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Chavarria V, Rubio-Valera M, Doménech Abella J, Baladón LH, Mateu I, Arias de la Torre J, Alvarós JC, Peña-Salazar C, Dima AL, Serrano-Blanco A. Patient Satisfaction and Willingness to Continue with Telemental Health Care During and After the Early Period of SARS-CoV-2 Pandemic: A User Survey. Telemed J E Health 2024. [PMID: 38597958 DOI: 10.1089/tmj.2023.0562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
Objective: The SARS-CoV-2 pandemic and related lockdown periods generated an increase in the use of virtual care for mental health (MH). This study aimed to assess patient satisfaction with Telemental Health services (TMH) during first lockdown and factors related to their willingness to continue using this service. Methods: We conducted a cross-sectional survey of 364 MH outpatients from 9 centers in the Barcelona region (Spain), who received TMH between April 20 and May 22, 2020. We assessed sociodemographic and clinical characteristics, prior experience, and familiarity with technologies and satisfaction with TMH. Willingness to receive TMH after the lockdown was measured separately for telephone and videoconferencing. We performed descriptive statistics and bivariate and multivariate regression models to predict TMH willingness. Results: From 450 patients contacted, 364 were interviewed. Satisfaction with TMH was high (mean 9.24, standard deviation 0.07); 2.47% preferred only TMH visits after lockdown, 23.08% preferred mostly TMH visits, 50.82% accepted some TMH visits, and 23.63% would prefer in-person consultations. Female patients and those having received TMH during lockdown showed higher odds of willingness to receive TMH in the future, while patients unfamiliar with technologies showed lower odds. Concerning TMH through telephone, willingness was more likely in patients living with more persons. Videoconferencing willingness was more likely for people living with depression. Conclusions: TMH was well accepted during the first lockdown and patients were willing to maintain it after lockdown. Low familiarity with new technologies is an important barrier to TMH willingness, which needs to be addressed for appropriate implementation going forward.
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Affiliation(s)
- Victor Chavarria
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Red de Investigación en Actividades Preventivas y Promoción de la Salud, Madrid, Spain
| | - Maria Rubio-Valera
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Joan Doménech Abella
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Consorcio de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Luisa Higuera Baladón
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Red de Investigación en Actividades Preventivas y Promoción de la Salud, Madrid, Spain
| | - Isabel Mateu
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Jorge Arias de la Torre
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
- Care in Long Term Conditions Research Division, King's College London, London, United Kingdom
- Institute of Biomedicina, University of Leon, Leon, Spain
| | | | - Carlos Peña-Salazar
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Alexandra L Dima
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Antoni Serrano-Blanco
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
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Fuente-Moreno M, Dima AL, Rubio-Valera M, Baladon L, Chavarria V, Contaldo SF, Peña-Salazar C, Serra-Sutton V, Hermida-González P, de Loño JP, Rey-Abella ME, Aznar-Lou I, Serrano-Blanco A. Evaluation of adherence to antipsychotics: A real-world data study using four different dosing assumptions. Br J Clin Pharmacol 2024. [PMID: 38499460 DOI: 10.1111/bcp.16042] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/28/2023] [Accepted: 02/09/2024] [Indexed: 03/20/2024] Open
Abstract
AIMS This study aimed to assess the frequency of dosing inconsistencies in prescription data and the effect of four dosing assumption strategies on adherence estimates for antipsychotic treatment. METHODS A retrospective cohort, which linked prescription and dispensing data of adult patients with ≥1 antipsychotic prescription between 2015-2016 and followed up until 2019, in Catalonia (Spain). Four strategies were proposed for selecting the recommended dosing in overlapping prescription periods for the same patient and antipsychotic drug: (i) the minimum dosing prescribed; (ii) the dose corresponding to the latest prescription issued; (iii) the highest dosing prescribed; and (iv) all doses included in the overlapped period. For each strategy, one treatment episode per patient was selected, and the Continuous Medication Availability measure was used to assess adherence. Descriptive statistics were used to describe results by strategy. RESULTS Of the 277 324 prescriptions included, 76% overlapped with other prescriptions (40% with different recommended dosing instructions). The number and characteristics of patients and treatment episodes (18 292, 18 303, 18 339 and 18 536, respectively per strategy) were similar across strategies. Mean adherence was similar between strategies, ranging from 57 to 60%. However, the proportion of patients with adherence ≥90% was lower when selecting all doses (28%) compared with the other strategies (35%). CONCLUSION Despite the high prevalence of overlapping prescriptions, the strategies proposed did not show a major effect on the adherence estimates for antipsychotic treatment. Taking into consideration the particularities of antipsychotic prescription practices, selecting the highest dose in the overlapped period seemed to provide a more accurate adherence estimate.
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Affiliation(s)
- Marina Fuente-Moreno
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
| | - Alexandra L Dima
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Maria Rubio-Valera
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Luisa Baladon
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Victor Chavarria
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | | | - Carlos Peña-Salazar
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS); Health Quality and Assessment Agency of Catalonia, Barcelona, Spain
| | - Vicky Serra-Sutton
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Unitat de Farmàcia. Regió Sanitària Metropolitana Sud CatSalut, Barcelona, Spain
| | | | - Jorge Peláez de Loño
- Unitat de Farmàcia. Regió Sanitària Metropolitana Sud CatSalut, Barcelona, Spain
| | | | - Ignacio Aznar-Lou
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Antoni Serrano-Blanco
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
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Chavarria V, Boix JA, De La Puente1 B, Gimenez L, Pou C, Peña-Salazar C, Grimal I, Haro JM, Serrano-Blanco A. Spirituality, Religiosity and Mental Health: A Clinical-care Approach. Actas Esp Psiquiatr 2023; 51:281-282. [PMID: 38321718 PMCID: PMC10847662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
No abstract present.
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Affiliation(s)
- Victor Chavarria
- Psychiatry Department, Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Barcelona, Spain
- Research Institute Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- RICAPPS. Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud, 08007 Madrid, Spain
| | - Josep Antoni Boix
- Psychiatry Department, Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Barcelona, Spain
| | - Blanca De La Puente1
- Psychiatry Department, Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Barcelona, Spain
| | - Laura Gimenez
- Psychiatry Department, Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Barcelona, Spain
| | - Cristina Pou
- Psychiatry Department, Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Barcelona, Spain
| | - Carlos Peña-Salazar
- Psychiatry Department, Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Barcelona, Spain
- Research Institute Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Mental Health Networking Biomedical Research Centre (CIBERSAM), 28029 Madrid, Spain
| | - Isabel Grimal
- Psychiatry Department, Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Barcelona, Spain
| | - Josep Maria Haro
- Psychiatry Department, Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Barcelona, Spain
- Research Institute Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- CIBERSAM, Consorcio de Investigación Biomédica en Red de Salud Mental, 28029 Madrid, Spain
| | - Antoni Serrano-Blanco
- Psychiatry Department, Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Barcelona, Spain
- Research Institute Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Mental Health Networking Biomedical Research Centre (CIBERSAM), 28029 Madrid, Spain
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Smith JAD, Bailey KC, Chavarria V. Head to Head Clinical Comparison of Two Confrontation Naming Measures in Spanish Speaking People with Epilepsy. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz029.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objective
The incidence of epilepsy in Hispanic, adult Spanish-speaking people with epilepsy (PWE) residing in the United States is nearly twice that of non-Hispanic US adults. Neuropsychologists are asked to discern if test findings reveal lateralization or localization regarding known epileptiform activity. Given the high stakes nature of surgical procedures (e.g., partial temporal lobectomy), it is imperative that intervention approaches are guided by valid and reliable neuropsychological measures. Identifying these measures is especially challenging in this underserved group, where test options are limited. The purpose of the present investigation was to compare the clinical utility of two confrontation naming measures, the Pontón-Satz Modified Boston Naming Test (MBNT) and the Vocabulario Sobre Dibujos subtest from the Batería III Woodcock-Muñoz.
Participants and Method
Seventy-one Hispanic, primarily immigrant, Spanish-speaking PWE underwent neuropsychological assessment which included both confrontation naming measures. Seizure lateralization was agreed upon by consensus via an interdisciplinary epilepsy conference (left hemisphere [LH] = 35, right hemisphere [RH] = 36).
Results
Analyses used education adjusted standard scores. Independent t-tests revealed that, as expected, LH Vocabulario Sobre Dibujos scores were significantly lower than RH, t(69) = 2.0, p = 0.049. Notably, LH and RH MBNT scores did not significantly differ. ROC analyses of Vocabulario Sobre Dibujos yielded adequate classification accuracy (AUC = 0.639, p < .05; Sensitivity = 71%; Specificity = 89%); however, the MBNT was not significant (AUC = 0.594, p = .17).
Conclusions
Education adjusted standard scores for Vocabulario Sobre Dibujos outperformed the MBNT for detecting language impairment as well as discriminating between seizure laterality; thus, suggesting a need for further investigation and, possibly, evidence-based change in clinical neuropsychological practice with US Spanish speaking PWE.
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Abstract
Background Bipolar disorder is a chronic and often debilitating illness. Current treatment options (both pharmaco- and psychotherapy) have shown efficacy, but for many leave a shortfall in recovery. Advances in the understanding of the pathophysiology of bipolar disorder suggest that interventions that target mitochondrial dysfunction may provide a therapeutic benefit. Methods This review explores the current and growing theoretical rationale as well as existing preclinical and clinical data for those therapies aiming to target the mitochondrion in bipolar disorder. A Clinicaltrials.gov and ANZCTR search was conducted for complete and ongoing trials on mitochondrial agents used in psychiatric disorders. A PubMed search was also conducted for literature published between January 1981 and July 2017. Systematic reviews, randomized controlled trials, observational studies, case series, and animal studies with an emphasis on agents affecting mitochondrial function and its role in bipolar disorder were included. The search was augmented by manually searching the references of key papers and related literature. The results were presented as a narrative review. Results Mitochondrial agents offer new horizons in mood disorder treatment. While some negative effects have been reported, most compounds are overall well tolerated and have generally benign side-effect profiles. Conclusions The study of neuroinflammation, neurodegeneration, and mitochondrial function has contributed the understanding of bipolar disorder's pathophysiology. Agents targeting these pathways could be a potential therapeutic strategy. Future directions include identification of novel candidate mitochondrial modulators as well as rigorous and well-powered clinical trials.
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Affiliation(s)
- Círia Pereira
- Psychiatry and Mental Health Department, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
- Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | | | - João Vian
- Psychiatry and Mental Health Department, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
- Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Melanie Maree Ashton
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Australia
- University of Melbourne, Department of Psychiatry, Royal Melbourne Hospital, Parkville, Australia
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Australia
| | - Michael Berk
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Australia
- University of Melbourne, Department of Psychiatry, Royal Melbourne Hospital, Parkville, Australia
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Wolfgang Marx
- Deakin University, Food & Mood Centre, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Olivia May Dean
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Australia
- University of Melbourne, Department of Psychiatry, Royal Melbourne Hospital, Parkville, Australia
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Australia
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Brownstein DJ, Salagre E, Köhler C, Stubbs B, Vian J, Pereira C, Chavarria V, Karmakar C, Turner A, Quevedo J, Carvalho AF, Berk M, Fernandes BS. Blockade of the angiotensin system improves mental health domain of quality of life: A meta-analysis of randomized clinical trials. Aust N Z J Psychiatry 2018; 52:24-38. [PMID: 28754072 DOI: 10.1177/0004867417721654] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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] [Indexed: 12/30/2022]
Abstract
OBJECTIVE It is unclear whether blockade of the angiotensin system has effects on mental health. Our objective was to determine the impact of angiotensin converting enzyme inhibitors and angiotensin II type 1 receptor (AT1R) blockers on mental health domain of quality of life. STUDY DESIGN Meta-analysis of published literature. DATA SOURCES PubMed and clinicaltrials.gov databases. The last search was conducted in January 2017. STUDY SELECTION Randomized controlled trials comparing any angiotensin converting enzyme inhibitor or AT1R blocker versus placebo or non-angiotensin converting enzyme inhibitor or non-AT1R blocker were selected. Study participants were adults without any major physical symptoms. We adhered to meta-analysis reporting methods as per PRISMA and the Cochrane Collaboration. DATA SYNTHESIS Eleven studies were included in the analysis. When compared with placebo or other antihypertensive medications, AT1R blockers and angiotensin converting enzyme inhibitors were associated with improved overall quality of life (standard mean difference = 0.11, 95% confidence interval = [0.08, 0.14], p < 0.0001), positive wellbeing (standard mean difference = 0.11, 95% confidence interval = [0.05, 0.17], p < 0.0001), mental (standard mean difference = 0.15, 95% confidence interval = [0.06, 0.25], p < 0.0001), and anxiety (standard mean difference = 0.08, 95% confidence interval = [0.01, 0.16], p < 0.0001) domains of QoL. No significant difference was found for the depression domain (standard mean difference = 0.05, 95% confidence interval = [0.02, 0.12], p = 0.15). CONCLUSIONS Use of angiotensin blockers and inhibitors for the treatment of hypertension in otherwise healthy adults is associated with improved mental health domains of quality of life. Mental health quality of life was a secondary outcome in the included studies. Research specifically designed to analyse the usefulness of drugs that block the angiotensin system is necessary to properly evaluate this novel psychiatric target.
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Affiliation(s)
- Daniel J Brownstein
- 1 Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Estela Salagre
- 2 Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Cristiano Köhler
- 3 Translational Psychiatry Research Group and Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Brendon Stubbs
- 4 Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK.,5 Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK.,6 Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK
| | - João Vian
- 7 Psychiatry and Mental Health Department, Centro Hospitalar Lisboa Norte, Lisbon, Portugal.,8 Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Ciria Pereira
- 7 Psychiatry and Mental Health Department, Centro Hospitalar Lisboa Norte, Lisbon, Portugal.,8 Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Victor Chavarria
- 9 Institut de Neuropsiquiatria i Adiccions (INAD), Parc de Salut Mar (PSM), Barcelona, Spain
| | - Chandan Karmakar
- 10 Center for Pattern Recognition and Data Analytics, School of Information Technology, Deakin University, Geelong, VIC, Australia
| | - Alyna Turner
- 11 IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia.,12 Barwon Health, Geelong, VIC, Australia
| | - João Quevedo
- 13 Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,14 Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,15 Neuroscience Graduate Program, Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center UTHealth, Houston, TX, USA.,16 Laboratory of Neurosciences, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina (UNESC), Criciúma, Brazil
| | - André F Carvalho
- 3 Translational Psychiatry Research Group and Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Michael Berk
- 11 IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia.,12 Barwon Health, Geelong, VIC, Australia.,17 Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,18 Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia.,19 The Florey Institute for Neuroscience Mental Health, Parkville, VIC, Australia
| | - Brisa S Fernandes
- 11 IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia.,12 Barwon Health, Geelong, VIC, Australia.,20 Laboratory of Calcium Binding Proteins in the Central Nervous System, Department of Biochemistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Chavarria V, Vian J, Pereira C, Data-Franco J, Fernandes BS, Berk M, Dodd S. The Placebo and Nocebo Phenomena: Their Clinical Management and Impact on Treatment Outcomes. Clin Ther 2017; 39:477-486. [PMID: 28237673 DOI: 10.1016/j.clinthera.2017.01.031] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [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: 11/14/2016] [Revised: 01/25/2017] [Accepted: 01/30/2017] [Indexed: 12/18/2022]
Abstract
PURPOSE This overview focuses on placebo and nocebo effects in clinical trials and routine care. Our goal was to propose strategies to improve outcomes in clinical practice, maximizing placebo effects and reducing nocebo effects, as well as managing these phenomena in clinical trials. METHODS A narrative literature search of PubMed was conducted (January 1980-September 2016). Systematic reviews, randomized controlled trials, observational studies, and case series that had an emphasis on placebo or nocebo effects in clinical practice were included in the qualitative synthesis. Search terms included: placebo, nocebo, clinical, clinical trial, clinical setting, placebo effect, nocebo effect, adverse effects, and treatment outcomes. This search was augmented by a manual search of the references of the key articles and the related literature. FINDINGS Placebo and nocebo effects are psychobiological events imputable to the therapeutic context. Placebo is defined as an inert substance that provokes perceived benefits, whereas the term nocebo is used when an inert substance causes perceived harm. Their major mechanisms are expectancy and classical conditioning. Placebo is used in several fields of medicine, as a diagnostic tool or to reduce drug dosage. Placebo/nocebo effects are difficult to disentangle from the natural course of illness or the actual effects of a new drug in a clinical trial. There are known strategies to enhance clinical results by manipulating expectations and conditioning. IMPLICATIONS Placebo and nocebo effects occur frequently and are clinically significant but are underrecognized in clinical practice. Physicians should be able to recognize these phenomena and master tactics on how to manage these effects to enhance the quality of clinical practice.
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Affiliation(s)
- Victor Chavarria
- Institut de Neuropsiquiatria i Adiccions (INAD), Parc de salut Mar (PSM), Barcelona, Spain
| | - João Vian
- Psychiatry and Mental Health Department, Centro Hospitalar Lisboa Norte, Lisbon, Portugal; Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Círia Pereira
- Psychiatry and Mental Health Department, Centro Hospitalar Lisboa Norte, Lisbon, Portugal; Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - João Data-Franco
- Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal; Departamento de Psiquiatria e Saúde Mental, Hospital Beatriz Ângelo, Lisboa, Portugal
| | - Brisa S Fernandes
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia; Laboratory of Calcium Binding Proteins in the Central Nervous System, Department of Biochemistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia; University Hospital Geelong, Barwon Health, Geelong, VIC Australia; Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia; Centre for Youth Mental Health, Parkville, VIC, Australia; Florey Institute, University of Melbourne, Parkville, VIC, Australia
| | - Seetal Dodd
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia; University Hospital Geelong, Barwon Health, Geelong, VIC Australia; Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia; Centre for Youth Mental Health, Parkville, VIC, Australia.
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Galindo L, Grifell M, Peréz E, Dinamarca F, Chavarria V, Salgado P, Pérez V. Are there more mechanical restraint in patients admitted for substance use disorder? Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.1013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Introduction and objectivesMechanical restraint is a therapeutic procedure commonly applied in acute units in response to psychomotor agitation. Its frequency is between 21 and 59% of patients admitted. These patients represent a risk to both themselves and for health workers. There is a myth that patients with substance use disorder (SUD) are more aggressive and require more forceful measures. There are not clinical studies that compared if there are differences of the frequency of mechanical restrain in patients with SUD.The aim of this study is to explore the differences of frequency of mechanical restraint on patients with SUD in the psychiatry acute and dual pathology units and others psychiatric diagnostics.Material and methodsWe reviewed retrospectively the informatics record of all the mechanical restraints made and the total discharges of the three acute care units and dual disorders of Neuropsychiatry and Addictions Institute (INAD) of the Parc de Salut Mar de Barcelona, between January 2012 and January 2015. For every discharge the presence of at least one mechanical restraint and the DSM-IV diagnostic were coded. Then was calculated the frequency and proportion of mechanical retrains in every diagnostic group.ResultsThe number of discharges analyzed was 4659 from which 838 had an episode of mechanical restraint. The 37% of patients with SUD of cocaine had an episode of mechanical restrain. The patients with SUD of alcohol only the 4%, and there no one case on patients with SUD of Cannabis. Thirty percent of patients with schizophrenia and 28% of bipolar disorder.AcknowledgementsL. Galindo is a Rio-Hortega-fellowship-(ISC-III;CM14/00111).Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Dinamarca F, Galindo L, Grifell M, Perez E, Chavarria V, Salgado P, Perez S. The agitated patient; need for mechanical restraint and prevention measures in relation to psychiatric diagnosis. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
IntroductionPsychomotor agitation is a common psychiatric emergency in our environment that can occur in a wide clinical spectrum. Both the agitation itself as the procedures for their control, carry an implicit risk to patient safety and health workers.ObjectiveTo describe the prevention measures used in patients requiring mechanical restraint in relation to diagnosis of psychiatric disorders.Material and methodsThis is a naturalistic descriptive study. Mechanical restraints made in brief psychiatric hospitalization units of “Hospital del Mar” between January of 2013 to March of 2015, were analyzed by diagnosis. Proportions of the prevention intervention performed by nurses in each episode were compared. The groups of prevention interventions done were: “verbal approach”, “environmental measures”, “psychopharmacological intervention”, “observation increase” and “inability for applying any measure because unpredictability”.ResultsA total of 2986 mechanical restraints were done in brief hospitalization units. Among the results, we find that verbal approach measure was use in 77.23% of patient with personality disorders. Environmental measures were used in 40% of the total of restraints. The most of psychopharmacological intervention was done in alcohol intoxication (50%) and then in psychotic spectrum (42.01%). The inability for applying measures was greater in alcohol intoxication (45.4%).ConclusionSome of the results of this study are interesting and consistent with clinical practice (for example, effectivity of pharmacological intervention in psychosis and bipolar disorders, as well verbal approach in anxiety, etc.), we can predict the usefulness of measures applied to prevent a mechanical restraint. Further research is needed in this topic.Disclosure of interestL. Galindo is a Rio-Hortega-fellowship – (ISC-III; CM14/00111).
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Toll A, Mané A, Bergé D, Gómez – Pérez L, Samsó B, Chavarria V, Pérez – Solà V. Decreased Incidence of Readmission in First Episode Psychosis in Treatment with Long – Acting Injectable Antipsychotics. Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)30189-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Frieri M, Therattil J, Chavarria V, Cosachov J, Kumar NS, Wang SF, Sansone G, Etzel J, Dellevecchia D, Zitt M, Mesarina-Wicki B, Nolop KB. Effect of mometasone furoate on early and late phase inflammation in patients with seasonal allergic rhinitis. Ann Allergy Asthma Immunol 1998; 81:431-7. [PMID: 9860036 DOI: 10.1016/s1081-1206(10)63141-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Mometasone furoate is a potent glucocorticoid that can markedly inhibit proinflammatory Th2 cytokines in vitro. An aqueous nasal spray formulation has been shown to be clinically active in reducing the symptoms of perennial and seasonal allergic rhinitis. OBJECTIVE To determine whether pretreatment with mometasone furoate 200 microg once daily decreases specific indices of early and late phase nasal inflammation compared with placebo. METHODS A randomized, double-blind, placebo-controlled crossover study was conducted using nasal provocation with ragweed antigen in 21 patients with ragweed-induced allergic rhinitis out of the ragweed season; the treatment period was 2 weeks. Symptom scores, rhinoprobe cytology, and nasal lavage fluid were collected during early and late phase periods for nasal cytokines (interleukin, 1, 4, 5, 6, and 8) and leukotriene B4 determinations using ELISA and RIA. RESULTS Mean nasal symptom scores and sneezing frequency were consistently lower with mometasone furoate compared with placebo. Treatment was associated with a statistically significant early phase (30-minute time point) reduction in nasal lavage histamine levels compared with placebo (14.3 versus 20.2 ng/mL, P = .02). Within-treatment comparisons suggested that mometasone furoate reduced the antigen-induced late-phase response for IL-6, IL-8, and eosinophils compared with pretreatment. There were similar, but smaller, changes seen in the placebo group for these measurements. There were no statistically significant changes following antigen challenge in IL-1, IL-4, IL-5, LTB4, or in other nasal cytology parameters. CONCLUSION These results suggest that the clinical activity of mometasone furoate nasal spray in seasonal allergic rhinitis is likely due, in part, to a reduction in the levels of histamine in nasal secretions related to the early phase response, and reductions in IL-6, IL-8, and eosinophils during the late phase response.
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Affiliation(s)
- M Frieri
- Department of Medicine, Nassau County Medical Center, East Meadow, New York 11554, USA
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