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Martínez P, Gloger S, Diez de Medina D, González A, Carrasco MI, Vöhringer PA. Tratamiento de la depresión en adultos con estrés adverso temprano: revisión sistemática de su efecto en síntomas relacionados a trauma, ansiedad, desajuste social y calidad de vida. Rev Med Chil 2021; 149:1473-1484. [DOI: 10.4067/s0034-98872021001001473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/19/2021] [Indexed: 11/17/2022]
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Martínez V, Espinosa-Duque D, Jiménez-Molina Á, Rojas G, Vöhringer PA, Fernández-Arcila M, Luttges C, Irarrázaval M, Bauer S, Moessner M. Feasibility and Acceptability of "Cuida tu Ánimo" (Take Care of Your Mood): An Internet-Based Program for Prevention and Early Intervention of Adolescent Depression in Chile and Colombia. Int J Environ Res Public Health 2021; 18:ijerph18189628. [PMID: 34574553 PMCID: PMC8472675 DOI: 10.3390/ijerph18189628] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/29/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022]
Abstract
The rapid internet penetration in Latin American countries has made it possible to implement digital mental health interventions. “Cuida tu Ánimo” (Take Care of Your Mood) is an internet-based program for the prevention and early intervention of depression in adolescents. A pilot study was conducted in Chile and Colombia to study the feasibility and acceptability of the program and estimate its effects. There were 199 participants (53.3% women; mean age = 14.8 years, SD = 1.0) recruited from two schools in Chile and two schools in Colombia. Qualitative and quantitative methods were applied for data collection and analyses. Although the levels of acceptance were moderate to high across all variables, adherence was lower than expected. The participants deemed important for an intervention of this type offered a higher level of interaction with team members through internet-based and face-to-face activities. Post-intervention outcomes show a reduction in depressive and anxious symptoms in adolescents in Chile, while there were no significant changes in the level of symptomatology in adolescents in Colombia. The women used the program more than the men. Results show the need to improve the intervention by increasing its levels of customization and developing strategies to achieve better adherence. The contradictory results of the program in Chile and Colombia suggest the importance of other variables beyond the content of the intervention, such as the setting or context of the intervention.
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Affiliation(s)
- Vania Martínez
- Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente (CEMERA), Facultad de Medicina, Universidad de Chile, Santiago 8380455, Chile; (Á.J.-M.); (C.L.)
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago 8380455, Chile;
- Millennium Institute for Research in Depression and Personality (MIDAP), Santiago 8380455, Chile; (D.E.-D.); (P.A.V.); (M.I.)
- Correspondence: ; Tel.: +562-2978-6484
| | - Daniel Espinosa-Duque
- Millennium Institute for Research in Depression and Personality (MIDAP), Santiago 8380455, Chile; (D.E.-D.); (P.A.V.); (M.I.)
- Facultad de Psicología, Universidad CES, Medellín 050010, Colombia
| | - Álvaro Jiménez-Molina
- Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente (CEMERA), Facultad de Medicina, Universidad de Chile, Santiago 8380455, Chile; (Á.J.-M.); (C.L.)
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago 8380455, Chile;
- Millennium Institute for Research in Depression and Personality (MIDAP), Santiago 8380455, Chile; (D.E.-D.); (P.A.V.); (M.I.)
- Millennium Nucleus in Social Development (DESOC), Santiago 8380455, Chile
- Facultad de Psicología, Universidad Diego Portales, Santiago 8380455, Chile
| | - Graciela Rojas
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago 8380455, Chile;
- Millennium Institute for Research in Depression and Personality (MIDAP), Santiago 8380455, Chile; (D.E.-D.); (P.A.V.); (M.I.)
- Millennium Nucleus in Social Development (DESOC), Santiago 8380455, Chile
- Departamento de Psiquiatría y Salud Mental, Hospital Clínico Universidad de Chile, Santiago 8380455, Chile
| | - Paul A. Vöhringer
- Millennium Institute for Research in Depression and Personality (MIDAP), Santiago 8380455, Chile; (D.E.-D.); (P.A.V.); (M.I.)
- Departamento de Psiquiatría y Salud Mental, Hospital Clínico Universidad de Chile, Santiago 8380455, Chile
- Mood Disorders Program, Tufts Medical Center, Tufts University, Boston, MA 02155, USA
| | | | - Carolina Luttges
- Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente (CEMERA), Facultad de Medicina, Universidad de Chile, Santiago 8380455, Chile; (Á.J.-M.); (C.L.)
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago 8380455, Chile;
| | - Matías Irarrázaval
- Millennium Institute for Research in Depression and Personality (MIDAP), Santiago 8380455, Chile; (D.E.-D.); (P.A.V.); (M.I.)
- Departamento de Psiquiatría y Salud Mental, Hospital Clínico Universidad de Chile, Santiago 8380455, Chile
| | - Stephanie Bauer
- Center for Psychotherapy Research, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.B.); (M.M.)
| | - Markus Moessner
- Center for Psychotherapy Research, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.B.); (M.M.)
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Rojas G, Martínez P, Guajardo V, Campos S, Herrera P, Vöhringer PA, Gómez V, Szabo W, Araya R. A collaborative, computer-assisted, psycho-educational intervention for depressed patients with chronic disease at primary care: protocol for a cluster randomized controlled trial. BMC Psychiatry 2021; 21:418. [PMID: 34419010 PMCID: PMC8380397 DOI: 10.1186/s12888-021-03380-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/29/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Depression and chronic diseases are frequently comorbid public health problems. However, clinical guidelines often fail to consider comorbidities. This study protocol describes a cluster randomized trial (CRT) aimed to compare the effectiveness of a collaborative, computer-assisted, psycho-educational intervention versus enhanced usual care (EUC) in the treatment of depressed patients with hypertension and/or diabetes in primary care clinics (PCC) in Santiago, Chile. METHODS Two-arm, single-blind, CRT carried out at two municipalities in Santiago, Chile. Eight PCC will be randomly assigned (1:1 ratio within each municipality, 4 PCC in each municipality) to the INTERVENTION or EUC. A total of 360 depressed patients, aged at least 18 years, with Patient Health Questionnaire-9 Item [PHQ-9] scores ≥15, and enrolled in the Cardiovascular Health Program at the participating PCC. Patients with alcohol/substance abuse; current treatment for depression, bipolar disorder, or psychosis; illiteracy; severe impairment; and resident in long-term care facilities, will be excluded. Patients in both arms will be invited to use the Web page of the project, which includes basic health education information. Patients in the INTERVENTION will receive eight sessions of a computer-assisted, psycho-educational intervention delivered by trained therapists, a structured telephone calls to monitor progress, and usual medical care for chronic diseases. Therapists will receive biweekly and monthly supervision by psychologist and psychiatrist, respectively. A monthly meeting will be held between the PCC team and a member of the research team to ensure continuity of care. Patients in EUC will receive depression treatment according to clinical guidelines and usual medical care for chronic diseases. Outcome assessments will be conducted at 3, 6, and 12 months after enrollment. The primary outcome will be depression improvement at 6 months, defined as ≥50% reduction in baseline PHQ-9 scores. Intention-to-treat analyses will be performed. DISCUSSION This study will be one of the first to provide evidence for the effectiveness of a collaborative, computer-assisted, psycho-educational intervention for depressed patients with chronic disease at primary care in a Latin American country. TRIAL REGISTRATION retrospectively registered in ClinicalTrials.gov , first posted: November 3, 2020, under identifier: NCT04613076 .
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Affiliation(s)
- Graciela Rojas
- Departamento de Psiquiatría y Salud Mental, Hospital Clínico Universidad de Chile, Avenida La Paz, 1003, Santiago, Chile. .,ANID, Millennium Science Initiative Program, Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile. .,ANID, Millennium Science Initiative Program, Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay, Santiago, Chile. .,ANID, Millennium Science Initiative Program, Millennium Nucleus in Social Development (DESOC), Santiago, Chile.
| | - Pablo Martínez
- grid.412248.9Departamento de Psiquiatría y Salud Mental, Hospital Clínico Universidad de Chile, Avenida La Paz, 1003 Santiago, Chile ,grid.488997.3ANID, Millennium Science Initiative Program, Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile ,grid.424112.00000 0001 0943 9683ANID, Millennium Science Initiative Program, Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay, Santiago, Chile ,grid.412179.80000 0001 2191 5013Escuela de Psicología, Facultad de Humanidades, Universidad de Santiago de Chile, Santiago, Chile ,Psicomedica, Clinical & Research Group, Santiago, Chile
| | - Viviana Guajardo
- grid.412248.9Departamento de Psiquiatría y Salud Mental, Hospital Clínico Universidad de Chile, Avenida La Paz, 1003 Santiago, Chile ,grid.488997.3ANID, Millennium Science Initiative Program, Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile ,Servicio de Psiquiatría, Hospital El Pino, Santiago, Chile
| | - Solange Campos
- grid.7870.80000 0001 2157 0406Escuela de Enfermería, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Herrera
- grid.443909.30000 0004 0385 4466Escuela de Psicología, Facultad de Ciencias Sociales, Universidad de Chile, Santiago, Chile
| | - Paul A. Vöhringer
- grid.412248.9Departamento de Psiquiatría y Salud Mental, Hospital Clínico Universidad de Chile, Avenida La Paz, 1003 Santiago, Chile ,grid.488997.3ANID, Millennium Science Initiative Program, Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile ,grid.412179.80000 0001 2191 5013Escuela de Psicología, Facultad de Humanidades, Universidad de Santiago de Chile, Santiago, Chile ,grid.67033.310000 0000 8934 4045Mood Disorders Program, Tufts Medical Center, Boston, MA USA ,grid.67033.310000 0000 8934 4045Department of Psychiatry, Tufts University School of Medicine, Boston, MA USA
| | - Víctor Gómez
- grid.488997.3ANID, Millennium Science Initiative Program, Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile ,grid.443909.30000 0004 0385 4466Facultad de Medicina, Universidad de Chile, Santiago, Chile ,grid.7870.80000 0001 2157 0406Programa de Doctorado en Psicoterapia, Facultad de Medicina y Facultad de Ciencias Sociales, Universidad de Chile y Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Wilsa Szabo
- grid.488997.3ANID, Millennium Science Initiative Program, Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile ,grid.412179.80000 0001 2191 5013Escuela de Psicología, Facultad de Humanidades, Universidad de Santiago de Chile, Santiago, Chile ,grid.443909.30000 0004 0385 4466Facultad de Medicina, Universidad de Chile, Santiago, Chile ,grid.7870.80000 0001 2157 0406Programa de Doctorado en Psicoterapia, Facultad de Medicina y Facultad de Ciencias Sociales, Universidad de Chile y Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ricardo Araya
- grid.13097.3c0000 0001 2322 6764Department of Health Services and Population Research, King’s College London, London, UK
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Gloger S, Vöhringer PA, Martínez P, Chacón MV, Cáceres C, Diez de Medina D, Cottin M, Behn A. The contribution of early adverse stress to complex and severe depression in depressed outpatients. Depress Anxiety 2021; 38:431-438. [PMID: 33621410 DOI: 10.1002/da.23144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/16/2020] [Accepted: 02/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To assess whether linear effects or threshold effects best describe the association between early adverse stress (EAS) and complex and severe depression (i.e., depression with treatment resistance, psychotic symptoms, and/or suicidal ideation), and to examine the attributable risk of complex and severe depression associated with EAS. METHODS A cross-sectional study was conducted using deidentified clinical data (on demographics, presence of complex and severe depression, and exposure to seven types of EAS) from 1,013 adults who were seen in an outpatient mental health clinic in Santiago, Chile, for a major depressive episode. Multivariate logistic regressions were fitted to estimate odds ratios (ORs), using a bootstrap approach to compute 95% bias-corrected confidence intervals (95% BC CIs). A detailed examination of the cumulative risk score and calculations of the attributable risk was conducted. RESULTS Exposure to at least five EASs was reported by 3.6% of the sample. In the multivariate logistic regression models, there was a marked increase in the odds of having complex and severe depression associated with exposure to at least five EASs (OR = 4.24; 95% BC CI: 1.25 to 9.09), according to a threshold effect. The attributable risk of complex and severe depression associated with exposure to at least one EAS was 36.8% (95% BC CI: 17.7 to 55.9). CONCLUSIONS High levels of EAS distinctively contribute to complex clinical presentations of depression in adulthood. Patients with complex clinical presentations of depression and history of EAS should need a differentiated treatment approach, particularly those having high levels of EAS.
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Affiliation(s)
- Sergio Gloger
- Psicomedica, Clinical & Research Group, Santiago, Chile.,Departamento de Psiquiatría y Salud Mental Campus Oriente, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Paul A Vöhringer
- Psicomedica, Clinical & Research Group, Santiago, Chile.,Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile.,Departamento de Psiquiatría y Salud Mental, Hospital Clínico Universidad de Chile, Santiago, Chile.,Mood Disorders Program, Tufts Medical Center, Boston, Massachusetts, USA.,Department of Psychiatry, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Pablo Martínez
- Psicomedica, Clinical & Research Group, Santiago, Chile.,Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile.,Departamento de Psiquiatría y Salud Mental, Hospital Clínico Universidad de Chile, Santiago, Chile.,Núcleo Milenio para Mejorar la Salud Mental de Adolescentes y Jóvenes (Imhay), Santiago, Chile
| | - M Victoria Chacón
- Psicomedica, Clinical & Research Group, Santiago, Chile.,Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile
| | - Cristian Cáceres
- Psicomedica, Clinical & Research Group, Santiago, Chile.,Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile
| | | | - Marianne Cottin
- Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile.,Escuela de Psicología, Pontificia Universidad Católica de Chile, Santiago, Chile.,Facultad de Medicina, Universidad de Chile, Santiago, Chile.,Escuela de Psicología, Universidad Finis Terrae, Santiago, Chile
| | - Alex Behn
- Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile.,Escuela de Psicología, Pontificia Universidad Católica de Chile, Santiago, Chile
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Gloger S, Martínez P, Behn A, Chacón MV, Cottin M, Diez de Medina D, Vöhringer PA. Population-attributable risk of adverse childhood experiences for high suicide risk, psychiatric admissions, and recurrent depression, in depressed outpatients. Eur J Psychotraumatol 2021; 12:1874600. [PMID: 34025917 PMCID: PMC8118528 DOI: 10.1080/20008198.2021.1874600] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Population-attributable risk (PAR) may help estimate the potential contribution of adverse childhood experiences (ACEs) to serious clinical presentations of depression, characterized by suicidality, previous psychiatric admissions, and episode recurrence. Objective: To determine the PAR of ACEs for serious clinical presentations of depression (high suicide risk, previous psychiatric admissions, and recurrent depression) in outpatients with ICD-10 clinical depression. Method: Systematic chart review of 1,013 adults who were assessed and/or treated in a mental health clinic in Santiago, Chile for a major depressive episode. Data were collected on demographics and clinical characteristics of depression. Exposure to ACEs was determined with the Brief Physical and Sexual Abuse Questionnaire, assessing seven types of ACEs. Multivariable logistic regression analysis was used to assess the association between exposure to ACEs and suicidality, previous psychiatric admissions, and recurrence. Predicted probabilities were used for calculations of PAR. Results: Of the 1,001 study participants with complete data, 53.3% had recurrent depression, 13.5% had high suicide risk, and 5.0% had previous psychiatric admissions. Exposure to at least one ACE was recorded for 69.0% of the sample. Exposure to at least one ACE and specific types of ACEs (i.e. childhood sexual abuse and traumatic separation from caregiver) were associated with serious clinical presentations of depression. A dose-response relationship was observed between cumulative exposure to ACEs and the most serious clinical presentations of depression. ACEs were attributed to a significant proportion of disease: 61.6% of previous psychiatric admissions, 45.0% of high suicide risk, and 14.5% of recurrent depression. Conclusions: A substantial proportion of serious clinical presentations of depression among outpatients are associated with ACEs. Early detection of depressive episodes associated with ACEs, and tailored treatment for these patients, may potentially reduce the incidence of serious complications in this population.
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Affiliation(s)
- Sergio Gloger
- Psicomedica, Clinical & Research Group, Santiago, Chile.,Departamento de Psiquiatría y Salud Mental Campus Oriente, Facultad de Medicina, Universidad de Chile, Santiago, Chile.,ANID, Millennium Science Initiative Program, Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile
| | - Pablo Martínez
- Psicomedica, Clinical & Research Group, Santiago, Chile.,ANID, Millennium Science Initiative Program, Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile.,Departamento de Psiquiatría y Salud Mental, Hospital Clínico Universidad de Chile, Santiago, Chile.,ANID, Millennium Science Initiative Program, Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay, Santiago, Chile.,Escuela de Psicología, Facultad de Humanidades, Universidad de Santiago de Chile, Santiago, Chile.,CITIAPS, Universidad de Santiago de Chile, Santiago, Chile
| | - Alex Behn
- ANID, Millennium Science Initiative Program, Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile.,Escuela de Psicología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - M Victoria Chacón
- Psicomedica, Clinical & Research Group, Santiago, Chile.,ANID, Millennium Science Initiative Program, Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile
| | - Marianne Cottin
- ANID, Millennium Science Initiative Program, Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile.,Escuela de Psicología, Pontificia Universidad Católica de Chile, Santiago, Chile.,Facultad de Medicina, Universidad de Chile, Santiago, Chile.,Escuela de Psicología, Universidad Finis Terrae, Santiago, Chile
| | | | - Paul A Vöhringer
- Psicomedica, Clinical & Research Group, Santiago, Chile.,ANID, Millennium Science Initiative Program, Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile.,Departamento de Psiquiatría y Salud Mental, Hospital Clínico Universidad de Chile, Santiago, Chile.,Mood Disorders Program, Tufts Medical Center, Boston, MA, USA.,Department of Psychiatry, Tufts University School of Medicine, Boston, MA, USA
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McGirr A, Vöhringer PA, Nassir Ghaemi S, Lam RW, Yatham LN. Safety and Efficacy of Adjunctive Second-Generation Antidepressant Therapy With A Mood Stabiliser or an Atypical Antipsychotic in Acute Bipolar Depression: Randomised Systematic Review and Meta-Analysis of A Placebo-Controlled Trials. Focus (Am Psychiatr Publ) 2021; 19:129-137. [PMID: 34483777 PMCID: PMC8412150 DOI: 10.1176/appi.focus.19102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
(Reprinted with permission from Lancet Psychiatry 2016; 3: 1138-46).
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Martínez P, Gloger S, Diez de Medina D, González A, Carrasco MI, Schilling S, Vöhringer PA. Early Adverse Stress and Depressive and Bipolar Disorders: A Systematic Review and Meta-Analysis of Treatment Interventions. Front Psychiatry 2021; 12:650706. [PMID: 33981259 PMCID: PMC8107272 DOI: 10.3389/fpsyt.2021.650706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/22/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction: A significant proportion of adults with depressive or bipolar disorders exposed to early adverse stressors do not adequately respond to standard treatments. This review aimed at synthesizing the evidence on the effectiveness of treatment interventions for depressive or bipolar disorders in adult individuals (aged 18 years or more) exposed to adverse stress early in life. Methods: Systematic review and meta-analysis including experimental and quasi-experimental published studies indexed in CINAHL, EMBASE, PubMed, and Web of Science databases and/or in reference lists. Data management and critical appraisal (with the Study Quality Assessment Tools) was conducted independently by multiple researchers. A quality-effects model for meta-analysis was used for data synthesis and publication bias was assessed using the Doi plot and LFK index. The main outcome was short-term reductions in depressive symptoms. Results: Eight randomized controlled trials, three controlled before-and-after (pre-post) studies, and three uncontrolled before-and-after studies were included. Studies lacked bipolar disorder patients. Unclear randomization procedures and reporting of blinded outcome assessor, and limited use of intention-to-treat analysis, were relevant potential sources of bias. Meta-analyses indicated that psychological, pharmacological, and combined interventions were effective in reducing depressive symptoms in the short- (Cohen's d = -0.55, 95% CI -0.75 to -0.36, I 2 = 0%) and mid-term (Cohen's d = -0.66, 95% CI -1.07 to -0.25, I 2 = 65.0%). However, a high risk of publication bias was detected for these outcomes. A small number of studies, with mixed results, reported interventions with long-term improvements in depressive symptomatology, and short- and mid-term response to treatment and remission. Conclusion: Despite the well-documented long-lasting, negative, and costly impact of early adverse stressors on adult psychopathology, evidence on treatment alternatives remains scant. Trauma-focused treatment interventions-whether psychological interventions alone or in combination with pharmacotherapy-may have the potential to reduce the severity of depressive symptom in adults who were exposed to early adverse stress. Findings must be interpreted with considerable caution, as important study and outcome-level limitations were observed and gray literature was not considered in this systematic review and meta-analysis.
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Affiliation(s)
- Pablo Martínez
- Psicomedica, Clinical and Research Group, Santiago, Chile.,Departamento de Psiquiatría y Salud Mental, Hospital Clínico Universidad de Chile, Santiago, Chile.,Escuela de Psicología, Facultad de Humanidades, Universidad de Santiago de Chile, Santiago, Chile.,Instituto Milenio para la Investigación en Depresión y Personalidad (MIDAP), Santiago, Chile.,Núcleo Milenio para Mejorar la Salud Mental de Adolescentes y Jóvenes, Imhay, Santiago, Chile
| | - Sergio Gloger
- Psicomedica, Clinical and Research Group, Santiago, Chile.,Departamento de Psiquiatría y Salud Mental Campus Oriente, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | | | | | | | - Sara Schilling
- Escuela de Medicina, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Paul A Vöhringer
- Psicomedica, Clinical and Research Group, Santiago, Chile.,Departamento de Psiquiatría y Salud Mental, Hospital Clínico Universidad de Chile, Santiago, Chile.,Instituto Milenio para la Investigación en Depresión y Personalidad (MIDAP), Santiago, Chile.,Mood Disorders Program, Tufts Medical Center, Boston, MA, United States.,Department of Psychiatry, Tufts University School of Medicine, Boston, MA, United States
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Martínez P, Magaña I, Vöhringer PA, Guajardo V, Rojas G. Development and validation of a three‐item version of the Edinburgh Postnatal Depression Scale. J Clin Psychol 2020; 76:2198-2211. [DOI: 10.1002/jclp.23041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/29/2020] [Accepted: 08/03/2020] [Indexed: 01/16/2023]
Affiliation(s)
- Pablo Martínez
- Escuela de Psicología, Facultad de Humanidades Universidad de Santiago de Chile Santiago Chile
- Millennium Institute for Research in Depression and Personality Santiago Chile
- Departamento de Psiquiatría y Salud Mental Hospital Clínico Universidad de Chile Santiago Chile
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay Santiago Chile
| | - Irene Magaña
- Escuela de Psicología, Facultad de Humanidades Universidad de Santiago de Chile Santiago Chile
- Centro de Estudios Migratorios (CEM) Universidad de Santiago de Chile Santiago Chile
| | - Paul A. Vöhringer
- Millennium Institute for Research in Depression and Personality Santiago Chile
- Departamento de Psiquiatría y Salud Mental Hospital Clínico Universidad de Chile Santiago Chile
- Department of Psychiatry Tufts Medical Center Boston MA USA
- Tufts University School of Medicine Boston Massachusetts USA
| | - Viviana Guajardo
- Millennium Institute for Research in Depression and Personality Santiago Chile
- Departamento de Psiquiatría y Salud Mental Hospital Clínico Universidad de Chile Santiago Chile
- Servicio de Psiquiatría Hospital El Pino Santiago Chile
| | - Graciela Rojas
- Millennium Institute for Research in Depression and Personality Santiago Chile
- Departamento de Psiquiatría y Salud Mental Hospital Clínico Universidad de Chile Santiago Chile
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay Santiago Chile
- Millennium Nucleus of Social Development Santiago Chile
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Behn A, Vöhringer PA, Martínez P, Domínguez AP, González A, Carrasco MI, Gloger S. Validación de la versión en español del Childhood Trauma Questionnaire-Short Form en Chile, en una muestra de pacientes con depresión clínica. Rev Med Chil 2020; 148:336-343. [DOI: 10.4067/s0034-98872020000300336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/18/2020] [Indexed: 11/17/2022]
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Levis B, Benedetti A, Ioannidis JPA, Sun Y, Negeri Z, He C, Wu Y, Krishnan A, Bhandari PM, Neupane D, Imran M, Rice DB, Riehm KE, Saadat N, Azar M, Boruff J, Cuijpers P, Gilbody S, Kloda LA, McMillan D, Patten SB, Shrier I, Ziegelstein RC, Alamri SH, Amtmann D, Ayalon L, Baradaran HR, Beraldi A, Bernstein CN, Bhana A, Bombardier CH, Carter G, Chagas MH, Chibanda D, Clover K, Conwell Y, Diez-Quevedo C, Fann JR, Fischer FH, Gholizadeh L, Gibson LJ, Green EP, Greeno CG, Hall BJ, Haroz EE, Ismail K, Jetté N, Khamseh ME, Kwan Y, Lara MA, Liu SI, Loureiro SR, Löwe B, Marrie RA, Marsh L, McGuire A, Muramatsu K, Navarrete L, Osório FL, Petersen I, Picardi A, Pugh SL, Quinn TJ, Rooney AG, Shinn EH, Sidebottom A, Spangenberg L, Tan PLL, Taylor-Rowan M, Turner A, van Weert HC, Vöhringer PA, Wagner LI, White J, Winkley K, Thombs BD. Patient Health Questionnaire-9 scores do not accurately estimate depression prevalence: individual participant data meta-analysis. J Clin Epidemiol 2020; 122:115-128.e1. [PMID: 32105798 DOI: 10.1016/j.jclinepi.2020.02.002] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 02/08/2020] [Accepted: 02/18/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Depression symptom questionnaires are not for diagnostic classification. Patient Health Questionnaire-9 (PHQ-9) scores ≥10 are nonetheless often used to estimate depression prevalence. We compared PHQ-9 ≥10 prevalence to Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID) major depression prevalence and assessed whether an alternative PHQ-9 cutoff could more accurately estimate prevalence. STUDY DESIGN AND SETTING Individual participant data meta-analysis of datasets comparing PHQ-9 scores to SCID major depression status. RESULTS A total of 9,242 participants (1,389 SCID major depression cases) from 44 primary studies were included. Pooled PHQ-9 ≥10 prevalence was 24.6% (95% confidence interval [CI]: 20.8%, 28.9%); pooled SCID major depression prevalence was 12.1% (95% CI: 9.6%, 15.2%); and pooled difference was 11.9% (95% CI: 9.3%, 14.6%). The mean study-level PHQ-9 ≥10 to SCID-based prevalence ratio was 2.5 times. PHQ-9 ≥14 and the PHQ-9 diagnostic algorithm provided prevalence closest to SCID major depression prevalence, but study-level prevalence differed from SCID-based prevalence by an average absolute difference of 4.8% for PHQ-9 ≥14 (95% prediction interval: -13.6%, 14.5%) and 5.6% for the PHQ-9 diagnostic algorithm (95% prediction interval: -16.4%, 15.0%). CONCLUSION PHQ-9 ≥10 substantially overestimates depression prevalence. There is too much heterogeneity to correct statistically in individual studies.
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Affiliation(s)
- Brooke Levis
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Andrea Benedetti
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada; Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montréal, Québec, Canada; Department of Medicine, McGill University, Montréal, Québec, Canada
| | - John P A Ioannidis
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA; Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA; Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA; Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, CA, USA
| | - Ying Sun
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Zelalem Negeri
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Chen He
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Yin Wu
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada; Department of Psychiatry, McGill University, Montréal, Québec, Canada
| | - Ankur Krishnan
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Parash Mani Bhandari
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Dipika Neupane
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Mahrukh Imran
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Danielle B Rice
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Psychology, McGill University, Montréal, Québec, Canada
| | - Kira E Riehm
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Nazanin Saadat
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Marleine Azar
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Jill Boruff
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montréal, Québec, Canada
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Simon Gilbody
- Hull York Medical School and the Department of Health Sciences, University of York, Heslington, NY, UK
| | - Lorie A Kloda
- Library, Concordia University, Montréal, Québec, Canada
| | - Dean McMillan
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Scott B Patten
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Ian Shrier
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada; Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Roy C Ziegelstein
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sultan H Alamri
- Faculty of Medicine, King Abdulaziz University, Jeddah, Makkah, Saudi Arabia
| | - Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Liat Ayalon
- Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
| | - Hamid R Baradaran
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran; Ageing Clinical & Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland, UK
| | - Anna Beraldi
- Kbo-Lech-Mangfall-Klinik Garmisch-Partenkirchen, Klinik für Psychiatrie, Psychotherapie & Psychosomatik, Lehrkrankenhaus der Technischen Universität München, Munich, Germany
| | - Charles N Bernstein
- University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Arvin Bhana
- Centre for Rural Health, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa; Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Charles H Bombardier
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Gregory Carter
- Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia
| | - Marcos H Chagas
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Dixon Chibanda
- Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - Kerrie Clover
- Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Crisanto Diez-Quevedo
- Servei de Psiquiatria, Hospital Germans Trias i Pujol, Badalona, Spain; Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Jesse R Fann
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Felix H Fischer
- Department of Psychiatry, McGill University, Montréal, Québec, Canada; Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Leila Gholizadeh
- Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Lorna J Gibson
- Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Eric P Green
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | | | - Brian J Hall
- Department of Psychology, Faculty of Social Sciences, Global and Community Mental Health Research Group, University of Macau, Macau Special Administrative Region, China; Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emily E Haroz
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Khalida Ismail
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neurosciences, King's College London Weston Education Centre, London, UK
| | - Nathalie Jetté
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mohammad E Khamseh
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Yunxin Kwan
- Department of Psychological Medicine, Tan Tock Seng Hospital, Singapore
| | - Maria Asunción Lara
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz. San Lorenzo Huipulco, Tlalpan, México D. F. Mexico
| | - Shen-Ing Liu
- Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore; Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, Taipei, Taiwan
| | - Sonia R Loureiro
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ruth Ann Marrie
- Departments of Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Laura Marsh
- Baylor College of Medicine, Houston and Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Anthony McGuire
- Department of Nursing, St. Joseph's College, Standish, ME, USA
| | - Kumiko Muramatsu
- Department of Clinical Psychology, Graduate School of Niigata Seiryo University, Niigata, Japan
| | - Laura Navarrete
- Department of Epidemiology and Psychosocial Research, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Flávia L Osório
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; National Institute of Science and Technology, Translational Medicine, Ribeirão Preto, Brazil
| | - Inge Petersen
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Angelo Picardi
- Centre for Behavioural Sciences and Mental Health, Italian National Institute of Health, Rome, Italy
| | - Stephanie L Pugh
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA, USA; American College of Radiology, Philadelphia, PA, USA
| | - Terence J Quinn
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Alasdair G Rooney
- Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburg, Edinburgh, Scotland, UK
| | - Eileen H Shinn
- Department of Behavioral Science, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | | | - Lena Spangenberg
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | | | - Martin Taylor-Rowan
- Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, Scotland, UK
| | - Alyna Turner
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia; Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Victoria, Australia
| | - Henk C van Weert
- Department of General Practice, Amsterdam Institute for General Practice and Public Health, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - Paul A Vöhringer
- Department of Psychiatry and Mental Health, Clinical Hospital, Universidad de Chile, Santiago, Chile; Millennium Institute for Depression and Personality Research (MIDAP), Ministry of Economy, Macul, Santiago, Chile; Psychiatry Department, Tufts Medical Center, Tufts University, Boston, MA, USA
| | - Lynne I Wagner
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC, USA; Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Jennifer White
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Kirsty Winkley
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada; Department of Medicine, McGill University, Montréal, Québec, Canada; Department of Psychiatry, McGill University, Montréal, Québec, Canada; Department of Psychology, McGill University, Montréal, Québec, Canada; Department of Educational and Counselling Psychology, McGill University, Montréal, Québec, Canada; Biomedical Ethics Unit, McGill University, Montréal, Québec, Canada.
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Ramirez-Mahaluf JP, Rozas-Serri E, Ivanovic-Zuvic F, Risco L, Vöhringer PA. Effectiveness of Sleep Deprivation in Treating Acute Bipolar Depression as Augmentation Strategy: A Systematic Review and Meta-Analysis. Front Psychiatry 2020; 11:70. [PMID: 32161557 PMCID: PMC7052359 DOI: 10.3389/fpsyt.2020.00070] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/27/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Bipolar disorder is a disabling disease characterized by the recurrence of mood episodes. Successful strategies for the acute treatment of bipolar depression are still a matter of controversy. Total sleep deprivation (TSD) has shown acute antidepressant effect; however, the prompt relapse of depressive symptoms after sleep recovery has been reported. Taking this into consideration, we aimed to address a twofold research question: what are the acute effects of adding TSD to pharmacological treatment and what are the acute and chronic effects of adding medications to TSD. METHODS MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched for clinical trials assessing bipolar depression and TSD. Two independent reviewers selected and classified 90 abstracts. The outcomes we assessed were change in Hamilton Depression Rating Scale (HDRS) or Montgomery-Asberg Depression Rating Scale (MADRS), sustained long-term response rate, treatment-emergent mania or hypomania, and tolerability (using dropout rates as a proxy). The compared groups were: TSD alone versus TSD plus medications and medications alone versus medications plus TSD. Data was analyzed using Stata 16.0. RESULTS Patients treated with TSD plus medications compared with medications alone showed a significant decrease in depressive symptomatology after one week (SMD -0.584 [95% CI -1.126 to -0.042], p = 0.03. Also, a significant decrease in depressive symptomatology (SMD -0.894 [95% CI -1.388 to -0.399], p < 0.001) was found in the group with TSD plus medications compared with TSD alone, at the 10th day of treatment. We meta-analyzed the long-term effect of the TSD. It showed a sustained antidepressant effect (log OR = 2.365 (95% CI 0.95 to 3.779, p < 0.001) in the group where TSD was combined with medication when compared with patients treated only with TSD. Finally, no differences in tolerability (log OR = 0.234 (95% CI -1.164 to 1.632, p = 0.74) or affective switch were found. CONCLUSION Adding TSD to medications to bipolar depression treatment resulted in an augmentation in acute response. We also found that medications have a positive impact in acute response when added to TSD. Furthermore, this higher response rate was maintained after 3 months while keeping Lithium therapy.
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Affiliation(s)
- Juan P Ramirez-Mahaluf
- Department of Psychiatry, Hospital Clínico, Facultad de Medicina, Universidad de Chile, Santiago, Chile.,Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Enzo Rozas-Serri
- Department of Psychiatry, Hospital Clínico, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Fernando Ivanovic-Zuvic
- Department of Psychiatry, Hospital Clínico, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Luis Risco
- Department of Psychiatry, Hospital Clínico, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Paul A Vöhringer
- Department of Psychiatry, Hospital Clínico, Facultad de Medicina, Universidad de Chile, Santiago, Chile.,Tufts Medical Center, Mood Disorders Program, Tufts University School of Medicine, Boston, MA, United States
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12
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Villarroel J, Salinas V, Silva H, Herrera L, Montes C, Jerez S, Vöhringer PA, Bustamante ML. Beyond the Categorical Distinction Between Borderline Personality Disorder and Bipolar II Disorder Through the Identification of Personality Traits Profiles. Front Psychiatry 2020; 11:552. [PMID: 32922312 PMCID: PMC7456877 DOI: 10.3389/fpsyt.2020.00552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/29/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The relationship between borderline personality disorder (BPD) and type-II bipolar disorder (BDII) is not clearly understood. Nevertheless, in clinical practice and research, most efforts focus on establishing a categorical distinction between the two. We propose using personality traits as a more informative strategy to describe them. METHODS Five-Factor Model personality traits were measured in 73 individuals with either BPD or BDII. Latent class cluster analysis was applied to the sample. RESULTS A three-cluster model resulted the best fit to the data, where all clusters had high neuroticism and low extraversion scores but differed widely on the other traits. The clusters' boundaries did not match the categorical diagnosis. CONCLUSIONS Our sample showed significant heterogeneity on personality traits, which can have a relevant effect on the outcome of each disorder and that was not captured by the categorical diagnosis. Thus, we advocate for a multivariate approach as a better way to understand the relationship between BPD and BDII.
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Affiliation(s)
- Juana Villarroel
- University Psychiatric Clinic, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Valeria Salinas
- Neurogenetics Outpatient Clinic and Laboratory, University Neurology Center and Neurology Section, J.M. Ramos Mejía Hospital, Faculty of Medicine, Universidad de Buenos Aires, Buenos Aires, Argentina.,Precision Medicine and Clinical Genomics Program, Faculty of Biomedical Sciences, Translational Medicine Research Institute, Universidad Austral-CONICET, Buenos Aires, Argentina
| | - Hernán Silva
- University Psychiatric Clinic, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Luisa Herrera
- Human Genetics Program, Faculty of Medicine, Biomedical Sciences Institute, Universidad de Chile, Santiago, Chile
| | - Cristián Montes
- University Psychiatric Clinic, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Sonia Jerez
- University Psychiatric Clinic, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Paul A Vöhringer
- University Psychiatric Clinic, Faculty of Medicine, Universidad de Chile, Santiago, Chile.,Mood Disorders Program, Tufts Medical Center, Tufts University, Boston, MA, United States
| | - Maria Leonor Bustamante
- University Psychiatric Clinic, Faculty of Medicine, Universidad de Chile, Santiago, Chile.,Human Genetics Program, Faculty of Medicine, Biomedical Sciences Institute, Universidad de Chile, Santiago, Chile
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Martínez V, Rojas G, Martínez P, Gaete J, Zitko P, Vöhringer PA, Araya R. Computer-Assisted Cognitive-Behavioral Therapy to Treat Adolescents With Depression in Primary Health Care Centers in Santiago, Chile: A Randomized Controlled Trial. Front Psychiatry 2019; 10:552. [PMID: 31417440 PMCID: PMC6682617 DOI: 10.3389/fpsyt.2019.00552] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 07/15/2019] [Indexed: 12/19/2022] Open
Abstract
Introduction: Evidence from developed countries shows the efficacy of computer-assisted cognitive-behavioral therapy (cCBT) in addressing adolescent depression in home and/or school settings. This paper presents the results of a randomized controlled trial (RCT) of a brief therapist-guided cCBT intervention for adolescent depression in resource-constrained primary health care (PHC) settings. Material and methods: A multicenter, two-arm parallel-group, individually RCT with a 1:1 allocation ratio assigned 216 depressed adolescents (aged 15-19) attending four PHC centers in a low-income municipality of Santiago, Chile, to receive eight weekly face-to-face therapist-guided cCBT sessions by study therapists (N = 108), or to receive an enhanced usual care (EUC) intervention by trained PHC psychologists, encouraged to adhere to the national clinical guidelines for the management of depression (N = 108). Both groups received pharmacotherapy concordant with these guidelines. The primary outcome was the Beck Depression Inventory (BDI) at 4 months post-randomization, to assess depressive symptoms. BDI at 6 months post-randomization was a secondary outcome. Additional measures included patients' compliance, and satisfaction with different treatment components, at 6 months post-randomization. Main Results: The adjusted difference in mean BDI score between groups was -3.75 (95% CI -6.23 to -1.28; p = 0.003) at 4 months post-randomization. At 6 months post-randomization, the adjusted difference in mean BDI score between groups was -2.31 (95% CI -4.89 to 0.27; p = 0.078). The effect size was small-to-medium at 4 months post-randomization, d = 0.39 (0.12 to 0.67), and small and non-significant at 6 months post-randomization d = 0.29 (-0.00 to 0.59). Adolescents in the experimental treatment group were significantly more satisfied with treatment, with the PHC centers' facilities, with the psychological care received, and with non-professional staff than those in the comparator treatment group. Discussion: A brief therapist-guided cCBT eight-session intervention improves the response of depressed adolescents attending PHC centers at 4 months post-randomization. At 6 months post-randomization, the differences of between groups were not significant. Future research may focus on exploring strategies to sustain and increase response. Clinical trial registration: www.ClinicalTrials.gov, identifier NCT01862913 and URL: https://clinicaltrials.gov/ct2/show/NCT01862913.
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Affiliation(s)
- Vania Martínez
- Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente (CEMERA), Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile
- Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile
| | - Graciela Rojas
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile
- Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile
- Department of Psychiatry and Mental Health, Clinical Hospital, Universidad de Chile, Santiago, Chile
| | - Pablo Martínez
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile
- Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile
- Department of Psychiatry and Mental Health, Clinical Hospital, Universidad de Chile, Santiago, Chile
- School of Psychology, Faculty of Humanities, Universidad de Santiago de Chile, Santiago, Chile
| | - Jorge Gaete
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile
- Department of Public Health and Epidemiology, Faculty of Medicine, Universidad de Los Andes, Santiago, Chile
| | - Pedro Zitko
- Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- Unit of Healthcare Studies, Complejo Asistencial Barros Luco, Santiago, Chile
| | - Paul A. Vöhringer
- Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile
- Department of Psychiatry and Mental Health, Clinical Hospital, Universidad de Chile, Santiago, Chile
- Mood Disorders Program, Tufts Medical Center, Tufts University, Boston, MA, United States
| | - Ricardo Araya
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile
- Unit of Healthcare Studies, Complejo Asistencial Barros Luco, Santiago, Chile
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Borghero F, Martínez V, Zitko P, Vöhringer PA, Cavada G, Rojas G. [Screening depressive episodes in adolescents. Validation of the Patient Health Questionnaire-9 (PHQ-9)]. Rev Med Chil 2018; 146:479-486. [PMID: 29999123 DOI: 10.4067/s0034-98872018000400479] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 03/05/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is a paucity of validated instruments for screening depression in adolescent populations in Chile. AIM To determine the diagnostic accuracy of the adolescent version of Patient Health Questionnaire-9 (PHQ-9). MATERIAL AND METHODS The PHQ-9 was transculturally adapted and administered to adolescents aged 15 to 19 years residing in Santiago de Chile, who were then evaluated with a semi structured interview (Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version or K-SADS-PL) and the Beck Depression Inventory. Internal validity, concurrent validity, and discriminatory power of the PHQ-9 were analyzed. RESULTS We evaluated 245 adolescents aged 16.2 ± 1 years (71% females). Two hundred and ten presented with a depressive episode and 35 were healthy. The sensitivity and specificity of the scale were 86.2 and 82.9% for 11 points, with a positive likelihood ratio of 5.02. CONCLUSIONS The PHQ-9 is sensitive and specific enough to be used as a screening tool in adolescents with suspected depression. At a 11-point cut-off score as proposed, the likelihood to find a positive result in a subject with depression is five times higher.
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Affiliation(s)
| | - Vania Martínez
- Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente (CEMERA), Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Pedro Zitko
- Unidad de Estudios Asistenciales, Complejo Asistencial Barros Luco, Santiago, Chile
| | - Paul A Vöhringer
- Instituto Milenio para la Investigación en Depresión y Personalidad, Santiago, Chile
| | | | - Graciela Rojas
- Instituto Milenio para la Investigación en Depresión y Personalidad, Santiago, Chile
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Levis B, Benedetti A, Riehm KE, Saadat N, Levis AW, Azar M, Rice DB, Chiovitti MJ, Sanchez TA, Cuijpers P, Gilbody S, Ioannidis JPA, Kloda LA, McMillan D, Patten SB, Shrier I, Steele RJ, Ziegelstein RC, Akena DH, Arroll B, Ayalon L, Baradaran HR, Baron M, Beraldi A, Bombardier CH, Butterworth P, Carter G, Chagas MH, Chan JCN, Cholera R, Chowdhary N, Clover K, Conwell Y, de Man-van Ginkel JM, Delgadillo J, Fann JR, Fischer FH, Fischler B, Fung D, Gelaye B, Goodyear-Smith F, Greeno CG, Hall BJ, Hambridge J, Harrison PA, Hegerl U, Hides L, Hobfoll SE, Hudson M, Hyphantis T, Inagaki M, Isamail K, Jetté N, Khamseh ME, Kiely KM, Lamers F, Liu SI, Lotrakul M, Loureiro SR, Löwe B, Marsh L, McGuire A, Sidik SM, Munhoz TN, Muramatsu K, Osório FL, Patel V, Pence BW, Persoons P, Picardi A, Rooney AG, Santos IS, Shaaban J, Sidebottom A, Simning A, Stafford L, Sung S, Tan PLL, Turner A, van der Feltz-Cornelis CM, van Weert HC, Vöhringer PA, White J, Whooley MA, Winkley K, Yamada M, Zhang Y, Thombs BD. Probability of major depression diagnostic classification using semi-structured versus fully structured diagnostic interviews. Br J Psychiatry 2018; 212:377-385. [PMID: 29717691 PMCID: PMC6415695 DOI: 10.1192/bjp.2018.54] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Different diagnostic interviews are used as reference standards for major depression classification in research. Semi-structured interviews involve clinical judgement, whereas fully structured interviews are completely scripted. The Mini International Neuropsychiatric Interview (MINI), a brief fully structured interview, is also sometimes used. It is not known whether interview method is associated with probability of major depression classification.AimsTo evaluate the association between interview method and odds of major depression classification, controlling for depressive symptom scores and participant characteristics. METHOD Data collected for an individual participant data meta-analysis of Patient Health Questionnaire-9 (PHQ-9) diagnostic accuracy were analysed and binomial generalised linear mixed models were fit. RESULTS A total of 17 158 participants (2287 with major depression) from 57 primary studies were analysed. Among fully structured interviews, odds of major depression were higher for the MINI compared with the Composite International Diagnostic Interview (CIDI) (odds ratio (OR) = 2.10; 95% CI = 1.15-3.87). Compared with semi-structured interviews, fully structured interviews (MINI excluded) were non-significantly more likely to classify participants with low-level depressive symptoms (PHQ-9 scores ≤6) as having major depression (OR = 3.13; 95% CI = 0.98-10.00), similarly likely for moderate-level symptoms (PHQ-9 scores 7-15) (OR = 0.96; 95% CI = 0.56-1.66) and significantly less likely for high-level symptoms (PHQ-9 scores ≥16) (OR = 0.50; 95% CI = 0.26-0.97). CONCLUSIONS The MINI may identify more people as depressed than the CIDI, and semi-structured and fully structured interviews may not be interchangeable methods, but these results should be replicated.Declaration of interestDrs Jetté and Patten declare that they received a grant, outside the submitted work, from the Hotchkiss Brain Institute, which was jointly funded by the Institute and Pfizer. Pfizer was the original sponsor of the development of the PHQ-9, which is now in the public domain. Dr Chan is a steering committee member or consultant of Astra Zeneca, Bayer, Lilly, MSD and Pfizer. She has received sponsorships and honorarium for giving lectures and providing consultancy and her affiliated institution has received research grants from these companies. Dr Hegerl declares that within the past 3 years, he was an advisory board member for Lundbeck, Servier and Otsuka Pharma; a consultant for Bayer Pharma; and a speaker for Medice Arzneimittel, Novartis, and Roche Pharma, all outside the submitted work. Dr Inagaki declares that he has received grants from Novartis Pharma, lecture fees from Pfizer, Mochida, Shionogi, Sumitomo Dainippon Pharma, Daiichi-Sankyo, Meiji Seika and Takeda, and royalties from Nippon Hyoron Sha, Nanzando, Seiwa Shoten, Igaku-shoin and Technomics, all outside of the submitted work. Dr Yamada reports personal fees from Meiji Seika Pharma Co., Ltd., MSD K.K., Asahi Kasei Pharma Corporation, Seishin Shobo, Seiwa Shoten Co., Ltd., Igaku-shoin Ltd., Chugai Igakusha and Sentan Igakusha, all outside the submitted work. All other authors declare no competing interests. No funder had any role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.
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Affiliation(s)
- Brooke Levis
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1E4, Canada
| | - Andrea Benedetti
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, 5252 boul de Maisonneuve, Office/Workstation # 3D.59, Montréal, QC, H4A 3S5, Canada
| | - Kira E. Riehm
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1E4, Canada
| | - Nazanin Saadat
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1E4, Canada
| | - Alexander W. Levis
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1E4, Canada
| | - Marleine Azar
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1E4, Canada
| | - Danielle B. Rice
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1E4, Canada
| | - Matthew J. Chiovitti
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1E4, Canada
| | - Tatiana A. Sanchez
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1E4, Canada
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Simon Gilbody
- Mental Health and Addiction Research Group, Department of Health Sciences and Hull York Medical School, University of York, Heslington YO10 5DD, United Kingdom
| | | | - Lorie A. Kloda
- Concordia University, 1455, boul. de Maisonneuve Ouest, FB-802, Montréal, QC, H3G 1M8, Canada
| | - Dean McMillan
- Mental Health and Addiction Research Group, Department of Health Sciences and Hull York Medical School, University of York, Heslington YO10 5DD, United Kingdom
| | - Scott B. Patten
- Department of Community Health Sciences, 3rd Floor, TRW Building, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Ian Shrier
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Cote Ste-Catherine Rd, Montréal, QC, H3T 1E2, Canada
| | - Russell J. Steele
- Department of Mathematics and Statistics, McGill University, 805 Rue Sherbrooke O., Montreal, QC, H3A 0B9, Canada
| | - Roy C. Ziegelstein
- Johns Hopkins University School of Medicine, Miller Research Building, 733 N. Broadway, Suite 115, Baltimore, MD, 21205, USA
| | - Dickens H. Akena
- Department of Psychiatry, Makerere University College of Health Sciences, P.O.Box 7062 Kampala, Uganda
| | - Bruce Arroll
- Department of General Practice and Primary Health Care, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Liat Ayalon
- Louis and Gabi Weisfeld School of Social Work, Ramat Gan, Bar Ilan University, 52900, Israel
| | - Hamid R. Baradaran
- Endocrinology and Metabolism Research Institute, Shariati Hospital Complex, North Kargar Avenue, Tehran, 14114-13137, Iran
| | - Murray Baron
- Jewish General Hospital, Suite A 725, 3755 Cote St Catherine Rd, Montréal, QC, H3T 1E2, Canada
| | - Anna Beraldi
- Auenstraße 6, D-82467 Garmisch-Partenkirchen, Germany
| | - Charles H. Bombardier
- Division of Clinical and Neuropsychology, Department of Rehabilitation Medicine, University of Washington, Box 359612, Harborview Medical Center, 325 9th Avenue, Seattle, WA, 98104, USA
| | - Peter Butterworth
- Centre for Mental Health, Level 4, 207 Bouverie St, The University of Melbourne, Victoria 3010, Australia
| | - Gregory Carter
- Locked Bag #7, Hunter Region Mail Centre, NSW 2310, Australia
| | - Marcos H. Chagas
- University of São Paulo, Av. Bandeirantes, 3900, 14048-900-Ribeirão Preto, SP, Brazil
| | - Juliana C. N. Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, 9/F Lui Che Woo Clinical Sciences Building, Prince of Wales Hospital, Shatin, Hong Kong
| | - Rushina Cholera
- UNC School of Medicine, Department of Pediatrics, CB# 7593, Chapel Hill, NC, 27599-7593, USA
| | - Neerja Chowdhary
- World Health Organization. Avenue Appia 20, 1211 Genève 27, Switzerland
| | - Kerrie Clover
- Psycho-oncology #51, Calvary Mater Newcastle, Platt St, Waratah NSW 2301, Australia
| | - Yeates Conwell
- University of Rochester Medical Center, 300 Crittenden Blvd., Rochester, NY, 14642, USA
| | - Janneke M. de Man-van Ginkel
- University Medical Center Utrecht, Internal mail no Str. 6.131, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Jaime Delgadillo
- Clinical Psychology Unit, University of Sheffield, Cathedral Court, Floor F, 1 Vicar Lane, Sheffield, S1 1HD, United Kingdom
| | - Jesse R. Fann
- Department of Psychiatry & Behavioral Sciences, Univerisity of Washington, Box 356560, Seattle, WA 98195
| | - Felix H. Fischer
- Medizinische Klinik mit Schwerpunkt Psychosomatik, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10098 Berlin, Germany
| | | | - Daniel Fung
- Institute of Mental Health, 10 Buangkok View, 539747, Singapore
| | - Bizu Gelaye
- Department of Epidemiology, 677 Huntington Ave, Room 505F, Boston, MA, 02115, USA
| | - Felicity Goodyear-Smith
- Department of General Practice & Primary Health Care, University of Auckland, PB 92019, Auckland, 1142, New Zealand
| | - Catherine G. Greeno
- 2204 Cathedral of Learning, University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA, 15260, USA
| | - Brian J. Hall
- Department of Psychology, Faculty of Social Sciences, Humanities and Social Sciences Building E21-3040, University of Macau, E21 Avenida da Universidade, Taipa, Macau, China
| | | | - Patricia A. Harrison
- City of Minneapolis Health Department, 250 S. Fourth St., Room 510, Minneapolis, MN 55415, USA
| | - Ulrich Hegerl
- University of Leipzig, Department of Psychiatry and Psychotherapy, Semmelweisstrasse 10, 04103 Leipzig, Germany
| | - Leanne Hides
- School of Psychology, University of Queensland, St Lucia, Brisbane, Queensland, 4072, Australia
| | - Stevan E. Hobfoll
- 1645 W. Jackson Blvd, Suite 400, Dept of Behavioral Sciences, Rush University Medical Center, Chicago, IL, 60614, USA
| | - Marie Hudson
- Jewish General Hospital and Lady Davis Research Institute, 3755 Côte Ste-Catherine Rd, Room A725, Montréal, QC, H3T 1E2, Canada
| | - Thomas Hyphantis
- Department of Psychiatry, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina 451 10, Greece
| | - Masatoshi Inagaki
- Department of Neuropsychiatry, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Khalida Isamail
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 10 Cutcombe Road, London, SE5 9AF, United Kingdom
| | - Nathalie Jetté
- Department of Clinical Neurosciences, University of Calgary, 1403 29th Street NW, T2N 2T9, Canada
| | - Mohammad E. Khamseh
- Endocrinology and Metabolism Research Institute, Shariati Hospital Complex, North Kargar Avenue, Tehran, 14114-13137, Iran
| | - Kim M. Kiely
- Centre for Research on Ageing, Health and Wellbeing, The Australian National University, Building 54 Mills Road, ACT 2601, Australia
| | - Femke Lamers
- VU University Medical Center, Department Psychiatry, A.J. Ernststraat 1187, room D2.14, 1081 HL Amsterdam, The Netherlands
| | - Shen-Ing Liu
- Department of Psychiatry, Mackay Memorial Hospital, No. 92, Section 2, Chung-Shan North Rd, Taipei, Taiwan
| | - Manote Lotrakul
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Sonia R. Loureiro
- Rua Tenente Catão Roxo, 2650, CEP 14051-140, Ribeirão Preto, SP, Brazil
| | - Bernd Löwe
- Universitätsklinikum Hamburg-Eppendorf, Institut und Poliklinik für Psychosomatische Medizin und Psychotherapie, Martinistr. 52, Gebäude O25, 20246 Hamburg, Germany
| | - Laura Marsh
- Mental Health Care Line, Michael E DeBakey VA Medical Center, Departments of Psychiatry and Neurology, Baylor College of Medicine, 2002 Holcombe Blvd, Houston, TX, 77030, USA
| | | | - Sherina Mohd Sidik
- Cancer Resource & Education Centre / Department of Psychiatry, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia
| | - Tiago N. Munhoz
- Depto Medicina Social, Programa Pós-graduação Epidemiologia, Universidade Federal de Pelotas, Rua Marechal Deodoro 1160, 3º piso, 96020-220 - Pelotas, RS, Brasil
| | - Kumiko Muramatsu
- Department of Clinical Psychology, Graduate School of Niigata Seiryo University, 1-5939, Suidocho, Chuo-ku, Niigata 951-8121, Japan
| | - Flávia L. Osório
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - USP. Avenida dos Bandeirantes 3900- 3 andar- alaC. Ribeirão Preto - São Paulo - Brasil - CEP 14049-900
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA 02119, USA
| | - Brian W. Pence
- Department of Epidemiology, UNC-Chapel Hill, McGavran-Greenberg 2103C, CB#7435, 135 Dauer Dr, Chapel Hill NC 27599-7435, USA
| | - Philippe Persoons
- Katholieke Universiteit Leuven, Department of Neurosciences, Research Group Psychiatry, University Psychiatric Center KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Angelo Picardi
- Italian National Institute of Health, Centre for Behavioural Sciences and Mental Health, Viale Regina Elena 299, 00161 Rome, Italy
| | - Alasdair G. Rooney
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital Edinburgh, EH10 5HF, Scotland
| | - Iná S. Santos
- Depto Medicina Social, Programa Pós-graduação Epidemiologia, Universidade Federal de Pelotas, Rua Marechal Deodoro 1160, 3º piso 96020-220 - Pelotas, RS, Brasil
| | - Juwita Shaaban
- School of Medical Science, Health Campus Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Abbey Sidebottom
- Allina Health, 800 E 28th Street, MR 15521, Minneapolis, MN 55407-3799, USA
| | - Adam Simning
- Strong Behavioral Health, 300 Crittenden Blvd, Rochester, NY, 14642, USA
| | - Lesley Stafford
- Centre for Women’s Mental Health, The Royal Women’s Hospital, Locked Bag 300, Parkville Victoria 3052, Australia
| | - Sharon Sung
- Office of Clinical Sciences, Duke-NUS Medical School, 20 College Road, Level 6, 169856, Singapore
| | | | - Alyna Turner
- School of Medicine and Public Health, Faculty of Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | | | - Henk C. van Weert
- Dpt. General Practice, Academic Medical Centre Amsterdam, Meibergdree 9, 1105 AZ Amsterdam, The Netherlands
| | | | - Jennifer White
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing & Health Sciences, Monash University, Kingston Centre, 400 Warrigal Rd, Cheltenham Victoria 3192, Australia
| | - Mary A. Whooley
- Department of Veterans Affairs Medical Center, 4150 Clement Street (111A1), San Francisco, CA 94121, USA
| | - Kirsty Winkley
- King’s College London & Institute of Psychiatry, Psychology & Neuroscience, Weston Education Centre, London SE5 9RS, UK
| | - Mitsuhiko Yamada
- National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, Tokyo 187-8553, Japan
| | - Yuying Zhang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, 9/F Lui Che Woo Clinical Sciences Building, Prince of Wales Hospital, Shatin, Hong Kong
| | - Brett D. Thombs
- Room 302, Institute of Community and Family Psychiatry, Jewish General Hospital, 4333 Cote Ste Catherine Road, Montréal, QC, H3T 1E4, Canada
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Sani G, Vöhringer PA, Barroilhet SA, Koukopoulos AE, Ghaemi SN. The Koukopoulos Mixed Depression Rating Scale (KMDRS): An International Mood Network (IMN) validation study of a new mixed mood rating scale. J Affect Disord 2018; 232:9-16. [PMID: 29459190 DOI: 10.1016/j.jad.2018.01.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 01/14/2018] [Accepted: 01/29/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND It has been proposed that the broad major depressive disorder (MDD) construct is heterogenous. Koukopoulos has provided diagnostic criteria for an important subtype within that construct, "mixed depression" (MxD), which encompasses clinical pictures characterized by marked psychomotor or inner excitation and rage/anger, along with severe depression. This study provides psychometric validation for the first rating scale specifically designed to assess MxD symptoms cross-sectionally, the Koukopoulos Mixed Depression Rating Scale (KMDRS). METHODS 350 patients from the international mood network (IMN) completed three rating scales: the KMDRS, Montgomery-Asberg Depression Rating Scale (MADRS) and Young Mania Rating Scale (YMRS). KMDRS' psychometric properties assessed included Cronbach's alpha, inter-rater reliability, factor analysis, predictive validity, and Receiver Operator Curve analysis. RESULTS Internal consistency (Cronbach's alpha = 0.76; 95% CI 0.57, 0.94) and interrater reliability (kappa = 0.73) were adequate. Confirmatory factor analysis identified 2 components: anger and psychomotor excitation (80% of total variance). Good predictive validity was seen (C-statistic = 0.82 95% CI 0.68, 0.93). Severity cut-off scores identified were as follows: none (0-4), possible (5-9), mild (10-15), moderate (16-20) and severe (> 21) MxD. LIMITATIONS Non DSM-based diagnosis of MxD may pose some difficulties in the initial use and interpretation of the scoring of the scale. Moreover, the cross-sectional nature of the evaluation does not verify the long-term stability of the scale. CONCLUSIONS KMDRS was a reliable and valid instrument to assess MxD symptoms.
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Affiliation(s)
- Gabriele Sani
- NeSMOS Department, Sapienza University of Rome, Italy; Department of Psychiatry, Tufts Medical Center, Boston, MA, USA; Centro Lucio Bini, Rome, Italy; Tufts University School of Medicine, USA.
| | - Paul A Vöhringer
- Department of Psychiatry, Tufts Medical Center, Boston, MA, USA; Psychiatry Department, Hospital Clinico University of Chile, Chile; Millenium Institute for Depression and Personality Research, Ministry of Economy, Macul, Santiago, Chile; Tufts University School of Medicine, USA
| | - Sergio A Barroilhet
- Department of Psychiatry, Tufts Medical Center, Boston, MA, USA; University of Chile, Chile; Tufts University School of Medicine, USA
| | - Alexia E Koukopoulos
- Centro Lucio Bini, Rome, Italy; Umberto I Hospital, Psychiatry Department, Rome, Italy
| | - S Nassir Ghaemi
- Tufts University School of Medicine, USA; Department of Psychiatry, Harvard Medical School, USA; Translational Medicine-Neuroscience, Novartis Institutes of Biomedical Research, Cambridge, MA, USA
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Martínez P, Castro A, Alonso D, Vöhringer PA, Rojas G. Effectiveness of the management of major depressive episodes/disorder in adults with comorbid chronic physical diseases: a protocol for a systematic review and meta-analysis. BMJ Open 2017; 7:e011249. [PMID: 28729304 PMCID: PMC5541516 DOI: 10.1136/bmjopen-2016-011249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Depression is a global-scale public health problem, and a significant association has been established between depression and chronic physical diseases. This growing comorbidity poses a challenge to healthcare systems. We aim to assess the effectiveness of the management of major depressive episodes/disorder in adults with comorbid chronic physical diseases. METHODS AND ANALYSIS We will conduct a systematic review and meta-analysis of randomised clinical trials. Two databases MEDLINE and Cochrane Library (Cochrane Database for Systematic Reviews and CENTRAL), as well as the reference lists of the included articles, will be searched for studies either in English or Spanish with published results within the 2005-2015 period. Studies must fulfil the following conditions: (1) participants aged 18 years or older, diagnosed as having a major depressive episodes/disorder according to standardised criteria and chronic physical diseases; (2)interventions (be it pharmacological, psychological, psychosocial or a combination) must be compared with control conditions (other 'active' intervention, treatment as usual, waiting list or placebo); (3)and must report reduction in depressive symptoms after treatment, response to treatment, remission of major depressive episodes/disorder and significant improvement in quality of life. Data extraction, risk of bias evaluation, results summarisation and quality of the evidence (GRADE) will be performed as recommended by the Cochrane Collaboration. A qualitative synthesis and a random effects meta-analysis will be carried out. Effect sizes will be calculated (relative risk and Cohen's d), I2 and Q statistics will be employed to study heterogeneity and publication bias analysis will be performed. Subgroup analyses and meta-regression will be carried out. ETHICS AND DISSEMINATION Results are expected to be published in specialised peer-reviewed journals (preferred topics: Mental Health, Psychology, Psychiatry and/or Systematic Reviews) and dissemination activities will be targeted to all the healthcare providers. TRIAL REGISTRATION NUMBER International Prospective Register of Systematic Reviews (CRD42016029166) submitted on 11 January 2016.
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Affiliation(s)
- Pablo Martínez
- Department of Psychiatry and Mental Health, Clinical Hospital, Universidad de Chile, Santiago de Chile, Chile
- Information Technology Innovation Centre for Social Applications (CITIAPS), Universidad de Santiago de Chile, Santiago, Chile
- Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile
- School of Psychology, Faculty of Humanities, Universidad de Santiago de Chile, Santiago, Chile
| | - Ariel Castro
- School of Medicine, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Diego Alonso
- School of Medicine, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Paul A Vöhringer
- Department of Psychiatry and Mental Health, Clinical Hospital, Universidad de Chile, Santiago de Chile, Chile
- Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile
- Mood Disorders Program, Tufts Medical Center, Tufts University, Boston, Massachusetts, USA
| | - Graciela Rojas
- Department of Psychiatry and Mental Health, Clinical Hospital, Universidad de Chile, Santiago de Chile, Chile
- Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile
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18
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Martínez P, Rojas G, Fritsch R, Martínez V, Vöhringer PA, Castro A. [Comorbidity in people with depression seeking help at primary health care centers in Santiago, Chile]. Rev Med Chil 2017; 145:25-32. [PMID: 28393966 DOI: 10.4067/s0034-98872017000100004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 12/26/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND International evidence has shown the complex interaction between depression and chronic physical diseases. Depression in scenarios involving multiple comorbidities has not received enough attention in Chile. AIM To characterize the depressed people who consult at Primary Health Care Centers (PHCCs), taking into account the presence of chronic physical or psychiatric comorbidity. MATERIALS AND METHODS A secondary analysis of databases used in a clinical trial. Two hundred fifty six adults seeking professional help were recruited in four PHCCs located in the Metropolitan Region. These people had a major depressive episode, identified with a structured psychiatric interview (MINI), and gave their informed consent to participate. Socio-demographic information was collected, depressive symptomatology was measured with the patient health questionnaire 9 (PHQ-9), psychiatric morbidity was assessed using the Mini International Neuropsychiatric Interview (MINI), and chronic physical diseases were self-reported by the patients. Descriptive analyses of all the variables were conducted. RESULTS Seventy percent of patients had a history of depression, with a median of two prior depressive episodes. Depressive symptoms were mostly considered as moderate to severe and severe and 31% of the patients had high suicide risk. Seventy eight percent displayed a physical or psychiatric comorbidity. Of these patients, 29% only had a chronic physical comorbidity, while 46% suffered from an additional psychiatric disorder. CONCLUSIONS Depressed individuals who seek help at PHCCs constitute an especially complex population that must be treated taking into account multiple comorbidities.
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Affiliation(s)
- Pablo Martínez
- Departamento de Psiquiatría y Salud Mental, Hospital Clínico, Universidad de Chile, Santiago, Chile
| | - Graciela Rojas
- Departamento de Psiquiatría y Salud Mental, Hospital Clínico, Universidad de Chile, Santiago, Chile
| | - Rosemarie Fritsch
- Departamento de Psiquiatría y Salud Mental, Hospital Clínico, Universidad de Chile, Santiago, Chile
| | - Vania Martínez
- Instituto Milenio para la Investigación en Depresión y Personalidad, Santiago, Chile
| | - Paul A Vöhringer
- Departamento de Psiquiatría y Salud Mental, Hospital Clínico, Universidad de Chile, Santiago, Chile
| | - Ariel Castro
- Subdirección de Investigación, Hospital Clínico, Universidad de Chile, Santiago, Chile
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Vöhringer PA, Barroilhet SA, Alvear K, Medina S, Espinosa C, Alexandrovich K, Riumallo P, Leiva F, Hurtado ME, Cabrera J, Sullivan M, Holtzman N, Ghaemi SN. The International Mood Network (IMN) Nosology Project: differentiating borderline personality from bipolar illness. Acta Psychiatr Scand 2016; 134:504-510. [PMID: 27611723 DOI: 10.1111/acps.12643] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The differential diagnosis of bipolar illness vs. borderline personality is controversial. Both conditions manifest impulsive behavior, unstable interpersonal relationships, and mood symptoms. This study examines whether and which mood clinical features can differentiate between both conditions. METHOD A total of 260 patients (mean ± standard deviation age 41 ± 13 years, 68% female) attending to a mood clinic were examined for diagnosis of bipolar illness and borderline personality disorder using SCID-I, SCID-II, and clinical mood criteria extracted from Mood Disorder Questionnaire (MDQ). They were analyzed using diagnoses as dependent variables. Predictors of bipolar and borderline diagnoses were identified by multivariable logistic regressions, and predictive validity of models was assessed using ROC curve analysis. RESULTS Bipolar illness was strongly predicted by elevated mood (OR = 4.02, 95% CI: 1.80-9.15), increased goal-directed activities (OR = 3.90, 95% CI: 1.73-8.96), and episodicity of mood symptoms (OR = 3.48, 95% CI 1.49-8.39). This triad model predicted bipolar illness with 88.7% sensitivity, 81.4% specificity, and obtained an auROC of 0.91 (95% CI: 0.76-0.96) and a positive predictive value of 85.1%. For borderline personality disorder, only female gender was a statistically significant predictor (OR = 3.41, 95% CI: 1.29-13.7), and the predictive model obtained an auROC of 0.67 (95% CI: 0.53-0.74). CONCLUSION In a mood disorder clinic setting, manic criteria and episodic mood course distinguished bipolar illness from borderline personality disorder.
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Affiliation(s)
- P A Vöhringer
- Unidad de Trastornos del Ánimo, Clínica Psiquiátrica Universitaria, Hospital Clínico Universidad de Chile, Facultad de Medicina Universidad de Chile, Santiago, Chile.,Clínica de Trastornos del Ánimo, Instituto Psiquiátrico "Dr. José Horwitz B", Santiago, Chile.,Mood Disorders Program, Tufts Medical Center, Boston, MA, USA.,Millenium Institute for Depression and Personality Research, Ministry of Economy, Macul, Santiago, Chile
| | - S A Barroilhet
- Mood Disorders Program, Tufts Medical Center, Boston, MA, USA.,Escuela de Psicología, Universidad de los Andes, Santiago, Chile.,Unidad de Psiquiatría de Enlace, Clínica Psiquiátrica Universitaria, Hospital Clínico Universidad de Chile, Facultad de Medicina Universidad de Chile, Santiago, Chile
| | - K Alvear
- Clínica de Trastornos del Ánimo, Instituto Psiquiátrico "Dr. José Horwitz B", Santiago, Chile.,Universidad Diego Portales, Santiago, Chile
| | - S Medina
- Clínica de Trastornos del Ánimo, Instituto Psiquiátrico "Dr. José Horwitz B", Santiago, Chile
| | - C Espinosa
- Clínica de Trastornos del Ánimo, Instituto Psiquiátrico "Dr. José Horwitz B", Santiago, Chile
| | - K Alexandrovich
- Clínica de Trastornos del Ánimo, Instituto Psiquiátrico "Dr. José Horwitz B", Santiago, Chile
| | - P Riumallo
- Clínica de Trastornos del Ánimo, Instituto Psiquiátrico "Dr. José Horwitz B", Santiago, Chile
| | - F Leiva
- Clínica de Trastornos del Ánimo, Instituto Psiquiátrico "Dr. José Horwitz B", Santiago, Chile
| | - M E Hurtado
- Clínica de Trastornos del Ánimo, Instituto Psiquiátrico "Dr. José Horwitz B", Santiago, Chile
| | - J Cabrera
- Clínica de Trastornos del Ánimo, Instituto Psiquiátrico "Dr. José Horwitz B", Santiago, Chile
| | - M Sullivan
- Mood Disorders Program, Tufts Medical Center, Boston, MA, USA
| | - N Holtzman
- Mood Disorders Program, Tufts Medical Center, Boston, MA, USA
| | - S N Ghaemi
- Mood Disorders Program, Tufts Medical Center, Boston, MA, USA
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McGirr A, Vöhringer PA, Ghaemi SN, Lam RW, Yatham LN. Safety and efficacy of adjunctive second-generation antidepressant therapy with a mood stabiliser or an atypical antipsychotic in acute bipolar depression: a systematic review and meta-analysis of randomised placebo-controlled trials. Lancet Psychiatry 2016; 3:1138-1146. [PMID: 28100425 DOI: 10.1016/s2215-0366(16)30264-4] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/03/2016] [Accepted: 08/16/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although mania and hypomania define bipolar disorder, depressive episodes are more common and impairing, with few proven treatments. Adjunctive therapy with second-generation antidepressants is widely used to treat acute bipolar depression, but their efficacy and safety remain controversial. METHODS In this systematic review and meta-analysis, we searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov from inception to Jan 31, 2016, for randomised, double-blind, placebo-controlled trials of second-generation antidepressants adjunctive to a mood stabiliser or an antipsychotic in patients with acute bipolar depression. We extracted data from published reports. The primary outcome was change in clinician-rated depressive symptom score; secondary outcomes were clinical response, clinical remission, treatment-emergent mania or hypomania, and tolerability (using dropout rates as a proxy). We used pooled random-effects models, subgroup comparisons, and meta-regression for analyses. We made subgroup comparisons on the basis of mood stabiliser or antipsychotic treatment and did meta-regression examining trial duration. This study is registered with PROSPERO, number CRD#42015016024. FINDINGS We identified six trials representing 1383 patients with bipolar depression. Second-generation antidepressants were associated with a small but significant improvement in clinician-rated depressive symptom score (standardised mean differences 0·165 [95% CI 0·051-0·278], p=0·004). However, clinical response and remission rates did not differ significantly between patients receiving adjunctive antidepressants and those receiving placebo (1·158 [0·840-1·597], p=0·371 for clinical response; 1·220 [0·874-1·703], p=0·243 for remission). Acute treatment was not associated with an increased risk of treatment-emergent mania or hypomania (0·926 [0·576-1·491], p=0·753), but 52 week extension periods were associated with an increase in risk (1·774 [1·018-3·091], p=0·043). INTERPRETATION Adjunctive second-generation antidepressants are associated with reduced symptoms of acute bipolar depression, but the magnitude of benefit is small because they do not increase clinical response or remission rates. However, these medications should be used only in the short term because prolonged use is associated with an increased risk of treatment-emergent mania or hypomania. FUNDING None.
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Affiliation(s)
- Alexander McGirr
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
| | - Paul A Vöhringer
- Unidad Tratornos del Animo, Hospital Clinico Universidad de Chile, Santiago, Chile; Millennium Institute for Depression and Personality Resarch, Ministry of Economy, Santiago, Chile; Mood Disorders Program, Tufts University Medical School, Boston, MA, USA
| | - S Nassir Ghaemi
- Mood Disorders Program, Tufts University Medical School, Boston, MA, USA
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; Mood Disorders Centre of Excellence, University of British Columbia, Vancouver, BC, Canada
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; Mood Disorders Centre of Excellence, University of British Columbia, Vancouver, BC, Canada.
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Vöhringer PA, Castro A, Martínez P, Tala Á, Medina S, Rojas G. Healthcare team training programs aimed at improving depression management in primary care: A systematic review. J Affect Disord 2016; 200:142-7. [PMID: 27136411 DOI: 10.1016/j.jad.2016.04.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/16/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although evidence from Latin America and the Caribbean suggests that depression can be effectively treated in primary care settings, depression management remains unevenly performed. This systematic review evaluates all the international evidence on healthcare team training programs aimed at improving the outcomes of patients with depression. METHODS Three databases were searched for articles in English or Spanish indexed up to November 20, 2014. Studies were included if they fulfilled the following conditions: clinical trials, meta-analyses, or systematic reviews; and if they evaluated a training or educational program intended to improve the management of depression by primary healthcare teams, and assessed change in depressive symptoms, diagnosis or response rates, referral rates, patients' satisfaction and/or quality of life, and the effectiveness of treatments. RESULTS Nine studies were included in this systematic review. Five trials tested the effectiveness of multi-component interventions (training included), and the remaining studies evaluated the effectiveness of specific training programs for depression management. All the studies that implemented multi-component interventions were efficacious, and half of the training trials were shown to be effective. LIMITATIONS Contribution of training programs alone to the effectiveness of multi-component interventions is yet to be established. The lack of specificity regarding health providers' characteristics might be a confounding factor. CONCLUSIONS The review conducted suggests that stand-alone training programs are less effective than multi-component interventions. In applying the evidence gathered from developed countries to Latin America and the Caribbean, these training programs must consider and address local conditions of mental health systems, and therefore multi-component interventions may be warranted.
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Affiliation(s)
- Paul A Vöhringer
- Department of Psychiatry and Mental Health, Clinical Hospital, Universidad de Chile, Santiago, Chile; Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile; Mood Disorders Program, Tufts Medical Center, Tufts University, Boston, USA
| | - Ariel Castro
- Clinical Hospital, Universidad de Chile, Santiago, Chile
| | - Pablo Martínez
- Department of Psychiatry and Mental Health, Clinical Hospital, Universidad de Chile, Santiago, Chile; Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile; School of Psychology, Faculty of Humanities, Universidad de Santiago de Chile, Santiago, Chile.
| | - Álvaro Tala
- Department of Psychiatry and Mental Health, Clinical Hospital, Universidad de Chile, Santiago, Chile
| | - Simón Medina
- School of Medicine, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Graciela Rojas
- Department of Psychiatry and Mental Health, Clinical Hospital, Universidad de Chile, Santiago, Chile; Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile
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Martínez P, Vöhringer PA, Rojas G. Barriers to access to treatment for mothers with postpartum depression in primary health care centers: a predictive model. Rev Lat Am Enfermagem 2016; 24:e2675. [PMID: 27027674 PMCID: PMC4809181 DOI: 10.1590/1518-8345.0982.2675] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 07/21/2015] [Indexed: 10/29/2022] Open
Abstract
OBJECTIVE to develop a predictive model to evaluate the factors that modify the access to treatment for Postpartum Depression (PPD). METHODS prospective study with mothers who participated in the monitoring of child health in primary care centers. For the initial assessment and during 3 months, it was considered: sociodemographic data, gyneco-obstetric data, data on the services provided, depressive symptoms according to the Edinburgh Postpartum Depression Scale (EPDS) and quality of life according to the Short Form-36 Health Status Questionnaire (SF-36). The diagnosis of depression was made based on MINI. Mothers diagnosed with PPD in the initial evaluation, were followed-up. RESULTS a statistical model was constructed to determine the factors that prevented access to treatment, which consisted of: item 2 of EPDS (OR 0.43, 95%CI: 0.20-0.93) and item 5 (OR 0.48, 95%CI: 0.21-1.09), and previous history of depression treatment (OR 0.26, 95%CI: 0.61-1.06). Area under the ROC curve for the model=0.79; p-value for the Hosmer-Lemershow=0.73. CONCLUSION it was elaborated a simple, well standardized and accurate profile, which advises that nurses should pay attention to those mothers diagnosed with PPD, presenting low/no anhedonia (item 2 of EPDS), scarce/no panic/fear (item 5 of EPDS), and no history of depression, as it is likely that these women do not initiate treatment.
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Affiliation(s)
- Pablo Martínez
- Escuela de Psicología, Universidad de Santiago de Chile, Santiago, Chile
| | | | - Graciela Rojas
- Facultad de Medicina, Universidad de Chile, Santiago, Chile
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Abstract
Rates of misdiagnosis between major depressive disorder and bipolar disorder have been reported to be substantial, and the consequence of such misdiagnosis is likely to be a delay in achieving effective control of symptoms, in some cases spanning many years. Particularly in the midst of a depressive episode, or early in the illness course, it may be challenging to distinguish the 2 mood disorders purely on the basis of cross-sectional features. To date, no useful biological markers have been reliably shown to distinguish between bipolar disorder and major depressive disorder.
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Affiliation(s)
- Paul A Vöhringer
- Department of Psychiatry, Tufts University School of Medicine, 800 Washington Street, Boston, MA 02111, USA; Department of Psychiatry, University of Chile, Av. Independencia 1027, Santiago 8071146, Chile
| | - Roy H Perlis
- Department of Psychiatry, Center for Experimental Drugs and Diagnostics, Massachusetts General Hospital, Harvard Medical School, 185 Cambridge Street, Boston, MA 02114, USA.
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Ghaemi N, El-Mallakh R, Vöhringer PA. Reply to letter to the editor. J Affect Disord 2016; 190:891-892. [PMID: 26300230 DOI: 10.1016/j.jad.2015.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Nassir Ghaemi
- Department of Psychiatry, 800 Washington St, Boston, MA 02111, United States.
| | - Rif El-Mallakh
- Department of Psychiatry, 800 Washington St, Boston, MA 02111, United States
| | - Paul A Vöhringer
- Department of Psychiatry, 800 Washington St, Boston, MA 02111, United States
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Baudrand R, Pojoga LH, Vaidya A, Garza AE, Vöhringer PA, Jeunemaitre X, Hopkins PN, Yao TM, Williams J, Adler GK, Williams GH. Statin Use and Adrenal Aldosterone Production in Hypertensive and Diabetic Subjects. Circulation 2015; 132:1825-33. [PMID: 26432671 DOI: 10.1161/circulationaha.115.016759] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 08/20/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND Statins substantially reduce cardiovascular mortality and appear to have beneficial effects independent of their lipid-lowering properties. We evaluated the hypothesis that statin use may modulate the secretion of aldosterone, a well-known contributor to cardiovascular disease. METHODS AND RESULTS We measured adrenal hormones in 2 intervention studies. In study 1 in hypertensive subjects, aldosterone was analyzed at baseline and after angiotensin II stimulation on both high- and low-sodium diets (1122 observations, 15% on statins for >3 months). Statin users had 33% lower aldosterone levels in adjusted models (P<0.001). Cortisol was not modified by statins. In secondary analyses, the lowest aldosterone levels were seen with lipophilic statins and with higher doses. Statin users had lower blood pressure and reduced salt sensitivity of blood pressure (both P<0.001). In study 2, aldosterone was measured in diabetic patients on a high-sodium diet, before and after angiotensin II stimulation (143 observations, 79% statin users). Again, statin users had 26% lower aldosterone levels (P=0.006), particularly those using lipophilic statins. Ex vivo studies in rat adrenal glomerulosa cells confirmed that lipophilic statins acutely inhibited aldosterone, but not corticosterone, in response to different secretagogues. CONCLUSIONS Statin use among hypertensive and diabetic subjects was associated with lower aldosterone secretion in response to angiotensin II and a low-sodium diet in 2 human intervention studies. This effect appeared to be most pronounced with lipophilic statins and higher doses. Future studies to evaluate whether aldosterone inhibition may partially explain the robust cardioprotective effects of statins are warranted.
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Affiliation(s)
- Rene Baudrand
- From Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.B., L.H.P., A.V., A.E.G., T.M.Y., J.W., G.K.A., G.H.W.); Department of Endocrinology, School Of Medicine, Pontificia Universidad Catolica De Chile, Santiago, Chile (R.B.); Hospital Clinico, Facultad Medicina Universidad de Chile, Santiago, Chile and Tufts Medical Center, Tufts University School of Medicine, Boston, MA (P.A.V.); Centre Investigation Clinique, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Universite Paris Descartes, Paris, France (X.J.); and Cardiovascular Genetics Research, University of Utah School of Medicine Salt Lake City (P.N.H.).
| | - Luminita H Pojoga
- From Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.B., L.H.P., A.V., A.E.G., T.M.Y., J.W., G.K.A., G.H.W.); Department of Endocrinology, School Of Medicine, Pontificia Universidad Catolica De Chile, Santiago, Chile (R.B.); Hospital Clinico, Facultad Medicina Universidad de Chile, Santiago, Chile and Tufts Medical Center, Tufts University School of Medicine, Boston, MA (P.A.V.); Centre Investigation Clinique, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Universite Paris Descartes, Paris, France (X.J.); and Cardiovascular Genetics Research, University of Utah School of Medicine Salt Lake City (P.N.H.)
| | - Anand Vaidya
- From Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.B., L.H.P., A.V., A.E.G., T.M.Y., J.W., G.K.A., G.H.W.); Department of Endocrinology, School Of Medicine, Pontificia Universidad Catolica De Chile, Santiago, Chile (R.B.); Hospital Clinico, Facultad Medicina Universidad de Chile, Santiago, Chile and Tufts Medical Center, Tufts University School of Medicine, Boston, MA (P.A.V.); Centre Investigation Clinique, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Universite Paris Descartes, Paris, France (X.J.); and Cardiovascular Genetics Research, University of Utah School of Medicine Salt Lake City (P.N.H.)
| | - Amanda E Garza
- From Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.B., L.H.P., A.V., A.E.G., T.M.Y., J.W., G.K.A., G.H.W.); Department of Endocrinology, School Of Medicine, Pontificia Universidad Catolica De Chile, Santiago, Chile (R.B.); Hospital Clinico, Facultad Medicina Universidad de Chile, Santiago, Chile and Tufts Medical Center, Tufts University School of Medicine, Boston, MA (P.A.V.); Centre Investigation Clinique, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Universite Paris Descartes, Paris, France (X.J.); and Cardiovascular Genetics Research, University of Utah School of Medicine Salt Lake City (P.N.H.)
| | - Paul A Vöhringer
- From Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.B., L.H.P., A.V., A.E.G., T.M.Y., J.W., G.K.A., G.H.W.); Department of Endocrinology, School Of Medicine, Pontificia Universidad Catolica De Chile, Santiago, Chile (R.B.); Hospital Clinico, Facultad Medicina Universidad de Chile, Santiago, Chile and Tufts Medical Center, Tufts University School of Medicine, Boston, MA (P.A.V.); Centre Investigation Clinique, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Universite Paris Descartes, Paris, France (X.J.); and Cardiovascular Genetics Research, University of Utah School of Medicine Salt Lake City (P.N.H.)
| | - Xavier Jeunemaitre
- From Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.B., L.H.P., A.V., A.E.G., T.M.Y., J.W., G.K.A., G.H.W.); Department of Endocrinology, School Of Medicine, Pontificia Universidad Catolica De Chile, Santiago, Chile (R.B.); Hospital Clinico, Facultad Medicina Universidad de Chile, Santiago, Chile and Tufts Medical Center, Tufts University School of Medicine, Boston, MA (P.A.V.); Centre Investigation Clinique, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Universite Paris Descartes, Paris, France (X.J.); and Cardiovascular Genetics Research, University of Utah School of Medicine Salt Lake City (P.N.H.)
| | - Paul N Hopkins
- From Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.B., L.H.P., A.V., A.E.G., T.M.Y., J.W., G.K.A., G.H.W.); Department of Endocrinology, School Of Medicine, Pontificia Universidad Catolica De Chile, Santiago, Chile (R.B.); Hospital Clinico, Facultad Medicina Universidad de Chile, Santiago, Chile and Tufts Medical Center, Tufts University School of Medicine, Boston, MA (P.A.V.); Centre Investigation Clinique, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Universite Paris Descartes, Paris, France (X.J.); and Cardiovascular Genetics Research, University of Utah School of Medicine Salt Lake City (P.N.H.)
| | - Tham M Yao
- From Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.B., L.H.P., A.V., A.E.G., T.M.Y., J.W., G.K.A., G.H.W.); Department of Endocrinology, School Of Medicine, Pontificia Universidad Catolica De Chile, Santiago, Chile (R.B.); Hospital Clinico, Facultad Medicina Universidad de Chile, Santiago, Chile and Tufts Medical Center, Tufts University School of Medicine, Boston, MA (P.A.V.); Centre Investigation Clinique, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Universite Paris Descartes, Paris, France (X.J.); and Cardiovascular Genetics Research, University of Utah School of Medicine Salt Lake City (P.N.H.)
| | - Jonathan Williams
- From Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.B., L.H.P., A.V., A.E.G., T.M.Y., J.W., G.K.A., G.H.W.); Department of Endocrinology, School Of Medicine, Pontificia Universidad Catolica De Chile, Santiago, Chile (R.B.); Hospital Clinico, Facultad Medicina Universidad de Chile, Santiago, Chile and Tufts Medical Center, Tufts University School of Medicine, Boston, MA (P.A.V.); Centre Investigation Clinique, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Universite Paris Descartes, Paris, France (X.J.); and Cardiovascular Genetics Research, University of Utah School of Medicine Salt Lake City (P.N.H.)
| | - Gail K Adler
- From Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.B., L.H.P., A.V., A.E.G., T.M.Y., J.W., G.K.A., G.H.W.); Department of Endocrinology, School Of Medicine, Pontificia Universidad Catolica De Chile, Santiago, Chile (R.B.); Hospital Clinico, Facultad Medicina Universidad de Chile, Santiago, Chile and Tufts Medical Center, Tufts University School of Medicine, Boston, MA (P.A.V.); Centre Investigation Clinique, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Universite Paris Descartes, Paris, France (X.J.); and Cardiovascular Genetics Research, University of Utah School of Medicine Salt Lake City (P.N.H.)
| | - Gordon H Williams
- From Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.B., L.H.P., A.V., A.E.G., T.M.Y., J.W., G.K.A., G.H.W.); Department of Endocrinology, School Of Medicine, Pontificia Universidad Catolica De Chile, Santiago, Chile (R.B.); Hospital Clinico, Facultad Medicina Universidad de Chile, Santiago, Chile and Tufts Medical Center, Tufts University School of Medicine, Boston, MA (P.A.V.); Centre Investigation Clinique, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Universite Paris Descartes, Paris, France (X.J.); and Cardiovascular Genetics Research, University of Utah School of Medicine Salt Lake City (P.N.H.).
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El-Mallakh RS, Vöhringer PA, Ostacher MM, Baldassano CF, Holtzman NS, Whitham EA, Thommi SB, Goodwin FK, Ghaemi SN. Antidepressants worsen rapid-cycling course in bipolar depression: A STEP-BD randomized clinical trial. J Affect Disord 2015; 184:318-21. [PMID: 26142612 PMCID: PMC4519402 DOI: 10.1016/j.jad.2015.04.054] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Revised: 03/10/2015] [Accepted: 04/29/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The use of antidepressants in rapid-cycling bipolar disorder has been controversial. We report the first randomized clinical trial with modern antidepressants on this topic. METHODS As part of the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study, we analyzed, as an a priori secondary outcome, rapid cycling as a predictor of response in 68 patients randomized to continue vs. discontinue antidepressant treatment, after initial response for an acute major depressive episode. Outcomes assessed were percent time well and total number of episodes. All patients received standard mood stabilizers. RESULTS In those continued on antidepressants (AD), rapid cycling (RC) subjects experienced 268% (3.14/1.17) more total mood episodes/year, and 293% (1.29/0.44) more depressive episodes/year, compared with non-rapid cycling (NRC) subjects (mean difference in depressive episodes per year RC vs. NRC was 0.85 ± 0.37 (SE), df = 28, p = 0.03). In the AD continuation group, RC patients also had 28.8% less time in remission than NRC patients (95% confidence intervals (9.9%, 46.5%), p = 0.004). No such differences between RC and NRC subjects were seen in the AD discontinuation group (Table 1). Analyses within the rapid-cycling subgroup alone were consistent with the above comparisons between RC and NRC subjects, stratified by maintenance antidepressant treatment, though limited by sample size. CONCLUSIONS In an a priori analysis, despite preselection for good antidepressant response and concurrent mood stabilizer treatment, antidepressant continuation in rapid-cycling was associated with worsened maintenance outcomes, especially for depressive morbidity, vs. antidepressant discontinuation.
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Affiliation(s)
| | - Paul A. Vöhringer
- Mood Disorders Program, Department of Psychiatry, Tufts Medical Center, Boston, MA, Clinic University Hospital, University of Chile, Santiago, Chile
| | - Michael M. Ostacher
- Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Palo Alto, CA
| | | | - Niki S. Holtzman
- Mood Disorders Program, Department of Psychiatry, Tufts Medical Center, Boston, MA
| | - Elizabeth A. Whitham
- Mood Disorders Program, Department of Psychiatry, Tufts Medical Center, Boston, MA
| | - Sairah B. Thommi
- Mood Disorders Program, Department of Psychiatry, Tufts Medical Center, Boston, MA
| | | | - S. Nassir Ghaemi
- Mood Disorders Program, Department of Psychiatry, Tufts Medical Center, Boston, MA, Tufts University School of Medicine, Boston, MA
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Errázuriz P, Valdés C, Vöhringer PA, Calvo E. Financiamiento de la salud mental en Chile: una deuda pendiente. Rev Med Chil 2015; 143:1179-86. [DOI: 10.4067/s0034-98872015000900011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 07/28/2015] [Indexed: 11/17/2022]
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Rojas G, Martínez P, Vöhringer PA, Martínez V, Castro-Lara A, Fritsch R. Comprehensive technology-assisted training and supervision program to enhance depression management in primary care in Santiago, Chile: study protocol for a cluster randomized controlled trial. Trials 2015. [PMID: 26201546 PMCID: PMC4512091 DOI: 10.1186/s13063-015-0845-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Depression is a common and disabling condition. Since 2001, Chile has had a national program for depression in primary care and universal access to treatment for depressed people over the age of 15. There are National Guidelines to treat depression but no training program exists. The aim of the present study protocol is to measure the effectiveness of a comprehensive technology-assisted training and supervision program to enhance depression management in primary care. Methods and design This is a two-arm, single-blind, cluster randomized controlled trial to compare the efficacy of the program versus usual care to treat depression in primary care clinics. In total, 434 depressed persons 18 to 65 years of age, recruited from four primary care clinics located in Santiago, will participate in the study. Discussion In order to ensure the quality of interventions supported by the national program for depression in Chile, it is desirable to have training programs of proven effectiveness. Trial registration NCT02232854, registered on 2 September 2014.
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Affiliation(s)
- Graciela Rojas
- Universidad de Chile, Departamento de Psiquiatría y Salud Mental, Clínica Psiquiátrica Universitaria, Av. La Paz 1003, Recoleta, Santiago, Chile. .,Núcleo Milenio de Intervención Psicológica y Cambio en Depresión, Av. Vicuña Mackenna 4860, Macul, Santiago, Chile.
| | - Pablo Martínez
- Universidad de Chile, Departamento de Psiquiatría y Salud Mental, Clínica Psiquiátrica Universitaria, Av. La Paz 1003, Recoleta, Santiago, Chile.
| | - Paul A Vöhringer
- Universidad de Chile, Departamento de Psiquiatría y Salud Mental, Clínica Psiquiátrica Universitaria, Av. La Paz 1003, Recoleta, Santiago, Chile. .,Mood Disorders Program, Psychiatry Department, Tufts Medical Center Tufts University School of Medicine, Boston, Massachusetts, USA.
| | - Vania Martínez
- Núcleo Milenio de Intervención Psicológica y Cambio en Depresión, Av. Vicuña Mackenna 4860, Macul, Santiago, Chile. .,Universidad de Chile, Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente, Facultad de Medicina, Universidad de Chile, Av. Profesor Zañartu 1030, Independencia, Santiago, Chile.
| | - Ariel Castro-Lara
- Universidad de Chile, Departamento de Psiquiatría y Salud Mental, Clínica Psiquiátrica Universitaria, Av. La Paz 1003, Recoleta, Santiago, Chile.
| | - Rosemarie Fritsch
- Universidad de Chile, Departamento de Psiquiatría y Salud Mental, Clínica Psiquiátrica Universitaria, Av. La Paz 1003, Recoleta, Santiago, Chile.
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Sani G, Napoletano F, Vöhringer PA, Sullivan M, Simonetti A, Koukopoulos A, Danese E, Girardi P, Ghaemi N. Mixed depression: clinical features and predictors of its onset associated with antidepressant use. Psychother Psychosom 2015; 83:213-21. [PMID: 24970376 DOI: 10.1159/000358808] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 01/16/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Mixed depression (MxD) is narrowly defined in the DSM-IV and somewhat broader in the DSM-5, although both exclude psychomotor agitation as a diagnostic criterion. This article proposes a clinical description for defining MxD, which emphasizes psychomotor excitation. METHODS Two hundred and nineteen consecutive outpatients were diagnosed with an MxD episode using criteria proposed by Koukopoulos et al. [Acta Psychiatr Scand 2007;115(suppl 433):50-57]; we here report their clinical features and antidepressant-related effects. RESULTS The most frequent MxD symptoms were: psychic agitation or inner tension (97%), absence of retardation (82%), dramatic description of suffering or weeping spells (53%), talkativeness (49%), and racing or crowded thoughts (48%). MxD was associated with antidepressants in 50.7% of patients, with similar frequency for tricyclic antidepressants (45%) versus selective serotonin reuptake inhibitors (38.5%). Positive predictors of antidepressant-associated MxD were bipolar disorder type II diagnosis, higher index depression severity, and higher age at index episode. Antipsychotic or no treatment was protective against antidepressant-associated MxD. CONCLUSIONS MxD, defined as depression with excitatory symptoms, can be clinically identified, is common, occurs in both unipolar depression and bipolar disorder, and is frequently associated with antidepressant use. If replicated, this view of MxD could be considered a valid alternative to the DSM-5 criteria for depression with mixed features.
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Affiliation(s)
- Gabriele Sani
- NESMOS Department (Neuroscience, Mental Health, and Sensory Organs), Sapienza University, School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy
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Martínez V, Martínez P, Vöhringer PA, Araya R, Rojas G. Computer-assisted cognitive-behavioral therapy for adolescent depression in primary care clinics in Santiago, Chile (YPSA-M): study protocol for a randomized controlled trial. Trials 2014; 15:309. [PMID: 25091593 PMCID: PMC4132907 DOI: 10.1186/1745-6215-15-309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Accepted: 07/22/2014] [Indexed: 11/12/2022] Open
Abstract
Background Depression is a common and disabling condition. In Chile, assistance is guaranteed by law through a national program for depression in primary care services, and there is evidence of effective treatment for depressed women. However, there is a shortage of evidence-based treatments for depression in adolescents. The incorporation of technology to expand therapeutic options is becoming more common. This proposal aims to compare the efficacy of therapy that enhances traditional face-to-face cognitive-behavioral therapy (CBT) with a computer-based program versus usual care to treat depression in adolescents in primary care clinics in Santiago, Chile. Methods and design This is a two-arm, single-blind, randomized controlled trial with a target enrollment of 216 depressed adolescents between 15 and 19 years of age, attending four primary care clinics in Santiago, Chile. In the active arm, depressed adolescents will receive eight sessions of computer-assisted CBT, led by trained psychologists on a weekly basis. In the control arm, depressed adolescents will receive treatment as usual from the primary care centers. Mean depression scores and indicators of dysfunctional thoughts, problem-solving strategies, and health-related quality of life will be measured at baseline and four and six months after randomization. Discussion As far as we know, this is the first randomized controlled trial of a computer-assisted CBT intervention for depressed adolescents in a Latin American country. Trial registration Clinical Trials: NCT01862913
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Affiliation(s)
- Vania Martínez
- Universidad de Chile, CEMERA, Facultad de Medicina, Profesor Zañartu 1030, Independencia, Santiago, Chile.
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Baudrand R, Campino C, Carvajal CA, Olivieri O, Guidi G, Faccini G, Vöhringer PA, Cerda J, Owen G, Kalergis AM, Fardella CE. High sodium intake is associated with increased glucocorticoid production, insulin resistance and metabolic syndrome. Clin Endocrinol (Oxf) 2014; 80:677-84. [PMID: 23594269 DOI: 10.1111/cen.12225] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 12/27/2012] [Accepted: 04/11/2013] [Indexed: 01/27/2023]
Abstract
OBJECTIVE High sodium (HS) diet is associated with hypertension (HT) and insulin resistance (IR). We evaluated whether HS diet was associated with a dysregulation of cortisol production and metabolic syndrome (MetS). PATIENTS AND MEASUREMENTS We recruited 370 adults (18-85 years, BMI 29·3 ± 4·4 kg/m(2) , 70% women, 72% HT, 61% MetS). HS diet (urinary sodium >150 mEq/day) was observed in 70% of subjects. We measured plasma hormones, lipid profile, urinary free cortisol (UFC) and cortisol tetrahydrometabolites (THM). RESULTS Urinary sodium was correlated with UFC (r = +0·45, P < 0·001), cortisol THM (r = +0·41, P < 0·001) and inversely with adiponectin, HDL and aldosterone, after adjusting by age, gender and BMI. Subjects with high, compared with adequate sodium intake (50-149 mEq/day) had higher UFC (P < 0·001), THM (P < 0·001), HOMA-IR (P = 0·04), HT (81% vs 50%, P < 0·001), MetS (69% vs 41%, P < 0·001) and lower adiponectin (P = 0·003). A multivariate predictive model adjusted by confounders showed a high discriminative capacity for MetS (ROC curve 0·878) using four clinical variables: HS intake [OR = 5·6 (CI 2·3-15·3)], HOMA-IR [OR 1·7 (1·3-2·2)] cortisol THM [OR 1·2 (1·1-1·4)] and adiponectin [OR = 0·9 (0·8-0·9)], the latter had a protective effect. CONCLUSIONS High sodium diet was associated with increased urinary cortisol and its metabolites. Also, HS diet was associated with HT, insulin resistance, dyslipidaemia and hypoadiponectinaemia, even when adjusting by confounding variables. Further, we observed that high salt intake, IR and higher cortisol metabolites, alone or combined in a clinical simple model, accurately predicted MetS status, suggesting an additive mechanism in obesity-related metabolic disorders.
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Affiliation(s)
- R Baudrand
- Department of Endocrinology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile; Millennium Institute of Immunology and Immunotherapy, Pontificia Universidad Catolica de Chile, Santiago, Chile
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Vöhringer PA, Jimenez MI, Igor MA, Forés GA, Correa MO, Sullivan MC, Holtzman NS, Whitham EA, Barroilhet SA, Alvear K, Logvinenko T, Kent DM, Ghaemi SN. A clinical predictive score for mood disorder risk in low-income primary care settings. J Affect Disord 2013; 151:1125-31. [PMID: 23916307 DOI: 10.1016/j.jad.2013.06.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Accepted: 06/26/2013] [Indexed: 01/09/2023]
Abstract
BACKGROUND Despite availability of validated screening tests for mood disorders, busy general practitioners (GPs) often lack the time to use them routinely. This study aimed to develop a simplified clinical predictive score to help screen for presence of current mood disorder in low-income primary care settings. METHODS In a cross-sectional study, 197 patients seen at 10 primary care centers in Santiago, Chile completed self-administered screening tools for mood disorders: the Patient Health questionnaire (PHQ-9) and the Mood Disorder Questionnaire (MDQ). To determine participants' current-point mood disorder status, trained clinicians applied a gold-standard diagnostic interview (SCID-I). A simplified clinical predictive model (CM) was developed based on clinical features and selected questions from the screening tools. Using CM, a clinical predictive score (PS) was developed. Full PHQ-9 and GP assessment were compared with PS. RESULTS Using multivariate logistic regression, clinical and demographic variables predictive of current mood disorder were identified for a simplified 8-point predictive score (PS). PS had better discrimination than GP assessment (auROC-statistic=0.80 [95% CI 0.72, 0.85] vs. 0.58 [95% CI 0.52, 0.62] p-value <0.0001), but not as good as the full PHQ-9 (0.89 [95% CI 0.85, 0.93], p-value=0.03). Compared with GP assessment, PS increased sensitivity by 50% at a fixed specificity of 90%. Administered in a typical primary care clinical population, it correctly predicted almost 80% of cases. LIMITATIONS Further research must verify external validity of the PS. CONCLUSION An easily administered clinical predictive score determined, with reasonable accuracy, the current risk of mood disorders in low-income primary care settings.
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Affiliation(s)
- P A Vöhringer
- Hospital Clínico Universidad de Chile, Unidad de Trastornos del Ánimo, Clínica Psiquiátrica Universitaria, Facultad Medicina, Universidad de Chile, Santiago, Chile; Mood Disorders Program, Tufts Medical Center, Boston, MA, United States; Tufts University School of Medicine, Boston, MA, United States; Graduate Program, Clinical and Translational Science Institute (CTSI), Sackler School of Graduate Biomedical Sciences, Tufts University, Boston, MA, United States.
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Affiliation(s)
- S Barroilhet
- Escuela de Psicología, Universidad de los Andes, Santiago, Chile; Department of Psychiatry, Hospital Clinico Universidad de Chile, Facultad Medicina Universidad de Chile, Santiago, Chile
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Vöhringer PA, Jimenez MI, Igor MA, Fores GA, Correa MO, Sullivan MC, Holtzman NS, Whitham EA, Barroilhet SA, Alvear K, Logvinenko T, Kent DM, Ghaemi NS. Detecting Mood Disorder in Resource-Limited Primary Care Settings: Comparison of a self-administered screening tool to general practitioner assessment. J Med Screen 2013; 20:118-24. [DOI: 10.1177/0969141313503954] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Although efficacious treatments for mood disorders are available in primary care, under-diagnosis is associated with under-treatment and poorer outcomes. This study compares the accuracy of self-administered screening tests with routine general practitioner (GP) assessment for detection of current mood disorder. Methods 197 consecutive patients attending primary care centres in Santiago, Chile enrolled in this cross-sectional study, filling out the Patients Health Questionnaire-9 (PHQ-9) for depression and the Mood Disorder Questionnaire (MDQ) for bipolar disorder, after routine GP assessment. Diagnostic accuracy of these self-administered tools was compared with GP assessment, with gold standard diagnosis established by a structured diagnostic interview with trained clinicians (SCID-I). Results The sample was 75% female, with a mean age of 48.5 (SD 16.8); 37% had a current mood disorder (positive SCID-I result for depression or bipolar disorder). Sensitivity of the screening instruments (SI) was substantially higher than GP assessment (SI: 0.8, [95% CI 0.71, 0.81], versus GP: 0.2, [95% CI 0.12, 0.25]: p-value < 0.0001), without sacrifice in specificity (SI: 0.9, [95% CI 0.86, 0.96], versus GP: 0.9, [95% CI 0.88, 0.97]: p-value = 0.7). This led to improvement in both positive predictive value (SI: 0.8, [95% CI 0.82, 0.90], versus GP: 0.6, [95% CI 0.50, 0.64]: p-value < 0.001) and negative predictive value (SI: 0.9, [95% CI 0.78, 0.91] versus GP: 0.7, [95% CI 0.56, 0.72]: p-value < 0.01). Conclusion Self-administered screening tools are more accurate than GP assessment in detecting current mood disorder in low-income primary care. Such screening tests may improve detection of current mood disorder if implemented in primary care settings.
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Affiliation(s)
- Paul A Vöhringer
- Hospital Clínico Universidad de Chile, Unidad de Trastornos del Ánimo, Clínica Psiquiátrica Universitaria. Facultad Medicina, Universidad de Chile, Santiago, Chile
- Mood Disorders Program, Tufts Medical Center, Boston, MA
- Graduate Program, Clinical and Translational Science Institute (CTSI), Sackler School of Graduate Biomedical Sciences, Tufts University, Boston, MA, United States
| | - Mirtha I Jimenez
- Hospital Clínico Universidad de Chile, Unidad de Trastornos del Ánimo, Clínica Psiquiátrica Universitaria. Facultad Medicina, Universidad de Chile, Santiago, Chile
| | - Mirko A Igor
- Hospital Clínico Universidad de Chile, Unidad de Trastornos del Ánimo, Clínica Psiquiátrica Universitaria. Facultad Medicina, Universidad de Chile, Santiago, Chile
| | | | - Matias O Correa
- Departamento Psiquiatría, Facultad Medicina, Universidad de los Andes, Santiago, Chile
| | | | | | | | - Sergio A Barroilhet
- Escuela de Psicología, Universidad de los Andes, Santiago, Chile
- Mood Disorders Program, Tufts Medical Center, Boston, MA
| | | | - Tanya Logvinenko
- Biostatistics Research Center at the Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - David M Kent
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Nassir S Ghaemi
- Mood Disorders Program, Tufts Medical Center, Boston, MA
- Tufts University School of Medicine
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Vöhringer PA, Barroilhet SA, Amerio A, Reale ML, Alvear K, Vergne D, Ghaemi SN. Cognitive impairment in bipolar disorder and schizophrenia: a systematic review. Front Psychiatry 2013; 4:87. [PMID: 23964248 PMCID: PMC3737461 DOI: 10.3389/fpsyt.2013.00087] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 07/29/2013] [Indexed: 01/10/2023] Open
Abstract
AIMS Previous comparisons of cognitive decline among patients with bipolar disorder (BD) and schizophrenia (SZ) have found somehow quite similar profiles of deficits, but results have varied between studies. Therefore an extensive and thoughtful systematic review of the matter is warranted. METHODS Studies were found through systematic search (PubMed) following PRISMA guidelines. To be included, studies must have assessed the following cognitive functions: executive functions, memory, IQ, attention-concentration, and perceptuomotor function. In order to make comparison between the two entities, studies should include BD patients with operationally defined euthymia, schizophrenic patients in remission, and third group of healthy control patients. Comparisons were made after controlling for years of schooling and residual affective symptoms. RESULTS We found that overall both SZ and BD patients present deficits on all neurocognitive measures compared to healthy controls. In particular, SZ patients show more severe and pervasive cognitive deficits while BD patients present a milder and more confined impairment. In addition, evidence from the literature suggests that SZ and BD patients share a similar cognitive impairment profile with different degrees of deficits. Therefore, the difference between the two groups seems to be more quantitative (degree of deficit) rather than qualitative (profile), supporting a dimensional approach to the two clinical entities. Limitations of the present review includes the impossibility to control for effects of medication, varying time required for assessment across studies, illness diagnosis reliability, and course severity. CONCLUSION Patients with BD might exhibit a cognitive impairment that could be similar to SZ in terms of their profile, although patients with SZ may have more severe and widespread impairments.
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Affiliation(s)
- Paul A Vöhringer
- Unidad de Trastornos del Ánimo, Clínica Psiquiátrica, Departamento de Psiquiatria, Facultad Medicina, Hospital Clínico Universidad de Chile , Santiago , Chile ; Mood Disorders Program, Tufts Medical Center , Boston, MA , USA ; Harvard School of Public Health , Boston, MA , USA
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Patkar A, Gilmer W, Pae CU, Vöhringer PA, Ziffra M, Pirok E, Mulligan M, Filkowski MM, Whitham EA, Holtzman NS, Thommi SB, Logvinenko T, Loebel A, Masand P, Ghaemi SN. A 6 week randomized double-blind placebo-controlled trial of ziprasidone for the acute depressive mixed state. PLoS One 2012; 7:e34757. [PMID: 22545088 PMCID: PMC3335844 DOI: 10.1371/journal.pone.0034757] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 03/05/2012] [Indexed: 11/18/2022] Open
Abstract
Objective To examine the efficacy of ziprasidone vs. placebo for the depressive mixed state in patients with bipolar disorder type II or major depressive disorder (MDD). Methods 73 patients were randomized in a double-blinded, placebo-controlled study to ziprasidone (40-160 mg/d) or placebo for 6 weeks. They met DSM-IV criteria for a major depressive episode (MDE), while also meeting 2 or 3 (but not more nor less) DSM-IV manic criteria. They did not meet DSM-IV criteria for a mixed or manic episode. Baseline psychotropic drugs were continued unchanged. The primary endpoint measured was Montgomery- Åsberg Depression Rating Scale (MADRS) scores over time. The mean dose of ziprasidone was 129.7±45.3 mg/day and 126.1±47.1 mg/day for placebo. Results The primary outcome analysis indicated efficacy of ziprasidone versus placebo (p = 0.0038). Efficacy was more pronounced in type II bipolar disorder than in MDD (p = 0.036). Overall ziprasidone was well tolerated, without notable worsening of weight or extrapyramidal symptoms. Conclusions There was a statistically significant benefit with ziprasidone versus placebo in this first RCT of any medication for the provisional diagnostic concept of the depressive mixed state. Trial Registration Clinicaltrials.gov NCT00490542
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Affiliation(s)
- Ashwin Patkar
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, United States of America
| | - William Gilmer
- Department of Psychiatry, Northwestern University, School of Medicine, Chicago, Illinois, United States of America
| | - Chi-un Pae
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Paul A. Vöhringer
- Mood Disorders Program, Department of Psychiatry, Tufts Medical Center, Boston, Massachusetts, United States of America
- Hospital Clinico, Facultad de Medicina, Universidad Chile, Santiago, Chile
- Graduate Program, Clinical and Translational Science Institute, Sackler School of Graduate and Biomedical Sciences, Tufts University, Boston, Massachusetts, United States of America
| | - Michael Ziffra
- Department of Psychiatry, Northwestern University, School of Medicine, Chicago, Illinois, United States of America
| | - Edward Pirok
- Department of Psychiatry, Northwestern University, School of Medicine, Chicago, Illinois, United States of America
| | - Molly Mulligan
- Department of Psychiatry, Northwestern University, School of Medicine, Chicago, Illinois, United States of America
| | - Megan M. Filkowski
- Department of Psychiatry, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Elizabeth A. Whitham
- Mood Disorders Program, Department of Psychiatry, Tufts Medical Center, Boston, Massachusetts, United States of America
| | - Niki S. Holtzman
- Mood Disorders Program, Department of Psychiatry, Tufts Medical Center, Boston, Massachusetts, United States of America
| | - Sairah B. Thommi
- Mood Disorders Program, Department of Psychiatry, Tufts Medical Center, Boston, Massachusetts, United States of America
| | - Tanya Logvinenko
- Biostatistics Research Center at the Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, United States of America
| | - Antony Loebel
- Sunovion Pharmaceuticals, Fort Lee, New Jersey, United States of America
| | - Prakash Masand
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, United States of America
| | - S. Nassir Ghaemi
- Mood Disorders Program, Department of Psychiatry, Tufts Medical Center, Boston, Massachusetts, United States of America
- Tufts University School of Medicine, Boston, Massachusetts, United States of America
- * E-mail:
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Abstract
Biopsychosocial eclecticism has led, the authors believe, to a simplistic acceptance of a unitary view of MDD with little scientific solidity. The authors propose a return to careful psychopathology as the basis of all nosology, which has led to identifying four main types of depressive illness, and a method-based, existential approach to understanding depression.
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Affiliation(s)
- S Nassir Ghaemi
- Mood Disorders Program, Department of Psychiatry, Tufts Medical Center, Tufts University School of Medicine, 800 Washington Street #1007, Boston, MA 02111, USA.
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Vöhringer PA, Whitham EA, Thommi SB, Holtzman NS, Khrad H, Ghaemi SN. Affective temperaments in clinical practice: a validation study in mood disorders. J Affect Disord 2012; 136:577-80. [PMID: 22100132 DOI: 10.1016/j.jad.2011.10.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 07/06/2011] [Accepted: 10/20/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND We sought to examine correlations between clinical validators and temperaments in clinical practice. METHODS We provided the self-report TEMPS-A (50 item long) to 123 consecutive patients seen in the Mood Disorders Program of Tufts Medical Center. Temperament was assessed as cyclothymia, dysthymia, irritable or hyperthymia. Cut-offs were tested using (50%) and (75%) thresholds of affirmative responses, as well as highest percent for dominant temperament. We reported no dominant temperament at 75% cut-off . Multivariate regression modeling was conducted to assess confounding bias. RESULTS Using clinical and demographic validators, cyclothymia was the most strongly validated temperament, followed by dysthymia and hyperthymia. Irritable temperament did not appear to be valid in this sample. A 75% item endorsement cut-off appeared to identify clinically important temperaments in slightly less than half of this sample. Those without any temperament at 75% cut-off had better prognostic features. 50% cut-off was highly nonspecific, and poorly correlated with diagnostic validators. CONCLUSIONS Affective temperaments correlate with clinical validators, most robustly for cyclothymia. 75% cut-off on the TEMPS may provide a useful categorical definition of abnormal affective temperaments in mood disorders. With that definition, slightly less than one-half of patients with mood disorders have affective temperaments. Those without abnormal affective temperaments have better prognostic features.
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Affiliation(s)
- P A Vöhringer
- Mood Disorders Program, Department of Psychiatry, Tufts Medical Center, Tufts University School of Medicine, Boston, MA 02111, United States
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Pae CU, Vöhringer PA, Holtzman NS, Thommi SB, Patkar A, Gilmer W, Ghaemi SN. Mixed depression: a study of its phenomenology and relation to treatment response. J Affect Disord 2012; 136:1059-61. [PMID: 22173265 DOI: 10.1016/j.jad.2011.11.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 11/14/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Mixed depression reflects the occurrence of a major depressive episode with subsyndromal manic symptoms. Not recognized in DSM-IV, it is included in the proposed changes for DSM-5. Observational and cross-sectional studies have suggested that mixed depression is present in up to one-half of major depressive episodes, whether in MDD or bipolar disorder. Based on observational studies, antidepressants appear to be less effective, and neuroleptics more effective, in mixed than pure depression (major depressive episodes with no manic symptoms). In this report, we examine the specific manic symptoms that are most present in mixed depression, especially as they correlate with prospectively assessed treatment response. METHODS In 72 patients treated in a randomized clinical trial (ziprasidone versus placebo), we assessed the phenomenology of manic symptom type at study entry and their influence as predictors of treatment response. RESULTS The most common symptom presentation was a clinical triad of flight of ideas (60%), distractibility (58%), and irritable mood (55%). Irritable mood was the major predictor of treatment response. DSM-based diagnostic distinctions between MDD and bipolar disorder (type II) did not predict treatment response. CONCLUSION In this prospective study, mixed depression seems to be most commonly associated with irritable mood, flight of ideas, and distractibility, with irritability being an important predictor of treatment outcome with neuroleptic agents. If these data are correct, in the presence of mixed depression, the DSM-based dichotomy between MDD and bipolar disorder does not appear to influence treatment response.
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Affiliation(s)
- Chi-Un Pae
- Department of Psychiatry, Duke University Medical Center, Durham, NC, United States
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Vöhringer PA, Ghaemi SN. Solving the antidepressant efficacy question: effect sizes in major depressive disorder. Clin Ther 2011; 33:B49-61. [PMID: 22136980 DOI: 10.1016/j.clinthera.2011.11.019] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 11/08/2011] [Accepted: 11/09/2011] [Indexed: 12/28/2022]
Abstract
BACKGROUND Numerous reviews and meta-analyses of the antidepressant literature in major depressive disorders (MDD), both acute and maintenance, have been published, some claiming that antidepressants are mostly ineffective and others that they are mostly effective, in either acute or maintenance treatment. OBJECTIVE The aims of this study were to review and critique the latest and most notable antidepressant MDD studies and to conduct our own reanalysis of the US Food and Drug Administration database studies specifically analyzed by Kirsch et al. METHODS We gathered effect estimates of each MDD study. In our reanalysis of the acute depression studies, we corrected analyses for a statistical floor effect so that relative (instead of absolute) effect size differences were calculated. We also critiqued a recent meta-analysis of the maintenance treatment literature. RESULTS Our reanalysis showed that antidepressant benefit is seen not only in severe depression but also in moderate depression and confirmed a lack of benefit for antidepressants over placebo in mild depression. Relative antidepressant versus placebo benefit increased linearly from 5% in mild depression to 12% in moderate depression to 16% in severe depression. The claim that antidepressants are completely ineffective, or even harmful, in maintenance treatment studies involves unawareness of the enriched design effect, which, in that analysis, was used to analyze placebo efficacy. The same problem exists for the standard interpretation of those studies, although they do not prove antidepressant efficacy either, since they are biased in favor of antidepressants. CONCLUSIONS In sum, we conclude that antidepressants are effective in acute depressive episodes that are moderate to severe but are not effective in mild depression. Except for the mildest depressive episodes, correction for the statistical floor effect proves that antidepressants are effective acutely. These considerations only apply to acute depression, however. For maintenance, the long-term efficacy of antidepressants is unproven, but the data do not support the conclusion that they are harmful.
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Affiliation(s)
- Paul A Vöhringer
- Facultad de Medicina, Hospital Clinico, Universidad de Chile, Santiago, Chile
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Affiliation(s)
- S Nassir Ghaemi
- Mood Disorders Program, Tufts Medical Center, Boston, MA, USA.
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