Time to lack of persistence with pharmacological treatment among patients with current depressive episodes: a natural study with 1-year follow-up

Clinical Predictors of Engagement in Teleintegrated Care and Telereferral Care for Complex Psychiatric Disorders in Primary Care: a Randomized Trial

BACKGROUND

Telepsychiatry Collaborative Care (TCC) and Telepsychiatry/Telepsychology Enhanced Referral (TER) expand the reach of specialty mental health services to underserved populations.

OBJECTIVE

Assess clinical predictors of treatment engagement for complex psychiatric conditions in TCC-in which remote specialists consult with primary care teams via an onsite care manager who also provides brief psychotherapy-and TER, in which remote specialists provide direct telehealth treatment.

DESIGN

A randomized pragmatic trial from twenty-four primary care clinics without onsite psychiatrists or psychologists.

PARTICIPANTS

A total of 1,004 adult patients screened positive for posttraumatic stress disorder (PTSD)and/or bipolar disorder were randomized to receive TCC or TER for 1 year.

MAIN MEASURES

Psychotherapy engagement was measured by the number of sessions completed, and pharmacotherapy engagement by the medication adherence item from the Schizophrenia Care and Assessment Program Health Questionnaire (SCAP-HQ).

KEY RESULTS

Engagement in TCC psychotherapy visits was greater compared to TER. There was no association between the PTSD symptom severity and treatment engagement. The internal state scale (ISS) activation subscale, an indicator of mania, was associated with reduced odds of initiating psychotherapy (odds ratio [OR] = 0.70; 95% CI, 0.59 to 0.84) but not the number of sessions attended once psychotherapy started. The Drug Abuse Screening Test-10(DAST-10) score was associated with receipt of fewer psychotherapy sessions (incidence ratio rate [IRR] = 0.88; 95% CI, 0.81 to 0.95). The number of physical health comorbidities was associated with greater engagement in psychotherapy (IRR = 1.11, 95% CI, 1.03 to 1.19) and pharmacotherapy (OR = 1.54; 95% CI, 1.27 to 1.87). None of the findings varied by intervention group.

CONCLUSIONS

Both teleintegrated and telereferral care offer an opportunity to treat patients with complex psychiatric conditions. While there was no difference in clinical characteristics predicting engagement, onsite care managers engaged patients in more psychotherapy sessions than remote therapists.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02738944.

Prevalence of suicidal ideation and planning in patients with major depressive disorder: A meta-analysis of observation studies

BACKGROUND

Suicidal ideation (SI) and suicide planning (SP) are associated with an increased risk of future suicide. We performed a meta-analysis of observational studies to estimate the prevalence of SI and SP in patients with major depressive disorder (MDD) and its associated factors.

METHODS

A systematic literature search was conducted in PubMed, EMBASE, PsycINFO and Web of Science from their commencement date until 7 October 2020. Original studies containing data on the prevalence of SI and SP in individuals with MDD were analyzed.

RESULTS

Forty-six articles covering 53,598 patients were included in the meta-analysis. The overall prevalence of SI was 37.7% (95% confidence interval (CI): 32.3-43.4%) and the pooled prevalence of SP was 15.1% (95% CI: 8.0--26.8%). Subgroup analyses revealed that the timeframe over which SI was assessed, source of patients, study design, and diagnostic criteria were significantly associated with the pooled prevalence of SI. Meta-regression analyses revealed that the Hamilton Depression Rating Scale (HAMD) score and percentage of male participants were positively associated with the pooled prevalence of SI. Study quality and mean age were negatively associated with the pooled prevalence of SI. In contrast, survey year and study quality were negatively associated with pooled prevalence of SP LIMITATION: SI and SP were self-reported and subject to recall bias and impression management.

CONCLUSIONS

SI and SP are common in patients with MDD, especially among inpatients. Preventive measures and treatments focusing on factors associated with SI and SP may reduce the risk of suicide in patients with MDD.

Case Report: Paliperidone Palmitate in the Management of Bipolar I Disorder With Non-compliance

Background: Medication non-adherence is prevalent in patients with bipolar disorder (BD). Long-acting injectable antipsychotics (LAIAs) are widely used to improve compliance with treatment. This study aimed to illustrate the effectiveness, compliance, and safety profile of once-monthly paliperidone palmitate (PP1M), a novel therapeutic LAIA, in the management of bipolar I disorder (BDI). Method: A prospective follow-up was arranged to 11 BDI patients who were prescribed PP1M as monotherapy or adjunctive treatment. Severity of symptoms, disturbing behavior, status of employment, 17-item Hamilton Depression Rating Scale (HAMD-17), and Young Mania Rating Scale (YMRS) were evaluated at the baseline and the endpoint of follow-up. Clinical Global Impression-Bipolar Disorder-Severity of Illness Scale (CGI-BP) and Treatment Emergent Symptom Scale (TESS) were measured at each injection of PP1M. Compliance, relapse or switch, and new hospitalization were monitored through the period of follow-up. Results: The median duration of treatment was 14 months, ranging from 5 to 22 months. The scores (mean ± standard deviation) of HAMD-17, YMRS, and CGI-BP generally decreased from the baseline (16.1 ± 10.3, 30.9 ± 12.6, 5.3 ± 0.7) to the endpoint (7.4 ± 5.7, 3.7 ± 3.2, 2.3 ± 0.7). No disturbing behavior was detected at the endpoint. Neither new hospitalization nor manic/mixed episode occurred during treatment, whereas mild to moderate depressive episodes were reported in three cases. The status of employment of 10 participants (90.9%) was improved, and no new safety concern was detected. Conclusion: PP1M might offer a new valid treatment option in the long-term management of BDI, especially for those with poor compliance with oral medication. However, more studies are needed to further justify such role.

Prevalence of suicide attempt in individuals with major depressive disorder: a meta-analysis of observational surveys

BACKGROUND

Suicide attempt (SA), which is one of the strongest predictors of completed suicide, is common in major depressive disorder (MDD) but its prevalence across epidemiological studies has been mixed. The aim of this comprehensive meta-analysis was to examine the pooled prevalence of SA in individuals with MDD.

METHODS

A systematic literature search was conducted in PubMed, Embase, PsycINFO, Web of Science and Cochrane Library from their commencement date until 27 December 2017. Original studies containing data on prevalence of SA in individuals with MDD were analyzed.

RESULTS

In all, 65 studies with a total of 27 340 individuals with MDD were included. Using the random effects model, the pooled lifetime prevalence of SA was 31% [95% confidence interval (CI) 27-34%], 1-year prevalence was 8% (95% CI 3-14%) and 1-month prevalence was 24% (95% CI 15-34%). Subgroup analyses revealed that the lifetime prevalence of SA was significantly associated with the patient setting, study region and income level, while the 1-month prevalence of SA was associated with only the patient setting.

CONCLUSION

This meta-analysis confirmed that SA was common in individuals with MDD across the world. Careful screening and appropriate interventions should be implemented for SA in the MDD population.

Patterns of persistence with pharmacological treatment among patients with current depressive episode and their impact on long-term outcome: a naturalistic study with 5-year follow-up

BACKGROUND

The aim of the study was to describe and compare the patterns of medication persistence among patients with unipolar depression (UD) or bipolar depression in a 5-year follow-up, and explore their impact on long-term outcome.

PATIENTS AND METHODS

A total of 333 eligible patients with current major depressive episode were observed and followed up from the first index prescription for 5 years. Lack of persistence or treatment interruption was defined as a gap of at least 2 consecutive months without taking any medication. Time to lack of persistence in the first (TLP1) and the second (TLP2) episode of treatment, number of visits before the first treatment interruption (NV) and number of treatment interruptions (NTI) were measured.

RESULTS

During the 5-year follow-up, nearly 50% of patients experienced at least two times of treatment interruption. Pattern of medication persistence did not significantly differ between UD and bipolar disorder (BD) patients. TLP1 was positively associated with TLP2. Shorter TLP1 predicted a higher possibility of subsequent visits because of recurrence or relapse and more NTI meant a lower likelihood of achieving full remission in the fifth year for both UD and BD patients. For UD patients, shorter TLP1 or less NV predicted a lower chance of achieving remission, while for BD patients, shorter TLP1 meant an earlier subsequent visit and more NTI predicted a lower possibility of achieving remission.

CONCLUSION

Pattern of medication persistence was similar but its impact on the long-term outcome was quite different between UD and BD.