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Alphs L, Fu DJ, Williamson D, Jamieson C, Greist J, Harrington M, Lindenmayer JP, McCullumsmith C, Sheehan DV, Shelton RC, Wicks P, Canuso CM. SIBAT-A Computerized Assessment Tool for Suicide Ideation and Behavior: Development and Psychometric Properties. Innov Clin Neurosci 2022; 19:36-47. [PMID: 35958973 PMCID: PMC9341319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Most assessments of suicidal ideation and behavior (SIB) are limited by reliance on a single assessor, typically a clinician or patient, with scant detail on patient-related drivers of SIB and inability to detect rapid change in SIB. Furthermore, many techniques do not include a semistructured interview, increasing rater variability. The Suicide Ideation and Behavior Assessment Tool (SIBAT) addresses these limitations. DESIGN More than 30 experts in scale development, statistics, and clinical management of suicidal patients collaborated over a greater than four-year period to develop the SIBAT. Input for content and validity was received from patients, clinicians, and regulatory authorities in the United States (US) and Europe. Psychometric properties of the SIBAT were evaluated in validation studies. RESULTS The SIBAT is organized into eight independent patient- or clinician-rated modules with branching logic and scoring algorithms, which necessitates computerization. Patient-reported information is first captured in Modules 1 to 5. Thereafter, an experienced clinician reviews the patient's report, conducts a semistructured interview (Module 6), and assesses the patient's suicide risk (Module 7) and optimal antisuicide management (Module 8). Input from cognitive interviews of diverse adult, adolescent, and clinician participants was incorporated into the final version of the SIBAT. Psychometric testing demonstrated good inter-rater reliability (intraclass coefficient range: 0.68-0.82), intra-rater reliability (weighted-kappa range: 0.64-0.76), and concurrent validity with other instruments for assessing SIB. CONCLUSION Patient- and clinician-based assessments and the psychometric studies summarized in this report support the validity and reliability of the SIBAT for capturing critical information related to assessment of SIB in adolescents and adults at risk for suicide.
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Affiliation(s)
- Larry Alphs
- Dr. Alphs is with Denovo Biopharma in San Diego, California (he was with Janssen Scientific Affairs, LLC in Titusville, New Jersey at the time the work reported herein was performed)
| | - Dong-Jing Fu
- Drs. Fu and Canuso are with Janssen Research and Development, LLC in Titusville, New Jersey
| | - David Williamson
- Dr. Williamson is with the Departments of Psychiatry and Neurology at University of South Alabama College of Medicine in Mobile, Alabama and Department of Psychiatry and Health Behavior at Augusta University in Augusta, Georgia (he was with Janssen Scientific Affairs, LLC in Titusville, New Jersey at the time the work reported herein was performed)
| | - Carol Jamieson
- Ms. Jamieson is with Janssen Research and Development, LLC in Milpitas, California
| | - John Greist
- Dr. Greist is a Professor Emeritus–Psychiatry at the University of Wisconsin School of Medicine and Public Health and is with Healthcare Technology Systems, Inc. in Madison, Wisconsin
| | - Magdalena Harrington
- Dr. Harrington is with Pfizer, Inc. in Cambridge, Massachussetts (she was a Psychometrician/Patient-Reported Outcomes at PatientsLikeMe in Cambridge, Massachusetts at the time the work reported herein was performed)
| | - Jean-Pierre Lindenmayer
- Dr. Lindenmayer is with New York University Grossman School of Medicine, Department of Psychiatry in New York City, New York
| | - Cheryl McCullumsmith
- Dr. McCullumsmith is with the University of Toledo, Department of Psychiatry in Toledo, Ohio
| | - David V. Sheehan
- Dr. Sheehan is a Distinguished University Health Professor Emeritus, University of South Florida College of Medicine in Tampa, Florida
| | - Richard C. Shelton
- Dr. Shelton is with the University of Alabama at Birmingham School of Medicine, Department of Psychiatry in Birmingham, Alabama
| | - Paul Wicks
- Dr. Wicks is with Wicks Digital Health Ltd. in Lichfield, United Kingdom (he was with PatientsLikeMe in Cambridge, Massachusetts at the time the work reported herein was performed)
| | - Carla M. Canuso
- Drs. Fu and Canuso are with Janssen Research and Development, LLC in Titusville, New Jersey
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Yee KS, Pokrzywinski R, Hareendran A, Shaffer S, Sheehan DV. Evaluating functional disability in clinical trials of lisdexamfetamine dimesylate in binge eating disorder using the Sheehan Disability Scale. Int J Methods Psychiatr Res 2021; 30:e1849. [PMID: 32841462 PMCID: PMC7992284 DOI: 10.1002/mpr.1849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/28/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES This study examined Sheehan Disability Scale (SDS) performance in binge eating disorder (BED) and explored relationships between SDS and BED outcomes using data from three placebo-controlled lisdexamfetamine (LDX) studies (two short-term, dose-optimized studies and one double-blind, randomized-withdrawal study) in adults with Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR)-defined BED. METHODS Analyses evaluated the psychometric properties of the SDS. RESULTS Confirmatory factor analysis supported a unidimensional total score in the short-term studies, with internal consistency (Cronbach's α) being 0.878. Total score exhibited good construct validity, with moderate and statistically significant correlations observed with Yale-Brown Obsessive Compulsive Scale modified for binge eating, Binge Eating Scale (BES), and EuroQol Group 5-Dimension 5-Level health status index scores. Known-groups validity analysis for the short-term studies demonstrated a significantly lower total score at end of study in participants considered "not ill" versus "ill" based on Clinical Global Impressions-Severity scores. SDS total score changes in the short-term studies were greater in responders than nonresponders based on binge eating abstinence or BES score. In the randomized-withdrawal study, SDS scores increased relative to baseline to a greater extent in participants randomized to placebo than LDX. CONCLUSIONS These analyses support the reliability, validity, and responsiveness to change of the SDS in individuals with BED.
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Affiliation(s)
- Karen S Yee
- Shire, a Member of the Takeda Group of Companies, Cambridge, Massachusetts, USA
| | | | | | | | - David V Sheehan
- University of South Florida College of Medicine, Tampa, Florida, USA
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Dahal S, Dhimal M, Pant SB, Sharma P, Marahatta K, Luitel N, Shakya S, Labh S, Ojha SP, Jha AK, Sheehan DV. Pilot Mental Health Survey, Nepal: Lessons Learned for Survey Design and Instrumentation. Innov Clin Neurosci 2020; 17:17-23. [PMID: 33898097 PMCID: PMC7819577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Objective: Learning from pilot studies is crucial for the successful implementation of large-scale surveys. In this manuscript, we present the lessons learned for instrumentation and survey methods from a pilot national mental health survey conducted in Nepal. Design: We conducted a cross-sectional study among 1,647 participants aged 13 years and older in three districts of Nepal. We used the Nepali translated standard adult and adolescent versions of the Mini International Neuropsychiatric Interview (MINI) 7.0.2 for Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) to do face-to-face structured diagnostic interviews. In addition, we included questionnaires on help-seeking behavior and barriers in accessing care. Results: We used a six-step procedure to translate and fit the tools in the context of Nepal. We conducted pretesting to evaluate the Nepali translated tools and adaptations, such as the addition of bridging sentences at the start of different modules. We identified different challenges during the tools administration and the ways to minimize reporting bias during data collection. Conclusion: The pilot survey identified the areas for improvement in survey tools, techniques, and methodology. The lessons learned from the pilot survey and the resulting corrective recommendations helped in more successful implementation of the Nepal national mental health survey.
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Affiliation(s)
- Sushma Dahal
- Drs. Dhimal and Jha and Ms. Dahal and Ms. Labh are with the Nepal Health Research Council in Kathmandu, Nepal, and are members of the Technical Working Group, National Mental Health Survey, in Nepal
- Drs. Pant, Shakya, and Ojha are members of the Technical Working Group, National Mental Health Survey, in Nepal and are with the Department of Psychiatry and Mental Health, Institute of Medicine at Tribhuvan University in Kathmandu, Nepal
- Dr. Sharma is a member of the Technical Working Group, National Mental Health Survey, in Nepal and with the Patan Academy of Health Sciences in Lalitpur, Nepal
- Dr. Marahatta is a member of the Technical Working Group, National Mental Health Survey, in Nepal. Mr. Luitel is a member of the Technical Working Group, National Mental Health Survey, in Nepal and is with the Transcultural Psychosocial Organization Nepal in Kathmandu, Nepal
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
| | - Meghnath Dhimal
- Drs. Dhimal and Jha and Ms. Dahal and Ms. Labh are with the Nepal Health Research Council in Kathmandu, Nepal, and are members of the Technical Working Group, National Mental Health Survey, in Nepal
- Drs. Pant, Shakya, and Ojha are members of the Technical Working Group, National Mental Health Survey, in Nepal and are with the Department of Psychiatry and Mental Health, Institute of Medicine at Tribhuvan University in Kathmandu, Nepal
- Dr. Sharma is a member of the Technical Working Group, National Mental Health Survey, in Nepal and with the Patan Academy of Health Sciences in Lalitpur, Nepal
- Dr. Marahatta is a member of the Technical Working Group, National Mental Health Survey, in Nepal. Mr. Luitel is a member of the Technical Working Group, National Mental Health Survey, in Nepal and is with the Transcultural Psychosocial Organization Nepal in Kathmandu, Nepal
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
| | - Sagun Ballav Pant
- Drs. Dhimal and Jha and Ms. Dahal and Ms. Labh are with the Nepal Health Research Council in Kathmandu, Nepal, and are members of the Technical Working Group, National Mental Health Survey, in Nepal
- Drs. Pant, Shakya, and Ojha are members of the Technical Working Group, National Mental Health Survey, in Nepal and are with the Department of Psychiatry and Mental Health, Institute of Medicine at Tribhuvan University in Kathmandu, Nepal
- Dr. Sharma is a member of the Technical Working Group, National Mental Health Survey, in Nepal and with the Patan Academy of Health Sciences in Lalitpur, Nepal
- Dr. Marahatta is a member of the Technical Working Group, National Mental Health Survey, in Nepal. Mr. Luitel is a member of the Technical Working Group, National Mental Health Survey, in Nepal and is with the Transcultural Psychosocial Organization Nepal in Kathmandu, Nepal
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
| | - Pawan Sharma
- Drs. Dhimal and Jha and Ms. Dahal and Ms. Labh are with the Nepal Health Research Council in Kathmandu, Nepal, and are members of the Technical Working Group, National Mental Health Survey, in Nepal
- Drs. Pant, Shakya, and Ojha are members of the Technical Working Group, National Mental Health Survey, in Nepal and are with the Department of Psychiatry and Mental Health, Institute of Medicine at Tribhuvan University in Kathmandu, Nepal
- Dr. Sharma is a member of the Technical Working Group, National Mental Health Survey, in Nepal and with the Patan Academy of Health Sciences in Lalitpur, Nepal
- Dr. Marahatta is a member of the Technical Working Group, National Mental Health Survey, in Nepal. Mr. Luitel is a member of the Technical Working Group, National Mental Health Survey, in Nepal and is with the Transcultural Psychosocial Organization Nepal in Kathmandu, Nepal
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
| | - Kedar Marahatta
- Drs. Dhimal and Jha and Ms. Dahal and Ms. Labh are with the Nepal Health Research Council in Kathmandu, Nepal, and are members of the Technical Working Group, National Mental Health Survey, in Nepal
- Drs. Pant, Shakya, and Ojha are members of the Technical Working Group, National Mental Health Survey, in Nepal and are with the Department of Psychiatry and Mental Health, Institute of Medicine at Tribhuvan University in Kathmandu, Nepal
- Dr. Sharma is a member of the Technical Working Group, National Mental Health Survey, in Nepal and with the Patan Academy of Health Sciences in Lalitpur, Nepal
- Dr. Marahatta is a member of the Technical Working Group, National Mental Health Survey, in Nepal. Mr. Luitel is a member of the Technical Working Group, National Mental Health Survey, in Nepal and is with the Transcultural Psychosocial Organization Nepal in Kathmandu, Nepal
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
| | - Nagendra Luitel
- Drs. Dhimal and Jha and Ms. Dahal and Ms. Labh are with the Nepal Health Research Council in Kathmandu, Nepal, and are members of the Technical Working Group, National Mental Health Survey, in Nepal
- Drs. Pant, Shakya, and Ojha are members of the Technical Working Group, National Mental Health Survey, in Nepal and are with the Department of Psychiatry and Mental Health, Institute of Medicine at Tribhuvan University in Kathmandu, Nepal
- Dr. Sharma is a member of the Technical Working Group, National Mental Health Survey, in Nepal and with the Patan Academy of Health Sciences in Lalitpur, Nepal
- Dr. Marahatta is a member of the Technical Working Group, National Mental Health Survey, in Nepal. Mr. Luitel is a member of the Technical Working Group, National Mental Health Survey, in Nepal and is with the Transcultural Psychosocial Organization Nepal in Kathmandu, Nepal
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
| | - Suraj Shakya
- Drs. Dhimal and Jha and Ms. Dahal and Ms. Labh are with the Nepal Health Research Council in Kathmandu, Nepal, and are members of the Technical Working Group, National Mental Health Survey, in Nepal
- Drs. Pant, Shakya, and Ojha are members of the Technical Working Group, National Mental Health Survey, in Nepal and are with the Department of Psychiatry and Mental Health, Institute of Medicine at Tribhuvan University in Kathmandu, Nepal
- Dr. Sharma is a member of the Technical Working Group, National Mental Health Survey, in Nepal and with the Patan Academy of Health Sciences in Lalitpur, Nepal
- Dr. Marahatta is a member of the Technical Working Group, National Mental Health Survey, in Nepal. Mr. Luitel is a member of the Technical Working Group, National Mental Health Survey, in Nepal and is with the Transcultural Psychosocial Organization Nepal in Kathmandu, Nepal
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
| | - Sweta Labh
- Drs. Dhimal and Jha and Ms. Dahal and Ms. Labh are with the Nepal Health Research Council in Kathmandu, Nepal, and are members of the Technical Working Group, National Mental Health Survey, in Nepal
- Drs. Pant, Shakya, and Ojha are members of the Technical Working Group, National Mental Health Survey, in Nepal and are with the Department of Psychiatry and Mental Health, Institute of Medicine at Tribhuvan University in Kathmandu, Nepal
- Dr. Sharma is a member of the Technical Working Group, National Mental Health Survey, in Nepal and with the Patan Academy of Health Sciences in Lalitpur, Nepal
- Dr. Marahatta is a member of the Technical Working Group, National Mental Health Survey, in Nepal. Mr. Luitel is a member of the Technical Working Group, National Mental Health Survey, in Nepal and is with the Transcultural Psychosocial Organization Nepal in Kathmandu, Nepal
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
| | - Saroj Prasad Ojha
- Drs. Dhimal and Jha and Ms. Dahal and Ms. Labh are with the Nepal Health Research Council in Kathmandu, Nepal, and are members of the Technical Working Group, National Mental Health Survey, in Nepal
- Drs. Pant, Shakya, and Ojha are members of the Technical Working Group, National Mental Health Survey, in Nepal and are with the Department of Psychiatry and Mental Health, Institute of Medicine at Tribhuvan University in Kathmandu, Nepal
- Dr. Sharma is a member of the Technical Working Group, National Mental Health Survey, in Nepal and with the Patan Academy of Health Sciences in Lalitpur, Nepal
- Dr. Marahatta is a member of the Technical Working Group, National Mental Health Survey, in Nepal. Mr. Luitel is a member of the Technical Working Group, National Mental Health Survey, in Nepal and is with the Transcultural Psychosocial Organization Nepal in Kathmandu, Nepal
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
| | - Anjani Kumar Jha
- Drs. Dhimal and Jha and Ms. Dahal and Ms. Labh are with the Nepal Health Research Council in Kathmandu, Nepal, and are members of the Technical Working Group, National Mental Health Survey, in Nepal
- Drs. Pant, Shakya, and Ojha are members of the Technical Working Group, National Mental Health Survey, in Nepal and are with the Department of Psychiatry and Mental Health, Institute of Medicine at Tribhuvan University in Kathmandu, Nepal
- Dr. Sharma is a member of the Technical Working Group, National Mental Health Survey, in Nepal and with the Patan Academy of Health Sciences in Lalitpur, Nepal
- Dr. Marahatta is a member of the Technical Working Group, National Mental Health Survey, in Nepal. Mr. Luitel is a member of the Technical Working Group, National Mental Health Survey, in Nepal and is with the Transcultural Psychosocial Organization Nepal in Kathmandu, Nepal
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
| | - David V Sheehan
- Drs. Dhimal and Jha and Ms. Dahal and Ms. Labh are with the Nepal Health Research Council in Kathmandu, Nepal, and are members of the Technical Working Group, National Mental Health Survey, in Nepal
- Drs. Pant, Shakya, and Ojha are members of the Technical Working Group, National Mental Health Survey, in Nepal and are with the Department of Psychiatry and Mental Health, Institute of Medicine at Tribhuvan University in Kathmandu, Nepal
- Dr. Sharma is a member of the Technical Working Group, National Mental Health Survey, in Nepal and with the Patan Academy of Health Sciences in Lalitpur, Nepal
- Dr. Marahatta is a member of the Technical Working Group, National Mental Health Survey, in Nepal. Mr. Luitel is a member of the Technical Working Group, National Mental Health Survey, in Nepal and is with the Transcultural Psychosocial Organization Nepal in Kathmandu, Nepal
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
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Vaccarino AL, Kalali AH, Blier P, Gilbert Evans S, Engelhardt N, Foster JA, Frey BN, Greist JH, Kobak KA, Lam RW, MacQueen G, Milev R, Müller DJ, Parikh SV, Placenza FM, Rizvi SJ, Rotzinger S, Sheehan DV, Sills T, Soares CN, Turecki G, Uher R, Williams JBW, Kennedy SH, Evans KR. THE DEPRESSION INVENTORY DEVELOPMENT SCALE: Assessment of Psychometric Properties Using Classical and Modern Measurement Theory in a CAN-BIND Trial. Innov Clin Neurosci 2020; 17:30-40. [PMID: 33520402 PMCID: PMC7839654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Objective: The goal of the Depression Inventory Development (DID) project is to develop a comprehensive and psychometrically sound rating scale for major depressive disorder (MDD) that reflects current diagnostic criteria and conceptualizations of depression. We report here the evaluation of the current DID item bank using Classical Test Theory (CTT), Item Response Theory (IRT) and Rasch Measurement Theory (RMT). Methods: The present study was part of a larger multisite, open-label study conducted by the Canadian Biomarker Integration Network in Depression (ClinicalTrials.gov: NCT01655706). Trained raters administered the 32 DID items at each of two visits (MDD: baseline, n=211 and Week 8, n=177; healthy participants: baseline, n=112 and Week 8, n=104). The DID's "grid" structure operationalizes intensity and frequency of each item, with clear symptom definitions and a structured interview guide, with the current iteration assessing symptoms related to anhedonia, cognition, fatigue, general malaise, motivation, anxiety, negative thinking, pain, and appetite. Participants were also administered the Montgomery- Åsberg Depression Rating Scale (MADRS) and Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR) that allowed DID items to be evaluated against existing "benchmark" items. CTT was used to assess data quality/reliability (i.e., missing data, skewness, scoring frequency, internal consistency), IRT to assess individual item performance by modelling an item's ability to discriminate levels of depressive severity (as assessed by the MADRS), and RMT to assess how the items perform together as a scale to capture a range of depressive severity (item targeting). These analyses together provided empirical evidence to base decisions on which DID items to remove, modify, or advance. Results: Of the 32 DID items evaluated, eight items were identified by CTT as problematic, displaying low variability in the range of responses, floor effects, and/or skewness; and four items were identified by IRT to show poor discriminative properties that would limit their clinical utility. Five additional items were deemed to be redundant. The remaining 15 DID items all fit the Rasch model, with person and item difficulty estimates indicating satisfactory item targeting, with lower precision in participants with mild levels of depression. These 15 DID items also showed good internal consistency (alpha=0.95 and inter-item correlations ranging from r=0.49 to r=0.84) and all items were sensitive to change following antidepressant treatment (baseline vs. Week 8). RMT revealed problematic item targeting for the MADRS and QIDSSR, including an absence of MADRS items targeting participants with mild/moderate depression and an absence of QIDS-SR items targeting participants with mild or severe depression. Conclusion: The present study applied CTT, IRT, and RMT to assess the measurement properties of the DID items and identify those that should be advanced, modified, or removed. Of the 32 items evaluated, 15 items showed good measurement properties. These items (along with previously evaluated items) will provide the basis for validation of a penultimate DID scale assessing anhedonia, cognitive slowing, concentration, executive function, recent memory, drive, emotional fatigue, guilt, self-esteem, hopelessness, tension, rumination, irritability, reduced appetite, insomnia, sadness, worry, suicidality, and depressed mood. The strategies adopted by the DID process provide a framework for rating scale development and validation.
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Affiliation(s)
- Anthony L Vaccarino
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Amir H Kalali
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Pierre Blier
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Susan Gilbert Evans
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Nina Engelhardt
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Jane A Foster
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Benicio N Frey
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - John H Greist
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Kenneth A Kobak
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Raymond W Lam
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Glenda MacQueen
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Roumen Milev
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Daniel J Müller
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Sagar V Parikh
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Franca M Placenza
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Sakina J Rizvi
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Susan Rotzinger
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - David V Sheehan
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Terrence Sills
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Claudio N Soares
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Gustavo Turecki
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Rudolph Uher
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Janet B W Williams
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Sidney H Kennedy
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
| | - Kenneth R Evans
- Drs. Vaccarino, Evans and Gilbert Evans are with Indoc Research in Toronto, Ontario, Canada
- Dr Kalali is with the International Society for CNS Drug Development in San Diego, California
- Dr. Blier is with the Departments of Psychiatry and Cellular & Molecular Medicine at the University of Ottawa Institute of Mental Health Research in Ottawa, Ontario, Canada
- Dr. Engelhardt is with Intra-Cellular Therapies in New York, New York
- Dr. Foster is with Department of Psychiatry & Behavioural Neurosciences at McMaster University in Hamilton, Ontario, Canada
- Dr. Frey is with the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare in Hamilton, Ontario, Canada
- Dr. Greist is with the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin
- Dr. Kobak is with the Center for Telepsychology in Madison, Wisconsin
- Dr. Lam is with the Department of Psychiatry at the University of British Columbia in Vancouver, British Columbia, Canada
- Dr. MacQueen is with Mathison Centre for Mental Health Research and Education at the Department of Psychiatry, University of Calgary in Calgary, Alberta, Canada
- Dr. Milev is with the Department of Psychiatry and the Department of Psychology, and Centre for Neuroscience Studies at Queen's University in Kingston, Ontario, Canada
- Dr. Müller is with the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada. Parikh is with the Department of Psychiatry at the University of Michigan in Ann Arbor, Michigan
- Dr. Placenza is with the Department of Psychiatry at the Krembil Research Centre, University Health Network, University of Toronto in Toronto, Ontario, Canada
- Dr. Rizvi is with Arthur Sommer Rotenberg Program for Suicide and Depression Studies at St. Michael's Hospital in Toronto, Ontario, Canada
- Dr. Rotzinger is with St. Michael's Hospital (Unity Health Toronto) and Department of Psychiatry at the University of Toronto in Toronto, Ontario, Canada
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Dr. Sills was with OCBN in Toronto, Ontario, Canada
- Dr. Soares is with the Department of Psychiatry at Queen's University and Providence Care Hospital in Kingston, Ontario, Canada
- Dr. Turecki is with the Department of Psychiatry at McGill University in Montreal, Quebec, Canada
- Dr. Uher is with the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada
- Dr. Williams is with the Departments of Psychiatry and Neurology at Columbia University in New York, New York
- Dr. Kennedy is with the Department of Psychiatry at the University of Toronto and Centre for Depression and Suicide, St. Michael's Hospital in Toronto, Ontario, Canada
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Chamali R, Ghuloum S, Sheehan DV, Mahfoud Z, Yehya A, Opler MGA, Khan A, Hammoudeh S, Hani Y, Al-Amin H. Cross-Validation of the Arabic Mini International Neuropsychiatric Interview, Module K, for Diagnosis of Schizophrenia and the Arabic Positive and Negative Syndrome Scale. J Psychopathol Behav Assess 2019. [DOI: 10.1007/s10862-019-09759-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sheehan DV, Gasior M, McElroy SL, Radewonuk J, Herman BK, Hudson J. Effects of Lisdexamfetamine Dimesylate on Functional Impairment Measured on the Sheehan Disability Scale in Adults With Moderate-to-severe Binge Eating Disorder: Results from Two Randomized, Placebo-controlled Trials. Innov Clin Neurosci 2018; 15:22-29. [PMID: 30013816 PMCID: PMC6040726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Objective: In two Phase III, randomized, placebo-controlled trials (NCT01718483 and NCT01718509 at ClinicalTrials.gov), lisdexamfetamine dimesylate (LDX) reduced binge eating days/week in adults with moderate-to-severe binge eating disorder (BED). We describe the effects of LDX (50mg and 70mg) on the Sheehan Disability Scale (SDS; exploratory endpoint) from both studies. Design: The SDS was assessed at baseline, Week 6, and Week 12/early termination. Analyses included mixed-effects models for repeated measures for the examination of SDS total and domain score changes and a generalized estimating equation model to assess dichotomized remission status (remission [total score ≤6] versus nonremission [total score >6]). Results: Least squares (95% confidence interval [CI]) mean treatment differences for SDS total score change from baseline at Week 12 were -2.80 (-3.98, -1.61) in Study 1 and -3.70 (-4.81, -2.58) in Study 2 (both p<0.001). Least squares (95% CI) mean treatment differences across SDS domains favored LDX over placebo in both studies for the change from baseline at Week 12 (work/school: -0.8 [-1.2, -0.4] and -1.1 [-1.5, -0.7], both p<0.001; social life/leisure activities: -1.0 [-1.4, -0.5] and -1.4 [-1.8, -1.0], both p<0.001; and family life/home responsibilities: -1.0 [-1.4, -0.5] and -1.3 [-1.7, -0.9], both p<0.001). Odds ratios (95% CI) for SDS remission versus nonremission favored LDX over placebo at Week 12 (Study 1: 2.39 [1.44, 3.96]; p<0.001 and Study 2: 5.12 [2.80, 9.33]; p<0.001). Conclusion: These findings indicate that LDX treatment is associated with improvement on the SDS in adults with moderate-to-severe BED.
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Affiliation(s)
- David V Sheehan
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Drs. Herman and Gasior and Ms. Radewonuk are formerly affiliated with Shire Pharmaceuticals in Lexington, Massachusetts
- Dr. McElroy is with the Lindner Center of HOPE and the University of Cincinnati College of Medicine in Mason, Ohio
- Dr. Hudson is with McLean Hospital/Harvard Medical School in Belmont, Massachusetts
| | - Maria Gasior
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Drs. Herman and Gasior and Ms. Radewonuk are formerly affiliated with Shire Pharmaceuticals in Lexington, Massachusetts
- Dr. McElroy is with the Lindner Center of HOPE and the University of Cincinnati College of Medicine in Mason, Ohio
- Dr. Hudson is with McLean Hospital/Harvard Medical School in Belmont, Massachusetts
| | - Susan L McElroy
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Drs. Herman and Gasior and Ms. Radewonuk are formerly affiliated with Shire Pharmaceuticals in Lexington, Massachusetts
- Dr. McElroy is with the Lindner Center of HOPE and the University of Cincinnati College of Medicine in Mason, Ohio
- Dr. Hudson is with McLean Hospital/Harvard Medical School in Belmont, Massachusetts
| | - Jana Radewonuk
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Drs. Herman and Gasior and Ms. Radewonuk are formerly affiliated with Shire Pharmaceuticals in Lexington, Massachusetts
- Dr. McElroy is with the Lindner Center of HOPE and the University of Cincinnati College of Medicine in Mason, Ohio
- Dr. Hudson is with McLean Hospital/Harvard Medical School in Belmont, Massachusetts
| | - Barry K Herman
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Drs. Herman and Gasior and Ms. Radewonuk are formerly affiliated with Shire Pharmaceuticals in Lexington, Massachusetts
- Dr. McElroy is with the Lindner Center of HOPE and the University of Cincinnati College of Medicine in Mason, Ohio
- Dr. Hudson is with McLean Hospital/Harvard Medical School in Belmont, Massachusetts
| | - James Hudson
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
- Drs. Herman and Gasior and Ms. Radewonuk are formerly affiliated with Shire Pharmaceuticals in Lexington, Massachusetts
- Dr. McElroy is with the Lindner Center of HOPE and the University of Cincinnati College of Medicine in Mason, Ohio
- Dr. Hudson is with McLean Hospital/Harvard Medical School in Belmont, Massachusetts
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Florea I, Loft H, Danchenko N, Rive B, Brignone M, Merikle E, Jacobsen PL, Sheehan DV. The effect of vortioxetine on overall patient functioning in patients with major depressive disorder. Brain Behav 2017; 7:e00622. [PMID: 28293465 PMCID: PMC5346512 DOI: 10.1002/brb3.622] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 10/05/2016] [Accepted: 11/09/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The objectives of this meta-analysis of data from randomized, placebo-controlled studies were to assess the effect of vortioxetine on overall functioning (primary) and functional remission (secondary) using the Sheehan Disability Scale (SDS) in adults with major depressive disorder (MDD). METHODS Data from nine short-term (6/8 weeks) pivotal studies that included patient functioning assessments were included in this random-effects meta-analysis, which used aggregated study-level data for all therapeutic vortioxetine doses and a mixed-effect model for repeated measures using the full analysis set. RESULTS A total of 4,216 patients received ≥1 dose of study treatment (1,522 placebo, 2,694 vortioxetine 5-20 mg/day). At study end, the meta-analysis showed improvement for vortioxetine versus placebo (n = 911) in SDS total score (vortioxetine 5 mg, n = 564, change from baseline versus placebo [Δ] -0.24, p = NS; 10 mg, n = 445, Δ -1.68, p ≤ .001; 15 mg, n = 204, Δ -0.91, p = NS; 20 mg, n = 340, Δ -1.94, p ≤ .01). Functional remission (SDS total score ≤6) was observed with vortioxetine 10 mg (n = 170/573; odds ratio [OR] relative to placebo 1.7, p < .001) and 20 mg (n = 144/447; OR 1.6, p < .05), but not 5 mg (n = 207/757; OR 1.1, p = NS) or 15 mg (n = 92/295; OR 1.3, p = NS). CONCLUSION Vortioxetine 5-20 mg for 6/8 weeks improved overall patient functioning in patients with MDD. Relative to placebo, vortioxetine 10 and 20 mg demonstrated significant improvement in SDS total score and functional remission.
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Affiliation(s)
| | | | | | | | | | | | | | - David V Sheehan
- University of South Florida College of Medicine Tampa FL USA
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8
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Durgam S, Gommoll C, Forero G, Nunez R, Tang X, Mathews M, Sheehan DV. Efficacy and Safety of Vilazodone in Patients With Generalized Anxiety Disorder: A Randomized, Double-Blind, Placebo-Controlled, Flexible-Dose Trial. J Clin Psychiatry 2016; 77:1687-1694. [PMID: 27232052 DOI: 10.4088/jcp.15m09885] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 08/18/2015] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the efficacy, safety, and tolerability of vilazodone as an acute treatment for generalized anxiety disorder (GAD). Vilazodone is a selective serotonin reuptake inhibitor and 5-HT1A receptor partial agonist approved for the treatment of major depressive disorder in adults. METHODS This was a randomized, placebo-controlled, parallel-group, multicenter, flexible-dose study conducted from May 2013-March 2014. Adult patients (18-70 years, inclusive) who met DSM-IV-TR criteria for GAD were randomized (1:1) to placebo or vilazodone 20-40 mg/d for 8 weeks of double-blind treatment. Primary and secondary efficacy parameters were change from baseline to week 8 in the Hamilton Anxiety Rating Scale (HARS) total score and in the Sheehan Disability Scale (SDS) total score, respectively, analyzed using a mixed-effects model for repeated measures approach on a modified intent-to-treat population. Safety outcomes were summarized descriptively. RESULTS Efficacy analyses were based on 400 patients (placebo = 200, vilazodone = 200); 76% completed the study (placebo = 81%, vilazodone = 71%). The least squares mean difference (95% CI) in total score change from baseline to week 8 was statistically significant for vilazodone versus placebo on the HARS (-2.20 [-3.72 to -0.68]; P = .0048) and on the SDS (-1.89 [-3.52 to -0.26]; P = .0236). Treatment-emergent adverse events reported in ≥ 5% of vilazodone patients and at least twice the rate of placebo were nausea, diarrhea, dizziness, fatigue, delayed ejaculation, and erectile dysfunction. CONCLUSION Statistically significant differences in favor of vilazodone 20-40 mg/d versus placebo were seen on all measures of anxiety and functional impairment in patients with GAD. Vilazodone was generally well tolerated, and no new safety concerns were noted. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01844115.
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Affiliation(s)
- Suresh Durgam
- Forest Research Institute, Harborside Financial Center, Jersey City, NJ 07311. .,Forest Research Institute, an affiliate of Actavis, Inc, Jersey City, New Jersey, USA
| | - Carl Gommoll
- Forest Research Institute, an affiliate of Actavis, Inc, Jersey City, New Jersey, USA
| | - Giovanna Forero
- Forest Research Institute, an affiliate of Actavis, Inc, Jersey City, New Jersey, USA
| | - Rene Nunez
- Forest Research Institute, an affiliate of Actavis, Inc, Jersey City, New Jersey, USA
| | - Xiongwen Tang
- Forest Research Institute, an affiliate of Actavis, Inc, Jersey City, New Jersey, USA
| | - Maju Mathews
- Forest Research Institute, an affiliate of Actavis, Inc, Jersey City, New Jersey, USA
| | - David V Sheehan
- Distinguished University Health Professor Emeritus, University of South Florida College of Medicine, Tampa, Florida, USA
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9
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Weisler RH, Ota A, Tsuneyoshi K, Perry P, Weiller E, Baker RA, Sheehan DV. Brexpiprazole as an adjunctive treatment in young adults with major depressive disorder who are in a school or work environment. J Affect Disord 2016; 204:40-7. [PMID: 27322768 DOI: 10.1016/j.jad.2016.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 05/31/2016] [Accepted: 06/03/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) is a common, debilitating disorder with substantial socioeconomic burden. Many patients with MDD experience symptoms that impair functioning and productivity, often negatively affecting work or educational pursuits. This Phase 3b open-label study evaluated adjunctive brexpiprazole in young adults with MDD, who were in work or study. METHODS Young patients (18-35 years) with MDD (inadequate responders to 1-3 antidepressant treatments [ADT] for their current episode) received brexpiprazole 1-3mg/day (target dose, 2mg/day) adjunctive to the same stable dose of ADT for 12 weeks. RESULTS Depressive symptoms improved during treatment with adjunctive brexpiprazole (primary endpoint, least squares [LS] mean change from baseline in Montgomery-Åsberg Depression Rating Scale [MADRS] total score, -18.1 [p<0.0001]). Reductions from baseline in Sheehan Disability Scale Score (SDS; LS mean change -11.2 [p<0.0001]) and Work Limitations Questionnaire (WLQ; p<0.0001) indicated improvements in the effects of patients' symptoms on functioning (work/school, social life, and home responsibilities). Changes from baseline in additional measures supported improvements in patient functioning and depression symptoms. The most common adverse events were headache (21.3%), weight increase (17.0%), and somnolence (17.0%); reported rates of akathisia were low (6.4%). Clinically relevant increases in weight (≥7%) occurred in 10.5% of patients. LIMITATIONS Open-label design; absence of comparator. CONCLUSIONS Brexpiprazole may represent an effective therapy for adjunctive treatment strategy of young adults with MDD who are working or studying. The observed improvements in work/school functioning in patients with MDD, whose depression was treated with ADT+brexpiprazole, suggests potential to reduce socioeconomic burden.
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Affiliation(s)
- Richard H Weisler
- Duke University Medical Center Durham, University of North Carolina, Chapel Hill, NC, USA; Richard H Weisler Md And Association, MD, PA, Raleigh, NC, USA.
| | - Ai Ota
- Otsuka Pharmaceutical Co., Ltd., Tokyo, Japan
| | | | - Pamela Perry
- Otsuka Pharmaceutical Development and Commercialization Inc., Princeton, NJ 08540, USA
| | | | - Ross A Baker
- Otsuka Pharmaceutical Development and Commercialization Inc., Princeton, NJ 08540, USA
| | - David V Sheehan
- University of South Florida College of Medicine, Tampa, FL, USA
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10
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Vaccarino AL, Evans KR, Kalali AH, Kennedy SH, Engelhardt N, Frey BN, Greist JH, Kobak KA, Lam RW, MacQueen G, Milev R, Placenza FM, Ravindran AV, Sheehan DV, Sills T, Williams JBW. The Depression Inventory Development Workgroup: A Collaborative, Empirically Driven Initiative to Develop a New Assessment Tool for Major Depressive Disorder. Innov Clin Neurosci 2016; 13:20-31. [PMID: 27974997 PMCID: PMC5141593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The Depression Inventory Development project is an initiative of the International Society for CNS Drug Development whose goal is to develop a comprehensive and psychometrically sound measurement tool to be utilized as a primary endpoint in clinical trials for major depressive disorder. Using an iterative process between field testing and psychometric analysis and drawing upon expertise of international researchers in depression, the Depression Inventory Development team has established an empirically driven and collaborative protocol for the creation of items to assess symptoms in major depressive disorder. Depression-relevant symptom clusters were identified based on expert clinical and patient input. In addition, as an aid for symptom identification and item construction, the psychometric properties of existing clinical scales (assessing depression and related indications) were evaluated using blinded datasets from pharmaceutical antidepressant drug trials. A series of field tests in patients with major depressive disorder provided the team with data to inform the iterative process of scale development. We report here an overview of the Depression Inventory Development initiative, including results of the third iteration of items assessing symptoms related to anhedonia, cognition, fatigue, general malaise, motivation, anxiety, negative thinking, pain and appetite. The strategies adopted from the Depression Inventory Development program, as an empirically driven and collaborative process for scale development, have provided the foundation to develop and validate measurement tools in other therapeutic areas as well.
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Affiliation(s)
- Anthony L Vaccarino
- Dr. Vaccarino is with Indoc Research, Toronto, Ontario, Canada; Dr. Evans is with Indoc Research, Toronto, Ontario, Canada, and Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada; Dr. Kalali is with Quintiles Inc, San Diego, California, USA, and Department of Psychiatry, University of California, San Diego, California, USA; Drs. Kennedy and Placenza are with University Health Network, Toronto, Ontario, Canada; Dr. Engelhardt is with Cronos Clinical Consulting Services, Lambertville, New Jersey, USA; Dr. Frey is with Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada, and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada; Dr. Greist is with Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Dr. Kobak is with Center for Telepsychology, Madison, Wisconsin, USA; Dr. Lam is with Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Dr. MacQueen is with Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Dr. Milev is with Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; Dr. Ravindran is with Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dr. Sheehan is with Department of Psychiatry and Behavioral Health, University of South Florida College of Medicine, Tampa, Florida, USA; Dr. Sills was with OCBN, Toronto, Ontario, Canada; Dr. Williams is with Columbia University, New York, New York, USA, and Medavante Inc., Trenton, New Jersey, USA
| | - Kenneth R Evans
- Dr. Vaccarino is with Indoc Research, Toronto, Ontario, Canada; Dr. Evans is with Indoc Research, Toronto, Ontario, Canada, and Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada; Dr. Kalali is with Quintiles Inc, San Diego, California, USA, and Department of Psychiatry, University of California, San Diego, California, USA; Drs. Kennedy and Placenza are with University Health Network, Toronto, Ontario, Canada; Dr. Engelhardt is with Cronos Clinical Consulting Services, Lambertville, New Jersey, USA; Dr. Frey is with Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada, and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada; Dr. Greist is with Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Dr. Kobak is with Center for Telepsychology, Madison, Wisconsin, USA; Dr. Lam is with Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Dr. MacQueen is with Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Dr. Milev is with Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; Dr. Ravindran is with Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dr. Sheehan is with Department of Psychiatry and Behavioral Health, University of South Florida College of Medicine, Tampa, Florida, USA; Dr. Sills was with OCBN, Toronto, Ontario, Canada; Dr. Williams is with Columbia University, New York, New York, USA, and Medavante Inc., Trenton, New Jersey, USA
| | - Amir H Kalali
- Dr. Vaccarino is with Indoc Research, Toronto, Ontario, Canada; Dr. Evans is with Indoc Research, Toronto, Ontario, Canada, and Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada; Dr. Kalali is with Quintiles Inc, San Diego, California, USA, and Department of Psychiatry, University of California, San Diego, California, USA; Drs. Kennedy and Placenza are with University Health Network, Toronto, Ontario, Canada; Dr. Engelhardt is with Cronos Clinical Consulting Services, Lambertville, New Jersey, USA; Dr. Frey is with Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada, and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada; Dr. Greist is with Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Dr. Kobak is with Center for Telepsychology, Madison, Wisconsin, USA; Dr. Lam is with Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Dr. MacQueen is with Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Dr. Milev is with Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; Dr. Ravindran is with Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dr. Sheehan is with Department of Psychiatry and Behavioral Health, University of South Florida College of Medicine, Tampa, Florida, USA; Dr. Sills was with OCBN, Toronto, Ontario, Canada; Dr. Williams is with Columbia University, New York, New York, USA, and Medavante Inc., Trenton, New Jersey, USA
| | - Sidney H Kennedy
- Dr. Vaccarino is with Indoc Research, Toronto, Ontario, Canada; Dr. Evans is with Indoc Research, Toronto, Ontario, Canada, and Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada; Dr. Kalali is with Quintiles Inc, San Diego, California, USA, and Department of Psychiatry, University of California, San Diego, California, USA; Drs. Kennedy and Placenza are with University Health Network, Toronto, Ontario, Canada; Dr. Engelhardt is with Cronos Clinical Consulting Services, Lambertville, New Jersey, USA; Dr. Frey is with Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada, and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada; Dr. Greist is with Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Dr. Kobak is with Center for Telepsychology, Madison, Wisconsin, USA; Dr. Lam is with Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Dr. MacQueen is with Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Dr. Milev is with Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; Dr. Ravindran is with Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dr. Sheehan is with Department of Psychiatry and Behavioral Health, University of South Florida College of Medicine, Tampa, Florida, USA; Dr. Sills was with OCBN, Toronto, Ontario, Canada; Dr. Williams is with Columbia University, New York, New York, USA, and Medavante Inc., Trenton, New Jersey, USA
| | - Nina Engelhardt
- Dr. Vaccarino is with Indoc Research, Toronto, Ontario, Canada; Dr. Evans is with Indoc Research, Toronto, Ontario, Canada, and Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada; Dr. Kalali is with Quintiles Inc, San Diego, California, USA, and Department of Psychiatry, University of California, San Diego, California, USA; Drs. Kennedy and Placenza are with University Health Network, Toronto, Ontario, Canada; Dr. Engelhardt is with Cronos Clinical Consulting Services, Lambertville, New Jersey, USA; Dr. Frey is with Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada, and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada; Dr. Greist is with Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Dr. Kobak is with Center for Telepsychology, Madison, Wisconsin, USA; Dr. Lam is with Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Dr. MacQueen is with Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Dr. Milev is with Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; Dr. Ravindran is with Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dr. Sheehan is with Department of Psychiatry and Behavioral Health, University of South Florida College of Medicine, Tampa, Florida, USA; Dr. Sills was with OCBN, Toronto, Ontario, Canada; Dr. Williams is with Columbia University, New York, New York, USA, and Medavante Inc., Trenton, New Jersey, USA
| | - Benicio N Frey
- Dr. Vaccarino is with Indoc Research, Toronto, Ontario, Canada; Dr. Evans is with Indoc Research, Toronto, Ontario, Canada, and Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada; Dr. Kalali is with Quintiles Inc, San Diego, California, USA, and Department of Psychiatry, University of California, San Diego, California, USA; Drs. Kennedy and Placenza are with University Health Network, Toronto, Ontario, Canada; Dr. Engelhardt is with Cronos Clinical Consulting Services, Lambertville, New Jersey, USA; Dr. Frey is with Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada, and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada; Dr. Greist is with Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Dr. Kobak is with Center for Telepsychology, Madison, Wisconsin, USA; Dr. Lam is with Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Dr. MacQueen is with Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Dr. Milev is with Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; Dr. Ravindran is with Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dr. Sheehan is with Department of Psychiatry and Behavioral Health, University of South Florida College of Medicine, Tampa, Florida, USA; Dr. Sills was with OCBN, Toronto, Ontario, Canada; Dr. Williams is with Columbia University, New York, New York, USA, and Medavante Inc., Trenton, New Jersey, USA
| | - John H Greist
- Dr. Vaccarino is with Indoc Research, Toronto, Ontario, Canada; Dr. Evans is with Indoc Research, Toronto, Ontario, Canada, and Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada; Dr. Kalali is with Quintiles Inc, San Diego, California, USA, and Department of Psychiatry, University of California, San Diego, California, USA; Drs. Kennedy and Placenza are with University Health Network, Toronto, Ontario, Canada; Dr. Engelhardt is with Cronos Clinical Consulting Services, Lambertville, New Jersey, USA; Dr. Frey is with Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada, and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada; Dr. Greist is with Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Dr. Kobak is with Center for Telepsychology, Madison, Wisconsin, USA; Dr. Lam is with Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Dr. MacQueen is with Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Dr. Milev is with Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; Dr. Ravindran is with Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dr. Sheehan is with Department of Psychiatry and Behavioral Health, University of South Florida College of Medicine, Tampa, Florida, USA; Dr. Sills was with OCBN, Toronto, Ontario, Canada; Dr. Williams is with Columbia University, New York, New York, USA, and Medavante Inc., Trenton, New Jersey, USA
| | - Kenneth A Kobak
- Dr. Vaccarino is with Indoc Research, Toronto, Ontario, Canada; Dr. Evans is with Indoc Research, Toronto, Ontario, Canada, and Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada; Dr. Kalali is with Quintiles Inc, San Diego, California, USA, and Department of Psychiatry, University of California, San Diego, California, USA; Drs. Kennedy and Placenza are with University Health Network, Toronto, Ontario, Canada; Dr. Engelhardt is with Cronos Clinical Consulting Services, Lambertville, New Jersey, USA; Dr. Frey is with Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada, and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada; Dr. Greist is with Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Dr. Kobak is with Center for Telepsychology, Madison, Wisconsin, USA; Dr. Lam is with Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Dr. MacQueen is with Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Dr. Milev is with Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; Dr. Ravindran is with Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dr. Sheehan is with Department of Psychiatry and Behavioral Health, University of South Florida College of Medicine, Tampa, Florida, USA; Dr. Sills was with OCBN, Toronto, Ontario, Canada; Dr. Williams is with Columbia University, New York, New York, USA, and Medavante Inc., Trenton, New Jersey, USA
| | - Raymond W Lam
- Dr. Vaccarino is with Indoc Research, Toronto, Ontario, Canada; Dr. Evans is with Indoc Research, Toronto, Ontario, Canada, and Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada; Dr. Kalali is with Quintiles Inc, San Diego, California, USA, and Department of Psychiatry, University of California, San Diego, California, USA; Drs. Kennedy and Placenza are with University Health Network, Toronto, Ontario, Canada; Dr. Engelhardt is with Cronos Clinical Consulting Services, Lambertville, New Jersey, USA; Dr. Frey is with Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada, and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada; Dr. Greist is with Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Dr. Kobak is with Center for Telepsychology, Madison, Wisconsin, USA; Dr. Lam is with Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Dr. MacQueen is with Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Dr. Milev is with Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; Dr. Ravindran is with Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dr. Sheehan is with Department of Psychiatry and Behavioral Health, University of South Florida College of Medicine, Tampa, Florida, USA; Dr. Sills was with OCBN, Toronto, Ontario, Canada; Dr. Williams is with Columbia University, New York, New York, USA, and Medavante Inc., Trenton, New Jersey, USA
| | - Glenda MacQueen
- Dr. Vaccarino is with Indoc Research, Toronto, Ontario, Canada; Dr. Evans is with Indoc Research, Toronto, Ontario, Canada, and Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada; Dr. Kalali is with Quintiles Inc, San Diego, California, USA, and Department of Psychiatry, University of California, San Diego, California, USA; Drs. Kennedy and Placenza are with University Health Network, Toronto, Ontario, Canada; Dr. Engelhardt is with Cronos Clinical Consulting Services, Lambertville, New Jersey, USA; Dr. Frey is with Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada, and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada; Dr. Greist is with Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Dr. Kobak is with Center for Telepsychology, Madison, Wisconsin, USA; Dr. Lam is with Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Dr. MacQueen is with Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Dr. Milev is with Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; Dr. Ravindran is with Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dr. Sheehan is with Department of Psychiatry and Behavioral Health, University of South Florida College of Medicine, Tampa, Florida, USA; Dr. Sills was with OCBN, Toronto, Ontario, Canada; Dr. Williams is with Columbia University, New York, New York, USA, and Medavante Inc., Trenton, New Jersey, USA
| | - Roumen Milev
- Dr. Vaccarino is with Indoc Research, Toronto, Ontario, Canada; Dr. Evans is with Indoc Research, Toronto, Ontario, Canada, and Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada; Dr. Kalali is with Quintiles Inc, San Diego, California, USA, and Department of Psychiatry, University of California, San Diego, California, USA; Drs. Kennedy and Placenza are with University Health Network, Toronto, Ontario, Canada; Dr. Engelhardt is with Cronos Clinical Consulting Services, Lambertville, New Jersey, USA; Dr. Frey is with Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada, and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada; Dr. Greist is with Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Dr. Kobak is with Center for Telepsychology, Madison, Wisconsin, USA; Dr. Lam is with Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Dr. MacQueen is with Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Dr. Milev is with Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; Dr. Ravindran is with Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dr. Sheehan is with Department of Psychiatry and Behavioral Health, University of South Florida College of Medicine, Tampa, Florida, USA; Dr. Sills was with OCBN, Toronto, Ontario, Canada; Dr. Williams is with Columbia University, New York, New York, USA, and Medavante Inc., Trenton, New Jersey, USA
| | - Franca M Placenza
- Dr. Vaccarino is with Indoc Research, Toronto, Ontario, Canada; Dr. Evans is with Indoc Research, Toronto, Ontario, Canada, and Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada; Dr. Kalali is with Quintiles Inc, San Diego, California, USA, and Department of Psychiatry, University of California, San Diego, California, USA; Drs. Kennedy and Placenza are with University Health Network, Toronto, Ontario, Canada; Dr. Engelhardt is with Cronos Clinical Consulting Services, Lambertville, New Jersey, USA; Dr. Frey is with Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada, and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada; Dr. Greist is with Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Dr. Kobak is with Center for Telepsychology, Madison, Wisconsin, USA; Dr. Lam is with Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Dr. MacQueen is with Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Dr. Milev is with Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; Dr. Ravindran is with Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dr. Sheehan is with Department of Psychiatry and Behavioral Health, University of South Florida College of Medicine, Tampa, Florida, USA; Dr. Sills was with OCBN, Toronto, Ontario, Canada; Dr. Williams is with Columbia University, New York, New York, USA, and Medavante Inc., Trenton, New Jersey, USA
| | - Arun V Ravindran
- Dr. Vaccarino is with Indoc Research, Toronto, Ontario, Canada; Dr. Evans is with Indoc Research, Toronto, Ontario, Canada, and Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada; Dr. Kalali is with Quintiles Inc, San Diego, California, USA, and Department of Psychiatry, University of California, San Diego, California, USA; Drs. Kennedy and Placenza are with University Health Network, Toronto, Ontario, Canada; Dr. Engelhardt is with Cronos Clinical Consulting Services, Lambertville, New Jersey, USA; Dr. Frey is with Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada, and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada; Dr. Greist is with Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Dr. Kobak is with Center for Telepsychology, Madison, Wisconsin, USA; Dr. Lam is with Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Dr. MacQueen is with Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Dr. Milev is with Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; Dr. Ravindran is with Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dr. Sheehan is with Department of Psychiatry and Behavioral Health, University of South Florida College of Medicine, Tampa, Florida, USA; Dr. Sills was with OCBN, Toronto, Ontario, Canada; Dr. Williams is with Columbia University, New York, New York, USA, and Medavante Inc., Trenton, New Jersey, USA
| | - David V Sheehan
- Dr. Vaccarino is with Indoc Research, Toronto, Ontario, Canada; Dr. Evans is with Indoc Research, Toronto, Ontario, Canada, and Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada; Dr. Kalali is with Quintiles Inc, San Diego, California, USA, and Department of Psychiatry, University of California, San Diego, California, USA; Drs. Kennedy and Placenza are with University Health Network, Toronto, Ontario, Canada; Dr. Engelhardt is with Cronos Clinical Consulting Services, Lambertville, New Jersey, USA; Dr. Frey is with Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada, and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada; Dr. Greist is with Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Dr. Kobak is with Center for Telepsychology, Madison, Wisconsin, USA; Dr. Lam is with Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Dr. MacQueen is with Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Dr. Milev is with Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; Dr. Ravindran is with Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dr. Sheehan is with Department of Psychiatry and Behavioral Health, University of South Florida College of Medicine, Tampa, Florida, USA; Dr. Sills was with OCBN, Toronto, Ontario, Canada; Dr. Williams is with Columbia University, New York, New York, USA, and Medavante Inc., Trenton, New Jersey, USA
| | - Terrence Sills
- Dr. Vaccarino is with Indoc Research, Toronto, Ontario, Canada; Dr. Evans is with Indoc Research, Toronto, Ontario, Canada, and Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada; Dr. Kalali is with Quintiles Inc, San Diego, California, USA, and Department of Psychiatry, University of California, San Diego, California, USA; Drs. Kennedy and Placenza are with University Health Network, Toronto, Ontario, Canada; Dr. Engelhardt is with Cronos Clinical Consulting Services, Lambertville, New Jersey, USA; Dr. Frey is with Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada, and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada; Dr. Greist is with Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Dr. Kobak is with Center for Telepsychology, Madison, Wisconsin, USA; Dr. Lam is with Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Dr. MacQueen is with Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Dr. Milev is with Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; Dr. Ravindran is with Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dr. Sheehan is with Department of Psychiatry and Behavioral Health, University of South Florida College of Medicine, Tampa, Florida, USA; Dr. Sills was with OCBN, Toronto, Ontario, Canada; Dr. Williams is with Columbia University, New York, New York, USA, and Medavante Inc., Trenton, New Jersey, USA
| | - Janet B W Williams
- Dr. Vaccarino is with Indoc Research, Toronto, Ontario, Canada; Dr. Evans is with Indoc Research, Toronto, Ontario, Canada, and Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada; Dr. Kalali is with Quintiles Inc, San Diego, California, USA, and Department of Psychiatry, University of California, San Diego, California, USA; Drs. Kennedy and Placenza are with University Health Network, Toronto, Ontario, Canada; Dr. Engelhardt is with Cronos Clinical Consulting Services, Lambertville, New Jersey, USA; Dr. Frey is with Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada, and Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada; Dr. Greist is with Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Dr. Kobak is with Center for Telepsychology, Madison, Wisconsin, USA; Dr. Lam is with Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Dr. MacQueen is with Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Dr. Milev is with Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; Dr. Ravindran is with Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dr. Sheehan is with Department of Psychiatry and Behavioral Health, University of South Florida College of Medicine, Tampa, Florida, USA; Dr. Sills was with OCBN, Toronto, Ontario, Canada; Dr. Williams is with Columbia University, New York, New York, USA, and Medavante Inc., Trenton, New Jersey, USA
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11
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Ágh T, Kovács G, Supina D, Pawaskar M, Herman BK, Vokó Z, Sheehan DV. A systematic review of the health-related quality of life and economic burdens of anorexia nervosa, bulimia nervosa, and binge eating disorder. Eat Weight Disord 2016; 21:353-364. [PMID: 26942768 PMCID: PMC5010619 DOI: 10.1007/s40519-016-0264-x] [Citation(s) in RCA: 186] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 02/17/2016] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To perform a systematic review of the health-related quality of life (HRQoL) and economic burdens of anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). METHODS A systematic literature search of English-language studies was performed in Medline, Embase, PsycINFO, PsycARTICLES, Academic Search Complete, CINAHL Plus, Business Source Premier, and Cochrane Library. Cost data were converted to 2014 Euro. RESULTS Sixty-nine studies were included. Data on HRQoL were reported in 41 studies (18 for AN, 17 for BN, and 18 for BED), on healthcare utilization in 20 studies (14 for AN, 12 for BN, and 8 for BED), and on healthcare costs in 17 studies (9 for AN, 11 for BN, and only 2 for BED). Patients' HRQoL was significantly worse with AN, BN, and BED compared with healthy populations. AN, BN, and BED were associated with a high rate of hospitalization, outpatient care, and emergency department visits. However, patients rarely received specific treatment for their eating disorder. The annual healthcare costs for AN, BN, and BED were €2993 to €55,270, €888 to €18,823, and €1762 to €2902, respectively. CONCLUSIONS AN, BN, and BED have a serious impact on patient's HRQoL and are also associated with increased healthcare utilization and healthcare costs. The burden of BED should be examined separately from that of BN. The limited evidence suggests that further research is warranted to better understand the differences in long-term HRQoL and economic burdens of AN, BN, and BED.
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Affiliation(s)
- Tamás Ágh
- Syreon Research Institute, 119 Thököly Street, 1146, Budapest, Hungary.
| | - Gábor Kovács
- Syreon Research Institute, 119 Thököly Street, 1146, Budapest, Hungary
| | - Dylan Supina
- Formerly of Shire, 300 Shire Way, Lexington, MA, 02421, USA
| | | | | | - Zoltán Vokó
- Syreon Research Institute, 119 Thököly Street, 1146, Budapest, Hungary.,Department of Health Policy and Health Economics, Faculty of Social Sciences, Eötvös Loránd University, 1/a Pázmány Péter Street, 1117, Budapest, Hungary
| | - David V Sheehan
- University of South Florida College of Medicine, 12901 Bruce B. Downs Boulevard, Tampa, FL, 33612, USA
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Khan SA, Revicki DA, Hassan M, Locklear JC, Friedman LA, Mannix S, Tummala R, Dunbar GC, Eriksson H, Sheehan DV. Assessing the Reliability and Validity of the Sheehan Irritability Scale in Patients With Major Depressive Disorder. J Clin Psychiatry 2016; 77:1080-6. [PMID: 26579723 DOI: 10.4088/jcp.14m09719] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 06/01/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Irritability is a significant component in the clinical manifestation of major depressive disorder (MDD). The Sheehan Irritability Scale (SIS) was developed to assess irritability-related symptoms in patients with psychiatric disorders. Data from a phase 2 clinical trial (June 2008-July 2009) was utilized to evaluate the psychometric properties of the SIS. The trial population included patients diagnosed with MDD, according to DSM-IV and confirmed via the MINI diagnostic scale, who had inadequate response to citalopram. METHOD The secondary analyses included 586 patients from the United States and India. Data from the SIS, depression severity measures (17-item Hamilton Depression Rating Scale [HDRS-17], Montgomery-Asberg Depression Rating Scale [MADRS], Quick Inventory of Depressive Symptomatology-Self-Report [QIDS-SR]), and other measures (Sheehan Disability Scale [SDS], Clinical Global Impressions-Severity of Illness scale [CGI-S]) were used in the psychometric evaluation. All statistical tests used a significance level of .05 unless otherwise noted. RESULTS Internal consistency (0.92-0.99) and test-retest reliability (0.83 to 0.98) were excellent. Concurrent validity was demonstrated through strong correlations between the SIS total score and HDRS-17, QIDS-SR, SDS, CGI-S, and MADRS scores. SIS total scores were significantly different by clinical severity level (P < .001). Minimally important difference estimates suggest that a 7- to 8-point change in the SIS total score may be clinically meaningful. CONCLUSIONS The SIS has excellent reliability, acceptable validity, and good responsiveness, making the SIS appropriate for use in clinical research and practice. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00692445.
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Affiliation(s)
| | - Dennis A Revicki
- Evidera, Outcomes Research, 7101 Wisconsin Ave, Ste 1400, Bethesda, MD 20814. .,Evidera, Bethesda, Maryland, USA
| | - Mariam Hassan
- AstraZeneca Pharmaceuticals LP, Wilmington, Delaware, USA.,Vertex Pharmaceuticals (current affiliation)
| | - Julie C Locklear
- AstraZeneca Pharmaceuticals LP, Wilmington, Delaware, USA.,EMD Serono (current affiliation)
| | | | | | - Raj Tummala
- AstraZeneca Pharmaceuticals LP, Wilmington, Delaware, USA
| | - Geoffrey C Dunbar
- Targacept Inc, Winston-Salem, North Carolina, USA.,EMD Serono (current affiliation).,Lundbeck (current affiliation)
| | | | - David V Sheehan
- University of Southern Florida College of Medicine, Tampa, Florida, USA
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13
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Abstract
Patients with depression experience symptoms that hinder their ability to function at home, at work, and in social settings. Even when mood symptoms improve, patients' function may not return to normal. Clinicians must make restoration of function a treatment goal along with symptom remission. Rating scales that assess function can help clinicians monitor areas such as work performance, role fulfillment, social activities, and more. The process of treating functional impairments will take time and may require specific interventions, but patients will feel "recovered" only when these areas are restored.
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Sheehan DV, Mancini M, Wang J, Berggren L, Cao H, Dueñas HJ, Yue L. Assessment of functional outcomes by Sheehan Disability Scale in patients with major depressive disorder treated with duloxetine versus selective serotonin reuptake inhibitors. Hum Psychopharmacol 2016; 31:53-63. [PMID: 26331440 PMCID: PMC5049604 DOI: 10.1002/hup.2500] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 05/11/2015] [Accepted: 07/10/2015] [Indexed: 12/03/2022]
Abstract
OBJECTIVE We compared functional impairment outcomes assessed with Sheehan Disability Scale (SDS) after treatment with duloxetine versus selective serotonin reuptake inhibitors (SSRIs) in patients with major depressive disorder. METHODS Data were pooled from four randomized studies comparing treatment with duloxetine and SSRIs (three double blind and one open label). Analysis of covariance, with last-observation-carried-forward approach for missing data, explored treatment differences between duloxetine and SSRIs on SDS changes during 8 to 12 weeks of acute treatment for the intent-to-treat population. Logistic regression analysis examined the predictive capacity of baseline patient characteristics for remission in functional impairment (SDS total score ≤ 6 and SDS item scores ≤ 2) at endpoint. RESULTS Included were 2193 patients (duloxetine n = 1029; SSRIs n = 835; placebo n = 329). Treatment with duloxetine and SSRIs resulted in significantly (p < 0.01) greater improvements in the SDS total score versus treatment with placebo. Higher SDS (p < 0.0001) or 17-item Hamilton Depression Rating Scale baseline scores (p < 0.01) predicted lower probability of functional improvement after treatment with duloxetine or SSRIs. Female gender (p ≤ 0.05) predicted higher probability of functional improvement after treatment with duloxetine or SSRIs. CONCLUSIONS Treatment with SSRIs and duloxetine improved functional impairment in patients with major depressive disorder. Higher SDS or 17-item Hamilton Depression Rating Scale baseline scores predicted less probability of SDS improvement; female gender predicted better improvement in functional impairment at endpoint.
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Affiliation(s)
- David V Sheehan
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | | | - Jianing Wang
- Lilly Suzhou Pharmaceutical Company Ltd, Shanghai, China
| | | | - Haijun Cao
- Lilly Suzhou Pharmaceutical Company Ltd, Shanghai, China
| | | | - Li Yue
- Lilly Suzhou Pharmaceutical Company Ltd, Shanghai, China
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15
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Sheehan DV, Herman BK. The Psychological and Medical Factors Associated With Untreated Binge Eating Disorder. Prim Care Companion CNS Disord 2015; 17:14r01732. [PMID: 26445695 DOI: 10.4088/pcc.14r01732] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 12/19/2014] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE Although binge eating disorder (BED) is the most prevalent eating disorder, the impact of untreated BED is underappreciated. This review describes the relationship of BED to physical and mental health, quality of life, and functionality. DATA SOURCES PubMed searches were conducted on March 21, 2014; searches were limited to English-language research articles, meta-analyses, and reviews published between January 1, 2003 and March 21, 2014. Search terms included (binge eating OR binge-eating OR binge eating disorder) AND (cardiovascular OR metabolic OR metabolic syndrome OR gastrointestinal OR health OR rehabilitation OR recovery OR sleep OR pregnancy OR quality of life OR functional impairment OR activities of daily living OR QoL OR SF-12 OR ED-5D OR SF-36 OR psychosocial OR depressive OR anxiety OR self-esteem OR suicidality OR suicide OR productivity OR family). STUDY SELECTION/DATA EXTRACTION Of 326 identified publications, 43 were relevant to the topic and reported on the association of BED with psychiatric and medical comorbidities, quality of life, and functional outcomes. RESULTS Individuals diagnosed with BED have increased rates of mental health comorbidities (eg, depression and anxiety) and more pronounced medical impairments (eg, cardiovascular disorders) compared with individuals without BED. BED is also associated with functional impairment and reduced quality of life. CONCLUSIONS Binge eating disorder is associated with impairments in physical and mental health, which can decrease quality of life and functionality and lead to increased health care utilization and decreased productivity. However, some caution is warranted in interpreting these findings because it remains unclear whether BED is an antecedent condition, a complication associated with a comorbid psychiatric condition, or an unrelated feature that occurs concurrently with these comorbidities and impairments. Much of the research on BED is based on observational or epidemiologic studies. Controlled studies are needed to clearly define the long-term impairments associated with BED.
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Affiliation(s)
- David V Sheehan
- Department of Psychiatry and Behavioral Health, University of South Florida College of Medicine, Tampa (Dr Sheehan), and Shire Development LLC, Wayne, Pennsylvania (Dr Herman)
| | - Barry K Herman
- Department of Psychiatry and Behavioral Health, University of South Florida College of Medicine, Tampa (Dr Sheehan), and Shire Development LLC, Wayne, Pennsylvania (Dr Herman)
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16
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Giddens JM, Sheehan DV. How the Timing of a Patient's Self-ratings of Suicidality and the Relationship to the Recipient Affect Patient Responses: A Case Study. Innov Clin Neurosci 2014; 11:191-193. [PMID: 25520898 PMCID: PMC4267795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE This case study explores to what extent, if any, a subject's reporting varies depending upon whom the subject believes will view the data and the relationship the subject has with the reviewer. It also explores the variance in reporting if several days pass between the timeframe in question and the time of data collection. METHOD The subject answered three suicidality-related scales (the Sheehan-Suicidality Tracking Scale, the Suicidality Modifiers, and the Alphs Dichotomous Impulsivity and Hopelessness Two Questions) for 24 distinct timeframes. The scales were rated three different ways for each timeframe. The first was for only the patient. Immediately afterward, the scales were answered for the subject's therapist. A few days later, the scales were again answered by the patient, but only for the patient. The three different interviews for the same timeframe were compared to investigate any deviations. RESULTS This case study found clinically relevant deviations between the three ratings completed for the same timeframe. CONCLUSION This case study illustrates that a patient's reporting of his or her symptoms of suicidality using a patient-rated scale can vary depending upon the context, distance from timeframe in question, and the patient's relationship with the reviewer of the data.
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Affiliation(s)
- Jennifer M Giddens
- J. Giddens is Co-founder of the Tampa Center for Research on Suicidality, Tampa, Florida; and Dr. Sheehan is Distinguished University Health Professor Emeritus, University of South Florida College of Medicine, Tampa, Florida
| | - David V Sheehan
- J. Giddens is Co-founder of the Tampa Center for Research on Suicidality, Tampa, Florida; and Dr. Sheehan is Distinguished University Health Professor Emeritus, University of South Florida College of Medicine, Tampa, Florida
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17
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Sheehan DV, Alphs LD, Mao L, Li Q, May RS, Bruer EH, Mccullumsmith CB, Gray CR, Li X, Williamson DJ. Comparative Validation of the S-STS, the ISST-Plus, and the C-SSRS for Assessing the Suicidal Thinking and Behavior FDA 2012 Suicidality Categories. Innov Clin Neurosci 2014; 11:32-46. [PMID: 25520887 PMCID: PMC4267798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE This exploratory study examines the concurrent validity for mapping symptoms of suicidal ideation, self-harm, and suicidal behavior as recorded on the InterSePT Scale for Suicidal Thinking-Plus, the Sheehan-Suicidality Tracking Scale (clinician- and patient-rated and reconciled patient/clinician versions), and the Columbia-Suicide Severity Rating Scale to the 11 United States Food and Drug Administration-Classification Algorithm of Suicide Assessment (September 2012) categories. METHOD Forty subjects with varying degrees of suicidal ideation and behavior severity (from not present to extremely severe) were recruited from inpatient, outpatient, and emergency room settings. Each patient was interviewed using all three scales (InterSePT Scale for Suicidal Thinking-Plus, the Sheehan-Suicidality Tracking Scale, and the Columbia-Suicide Severity Rating Scale) on the same day. The scales were administered in a random sequence by three independent raters who were blind to the ratings on the other scales. RESULTS The Sheehan-Suicidality Tracking Scale and the InterSePT Scale for Suicidal Thinking-Plus show acceptable agreement with the Columbia-Suicide Severity Rating Scale in detecting the presence or absence of the 2012 Food and Drug Administration-Classification Algorithm of Suicide Assessment categories 1, 5, 6, 10, and 11 (passive ideation; active ideation with method, intent, and plan; completed suicide; preparatory actions; and self-injurious behavior) but not of categories 2, 3, and 4 (3 other active suicidal ideation combination categories) or to 8 and 9 (aborted and interrupted attempt). Despite the significant disagreement between the Columbia-Suicide Severity Rating Scale on the one side and the InterSePT Scale for Suicidal Thinking-Plus and the Sheehan-Suicidality Tracking Scale on the other in the ability to accurately map to the 2012 Food and Drug Administration-Classification Algorithm of Suicide Assessment categories on some items, there was close agreement between the InterSePT Scale for Suicidal Thinking-Plus and the Sheehan-Suicidality Tracking Scale on these categories. CONCLUSION The results of this exploratory study invite discussion and debate about the validity of the Columbia-Suicide Severity Rating Scale and its ability to accurately assess key active suicidal ideation categories, since it disagrees so much with the other two standardized scales that agree so closely with each other.
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Affiliation(s)
- David V Sheehan
- Dr. Sheehan is Distinguished University Health Professor Emeritus, University of South Florida College of Medicine, Tampa, Florida; Dr. Alphs is with Janssen Medical Affairs, LLC, Titusville, New Jersey; Dr. Mao is with Janssen Research & Development, LLC, Titusville, New Jersey; Mr. Q. Li is Director, Statistical Programming, Regeneron Pharmaceuticals, Inc., Basking Ridge, New Jersey; Ms. May is with the University of Alabama, Birmingham, Alabama; Ms Bruer is with the University of Alabama, Department of Psychiatry and Behavioral Neurobiology, Birmingham, Alabama; Dr. McCullumsmith is with the University of Cincinnati Department of Psychiatry and Behavioral Neuroscience, Cincinnati, Ohio; Mr. Gray is with Medical Outcomes Systems, Jacksonville, Florida; Mr. X. Li is with St. Vincent East Hospital, St. Vincent Health System, Birmingham, Alabama; and Dr. Williamson is with the University of South Alabama College of Medicine, Departments of Psychiatry and Neurology, Birmingham, Alabama, and Janssen Medical Affairs, LLC, Titusville, New Jersey
| | - Larry D Alphs
- Dr. Sheehan is Distinguished University Health Professor Emeritus, University of South Florida College of Medicine, Tampa, Florida; Dr. Alphs is with Janssen Medical Affairs, LLC, Titusville, New Jersey; Dr. Mao is with Janssen Research & Development, LLC, Titusville, New Jersey; Mr. Q. Li is Director, Statistical Programming, Regeneron Pharmaceuticals, Inc., Basking Ridge, New Jersey; Ms. May is with the University of Alabama, Birmingham, Alabama; Ms Bruer is with the University of Alabama, Department of Psychiatry and Behavioral Neurobiology, Birmingham, Alabama; Dr. McCullumsmith is with the University of Cincinnati Department of Psychiatry and Behavioral Neuroscience, Cincinnati, Ohio; Mr. Gray is with Medical Outcomes Systems, Jacksonville, Florida; Mr. X. Li is with St. Vincent East Hospital, St. Vincent Health System, Birmingham, Alabama; and Dr. Williamson is with the University of South Alabama College of Medicine, Departments of Psychiatry and Neurology, Birmingham, Alabama, and Janssen Medical Affairs, LLC, Titusville, New Jersey
| | - Lian Mao
- Dr. Sheehan is Distinguished University Health Professor Emeritus, University of South Florida College of Medicine, Tampa, Florida; Dr. Alphs is with Janssen Medical Affairs, LLC, Titusville, New Jersey; Dr. Mao is with Janssen Research & Development, LLC, Titusville, New Jersey; Mr. Q. Li is Director, Statistical Programming, Regeneron Pharmaceuticals, Inc., Basking Ridge, New Jersey; Ms. May is with the University of Alabama, Birmingham, Alabama; Ms Bruer is with the University of Alabama, Department of Psychiatry and Behavioral Neurobiology, Birmingham, Alabama; Dr. McCullumsmith is with the University of Cincinnati Department of Psychiatry and Behavioral Neuroscience, Cincinnati, Ohio; Mr. Gray is with Medical Outcomes Systems, Jacksonville, Florida; Mr. X. Li is with St. Vincent East Hospital, St. Vincent Health System, Birmingham, Alabama; and Dr. Williamson is with the University of South Alabama College of Medicine, Departments of Psychiatry and Neurology, Birmingham, Alabama, and Janssen Medical Affairs, LLC, Titusville, New Jersey
| | - Qin Li
- Dr. Sheehan is Distinguished University Health Professor Emeritus, University of South Florida College of Medicine, Tampa, Florida; Dr. Alphs is with Janssen Medical Affairs, LLC, Titusville, New Jersey; Dr. Mao is with Janssen Research & Development, LLC, Titusville, New Jersey; Mr. Q. Li is Director, Statistical Programming, Regeneron Pharmaceuticals, Inc., Basking Ridge, New Jersey; Ms. May is with the University of Alabama, Birmingham, Alabama; Ms Bruer is with the University of Alabama, Department of Psychiatry and Behavioral Neurobiology, Birmingham, Alabama; Dr. McCullumsmith is with the University of Cincinnati Department of Psychiatry and Behavioral Neuroscience, Cincinnati, Ohio; Mr. Gray is with Medical Outcomes Systems, Jacksonville, Florida; Mr. X. Li is with St. Vincent East Hospital, St. Vincent Health System, Birmingham, Alabama; and Dr. Williamson is with the University of South Alabama College of Medicine, Departments of Psychiatry and Neurology, Birmingham, Alabama, and Janssen Medical Affairs, LLC, Titusville, New Jersey
| | - Roberta S May
- Dr. Sheehan is Distinguished University Health Professor Emeritus, University of South Florida College of Medicine, Tampa, Florida; Dr. Alphs is with Janssen Medical Affairs, LLC, Titusville, New Jersey; Dr. Mao is with Janssen Research & Development, LLC, Titusville, New Jersey; Mr. Q. Li is Director, Statistical Programming, Regeneron Pharmaceuticals, Inc., Basking Ridge, New Jersey; Ms. May is with the University of Alabama, Birmingham, Alabama; Ms Bruer is with the University of Alabama, Department of Psychiatry and Behavioral Neurobiology, Birmingham, Alabama; Dr. McCullumsmith is with the University of Cincinnati Department of Psychiatry and Behavioral Neuroscience, Cincinnati, Ohio; Mr. Gray is with Medical Outcomes Systems, Jacksonville, Florida; Mr. X. Li is with St. Vincent East Hospital, St. Vincent Health System, Birmingham, Alabama; and Dr. Williamson is with the University of South Alabama College of Medicine, Departments of Psychiatry and Neurology, Birmingham, Alabama, and Janssen Medical Affairs, LLC, Titusville, New Jersey
| | - Emily H Bruer
- Dr. Sheehan is Distinguished University Health Professor Emeritus, University of South Florida College of Medicine, Tampa, Florida; Dr. Alphs is with Janssen Medical Affairs, LLC, Titusville, New Jersey; Dr. Mao is with Janssen Research & Development, LLC, Titusville, New Jersey; Mr. Q. Li is Director, Statistical Programming, Regeneron Pharmaceuticals, Inc., Basking Ridge, New Jersey; Ms. May is with the University of Alabama, Birmingham, Alabama; Ms Bruer is with the University of Alabama, Department of Psychiatry and Behavioral Neurobiology, Birmingham, Alabama; Dr. McCullumsmith is with the University of Cincinnati Department of Psychiatry and Behavioral Neuroscience, Cincinnati, Ohio; Mr. Gray is with Medical Outcomes Systems, Jacksonville, Florida; Mr. X. Li is with St. Vincent East Hospital, St. Vincent Health System, Birmingham, Alabama; and Dr. Williamson is with the University of South Alabama College of Medicine, Departments of Psychiatry and Neurology, Birmingham, Alabama, and Janssen Medical Affairs, LLC, Titusville, New Jersey
| | - Cheryl B Mccullumsmith
- Dr. Sheehan is Distinguished University Health Professor Emeritus, University of South Florida College of Medicine, Tampa, Florida; Dr. Alphs is with Janssen Medical Affairs, LLC, Titusville, New Jersey; Dr. Mao is with Janssen Research & Development, LLC, Titusville, New Jersey; Mr. Q. Li is Director, Statistical Programming, Regeneron Pharmaceuticals, Inc., Basking Ridge, New Jersey; Ms. May is with the University of Alabama, Birmingham, Alabama; Ms Bruer is with the University of Alabama, Department of Psychiatry and Behavioral Neurobiology, Birmingham, Alabama; Dr. McCullumsmith is with the University of Cincinnati Department of Psychiatry and Behavioral Neuroscience, Cincinnati, Ohio; Mr. Gray is with Medical Outcomes Systems, Jacksonville, Florida; Mr. X. Li is with St. Vincent East Hospital, St. Vincent Health System, Birmingham, Alabama; and Dr. Williamson is with the University of South Alabama College of Medicine, Departments of Psychiatry and Neurology, Birmingham, Alabama, and Janssen Medical Affairs, LLC, Titusville, New Jersey
| | - Christopher R Gray
- Dr. Sheehan is Distinguished University Health Professor Emeritus, University of South Florida College of Medicine, Tampa, Florida; Dr. Alphs is with Janssen Medical Affairs, LLC, Titusville, New Jersey; Dr. Mao is with Janssen Research & Development, LLC, Titusville, New Jersey; Mr. Q. Li is Director, Statistical Programming, Regeneron Pharmaceuticals, Inc., Basking Ridge, New Jersey; Ms. May is with the University of Alabama, Birmingham, Alabama; Ms Bruer is with the University of Alabama, Department of Psychiatry and Behavioral Neurobiology, Birmingham, Alabama; Dr. McCullumsmith is with the University of Cincinnati Department of Psychiatry and Behavioral Neuroscience, Cincinnati, Ohio; Mr. Gray is with Medical Outcomes Systems, Jacksonville, Florida; Mr. X. Li is with St. Vincent East Hospital, St. Vincent Health System, Birmingham, Alabama; and Dr. Williamson is with the University of South Alabama College of Medicine, Departments of Psychiatry and Neurology, Birmingham, Alabama, and Janssen Medical Affairs, LLC, Titusville, New Jersey
| | - Xiaohua Li
- Dr. Sheehan is Distinguished University Health Professor Emeritus, University of South Florida College of Medicine, Tampa, Florida; Dr. Alphs is with Janssen Medical Affairs, LLC, Titusville, New Jersey; Dr. Mao is with Janssen Research & Development, LLC, Titusville, New Jersey; Mr. Q. Li is Director, Statistical Programming, Regeneron Pharmaceuticals, Inc., Basking Ridge, New Jersey; Ms. May is with the University of Alabama, Birmingham, Alabama; Ms Bruer is with the University of Alabama, Department of Psychiatry and Behavioral Neurobiology, Birmingham, Alabama; Dr. McCullumsmith is with the University of Cincinnati Department of Psychiatry and Behavioral Neuroscience, Cincinnati, Ohio; Mr. Gray is with Medical Outcomes Systems, Jacksonville, Florida; Mr. X. Li is with St. Vincent East Hospital, St. Vincent Health System, Birmingham, Alabama; and Dr. Williamson is with the University of South Alabama College of Medicine, Departments of Psychiatry and Neurology, Birmingham, Alabama, and Janssen Medical Affairs, LLC, Titusville, New Jersey
| | - David J Williamson
- Dr. Sheehan is Distinguished University Health Professor Emeritus, University of South Florida College of Medicine, Tampa, Florida; Dr. Alphs is with Janssen Medical Affairs, LLC, Titusville, New Jersey; Dr. Mao is with Janssen Research & Development, LLC, Titusville, New Jersey; Mr. Q. Li is Director, Statistical Programming, Regeneron Pharmaceuticals, Inc., Basking Ridge, New Jersey; Ms. May is with the University of Alabama, Birmingham, Alabama; Ms Bruer is with the University of Alabama, Department of Psychiatry and Behavioral Neurobiology, Birmingham, Alabama; Dr. McCullumsmith is with the University of Cincinnati Department of Psychiatry and Behavioral Neuroscience, Cincinnati, Ohio; Mr. Gray is with Medical Outcomes Systems, Jacksonville, Florida; Mr. X. Li is with St. Vincent East Hospital, St. Vincent Health System, Birmingham, Alabama; and Dr. Williamson is with the University of South Alabama College of Medicine, Departments of Psychiatry and Neurology, Birmingham, Alabama, and Janssen Medical Affairs, LLC, Titusville, New Jersey
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Giddens JM, Sheehan DV. Is There Value in Asking the Question "Do you think you would be better off dead?" in Assessing Suicidality? A Case Study. Innov Clin Neurosci 2014; 11:182-190. [PMID: 25520897 PMCID: PMC4267794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The author of the widely used suicidality scale, the Columbia-Suicide Severity Rating Scale, has repeatedly made the claim that asking the question, "Do you think you would be better off dead?" in suicidality assessment delivers false positive results. This case study investigates the value of this question as an immediate antecedent to impulsive suicidality and as a correlate of functional impairment. METHOD One subject with daily suicidality and frequent impulsive suicidality rated five passive suicidal ideation phenomena and impulsive suicidality daily on a 0 to 4 Likert scale and rated weekly functional impairment scores for 13 weeks on a 0 to 10 Discan metric. RESULTS Each of the five passive suicidal ideation phenomena studied frequently occurred at a different severity level, and the five phenomena did not move in synchrony. Most passive suicidal ideation phenomena were very low on dates of impulsive suicidality. Thoughts of being better off dead were a frequent antecedent to impulsive suicidality and were related to an increase in functional impairment. CONCLUSION The relationship to both functional impairment and impulsive suicidality suggest that it is potentially dangerous to ignore thoughts of being better off dead in suicidality assessment.
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Affiliation(s)
- Jennifer M Giddens
- J. Giddens is the Co-founder of the Tampa Center for Research on Suicidality, Tampa, Florida; and Dr. Sheehan is Distinguished University Health Professor Emeritus, University of South Florida College of Medicine, Tampa, Florida
| | - David V Sheehan
- J. Giddens is the Co-founder of the Tampa Center for Research on Suicidality, Tampa, Florida; and Dr. Sheehan is Distinguished University Health Professor Emeritus, University of South Florida College of Medicine, Tampa, Florida
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Sheehan DV, Giddens JM, Sheehan IS. Status Update on the Sheehan-Suicidality Tracking Scale (S-STS) 2014. Innov Clin Neurosci 2014; 11:93-140. [PMID: 25520892 PMCID: PMC4267803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
There is a need for a choice of scales to evaluate the full range of suicidal phenomena. Such scales must be capable of use as both safety and efficacy outcome measures in research and in clinical settings. Central to the success in finding and developing effective anti-suicidal medications is having a sensitive suicidality scale that can detect an efficacy signal in conventional sample sizes used in clinical trials. The Sheehan-Suicidality Tracking Scale was developed for these purposes. This article provides a 2014 status update on the scale's progress, its use, and its properties. The authors review why and how the scale was developed; the scale structure, versions, and properties; the trials in which it was used; the time frames accommodated; its validation and reliability studies; its utility in screening and assessment; its utility in assessing treatment-emergent suicidal adverse events; its use as an efficacy outcome measure; its availability in self-rated and clinician-rated forms; the availability and linguistic validation of pediatric versions; linguistic validation in other languages; how it compares with global ratings of suicidality; and its possible utility and applications.
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Affiliation(s)
- David V Sheehan
- Dr. D. Sheehan is Distinguished University Health Professor Emeritus at the University of South Florida College of Medicine, Tampa, Florida; J. Giddens is the Co-founder of the Tampa Center for Research on Suicidality, Tampa, Florida; and Dr. I. S. Sheehan is Assistant Professor and Graduate Program Director, School of Public and International Affairs, University of Baltimore, Baltimore, Maryland
| | - Jennifer M Giddens
- Dr. D. Sheehan is Distinguished University Health Professor Emeritus at the University of South Florida College of Medicine, Tampa, Florida; J. Giddens is the Co-founder of the Tampa Center for Research on Suicidality, Tampa, Florida; and Dr. I. S. Sheehan is Assistant Professor and Graduate Program Director, School of Public and International Affairs, University of Baltimore, Baltimore, Maryland
| | - Ivan Sascha Sheehan
- Dr. D. Sheehan is Distinguished University Health Professor Emeritus at the University of South Florida College of Medicine, Tampa, Florida; J. Giddens is the Co-founder of the Tampa Center for Research on Suicidality, Tampa, Florida; and Dr. I. S. Sheehan is Assistant Professor and Graduate Program Director, School of Public and International Affairs, University of Baltimore, Baltimore, Maryland
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Giddens JM, Sheehan DV. Is a count of suicidal ideation and behavior events useful in assessing global severity of suicidality? A case study. Innov Clin Neurosci 2014; 11:179-181. [PMID: 25520896 PMCID: PMC4267793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Regulatory agencies and suicidality scales have focused on the value of a count of suicidal ideation and behavior events, even though the clinical usefulness and predictive value of the count of events in the global assessment of suicidality is unclear. This case study explores the value of this event count and offers a more sensitive alternative to tracking the count of events. METHODS One subject documented her suicidality daily for 366 days. This documentation included the global severity of suicidality, the count of suicidal events, and the time spent experiencing those events. The relationship between both the count of events and the time spent were each compared to the global severity rating. RESULTS We found the relationship between the time spent experiencing suicidality and the global severity of suicidality was much stronger than the relationship between the count of suicidal events and global severity. CONCLUSION This case study suggests that tracking the time a patient spends experiencing suicidality may be more clinically useful and may have more value in assessing global severity of suicidality than tracking the count of events of suicidal ideation and behavior.
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Affiliation(s)
- Jennifer M Giddens
- J. Giddens is Co-founder of the Tampa Center for Research on Suicidality, Tampa, Florida; and Dr. Sheehan is Distinguished University Health Professor Emeritus, University of South Florida College of Medicine, Tampa, Florida
| | - David V Sheehan
- J. Giddens is Co-founder of the Tampa Center for Research on Suicidality, Tampa, Florida; and Dr. Sheehan is Distinguished University Health Professor Emeritus, University of South Florida College of Medicine, Tampa, Florida
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Amado DM, Beamon DA, Sheehan DV. Linguistic Validation of the Pediatric Versions of the Sheehan Suicidality Tracking Scale (S-STS). Innov Clin Neurosci 2014; 11:141-163. [PMID: 25520893 PMCID: PMC4267790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The United States Food and Drug Administration meta-analysis of registration trials of antidepressants found that emergent suicidality under the age of 25 years increases with decreasing age. This led to boxed warnings for antidepressants and the recommendation for careful assessment and monitoring of suicidality in children and adolescents. To address this need, we describe the development of a pediatric suicidality assessment and tracking scale and a novel, empirically based approach to its age-appropriate linguistic validation. METHOD Starting with the adult version of the Sheehan-Suicidality Tracking Scale, we collaborated with reading specialists who use the sight word lists of Dolch and Fry and the grade level vocabulary lists of Beck, Farr, and Strickland to adapt the adult version to each age group. RESULTS Our approach resulted in the development and documentation of a process for linguistically validating three age-appropriate pediatric versions of the Sheehan-Suicidality Tracking Scale from the adult version of the scale: one for 6- to 8-year-olds, a second for 9- to 12-year-olds, and a third for 13- to 17-year-olds. CONCLUSION Further reliability and cognitive debriefing studies are needed in diverse demographic, ethnic, and cultural groups to make the pediatric versions of the Sheehan-Suicidality Tracking Scale more reliable, more generalizable, and more useful.
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Affiliation(s)
- Darlene M Amado
- Mrs. Amado is with the University of South Florida College of Public Health and the University of South Florida College of Medicine, Tampa, Florida; Mrs. Beamon is with the Springfield Public School System, Springfield, Massachusetts; and Dr. Sheehan is Distinguished University Health Professor Emeritus at the University of South Florida College of Medicine, Tampa, Florida
| | - Darlene A Beamon
- Mrs. Amado is with the University of South Florida College of Public Health and the University of South Florida College of Medicine, Tampa, Florida; Mrs. Beamon is with the Springfield Public School System, Springfield, Massachusetts; and Dr. Sheehan is Distinguished University Health Professor Emeritus at the University of South Florida College of Medicine, Tampa, Florida
| | - David V Sheehan
- Mrs. Amado is with the University of South Florida College of Public Health and the University of South Florida College of Medicine, Tampa, Florida; Mrs. Beamon is with the Springfield Public School System, Springfield, Massachusetts; and Dr. Sheehan is Distinguished University Health Professor Emeritus at the University of South Florida College of Medicine, Tampa, Florida
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Giddens JM, Sheehan DV. The complexity of assessing overall severity of suicidality: a case study. Innov Clin Neurosci 2014; 11:164-171. [PMID: 25520894 PMCID: PMC4267791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES This paper investigates the relationship between total scale scores and some other measures used to assess global severity of suicidality in order to determine if "global assessment" can be accomplished with one metric or if is it necessary to judge severity of suicidality in a multidimensional fashion. METHODS For over a year, one subject with daily suicidality self-rated a global severity of suicidality score, the time spent in suicidality over 31,183 events of suicidality, the Sheehan-Suicidality Tracking Scale, Hopelessness Spectrum measure, and the Suicide Plan Tracking Scale. RESULTS Relying on only one or two metrics to assess global severity of suicidality appears to have significant limitations. As with all single case reports, the findings may not be generalizable to other cases of suicidality. CONCLUSION At the middle to high end of the suicidality spectrum, it is necessary to rely on multiple metrics, not just a global severity of suicidality rating, to properly assess the overall severity of suicidality.
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Affiliation(s)
- Jennifer M Giddens
- J. Giddens is Co-founder of the Tampa Center for Research on Suicidality, Tampa, Florida; and Dr. Sheehan is Distinguished University Health Professor Emeritus, University of South Florida College of Medicine, Tampa, Florida
| | - David V Sheehan
- J. Giddens is Co-founder of the Tampa Center for Research on Suicidality, Tampa, Florida; and Dr. Sheehan is Distinguished University Health Professor Emeritus, University of South Florida College of Medicine, Tampa, Florida
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Sheehan DV, Giddens JM, Sheehan KH. Current Assessment and Classification of Suicidal Phenomena using the FDA 2012 Draft Guidance Document on Suicide Assessment: A Critical Review. Innov Clin Neurosci 2014; 11:54-65. [PMID: 25520889 PMCID: PMC4267800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Standard international classification criteria require that classification categories be comprehensive to avoid type II error. Categories should be mutually exclusive and definitions should be clear and unambiguous (to avoid type I and type II errors). In addition, the classification system should be robust enough to last over time and provide comparability between data collections. This article was designed to evaluate the extent to which the classification system contained in the United States Food and Drug Administration 2012 Draft Guidance for the prospective assessment and classification of suicidal ideation and behavior in clinical trials meets these criteria. METHOD A critical review is used to assess the extent to which the proposed categories contained in the Food and Drug Administration 2012 Draft Guidance are comprehensive, unambiguous, and robust. Assumptions that underlie the classification system are also explored. RESULTS The Food and Drug Administration classification system contained in the 2012 Draft Guidance does not capture the full range of suicidal ideation and behavior (type II error). Definitions, moreover, are frequently ambiguous (susceptible to multiple interpretations), and the potential for misclassification (type I and type II errors) is compounded by frequent mismatches in category titles and definitions. These issues have the potential to compromise data comparability within clinical trial sites, across sites, and over time. CONCLUSION These problems need to be remedied because of the potential for flawed data output and consequent threats to public health, to research on the safety of medications, and to the search for effective medication treatments for suicidality.
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Affiliation(s)
- David V Sheehan
- Dr. D. Sheehan is Distinguished University Health Professor Emeritus at the University of South Florida College of Medicine, Tampa, Florida; J. Giddens is the Co-founder of the Tampa Center for Research on Suicidality, Tampa, Florida; and Dr. K. Sheehan is Associate Professor Emeritus at the University of South Florida College of Medicine, Tampa, Florida
| | - Jennifer M Giddens
- Dr. D. Sheehan is Distinguished University Health Professor Emeritus at the University of South Florida College of Medicine, Tampa, Florida; J. Giddens is the Co-founder of the Tampa Center for Research on Suicidality, Tampa, Florida; and Dr. K. Sheehan is Associate Professor Emeritus at the University of South Florida College of Medicine, Tampa, Florida
| | - Kathy Harnett Sheehan
- Dr. D. Sheehan is Distinguished University Health Professor Emeritus at the University of South Florida College of Medicine, Tampa, Florida; J. Giddens is the Co-founder of the Tampa Center for Research on Suicidality, Tampa, Florida; and Dr. K. Sheehan is Associate Professor Emeritus at the University of South Florida College of Medicine, Tampa, Florida
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Giddens JM, Sheehan DV. Do the Five Combinations of Suicidal Ideation in the FDA 2012 Draft Guidance Document and the C-SSRS Adequately Cover All Suicidal Ideation Combinations in Practice? A Case Study. Innov Clin Neurosci 2014; 11:172-178. [PMID: 25520895 PMCID: PMC4267792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The United States Food and Drug Administration's newest classification system for suicidality assessment anchors suicidal ideation to various combinations of passive suicidal ideation, active suicidal ideation, method, intent, and plan. This is based upon the suicidal ideation categories in the Columbia-Suicide Severity Rating Scale. Although there are 32 possible combinations of these suicidal ideation phenomena, the Food and Drug Administration's 2012 system and the Columbia-Suicide Severity Rating Scale accommodate six combinations. We use a case study to explore the impact of possible type II errors on suicidality classification posed by not including remaining 26 possible categories. METHODS A suicidal subject kept detailed daily records of her experience of suicidality over two separate intervals of eight-months' and nine-months' duration. These records permitted classification of individual events into each of the possible 32 suicidal ideation combinations. RESULTS Although only a small percentage of all events of suicidality from either collection period fell outside of the Food and Drug Administration's classification system and the Columbia -Suicide Severity Rating Scale categories, those that were not so categorized constituted a large percentage of the time this subject experienced suicidality. When these two timeframes were aggregated, more than half of the subject's time spent experiencing suicidality fell into the suicidal ideation combinations not captured by the Food and Drug Administration's classification system and the Columbia-Suicide Severity Rating Scale categories. CONCLUSION This case study suggests that type II errors in the Food and Drug Administration's classification system and in the Columbia-Suicide Severity Rating Scale categories for suicidal ideation may represent important omissions.
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Affiliation(s)
- Jennifer M Giddens
- J. Giddens is Co-founder of the Tampa Center for Research on Suicidality, Tampa, Florida; and Dr. Sheehan is Distinguished University Health Professor Emeritus, University of South Florida College of Medicine, Tampa, Florida
| | - David V Sheehan
- J. Giddens is Co-founder of the Tampa Center for Research on Suicidality, Tampa, Florida; and Dr. Sheehan is Distinguished University Health Professor Emeritus, University of South Florida College of Medicine, Tampa, Florida
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Giddens JM, Sheehan KH, Sheehan DV. The Columbia-Suicide Severity Rating Scale (C-SSRS): Has the "Gold Standard" Become a Liability? Innov Clin Neurosci 2014; 11:66-80. [PMID: 25520890 PMCID: PMC4267801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The Columbia- Suicide Severity Rating Scale has become the gold standard for the assessment of suicidal ideation and behavior in clinical trials. Criticism of the instrument has been mounting. We examine whether the instrument meets widely accepted psychometric standards and maps to the United States Food and Drug Administration's most recent 2012 algorithm for assessment of suicidal phenomena. Our goal is to determine if the Columbia-Suicide Severity Rating Scale should be retained as the preferred instrument for assessment of suicidal ideation and behavior. METHOD Standard psychometric criteria dictate that categorizations to avoid type I and type II errors should be comprehensive and address the full spectrum (i.e., all dimensions) of a phenomenon. The criteria should also be well defined and consistent, and the wording throughout should be unambiguous. We examine the Columbia-Suicide Severity Rating Scale in terms of these criteria. RESULTS The Columbia-Suicide Severity Rating Scale does not address the full spectrum of suicidal ideation or behavior. As a result, it has the potential to miss many combinations of suicidal ideation and behavior that present to clinicians in practice (type II error). Potential misclassifications (type I and II errors) are compounded by flawed navigation instructions; mismatches in category titles, definitions, and probes; and wording that is susceptible to multiple interpretations. Further, the Columbia-Suicide Severity Rating Scale in its current form does not map to the 2012 Food and Drug Administration's draft classification algorithm for suicidal ideation and behavior. CONCLUSION The evidence suggests that the Columbia-Suicide Severity Rating Scale is conceptually and psychometrically flawed and does not map to the Food and Drug Administration's new standards. A new gold standard for assessment of suicidality may be warranted.
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Affiliation(s)
- Jennifer M Giddens
- J. Giddens is the Co-founder of the Tampa Center for Research on Suicidality, Tampa, Florida; Dr. K. Sheehan is Associate Professor Emeritus at the University of South Florida College of Medicine, Tampa, Florida; and Dr. D. Sheehan is Distinguished University Health Professor Emeritus at the University of South Florida College of Medicine, Tampa, Florida
| | - Kathy Harnett Sheehan
- J. Giddens is the Co-founder of the Tampa Center for Research on Suicidality, Tampa, Florida; Dr. K. Sheehan is Associate Professor Emeritus at the University of South Florida College of Medicine, Tampa, Florida; and Dr. D. Sheehan is Distinguished University Health Professor Emeritus at the University of South Florida College of Medicine, Tampa, Florida
| | - David V Sheehan
- J. Giddens is the Co-founder of the Tampa Center for Research on Suicidality, Tampa, Florida; Dr. K. Sheehan is Associate Professor Emeritus at the University of South Florida College of Medicine, Tampa, Florida; and Dr. D. Sheehan is Distinguished University Health Professor Emeritus at the University of South Florida College of Medicine, Tampa, Florida
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Mccullumsmith CB, Williamson DJ, May RS, Bruer EH, Sheehan DV, Alphs LD. Simple Measures of Hopelessness and Impulsivity are Associated with Acute Suicidal Ideation and Attempts in Patients in Psychiatric Crisis. Innov Clin Neurosci 2014; 11:47-53. [PMID: 25520888 PMCID: PMC4267799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To explore the authors' predictions 1) that hopelessness would positively correlate with suicidal ideation and that impulsivity (either transient urges to self-harm or impulsive acting out) would positively correlate with suicidal behavior, and 2) that the recent or long-standing nature of the traits will have corresponding effects on reported histories of suicidal ideation and behavior. DESIGN Questionnaire validation trial in which each subject received every measure in counterbalanced fashion. SETTING Inpatient and outpatient psychiatric settings associated with a medium-sized medical school in the southeastern United States. PARTICIPANTS Forty-five subjects presenting with varying levels of suicidal ideation and behavior completed measures providing information about their histories of suicidal ideation and behavior, recent feelings of hopelessness, feelings of general hopelessness, recent feelings of difficulty controlling urges to self-harm, and feeling about general levels of impulsivity. MEASUREMENTS The InterSePT Scale for Suicidal Thinking-Plus, the Sheehan-Suicidality Tracking Scale, the Columbia-Suicide Severity Rating Scale, and six additional questions to assess hopelessness and impulsivity. RESULTS Recent and trait hopelessness correlated positively with suicidal ideation. Patients who reported any suicide attempt endorsed higher levels of general impulsivity than those who did not report a history of at least one suicide attempt. Those enrolled in the study secondary to a very recent suicide attempt reported more difficulties with recent suicidal impulses. CONCLUSION Simple measures of hopelessness and impulsivity are associated with suicidal ideation and attempts and may add to determination of suicide risk.
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Affiliation(s)
- Cheryl B Mccullumsmith
- Dr. McCullumsmith is with the University of Cincinnati Department of Psychiatry and Behavioral Neuroscience, Cincinnati, Ohio; Dr. Williamson is with the University of South Alabama College of Medicine, Departments of Psychiatry and Neurology, Birmingham, Alabama, and Janssen Medical Affairs, LLC, Titusville, New Jersey; Ms. May is with the University of Alabama, Birmingham, Alabama; Ms Bruer is with the University of Alabama, Department of Psychiatry and Behavioral Neurobiology, Birmingham, Alabama; Dr. Sheehan is Distinguished University Health Professor Emeritus, University of South Florida College of Medicine, Tampa, Florida; and Dr. Alphs is with Janssen Medical Affairs, LLC, Titusville, New Jersey
| | - David J Williamson
- Dr. McCullumsmith is with the University of Cincinnati Department of Psychiatry and Behavioral Neuroscience, Cincinnati, Ohio; Dr. Williamson is with the University of South Alabama College of Medicine, Departments of Psychiatry and Neurology, Birmingham, Alabama, and Janssen Medical Affairs, LLC, Titusville, New Jersey; Ms. May is with the University of Alabama, Birmingham, Alabama; Ms Bruer is with the University of Alabama, Department of Psychiatry and Behavioral Neurobiology, Birmingham, Alabama; Dr. Sheehan is Distinguished University Health Professor Emeritus, University of South Florida College of Medicine, Tampa, Florida; and Dr. Alphs is with Janssen Medical Affairs, LLC, Titusville, New Jersey
| | - Roberta S May
- Dr. McCullumsmith is with the University of Cincinnati Department of Psychiatry and Behavioral Neuroscience, Cincinnati, Ohio; Dr. Williamson is with the University of South Alabama College of Medicine, Departments of Psychiatry and Neurology, Birmingham, Alabama, and Janssen Medical Affairs, LLC, Titusville, New Jersey; Ms. May is with the University of Alabama, Birmingham, Alabama; Ms Bruer is with the University of Alabama, Department of Psychiatry and Behavioral Neurobiology, Birmingham, Alabama; Dr. Sheehan is Distinguished University Health Professor Emeritus, University of South Florida College of Medicine, Tampa, Florida; and Dr. Alphs is with Janssen Medical Affairs, LLC, Titusville, New Jersey
| | - Emily H Bruer
- Dr. McCullumsmith is with the University of Cincinnati Department of Psychiatry and Behavioral Neuroscience, Cincinnati, Ohio; Dr. Williamson is with the University of South Alabama College of Medicine, Departments of Psychiatry and Neurology, Birmingham, Alabama, and Janssen Medical Affairs, LLC, Titusville, New Jersey; Ms. May is with the University of Alabama, Birmingham, Alabama; Ms Bruer is with the University of Alabama, Department of Psychiatry and Behavioral Neurobiology, Birmingham, Alabama; Dr. Sheehan is Distinguished University Health Professor Emeritus, University of South Florida College of Medicine, Tampa, Florida; and Dr. Alphs is with Janssen Medical Affairs, LLC, Titusville, New Jersey
| | - David V Sheehan
- Dr. McCullumsmith is with the University of Cincinnati Department of Psychiatry and Behavioral Neuroscience, Cincinnati, Ohio; Dr. Williamson is with the University of South Alabama College of Medicine, Departments of Psychiatry and Neurology, Birmingham, Alabama, and Janssen Medical Affairs, LLC, Titusville, New Jersey; Ms. May is with the University of Alabama, Birmingham, Alabama; Ms Bruer is with the University of Alabama, Department of Psychiatry and Behavioral Neurobiology, Birmingham, Alabama; Dr. Sheehan is Distinguished University Health Professor Emeritus, University of South Florida College of Medicine, Tampa, Florida; and Dr. Alphs is with Janssen Medical Affairs, LLC, Titusville, New Jersey
| | - Larry D Alphs
- Dr. McCullumsmith is with the University of Cincinnati Department of Psychiatry and Behavioral Neuroscience, Cincinnati, Ohio; Dr. Williamson is with the University of South Alabama College of Medicine, Departments of Psychiatry and Neurology, Birmingham, Alabama, and Janssen Medical Affairs, LLC, Titusville, New Jersey; Ms. May is with the University of Alabama, Birmingham, Alabama; Ms Bruer is with the University of Alabama, Department of Psychiatry and Behavioral Neurobiology, Birmingham, Alabama; Dr. Sheehan is Distinguished University Health Professor Emeritus, University of South Florida College of Medicine, Tampa, Florida; and Dr. Alphs is with Janssen Medical Affairs, LLC, Titusville, New Jersey
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Suppes T, McElroy SL, Sheehan DV, Hidalgo RB, Cosgrove VE, Gwizdowski IS, Feldman NS. A randomized, double-blind, placebo-controlled study of ziprasidone monotherapy in bipolar disorder with co-occurring lifetime panic or generalized anxiety disorder. J Clin Psychiatry 2014; 75:77-84. [PMID: 24345758 DOI: 10.4088/jcp.12m08297] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 04/17/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Bipolar disorder often co-occurs with anxiety disorders. Evidence suggests that second-generation antipsychotics (SGAs) may be useful in treating both conditions. This study examined the efficacy of ziprasidone in the treatment of these disorders. METHOD This 3-site, randomized, double-blind, placebo-controlled, parallel group, 8-week trial of ziprasidone monotherapy examined 49 subjects with bipolar disorder and lifetime panic disorder (with or without agoraphobia) or generalized anxiety disorder (GAD) experiencing moderately severe anxiety symptoms at entrance into the study. Both bipolar disorder and anxiety diagnoses were based on DSM-IV-TR criteria. Patients were screened and randomized from June 25, 2010, through August 23, 2011. Primary outcome measures were the Clinical Global Impressions-21 Anxiety Scale (CGI-21 Anxiety) and the Sheehan Disability Scale (SDS), with secondary measures monitoring anxiety and mood symptoms. RESULTS Last-observation-carried-forward analyses demonstrated that patients in the ziprasidone group did not improve significantly more than those in the placebo group on the CGI-21 Anxiety (F1 = 0.34; P = .564) or SDS (F1 = 0.26; P = .611). Secondary analysis using hierarchical linear modeling found similar results (CGI-21 Anxiety: F1 = 1.82; P = .178; and SDS: F1 = 0.70; P = .408). Regardless of group, time in the study was associated with significant decrease in anxiety (F1 = 11.08; P = .001) and total disability (F1 = 26.16; P < .001). Patients in the ziprasidone group showed a greater increase in abnormal involuntary movement, and 81.8% (n = 9) of the subjects who withdrew from the study due to adverse events, serious adverse events, or side effects were in the ziprasidone group. CONCLUSIONS Results suggest that ziprasidone monotherapy was not associated with a clinically significant improvement in anxiety symptoms or improved function for patients with bipolar disorder, lifetime panic disorder or GAD, and concurrent moderately severe anxiety symptoms, and it was associated with a more negative side-effect profile relative to placebo. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01172652.
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Affiliation(s)
- Trisha Suppes
- VA Palo Alto Health Care System, 3801 Miranda Ave (151T), Palo Alto, CA 94304
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Sheehan DV, Svedsäter H, Locklear JC, Eriksson H. Effects of extended-release quetiapine fumarate on long-term functioning and sleep quality in patients with Generalized Anxiety Disorder (GAD): data from a randomized-withdrawal, placebo-controlled maintenance study. J Affect Disord 2013; 151:906-13. [PMID: 24135509 DOI: 10.1016/j.jad.2013.07.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 07/31/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND This analysis evaluated effects of quetiapine XR maintenance treatment on functioning and sleep in patients with GAD. METHODS Analysis of patient-reported data from a randomized-withdrawal, double-blind, placebo-controlled study of quetiapine XR monotherapy in GAD. Following open-label run-in (4-8 weeks) and a 12-18-week stabilization phase (quetiapine XR 50, 150, or 300 mg/day), eligible patients were randomized to continue on quetiapine XR or receive placebo for up to 52 weeks. Primary variable was time to an anxiety event. Secondary variables included the Sheehan Disability Scale (SDS) and Pittsburgh Sleep Quality Index (PSQI). RESULTS In total, 432 patients were randomized (quetiapine XR, N=216; placebo, N=216). The risk of an anxiety event was significantly reduced for quetiapine XR vs. placebo (HR 0.19; 95% CI 0.12, 0.31; p<0.001). Quetiapine XR was more effective than placebo at maintaining SDS total scores (LSM change: -0.19 vs. 1.01; p=0.017) and non-work-related SDS domain score 'family life/home responsibilities' (-0.13 vs. 0.32; p=0.011), but not 'social life' (0.05 vs. 0.34; p=0.114). Quetiapine XR was more effective than placebo at maintaining the work-related SDS domain score 'days lost' (-0.05 vs. 0.11; p=0.027), but not 'work/school' (-0.10 vs. 0.29; p=0.051) or 'days underproductive' (0.06 vs. 0.13; p=0.619). PSQI global scores were reduced from randomization with quetiapine XR vs. placebo (0.39 vs. 1.60; p<0.001). LIMITATIONS Lack of active-comparator arm, exclusion of patients with comorbid depression. CONCLUSIONS In patients with GAD, long-term treatment with quetiapine XR (50-300 mg/day) monotherapy was effective at maintaining improvements in functioning and sleep quality.
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Affiliation(s)
- David V Sheehan
- University of South Florida College of Medicine, Tampa, FL 33613, USA.
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Preti A, Sheehan DV, Coric V, Distinto M, Pitanti M, Vacca I, Siddi A, Masala C, Petretto DR. Sheehan Suicidality Tracking Scale (S-STS): reliability, convergent and discriminative validity in young Italian adults. Compr Psychiatry 2013; 54:842-9. [PMID: 23618606 DOI: 10.1016/j.comppsych.2013.03.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 02/12/2013] [Accepted: 03/04/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE The Sheehan Suicidality Tracking Scale (S-STS) is a patient self-report or clinician-administered rating scale that tracks spontaneous and treatment-emergent suicidal ideation and behaviors. This study set out to evaluate the reliability, convergent and divergent validity of the S-STS in a sample of college students, a population with a high risk of completed and attempted suicide. METHODS Cross-sectional, survey design. Participants (303 undergraduate students; males: 42%) completed several measures assessing psychological distress (General Health Questionnaire; GHQ); self-esteem (Rosenberg Self Esteem Scale; RSES); social support (Modified Social Support Survey; MOSSS); and suicidal behavior, including ideation and attempts (S-STS). RESULTS Both internal consistency and test-retest stability were excellent for the S-STS-global score. The S-STS subscale on suicide ideation also showed good reliability, while the subscale on suicidal behavior showed some inconsistency at retest. Convergent and divergent validity of S-STS was confirmed. All S-STS items loaded on a single factor, which had an excellent fit for the unidimensional model, thus justifying the use of the S-STS as a screening tool. In a mediation model, self-esteem and social support explained 45% of the effects of psychological distress on suicide ideation and behavior as measured by the S-STS-global score. CONCLUSIONS This study provided promising evidence on the convergent, divergent, internal consistency and test-retest stability of the Sheehan Suicidality Tracking Scale. The cross-sectional design and lack of measures of hopelessness and helplessness prevent any conclusion about the links of suicidal behavior with self-esteem and social support.
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Affiliation(s)
- Antonio Preti
- Department of Education, Psychology, Philosophy, University of Cagliari, Cagliari, Italy; Genneruxi Medical Center, Cagliari, Italy.
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Sheehan DV, Harnett-Sheehan K, Hidalgo RB, Janavs J, McElroy SL, Amado D, Suppes T. Randomized, placebo-controlled trial of quetiapine XR and divalproex ER monotherapies in the treatment of the anxious bipolar patient. J Affect Disord 2013; 145:83-94. [PMID: 22920718 DOI: 10.1016/j.jad.2012.07.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 07/08/2012] [Accepted: 07/17/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND Anxiety disorders complicate the treatment of bipolar disorder but are seldom the focus of bipolar treatment studies. METHODS The anxiolytic effect of quetiapine XR 50-300 mg/day compared to divalproex ER (500-3000 mg/day) was tested in an 8-week, double-blind, placebo-controlled, randomized clinical trial in 149 patients with bipolar disorder and a co-occurring panic disorder or GAD. The primary efficacy measure was the Clinician Global Improvement-21 Anxiety Scale (CGI-21). Secondary measures included the Hamilton Anxiety Scale (HAM-A) and Sheehan Panic Disorder Scale (SPS). RESULTS Repeated measures last-observation-carried-forward (LOCF) analyses of variance demonstrated significant treatment-by-time interaction effects on 3 of the 4 anxiety measures. Quetiapine XR at a mean endpoint dose of 186 mg/day produced rapid sustained improvements relative to baseline, divalproex ER and placebo on anxiety. Mean baseline-to-endpoint improvement was significantly greater for quetiapine XR compared to divalproex ER and placebo on the HAM-A and SPS. Both active medications were well tolerated, but weight gain was higher on quetiapine XR. LIMITATIONS The study was limited to 8 weeks and to patients with bipolar disorder and comorbid panic disorder or GAD. The results may not be applicable to quetiapine XR as an add-on treatment to mood stabilizers or to bipolar disorder comorbid with other anxiety disorders. CONCLUSIONS Quetiapine XR in a dose range of 50-300 mg/day appears to reduce anxiety in bipolar patients with comorbid panic disorder or GAD treated for 8 weeks. The efficacy of other second-generation antipsychotics and mood stabilizers in patients with bipolar disorder and a co-occurring anxiety disorder should be investigated in double-blind, placebo-controlled studies.
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Affiliation(s)
- David V Sheehan
- Clinical and Translational Science Institute, University of South Florida, College of Medicine, 3515 East Fletcher Ave, Tampa, FL 33613, USA.
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Bidzan L, Mahableshwarkar AR, Jacobsen P, Yan M, Sheehan DV. Vortioxetine (Lu AA21004) in generalized anxiety disorder: results of an 8-week, multinational, randomized, double-blind, placebo-controlled clinical trial. Eur Neuropsychopharmacol 2012; 22:847-57. [PMID: 22898365 DOI: 10.1016/j.euroneuro.2012.07.012] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 06/20/2012] [Accepted: 07/19/2012] [Indexed: 10/28/2022]
Abstract
Vortioxetine is a multimodal antidepressant, with anxiolytic properties observed in preclinical studies. The goal of the current study was to evaluate the efficacy and tolerability of vortioxetine 5mg vs placebo in adults with generalized anxiety disorder (GAD). Adults with a primary diagnosis of GAD (HAM-A total score ≥20 and MADRS score ≤16) received vortioxetine 5mg or placebo for 8 weeks. The primary efficacy endpoint was reduction in HAM-A total scores from baseline after 8 weeks of treatment compared with placebo. Key secondary measurements were HAD anxiety subscore, CGI-I, SDS total score, HAM-A response rates, HAM-A total score for subjects whose baseline HAM-A total score was ≥25, and SF-36 social functioning subscore. HAM-A remission rates were also measured. Adverse events (AEs) were assessed throughout the study. In total, 301 subjects (mean age, 45.2 years; 31% male) were randomized (1:1) to receive vortioxetine 5mg (n=150) or placebo (n=151). After 8 weeks of treatment, there was a statistically significant difference in reduction from baseline in HAM-A total score for the vortioxetine group (-14.30) compared with placebo recipients (-10.49) (P<0.001). Statistically significant differences were observed for all key secondary outcomes favoring vortioxetine treatment (vs placebo), using a mixed model for repeated measurements (MMRM) analysis. Active treatment resulted in a significantly higher rate of remission. Vortioxetine was well tolerated. The most common treatment-related AEs were nausea, headache, dizziness, and dry mouth. In sum, vortioxetine was safe and effective in treating adults with GAD in this multinational population.
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Affiliation(s)
- Leszek Bidzan
- Department of Developmental, Psychotic, and Geriatric Psychiatry, Medical University of Gdansk, Gdańsk, Poland
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Rothschild AJ, Mahableshwarkar AR, Jacobsen P, Yan M, Sheehan DV. Vortioxetine (Lu AA21004) 5 mg in generalized anxiety disorder: results of an 8-week randomized, double-blind, placebo-controlled clinical trial in the United States. Eur Neuropsychopharmacol 2012; 22:858-66. [PMID: 22901736 DOI: 10.1016/j.euroneuro.2012.07.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 06/20/2012] [Accepted: 07/20/2012] [Indexed: 12/29/2022]
Abstract
The goal of the current clinical study, conducted in the United States (US), was to evaluate the efficacy and tolerability of vortioxetine 5mg vs placebo in adults with a primary diagnosis of generalized anxiety disorder (GAD; HAM-A total score ≥20 and MADRS score ≤16). Subjects were randomized (1:1) to receive vortioxetine 5mg (n=152) or placebo (n=152) for 8 weeks. Efficacy was assessed using change from baseline in HAM-A total scores after 8 weeks of treatment compared with placebo, using mixed-model repeated measures (MMRM) analyses. Adverse events (AEs) were assessed throughout the study. A total of 304 subjects were randomized (mean age, 41.2 years). After 8 weeks of treatment, there was no statistically significant difference in the reduction in HAM-A total score from baseline between the Vortioxetine (n=145) and placebo (n=145) groups. There were no statistically significant differences in any key secondary efficacy outcome between vortioxetine and placebo. Factors potentially contributing to the differences between the results of this study and those of one of identical design conducted outside the US are discussed. The most common treatment-emergent AEs were nausea, headache, dizziness, and dry mouth. Nausea was more frequently reported in the vortioxetine group (25% vs 4.6% for the placebo group). Most AEs were mild to moderate in severity. In conclusion, in this trial, vortioxetine did not improve symptoms of GAD (compared with placebo) over 8 weeks of treatment. Vortioxetine was well tolerated in this study.
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Affiliation(s)
- Anthony J Rothschild
- University of Massachusetts Medical School and UMass Memorial HealthCare, Worcester, MA, United States
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Revicki DA, Travers K, Wyrwich KW, Svedsäter H, Locklear J, Mattera MS, Sheehan DV, Montgomery S. Humanistic and economic burden of generalized anxiety disorder in North America and Europe. J Affect Disord 2012; 140:103-12. [PMID: 22154706 DOI: 10.1016/j.jad.2011.11.014] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 11/15/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND To review the humanistic and economic burden of generalized anxiety disorder (GAD). METHODS MEDLINE, EMBASE and the Cochrane Library, limited to articles published in English, between 1987 and 2010, in North America, Europe and Australia. The key focus was humanistic or functional outcomes, cost of illness and economic outcomes. Ninety articles fitting criteria on (a) GAD study population, (b) United States, Europe or Australia, and (c) humanistic burden or economic burden were reviewed. Methods and findings were summarized by two researchers; inconsistencies were resolved by a third reviewer. RESULTS GAD was associated with increased impairments in psychosocial functioning, role functioning, work productivity and health-related quality of life (HRQL). The HRQL impairments were comparable with those associated with depression or panic disorder. Patients with GAD and co-morbid depression reported significantly greater impairment in HRQL than did those with either disorder alone. GAD patients had significantly higher median medical costs than primary care patients without GAD (US $2375 versus $1448). The mean annual medical cost of GAD was $2138 higher than for other anxiety disorders (mean $6475). Finally, GAD was frequently under-recognized in primary care, and available studies reported that only 20% to 32% of patients were adequately treated. LIMITATIONS The review was limited to pharmacologic treatments for GAD and to publications in English. CONCLUSIONS GAD is associated with significant burden on patient functioning and well-being, leading to increased health care utilization and medical costs. Patients with GAD are often suboptimally treated, which adds to the HRQL burden of this disorder.
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Affiliation(s)
- Dennis A Revicki
- Center for Health Outcomes Research, United BioSource Corporation, Bethesda, MD 20814, USA.
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Seo JS, Jamieson K, Cosgrove V, Gwizdowski IS, Yang H, Sheehan DV, McElroy SL, Suppes T. Characteristics of responders and non-responders to risperidone monotherapy or placebo in co-occurring bipolar disorder and anxiety disorder. Eur Psychiatry 2011; 28:190-6. [PMID: 22130178 DOI: 10.1016/j.eurpsy.2011.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 08/12/2011] [Accepted: 08/13/2011] [Indexed: 10/27/2022] Open
Abstract
Clinical characteristics predicting response and remission to psychopharmacological treatment of bipolar disorder (BD) and co-occurring anxiety disorders have been understudied. We hypothesized that non-response to risperidone or placebo in individuals with co-occurring BD and anxiety symptoms would be associated with a more severe clinical course of BD, and certain demographic variables. This study was a secondary analysis of a randomized, double-blind, parallel, 8-week study comparing risperidone monotherapy and placebo in individuals with BD plus current panic disorder, current generalized anxiety disorder (GAD), or lifetime panic disorder (n=111) [31]. We compared clinical characteristics of responders (50% improvement on the Hamilton Anxiety Scale [HAM-A]) and non-responders as well as remitters (HAM-A<7) and non-remitters in risperidone treatment (n=54) and placebo (n=57) groups. For non-responders in the risperidone group, co-occurring lifetime panic disorder was significantly more common than for non-responders in the placebo group. Apart from this, no significant differences in course of illness or demographics were found either between or across groups for patients with BD and co-occurring anxiety symptoms receiving risperidone or placebo in this acute phase study.
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Affiliation(s)
- J S Seo
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, VA Palo Alto Health Care System, 3801, Miranda Avenue (151T), Palo Alto, CA 94304, USA
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Goldberger C, Guelfi JD, Sheehan DV. Assessment of Anxiety in Clinical Trials with Depressed Patients Using the Hamilton Depression Rating Scale. Psychopharmacol Bull 2011; 44:34-50. [PMID: 27738361 PMCID: PMC5044547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND The Hamilton Depression Rating Scale (HAMD17) is an outcome measure widely used in major depressive disorder (MDD) clinical trials. The objective of this analysis was to assess the validity of the anxiety/somatisation factor of the HAMD17 as a measure of anxiety in patients with MDD. METHODS We pooled data from 1466 outpatients with MDD from four 8-week controlled studies of duloxetine. We performed a factor analysis of the HAMD17 to investigate the anxiety/somatisation factor. RESULTS The HAMD17 factor analysis yielded 6 factors, but did not yield the pre-specified anxiety/somatisation factor. This latter factor showed weak correlation with the Hamilton Anxiety Scale total and subscale scores at baseline (0.46), but higher correlation coefficients over the trials up to 0.81. We identified another anxiety factor that included the hypochondriasis item in this sample. CONCLUSION Findings from this large sample suggest that the factor structure of the HAMD17 is unstable in MDD and that the anxiety/somatisation subscale should not be routinely used for anxiety assessment in depressed patients.
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Affiliation(s)
- C Goldberger
- Dr. Goldberger, MD, PhD, Clinical Research Physician, Lilly Research Laboratories, Indianapolis, IN. Dr. Guelfi, MD, Professor of Psychiatry, CMME, Ste Anne Hospital, Paris, France. Dr. Sheehan, MD, MBA, Distinguished University Health Professor, Professor of Psychiatry, Director, Depression and Anxiety Disorders Research Institute, University of South Florida College of Medicine, Tampa, FL
| | - J D Guelfi
- Dr. Goldberger, MD, PhD, Clinical Research Physician, Lilly Research Laboratories, Indianapolis, IN. Dr. Guelfi, MD, Professor of Psychiatry, CMME, Ste Anne Hospital, Paris, France. Dr. Sheehan, MD, MBA, Distinguished University Health Professor, Professor of Psychiatry, Director, Depression and Anxiety Disorders Research Institute, University of South Florida College of Medicine, Tampa, FL
| | - D V Sheehan
- Dr. Goldberger, MD, PhD, Clinical Research Physician, Lilly Research Laboratories, Indianapolis, IN. Dr. Guelfi, MD, Professor of Psychiatry, CMME, Ste Anne Hospital, Paris, France. Dr. Sheehan, MD, MBA, Distinguished University Health Professor, Professor of Psychiatry, Director, Depression and Anxiety Disorders Research Institute, University of South Florida College of Medicine, Tampa, FL
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Fava M, Asnis GM, Shrivastava RK, Lydiard B, Bastani B, Sheehan DV, Roth T. Improved insomnia symptoms and sleep-related next-day functioning in patients with comorbid major depressive disorder and insomnia following concomitant zolpidem extended-release 12.5 mg and escitalopram treatment: a randomized controlled trial. J Clin Psychiatry 2011; 72:914-28. [PMID: 21208597 DOI: 10.4088/jcp.09m05571gry] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Accepted: 11/24/2009] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This investigation was performed to assess the efficacy and safety of zolpidem extended-release in patients with insomnia associated with major depressive disorder (MDD). METHOD Patients (N = 385) received open-label escitalopram 10 mg/d and were randomized to concomitant zolpidem extended-release 12.5 mg/night or placebo for 8 weeks (phase 1) in a randomized, parallel-group, multicenter trial. Responders (≥ 50% in 17-item Hamilton Depression Rating Scale [HDRS(17)] score) continued 16 weeks of double-blind treatment (phase 2); escitalopram only was given during a 2-week run-out period. The study was conducted between February 2006 and June 2007. The primary efficacy measure was change from baseline in subjective total sleep time. Secondary efficacy measures included subjective sleep-onset latency, number of awakenings, wake time after sleep onset, sleep quality, sleep-related next-day functioning, HDRS(17), Sleep Impact Scale score, Patient and Clinical Global Impressions of Insomnia Treatment, the Massachusetts General Hospital Cognitive and Physical Functioning Questionnaire, and the Quality of Life Enjoyment and Satisfaction Questionnaire. Adverse events were recorded throughout the study; sleep measures were also evaluated during the run-out period. RESULTS Throughout phase 1, zolpidem extended-release led to significantly greater improvements in total sleep time (P < .0001), wake time after sleep onset, sleep onset latency, number of awakenings, and sleep quality (P ≤ .0003), and some measures of sleep-related next-day functioning but not in depressive symptoms or quality of life. During phase 2, improvements with the zolpidem extended-release/escitalopram group occurred for total sleep time (significant [P < .05] at weeks 12 and 16), as well as for a few other secondary efficacy measures but not in depressive symptoms or quality of life. The most common adverse events associated with combination treatment included nausea, somnolence, dry mouth, dizziness, fatigue, and amnesia. CONCLUSIONS Zolpidem extended-release administered concomitantly with escitalopram for up to 24 weeks was well tolerated and improved insomnia and some sleep-related next-day symptoms and next-day functioning in patients with MDD but did not significantly augment the antidepressant response of escitalopram. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00296179.
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Affiliation(s)
- Maurizio Fava
- MGH Clinical Trials Network and Institute, Massachusetts General Hospital, 55 Fruit St, Bulfinch 351, Boston, MA, USA.
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Sheehan DV, Chokka PR, Granger RE, Walton RJ, Raskin J, Sagman D. Clinical and functional outcomes in patients with major depressive disorder and painful physical symptoms switched to treatment with duloxetine. Hum Psychopharmacol 2011; 26:242-51. [PMID: 21681815 DOI: 10.1002/hup.1199] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This post hoc analysis of a multicenter, single-arm, open-label trial (the Attributes of Response in Depressed Patients Switched to Treatment with Duloxetine [ARDENT] study) assessed the relationship between functional improvement in the Sheehan Disability Scale (SDS) and clinical outcomes of mood, pain, and anxiety over 8 weeks after switching treatment to duloxetine in patients with major depressive disorder. METHODS Analyses included all 195 patients who completed the study. Pearson's correlation and multivariate regression analyses were used to evaluate the relationship between change from baseline in SDS total score and 17-item Hamilton Rating Scale for Depression (HAMD(17)) Maier score (mood), Brief Pain Inventory-Short Form average pain score (pain), and Hamilton Anxiety Rating Scale total score (anxiety) at week 8. RESULTS At week 8, change in SDS total score was positively correlated with change in mood (r = 0.49), anxiety (r = 0.44), and pain (r = 0.40). Multivariate linear regression coefficients for mood and pain were estimated at 1.21 (standard error [SE] = 0.184) and 1.16 (SE = 0.180), respectively (both p < 0.0001) compared with 0.02 (SE = 0.097; p = 0.82) for anxiety. Overall, 43% of patients achieved both HAMD(17) and SDS total remission. CONCLUSIONS Functional improvement at 8 weeks was positively correlated with mood, pain, and anxiety in patients with major depressive disorder switched to duloxetine. Change in mood and pain exerted a relatively stronger joint effect on functioning than did anxiety in this patient population. Copyright © 2011 John Wiley & Sons, Ltd.
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Affiliation(s)
- David V Sheehan
- College of Medicine, University of South Florida, Tampa, FL, USA
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Busner J, Kaplan SL, Greco N, Sheehan DV. The use of research measures in adult clinical practice. Innov Clin Neurosci 2011; 8:19-23. [PMID: 21637630 PMCID: PMC3105844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Many psychopathology research assessment tools can be used easily and productively in clinical practice. We conducted a workshop in 2009 and 2010 at the American Psychiatric Association annual meeting designed to bring clinicians some commonly used adult research measures with broad applicability to a variety of conditions. This article reviews what was most helpful to the practicing clinicians at the workshop.
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Affiliation(s)
- Joan Busner
- Penn State College of Medicine, Hershey, Pennsylvania, USA.
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Camacho F, Kong MC, Sheehan DV, Balkrishnan R. Expenditures associated with dose titration at initiation of therapy in patients with major depressive disorder: a retrospective analysis of a large managed care claims database. P T 2010; 35:452-468. [PMID: 20844695 PMCID: PMC2935651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE.: Although selective serotonin reuptake inhibitors (SSRIs) are considered cost-effective medications for patients with major depressive disorder (MDD), significant dosage adjustments are often necessary when treatment is initiated. Our study was conducted to examine whether dose titration for SSRIs at initiation of therapy was associated with a greater use of health care resources and higher costs. STUDY DESIGN.: A retrospective database analysis was conducted. METHODS.: A nationally representative cohort of individuals with MDD was identified in a large managed care claims database between January 1, 2004, and December 31, 2006. A study-specific titration algorithm was used to identify patients who underwent dose titration, compared with those who did not, within the first eight weeks of initiating SSRI therapy. We calculated propensity scores and identified a 1:1 matched cohort of titration versus non-titration patients. We used univariate and multivariate statistical tests to compare the mean number of therapeutic days, health care service utilization, and expenditures between the two groups during the first eight weeks (56 days) of treatment and six months (180 days) after treatment began. RESULTS.: Over the first eight weeks, the titration cohort had a 32% decrease in the adjusted mean number of therapeutic days (38 vs. 56, respectively; P < 0.001), a 50% increase in depression-related outpatient visits (1.8 vs. 1.2; P < 0.001), a 38% increase in depression-related outpatient costs ($137 vs. $81; P ≤ 0.001), an increase in antidepressant pharmacy costs ($139 vs. $61; P < 0.001), and a 64% increase in psychiatric visits (0.69 vs. 0.42; P = 0.001), compared with the matched non-titration cohort. These differences were consistent among individual SSRI groups as well as during the six-month period. CONCLUSION.: Patients undergoing dose titration of SSRIs at the beginning of therapy consumed more medical resources and spent more days receiving a subtherapeutic dose than a comparable control group without dose titration. Differences in the utilization of resources were consistent with increased patient monitoring in the titration group; however, the added benefit of titration could not be assessed with this database.
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Meyer RE, Salzman C, Youngstrom EA, Clayton PJ, Goodwin FK, Mann JJ, Alphs LD, Broich K, Goodman WK, Greden JF, Meltzer HY, Normand SLT, Posner K, Shaffer D, Oquendo MA, Stanley B, Trivedi MH, Turecki G, Beasley CM, Beautrais AL, Bridge JA, Brown GK, Revicki DA, Ryan ND, Sheehan DV. Suicidality and risk of suicide--definition, drug safety concerns, and a necessary target for drug development: a brief report. J Clin Psychiatry 2010; 71:1040-6. [PMID: 20673551 DOI: 10.4088/jcp.10cs06070ablu] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2010] [Accepted: 05/19/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To address issues concerning potential treatment-emergent "suicidality," a consensus conference was convened March 23-24, 2009. PARTICIPANTS This gathering of participants from academia, government, and industry brought together experts in suicide prevention, clinical trial design, psychometrics, pharmacoepidemiology, and genetics, as well as research psychiatrists involved in studies in studies of psychiatric disorders associated with elevated suicide risk across the life cycle. The process involved reviews of the relevant literature, and a series of 6 breakout sessions focused on specific questions of interest. EVIDENCE Each of the participants at the meeting received references relevant to the formal presentations (as well as the slides for the presentations) for their review prior to the meeting. In addition, the assessment instruments of suicidal ideation/behavior were reviewed in relationship to standard measures of validity, reliability, and clinical utility, and these findings were discussed at length in relevant breakout groups, in the final plenary session, and in the preparation of the article. Consensus and dissenting views were noted. CONSENSUS PROCESS Discussion and questions followed each formal presentation during the plenary sessions. Approximately 6 questions per breakout group were prepared in advance by members of the Steering Committee and each breakout group chair. Consensus in the breakout groups was achieved by nominal group process. Consensus recommendations and any dissent were reviewed for each breakout group at the final plenary session. All plenary sessions were recorded and transcribed by a court stenographer. Following the transcript, with input by each of the authors, the final paper went through 14 drafts. The output of the meeting was organized into this brief report and the accompanying full article from which it is distilled. The full article was developed by the authors with feedback from all participants at the meeting and represents a consensus view. Any areas of disagreement at the conference have been noted in the text. CONCLUSIONS The term suicidality is not as clinically useful as more specific terminology (ideation, behavior, attempts, and suicide). Most participants applauded the FDA's encouragement of standard definitions and definable expectations for investigators and industry sponsors. Further research of available assessment instruments is needed to verify their utility, reliability, and validity in identifying suicide-associated treatment-emergent adverse effects and/or a signal of efficacy in suicide prevention trials. The FDA needs to systematically monitor postmarketing events by encouraging the development of a validated instrument for postmarketing surveillance of suicidal ideation, behavior, and risk. Over time, the FDA, industry, and clinical researchers should evaluate the impact of the requirement that all central nervous system clinical drug trials must include a Columbia Classification Algorithm of Suicide Assessment (C-CASA)-compatible screening instrument for assessing and documenting the occurrence of treatment-emergent suicidal ideation and behavior. Finally, patients at high risk for suicide can safely be included in clinical trials, if proper precautions are followed.
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Affiliation(s)
- Roger E Meyer
- Best Practice Project Management, Inc, PO Box 30219, Bethesda, MD 20824, USA.
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Meyer RE, Salzman C, Youngstrom EA, Clayton PJ, Goodwin FK, Mann JJ, Alphs LD, Broich K, Goodman WK, Greden JF, Meltzer HY, Normand SLT, Posner K, Shaffer D, Oquendo MA, Stanley B, Trivedi MH, Turecki G, Beasley CM, Beautrais AL, Bridge JA, Brown GK, Revicki DA, Ryan ND, Sheehan DV. Suicidality and risk of suicide--definition, drug safety concerns, and a necessary target for drug development: a consensus statement. J Clin Psychiatry 2010; 71:e1-e21. [PMID: 20797373 DOI: 10.4088/jcp.10cs06070blu] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2010] [Accepted: 05/19/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To address issues concerning potential treatment-emergent "suicidality," a consensus conference was convened March 23-24, 2009. PARTICIPANTS This gathering of participants from academia, government, and industry brought together experts in suicide prevention, clinical trial design, psychometrics, pharmacoepidemiology, and genetics, as well as research psychiatrists involved in studies of major depression, bipolar disorder, schizophrenia, substance abuse/dependence, and other psychiatric disorders associated with elevated suicide risk across the life cycle. The process involved reviews of the relevant literature, and a series of 6 breakout sessions focused on specific questions of interest. EVIDENCE Each of the participants at the meeting received references relevant to the formal presentations (as well as the slides for the presentations) for their review prior to the meeting. In addition, the assessment instruments of suicidal ideation/behavior were reviewed in relationship to standard measures of validity, reliability, and clinical utility, and these findings were discussed at length in relevant breakout groups, in the final plenary session, and in the preparation of the article. Consensus and dissenting views were noted. CONSENSUS PROCESS Discussion and questions followed each formal presentation during the plenary sessions. Approximately 6 questions per breakout group were prepared in advance by members of the Steering Committee and each breakout group chair. Consensus in the breakout groups was achieved by nominal group process. Consensus recommendations and any dissent were reviewed for each breakout group at the final plenary session. All plenary sessions were recorded and transcribed by a court stenographer. Following the transcript, with input by each of the authors, the final paper went through 14 drafts. The output of the meeting was organized into this scholarly article, which has been developed by the authors with feedback from all participants at the meeting and represents a consensus view. Any areas of disagreement have been noted. CONCLUSIONS The term suicidality is not as clinically useful as more specific terminology (ideation, behavior, attempts, and suicide). Most participants applauded the FDA's effort to promote standard definitions and definable expectations for investigators and industry sponsors by endorsing the terminology in the Columbia Classification Algorithm of Suicide Assessment (C-CASA). Further research of available assessment instruments is needed to verify their utility, reliability, and validity in identifying suicide-associated treatment-emergent adverse effects and/or a signal of efficacy in suicide prevention trials. The FDA needs to build upon its new authority to systematically monitor postmarketing events by encouraging the development of a validated instrument for postmarketing surveillance of suicidal ideation, behavior, and risk within informative large health care-related databases in the United States and abroad. Over time, the FDA, industry, and clinical researchers should evaluate the impact of the current Agency requirement that all CNS clinical drug trials must include a C-CASA-compatible screening instrument for assessing and documenting the occurrence of treatment-emergent suicidal ideation and behavior. Finally, patients at high risk for suicide can safely be included in clinical trials, if proper precautions are followed, and they need to be included to enable premarket assessments of the risks and benefits of medications related to suicidal ideation, suicidal behavior, and suicide in such patients.
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Affiliation(s)
- Roger E Meyer
- Best Practice Project Management, Inc, PO Box 30219, Bethesda, MD 20824, USA.
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Sheehan DV, Sheehan KH, Shytle RD, Janavs J, Bannon Y, Rogers JE, Milo KM, Stock SL, Wilkinson B. Reliability and validity of the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID). J Clin Psychiatry 2010; 71:313-26. [PMID: 20331933 DOI: 10.4088/jcp.09m05305whi] [Citation(s) in RCA: 953] [Impact Index Per Article: 68.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2009] [Accepted: 07/23/2009] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate the concurrent validity and reliability of the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID), a short structured diagnostic interview for DSM-IV and ICD-10 psychiatric disorders in children and adolescents. METHOD Participants were 226 children and adolescents (190 outpatients and 36 controls) aged 6 to 17 years. To assess the concurrent validity of the MINI-KID, participants were administered the MINI-KID and the Schedule for Affective Disorders and Schizophrenia for School Aged Children-Present and Lifetime Version (K-SADS-PL) by blinded interviewers in a counterbalanced order on the same day. Participants also completed a self-rated measure of disability. In addition, interrater (n = 57) and test-retest (n = 83) reliability data (retest interval, 1-5 days) were collected, and agreement between the parent version of the MINI-KID and the standard MINI-KID (n = 140) was assessed. Data were collected between March 2004 and January 2008. RESULTS Substantial to excellent MINI-KID to K-SADS-PL concordance was found for syndromal diagnoses of any mood disorder, any anxiety disorder, any substance use disorder, any ADHD or behavioral disorder, and any eating disorder (area under curve [AUC] = 0.81-0.96, kappa = 0.56-0.87). Results were more variable for psychotic disorder (AUC = 0.94, kappa = 0.41). Sensitivity was substantial (0.61-1.00) for 15/20 individual DSM-IV disorders. Specificity was excellent (0.81-1.00) for 18 disorders and substantial (> 0.73) for the remaining 2. The MINI-KID identified a median of 3 disorders per subject compared to 2 on the K-SADS-PL and took two-thirds less time to administer (34 vs 103 minutes). Interrater and test-retest kappas were substantial to almost perfect (0.64-1.00) for all individual MINI-KID disorders except dysthymia. Concordance of the parent version (MINI-KID-P) with the standard MINI-KID was good. CONCLUSIONS The MINI-KID generates reliable and valid psychiatric diagnoses for children and adolescents and does so in a third of the time as the K-SADS-PL.
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Affiliation(s)
- David V Sheehan
- Depression & Anxiety Disorders Research Institute, University of South Florida College of Medicine, 3515 East Fletcher Ave, Tampa, FL 33613-4706, USA.
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Hidalgo RB, Sheehan DV. Benzodiazepines risk, abuse, and dependence: a tsunami in a tea cup. Psychiatry (Edgmont) 2009; 6:13-15. [PMID: 20104285 PMCID: PMC2811137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Rosario B Hidalgo
- University of South Florida College of Medicine. Depression and Anxiety Disorders Research Institute
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Gao K, Sheehan DV, Calabrese JR. Atypical antipsychotics in primary generalized anxiety disorder or comorbid with mood disorders. Expert Rev Neurother 2009; 9:1147-58. [PMID: 19673604 DOI: 10.1586/ern.09.37] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Generalized anxiety disorder (GAD) is a chronic, highly prevalent and debilitating disorder that commonly co-occurrs with mood disorders. Current available agents for GAD are limited either by their slow onsets of actions, unsatisfactory anxiolytic effects or potential for abuse/dependence. Atypical antipsychotics have been studied as alternatives. Olanzapine, risperidone and quetiapine immediate release have been explored in the treatment of refractory GAD and risperidone in bipolar anxiety with randomized, double-blind, placebo-controlled trials, but the results were not consistent. By contrast, quetiapine extended release (quetiapine-XR) 150 mg/day monotherapy yielded consistent anxiolytic effects across three studies that were superior to placebo and as effective as paroxetine 20 mg/day and escitalopram 10 mg/day but with an earlier onset of action. In a 52-week treatment of GAD, quetiapine-XR was superior to placebo in the prevention of anxiety relapses. Overall, atypical antipsychotics were relatively well tolerated, with common side effects of somnolence and sedation. However, in contrast to antidepressants and benzodiazepines, the long-term risk and benefit of atypical antipsychotics in the treatment of GAD is yet to be determined.
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Affiliation(s)
- Keming Gao
- Department of Psychiatry, Mood and Anxiety Clinic in the Mood Disorders Program, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH 44106, USA.
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Sheehan DV, Croft HA, Gossen ER, Levitt RJ, Brullé C, Bouchard S, Rozova A. Extended-release Trazodone in Major Depressive Disorder: A Randomized, Double-blind, Placebo-controlled Study. Psychiatry (Edgmont) 2009; 6:20-33. [PMID: 19724732 PMCID: PMC2719441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To investigate the efficacy, safety, and clinical benefit of a once-daily formulation of trazodone (Trazodone Contramid((c)) OAD) in the treatment of major depressive disorder. DESIGN/PARTICIPANTS In this double-blind study, 412 patients with major depressive disorder (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria) were randomized 1:1 to receive either Trazodone Contramid OAD (150 to 375mg) or placebo. Treatment was titrated over two weeks to each individual optimal dose. Patients then continued six weeks of treatment; further dose adjustments were allowed based on efficacy and tolerability. MEASUREMENTS The primary end point was change in the 17-item Hamilton Depression Rating Scale total score from baseline to last study visit. Secondary end points included Hamilton Depression Rating Scale responders/remitters, change in Montgomery-Asberg Depression Rating Scale, Clinician and Patient Global Improvement Scales, and quality of sleep. RESULTS From the end of titration to the end of the six-week treatment period, the mean maximum daily dose of the intent-to-treat population was 310mg for the active group and 355mg for the placebo group. There was a statistically significant difference between trazodone and placebo on the mean HAMD-17 score (-11.4 vs. -9.3, P=0.012). A significant difference was present as early as Week 1 and was maintained at all subsequent study visits. Many secondary end points supported these findings, including improvements in quality of sleep. The most frequent adverse events were the same for both the treatment and placebo groups: headache and somnolence. There were no serious adverse events that were considered related to treatment. There were no clinically significant electrocardiogram or laboratory abnormalities. CONCLUSIONS The trazodone Contramid formulation was more effective than placebo in major depressive disorder and was well tolerated.
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Affiliation(s)
- David V Sheehan
- Dr. Sheehan is Distinguished University Health Professor, Professor of Psychiatry, Director, Depression and Anxiety Disorders Research Institute, University of South Florida College of Medicine, Tampa, Florida; Dr. Croft is Medical Director, San Antonio Psychiatric Research Center, San Antonio, Texas; Drs. Gossen, Levitt, Brullé, and Rozova are from Labopharm Inc., Laval, Québec, Canada; and Dr. Bouchard is from Lakeshore General Hospital, Montréal, Québec, Canada
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Sheehan DV, Keene MS, Eaddy M, Krulewicz S, Kraus JE, Carpenter DJ. Differences in medication adherence and healthcare resource utilization patterns: older versus newer antidepressant agents in patients with depression and/or anxiety disorders. CNS Drugs 2009; 22:963-73. [PMID: 18840035 DOI: 10.2165/00023210-200822110-00005] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Given the number of antidepressants available and their rising costs, healthcare payers have initiated restrictive reimbursement policies for newer antidepressants, without consideration for differences in their effectiveness or tolerability. OBJECTIVE The objective of this study was to comprehensively compare medication adherence rates and associated healthcare utilization costs for patients using later-generation versus earlier-generation antidepressants in a managed care setting. Antidepressants launched after 2002 were deemed third-generation antidepressants, while antidepressants available prior to 2002 were deemed first-generation (TCAs and MAOIs) and second-generation (serotonin and noradrenaline [norepinephrine]-dopamine reuptake inhibitors). STUDY DESIGN Retrospective database analysis using medical and pharmacy data from over 75 managed care plans covering 55 million lives. SETTING/PATIENTS All patients receiving an antidepressant between 1 January 2002 and 30 September 2004 were identified. The index date for patients was the date of their first antidepressant prescription within this time period. Patients had to (i) have a diagnosis of depression or anxiety disorder, or depression and anxiety disorder within 6 months prior to or 30 days after their index prescription; (ii) be at least 18 years of age, without having taken antidepressant therapy for 6 months prior to their index date; and (iii) be continuously eligible for 6 months prior to their index date and during their 6-month follow-up period. Patients were excluded if they had a diagnosis of psychosis-related disease, Alzheimer's or Parkinson's disease, or were initiated on psychosis-related medications. INTERVENTION/MAIN OUTCOME MEASURE: Patients meeting selection criteria were followed for 6 months to assess rates of antidepressant adherence, therapy change rates and medical healthcare costs. STUDY POPULATION A total of 266 665 patients met the study criteria. Approximately 66% were female, with a mean age of 39 years. About 63% had a diagnosis of depression, 31% had an anxiety disorder diagnosis and 6% had diagnoses for both an anxiety disorder and depression. Therapy change: Therapy change within 6 months occurred in 18% of patients receiving third-generation agents compared with 21% and 40% for second- and first-generation agents, respectively. The odds of a therapy change were significantly lower with third-generation antidepressants compared with both older agent cohorts. Adherence: Of patients receiving third-generation antidepressants, 33.6% were adherent compared with 29.3% and 12.4% of patients receiving second- and first-generation antidepressants, respectively. Newer agents also had better adherence rates across all diagnostic cohorts. After adjusting for baseline differences, the odds of being adherent to therapy were significantly lower for those taking second- and first-generation agents versus newer antidepressants. Among the newer agents, the proportion of patients adherent to their therapy was: venlafaxine extended release 38%, paroxetine controlled release (CR) 35%, escitalopram 34%, duloxetine 32% and bupropion extended release (XL) 31%. Healthcare utilization: Of the patients taking older antidepressants, 13% (second generation) and 21% (first generation) were hospitalized at least once for any reason compared with 12% of patients taking newer agents. Overall, the odds of all-cause hospitalization within 6 months of therapy initiation were significantly higher for patients taking older antidepressants. Among the newer agents, hospitalization rates ranged from 15.9% for duloxetine to 12.5% for paroxetine CR and bupropion XL. The unadjusted 6-month total medical costs (not including pharmacy costs) per patient were $US 3514 for second-generation, $US 5744 for first-generation and $US 3284 for newer antidepressants. After controlling for baseline differences, patients receiving second- and first-generation antidepressants incurred 12% and 44% higher costs, respectively. The unadjusted 6-month medical costs for the newer agents ranged from $US 2715 for paroxetine CR to $US 6042 for duloxetine. CONCLUSION The results of this study provide essential information for healthcare decision makers about the potential advantages of newer generation antidepressants versus older generation antidepressants, as well as the differences between the specific newer agents, with respect to improved rates of adherence and therapy change, reduced hospitalizations and healthcare costs.
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Affiliation(s)
- David V Sheehan
- University of South Florida College of Medicine, Tampa, Florida, USA
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Coric V, Stock EG, Pultz J, Marcus R, Sheehan DV. Sheehan Suicidality Tracking Scale (Sheehan-STS): Preliminary Results from a Multicenter Clinical Trial in Generalized Anxiety Disorder. Psychiatry (Edgmont) 2009; 6:26-31. [PMID: 19724740 PMCID: PMC2719443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Accurate and prospective assessments of treatment-emergent suicidal thoughts and behaviors are essential to both clinical care and randomized clinical trials. The Sheehan Suicidality Tracking Scale is a prospective, patient self-report or clinician-administered rating scale that tracks both treatment-emergent suicidal ideation and behaviors. The Sheehan Suicidality Tracking Scale was incorporated into a multicenter, randomized, double-blind, placebo-controlled, and active comparator study examining the efficacy of an experimental corticotropin-releasing factor antagonist (BMS-562086) for the treatment of generalized anxiety disorder. METHOD The Sheehan Suicidality Tracking Scale was administered to subjects at baseline, Week 2, Week 4, and Week 8 or early termination. Subjects completed theSheehan Suicidality Tracking Scale by self report. The Sheehan Suicidality Tracking Scale was designated as an exploratory outcome measure in the study protocol, and post-hoc analyses were performed to examine the performance of the Sheehan Suicidality Tracking Scale. RESULTS A total of 82 subjects completed the Sheehan Suicidality Tracking Scale during the course of the study. Altogether, these subjects provided 297 completed Sheehan Suicidality Tracking Scale ratings across the study time points. Sixty-one subjects (n=25 placebo, n=24 BMS-562086, and n=12 escitalopram) had a baseline and at least one post-baseline Sheehan Suicidality Tracking Scale measurement. The mean change from baseline at Week 8 in the Sheehan Suicidality Tracking Scale total score was -0.10, -0.02, and -0.06 for escitalopram, placebo, and BMS-562086 groups, respectively. The sensitivity of the Sheehan Suicidality Tracking Scale and HAM-D Item #3 (suicide) for identifying subjects with suicidal thoughts or behaviors was 100 percent and 63 percent, respectively. CONCLUSIONS The Sheehan Suicidality Tracking Scale may be a sensitive psychometric tool to prospectively assess for treatment-emergent suicidal thoughts and behaviors. Despite the small sample size and low occurrence of suicidal ideation during the course of this clinical trial, the self-reported Sheehan Suicidality Tracking Scale demonstrated increased sensitivity over the rater administered HAM-D Item #3 in identifying suicide related ideations and behaviors. Further research in larger study samples as well as in other psychiatric disorders are needed.
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Affiliation(s)
- Vladimir Coric
- Dr. Coric is Associate Clinical Professor of Psychiatry, Yale University School of Medicine, Senior Research Scientist, Yale OCD Research Clinic, New Haven, and an employee of Bristol-Myers Squibb Company, Neuroscience Global Clinical Research, Wallingford, Connecticut
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Sheehan DV, Rozova A, Gossen ER, Gibertini M. The efficacy and tolerability of once-daily controlled-release trazodone for depressed mood, anxiety, insomnia, and suicidality in major depressive disorder. Psychopharmacol Bull 2009; 42:5-22. [PMID: 20581790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Trazodone Contramid(R) once-a-day (TzCOAD) is a reformulation of trazodone hydrochloride that controls the release of trazodone over 24 hours. A standard effect size analysis (Cohen's d) determined which items of the 17-item Hamilton Depression Rating Scale (HAMD-17) and the Montgomery-Asberg Depression Rating Scale (MADRS) showed the greatest improvement in patients with major depressive disorder (MDD), following up to 8 weeks of therapy with TzCOAD. An additional insomnia analysis assessed whether the efficacy of TzCOAD is influenced by improvements in insomnia or baseline severity of insomnia. The analyses used data from a randomized study of 412 patients receiving 150-375 mg TzCOAD (N = 206) or placebo (N = 206). The results of the Cohen's d analysis on the modified intent-to-treat population (LOCF) showed HAMD items with the greatest improvement were insomnia items (middle (-0.35), late (-0.24)), feelings of guilt (-0.24), and depressed mood (-0.23); for MADRS items they were reduced sleep (-0.31), inner tension (-0.22), reported sadness (-0.21), and suicidal thoughts (-0.21). An analysis of covariance showed no significant interaction between improvements in the HAMD Bech-6 core symptoms of depression and the baseline MADRS reduced sleep item or early changes in the HAMD-17 sleep disturbance factor. These results suggest that the antidepressant efficacy was independent of the baseline severity of insomnia and of the improvement in insomnia. Overall, the results elucidate the efficacy components and tolerability characteristics previously demonstrated for TzCOAD monotherapy for patients with MDD at the recommended daily dose of 300 mg.
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Affiliation(s)
- David V Sheehan
- University of South Florida College of Medicine, Tampa, FL, USA
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Sheehan DV, Meyers AL, Prakash A, Robinson MJ, Swindle RW, Russell JM, Mallinckrodt CH. The relationship between functional outcomes and the treatment of anxious and painful somatic symptoms in patients with generalized anxiety disorder. Curr Med Res Opin 2008; 24:2457-66. [PMID: 18662492 DOI: 10.1185/03007990802293643] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To examine the relationship between global functional impairment and the treatment of anxious symptoms and painful somatic symptoms (PSS) in patients with generalized anxiety disorder (GAD). RESEARCH DESIGN AND METHODS Data from two double-blind, placebo-controlled trials in adult outpatients meeting DSM-IV criteria for GAD were pooled. In the first trial (9-week, fixed-dose treatment period), patients were randomized to duloxetine 60 mg QD (n=168), duloxetine 120 mg QD (n=170), or placebo (n=175). In the second trial (10-week, flexible-dose treatment period), patients were randomized to 60-120 mg QD of duloxetine (n=168) or placebo (n=159). Path analysis was used to assess the relative contributions of changes in psychic and somatic anxiety and PSS on improved functional outcomes. CLINICAL TRIAL REGISTRATION INFORMATION Study 1: NCT00122824; Study 2: study completed before registration required. MAIN OUTCOME MEASURES Sheehan Disability Scale (SDS), Hamilton Anxiety Rating Scale (HAMA), and Visual Analog Scale for overall pain (VAS). RESULTS There was a moderate correlation (0.45, p<0.05) at endpoint between changes in global functional impairment and changes in psychic anxiety (controlling for somatic anxiety and PSS); whereas the correlation between changes in global functional impairment and changes in somatic anxiety (controlling for psychic anxiety and PSS) was weak (0.09, p<0.05). The correlation between changes in global functional impairment and changes in PSS (controlling for psychic and somatic anxiety) was weak (0.27, p<0.05). Path analysis revealed that 37% of the total improvement in functional impairment (Sheehan Disability Scale total score) due to duloxetine treatment was independent of improvement in the Hamilton Anxiety Rating Scale (HAMA) psychic and somatic anxiety subscale scores or Visual Analog Scale for overall pain (VAS) score. Improvement in psychic anxiety accounted for 47% of the total treatment effect on improvement of functional impairment, whereas 7% and 9% of the improvement in functional impairment was accounted for by improvements in somatic anxiety and overall pain, respectively.
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Affiliation(s)
- David V Sheehan
- University of South Florida College of Medicine, Tampa, FL, USA
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