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Metzger CE, Olayooye P, Tak LY, Culpepper O, LaPlant AN, Jalaie P, Andoh PM, Bandara W, Reul ON, Tomaschke AA, Surowiec RK. Estrogen deficiency induces changes in bone matrix bound water that do not closely correspond with bone turnover. Bone 2024; 186:117173. [PMID: 38906519 DOI: 10.1016/j.bone.2024.117173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 06/12/2024] [Accepted: 06/17/2024] [Indexed: 06/23/2024]
Abstract
Postmenopausal osteoporosis, marked by estrogen deficiency, is a major contributor to osteoporotic fractures, yet early prediction of fractures in this population remains challenging. Our goal was to explore the temporal changes in bone-specific inflammation, oxidative stress, bone turnover, and bone-matrix water, and their relationship with estrogen deficiency-induced modifications in bone structure and mechanical properties. Additionally, we sought to determine if emerging clinically translatable imaging techniques could capture early bone modifications prior to standard clinical imaging. Two-month-old female Sprague Dawley rats (n = 48) underwent ovariectomy (OVX, n = 24) or sham operations (n = 24). A subgroup of n = 8 rats per group was sacrificed at 2-, 5-, and 10-weeks post-surgery to assess the temporal relationships of inflammation, oxidative stress, bone turnover, bone matrix water, mechanics, and imaging outcomes. OVX rats exhibited higher body weight compared to sham rats at all time points. By 5-weeks, OVX animals showed elevated markers of inflammation and oxidative stress in cortical bone, which persisted throughout the study, while cortical bone formation rate did not differ from sham until 10-weeks. DXA outcomes did not reveal differences between OVX and sham at any time point. Bound water, assessed using ultrashort echo time magnetic resonance imaging (UTE MRI), was lower in OVX at the earliest time point (2-weeks) and reduced again at 10-weeks with no difference at 5-weeks. These data demonstrate that bound water assessment using novel UTE MRI technology was lower at the earliest time point following OVX. However, no temporal relationship with bone turnover, inflammation, or oxidative stress was observed at the time points assessed in this study. These findings underscore both the increased need to understand bone hydration changes and highlight the usefulness of UTE MRI for non-invasive bone hydration measurements.
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Affiliation(s)
- Corinne E Metzger
- Dept. of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Peter Olayooye
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
| | - Landon Y Tak
- Dept. of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Oli Culpepper
- Dept. of Biomedical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
| | - Alec N LaPlant
- Dept. of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, IN, USA; Dept. of Biomedical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
| | - Peter Jalaie
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
| | - Pearl-Marie Andoh
- Dept. of Biomedical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
| | - Wikum Bandara
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
| | - Olivia N Reul
- Dept. of Biomedical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
| | - Andrew A Tomaschke
- Dept. of Biomedical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
| | - Rachel K Surowiec
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA; Dept. of Biomedical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA; Dept. of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA.
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de Bejczy A, Addolorato G, Aubin HJ, Guiraud J, Korpi ER, John Nutt D, Witkiewitz K, Söderpalm B. AUD in perspective. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2024; 175:1-19. [PMID: 38555113 DOI: 10.1016/bs.irn.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Alcohol is a major cause of pre-mature death and individual suffering worldwide, and the importance of diagnosing and treating AUD cannot be overstated. Given the global burden and the high attributable factor of alcohol in a vast number of diseases, the need for additional interventions and the development of new medicines is considered a priority by the World Health Organization (WHO). As of today, AUD is severely under-treated with a treatment gap nearing 90%, strikingly higher than that for other psychiatric disorders. Patients often seek treatment late in the progress of the disease and even among those who seek treatment only a minority receive medication, mirroring the still-prevailing stigma of the disease, and a lack of access to effective treatments, as well as a reluctance to total abstinence. To increase adherence, treatment goals should focus not only on maintaining abstinence, but also on harm reduction and psychosocial functioning. A personalised approach to AUD treatment, with a holistic view, and tailored therapy has the potential to improve AUD treatment outcomes by targeting the heterogeneity in genetics and pathophysiology, as well as reason for, and reaction to drinking. Also, the psychiatric co-morbidity rates are high in AUD and dual diagnosis can worsen symptoms and influence treatment response and should be considered in the treatment strategies.
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Affiliation(s)
- Andrea de Bejczy
- Addiction Biology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Addiction and Dependency, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Giovanni Addolorato
- Department of Medical and Surgical Sciences, Università Cattolica di Roma, Rome, Italy; Internal Medicine and Alcohol Related Disease Unit, Columbus-Gemelli Hospital, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Henri-Jean Aubin
- Université Paris-Saclay, Inserm, CESP, Villejuif, France; AP-HP, Université Paris Saclay, Villejuif, France
| | - Julien Guiraud
- Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands; Vergio, Clichy, France
| | - Esa R Korpi
- Department of Pharmacology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - David John Nutt
- Imperial College London and GABA Labs, London, United Kingdom
| | - Katie Witkiewitz
- Department of Psychology and Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Albuquerque, New Mexico, United States
| | - Bo Söderpalm
- Addiction Biology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Addiction and Dependency, Sahlgrenska University Hospital, Gothenburg, Sweden
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Sturmberg JP, Marcum JA. From cause and effect to causes and effects. J Eval Clin Pract 2024; 30:296-308. [PMID: 36779244 DOI: 10.1111/jep.13814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 01/27/2023] [Accepted: 01/29/2023] [Indexed: 02/14/2023]
Abstract
It is now-at least loosely-acknowledged that most health and clinical outcomes are influenced by different interacting causes. Surprisingly, medical research studies are nearly universally designed to study-usually in a binary way-the effect of a single cause. Recent experiences during the coronavirus disease 2019 pandemic brought to the forefront that most of our challenges in medicine and healthcare deal with systemic, that is, interdependent and interconnected problems. Understanding these problems defy simplistic dichotomous research methodologies. These insights demand a shift in our thinking from 'cause and effect' to 'causes and effects' since this transcends the classical way of Cartesian reductionist thinking. We require a shift to a 'causes and effects' frame so we can choose the research methodology that reflects the relationships between variables of interest-one-to-one, one-to-many, many-to-one or many-to-many. One-to-one (or cause and effect) relationships are amenable to the traditional randomized control trial design, while all others require systemic designs to understand 'causes and effects'. Researchers urgently need to re-evaluate their science models and embrace research designs that allow an exploration of the clinically obvious multiple 'causes and effects' on health and disease. Clinical examples highlight the application of various systemic research methodologies and demonstrate how 'causes and effects' explain the heterogeneity of clinical outcomes. This shift in scientific thinking will allow us to find the necessary personalized or precise clinical interventions that address the underlying reasons for the variability of clinical outcomes and will contribute to greater health equity.
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Affiliation(s)
- Joachim P Sturmberg
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Holgate, New South Wales, Australia
- Foundation President, International Society for Systems and Complexity Sciences for Health, Waitsfield, Vermont, USA
| | - James A Marcum
- Department of Philosophy, Baylor University, Waco, Texas, USA
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Arnone D, Wise T, Fitzgerald PB, Harmer CJ. The involvement of serotonin in major depression: nescience in disguise? Mol Psychiatry 2024:10.1038/s41380-024-02459-y. [PMID: 38374356 DOI: 10.1038/s41380-024-02459-y] [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: 07/24/2022] [Revised: 02/22/2023] [Accepted: 01/24/2024] [Indexed: 02/21/2024]
Affiliation(s)
- Danilo Arnone
- Department of Psychiatry, University of Ottawa, Ottawa, Canada.
- Centre for Affective Disorders, Psychological Medicine, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK.
- Department of Mental Health, The Ottawa Hospital, Ottawa, Canada.
| | - Toby Wise
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - Paul B Fitzgerald
- School of Medicine and Psychology, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Catherine J Harmer
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
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Lin X, Li X, Qulian G, Bai Y, Liu Q. Efficay of high-flow nasal cannula in the paediatric population: A systematic evidence map. J Pediatr Nurs 2023; 73:e327-e363. [PMID: 37838549 DOI: 10.1016/j.pedn.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 09/30/2023] [Accepted: 10/01/2023] [Indexed: 10/16/2023]
Abstract
PROBLEM High-flow nasal cannula (HFNC) has been widely used in paediatric medicine as a non-invasive ventilation mode for respiratory support. However, the differences in its efficacy across different diseases and intervention types remain poorly understood. ELIGIBILITY CRITERIA An extensive literature search was performed across multiple academic databases to investigate the systematic reviews and meta-analyses of HFNC. SAMPLE This study included 35 systematic reviews and meta-analyses, which collectively examined 355 randomised controlled trials and assessed 51 outcome indicators. RESULTS The findings suggest that the existing clinical research evidence predominantly supports the therapeutic efficacy of HFNC. Notably, there is a significant focus on treating acute lower respiratory infection, hypoxaemia, bronchiolitis, and respiratory distress syndrome following extubation. However, concerning the respiratory status, the existing clinical research evidence mainly demonstrates the therapeutic benefits in post-extubation respiratory support and primary respiratory support. CONCLUSIONS The research on HFNC has witnessed significant expansion, primarily focusing on respiratory disorders, post-extubation respiratory support, conscious sedation, and related fields. The evidence mapping provides a systematic and comprehensive overview of the available evidence on HFNC therapy in paediatric patients. IMPLICATIONS This study systematically and comprehensively assessed the clinical subjects and populations involved in HFNC therapy. Notably, this study analyzed the trends, current status, and evidence gaps of research, and furnished decision-makers and relevant researchers with a more comprehensive reference basis.
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Affiliation(s)
- Xi Lin
- Department of Pediatrics, Children Hematological Oncology and Birth Defects Laboratory, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, PR China; Sichuan Clinical Research Center for Birth Defects, Luzhou, Sichuan 646000, PR China; Department of Nursing, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China
| | - Xiaoqin Li
- Department of Pediatrics, Children Hematological Oncology and Birth Defects Laboratory, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, PR China
| | - Guo Qulian
- Department of Pediatrics, Children Hematological Oncology and Birth Defects Laboratory, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, PR China; Sichuan Clinical Research Center for Birth Defects, Luzhou, Sichuan 646000, PR China
| | - Yongqi Bai
- Department of Pediatrics, Children Hematological Oncology and Birth Defects Laboratory, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, PR China; Department of Nursing, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China.
| | - Qin Liu
- Department of Pediatrics, Children Hematological Oncology and Birth Defects Laboratory, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, PR China.
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Sadri A. Is Target-Based Drug Discovery Efficient? Discovery and "Off-Target" Mechanisms of All Drugs. J Med Chem 2023; 66:12651-12677. [PMID: 37672650 DOI: 10.1021/acs.jmedchem.2c01737] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Target-based drug discovery is the dominant paradigm of drug discovery; however, a comprehensive evaluation of its real-world efficiency is lacking. Here, a manual systematic review of about 32000 articles and patents dating back to 150 years ago demonstrates its apparent inefficiency. Analyzing the origins of all approved drugs reveals that, despite several decades of dominance, only 9.4% of small-molecule drugs have been discovered through "target-based" assays. Moreover, the therapeutic effects of even this minimal share cannot be solely attributed and reduced to their purported targets, as they depend on numerous off-target mechanisms unconsciously incorporated by phenotypic observations. The data suggest that reductionist target-based drug discovery may be a cause of the productivity crisis in drug discovery. An evidence-based approach to enhance efficiency seems to be prioritizing, in selecting and optimizing molecules, higher-level phenotypic observations that are closer to the sought-after therapeutic effects using tools like artificial intelligence and machine learning.
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Affiliation(s)
- Arash Sadri
- Lyceum Scientific Charity, Tehran, Iran, 1415893697
- Interdisciplinary Neuroscience Research Program (INRP), Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran, 1417755331
- Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran, 1417614411
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Lorenzo-Luaces L. Identifying active ingredients in cognitive-behavioral therapies: What if we didn't? Behav Res Ther 2023; 168:104365. [PMID: 37453179 PMCID: PMC10534234 DOI: 10.1016/j.brat.2023.104365] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/24/2023] [Accepted: 07/02/2023] [Indexed: 07/18/2023]
Abstract
Identifying active ingredients of psychological interventions is a major goal of psychotherapy researchers that is often justified by the promise that it will lead to improved patient outcomes. Much of this "active ingredients" research is conducted within randomized controlled trials (RCTs) with patient populations, putting it in Phase T2 of the clinical-translational spectrum. I argue that RCTs in patient populations are very "messy laboratories" in which to conduct active ingredient work and that T0 and T1 research provide more controlled contexts. However, I call attention to the long road from identifying active ingredients of CBTs, whether in T0, T1, or T2 research, to improving outcomes. Dissemination and implementation research (T3 and T4 approaches) may be conceptually closer to improving outcomes. Given how common and disabling mental health symptoms are, I argue that if researchers want to improve patient outcomes, these research programs must receive more attention including work on the uptake of psychological interventions as well as work on optimal ordering of existing interventions.
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8
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Burton CZ, Garnett EO, Capellari E, Chang SE, Tso IF, Hampstead BM, Taylor SF. Combined Cognitive Training and Transcranial Direct Current Stimulation in Neuropsychiatric Disorders: A Systematic Review and Meta-analysis. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023; 8:151-161. [PMID: 36653210 PMCID: PMC10823589 DOI: 10.1016/j.bpsc.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/25/2022] [Accepted: 09/19/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Treatments for cognitive dysfunction in neuropsychiatric conditions are urgently needed. Cognitive training and transcranial direct current stimulation (tDCS) hold promise, and there is growing interest in combined or multimodal treatments, though studies to date have had small samples and inconsistent results. METHODS A systematic review and meta-analysis was completed. Retained studies included cognitive training combined with active or sham tDCS in a neuropsychiatric population and reported a posttreatment cognitive outcome. Meta-analyses included effect sizes comparing cognitive training plus active tDCS and cognitive training plus sham tDCS in 5 cognitive domains. Risk of bias in included studies and across studies was explored. RESULTS Fifteen studies were included: 10 in neurodegenerative disorders and 5 in psychiatric disorders (n = 629). There were several tDCS montages, though two-thirds of studies placed the anode over the left dorsolateral prefrontal cortex. A wide variety of cognitive training types and outcome measures were reported. There was a small, statistically significant effect of combined treatment on measures of attention/working memory, as well as small and non-statistically significant effects favoring combined treatment on global cognition and language. There was no evidence of bias in individual studies but some evidence of nonreporting or small-study bias across studies. CONCLUSIONS These results may provide preliminary support for the efficacy of combined cognitive training and tDCS on measures of attention/working memory. More data are needed, particularly via studies that explicitly align the cognitive ability of interest, stimulation target, training type, and outcome measures.
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Affiliation(s)
- Cynthia Z Burton
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.
| | - Emily O Garnett
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Emily Capellari
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan
| | - Soo-Eun Chang
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Ivy F Tso
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Benjamin M Hampstead
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan; Mental Health Service, U.S. Department of Veterans Affairs, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Stephan F Taylor
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
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Cusanno BR, Dean M, Silva VT. "I'm Worth Saving": Making Sense of Medication Taking in a Care Coordination Organization. HEALTH COMMUNICATION 2022; 37:1798-1811. [PMID: 33947311 DOI: 10.1080/10410236.2021.1920713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Patients and healthcare providers (HCPs) may communicatively make sense of medication taking in divergent ways. Often, HCPs prioritize medication adherence, the extent to which patients consume medications as prescribed. In contrast, patients may focus on how medications fit in with their everyday lives. Care coordination organizations (CCOs) provide cohesive, interdisciplinary, health services to chronically ill patients and may help bridge the gap between patient and HCP sensemaking. Our qualitative study asked: How do patients and HCPs involved in a CCO communicatively make sense of medication taking? Through thematic analysis, we found three themes related to patients' sensemaking. Patients (N = 9) made sense of medication taking (1) as necessary and important through embodied experiences, social discourses, and interpersonal interactions; (2) as easy when supported; and (3) through building bonds. We also found three themes related to HCPs' sensemaking: HCP participants (N = 5) made sense of medication taking (1) through dialogue with patients; (2) by interacting in patients' home spaces; and (3) through building relationships with patients. Our final theme explores how communicative sensemaking became more complicated for participants in the context of psychotropic medications. Using Mishler's Voice of the Lifeworld (VoL) and Weick's sensemaking, we advance a constitutive perspective on medication taking. We suggest that researchers and HCPs should focus on constructing shared meanings about medication taking through dialogue, rather than on increasing adherence. Our study provides evidence that, by promoting engagement with the VoL, CCOs may facilitate such dialogs.
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Affiliation(s)
| | - Marleah Dean
- Department of Communication, University of South Florida
- Department of Health Outcomes and Behavior, Moffitt Cancer Center
| | - Vesta T Silva
- Department of Communication Arts and Theatre, Allegheny College
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De Rossi P, Pretelli I, Menghini D, D'Aiello B, Di Vara S, Vicari S. Clinical characteristics of children and adolescents with ADHD with or without methylphenidate prescription at their first diagnostic assessment. Eur Arch Psychiatry Clin Neurosci 2022; 272:1437-1442. [PMID: 35211779 DOI: 10.1007/s00406-022-01386-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 02/01/2022] [Indexed: 11/30/2022]
Abstract
Attention Deficit/Hyperactivity Disorder (ADHD) is the most prevalent neurodevelopmental disorder diagnosed in the scholar age. It is associated with significant impairment in global functioning, and in moderate/severe presentations the outcome is critically dependent on pharmacological optimization of the multi-modal treatment. Methylphenidate (MPH) is the first-choice pharmacological treatment in children and adolescents with ADHD, with substantial evidence of significant efficacy and effectiveness on global functioning and symptoms' severity. There is some evidence supporting a few clinical and socio-demographic variables as predictors of pharmacological treatment prescription in children with ADHD independently of ADHD symptoms severity. However, it is warranted to investigate clinical and general psychopathological characteristics potentially associated with negative outcomes and the need for pharmacological treatment to inform appropriate prescription strategies. In this context, we compared 268 children and adolescents who were prescribed MPH (ADHD/MPH) for the first time after their first diagnostic assessment at our center, and 444 children and adolescents with ADHD (ADHD/noMPH) who were recommended non-pharmacological evidence-based interventions alone. ADHD/MPH group had higher severity of non-ADHD psychopathological symptoms compared to the ADHD/noMPH group, as documented by higher scores on the Child Behavior Checklist (CBCL) subscales, higher severity of ADHD symptoms, lower average IQ and lower adaptive levels independently of IQ. More specifically, beside externalizing symptoms, also internalizing symptoms were significantly higher in the ADHD/MPH group. The presence of significant non-ADHD psychopathology should be considered as a clinical factor associated with the need for MPH prescription in children and adolescents with ADHD.
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Affiliation(s)
- Pietro De Rossi
- Department of Neuroscience, Child and Adolescence Neuropsychiatry Unit, I. R. C. C. S. Bambino Gesù Children's Hospital, Rome, Italy
| | - Italo Pretelli
- Department of Neuroscience, Child and Adolescence Neuropsychiatry Unit, I. R. C. C. S. Bambino Gesù Children's Hospital, Rome, Italy
| | - Deny Menghini
- Department of Neuroscience, Child and Adolescence Neuropsychiatry Unit, I. R. C. C. S. Bambino Gesù Children's Hospital, Rome, Italy
| | - Barbara D'Aiello
- Department of Neuroscience, Child and Adolescence Neuropsychiatry Unit, I. R. C. C. S. Bambino Gesù Children's Hospital, Rome, Italy
- Department of Human Science, LUMSA University, Rome, Italy
| | - Silvia Di Vara
- Department of Neuroscience, Child and Adolescence Neuropsychiatry Unit, I. R. C. C. S. Bambino Gesù Children's Hospital, Rome, Italy
| | - Stefano Vicari
- Department of Neuroscience, Child and Adolescence Neuropsychiatry Unit, I. R. C. C. S. Bambino Gesù Children's Hospital, Rome, Italy.
- Department of Life Sciences and Public Health, Catholic University, Rome, Italy.
- Centro di Riabilitazione, Casa San Giuseppe, Opera Don Guanella, Rome, Italy.
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Hughes JW, Kuhn TA, Ede D, Gathright EC, Josephson RA. Meta-Analysis of Antidepressant Pharmacotherapy in Patients Eligible for Cardiac Rehabilitation: ANTIDEPRESSANT AMBIVALENCE. J Cardiopulm Rehabil Prev 2022; 42:434-441. [PMID: 35797521 PMCID: PMC9643590 DOI: 10.1097/hcr.0000000000000699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE Many patients exhibit clinically significant depression upon enrollment in cardiac rehabilitation (CR). Antidepressants are a first-line treatment option for depression, but the effectiveness of antidepressants in patients with heart disease is mixed. The purpose of this meta-analysis was to evaluate the efficacy of antidepressants for depression in patients eligible for CR. METHODS A meta-analysis was conducted including randomized controlled trials of antidepressants from January 1990 to September 2021 that compared antidepressants with placebo. Random-effects models were used between group effect sizes (Hedges' g ). RESULTS A total of 13 trials with predominately White (68% ± 12; n =7) male (70% ± 11) samples averaging 61 ± 5 yr compared antidepressants (1128 participants) with placebo (1079 participants). Antidepressants reduced depressive symptoms ( g = 0.17: 95% CI, 0.08-0.27), but the effect was small. Heterogeneity among study effects was low ( I2 = 6.42) and nonsignificant ( Q = 10.75, P = .46), although patients with heart failure ( gHF = 0.05: 95% CI, -0.09 to 0.18) demonstrated smaller effects compared with patients with other cardiovascular disease conditions (g non-HF = 0.22: 95% CI, 0.11-0.32) ( QB [1] = 3.97; P < .05). No study reported safety concerns associated with antidepressants. SUMMARY The effect size of antidepressant pharmacotherapy in this population is small. No trials reported on the combined effects of exercise and pharmacotherapy. If the patient is not suicidal, CR staff may consider patient preference and refer patients for additional treatment as necessary.
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Affiliation(s)
- Joel W. Hughes
- Department of Psychological Sciences, Kent State University, Kent, OH
| | - Tyler A. Kuhn
- Department of Psychological Sciences, Kent State University, Kent, OH
| | - David Ede
- Department of Psychological Sciences, Kent State University, Kent, OH
| | - Emily C. Gathright
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI
| | - Richard A. Josephson
- Case Western Reserve University School of Medicine, Cleveland Medical Center, Harrington Heart & Vascular Institute, University Hospitals Health System, Cleveland, Ohio
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Goldberg JF. Perspectives on the success rate of current antidepressant pharmacotherapy. Expert Opin Pharmacother 2022; 23:1781-1791. [PMID: 36259350 DOI: 10.1080/14656566.2022.2138333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION There has been growing debate about the effectiveness of traditional antidepressants for the treatment of depression, and whether the clinical trials literature overstates the value of existing agents. Antidepressant efficacy is limited by suboptimal remission rates, lack of robust efficacy across diverse depressed subgroups, slow onset, and challenges managing tolerability. Clinicians can better navigate uncertainties in this area by recognizing patient-specific clinical and prognostic factors that influence the likelihood of antidepressant drug response. AREAS COVERED The author summarizes pertinent literature regarding drug-placebo differences in antidepressant outcome as well as patient-specific factors that influence antidepressant drug responsivity across subtypes of depressive disorders. EXPERT OPINION Standardized effect sizes for most monoaminergic antidepressants are relatively modest. At least one-third of treatment response derives from nonspecific (yet substantial) placebo effects, limiting the ability to compare antidepressant medication effects to that of "no treatment." Patients with high baseline depressive symptom severity are less likely to respond to placebo but may be more responsive to antidepressant pharmacotherapy than is the case in mild forms of depression. Patient satisfaction with antidepressant response must take into consideration not only efficacy for reducing symptoms but also drug tolerability/acceptability and tangible improvement in functional outcome and quality of life.
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Affiliation(s)
- Joseph F Goldberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
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Hiort P, Hugo J, Zeinert J, Müller N, Kashyap S, Rajapakse JC, Azuaje F, Renard BY, Baum K. DrDimont: explainable drug response prediction from differential analysis of multi-omics networks. Bioinformatics 2022; 38:ii113-ii119. [PMID: 36124784 PMCID: PMC9486584 DOI: 10.1093/bioinformatics/btac477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
MOTIVATION While it has been well established that drugs affect and help patients differently, personalized drug response predictions remain challenging. Solutions based on single omics measurements have been proposed, and networks provide means to incorporate molecular interactions into reasoning. However, how to integrate the wealth of information contained in multiple omics layers still poses a complex problem. RESULTS We present DrDimont, Drug response prediction from Differential analysis of multi-omics networks. It allows for comparative conclusions between two conditions and translates them into differential drug response predictions. DrDimont focuses on molecular interactions. It establishes condition-specific networks from correlation within an omics layer that are then reduced and combined into heterogeneous, multi-omics molecular networks. A novel semi-local, path-based integration step ensures integrative conclusions. Differential predictions are derived from comparing the condition-specific integrated networks. DrDimont's predictions are explainable, i.e. molecular differences that are the source of high differential drug scores can be retrieved. We predict differential drug response in breast cancer using transcriptomics, proteomics, phosphosite and metabolomics measurements and contrast estrogen receptor positive and receptor negative patients. DrDimont performs better than drug prediction based on differential protein expression or PageRank when evaluating it on ground truth data from cancer cell lines. We find proteomic and phosphosite layers to carry most information for distinguishing drug response. AVAILABILITY AND IMPLEMENTATION DrDimont is available on CRAN: https://cran.r-project.org/package=DrDimont. SUPPLEMENTARY INFORMATION Supplementary data are available at Bioinformatics online.
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Affiliation(s)
- Pauline Hiort
- Hasso Plattner Institute, Digital Engineering Faculty, University of Potsdam, Potsdam 14482, Germany
| | - Julian Hugo
- Hasso Plattner Institute, Digital Engineering Faculty, University of Potsdam, Potsdam 14482, Germany
| | - Justus Zeinert
- Hasso Plattner Institute, Digital Engineering Faculty, University of Potsdam, Potsdam 14482, Germany
| | - Nataniel Müller
- Hasso Plattner Institute, Digital Engineering Faculty, University of Potsdam, Potsdam 14482, Germany
| | - Spoorthi Kashyap
- Hasso Plattner Institute, Digital Engineering Faculty, University of Potsdam, Potsdam 14482, Germany
| | - Jagath C Rajapakse
- School of Computer Science and Engineering, Nanyang Technological University, Singapore 639798, Singapore
| | | | - Bernhard Y Renard
- Hasso Plattner Institute, Digital Engineering Faculty, University of Potsdam, Potsdam 14482, Germany
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Oxman AD, Chalmers I, Dahlgren A. Key concepts for informed health choices. 1.1: assumptions that treatments are safe or effective can be misleading. J R Soc Med 2022; 115:354-359. [PMID: 36321676 PMCID: PMC9634226 DOI: 10.1177/01410768221120491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- A D Oxman
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, 0213 Oslo, Norway
| | - I Chalmers
- Centre for Evidence-Based Medicine, University of Oxford, OX2 6GG, UK
| | - A Dahlgren
- Centre for Evidence-Based Medicine, University of Oxford, OX2 6GG, UK
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15
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Konigorski S, Wernicke S, Slosarek T, Zenner AM, Strelow N, Ruether DF, Henschel F, Manaswini M, Pottbäcker F, Edelman JA, Owoyele B, Danieletto M, Golden E, Zweig M, Nadkarni GN, Böttinger E. StudyU: A Platform for Designing and Conducting Innovative Digital N-of-1 Trials. J Med Internet Res 2022; 24:e35884. [PMID: 35787512 PMCID: PMC9297132 DOI: 10.2196/35884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/17/2022] [Accepted: 04/18/2022] [Indexed: 11/28/2022] Open
Abstract
N-of-1 trials are the gold standard study design to evaluate individual treatment effects and derive personalized treatment strategies. Digital tools have the potential to initiate a new era of N-of-1 trials in terms of scale and scope, but fully functional platforms are not yet available. Here, we present the open source StudyU platform, which includes the StudyU Designer and StudyU app. With the StudyU Designer, scientists are given a collaborative web application to digitally specify, publish, and conduct N-of-1 trials. The StudyU app is a smartphone app with innovative user-centric elements for participants to partake in trials published through the StudyU Designer to assess the effects of different interventions on their health. Thereby, the StudyU platform allows clinicians and researchers worldwide to easily design and conduct digital N-of-1 trials in a safe manner. We envision that StudyU can change the landscape of personalized treatments both for patients and healthy individuals, democratize and personalize evidence generation for self-optimization and medicine, and can be integrated in clinical practice.
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Affiliation(s)
- Stefan Konigorski
- Digital Health Center, Hasso Plattner Institute for Digital Engineering, University of Potsdam, Potsdam, Germany
- Digital Engineering Faculty, University of Potsdam, Potsdam, Germany
- Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Sarah Wernicke
- Digital Health Center, Hasso Plattner Institute for Digital Engineering, University of Potsdam, Potsdam, Germany
- Digital Engineering Faculty, University of Potsdam, Potsdam, Germany
- Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Tamara Slosarek
- Digital Health Center, Hasso Plattner Institute for Digital Engineering, University of Potsdam, Potsdam, Germany
- Digital Engineering Faculty, University of Potsdam, Potsdam, Germany
- Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Alexander M Zenner
- Digital Health Center, Hasso Plattner Institute for Digital Engineering, University of Potsdam, Potsdam, Germany
- Digital Engineering Faculty, University of Potsdam, Potsdam, Germany
| | - Nils Strelow
- Digital Health Center, Hasso Plattner Institute for Digital Engineering, University of Potsdam, Potsdam, Germany
- Digital Engineering Faculty, University of Potsdam, Potsdam, Germany
| | - Darius F Ruether
- Digital Health Center, Hasso Plattner Institute for Digital Engineering, University of Potsdam, Potsdam, Germany
- Digital Engineering Faculty, University of Potsdam, Potsdam, Germany
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Florian Henschel
- Digital Health Center, Hasso Plattner Institute for Digital Engineering, University of Potsdam, Potsdam, Germany
- Digital Engineering Faculty, University of Potsdam, Potsdam, Germany
| | - Manisha Manaswini
- Digital Health Center, Hasso Plattner Institute for Digital Engineering, University of Potsdam, Potsdam, Germany
- Digital Engineering Faculty, University of Potsdam, Potsdam, Germany
| | - Fabian Pottbäcker
- Digital Health Center, Hasso Plattner Institute for Digital Engineering, University of Potsdam, Potsdam, Germany
- Digital Engineering Faculty, University of Potsdam, Potsdam, Germany
| | - Jonathan A Edelman
- Digital Health Center, Hasso Plattner Institute for Digital Engineering, University of Potsdam, Potsdam, Germany
- The Center for Advanced Design Studies, Palo Alto, CA, United States
| | - Babajide Owoyele
- Digital Health Center, Hasso Plattner Institute for Digital Engineering, University of Potsdam, Potsdam, Germany
| | - Matteo Danieletto
- Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Eddye Golden
- Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Micol Zweig
- Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Girish N Nadkarni
- Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Erwin Böttinger
- Digital Health Center, Hasso Plattner Institute for Digital Engineering, University of Potsdam, Potsdam, Germany
- Digital Engineering Faculty, University of Potsdam, Potsdam, Germany
- Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Goldberg JF, Nasrallah HA. Major depression is a serious and potentially fatal brain syndrome requiring pharmacotherapy or neuromodulation, and psychotherapy. Psychol Med 2022; 52:1423-1425. [PMID: 35502638 DOI: 10.1017/s0033291722001179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Joseph F Goldberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Henry A Nasrallah
- Department of Psychiatry, University of Cincinnati, Cincinnati, OH, USA
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17
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Excess significance and power miscalculations in neurofeedback research. Neuroimage Clin 2022; 35:103008. [PMID: 35525708 PMCID: PMC9421468 DOI: 10.1016/j.nicl.2022.103008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 12/21/2022]
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Feinberg ME, A. Mogle J, Lee J, Tornello SL, Hostetler ML, Cifelli JA, Bai S, Hotez E. Impact of the COVID-19 Pandemic on Parent, Child, and Family Functioning. FAMILY PROCESS 2022; 61:361-374. [PMID: 33830510 PMCID: PMC8250962 DOI: 10.1111/famp.12649] [Citation(s) in RCA: 126] [Impact Index Per Article: 63.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 05/05/2023]
Abstract
To quantify the impact of the COVID-19 pandemic and public health interventions on parent and child mental health and family relationships, we examined change in individual and family functioning in a sample of parents enrolled in a prevention trial; we examined change before the pandemic (2017-2019) when children were an average of 7 years old to the first months after the imposition of widespread public health interventions in the United States (2020) with paired t tests and HLM models. We examined moderation by parent gender, education, family income, and coparenting conflict. We found large deteriorations from before the pandemic to the first months of the pandemic in child internalizing and externalizing problems and parent depression, and a moderate decline in coparenting quality. Smaller changes were found for parent anxiety and parenting quality. Mothers and families with lower levels of income were at particular risk for deterioration in well-being. Results indicate a need for widespread family support and intervention to prevent potential family "scarring," that is, prolonged, intertwined individual mental health and family relationship problems.
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Affiliation(s)
- Mark E. Feinberg
- Prevention Research CenterCollege of Health and Human DevelopmentHuman Development and Family StudiesThe Pennsylvania State UniversityUniversity ParkPAUSA
| | - Jacqueline A. Mogle
- Prevention Research CenterCollege of Health and Human DevelopmentHuman Development and Family StudiesThe Pennsylvania State UniversityUniversity ParkPAUSA
| | - Jin‐Kyung Lee
- Department of PsychologyCollege of Liberal ArtsThe Pennsylvania State UniversityUniversity ParkPAUSA
| | - Samantha L. Tornello
- Human Development and Family StudiesCollege of Health and Human DevelopmentThe Pennsylvania State UniversityUniversity ParkPAUSA
| | - Michelle L. Hostetler
- Prevention Research CenterCollege of Health and Human DevelopmentHuman Development and Family StudiesThe Pennsylvania State UniversityUniversity ParkPAUSA
| | - Joseph A. Cifelli
- Prevention Research CenterCollege of Health and Human DevelopmentHuman Development and Family StudiesThe Pennsylvania State UniversityUniversity ParkPAUSA
| | - Sunhye Bai
- Human Development and Family StudiesCollege of Health and Human DevelopmentThe Pennsylvania State UniversityUniversity ParkPAUSA
| | - Emily Hotez
- Department of MedicineUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
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19
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Clinically Meaningful Benefit in Women with Hypoactive Sexual Desire Disorder Treated with Flibanserin. Sex Med 2022; 10:100476. [PMID: 34999484 PMCID: PMC8847820 DOI: 10.1016/j.esxm.2021.100476] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/17/2021] [Accepted: 12/01/2021] [Indexed: 12/18/2022] Open
Abstract
Background The efficacy of flibanserin in treating hypoactive sexual desire disorder (HSDD) is based upon statistically significant improvements in sexual desire, satisfying sexual events, and distress. However, clinically meaningful benefit has not been well characterized. Aim Evaluate clinically meaningful benefit of flibanserin. Methods Data were pooled from 3 pivotal trials evaluating flibanserin 100 mg qhs in premenopausal women (flibanserin, n = 1192; placebo, n = 1215). Flibanserin trial data in postmenopausal women (flibanserin, n = 450; placebo, n = 476) were analyzed separately. Clinically meaningful benefit was evaluated by the Patient Global Impression of Improvement (PGI-I). Responders were determined through anchor-based analyses that used the PGI-I for key efficacy endpoints: satisfying sexual events (SSE), desire domain of the Female Sexual Function Index (FSFI-d), and distress associated with decreased sexual desire (FSDS-R13). Odds ratios were calculated to assess effect size and Kaplan-Meier analyses were performed to estimate onset time for treatment benefit. Outcomes PGI-I, anchor-based analyses for key efficacy endpoints (SSE, FSFI-d, FSDS-R13), odds ratios, onset time for treatment benefit. Results Based on the PGI-I, more patients reported clinically meaningful benefit with flibanserin treatment versus placebo (49.8% vs 33.6%, premenopausal cohort; 40.5% vs 28.7%, postmenopausal cohort). In anchor-based analyses, responder rates were significantly higher for premenopausal women on flibanserin (46.1%–55.2%) than placebo (34.1%–44.2%) for all 3 key efficacy endpoints (P < .0001). Responder rates for postmenopausal women on flibanserin were higher compared to placebo for SSE (29.8% vs 22.9%; P = .015) and FSFI-d (38.9% vs 26.3%; P = .0001). Odds ratios for key endpoints indicated that premenopausal women were 2.0–2.4 times as likely to be responders with flibanserin treatment compared to placebo. Postmenopausal women were 1.6 times as likely to be responders with flibanserin for FSFI-d. Kaplan-Meier analyses indicated significant separation between flibanserin and placebo for the key endpoints in both premenopausal and postmenopausal cohorts (log-rank tests P < .01) with earlier median response times among patients receiving flibanserin. Clinical Implications Patient-reported benefit assessments such as the PGI-I capture the patient's perspective and may be a useful approach in assessing overall clinical meaningfulness for sexual dysfunction therapies. Strengths and Limitations Strengths include a well-powered study with large enrollment, use of validated instruments, and self-assessment of treatment benefit. Limitations include pooling of trial data in premenopausal women with slightly different study designs and use of an endpoint (SSE) indirectly related to HSDD. Conclusion Assessment of clinically meaningful benefit and additional responder analyses provide further support for flibanserin's efficacy beyond numerical improvements in endpoint measures. Simon JA, Clayton AH, Kim NN, et al. Clinically Meaningful Benefit in Women with Hypoactive Sexual Desire Disorder Treated with Flibanserin. Sex Med 2022;10:100476.
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20
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Pittelkow MM, de Vries YA, Monden R, Bastiaansen JA, van Ravenzwaaij D. Comparing the evidential strength for psychotropic drugs: a Bayesian meta-analysis. Psychol Med 2021; 51:2752-2761. [PMID: 34620261 PMCID: PMC8640368 DOI: 10.1017/s0033291721003950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/06/2021] [Accepted: 09/09/2021] [Indexed: 11/17/2022]
Abstract
Approval and prescription of psychotropic drugs should be informed by the strength of evidence for efficacy. Using a Bayesian framework, we examined (1) whether psychotropic drugs are supported by substantial evidence (at the time of approval by the Food and Drug Administration), and (2) whether there are systematic differences across drug groups. Data from short-term, placebo-controlled phase II/III clinical trials for 15 antipsychotics, 16 antidepressants for depression, nine antidepressants for anxiety, and 20 drugs for attention deficit hyperactivity disorder (ADHD) were extracted from FDA reviews. Bayesian model-averaged meta-analysis was performed and strength of evidence was quantified (i.e. BFBMA). Strength of evidence and trialling varied between drugs. Median evidential strength was extreme for ADHD medication (BFBMA = 1820.4), moderate for antipsychotics (BFBMA = 365.4), and considerably lower and more frequently classified as weak or moderate for antidepressants for depression (BFBMA = 94.2) and anxiety (BFBMA = 49.8). Varying median effect sizes (ESschizophrenia = 0.45, ESdepression = 0.30, ESanxiety = 0.37, ESADHD = 0.72), sample sizes (Nschizophrenia = 324, Ndepression = 218, Nanxiety = 254, NADHD = 189.5), and numbers of trials (kschizophrenia = 3, kdepression = 5.5, kanxiety = 3, kADHD = 2) might account for differences. Although most drugs were supported by strong evidence at the time of approval, some only had moderate or ambiguous evidence. These results show the need for more systematic quantification and classification of statistical evidence for psychotropic drugs. Evidential strength should be communicated transparently and clearly towards clinical decision makers.
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Affiliation(s)
- Merle-Marie Pittelkow
- Department Psychometrics and Statistics, University of Groningen, Groningen, the Netherlands
| | - Ymkje Anna de Vries
- Department of Developmental Psychology, University of Groningen, Groningen, the Netherlands
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, Groningen, the Netherlands
| | - Rei Monden
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, Groningen, the Netherlands
- Department of Biomedical Statistics, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Jojanneke A. Bastiaansen
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, Groningen, the Netherlands
- Department of Education and Research, Friesland Mental Health Care Services, Leeuwarden, the Netherlands
| | - Don van Ravenzwaaij
- Department Psychometrics and Statistics, University of Groningen, Groningen, the Netherlands
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21
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Coppersmith V, Hudgins S, Stoltzfus J, Stankewicz H. The use of N-acetylcysteine in the prevention of hangover: a randomized trial. Sci Rep 2021; 11:13397. [PMID: 34183702 PMCID: PMC8238992 DOI: 10.1038/s41598-021-92676-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 06/11/2021] [Indexed: 01/15/2023] Open
Abstract
Hangovers resulting from alcohol intoxication can lead to adverse effects ranging from generalized discomfort and work-related absenteeism to emergency department visits from patients seeking symptomatic care. The purpose of this study was to evaluate the efficacy of a low dose (600–1800 mg) of N-Acetylcysteine (NAC) vs placebo on mitigating hangover symptoms. This was a randomized, double-blinded, placebo controlled crossover study involving 49 volunteers who consumed beer to obtain a breath alcohol content (BrAC) of 0.1 g/210L. The participants met on two separate occasions at which time they were given either NAC or placebo capsules. Opposing treatments were administered during the second encounter. The morning after the participant’s intoxication and treatment, a Hangover Symptom Scale Questionnaire was administered to determine subjective changes in hangover symptoms. Data was analyzed by self-control, comparing the participant’s hangover symptom severity when using NAC compared to placebo. No significant difference was found in the general distribution of total hangover scores (P = .45) (NAC = 10; Placebo = 13). There was also no significant difference found in the general distribution of specific hangover symptoms. However, a significant difference was found in the general distribution of total hangover difference scores based on gender (P = .04) (Female − 3.5; Male 2), specifically for nausea (P = .05) and weakness (P = .03). Although no difference was found in the general hangover scale scores, the study was suggestive of gender specific susceptibility with female participants having improved hangover symptoms after NAC use.
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Affiliation(s)
- Veronica Coppersmith
- St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA, 18015, USA
| | - Sarah Hudgins
- St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA, 18015, USA
| | - Jill Stoltzfus
- St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA, 18015, USA
| | - Holly Stankewicz
- St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA, 18015, USA.
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22
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Russell LE, Zhou Y, Almousa AA, Sodhi JK, Nwabufo CK, Lauschke VM. Pharmacogenomics in the era of next generation sequencing - from byte to bedside. Drug Metab Rev 2021; 53:253-278. [PMID: 33820459 DOI: 10.1080/03602532.2021.1909613] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Pharmacogenetic research has resulted in the identification of a multitude of genetic variants that impact drug response or toxicity. These polymorphisms are mostly common and have been included as actionable information in the labels of numerous drugs. In addition to common variants, recent advances in Next Generation Sequencing (NGS) technologies have resulted in the identification of a plethora of rare and population-specific pharmacogenetic variations with unclear functional consequences that are not accessible by conventional forward genetics strategies. In this review, we discuss how comprehensive sequencing information can be translated into personalized pharmacogenomic advice in the age of NGS. Specifically, we provide an update of the functional impacts of rare pharmacogenetic variability and how this information can be leveraged to improve pharmacogenetic guidance. Furthermore, we critically discuss the current status of implementation of pharmacogenetic testing across drug development and layers of care. We identify major gaps and provide perspectives on how these can be minimized to optimize the utilization of NGS data for personalized clinical decision-support.
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Affiliation(s)
| | - Yitian Zhou
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Ahmed A Almousa
- Department of Pharmacy, London Health Sciences Center, Victoria Hospital, London, ON, Canada
| | - Jasleen K Sodhi
- Department of Bioengineering and Therapeutic Sciences, Schools of Pharmacy and Medicine, University of California San Francisco, San Francisco, CA, USA.,Department of Drug Metabolism and Pharmacokinetics, Plexxikon, Inc., Berkeley, CA, USA
| | | | - Volker M Lauschke
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
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23
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Iserson KV. Should We Use Expired Drugs When Necessary? J Emerg Med 2021; 60:669-673. [PMID: 33745766 DOI: 10.1016/j.jemermed.2021.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/29/2020] [Accepted: 02/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Medication shortages commonly occur in resource-poor settings. The relatively short expiry dates on many medications exacerbate these shortages, often requiring clinicians to choose between providing needed medications to the patient and violating rules governing drug dispensing. CASE REPORT A patient presented to an emergency department in a resource-poor setting with an acute anterior myocardial infarction. Standard of care required using thrombolytics due to the unavailability of percutaneous coronary intervention. The only available thrombolytic, streptokinase, was 2 weeks past its labeled expiration date. The physicians faced the ethical dilemma of violating regulations and using the medication vs. failing to provide the patient with the best available therapy. DISCUSSION The physicians in this case needed to weigh their obligation to improve the patient's health against the professional danger to themselves, their colleagues, and their institution for violating a health care regulation. The information they needed to make this decision and to provide the patient with factual informed consent requires an understanding of the myths, regulations, and science surrounding drug expiry dates. Two myths about medications pervade both the professional and lay communities-that they are uniformly effective and that medications taken past their expiry dates may be ineffective or even harmful. Scientific studies have demonstrated that both are false. CONCLUSIONS Ethically, physicians have a duty to place their patient's welfare above their own self-interest. In a time of increasing medication shortages around the globe, clinicians need to push rule makers to synchronize drug expiry dates with scientific findings.
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Affiliation(s)
- Kenneth V Iserson
- Department of Emergency Medicine, The University of Arizona, Tucson, Arizona
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24
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Thürmer JL, Wieber F, Gollwitzer PM. How can we master the 2020 Coronavirus pandemic? The role of planning at social levels. EUROPEAN REVIEW OF SOCIAL PSYCHOLOGY 2021. [DOI: 10.1080/10463283.2020.1852699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- J. Lukas Thürmer
- Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Frank Wieber
- Research Institute Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Peter M. Gollwitzer
- Department of Psychology, University of Konstanz, Konstanz, Germany
- Department of Psychology, New York University, New York, USA
- Department of Psychology, Leuphana University Lüneburg, Lüneburg, Germany
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25
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Cavezzi A. Medicine and Phlebolymphology: Time to Change? J Clin Med 2020; 9:jcm9124091. [PMID: 33353052 PMCID: PMC7766771 DOI: 10.3390/jcm9124091] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/10/2020] [Accepted: 12/15/2020] [Indexed: 02/07/2023] Open
Abstract
Biomedical science is undergoing a reappraisal of its scientific advancement process and of the related healthcare management. Progress in medicine should combine improvements of knowledge, efficacy, and safety of diagnostic/therapeutic procedures, with adequate cost-effectiveness profiles. This narrative review is aimed at assessing in medicine, more specifically in phlebology and lymphology: (a) scientific literature possible biases, (b) the level of evidence, comprehensiveness, and cost-effectiveness of the main therapeutic options, and (c) the possible contribution of integrative and translational medicine. Current medical research may have cognitive biases, or industry-tied influences, which impacts clinical practice. Some reductionism, with an increasing use of drugs and technology, often neglecting the understanding and care of the root causative pathways of the diseases, is affecting biomedical science as well. Aging brings a relevant burden of chronic degenerative diseases and disabilities, with relevant socio-economic repercussions; thus, a major attention to cost-effectiveness and appropriateness of healthcare is warranted. In this scenario, costly and innovative but relatively validated therapies may tend to be adopted in venous and lymphatic diseases, such as varicose veins, leg venous ulcer, post-thrombotic syndrome, pelvic congestion syndrome, and lymphedema. Conversely, a more comprehensive approach to the basic pathophysiology of chronic venous and lymphatic insufficiency and the inclusion of pharmacoeconomics analyses would benefit overall patients’ management. Erroneous lifestyle and nutrition, together with chronic stress-induced syndromes, significantly influence chronic degenerative phlebo-lymphatic diseases. The main active epigenetic socio-biologic factors are obesity, dysfunctions of musculo-respiratory-vascular pumps, pro-inflammatory nutrition, hyperactivation of stress axis, and sedentarism. An overall critical view of the scientific evidence and innovations in phebolymphology could be of help to improve efficacy, safety, and sustainability of current practice. Translational and integrative medicine may contribute to a patient-centered approach. Conversely, reductionism, eminence/reimbursement-based decisional processes, patients’ lack of education, industry-influenced science, and physician’s improvable awareness, may compromise efficacy, safety, appropriateness, and cost-effectiveness of future diagnostic and therapeutic patterns of phlebology and lymphology.
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Llorca PM, Zimmer L. Clinical research in psychopharmacology, the current situation and its perspectives. A conversation with Pierre-Michel Llorca. Therapie 2020; 76:67-70. [PMID: 33358188 DOI: 10.1016/j.therap.2020.12.003] [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: 06/12/2020] [Accepted: 06/16/2020] [Indexed: 11/18/2022]
Abstract
For this issue, Luc Zimmer, professor of pharmacology and chair of the Neuropsychopharmacology Committee of the French Society of Pharmacology and Therapeutics (SFPT), talked with Michel Llorca, professor of psychiatry at the Université d'Auvergne and head of a department of psychiatry at the University Hospital of Clermond-Ferrand. They discuss together the positioning of psychiatry in the neurosciences and the need to build bridges with other medical disciplines. Through examples and professional experiences, they also talk about the difficulties of developing clinical biomarkers for psychiatry and ultimately for psychopharmacology. Finally, they discuss the current difficulties facing research of drugs for psychiatry, pointing out some success stories.
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Affiliation(s)
- Pierre-Michel Llorca
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, 63100 Clermont-Ferrand, France; Fondation Fondamental, 94000 Créteil, France
| | - Luc Zimmer
- Lyon Neuroscience Research Centre, INSERM, CNRS, Université Claude Bernard Lyon 1, 69675 Bron, France; CERMEP, Hospices Civils de Lyon, 69500 Bron, France; National Institute for Nuclear Science and Technology INSTN, CEA, 91400 Saclay, France.
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27
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Stein R, Beuren T, Cela LR, Ferrari F. Farmacogenômica e Doença Cardiovascular: Onde Estamos e Para Onde Vamos. Arq Bras Cardiol 2020; 115:690-700. [PMID: 33111871 PMCID: PMC8386961 DOI: 10.36660/abc.20200151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/10/2020] [Indexed: 11/18/2022] Open
Abstract
A farmacogenômica (FGx) investiga a interação entre genes e medicamentos. Através da análise de regiões específicas do DNA, informações sobre o perfil de metabolização do paciente para um determinado fármaco podem ser descritas, assim como o perfil esperado de resposta ao tratamento. Objetivamente, esse tipo de teste pode ter impacto no tratamento de pacientes que não estão respondendo adequadamente a um determinado medicamento, seja pela ausência dos efeitos esperados ou em virtude do aparecimento de efeitos adversos. Neste cenário, o objetivo desta revisão é o de informar o cardiologista clínico sobre esta importante área do conhecimento e atualizá-lo sobre o tema, procurando preencher as lacunas no que diz respeito à relação custo-benefício da aplicação da FGx nas doenças cardiovasculares, além de fornecer informações para a implementação da terapia guiada pela FGx na prática clínica.
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Mitochondria under the spotlight: On the implications of mitochondrial dysfunction and its connectivity to neuropsychiatric disorders. Comput Struct Biotechnol J 2020; 18:2535-2546. [PMID: 33033576 PMCID: PMC7522539 DOI: 10.1016/j.csbj.2020.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/06/2020] [Accepted: 09/07/2020] [Indexed: 12/30/2022] Open
Abstract
Neuropsychiatric disorders (NPDs) such as bipolar disorder (BD), schizophrenia (SZ) and mood disorder (MD) are hard to manage due to overlapping symptoms and lack of biomarkers. Risk alleles of BD/SZ/MD are emerging, with evidence suggesting mitochondrial (mt) dysfunction as a critical factor for disease onset and progression. Mood stabilizing treatments for these disorders are scarce, revealing the need for biomarker discovery and artificial intelligence approaches to design synthetically accessible novel therapeutics. Here, we show mt involvement in NPDs by associating 245 mt proteins to BD/SZ/MD, with 7 common players in these disease categories. Analysis of over 650 publications suggests that 245 NPD-linked mt proteins are associated with 800 other mt proteins, with mt impairment likely to rewire these interactions. High dosage of mood stabilizers is known to alleviate manic episodes, but which compounds target mt pathways is another gap in the field that we address through mood stabilizer-gene interaction analysis of 37 prescriptions and over-the-counter psychotropic treatments, which we have refined to 15 mood-stabilizing agents. We show 26 of the 245 NPD-linked mt proteins are uniquely or commonly targeted by one or more of these mood stabilizers. Further, induced pluripotent stem cell-derived patient neurons and three-dimensional human brain organoids as reliable BD/SZ/MD models are outlined, along with multiomics methods and machine learning-based decision making tools for biomarker discovery, which remains a bottleneck for precision psychiatry medicine.
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29
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Coveney PV, Highfield RR. From digital hype to analogue reality: Universal simulation beyond the quantum and exascale eras. JOURNAL OF COMPUTATIONAL SCIENCE 2020; 46:101093. [PMID: 33312270 PMCID: PMC7709487 DOI: 10.1016/j.jocs.2020.101093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 03/03/2020] [Indexed: 05/23/2023]
Abstract
Many believe that the future of innovation lies in simulation. However, as computers are becoming ever more powerful, so does the hyperbole used to discuss their potential in modelling across a vast range of domains, from subatomic physics to chemistry, climate science, epidemiology, economics and cosmology. As we are about to enter the era of quantum and exascale computing, machine learning and artificial intelligence have entered the field in a significant way. In this article we give a brief history of simulation, discuss how machine learning can be more powerful if underpinned by deeper mechanistic understanding, outline the potential of exascale and quantum computing, highlight the limits of digital computing - classical and quantum - and distinguish rhetoric from reality in assessing the future of modelling and simulation, when we believe analogue computing will play an increasingly important role.
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Affiliation(s)
- Peter V. Coveney
- Centre for Computational Science, University College London, Gordon Street, London, WC1H 0AJ, UK
- Institute for Informatics, Science Park 904, University of Amsterdam, 1098 XH, Amsterdam, Netherlands
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30
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Rief W. [The role of placebo and nocebo mechanisms in depressive diseases and their treatment]. DER NERVENARZT 2020; 91:675-683. [PMID: 32607602 DOI: 10.1007/s00115-020-00940-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND There is substantial evidence that placebo and nocebo effects occur during treatment with antidepressants. A better understanding of the underlying mechanisms of these effects is necessary to optimize the outcome of treatment and to make clinical studies more sensitive. METHODS Placebo and nocebo mechanisms were analyzed based on empirical studies and the results are summarized in a narrative review. RESULTS Clinical studies and also experimental mechanism-oriented studies underline the effects of placebo and nocebo mechanisms in the treatment with antidepressants. CONCLUSION The success of treatment in the use of antidepressants can be increased and the probability of side effects can be reduced by the effective use of placebo mechanisms and reduction of nocebo effects. The results emphasize the influence of clinician-patient interactions, the role of the treatment context and previous experiences with other treatments of the patient. Simultaneously, the results of this research field stimulate a new understanding of mental disorders, in particular depression and also provide points of reference for optimization of psychotherapeutic treatment.
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Affiliation(s)
- Winfried Rief
- Psychotherapie Ambulanz, Philipps Universität Marburg, Gutenbergstraße 18, 35032, Marburg, Deutschland.
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31
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Johann AF, Hertenstein E, Feige B, Akram U, Holub F, Baglioni C, Domschke K, Schramm E, Nissen C, Kyle SD, Riemann D, Biermann J, Spiegelhalder K. Cognitive behavioural therapy for insomnia does not appear to have a substantial impact on early markers of cardiovascular disease: A preliminary randomized controlled trial. J Sleep Res 2020; 29:e13102. [PMID: 32596882 DOI: 10.1111/jsr.13102] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 05/04/2020] [Accepted: 05/13/2020] [Indexed: 11/29/2022]
Abstract
According to the World Health Organization, cardiovascular diseases are the leading cause of death in the world. Therefore, early prevention of these diseases is a public health priority. Epidemiological data suggest that insomnia may be a modifiable risk factor for cardiovascular diseases. A randomized controlled trial in a sample of insomnia patients without cardiovascular disease was conducted to investigate the effects of insomnia treatment on early markers of cardiovascular diseases assessed by 24-hr ambulatory blood pressure, heart rate and heart rate variability monitoring, and morning fasting blood samples. Forty-six patients with insomnia disorder were randomized to cognitive behavioural therapy for insomnia (CBT-I; n = 23) or a waitlist control condition (n = 23). Contrary to the hypothesis, intention-to-treat analyses did not show any significant treatment effects on early markers of cardiovascular disease (d = 0.0-0.6) despite successful insomnia treatment (d = 1.3). Potential methodological and conceptual reasons for these negative findings are discussed. Future studies might include larger sample sizes that are at risk of cardiovascular diseases and focus on other cardiovascular markers.
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Affiliation(s)
- Anna Friederike Johann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany.,Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Bernd Feige
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Umair Akram
- Department of Psychology, Sociology and Politics, Sheffield Hallam University, Sheffield, UK.,Nuffield Department of Clinical Neurosciences, Sleep and Circadian Neuroscience Institute (SCNi), University of Oxford, Oxford, UK
| | - Florian Holub
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Chiara Baglioni
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany.,Department of Human Sciences, University of Rome 'G. Marconi' - Telematic, Rome, Italy
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Elisabeth Schramm
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, Bern, Switzerland
| | - Simon D Kyle
- Nuffield Department of Clinical Neurosciences, Sleep and Circadian Neuroscience Institute (SCNi), University of Oxford, Oxford, UK
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Jürgen Biermann
- Department of Cardiology and Angiology, Cardiac Electrophysiology, St. Franziskus-Hospital Münster, Münster, Germany.,Department of Cardiology and Angiology I, Faculty of Medicine, Heart Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Kai Spiegelhalder
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
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32
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Schwartz B, Cohen ZD, Rubel JA, Zimmermann D, Wittmann WW, Lutz W. Personalized treatment selection in routine care: Integrating machine learning and statistical algorithms to recommend cognitive behavioral or psychodynamic therapy. Psychother Res 2020; 31:33-51. [DOI: 10.1080/10503307.2020.1769219] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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33
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Abstract
Lymphology is evolving in search of a better management of lymphedema patients, both as to the diagnostic pathway and as to the therapeutic options. Similarly, lymphatic system is involved in a wide spectrum of pathophysiologic processes of most chronic degenerative diseases. Translational medicine integrates the interdisciplinary scientific knowledge to improve diagnostic and therapeutic options in the biomedical field. Inflammation and lymphatic function are regarded as the connecting biochemical factors in most diseases. This review focuses on the scientific publications regarding lymphatic system in connection to psycho-neuroendocrine immunology, hormesis, epigenetics and more generally nutrition and lifestyle. The interaction between lymphology and translational medicine may play a relevant role to improve management of lymphedema on the one hand, and of chronic degenerative diseases on the other.
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Affiliation(s)
- Attilio Cavezzi
- Eurocenter Venalinfa, San Benedetto del Tronto, Ascoli Piceno, Italy -
| | - Roberto Colucci
- Eurocenter Venalinfa, San Benedetto del Tronto, Ascoli Piceno, Italy
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34
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Buckman JE, Saunders R, Cohen ZD, Clarke K, Ambler G, DeRubeis RJ, Gilbody S, Hollon SD, Kendrick T, Watkins E, White IR, Lewis G, Pilling S. What factors indicate prognosis for adults with depression in primary care? A protocol for meta-analyses of individual patient data using the Dep-GP database. Wellcome Open Res 2020; 4:69. [PMID: 31815189 PMCID: PMC6880263 DOI: 10.12688/wellcomeopenres.15225.3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Pre-treatment severity is a key indicator of prognosis for those with depression. Knowledge is limited on how best to encompass severity of disorders. A number of non-severity related factors such as social support and life events are also indicators of prognosis. It is not clear whether this holds true after adjusting for pre-treatment severity as a) a depressive symptom scale score, and b) a broader construct encompassing symptom severity and related indicators: "disorder severity". In order to investigate this, data from the individual participants of clinical trials which have measured a breadth of "disorder severity" related factors are needed. Aims: 1) To assess the association between outcomes for adults seeking treatment for depression and the severity of depression pre-treatment, considered both as i) depressive symptom severity only and ii) "disorder severity" which includes depressive symptom severity and comorbid anxiety, chronicity, history of depression, history of previous treatment, functional impairment and health-related quality of life. 2) To determine whether i) social support, ii) life events, iii) alcohol misuse, and iv) demographic factors (sex, age, ethnicity, marital status, employment status, level of educational attainment, and financial wellbeing) are prognostic indicators of outcomes, independent of baseline "disorder severity" and the type of treatment received. Methods: Databases were searched for randomised clinical trials (RCTs) that recruited adults seeking treatment for depression from their general practitioners and used the same diagnostic and screening instrument to measure severity at baseline - the Revised Clinical Interview Schedule; outcome measures could differ between studies. Chief investigators of all studies meeting inclusion criteria were contacted and individual patient data (IPD) were requested. Conclusions: In total 15 RCTs met inclusion criteria. The Dep-GP database will include the 6271 participants from the 13 studies that provided IPD. This protocol outlines how these data will be analysed. Registration: PROSPERO CRD42019129512 (01/04/2019).
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Affiliation(s)
- Joshua E.J. Buckman
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
| | - Rob Saunders
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
| | - Zachary D. Cohen
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Katherine Clarke
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
| | - Gareth Ambler
- Statistical Science, University College London, London, WC1E 7HB, UK
| | - Robert J. DeRubeis
- School of Arts and Sciences, Department of Psychology, University of Pennsylvania, Philadelphia, PA, 19104-60185, USA
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Steven D. Hollon
- Department of Psychology, Vanderbilt University, Nashville, TN, 407817, USA
| | - Tony Kendrick
- Primary Care & Population Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 5ST, UK
| | - Edward Watkins
- Department of Psychology, University of Exeter, Exeter, EX4 4QG, UK
| | - Ian R. White
- Institute of Clinical Trials and Methodology, MRC Clinical Trials Unit, University College London, London, WC1V 6LJ, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, W1T 7NF, UK
| | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
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35
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Chi T, Gold JA. A review of emerging therapeutic potential of psychedelic drugs in the treatment of psychiatric illnesses. J Neurol Sci 2020; 411:116715. [PMID: 32044687 DOI: 10.1016/j.jns.2020.116715] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 11/03/2019] [Accepted: 01/29/2020] [Indexed: 12/22/2022]
Abstract
Though there was initial interest in the use of psychedelic drugs for psychiatric treatment, bad outcomes and subsequent passage of the Substance Act of 1970, which placed psychedelic drugs in the Schedule I category, significantly limited potential progress. More recently, however, there has been renewal in interest and promise of psychedelic research. The purpose of this review is to highlight contemporary human studies on the use of select psychedelic drugs, such as psilocybin, LSD, MDMA and ayahuasca, in the treatment of various psychiatric illnesses, including but not limited to treatment-resistant depression, post-traumatic stress disorder, end-of-life anxiety, and substance use disorders. The safety and efficacy as reported from human and animal studies will also be discussed. Accumulated research to date has suggested the potential for psychedelics to emerge as breakthrough therapies for psychiatric conditions refractory to conventional treatments. However, given the unique history and high potential for misuse with popular distribution, special care and considerations must be undertaken to safeguard their use as viable medical treatments rather than drugs of abuse.
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Affiliation(s)
- Tingying Chi
- Department of Psychiatry, Washington University School of Medicine, USA.
| | - Jessica A Gold
- Department of Psychiatry, Washington University School of Medicine, USA.
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36
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Penninx B. Examining the antidepressant scattergun approach. Lancet Psychiatry 2019; 6:878-879. [PMID: 31543475 DOI: 10.1016/s2215-0366(19)30367-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 09/05/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Brenda Penninx
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, Amsterdam 1081 HJ, Netherlands.
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37
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Buckman JE, Saunders R, Cohen ZD, Clarke K, Ambler G, DeRubeis RJ, Gilbody S, Hollon SD, Kendrick T, Watkins E, White IR, Lewis G, Pilling S. What factors indicate prognosis for adults with depression in primary care? A protocol for meta-analyses of individual patient data using the Dep-GP database. Wellcome Open Res 2019; 4:69. [PMID: 31815189 PMCID: PMC6880263 DOI: 10.12688/wellcomeopenres.15225.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2019] [Indexed: 02/15/2024] Open
Abstract
Background: Pre-treatment severity is a key indicator of prognosis for those with depression. Knowledge is limited on how best to encompass severity of disorders. A number of non-severity related factors such as social support and life events are also indicators of prognosis. It is not clear whether this holds true after adjusting for pre-treatment severity as a) a depressive symptom scale score, and b) a broader construct encompassing symptom severity and related indicators: "disorder severity". In order to investigate this, data from the individual participants of clinical trials which have measured a breadth of "disorder severity" related factors are needed. Aims: 1) To assess the association between outcomes for adults seeking treatment for depression and the severity of depression pre-treatment, considered both as i) depressive symptom severity only and ii) "disorder severity" which includes depressive symptom severity and comorbid anxiety, chronicity, history of depression, history of previous treatment, functional impairment and health-related quality of life. 2) To determine whether i) social support, ii) life events, iii) alcohol misuse, and iv) demographic factors (sex, age, ethnicity, marital status, employment status, level of educational attainment, and financial wellbeing) are prognostic indicators of outcomes, independent of baseline "disorder severity" and the type of treatment received. Methods: Databases were searched for randomised clinical trials (RCTs) that recruited adults seeking treatment for depression from their general practitioners and used the same diagnostic and screening instrument to measure severity at baseline - the Revised Clinical Interview Schedule; outcome measures could differ between studies. Chief investigators of all studies meeting inclusion criteria were contacted and individual patient data (IPD) were requested. Conclusions: In total 15 RCTs met inclusion criteria. The Dep-GP database will include the 6271 participants from the 13 studies that provided IPD. This protocol outlines how these data will be analysed. Registration: PROSPERO CRD42019129512 (01/04/2019).
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Affiliation(s)
- Joshua E.J. Buckman
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
| | - Rob Saunders
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
| | - Zachary D. Cohen
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Katherine Clarke
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
| | - Gareth Ambler
- Statistical Science, University College London, London, WC1E 7HB, UK
| | - Robert J. DeRubeis
- School of Arts and Sciences, Department of Psychology, University of Pennsylvania, Philadelphia, PA, 19104-60185, USA
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Steven D. Hollon
- Department of Psychology, Vanderbilt University, Nashville, TN, 407817, USA
| | - Tony Kendrick
- Primary Care & Population Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 5ST, UK
| | - Edward Watkins
- Department of Psychology, University of Exeter, Exeter, EX4 4QG, UK
| | - Ian R. White
- Institute of Clinical Trials and Methodology, MRC Clinical Trials Unit, University College London, London, WC1V 6LJ, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, W1T 7NF, UK
| | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
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38
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Digitizable therapeutics for decentralized mitigation of global pandemics. Sci Rep 2019; 9:14345. [PMID: 31586137 PMCID: PMC6778202 DOI: 10.1038/s41598-019-50553-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 09/15/2019] [Indexed: 01/31/2023] Open
Abstract
When confronted with a globally spreading epidemic, we seek efficient strategies for drug dissemination, creating a competition between supply and demand at a global scale. Propagating along similar networks, e.g., air-transportation, the spreading dynamics of the supply vs. the demand are, however, fundamentally different, with the pathogens driven by contagion dynamics, and the drugs by commodity flow. We show that these different dynamics lead to intrinsically distinct spreading patterns: while viruses spread homogeneously across all destinations, creating a concurrent global demand, commodity flow unavoidably leads to a highly uneven spread, in which selected nodes are rapidly supplied, while the majority remains deprived. Consequently, even under ideal conditions of extreme production and shipping capacities, due to the inherent heterogeneity of network-based commodity flow, efficient mitigation becomes practically unattainable, as homogeneous demand is met by highly heterogeneous supply. Therefore, we propose here a decentralized mitigation strategy, based on local production and dissemination of therapeutics, that, in effect, bypasses the existing distribution networks. Such decentralization is enabled thanks to the recent development of digitizable therapeutics, based on, e.g., short DNA sequences or printable chemical compounds, that can be distributed as digital sequence files and synthesized on location via DNA/3D printing technology. We test our decentralized mitigation under extremely challenging conditions, such as suppressed local production rates or low therapeutic efficacy, and find that thanks to its homogeneous nature, it consistently outperforms the centralized alternative, saving many more lives with significantly less resources.
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39
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Carvalho AF, Heilig M, Perez A, Probst C, Rehm J. Alcohol use disorders. Lancet 2019; 394:781-792. [PMID: 31478502 DOI: 10.1016/s0140-6736(19)31775-1] [Citation(s) in RCA: 313] [Impact Index Per Article: 62.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 05/30/2019] [Accepted: 06/25/2019] [Indexed: 12/12/2022]
Abstract
Alcohol use disorders consist of disorders characterised by compulsive heavy alcohol use and loss of control over alcohol intake. Alcohol use disorders are some of the most prevalent mental disorders globally, especially in high-income and upper-middle-income countries; and are associated with high mortality and burden of disease, mainly due to medical consequences, such as liver cirrhosis or injury. Despite their high prevalence, alcohol use disorders are undertreated partly because of the high stigma associated with them, but also because of insufficient systematic screening in primary health care, although effective and cost-effective psychosocial and pharmacological interventions do exist. Primary health care should be responsible for most treatment, with routine screening for alcohol use, and the provision of a staggered treatment response, from brief advice to pharmacological treatment. Clinical interventions for these disorders should be embedded in a supportive environment, which can be bolstered by the creation of alcohol control policies aimed at reducing the overall level of consumption.
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Affiliation(s)
- Andre F Carvalho
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Markus Heilig
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | | | - Charlotte Probst
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Clinical Psychology and Psychotherapy, and Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany; Department of International Health Projects, Institute for Leadership and Health Management, IM Sechenov First Moscow State Medical University, Moscow, Russia.
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40
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Margiotta-Casaluci L, Owen SF, Rand-Weaver M, Winter MJ. Testing the Translational Power of the Zebrafish: An Interspecies Analysis of Responses to Cardiovascular Drugs. Front Pharmacol 2019; 10:893. [PMID: 31474857 PMCID: PMC6707810 DOI: 10.3389/fphar.2019.00893] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/16/2019] [Indexed: 12/04/2022] Open
Abstract
The zebrafish is rapidly emerging as a promising alternative in vivo model for the detection of drug-induced cardiovascular effects. Despite its increasing popularity, the ability of this model to inform the drug development process is often limited by the uncertainties around the quantitative relevance of zebrafish responses compared with nonclinical mammalian species and ultimately humans. In this test of concept study, we provide a comparative quantitative analysis of the in vivo cardiovascular responses of zebrafish, rat, dog, and human to three model compounds (propranolol, losartan, and captopril), which act as modulators of two key systems (beta-adrenergic and renin–angiotensin systems) involved in the regulation of cardiovascular functions. We used in vivo imaging techniques to generate novel experimental data of drug-mediated cardiovascular effects in zebrafish larvae. These data were combined with a database of interspecies mammalian responses (i.e., heart rate, blood flow, vessel diameter, and stroke volume) extracted from the literature to perform a meta-analysis of effect size and direction across multiple species. In spite of the high heterogeneity of study design parameters, our analysis highlighted that zebrafish and human responses were largely comparable in >80% of drug/endpoint combinations. However, it also revealed a high intraspecies variability, which, in some cases, prevented a conclusive interpretation of the drug-induced effect. Despite the shortcomings of our study, the meta-analysis approach, combined with a suitable data visualization strategy, enabled us to observe patterns of response that would likely remain undetected with more traditional methods of qualitative comparative analysis. We propose that expanding this approach to larger datasets encompassing multiple drugs and modes of action would enable a rigorous and systematic assessment of the applicability domain of the zebrafish from both a mechanistic and phenotypic standpoint. This will increase the confidence in its application for the early detection of adverse drug reactions in any major organ system.
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Affiliation(s)
| | - Stewart F Owen
- Global Safety, Health & Environment, AstraZeneca, Alderley Park, Macclesfield, United Kingdom
| | - Mariann Rand-Weaver
- College of Health and Life Sciences, Brunel University London, London, United Kingdom
| | - Matthew J Winter
- School of Biosciences, College of Life and Environmental Science, University of Exeter, Exeter, United Kingdom
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Buckman JE, Saunders R, Cohen ZD, Clarke K, Ambler G, DeRubeis RJ, Gilbody S, Hollon SD, Kendrick T, Watkins E, White IR, Lewis G, Pilling S. What factors indicate prognosis for adults with depression in primary care? A protocol for meta-analyses of individual patient data using the Dep-GP database. Wellcome Open Res 2019; 4:69. [PMID: 31815189 PMCID: PMC6880263 DOI: 10.12688/wellcomeopenres.15225.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2019] [Indexed: 02/15/2024] Open
Abstract
Background: Pre-treatment severity is a key indicator of prognosis for those with depression. Knowledge is limited on how best to encompass severity of disorders. A number of non-severity related factors such as social support and life events are also indicators of prognosis. It is not clear whether this holds true after adjusting for pre-treatment severity as a) a depressive symptom scale score, and b) a broader construct encompassing symptom severity and related indicators: "disorder severity". In order to investigate this, data from the individual participants of clinical trials which have measured a breadth of "disorder severity" related factors are needed. Aims: 1) To assess the association between outcomes for adults seeking treatment for depression and the severity of depression pre-treatment, considered both as i) depressive symptom severity only and ii) "disorder severity" which includes depressive symptom severity and comorbid anxiety, chronicity, history of depression, history of previous treatment, functional impairment and health-related quality of life. 2) To determine whether i) social support, ii) life events, iii) alcohol misuse, and iv) demographic factors (sex, age, ethnicity, marital status, employment status, level of educational attainment, and financial wellbeing) are prognostic indicators of outcomes, independent of baseline "disorder severity" and the type of treatment received. Methods: Databases were searched for randomised clinical trials (RCTs) that recruited adults seeking treatment for depression from their general practitioners and used the same diagnostic and screening instrument to measure severity at baseline - the Revised Clinical Interview Schedule; outcome measures could differ between studies. Chief investigators of all studies meeting inclusion criteria were contacted and individual patient data (IPD) were requested. Conclusions: In total 13 RCTs were found to meet inclusion criteria. The Dep-GP database was formed from the 6271 participants. This protocol outlines how these data will be analysed. Registration: PROSPERO CRD42019129512 (01/04/2019).
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Affiliation(s)
- Joshua E.J. Buckman
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
| | - Rob Saunders
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
| | - Zachary D. Cohen
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Katherine Clarke
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
| | - Gareth Ambler
- Statistical Science, University College London, London, WC1E 7HB, UK
| | - Robert J. DeRubeis
- School of Arts and Sciences, Department of Psychology, University of Pennsylvania, Philadelphia, PA, 19104-60185, USA
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Steven D. Hollon
- Department of Psychology, Vanderbilt University, Nashville, TN, 407817, USA
| | - Tony Kendrick
- Primary Care & Population Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 5ST, UK
| | - Edward Watkins
- Department of Psychology, University of Exeter, Exeter, EX4 4QG, UK
| | - Ian R. White
- Institute of Clinical Trials and Methodology, MRC Clinical Trials Unit, University College London, London, WC1V 6LJ, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, W1T 7NF, UK
| | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
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Haram A, Jonsbu E, Hole T, Fosse R. Dialogue therapy in psychosis: A philosophical-ethical approach. NORDIC PSYCHOLOGY 2019. [DOI: 10.1080/19012276.2019.1586570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Annbjørg Haram
- Department of Psychiatry, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Egil Jonsbu
- Department of Psychiatry, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Torstein Hole
- Clinic of Medicine and Rehabilitation, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Roar Fosse
- Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway
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Dawson JC, Warchal SJ, Carragher NO. Drug Screening Platforms and RPPA. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1188:203-226. [PMID: 31820390 DOI: 10.1007/978-981-32-9755-5_11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Since its inception as a scalable and cost-effective method for precise quantification of the abundance of multiple protein analytes and post-translational epitopes across large sample sets, reverse phase protein array (RPPA) has been utilized as a drug discovery tool. Key RPPA drug discovery applications include primary screening of abundance or activation state of nominated protein targets, secondary screening for toxicity and selectivity, mechanism-of-action profiling, biomarker discovery, and drug combination discovery. In recent decades, drug discovery strategies have evolved dramatically in response to continual advances in technology platforms supporting high-throughput screening, structure-based drug design, new therapeutic modalities, and increasingly more complex and disease-relevant cell-based and in vivo preclinical models of disease. Advances in biological laboratory capabilities in drug discovery are complemented by significant developments in bioinformatics and computational approaches for integrating large complex datasets. Bioinformatic and computational analysis of integrated molecular, pathway network and phenotypic datasets enhance multiple stages of the drug discovery process and support more informative drug target hypothesis generation and testing. In this chapter we discuss and present examples demonstrating how the latest advances in RPPA complement and integrate with other emerging drug screening platforms to support a new era of more informative and evidence-led drug discovery strategies.
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Affiliation(s)
- John C Dawson
- Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, Scotland, UK
| | - Scott J Warchal
- Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, Scotland, UK
| | - Neil O Carragher
- Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, Scotland, UK.
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Defending psychiatry or defending the trivial effects of therapeutic interventions? A citation content analysis of an influential paper. Epidemiol Psychiatr Sci 2018; 27:230-239. [PMID: 29183418 PMCID: PMC6998859 DOI: 10.1017/s2045796017000750] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIMS Leucht et al. in 2012 described an overview of meta-analyses of the efficacy of medication in psychiatry and general medicine, concluding that psychiatric drugs were not less efficacious than other drugs. Our goal was to explore the dissemination of this highly cited paper, which combined a thought provoking message with a series of caveats. METHODS We conducted a prospectively registered citation content analysis. All papers published before June 1st citing the target paper were independently rated by two investigators. The primary outcome coded dichotomously was whether the citation was used to justify a small or modest effect observed for a given treatment. Secondary outcomes regarded mentioning any caveats when citing the target paper, the point the citation was making (treatment effectiveness in psychiatry closely resembles that in general medicine, others), the type of condition (psychiatric, medical or both), specific disease, treatment category and specific type. We also extracted information about the type of citing paper, financial conflict of interest (COI) declared and any industry support. The primary analysis was descriptive by tabulating the extracted variables, with numbers and percentages where appropriate. Co-authorship networks were constructed to identify possible clusters of citing authors. An exploratory univariate logistic regression was used to explore the relationship between each of a subset of pre-specified secondary outcomes and the primary outcome. RESULTS We identified 135 records and retrieved and analysed 120. Sixty-three (53%) quoted Leucht et al.'s paper to justify a small or modest effect observed for a given therapy, and 113 (94%) did not mention any caveats. Seventy-two (60%) used the citation to claim that treatment effectiveness in psychiatry closely resembles that in general medicine; 110 (91%) paper were about psychiatric conditions. Forty-one (34%) papers quoted it without pointing towards any specific treatment category, 28 (23%) were about antidepressants, 18 (15%) about antipsychotics. Forty (33%) of the citing papers included data. COIs were reported in 55 papers (46%). Univariate and multivariate regressions showed an association between a quote justifying small or modest effects and the point that treatment effectiveness in psychiatry closely resembles that in general medicine. CONCLUSIONS Our evaluation revealed an overwhelmingly uncritical reception and seemed to indicate that beyond defending psychiatry as a discipline, the paper by Leucht et al. served to lend support and credibility to a therapeutic myth: trivial effects of mental health interventions, most often drugs, are to be expected and therefore accepted.Protocol registration: https://osf.io/9dqat/.
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46
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Hall W. Psychiatric Medication Withdrawal: Survivor Perspectives and Clinical Practice. JOURNAL OF HUMANISTIC PSYCHOLOGY 2018. [DOI: 10.1177/0022167818765331] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
As patient/survivor movements continue to challenge reductionist biological views of mental health and psychosis, there is rising skepticism toward psychiatric medications and growing interest in withdrawal and alternatives. This new perspective also calls for a rethinking of reductionist assumptions about psychiatric medications themselves. General medical patient experience with collaborative decision making for other conditions has broad implications for psychiatric drug withdrawal, and by recognizing psychiatric medications as psychoactive substances, addiction science also suggests a central role for social context and therapeutic common factors in medication withdrawal response. New understandings of madness and medications support an emerging reconsideration of what constitutes the very definition of “health,” where measuring the absence of disease symptoms gives way to a systems-based focus on self-management, social relationships, and adaptability.
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Affiliation(s)
- Will Hall
- Maastricht University MHeNS School for Mental Health and Neuroscience, Maastricht, Netherlands
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47
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Trends in Drug Prescription Rates for Dementia: An Observational Population-Based Study in France, 2006-2014. Drugs Aging 2018; 34:711-721. [PMID: 28752503 DOI: 10.1007/s40266-017-0481-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Since the 2011 French guidance updates, cholinesterase inhibitors and memantine are considered optional in the management of dementia and leave physicians free to prescribe based on their clinical expertise. OBJECTIVES The aims of this study were to analyze the influence of these recent guidance updates on the prescription rates of these drugs and to quantify the impact of potential changes on healthcare expenditures. METHODS Patients over 65 years old from a representative sample of a national administrative claims database, the French national health insurance database, were retrospectively included from 2006 to 2014. Trends of annual prescription rates were tested using adjusted segmented regression analysis. Drug costs with and without prescribers' behavioral changes were estimated. RESULTS A total of 119,731 individuals were included and followed during the study period. Among them, 5514 individuals were treated for dementia. According to the unadjusted segmented regression model, there was a significant increase in prescription rates between 2006 and 2010, from 2.23% (95% confidence interval 2.13-2.34) to 2.73% (95% confidence interval 2.62-2.84) of the study population. Since 2011, the trend has reversed with a significant decrease until 2014, from 2.64% (95% confidence interval 2.54-2.75) to 1.92% (95% confidence interval 1.84-2.01). In the multivariate analysis, we also found a gradual decline since 2011, particularly for patients aged 65-69 years and with one or more other chronic diseases. Cost savings associated with prescribers' behavioral changes were estimated at €108 million. CONCLUSION Drugs prescribed for dementia are on a declining trend with important cost savings, and this was concomitant with guidance updates that left physicians to rely on their clinical expertise while managing dementia.
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Rehm J, Barbosa C. The cost-effectiveness of therapies to treat alcohol use disorders. Expert Rev Pharmacoecon Outcomes Res 2017; 18:43-49. [DOI: 10.1080/14737167.2018.1392241] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- J. Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Addiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Faculty of Medicine, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - C. Barbosa
- Behavioral Health and Criminal Justice Division, RTI International, Chicago, IL, USA
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49
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Henshall C, Marzano L, Smith K, Attenburrow MJ, Puntis S, Zlodre J, Kelly K, Broome MR, Shaw S, Barrera A, Molodynski A, Reid A, Geddes JR, Cipriani A. A web-based clinical decision tool to support treatment decision-making in psychiatry: a pilot focus group study with clinicians, patients and carers. BMC Psychiatry 2017; 17:265. [PMID: 28732477 PMCID: PMC5521138 DOI: 10.1186/s12888-017-1406-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 06/27/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Treatment decision tools have been developed in many fields of medicine, including psychiatry, however benefits for patients have not been sustained once the support is withdrawn. We have developed a web-based computerised clinical decision support tool (CDST), which can provide patients and clinicians with continuous, up-to-date, personalised information about the efficacy and tolerability of competing interventions. To test the feasibility and acceptability of the CDST we conducted a focus group study, aimed to explore the views of clinicians, patients and carers. METHODS The CDST was developed in Oxford. To tailor treatments at an individual level, the CDST combines the best available evidence from the scientific literature with patient preferences and values, and with patient medical profile to generate personalised clinical recommendations. We conducted three focus groups comprising of three different participant types: consultant psychiatrists, participants with a mental health diagnosis and/or experience of caring for someone with a mental health diagnosis, and primary care practitioners and nurses. Each 1-h focus group started with a short visual demonstration of the CDST. To standardise the discussion during the focus groups, we used the same topic guide that covered themes relating to the acceptability and usability of the CDST. Focus groups were recorded and any identifying participant details were anonymised. Data were analysed thematically and managed using the Framework method and the constant comparative method. RESULTS The focus groups took place in Oxford between October 2016 and January 2017. Overall 31 participants attended (12 consultants, 11 primary care practitioners and 8 patients or carers). The main themes that emerged related to CDST applications in clinical practice, communication, conflicting priorities, record keeping and data management. CDST was considered a useful clinical decision support, with recognised value in promoting clinician-patient collaboration and contributing to the development of personalised medicine. One major benefit of the CDST was perceived to be the open discussion about the possible side-effects of medications. Participants from all the three groups, however, universally commented that the terminology and language presented on the CDST were too medicalised, potentially leading to ethical issues around consent to treatment. CONCLUSIONS The CDST can improve communication pathways between patients, carers and clinicians, identifying care priorities and providing an up-to-date platform for implementing evidence-based practice, with regard to prescribing practices.
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Affiliation(s)
- Catherine Henshall
- 0000 0001 0726 8331grid.7628.bOxINMAHR, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK ,0000 0004 0641 5119grid.416938.1Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Lisa Marzano
- 0000 0001 0710 330Xgrid.15822.3cDepartment of Psychology, Middlesex University, London, UK
| | - Katharine Smith
- 0000 0004 0641 5119grid.416938.1Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK ,0000 0004 1936 8948grid.4991.5Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX UK
| | - Mary-Jane Attenburrow
- 0000 0004 0641 5119grid.416938.1Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK ,0000 0004 1936 8948grid.4991.5Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX UK
| | - Stephen Puntis
- 0000 0004 1936 8948grid.4991.5Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX UK
| | - Jakov Zlodre
- 0000 0004 0641 5119grid.416938.1Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Kathleen Kelly
- 0000 0004 0641 5119grid.416938.1Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Matthew R Broome
- 0000 0004 0641 5119grid.416938.1Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK ,0000 0004 1936 8948grid.4991.5Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX UK
| | - Susan Shaw
- 0000 0004 0641 5119grid.416938.1Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Alvaro Barrera
- 0000 0004 0641 5119grid.416938.1Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Andrew Molodynski
- 0000 0004 0641 5119grid.416938.1Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Alastair Reid
- 0000 0004 0641 5119grid.416938.1Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - John R Geddes
- 0000 0004 0641 5119grid.416938.1Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK ,0000 0004 1936 8948grid.4991.5Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX UK
| | - Andrea Cipriani
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK. .,Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.
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Berna F, Göritz AS, Llorca PM, Vidailhet P, Fond G, Moritz S. Would I take antipsychotics, if I had psychotic symptoms? Examining determinants of the decision to take antipsychotics. Prog Neuropsychopharmacol Biol Psychiatry 2017; 77:155-163. [PMID: 28342943 DOI: 10.1016/j.pnpbp.2017.03.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 03/08/2017] [Accepted: 03/20/2017] [Indexed: 01/30/2023]
Abstract
Poor adherence to treatment in schizophrenia is mainly associated to patients-related factors. However, social negative representations of schizophrenia and its treatment may also contribute to patients' decision to take or not to take antipsychotics. A web-based study on 1,807 participants was conducted during which participants imagined that they had a particular chronic illness based on clinical vignettes (mental illnesses: schizophrenia, depression; somatic illnesses: multiple sclerosis, rheumatoid arthritis). Participants rated their subjective distress and perceived social stigma associated with each illness. They also rated the perceived treatability of the illness, their belief in the effectiveness of treatment, and their treatment preference regarding medication. Results show that schizophrenia was considered more distressful, less treatable and associated with higher social stigma than somatic illnesses. Medication was less preferred for treating schizophrenia compared to somatic illnesses. Perceived treatability of illness and belief in the effectiveness of pharmacological treatment were the factors driving preference for medication in schizophrenia and depression, respectively; these factors had weaker influence on preference for medication in somatic illnesses. Our study points out more severe negative representations of mental illnesses in general, and their treatment, particularly schizophrenia. These attitudes are not confined to patients, and may influence patients' decisions to take psychotropic drugs.
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Affiliation(s)
- Fabrice Berna
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistr. 52, D-20246 Hamburg, Germany.
| | - Anja S Göritz
- Occupational and Consumer Psychology, Freiburg University, Freiburg, Germany
| | - Pierre-Michel Llorca
- CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69 63003 Clermont-Ferrand Cedex 1, France; Fondation FondaMental, Créteil, France
| | - Pierre Vidailhet
- Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France; Fondation FondaMental, Créteil, France
| | - Guillaume Fond
- INSERM U955, équipe de psychiatrie translationnelle, Créteil, France; Fondation FondaMental, Créteil, France; Université Paris-Est Créteil, DHU Pe-PSY, Pôle de Psychiatrie des Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Steffen Moritz
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistr. 52, D-20246 Hamburg, Germany
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