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Fava GA, Sonino N, Aron DC, Balon R, Berrocal Montiel C, Cao J, Concato J, Eory A, Horwitz RI, Rafanelli C, Schnyder U, Wang H, Wise TN, Wright JH, Zipfel S, Patierno C. Clinical Interviewing: An Essential but Neglected Method of Medicine. PSYCHOTHERAPY AND PSYCHOSOMATICS 2024; 93:94-99. [PMID: 38382481 DOI: 10.1159/000536490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 01/23/2024] [Indexed: 02/23/2024]
Abstract
Clinical interviewing is the basic method to understand how a person feels and what are the presenting complaints, obtain medical history, evaluate personal attitudes and behavior related to health and disease, give the patient information about diagnosis, prognosis, and treatment, and establish a bond between patient and physician that is crucial for shared decision making and self-management. However, the value of this basic skill is threatened by time pressures and emphasis on technology. Current health care trends privilege expensive tests and procedures and tag the time devoted to interaction with the patient as lacking cost-effectiveness. Instead, the time spent to inquire about problems and life setting may actually help to avoid further testing, procedures, and referrals. Moreover, the dialogue between patient and physician is an essential instrument to increase patient's motivation to engage in healthy behavior. The aim of this paper was to provide an overview of clinical interviewing and its optimal use in relation to style, flow and hypothesis testing, clinical domains, modifications according to settings and goals, and teaching. This review points to the primacy of interviewing in the clinical process. The quality of interviewing determines the quality of data that are collected and, eventually, of assessment and treatment. Thus, interviewing deserves more attention in educational training and more space in clinical encounters than it is currently receiving.
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Affiliation(s)
- Giovanni A Fava
- Department of Psychiatry, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Nicoletta Sonino
- Department of Psychiatry, University at Buffalo, State University of New York, Buffalo, New York, USA
- Department of Statistical Sciences, University of Padova, Padova, Italy
| | - David C Aron
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Richard Balon
- Departments of Psychiatry and Behavioral Sciences and Anesthesiology, Wayne State University, Detroit, Michigan, USA
| | - 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
| | - 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
| | - Ajandek Eory
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Ralph I Horwitz
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, 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
| | - Jesse H Wright
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tubingen, Tubingen, Germany
- German Centre of Mental Health, Tubingen, Germany
| | - Chiara Patierno
- Department of Psychology "Renzo Canestrari", University of Bologna, Bologna, Italy
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2
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Fava GA, Guidi J. Management of Depression in Medical Patients: The Role of Clinical Evaluation. PSYCHOTHERAPY AND PSYCHOSOMATICS 2023; 92:287-291. [PMID: 37866352 DOI: 10.1159/000533954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 10/24/2023]
Affiliation(s)
- Giovanni A Fava
- Department of Psychiatry, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Jenny Guidi
- Department of Psychology "Renzo Canestrari", University of Bologna, Bologna, Italy
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Barbalat G, Reddy G, Franck N. Association of globalization with the burden of opioid use disorders 2019. A country-level analysis using targeted maximum likelihood estimation. Global Health 2023; 19:76. [PMID: 37845722 PMCID: PMC10577998 DOI: 10.1186/s12992-023-00980-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 10/07/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND The "opioid crisis" has been responsible for hundreds of thousands deaths in the US, and is at risk of dissemination worldwide. Within-country studies have demonstrated that the rise of opioid use disorders (OUD) is linked to increased access to opioid prescriptions and to so-called "diseases of despair". Both have been related to the emergence of globalization policies since the 1980s. First, globalized countries have seen a reorganization of healthcare practices towards quick and easy answers to complex needs, including increased opioid prescriptions. Second, despair has gained those suffering from the mutations of socio-economic systems and working conditions that have accompanied globalization policies (e.g. delocalization, deindustrialization, and the decline of social services). Here, using data with high quality ratings from the Global Burden of Disease database, we evaluated the country-based association between four levels of globalization and the burden of OUD 2019. RESULTS The sample included 87 countries. Taking into account potential country-level confounders, we found that countries with the highest level of globalization were associated with a 31% increase in the burden of OUD 2019 compared to those with the lowest level of globalization (mean log difference: 0.31; 95%CI, 0.04-0.57; p = 0.02). Additional analyses showed a significant effect for low back pain (mean log difference: 0.07; 95%CI, 0.02-0.12; p = 0.007). In contrast, despite sharing some of the risk factors of OUD, other mental and substance use disorders did not show any significant relationship with globalization. Finally, socio-cultural de jure globalization, which compiles indicators related to gender equality, human capital and civil rights, was specifically associated with the burden of OUD (mean log difference: 0.49; 95%CI: 0.23,0.75; p < 0.001). CONCLUSIONS These findings suggest that OUD may have inherent underpinnings linked to globalization, and more particularly socio-cultural aspects of globalization. Key factors may be increased rights to access prescriptions, as well as increased feelings of despair related to the erosion of local cultures and widening educational gaps.
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Affiliation(s)
- Guillaume Barbalat
- Centre ressource de réhabilitation psychosociale et de remédiation cognitive, Pôle Centre rive gauche UMR 5229, Hôpital Le Vinatier, CNRS & Université Lyon 1, Lyon, France.
| | - Geeta Reddy
- International Committee of the Red Cross (ICRC), 19, Avenue de la Paix, Geneva, 1202, Switzerland
| | - Nicolas Franck
- Centre ressource de réhabilitation psychosociale et de remédiation cognitive, Pôle Centre rive gauche UMR 5229, Hôpital Le Vinatier, CNRS & Université Lyon 1, Lyon, France
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de Figueiredo JM, Zhu B, Patel AS, Kohn R, Koo BB, Louis ED. Differential impact of resilience on demoralization and depression in Parkinson disease. Front Psychiatry 2023; 14:1207019. [PMID: 37559912 PMCID: PMC10408307 DOI: 10.3389/fpsyt.2023.1207019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/19/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVES The objective of this study was to study the interrelations of demoralization, depression, and resilience in patients with Parkinson disease, and, more specifically, to determine if higher resilience in patients with Parkinson disease is associated with lower demoralization, lower depression, or both. METHODS Outpatients with Parkinson disease (N = 95) were assessed for demoralization, depression, and resilience, as well as sociodemographic, clinical, and treatment-related variables. Bivariable associations, standard regressions, linear regression with copula correction, and correspondence analysis were used to analyze the data. RESULTS Although the bivariable association between resilience and depression was statistically significant, the association ceased to be significant when demoralization was taken into consideration in both standard regressions and linear regression with copula correction. By contrast, the association between resilience and demoralization was significant when depression was not taken into consideration and continued to be significant when depression was taken into consideration. Correspondence analysis revealed that low resilience was strongly related to demoralization combined with depression, whereas normal resilience was closely correlated with depression without demoralization. CONCLUSION These results expand our understanding of resilience by suggesting that it is a mechanism evolved to reduce or prevent demoralization and not just depression. Reducing demoralization and strengthening resilience as part of a comprehensive treatment plan are likely to improve the prognosis of Parkinson disease.
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Affiliation(s)
- John M. de Figueiredo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Boheng Zhu
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Amar S. Patel
- Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
| | - Robert Kohn
- Department of Psychiatry, Brown University School of Medicine, Providence, RI, United States
| | - Brian B. Koo
- Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
| | - Elan D. Louis
- Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
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Depression screening in pregnancy and postpartum: Just do something? Gen Hosp Psychiatry 2023; 82:14-18. [PMID: 36893651 DOI: 10.1016/j.genhosppsych.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 03/11/2023]
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Abstract
Individual attitudes and behavior related to health and disease are major components of clinical encounters. These factors shape lifestyle, presentation of symptoms, access to patient care, interactions between patients and physicians, adherence to medical advice, and response to treatment. Health attitudes and behavior may range from anxiety and worry about illness to various forms of denial, such as delay of seeking care and lack of adherence to treatment. When attitudes result in health-damaging behavior, they may be particularly difficult to understand and become a source of frustration to both physicians and patients. Devising appropriate responses by health care providers may contribute to improving final outcomes and decrease health care costs. In particular, health behavior is likely to play a major role in the process of convalescence, in self-management of chronic conditions, in determining a state of recovery, and whenever a rehabilitation process is involved. Understanding the spectrum of health attitudes and behavior is also crucial for motivating people to make beneficial changes (lifestyle medicine), as well as for implementing safety procedures in the community.
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Fava GA. An Editor's Journey Ends, but the Journal's Mission Continues. PSYCHOTHERAPY AND PSYCHOSOMATICS 2022; 91:218-226. [PMID: 35724641 DOI: 10.1159/000524654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 04/19/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Giovanni A Fava
- Department of Psychiatry, University at Buffalo, State University of New York, Buffalo, New York, New York, USA
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Kathmann N, Jacobi T, Elsner B, Reuter B. Effectiveness of Individual Cognitive-Behavioral Therapy and Predictors of Outcome in Adult Patients with Obsessive-Compulsive Disorder. PSYCHOTHERAPY AND PSYCHOSOMATICS 2022; 91:123-135. [PMID: 35034016 DOI: 10.1159/000520454] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 10/22/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Cognitive-behavioral therapy (CBT) for obsessive-compulsive disorder (OCD) has proven its efficacy in randomized controlled trials (RCTs). OBJECTIVE To test generalizability to routine care settings, we conducted an effectiveness study to provide naturalistic outcome data and their predictors. METHODS Pre-post changes in symptoms and impairment as well as response rates were determined in a naturalistic OCD sample (intention-to-treat, ITT, n = 393). Patients received individual CBT for OCD adopting an exposure-based, non-manualized treatment format. Linear and logistic regression analyses were applied to identify associations of sociodemographic and clinical variables with symptom change. RESULTS Effect size in ITT patients amounted to d = 1.47 in primary outcome (Yale-Brown Obsessive-Compulsive Scale, Y-BOCS). Remission rates were 46.3% (ITT), 52.0% (completers), and 18.2% (non-completers). The rates of treatment response without remission, no change, and deterioration in the ITT sample were 13.2, 38, and 3%, respectively. Initial symptom severity, comorbid personality disorder, and unemployment were associated with a poorer outcome, and previous medication with a better outcome. Comorbid depressive and anxiety disorders as well as other clinical or sociodemographic variables showed no effects on symptom change. CONCLUSIONS Outcomes in this large observational trial in a naturalistic setting correspond to available RCT findings suggesting that CBT for OCD should be strongly recommended for dissemination in routine care. Targets for further research include early prediction of non-response and development of alternative treatment strategies for patients who respond insufficiently.
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Affiliation(s)
- Norbert Kathmann
- Department of Psychology and Outpatient Clinical Care Unit, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Tanja Jacobi
- Department of Psychology and Outpatient Clinical Care Unit, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Björn Elsner
- Department of Psychology and Outpatient Clinical Care Unit, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Benedikt Reuter
- Department of Psychology and Outpatient Clinical Care Unit, Humboldt-Universität zu Berlin, Berlin, Germany
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9
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Zhu B, Kohn R, Patel A, Koo BB, Louis ED, de Figueiredo JM. Demoralization and Quality of Life of Patients with Parkinson Disease. PSYCHOTHERAPY AND PSYCHOSOMATICS 2022; 90:415-421. [PMID: 33601384 DOI: 10.1159/000514270] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 01/07/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Demoralization is quite prevalent in patients with Parkinson disease (PD). Unrecognized or untreated, demoralization may progress, at times, to demands for euthanasia and the desire for suicide. Typically, patients with PD do not complain of being "demoralized"; rather, they report disruptions in the quality of their lives. Hence, early identification of disruptions in health-related quality of life (HRQoL) specifically associated with demoralization may prompt earlier recognition and treatment. Published data on such associations, however, could not be found. Alleviation of demoralization in PD is likely to improve treatment outcomes. OBJECTIVE This research aimed at identifying the disruptions of HRQoL specifically associated with the demoralization of patients with PD. METHODS Consecutive general hospital outpatients with PD (n = 95) were assessed for: demoralization, with the Diagnostic Criteria for Psychosomatic Research Demoralization Scale (DCPR-D) and the Demoralization Scale (DS); depression, with the Patient Health Questionnaire-9 (PHQ-9); HRQoL, with the Parkinson Disease Questionnaire-Short Form (PDQ-8); sociodemographic variables; medical comorbidities; PD severity; and types of treatment. RESULTS The prevalence of demoralization was 19%. Regression analyses showed that demoralization was significantly more likely to be experienced by participants who had difficulty with mobility and felt embarrassed in public due to having PD. Demoralization explained HRQoL over and above depression. CONCLUSIONS Stigma and perceived difficulty with mobility are associated with demoralization of PD patients, and they may signal the need for psychotherapeutic and behavioral interventions to prevent the progression to helplessness, hopelessness, demands for euthanasia, and desire for suicide.
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Affiliation(s)
- Boheng Zhu
- Department of Psychology, University of Bologna, Bologna, Italy.,Formerly at the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Robert Kohn
- Department of Psychiatry, Brown University School of Medicine, Providence, Rhode Island, USA
| | - Amar Patel
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Brian B Koo
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Elan D Louis
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Formerly at the Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - John M de Figueiredo
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA,
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Cohen BM, Öngür D, Babb SM. Alternative Diagnostic Models of the Psychotic Disorders: Evidence-Based Choices. PSYCHOTHERAPY AND PSYCHOSOMATICS 2022; 90:373-385. [PMID: 34233335 DOI: 10.1159/000517027] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/19/2021] [Indexed: 11/19/2022]
Abstract
Standard diagnostic systems, the predominantly categorical DSM-5 and ICD-11, have limitations in validity, utility, and predictive and descriptive power. For psychotic disorders, these issues were partly addressed in current versions, but additional modifications are thought to be needed. Changes should be evidence based. We reviewed categorical, modified-categorical, and continuum-based models versus factor-based models of psychosis. Factors are clusters of symptoms or single prominent aspects of illness. Consistent evidence from studies of the genetics, pathobiology, and clinical presentation of psychotic disorders all support an underlying structure of factors, not categories, as best characterizing psychoses. Factors are not only the best fit but also comprehensive, as they can encompass any key feature of illness, including symptoms and course, as well as determinants of risk or response. Factors are inherently dimensional, even multidimensional, as are the psychoses themselves, and they provide the detail needed for either grouping or distinguishing patients for treatment decisions. The tools for making factor-based diagnoses are available, reliable, and concordant with actual practices used for clinical assessments. If needed, factors can be employed to create categories similar to those in current use. In addition, they can be used to define unique groupings of patients relevant to specific treatments or studies of the psychoses. Lastly, factor-based classifications are concordant with other comprehensive approaches to psychiatric nosology, including personalized (precision treatment) models and hierarchical models, both of which are currently being explored. Factors might be considered as the right primary structural choice for future versions of standard diagnostic systems, both DSM and ICD.
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Affiliation(s)
- Bruce M Cohen
- Harvard Medical School, Boston, Massachusetts, USA.,McLean Hospital, Belmont, Massachusetts, USA
| | - Dost Öngür
- Harvard Medical School, Boston, Massachusetts, USA.,McLean Hospital, Belmont, Massachusetts, USA
| | - Suzann M Babb
- Harvard Medical School, Boston, Massachusetts, USA.,McLean Hospital, Belmont, Massachusetts, USA
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11
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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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12
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Cosci F, Fava GA. Prescribing Pharmacotherapy for Major Depressive Disorder: How Does a Clinician Decide? Biomed Hub 2021; 6:118-121. [PMID: 34950673 PMCID: PMC8647051 DOI: 10.1159/000519656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 09/13/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy.,Clinical Pharmacopsychology Laboratory, University of Florence, Florence, Italy.,Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Giovanni A Fava
- Department of Psychiatry, University at Buffalo, State University of New York, Buffalo, New York, USA
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13
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Palagini L, Geoffroy PA, Riemann D. Sleep markers in psychiatry: do insomnia and disturbed sleep play as markers of disrupted neuroplasticity in mood disorders? A proposed model. Curr Med Chem 2021; 29:5595-5605. [PMID: 34906053 DOI: 10.2174/0929867328666211214164907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/31/2021] [Accepted: 09/05/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Since insomnia and disturbed sleep may affect neuroplasticity, we aimed at reviewing their potential role as markers of disrupted neuroplasticity involved in mood disorders. METHOD We performed a systematic review, according to PRIMA, on PubMed, PsycINFO and Embase electronic databases for literature regarding mood disorders, insomnia, sleep loss/deprivation in relation to different pathways involved in the impairment of neuroplasticity in mood disorders such as 1] alterations in neurodevelopment 2] activation of the stress system 3] neuroinflammation 4] neurodegeneration/neuroprogression, 4] deficit in neuroprotection. RESULTS Sixty-five articles were analyzed and a narrative/ theoretical review was conducted. Studies showed that insomnia, sleep loss and sleep deprivation might impair brain plasticity of those areas involved in mood regulation throughout different pathways. Insomnia and disrupted sleep may act as neurobiological stressors that by over-activating the stress and inflammatory systems may affect neural plasticity causing neuronal damage. In addition, disturbed sleep may favor a deficit in neuroprotection hence contributing to impaired neuroplasticity. CONCLUSIONS Insomnia and disturbed sleep may play a role as markers of alteration in brain plasticity in mood disorders. Assessing and targeting insomnia in the clinical practice may potentially play a neuroprotective role, contributing to "repairing" alterations in neuroplasticity or to the functional recovery of those areas involved in mood and emotion regulation.
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Affiliation(s)
- Laura Palagini
- Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, Via Roma 67, 56100, Pisa. Italy
| | - Pierre Alexis Geoffroy
- Département de psychiatrie et d'addictologie, AP-HP, Hopital Bichat - Claude Bernard, F-75018 Paris, France; Université de Paris, NeuroDiderot, Inserm U1141, F-75019 Paris. France
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg. Germany
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Evers AWM, Colloca L, Blease C, Gaab J, Jensen KB, Atlas LY, Beedie CJ, Benedetti F, Bingel U, Büchel C, Bussemaker J, Colagiuri B, Crum AJ, Finniss DG, Geers AL, Howick J, Klinger R, Meeuwis SH, Meissner K, Napadow V, Petrie KJ, Rief W, Smeets I, Wager TD, Wanigasekera V, Vase L, Kelley JM, Kirsch I. What Should Clinicians Tell Patients about Placebo and Nocebo Effects? Practical Considerations Based on Expert Consensus. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 90:49-56. [PMID: 33075796 DOI: 10.1159/000510738] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/23/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Clinical and laboratory studies demonstrate that placebo and nocebo effects influence various symptoms and conditions after the administration of both inert and active treatments. OBJECTIVE There is an increasing need for up-to-date recommendations on how to inform patients about placebo and nocebo effects in clinical practice and train clinicians how to disclose this information. METHODS Based on previous clinical recommendations concerning placebo and nocebo effects, a 3-step, invitation-only Delphi study was conducted among an interdisciplinary group of internationally recognized experts. The study consisted of open- and closed-ended survey questions followed by a final expert meeting. The surveys were subdivided into 3 parts: (1) informing patients about placebo effects, (2) informing patients about nocebo effects, and (3) training clinicians how to communicate this information to the patients. RESULTS There was consensus that communicating general information about placebo and nocebo effects to patients (e.g., explaining their role in treatment) could be beneficial, but that such information needs to be adjusted to match the specific clinical context (e.g., condition and treatment). Experts also agreed that training clinicians to communicate about placebo and nocebo effects should be a regular and integrated part of medical education that makes use of multiple formats, including face-to-face and online modalities. CONCLUSIONS The current 3-step Delphi study provides consensus-based recommendations and practical considerations for disclosures about placebo and nocebo effects in clinical practice. Future research is needed on how to optimally tailor information to specific clinical conditions and patients' needs, and on developing standardized disclosure training modules for clinicians.
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Affiliation(s)
- Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands, .,Erasmus University Rotterdam & Delft University of Technology, Rotterdam/Delft, The Netherlands,
| | - Luana Colloca
- Departments of Pain Translational Symptoms Science and Anesthesiology, School of Nursing and Medicine, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Charlotte Blease
- General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jens Gaab
- Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Karin B Jensen
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Lauren Y Atlas
- National Center for Complementary and Integrative Health, National Institute of Mental Health, and National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, USA
| | - Chris J Beedie
- School of Psychology, University of Kent, Canterbury, United Kingdom
| | - Fabrizio Benedetti
- Physiology and Neuroscience, University of Turin Medical School, Turin, Italy
| | - Ulrike Bingel
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Christian Büchel
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jet Bussemaker
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Ben Colagiuri
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Alia J Crum
- Department of Psychology, Stanford University, Stanford, California, USA
| | | | - Andrew L Geers
- Department of Psychology, University of Toledo, Toledo, Ohio, USA
| | - Jeremy Howick
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Regine Klinger
- Center for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefanie H Meeuwis
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Karin Meissner
- Division of Health Promotion, University of Applied Sciences, Coburg, Germany
| | - Vitaly Napadow
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, USA
| | - Keith J Petrie
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
| | - Ionica Smeets
- Science Communication and Society, Institute of Biology, Leiden University, Leiden, The Netherlands
| | - Tor D Wager
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire, USA
| | | | - Lene Vase
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - John M Kelley
- Beth Israel Deaconess Medical Center, Harvard Medical School, Program in Placebo Studies, Boston, Massachusetts, USA
| | - Irving Kirsch
- Beth Israel Deaconess Medical Center, Harvard Medical School, Program in Placebo Studies, Boston, Massachusetts, USA
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Guidi J, Lucente M, Sonino N, Fava GA. Allostatic Load and Its Impact on Health: A Systematic Review. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 90:11-27. [PMID: 32799204 DOI: 10.1159/000510696] [Citation(s) in RCA: 382] [Impact Index Per Article: 127.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 08/06/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Allostatic load refers to the cumulative burden of chronic stress and life events. It involves the interaction of different physiological systems at varying degrees of activity. When environmental challenges exceed the individual ability to cope, then allostatic overload ensues. Allostatic load is identified by the use of biomarkers and clinical criteria. OBJECTIVE To summarize the current knowledge on allostatic load and overload and its clinical implications based on a systematic review of the literature. METHODS PubMed, PsycINFO, Web of Science, and the Cochrane Library were searched from inception to December 2019. A manual search of the literature was also performed, and reference lists of the retrieved articles were examined.We considered only studies in which allostatic load or overload were adequately described and assessed in either clinical or non-clinical adult populations. RESULTS A total of 267 original investigations were included. They encompassed general population studies, as well as clinical studies on consequences of allostatic load/overload on both physical and mental health across a variety of settings. CONCLUSIONS The findings indicate that allostatic load and overload are associated with poorer health outcomes. Assessment of allostatic load provides support to the understanding of psychosocial determinants of health and lifestyle medicine. An integrated approach that includes both biological markers and clinimetric criteria is recommended.
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Affiliation(s)
- Jenny Guidi
- Department of Psychology, University of Bologna, Bologna, Italy,
| | | | - Nicoletta Sonino
- Department of Statistical Sciences, University of Padova, Padova, Italy.,Department of Psychiatry, State University of New York at Buffalo, Buffalo, New York, USA
| | - Giovanni A Fava
- Department of Psychiatry, State University of New York at Buffalo, Buffalo, New York, USA
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16
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Wang J, Cosci F. Neonatal Withdrawal Syndrome following Late in utero Exposure to Selective Serotonin Reuptake Inhibitors: A Systematic Review and Meta-Analysis of Observational Studies. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 90:299-307. [PMID: 33971648 DOI: 10.1159/000516031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/20/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION A clear picture of neonatal withdrawal signs due to in utero selective serotonin reuptake inhibitor (SSRI) exposure and its consequences is still missing. OBJECTIVE A systematic review and a meta-analysis were performed to provide an overview of neonatal withdrawal signs following late in utero exposure to SSRIs and to quantify the corresponding risks. METHODS MEDLINE, Web of Science, and Embase were searched from inception to January 2021. The Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines were followed. English-language observational studies reporting on acute postpartum outcomes following late in utero exposure to SSRIs or SSRIs/venlafaxine were evaluated. RESULTS Of 2,269 citations reviewed, 79 studies were assessed for eligibility; 13 were included in the qualitative analysis of the literature, which allowed us to identify 26 signs. A meta-analysis was run separately for studies on SSRI exposure (n = 3) and those on SSRI/venlafaxine exposure (n = 6). Hypoglycemia was identified as a withdrawal sign based on the SSRI studies. Tremors, hypotonia, tachycardia, rapid breathing, respiratory distress, and hypertonia were identified as withdrawal signs based on the SSRI/venlafaxine studies. CONCLUSIONS The present work provides a framework for the identification of neonatal SSRI withdrawal syndrome. Tapering and discontinuation of antidepressant drugs before and during the early phase of pregnancy are worth attempting to prevent the occurrence of this syndrome.
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Affiliation(s)
- Jianjun Wang
- Department of Neurology and Psychology, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy.,Clinical Pharmacopsychology Laboratory, University of Florence, Florence, Italy.,Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
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17
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Costa MDA, Gonçalves FG, Tatton-Ramos T, Fonseca NKDOD, Schwinn JK, Alves SG, Salum GA, Manfro GG. A Three-Arm Randomized Clinical Trial Comparing the Efficacy of a Mindfulness-Based Intervention with an Active Comparison Group and Fluoxetine Treatment for Adults with Generalized Anxiety Disorder. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 90:269-279. [PMID: 33321509 DOI: 10.1159/000511880] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 09/25/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Mindfulness-based interventions have been studied as an alternative treatment for anxiety disorders, but there are only a few studies comparing these with established treatments. OBJECTIVE To evaluate the efficacy of a Body in Mind Training (BMT) program for adults with generalized anxiety disorder (GAD), an active comparison protocol called Quality of Life and Psychoeducation (QoL), and treatment with fluoxetine (FLX). METHODS This study comprises a 3-arm parallel-group, randomized clinical trial (ClinicalTrials.gov ID: NCT03072264). Adults with a primary diagnosis of GAD and no current treatment were recruited from the community and randomized in a ratio 1:1:1. The primary outcomes were assessed by means of the Hamilton Anxiety Rating Scale (HAM-A) and the Penn State Worry Questionnaire (PSWQ) at week 8. Data were analyzed using a superiority analysis (BMT vs. QoL) and a noninferiority analysis (BMT vs. FLX). RESULTS A total of 249 participants were included and 223 were analyzed (76 BMT, 79 FLX, and 68 QoL). All groups improved after intervention. However, BMT was not superior to QoL at week 8 (mean difference = -1.36; p = 0.47), nor was it noninferior to FLX as assessed with theHAM-A (mean difference = 3.5; 95% CI -0.06 to 7.06; noninferiority margin = -2.43; p = 0.054). QoL (mean difference = 3.54; p = 0.04) and FLX (mean difference = -7.72; 95% CI -10.89 to -4.56; noninferiority margin = -2.09; p < 0.001) were superior to BMT in reducing PSWQ score. CONCLUSION Our data suggest that BMT, in its current format, cannot be considered an effective mindfulness protocol to improve GAD.
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Affiliation(s)
- Marianna de Abreu Costa
- Anxiety Disorders Program (PROTAN), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil, .,Graduate Program in Psychiatry and Behavioral Sciences, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil,
| | - Francine Guimarães Gonçalves
- Anxiety Disorders Program (PROTAN), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Graduate Program in Psychiatry and Behavioral Sciences, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | | | - Natasha Kim de Oliveira da Fonseca
- Anxiety Disorders Program (PROTAN), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Graduate Program in Psychiatry and Behavioral Sciences, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Julia Karl Schwinn
- Anxiety Disorders Program (PROTAN), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Sofia Giusti Alves
- Anxiety Disorders Program (PROTAN), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Giovanni Abrahão Salum
- Anxiety Disorders Program (PROTAN), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Graduate Program in Psychiatry and Behavioral Sciences, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Gisele Gus Manfro
- Anxiety Disorders Program (PROTAN), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Graduate Program in Psychiatry and Behavioral Sciences, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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18
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Svensson M, Nilsson T, Perrin S, Johansson H, Viborg G, Falkenström F, Sandell R. The Effect of Patient's Choice of Cognitive Behavioural or Psychodynamic Therapy on Outcomes for Panic Disorder: A Doubly Randomised Controlled Preference Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 90:107-118. [PMID: 33227785 DOI: 10.1159/000511469] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/04/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION It remains unclear whether offering psychiatric patients their preferred treatment influences outcomes at the symptom level. OBJECTIVE To assess whether offering patients with panic disorder with/without agoraphobia (PD/A) a choice between 2 psychotherapies yields superior outcomes to random assignment. METHODS In a doubly randomised, controlled preference trial (DRCPT), 221 adults with PD/A were randomly assigned to: choosing panic-focused psychodynamic therapy (PFPP) or panic control treatment (PCT; a form of cognitive behavioural therapy); random assignment to PFPP or PCT; or waiting list control. Primary outcomes were PD/A severity, work status and work absences at post-treatment assessment. Outcomes at post-treatment assessment, 6-, 12-, and 24-month follow-ups were assessed using segmented multilevel linear growth models. RESULTS At post-treatment assessment, the choice and random conditions were superior to the control for panic severity but not work status/absences. The choice and random conditions did not differ during treatment or follow-up for the primary outcomes. For panic severity, PCT was superior to PFPP during treatment (standardised mean difference, SMD, -0.64; 95% confidence interval, CI, -1.02 to -0.25); PFPP was superior to PCT during follow-up (SMD 0.62; 95% CI 0.27-0.98). There was no allocation by treatment type interaction (SMD -0.57; 95% CI -1.31 to 0.17). CONCLUSIONS Previous studies have found that offering patients their preferred treatment yields small to moderate effects but have not employed designs that could rigorously test preference effects. In this first DRCPT of 2 evidence-based psychotherapies, allowing patients with PD/A to choose their preferred treatment was not associated with improved outcomes. Further DRCPTs are needed.
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Affiliation(s)
| | | | - Sean Perrin
- Department of Psychology, Lund University, Lund, Sweden
| | | | - Gardar Viborg
- Department of Psychology, Lund University, Lund, Sweden
| | - Fredrik Falkenström
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Rolf Sandell
- Department of Psychology, Lund University, Lund, Sweden
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Cosci F, Fava GA. When Anxiety and Depression Coexist: The Role of Differential Diagnosis Using Clinimetric Criteria. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 90:308-317. [PMID: 34344013 DOI: 10.1159/000517518] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/31/2021] [Indexed: 11/19/2022]
Abstract
Depressive and anxiety disorders are frequently associated. Depression may be a complication of anxiety and anxiety can complicate depression. The nature of their relationship has been a source of controversy. Reviews generally base their conclusions on randomized controlled trials and meta-analyses that refer to the average patient and often clash with the variety of clinical presentations that may occur when anxiety and depression coexist. The aim of this review was to examine the literature according to profiling of subgroups of patients based on clinimetric criteria, in line with the recently developed concept of medicine-based evidence. We critically reviewed the literature pertaining to the specific presentations of anxiety and depression, outlining the advantages and disadvantages of each treatment approach. The following prototypic cases were presented: depression secondary to an active anxiety disorder, depression in patients with anxiety disorders under treatment, anxious depression, anxiety as a residual component of depression, and demoralization secondary to anxiety disorder. We argue that the selection of treatment when anxiety and depression coexist should take into account the modalities of presentation and be filtered by clinical judgment. Very different indications may ensue when the literature is examined according to this perspective.
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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
| | - Giovanni A Fava
- Department of Psychiatry, University at Buffalo, State University of New York, New York, New York, USA
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20
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Schmid C, Hansen K, Kröner-Borowik T, Steil R. Imagery Rescripting and Imaginal Exposure in Nightmare Disorder Compared to Positive Imagery: A Randomized Controlled Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 90:328-340. [PMID: 33477151 DOI: 10.1159/000512757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 11/02/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Both imagery rescripting and imaginal exposure have been proven to be effective in the treatment of chronic nightmares when compared to a waitlist condition. Little is known about their comparative efficacy and their efficacy compared to an active control. OBJECTIVE The aims of this study were to compare the two treatments to one another and to positive imagery as an active control, and to explore covariates of the treatment effect. METHODS In this single-blinded randomized controlled trial, 96 patients with nightmare disorder (idiopathic nightmares) from an outpatient clinic were randomly assigned to a single individual treatment session of rescripting, exposure, or positive imagery and 4 weeks of practice at home. The primary outcome was nightmare distress, and the secondary outcomes were nightmare frequency, nightmare effects, self-efficacy, and general psychopathology. RESULTS Nightmare distress was reduced in all groups (imagery rescripting: Cohen's d = -1.04, imaginal exposure: d = -0.68, positive imagery: d = -0.57), as were nightmare frequency, nightmare effects, and psychopathology. Self-efficacy was enhanced. No differential treatment effects were found on any primary or secondary measure. Treatment gains were not associated with demographic or disorder characteristics, baseline values, treatment credibility, or the number of practice sessions. CONCLUSIONS Even short nightmare treatments are effective regardless of personal characteristics, and different interventions produce similar results. Future research should aim to clarify the mechanisms of action. Health care should make more use of these powerful and easy-to-administer nightmare treatments.
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Affiliation(s)
- Carolin Schmid
- Department of Clinical Psychology, Goethe University, Frankfurt am Main, Germany,
| | - Kathrin Hansen
- Department of Clinical Psychology, Goethe University, Frankfurt am Main, Germany
| | - Tana Kröner-Borowik
- Department of Clinical Psychology, Goethe University, Frankfurt am Main, Germany
| | - Regina Steil
- Department of Clinical Psychology, Goethe University, Frankfurt am Main, Germany
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21
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Patacchini A, Cosci F. Exposure to serotonin selective reuptake inhibitors or serotonin noradrenaline reuptake inhibitors and sexual dysfunction: Results from an online survey. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2021; 32:229-242. [DOI: 10.3233/jrs-200074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Post-SSRI Sexual Dysfunction (PSSD) is characterized by sexual and emotional symptoms associated to the exposure to Selective Serotonin Reuptake Inhibitors (SSRI) or Serotonin Noradrenaline Reuptake Inhibitors (SNRI). OBJECTIVE: The present study provides a comprehensive picture on demographic and clinical characteristics associated to PSSD. METHODS: An online survey was run on subjects self-declaring as affected by PSSD. The survey collected socio-demographic and clinical data via questions created ad hoc and three standardized scales (Arizona Sexual Experiences Scale, Hospital Anxiety and Depression Scale, World Health Organization Wellbeing Index). RESULTS: A total of 135 subjects (115 males; mean age 31.9 ± 8.9 years) was analysed. The syndrome was more represented among young, heterosexual males after the exposure to SSRI/SNRI at relatively high doses. The major findings involved the temporal sequence of symptoms: 118 subjects had symptoms both during and after SSRI/SNRI administration, and 17 only after, thus deposing for a iatrogenic action of SSRI/SNRI. Different variables, represented by both emotional and sexual symptoms, accounted for the variability of the severity of the sexual dysfunction as well as of wellbeing. CONCLUSIONS: Based on the present results, PSSD is a complex iatrogenic syndrome in need of being further studied and understood.
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Affiliation(s)
| | - Fiammetta Cosci
- , University of Florence, , Italy
- , University of Florence, , Italy
- , Maastricht University, , The Netherlands
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22
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Rafanelli C, Gostoli S, Buzzichelli S, Guidi J, Sirri L, Gallo P, Marzola E, Bergerone S, De Ferrari GM, Roncuzzi R, Di Pasquale G, Abbate-Daga G, Fava GA. Sequential Combination of Cognitive-Behavioral Treatment and Well-Being Therapy in Depressed Patients with Acute Coronary Syndromes: A Randomized Controlled Trial (TREATED-ACS Study). PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 89:345-356. [PMID: 32791501 DOI: 10.1159/000510006] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/06/2020] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Randomized controlled trials (RCT) of psychotherapeutic interventions have addressed depression and demoralization associated with acute coronary syndromes (ACS). The present trial introduces psychological well-being, an increasingly recognized factor in cardiovascular health, as a therapeutic target. OBJECTIVE This study was designed to determine whether the sequential combination of cognitive-behavioral therapy (CBT) and well-being therapy (WBT) may yield more favorable outcomes than an active control group (clinical management; CM) and to identify subgroups of patients at greater risk for cardiac negative outcomes. METHODS This multicenter RCT comparedCBT/WBT sequential combination versus CM, with up to 30 months of follow-up. One hundred consecutive depressed and/or demoralized patients (out of 740 initially screened by cardiologists after a first episode of ACS) were randomized to CBT/WBT associated with lifestyle suggestions (n = 50) and CM (n = 50). The main outcome measures included: severity of depressive symptoms according to the Clinical Interview for Depression, changes in subclinical psychological distress, well-being, and biomarkers, and medical complications and events. RESULTS CBT/WBT sequential combination was associated with a significant improvement in depressive symptoms compared to CM. In both groups, the benefits persisted at follow-up, even though the differences faded. Treatment was also related to a significant amelioration of biomarkers (platelet count, HDL, and D-dimer), whereas the 2 groups showed similar frequencies of adverse cardiac events. CONCLUSIONS Addressing psychological well-being in the psychotherapeutic approach to ACS patients with depressive symptoms was found to entail important clinical benefits. It is argued that lifestyle changes geared toward cardiovascular health may be facilitated by a personalized approach that targets well-being.
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Affiliation(s)
- Chiara Rafanelli
- Department of Psychology, University of Bologna, Bologna, Italy,
| | - Sara Gostoli
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Sara Buzzichelli
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Jenny Guidi
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Laura Sirri
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Pamela Gallo
- Division of Cardiology, Maggiore Hospital, Bologna, Italy
| | - Enrica Marzola
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Serena Bergerone
- Division of Cardiology, Internal Medicine Department, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Internal Medicine Department, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Renzo Roncuzzi
- Division of Cardiology, Bellaria Hospital, Bologna, Italy
| | | | - Giovanni Abbate-Daga
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Giovanni A Fava
- Department of Psychiatry, University at Buffalo, Buffalo, New York, USA
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Fava GA, Cosci F, Guidi J, Rafanelli C. The Deceptive Manifestations of Treatment Resistance in Depression: A New Look at the Problem. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 89:265-273. [PMID: 32325457 DOI: 10.1159/000507227] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 03/11/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Giovanni A Fava
- Department of Psychiatry, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Jenny Guidi
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Chiara Rafanelli
- Department of Psychology, University of Bologna, Bologna, Italy,
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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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25
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van Gelderen MJ, Nijdam MJ, Haagen JFG, Vermetten E. Interactive Motion-Assisted Exposure Therapy for Veterans with Treatment-Resistant Posttraumatic Stress Disorder: A Randomized Controlled Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 89:215-227. [PMID: 32203971 DOI: 10.1159/000505977] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/16/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Veterans with posttraumatic stress disorder (PTSD) tend to benefit less from evidence-based treatments than other PTSD populations. A novel virtual reality and motion-assisted exposure therapy, called 3MDR, provides treatment in an immersive, personalized and activating context. OBJECTIVE To study the efficacy of 3MDR for veterans with treatment-resistant PTSD. METHOD In a randomized controlled trial (n = 43) 3MDR was compared to a non-specific treatment component control group. Primary outcome was clinician-rated PTSD symptoms at baseline, after 3MDR, and at the 12-week and 16-week follow-up (primary end point). Intention-to-treat analyses of covariance and mixed models were applied to study differences between groups at the end point and over the course of intervention, controlling for baseline scores. RESULTS The decrease in PTSD symptom severity from baseline to end point was significantly greater for 3MDR as compared to the control group, with a large effect size (F[1, 37] = 6.43, p = 0.016, d = 0.83). No significant between-group difference was detected in the course of PTSD symptoms during treatment when including all time points. The dropout rate was low (7%), and 45% of the patients in the 3MDR group improved clinically. The number needed to treat was 2.86. CONCLUSIONS In this trial, 3MDR significantly decreased PTSD symptoms in veterans with, on average, a history of 4 unsuccessful treatments. The low dropout rate may be indicative of high engagement. However, a lack of significant differences on secondary outcomes limits conclusions that can be drawn on its efficacy and underlines the need for larger phase III trials. These data show emerging evidence for 3MDR and its potential to progress PTSD treatment for veterans (Dutch Trial Register Identifier: NL5126).
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Affiliation(s)
- Marieke J van Gelderen
- ARQ Centrum'45, Diemen, The Netherlands, .,Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands,
| | - Mirjam J Nijdam
- ARQ Centrum'45, Diemen, The Netherlands.,Department of Psychiatry, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Eric Vermetten
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.,ARQ National Psychotrauma Centre, Diemen, The Netherlands.,Military Mental Health Research, Ministry of Defense, Utrecht, The Netherlands
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27
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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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Kimura H, Kanahara N, Iyo M. Rationale and neurobiological effects of treatment with antipsychotics in patients with chronic schizophrenia considering dopamine supersensitivity. Behav Brain Res 2021; 403:113126. [PMID: 33460681 DOI: 10.1016/j.bbr.2021.113126] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/29/2020] [Accepted: 01/04/2021] [Indexed: 12/12/2022]
Abstract
The long-term treatment of patients with schizophrenia often involves the management of relapses for most patients and the development of treatment resistance in some patients. To stabilize the clinical course and allow as many patients as possible to recover, clinicians need to recognize dopamine supersensitivity, which can be provoked by administration of high dosages of antipsychotics, and deal with it properly. However, no treatment guidelines have addressed this issue. The present review summarized the characteristics of long-acting injectable antipsychotics, dopamine partial agonists, and clozapine in relation to dopamine supersensitivity from the viewpoints of receptor profiles and pharmacokinetics. The potential merits and limitations of these medicines are discussed, as well as the risks of treating patients with established dopamine supersensitivity with these classes of drugs. Finally, the review discussed the biological influence of antipsychotic treatment on the human brain based on findings regarding the relationship between the hippocampus and antipsychotics.
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Affiliation(s)
- Hiroshi Kimura
- Department of Psychiatry, School of Medicine, International University of Health and Welfare, Chiba, Japan; Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan; Department of Psychiatry, Gakuji-kai Kimura Hospital, Chiba, Japan.
| | - Nobuhisa Kanahara
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan; Division of Medical Treatment and Rehabilitation, Chiba University Center for Forensic Mental Health, Chiba, Japan
| | - Masaomi Iyo
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
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30
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Marín-Navarrete R, Torrens M, Toledo-Fernández A, Mestre-Pinto JI, Sánchez-Domínguez R, Pérez-Lopez A, Saracco-Alvarez R, Madrigal-De León EÁ, Szerman N. Developing an App to Screen for Dual Disorders: A Tool for Improving Treatment Services in Mexico. Front Psychiatry 2021; 12:697598. [PMID: 34777035 PMCID: PMC8585995 DOI: 10.3389/fpsyt.2021.697598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/31/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Previous studies in Mexico undertaken at residential facilities for treating substance use disorders (SUDs) reported that the prevalence of Dual Disorders (DDs) is over 65%. DDs pose a major challenge for the Mexican health system, particularly for community-based residential care facilities for SUDs, due to the shortage of certified professionals to diagnose and treat these patients. Moreover, the lack of standardized algorithms for screening for and evaluating DDs to refer patients to specialized services (whether private or public) hinders timely care, delaying the start of integrated treatment. The use of new technologies provides a strategic opportunity for the timely detection of DDs through the development of standardized digital applications for the timely detection of DDs. Objective: To develop an app to screen for DDs, which will contribute to referral to specialized services in keeping with the level of severity of psychiatric and addictive symptomatology, and be suitable for use by community-based residential care facilities for SUDs. Method: The research project was implemented in two stages. Stage 1 involved obtaining the psychometric properties of the Dual Diagnosis Screening Interview (DDSI). Stage 2 consisted of two steps to test the Beta version of the app and the quality of version 1.0. Results: The DDS obtained sensitivity and specificity scores above 85%. The app and its algorithm to screen for and refer DDs proved to be efficient and easy to apply with satisfactory community acceptance. Conclusion: The app promises to be a useful screening tool at residential addiction treatment centers.
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Affiliation(s)
- Rodrigo Marín-Navarrete
- Unidad de Ensayos Clínicos en Adicciones y Salud Mental, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Marta Torrens
- Programa de Investigación en Neurociencias, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Aldebarán Toledo-Fernández
- Unidad de Ensayos Clínicos en Adicciones y Salud Mental, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico.,Centro Anáhuac de Investigación en Psicología, Facultad de Psicología, Universidad Anahuac Mexico, Mexico, Mexico
| | - Joan Ignasi Mestre-Pinto
- Programa de Investigación en Neurociencias, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Ricardo Sánchez-Domínguez
- Unidad de Ensayos Clínicos en Adicciones y Salud Mental, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Alejandro Pérez-Lopez
- Unidad de Ensayos Clínicos en Adicciones y Salud Mental, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Ricardo Saracco-Alvarez
- Unidad de Ensayos Clínicos en Adicciones y Salud Mental, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Eduardo Ángel Madrigal-De León
- Unidad de Ensayos Clínicos en Adicciones y Salud Mental, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Nestor Szerman
- Hospital Gregorio Marañón, Servicio de Salud Mental Retiro, Madrid, Spain
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31
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Guidi J, Fava GA. The emerging role of euthymia in psychotherapy research and practice. Clin Psychol Rev 2020; 82:101941. [DOI: 10.1016/j.cpr.2020.101941] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/26/2020] [Accepted: 10/20/2020] [Indexed: 12/13/2022]
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32
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Fava GA. The Decline of Pluralism in Medicine: Dissent Is Welcome. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 89:1-5. [PMID: 31838479 DOI: 10.1159/000505085] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 11/21/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Giovanni A Fava
- Department of Psychiatry, University at Buffalo, State University of New York, Buffalo, New York, USA,
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33
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Cosci F, Mansueto G, Fava GA. Relapse prevention in recurrent major depressive disorder. A comparison of different treatment options based on clinical experience and a critical review of the literature. Int J Psychiatry Clin Pract 2020; 24:341-348. [PMID: 32716222 DOI: 10.1080/13651501.2020.1779308] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Reducing the risk of relapses is a critical component of major depressive disorders treatment. Guidelines suggest maintenance with antidepressant drugs in recurrent depression, but this solution has recently been questioned. OBJECTIVE The aim of this article is to provide a critical review of the literature of the main treatment options currently available to prevent relapse and recurrence in depression. METHODS We compared long-term antidepressant therapy (i.e., indefinite maintenance of antidepressant), intermittent antidepressant therapy (i.e., use of antidepressants mainly limited to the acute phases), use of psychotherapy in the sequential model (i.e., pharmacotherapy in the acute phase and psychotherapy in the residual phase). RESULTS We argue that the same solution may not apply to all patients and question the feasibility of a single course of treatment in the setting of complex disorders that are encountered in practice. The clinician should weigh advantages and disadvantages in the individual case. CONCLUSIONS The sequential model appears to be particularly indicated in recurrent depression. KEY POINTS Relapse is a major challenge of depressive disorders treatment Treatment options currently available include long-term antidepressants, intermittent antidepressants, addition of psychotherapy to pharmacotherapy in the sequential model Maintenance with antidepressants in recurrent depression has recently been questioned The sequential model appears to be particularly indicated in recurrent depression.
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Affiliation(s)
- Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy.,Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | - Giovanni Mansueto
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Giovanni Andrea Fava
- Department of Psychiatry, State University of New York at Buffalo, Buffalo, NY, USA
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34
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Fava GA. The Age of Transition. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 90:1-4. [PMID: 33080595 DOI: 10.1159/000511544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 09/13/2020] [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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35
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Schifano F. Coming Off Prescribed Psychotropic Medications: Insights from Their Use as Recreational Drugs. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 89:274-282. [PMID: 32615566 DOI: 10.1159/000507897] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/15/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Fabrizio Schifano
- Psychopharmacology, Drug Misuse, and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom,
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36
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Cosci F, Guidi J, Mansueto G, Fava GA. Psychotherapy in recurrent depression: efficacy, pitfalls, and recommendations. Expert Rev Neurother 2020; 20:1169-1175. [DOI: 10.1080/14737175.2020.1804870] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Jenny Guidi
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Giovanni Mansueto
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Giovanni A. Fava
- Department of Psychiatry, University at Buffalo, State University of New York, Buffalo, NY, USA
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37
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Holt RIG. The Management of Obesity in People with Severe Mental Illness: An Unresolved Conundrum. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 88:327-332. [PMID: 31587002 DOI: 10.1159/000503835] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 10/01/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Richard I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom,
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38
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Streltzer J. Iatrogenic Psychopathology in Chronic Pain. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 88:312. [PMID: 31487727 DOI: 10.1159/000502153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 07/15/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Jon Streltzer
- Department of Psychiatry, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA,
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39
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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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40
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Thombs B, Turner KA, Shrier I. Defining and Evaluating Overdiagnosis in Mental Health: A Meta-Research Review. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 88:193-202. [PMID: 31340212 DOI: 10.1159/000501647] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 06/21/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Overdiagnosis is thought to be common in some mental disorders, but it has not been defined or examined systematically. Assessing overdiagnosis in mental health requires a consistently applied definition that differentiates overdiagnosis from other problems (e.g., misdiagnosis), as well as methods for quantification. OBJECTIVES Our objectives were to (1) describe how the term "overdiagnosis" has been defined explicitly or implicitly in published articles on mental disorders, including usages consistent (overdefinition, overdetection) and inconsistent (misdiagnosis, false-positive test results, overtreatment, overtesting) with accepted definitions of overdiagnosis; and (2) identify examples of attempts to quantify overdiagnosis. METHOD We searchedPubMed through January 5, 2019. Articles on mental disorders, excluding neurocognitive disorders, were eligible if they usedthe term "overdiagnosis" in the title, abstract, or text. RESULTS We identified 164 eligible articles with 193 total explicit or implicit uses of the term "overdiagnosis." Of 9 articles with an explicit definition, only one provided a definition that was partially consistent with accepted definitions. Of all uses, 11.4% were consistent, and 76.7% were related to misdiagnosis and thus inconsistent. No attempts to quantify the proportion of patients who were overdiagnosed based on overdetection or overdefinition were identified. CONCLUSIONS There are few examples of mental health articles that describe overdiagnosis consistent with accepted definitions and no examples of quantifying overdiagnosis based on these definitions. A definition of overdiagnosis based on diagnostic criteria that include people with transient or mild symptoms not amenable to treatment (overdefinition) could be used to quantify the extent of overdiagnosis in mental disorders.
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Affiliation(s)
- Brett Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Québec, Canada, .,Department of Psychiatry, McGill University, Montreal, Québec, Canada, .,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada, .,Department of Medicine, McGill University, Montreal, Québec, Canada, .,Department of Psychology, McGill University, Montreal, Québec, Canada, .,Department of Educational and Counselling Psychology, McGill University, Montreal, Québec, Canada,
| | - Kimberly A Turner
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Québec, Canada.,Department of Psychiatry, McGill University, Montreal, Québec, Canada
| | - Ian Shrier
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
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41
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Kim DD, Barr AM, Lu C, Stewart SE, White RF, Honer WG, Procyshyn RM. Clozapine-Associated Obsessive-Compulsive Symptoms and Their Management: A Systematic Review and Analysis of 107 Reported Cases. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 89:151-160. [PMID: 32045914 DOI: 10.1159/000505876] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 01/12/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND It is not uncommon to find obsessive-compulsive symptoms (OCS) in patients treated with clozapine. These symptoms are attributed to anti-serotonergic effects of clozapine. The objective of this study was to conduct a systematic review of reported cases of clozapine-associated OCS to better understand the nature and management of these symptoms. METHODS MEDLINE, Embase, and PsycINFO databases were searched with no publication year or language restrictions. Studies reporting cases of clozapine-associated OCS, either de novo or exacerbation of preexisting OCS, were included. The final search date was July 11, 2019. RESULTS Fifty-seven studies, involving 107 cases (75 de novo, 32 exacerbated OCS), were included. Clozapine triggered moderate-severe OCS at varying doses (100-900 mg/day) and treatment durations (median 6 months, interquartile range 2-24 months). Higher severity was significantly associated with preexisting OCS, poorer insight into OCS, and active psychosis at the time of OCS. Common strategies to treat clozapine-associated OCS included adding selective serotonin reuptake inhibitors, clomipramine, or aripiprazole, often accompanied by clozapine dose reduction. The rate of response to antidepressants was 49% (29/59), where younger age, shorter duration of underlying illness, shorter cloza-pine treatment duration, better insight into OCS, and presence of taboo thoughts were significantly associated with antidepressant response. Subsequent clozapine dose reduction was effective in many non-responders, where aripiprazole was simultaneously added in 50% (8/16). CONCLUSIONS Clozapine can trigger severe OCS. Adding aripiprazole with/without clozapine dose reduction may be a good alternative to antidepressants for managing clozapine-associated OCS. Clinicians should be more vigilant about these adverse effects and administer appropriate treatments.
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Affiliation(s)
- David D Kim
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Mental Health and Substance Use Services, Vancouver, British Columbia, Canada
| | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Mental Health and Substance Use Services, Vancouver, British Columbia, Canada
| | - Cynthia Lu
- British Columbia Mental Health and Substance Use Services, Vancouver, British Columbia, Canada
| | - S Evelyn Stewart
- British Columbia Mental Health and Substance Use Services, Vancouver, British Columbia, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Randall F White
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - William G Honer
- British Columbia Mental Health and Substance Use Services, Vancouver, British Columbia, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ric M Procyshyn
- British Columbia Mental Health and Substance Use Services, Vancouver, British Columbia, Canada,
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada,
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42
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Fava GA. May antidepressant drugs worsen the conditions they are supposed to treat? The clinical foundations of the oppositional model of tolerance. Ther Adv Psychopharmacol 2020; 10:2045125320970325. [PMID: 33224471 PMCID: PMC7649913 DOI: 10.1177/2045125320970325] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 10/02/2020] [Indexed: 12/16/2022] Open
Abstract
In recent years there has been a considerable debate on antidepressant drugs. Continued drug treatment with antidepressant medications may stimulate processes that run counter to the initial acute effects of a drug. The oppositional model of tolerance may explain loss of treatment efficacy during maintenance treatment and the fact that some side effects tend to occur only after a certain time. These processes may also direct the illness into a treatment-unresponsive course, including manifestations of bipolar disorder or paradoxical reactions. When drug treatment ends, oppositional processes no longer encounter resistance, resulting in potential onset of new withdrawal symptoms, persistent post-withdrawal disorders, hypomania, and resistance to treatment if it is reinstituted. In all these cases, antidepressant medications may constitute a form of iatrogenic comorbidity, which increases chronicity and vulnerability to depressive episodes. Antidepressant medications are essential drugs for the treatment of major depressive episodes. They are less likely, however, to provide protection for relapse prevention. Current prescription practices need to be reformulated in light of consideration of vulnerabilities and adverse effects of treatment. The oppositional model of tolerance provides a conceptual framework for weighing all these elements in the individual case. The model does not appear to apply to all patients who undergo treatment with AD, but only to a part of them. Studying the variables that are associated with such occurrence in certain patients and not in others would be one of the most important tasks of current therapeutic research. Current diagnostic systems in psychiatry do not consider the iatrogenic components of psychopathology, and can be applied to only patients who are drug free. They are suited for a patient who no longer exists: most of the cases that are seen in psychiatric clinical practice receive psychotropic drugs and such treatment is likely to affect prognosis and treatment choices.
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Affiliation(s)
- Giovanni A Fava
- Department of Psychiatry, University at Buffalo, Erie County Medical Center, 462 Grider Street, Buffalo, NY 14215, USA
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43
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Yu Z, Zhang J, Zheng Y, Yu L. Trends in Antidepressant Use and Expenditure in Six Major Cities in China From 2013 to 2018. Front Psychiatry 2020; 11:551. [PMID: 32765307 PMCID: PMC7378967 DOI: 10.3389/fpsyt.2020.00551] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 05/29/2020] [Indexed: 01/21/2023] Open
Abstract
The objective of this study was to investigate the current status and trends in antidepressant use and expenditure in China from 2013 to 2018. The study had a retrospective design based on prescribing data on antidepressant drugs, which was sourced from the Hospital Prescription Analysis Cooperative Project. The trends in hospital visits and corresponding expenditure on antidepressant drugs were examined. Subgroup analyses were carried out by sex, age, and drug class. A total of 1,795,230 outpatient prescriptions were collected from 79 hospitals in six major cities in China. Hospital visits with antidepressant prescriptions rose significantly from 244,626 in 2013 to 348,718 in 2018, reflecting a 42.6% increase (P < 0.05). The antidepressant expenditure also rose, increasing from 48.0 million Chinese yuan in 2013 to 64.8 million Chinese yuan in 2018. There were approximately 1.6 times more antidepressant prescriptions written for women than for men. The most frequent age category for antidepressant prescriptions was 45-64 years. The most commonly prescribed antidepressants were selective serotonin reuptake inhibitors (N06AB) and other antidepressants (N06AX), whereas tricyclic antidepressants (N06AA) accounted for only a small part of the total antidepressant prescriptions. Flupentixol/melitracen and escitalopram were the most frequently prescribed antidepressants. Antidepressant prescribing rates continue to increase in China, although the prescribing patterns have changed over the past few years. The wide use of expensive antidepressants and those with weak clinical evidence raises concerns regarding the rational use of antidepressants. This study provides a basis for future stewardship by the government and medical institutions.
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Affiliation(s)
- Zhenwei Yu
- Department of Pharmacy, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jianying Zhang
- Department of Outpatient Nursing, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Ying Zheng
- Department of Pharmacy, The 903 Hospital of the Joint Logistic Support Force of the PLA, Hangzhou, China
| | - Lingyan Yu
- Department of Pharmacy, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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44
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Cohen D, Recalt A. Withdrawal effects confounding in clinical trials: another sign of a needed paradigm shift in psychopharmacology research. Ther Adv Psychopharmacol 2020; 10:2045125320964097. [PMID: 33224467 PMCID: PMC7656873 DOI: 10.1177/2045125320964097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 09/09/2020] [Indexed: 11/24/2022] Open
Abstract
Randomized controlled trials' ability to produce evidence useful for people to decide whether to take, continue taking, or stop taking psychotropic drugs has been intensely critiqued, along with the trials' commercial, ideological, and regulatory contexts. This article applies the critique to the topic of withdrawal effects confounding the outcomes of relapse-prevention trials where prescribed psychotropic drugs are discontinued. Until recently, the complexity and reach of withdrawal and post-withdrawal effects were neglected by mainstream psychiatry, but not by lay users of prescribed psychotropics. This article discusses withdrawal effects as part of the pharmacology of psychotropic drugs but shaped by psychosocial factors, and possibly shaping the presentation of psychological distress generally. It outlines biases and misconceptions in assumptions, design, and reporting of general efficacy trials and findings from a recent review of 80 discontinuation trials. In theory, relapse-prevention trials are tautological and exaggerate efficacy. In publications, they pay little attention to the central feature of their design, favor abrupt or rapid discontinuations, do not attend to environmental factors, and provide insufficient data to allow re-analyses. Thus, relapse-prevention RCTs likely confound the detection of their main outcome of interest: "relapse." Using slower tapers, active placebo controls, and specific covariates in analyses would reduce the risk of withdrawal confounding, and better reporting would reduce the opaqueness of trials. The crisis in psychopharmacology is fueled partly by the disconnect between claims of therapeutic efficacy from so-called best-evidence methods despite unchanging population-level indicators of psychiatric sickness. Only by "stacking the deck" against trial sponsors' hoped-for outcomes can psychopharmacology trials regain scientific credibility.
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Affiliation(s)
- David Cohen
- UCLA Luskin School of Public Affairs, 3250 Public Affairs Building, Los Angeles, CA 90095-1656, USA
| | - Alexander Recalt
- Department of Social Welfare, Luskin School of Public Affairs, and Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
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45
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Hengartner MP, Schulthess L, Sorensen A, Framer A. Protracted withdrawal syndrome after stopping antidepressants: a descriptive quantitative analysis of consumer narratives from a large internet forum. Ther Adv Psychopharmacol 2020; 10:2045125320980573. [PMID: 33489088 PMCID: PMC7768871 DOI: 10.1177/2045125320980573] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 11/23/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Protracted withdrawal syndrome (PWS) after stopping antidepressants (frequently also referred to as post-acute withdrawal syndrome or PAWS) has been described in a few case reports. However, a detailed quantitative analysis of specific symptom manifestations in antidepressant PWS is still lacking. METHODS We extracted patient narratives from a large English-language internet forum SurvivingAntidepressants.org, a peer support site concerned about withdrawal from antidepressants. PWS was ascertained based on diagnostic criteria proposed by Chouinard and Chouinard, specifically ⩾6 months of continuous antidepressant use, with emergence of new and/or more intense symptoms after discontinuation that last beyond the initial 6 weeks of acute withdrawal. We assessed medication history, outcome of PWS, and the prevalence of specific symptoms. RESULTS In total, n = 69 individual reports of protracted withdrawal were selected for analysis. At time of the subjects' most recent reports, duration of PWS ranged from 5 to 166 months, mean = 37 months, median = 26 months. Length of time on the antidepressant causing protracted withdrawal ranged from 6 to 278 months, mean = 96 months, and median = 79 months. Throughout the withdrawal experience, affective symptoms, mostly anxiety, depression, emerging suicidality and agitation, were reported by 81%. Somatic symptoms, mostly headache, fatigue, dizziness, brain zaps, visual changes, muscle aches, tremor, diarrhea, and nausea were reported by 75%. Sleep problems (44%) and cognitive impairments (32%) were mentioned less frequently. These broad symptom domains were largely uncorrelated. CONCLUSION PWS or PAWS from antidepressants can be severe and long-lasting, and its manifestations clinically heterogeneous. Long-term antidepressant exposure may cause multiple body system impairments. Although both somatic and affective symptoms are frequent, they are mostly unrelated in terms of occurrence. Proper recognition and detection of PWS thus requires a comprehensive assessment of medication history, duration of the withdrawal syndrome, and its various somatic, affective, sleep, and cognitive symptoms.
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Affiliation(s)
- Michael P Hengartner
- Department of Applied Psychology, Zurich University of Applied Sciences (ZHAW), PO Box 707, Zurich, 8037, Switzerland
| | - Lukas Schulthess
- Department of Applied Psychology, Zurich University of Applied Sciences, Switzerland
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