento de Psiquiatria e Medicina Legal, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Danilo Carrozzino
- Dipartimento di Scienze Psicologiche, della Salute e del Territorio, Università degli Studi “G. d’Annunzio” Chieti e Pescara, Chieti, Italy
| | - Giovanni A. Fava
- Dipartimento di Psicologia, Università di Bologna, Bologna, Italy
- Department of Psychiatry, State University of New York at Buffalo, Buffalo, NY, USA
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19
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Carrozzino D. Clinimetric approach to rating scales for the assessment of apathy in Parkinson's disease: A systematic review. Prog Neuropsychopharmacol Biol Psychiatry 2019; 94:109641. [PMID: 31059722 DOI: 10.1016/j.pnpbp.2019.109641] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 04/23/2019] [Accepted: 04/30/2019] [Indexed: 02/09/2023]
Abstract
A number of rating scales for the assessment of apathy in Parkinson's disease (PD) were developed. Unfortunately, previous studies focused mainly on psychometric criteria rather than on clinimetric principles to develop these assessment instruments. In the clinimetric approach, the clinical validity of a rating scale, rather than its statistical significance, has the priority. The aim of the present systematic review was to capture the clinimetric properties of these rating scales and to identify the measures, which display clinical validity for the assessment of apathy in PD. The systematic search was conducted on Scopus, PsycINFO, PubMed, Web of Science, ScienceDirect, and Medline following the PRISMA guidelines. A total of 44 studies were included and analyzed in this systematic review. The apathy rating scales, which were found to be psychometrically robust and reliable, were actually clinically questionable. The apathy measures, which displayed clinimetric properties, were the Starkstein Apathy Scale (SAS), the 5-item version of the World Health Organization Well-Being Index (WHO-5), the Neurasthenia Scale and the Lille Apathy Rating Scale (LARS). The SAS was found to be clinically valid at a macro-analytic level, particularly when used either to exclude the presence of symptoms of apathy or to evaluate the side effects of medications. The WHO-5 and the Neurasthenia Scale were found to be clinically valid only at a micro-analytic level and can be used as screening measures for the assessment of the severity of symptoms of apathy. The LARS was a clinically valid instrument to be used for the diagnosis of apathy.
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Affiliation(s)
- Danilo Carrozzino
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Via dei Vestini no. 31, 66100 Chieti, Italy.
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Abstract
Clinical pharmacopsychology is an area of clinical psychology that is concerned with the application of clinimetric methods to the assessment of psychotropic effects of drugs on psychological functioning, and the interaction of such drugs with specific or non-specific treatment ingredients. Clinical pharmacopsychology derives its data from observational and controlled studies on clinical populations and refers to the therapeutic use of medical drugs, not to the effects of substances used for other purposes.
Domains and operational settings of clinical pharmacopsychology are illustrated.
The domains of clinical pharmacopsychology extend over several areas of application which encompass the psychological effects of psychotropic drugs (with particular emphasis on subclinical changes), the characteristics that predict responsiveness to treatment, the vulnerabilities induced by treatment (i.e., side effects, behavioral toxicity, iatrogenic comorbidity), and the interactions between drug therapy and psychological variables. A service for clinical pharmacopsychology is here proposed as an example of the innovative role of clinical psychology in medical settings.
Clinical pharmacopsychology offers a unifying framework for the understanding of clinical phenomena in medical and psychiatric settings. Its aim is to provide a comprehensive assessment of the clinical important changes that are concerned with wanted and expected treatment effects; treatment-induced unwanted side effects; and the patient's own personal experience of a change in terms of well-being and/or quality of life. It is now time to practice clinical pharmacopsychology, creating ad hoc services in Europe.
Clinical pharmacopsychology assesses the effects of medications on psychological functioning
Since clinical psychologists visit medicated patients, a comprehensive clinical evaluation is crucial
Vulnerabilities induced by psychotropic drugs are an important area of application of clinical pharmacopsychology
Clinical pharmacopsychology assesses the effects of medications on psychological functioning
Since clinical psychologists visit medicated patients, a comprehensive clinical evaluation is crucial
Vulnerabilities induced by psychotropic drugs are an important area of application of clinical pharmacopsychology
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21
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De Las Cuevas C, de Leon J. A Clinimetric Approach for Improving the Measurement of Pharmacophobia with Replication in Two Other Samples. PSYCHOTHERAPY AND PSYCHOSOMATICS 2019; 88:116-118. [PMID: 30650413 DOI: 10.1159/000495940] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 11/21/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Carlos De Las Cuevas
- Department of Internal Medicine, Dermatology and Psychiatry, University of La Laguna, San Cristóbal de La Laguna, Spain
| | - Jose de Leon
- Mental Health Research Center at Eastern State Hospital, Lexington, Kentucky, USA, .,Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada, Spain, .,Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apóstol Hospital, University of the Basque Country, Vitoria, Spain,
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22
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Fava GA, Cosci F, Berrocal Montiel C, Tomba E. The Journal's Mission. PSYCHOTHERAPY AND PSYCHOSOMATICS 2019; 88:1-4. [PMID: 30677767 DOI: 10.1159/000495967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 12/03/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Giovanni A Fava
- Department of Psychology, University of Bologna, Bologna, Italy, .,Department of Psychiatry, State University of New York at Buffalo, Buffalo, New York, USA,
| | - Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Carmen Berrocal Montiel
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Elena Tomba
- Department of Psychology, University of Bologna, Bologna, Italy
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23
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Carrozzino D, Siri C, Bech P. The prevalence of psychological distress in Parkinson's disease patients: The brief symptom inventory (BSI-18) versus the Hopkins symptom checklist (SCL-90-R). Prog Neuropsychopharmacol Biol Psychiatry 2019; 88:96-101. [PMID: 30017779 DOI: 10.1016/j.pnpbp.2018.07.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 06/26/2018] [Accepted: 07/11/2018] [Indexed: 11/16/2022]
Abstract
The prevalence of psychological distress in Parkinson's disease (PD) patients has been evaluated by many different assessment instruments and with diverse control groups. The most frequently used distress symptom scale has been the Hopkins Symptom Checklist (SCL-90-R), although it contains many symptoms with problematic validity clinically. The 18-item subscale of the SCL-90-R, the Brief Symptom Inventory (BSI-18) has recently been shown to have a sufficient validity to screen for the prevalence of psychological distress (somatization) in PD patients. We have performed a clinimetric analysis by comparing the BSI-18 with SCL-90-R relevant subscales in PD patients. Our micro-analysis has focused on the Mokken model to test the scalability of the subscales. The macro-analysis has focused both on effect size statistics and the normative level of psychological distress with reference to the Italian general population data using T-score metric. The Mokken analysis indicated acceptable scalability for all the subscales of BSI-18. The effect size statistics identified somatization in both BSI-18 and SCL-90-R as the most prevalent and intense symptom of psychological distress. The T-score metric identified the phobic anxiety subscale of SCL-90-R to be clinically much more important than the BSI-18 anxiety subscale in the PD patients. We have found the SCL-90-R subscale of phobic anxiety and the BSI-18 somatization subscale most clinically valid when measuring psychological distress in PD patients.
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Affiliation(s)
- Danilo Carrozzino
- Psychiatric Research Unit, Psychiatric Centre North Zealand, Copenhagen University Hospital, Hillerød, Denmark; Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy.
| | - Chiara Siri
- Parkinson Institute, ASST G. Pini-CTO, ex ICP, Milan, Italy
| | - Per Bech
- Psychiatric Research Unit, Psychiatric Centre North Zealand, Copenhagen University Hospital, Hillerød, Denmark
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24
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Fava GA, Carrozzino D, Lindberg L, Tomba E. The Clinimetric Approach to Psychological Assessment: A Tribute to Per Bech, MD (1942-2018). PSYCHOTHERAPY AND PSYCHOSOMATICS 2019; 87:321-326. [PMID: 30269137 DOI: 10.1159/000493746] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Giovanni A Fava
- Department of Psychology, University of Bologna, Bologna, .,Department of Psychiatry, State University of New York at Buffalo, Buffalo, New York,
| | - Danilo Carrozzino
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Lone Lindberg
- Psychiatric Research Unit, Psychiatric Centre North Zealand, Copenhagen University Hospital, Hillerød, Denmark
| | - Elena Tomba
- Department of Psychology, University of Bologna, Bologna, Italy
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25
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The emergence of loss of efficacy during antidepressant drug treatment for major depressive disorder: An integrative review of evidence, mechanisms, and clinical implications. Pharmacol Res 2019; 139:494-502. [DOI: 10.1016/j.phrs.2018.10.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/20/2018] [Accepted: 10/23/2018] [Indexed: 12/11/2022]
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26
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Ducasse D, Jaussent I, Arpon-Brand V, Vienot M, Laglaoui C, Béziat S, Calati R, Carrière I, Guillaume S, Courtet P, Olié E. Acceptance and Commitment Therapy for the Management of Suicidal Patients: A Randomized Controlled Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2018; 87:211-222. [PMID: 29874680 DOI: 10.1159/000488715] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 03/22/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND The management of suicidal crisis remains a major issue for clinicians, driving the development of new strategies to improve suicide prevention. METHODS We conducted a randomized controlled trial comparing a 7-week acceptance and commitment therapy (ACT) versus relaxation group, as adjunct to treatment as usual for adult outpatients suffering from a current suicidal behavior disorder. The primary outcome was the rate of change in the Columbia Suicide Severity Rating Scale suicidal ideation subscore (adding severity and intensity subscores). Secondary outcomes were the rates of change for depressive symptomatology, psychological pain, anxiety, hopelessness, anger, quality of life, and therapeutic processes. Assessments were performed in the 2 weeks preceding the beginning of the treatment (pretreatment assessment), and within 1 week (posttherapy assessment) and 3 months (follow-up assessment) after therapy completion. RESULTS Forty adults were included and randomized. The rate of change in ACT for suicidal ideation at the posttherapy assessment was higher than in the relaxation group (β [SE] = -1.88 [0.34] vs. -0.79 [0.37], respectively; p = 0.03). ACT effectiveness remained stable at the 3-month follow-up. We found a similar pattern of change for depressive symptomatology and anxiety, psychological pain, hopelessness, anger, and quality of life. Therapeutic processes improved more in the ACT group than in the relaxation group. Treatment adherence was high in the ACT group, all participants reported satisfaction with the program. CONCLUSIONS Through its effectiveness in reducing suicidal ideation and improving the clinical dimensions associated with suicidal risk in patients suffering from a suicidal behavior disorder, ACT could be developed as an adjunctive strategy in programs for suicide prevention.
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Affiliation(s)
- Déborah Ducasse
- Department of Emergency Psychiatry and Postacute Care, Lapeyronie Hospital, CHU Montpellier, CHRU Montpellier, Montpellier, France.,Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, Montpellier, France.,Fondation FondaMental, Créteil, France
| | - Isabelle Jaussent
- Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, Montpellier, France
| | - Véronique Arpon-Brand
- Department of Emergency Psychiatry and Postacute Care, Lapeyronie Hospital, CHU Montpellier, CHRU Montpellier, Montpellier, France
| | - Marina Vienot
- Department of Emergency Psychiatry and Postacute Care, Lapeyronie Hospital, CHU Montpellier, CHRU Montpellier, Montpellier, France
| | - Camelia Laglaoui
- Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, Montpellier, France
| | - Séverine Béziat
- Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, Montpellier, France
| | - Raffaella Calati
- Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, Montpellier, France.,Fondation FondaMental, Créteil, France
| | - Isabelle Carrière
- Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, Montpellier, France
| | - Sébastien Guillaume
- Department of Emergency Psychiatry and Postacute Care, Lapeyronie Hospital, CHU Montpellier, CHRU Montpellier, Montpellier, France.,Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, Montpellier, France
| | - Philippe Courtet
- Department of Emergency Psychiatry and Postacute Care, Lapeyronie Hospital, CHU Montpellier, CHRU Montpellier, Montpellier, France.,Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, Montpellier, France.,Fondation FondaMental, Créteil, France
| | - Emilie Olié
- Department of Emergency Psychiatry and Postacute Care, Lapeyronie Hospital, CHU Montpellier, CHRU Montpellier, Montpellier, France.,Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, Montpellier, France.,Fondation FondaMental, Créteil, France
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27
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Fava GA, Cosci F, Tomba E. Overcoming the Crisis of Clinical Research. PSYCHOTHERAPY AND PSYCHOSOMATICS 2018; 87:1-4. [PMID: 29306948 DOI: 10.1159/000485001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Giovanni A Fava
- Department of Psychology, University of Bologna, Bologna, Italy
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28
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Fava GA, Guidi J, Rafanelli C, Rickels K. The Clinical Inadequacy of the Placebo Model and the Development of an Alternative Conceptual Framework. PSYCHOTHERAPY AND PSYCHOSOMATICS 2018; 86:332-340. [PMID: 29131050 DOI: 10.1159/000480038] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 08/07/2017] [Indexed: 12/11/2022]
Abstract
Placebo effects are often attributed to clinical interactions and contextual factors that affect expectations of the patient about the treatment and result in symptom changes. The prevailing conceptualization consists of an undifferentiated placebo response that needs to be minimized in controlled investigations and maximized in clinical practice. However, treatment outcome is the cumulative result of the interaction of several classes of variables with a selected treatment: living conditions (housing, nutrition, work environment, social support), patient characteristics (age, sex, genetics, general health conditions, personality, well-being), illness features and previous therapeutic experience, self-management, and treatment setting (physician's attitude and attention, illness behavior). Such variables may be therapeutic or countertherapeutic, and are unlikely to be simply additive. In certain patients their interactive combination may lead to clinical improvement, whereas in other cases it may produce no effect, and, in a third group, it may lead to worsening of the condition. Maximizing patients' expectations does not necessarily result in sustained effects and, in due course, may actually lead to worsening of the condition (violation of expectations). In this paper, we outline a multifactorial conceptual model that may have implications for the design of clinical trials as well as for clinical practice, with special reference to psychopharmacology and psychotherapy. The effects of drug treatment may be potentiated by specific nonpharmacological treatment strategies, and this synergism may disclose significant differences against placebo. Medical outcomes may be unsatisfactory not because technical interventions are missing, but because our conceptual models and thinking are inadequate.
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Affiliation(s)
- Giovanni A Fava
- Department of Psychology, University of Bologna, Bologna, Italy
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29
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Abstract
PURPOSE There are several clinical areas where psychological well-being may play an important role: the assessment of the dynamic balance between ill-being and well-being; reduction of incidence, prevention of recurrence and achievement of full recovery in psychiatric disorders such as depression; patient's satisfaction and perceived change after treatment. The aim of this article is to discuss the clinical role of Well-Being Therapy (WBT). MATERIALS AND METHODS A critical review of the literature concerned with psychological well-being and its treatment was performed. WBT is a short-term psychotherapeutic strategy that emphasizes self-observation of psychological well-being, with the use of a structured diary, cognitive restructuring of interfering thoughts and/or behaviors through cognitive behavioral techniques, and homework assignments (i.e. pursuing optimal experiences). WBT is based on a multidimensional model of psychological well-being that was originally developed by Marie Jahoda and it is aimed at achieving a state of euthymia. RESULTS WBT has been validated in a number of randomized controlled trials. The sequential combination of cognitive behavior therapy (CBT) and WBT has mainly characterized its use so far. Illustration of a clinical case exemplifies its application and the potential role of psychological well-being in the clinical process. CONCLUSIONS Even though more randomized controlled trials concerned with WBT are needed, consideration of psychological well-being may unravel innovative approaches to the prevention, assessment and treatment of mood and anxiety disorders.
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Affiliation(s)
- Jenny Guidi
- a Department of Psychology , University of Bologna , Bologna , Italy
| | - Chiara Rafanelli
- a Department of Psychology , University of Bologna , Bologna , Italy
| | - Giovanni A Fava
- a Department of Psychology , University of Bologna , Bologna , Italy.,b Department of Psychiatry , State University of New York at Buffalo , Buffalo , New York , USA
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30
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Abstract
UNLABELLED ABSTRACTBackground:The use of the pharmacopsychometric triangle to enhance patient-reported well-being as the ultimate goal of treatment has most intensively been studied in patients with a major depressive episode. METHODS The review is structured on the pharmacopsychometric triangle in which the desired clinical effect of an antidepressive medication is balanced against the undesired side effects induced by this medication in terms of restored well-being. As a biological treatment, the antidepressive medication is compared clinically with both electroconvulsive therapy and psychological treatment. RESULTS In the process of this review, evidence from a dose-response study in patients suffering from a major depressive episode with an adequate duration and symptom severity has demonstrated that the dose-response relationship emerged when using the patient-reported well-being outcome rather than the symptomatic reduction as outcome. CONCLUSION The pharmacopsychometric triangle is in patients with major depressive episodes providing important information within positive psychiatry.
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31
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Bech P, Tomba E, Fava GA. Response to "An Evolutionary Approach to Clinical Pharmacopsychology". PSYCHOTHERAPY AND PSYCHOSOMATICS 2018; 86:372. [PMID: 29131122 DOI: 10.1159/000481100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Per Bech
- Psychiatric Research Unit, Psychiatric Centre North Zealand, Copenhagen University Hospital, Hillerød, Denmark
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32
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Rantala MJ, Luoto S, Krams I. An Evolutionary Approach to Clinical Pharmacopsychology. PSYCHOTHERAPY AND PSYCHOSOMATICS 2018; 86:370-371. [PMID: 29131107 DOI: 10.1159/000480709] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 08/22/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Markus J Rantala
- Department of Biology and Turku Brain and Mind Center, University of Turku, Turku, Finland
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Tomba E, Guidi J, Fava GA. What psychologists need to know about psychotropic medications. Clin Psychol Psychother 2017; 25:181-187. [PMID: 29168605 DOI: 10.1002/cpp.2154] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 12/21/2022]
Abstract
Despite the fact that today most of the patients with psychological disturbances assume some form of psychotropic drug treatment, clinical psychologists may have little familiarity with psychopharmacology and are substantially unaware of subtle and yet pervasive potential effects of medications in clinical presentations. In their training, psychologists are generally exposed, at best, to some general principles of drug action. Standard psychopharmacology textbooks tend to omit the subtle psychological changes that may occur during psychotropic drug treatment. Clinical pharmacopsychology consists of the application of clinical psychology to the full understanding of pharmacological effects. The domains of clinical pharmacopsychology encompass the clinical benefits of psychotropic drugs, the characteristics that predict responsiveness to treatment, the vulnerabilities induced by treatment (side effects, behavioural toxicity, iatrogenic comorbidity), and the interactions between drug treatment and psychological variables. The DSM-5 refers to a patient population that no longer exists: subjects who display various manifestations of psychological distress who do not receive any form of drug treatment for it. Any type of psychotropic drug treatment, particularly after long-term use, may increase the risk of experiencing additional psychopathological problems that do not necessarily subside with discontinuation of the drug. The changes may be persistent and not limited to a short phase, such as in the case of withdrawal reactions, and cannot be subsumed under the generic rubrics of adverse events or side effects.
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Affiliation(s)
- Elena Tomba
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Jenny Guidi
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Giovanni A Fava
- Department of Psychology, University of Bologna, Bologna, Italy.,Department of Psychiatry, University at Buffalo, Buffalo, NY, USA
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Fulcheri M, Carrozzino D. The clinical consequence of positive mental health in psychotherapy. RESEARCH IN PSYCHOTHERAPY 2017; 20:280. [PMID: 32913745 PMCID: PMC7451366 DOI: 10.4081/ripppo.2017.280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 06/18/2017] [Accepted: 06/20/2017] [Indexed: 11/23/2022]
Abstract
The current commentary is aimed at critically analyzing the document Psychotherapies for Anxiety and Depression: benefits and costs by focusing on specific theoretical concepts and empirical evidences arising from research studies fulfilled in the area of study of Clinical and Health Psychology. Specifically, the following were the main topics on which we are focused on: i) the clinical consequence potentially resulting from considering the psychological well-being and the euthymia condition as the main targets of a psychotherapeutic treatment; ii) a critical reappraisal of the clinical inadequacy of the evidence based model in psychotherapy; iii) clinimetrics as a clinically based measurement method for evaluating the psychological well-being of a patient after a psychotherapeutic intervention.
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Affiliation(s)
- Mario Fulcheri
- Department of Psychological, Health, and Territorial Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Danilo Carrozzino
- Department of Psychological, Health, and Territorial Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.,Psychiatric Research Unit, Psychiatric Centre North Zealand, Copenhagen University Hospital, Hillerød, Denmark
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