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Gonzalez-Torres C, Mulsant BH, Husain MI, Alda M, Young RC, Ortiz A. Challenges in defining treatment-resistant mania in adults: A systematic review. Bipolar Disord 2024; 26:7-21. [PMID: 37963496 PMCID: PMC10922285 DOI: 10.1111/bdi.13383] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
OBJECTIVES To review the definitions of treatment-resistant mania (TRM) in the literature and propose criteria for an operationalized definition. METHODS A systematic search of five databases (MEDLINE, EMBASE, PsychInfo, Cochrane Central, and CINAHL) and data extraction of eligible articles. RESULTS In total, 47 articles addressing the concept of TRM were included, comprising 16 case reports, 11 case series, 3 randomized clinical trials, 8 open-label clinical trials, 1 experimental study, 7 narrative reviews, and 1 systematic review. While reviews discussed several challenges in defining TRM, definitions varied substantially based on different criteria for severity of mania, duration of mania, and use of specific therapeutic agents with minimal dosages and duration of treatment. Only a handful of the reviewed articles operationalized these criteria. CONCLUSION While the concept of TRM has been discussed in the literature for over three decades, we could not find an agreed-upon operationalized definition based on specific criteria. We propose and discuss a possible definition that could be used by clinicians to guide their practice and by researchers to assess the prevalence of TRM and develop and test interventions targeting TRM.
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Affiliation(s)
- Christina Gonzalez-Torres
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Benoit H. Mulsant
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - M. Ishrat Husain
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- National Institute of Mental Health, Klecany, Czech Republic
| | - Robert C. Young
- Department of Psychiatry, Weil Cornell Medicine, New York, New York, US
| | - Abigail Ortiz
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Rabinowitz J, Young RC, Yavorsky C, Williams JBW, Sedway J, Marino P, Matteo C, Mahableshwarkar A, Kott A, Hefting N, Engler J, Brady C. Consistency checks to improve measurement with the Young Mania Rating Scale (YMRS). J Affect Disord 2024; 345:24-31. [PMID: 37865349 DOI: 10.1016/j.jad.2023.10.098] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/22/2023] [Accepted: 10/15/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Mitigating rating inconsistency can improve measurement fidelity and detection of treatment response. METHODS The International Society for CNS Clinical Trials and Methodology convened an expert Working Group that developed logical consistency (LC) checks for ratings of the Young Mania Rating Scale (YMRS), which is widely used in studies of mood and bipolar disorders. LC and statistical outlier-response pattern checks (SC) were applied to 63,228 YMRS administrations from 14 clinical trials evaluating treatments for bipolar disorder. Checks were also applied to Monte Carlo-simulated data as a proxy for their use under conditions of inconsistency. RESULTS 42 LC flags were developed, and four SC flags were created from the data set (n = 14). Almost 20 % of the rating administrations had at least one LC flag, 6.7 % had two or more, 1.7 % had three or more; 17.3 % percent of the administrations had at least one SC flag and 4.6 % percent had two or more. Overall, 31 % of administrations had at least one flag of any type, 12.1 % had two or more and 5.3 % had three or more. In acute antimanic treatment trials (n = 10) there were more flags of any type compared to relapse prevention trials (n = 4). LIMITATIONS Flagged ratings may represent less-common presentations assessed correctly. CONCLUSIONS Using established methods, we illustrate development and application of consistency flags for YMRS ratings. Applying flags and mitigation during trials may improve the value of YMRS data, help focus attention on rater training, and improve reliability and validity of trial data.
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Affiliation(s)
| | - Robert C Young
- Dept. of Psychiatry, Weil Cornell Medical College, New York, NY 10065, USA
| | | | - Janet B W Williams
- Columbia University Department of Psychiatry, c/o 2466 Westlake Ave N., #19, Seattle, WA 98109, USA
| | - Jan Sedway
- WCG Clinical Endpoint Solutions, 5000 Centregreen Way, Suite 200, Cary, NC 27513, USA
| | - Patricia Marino
- Weill Cornell Medical College, 21 Bloomingdale Road, White Plains, NY 10605, USA
| | - Christopher Matteo
- TPS Global, 1777 Sentry Parkway West, Suite 100, Building 17, Blue Bell, PA 19422, USA
| | | | - Alan Kott
- Signant Health, Slezská 2127/13, 120 00 Prague 2, Czech Republic
| | | | - Jenicka Engler
- Cronos Clinical Consulting Services, Inc., an IQVIA business, 201 S Main St, Lambertville, NJ 08530, USA
| | - Chris Brady
- WCG Clinical Endpoint Solutions, 5000 Centregreen Way, Suite 200, Cary, NC 27513, USA
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Lisanby SH, McClintock SM, McCall WV, Knapp RG, Cullum CM, Mueller M, Deng ZD, Teklehaimanot AA, Rudorfer MV, Bernhardt E, Alexopoulos G, Bailine SH, Briggs MC, Geduldig ET, Greenberg RM, Husain MM, Kaliora S, Latoussakis V, Liebman LS, Petrides G, Prudic J, Rosenquist PB, Sampson S, Tobias KG, Weiner RD, Young RC, Kellner CH. Longitudinal Neurocognitive Effects of Combined Electroconvulsive Therapy (ECT) and Pharmacotherapy in Major Depressive Disorder in Older Adults: Phase 2 of the PRIDE Study. Am J Geriatr Psychiatry 2022; 30:15-28. [PMID: 34074611 PMCID: PMC8595359 DOI: 10.1016/j.jagp.2021.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 10/23/2020] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE There is limited information regarding neurocognitive outcomes of right unilateral ultrabrief pulse width electroconvulsive therapy (RUL-UB ECT) combined with pharmacotherapy in older adults with major depressive disorder. We report longitudinal neurocognitive outcomes from Phase 2 of the Prolonging Remission in Depressed Elderly (PRIDE) study. METHOD After achieving remission with RUL-UB ECT and venlafaxine, older adults (≥60 years old) were randomized to receive symptom-titrated, algorithm-based longitudinal ECT (STABLE) plus pharmacotherapy (venlafaxine and lithium) or pharmacotherapy-only. A comprehensive neuropsychological battery was administered at baseline and throughout the 6-month treatment period. Statistical significance was defined as a p-value of less than 0.05 (two-sided test). RESULTS With the exception of processing speed, there was statistically significant improvement across most neurocognitive measures from baseline to 6-month follow-up. There were no significant differences between the two treatment groups at 6 months on measures of psychomotor processing speed, autobiographical memory consistency, short-term and long-term verbal memory, phonemic fluency, inhibition, and complex visual scanning and cognitive flexibility. CONCLUSION To our knowledge, this is the first report of neurocognitive outcomes over a 6-month period of an acute course of RUL-UB ECT followed by one of 2 strategies to prolong remission in older adults with major depression. Neurocognitive outcome did not differ between STABLE plus pharmacotherapy versus pharmacotherapy alone over the 6-month continuation treatment phase. These findings support the safety of RUL-UB ECT in combination with pharmacotherapy in the prolonging of remission in late-life depression.
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Affiliation(s)
- Sarah H. Lisanby
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD,Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC (SHL now at the National Institute of Mental Health)
| | - Shawn M. McClintock
- Division of Psychology, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX
| | - William V. McCall
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA
| | | | - C. Munro Cullum
- Division of Psychology, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX
| | | | - Zhi-De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | | | - Matthew V. Rudorfer
- Division of Services and Intervention Research, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Elisabeth Bernhardt
- Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC (SHL now at the National Institute of Mental Health)
| | - George Alexopoulos
- Department of Psychiatry and Behavioral Sciences, New York Presbyterian/Weill Cornell Medical Center, White Plains, NY
| | - Samuel H. Bailine
- Department of Psychiatry, Zucker Hillside Hospital/North Shore-LIJ Health System, New York, NY
| | - Mimi C. Briggs
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Emma T. Geduldig
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Mustafa M. Husain
- Division of Psychology, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX
| | - Styliani Kaliora
- Department of Psychiatry, Zucker Hillside Hospital/North Shore-LIJ Health System, New York, NY
| | - Vassilios Latoussakis
- Department of Psychiatry and Behavioral Sciences, New York Presbyterian/Weill Cornell Medical Center, White Plains, NY
| | - Lauren S. Liebman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Georgios Petrides
- Department of Psychiatry, Zucker Hillside Hospital/North Shore-LIJ Health System, New York, NY
| | - Joan Prudic
- Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York, NY
| | - Peter B. Rosenquist
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA
| | - Shirlene Sampson
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | | | - Richard D. Weiner
- Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC (SHL now at the National Institute of Mental Health)
| | - Robert C. Young
- Department of Psychiatry and Behavioral Sciences, New York Presbyterian/Weill Cornell Medical Center, White Plains, NY
| | - Charles H. Kellner
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
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Lisanby SH, McClintock SM, Alexopoulos G, Bailine SH, Bernhardt E, Briggs MC, Cullum CM, Deng ZD, Dooley M, Geduldig ET, Greenberg RM, Husain MM, Kaliora S, Knapp RG, Latoussakis V, Liebman LS, McCall WV, Mueller M, Petrides G, Prudic J, Rosenquist PB, Rudorfer MV, Sampson S, Teklehaimanot AA, Tobias KG, Weiner RD, Young RC, Kellner CH. Neurocognitive Effects of Combined Electroconvulsive Therapy (ECT) and Venlafaxine in Geriatric Depression: Phase 1 of the PRIDE Study. Am J Geriatr Psychiatry 2020; 28:304-316. [PMID: 31706638 PMCID: PMC7050408 DOI: 10.1016/j.jagp.2019.10.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 09/12/2019] [Revised: 10/04/2019] [Accepted: 10/04/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There is limited information regarding the tolerability of electroconvulsive therapy (ECT) combined with pharmacotherapy in elderly adults with major depressive disorder (MDD). Addressing this gap, we report acute neurocognitive outcomes from Phase 1 of the Prolonging Remission in Depressed Elderly (PRIDE) study. METHODS Elderly adults (age ≥60) with MDD received an acute course of 6 times seizure threshold right unilateral ultrabrief pulse (RUL-UB) ECT. Venlafaxine was initiated during the first treatment week and continued throughout the study. A comprehensive neurocognitive battery was administered at baseline and 72 hours following the last ECT session. Statistical significance was defined as a two-sided p-value of less than 0.05. RESULTS A total of 240 elderly adults were enrolled. Neurocognitive performance acutely declined post ECT on measures of psychomotor and verbal processing speed, autobiographical memory consistency, short-term verbal recall and recognition of learned words, phonemic fluency, and complex visual scanning/cognitive flexibility. The magnitude of change from baseline to end for most neurocognitive measures was modest. CONCLUSION This is the first study to characterize the neurocognitive effects of combined RUL-UB ECT and venlafaxine in elderly adults with MDD and provides new evidence for the tolerability of RUL-UB ECT in an elderly sample. Of the cognitive domains assessed, only phonemic fluency, complex visual scanning, and cognitive flexibility qualitatively declined from low average to mildly impaired. While some acute changes in neurocognitive performance were statistically significant, the majority of the indices as based on the effect sizes remained relatively stable.
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Affiliation(s)
- Sarah H. Lisanby
- Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC (Now at the National Institute of Mental Health),Noninvasive Neuromodulation Unit, Experimental Therapeutics Branch, Intramural Research Program, National Institute of Mental Health
| | - Shawn M. McClintock
- Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC (Now at the National Institute of Mental Health),Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX
| | - George Alexopoulos
- Department of Psychiatry and Behavioral Sciences, New York Presbyterian/Weill Cornell Medical Center, White Plains, NY
| | - Samuel H. Bailine
- Department of Psychiatry, Zucker Hillside Hospital/North Shore-LIJ Health System, New York, NY
| | | | - Mimi C. Briggs
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - C. Munro Cullum
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX
| | - Zhi-De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutics Branch, Intramural Research Program, National Institute of Mental Health
| | - Mary Dooley
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC
| | - Emma T. Geduldig
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Mustafa M. Husain
- Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC (Now at the National Institute of Mental Health),Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX
| | - Styliani Kaliora
- Department of Psychiatry, Zucker Hillside Hospital/North Shore-LIJ Health System, New York, NY
| | - Rebecca G. Knapp
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC
| | - Vassilios Latoussakis
- Department of Psychiatry and Behavioral Sciences, New York Presbyterian/Weill Cornell Medical Center, White Plains, NY
| | - Lauren S. Liebman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - William V. McCall
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA
| | - Martina Mueller
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC
| | - Georgios Petrides
- Department of Psychiatry, Zucker Hillside Hospital/North Shore-LIJ Health System, New York, NY
| | - Joan Prudic
- Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York, NY
| | - Peter B. Rosenquist
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA
| | - Matthew V. Rudorfer
- Division of Services and Intervention Research, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Shirlene Sampson
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Abeba A. Teklehaimanot
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC
| | - Kristen G. Tobias
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Richard D. Weiner
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC
| | - Robert C. Young
- Department of Psychiatry and Behavioral Sciences, New York Presbyterian/Weill Cornell Medical Center, White Plains, NY
| | - Charles H. Kellner
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
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Sajatovic M, Eyler LT, Rej S, Almeida OP, Blumberg HP, Forester BP, Forlenza OV, Gildengers A, Mulsant BH, Strejilevich S, Tsai S, Vieta E, Young RC, Dols A. The Global Aging & Geriatric Experiments in Bipolar Disorder Database (GAGE-BD) project: Understanding older-age bipolar disorder by combining multiple datasets. Bipolar Disord 2019; 21:642-649. [PMID: 31081573 DOI: 10.1111/bdi.12795] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Indexed: 12/01/2022]
Abstract
OBJECTIVE There is a dearth of research about the aging process among individuals with bipolar disorder (BD). One potential strategy to overcome the challenge of interpreting findings from existing limited older-age bipolar disorder (OABD) research studies is to pool or integrate data, taking advantage of potential overlap or similarities in assessment methods and harmonizing or cross-walking measurements where different measurement tools are used to evaluate overlapping construct domains. This report describes the methods and initial start-up activities of a first-ever initiative to create an integrated OABD-focused database, the Global Aging & Geriatric Experiments in Bipolar Disorder Database (GAGE-BD) project. METHODS Building on preliminary work conducted by members of the International Society for Bipolar Disorders OABD taskforce, the GAGE-BD project will be operationalized in four stages intended to ready the dataset for hypothesis-driven analyses, establish a consortium of investigators to guide exploration, and set the stage for prospective investigation using a common dataset that will facilitate a high degree of generalizability. RESULTS Initial efforts in GAGE-BD have brought together 14 international investigators representing a broad geographic distribution and data on over 1,000 OABD. Start-up efforts include communication and guidance on meeting regulatory requirements, establishing a Steering Committee to guide an incremental analysis strategy, and learning from existing multisite data collaborations and other support resources. DISCUSSION The GAGE-BD project aims to advance understanding of associations between age, BD symptoms, medical burden, cognition and functioning across the life span and set the stage for future prospective research that can advance the understanding of OABD.
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Affiliation(s)
- Martha Sajatovic
- Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Lisa T Eyler
- Department of Psychiatry, University of California San Diego, San Diego, California.,Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, California
| | - Soham Rej
- Lady Davis Insitute, McGill University, Montreal, Canada
| | | | | | - Brent P Forester
- McLean Hospital, Belmont, Massachusetts.,Harvard Medical School, Boston, MA
| | - Orestes V Forlenza
- Laboratory of Neuroscience (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ariel Gildengers
- Ariel Gildengers, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Benoit H Mulsant
- Department of Psychiatry, Center for Addiction & Mental Health, University of Toronto, Toronto, Canada
| | - Sergio Strejilevich
- AREA, Assistance and Research in Affective Disorders, Buenos Aires, Argentina
| | - Shangying Tsai
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Eduard Vieta
- Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Robert C Young
- Weill Cornell Medicine and New York-Presbyterian Hospital, White Plains, New York
| | - Annemiek Dols
- GGZ inGeest, Amsterdam UMC, location VU Medical Center, Amsterdam Neuroscience, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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Eyler LT, Aebi ME, Daly RE, Hansen K, Tatsuoka C, Young RC, Sajatovic M. Understanding Aging in Bipolar Disorder by Integrating Archival Clinical Research Datasets. Am J Geriatr Psychiatry 2019; 27:1122-1134. [PMID: 31097301 PMCID: PMC6739177 DOI: 10.1016/j.jagp.2019.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 02/08/2019] [Revised: 04/08/2019] [Accepted: 04/08/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Although 25% of people with bipolar disorder (BD) are over age 60, there is a dearth of research on older age bipolar disorder (OABD). This report describes an initial effort to create an integrated OABD database using the U.S. National Institute of Mental Health Data Archive (NDA). Goals were to: 1) combine data from three BD studies in the United States that included overlapping data elements; 2) investigate research questions related to aims of the original studies; and 3) take an important first step toward combining existing datasets relevant to aging and BD. METHODS Data were prepared and uploaded to the NDA, with a focus on data elements common to all studies. As appropriate, data were harmonized to select or collapse categories suitable for cross-walk analysis. Associations between age, BD symptoms, functioning, medication load, medication adherence, and medical comorbidities were assessed. The total sample comprised 451 individuals, mean age 57.7 (standard deviation: 13.1) years. RESULTS Medical comorbidity was not significantly associated with either age or functioning and there did not appear to be an association between medication load, comorbidity, age, and adherence. Men and African-Americans were significantly more likely to have poor adherence. Both BD mania and depression symptoms were associated with functioning, but this differed across studies. CONCLUSION Despite limitations including heterogeneity in study design and samples and cross-sectional methodology, integrated datasets represent an opportunity to better understand how aging may impact the presentation and evolution of chronic mental health disorders across the lifespan.
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Affiliation(s)
- Lisa T. Eyler
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness
Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA
| | - Michelle E. Aebi
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, Ohio. U.S.A
| | - Rebecca E. Daly
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Kristen Hansen
- Division of Biostatistics, University of California San Diego, San Diego, CA, USA
| | - Curtis Tatsuoka
- Department of Neurology and Neurological & Behavioral Outcomes Center, Case Western Reserve University School of
Medicine, Cleveland, Ohio. U.S.A
| | - Robert C. Young
- Weill Cornell Medicine and New York Presbyterian Hospital, NY, U.S.A
| | - Martha Sajatovic
- Department of Psychiatry (MEA, MS), Case Western Reserve University School of Medicine, Cleveland; Department of Neurology (CT, MS), Case Western Reserve University School of Medicine, Cleveland; Neurological and Behavioral Outcomes Center (CT, MS), Case Western Reserve University School of Medicine, Cleveland.
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Young RC, Mulsant BH, Sajatovic M, Gildengers AG, Gyulai L, Al Jurdi RK, Beyer J, Evans J, Banerjee S, Greenberg R, Marino P, Kunik ME, Chen P, Barrett M, Schulberg HC, Bruce ML, Reynolds CF, Alexopoulos GS. GERI-BD: A Randomized Double-Blind Controlled Trial of Lithium and Divalproex in the Treatment of Mania in Older Patients With Bipolar Disorder. Focus (Am Psychiatr Publ) 2019; 17:314-321. [PMID: 32015723 PMCID: PMC6996060 DOI: 10.1176/appi.focus.17308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
(Reprinted with permission from Am J Psychiatry 2017; 174:1086-1093).
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Fuh KC, Java JJ, Chan JK, Kapp DS, Monk BJ, Burger RA, Young RC, Alberts DS, McGuire WP, Markman M, Bell J, Ozols RF, Armstrong DK, Aghajanian C, Bookman MA, Mannel RS. Differences in presentation and survival of Asians compared to Caucasians with ovarian cancer: An NRG Oncology/GOG Ancillary study of 7914 patients. Gynecol Oncol 2019; 154:420-425. [PMID: 31229298 DOI: 10.1016/j.ygyno.2019.05.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 01/17/2019] [Revised: 05/10/2019] [Accepted: 05/15/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE To compare patient/tumor characteristics and outcomes of Asians to Caucasian patients with epithelial ovarian cancer. METHODS Ancillary data were pooled and analyzed from ten prospective randomized front-line Gynecologic Oncology Group clinical trials from 1996 to 2011. Demographic, clinicopathologic features, disease-specific and all-cause survival were analyzed. RESULTS Of 7914 patients, 7641 were Caucasian and 273 Asian. When compared to Caucasians, Asians were younger at trial enrollment, had a better performance status, earlier-stage cancers (17.2% vs. 8.1% with stage I; p < 0.001), and were more likely to be of clear cell (15.8% vs. 6.2%, p < 0.001) and mucinous (3.3% vs. 1.9%, p < 0.001) histology. Asians had an improved 5-year disease-specific survival of 54.1% compared to 46.1% for Caucasians, p = 0.001. In multivariate analysis, the Asian race remained a significant prognostic factor for all-cause survival (HR: 0.84; 95% CI: 0.72-0.99; p = 0.04). Other factors predictive of improved survival included younger age, better performance status, optimal cytoreduction, earlier stage, non-clear cell histology, and lower grade tumors. CONCLUSION Asians enrolled into phase III ovarian cancer clinical trials were younger, with better performance status, earlier-stage of disease, and have a greater number of clear cell and mucinous tumors. After adjusting for these prognostic factors, Asians have a better survival compared to Caucasians.
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Affiliation(s)
- Katherine C Fuh
- Department of Gynecologic Oncology, Washington University, St Louis, MO 63110, USA.
| | - James J Java
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - John K Chan
- Department of Gynecologic Oncology, California Pacific Medical Center/Sutter Cancer Research Consortium/Palo Alto Medical Foundation, San Francisco, CA 94118, USA.
| | - Daniel S Kapp
- Department of Radiation Oncology, Stanford University, Stanford, CA 94305, USA.
| | - Bradley J Monk
- Department of Gynecologic Oncology, Biltmore Cancer Center, Phoenix, AZ 85016, USA.
| | - Robert A Burger
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Robert C Young
- RCY Consulting, Fox Chase Cancer Center, Philadelphia, PA 19111, USA.
| | | | - William P McGuire
- Virginia Commonwealth University Massey Cancer Center, Richmond, VA 980037, USA.
| | - Maurie Markman
- Eastern Regional Medical Center, Meadowbrook, PA 19046, USA.
| | - Jeffrey Bell
- Ohio Riverside Methodist Hospital, Columbus, OH 43214, USA
| | | | - Deborah K Armstrong
- Department of Medical Oncology, Johns Hopkins Kimmel Cancer Center, Baltimore, MD 21287, USA.
| | | | | | - Robert S Mannel
- Department of Obstetrics and Gynecology, Peggy and Charles Stephenson Cancer Center - University of Oklahoma, Oklahoma City, OK 73104, USA.
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Agarkar S, Hurt SW, Young RC. Speed of antidepressant response to electroconvulsive therapy in bipolar disorder vs. major depressive disorder. Psychiatry Res 2018; 265:355-359. [PMID: 29803951 PMCID: PMC6080253 DOI: 10.1016/j.psychres.2018.02.048] [Citation(s) in RCA: 6] [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: 02/11/2018] [Accepted: 02/22/2018] [Indexed: 12/13/2022]
Abstract
AIMS We reviewed studies that reported speed of antidepressant response to electroconvulsive therapy (ECT) in both bipolar depression (BPD) and major depressive disorder (MDD). METHODS We identified English language reports allowing this comparison. RESULTS Ten studies met our criteria. Four reported significantly faster response in BPD and in one there was trend for faster response. None reported evidence for slower response in BPD. CONCLUSION The findings support further study of speed of response to ECT in BPD.
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Affiliation(s)
- Smita Agarkar
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, United States.
| | - Stephen W. Hurt
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, United States
| | - Robert C. Young
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, United States,New York Presbyterian Hospital, White Plains, NY, United States
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McCall WV, Lisanby SH, Rosenquist PB, Dooley M, Husain MM, Knapp RG, Petrides G, Rudorfer MV, Young RC, McClintock SM, Mueller M, Prudic J, Greenberg RM, Weiner RD, Bailine SH, Youssef NA, McCloud L, Kellner CH. Effects of continuation electroconvulsive therapy on quality of life in elderly depressed patients: A randomized clinical trial. J Psychiatr Res 2018; 97:65-69. [PMID: 29195125 PMCID: PMC5742556 DOI: 10.1016/j.jpsychires.2017.11.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 09/05/2017] [Revised: 10/06/2017] [Accepted: 11/02/2017] [Indexed: 10/18/2022]
Abstract
We examined whether electroconvulsive therapy (ECT) plus medications ("STABLE + PHARM" group) had superior HRQOL compared with medications alone ("PHARM" group) as continuation strategy after successful acute right unilateral ECT for major depressive disorder (MDD). We hypothesized that scores from the Medical Outcomes Study Short Form-36 (SF-36) would be higher during continuation treatment in the "STABLE + PHARM" group versus the "PHARM" group. The overall study design was called "Prolonging Remission in Depressed Elderly" (PRIDE). Remitters to the acute course of ECT were re-consented to enter a 6 month RCT of "STABLE + PHARM" versus "PHARM". Measures of depressive symptoms and cognitive function were completed by blind raters; SF-36 measurements were patient self-report every 4 weeks. Participants were 120 patients >60 years old. Patients with dementia, schizophrenia, bipolar disorder, or substance abuse were excluded. The "PHARM" group received venlafaxine and lithium. The "STABLE + PHARM" received the same medications, plus 4 weekly outpatient ECT sessions, with additional ECT session as needed. Participants were mostly female (61.7%) with a mean age of 70.5 ± 7.2 years. "STABLE + PHARM" patients received 4.5 ± 2.5 ECT sessions during Phase 2. "STABLE + PHARM" group had 7 point advantage (3.5-10.4, 95% CI) for Physical Component Score of SF-36 (P < 0.0001), and 8.2 point advantage (4.2-12.2, 95% CI) for Mental Component Score (P < 0.0001). Additional ECT resulted in overall net health benefit. Consideration should be given to administration of additional ECT to prevent relapse during the continuation phase of treatment of MDD. CLINICAL TRIALS.GOV: NCT01028508.
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Affiliation(s)
- W. Vaughn McCall
- Department of Psychiatry and Health Behavior; Medical College of Georgia; Augusta University
| | | | - Peter B. Rosenquist
- Department of Psychiatry and Health Behavior; Medical College of Georgia; Augusta University
| | - Mary Dooley
- Medical University of South Carolina, Charleston
| | | | | | | | | | - Robert C. Young
- New York Presbyterian/Weill Cornell Medical Center, New York
| | | | | | - Joan Prudic
- Department of Psychiatry, Columbia University, New York
| | | | - Richard D. Weiner
- Department of Psychiatry, Duke University School of Medicine, Durham
| | | | - Nagy A. Youssef
- Department of Psychiatry and Health Behavior; Medical College of Georgia; Augusta University
| | - Laryssa McCloud
- Department of Psychiatry and Health Behavior; Medical College of Georgia; Augusta University
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Marino P, Schulberg HC, Gildengers AG, Mulsant BH, Sajatovic M, Gyulai L, Aljurdi RK, Evans LD, Banerjee S, Gur RC, Young RC. Assessing bipolar disorder in the older adult: the GERI-BD toolbox. Int J Geriatr Psychiatry 2018; 33:e150-e157. [PMID: 28543407 PMCID: PMC6093209 DOI: 10.1002/gps.4738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 04/19/2017] [Indexed: 11/11/2022]
Abstract
INTRODUCTION The evidence base regarding characteristics of older adults with bipolar disorder (BD) remains limited. The NIH-funded multicenter study Acute Pharmacotherapy of Late-Life Mania (GERI-BD) assessed various clinical domains before and during mood stabilizer treatment in older adults participating in a 9-week, double-blind randomized controlled trial. We describe the rationale for selecting these instruments. METHODS Domains and instruments were selected on the basis of the study design and the participants. The investigators' experience in clinical trials involving young adults with BD or older adults with major depressive disorder, along with open studies of older adults with BD, contributed to the selection process. RESULTS We identified domains and selected instruments that could be used to assess the participants given their diagnostic, treatment history, and medical and mood state characteristics. They were also intended to measure tolerability and efficacy and permit examination of potential moderating and mediating factors. CONCLUSIONS Decisions regarding the assessment domains to be included in the clinical trial highlight the challenges facing researchers studying drug treatments for older adults with BD, or more generally, mood disorders. We suggest that the domains and instruments selected by GERI-BD investigators constitute a "toolbox" that can be customized for other investigators. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ruben C Gur
- University of Pennsylvania, Philadelphia, PA, USA
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McCall WV, Lisanby SH, Rosenquist PB, Dooley M, Husain MM, Knapp RG, Petrides G, Rudorfer MV, Young RC, McClintock SM, Mueller M, Prudic J, Greenberg RM, Weiner RD, Bailine SH, Riley MA, McCloud L, Kellner CH. Effects of a Course of Right Unilateral Ultrabrief Pulse Electroconvulsive Therapy Combined With Venlafaxine on Insomnia Symptoms in Elderly Depressed Patients. J Clin Psychiatry 2018; 79:16m11089. [PMID: 28742292 PMCID: PMC6704475 DOI: 10.4088/jcp.16m11089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 12/19/2016] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Antidepressant medications have a variety of effects on sleep, apart from their antidepressant effects. It is unknown whether electroconvulsive therapy (ECT) has effects on perceived sleep in depressed patients. This secondary analysis examines the effects of ECT on perceived sleep, separate from its antidepressant effects. METHODS Elderly patients with major depressive disorder, as defined by DSM-IV, received open-label high-dose, right unilateral ultrabrief pulse ECT, combined with venlafaxine, as part of participating in phase 1 of the National Institute of Mental Health-supported study Prolonging Remission in Depressed Elderly (PRIDE). Phase 1 of PRIDE participant enrollment period extended from February 2009 to August 2014. Depression severity was measured with the Hamilton Depression Rating Scale-24 item (HDRS₂₄), and measures of insomnia severity were extracted from the HDRS₂₄. Participants were characterized at baseline as either "high-insomnia" or "low-insomnia" subtypes, based upon the sum of the 3 HDRS₂₄ sleep items as either 4-6 or 0-3, respectively. Insomnia scores were followed during ECT and were adjusted for the sum of all the HDRS₂₄ non-sleep items. Generalized linear models were used for longitudinal analysis of insomnia scores. RESULTS Two hundred forty patients participated, with 48.3% in the high-insomnia and 51.7% in the low-insomnia group. Although there was a reduction in the insomnia scores in the high-insomnia group, only 12.4% of them experienced remission of insomnia after a course of ECT, despite an increase in utilization of sleep aids across the course of ECT, from 8.6% to 23.2%. The degree of improvement in insomnia symptoms paralleled the degree of improvement in non-insomnia symptoms. A "low" amount of improvement on the sum of the HDRS non-insomnia items (HDRS-sleep) was accompanied by a "low" amount of improvement in insomnia scores (change of -1.6 ± 1.2, P < .0001), while a "high" amount of improvement on the sum of the HDRS non-insomnia items was accompanied by a "higher" amount of improvement in insomnia scores (change of -3.1 ± 1.6, P < .0001). After adjustment for non-insomnia symptoms, there was no change in insomnia in the low-insomnia group. CONCLUSIONS We found that ECT, combined with venlafaxine, has a modest anti-insomnia effect that is linked to its antidepressant effect. Most patients will have some degree of residual insomnia after ECT, and will require some consideration of whether additional, targeted assessment and treatment of insomnia is warranted. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01028508.
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Affiliation(s)
- W. Vaughn McCall
- Department of Psychiatry and Health Behavior; Augusta University/Medical College of Georgia, Augusta, Georgia
| | - Sarah H. Lisanby
- Department of Psychiatry and Behavioral Sciences; Duke University School of Medicine, Durham, North Carolina
| | - Peter B. Rosenquist
- Department of Psychiatry and Health Behavior; Augusta University/Medical College of Georgia, Augusta, Georgia
| | - Mary Dooley
- Department of Psychiatry and Behavioral Sciences; Medical University of South Carolina, Charleston, South Carolina
| | - Mustafa M. Husain
- Department of Psychiatry; University of Texas Southwestern Medical Center, Dallas, Texas
| | - Rebecca G. Knapp
- Department of Psychiatry and Behavioral Sciences; Medical University of South Carolina, Charleston, South Carolina
| | | | | | - Robert C. Young
- Department of Psychiatry; Weill Cornell Medicine; New York, New York
| | - Shawn M. McClintock
- Department of Psychiatry; University of Texas Southwestern Medical Center, Dallas, Texas
| | - Martina Mueller
- Department of Psychiatry and Behavioral Sciences; Medical University of South Carolina, Charleston, South Carolina
| | - Joan Prudic
- Department of Psychiatry; Columbia University and New York State Psychiatric Institute, New York, New York
| | | | - Richard D. Weiner
- Department of Psychiatry and Behavioral Sciences; Duke University School of Medicine, Durham, North Carolina
| | | | - Mary Anne Riley
- Department of Psychiatry and Health Behavior; Augusta University/Medical College of Georgia, Augusta, Georgia
| | - Laryssa McCloud
- Department of Psychiatry and Health Behavior; Augusta University/Medical College of Georgia, Augusta, Georgia
| | - Charles H. Kellner
- Department of Psychiatry; Icahn School of Medicine at Mount Sinai, New York, New York
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Young RC, Mulsant BH, Sajatovic M, Gildengers AG, Gyulai L, Al Jurdi RK, Beyer J, Evans J, Banerjee S, Greenberg R, Marino P, Kunik ME, Chen P, Barrett M, Schulberg HC, Bruce ML, Reynolds CF, Alexopoulos GS. GERI-BD: A Randomized Double-Blind Controlled Trial of Lithium and Divalproex in the Treatment of Mania in Older Patients With Bipolar Disorder. Am J Psychiatry 2017; 174:1086-1093. [PMID: 29088928 PMCID: PMC6214451 DOI: 10.1176/appi.ajp.2017.15050657] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Clinicians treating older patients with bipolar disorder with mood stabilizers need evidence from age-specific randomized controlled trials. The authors describe findings from a first such study of late-life mania. METHOD The authors compared the tolerability and efficacy of lithium carbonate and divalproex in 224 inpatients and outpatients age 60 or older with bipolar I disorder who presented with a manic, hypomanic, or mixed episode. Participants were randomly assigned, under double-blind conditions, to treatment with lithium (target serum concentration, 0.80-0.99 mEq/L) or divalproex (target serum valproate concentration, 80-99 μg/mL) for 9 weeks. Participants with an inadequate response after 3 weeks received open adjunctive risperidone. The authors hypothesized that divalproex would be better tolerated and more efficacious than lithium. Tolerability was assessed based on a measure of sedation and on the proportions of participants achieving target concentrations. Efficacy was assessed with the Young Mania Rating Scale (YMRS). RESULTS Attrition rates were similar for lithium and divalproex (14% and 18% at week 3 and 51% and 44% at week 9, respectively). The groups did not differ significantly in sedation. Participants in the lithium group tended to experience more tremor. Similar proportions of participants in the lithium and divalproex groups achieved target concentrations (57% and 56%, respectively). A longitudinal mixed model of improvement (change from baseline in YMRS score) favored lithium (change in score, 3.90; 97.5% CI=1.71, 6.09). Nine-week response rates did not differ significantly between the lithium and divalproex groups (79% and 73%, respectively). The need for adjunctive risperidone was low and similar between groups (17% and 14%, respectively). CONCLUSIONS Both lithium and divalproex were adequately tolerated and efficacious; lithium was associated with a greater reduction in mania scores over 9 weeks.
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Affiliation(s)
- Robert C Young
- From the Department of Psychiatry and the Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, and New York Presbyterian Hospital, New York; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland; the Department of Psychiatry, Louis Stokes Cleveland VA Medical Center, Cleveland; the Department of Psychiatry, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz VA Medical Center, Philadelphia; the Department of Psychiatry, Baylor College of Medicine, and the Michael E. DeBakey VA Medical Center, Houston; the Department of Psychiatry, Duke University Medical College, Durham, N.C.; and NIMH, Bethesda, Md
| | - Benoit H Mulsant
- From the Department of Psychiatry and the Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, and New York Presbyterian Hospital, New York; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland; the Department of Psychiatry, Louis Stokes Cleveland VA Medical Center, Cleveland; the Department of Psychiatry, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz VA Medical Center, Philadelphia; the Department of Psychiatry, Baylor College of Medicine, and the Michael E. DeBakey VA Medical Center, Houston; the Department of Psychiatry, Duke University Medical College, Durham, N.C.; and NIMH, Bethesda, Md
| | - Martha Sajatovic
- From the Department of Psychiatry and the Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, and New York Presbyterian Hospital, New York; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland; the Department of Psychiatry, Louis Stokes Cleveland VA Medical Center, Cleveland; the Department of Psychiatry, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz VA Medical Center, Philadelphia; the Department of Psychiatry, Baylor College of Medicine, and the Michael E. DeBakey VA Medical Center, Houston; the Department of Psychiatry, Duke University Medical College, Durham, N.C.; and NIMH, Bethesda, Md
| | - Ariel G Gildengers
- From the Department of Psychiatry and the Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, and New York Presbyterian Hospital, New York; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland; the Department of Psychiatry, Louis Stokes Cleveland VA Medical Center, Cleveland; the Department of Psychiatry, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz VA Medical Center, Philadelphia; the Department of Psychiatry, Baylor College of Medicine, and the Michael E. DeBakey VA Medical Center, Houston; the Department of Psychiatry, Duke University Medical College, Durham, N.C.; and NIMH, Bethesda, Md
| | - Laszlo Gyulai
- From the Department of Psychiatry and the Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, and New York Presbyterian Hospital, New York; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland; the Department of Psychiatry, Louis Stokes Cleveland VA Medical Center, Cleveland; the Department of Psychiatry, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz VA Medical Center, Philadelphia; the Department of Psychiatry, Baylor College of Medicine, and the Michael E. DeBakey VA Medical Center, Houston; the Department of Psychiatry, Duke University Medical College, Durham, N.C.; and NIMH, Bethesda, Md
| | - Rayan K Al Jurdi
- From the Department of Psychiatry and the Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, and New York Presbyterian Hospital, New York; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland; the Department of Psychiatry, Louis Stokes Cleveland VA Medical Center, Cleveland; the Department of Psychiatry, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz VA Medical Center, Philadelphia; the Department of Psychiatry, Baylor College of Medicine, and the Michael E. DeBakey VA Medical Center, Houston; the Department of Psychiatry, Duke University Medical College, Durham, N.C.; and NIMH, Bethesda, Md
| | - John Beyer
- From the Department of Psychiatry and the Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, and New York Presbyterian Hospital, New York; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland; the Department of Psychiatry, Louis Stokes Cleveland VA Medical Center, Cleveland; the Department of Psychiatry, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz VA Medical Center, Philadelphia; the Department of Psychiatry, Baylor College of Medicine, and the Michael E. DeBakey VA Medical Center, Houston; the Department of Psychiatry, Duke University Medical College, Durham, N.C.; and NIMH, Bethesda, Md
| | - Jovier Evans
- From the Department of Psychiatry and the Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, and New York Presbyterian Hospital, New York; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland; the Department of Psychiatry, Louis Stokes Cleveland VA Medical Center, Cleveland; the Department of Psychiatry, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz VA Medical Center, Philadelphia; the Department of Psychiatry, Baylor College of Medicine, and the Michael E. DeBakey VA Medical Center, Houston; the Department of Psychiatry, Duke University Medical College, Durham, N.C.; and NIMH, Bethesda, Md
| | - Samprit Banerjee
- From the Department of Psychiatry and the Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, and New York Presbyterian Hospital, New York; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland; the Department of Psychiatry, Louis Stokes Cleveland VA Medical Center, Cleveland; the Department of Psychiatry, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz VA Medical Center, Philadelphia; the Department of Psychiatry, Baylor College of Medicine, and the Michael E. DeBakey VA Medical Center, Houston; the Department of Psychiatry, Duke University Medical College, Durham, N.C.; and NIMH, Bethesda, Md
| | - Rebecca Greenberg
- From the Department of Psychiatry and the Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, and New York Presbyterian Hospital, New York; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland; the Department of Psychiatry, Louis Stokes Cleveland VA Medical Center, Cleveland; the Department of Psychiatry, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz VA Medical Center, Philadelphia; the Department of Psychiatry, Baylor College of Medicine, and the Michael E. DeBakey VA Medical Center, Houston; the Department of Psychiatry, Duke University Medical College, Durham, N.C.; and NIMH, Bethesda, Md
| | - Patricia Marino
- From the Department of Psychiatry and the Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, and New York Presbyterian Hospital, New York; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland; the Department of Psychiatry, Louis Stokes Cleveland VA Medical Center, Cleveland; the Department of Psychiatry, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz VA Medical Center, Philadelphia; the Department of Psychiatry, Baylor College of Medicine, and the Michael E. DeBakey VA Medical Center, Houston; the Department of Psychiatry, Duke University Medical College, Durham, N.C.; and NIMH, Bethesda, Md
| | - Mark E Kunik
- From the Department of Psychiatry and the Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, and New York Presbyterian Hospital, New York; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland; the Department of Psychiatry, Louis Stokes Cleveland VA Medical Center, Cleveland; the Department of Psychiatry, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz VA Medical Center, Philadelphia; the Department of Psychiatry, Baylor College of Medicine, and the Michael E. DeBakey VA Medical Center, Houston; the Department of Psychiatry, Duke University Medical College, Durham, N.C.; and NIMH, Bethesda, Md
| | - Peijun Chen
- From the Department of Psychiatry and the Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, and New York Presbyterian Hospital, New York; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland; the Department of Psychiatry, Louis Stokes Cleveland VA Medical Center, Cleveland; the Department of Psychiatry, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz VA Medical Center, Philadelphia; the Department of Psychiatry, Baylor College of Medicine, and the Michael E. DeBakey VA Medical Center, Houston; the Department of Psychiatry, Duke University Medical College, Durham, N.C.; and NIMH, Bethesda, Md
| | - Marna Barrett
- From the Department of Psychiatry and the Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, and New York Presbyterian Hospital, New York; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland; the Department of Psychiatry, Louis Stokes Cleveland VA Medical Center, Cleveland; the Department of Psychiatry, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz VA Medical Center, Philadelphia; the Department of Psychiatry, Baylor College of Medicine, and the Michael E. DeBakey VA Medical Center, Houston; the Department of Psychiatry, Duke University Medical College, Durham, N.C.; and NIMH, Bethesda, Md
| | - Herbert C Schulberg
- From the Department of Psychiatry and the Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, and New York Presbyterian Hospital, New York; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland; the Department of Psychiatry, Louis Stokes Cleveland VA Medical Center, Cleveland; the Department of Psychiatry, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz VA Medical Center, Philadelphia; the Department of Psychiatry, Baylor College of Medicine, and the Michael E. DeBakey VA Medical Center, Houston; the Department of Psychiatry, Duke University Medical College, Durham, N.C.; and NIMH, Bethesda, Md
| | - Martha L Bruce
- From the Department of Psychiatry and the Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, and New York Presbyterian Hospital, New York; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland; the Department of Psychiatry, Louis Stokes Cleveland VA Medical Center, Cleveland; the Department of Psychiatry, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz VA Medical Center, Philadelphia; the Department of Psychiatry, Baylor College of Medicine, and the Michael E. DeBakey VA Medical Center, Houston; the Department of Psychiatry, Duke University Medical College, Durham, N.C.; and NIMH, Bethesda, Md
| | - Charles F Reynolds
- From the Department of Psychiatry and the Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, and New York Presbyterian Hospital, New York; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland; the Department of Psychiatry, Louis Stokes Cleveland VA Medical Center, Cleveland; the Department of Psychiatry, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz VA Medical Center, Philadelphia; the Department of Psychiatry, Baylor College of Medicine, and the Michael E. DeBakey VA Medical Center, Houston; the Department of Psychiatry, Duke University Medical College, Durham, N.C.; and NIMH, Bethesda, Md
| | - George S Alexopoulos
- From the Department of Psychiatry and the Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, and New York Presbyterian Hospital, New York; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland; the Department of Psychiatry, Louis Stokes Cleveland VA Medical Center, Cleveland; the Department of Psychiatry, University of Pennsylvania, Philadelphia, and the Corporal Michael J. Crescenz VA Medical Center, Philadelphia; the Department of Psychiatry, Baylor College of Medicine, and the Michael E. DeBakey VA Medical Center, Houston; the Department of Psychiatry, Duke University Medical College, Durham, N.C.; and NIMH, Bethesda, Md
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Kellner CH, Knapp RG, Petrides G, McCall WV, Young RC, Husain MM, Lisanby SH. A Step Toward Optimizing Treatment Schedules for Continuation ECT: Response to Rasmussen. Am J Psychiatry 2017; 174:397-398. [PMID: 28366097 PMCID: PMC7073257 DOI: 10.1176/appi.ajp.2017.16111322r] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
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- From the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York; the Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York; the Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston; the Department of Psychiatry, Zucker Hillside Hospital/Northwell Health System, New York; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Department of Psychiatry, New York Presbyterian/Weill Cornell Medical Center, New York and White Plains; the Department of Psychiatry and Health Behavior, Augusta University/Medical College of Georgia, Augusta; and the Division of Services and Intervention Research, NIMH, Bethesda, Md
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15
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McCall WV, Lisanby SH, Rosenquist PB, Dooley M, Husain MM, Knapp RG, Petrides G, Rudorfer MV, Young RC, McClintock SM, Mueller M, Prudic J, Greenberg RM, Weiner RD, Bailine SH, Riley MA, McCloud L, Kellner CH. Effects of a right unilateral ultrabrief pulse electroconvulsive therapy course on health related quality of life in elderly depressed patients. J Affect Disord 2017; 209:39-45. [PMID: 27886569 PMCID: PMC5278419 DOI: 10.1016/j.jad.2016.11.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 09/30/2016] [Accepted: 11/06/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Patients with Major Depressive Disorder (MDD) referred for electroconvulsive therapy (ECT) have poorer Health Related Quality of Life (HRQOL), compared with other patients with MDD, but ECT is associated with significant and durable improvement in HRQOL. However, no prior research has focused exclusively on elderly patients with MDD receiving ECT. METHODS HRQOL data from 240 depressed patients over the age of 60 was measured with the Medical Outcomes Study Short Form 36 (SF-36). The SF-36 was measured before and after a course of acute ECT. Predictors of change in HRQOL scores were identified by generalized linear modeling. RESULTS At baseline, participants showed very poor HRQOL. After treatment with ECT, the full sample showed marked and significant improvement across all SF-36 measures, with the largest gains seen in dimensions of mental health. Across all participants, the Physical Component Summary (PCS) score improved by 2.1 standardized points (95% CI, 0.61,3.56), while the Mental Component Summary (MCS) score improved by 12.5 points (95% CI, 7.2,10.8) Compared with non-remitters, remitters showed a trend toward greater improvement in the PCS summary score of 2.7 points (95%CI, -0.45, 5.9), while the improvement in the MCS summary score was significantly greater (8.5 points, 95% CI, 4.6,12.3) in the remitters than non-remitters. Post-ECT SF-36 measurements were consistently and positively related to baseline scores and remitter/non-remitter status or change in depression severity from baseline. Objective measures of cognitive function had no significant relationships to changes in SF-36 scores. LIMITATIONS This study's limitations include that it was an open label study with no comparison group, and generalizability is limited to elderly patients. DISCUSSION ECT providers and elderly patients with MDD treated with ECT can be confident that ECT will result in improved HRQOL in the short-term. Attaining remission is a key factor in the improvement of HRQOL. Acute changes in select cognitive functions were outweighed by improvement in depressive symptoms in determining the short term HRQOL of the participants treated with ECT.
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Affiliation(s)
- W. Vaughn McCall
- Icahn School of Medicine at Mount Sinai, New York,Columbia University and New York State Psychiatric Institute, New York,Medical University of South Carolina, Charleston,Zucker Hillside Hospital/North Shore-LIJ Health System, New York,University of Texas Southwestern Medical Center, Dallas,New York Presbyterian/Weill Cornell Medical Center, New York,Duke University School of Medicine, Durham,Augusta University/Medical College of Georgia,National Institute of Mental Health, Bethesda, Maryland,Address correspondence to Dr. W Vaughn McCall; Dept. Psychiatry and Health Behavior; Medical College of Georgia; Augusta University; 997 St Sebastian Way; Augusta, Georgia, 30912. Phone 706-721-6719. Fax 706-721-1793 ()
| | - Sarah H. Lisanby
- Icahn School of Medicine at Mount Sinai, New York,Columbia University and New York State Psychiatric Institute, New York,Medical University of South Carolina, Charleston,Zucker Hillside Hospital/North Shore-LIJ Health System, New York,University of Texas Southwestern Medical Center, Dallas,New York Presbyterian/Weill Cornell Medical Center, New York,Duke University School of Medicine, Durham,Augusta University/Medical College of Georgia,National Institute of Mental Health, Bethesda, Maryland
| | - Peter B. Rosenquist
- Icahn School of Medicine at Mount Sinai, New York,Columbia University and New York State Psychiatric Institute, New York,Medical University of South Carolina, Charleston,Zucker Hillside Hospital/North Shore-LIJ Health System, New York,University of Texas Southwestern Medical Center, Dallas,New York Presbyterian/Weill Cornell Medical Center, New York,Duke University School of Medicine, Durham,Augusta University/Medical College of Georgia,National Institute of Mental Health, Bethesda, Maryland
| | - Mary Dooley
- Icahn School of Medicine at Mount Sinai, New York,Columbia University and New York State Psychiatric Institute, New York,Medical University of South Carolina, Charleston,Zucker Hillside Hospital/North Shore-LIJ Health System, New York,University of Texas Southwestern Medical Center, Dallas,New York Presbyterian/Weill Cornell Medical Center, New York,Duke University School of Medicine, Durham,Augusta University/Medical College of Georgia,National Institute of Mental Health, Bethesda, Maryland
| | - Mustafa M. Husain
- Icahn School of Medicine at Mount Sinai, New York,Columbia University and New York State Psychiatric Institute, New York,Medical University of South Carolina, Charleston,Zucker Hillside Hospital/North Shore-LIJ Health System, New York,University of Texas Southwestern Medical Center, Dallas,New York Presbyterian/Weill Cornell Medical Center, New York,Duke University School of Medicine, Durham,Augusta University/Medical College of Georgia,National Institute of Mental Health, Bethesda, Maryland
| | - Rebecca G. Knapp
- Icahn School of Medicine at Mount Sinai, New York,Columbia University and New York State Psychiatric Institute, New York,Medical University of South Carolina, Charleston,Zucker Hillside Hospital/North Shore-LIJ Health System, New York,University of Texas Southwestern Medical Center, Dallas,New York Presbyterian/Weill Cornell Medical Center, New York,Duke University School of Medicine, Durham,Augusta University/Medical College of Georgia,National Institute of Mental Health, Bethesda, Maryland
| | - Georgios Petrides
- Icahn School of Medicine at Mount Sinai, New York,Columbia University and New York State Psychiatric Institute, New York,Medical University of South Carolina, Charleston,Zucker Hillside Hospital/North Shore-LIJ Health System, New York,University of Texas Southwestern Medical Center, Dallas,New York Presbyterian/Weill Cornell Medical Center, New York,Duke University School of Medicine, Durham,Augusta University/Medical College of Georgia,National Institute of Mental Health, Bethesda, Maryland
| | - Matthew V. Rudorfer
- Icahn School of Medicine at Mount Sinai, New York,Columbia University and New York State Psychiatric Institute, New York,Medical University of South Carolina, Charleston,Zucker Hillside Hospital/North Shore-LIJ Health System, New York,University of Texas Southwestern Medical Center, Dallas,New York Presbyterian/Weill Cornell Medical Center, New York,Duke University School of Medicine, Durham,Augusta University/Medical College of Georgia,National Institute of Mental Health, Bethesda, Maryland
| | - Robert C. Young
- Icahn School of Medicine at Mount Sinai, New York,Columbia University and New York State Psychiatric Institute, New York,Medical University of South Carolina, Charleston,Zucker Hillside Hospital/North Shore-LIJ Health System, New York,University of Texas Southwestern Medical Center, Dallas,New York Presbyterian/Weill Cornell Medical Center, New York,Duke University School of Medicine, Durham,Augusta University/Medical College of Georgia,National Institute of Mental Health, Bethesda, Maryland
| | - Shawn M. McClintock
- Icahn School of Medicine at Mount Sinai, New York,Columbia University and New York State Psychiatric Institute, New York,Medical University of South Carolina, Charleston,Zucker Hillside Hospital/North Shore-LIJ Health System, New York,University of Texas Southwestern Medical Center, Dallas,New York Presbyterian/Weill Cornell Medical Center, New York,Duke University School of Medicine, Durham,Augusta University/Medical College of Georgia,National Institute of Mental Health, Bethesda, Maryland
| | - Martina Mueller
- Icahn School of Medicine at Mount Sinai, New York,Columbia University and New York State Psychiatric Institute, New York,Medical University of South Carolina, Charleston,Zucker Hillside Hospital/North Shore-LIJ Health System, New York,University of Texas Southwestern Medical Center, Dallas,New York Presbyterian/Weill Cornell Medical Center, New York,Duke University School of Medicine, Durham,Augusta University/Medical College of Georgia,National Institute of Mental Health, Bethesda, Maryland
| | - Joan Prudic
- Icahn School of Medicine at Mount Sinai, New York,Columbia University and New York State Psychiatric Institute, New York,Medical University of South Carolina, Charleston,Zucker Hillside Hospital/North Shore-LIJ Health System, New York,University of Texas Southwestern Medical Center, Dallas,New York Presbyterian/Weill Cornell Medical Center, New York,Duke University School of Medicine, Durham,Augusta University/Medical College of Georgia,National Institute of Mental Health, Bethesda, Maryland
| | - Robert M. Greenberg
- Icahn School of Medicine at Mount Sinai, New York,Columbia University and New York State Psychiatric Institute, New York,Medical University of South Carolina, Charleston,Zucker Hillside Hospital/North Shore-LIJ Health System, New York,University of Texas Southwestern Medical Center, Dallas,New York Presbyterian/Weill Cornell Medical Center, New York,Duke University School of Medicine, Durham,Augusta University/Medical College of Georgia,National Institute of Mental Health, Bethesda, Maryland
| | - Richard D. Weiner
- Icahn School of Medicine at Mount Sinai, New York,Columbia University and New York State Psychiatric Institute, New York,Medical University of South Carolina, Charleston,Zucker Hillside Hospital/North Shore-LIJ Health System, New York,University of Texas Southwestern Medical Center, Dallas,New York Presbyterian/Weill Cornell Medical Center, New York,Duke University School of Medicine, Durham,Augusta University/Medical College of Georgia,National Institute of Mental Health, Bethesda, Maryland
| | - Samuel H. Bailine
- Icahn School of Medicine at Mount Sinai, New York,Columbia University and New York State Psychiatric Institute, New York,Medical University of South Carolina, Charleston,Zucker Hillside Hospital/North Shore-LIJ Health System, New York,University of Texas Southwestern Medical Center, Dallas,New York Presbyterian/Weill Cornell Medical Center, New York,Duke University School of Medicine, Durham,Augusta University/Medical College of Georgia,National Institute of Mental Health, Bethesda, Maryland
| | - Mary Anne Riley
- Icahn School of Medicine at Mount Sinai, New York,Columbia University and New York State Psychiatric Institute, New York,Medical University of South Carolina, Charleston,Zucker Hillside Hospital/North Shore-LIJ Health System, New York,University of Texas Southwestern Medical Center, Dallas,New York Presbyterian/Weill Cornell Medical Center, New York,Duke University School of Medicine, Durham,Augusta University/Medical College of Georgia,National Institute of Mental Health, Bethesda, Maryland
| | - Laryssa McCloud
- Icahn School of Medicine at Mount Sinai, New York,Columbia University and New York State Psychiatric Institute, New York,Medical University of South Carolina, Charleston,Zucker Hillside Hospital/North Shore-LIJ Health System, New York,University of Texas Southwestern Medical Center, Dallas,New York Presbyterian/Weill Cornell Medical Center, New York,Duke University School of Medicine, Durham,Augusta University/Medical College of Georgia,National Institute of Mental Health, Bethesda, Maryland
| | - Charles H. Kellner
- Icahn School of Medicine at Mount Sinai, New York,Columbia University and New York State Psychiatric Institute, New York,Medical University of South Carolina, Charleston,Zucker Hillside Hospital/North Shore-LIJ Health System, New York,University of Texas Southwestern Medical Center, Dallas,New York Presbyterian/Weill Cornell Medical Center, New York,Duke University School of Medicine, Durham,Augusta University/Medical College of Georgia,National Institute of Mental Health, Bethesda, Maryland
| | - the CORE/PRIDE Work Group
- Icahn School of Medicine at Mount Sinai, New York,Columbia University and New York State Psychiatric Institute, New York,Medical University of South Carolina, Charleston,Zucker Hillside Hospital/North Shore-LIJ Health System, New York,University of Texas Southwestern Medical Center, Dallas,New York Presbyterian/Weill Cornell Medical Center, New York,Duke University School of Medicine, Durham,Augusta University/Medical College of Georgia,National Institute of Mental Health, Bethesda, Maryland
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16
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Kellner CH, Husain MM, Knapp RG, McCall WV, Petrides G, Rudorfer MV, Young RC, Sampson S, McClintock SM, Mueller M, Prudic J, Greenberg RM, Weiner RD, Bailine SH, Rosenquist PB, Raza A, Kaliora S, Latoussakis V, Tobias KG, Briggs MC, Liebman LS, Geduldig ET, Teklehaimanot AA, Lisanby SH. Right Unilateral Ultrabrief Pulse ECT in Geriatric Depression: Phase 1 of the PRIDE Study. Am J Psychiatry 2016; 173:1101-1109. [PMID: 27418379 PMCID: PMC7130447 DOI: 10.1176/appi.ajp.2016.15081101] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The Prolonging Remission in Depressed Elderly (PRIDE) study evaluated the efficacy of right unilateral ultrabrief pulse electroconvulsive therapy (ECT) combined with venlafaxine for the treatment of geriatric depression. METHOD PRIDE was a two-phase multisite study. Phase 1 was an acute course of right unilateral ultrabrief pulse ECT, combined with open-label venlafaxine at seven academic medical centers. In phase 2 (reported separately), patients who had remitted were randomly assigned to receive pharmacotherapy (venlafaxine plus lithium) or pharmacotherapy plus continuation ECT. In phase 1, depressed patients received high-dose ECT (at six times the seizure threshold) three times per week. Venlafaxine was started during the first week of treatment and continued throughout the study. The primary outcome measure was remission, assessed with the 24-item Hamilton Depression Rating Scale (HAM-D), which was administered three times per week. Secondary outcome measures were post-ECT reorientation and safety. Paired t tests were used to estimate and evaluate the significance of change from baseline in HAM-D scores. RESULTS Of 240 patients who entered phase 1 of the study, 172 completed it. Overall, 61.7% (148/240) of all patients met remission criteria, 10.0% (24/240) did not remit, and 28.3% (68/240) dropped out; 70% (169/240) met response criteria. Among those who remitted, the mean decrease in HAM-D score was 24.7 points (95% CI=23.4, 25.9), with a mean final score of 6.2 (SD=2.5) and an average change from baseline of 79%. The mean number of ECT treatments to remission was 7.3 (SD=3.1). CONCLUSIONS Right unilateral ultrabrief pulse ECT, combined with venlafaxine, is a rapidly acting and highly effective treatment option for depressed geriatric patients, with excellent safety and tolerability. These data add to the evidence base supporting the efficacy of ECT to treat severe depression in elderly patients.
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Affiliation(s)
- Charles H. Kellner
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York; the Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York; the Department of Psychiatry and Behavioral Health Sciences, NYU Lutheran Medical Center, New York; the Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston; the Department of Psychiatry, Zucker Hillside Hospital/North Shore-LIJ Health System, New York; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Department of Psychiatry, New York Presbyterian/Weill Cornell Medical Center, New York and White Plains; the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C.; the Department of Psychiatry and Health Behavior, Augusta University/Medical College of Georgia, Augusta; the Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minn.; and the Division of Services and Intervention Research, NIMH, Bethesda, Md
| | - Mustafa M. Husain
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York; the Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York; the Department of Psychiatry and Behavioral Health Sciences, NYU Lutheran Medical Center, New York; the Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston; the Department of Psychiatry, Zucker Hillside Hospital/North Shore-LIJ Health System, New York; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Department of Psychiatry, New York Presbyterian/Weill Cornell Medical Center, New York and White Plains; the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C.; the Department of Psychiatry and Health Behavior, Augusta University/Medical College of Georgia, Augusta; the Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minn.; and the Division of Services and Intervention Research, NIMH, Bethesda, Md
| | - Rebecca G. Knapp
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York; the Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York; the Department of Psychiatry and Behavioral Health Sciences, NYU Lutheran Medical Center, New York; the Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston; the Department of Psychiatry, Zucker Hillside Hospital/North Shore-LIJ Health System, New York; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Department of Psychiatry, New York Presbyterian/Weill Cornell Medical Center, New York and White Plains; the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C.; the Department of Psychiatry and Health Behavior, Augusta University/Medical College of Georgia, Augusta; the Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minn.; and the Division of Services and Intervention Research, NIMH, Bethesda, Md
| | - W. Vaughn McCall
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York; the Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York; the Department of Psychiatry and Behavioral Health Sciences, NYU Lutheran Medical Center, New York; the Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston; the Department of Psychiatry, Zucker Hillside Hospital/North Shore-LIJ Health System, New York; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Department of Psychiatry, New York Presbyterian/Weill Cornell Medical Center, New York and White Plains; the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C.; the Department of Psychiatry and Health Behavior, Augusta University/Medical College of Georgia, Augusta; the Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minn.; and the Division of Services and Intervention Research, NIMH, Bethesda, Md
| | - Georgios Petrides
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York; the Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York; the Department of Psychiatry and Behavioral Health Sciences, NYU Lutheran Medical Center, New York; the Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston; the Department of Psychiatry, Zucker Hillside Hospital/North Shore-LIJ Health System, New York; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Department of Psychiatry, New York Presbyterian/Weill Cornell Medical Center, New York and White Plains; the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C.; the Department of Psychiatry and Health Behavior, Augusta University/Medical College of Georgia, Augusta; the Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minn.; and the Division of Services and Intervention Research, NIMH, Bethesda, Md
| | - Matthew V. Rudorfer
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York; the Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York; the Department of Psychiatry and Behavioral Health Sciences, NYU Lutheran Medical Center, New York; the Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston; the Department of Psychiatry, Zucker Hillside Hospital/North Shore-LIJ Health System, New York; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Department of Psychiatry, New York Presbyterian/Weill Cornell Medical Center, New York and White Plains; the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C.; the Department of Psychiatry and Health Behavior, Augusta University/Medical College of Georgia, Augusta; the Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minn.; and the Division of Services and Intervention Research, NIMH, Bethesda, Md
| | - Robert C. Young
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York; the Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York; the Department of Psychiatry and Behavioral Health Sciences, NYU Lutheran Medical Center, New York; the Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston; the Department of Psychiatry, Zucker Hillside Hospital/North Shore-LIJ Health System, New York; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Department of Psychiatry, New York Presbyterian/Weill Cornell Medical Center, New York and White Plains; the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C.; the Department of Psychiatry and Health Behavior, Augusta University/Medical College of Georgia, Augusta; the Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minn.; and the Division of Services and Intervention Research, NIMH, Bethesda, Md
| | - Shirlene Sampson
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York; the Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York; the Department of Psychiatry and Behavioral Health Sciences, NYU Lutheran Medical Center, New York; the Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston; the Department of Psychiatry, Zucker Hillside Hospital/North Shore-LIJ Health System, New York; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Department of Psychiatry, New York Presbyterian/Weill Cornell Medical Center, New York and White Plains; the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C.; the Department of Psychiatry and Health Behavior, Augusta University/Medical College of Georgia, Augusta; the Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minn.; and the Division of Services and Intervention Research, NIMH, Bethesda, Md
| | - Shawn M. McClintock
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York; the Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York; the Department of Psychiatry and Behavioral Health Sciences, NYU Lutheran Medical Center, New York; the Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston; the Department of Psychiatry, Zucker Hillside Hospital/North Shore-LIJ Health System, New York; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Department of Psychiatry, New York Presbyterian/Weill Cornell Medical Center, New York and White Plains; the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C.; the Department of Psychiatry and Health Behavior, Augusta University/Medical College of Georgia, Augusta; the Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minn.; and the Division of Services and Intervention Research, NIMH, Bethesda, Md
| | - Martina Mueller
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York; the Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York; the Department of Psychiatry and Behavioral Health Sciences, NYU Lutheran Medical Center, New York; the Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston; the Department of Psychiatry, Zucker Hillside Hospital/North Shore-LIJ Health System, New York; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Department of Psychiatry, New York Presbyterian/Weill Cornell Medical Center, New York and White Plains; the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C.; the Department of Psychiatry and Health Behavior, Augusta University/Medical College of Georgia, Augusta; the Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minn.; and the Division of Services and Intervention Research, NIMH, Bethesda, Md
| | - Joan Prudic
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York; the Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York; the Department of Psychiatry and Behavioral Health Sciences, NYU Lutheran Medical Center, New York; the Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston; the Department of Psychiatry, Zucker Hillside Hospital/North Shore-LIJ Health System, New York; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Department of Psychiatry, New York Presbyterian/Weill Cornell Medical Center, New York and White Plains; the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C.; the Department of Psychiatry and Health Behavior, Augusta University/Medical College of Georgia, Augusta; the Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minn.; and the Division of Services and Intervention Research, NIMH, Bethesda, Md
| | - Robert M. Greenberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York; the Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York; the Department of Psychiatry and Behavioral Health Sciences, NYU Lutheran Medical Center, New York; the Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston; the Department of Psychiatry, Zucker Hillside Hospital/North Shore-LIJ Health System, New York; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Department of Psychiatry, New York Presbyterian/Weill Cornell Medical Center, New York and White Plains; the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C.; the Department of Psychiatry and Health Behavior, Augusta University/Medical College of Georgia, Augusta; the Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minn.; and the Division of Services and Intervention Research, NIMH, Bethesda, Md
| | - Richard D. Weiner
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York; the Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York; the Department of Psychiatry and Behavioral Health Sciences, NYU Lutheran Medical Center, New York; the Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston; the Department of Psychiatry, Zucker Hillside Hospital/North Shore-LIJ Health System, New York; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Department of Psychiatry, New York Presbyterian/Weill Cornell Medical Center, New York and White Plains; the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C.; the Department of Psychiatry and Health Behavior, Augusta University/Medical College of Georgia, Augusta; the Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minn.; and the Division of Services and Intervention Research, NIMH, Bethesda, Md
| | - Samuel H. Bailine
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York; the Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York; the Department of Psychiatry and Behavioral Health Sciences, NYU Lutheran Medical Center, New York; the Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston; the Department of Psychiatry, Zucker Hillside Hospital/North Shore-LIJ Health System, New York; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Department of Psychiatry, New York Presbyterian/Weill Cornell Medical Center, New York and White Plains; the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C.; the Department of Psychiatry and Health Behavior, Augusta University/Medical College of Georgia, Augusta; the Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minn.; and the Division of Services and Intervention Research, NIMH, Bethesda, Md
| | - Peter B. Rosenquist
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York; the Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York; the Department of Psychiatry and Behavioral Health Sciences, NYU Lutheran Medical Center, New York; the Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston; the Department of Psychiatry, Zucker Hillside Hospital/North Shore-LIJ Health System, New York; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Department of Psychiatry, New York Presbyterian/Weill Cornell Medical Center, New York and White Plains; the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C.; the Department of Psychiatry and Health Behavior, Augusta University/Medical College of Georgia, Augusta; the Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minn.; and the Division of Services and Intervention Research, NIMH, Bethesda, Md
| | - Ahmad Raza
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York; the Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York; the Department of Psychiatry and Behavioral Health Sciences, NYU Lutheran Medical Center, New York; the Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston; the Department of Psychiatry, Zucker Hillside Hospital/North Shore-LIJ Health System, New York; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Department of Psychiatry, New York Presbyterian/Weill Cornell Medical Center, New York and White Plains; the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C.; the Department of Psychiatry and Health Behavior, Augusta University/Medical College of Georgia, Augusta; the Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minn.; and the Division of Services and Intervention Research, NIMH, Bethesda, Md
| | - Styliani Kaliora
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York; the Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York; the Department of Psychiatry and Behavioral Health Sciences, NYU Lutheran Medical Center, New York; the Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston; the Department of Psychiatry, Zucker Hillside Hospital/North Shore-LIJ Health System, New York; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Department of Psychiatry, New York Presbyterian/Weill Cornell Medical Center, New York and White Plains; the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C.; the Department of Psychiatry and Health Behavior, Augusta University/Medical College of Georgia, Augusta; the Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minn.; and the Division of Services and Intervention Research, NIMH, Bethesda, Md
| | - Vassilios Latoussakis
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York; the Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York; the Department of Psychiatry and Behavioral Health Sciences, NYU Lutheran Medical Center, New York; the Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston; the Department of Psychiatry, Zucker Hillside Hospital/North Shore-LIJ Health System, New York; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Department of Psychiatry, New York Presbyterian/Weill Cornell Medical Center, New York and White Plains; the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C.; the Department of Psychiatry and Health Behavior, Augusta University/Medical College of Georgia, Augusta; the Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minn.; and the Division of Services and Intervention Research, NIMH, Bethesda, Md
| | - Kristen G. Tobias
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York; the Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York; the Department of Psychiatry and Behavioral Health Sciences, NYU Lutheran Medical Center, New York; the Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston; the Department of Psychiatry, Zucker Hillside Hospital/North Shore-LIJ Health System, New York; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Department of Psychiatry, New York Presbyterian/Weill Cornell Medical Center, New York and White Plains; the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C.; the Department of Psychiatry and Health Behavior, Augusta University/Medical College of Georgia, Augusta; the Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minn.; and the Division of Services and Intervention Research, NIMH, Bethesda, Md
| | - Mimi C. Briggs
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York; the Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York; the Department of Psychiatry and Behavioral Health Sciences, NYU Lutheran Medical Center, New York; the Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston; the Department of Psychiatry, Zucker Hillside Hospital/North Shore-LIJ Health System, New York; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Department of Psychiatry, New York Presbyterian/Weill Cornell Medical Center, New York and White Plains; the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C.; the Department of Psychiatry and Health Behavior, Augusta University/Medical College of Georgia, Augusta; the Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minn.; and the Division of Services and Intervention Research, NIMH, Bethesda, Md
| | - Lauren S. Liebman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York; the Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York; the Department of Psychiatry and Behavioral Health Sciences, NYU Lutheran Medical Center, New York; the Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston; the Department of Psychiatry, Zucker Hillside Hospital/North Shore-LIJ Health System, New York; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Department of Psychiatry, New York Presbyterian/Weill Cornell Medical Center, New York and White Plains; the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C.; the Department of Psychiatry and Health Behavior, Augusta University/Medical College of Georgia, Augusta; the Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minn.; and the Division of Services and Intervention Research, NIMH, Bethesda, Md
| | - Emma T. Geduldig
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York; the Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York; the Department of Psychiatry and Behavioral Health Sciences, NYU Lutheran Medical Center, New York; the Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston; the Department of Psychiatry, Zucker Hillside Hospital/North Shore-LIJ Health System, New York; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Department of Psychiatry, New York Presbyterian/Weill Cornell Medical Center, New York and White Plains; the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C.; the Department of Psychiatry and Health Behavior, Augusta University/Medical College of Georgia, Augusta; the Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minn.; and the Division of Services and Intervention Research, NIMH, Bethesda, Md
| | - Abeba A. Teklehaimanot
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York; the Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York; the Department of Psychiatry and Behavioral Health Sciences, NYU Lutheran Medical Center, New York; the Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston; the Department of Psychiatry, Zucker Hillside Hospital/North Shore-LIJ Health System, New York; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Department of Psychiatry, New York Presbyterian/Weill Cornell Medical Center, New York and White Plains; the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C.; the Department of Psychiatry and Health Behavior, Augusta University/Medical College of Georgia, Augusta; the Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minn.; and the Division of Services and Intervention Research, NIMH, Bethesda, Md
| | - Sarah H. Lisanby
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York; the Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York; the Department of Psychiatry and Behavioral Health Sciences, NYU Lutheran Medical Center, New York; the Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston; the Department of Psychiatry, Zucker Hillside Hospital/North Shore-LIJ Health System, New York; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Department of Psychiatry, New York Presbyterian/Weill Cornell Medical Center, New York and White Plains; the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C.; the Department of Psychiatry and Health Behavior, Augusta University/Medical College of Georgia, Augusta; the Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minn.; and the Division of Services and Intervention Research, NIMH, Bethesda, Md
| | - CORE/PRIDE Work Group
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York; the Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York; the Department of Psychiatry and Behavioral Health Sciences, NYU Lutheran Medical Center, New York; the Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston; the Department of Psychiatry, Zucker Hillside Hospital/North Shore-LIJ Health System, New York; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Department of Psychiatry, New York Presbyterian/Weill Cornell Medical Center, New York and White Plains; the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C.; the Department of Psychiatry and Health Behavior, Augusta University/Medical College of Georgia, Augusta; the Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minn.; and the Division of Services and Intervention Research, NIMH, Bethesda, Md
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17
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Kellner CH, Husain MM, Knapp RG, McCall WV, Petrides G, Rudorfer MV, Young RC, Sampson S, McClintock SM, Mueller M, Prudic J, Greenberg RM, Weiner RD, Bailine SH, Rosenquist PB, Raza A, Kaliora S, Latoussakis V, Tobias KG, Briggs MC, Liebman LS, Geduldig ET, Teklehaimanot AA, Dooley M, Lisanby SH. A Novel Strategy for Continuation ECT in Geriatric Depression: Phase 2 of the PRIDE Study. Am J Psychiatry 2016; 173:1110-1118. [PMID: 27418381 PMCID: PMC7130448 DOI: 10.1176/appi.ajp.2016.16010118] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The randomized phase (phase 2) of the Prolonging Remission in Depressed Elderly (PRIDE) study evaluated the efficacy and tolerability of continuation ECT plus medication compared with medication alone in depressed geriatric patients after a successful course of ECT (phase 1). METHOD PRIDE was a two-phase multisite study. Phase 1 was an acute course of right unilateral ultrabrief pulse ECT, augmented with venlafaxine. Phase 2 compared two randomized treatment arms: a medication only arm (venlafaxine plus lithium, over 24 weeks) and an ECT plus medication arm (four continuation ECT treatments over 1 month, plus additional ECT as needed, using the Symptom-Titrated, Algorithm-Based Longitudinal ECT [STABLE] algorithm, while continuing venlafaxine plus lithium). The intent-to-treat sample comprised 120 remitters from phase 1. The primary efficacy outcome measure was score on the 24-item Hamilton Depression Rating Scale (HAM-D), and the secondary efficacy outcome was score on the Clinical Global Impressions severity scale (CGI-S). Tolerability as measured by neurocognitive performance (reported elsewhere) was assessed using an extensive test battery; global cognitive functioning as assessed by the Mini-Mental State Examination (MMSE) is reported here. Longitudinal mixed-effects repeated-measures modeling was used to compare ECT plus medication and medication alone for efficacy and global cognitive function outcomes. RESULTS At 24 weeks, the ECT plus medication group had statistically significantly lower HAM-D scores than the medication only group. The difference in adjusted mean HAM-D scores at study end was 4.2 (95% CI=1.6, 6.9). Significantly more patients in the ECT plus medication group were rated "not ill at all" on the CGI-S compared with the medication only group. There was no statistically significant difference between groups in MMSE score. CONCLUSIONS Additional ECT after remission (here operationalized as four continuation ECT treatments followed by further ECT only as needed) was beneficial in sustaining mood improvement for most patients.
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19
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Sajatovic M, Strejilevich SA, Gildengers AG, Dols A, Al Jurdi RK, Forester BP, Kessing LV, Beyer J, Manes F, Rej S, Rosa AR, Schouws SNTM, Tsai SY, Young RC, Shulman KI. A report on older-age bipolar disorder from the International Society for Bipolar Disorders Task Force. Bipolar Disord 2015; 17:689-704. [PMID: 26384588 PMCID: PMC4623878 DOI: 10.1111/bdi.12331] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [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: 01/31/2015] [Accepted: 07/24/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES In the coming generation, older adults with bipolar disorder (BD) will increase in absolute numbers as well as proportion of the general population. This is the first report of the International Society for Bipolar Disorder (ISBD) Task Force on Older-Age Bipolar Disorder (OABD). METHODS This task force report addresses the unique aspects of OABD including epidemiology and clinical features, neuropathology and biomarkers, physical health, cognition, and care approaches. RESULTS The report describes an expert consensus summary on OABD that is intended to advance the care of patients, and shed light on issues of relevance to BD research across the lifespan. Although there is still a dearth of research and health efforts focused on older adults with BD, emerging data have brought some answers, innovative questions, and novel perspectives related to the notion of late onset, medical comorbidity, and the vexing issue of cognitive impairment and decline. CONCLUSIONS Improving our understanding of the biological, clinical, and social underpinnings relevant to OABD is an indispensable step in building a complete map of BD across the lifespan.
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Affiliation(s)
- Martha Sajatovic
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Sergio A Strejilevich
- Bipolar Disorder Program, Neurosciences Institute, Favaloro University, Buenos Aires, Argentina
| | - Ariel G Gildengers
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
| | - Annemiek Dols
- GGZinGeest, VU Medical Center, Amsterdam, the Netherlands
| | - Rayan K Al Jurdi
- Michael E. DeBakey VA Medical Center, Houston, TX, USA,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Brent P Forester
- Geriatric Psychiatry Research Program, McLean Hospital, Harvard Medical School, Boston, MA, USA
| | - Lars Vedel Kessing
- Psychiatric Centre Copenhagen, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - John Beyer
- Duke University Medical Center, Durham, NC, USA
| | - Facundo Manes
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive Neurology (INECO), Favaloro University, Buenos Aires, Argentina,UPD-INECO Foundation Core on Neuroscience (UNIFCoN), Chile,National Scientific and Technical Rsearch Council (CONICET), Argentina,Australian Research Council Centre of Excellence in Cognition and its Disorders, Australia
| | - Soham Rej
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada,Geri PARTy Research Group, Jewish General Hospital, Montreal, QC, Canada
| | - Adriane R Rosa
- Federal University of Rio Grande do Sul, Brazil,Department of Pharmacology, Laboratory of Molecular Psychiatry, INCT for Translational Medicine–CNPq, Hospital de Clínicas de Porto Alegre, Brazil
| | - Sigfried NTM Schouws
- GGZ inGeest, Department of Psychiatry, EMGO Institute of Care and Health Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Shang-Ying Tsai
- Department of Psychiatry, Taipei Medical University Hospital,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Robert C Young
- Weill Cornell Medical College and New York Presbyterian Hospital, White Plains, NY, USA
| | - Kenneth I Shulman
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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20
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Fuh KC, Java J, Kapp DS, Burger RA, Young RC, Alberts DS, McGuire WP, Markman M, Chan JK. Comparison of clear cell ovarian cancer in Asian versus Caucasians: A NRG/GOG study. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e16572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Robert Allen Burger
- Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA
| | | | | | | | - Maurie Markman
- ERMC, Cancer Treatment Centers of America, Philadelphia, PA
| | - John K. Chan
- Palo Alto Medical Founndation, San Francisco, CA
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21
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Young RC. NCCN: Evolution in the Early Years. J Natl Compr Canc Netw 2015; 13:255-6. [DOI: 10.6004/jnccn.2015.0037] [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] [Indexed: 11/17/2022]
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22
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Kellner CH, Geduldig ET, Knapp RG, Young RC, Weiner RD, Greenberg RM, Prudic J, McCall WV, Petrides G, Husain MM, Rudorfer MV, Lisanby SH. More data on speed of remission with ECT in geriatric depression. Br J Psychiatry 2015; 206:167. [PMID: 25644884 PMCID: PMC7059947 DOI: 10.1192/bjp.206.2.167] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 11/23/2022]
Affiliation(s)
| | | | - Rebecca G. Knapp
- Department of Public Health Sciences, Medical University of South
Carolina
| | - Robert C. Young
- Department of Psychiatry, Weill Medical College of Cornell
University
| | - Richard D. Weiner
- Department of Psychiatry and Behavioral Sciences, Duke University
School of Medicine
| | | | - Joan Prudic
- Charles H. Kellner, Professor, Department of Psychiatry, Icahn School of Medicine, USA. . Emma T. Geduldig, Clinical Research Coordinator, Department of Psychiatry, Icahn School of Medicine, Rebecca G. Knapp, Professor Emerita, Department of Public Health Sciences, Medical University of South Carolina, Robert C. Young, Professor, Department of Psychiatry, Weill Medical College of Cornell University, Richard D. Weiner, Professor, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Robert M. Greenberg, Chief, Geriatric Psychiatry, Lutheran Medical Center, Joan Prudic, Clinical Professor of Psychiatry, New York State Psychiatric Institute and the College of Physicians and Surgeons of Columbia University, W. Vaughn McCall, Professor and Case Distinguished Chairman, Department of Psychiatry and Health Behavior, Georgia Regents University, Georgios Petrides, Associate Professor, Department of Psychiatry, Hofstra North Shore-LIJ School of Medicine at Hofstra University, Mustafa M. Husain, Professor, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Matthew V. Rudorfer, Program Chief, Somatic Treatments Program, National Institute of Mental Health, Sarah H. Lisanby, JP Gibbons Professor and Chair, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, USA
| | - W. Vaughn McCall
- Department of Psychiatry and Health Behavior, Georgia Regents
University
| | - Georgios Petrides
- Charles H. Kellner, Professor, Department of Psychiatry, Icahn School of Medicine, USA. . Emma T. Geduldig, Clinical Research Coordinator, Department of Psychiatry, Icahn School of Medicine, Rebecca G. Knapp, Professor Emerita, Department of Public Health Sciences, Medical University of South Carolina, Robert C. Young, Professor, Department of Psychiatry, Weill Medical College of Cornell University, Richard D. Weiner, Professor, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Robert M. Greenberg, Chief, Geriatric Psychiatry, Lutheran Medical Center, Joan Prudic, Clinical Professor of Psychiatry, New York State Psychiatric Institute and the College of Physicians and Surgeons of Columbia University, W. Vaughn McCall, Professor and Case Distinguished Chairman, Department of Psychiatry and Health Behavior, Georgia Regents University, Georgios Petrides, Associate Professor, Department of Psychiatry, Hofstra North Shore-LIJ School of Medicine at Hofstra University, Mustafa M. Husain, Professor, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Matthew V. Rudorfer, Program Chief, Somatic Treatments Program, National Institute of Mental Health, Sarah H. Lisanby, JP Gibbons Professor and Chair, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, USA
| | - Mustafa M. Husain
- Department of Psychiatry and Behavioral Sciences, Duke University
School of Medicine
| | | | - Sarah H. Lisanby
- Department of Psychiatry and Behavioral Sciences, Duke University
School of Medicine, USA
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23
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Kellner CH, Lisanby SH, Weiner R, Prudic J, Rudorfer MV, Young RC, Petrides G, McCall WV, Husain M, Greenberg RM, Knapp RG. Speed of response to electroconvulsive therapy compared with ketamine. Psychiatry Res 2015; 225:215. [PMID: 25511506 PMCID: PMC7059957 DOI: 10.1016/j.psychres.2014.08.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 06/25/2014] [Accepted: 08/11/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Charles H Kellner
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Sarah H Lisanby
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Richard Weiner
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Joan Prudic
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Matthew V Rudorfer
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Robert C Young
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - George Petrides
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - W Vaughn McCall
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Mustafa Husain
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Robert M Greenberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Rebecca G Knapp
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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24
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Beyer JL, Greenberg RL, Marino P, Bruce ML, Al Jurdi RK, Sajatovic M, Gyulai L, Mulsant BH, Gildengers A, Young RC. Social support in late life mania: GERI-BD. Int J Geriatr Psychiatry 2014; 29:1028-32. [PMID: 24664811 PMCID: PMC4545672 DOI: 10.1002/gps.4093] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 01/23/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Using the database of the National Institute of Mental Health-sponsored acute treatment of late life mania study (GERI-BD), we assessed the role of social support in the presentation of late life bipolar mania. METHODS In the first 100 subjects randomized in geriatric BD, we explored the demographic, clinical, and social support characteristics (assessed using the Duke Social Support Index) and aspects of manic presentation. We selected two dependent variables: symptom severity, as determined by the Young Mania Rating Scale (YMRS) at baseline, and duration of episode. We selected nine potential independent variables on the basis of Pearson correlation coefficients. We derived two final models using multiple regression analysis employing an iterative process. RESULTS In our severity model, being married was associated with a higher YMRS score (p = 0.05), whereas higher social interaction scores with non-family members were associated with a lower YMRS score (p = 0.011). In the episode duration model, longer duration was associated with a higher Hamilton Depression Rating Scale score (p = 0.03) and higher social interaction scores with non-family members (p = 0.0003), younger age (p = 0.04), higher number of persons in one's family social network (p = 0.017), and higher instrumental support scores (p = 0.0062). CONCLUSIONS In late life mania, more social interaction with one's community appears to be associated with less severe symptoms at presentation for treatment, however, it can also be associated with slightly longer the duration of episode. Two aspects of the Duke Social Support Index are associated with a shorter episode duration prior to seeking treatment: being part of a larger family network and a having a higher level of instrumental support prior to treatment. The Instrumental Support Subscale measures the degree of assistance that is available for the respondent in performing daily tasks. These findings suggest that in older adults with BD, close social interactions and support are important in limiting the length of the illness episode prior to treatment. Social interactions involving non-family members may be less important in moderating the intensity of the symptoms at presentation.
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Affiliation(s)
| | | | | | | | | | | | | | - Benoit H. Mulsant
- Centre for Addiction and Mental Health, Toronto and University of Toronto, Ontario,University of Pittsburg School of Medicine
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25
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Kellner CH, McClintock SM, McCall WV, Petrides G, Knapp RG, Weiner RD, Young RC, Greenberg RM, Rudorfer MV, Ahle GM, Liebman LS, Lisanby SH. Brief pulse and ultrabrief pulse right unilateral electroconvulsive therapy (ECT) for major depression: efficacy, effectiveness, and cognitive effects. J Clin Psychiatry 2014; 75:777. [PMID: 25093475 PMCID: PMC7059912 DOI: 10.4088/jcp.14lr08997] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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: 10/25/2022]
Affiliation(s)
- Charles H. Kellner
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai,
New York, New York
| | - Shawn M. McClintock
- Department of Psychiatry and Behavioral Sciences, Duke University
School of Medicine, Durham, North Carolina
| | - W. Vaughn McCall
- Department of Psychiatry and Human Health, Georgia Regents
University, Augusta
| | - George Petrides
- Department of Psychiatry, Northshore LIJ Health System, Zucker
Hillside Hospital, Glen Oaks, New York
| | - Rebecca G. Knapp
- Department of Public Health Sciences, Medical University of South
Carolina, Charleston
| | - Richard D. Weiner
- Department of Psychiatry and Behavioral Sciences, Duke University
School of Medicine, Durham, North Carolina
| | - Robert C. Young
- Department of Psychiatry, Weill Cornell Medical College, White
Plains, New York
| | | | - Matthew V. Rudorfer
- Somatic Treatments Program, National Institute of Mental Health,
Bethesda, Maryland
| | - Gabriella M. Ahle
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai,
New York, New York
| | - Lauren S. Liebman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai,
New York, New York
| | - Sarah H. Lisanby
- Department of Psychiatry and Behavioral Sciences, Duke University
School of Medicine, Durham, North Carolina
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Kellner CH, Liebman LS, Nazarian R, Knapp RG, McCall WV, Husain MM, Petrides G, Young RC, Greenberg RM, Weiner RD, Prudic J, Rudorfer MV, Lisanby SH. Efficacy of Right Unilateral Ultrabrief Pulse Electroconvulsive Therapy (ECT): Data from Phase 1 of the PRIDE Study. The American Journal of Geriatric Psychiatry 2013. [DOI: 10.1016/j.jagp.2012.12.175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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27
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Gildengers A, Tatsuoka C, Bialko C, Cassidy KA, Dines P, Emanuel J, Al Jurdi RK, Gyulai L, Mulsant BH, Young RC, Sajatovic M. Correlates of disability in depressed older adults with bipolar disorder. Cut Edge Psychiatry Pract 2013; 2013:332-338. [PMID: 24358446 PMCID: PMC3864697] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Aims To identify clinical factors associated with disability in depressed older adults with bipolar disorder (BPD) receiving lamotrigine. Methods Secondary analysis of a multi-site, 12-week, open-label, uncontrolled study of addon lamotrigine in 57 adults 60 years and older with BD I or II depression. Measures included the Montgomery Asberg Depression Rating Scale (MADRS), Young Mania Rating Scale (YMRS), Cumulative Illness Rating Scale for Geriatrics (CIRS-G), Dementia Rating Scale (DRS), and WHO-Disability Assessment Scale II (WHO-DAS II). Results Medical comorbidiy in this group of elders was substantial, with roughly 60% of subjects having disorders of the vascular, musculoskeletal/integument, and endodrine/metabolic/breast systems. We found significant relationships among mood (MADRS), medical comorbidity (CIRS-G), cognition (DRS), and disability (WHO-DAS II). More severe BPD depression, more medical comorbidity and more impaired cognition were all associated with lower functioning in BPD elders. Conclusions Our findings fit the paradigm shift that has been occurring in BPD, supporting the notion that BPD is not solely an illness of mood but that it affects multiple domains impacting overall functioning.
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Affiliation(s)
- Ariel Gildengers
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic
| | - Curtis Tatsuoka
- Department of Neurology, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center
| | - Christopher Bialko
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center
| | - Kristin A Cassidy
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center
| | - Philipp Dines
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center
| | - James Emanuel
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic
| | - Rayan K Al Jurdi
- Mental Health Care Line, Michael E. DeBakey, VA medical Center, Baylor College of Medicine
| | - Laszlo Gyulai
- University of Pennsylvania Medical Center and School of Medicine
| | | | | | - Martha Sajatovic
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center
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Sheeran T, Greenberg RL, Davan LA, Dealy JA, Young RC, Bruce ML. A descriptive study of older bipolar disorder residents living in New York City's adult congregate facilities. Bipolar Disord 2012; 14:756-63. [PMID: 23107221 PMCID: PMC4098752 DOI: 10.1111/bdi.12008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Much of the research on geriatric bipolar disorder is from outpatient populations or epidemiological surveys with small samples. In contrast, in this study a descriptive analysis was conducted of geriatric and younger adult residents with bipolar disorder or mania in non-clinical adult congregate facilities (ACFs) in the greater New York City region. METHODS A total of 2602 ACF residents were evaluated in 19 facilities, across multiple demographic and health domains. Within this sample, 200 residents had chart diagnoses of bipolar disorder or mania. Among these, 50 geriatric residents (age ≥ 60) were compared to 50 younger adult residents (age < 50) on a number of demographic and health measures. RESULTS Based on chart diagnoses, the overall prevalence of bipolar disorder was 7.8%. Compared to other studies of outpatient, epidemiological, and census samples, both older and younger residents with bipolar disorder had higher rates of cognitive impairment, impairment in executive functioning, vision impairment, and proportion of residents who had never been married. The younger group also had higher rates of obesity and the elderly group had a greater proportion of residents without high-school education. Both age groups had rates of lithium or valproate use comparable to those found in outpatient studies. Comparing the two age groups, the elderly sample had lower overall cognitive and executive functioning, and was using a larger number of medication classes than the younger group. The elderly group also had a larger proportion of residents who were separated/divorced or widowed compared to the younger group, which had higher rates of never-married residents. CONCLUSIONS Overall, both age groups had relatively high rates of bipolar disorder, with significant cognitive impairment, medical burden, obesity, mental health service use, and lower education levels, as compared to outpatient, epidemiological, and census samples. Of note was the significant cognitive impairment across age groups.
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Affiliation(s)
- Thomas Sheeran
- Alpert Medical School, Brown University and Rhode Island Hospital, Providence, RI 02903, USA.
| | - Rebecca L Greenberg
- Institute of Geriatric Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | - Laura A Davan
- Institute of Geriatric Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | - Jennifer A Dealy
- Alpert Medical School, Brown University and Rhode Island Hospital, Providence, RI
| | - Robert C Young
- Institute of Geriatric Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | - Martha L Bruce
- Institute of Geriatric Psychiatry, Weill Cornell Medical College, New York, NY, USA
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Abstract
Antiphospholipidsyndrome (APS) is an autoimmune disorder which causes a hyper-coagulable state characterized by recurrent thrombosis. It has a diverse range of central nervous system manifestations. We describe a case of a 61 year old man with bipolar disorder and APS, and we compare this to a previously reported case. Additionally, we reviewed literature regarding APS-related markers and the relationship of APS to other psychiatric and neurologic illnesses. We discuss possible mechanisms for an association between APS and bipolar disorder. We encourage clinicians to be aware of this possible relationship and have proposed research strategies.
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Affiliation(s)
- Jimmy N. Avari
- Department of Psychiatry, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA
| | - Robert C. Young
- Department of Psychiatry, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA
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Gildengers A, Tatsuoka C, Bialko C, Cassidy KA, Al Jurdi RK, Gyulai L, Mulsant BH, Young RC, Sajatovic M. Correlates of treatment response in depressed older adults with bipolar disorder. J Geriatr Psychiatry Neurol 2012; 25:37-42. [PMID: 22467845 PMCID: PMC3621979 DOI: 10.1177/0891988712436685] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS To identify baseline clinical factors associated with acute treatment response in depressed older adults with bipolar disorder (BD) receiving lamotrigine. METHODS Secondary analysis of a multisite, 12-week, open-label, uncontrolled study of add-on lamotrigine in 57 adults 60 years and older with BD I or II depression. Measures included the Montgomery Asberg Depression Rating Scale (MADRS) and Young Mania Rating Scale (YMRS). Cardiometabolic risk was measured with total serum cholesterol and the Cumulative Illness Rating Scale-Geriatric (CIRS-G) item #13 (endocrine/metabolic burden). Neurocognitive (executive) function was evaluated using the Trail Making Test. RESULTS Greater reduction in MADRS from baseline was associated with higher baseline cardiometabolic burden at 6 and 9 weeks and lower YMRS scores at 9 weeks. At 12 weeks, improvement in the MADRS from baseline was no longer significantly related to baseline cardiometabolic burden or YMRS scores. A longitudinal mixed model of MADRS scores corroborated these findings with a significant finding of time-by-baseline cholesterol level interaction. In a subset of participants, better baseline executive function was related to greater improvement in the MADRS at 9 weeks but not at 6 or 12 weeks. Among all participants, higher baseline YMRS scores were related to greater likelihood of dropout. CONCLUSIONS Lamotrigine appears to work best in depressed elderly patients with BD who have high cardiometabolic risk and low level of mania. Agents like lamotrigine that act primarily on neuroprogressive pathways involving oxidative stress, neurotrophins, and inflammation may be particularly effective in individuals with BD who have significant cardiometabolic burden because of their effects on shared vulnerability factors in BD and medical illness.
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Affiliation(s)
- Ariel Gildengers
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213, USA.
| | - Curtis Tatsuoka
- Department of Neurology, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Christopher Bialko
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Kristin A. Cassidy
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Rayan K. Al Jurdi
- Mental Health Care Line, Michael E. DeBakey, VA Medical Center, Baylor College of Medicine, TX, USA
| | - Laszlo Gyulai
- University of Pennsylvania Medical Center and School of Medicine, Pennsylvania, PA, USA
| | - Benoit H. Mulsant
- Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Robert C. Young
- Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | - Martha Sajatovic
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
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Al Jurdi RK, Schulberg HC, Greenberg RL, Kunik ME, Gildengers A, Sajatovic M, Mulsant BH, Young RC. Characteristics associated with inpatient versus outpatient status in older adults with bipolar disorder. J Geriatr Psychiatry Neurol 2012; 25:62-8. [PMID: 22467848 PMCID: PMC3623950 DOI: 10.1177/0891988712436684] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This is an exploratory analysis of ambulatory and inpatient services utilization by older persons with type I bipolar disorder experiencing elevated mood. The association between type of treatment setting and the person's characteristics is explored within a framework that focuses upon predisposing, enhancing, and need characteristics. METHOD Baseline assessments were conducted with the first 51 inpatients and 49 outpatients 60 years of age and older, meeting criteria for type I bipolar disorder, manic, hypomanic, or mixed episode enrolled in the geriatric bipolar disorder study (GERI-BD) study. We compared participants recruited from inpatient versus outpatient settings in regard to the patients' predisposing, enabling, and need characteristics. RESULTS Being treated in an inpatient rather than an outpatient setting was associated with the predisposing characteristic of being non-Hispanic caucasian (odds ratio [OR]: 0.1; P = .005) and past history of treatment with first-generation antipsychotics (OR: 6.5; P < .001), and the need characteristic reflected in having psychotic symptoms present in the current episode (OR: 126.08; P < .001). CONCLUSION Ethnicity, past pharmacologic treatment, and current symptom severity are closely associated with treatment in inpatient settings. Clinicians and researchers should investigate whether closer monitoring of persons with well-validated predisposing and need characteristics can lead to their being treated in less costly but equally effective ambulatory rather than inpatient settings.
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Affiliation(s)
- Rayan K. Al Jurdi
- The Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA,Baylor College of Medicine, Houston, TX, USA,Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
| | | | | | - Mark E. Kunik
- The Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA,Baylor College of Medicine, Houston, TX, USA,Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA,Houston Center for Quality of Care & Utilization Studies, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Ariel Gildengers
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Martha Sajatovic
- Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland OH, USA
| | - Benoit H. Mulsant
- Center for Addiction and Mental Health and Department of Psychiatry, University of Toronto, Toronto ON, Canada
| | - Robert C. Young
- Weill Cornell Medical College, White Plains, New York, NY, USA
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Affiliation(s)
- Martha Sajatovic
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland OH
| | - Ariel Gildengers
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh PA
| | - Robert C. Young
- Department of Psychiatry, Weill Cornell Medical College and New York-Presbyterian Hospital, White Plains NY
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Sajatovic M, Al Jurdi R, Gildengers A, Greenberg RL, Tenhave T, Bruce ML, Mulsant B, Young RC. Depression symptom ratings in geriatric patients with bipolar mania. Int J Geriatr Psychiatry 2011; 26:1201-8. [PMID: 21360754 PMCID: PMC3651791 DOI: 10.1002/gps.2664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 05/18/2010] [Accepted: 10/26/2010] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Given the paucity of information available regarding standardized ratings of depression symptoms in bipolar manic states, and in particular those in older adults, we explored depression ratings in symptomatic participants in a multicenter study of treatment of bipolar I disorder in late life. METHODS Baseline data was obtained from the first 100 patients enrolled in an NIMH-funded, 9-week, randomized, double-blind RCT comparing treatment with lithium or valproate in patients of age 60 years and older with Type I Bipolar mania or hypomania. This multi-site study was conducted at six academic medical centers in the United States and enrolled inpatients and outpatients with a total Young Mania Rating Scale (YMRS) score of 18 or greater. Depressive symptoms were evaluated with the Hamilton Depression Rating Scale (HAM-D) and the Montgomery-Asberg Depression Rating Scale (MADRS). The criterion for at least moderate bipolar depressive symptoms was the European College of Neuropsychopharmacology (ECNP) Consensus Meeting definition of HAM-D 17 total score >20. RESULTS Eleven percent of patients had mixed symptoms defined by depression scale severity according to ECNP criterion. In the overall sample, total scores on the two depression scales were highly correlated. Total YMRS scores of this mixed symptom group were similar to the remainder of the sample. CONCLUSIONS These preliminary findings suggest that moderate to severe depressive symptoms occur in about one in ten bipolar manic elders. Future studies are needed to further evaluate symptom profiles, clinical correlates, and treatments for bipolar older adults with combined manic and depressive symptoms.
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Affiliation(s)
- Martha Sajatovic
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA.
| | - Rayan Al Jurdi
- Department of Psychiatry, The Menninger Department of Psychiatry at Baylor College of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
| | - Ariel Gildengers
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA
| | | | - Thomas Tenhave
- Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Martha L. Bruce
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY
| | - Benoit Mulsant
- Geriatric Mental Health Program, Center for Addiction and Mental Health and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Robert C. Young
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY
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Sajatovic M, Gildengers A, Jurdi RKA, Gyulai L, Cassidy KA, Greenberg RL, Bruce ML, Mulsant BH, Have TT, Young RC. Multisite, open-label, prospective trial of lamotrigine for geriatric bipolar depression: a preliminary report. Bipolar Disord 2011; 13:294-302. [PMID: 21676132 PMCID: PMC3610426 DOI: 10.1111/j.1399-5618.2011.00923.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [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] [Indexed: 11/29/2022]
Abstract
AIMS This is a multisite, 12-week, open-label trial of lamotrigine augmentation in 57 older adults (≥ 60 years; mean ± SD age = 66.5 ± 6.7 years) with either type I or type II bipolar depression. METHODS Primary outcome measure was change from baseline on the Montgomery-Åsberg Depression Rating Scale (MADRS). Secondary outcome measures included Hamilton Depression Rating Scale (HAM-D), Clinical Global Impression-Bipolar version (CGI-BP), and the WHO-Disability Assessment Schedule II (WHO-DAS II). The Udvalg for Kliniske Undersøgelser (UKU) was used to assess side effects. RESULTS A total of 77.2% of the study subjects had bipolar I disorder. The mean (SD) lamotrigine dose was 150.9 (68.5) mg/day. There was significant improvement in the MADRS, HAM-D, CGI-BP, and in most domains on the WHO-DAS II. For patients for whom final MADRS score was available: 31 (57.4%) met remission criteria and 35 (64.8%) met response criteria. There were 19/57 (33.3%) who dropped out of the study prematurely, with 6 dropouts due to adverse events (4 cases of rash, 1 manic switch, and 1 hyponatremia). Two cases of rash were possibly drug related and were resolved with drug discontinuation. The most common UKU adverse effects were reduced sleep duration (n = 14, 24.6%), weight loss (n = 12, 21.1%), increased dream activity (n = 12, 21.1%), polyuria/polydipsia (n = 11, 19.3%), weight gain (n = 9, 15.8%), diminished sexual desire (n = 9, 15.8%), increased sleep (n = 9, 15.8%), lassitude/fatigue (n = 8, 14%), and unsteady gait (n = 8, 14%). No significant changes in electrocardiogram or laboratory tests were observed. CONCLUSIONS In bipolar depressed elders, lamotrigine was associated with improvement in depression, psychopathology, and functional status. There was a moderate number of adverse events, although relationship of adverse events (particularly falls) to study medication could not be clearly determined in this uncontrolled trial. Controlled studies are needed to further evaluate efficacy and tolerability of lamotrigine therapy in geriatric bipolar depression.
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Affiliation(s)
- Martha Sajatovic
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA.
| | - Ariel Gildengers
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA
| | - Rayan K Al Jurdi
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX
| | - Laszlo Gyulai
- Deparment of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Kristin A Cassidy
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH
| | | | - Martha L Bruce
- Department of Psychiatry, Weill Cornell Medical College, New, York, NY, USA
| | - Benoit H Mulsant
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA
,Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Thomas Ten Have
- Division of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Robert C Young
- Department of Psychiatry, Weill Cornell Medical College, New, York, NY, USA
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Gildengers AG, Mulsant BH, Al Jurdi RK, Beyer JL, Greenberg RL, Gyulai L, Moberg PJ, Sajatovic M, ten Have T, Young RC. The relationship of bipolar disorder lifetime duration and vascular burden to cognition in older adults. Bipolar Disord 2010; 12:851-8. [PMID: 21176032 PMCID: PMC3038329 DOI: 10.1111/j.1399-5618.2010.00877.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We describe the cognitive function of older adults presenting with bipolar disorder (BD) and mania and examine whether longer lifetime duration of BD is associated with greater cognitive dysfunction. We also examine whether there are negative, synergistic effects between lifetime duration of BD and vascular disease burden on cognition. METHODS A total of 87 nondemented individuals with bipolar I disorder, age 60 years and older, experiencing manic, hypomanic, or mixed episodes, were assessed with the Dementia Rating Scale (DRS) and the Framingham Stroke Risk Profile (FSRP) as a measure of vascular disease burden. RESULTS Subjects had a mean (SD) age of 68.7 (7.1) years and 13.6 (3.1) years of education; 50.6% (n = 44) were females, 89.7% (n = 78) were white, and 10.3% (n = 9) were black. They presented with overall and domain-specific cognitive impairment in memory, visuospatial ability, and executive function compared to age-adjusted norms. Lifetime duration of BD was not related to DRS total score, any other subscale scores, or vascular disease burden. FSRP scores were related to the DRS memory subscale scores, but not total scores or any other domain scores. A negative interactive effect between lifetime duration of BD and FSRP was only observed with the DRS construction subscale. CONCLUSIONS In this study, lifetime duration of BD had no significant relationship with overall cognitive function in older nondemented adults. Greater vascular disease burden was associated with worse memory function. There was no synergistic relationship between lifetime duration of BD and vascular disease burden on overall cognition function. Addressing vascular disease, especially early in the course of BD, may mitigate cognitive impairment in older age.
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Affiliation(s)
- Ariel G Gildengers
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
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Gunning-Dixon FM, Walton M, Cheng J, Acuna J, Klimstra S, Zimmerman ME, Brickman AM, Hoptman MJ, Young RC, Alexopoulos GS. MRI signal hyperintensities and treatment remission of geriatric depression. J Affect Disord 2010; 126:395-401. [PMID: 20452031 PMCID: PMC2946967 DOI: 10.1016/j.jad.2010.04.004] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [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: 10/07/2008] [Revised: 02/25/2010] [Accepted: 04/09/2010] [Indexed: 12/21/2022]
Abstract
BACKGROUND White matter abnormalities may interfere with limbic-cortical balance and contribute to chronic depressive syndromes in the elderly. This study sought to clarify the relationship of SH to treatment response. We hypothesized that patients who failed to remit during a 12-week controlled treatment trial of escitalopram would exhibit greater SH burden than patients who remitted. METHODS The participants were 42 non-demented individuals with non-psychotic major depression and 25 elderly comparison subjects. After a 2-week single blind placebo period, subjects who still had a Hamilton Depression Rating Scale (HDRS) of 18 or greater received escitalopram 10mg daily for 12 weeks. Remission was defined as a HDRS score of 7 or below for 2 consecutive weeks. FLAIR sequences were acquired on a 1.5 T scanner and total SH were quantified using a semi-automated thresholding method. RESULTS The patient sample consisted of 22 depressed patients who achieved remission during the study and 20 depressed patients who remained symptomatic. ANCOVA, with age and gender as covariates, revealed that depressed subjects had greater total SH burden relative to non-depressed controls. Furthermore, patients who failed to remit following escitalopram treatment had significantly greater SH burden than both patients who remitted and elderly comparison subjects, whereas SH burden did not differ between depressed patients who remitted and elderly comparison subjects. LIMITATIONS Patients were treated with a fixed dose of antidepressants and the index of SH is an overall measure that does not permit examination of the relationship of regional SH to treatment remission. DISCUSSION SH may contribute to a "disconnection state" both conferring vulnerability to and perpetuating late-life depression.
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Affiliation(s)
- Faith M. Gunning-Dixon
- Weill Medical College of Cornell University, Weill Cornell Institute of Geriatric Psychiatry, White Plains, NY
| | - Michael Walton
- Weill Medical College of Cornell University, Weill Cornell Institute of Geriatric Psychiatry, White Plains, NY
| | - Janice Cheng
- Weill Medical College of Cornell University, Weill Cornell Institute of Geriatric Psychiatry, White Plains, NY
| | - Jessica Acuna
- Weill Medical College of Cornell University, Weill Cornell Institute of Geriatric Psychiatry, White Plains, NY
| | - Sibel Klimstra
- Weill Medical College of Cornell University, Weill Cornell Institute of Geriatric Psychiatry, White Plains, NY
| | - Molly E. Zimmerman
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY
| | - Adam M. Brickman
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Matthew J. Hoptman
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, Department of Psychiatry, New York University School of Medicine, New York, NY
| | - Robert C. Young
- Weill Medical College of Cornell University, Weill Cornell Institute of Geriatric Psychiatry, White Plains, NY
| | - George S. Alexopoulos
- Weill Medical College of Cornell University, Weill Cornell Institute of Geriatric Psychiatry, White Plains, NY
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Mahgoub N, Kotbi N, Ferrando SJ, Young RC. Two Women with History of Bipolar Disorder. Psychiatr Ann 2010; 40:181-183. [DOI: 10.3928/00485713-20100330-01] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Young RC, Schulberg HC, Gildengers AG, Sajatovic M, Mulsant BH, Gyulai L, Beyer J, Marangell L, Kunik M, Ten Have T, Bruce ML, Gur R, Marino P, Evans JD, Reynolds CF, Alexopoulos GS. Conceptual and methodological issues in designing a randomized, controlled treatment trial for geriatric bipolar disorder: GERI-BD. Bipolar Disord 2010; 12:56-67. [PMID: 20148867 PMCID: PMC3039416 DOI: 10.1111/j.1399-5618.2009.00779.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This report considers the conceptual and methodological concerns confronting clinical investigators seeking to generate knowledge regarding the tolerability and benefits of pharmacotherapy in geriatric bipolar disorder (BD) patients. METHOD There is continuing need for evidence-based guidelines derived from randomized controlled trials that will enhance drug treatment of geriatric BD patients. Therefore, we present the complex conceptual and methodological choices encountered in designing a multisite clinical trial and the decisions reached by the investigators with the intention that study findings be pertinent to, and can facilitate, routine treatment decisions. RESULTS Guided by a literature review and input from peers, the tolerability and antimanic effects of lithium and valproate were judged to be the key mood stabilizers to investigate with regard to treating bipolar I disorder manic, mixed, and hypomanic states. The patient selection criteria are intended to generate a sample that not only experiences common treatment needs but also represents the variety of older patients seen in university-based clinical settings. The clinical protocol guides titration of lithium and valproate to target serum concentrations, with lower levels allowed when necessitated by limited tolerability. The protocol emphasizes initial monotherapy. However, augmentation with risperidone is permitted after three weeks when indicated by operational criteria. CONCLUSIONS A randomized, controlled trial that both investigates commonly prescribed mood stabilizers and maximizes patient participation can meaningfully address high-priority clinical concerns directly relevant to the routine pharmacologic treatment of geriatric BD patients.
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Affiliation(s)
- Robert C Young
- Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, NY 10605, USA.
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Alexopoulos GS, Murphy CF, Gunning-Dixon FM, Glatt CE, Latoussakis V, Kelly RE, Kanellopoulos D, Klimstra S, Lim KO, Young RC, Hoptman MJ. Serotonin transporter polymorphisms, microstructural white matter abnormalities and remission of geriatric depression. J Affect Disord 2009; 119:132-41. [PMID: 19375170 PMCID: PMC2796561 DOI: 10.1016/j.jad.2009.03.004] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [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: 01/22/2009] [Accepted: 03/03/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study compared microstructural abnormalities in depressed elders and controls and studied the association of the serotonin transporter gene status to white matter abnormalities and to remission of depression. METHODS The subjects were Caucasians with non-psychotic major depression and normal elders. Depressed subjects received escitalopram 10 mg daily for 12 weeks. Remission was defined as a HDRS score of 7 or below for 2 consecutive weeks. Diffusion tensor imaging was performed and voxel-based analysis of fractional anisotropy (FA) was conducted using age and mean diffusivity as covariates. RESULTS Depressed elders (N=27) had lower FA than controls (N=27) in several frontolimbic areas. Depressed elderly S-allele carriers also had lower FA than L homozygotes in frontolimbic brain areas, including the dorsal and rostral anterior cingulate, posterior cingulate, dorsolateral prefrontal and medial prefrontal regions, thalamus, and in other regions. S-allele carriers had a lower remission rate than L homozygotes. LIMITATIONS Small number of subjects, lack of random sampling, fixed antidepressant dose, short follow-up. CONCLUSIONS Lower FA was observed in several frontolimbic and other regions in depressed elders compared to controls. Depressed S-allele carriers had both microstructural white matter abnormalities in frontolimbic networks and a low remission rate. It remains unclear whether the risk for chronicity of geriatric depression in S-allele carriers is mediated by frontolimbic compromise. However, these observations set the stage for studies aiming to identify the relationship of S allele to impairment in specific frontolimbic functions interfering with response of geriatric depression to antidepressants.
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Affiliation(s)
| | | | | | - Charles E. Glatt
- Weill Cornell Medical College, Weill-Cornell Institute of Geriatric Psychiatry
| | | | - Robert E. Kelly
- Weill Cornell Medical College, Weill-Cornell Institute of Geriatric Psychiatry
| | - Dora Kanellopoulos
- Weill Cornell Medical College, Weill-Cornell Institute of Geriatric Psychiatry
| | - Sibel Klimstra
- Weill Cornell Medical College, Weill-Cornell Institute of Geriatric Psychiatry
| | | | - Robert C. Young
- Weill Cornell Medical College, Weill-Cornell Institute of Geriatric Psychiatry
| | - Matthew J. Hoptman
- Nathan S. Kline Institute for Psychiatric Research,Department of Psychiatry, New York University School of Medicine
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Alexopoulos GS, Murphy CF, Gunning-Dixon FM, Glatt CE, Latoussakis V, Kelly RE, Kanellopoulos D, Klimstra S, Lim KO, Young RC, Hoptman MJ. Serotonin transporter polymorphisms, microstructural white matter abnormalities and remission of geriatric depression. J Affect Disord 2009. [PMID: 19375170 DOI: 10.1016/j.jad] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This study compared microstructural abnormalities in depressed elders and controls and studied the association of the serotonin transporter gene status to white matter abnormalities and to remission of depression. METHODS The subjects were Caucasians with non-psychotic major depression and normal elders. Depressed subjects received escitalopram 10 mg daily for 12 weeks. Remission was defined as a HDRS score of 7 or below for 2 consecutive weeks. Diffusion tensor imaging was performed and voxel-based analysis of fractional anisotropy (FA) was conducted using age and mean diffusivity as covariates. RESULTS Depressed elders (N=27) had lower FA than controls (N=27) in several frontolimbic areas. Depressed elderly S-allele carriers also had lower FA than L homozygotes in frontolimbic brain areas, including the dorsal and rostral anterior cingulate, posterior cingulate, dorsolateral prefrontal and medial prefrontal regions, thalamus, and in other regions. S-allele carriers had a lower remission rate than L homozygotes. LIMITATIONS Small number of subjects, lack of random sampling, fixed antidepressant dose, short follow-up. CONCLUSIONS Lower FA was observed in several frontolimbic and other regions in depressed elders compared to controls. Depressed S-allele carriers had both microstructural white matter abnormalities in frontolimbic networks and a low remission rate. It remains unclear whether the risk for chronicity of geriatric depression in S-allele carriers is mediated by frontolimbic compromise. However, these observations set the stage for studies aiming to identify the relationship of S allele to impairment in specific frontolimbic functions interfering with response of geriatric depression to antidepressants.
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Affiliation(s)
- George S Alexopoulos
- Weill Cornell Medical College, Weill-Cornell Institute of Geriatric Psychiatry, United States.
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Rosen J, Mulsant BH, Marino P, Groening C, Young RC, Fox D. Web-based training and interrater reliability testing for scoring the Hamilton Depression Rating Scale. Psychiatry Res 2008; 161:126-30. [PMID: 18760843 PMCID: PMC2590758 DOI: 10.1016/j.psychres.2008.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2006] [Revised: 10/17/2007] [Accepted: 03/02/2008] [Indexed: 11/28/2022]
Abstract
Despite the importance of establishing shared scoring conventions and assessing interrater reliability in clinical trials in psychiatry, these elements are often overlooked. Obstacles to rater training and reliability testing include logistic difficulties in providing live training sessions, or mailing videotapes of patients to multiple sites and collecting the data for analysis. To address some of these obstacles, a web-based interactive video system was developed. It uses actors of diverse ages, gender and race to train raters how to score the Hamilton Depression Rating Scale and to assess interrater reliability. This system was tested with a group of experienced and novice raters within a single site. It was subsequently used to train raters of a federally funded multi-center clinical trial on scoring conventions and to test their interrater reliability. The advantages and limitations of using interactive video technology to improve the quality of clinical trials are discussed.
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Affiliation(s)
- Jules Rosen
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, United States.
| | - Benoit H. Mulsant
- Department of Psychiatry, University of Pittsburgh School of Medicine, PA,Geriatric Mental Health Program, Centre for Addiction and Mental Health, and University of Toronto
| | - Patricia Marino
- Department of Psychiatry, Weill Medical College of Cornell University
| | | | - Robert C. Young
- Department of Psychiatry, Weill Medical College of Cornell University
| | - Debra Fox
- Fox Learning Systems, Inc; Pittsburgh, PA
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Darcy KM, Brady WE, McBroom JW, Bell JG, Young RC, McGuire WP, Linnoila RI, Hendricks D, Bonome T, Farley JH. Associations between p53 overexpression and multiple measures of clinical outcome in high-risk, early stage or suboptimally-resected, advanced stage epithelial ovarian cancers A Gynecologic Oncology Group study. Gynecol Oncol 2008; 111:487-95. [PMID: 18834621 DOI: 10.1016/j.ygyno.2008.08.020] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Revised: 08/15/2008] [Accepted: 08/19/2008] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The Gynecologic Oncology Group (GOG) performed a detailed analysis of p53 overexpression in previously-untreated women with invasive early or advanced stage epithelial ovarian cancer (EOC). METHODS Women were eligible for the study if they provided a tumor block for translational research and participated in either GOG-157, a randomized phase III trial of three versus (vs.) six cycles of paclitaxel+carboplatin in high-risk, early stage EOC, or GOG-111, a randomized phase III trial of cyclophosphamide+cisplatin vs. paclitaxel+cisplatin in suboptimally-resected, advanced stage EOC. The N-terminal DO-7 p53 antibody was used to examine the expression of the major normal and mutant p53-isoforms. p53 overexpression was defined as >or=10% tumor cells exhibiting nuclear staining. RESULTS p53 was overexpressed in 51% (73/143) and 66% (90/136) of cases in the GOG-157 and GOG-111 cohorts, respectively. In the GOG-157 cohort, p53 overexpression was not associated with any clinical characteristics or overall survival (OS) but was associated with worse progression-free survival (PFS) (logrank test: p=0.013; unadjusted Cox modeling: p=0.015). In the GOG-111 cohort, p53 overexpression was associated with GOG performance status (p=0.018) and grade (p=0.003), but not with age, stage, cell type or with tumor response and disease status after primary chemotherapy, PFS or OS. Adjusted Cox regression modeling demonstrated that p53 overexpression was not an independent prognostic factor for PFS or OS in either cohort. CONCLUSIONS p53 overexpression assessed by DO-7 immunostaining is common in early and advanced stage EOC, but has limited prognostic value in women treated with surgical staging and platinum-based combination chemotherapy.
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Affiliation(s)
- Kathleen M Darcy
- GOG Statistical and Data Center, Elm and Carlton Street, Buffalo NY 14263-0001, USA
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Affiliation(s)
- Laszlo Gyulai
- Department of Psychiatry, University of Pennsylvania Medical Center, Philadelphia, PA
| | - Robert C. Young
- Weill Medical College of Cornell University, Institute of Geriatric Psychiatry, White Plains, NY, USA
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Chan JK, Tian C, Monk BJ, Herzog T, Kapp DS, Bell J, Young RC. Prognostic factors for high-risk early-stage epithelial ovarian cancer: a Gynecologic Oncology Group study. Cancer 2008; 112:2202-10. [PMID: 18348296 DOI: 10.1002/cncr.23390] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The purpose was to identify the factors predictive of recurrence and survival in patients with high-risk (stage I, grade 3; stage IC, stage II, or clear cell) epithelial ovarian cancer after adjuvant therapy. METHODS Data was extracted from patients who underwent primary surgery followed by adjuvant therapy in 2 randomized trials by the Gynecologic Oncology Group (Protocols 95 and 157). Kaplan-Meier survival estimates and Cox proportional hazards model adjusted for covariates were used for analyses. RESULTS Of 506 patients (median age = 56.2 years), 347 (68.6%) had stage I and 159 (31.4%) had stage II cancers. The 5-year recurrence-free (RFS) and overall survivals (OS) were 75.5% and 81.7%, respectively. On multivariate analysis, older age, higher stage, higher grade, and malignant cytology were independent prognostic factors predictive for recurrence and poorer survival. The risk of recurrence was higher for those >/=60 versus < 60 years (hazards ratio [HR] = 1.57, 95% confidence interval [CI], 1.12-2.19), stage II (stage II: HR = 2.70, 95% CI, 1.41-5.16) versus stage IA or IB, grade 2 (HR = 1.84, 95% CI, 1.04-3.27) and grade 3 (HR = 2.47, 95% CI, 1.39-4.37) versus grade 1, and positive versus negative cytology (HR = 1.72, 95% CI, 1.21-2.45). By using these factors in a prognostic index, those with low-risk (no or 1 risk factor), intermediate-risk (2 factors), and high-risk (3-4 risk factors) disease had survivals of 88%, 82%, and 75%, respectively (P < .05). CONCLUSIONS Age, stage, grade, and cytology are important prognostic factors in high-risk early-stage epithelial ovarian cancer. This information may be used in the design of future clinical trials.
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Affiliation(s)
- John K Chan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco School of Medicine, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California 94143-1702, USA.
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Abstract
OBJECTIVES Clinicians have suggested that manic psychopathology in adulthood changes with advanced age. We used rating scale evaluations of manic psychopathology in adult patients with bipolar (BP) disorder to test whether older age is associated with scores on items related to excesses of behaviors: i.e., Sexual Interest, Increased Activity-Energy, Speech--Rate and Amount, and Disruptive-Aggressive Behavior. METHODS The association of Young Mania Rating Scale item scores with current age was studied in symptomatic inpatients meeting DSM-IV criteria for BP disorder, manic. RESULTS The sample consisted of 149 patients ranging in age from 18 to 89 years; 48 of these were male. Age was not associated with differences in overall severity reflected in total score. Age was associated with lower scores on the Sexual Interest item (r = - 0.26, p < 0.001). A trend for higher scores with age on Speech--Rate and Amount (r = 0.19, p < 0.02) did not meet criteria for significance. Increased Activity-Energy, Disruptive-Aggressive Behavior and other item scores were not associated with age. In an exploratory analysis, age and Sexual Interest and Speech item scores were associated in female patients but not in male patients. CONCLUSIONS These findings suggest that age minimally influences manic psychopathology in patients with BP disorder. The modest correlation between age and Sexual Interest item scores warrants further investigation and the trend for an association between age and Speech--Rate and Amount can be examined in future studies. Possible gender differences in the associations between age and these item scores also invite future study.
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Affiliation(s)
- Robert C Young
- Institute of Geriatric Psychiatry, Weill Medical College of Cornell University, New York, NY, USA.
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Affiliation(s)
- Robert C Abrams
- Department of Psychiatry, Weill Medical College of Cornell University, New York, NY, USA.
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Alberts DS, Markman M, Muggia F, Ozols RF, Eldermire E, Bookman MA, Chen T, Curtin J, Hess LM, Liebes L, Young RC, Trimble E. Proceedings of a GOG workshop on intraperitoneal therapy for ovarian cancer. Gynecol Oncol 2006; 103:783-92. [PMID: 17070570 PMCID: PMC1987372 DOI: 10.1016/j.ygyno.2006.09.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2006] [Accepted: 09/11/2006] [Indexed: 11/18/2022]
Abstract
Ovarian cancer is the leading cause of gynecologic cancer deaths in the U.S. The concept of intraperitoneal drug delivery for therapy of intraperitoneal cancers, such as ovarian cancer, arose in the 1960s. The field of intraperitoneal cisplatin therapy for ovarian cancer was initiated in the late 1970s and early 1980s. The markedly improved survival data resulting from a phase III trial of intraperitoneal cisplatin for ovarian cancer in early 2006 led to an NCI Clinical Announcement and a Gynecologic Oncology Group-sponsored workshop on intraperitoneal therapy in January, 2006, in San Diego, California. The proceedings of this workshop summarize both research trial results and practical implementation issues associated with intraperitoneal therapy discussed at this workshop.
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Affiliation(s)
- D S Alberts
- University of Arizona, Arizona Cancer Center, 1515 N. Campbell Avenue, POB 245024, Tucson, AZ 85724-5024, and Case Western Reserve University Hospital, USA.
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