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Helmich MA. The Duration-Adjusted Reliable Change Index: Defining Clinically Relevant Symptom Changes of Varying Durations. Assessment 2024:10731911231221808. [PMID: 38279795 DOI: 10.1177/10731911231221808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
The time period over which relevant symptoms shifts unfold is not uniform across individuals. This article proposes an adaptation of the Reliable Change Index (RCI) to detect symptom changes of varying durations in individual patients' time series: the Duration-Adjusted RCI (DARCI). The DARCI proportionally raises the RCI cut-off to account for its extension over additional time increments, resulting in different DARCI thresholds for different change durations. The method is illustrated with a simulation study of depressive symptom time series with varying degrees of discontinuity and overall mean change, and four empirical case examples from two clinical samples. The results suggest that the DARCI may be particularly useful for identifying symptom shifts that appear relatively abrupt, which can help indicate when a patient is showing significant improvement or deterioration. Its ease of use makes it suitable for application in clinical contexts and a promising method for exploring transitions in psychiatric populations.
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Affiliation(s)
- Marieke A Helmich
- Department of Psychology, University of Oslo, Oslo, Norway
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands
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2
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Dang K, Ritvo P, Katz J, Gratzer D, Knyahnytska Y, Ortiz A, Walters C, Attia M, Gonzalez-Torres C, Lustig A, Daskalakis Z. The Role of Daily Steps in the Treatment of Major Depressive Disorder: Secondary Analysis of a Randomized Controlled Trial of a 6-Month Internet-Based, Mindfulness-Based Cognitive Behavioral Therapy Intervention for Youth. Interact J Med Res 2023; 12:e46419. [PMID: 38064262 PMCID: PMC10746981 DOI: 10.2196/46419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 08/15/2023] [Accepted: 08/28/2023] [Indexed: 12/25/2023] Open
Abstract
BACKGROUND Current evidence supports physical activity (PA) as an adjunctive treatment for major depressive disorder (MDD). Few studies, however, have examined the relationship between objectively measured PA and MDD treatment outcomes using prospective data. OBJECTIVE This study is a secondary analysis of data from a 24-week internet-based, mindfulness-based cognitive behavioral therapy program for MDD. The purpose of this analysis was twofold: (1) to examine average daily step counts in relation to MDD symptom improvement, and whether pain moderated this relationship; and (2) to examine whether changes in step activity (ie, step trajectories) during treatment were associated with baseline symptoms and symptom improvement. METHODS Patients from the Centre for Addiction and Mental Health were part of a randomized controlled trial evaluating the effects of internet-based, mindfulness-based cognitive behavioral therapy for young adults (aged 18-30 years old) with MDD. Data from 20 participants who had completed the intervention were analyzed. PA, in the form of objectively measured steps, was measured using the Fitbit-HR Charge 2 (Fitbit Inc), and self-reported depression severity was measured with the Beck Depression Inventory-II (BDI-II). Linear regression analysis was used to test PA's relationship with depression improvement and the moderating effect of pain severity and pain interference. Growth curve and multivariable regression models were used to test longitudinal associations. RESULTS Participants walked an average of 8269 steps per day, and each additional +1000-step difference between participants was significantly associated with a 2.66-point greater improvement (reduction) in BDI-II, controlling for anxiety, pain interference, and adherence to Fitbit monitoring (P=.02). Pain severity appeared to moderate (reduce) the positive effect of average daily steps on BDI-II improvement (P=.03). Higher baseline depression and anxiety symptoms predicted less positive step trajectories throughout treatment (Ps≤.001), and more positive step trajectories early in the trial predicted greater MDD improvement at the end of the trial (Ps<.04). However, step trajectories across the full duration of the trial did not significantly predict MDD improvement (Ps=.40). CONCLUSIONS This study used objective measurements to demonstrate positive associations between PA and depression improvement in the context of cognitive behavioral treatment. Pain appeared to moderate this relationship, and baseline symptoms of anxiety and depression predicted PA trajectories. The findings inform future interventions for major depression. Future research with larger samples should consider additional moderators of PA-related treatment success and the extent to which outcomes are related to PA change in multimodal interventions. TRIAL REGISTRATION Clinical Trials.gov NCT03406052; https://www.clinicaltrials.gov/ct2/show/NCT03406052. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/11591.
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Affiliation(s)
- Kevin Dang
- School of Kinesiology and Health Sciences, York University, Toronto, ON, Canada
| | - Paul Ritvo
- School of Kinesiology and Health Sciences, York University, Toronto, ON, Canada
- Department of Psychology, York University, Toronto, ON, Canada
| | - Joel Katz
- School of Kinesiology and Health Sciences, York University, Toronto, ON, Canada
- Department of Psychology, York University, Toronto, ON, Canada
| | - David Gratzer
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Yuliya Knyahnytska
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Abigail Ortiz
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Mohamed Attia
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Christina Gonzalez-Torres
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Andrew Lustig
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Zafiris Daskalakis
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
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3
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Leuchter MK, Citrenbaum C, Wilson AC, Tibbe TD, Jackson NJ, Krantz DE, Wilke SA, Corlier J, Strouse TB, Hoftman GD, Tadayonnejad R, Koek RJ, Slan AR, Ginder ND, Distler MG, Artin H, Lee JH, Adelekun AE, Leuchter AF. A comparison of self- and observer-rated scales for detecting clinical improvement during repetitive transcranial stimulation (rTMS) treatment of depression. Psychiatry Res 2023; 330:115608. [PMID: 37984281 DOI: 10.1016/j.psychres.2023.115608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/06/2023] [Accepted: 11/11/2023] [Indexed: 11/22/2023]
Abstract
Clinical outcomes of repetitive Transcranial Magnetic Stimulation (rTMS) for treatment of Major Depressive Disorder (MDD) vary widely, and no single mood rating scale is standard for assessing rTMS outcomes. This study of 708 subjects undergoing clinical rTMS compared the performance of four scales in measuring symptom change during rTMS treatment. Self-report and observer ratings were examined weekly with the Inventory of Depressive Symptomatology 30-item (IDS), Patient Health Questionnaire 9-item (PHQ), Profile of Mood States 30-item (POMS), and Hamilton Depression Rating Scale 17-item (HDRS). While all scales were correlated and detected significant improvement, the degree of improvement over time as well as response (33-50%) and remission (20-24%) rates varied significantly. Higher baseline severity was associated with lower likelihood of remission, and greater improvement by sessions 5 and 10 predicted response across all scales. Use of only a single scale to assess outcome conferred 14-36% risk of failing to detect response/remission indicated by another scale. The PHQ was most likely to indicate improvement and least likely to miss response or remission. These findings indicate that assessment of symptom burden during rTMS treatment may be most accurately assessed through use of multiple instruments.
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Affiliation(s)
- Michael K Leuchter
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA.
| | - Cole Citrenbaum
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | | | - Tristan D Tibbe
- Department of Psychology, University of California, Los Angeles, CA 90024, USA; Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA 90024, USA
| | - Nicholas J Jackson
- Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA 90024, USA
| | - David E Krantz
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Scott A Wilke
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Juliana Corlier
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Thomas B Strouse
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Gil D Hoftman
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Reza Tadayonnejad
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA; Division of Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, USA
| | - Ralph J Koek
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Aaron R Slan
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Nathaniel D Ginder
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Margaret G Distler
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Hewa Artin
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - John H Lee
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Adesewa E Adelekun
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
| | - Andrew F Leuchter
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA
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Zhou J, Duan J, Liu X, Wang Y, Zheng J, Tang L, Zhao P, Zhang X, Zhu R, Wang F. Functional network characteristics in adolescent psychotic mood disorder: associations with symptom severity and treatment effects. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02314-5. [PMID: 37934311 DOI: 10.1007/s00787-023-02314-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/02/2023] [Indexed: 11/08/2023]
Abstract
Adolescent psychotic mood disorder (MDP) is a specific phenotype that characterized by more severe symptoms and prognosis compared to nonpsychotic mood disorder (MDNP). But the underlying neural mechanisms remain unknown, and graph theory analysis can help to understand possible mechanisms of psychotic symptoms from the perspective of functional networks. A total of 177 adolescent patients with mood disorders were recruited, including 61 MDP and 116 MDNP. Functional networks were constructed, and topological properties were compared between the two groups at baseline and after treatment, and the association between properties changes and symptom improvement was explored. Compared to the MDNP group, the MDP group exhibited higher small-world properties (FDR q = 0.003) and normalized clustering coefficients (FDR q = 0.008) but demonstrated decreased nodal properties in the superior temporal gyrus (STG), Heschl's gyrus, and medial cingulate gyrus (all FDR q < 0.05). These properties were found to be correlated with the severity of psychotic symptoms. Topological properties also changed with improvement of psychotic symptoms after treatment, and changes in degree centrality of STG in the MDP was significantly positive correlated with improvement of psychotic symptoms (r = 0.377, P = 0.031). This study indicated that functional networks are more severely impaired in patients with psychotic symptoms. Topological properties, particularly those associated with the STG, hold promise as emerging metrics for assessing symptoms and treatment efficacy in patients with psychotic symptoms.
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Affiliation(s)
- Jingshuai Zhou
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Street, Nanjing, 210096, Jiangsu, People's Republic of China
- Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, People's Republic of China
| | - Jia Duan
- Department of Mental Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Xiaoxue Liu
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Street, Nanjing, 210096, Jiangsu, People's Republic of China
| | - Yang Wang
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Street, Nanjing, 210096, Jiangsu, People's Republic of China
- Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, People's Republic of China
| | - Junjie Zheng
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Street, Nanjing, 210096, Jiangsu, People's Republic of China
- Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, People's Republic of China
| | - Lili Tang
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Street, Nanjing, 210096, Jiangsu, People's Republic of China
- Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, People's Republic of China
| | - Pengfei Zhao
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Street, Nanjing, 210096, Jiangsu, People's Republic of China
- Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, People's Republic of China
| | - Xizhe Zhang
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Rongxin Zhu
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Street, Nanjing, 210096, Jiangsu, People's Republic of China.
| | - Fei Wang
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Street, Nanjing, 210096, Jiangsu, People's Republic of China.
- Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, People's Republic of China.
- Department of Mental Health, School of Public Health, Nanjing Medical University, Nanjing, China.
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Tian S, Wang Q, Zhang S, Chen Z, Dai Z, Zhang W, Yao Z, Lu Q. Local and large-scale resting-state oscillatory dysfunctions for early antidepressant response prediction in major depressive disorder. J Affect Disord 2023; 340:751-757. [PMID: 37597781 DOI: 10.1016/j.jad.2023.08.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/05/2023] [Accepted: 08/16/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Magnetoencephalography (MEG) could explore and resolve brain signals with realistic temporal resolution to investigate the underlying electrophysiology of major depressive disorder (MDD) and the treatment efficacy. Here, we explore whether neuro-electrophysiological features of MDD at baseline can be used as a neural marker to predict their early antidepressant response. METHODS Sixty-six medication-free patients with MDD and 48 healthy controls were enrolled and underwent resting-state MEG scans. Hamilton depression rating scale (HAMD-17) was assessed at both baseline and after two-week pharmacotherapy. We measured local and large-scale resting-state oscillatory dysfunctions with a data-driven model, the Fitting Oscillations & One-Over F algorithm. Then, we quantified band-limited regional power and functional connectivity between brain regions. RESULTS After two-week follow-up, 52 patients completed the re-interviews. Thirty-one patients showed early response (ER) to pharmacotherapy and 21 patients did not. Treatment response was defined as at least 50 % reduction of severity reflected by HAMD-17. We observed decreased regional periodic power in patients with MDD comparing to controls. However, patients with ER exhibited that functional couplings across brain regions in both alpha and beta band were increased and significantly correlated with severity of depressive symptoms after treatment. Receiver operating characteristic curves (ROC) further confirmed the predictive ability of baseline large-scale functional connectivity for early antidepressant efficacy (AUC = 0.9969). LIMITATIONS Relatively small sample size and not a double-blind design. CONCLUSIONS The current study demonstrated the electrophysiological dysfunctions of local neural oscillatory related with depression and highlighted the identification ability of large-scale couplings biomarkers in early antidepressant response prediction.
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Affiliation(s)
- Shui Tian
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Qiang Wang
- Department of Medical Psychology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Siqi Zhang
- Insitut des Sciences Cognitives, Marc Jeannerod, CNRS, France
| | - Zhilu Chen
- Department of Psychiatry, the Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zhongpeng Dai
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing 210096, China; Child Development and Learning Science, Key Laboratory of Ministry of Education, China
| | - Wei Zhang
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing 210096, China; Child Development and Learning Science, Key Laboratory of Ministry of Education, China
| | - Zhijian Yao
- Department of Psychiatry, the Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing 210029, China; School of Biological Sciences & Medical Engineering, Southeast University, Nanjing 210096, China; Nanjing Brain Hospital, Medical School of Nanjing University, Nanjing 210093, China.
| | - Qing Lu
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing 210096, China; Child Development and Learning Science, Key Laboratory of Ministry of Education, China.
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Wang L, Zhao P, Zhang J, Zhang R, Liu J, Duan J, Zhang X, Zhu R, Wang F. Functional connectivity between the cerebellar vermis and cerebrum distinguishes early treatment response for major depressive episodes in adolescents. J Affect Disord 2023; 339:256-263. [PMID: 37437740 DOI: 10.1016/j.jad.2023.07.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/01/2023] [Accepted: 07/08/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND The absence of biomarkers for predicting treatment response in adolescent mood disorder calls for further research. The vermis, a component of the cerebellum, is involved in mood disorder pathophysiology and relates to clinical symptoms and treatment outcomes. We investigated vermis functional connectivity (FC) as an early marker for treatment response identification. METHOD One hundred thirty-two adolescents with mood disorders including major depressive disorder or bipolar disorder, were recruited, who were experiencing a major depressive episode. All adolescents underwent baseline and 2-week treatment resting-state MRI scans. Hamilton Rating Scale for Depression (HAMD) assessments were completed to assess the severity of symptoms. Patients were divided into treatment-responsive (≥50 % HAMD reduction, n = 75) and treatment-unresponsive subgroups (n = 57). Vermis FCs were compared between subgroups at baseline. And we compared the pre- and post-treatment FC differences within subgroups. RESULT Higher vermis-left temporal lobe FC in treatment-responsive group compared to treatment-unresponsive group at baseline. The FC value showed positive prognosis for the efficacy, with the area under the curve (AUC) of 0.760 (95 % confidence interval: 0.678-0.843, p < 0.001), suggesting higher vermis-temporal FC is benefit to improve treatment-response. Furthermore, post-treatment analysis showed significant increases in the vermis-right frontal lobe FC values between in all patients, suggesting that vermis-frontal FCs were independent of treatment-outcome. LIMITATION Sample size was relatively small, which may limit the generalizability of our results. CONCLUSION Our study revealed that the FC between the vermis and the cortex is not only associated with symptom alleviation but also predictive of treatment outcomes.
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Affiliation(s)
- Lifei Wang
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, PR China; Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, PR China.
| | - Pengfei Zhao
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, PR China; Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, PR China.
| | - Jing Zhang
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, PR China; Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, PR China.
| | - Ran Zhang
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, PR China; Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, PR China.
| | - Juan Liu
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, PR China; Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, PR China.
| | - Jia Duan
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, PR China; Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, PR China.
| | - Xizhe Zhang
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, PR China; Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, PR China; School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, Jiangsu, China.
| | - Rongxin Zhu
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, PR China; Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, PR China.
| | - Fei Wang
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, PR China; Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, PR China.
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7
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Li F, Jörg F, Merkx MJM, Feenstra T. Early symptom change contributes to the outcome prediction of cognitive behavioral therapy for depression patients: A machine learning approach. J Affect Disord 2023; 334:352-357. [PMID: 37149055 DOI: 10.1016/j.jad.2023.04.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 04/19/2023] [Accepted: 04/28/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Limited evidence exists regarding the association between early symptom change and later outcomes of cognitive behavioral therapy (CBT). This study aimed to apply machine learning algorithms to predict continuous treatment outcomes based on pre-treatment predictors and early symptom changes and to uncover whether additional variance could be explained compared to regression methods. Additionally, the study examined early subscale symptom changes to determine the most significant predictors of treatment outcome. METHODS We investigated CBT outcomes in a large naturalistic dataset (N = 1975 depression patients). The sociodemographic profile, pre-treatment predictors, and early symptom change, including total and subscale scores were used to predict the Symptom Questionnaire (SQ)48 score at the 10th session as a continuous outcome. Different machine learners were compared to linear regression. RESULTS Early symptom change and baseline symptom score were the only significant predictors. Models with early symptom change explained 22.0 % to 23.3 % more variance than those without early symptom change. Specifically, the baseline total symptom score, and the early symptom score changes of the subscales pertaining to depression and anxiety were the top three predictors of treatment outcome. LIMITATION Excluded patients with missing treatment outcomes had slightly higher symptom scores at baseline, indicating possible selection bias. CONCLUSION Early symptom change improved the prediction of treatment outcomes. The prediction performance achieved is far from clinical relevance: the best learner could only explain 51.2 % of the variance in outcomes. Compared to linear regression, more sophisticated preprocessing and learning methods did not substantially improve performance.
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Affiliation(s)
- Fang Li
- University of Groningen, Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, Groningen, the Netherlands.
| | - Frederike Jörg
- University of Groningen, University Medical Center Groningen, University Center Psychiatry, Rob Giel Research Center, Interdisciplinary Centre for Psychopathology and Emotion Regulation, the Netherlands
| | | | - Talitha Feenstra
- University of Groningen, Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, Groningen, the Netherlands; Center for Nutrition, Prevention and Health Services Research, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
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Fu Y, Ji JL, Shi SX, Zhang HY, Lin GZ, Zhang YL, Li X, Wu WY. Early outcomes, associated factors and predictive values of clinical outcomes of tandospirone in generalized anxiety disorder: a post-hoc analysis of a randomized, controlled, multicenter clinical trial. Curr Med Res Opin 2023; 39:597-603. [PMID: 36842964 DOI: 10.1080/03007995.2023.2175998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
OBJECTIVE To examine the early outcomes, associated factors and predictive values of clinical outcomes of different tandospirone doses in patients with a generalized anxiety disorder (GAD). METHODS This was a posthoc analysis of "a randomized, controlled multicenter clinical trial of the efficacy and safety of different doses of tandospirone on GAD". A total of 274 patients with GAD were included and randomized into the high-dose (tandospirone 60 mg/d) and low-dose (tandospirone 30 mg/d) groups for a 6-week treatment. The Hamilton Anxiety (HAMA), Clinical Global Impression-Severity (CGI-S), Short-Form-12 (SF-12) scales were used for assessment. The trial was registered at clinical trail.gov (NCT01614041). RESULTS (1) In the first week of treatment, 35.8% of patients in the high-dose group fulfilled the early onset criteria, which was significantly higher than 19.0% found in the low-dose group (p = 0.002). In the second week of treatment, 22.6% of patients in the high-dose group achieved an early response, versus 12.4% in the low-dose group, indicating a significant difference (p = .026). (2) Factors associated with early onset at week 1 included baseline HAMA total score (OR = 0.916, 95%CI 0.882-0.952), age (OR = 0.974, 95%CI 0.950-0.998), drug dose (30 mg vs. 60 mg; OR = 0.298, 95%CI 0.156-0.568) and SF-12 physiological total score (OR = 1.030, 95%CI 1.010-1.050). (3) Early onset was significantly associated with response rate (OR = 18.34, 95%CI 12.10-27.81), remarkable response rate (OR = 27.56, 95%CI 11.65-65.17) and recovery rate (OR = 11.85, 95%CI 4.98-28.18). Group (high dose group vs. low dose group) (χ2 = 8.535, p = .003) and baseline HAMA total score (χ2 = 70.840, p < .001) were independent predictors of onset time. CONCLUSIONS The early outcomes of high-dose tandospirone in the treatment of GAD are better than those of the low-dose group. Patients with younger age at onset, milder anxiety symptoms and better physiological functions administered high-dose tandospirone showed rapid onset, great early outcomes, high recovery rate and good prognosis. Drug onset time had a good predictive effect on treatment outcome.
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Affiliation(s)
- Yi Fu
- Department of Psychiatry, Tongji Hospital, Tongji University School of Medicine, Shanghai, P.R. China
| | - Jian Lin Ji
- Zhongshan Hospital, Fudan University, Shanghai, P.R. China
| | - Shen Xun Shi
- Huashan Hospital Affiliated to Fudan University, Shanghai, P.R. China
| | | | - Guo Zhen Lin
- Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, P.R. China
| | | | - Xiuli Li
- Beijing Tsinghua Chang Gung Hospital, Beijing, P.R. China
| | - Wen Yuan Wu
- Department of Psychiatry, Tongji Hospital, Tongji University School of Medicine, Shanghai, P.R. China
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Lin T, Anderson T, Austin M, Mischkowski D. Early trajectories of symptom change and working alliance as predictors of treatment outcome. Psychother Res 2023; 33:185-197. [PMID: 35659497 DOI: 10.1080/10503307.2022.2080028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE We aim to examine how different trajectories of symptom change and working alliance in early psychotherapy predict treatment outcomes. METHOD We performed a growth mixture model (GMM) to examine trajectories of symptom change and working alliance in the first five therapy sessions in a sample of 272 outpatients and tested the association of early symptom trajectories and alliance patterns with treatment outcome. RESULTS We identified two symptom trajectories: high symptom/steady change (63.2%) and early improving (36.8%), and four alliance development patterns: undeveloped alliance (40.1%), strengthening moderate alliance (31.6%), optimal alliance (17.3%), and improved alliance (11%) in early psychotherapy. The symptom trajectories and alliance patterns both independently and interactively predicted treatment outcomes. The optimal alliance was generally associated with the best outcome. The effect of improved alliance on treatment outcome was moderated by symptom trajectories: for high symptom/steady change subgroup, the improved alliance was related to better treatment outcome, whereas for early improving subgroup, the improved alliance was associated with poorer outcome. CONCLUSIONS Patients fell into different trajectories regarding symptom reduction and alliance development in early psychotherapy that affected final treatment outcome. Combining early symptom trajectories and alliance trajectories simultaneously can facilitate routine outcome monitoring and contribute to the prediction of treatment outcome.
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Affiliation(s)
- Tao Lin
- Department of Psychology, Ohio University, Athens, OH, USA
| | | | - Megan Austin
- Department of Psychology, Ohio University, Athens, OH, USA
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10
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Mertens E, Deković M, Van Londen M, Nye E, Reitz E. Solid as a rock, flexible as water? Effectiveness of a school-based intervention addressing students' intrapersonal and interpersonal domains. J Sch Psychol 2022; 92:1-18. [DOI: 10.1016/j.jsp.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/30/2021] [Accepted: 02/11/2022] [Indexed: 10/19/2022]
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Fuhr K, Werle D, Batra A. How does early symptom change predict subsequent course of depressive symptoms during psychotherapy? Psychol Psychother 2022; 95:137-154. [PMID: 34676660 DOI: 10.1111/papt.12370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/28/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Previous studies reported about the influence of early changes on treatment response. However, the question of whether early changes can predict the subsequent course of depressive symptoms during treatment with psychotherapy has not yet been clearly answered. We aimed to investigate whether symptom course in the first weeks at the level of individual session can predict the further symptom progression on a session to session level during psychotherapy treatment in patients with Major Depression (MD). DESIGN Monocentric randomized controlled trial with psychotherapeutic treatment either with cognitive-behavioural therapy (CBT) or hypnotherapy (HT). The longitudinal course of weekly depressive symptoms during the six months treatment period was examined. METHODS In this RCT with 152 randomized patients suffering from current mild-to-moderate MD, depressive symptoms were assessed on a weekly basis during the 20 sessions' treatment with individual psychotherapy. We only included patients for which sufficient data for our analysis were available. Three different linear and quadratic mixed model analyses with random effects for each patient were tested: Early change was defined as the individual percentage symptom change during the first two, three, four and five weeks. Symptoms from session four, five, six and seven onward were predicted using different models, with early change added to the model in a final step. Calculating all models separately for CBT and HT lead to comparable results. RESULT A slow symptom decrease after session four, five, six, seven onward to the end of the treatment was found. However, adding early change to the model, had no effect on the further symptom course in all models. CONCLUSION Symptom changes at early stages of psychotherapy should not be considered as being predictive for further symptom course. PRACTITIONER POINTS The individual early symptom change in a treatment with psychotherapy in the first two, three, four, or five weeks of treatment does not predict the subsequent symptom course from session four, five, six, or seven onward at a session to session level. Symptom changes at early stages of psychotherapy should not be considered as being predictive for further symptom course. We found a symptom reduction ranging from 3% to 16% in the first two, three, four, or five weeks. Treatment response between the first and last therapy session was found in 54.5%, the number of remitted patients (with PHQ-9 scores < 5) was 44.7%. A small symptom improvement of between 0.21 and 0.42 points in the PHQ-9 scores per week in later stages of psychotherapy is likely in all patients (with and without early symptom improvement).
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Affiliation(s)
- Kristina Fuhr
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Germany
| | - Dustin Werle
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Tuebingen, Germany
| | - Anil Batra
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Germany
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Zhang A, Wang X, Li J, Jing L, Hu X, Li H, Yang C, Zhang K, Sun N. Resting-State fMRI in Predicting Response to Treatment With SSRIs in First-Episode, Drug-Naive Patients With Major Depressive Disorder. Front Neurosci 2022; 16:831278. [PMID: 35250466 PMCID: PMC8888836 DOI: 10.3389/fnins.2022.831278] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/27/2022] [Indexed: 01/01/2023] Open
Abstract
Objective For major depressive disorder (MDD), there has been a lack of neuroimaging markers of efficacy of pharmacological treatment. In this study, we aimed to explore the neuroimaging mechanisms in patients with first-episode MDD and identify markers that predict the efficacy of 5-hydroxytryptamine reuptake inhibitors (SSRIs) with the use of resting-state brain imaging technology. Methods A total of 101 patients with first-episode MDD and 53 normal controls were finally included in this study. Based on the reduction rate of the score of Hamilton Depression Rating Scale (HAMD-17) during the 2-week SSRI treatment, 31 patients were assigned into the unresponsive group and 32 were assigned into the responsive group. The brain function was compared between patients with MDD and normal controls, and the diagnostic value of brain function was analyzed. With brain regions showing differences between patients with MDD and normal controls as a mask, and the brain function between the responsive and unresponsive groups were compared. Correlations between brain function the HAMD-17 score reduction rate during the 2-week SSRI treatment were analyzed. Results Compared to normal controls, patients with MDD showed increased ReHo in the left parahippocampal gyrus and right parahippocampal gyrus, decreased ReHo in the right middle occipital gyrus, and decreased functional connectivity between the right and left parahippocampal gyri, right middle occipital gyrus and middle temporal gyrus. Receiver operator characteristic (ROC) curve analysis showed that the area under the curve (AUC) was 0.544 (95% CI: 0.445–0.644) for ReHo and 0.822 (95% CI: 0.734–0.909) for functional connectivity. Logistic regression pooling of the differences in ReHo mean time series with the functional connectivity mean time series was performed for the ROC curve analysis, which showed an AUC of 0.832 (95% CI: 0.752–0.911). Compared to the responsive group, the unresponsive group showed elevated ReHo in the right parahippocampal gyrus and lower functional connectivity in the middle temporal gyrus. We also found that the ReHo value was negatively correlated with the HAMD-17 score reduction after 2 weeks of SSRI treatment. Conclusion Altered resting-state brain function in some regions might be a neurobiological marker for the diagnosis of MDD, and ReHo values are expected to be predictors of patient response to treatment with SSRIs. Clinical Trial Registration [http://www.chictr.org.cn/], identifier [ChiCTR1900028722].
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Affiliation(s)
- Aixia Zhang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
- First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Xin Wang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
- First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Jianying Li
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
- First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Lin Jing
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
- First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Xiaodong Hu
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
- First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Hejun Li
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
- First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Chunxia Yang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
- First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Kerang Zhang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
- First Clinical Medical College of Shanxi Medical University, Taiyuan, China
- *Correspondence: Kerang Zhang,
| | - Ning Sun
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
- First Clinical Medical College of Shanxi Medical University, Taiyuan, China
- Department of Mental Health, Shanxi Medical University, Taiyuan, China
- Ning Sun,
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Ji S, Liu B, Li Y, Chen N, Fu Y, Shi J, Zhao Z, Yao Z, Hu B. Trait and state alterations in excitatory connectivity between subgenual anterior cingulate cortex and cerebellum in patients with current and remitted depression. Psychiatry Res Neuroimaging 2021; 317:111356. [PMID: 34509806 DOI: 10.1016/j.pscychresns.2021.111356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 07/06/2021] [Accepted: 08/03/2021] [Indexed: 11/27/2022]
Abstract
Neuroimaging studies have indicated that the altered functional connectivity (FC) of the subgenual anterior cingulate cortex (sgACC) might be potential pathophysiology of major depressive disorder (MDD). However, directed connectivity is proven to be more closely to neurophysiological processes underlying brain activity than FC. This study aimed to identify the alterations underlying directed connectivity of the sgACC in patients with current and remitted MDD. We conducted a cross-sectional neuroimaging study by recruiting 36 patients with current MDD, 20 patients with remitted MDD, and 36 matched healthy controls. Multiple linear regression was employed to estimate bidirectional connectivity between bilateral sgACC and 115 brain regions over 230 time points. Besides, graph theory was applied to further investigate the information transfer across bilateral sgACC and abnormal brain regions. We found that both patients with current and remitted MDD showed a similar abnormality in bidirectional excitatory connectivity between the left sgACC and the right cerebellum. Patients with current MDD exhibited an increase in excitatory connectivity from the left cerebellum to the right sgACC, which was positively correlated with the HAMD score. Meanwhile, significantly decreased betweenness of the left sgACC was detected in all depressive patients. Our findings suggest that the changed bidirectional excitatory connectivity between the left sgACC and the right cerebellum might be a trait alteration and the abnormal increased excitatory connectivity from the left cerebellum to the right sgACC might be a state alteration of MDD. This work may provide a valuable contribution to identify trait and state alterations in the brain for depression.
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Affiliation(s)
- Shanling Ji
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, PR China
| | - Bangshan Liu
- Department of Psychiatry, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, PR China; Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, PR China
| | - Yongchao Li
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, PR China
| | - Nan Chen
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, PR China
| | - Yu Fu
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, PR China
| | - Jie Shi
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, PR China
| | - Ziyang Zhao
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, PR China
| | - Zhijun Yao
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, PR China.
| | - Bin Hu
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, PR China; CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, PR China.
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Functional connectivity of the hippocampus in predicting early antidepressant efficacy in patients with major depressive disorder. J Affect Disord 2021; 291:315-321. [PMID: 34077821 DOI: 10.1016/j.jad.2021.05.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 05/01/2021] [Accepted: 05/05/2021] [Indexed: 02/08/2023]
Abstract
BAKGROUD The hippocampus is involved in the pathophysiology of major depressive disorder (MDD), and its structure and function have been reported to be related to the antidepressant response. This study aimed to identify relationships between hippocampal functional connectivity (FC) and early improvement in patients with MDD and to further explore the ability of hippocampal FC to predict early efficacy. METHODS Thirty-six patients with nonpsychotic MDD were recruited and underwent resting-state functional magnetic resonance imaging scans at baseline. After two weeks of treatment with escitalopram, patients were divided into subgroups with early improved depression (EID, n= 19) and nonimproved depression (NID, n=17) . A voxelwise FC analysis was performed with the bilateral hippocampus as seeds, two-sample t-tests were used to compare hippocampal FC between groups. Receiver operating characteristic (ROC) curves were constructed to determine the best FC measures and optimal threshold for differentiating EID from END. RESULTS The EID group showed significantly higher FC between the left hippocampus and left inferior frontal gyrus and precuneus than the END group. And the left hippocampal FC of these two regions were positively correlated with the reduction ratio of the depressive symptom scores. The ROC curve analysis revealed that summed FC scores for these two regions exhibited the highest area under the curve, with a sensitivity of 0.947 and specificity of 0.882 at a summed score of 0.14. LIMITATIONS The sample used in this study was relatively small. CONCLUSIONS These findings demonstrated that FC of the left hippocampus can predict early efficacy of antidepressant.
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15
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Wu P, Zhang A, Sun N, Lei L, Liu P, Wang Y, Li H, Yang C, Zhang K. Cortical Thickness Predicts Response Following 2 Weeks of SSRI Regimen in First-Episode, Drug-Naive Major Depressive Disorder: An MRI Study. Front Psychiatry 2021; 12:751756. [PMID: 35273524 PMCID: PMC8902047 DOI: 10.3389/fpsyt.2021.751756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 12/23/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Major depression disorder (MDD) is a harmful disorder, and the pathological mechanism remains unclear. The primary pharmacotherapy regimen for MDD is selective serotonin reuptake inhibitors (SSRIs), but fewer than 40% of patients with MDD are in remission following initial treatment. Neuroimaging biomarkers of treatment efficacy can be used to guide personalized treatment in MDD. This study aims to determine if cortical thickness can be used as a predictor for SSRIs. METHODS A total of 126 first-episode, drug-naive MDD patients (MDDs) and 71 healthy controls (HCs) were enrolled in our study. Demographic data were collected according to the self-made case report form (CRF) at the baseline of all subjects. Magnetic resonance imaging (MRI) scanning was performed for all the participants at baseline, and all imaging was processed using the DPABISurf software. All MDDs were treated with SSRIs, and symptoms were assessed at both the baseline and 2 weeks using the 17-item Hamilton Rating Scale (HAMD-17). According to HAMD-17 total score improvement from baseline to the end of 2 weeks, the MDDs were divided into the non-responder group (defined as ≤ 20% HAMD-17 reduction) and responder group (defined as ≥50% HAMD-17 reduction). The receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of MDDs' and HCs' cortical thickness for MDD. Correlation analysis was performed for the responder group and the non-responder group separately to identify the relationship between cortical thickness and SSRI treatment efficacy. To analyze whether cortical thickness was sufficient to differentiate responders and non-responders at baseline, we used ROC curve analysis. RESULTS Significant decreases were found in the cortical thickness of the right supplementary motor area (SMA) in MDDs at the baseline (corrected by the Monte Carlo permutation correction, cluster-wise significant threshold at p < 0.025 and vertex-wise threshold at p = 0.001), area under the curve (AUC) = 0.732 [95% confidence interval (CI) = 0.233-0.399]. In the responder group, the cortical thickness of the right SMA was significantly thinner than in the non-responder group at baseline. There was a negative correlation (r = -0.373, p = 0.044) between the cortical thickness of SMA (0 weeks) and HAMD-17 reductive rate (2 weeks) in the responder group. The results of ROC curve analyses of the responder and non-responder groups were AUC = 0.885 (95% CI = 0.803-0.968), sensitivity = 73.5%, and specificity = 96.6%, and the cutoff value was 0.701. CONCLUSION Lower cortical thickness of the right SMA in MDD patients at the baseline may be a neuroimaging biomarker for MDD diagnosis, and a greater extent of thinner cortical thickness in the right SMA at baseline may predict improved SSRI treatment response. Our study shows the potential of cortical thickness as a possible biomarker that predicts a patient's clinical treatment response to SSRIs in MDD.
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Affiliation(s)
- Peiyi Wu
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China.,Department of Psychiatry, Shanxi Medical University, Taiyuan, China
| | - Aixia Zhang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Ning Sun
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China.,Department of Mental Health, Shanxi Medical University, Taiyuan, China
| | - Lei Lei
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China.,Department of Psychiatry, Shanxi Medical University, Taiyuan, China
| | - Penghong Liu
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yikun Wang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Hejun Li
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Chunxia Yang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Kerang Zhang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
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Huntley ED, Swanson LM, Kolenic GE, Bertram H, Mooney A, Dopp R, Arnedt JT. Associations between Self-Reported Daily Affect Ratings and Sleep Duration during the First Two Weeks of Antidepressant Therapy. Behav Sleep Med 2021; 19:1-11. [PMID: 31760780 PMCID: PMC7244362 DOI: 10.1080/15402002.2019.1695617] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: In the context of a randomized controlled trial evaluating the efficacy of augmenting fluoxetine treatment in young adults with major depressive disorder (MDD) using a modified repeated partial sleep deprivation protocol contrasting 2 weeks of restricted time in bed (i.e., 6 h TIB) to no time in bed restriction (i.e., 8 h TIB) the study examines whether sleep duration and the timing of repeated partial sleep deprivation predicts patient-reported affect ratings. Participants: Participants included 58 young adults with DSM-IV-diagnosed MDD. Methods: Daily ratings of affect and sleep were collected during the first 2 weeks of initiating fluoxetine treatment, yielding 630 person-days. Actigraphy monitoring was employed to assess compliance with time in bed condition. Results: Negative affect ratings and positivity ratios in the morning were more improved among participants assigned to the 6 h TIB condition compared to the 8 h TIB group. Participants whose bedtime was delayed by 2-h nightly demonstrated the most significant improvement in negative affect and positivity ratio during the first 2 weeks of fluoxetine therapy. Moreover, the trajectory of morning negative affect ratings in the first 2 weeks was predictive of remission after 4 weeks of fluoxetine therapy. Conclusions: These findings suggest that monitoring changes in daily affect may be a valuable marker of early treatment response in young adults with MDD.
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Affiliation(s)
| | | | - Giselle E. Kolenic
- Program on Women’s Health Care Effectiveness Research, Department of Obstetrics and Gynecology, University of Michigan
| | | | - Ann Mooney
- Department of Psychiatry, University of Michigan
| | - Richard Dopp
- Department of Psychiatry, University of Michigan
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Mütze K, Witthöft M, Bräscher AK. Prediction of Therapeutic Outcome in a Naturalistic Setting Using Pretreatment Psychological Distress Indicators. VERHALTENSTHERAPIE 2020. [DOI: 10.1159/000510272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: Outcome predictions allow to improve psychotherapy and to increase economic benefit. The efficient translation into practice requires simple prediction methods. The present study evaluates the prediction of treatment outcome based on initial distress level. Methods: Routine data of a university psychotherapy outpatient clinic were used (N = 3,145, Mage = 35.8, 67% female). Low versus high distress patients (classified by overall psychological distress, symptomatology, and previous treatment) were compared on total reduction in psychopathology, (early) response, remission, and premature treatment discontinuation using t tests and logistic regressions. Response and remission were assessed via relative (percentage improvement) and absolute measures (Reliable Change Index; RCI). Results: Distress level was inversely related to percentage improvement (OR = 0.62) and remission (OR = 0.34). It was positively related to total reduction in psychopathology (d = 0.63), RCI response (OR = 2.37), and treatment discontinuation (OR = 2.15). Early response and treatment discontinuation partially mediated the relationship between distress level and treatment outcome. Conclusions: Treatment success tends to be lower when initial distress is high, but this finding appears contingent on the operationalization of treatment outcome. The presented classification approach is easy to implement in practice and may be useful in order to counter an excessive workload in psychotherapy trainees.
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Mütze K, Witthöft M, Bräscher AK. Die Prognose psychotherapeutischer Behandlungsergebnisse im naturalistischen Setting durch Belastungsindikatoren zu Behandlungsbeginn. VERHALTENSTHERAPIE 2020. [DOI: 10.1159/000509233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
<b><i>Hintergrund:</i></b> Erfolgsprognosen ermöglichen eine stetige Weiterentwicklung und ökonomische Anwendung von Psychotherapie. Deren effizienter Einsatz in der Praxis bedarf einer einfach umzusetzenden Prognosestellung. Die vorliegende Studie prüft die Vorhersage von Therapieerfolg aufgrund des anfänglichen Belastungsniveaus. <b><i>Methoden:</i></b> Verwendet wurden Daten aus der Routineevaluation einer psychotherapeutischen Hochschulambulanz von 3’145 PatientInnen (M<sub>Alter</sub> = 35,8, 67% weiblich). Anhand vor Therapiebeginn vorliegender Kriterien (allgemeine psychische Belastung, Symptomatik, Vorbehandlung) wurden niedrig versus hoch belastete PatientInnen differenziert und bezüglich der Erfolgsmaße absolute Belastungsreduktion, (Early) Response, Remission und Therapieabbruch mithilfe von <i>t</i>-Tests und logistischen Regressionsanalysen verglichen. Response und Remission wurden über ein relatives (prozentuale Verbesserung) und ein absolutes Maß (Reliable Change Index, RCI) operationalisiert. <b><i>Ergebnisse:</i></b> Hohe psychische Belastung stand in negativem Zusammenhang mit Response gemäß prozentualer Verbesserung (OR = 0,62) und Remission (OR = 0,34) sowie in positivem Zusammenhang mit absoluter Belastungsreduktion (<i>d</i> = 0,63), RCI-Response (OR = 2,37) und Therapieabbruch (OR = 2,15). Early Response und Therapieabbruch nahmen im Zusammenhang von anfänglichem Belastungsniveau und Behandlungserfolg eine partiell vermittelnde Rolle ein. <b><i>Schlussfolgerungen:</i></b> Behandlungserfolge fallen bei hoher anfänglicher psychischer Belastung vergleichsweise geringer aus, wobei die Operationalisierung von Erfolg eine entscheidende Rolle spielt. Die vorgestellte Klassifizierung ist leicht umzusetzen und kann im Ausbildungssetting helfen, einer therapeutischen Überlastung entgegenzuwirken.
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Ju Y, Horien C, Chen W, Guo W, Lu X, Sun J, Dong Q, Liu B, Liu J, Yan D, Wang M, Zhang L, Guo H, Zhao F, Zhang Y, Shen X, Constable RT, Li L. Connectome-based models can predict early symptom improvement in major depressive disorder. J Affect Disord 2020; 273:442-452. [PMID: 32560939 DOI: 10.1016/j.jad.2020.04.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/24/2020] [Accepted: 04/21/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) is a debilitating mental illness with more than 50% of patients not achieving an adequate response using first-line treatments. Reliable models that predict antidepressant treatment outcome are needed to guide clinical decision making. We aimed to build predictive models of treatment improvement for MDD patients using machine learning approaches based on fMRI resting-state functional connectivity patterns. METHODS Resting-state fMRI data were acquired from 192 untreated MDD patients at recruitment, and their severity of depression was assessed by Hamilton Rating Scale for Depression (HAMD) at baseline. Patients were given medication after the initial MR scan and their symptoms were monitored through HAMD for a period of six months. Connectome-based predictive modeling (CPM) algorithms were implemented to predict the improvement in HAMD score at one month from resting-state connectivity at baseline. Additionally, by selectively combining the features from all leave-one-out iterations in the model building stage, we created a consensus model that could be generalized to predict improvement in HAMD score in samples of non-overlapping subjects at different time points. RESULTS Using baseline functional connectivity, CPM successfully predicted symptom improvement of depression at one month. In addition, a consensus 'MDD improvement model' could predict symptom improvement for novel individuals at the two-week, one-month, two-month and three-month time points after antidepressant treatment. CONCLUSIONS Individual pre-treatment functional brain networks contain meaningful information that can be gleaned to build predictors of treatment outcome. The identified MDD improvement networks could be an appropriate biomarker for predicting individual therapeutic response of antidepressant treatment. Replication and validation using other large datasets will be a key next step before these models can be used in clinical practice.
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Affiliation(s)
- Yumeng Ju
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Corey Horien
- Interdepartmental Neuroscience Program, Yale University School of Medicine, New Haven, CT, USA
| | - Wentao Chen
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China
| | - Weilong Guo
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China
| | - Xiaowen Lu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China
| | - Jinrong Sun
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China
| | - Qiangli Dong
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China
| | - Bangshan Liu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China
| | - Jin Liu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China
| | - Danfeng Yan
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China
| | - Mi Wang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China
| | - Liang Zhang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China
| | - Hua Guo
- Zhumadian Psychiatric Hospital, Zhumadian, Henan 463000, China
| | - Futao Zhao
- Zhumadian Psychiatric Hospital, Zhumadian, Henan 463000, China
| | - Yan Zhang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China.
| | - Xilin Shen
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, USA
| | - R Todd Constable
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, USA; Department of Neurosurgery, Yale School of Medicine, USA; Interdepartmental Neuroscience Program, Yale School of Medicine, USA
| | - Lingjiang Li
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China.
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20
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Yuan H, Zhu X, Tang W, Cai Y, Shi S, Luo Q. Connectivity between the anterior insula and dorsolateral prefrontal cortex links early symptom improvement to treatment response. J Affect Disord 2020; 260:490-497. [PMID: 31539685 DOI: 10.1016/j.jad.2019.09.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/09/2019] [Accepted: 09/08/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Early improvement (EI) following treatment with antidepressants is a widely reported predictor to the treatment response. This study aimed to identify the resting-state functional connectivity (rs-FC) and its related clinical features that link the treatment response at the time of EI. METHODS This study included 23 first-episode treatment-naive patients with MDD. After 2 weeks of antidepressant treatment, these patients received 3.0 Tesla resting-state functional magnetic resonance imaging scanning and were subgrouped into an EI group (N = 13) and a non-EI group (N = 10). Using the anterior insula (rAI) as a seed region, this study identified the rs-FC that were associated with both EI and the treatment response at week 12, and further tested the associations of the identified rs-FC with either the clinical features or the early symptom improvement. RESULTS Rs-FC between rAI and the left dorsolateral prefrontal cortex (dlPFC) was associated with EI (t21 = -6.091, p = 0.022 after FDR correction for multiple comparisons). This rs-FC was also associated with an interaction between EI and the treatment response at the week 12 (t21 = -5.361, p = 6.37e-5). Moreover, among the clinical features, this rs-FC was associated with the early symptom improvement in the insomnia, somatic symptoms, and anxiety symptoms, and these early symptom improvements were associated with the treatment response. CONCLUSION Rs-FC between the rAI and the left dlPFC played a crucial role in the early antidepressant effect, which linked the treatment response. The early treatment effect relating to rAI may represent an early symptom improvement in self-perceptual anxiety, somatic symptoms and insomnia.
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Affiliation(s)
- Hsinsung Yuan
- Psychiatry Department of Huashan Hospital, Fudan University, Shanghai, China; Psychiatry Department of Nanjing Meishan Hospital, Nanjing, China
| | - Xiao Zhu
- Psychiatry Department of Huashan Hospital, Fudan University, Shanghai, China
| | - Weijun Tang
- Radiological Department of Huashan Hospital, Fudan University, Shanghai, China
| | - Yiyun Cai
- Psychiatry Department of Huashan Hospital, Fudan University, Shanghai, China
| | - Shenxun Shi
- Psychiatry Department of Huashan Hospital, Fudan University, Shanghai, China.
| | - Qiang Luo
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China; Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Ministry of Education), Fudan University, Shanghai, China.
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21
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Furukawa TA, Kato T, Shinagawa Y, Miki K, Fujita H, Tsujino N, Kondo M, Inagaki M, Yamada M. Prediction of remission in pharmacotherapy of untreated major depression: development and validation of multivariable prediction models. Psychol Med 2019; 49:2405-2413. [PMID: 30430961 PMCID: PMC6763536 DOI: 10.1017/s0033291718003331] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/29/2018] [Accepted: 10/15/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Depression is increasingly recognized as a chronic and relapsing disorder. However, an important minority of patients who start treatment for their major depressive episode recover to euthymia. It is clinically important to be able to predict such individuals. METHODS The study is a secondary analysis of a recently completed pragmatic megatrial examining first- and second-line treatments for hitherto untreated episodes of non-psychotic unipolar major depression (n = 2011). Using the first half of the cohort as the derivation set, we applied multiply-imputed stepwise logistic regression with backward selection to build a prediction model to predict remission, defined as scoring 4 or less on the Patient Health Quetionnaire-9 at week 9. We used three successively richer sets of predictors at baseline only, up to week 1, and up to week 3. We examined the external validity of the derived prediction models with the second half of the cohort. RESULTS In total, 37.0% (95% confidence interval 34.8-39.1%) were in remission at week 9. Only the models using data up to week 1 or 3 showed reasonable performance. Age, education, length of episode and depression severity remained in the multivariable prediction models. In the validation set, the discrimination of the prediction model was satisfactory with the area under the curve of 0.73 (0.70-0.77) and 0.82 (0.79-0.85), while the calibration was excellent with non-significant goodness-of-fit χ2 values (p = 0.41 and p = 0.29), respectively. CONCLUSIONS Patients and clinicians can use these prediction models to estimate their predicted probability of achieving remission after acute antidepressant therapy.
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Affiliation(s)
- Toshi A. Furukawa
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | | | | | | | - Hirokazu Fujita
- Center to Promote Creativity in Medical Education, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Naohisa Tsujino
- Department of Neuropsychiatry, Toho University School of Medicine, Tokyo, Japan
| | - Masaki Kondo
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Masatoshi Inagaki
- Department of Psychiatry, Shimane University Faculty of Medicine, Izumo, Japan
| | - Mitsuhiko Yamada
- Department of Neuropsychopharmacology, National Center of Neurology and Psychiatry, Tokyo, Japan
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22
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Beard JIL, Delgadillo J. Early response to psychological therapy as a predictor of depression and anxiety treatment outcomes: A systematic review and meta-analysis. Depress Anxiety 2019; 36:866-878. [PMID: 31233263 DOI: 10.1002/da.22931] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 05/10/2019] [Accepted: 05/25/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Previous studies indicate that early symptomatic improvement, typically observed during the first 4 weeks of psychological therapy, is associated with positive treatment outcomes for a range of mental health problems. However, the replicability, statistical significance, and magnitude of this association remain unclear. AIM The current study reviewed the literature on early response to psychological interventions for adults with depression and anxiety symptoms. METHODS A systematic review and random effects meta-analysis were conducted, including studies found in Medline, PsychINFO, SCOPUS, Web of Science, and through reference lists and reverse citations. RESULTS Twenty-five eligible studies including 11,091 patients measured early response and examined associations with posttreatment outcomes. It was possible to extract and/or calculate effect size data from 15 studies to conduct a meta-analysis. A large pooled effect size (g = 0.87 [95% confidence interval: 0.63-1.10], p < .0001) indicated that early responders had significantly better posttreatment outcomes compared to cases without early response, and this effect was larger in anxiety (g = 1.37) compared to depression (g = 0.76) measures. Most studies were of good quality and there was no evidence of publication bias. The main limitations concerned insufficient statistical reporting in some studies, which precluded their inclusion in meta-analysis, and it was not possible to examine effect sizes according to different outcome questionnaires. CONCLUSION There is robust and replicated evidence that early response to therapy is a reliable prognostic indicator for depression and anxiety treatment outcomes.
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Affiliation(s)
- Jessica I L Beard
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Jaime Delgadillo
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, United Kingdom
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23
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Singla DR, Hollon SD, Fairburn CG, Dimidjian S, Patel V. The Roles of Early Response and Sudden Gains on Depression Outcomes: Findings From a Randomized Controlled Trial of Behavioral Activation in Goa, India. Clin Psychol Sci 2019; 7:768-777. [PMID: 31380144 PMCID: PMC6628464 DOI: 10.1177/2167702619825860] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 10/29/2018] [Indexed: 11/15/2022]
Abstract
The Healthy Activity Program (HAP), a brief, lay-counselor-delivered, behavioral activation psychological treatment, was found to be effective in reducing depressive symptoms among primary care attendees in India. We now examine whether early response predicts depression (PHQ-9) outcomes at the primary endpoint of 3 months and sustained recovery at 12 months after enrollment and the extent to which this effect is influenced by sudden gains in the context of the larger randomized controlled trial. HAP participants (N = 245) who exhibited an early response (150 of 245 or 61.2%), as defined by a 50% reduction in depressive symptoms from baseline to Session 3, had lower depressive symptom scores than those who did not at 3 months (5.29 vs. 10.75, F = 33.21, p < .001) and at 12 months (6.56 vs. 11.02, F = 21.84, p < .001). Further exploratory analyses suggested that this advantage was largely confined to the subset of early responders who also showed sudden gains (87 of 150).
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Affiliation(s)
- Daisy R Singla
- Department of Psychiatry, University of Toronto, and Sinai Health System, Toronto, Canada
| | | | | | - Sona Dimidjian
- Department of Psychology and Neuroscience, University of Colorado Boulder
| | - Vikram Patel
- Sangath Center, Goa, India.,Department of Global Health and Social Medicine, Harvard Medical School.,Department of Global Health and Population, Harvard TH Chan School of Public Health
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24
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Vittengl JR, Clark LA, Thase ME, Jarrett RB. Estimating outcome probabilities from early symptom changes in cognitive therapy for recurrent depression. J Consult Clin Psychol 2019; 87:510-520. [PMID: 31008632 PMCID: PMC6853186 DOI: 10.1037/ccp0000409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Acute-phase cognitive therapy (CT) is an efficacious treatment for major depressive disorder (MDD) producing benefits comparable to pharmacotherapy, but not all patients respond or remit. The purpose of the current analyses was to estimate CT patients' probability of nonresponse and remission from symptom improvement early in treatment. METHOD Data from 2 clinical trials of acute-phase CT for recurrent depression were pooled for analysis (N = 679). Adult outpatients received 16- or 20-session CT protocols. Symptoms were measured repeatedly with the clinician-report Hamilton Rating Scale for Depression (HRSD) and Inventory of Depressive Symptomatology-Self-Report (IDS-SR). Outcomes at exit from CT were nonresponse (<50% reduction in HRSD scores) and remission (no MDD and HRSD score ≤6). RESULTS The nonresponse rate was 45.7%, and the remission rate was 33.4%. In logistic regression models, improvements on the HRSD or IDS-SR from intake to CT Sessions 3, 5, 7, 9, or 11 significantly predicted both outcomes, with prediction gaining in accuracy in later sessions. Clinician and self-report assessments yielded similar results. Prediction of outcomes replicated across data sets. Patients with no symptom improvement by CT Session 9 (Week 5) had ≤10% probability of remission and >75% probability of nonresponse. CONCLUSIONS Outcomes of CT for depression are predictable from early symptom changes. Clinicians may find nonresponse and remission probability estimates useful in the informed consent process and in choosing whether to continue, augment, or switch treatments for CT patients with recurrent MDD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | | | - Michael E Thase
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
| | - Robin B Jarrett
- Department of Psychiatry, The University of Texas Southwestern Medical Center
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25
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Noma H, Furukawa TA, Maruo K, Imai H, Shinohara K, Tanaka S, Ikeda K, Yamawaki S, Cipriani A. Exploratory analyses of effect modifiers in the antidepressant treatment of major depression: Individual-participant data meta-analysis of 2803 participants in seven placebo-controlled randomized trials. J Affect Disord 2019; 250:419-424. [PMID: 30878654 DOI: 10.1016/j.jad.2019.03.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 02/24/2019] [Accepted: 03/04/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND It is clinically important to know who are likely to respond more or less to antidepressants. However, meaningful effect modifiers (variables associated with differential response depending on the treatment) are yet to be identified. METHODS We conducted individual participant data (IPD) meta-analysis and meta-regression to explore effect modifiers in placebo-controlled antidepressant trials conducted so far in Japan. RESULTS We obtained access to IPD from seven placebo-controlled trials comparing bupropion, duloxetine, escitalopram, mirtazapine, paroxetine or venlafaxine with placebo in the acute phase treatment of major depression (total n = 2803). The higher the guilt subscale score of the baseline Hamilton Rating Scale for Depression (HRSD), the greater the difference in reduction in depression severity between the antidepressants and placebo at week 6, while the older the current age or the age at onset, the smaller the difference. At week 8, the guilt subscale score of HRSD and presence of suicidal ideation at baseline predicted greater, and the anhedonia subscale and insomnia subscale scores of HRSD and early response at week 2 predicted smaller, difference in reduction. LIMITATIONS Different studies measured different sets of baseline variables and we were able to analyze only a limited set of candidate variables for effect modification. CONCLUSION Age, age at onset, several HRSD subscales including guilt, anhedonia and insomnia, presence of suicidal ideation at baseline and early response are potential effect modifiers for response to antidepressants in the acute phase antidepressant treatment of major depression. Future trials need to measure these and additional variables in concerted efforts to enable matching of treatments with individual characteristics in depression.
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Affiliation(s)
- Hisashi Noma
- Department of Data Science, The Institute of Statistical Mathematics, Tokyo, Japan.
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan.
| | - Kazushi Maruo
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Hissei Imai
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan.
| | - Kiyomi Shinohara
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan.
| | - Shiro Tanaka
- Department of Clinical Biostatistics, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan.
| | - Kazutaka Ikeda
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.
| | - Shigeto Yamawaki
- Brain, Mind and Kansei Sciences Research Center, Hiroshima University, Hiroshima, Japan.
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26
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Prediction of prolonged treatment course for depressive and anxiety disorders in an outpatient setting: The Leiden routine outcome monitoring study. J Affect Disord 2019; 247:81-87. [PMID: 30658244 DOI: 10.1016/j.jad.2018.12.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/04/2018] [Accepted: 12/16/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of this study was to improve clinical identification of patients with a prolonged treatment course for depressive and anxiety disorders early in treatment. METHOD We conducted a cohort study in 1.225 adult patients with a depressive or anxiety disorders in psychiatric specialty care setting between 2007 and 2011, with at least two Brief Symptom Inventory (BSI) assessments within 6 months. With logistic regression, we modelled baseline age, gender, ethnicity, education, marital status, housing situation, employment status, psychiatric comorbidity and both baseline and 1st follow-up BSI scores to predict prolonged treatment course (>2 years). Based on the regression coefficients, we present an easy to use risk prediction score. RESULTS BSI at 1st follow-up proved to be a strong predictor for both depressive and anxiety disorders (OR = 2.17 (CI95% 1.73-2.74); OR = 2.52 (CI95% 1.86-3.23)). The final risk prediction score included BSI 1st follow-up and comorbid axis II disorder for depressive disorder, for anxiety disorders BSI 1st follow-up and age were included. For depressive disorders, for 28% of the patients with the highest scores, the positive predictive value for a prolonged treatment course was60% (sensitivity 0.38, specificity 0.81). For anxiety disorders, for 35% of the patients with the highest scores, the positive predictive value for a prolonged treatment course was 52% (sensitivity 0.55, specificity 0.75). CONCLUSIONS A high level of symptoms at 2-6 months of follow-up is a strong predictor for prolonged treatment course. This facilitates early identification of patients at risk of a prolonged course of treatment; in a relatively easy way by a self-assessed symptom severity.
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27
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Kubo K, Fleischhacker WW, Suzuki T, Yasui-Furukori N, Mimura M, Uchida H. Placebo effects in adult and adolescent patients with schizophrenia: combined analysis of nine RCTs. Acta Psychiatr Scand 2019; 139:108-116. [PMID: 30198163 DOI: 10.1111/acps.12960] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/20/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine characteristics of placebo responders and seek optimal criteria of early improvement with placebo for predicting subsequent placebo response in patients with schizophrenia. METHOD Data of 672 patients with schizophrenia randomized to placebo in nine double-blind antipsychotic trials were analyzed. Multiple logistic regression analyses were conducted to examine associations between placebo response at week 6 (i.e., a ≥ 25% reduction in the Positive and Negative Syndrome Scale [PANSS] score) and gender, age, study locations, baseline PANSS total or Marder 5-Factor scores, and per cent PANSS score reduction at week 1. Predictive power of improvement at week 1 for subsequent response was investigated; sensitivity and specificity of incremental 5% cutoff points between 5% and 25% reduction in the PANSS total score at week 1 were calculated. RESULTS Per cent PANSS total score reduction at week 1 and lower PANSS Marder disorganized thought scores at baseline were significantly associated with subsequent placebo response. A 10% reduction in a per-protocol analysis or a 15% reduction in last-observation-carried-forward analysis in the PANSS total score at week 1 showed the highest predictive power. CONCLUSION These findings are informative to identify potential placebo responders at the earliest opportunity for optimal trial design for schizophrenia.
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Affiliation(s)
- K Kubo
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - W W Fleischhacker
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - T Suzuki
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Department of Neuropsychiatry and Clinical Ethics, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - N Yasui-Furukori
- Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
| | - M Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - H Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
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28
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Yuan H, Zhu X, Luo Q, Halim A, Halim M, Yao H, Cai Y, Shi S. Early symptom non-improvement and aggravation are associated with the treatment response to SSRIs in MDD: a real-world study. Neuropsychiatr Dis Treat 2019; 15:957-966. [PMID: 31354272 PMCID: PMC6586220 DOI: 10.2147/ndt.s196533] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
PURPOSE Early improvement in major depressive disorder is defined as a reduction of ≥20% in the 17-item Hamilton Depression Rating Scale (HAM-D-17) score at the second week after initiation of treatment, predicting long-term treatment response. However, there remains no effective strategy for switching medications when a patient fails to reach early improvement at the second week. This study focused on the predictive value of early symptom changes in each item of the HAM-D-17 scale for treatment response to selective serotonin reuptake inhibitor (SSRI) monotherapy and to provide a reference for switching antidepressants to enhance early treatment efficacy. PATIENTS AND METHODS Our study was an observational, real-world study that enrolled 90 treatment-naïve patients experiencing their first episode of major depressive disorder in the outpatient department of Huashan Hospital. Patients who did not achieve the threshold of early improvement in the second week after starting treatment were switched to alternative SSRI monotherapy. Patient follow-up occurred at 2, 4, 8, and 12 weeks after the initiation of treatment. We analyzed the relationship between the change in each symptom on the HAM-D-17 scale and treatment efficacy. RESULTS Early improvement predicted the treatment response at 12 weeks (χ 2=19.249, P<0.001), whereas early non-improvement in insomnia and anxiety was associated with a poor response (OR =9.487, 95% CI: 1.312-68.588 and OR =12.947, 95% CI: 1.99-82.246, respectively). At week 2, general somatic symptom aggravation was associated with a poorer response (OR =73.337, 95% CI: 2.232->999.999); treatment-emergent headache and tremor were associated with treatment efficacy (t=-9.521, P<0.001 and t=3.660, P=0.001, respectively). In addition, the increase in suicidal thoughts, once treatment began, had no relationship with the treatment response (OR =0.821, P=0.872). CONCLUSION This study suggested that patients with early non-improvement in insomnia and anxiety were not suitable for switches in SSRI monotherapy. Patients with treatment-emergent symptoms, especially headaches and tremors, were not suitable for switching from monotherapy to another SSRI.
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Affiliation(s)
- Hsinsung Yuan
- Psychiatry Department of Huashan Hospital, Fudan University, Shanghai, People's Republic of China, .,Psychiatry Department of Nanjing Brain Hospital, Nanjing, People's Republic of China
| | - Xiao Zhu
- Psychiatry Department of Huashan Hospital, Fudan University, Shanghai, People's Republic of China,
| | - Qiang Luo
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Ministry of Education), Fudan University, Shanghai, People's Republic of China
| | - Alice Halim
- Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Michael Halim
- Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Hao Yao
- Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Yiyun Cai
- Psychiatry Department of Huashan Hospital, Fudan University, Shanghai, People's Republic of China, .,Shanghai Mental Health Center, Shanghai, People's Republic of China,
| | - Shenxun Shi
- Psychiatry Department of Huashan Hospital, Fudan University, Shanghai, People's Republic of China, .,Shanghai Mental Health Center, Shanghai, People's Republic of China,
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Graham B, Garcia NM, Burton MS, Cooper AA, Roy-Byrne PP, Mavissakalian MR, Feeny NC, Zoellner LA. High expectancy and early response produce optimal effects in sertraline treatment for post-traumatic stress disorder. Br J Psychiatry 2018; 213:704-708. [PMID: 30355364 PMCID: PMC6263783 DOI: 10.1192/bjp.2018.211] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Better indicators of prognosis are needed to personalise post-traumatic stress disorder (PTSD) treatments.AimsWe aimed to evaluate early symptom reduction as a predictor of better outcome and examine predictors of early response. METHOD Patients with PTSD (N = 134) received sertraline or prolonged exposure in a randomised trial. Early response was defined as 20% PTSD symptom reduction by session two and good end-state functioning defined as non-clinical levels of PTSD, depression and anxiety. RESULTS Early response rates were similar in prolonged exposure and sertraline (40 and 42%), but in sertraline only, early responders were four times more likely to achieve good end-state functioning at post-treatment (Number Needed to Treat = 1.8, 95% CI 1.28-3.00) and final follow-up (Number Needed to Treat = 3.1, 95% CI 1.68-16.71). Better outcome expectations of sertraline also predicted higher likelihood of early response. CONCLUSIONS Higher expectancy of sertraline coupled with early response may produce a cascade-like effect for optimal conditions for long-term symptom reduction. Therefore, assessing expectations and providing clear treatment rationales may optimise sertraline effects. DECLARATION OF INTEREST None.
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Affiliation(s)
- Belinda Graham
- Department of Psychology, University of Washington, Seattle, WA,Corresponding author’s current contact details: Belinda Graham, Department of Experimental Psychology, University of Oxford, The Old Rectory, Paradise Square, Oxford OX1 1TW, U.K.,
| | | | - Mark S. Burton
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH
| | - Andrew A. Cooper
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH
| | - Peter P. Roy-Byrne
- Department of Psychiatry and Behavioral Sciences, Harborview Medical Center, Seattle, WA
| | - Matig R. Mavissakalian
- Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland OH
| | - Norah C. Feeny
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH
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Kelley ME, Dunlop B, Nemeroff CB, Lori A, Carrillo-Roa T, Binder EB, Kutner MH, Rivera VA, Craighead WE, Mayberg HS. Response rate profiles for major depressive disorder: Characterizing early response and longitudinal nonresponse. Depress Anxiety 2018; 35:992-1000. [PMID: 30260539 PMCID: PMC6662579 DOI: 10.1002/da.22832] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/23/2018] [Accepted: 07/11/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Definition of response is critical when seeking to establish valid predictors of treatment success. However, response at the end of study or endpoint only provides one view of the overall clinical picture that is relevant in testing for predictors. The current study employed a classification technique designed to group subjects based on their rate of change over time, while simultaneously addressing the issue of controlling for baseline severity. METHODS A set of latent class trajectory analyses, incorporating baseline level of symptoms, were performed on a sample of 344 depressed patients from a clinical trial evaluating the efficacy of cognitive behavior therapy and two antidepressant medications (escitalopram and duloxetine) in patients with major depressive disorder. RESULTS Although very few demographic and illness-related features were associated with response rate profiles, the aggregated effect of candidate genetic variants previously identified in large pharmacogenetic studies and meta-analyses showed a significant association with early remission as well as nonresponse. These same genetic scores showed a less compelling relationship with endpoint response categories. In addition, consistent nonresponse throughout the study treatment period was shown to occur in different subjects than endpoint nonresponse, which was verified by follow-up augmentation treatment outcomes. CONCLUSIONS When defining groups based on the rate of change, controlling for baseline depression severity may help to identify the clinically relevant distinctions of early response on one end and consistent nonresponse on the other.
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Affiliation(s)
- Mary E. Kelley
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - BoadieW. Dunlop
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Charles B. Nemeroff
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Adriana Lori
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Tania Carrillo-Roa
- Department of Translational Research in Psychiatry, Max-Planck Institute of Psychiatry, Munich, Germany
| | - Elisabeth B. Binder
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia,Department of Translational Research in Psychiatry, Max-Planck Institute of Psychiatry, Munich, Germany
| | - Michael H. Kutner
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Vivianne Aponte Rivera
- Departmentof Psychiatry and Behavioral Sciences, Tulane University, NewOrleans, Louisiana
| | - W. Edward Craighead
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia,Department of Psychology, Emory University, Atlanta, Georgia
| | - Helen S. Mayberg
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia,Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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Petersen JJ, Hartig J, Paulitsch MA, Pagitz M, Mergenthal K, Rauck S, Reif A, Gerlach FM, Gensichen J. Classes of depression symptom trajectories in patients with major depression receiving a collaborative care intervention. PLoS One 2018; 13:e0202245. [PMID: 30192786 PMCID: PMC6128457 DOI: 10.1371/journal.pone.0202245] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 07/30/2018] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Collaborative care is effective in improving symptoms of patients with depression. The aims of this study were to characterize symptom trajectories in patients with major depression during one year of collaborative care and to explore associations between baseline characteristics and symptom trajectories. METHODS We conducted a cluster-randomized controlled trial in primary care. The collaborative care intervention comprised case management and behavioral activation. We used the Patient Health Questionnaire-9 (PHQ-9) to assess symptom severity as the primary outcome. Statistical analyses comprised latent growth mixture modeling and a hierarchical binary logistic regression model. RESULTS We included 74 practices and 626 patients (310 intervention and 316 control recipients) at baseline. Based on a minimum of 12 measurement points for each intervention recipient, we identified two latent trajectories, which we labeled 'fast improvers' (60.5%) and 'slow improvers' (39.5%). At all measurements after baseline, 'fast improvers' presented higher PHQ mean values than 'slow improvers'. At baseline, 'fast improvers' presented fewer physical conditions, higher health-related quality of life, and had made fewer suicide attempts in their history. CONCLUSIONS A notable proportion of 39.5% of patients improved only 'slowly' and probably needed more intense treatment. The third follow-up in month two could well be a sensible time to adjust treatment to support 'slow improvers'.
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Affiliation(s)
- Juliana J. Petersen
- Institute of General Practice, Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
- * E-mail:
| | - Johannes Hartig
- Department of Educational Quality and Evaluation, German Institute for International Educational Research, Frankfurt am Main, Germany
| | - Michael A. Paulitsch
- Institute of General Practice, Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
| | - Manuel Pagitz
- Institute of General Practice, Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
| | - Karola Mergenthal
- Institute of General Practice, Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
| | - Sandra Rauck
- Institute of General Practice, Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Ferdinand M. Gerlach
- Institute of General Practice, Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
| | - Jochen Gensichen
- Institute of General Practice, Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
- Institute of General Practice and Family Medicine, Ludwig-Maximilians University Clinic, Munich, Germany
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Abstract
Guided internet CBT (iCBT) is a promising treatment for depression; however, it is less well known through what mechanisms iCBT works. Two possible mediators of change are the acquisition of cognitive skills and increases in behavioral activation. We report results of an 8-week waitlist controlled trial of guided iCBT, and test whether early change in cognitive skills or behavioral activation mediated subsequent change in depression. The sample was 89 individuals randomized to guided iCBT (n = 59) or waitlist (n = 30). Participants were 75% female, 72% Caucasian, and 33 years old on average. The PHQ9 was the primary outcome measure. Mediators were the Competencies of Cognitive Therapy Scale-Self Report and the Behavioral Activation Scale for Depression-Short Form. Treatment was Beating the Blues plus manualized coaching. Outcomes were analyzed using linear mixed models, and mediation with a bootstrap resampling approach. The iCBT group was superior to waitlist, with large effect sizes at posttreatment (Hedges' g = 1.45). Dropout of iCBT was 29% versus 10% for waitlist. In the mediation analyses, the acquisition of cognitive skills mediated subsequent depression change (indirect effect = -.61, 95% bootstrapped biased corrected CI: -1.47, -0.09), but increases in behavioral activation did not. iCBT is an effective treatment for depression, but dropout rates remain high. Change in iCBT appears to be mediated by improvements in the use of cognitive skills, such as critically evaluating and restructuring negative thoughts.
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Olgiati P, Serretti A, Souery D, Dold M, Kasper S, Montgomery S, Zohar J, Mendlewicz J. Early improvement and response to antidepressant medications in adults with major depressive disorder. Meta-analysis and study of a sample with treatment-resistant depression. J Affect Disord 2018; 227:777-786. [PMID: 29254066 DOI: 10.1016/j.jad.2017.11.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 08/31/2017] [Accepted: 11/02/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Initial improvement in the first weeks of antidepressant (AD) treatment is a useful early predictor of complete AD response. We performed a meta-analysis of AD studies to investigate whether a partial decrease in depressive symptoms by week 4 was associated with response and remission by weeks 6-14 in major depressive disorder (MDD). Finally, we focused on treatment-resistant depression (TRD: lack of response to prior AD) to test the impact of early improvement on a second AD treatment outcome and to compare different switching strategies. METHODS Meta-analysis was conducted on AD naturalistic studies published between 01.01.2000 and 06.30.2017. TRD was an exclusion criterion. TRD was analyzed in 407 MDD patients treated with venlafaxine for 6 weeks. The MADRS was used to define very early improvement (VEI: > 20% decrease at week 2), early improvement (EI: > 30% decrease at week 4) and remission (week 6 MADRS < 10). A theoretical model was used to simulate AD switch in TRD patients who failed to achieve remission (Algorithm A), VEI (Algorithm B) or EI (Algorithm C). RESULTS Our meta-analysis (9 studies; N = 6185) showed significant associations between early improvement, response (OR: 3.28 95% C.I: 2.06-5.20) and remission (OR: 2.10 95% C.I: 1.53-2.87). 24.6% of TRD sample remitted. VEI was a poor outcome predictor: sensitivity = 0.52 (0.40-0.63); specificity = 0.82 (0.76-0.86); AUC = 0.67 (0.62-0.71). EI had a moderate predictive power: sensitivity = 0.87 (0.77-0.93); specificity = 0.71 (0.66-0.77); AUC = 0.76 (0.71-0.80). The best treatment scenario was Algorithm C (switch after 4 weeks) in which remission rate was marginally increased (35.1% vs 33.7% of Algorithm A). Algorithm B (switch after 2 weeks) led to a 4.3% decrease in remission compared to Algorithm A. LIMITATIONS Inclusion of a naturalistic sample without a control arm; simulation of treatments. CONCLUSION Although literature data suggest a correlation between an initial improvement of depressive symptoms and later response and remission during AD treatment, our analysis shows that such an early improvement is not a reliable outcome predictor in TRD. The nature of TRD is complex and different biological mechanisms and treatments might be necessary for TRD patients.
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Affiliation(s)
- Paolo Olgiati
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Viale Carlo Pepoli 5, 40123 Bologna, Italy
| | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Viale Carlo Pepoli 5, 40123 Bologna, Italy.
| | - Daniel Souery
- Laboratoire de Psychologie Médicale, Université Libre de Bruxelles, and Centre Européen de Psychologie Médicale-PsyPluriel, Brussels, Belgium
| | - Markus Dold
- Medical University of Vienna, Department of Psychiatry and Psychotherapy, Vienna, Austria
| | - Siegfried Kasper
- Medical University of Vienna, Department of Psychiatry and Psychotherapy, Vienna, Austria
| | | | - Joseph Zohar
- Chaim Sheba Medical Center, Chaim Sheba Medical Center, Tel-Hashomer, Israel
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Disrupted topology of hippocampal connectivity is associated with short-term antidepressant response in major depressive disorder. J Affect Disord 2018; 225:539-544. [PMID: 28866298 DOI: 10.1016/j.jad.2017.08.086] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 08/12/2017] [Accepted: 08/28/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Graph theoretical analyses have identified disrupted functional topological organization across the brain in patients with major depressive disorder (MDD). However, the relationship between brain topology and short-term treatment responses in patients with MDD remains unknown. METHODS Sixty-eight patients with MDD and 63 cognitively normal (CN) subjects were recruited at baseline and underwent resting-state functional magnetic resonance imaging scans. Graph theory analysis was used to examine group differences in the whole-brain functional topological properties. The association between altered brain topology and the early antidepressant response was examined. RESULTS Patients with MDD showed lower normalized clustering coefficients, lower small-worldness scalars and increased nodal efficiencies in the default mode network and decreased nodal efficiencies in basal ganglia and hippocampal networks. In addition, the decreased nodal efficiency in left hippocampus was negatively correlated with depressive severity at baseline and positively correlated with changes in the depressive scores after two weeks of antidepressant treatment. LIMITATIONS The patients in the present study received different medications. CONCLUSION These findings indicated that the altered brain functional topological organization in patients with MDD is associated with the treatment response in the early phase of medication. Therefore, brain topology assessments might be considered a useful and convenient predictor of short-term antidepressant responses.
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Pfeil S, Holtz K, Kopf KA, Hegerl U, Rummel-Kluge C. Minor depression in older, long-term unemployed people seeking vocational support. BMC Psychiatry 2017; 17:243. [PMID: 28679439 PMCID: PMC5498893 DOI: 10.1186/s12888-017-1404-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 06/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prevalence rates of minor and major depression vary from 0.7 to 6.8 (minor) and 3.8 to 10.9 (major) for the general population. Twenty-two percent of older, long-term unemployed people suffer from major depression. However, the prevalence rate of minor depression (depression on a subthreshold level with less than 5, but more than 1 depression symptom) in this population is unknown. The first aim of this study is to identify that prevalence rate, because we already know that minor depression increases the risk of developing a major depression and this in turn reduces the chances of reemployment what increases social and individual costs at the same time. The second aim is to find out whether there are symptoms that distinguish the different groups "no depression", "minor depression" and "major depression" in this population. In contrast to the general population, the most frequent symptoms within major and minor depression in older, long-term unemployed people are unknown so far. METHODS A total of 234 long-term unemployed people (response rate 59%) were included in a study within a project of the Department of Psychiatry and Psychotherapy at the University of Leipzig and an unemployment agency. Based on the results of the Patient Health Questionnaire, the participants were classified as non depressive, minor depressive or major depressive. Descriptive statistics and chi-square tests were performed to identify whether there are symptoms stated by the participants that are more frequent than others, and if the classified groups differ in this regard. RESULTS Fifty percent had no depression, 15.6% had a minor depression and 34.4% were suffering from major depression. Difficulty with concentration is the symptom that differentiated the last two groups the most. Fatigue, depressed mood and anhedonia were the symptoms that distinguished participants with minor depression the most from participants with no depression. Main limitations are: The sample was determined by programme conditions, e.g. not all potentially available people participated. The sample may therefore not be representative for the general long-term unemployed. Due to limited resources the PHQ 9 was used instead of a clinical interview to assess minor and major depression. CONCLUSIONS Results indicate that minor depression in older, long-term unemployed persons is significant, as, almost 16% of the participants were affected in the study. Especially when fatigue is present for a period of more than 2 weeks, people should be informed about the option to consult a primary care physician or professionals from the unemployment agency in order to prevent the possible onset of major depression.
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Affiliation(s)
- Sabrina Pfeil
- 0000 0001 2230 9752grid.9647.cDepartment of Psychiatry and Psychotherapy, Klinik und Poliklinik für Psychiatrie und Psychotherapie, University of Leipzig, Germany, Semmelweisstraße 10, 04103 Leipzig, Germany
| | - Katrin Holtz
- 0000 0001 2230 9752grid.9647.cDepartment of Psychiatry and Psychotherapy, Klinik und Poliklinik für Psychiatrie und Psychotherapie, University of Leipzig, Germany, Semmelweisstraße 10, 04103 Leipzig, Germany
| | - Kathrin-Andrea Kopf
- 0000 0001 2230 9752grid.9647.cDepartment of Psychiatry and Psychotherapy, Klinik und Poliklinik für Psychiatrie und Psychotherapie, University of Leipzig, Germany, Semmelweisstraße 10, 04103 Leipzig, Germany
| | - Ulrich Hegerl
- 0000 0001 2230 9752grid.9647.cDepartment of Psychiatry and Psychotherapy, Klinik und Poliklinik für Psychiatrie und Psychotherapie, University of Leipzig, Germany, Semmelweisstraße 10, 04103 Leipzig, Germany ,Depression Research Centre, German DepressionFoundation,, Leipzig, Germany
| | - Christine Rummel-Kluge
- Department of Psychiatry and Psychotherapy, Klinik und Poliklinik für Psychiatrie und Psychotherapie, University of Leipzig, Germany, Semmelweisstraße 10, 04103, Leipzig, Germany.
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Yoshida K, Roberts R, Suzuki T, Lebowitz B, Reeves S, Howard R, Abe T, Mimura M, Uchida H. Lack of Early Improvement with Antipsychotics is a Marker for Subsequent Nonresponse in Behavioral and Psychological Symptoms of Dementia: Analysis of CATIE-AD Data. Am J Geriatr Psychiatry 2017; 25:708-716. [PMID: 28215900 PMCID: PMC5474154 DOI: 10.1016/j.jagp.2017.01.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 01/23/2017] [Accepted: 01/26/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Prediction of response or nonresponse to antipsychotics is especially important in patients with behavioral and psychological symptoms of dementia (BPSD) in whom antipsychotic exposure increases risks of death. This study examined whether the presence or absence of early improvement of BPSD with antipsychotics is associated with subsequent response or nonresponse. METHODS In a post-hoc analysis of the Clinical Antipsychotic Trials of Intervention Effectiveness-Alzheimer's Disease (CATIE-AD) study (2001-2004) (clinicaltrials.gov; NCT00015548) in 45 U.S. sites, 245 subjects (olanzapine, N = 90; quetiapine, N = 81; risperidone, N = 74) with a DSM-IV diagnosis of dementia of the Alzheimer type who presented with a score of 1 or more in the Brief Psychiatric Rating Scale (BPRS) at baseline (phase I of CATIE-AD) were randomly assigned to treatment with olanzapine, quetiapine, risperidone, or placebo in a double-blind manner. Associations were examined between response at week 8 and demographic and clinical characteristics, including BPRS total score reduction at week 2, using logistic regression analyses. Prediction performance of binary classification (presence or absence) of improvement or no improvement at week 2 for response at week 8 was examined. RESULTS BPRS total score reduction at week 2 (mean percentage score reduction: 12.6%) was significantly associated with response at week 8 (odds ratio: 1.18; 95% CI: 1.11-1.26). The 5% score reduction cut-off at week 2 showed the highest accuracy (0.71), with sensitivity, specificity, and positive and negative predictivevalues of 0.76, 0.65, 0.69, and 0.72, respectively. CONCLUSION Lack of even a very small early improvement with antipsychotic treatment may be a marker of subsequent nonresponse in BPSD.
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Affiliation(s)
- Kazunari Yoshida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Rachel Roberts
- Center for Clinical Research, Keio University School of Medicine, Tokyo, Japan
| | - Takefumi Suzuki
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Department of Psychiatry, Inokashira Hospital, Tokyo, Japan
| | - Barry Lebowitz
- Department of Psychiatry, University of California, San Diego, CA
| | - Suzanne Reeves
- Division of Psychiatry, University College London, London, United Kingdom; Department of Old Age Psychiatry, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Robert Howard
- Division of Psychiatry, University College London, London, United Kingdom; Department of Old Age Psychiatry, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Takayuki Abe
- Center for Clinical Research, Keio University School of Medicine, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
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Flynn D, Kells M, Joyce M, Corcoran P, Gillespie C, Suarez C, Weihrauch M, Cotter P. Standard 12 month dialectical behaviour therapy for adults with borderline personality disorder in a public community mental health setting. Borderline Personal Disord Emot Dysregul 2017; 4:19. [PMID: 28989706 PMCID: PMC5610433 DOI: 10.1186/s40479-017-0070-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 08/13/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Dialectical behaviour therapy (DBT) is noted to be an intervention with a growing body of evidence that demonstrates its efficacy in treating individuals diagnosed with borderline personality disorder (BPD). Evidence for the effectiveness of DBT in publicly funded community mental health settings is lacking however. No study to our knowledge has been published on the effectiveness of a 12 month standard DBT programme without adaptations for individuals with BPD in a publicly funded community mental health setting and no study has included data across multiple time-points. The main objective of the current study was to determine if completion of a 12 month DBT programme is associated with improved outcomes in terms of borderline symptoms, anxiety, hopelessness, suicidal ideation, depression and quality of life. A secondary objective includes assessing client progress across multiple time-points throughout the treatment. METHODS Fifty-four adult participants with BPD completed the standard DBT programme across four sites in community mental health settings in the Republic of Ireland. Data was collected by the DBT therapists working with participants and took place at 8 week intervals across the 12 month programme. To explore the effects of the intervention for participants, linear mixed-effects models were used to estimate change utilising data available from all time-points. RESULTS At the end of the 12 month programme, significant reductions in borderline symptoms, anxiety, hopelessness, suicidal ideation and depression were observed. Increases in overall quality of life were also noted. In particular, gains were made during the first 6 months of the programme. There was a tendency for scores to slightly regress after the six-month mark which marks the start of the second delivery of the group skills cycles. CONCLUSIONS The current study provides evidence for the effectiveness of standard DBT in publicly funded community mental health settings. As participants were assessed at the end of every module, it was possible to observe trends in symptom reduction during each stage of the intervention. Despite real-world limitations of applying DBT in community settings, the results of this study are comparable with more tightly controlled studies. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT03166579; Registered May 24th 2017 'retrospectively registered'.
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Affiliation(s)
- Daniel Flynn
- Cork Mental Health Services, Health Service Executive, Block 2, St Finbarr's Hospital, Cork, Ireland
| | - Mary Kells
- Cork Mental Health Services, Health Service Executive, Block 2, St Finbarr's Hospital, Cork, Ireland
| | - Mary Joyce
- National Suicide Research Foundation, Western Gateway Building, University College Cork, Cork, Ireland
| | - Paul Corcoran
- Department of Epidemiology and Public Health, Western Gateway Building, University College Cork, Cork, Ireland
| | - Conall Gillespie
- National Suicide Research Foundation, Western Gateway Building, University College Cork, Cork, Ireland
| | - Catalina Suarez
- National Suicide Research Foundation, Western Gateway Building, University College Cork, Cork, Ireland
| | - Mareike Weihrauch
- National Suicide Research Foundation, Western Gateway Building, University College Cork, Cork, Ireland
| | - Padraig Cotter
- National Suicide Research Foundation, Western Gateway Building, University College Cork, Cork, Ireland
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Schlagert HS, Hiller W. Merkmale und prädiktiver Wert von früher Verschlechterung in der ambulanten Psychotherapie. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2017. [DOI: 10.1026/1616-3443/a000400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Trotz des anhaltenden Forschungsinteresses an frühen Therapieerfolgen (Early Response), wurden frühe Verschlechterungen in bisherigen Untersuchungen eher vernachlässigt. Fragestellung: Diese Studie untersucht Merkmale und prädiktive Qualität einer frühen Verschlechterung für das Behandlungsergebnis in einer verhaltenstherapeutischen Hochschulambulanz. Methode: 1983 Patienten wurden anhand des Reliable Change Indexes (RCI) auf das Vorliegen einer frühen Verschlechterung der psychischen Belastung überprüft. Ergebnisse: Es fanden sich nur wenige charakteristische Merkmale einer frühen Verschlechterung (z. B. höhere Anzahl psychischer Störungen). Sich früh verschlechternde Patienten erreichten seltener Response (OR = 7,45) beziehungsweise Remission (OR = 11,43) und zeigten häufiger Verschlechterungen (OR = 40,68) und pathologische Abschlusswerte (OR = 5,02) zu Therapieende. Schlussfolgerung: Verschlechterungen in der frühen Therapiephase sind mit negativen Behandlungsresultaten assoziiert und sollten bei der Behandlungsplanung ambulanter Psychotherapien berücksichtigt werden.
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Affiliation(s)
| | - Wolfgang Hiller
- Psychologisches Institut, Johannes Gutenberg-Universität Mainz
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Holloway E, Sturrock B, Lamoureux E, Keeffe J, Hegel M, Casten R, Mellor D, Rees G. Can we address depression in vision rehabilitation settings? Professionals' perspectives on the barriers to integrating problem-solving treatment. Disabil Rehabil 2016; 40:287-295. [PMID: 27868437 DOI: 10.1080/09638288.2016.1250172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Low vision rehabilitation (LVR) is a pertinent context for integrating early, evidence-based psychological interventions given the high prevalence of untreated depression in adults with vision impairment. This study aims to identify the perceived barriers and facilitators to staff-delivered telephone-based problem-solving treatment for primary care (PST-PC) offered as an integrated component of LVR. METHODS Qualitative semi-structured interviews, developed using the theoretical domains framework (TDF) and Consolidated Framework for Implementation Research (CFIR), were conducted with 21 LVR professionals and a clinical psychologist involved in the delivery of PST-PC. Barriers and facilitators at the practitioner, client, intervention, and organizational level were identified with thematic analysis using a "theoretical" approach. RESULTS Prominent barriers were a lack of role recognition for PST-PC practitioners (n = 32), unmet client expectation with PST-PC (n = 28), dissatisfaction with telephone delivery (n = 27), and limited organizational awareness of PST-PC (n = 39). Facilitating factors included a recognized need for evidence-based psychological services (n = 28), clients experiencing benefits in early sessions (n = 38), PST-PC promoting practical skills (n = 26), and comprehensive PST-PC training (n = 36). CONCLUSIONS PST-PC may provide an accessible early intervention for LVR clients with depressive symptoms. Ongoing practitioner training, clinical support, and screening potential LVR clients for treatment suitability are likely to enhance delivery in this setting. Implications for rehabilitation Depression is highly prevalent in adults engaged in low vision rehabilitation (LVR) programs, yet few receive support. Clinical guidelines recommend integrated models of care be offered within rehabilitation settings as early intervention for mild to moderate levels of depressive symptoms. Integrated telephone-based problem-solving treatment for primary care (PST-PC) delivered by trained LVR practitioners is a practical, skills-based model that has potential to increase access to an early psychological intervention in LVR clients with depressive symptoms. LVR clients are often older in age, have multiple comorbid health conditions and a significant level of functional disability, requiring flexibility in the delivery of PST-PC and specialized staff training, and support in working with older and more complex clients.
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Affiliation(s)
- Edith Holloway
- a Centre for Eye Research Australia , Royal Victorian Eye and Ear Hospital , Melbourne , Australia.,b Ophthalmology, Department of Surgery , University of Melbourne , Melbourne , Australia
| | - Bonnie Sturrock
- a Centre for Eye Research Australia , Royal Victorian Eye and Ear Hospital , Melbourne , Australia.,b Ophthalmology, Department of Surgery , University of Melbourne , Melbourne , Australia
| | - Ecosse Lamoureux
- a Centre for Eye Research Australia , Royal Victorian Eye and Ear Hospital , Melbourne , Australia.,b Ophthalmology, Department of Surgery , University of Melbourne , Melbourne , Australia.,c Singapore Eye Research Institute , National University of Singapore , Singapore.,d Duke-National University of Singapore Medical School , Singapore
| | - Jill Keeffe
- e LV Prasad Eye Institute , Hyderabad , India
| | - Mark Hegel
- f Department of Psychiatry , Dartmouth-Hitchcock Medical Center , Lebanon , NH , USA
| | - Robin Casten
- g Department of Psychiatry and Human Behavior , Thomas Jefferson University , Philadelphia , PA , USA
| | - David Mellor
- h School of Psychology , Deakin University , Melbourne , Australia
| | - Gwyneth Rees
- a Centre for Eye Research Australia , Royal Victorian Eye and Ear Hospital , Melbourne , Australia.,b Ophthalmology, Department of Surgery , University of Melbourne , Melbourne , Australia
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Melchior H, Schulz H, Kriston L, Hergert A, Hofreuter-Gätgens K, Bergelt C, Morfeld M, Koch U, Watzke B. Symptom change trajectories during inpatient psychotherapy in routine care and their associations with long-term outcomes. Psychiatry Res 2016; 238:228-235. [PMID: 27086238 DOI: 10.1016/j.psychres.2016.02.046] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 10/02/2015] [Accepted: 02/18/2016] [Indexed: 01/22/2023]
Abstract
This study examined symptom change trajectories during inpatient psychotherapy and the association of these changes with long-term outcomes. In an observational multicenter study, weekly measurements of symptom severity were performed during inpatient treatment and 6 months after discharge. The symptom severity was measured using the 18-item scale of the Hamburg Modules for the Assessment of Psychosocial Health. The sample included 576 inpatients (mean age: 43.9 years; 77.6% female; main diagnoses: depressive (57.2%), adjustment (15.8%), anxiety (7.4%), and eating disorders (7.2%); mean treatment duration: 42.0 days). With empirically and clinically informed growth mixture models four subgroups of symptom change were revealed: gradual response (71%), early response (9%), delayed response (5%), and nonresponse (11%). Particularly low educational level, non-employment and chronic disorders were associated with unfavorable symptom courses (non- and delayed response). Long-term outcomes differed systematically across subgroups (p<0.001; η(2)=0.165). The patients who responded early presented the highest rates of clinically significant improvement (43.9%) from admission to follow-up. Nearly all of these patients (92.7%) showed reliable improvement. Due to the high association of symptom change trajectories with long-term outcomes, results may contribute to interventions that are tailored to the needs of patients and may foster longer lasting therapeutic effectiveness.
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Affiliation(s)
- Hanne Melchior
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
| | - Holger Schulz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
| | - Anika Hergert
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
| | - Kerstin Hofreuter-Gätgens
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
| | - Corinna Bergelt
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
| | - Matthias Morfeld
- Department of Applied Human Sciences, University of Applied Sciences Magdeburg-Stendal, Osterburger Str. 25, 39576 Stendal, Germany.
| | - Uwe Koch
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
| | - Birgit Watzke
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany; Department of Psychology - Clinical Psychology and Psychotherapy Research, University of Zürich, Binzmühlestr. 14/16, 8050 Zürich, Switzerland.
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Tadić A, Wachtlin D, Berger M, Braus DF, van Calker D, Dahmen N, Dreimüller N, Engel A, Gorbulev S, Helmreich I, Kaiser AK, Kronfeld K, Schlicht KF, Tüscher O, Wagner S, Hiemke C, Lieb K. Randomized controlled study of early medication change for non-improvers to antidepressant therapy in major depression--The EMC trial. Eur Neuropsychopharmacol 2016; 26:705-16. [PMID: 26899588 DOI: 10.1016/j.euroneuro.2016.02.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 01/26/2016] [Accepted: 02/01/2016] [Indexed: 12/28/2022]
Abstract
Patients with Major Depressive Disorder (MDD) and no improvement after two weeks of antidepressant pharmacotherapy have a high risk of treatment failure. The aim of the study was to determine whether an early medication change (EMC) strategy is superior to a guideline-based treatment in MDD patients without improvement after two weeks of antidepressant pharmacotherapy. Eight-hundred-and-eighty-nine patients with MDD were enrolled, 879 patients received the SSRI escitalopram. Of those, 192 patients had no improvement, defined as a reduction of < 20% on the Hamilton Depression Rating Scale (HAMD-17) after 14 days of treatment, and were randomly assigned to open treatment with the EMC strategy (n = 97; venlafaxine XR for study days 15-56; in case of sustained non-improvement on day 28, lithium augmentation for days 29-56) or TAU (n = 95; escitalopram continuation; non-responders on day 28 were switched to venlafaxine XR for four weeks, i.e. days 29-56). The primary outcome was remission (HAMD-17 ≤ 7) after 8 weeks of treatment as assessed by blinded raters. Remission rates were 24% for EMC and 16% for TAU, which was not significantly different (p = 0.2056). Sensitivity analyses for the primary and secondary effectiveness endpoints consistently showed favorable results for patients randomized to EMC. The results confirm data from post-hoc analyses of clinical trials showing that early non-improvement identifies patients who likely need alternate interventions. However, the herein used two-step switch/augmentation strategy for this risk group was not more effective than the control intervention. Alternate strategies and other design aspects are discussed in order to support researchers addressing the same research question.
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Affiliation(s)
- André Tadić
- Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Germany.
| | - Daniel Wachtlin
- Interdisciplinary Centre for Clinical Trials (IZKS), University Medical Center Mainz, Germany
| | - Mathias Berger
- Department of Psychiatry and Psychotherapy of the University of Freiburg, Germany
| | - Dieter F Braus
- Department of Psychiatry and Psychotherapy, HELIOS Dr.-Horst-Schmidt-Hospital, Wiesbaden, Germany
| | - Dietrich van Calker
- Department of Psychiatry and Psychotherapy of the University of Freiburg, Germany
| | - Norbert Dahmen
- Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Germany; Hospital for Psychiatry and Psychotherapy, Katzenelnbogen, Germany
| | - Nadine Dreimüller
- Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Germany
| | - Alice Engel
- Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Germany
| | - Stanislav Gorbulev
- Interdisciplinary Centre for Clinical Trials (IZKS), University Medical Center Mainz, Germany
| | - Isabella Helmreich
- Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Germany
| | - Anne-Katrin Kaiser
- Interdisciplinary Centre for Clinical Trials (IZKS), University Medical Center Mainz, Germany
| | - Kai Kronfeld
- Interdisciplinary Centre for Clinical Trials (IZKS), University Medical Center Mainz, Germany
| | - Konrad F Schlicht
- Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Germany
| | - Oliver Tüscher
- Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Germany
| | - Stefanie Wagner
- Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Germany
| | - Christoph Hiemke
- Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Germany
| | - Klaus Lieb
- Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Germany
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Funaki K, Nakajima S, Suzuki T, Mimura M, Uchida H. Early Improvements in Individual Symptoms to Predict Later Remission in Major Depressive Disorder Treated With Mirtazapine. J Clin Pharmacol 2016; 56:1111-9. [PMID: 26813241 DOI: 10.1002/jcph.710] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 01/18/2016] [Accepted: 01/18/2016] [Indexed: 11/07/2022]
Abstract
Few studies, to our knowledge, have examined whether early improvements in individual, instead of overall, depressive symptoms predict remission in major depressive disorder (MDD). This post hoc analysis used data from 194 patients with MDD enrolled in a 6-week double-blind, placebo-controlled, randomized trial of mirtazapine, to identify improvements in specific individual depressive symptoms in the early phase that are associated with subsequent remission. Trajectories of individual depressive symptoms over 6 weeks were compared between remitters and nonremitters. Early improvement was defined as a ≥20% decrease in the Hamilton Rating Scale for Depression 17 items (HAM-D17) total score in weeks 1 and 2, and remission was defined as a HAM-D17 final score of ≤7. Reliability parameters were calculated for early improvements in predicting later remission. Whether improvement in each of the HAM-D17 symptoms in weeks 1 or 2 predicted remission was examined, using binary logistic regression analyses. As a result, improvements in weeks 1 and 2 were associated with sensitivity of 0.82 and 0.99 and specificity of 0.54 and 0.44, respectively, in predicting remission in week 6. Improvements in insomnia late (P = .04) and insight (P = .007) in week 1 and somatic symptoms general (P = .002) and insight (P = .04) in week 2 were associated with remission in week 6. In conclusion, early improvements in insight, insomnia late, and somatic symptoms general, as well as overall depressive symptoms, may serve as specific clinical indicators of subsequent remission in patients with MDD receiving mirtazapine.
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Affiliation(s)
- Kei Funaki
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Shinichiro Nakajima
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, ON, Canada
| | - Takefumi Suzuki
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Department of Psychiatry, Inokashira Hospital, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
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Abstract
OBJECTIVE Several randomized controlled trials have identified early response to psychotherapy as a predictor for later treatment outcome among patients with depressive disorders. However, supporting evidence under routine conditions is rare. This study evaluated the predictive value of early improvement for final outcomes in psychotherapy among depressive patients in the naturalistic setting of a German university outpatient clinic. METHOD We used the method of percent symptom reduction to classify 639 patients with major depression or dysthymic disorder who underwent an average of 40.0 sessions (SD = 16.3) of naturalistic cognitive-behavioral therapy (CBT) as having either an early response or an early nonresponse. RESULTS Early response was a good predictor for final response and remission regarding depressive symptoms (OR = 8.75 and OR = 5.32, respectively), as well as overall psychological distress (OR = 3.95 and OR = 3.16, respectively). Early nonresponse was distinctly associated with later deterioration of both depressive (OR = 9.56) and general psychological symptomatology (OR = 4.92). CONCLUSIONS Early response to psychotherapy has high predictive qualities for positive later treatment outcome in depressive patients under routine CBT. Therefore, early treatment effects should be considered in clinical decision-making and treatment planning in everyday clinical practice.
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Affiliation(s)
| | - Wolfgang Hiller
- a Department of Psychology , University of Mainz , Mainz , Germany
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Malhi GS, Bassett D, Boyce P, Bryant R, Fitzgerald PB, Fritz K, Hopwood M, Lyndon B, Mulder R, Murray G, Porter R, Singh AB. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry 2015; 49:1087-206. [PMID: 26643054 DOI: 10.1177/0004867415617657] [Citation(s) in RCA: 501] [Impact Index Per Article: 55.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To provide guidance for the management of mood disorders, based on scientific evidence supplemented by expert clinical consensus and formulate recommendations to maximise clinical salience and utility. METHODS Articles and information sourced from search engines including PubMed and EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (MDC) (e.g., books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Information was reviewed and discussed by members of the MDC and findings were then formulated into consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous successive consultation and external review involving: expert and clinical advisors, the public, key stakeholders, professional bodies and specialist groups with interest in mood disorders. RESULTS The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders (Mood Disorders CPG) provide up-to-date guidance and advice regarding the management of mood disorders that is informed by evidence and clinical experience. The Mood Disorders CPG is intended for clinical use by psychiatrists, psychologists, physicians and others with an interest in mental health care. CONCLUSIONS The Mood Disorder CPG is the first Clinical Practice Guideline to address both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. MOOD DISORDERS COMMITTEE Professor Gin Malhi (Chair), Professor Darryl Bassett, Professor Philip Boyce, Professor Richard Bryant, Professor Paul Fitzgerald, Dr Kristina Fritz, Professor Malcolm Hopwood, Dr Bill Lyndon, Professor Roger Mulder, Professor Greg Murray, Professor Richard Porter and Associate Professor Ajeet Singh. INTERNATIONAL EXPERT ADVISORS Professor Carlo Altamura, Dr Francesco Colom, Professor Mark George, Professor Guy Goodwin, Professor Roger McIntyre, Dr Roger Ng, Professor John O'Brien, Professor Harold Sackeim, Professor Jan Scott, Dr Nobuhiro Sugiyama, Professor Eduard Vieta, Professor Lakshmi Yatham. AUSTRALIAN AND NEW ZEALAND EXPERT ADVISORS Professor Marie-Paule Austin, Professor Michael Berk, Dr Yulisha Byrow, Professor Helen Christensen, Dr Nick De Felice, A/Professor Seetal Dodd, A/Professor Megan Galbally, Dr Josh Geffen, Professor Philip Hazell, A/Professor David Horgan, A/Professor Felice Jacka, Professor Gordon Johnson, Professor Anthony Jorm, Dr Jon-Paul Khoo, Professor Jayashri Kulkarni, Dr Cameron Lacey, Dr Noeline Latt, Professor Florence Levy, A/Professor Andrew Lewis, Professor Colleen Loo, Dr Thomas Mayze, Dr Linton Meagher, Professor Philip Mitchell, Professor Daniel O'Connor, Dr Nick O'Connor, Dr Tim Outhred, Dr Mark Rowe, Dr Narelle Shadbolt, Dr Martien Snellen, Professor John Tiller, Dr Bill Watkins, Dr Raymond Wu.
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Affiliation(s)
- Gin S Malhi
- Discipline of Psychiatry, Kolling Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Darryl Bassett
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, WA, Australia School of Medicine, University of Notre Dame, Perth, WA, Australia
| | - Philip Boyce
- Discipline of Psychiatry, Sydney Medical School, Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Paul B Fitzgerald
- Monash Alfred Psychiatry Research Centre (MAPrc), Monash University Central Clinical School and The Alfred, Melbourne, VIC, Australia
| | - Kristina Fritz
- CADE Clinic, Discipline of Psychiatry, Sydney Medical School - Northern, University of Sydney, Sydney, NSW, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Bill Lyndon
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia Mood Disorders Unit, Northside Clinic, Greenwich, NSW, Australia ECT Services Northside Group Hospitals, Greenwich, NSW, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago-Christchurch, Christchurch, New Zealand
| | - Greg Murray
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Richard Porter
- Department of Psychological Medicine, University of Otago-Christchurch, Christchurch, New Zealand
| | - Ajeet B Singh
- School of Medicine, Deakin University, Geelong, VIC, Australia
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Høifødt RS, Mittner M, Lillevoll K, Katla SK, Kolstrup N, Eisemann M, Friborg O, Waterloo K. Predictors of Response to Web-Based Cognitive Behavioral Therapy With High-Intensity Face-to-Face Therapist Guidance for Depression: A Bayesian Analysis. J Med Internet Res 2015; 17:e197. [PMID: 26333818 PMCID: PMC4642793 DOI: 10.2196/jmir.4351] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 05/08/2015] [Accepted: 07/08/2015] [Indexed: 01/20/2023] Open
Abstract
Background Several studies have demonstrated the effect of guided Internet-based cognitive behavioral therapy (ICBT) for depression. However, ICBT is not suitable for all depressed patients and there is a considerable level of nonresponse. Research on predictors and moderators of outcome in ICBT is inconclusive. Objective This paper explored predictors of response to an intervention combining the Web-based program MoodGYM and face-to-face therapist guidance in a sample of primary care patients with mild to moderate depressive symptoms. Methods Participants (N=106) aged between 18 and 65 years were recruited from primary care and randomly allocated to a treatment condition or to a delayed treatment condition. The intervention included the Norwegian version of the MoodGYM program, face-to-face guidance from a psychologist, and reminder emails. In this paper, data from the treatment phase of the 2 groups was merged to increase the sample size (n=82). Outcome was improvement in depressive symptoms during treatment as assessed with the Beck Depression Inventory-II (BDI-II). Predictors included demographic variables, severity variables (eg, number of depressive episodes and pretreatment depression and anxiety severity), cognitive variables (eg, dysfunctional thinking), module completion, and treatment expectancy and motivation. Using Bayesian analysis, predictors of response were explored with a latent-class approach and by analyzing whether predictors affected the slope of response. Results A 2-class model distinguished well between responders (74%, 61/82) and nonresponders (26%, 21/82). Our results indicate that having had more depressive episodes, being married or cohabiting, and scoring higher on a measure of life satisfaction had high odds for positively affecting the probability of response. Higher levels of dysfunctional thinking had high odds for a negative effect on the probability of responding. Prediction of the slope of response yielded largely similar results. Bayes factors indicated substantial evidence that being married or cohabiting predicted a more positive treatment response. The effects of life satisfaction and number of depressive episodes were more uncertain. There was substantial evidence that several variables were unrelated to treatment response, including gender, age, and pretreatment symptoms of depression and anxiety. Conclusions Treatment response to ICBT with face-to-face guidance may be comparable across varying levels of depressive severity and irrespective of the presence and severity of comorbid anxiety. Being married or cohabiting, reporting higher life satisfaction, and having had more depressive episodes may predict a more favorable response, whereas higher levels of dysfunctional thinking may be a predictor of poorer response. More studies exploring predictors and moderators of Internet-based treatments are needed to inform for whom this treatment is most effective. Trial Registration Australian New Zealand Clinical Trials Registry number: ACTRN12610000257066; https://www.anzctr.org.au/trial_view.aspx?id=335255 (Archived by WebCite at http://www.webcitation.org/6GR48iZH4).
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Affiliation(s)
- Ragnhild Sørensen Høifødt
- Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
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Schlagert H, Hiller W. Häufigkeit und prädiktiver Wert von Early Response in naturalistischen Psychotherapien. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2015. [DOI: 10.1026/1616-3443/a000314] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Verschiedene randomisiert-kontrollierte Studien konnten die Bedeutung frühzeitiger Therapieerfolge für das Therapieergebnis nachweisen. Entsprechende Erkenntnisse unter Routinebedingungen sind bislang selten. Fragestellung: Diese Studie untersucht Häufigkeit, prädiktiven Wert sowie Patientenmerkmale eines frühen Ansprechens auf die Therapie („Early Response“) in einer verhaltenstherapeutischen Hochschulambulanz. Methode: Wir klassifizierten anhand prozentualer Wertereduktion 1109 Patienten verschiedener Störungsgruppen hinsichtlich ihrer psychischen Belastung als Early Responder beziehungsweise Early Nonresponder. Ergebnisse: 48,2 % der Patienten zeigten frühe Therapieerfolge. Early Response erwies sich als Prädiktor für Response (OR = 6,36) und Remission (OR = 3,90). Early Nonresponse sagte eine Verschlechterung der Symptombelastung zu Therapieende vorher (OR = 12,14). Schlussfolgerungen: Frühzeitige Therapieeffekte sind im Routinesetting offenbar von hoher Bedeutung für das Therapieergebnis und sollten bei der Behandlungsplanung stärker berücksichtigt werden.
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Affiliation(s)
- Henrike Schlagert
- Poliklinische Institutsambulanz für Psychotherapie, Johannes Gutenberg-Universität Mainz
| | - Wolfgang Hiller
- Poliklinische Institutsambulanz für Psychotherapie, Johannes Gutenberg-Universität Mainz
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Reuter L, Munder T, Altmann U, Hartmann A, Strauss B, Scheidt CE. Pretreatment and process predictors of nonresponse at different stages of inpatient psychotherapy. Psychother Res 2015; 26:410-24. [PMID: 25959603 DOI: 10.1080/10503307.2015.1030471] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE Up to 50% of psychotherapeutic treatments end without significant improvements. While there is first evidence about predictors of nonresponse in outpatient psychotherapy, there are currently no studies investigating predictors of nonresponse in inpatient settings. Based upon a previous systematic literature review, we analyzed the predictive value of initial patient characteristics on nonresponse in symptom distress. METHODS Treatment episodes from 546 patients, treated for at least 4 weeks, were assessed under naturalistic conditions. Nonresponse status (i.e., lack of a reliable improvement in symptom distress) was investigated at four different time points: at week 4, at discharge, and at a two follow-ups (3 and 12 months after discharge). Hierarchical binary logistic regression models were used to predict nonresponse. Sociodemographic data, clinical variables, and the previous response status were entered subsequently in the model. RESULTS A moderate or functional level of initial symptom distress, a comorbid personality disorder, and previous nonresponse were the most consistent predictors of nonresponse. CONCLUSIONS The results point to the importance of early outcome assessment and suggest the implementation of more symptom-specific treatments.
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Affiliation(s)
- Laurence Reuter
- a Universitätsklinikum Freiburg, Zentrum für psychische Erkrankungen, Klinik für psychosomatische Medizin und Psychotherapie , Freiburg im Breisgau , Germany.,b Institut für Psychosoziale Medizin und Psychotherapie , Friedrich-Schiller Universität , Jena , Germany
| | - Thomas Munder
- c Psychologische Hochschule Berlin , Berlin , Germany
| | - Uwe Altmann
- b Institut für Psychosoziale Medizin und Psychotherapie , Friedrich-Schiller Universität , Jena , Germany
| | - Armin Hartmann
- a Universitätsklinikum Freiburg, Zentrum für psychische Erkrankungen, Klinik für psychosomatische Medizin und Psychotherapie , Freiburg im Breisgau , Germany
| | - Bernhard Strauss
- b Institut für Psychosoziale Medizin und Psychotherapie , Friedrich-Schiller Universität , Jena , Germany
| | - Carl Eduard Scheidt
- a Universitätsklinikum Freiburg, Zentrum für psychische Erkrankungen, Klinik für psychosomatische Medizin und Psychotherapie , Freiburg im Breisgau , Germany
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Gougol A, Zareh-Mohammadi N, Raheb S, Farokhnia M, Salimi S, Iranpour N, Yekehtaz H, Akhondzadeh S. Simvastatin as an adjuvant therapy to fluoxetine in patients with moderate to severe major depression: A double-blind placebo-controlled trial. J Psychopharmacol 2015; 29:575-81. [PMID: 25827645 DOI: 10.1177/0269881115578160] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Statins have been shown to decrease depressive symptoms in certain groups of patients, an effect that is mostly attributed to their anti-inflammatory and neurotransmitter modulatory potentials. We aimed to investigate the antidepressant effects of simvastatin as an adjuvant therapy in patients with moderate to severe depression. In this double-blind placebo-controlled clinical trial, 48 patients were randomly allocated to receive simvastatin or placebo as an adjunct to fluoxetine for six weeks. Patients were evaluated with the Hamilton Depression Rating Scale (HDRS) at baseline and weeks 2, 4 and 6. Probable clinical and laboratory adverse events were also monitored and compared between the two groups. Simvastatin-treated patients experienced significantly more reductions in HDRS scores compared to the placebo group by the end of the trial (p=0.02). Early improvement and response rates were significantly greater in the simvastatin group than the placebo group (p=0.02 and p=0.01, respectively) but remission rate was not significantly different between the two groups (p=0.36). No serious adverse event was reported during this trial. In conclusion, simvastatin seems to be a safe and effective adjuvant therapy for patients suffering from major depressive disorder. However, more confirmatory studies are warranted.
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Affiliation(s)
- Amirhossein Gougol
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nahid Zareh-Mohammadi
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Samira Raheb
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Farokhnia
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Samrand Salimi
- Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Iranpour
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Habibeh Yekehtaz
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahin Akhondzadeh
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Helmreich I, Wagner S, König J, Kohnen R, Szegedi A, Hiemke C, Tadić A. Hamilton depression rating subscales to predict antidepressant treatment outcome in the early course of treatment. J Affect Disord 2015; 175:199-208. [PMID: 25638793 DOI: 10.1016/j.jad.2014.12.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 12/02/2014] [Accepted: 12/16/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hamilton depression rating scale (HAMD) subscales provide an economic alternative for the full scale; however, their ability to detect onset of improvement in the early course of treatment (EI) has not yet been researched. The present study investigated in patients with major depression (MD) whether the subscales are a comparable option to predict treatment remission in the early course of treatment. METHODS Based on data from 210 MD patients of a 6-week randomised, placebo-controlled trial comparing mirtazapine (MIR) and paroxetine (PAR), the discriminative and predictive validity of EI for (stable) remission at treatment end was evaluated for seven subscales and the HAMD17 in the total and in treatment subgroups (MIR vs. PAR). Receiver operating characteristics (ROC) curves (at week 2) and the Clinical Global Impression scales (CGI) (at study endpoint) were used to validate the 20% EI criterion for the subscales. RESULTS Only the Evans6 and Toronto7 subscale had almost the same predictive value as the HAMD17 (e.g., sensitivities stable remission Evans6/Toronto7: 96/95% vs. 96% HAMD17). The optimal cut-off for EI to predict remission was just below 20% for most subscales and slightly over 20% for stable remission. LIMITATIONS Study sample representativeness, non-independence of subscales, missing external validation criterion, lack of control group. CONCLUSIONS The Evans6 and Toronto7 subscales are valuable alternatives in situations, where economic aspects play a larger role. A sum score reduction of ≥20% as definition for EI seems also appropriate for the HAMD subscales, in the total as well as in the antidepressant subgroups.
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Affiliation(s)
- Isabella Helmreich
- Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Mainz, Germany.
| | - Stefanie Wagner
- Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Mainz, Germany
| | - Jochem König
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Mainz, Germany
| | - Ralf Kohnen
- Psychology Department, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Armin Szegedi
- Employee of Merck, Rahway, NJ, USA (at the time of manuscript preparation)
| | - Christoph Hiemke
- Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Mainz, Germany
| | - André Tadić
- Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Mainz, Germany
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50
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Bares M, Novak T, Kopecek M, Brunovsky M, Stopkova P, Höschl C. The effectiveness of prefrontal theta cordance and early reduction of depressive symptoms in the prediction of antidepressant treatment outcome in patients with resistant depression: analysis of naturalistic data. Eur Arch Psychiatry Clin Neurosci 2015; 265:73-82. [PMID: 24848366 DOI: 10.1007/s00406-014-0506-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Accepted: 05/12/2014] [Indexed: 12/26/2022]
Abstract
Current studies suggest that an early improvement of depressive symptoms and the reduction of prefrontal theta cordance value predict the subsequent response to antidepressants. The aim of our study was (1) to compare the predictive abilities of early clinical improvement defined as ≥ 20 % reduction in Montgomery and Åsberg Depression Rating Scale (MADRS) total score at week 1 and 2, and the decrease of prefrontal theta cordance at week 1 in resistant depressive patients and (2) to assess whether the combination of individual predictors yields more robust predictive power than either predictor alone. Eighty-seven subjects were treated (≥ 4 weeks) with various antidepressants chosen according to the judgment of attending psychiatrists. Areas under curve (AUC) were calculated to compare predictive effect of defined single predictors (≥ 20 % reduction in MADRS total score at week 1 and 2, and the decrease of cordance at week 1) and combined prediction models. AUCs of all three predictors were not statistically different (pair-wise comparison). The model combining all predictors yielded an AUC value 0.91 that was significantly higher than AUCs of each individual predictor. The results indicate that the combined predictor model may be a useful and clinically meaningful tool for the prediction of antidepressant response in patients with resistant depression.
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Affiliation(s)
- Martin Bares
- Prague Psychiatric Center, Ustavni 91, 181 03, Prague 8-Bohnice, Czech Republic,
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