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Platona RI, Căiţă GA, Voiţă-Mekeres F, Peia AO, Enătescu RV. The impact of psychiatric comorbidities associated with depression: a literature review. Med Pharm Rep 2024; 97:143-148. [PMID: 38746031 PMCID: PMC11090285 DOI: 10.15386/mpr-2700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 01/18/2024] [Accepted: 02/04/2024] [Indexed: 05/16/2024] Open
Abstract
The comorbidity with anxiety disorders has profound adverse implications on the evolution, prognosis and therapeutic responsiveness of depression, it will prolong the time required to achieve remission of the depressive episode, and patients under treatment will tend to drop out of their therapeutic regimens faster than those with depression but without anxious comorbidity. The purpose of this study is to evaluate the importance of the clinical, etiopathogenetic, prognostic and especially therapeutic connotations given by the presence of psychiatric comorbidities in depression. Articles evaluating the presence of psychiatric comorbidities in depression were analyzed using PubMed, Medline, Scopus, Google Academics and WoS databases. To select the articles, we used keywords: psychiatric comorbidity, depression with anxiety disorders, depression with dysthymia, depression with psychoactive substances, depression with personality disorders. From a psychiatric perspective, the comorbidity of mental disorders can be divided into psychiatric comorbidity, when two or more distinct psychiatric conditions are present in the same individual, and medical comorbidity, when a medical-surgical illness is associated with a mental disorder. The presence of major depression is in itself a predictive factor for a later onset of generalized anxiety disorder. The comorbidity of depression in those with substance abuse or addiction has profound implications on their clinical prognosis. The association of personality disorder has a significant impact on the suicidal behavior of patients with major depression.
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Affiliation(s)
- Rita Ioana Platona
- Doctoral School, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
- County Clinical Emergency Hospital of Bihor, Oradea, Romania
- SC. Psiho neuro mag SRL, Oradea, Romania
| | - Georgiana Albina Căiţă
- SC. Psiho neuro mag SRL, Oradea, Romania
- Doctoral School, University of Oradea, Oradea, Romania
- Surgical Disciplines Department, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
| | - Florica Voiţă-Mekeres
- County Clinical Emergency Hospital of Bihor, Oradea, Romania
- Morphological Disciplines Department, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
| | | | - Radu Virgil Enătescu
- Department of Neurosciences, Discipline of Psychiatry, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
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Schwabenbauer AK, Merladet J, Metzner N, Salib B, Siffert K. Adapting Measurement-Based Care to VA Home-Based Primary Care Mental Health Treatment: A Quality Improvement Project. Clin Gerontol 2024:1-10. [PMID: 38226906 DOI: 10.1080/07317115.2024.2304889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
OBJECTIVES This quality improvement project sought to develop guidance for Home-Based Primary Care (HPBC) Mental Health (MH) clinicians on integrating Measurement-Based Care (MBC) into their practice and gain participating psychologists' feedback on their experience using MBC for treating mental health concerns with HBPC Veterans. METHODS Based on feedback from the HBPC MH community and in consultation with national leadership, a workgroup of HBPC psychologists developed a guide tailoring MBC to HBPC Veterans. Eight HBPC psychologists piloted the adapted MBC approach with 53 Veterans. Participating psychologists provided feedback on measure administration, Veterans' responses to MBC, and perceived benefits and challenges. RESULTS Pilot participants' feedback suggested that MBC can be a highly useful tool for delivering mental health services in HBPC, although feedback varied about specific MBC measures. Qualitative feedback was primarily positive, but participants noted challenges based on the nature of the presenting problem and Veteran-specific characteristics. CONCLUSIONS Findings indicate that MBC can be utilized with appropriate HBPC Veterans and has the potential to benefit care. Further research is needed to clarify factors that enhance or reduce MBC's utility within HBPC. CLINICAL IMPLICATIONS HBPC MH providers identified MBC as a useful tool particularly when adapted to meet the needs of HBPC Veterans.
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Affiliation(s)
| | - John Merladet
- Behavioral Health, Orlando VA Medical Center, Orlando, Florida, USA
| | - Neil Metzner
- Behavioral Health, White River Junction VA Medical Center, White River Junction, Vermont, USA
| | - Brea Salib
- Behavioral Health, Durham VA Health Care System, Durham, North Carolina, USA
| | - Kevin Siffert
- Behavioral Health, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
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3
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Duff J, Ellis R, Kaiser S, Grant LC. Psychological Screening, Standards and Spinal Cord Injury: Introducing Change in NHS England Commissioned Services. J Clin Med 2023; 12:7667. [PMID: 38137735 PMCID: PMC10743880 DOI: 10.3390/jcm12247667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
Psychologist resourcing across the United Kingdom (UK) spinal cord injury centres (SCICs) varies considerably, which has detrimentally impacted standardising service provision for people with spinal cord injuries/disorders (PwSCI/D) compared with other nations. This paper presents the outcome of a project involving the Spinal Cord Injury Psychology Advisory Group (SCIPAG) and NHS England Clinical Reference Group/SCI transformation groups to agree upon screening and standards and shares data from the National Spinal Injuries Centre (NSIC) and the Yorkshire and Midlands Regional SCICs. Inpatients completed the GAD-7, the PHQ-9, and the short form of the Appraisals of DisAbility: Primary and Secondary Scale (ADAPSSsf), assessing adjustment. A total of 646 participants were included, with 43% scoring above the clinical threshold on at least one of the measures on admission. A subset of 272 participants also completed discharge measures and 42% remained above the threshold on discharge, demonstrating sustained psychological need. This paper provides support for services to move to a screen-and-assessment model supplemented by referral options for those with changing needs or who present with difficulties outside the remit of screening. The findings also support the efficacy of universal screening across the system and consideration of screening and standards for psychological care by the wider psychology community.
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Affiliation(s)
- Jane Duff
- Department of Clinical Psychology, National Spinal Injuries Centre, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury HP21 8AL, UK
| | - Rebecca Ellis
- Department of Clinical Health Psychology, Yorkshire Regional Spinal Injuries Centre, Mid Yorkshire NHS Trust, Wakefield WF1 4DG, UK;
| | - Sally Kaiser
- Department of Clinical Psychology, Midlands Centre for Spinal Injuries, The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, UK;
| | - Lucy C Grant
- Department of Clinical Psychology, National Spinal Injuries Centre, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury HP21 8AL, UK
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4
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Webb L. Principles, tools and techniques for brief behaviour change interventions. Nurs Stand 2023; 38:48-52. [PMID: 36779292 DOI: 10.7748/ns.2023.e12025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2022] [Indexed: 02/14/2023]
Abstract
Nurses are well placed to deliver brief opportunistic health promotion interventions during routine encounters with patients. Brief interventions have been shown to be effective in prompting behaviour change among people who engage in harmful drinking or substance misuse. Nurses can use their communication, relationship-building and partnership-working skills to support people to consider behaviour change. This article explains the concepts that underlie brief behaviour change interventions, which include motivational interviewing and the transtheoretical model of behaviour change. The article also describes practical tools and techniques that nurses can use to deliver such interventions.
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Affiliation(s)
- Lucy Webb
- department of nursing, Manchester Metropolitan University, Manchester, England
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5
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Ciro CA, James SA, McGuire H, Lepak V, Dresser S, Costner-Lark A, Robinson W, Fritz T. Natural, longitudinal recovery of adults with COVID-19 using standardized rehabilitation measures. Front Aging Neurosci 2022; 14:958744. [PMID: 36092810 PMCID: PMC9452908 DOI: 10.3389/fnagi.2022.958744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/08/2022] [Indexed: 11/17/2022] Open
Abstract
Background While studies recommend rehabilitation following post-hospitalization recovery from COVID-19, few implement standardized tools to assess continued needs. The aim of this study was to identify post-hospitalization recommendations using an interdisciplinary needs assessment with standardized rehabilitation measures. A secondary aim was to use these tools to measure recovery over a 30-day period. Materials and methods Using a 30-day longitudinal design, we completed weekly rapid needs assessments in this convenience sample of 20 people diagnosed with COVID-19 discharged from the hospital to home. We computed summary statistics and used the Wilcoxon Signed Rank Test to assess change over the 4-week course of the study with alpha level = 0.05. Results Our sample (65% male, 47% over 50 years of age, 35% White, 37% with a confirmed diagnosis of diabetes, and 47% obese) included no patients who had required mechanical ventilation. Initial assessments demonstrated the majority of our participants were at an increased risk of falls, had disability in activities of daily living (ADL) and instrumental activities of daily living (IADL), mild cognitive impairment, and dyspnea. At the 30-day follow-up, most were independent in mobility and basic ADLs, with continued disability in IADLs and cognitive function. Discussion In this sample of patients who were not mechanically-ventilated, early and individualized rehabilitation was necessary. The results of this study suggest patients would benefit from a multi-disciplinary team needs assessment after medical stabilization to minimize fall risk and disability, and to prevent secondary complications resulting from post-hospital deconditioning due to COVID-19.
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Affiliation(s)
- Carrie A. Ciro
- Department of Rehabilitation Sciences, College of Allied Health, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- *Correspondence: Carrie A. Ciro,
| | - Shirley A. James
- Department of Rehabilitation Sciences, College of Allied Health, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Hillary McGuire
- Department of Rehabilitation Sciences, College of Allied Health, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Vince Lepak
- Department of Rehabilitation Sciences, The University of Oklahoma Health Sciences Center at the OU-Tulsa Schusterman Campus, Tulsa, OK, United States
| | - Susan Dresser
- College of Nursing, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Amy Costner-Lark
- College of Nursing, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Wanda Robinson
- College of Nursing, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Terrie Fritz
- Anne and Henry Zarrow School of Social Work, Dodge Family College of Arts and Sciences, The University of Oklahoma, Norman, OK, United States
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Somé NH, Wells S, Felsky D, Hamilton HA, Ali S, Elton-Marshall T, Rehm J. Self-reported mental health during the COVID-19 pandemic and its association with alcohol and cannabis use: a latent class analysis. BMC Psychiatry 2022; 22:306. [PMID: 35490222 PMCID: PMC9055215 DOI: 10.1186/s12888-022-03917-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 04/06/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Mental health problems and substance use co-morbidities during and after the COVID-19 pandemic are a public health priority. Identifying individuals at high-risk of developing mental health problems and potential sequela can inform mitigating strategies. We aimed to identify distinct groups of individuals (i.e., latent classes) based on patterns of self-reported mental health symptoms and investigate their associations with alcohol and cannabis use. METHODS We used data from six successive waves of a web-based cross-sectional survey of adults aged 18 years and older living in Canada (6,021 participants). We applied latent class analysis to three domains of self-reported mental health most likely linked to effects of the pandemic: anxiety, depression, and loneliness. Logistic regression was used to characterize latent class membership, estimate the association of class membership with alcohol and cannabis use, and perform sex-based analyses. RESULTS We identified two distinct classes: (1) individuals with low scores on all three mental health indicators (no/low-symptoms) and (2) those reporting high scores across the three measures (high-symptoms). Between 73.9 and 77.1% of participants were in the no/low-symptoms class and 22.9-26.1% of participants were in the high-symptom class. We consistently found across all six waves that individuals at greater risk of being in the high-symptom class were more likely to report worrying about getting COVID-19 with adjusted odds ratios (aORs) between 1.72 (95%CI:1.17-2.51) and 3.51 (95%CI:2.20-5.60). Those aged 60 + were less likely to be in this group with aORs (95%CI) between 0.26 (0.15-0.44) and 0.48 (0.29-0.77) across waves. We also found some factors associated with class membership varied at different time points. Individuals in the high-symptom class were more likely to use cannabis at least once a week (aOR = 2.28, 95%CI:1.92-2.70), drink alcohol heavily (aOR = 1.71, 95%CI:1.49-1.96); and increase the use of cannabis (aOR = 3.50, 95%CI:2.80-4.37) and alcohol (aOR = 2.37, 95%CI:2.06-2.74) during the pandemic. Women in the high-symptom class had lower odds of drinking more alcohol during the pandemic than men. CONCLUSIONS We identified the determinants of experiencing high anxiety, depression, and loneliness symptoms and found a significant association with alcohol and cannabis consumption. This suggests that initiatives and supports are needed to address mental health and substance use multi-morbidities.
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Affiliation(s)
- Nibene Habib Somé
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 100 Collip Circle, Suite 200, ON, N6G 4X8, London, Canada. .,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. .,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. .,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Samantha Wells
- grid.155956.b0000 0000 8793 5925Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 100 Collip Circle, Suite 200, ON N6G 4X8 London, Canada ,grid.155956.b0000 0000 8793 5925Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario Canada ,grid.39381.300000 0004 1936 8884Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario Canada ,grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, Ontario Canada ,grid.1021.20000 0001 0526 7079School of Psychology, Deakin University, Victoria, Australia
| | - Daniel Felsky
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, Ontario Canada ,grid.17063.330000 0001 2157 2938Institute of Medical Science, University of Toronto, Toronto, Ontario Canada ,grid.155956.b0000 0000 8793 5925Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, Ontario Canada
| | - Hayley A. Hamilton
- grid.155956.b0000 0000 8793 5925Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 100 Collip Circle, Suite 200, ON N6G 4X8 London, Canada ,grid.155956.b0000 0000 8793 5925Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario Canada ,grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
| | - Shehzad Ali
- grid.39381.300000 0004 1936 8884Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario Canada ,grid.39381.300000 0004 1936 8884Schulich Interfaculty Program in Public Health, Schulich School of Medicine and Dentistry, Western University, London, Canada ,grid.5685.e0000 0004 1936 9668Department of Health Sciences, University of York, York, UK ,grid.1004.50000 0001 2158 5405Department of Psychology, Macquarie University, Sydney, Australia ,grid.418792.10000 0000 9064 3333Bruyere Research Institute, Ottawa, Canada
| | - Tara Elton-Marshall
- grid.155956.b0000 0000 8793 5925Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 100 Collip Circle, Suite 200, ON N6G 4X8 London, Canada ,grid.155956.b0000 0000 8793 5925Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario Canada ,grid.39381.300000 0004 1936 8884Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario Canada ,grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada ,grid.28046.380000 0001 2182 2255School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada ,grid.258900.60000 0001 0687 7127Department of Health Sciences, Lakehead University, Thunder Bay, Ontario Canada
| | - Jürgen Rehm
- grid.155956.b0000 0000 8793 5925Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 100 Collip Circle, Suite 200, ON N6G 4X8 London, Canada ,grid.155956.b0000 0000 8793 5925Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario Canada ,grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, Ontario Canada ,grid.17063.330000 0001 2157 2938Institute of Medical Science, University of Toronto, Toronto, Ontario Canada ,grid.4488.00000 0001 2111 7257Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
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Russell M, Ames H, Dunn C, Beckwith S, Holmes SA. Appraisals of disability and psychological adjustment in veterans with spinal cord injuries. J Spinal Cord Med 2021; 44:958-965. [PMID: 32406809 PMCID: PMC8725773 DOI: 10.1080/10790268.2020.1754650] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Context/Objective: Following a spinal cord injury or disability (SCI/D), cognitive appraisals are a marker of psychological adjustment. The present study evaluated the clinical utility and discriminant validity of the Appraisals of DisAbility Primary and Secondary Scale - Short Form (ADAPSS-sf). The ADAPSS-sf was evaluated on 1. identification of individuals experiencing poor psychological adjustment and 2. prediction of life satisfaction beyond measures of emotional distress.Design: A retrospective study was completed using ROC analyses and odds ratios to identify the clinical utility of the ADAPSS-sf. In addition, blocked hierarchical regression explored the ADAPSS-sf predictive characteristics for satisfaction with life beyond measures of emotional distress.Setting: Veteran's Health Administration SCI Center.Participants: Ninety outpatient veterans with SCI/Ds.Outcome Measures: Measures of psychological adjustment post-SCI/D included the PHQ-9, GAD-7, PC-PTSD, and the Diener Satisfaction with Life Scale (SWLS). The ADAPSS-sf was used as a measure of cognitive appraisals.Results: Results indicated the ADAPSS-sf is effective in identification of poor psychological adjustment, P < .001. Diagnostic odds ratios and ADAPSS-sf cut scores were selected to prioritize sensitivity (7.17, ≤ 11), specificity (68.25, ≥ 22), or a balance of the two (16.32, ≤ 19). Hierarchical regression indicated the ADAPSS-sf accounted for unique variance in life satisfaction beyond measures of emotional distress, (ΔR2 = .20, β = -.66, t(89) = 6.54, P < .001).Conclusion: Results indicated SCI/D specific appraisals are predictive of concurrent poor psychological adjustment and provide insight into satisfaction with life beyond measures of emotional distress.
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Affiliation(s)
- Matthew Russell
- Spinal Cord Injury Care Line, Michael E. DeBakey VA Medical Center, HoustonTexas, USA,Department of Psychiatry, Baylor College of Medicine, HoustonTexas, USA
| | - Herb Ames
- Spinal Cord Injury Care Line, Michael E. DeBakey VA Medical Center, HoustonTexas, USA,Physical Medicine and Rehabilitation, Baylor College of Medicine, HoustonTexas, USA,Correspondence to: Herb Ames, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd, Houston, TX77030, USA; Ph: (713) 794-7044.
| | - Callie Dunn
- Behavioral Health Service Line, WellStar Medical Group Psychological Services, Marietta, Georgia, USA
| | - Sarah Beckwith
- Spinal Cord Injury Care Line, Michael E. DeBakey VA Medical Center, HoustonTexas, USA
| | - Sally A. Holmes
- Spinal Cord Injury Care Line, Michael E. DeBakey VA Medical Center, HoustonTexas, USA,Physical Medicine and Rehabilitation, Baylor College of Medicine, HoustonTexas, USA
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Yusoff MS. A comparative study on the psychological health status of pre-clinical medical students enrolled through different admission tests. J Taibah Univ Med Sci 2020; 15:439-446. [PMID: 33318735 PMCID: PMC7715458 DOI: 10.1016/j.jtumed.2020.08.011] [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: 04/03/2020] [Revised: 08/19/2020] [Accepted: 08/29/2020] [Indexed: 11/26/2022] Open
Abstract
Objective Methods Results Conclusions
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9
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White EJ, Wray JM, Shepardson RL. Clinical considerations in designing brief exposure interventions for primary care behavioral health settings. FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2020; 38:439-449. [PMID: 33119371 PMCID: PMC7928230 DOI: 10.1037/fsh0000543] [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] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Prevalence rates of anxiety disorders and symptoms in primary care (PC) settings are very high. Behavioral health consultants in primary care behavioral health (PCBH) settings enable increased access to evidence-based anxiety treatment. Despite strong extant support for exposure-based therapy for anxiety disorders, the use of exposure to treat anxiety in PC settings is low. Although barriers to exposure therapy (ET) may be exacerbated in PC settings, many anxiety presentations in PC warrant an exposure-based approach to treatment. Thus, exploration of feasibility and efficacy of ET in PC represents a critical area for advancing evidence-based treatment of anxiety symptoms. METHODS The current article addresses this gap through the presentation of two case examples of ET conducted in PCBH. Theoretical and practical information regarding the implementation of exposure using a brief (≤ 30 min), time-limited (4-6 visit) approached are presented. RESULTS Results from the case examples demonstrate feasibility of conducting exposure in a brief format consistent with a PCBH approach. Additionally, patient outcomes presented suggest that ET conducted in PCBH reduces anxiety symptoms and may facilitate referral to specialty care settings. DISCUSSION Exposure may offer promise in improving the quality of anxiety treatment in PC. Future work documenting both effectiveness and implementation outcomes of exposure in PC in clinical work and research trials is needed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | - Jennifer M. Wray
- Ralph H. Johnson VA Medical Center, Charleston, SC
- Medical University of South Carolina, Department of Psychiatry, Charleston, SC
| | - Robyn L. Shepardson
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY
- Department of Psychology, Syracuse University, Syracuse, NY
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Browne D, Roy S, Phillips M, Shamon S, Stephenson M. Supporting patient and clinician mental health during COVID-19: Via trauma-informed interdisciplinary systems. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2020; 66:e190-e192. [PMID: 32675108 PMCID: PMC7365150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Dillon Browne
- Registered clinical psychologist and Canada Research Chair in Child and Family Clinical Psychology at the University of Waterloo in Ontario
| | - Sylvain Roy
- Registered neuropsychologist in Toronto, Ont, Past President of the Ontario Psychological Association, and Lead of the Ontario Psychological Association Disaster Response Network
| | - Marjory Phillips
- Registered clinical psychologist and a faculty member of the University of Waterloo Clinical Psychology Program
| | - Sandy Shamon
- Private-practice family physician and palliative care specialist in Cambridge, Ont, and an adjunct faculty member of the Degroote School of Medicine at McMaster University
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11
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Shepardson RL, Buchholz LJ, Weisberg RB, Funderburk JS. Psychological interventions for anxiety in adult primary care patients: A review and recommendations for future research. J Anxiety Disord 2018; 54:71-86. [PMID: 29427898 PMCID: PMC7909724 DOI: 10.1016/j.janxdis.2017.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 11/07/2017] [Accepted: 12/23/2017] [Indexed: 10/18/2022]
Abstract
Anxiety symptoms are prevalent in primary care, yet treatment rates are low. The integration of behavioral health providers into primary care via the Primary Care Behavioral Health (PCBH) model offers a promising way to improve treatment options by adding a team member with the necessary skillset to deliver evidence-based psychological interventions for anxiety. We conducted a narrative review of psychological interventions for anxiety applied within adult primary care settings (k = 44) to update the literature and evaluate the fit of existing interventions with the PCBH model. The majority of studies were randomized controlled trials (RCTs; 70.5%). Most interventions utilized cognitive-behavioral therapy (68.2%) and were delivered individually, face-to-face (52.3%). Overall, 65.9% of interventions (58.6% of RCTs, 91.7% of pre-post) were effective in reducing anxiety symptoms, and 83.3% maintained the gains at follow-up. Although it is encouraging that most interventions significantly reduced anxiety, their longer formats (i.e., number and duration of sessions) and narrow symptom targets make translation into practice difficult. Methodological limitations of the research included homogenous samples, failure to report key procedural details, pre-post designs, and restrictive eligibility criteria. We offer recommendations to guide future research to improve the likelihood of successful translation of anxiety interventions into clinical practice.
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Affiliation(s)
- Robyn L Shepardson
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, United States; Department of Psychology, Syracuse University, Syracuse, NY, United States.
| | - Laura J Buchholz
- Center for Integrated Healthcare, VA Western New York Healthcare System at Buffalo, Buffalo, NY, United States; Department of Psychology, University at Buffalo/State University of New York, Buffalo, NY, United States; Department of Psychology, University of Tampa, Tampa, FL, United States.
| | - Risa B Weisberg
- VA Boston Healthcare System, Boston, MA, United States; Boston University School of Medicine, Boston, MA, United States; Alpert Medical School of Brown University, Providence, RI, United States.
| | - Jennifer S Funderburk
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, United States; Department of Psychology, Syracuse University, Syracuse, NY, United States; Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, United States.
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12
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Campbell-Sills L, Roy-Byrne PP, Craske MG, Bystritsky A, Sullivan G, Stein MB. Improving outcomes for patients with medication-resistant anxiety: effects of collaborative care with cognitive behavioral therapy. Depress Anxiety 2016; 33:1099-1106. [PMID: 27775823 DOI: 10.1002/da.22574] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 08/29/2016] [Accepted: 09/11/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Many patients with anxiety disorders remain symptomatic after receiving evidence-based treatment, yet research on treatment-resistant anxiety is limited. We evaluated effects of cognitive behavioral therapy (CBT) on outcomes of patients with medication-resistant anxiety disorders using data from the Coordinated Anxiety Learning and Management (CALM) trial. METHODS Primary care patients who met study entry criteria (including DSM-IV diagnosis of generalized anxiety disorder, panic disorder, posttraumatic stress disorder, or social anxiety disorder) despite ongoing pharmacotherapy of appropriate type, dose, and duration were classified as medication resistant (n = 227). Logistic regression was used to estimate effects of CALM's CBT program (CALM-CBT; chosen by 104 of 117 medication-resistant patients randomized to CALM) versus usual care (UC; n = 110) on response [≥ 50% reduction of 12-item Brief Symptom Inventory (BSI-12) anxiety and somatic symptom score] and remission (BSI-12 < 6) at 6, 12, and 18 months. Within-group analyses examined outcomes by treatment choice (CBT vs. CBT plus medication management) and CBT dose. RESULTS Approximately 58% of medication-resistant CALM-CBT patients responded and 46% remitted during the study. Relative to UC, CALM-CBT was associated with greater response at 6 months (AOR = 3.78, 95% CI 2.02-7.07) and 12 months (AOR = 2.49, 95% CI 1.36-4.58) and remission at 6, 12, and 18 months (AORs = 2.44 to 3.18). Patients in CBT plus medication management fared no better than those in CBT only. Some evidence suggested higher CBT dose produced better outcomes. CONCLUSIONS CBT can improve outcomes for patients whose anxiety symptoms are resistant to standard pharmacotherapy.
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Affiliation(s)
| | - Peter P Roy-Byrne
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Michelle G Craske
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Alexander Bystritsky
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Greer Sullivan
- Department of Psychiatry, University of California Riverside School of Medicine, Riverside, CA, USA
| | - Murray B Stein
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.,VA San Diego Healthcare System, San Diego, CA, USA.,Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
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Bomyea J, Lang A, Craske MG, Chavira DA, Sherbourne CD, Rose RD, Golinelli D, Campbell-Sills L, Welch SS, Sullivan G, Bystritsky A, Roy-Byrne P, Stein MB. Course of symptom change during anxiety treatment: Reductions in anxiety and depression in patients completing the Coordinated Anxiety Learning and Management program. Psychiatry Res 2015; 229:133-42. [PMID: 26228164 PMCID: PMC4656042 DOI: 10.1016/j.psychres.2015.07.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 04/19/2015] [Accepted: 07/19/2015] [Indexed: 01/25/2023]
Abstract
When treating anxious patients with co-occurring depression, research demonstrates that both types of symptoms independently improve. The current analyses examined how reductions in anxiety and depression may be interrelated both during treatment, as well as over time following treatment. Participants were 503 individuals with one or more DSM-IV anxiety disorders who completed a collaborative care anxiety management program. Anxiety and depression were assessed at each treatment session (i.e., session by session data) and also at 6, 12, and 18-month post-baseline assessments (i.e., long-term outcomes data). Mediation analyses examined changes in symptoms in session by session data and long-term outcomes data. Anxiety and depression changed reciprocally in session by session data; change in anxiety mediated change in depression to a greater extent than vice versa. In the long-term outcomes data, change in anxiety mediated change in depression. However, the reverse mediation model of the long-term outcomes period revealed that accounting for changes in depression altered the effect of time on anxiety. Thus, temporal change during active treatment may share similarities with those related to maintaining gains after treatment, although differences arose in the reverse mediation models. Limitations of the methodology and implications of anxiety treatment for depression outcomes are discussed.
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Affiliation(s)
- Jessica Bomyea
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
| | - Ariel Lang
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA,VA San Diego Health Care System Center of Excellence for Stress and Mental Health, San Diego, La Jolla, CA, USA
| | - Michelle G. Craske
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Denise A. Chavira
- Department of Psychology, University of California, Los Angeles, CA, USA
| | | | - Raphael D. Rose
- Department of Psychology, University of California, Los Angeles, CA, USA
| | | | - Laura Campbell-Sills
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Stacy S. Welch
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine and Harborview Center for Healthcare Improvement for Addictions, Mental Illness, and Medically Vulnerable Populations (CHAMMP), Seattle, WA, USA
| | - Greer Sullivan
- RAND Corporation, Santa Monica, CA, USA,Department of Psychiatry University of Arkansas for Medical Sciences, Little Rock, AR, USA,VA South Central Mental Illness Research, Education, and Clinical Center University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Alexander Bystritsky
- Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Peter Roy-Byrne
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine and Harborview Center for Healthcare Improvement for Addictions, Mental Illness, and Medically Vulnerable Populations (CHAMMP), Seattle, WA, USA
| | - Murray B. Stein
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA,Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
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Olariu E, Forero CG, Castro-Rodriguez JI, Rodrigo-Calvo MT, Álvarez P, Martín-López LM, Sánchez-Toto A, Adroher ND, Blasco-Cubedo MJ, Vilagut G, Fullana MA, Alonso J. DETECTION OF ANXIETY DISORDERS IN PRIMARY CARE: A META-ANALYSIS OF ASSISTED AND UNASSISTED DIAGNOSES. Depress Anxiety 2015; 32:471-84. [PMID: 25826526 DOI: 10.1002/da.22360] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 01/27/2015] [Accepted: 01/31/2015] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Evidence suggests that general practitioners (GPs) fail to diagnose up to half of common mental disorder cases. Yet no previous research has systematically summarized the evidence in the case of anxiety disorders. The aim of this review was to systematically assess and meta-analyze the diagnostic accuracy of GPs' assisted (i.e., using severity scales/diagnostic instruments) and unassisted (without such tools) diagnoses of anxiety disorders. METHODS Systematic review (PROSPERO registry CRD42013006736) was conducted. Embase, Ovid Journals--Ovid SP Medline, Pubmed, PsycINFO, Scopus, Web of Science, and Science Direct were searched from January 1980 through June 2014. Seven investigators, working in pairs, evaluated studies for eligibility. The quality of included studies was assessed with the Quality Assessment of Diagnostic Accuracy Studies tool version 2 (QUADAS-2). The main outcome measures were sensitivity and specificity of clinical diagnoses of any anxiety disorder. We pooled sensitivity and specificity levels from included studies using bivariate meta-analyses. RESULTS Twenty-four studies were included in the meta-analysis with a total sample of 34,902 patients. Pooled sensitivity and specificity were estimated at 44.5% (95% CI 33.7-55.9%) and 90.8% (95% CI 87-93.5%). GPs' sensitivity was higher when diagnoses were assisted (63.6%, 95% CI 50.3-75.1%) than when unassisted (30.5%, 95% CI 20.7-42.5%) to the expense of some specificity loss (87.9%, 95% CI 81.3-92.4% vs. 91.4%, 95% CI 86.6-94.6%, respectively). Identification rates remained constant over time (P-value = .998). CONCLUSIONS The use of diagnostic tools might improve detection of anxiety disorders in "primary care."
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Affiliation(s)
- Elena Olariu
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain.,Health Services Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
| | - Carlos G Forero
- Health Services Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
| | - Jose Ignacio Castro-Rodriguez
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain.,Health Services Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,Institut de Neuropsiquiatria i Addiccions (INAD), Parc Salut Mar, Barcelona, Spain
| | | | - Pilar Álvarez
- Institut de Neuropsiquiatria i Addiccions (INAD), Parc Salut Mar, Barcelona, Spain
| | - Luis M Martín-López
- Institut de Neuropsiquiatria i Addiccions (INAD), Parc Salut Mar, Barcelona, Spain
| | - Alicia Sánchez-Toto
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Núria D Adroher
- Health Services Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Maria J Blasco-Cubedo
- Health Services Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Gemma Vilagut
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain.,Health Services Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
| | - Miquel A Fullana
- Institut de Neuropsiquiatria i Addiccions (INAD), Parc Salut Mar, Barcelona, Spain
| | - Jordi Alonso
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain.,Health Services Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
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15
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Evaluation of integrated psychological services in a university-based primary care clinic. J Clin Psychol Med Settings 2014; 21:19-32. [PMID: 24165929 DOI: 10.1007/s10880-013-9378-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Primary care is increasingly moving toward integration of psychological services; however few studies have been conducted to test the efficacy of such an integrated approach. This paper presents a program evaluation of psychological services provided by doctoral trainees in clinical and counseling psychology within a primary care clinic at an urban academic medical center. It includes: (1) a description of the program, including types of patients served, their presenting problems, and treatments administered and; (2) evidence of the impact of behavioral health services on primary care patients' emotional adjustment and progress on behavioral goals. Intake and follow-up measures of depression, anxiety, smoking, insomnia, chronic pain, and weight loss were collected on 452 adult patients (mean age = 52; 59 % African-American; 35 % uninsured) who were provided brief interventions (mean visits = 2.2) over a 16-month period. Although conclusions are limited by the lack of a control or comparison group, preliminary findings indicate that the integrated behavioral health services provided were effective. Implications and future directions are discussed.
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16
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Effects of pain and prescription opioid use on outcomes in a collaborative care intervention for anxiety. Clin J Pain 2014; 29:800-6. [PMID: 23370069 DOI: 10.1097/ajp.0b013e318278d475] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the effects of pain and opioid pain medication use on clinical and functional outcomes in 1004 primary care patients with an anxiety disorder randomized to receive the Coordinated Anxiety Learning and Management (CALM) collaborative care intervention (cognitive-behavioral therapy and/or medication) versus usual care. METHODS A total of 1004 patients with panic disorder, generalized anxiety disorder, social anxiety disorder, or posttraumatic stress disorder were randomized to CALM or usual care. Outcomes at 6, 12, and 18 months were compared in patients with and without moderate pain interference (for the entire anxiety disorder group and then just those with comorbid major depression) and in patients taking and not taking opioid medication (entire group, just those with comorbid major depression, and just those with moderate pain interference). RESULTS Patients with pain interference and patients taking opioid pain medication were more anxious [Brief Symptom Inventory anxiety subscale] and disabled (Sheehan Disability) at baseline, improved over time at similar rates, but at 18 months had lower response and remission rates. There was no moderating effect on the intervention. In patients with comorbid major depression, patients using opioid medications showed a trend for less disability improvement over time, and in patients with pain, patients using opioids showed less sustained anxiety response at 18 months. CONCLUSIONS Anxious patients with pain benefit as much as those without pain from cognitive-behavioral therapy and medication treatment. Among patients with pain, however, there is some evidence of a reduced anxiety treatment response in those taking opioid medication, which should be further studied.
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Wetherell JL, Petkus AJ, Thorp SR, Stein MB, Chavira DA, Campbell-Sills L, Craske MG, Sherbourne C, Bystritsky A, Sullivan G, Roy-Byrne P. Age differences in treatment response to a collaborative care intervention for anxiety disorders. Br J Psychiatry 2013; 203:65-72. [PMID: 23580378 PMCID: PMC3696879 DOI: 10.1192/bjp.bp.112.118547] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Some data suggest that older adults with anxiety disorders do not respond as well to treatment as do younger adults. AIMS We examined age differences in outcomes from the Coordinated Anxiety Learning and Management (CALM) study, an effectiveness trial comparing usual care to a computer-assisted collaborative care intervention for primary care patients with panic disorder, generalised anxiety disorder, post-traumatic stress disorder (PTSD), and/or social anxiety disorder. This is the first study to examine the efficacy of a collaborative care intervention in a sample that included both younger and older adults with anxiety disorders. We hypothesised that older adults would show a poorer response to the intervention than younger adults. METHOD We examined findings for the overall sample, as well as within each diagnostic category (clinicaltrials.gov identifier: NCT00347269). RESULTS The CALM intervention was more effective than usual care among younger adults overall and for those with generalised anxiety disorder, panic disorder and social anxiety disorder. Among older adults, the intervention was effective overall and for those with social anxiety disorder and PTSD but not for those with panic disorder or generalised anxiety disorder. The effects of the intervention also appeared to erode by the 18-month follow-up, and there were no significant effects on remission among the older adults. CONCLUSIONS These results are consistent with the findings of other investigators suggesting that medications and psychotherapy for anxiety disorders may not be as effective for older individuals as they are for younger people.
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18
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Kroenke K, Outcalt S, Krebs E, Bair MJ, Wu J, Chumbler N, Yu Z. Association between anxiety, health-related quality of life and functional impairment in primary care patients with chronic pain. Gen Hosp Psychiatry 2013; 35:359-65. [PMID: 23639186 DOI: 10.1016/j.genhosppsych.2013.03.020] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 03/21/2013] [Accepted: 03/25/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Anxiety and chronic pain are prevalent and frequently co-occur. Our purpose was to examine the association between anxiety, health-related quality of life (HRQL) and functional impairment in primary care patients with chronic musculoskeletal pain. METHODS Data were drawn from baseline interviews of the 250 primary care patients enrolled in the Stepped Care to Optimize Pain care Effectiveness trial. Validated measures were used to determine the proportion of patients screening positive for five common anxiety disorders: generalized anxiety, panic, social anxiety, posttraumatic stress and obsessive-compulsive disorder. Bivariate analyses examined associations between the type and number of anxiety disorders for which patients screened positive and representative pain, psychological and other HRQL outcomes. Multivariable models controlling for major depression and other covariates examined the association between the number of screen-positive anxiety conditions and functional impairment in psychological [SF-12 mental component summary (MCS) score], pain [Brief Pain Inventory (BPI) interference score] and work (disability days) domains. RESULTS One hundred fourteen (45%) patients screened positive for at least one anxiety disorder and, compared to the 136 screen-negative patients, had significantly worse scores across multiple pain, psychological and other HRQL domains. Substantial impairment was seen for each of the five screen-positive anxiety conditions and progressively worsened as the number of conditions increased from one (n=54) to two (n=26) to ≥3 (n=34). The number of screen-positive anxiety conditions was strongly associated (P<.0001) with worse BPI interference and MCS scores and more disability days in models adjusting for age, sex and medical comorbidity. After further adjusting for major depression, associations were attenuated but remained significant for BPI interference (P<.0001) and MCS (P=.018) and marginally significant for disability days (P=.062). CONCLUSION Nearly half of primary care patients with chronic pain screen positive for one or more anxiety disorders, which in turn are adversely associated with impairment across multiple domains of HRQL. Detecting and treating anxiety may be an important component of pain management.
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Affiliation(s)
- Kurt Kroenke
- VA HSR&D Center for Implementing Evidence-Based Practice, Roudebush VA Medical Center, Indianapolis, IN, USA.
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19
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Outhoff K. The pharmacology of anxiolytics. S Afr Fam Pract (2004) 2013. [DOI: 10.1080/20786204.2013.10874339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- K Outhoff
- Department of Pharmacology, University of Pretoria, Pretoria, South Africa
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20
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Kim JH, Yang H, Schroeppel S. A pilot study examining the effects of Kouk Sun Do on university students with anxiety symptoms. Stress Health 2013; 29:99-107. [PMID: 22674565 DOI: 10.1002/smi.2431] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2011] [Revised: 03/21/2012] [Accepted: 03/27/2012] [Indexed: 11/10/2022]
Abstract
The effects of Kouk Sun Do (KSD), a mind-body exercise on mental health in university students, were investigated in this pilot study. University students (N = 30) with self-reported anxiety symptoms were randomly assigned to either the treatment group or the waiting list control group. Eighteen participants (N = 18; seven in the treatment group and 11 in the waiting list control group) completed a pre-test and a post-test, and 12 participants dropped out before or during the intervention. Ten 70-min KSD exercise sessions were conducted three times per week over a 4-week period. Trait anxiety, depressive symptoms and general self-efficacy in coping with stress were measured with the pre-test and the post-test. Qualitative data were collected using open-ended questions regarding benefits of KSD at the last session. A two (group) by two (time) repeated-measure analysis of variance was used to analyse the data. Trait anxiety and depressive symptoms decreased whereas general self-efficacy increased over a 4-week period. The treatment group had significantly reduced trait anxiety and depressive symptoms compared with the control group across time. Qualitative data provided support that the self-induced relaxation effects of KSD may lead to reduced anxiety.
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Affiliation(s)
- Jong-Ho Kim
- Department of Health Education and Recreation, Southern Illinois University Carbondale, Carbondale, IL 62901, USA.
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21
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Smitherman TA, Kolivas ED, Bailey JR. Panic disorder and migraine: comorbidity, mechanisms, and clinical implications. Headache 2012; 53:23-45. [PMID: 23278473 DOI: 10.1111/head.12004] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2012] [Indexed: 12/17/2022]
Abstract
A growing body of literature suggests that comorbid anxiety disorders are more common and more prognostically relevant among migraine sufferers than comorbid depression. Panic disorder (PD) appears to be more strongly associated with migraine than most other anxiety disorders. PD and migraine are both chronic diseases with episodic manifestations, involving significant functional impairment and shared symptoms during attacks, interictal anxiety concerning future attacks, and an absence of identifiable secondary pathology. A meta-analysis of high-quality epidemiologic study data from 1990 to 2012 indicates that the odds of PD are 3.76 times greater among individuals with migraine than those without. This association remains significant even after controlling for demographic variables and comorbid depression. Other less-rigorous community and clinical studies confirm these findings. The highest rates of PD are found among migraine with aura patients and those presenting to specialty clinics. Presence of PD is associated with greater negative impact of migraine, including more frequent attacks, increased disability, and risk for chronification and medication overuse. The mechanisms underlying this common comorbidity are poorly understood, but both pathophysiological (eg, serotonergic dysfunction, hormonal influences, dysregulation of the hypothalamic-pituitary-adrenal axis) and psychological (eg, interoceptive conditioning, fear of pain, anxiety sensitivity, avoidance behavior) factors are implicated. Means of assessing comorbid PD among treatment-seeking migraineurs are reviewed, including verbal screening for core PD symptoms, ruling out medical conditions with panic-like features, and administering validated self-report measures. Finally, evidence-based strategies for both pharmacologic and behavioral management are outlined. The first-line migraine prophylactics are not indicated for PD, and the selective serotonin re-uptake inhibitors used to treat PD are not efficacious for migraine; thus, separate agents are often required to address each condition. Core components of behavioral treatments for PD are reviewed, and their integration into clinical headache practice is discussed.
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Affiliation(s)
- Todd A Smitherman
- Department of Psychology, University of Mississippi, Oxford, MS, USA
| | | | - Jennifer R Bailey
- Department of Psychology, University of Mississippi, Oxford, MS, USA
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Recognition of anxiety disorders by the general practitioner: results from the DASMAP study. Gen Hosp Psychiatry 2012; 34:227-33. [PMID: 22341732 DOI: 10.1016/j.genhosppsych.2012.01.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 01/12/2012] [Accepted: 01/16/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The objectives were to determine the levels of general practitioner (GP) recognition of anxiety disorders and examine associated factors. METHODS An epidemiological survey was carried out in 77 primary care centers representative of Catalonia. A total of 3815 patients were assessed. RESULTS GPs identified 185 of the 666 individuals diagnosed as meeting the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) criteria for any anxiety disorder (sensitivity 0.28). Regarding specific anxiety disorders, panic disorder was registered in just three of the patients who, according to the SCID-I, did not meet the criteria for this condition .Generalized anxiety disorder was recorded by the GP in 46 cases, 4 of them being concordant with the SCID-I (sensitivity 0.03). The presence of comorbid hypertension was associated with an increased probability of recognition. Emotional problems as the patients' main complaint and additional appointments with a mental health specialist were associated with both adequate and erroneous recognition. Being female, having more frequent appointments with the GP and having higher levels of self-perceived stress were related to false positives. As disability increased, the probability of being erroneously detected decreased. CONCLUSION GPs recognized anxiety disorders in some sufferers but still failed with respect to differentiating between anxiety disorder subtypes and disability assessment.
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Stein MB, Roy-Byrne PP, Craske MG, Campbell-Sills L, Lang AJ, Golinelli D, Rose RD, Bystritsky A, Sullivan G, Sherbourne CD. Quality of and patient satisfaction with primary health care for anxiety disorders. J Clin Psychiatry 2011; 72:970-6. [PMID: 21367351 PMCID: PMC3111814 DOI: 10.4088/jcp.09m05626blu] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Accepted: 12/31/2009] [Indexed: 10/18/2022]
Abstract
BACKGROUND Most patients with anxiety disorders receive their care from primary care practitioners (PCPs). The purpose of this study was to evaluate quality of and patient satisfaction with primary health care for anxiety disorders. METHOD A survey was performed among 1,004 outpatients with anxiety disorders (diagnosed according to DSM-IV) referred by their PCPs from 17 primary care clinical settings (3 of which were university-affiliated) in 4 regions of the United States for participation in the Coordinated Anxiety Learning and Management (CALM) study, a therapeutic trial. Participating research institutions were the University of Washington at Seattle, the University of California at San Diego and Los Angeles, and the University of Arkansas for Medical Sciences at Little Rock. Enrollment took place between June 2006 and April 2008. Patients were contacted by telephone after enrollment to provide information about previous care received (during the 6 months prior to referral) and satisfaction with that care. Quality-of-care indicators were self-reported type, dose, and duration of antianxiety medication treatment and self-reported psychotherapy with cognitive-behavioral therapy (CBT) elements. RESULTS A total of 576 patients (57.4%) had received an appropriate antianxiety medication in the previous 6 months, but only 289 patients (29.4% of 983 who answered this question) had received the medication at adequate dose for at least 2 months. A total of 465 patients (46.3%) had received some counseling with at least 1 element of CBT, but only 213 patients (21.2%) had received counseling with a strong (3+ elements) CBT focus. Overall, 416 patients (41.4%) had received quality pharmacotherapy or psychotherapy, and 81 patients (8.1%) had received both. Only 432 patients (44.8% of 964 who answered this question) were at least somewhat satisfied with their mental health care. Receipt of quality psychotherapy was the sole positive predictor (adjusted odds ratio = 2.71; 95% CI, 1.94-3.80; P < .0005) of satisfaction with mental health care for anxiety. Moreover, there was a dose-response relationship between the number of CBT elements consistently delivered and satisfaction with care (test for trend, z = 4.06, P < .0005). CONCLUSIONS Despite recognition of these patients' anxiety disorders and referral by their PCPs to an anxiety treatment study, fewer than half of the patients had in the prior 6 months received quality pharmacologic and/or psychosocial mental health care. Receipt of CBT-oriented, quality psychosocial (but not pharmacologic) care showed a strong dose-response relationship with satisfaction with mental health care.
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Affiliation(s)
- Murray B. Stein
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive (0855), La Jolla, CA 92093-0855, Phone 858-534-6451, Fax 858-534-6460,
- Department of Family & Preventive Medicine, University of California San Diego
| | - Peter P. Roy-Byrne
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Harborview Center for Healthcare Improvement for Addictions, Mental Illness and Medically Vulnerable Populations (CHAMMP), Seattle
| | - Michelle G. Craske
- Department of Psychology, University of California, Los Angeles
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Laura Campbell-Sills
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive (0855), La Jolla, CA 92093-0855, Phone 858-534-6451, Fax 858-534-6460,
| | - Ariel J. Lang
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive (0855), La Jolla, CA 92093-0855, Phone 858-534-6451, Fax 858-534-6460,
| | | | - Raphael D. Rose
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Harborview Center for Healthcare Improvement for Addictions, Mental Illness and Medically Vulnerable Populations (CHAMMP), Seattle
| | - Alexander Bystritsky
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Greer Sullivan
- Department of Psychiatry, University of Arkansas for Medical Science, North Little Rock, AR
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24
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Craske MG, Stein MB, Sullivan G, Sherbourne C, Bystritsky A, Rose RD, Lang AJ, Welch S, Campbell-Sills L, Golinelli D, Roy-Byrne P. Disorder-specific impact of coordinated anxiety learning and management treatment for anxiety disorders in primary care. ARCHIVES OF GENERAL PSYCHIATRY 2011; 68:378-88. [PMID: 21464362 PMCID: PMC3074172 DOI: 10.1001/archgenpsychiatry.2011.25] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Anxiety disorders commonly present in primary care, where evidence-based mental health treatments often are unavailable or suboptimally delivered. OBJECTIVE To compare evidence-based treatment for anxiety disorders with usual care (UC) in primary care for principal and comorbid generalized anxiety disorder (GAD), panic disorder (PD), social anxiety disorder (SAD), and posttraumatic stress disorder (PTSD). DESIGN A randomized controlled trial comparing the Coordinated Anxiety Learning and Management (CALM) intervention with UC at baseline and at 6-, 12-, and 18-month follow-up assessments. SETTING Seventeen US primary care clinics. PATIENTS Referred primary care sample, 1004 patients, with principal DSM-IV diagnoses of GAD (n = 549), PD (n = 262), SAD (n = 132), or PTSD (n = 61) (mean [SD] age, 43.7 [13.7] years; 70.9% were female). Eighty percent of the participants completed 18-month follow-up. INTERVENTIONS CALM (cognitive behavior therapy and pharmacotherapy recommendations) and UC. MAIN OUTCOME MEASURES Generalized Anxiety Disorder Severity Scale, Panic Disorder Severity-Self-report Scale, Social Phobia Inventory, and PTSD Checklist-Civilian Version scores. RESULTS CALM was superior to UC for principal GAD at 6-month (-1.61; 95% confidence interval [CI], -2.42 to -0.79), 12-month (-2.34; -3.22 to -1.45), and 18-month (-2.37; -3.24 to -1.50), PD at 6-month (-2.00; -3.55 to -0.44) and 12-month (-2.71; -4.29 to -1.14), and SAD at 6-month (-7.05; -12.11 to -2.00) outcomes. CALM was superior to UC for comorbid SAD at 6-month (-4.26; 95% CI, -7.96 to -0.56), 12-month (-8.12, -11.84 to -4.40), and 18- month (-6.23, -9.90 to -2.55) outcomes. Effect sizes favored CALM but were not statistically significant for other comorbid disorders. CONCLUSIONS CALM (cognitive behavior therapy and pharmacotherapy medication recommendations) is more effective than is UC for principal anxiety disorders and, to a lesser extent, comorbid anxiety disorders that present in primary care.
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Affiliation(s)
- Michelle G Craske
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA 90095-1563, USA.
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Kroenke K, Spitzer RL, Williams JBW, Löwe B. The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review. Gen Hosp Psychiatry 2010; 32:345-59. [PMID: 20633738 DOI: 10.1016/j.genhosppsych.2010.03.006] [Citation(s) in RCA: 2515] [Impact Index Per Article: 179.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2009] [Revised: 03/05/2010] [Accepted: 03/09/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND Depression, anxiety and somatization are the most common mental disorders in primary care as well as medical specialty populations; each is present in at least 5-10% of patients and frequently comorbid with one another. An efficient means for measuring and monitoring all three conditions would be desirable. METHODS Evidence regarding the psychometric and pragmatic characteristics of the Patient Health Questionnaire (PHQ)-9 depression, generalized anxiety disorder (GAD)-7 anxiety and PHQ-15 somatic symptom scales are synthesized from two sources: (1) four multisite cross-sectional studies (three conducted in primary care and one in obstetric-gynecology practices) comprising 9740 patients, and (2) key studies from the literature that have studied these scales. RESULTS The PHQ-9 and its abbreviated eight-item (PHQ-8) and two-item (PHQ-2) versions have good sensitivity and specificity for detecting depressive disorders. Likewise, the GAD-7 and its abbreviated two-item (GAD-2) version have good operating characteristics for detecting generalized anxiety, panic, social anxiety and post-traumatic stress disorder. The optimal cutpoint is > or = 10 on the parent scales (PHQ-9 and GAD-7) and > or = 3 on the ultra-brief versions (PHQ-2 and GAD-2). The PHQ-15 is equal or superior to other brief measures for assessing somatic symptoms and screening for somatoform disorders. Cutpoints of 5, 10 and 15 represent mild, moderate and severe symptom levels on all three scales. Sensitivity to change is well-established for the PHQ-9 and emerging albeit not yet definitive for the GAD-7 and PHQ-15. CONCLUSIONS The PHQ-9, GAD-7 and PHQ-15 are brief well-validated measures for detecting and monitoring depression, anxiety and somatization.
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Affiliation(s)
- Kurt Kroenke
- Regenstrief Institute, Inc. and the Department of Medicine, Indiana University, Indianapolis, IN 46202, USA.
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Roy-Byrne P, Craske MG, Sullivan G, Rose RD, Edlund MJ, Lang AJ, Bystritsky A, Welch SS, Chavira DA, Golinelli D, Campbell-Sills L, Sherbourne CD, Stein MB. Delivery of evidence-based treatment for multiple anxiety disorders in primary care: a randomized controlled trial. JAMA 2010; 303:1921-8. [PMID: 20483968 PMCID: PMC2928714 DOI: 10.1001/jama.2010.608] [Citation(s) in RCA: 292] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Improving the quality of mental health care requires moving clinical interventions from controlled research settings into real-world practice settings. Although such advances have been made for depression, little work has been performed for anxiety disorders. OBJECTIVE To determine whether a flexible treatment-delivery model for multiple primary care anxiety disorders (panic, generalized anxiety, social anxiety, and posttraumatic stress disorders) would be better than usual care (UC). DESIGN, SETTING, AND PATIENTS A randomized controlled effectiveness trial of Coordinated Anxiety Learning and Management (CALM) compared with UC in 17 primary care clinics in 4 US cities. Between June 2006 and April 2008, 1004 patients with anxiety disorders (with or without major depression), aged 18 to 75 years, English- or Spanish-speaking, were enrolled and subsequently received treatment for 3 to 12 months. Blinded follow-up assessments at 6, 12, and 18 months after baseline were completed in October 2009. INTERVENTION CALM allowed choice of cognitive behavioral therapy (CBT), medication, or both; included real-time Web-based outcomes monitoring to optimize treatment decisions; and a computer-assisted program to optimize delivery of CBT by nonexpert care managers who also assisted primary care clinicians in promoting adherence and optimizing medications. MAIN OUTCOME MEASURES Twelve-item Brief Symptom Inventory (BSI-12) anxiety and somatic symptoms score. Secondary outcomes included proportion of responders (> or = 50% reduction from pretreatment BSI-12 score) and remitters (total BSI-12 score < 6). RESULTS A significantly greater improvement for CALM vs UC in global anxiety symptoms was found (BSI-12 group mean differences of -2.49 [95% confidence interval {CI}, -3.59 to -1.40], -2.63 [95% CI, -3.73 to -1.54], and -1.63 [95% CI, -2.73 to -0.53] at 6, 12, and 18 months, respectively). At 12 months, response and remission rates (CALM vs UC) were 63.66% (95% CI, 58.95%-68.37%) vs 44.68% (95% CI, 39.76%-49.59%), and 51.49% (95% CI, 46.60%-56.38%) vs 33.28% (95% CI, 28.62%-37.93%), with a number needed to treat of 5.27 (95% CI, 4.18-7.13) for response and 5.50 (95% CI, 4.32-7.55) for remission. CONCLUSION For patients with anxiety disorders treated in primary care clinics, CALM compared with UC resulted in greater improvement in anxiety symptoms, depression symptoms, functional disability, and quality of care during 18 months of follow-up. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00347269.
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Affiliation(s)
- Peter Roy-Byrne
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine and Harborview Center for Healthcare Improvement for Addictions, Mental Illness, and Medically Vulnerable Populations, Seattle, Washington 98104, USA.
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Outhoff K. The pharmacology of anxiolytics. S Afr Fam Pract (2004) 2010. [DOI: 10.1080/20786204.2010.10873947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Navarro-Mateu F, Garriga-Puerto A, Sánchez-Sánchez JA. [Tree decision analysis of the therapeutic alternatives for Panic Disorders in Primary Care]. Aten Primaria 2009; 42:86-94. [PMID: 19632004 DOI: 10.1016/j.aprim.2009.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Accepted: 05/06/2009] [Indexed: 11/27/2022] Open
Abstract
AIMS To analyse the different therapeutic alternatives for Panic Disorders to make it easier to make collaborative treatment decisions between patients and doctors in a Primary Care setting. DESIGN Quantitative analysis by a decision tree. DATA SOURCES Time period reviewed; 1990-2008 in Med-line, Embase, Cochrane-plus Library and Tripdatabase. Terms used "panic disorder", "psychotherapy" and "drug therapy". METHODS I) A decision tree was prepared with only one therapeutic option in each arm; II) The same procedure with two sequential therapeutic options; III) Sensitivity analysis to test the robustness of the model. STUDY SELECTION Evidence summary, systematic reviews, meta-analysis and clinical guidelines. RESULTS Cognitive-Behavioural Therapy (CBT) obtains the highest usefulness (UME=0.58), followed by the Selective serotonin reuptake inhibitors (SSRI) (UME=0.53) and by the tricyclic antidepressants (UME=0.44). CBT followed by SSRI is the therapeutic sequence with the highest usefulness (0.62). The sensitivity analysis suggests the model is not robust enough. CONCLUSIONS The CBT in monotherapy or followed by SSRI in a sequential strategy would be the options with the highest usefulness. The results are not robust enough because they can clearly vary with changes in the most important variables in a reasonable range.
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