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McInnis MG, Assari S, Kamali M, Ryan K, Langenecker SA, Saunders EFH, Versha K, Evans S, O’Shea KS, Mower Provost E, Marshall D, Forger D, Deldin P, Zoellner S. Cohort Profile: The Heinz C. Prechter Longitudinal Study of Bipolar Disorder. Int J Epidemiol 2018; 47:28-28n. [PMID: 29211851 PMCID: PMC5837550 DOI: 10.1093/ije/dyx229] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/09/2017] [Accepted: 10/16/2017] [Indexed: 12/13/2022] Open
Affiliation(s)
- Melvin G McInnis
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Shervin Assari
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Masoud Kamali
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Kelly Ryan
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Scott A Langenecker
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Erika FH Saunders
- Department of Psychiatry, Penn State Hershey Medical Group, Hershey, PA, USA
| | - Kritika Versha
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Simon Evans
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - K Sue O’Shea
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Department of Cell and Developmental Biology
| | | | - David Marshall
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Sebastian Zoellner
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
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Möller HJ, Bandelow B, Volz HP, Barnikol UB, Seifritz E, Kasper S. The relevance of 'mixed anxiety and depression' as a diagnostic category in clinical practice. Eur Arch Psychiatry Clin Neurosci 2016; 266:725-736. [PMID: 27002521 PMCID: PMC5097109 DOI: 10.1007/s00406-016-0684-7] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 02/17/2016] [Indexed: 01/04/2023]
Abstract
According to ICD-10 criteria, mixed anxiety and depressive disorder (MADD) is characterized by co-occurring, subsyndromal symptoms of anxiety and depression, severe enough to justify a psychiatric diagnosis, but neither of which are clearly predominant. MADD appears to be very common, particularly in primary care, although prevalence estimates vary, often depending on the diagnostic criteria applied. It has been associated with similarly pronounced distress, impairment of daily living skills, and reduced health-related quality of life as fully syndromal depression and anxiety. Although about half of the patients affected remit within a year, non-remitting patients are at a high risk of transition to a fully syndromal psychiatric disorder. The validity and clinical usefulness of MADD as a diagnostic category are under debate. It has not been included in the recently released DSM-5 since the proposed diagnostic criteria turned out to be not sufficiently reliable. Moreover, reviewers have disputed the justification of MADD based on divergent results regarding its prevalence and course, diagnostic stability over time, and nosological inconsistencies between subthreshold and threshold presentations of anxiety and depressive disorders. We review the evidence in favor and against MADD and argue that it should be included into classification systems as a diagnostic category because it may enable patients to gain access to appropriate treatment early. This may help to reduce patients' distress, prevent exacerbation to a more serious psychiatric disorder, and ultimately reduce the societal costs of this very common condition.
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Affiliation(s)
- Hans-Jürgen Möller
- Clinic and Polyclinic for Psychiatry and Psychotherapy, Ludwig Maximilian University, Nußbaumstrasse 7, 80336, Munich, Germany
| | - Borwin Bandelow
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, von-Siebold-Strasse 5, 37075, Göttingen, Germany
| | - Hans-Peter Volz
- Hospital for Psychiatry, Psychotherapy and Psychosomatic Medicine Schloss Werneck, Balthasar-Neumann-Platz 1, 97440, Werneck, Germany
| | - Utako Birgit Barnikol
- Research Unit Ethics, Institute for the History of Medicine and Medical Ethics, University Medical Center Cologne, Cologne, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Albertus Magnus University of Cologne, Joseph Stelzmann Strasse 20, 50937, Cologne, Germany
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, Lenggstrasse 31, 8032, Zurich, Switzerland
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Sharp C, Fowler JC, Salas R, Nielsen D, Allen J, Oldham J, Kosten T, Mathew S, Madan A, Frueh BC, Fonagy P. Operationalizing NIMH Research Domain Criteria (RDoC) in naturalistic clinical settings. Bull Menninger Clin 2016; 80:187-212. [DOI: 10.1521/bumc.2016.80.3.187] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Carvalho AF, Köhler CA, Fernandes BS, Quevedo J, Miskowiak KW, Brunoni AR, Machado-Vieira R, Maes M, Vieta E, Berk M. Bias in emerging biomarkers for bipolar disorder. Psychol Med 2016; 46:2287-2297. [PMID: 27193198 DOI: 10.1017/s0033291716000957] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND To date no comprehensive evaluation has appraised the likelihood of bias or the strength of the evidence of peripheral biomarkers for bipolar disorder (BD). Here we performed an umbrella review of meta-analyses of peripheral non-genetic biomarkers for BD. METHOD The Pubmed/Medline, EMBASE and PsycInfo electronic databases were searched up to May 2015. Two independent authors conducted searches, examined references for eligibility, and extracted data. Meta-analyses in any language examining peripheral non-genetic biomarkers in participants with BD (across different mood states) compared to unaffected controls were included. RESULTS Six references, which examined 13 biomarkers across 20 meta-analyses (5474 BD cases and 4823 healthy controls) met inclusion criteria. Evidence for excess of significance bias (i.e. bias favoring publication of 'positive' nominally significant results) was observed in 11 meta-analyses. Heterogeneity was high for (I 2 ⩾ 50%) 16 meta-analyses. Only two biomarkers met criteria for suggestive evidence namely the soluble IL-2 receptor and morning cortisol. The median power of included studies, using the effect size of the largest dataset as the plausible true effect size of each meta-analysis, was 15.3%. CONCLUSIONS Our findings suggest that there is an excess of statistically significant results in the literature of peripheral biomarkers for BD. Selective publication of 'positive' results and selective reporting of outcomes are possible mechanisms.
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Affiliation(s)
- A F Carvalho
- Department of Psychiatry and Translational Psychiatry Research Group,Faculty of Medicine,Federal University of Ceará,Fortaleza, CE,Brazil
| | - C A Köhler
- Department of Psychiatry and Translational Psychiatry Research Group,Faculty of Medicine,Federal University of Ceará,Fortaleza, CE,Brazil
| | - B S Fernandes
- IMPACT Strategic Research Centre, Deakin University, School of Medicine and Barwon Health,Geelong - VIC,Australia
| | - J Quevedo
- Department of Psychiatry and Behavioral Sciences,Center for Experimental Models in Psychiatry, The University of Texas Medical School at Houston,Houston, TX,USA
| | - K W Miskowiak
- Psychiatric Centre Copenhagen, Copenhagen University Hospital,Rigshospitalet,Copenhagen,Denmark
| | - A R Brunoni
- Interdisciplinary Center for Applied Neuromodulation (CINA), University Hospital, University of São Paulo,São Paulo,Brazil
| | - R Machado-Vieira
- Laboratory of Neuroscience, LIM- 27,Institute and Department of Psychiatry, University of Sao Paulo,Sao Paulo,Brazil
| | - M Maes
- IMPACT Strategic Research Centre, Deakin University, School of Medicine and Barwon Health,Geelong - VIC,Australia
| | - E Vieta
- Bipolar Disorders Unit,Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM,Barcelona,Catalonia,Spain
| | - M Berk
- IMPACT Strategic Research Centre, Deakin University, School of Medicine and Barwon Health,Geelong - VIC,Australia
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Abstract
The National Institute of Mental Health is actively promoting Research Domain Criteria as a new model for the research on mental disorders. Research Domain Criteria approaches disorders through a matrix, linking units of analysis with domains, based on the assumption that psychopathology reflects abnormal connectivity in the brain. This review suggests that the Research Domain Criteria perspective is likely to fail to provide an adequate basis for clinical psychiatric theory and practice. First, it uses models from neuroscience that are insufficiently developed. Second, it is based on the premise that mental phenomena and mental disorders can be reduced to neural activity, without consideration of cognition, experience, and social interaction. Third, it downplays psychosocial factors in psychopathology and treatment. Research Domain Criteria may therefore prove inadequate for providing a neuroscientific basis for psychiatric nosology and treatment and needs to be supplemented with a broader view that incorporates insights from social sciences, psychology, and phenomenology.
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Affiliation(s)
- Mario Luciano
- WHO Collaborating Centre for Research and Training in Mental HealthNaples, Italy
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Gros DF. Design challenges in transdiagnostic psychotherapy research: Comparing Transdiagnostic Behavior Therapy (TBT) to existing evidence-based psychotherapy in veterans with affective disorders. Contemp Clin Trials 2015; 43:114-9. [PMID: 26003434 PMCID: PMC10074285 DOI: 10.1016/j.cct.2015.05.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 05/14/2015] [Accepted: 05/17/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND To address the limitations of disorder-specific approaches, newer transdiagnostic approaches to psychotherapy have been developed to provide a single treatment that is capable of addressing several, related disorders. However, the recruitment of multiple diagnoses presents many challenges to the traditional design of psychotherapy randomized controlled trials (RCTs). OBJECTIVE The goal of the manuscript is to present the challenges and rationale for designing a RCT for transdiagnostic treatment to inform and aid in the development of future investigations. METHODS A recently funded and ongoing RCT for Transdiagnostic Behavior Therapy (TBT) is used as an example to discuss the related design challenges. The TBT study involves the recruitment of 96 veteran participants with any of the following eight principal diagnoses: posttraumatic stress disorder, panic disorder, social anxiety disorder, obsessive compulsive disorder, generalized anxiety disorder, specific phobia, major depressive disorder, or persistent depressive disorder. Within the TBT study, participants will complete a semi-structured diagnostic interview and a series of transdiagnostic self-report measures to determine eligibility and assess baseline symptomatology. Qualifying participants will be randomized to TBT or control psychotherapy. Additional assessments will be completed at post-treatment and 6-month follow-up. CONCLUSIONS Due to the transdiagnostic nature of the sample, adjustments to the recruitment and randomization procedures, selection of measures, selection of control psychotherapy, and analysis plan were required. These adjustments have implications to future trials on transdiagnostic psychotherapy protocols as well as future research in line with the transdiagnostic focus of the National Institute of Mental Health's Research Domain Criteria (RDoC) funding strategy.
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Affiliation(s)
- Daniel F Gros
- Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, United States; Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States.
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Hershenberg R, Goldfried MR. Implications of RDoC for the research and practice of psychotherapy. Behav Ther 2015; 46:156-65. [PMID: 25645165 DOI: 10.1016/j.beth.2014.09.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 09/30/2014] [Accepted: 09/30/2014] [Indexed: 11/16/2022]
Abstract
The field of psychotherapy is at an important juncture. Recent changes in the field include (a) the skeptical reception of the fifth edition of the Diagnostic and Statistical Manual and (b) NIMH's prioritization of an alternative classification system to guide translational and intervention research. Moreover, (c) the field continues to be held accountable to governmental agencies and third-party payers to demonstrate its empirical basis. Thus, psychological research as it relates to the practice of psychotherapy is at a crossroads. In this article, we provide a brief overview of several generations of psychotherapy outcome research, including the consequences that followed in the 1980s as psychotherapy research moved toward randomized controlled trials for clinical disorders. We delineate the inherent strengths and limitations of this movement and address how the NIMH has recently responded with the Research Domain Criteria (RDoC). We then address philosophical and practical implications of the emphasis on a neuroscientific conceptualization of psychological problems. Finally, we discuss opportunities for a next generation of convergent science that incorporates, rather than replaces, psychosocial variables across stages of translational research and treatment development.
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Affiliation(s)
- Rachel Hershenberg
- Mental Illness Research, Education and Clinical Center at Philadelphia VA Medical Center, and University of Pennsylvania.
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Affiliation(s)
- Gaia Sampogna
- WHO Collaborating Centre for Research and Training in Mental Health, University of Naples SUN, Naples, Italy
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Möller HJ, Bandelow B, Bauer M, Hampel H, Herpertz SC, Soyka M, Barnikol UB, Lista S, Severus E, Maier W. DSM-5 reviewed from different angles: goal attainment, rationality, use of evidence, consequences--part 1: general aspects and paradigmatic discussion of depressive disorders. Eur Arch Psychiatry Clin Neurosci 2015; 265:5-18. [PMID: 25119146 DOI: 10.1007/s00406-014-0520-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 08/01/2014] [Indexed: 01/01/2023]
Abstract
DSM-5 was published in 2013 after about 10 years of preparation. Part 1 of this paper discusses several more general aspects of DSM-5 and offers a detailed, paradigmatic analysis of changes made to the chapter on depressive disorders. The background for the changes is analysed on the basis of a PubMed search and review papers on the classification of mental disorders in general and on empirical knowledge about individual disorders. Contrary to the original plans, DSM-5 has not introduced a primarily dimensional diagnostic system but has widely preserved the categorical system of disorders. Also, it has not adopted a more neurobiological approach to disorders by including biological markers to increase the objectivity of psychiatric diagnoses but has maintained the primarily symptom-based, descriptive approach. The criteria for some disorders have been changed, including affective, schizophrenic and addiction disorders, and a few new disorders have been added. A minimal version of the dimensional approach was realised through the introduction of several transnosological specifiers and the option to make symptom- or syndrome-related severity and dimensional assessments. These specifiers and assessments might allow a more individualised description of a patient's psychopathological state and more personalised treatment. However, most of the symptom- and syndrome-related assessments are not mandatory and therefore may not be used in clinical practice.
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Affiliation(s)
- Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany,
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Lilienfeld SO. The Research Domain Criteria (RDoC): An analysis of methodological and conceptual challenges. Behav Res Ther 2014; 62:129-39. [DOI: 10.1016/j.brat.2014.07.019] [Citation(s) in RCA: 136] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 07/05/2014] [Accepted: 07/28/2014] [Indexed: 01/27/2023]
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