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Henshall C, Ostinelli E, Harvey J, Davey Z, Aghanenu B, Cipriani A, Attenburrow MJ. Examining the Effectiveness of Web-Based Interventions to Enhance Resilience in Health Care Professionals: Systematic Review. JMIR Med Educ 2022; 8:e34230. [PMID: 36066962 PMCID: PMC9490530 DOI: 10.2196/34230] [Citation(s) in RCA: 2] [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] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 07/12/2022] [Accepted: 07/31/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Internationally, the impact of continued exposure to workplace environmental and psychological stressors on health care professionals' mental health is associated with increased depression, substance misuse, sleep disorders, and posttraumatic stress. This can lead to staff burnout, poor quality health care, and reduced patient safety outcomes. Strategies to improve the psychological health and well-being of health care staff have been highlighted as a critical priority worldwide. The concept of resilience for health care professionals as a tool for negotiating workplace adversity has gained increasing prominence. OBJECTIVE This systematic review aims to examine the effectiveness of web-based interventions to enhance resilience in health care professionals. METHODS We searched the PubMed, CINAHL, PsycINFO, and Ovid SP databases for relevant records published after 1990 until July 2021. We included studies that focused on internet-delivered interventions aiming at enhancing resilience. Study quality was assessed with the Risk of Bias 2 tool for randomized controlled trial designs and Joanna Briggs Institute critical appraisal tool for other study designs. The protocol was registered on PROSPERO (International Prospective Register of Systematic Reviews; CRD42021253190). PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. RESULTS A total of 8 studies, conducted between 2014 and 2020 and involving 1573 health care workers, were included in the review. In total, 4 randomized controlled trial designs and 4 pre- and postdesign studies were conducted across a range of international settings and health care disciplines. All of these studies aimed to evaluate the impact of web-based interventions on resilience or related symptoms in health care professionals involved in patient-facing care. Interventions included various web-based formats and therapeutic approaches over variable time frames. One randomized controlled trial directly measured resilience, whereas the remaining 3 used proxy measures to measure psychological concepts linked to resilience. Three pretest and posttest studies directly measured resilience, whereas the fourth study used a proxy resilience measure. Owing to the heterogeneity of outcome measures and intervention designs, meta-analysis was not possible, and qualitative data synthesis was undertaken. All studies found that resilience or proxy resilience levels were enhanced in health care workers following the implementation of web-based interventions. The overall risk of bias of all 8 studies was low. CONCLUSIONS The findings indicate that web-based interventions designed to enhance resilience may be effective in clinical practice settings and have the potential to provide support to frontline staff experiencing prolonged workplace stress across a range of health care professional groups. However, the heterogeneity of included studies means that findings should be interpreted with caution; more web-based interventions need rigorous testing to further develop the evidence base. TRIAL REGISTRATION PROSPERO CRD42021253190; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=253190.
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Affiliation(s)
- Catherine Henshall
- Oxford School of Nursing and Midwifery, Oxford Brookes University, Oxford, United Kingdom
- Warneford Hospital, Oxford Health National Health Service Foundation Trust, Oxford, United Kingdom
- Oxford Precision Psychiatry Lab, National Institute for Health Research Oxford Health Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
- Oxford Institute for Nursing, Midwifery and Allied Health Research, Oxford Brookes University, Oxford, United Kingdom
| | - Edoardo Ostinelli
- Warneford Hospital, Oxford Health National Health Service Foundation Trust, Oxford, United Kingdom
- Oxford Precision Psychiatry Lab, National Institute for Health Research Oxford Health Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Jade Harvey
- Warneford Hospital, Oxford Health National Health Service Foundation Trust, Oxford, United Kingdom
| | - Zoe Davey
- Oxford Institute for Nursing, Midwifery and Allied Health Research, Oxford Brookes University, Oxford, United Kingdom
| | - Bemigho Aghanenu
- Oxford School of Nursing and Midwifery, Oxford Brookes University, Oxford, United Kingdom
| | - Andrea Cipriani
- Warneford Hospital, Oxford Health National Health Service Foundation Trust, Oxford, United Kingdom
- Oxford Precision Psychiatry Lab, National Institute for Health Research Oxford Health Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Mary-Jane Attenburrow
- Warneford Hospital, Oxford Health National Health Service Foundation Trust, Oxford, United Kingdom
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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Au-Yeung SK, Griffiths J, Roberts S, Edwards C, Yu LM, Bogacz R, Rendell J, Attenburrow MJ, Watson S, Chan F, Cipriani A, Cleare A, Harmer CJ, Kessler D, Evans J, Lewis G, Singh I, Simon J, Harrison PJ, Cowen P, Shanyinde M, Geddes J, Browning M. PAX-D: study protocol for a randomised placebo-controlled trial evaluating the efficacy and mechanism of pramipexole as add-on treatment for people with treatment resistant depression. Evid Based Ment Health 2021; 25:77-83. [PMID: 34810175 PMCID: PMC9046747 DOI: 10.1136/ebmental-2021-300282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction Clinical depression is usually treated in primary care with psychological therapies and antidepressant medication. However, when patients do not respond to at least two or more antidepressants within a depressive episode, they are considered to have treatment resistant depression (TRD). Previous small randomised controlled trials suggested that pramipexole, a dopamine D2/3 receptor agonist, may be effective for treating patients with unipolar and bipolar depression as it is known to influence motivational drive and reward processing. PAX-D will compare the effects of pramipexole vs placebo when added to current antidepressant medication for people with TRD. Additionally, PAX-D will investigate the mechanistic effect of pramipexole on reward sensitivity using a probabilistic decision-making task. Methods and analysis PAX-D will assess effectiveness in the short- term (during the first 12 weeks) and in the longer-term (48 weeks) in patients with TRD from the UK. The primary outcome will be change in self-reported depressive symptoms from baseline to week 12 post-randomisation measured using the Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR16). Performance on the decision-making task will be measured at week 0, week 2 and week 12. Secondary outcomes include anhedonia, anxiety and health economic measures including quality of life, capability, well-being and costs. PAX-D will also assess the adverse effects of pramipexole including impulse control difficulties. Discussion Pramipexole is a promising augmentation agent for TRD and may be a useful addition to existing treatment regimes. PAX-D will assess its effectiveness and test for a potential mechanism of action in patients with TRD. Trial registration number ISRCTN84666271
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Affiliation(s)
| | | | - Sophie Roberts
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Chloe Edwards
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Ly-Mee Yu
- Department of Primary Care Health Sciences, University of Oxford Nuffield, Oxford, UK
| | - Rafal Bogacz
- Brain Network Dynamics Unit, University of Oxford, Oxford, UK
| | - Jennifer Rendell
- Department of Psychiatry, University of Oxford, Oxford, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
| | - Mary-Jane Attenburrow
- Department of Psychiatry, University of Oxford, Oxford, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
| | - Stuart Watson
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.,Inpatient Services, Cumbria, Northumberland, Tyne and Wear NHS Mental Health Trust, Northumberland, UK
| | | | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
| | - Anthony Cleare
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Bristol, UK
| | | | - David Kessler
- Bristol Medical School, Bristol Population Health Science Institute, University of Bristol, Bristol, UK
| | - Jonathan Evans
- Bristol Medical School, Bristol Population Health Science Institute, University of Bristol, Bristol, UK
| | - Glyn Lewis
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Ilina Singh
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Judit Simon
- Department of Health Economics, Medical University of Vienna, Wien, Austria
| | - Paul J Harrison
- Department of Psychiatry, University of Oxford, Oxford, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
| | - Phil Cowen
- Department of Psychiatry, University of Oxford, Oxford, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
| | - Milensu Shanyinde
- Department of Primary Care Health Sciences, University of Oxford Nuffield, Oxford, UK
| | - John Geddes
- Department of Psychiatry, University of Oxford, Oxford, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
| | - Michael Browning
- Department of Psychiatry, University of Oxford, Oxford, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
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Goodday SM, Atkinson L, Goodwin G, Saunders K, South M, Mackay C, Denis M, Hinds C, Attenburrow MJ, Davies J, Welch J, Stevens W, Mansfield K, Suvilehto J, Geddes J. The True Colours Remote Symptom Monitoring System: A Decade of Evolution. J Med Internet Res 2020; 22:e15188. [PMID: 31939746 PMCID: PMC6996723 DOI: 10.2196/15188] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/25/2019] [Accepted: 10/22/2019] [Indexed: 01/04/2023] Open
Abstract
The True Colours remote mood monitoring system was developed over a decade ago by researchers, psychiatrists, and software engineers at the University of Oxford to allow patients to report on a range of symptoms via text messages, Web interfaces, or mobile phone apps. The system has evolved to encompass a wide range of measures, including psychiatric symptoms, quality of life, and medication. Patients are prompted to provide data according to an agreed personal schedule: weekly, daily, or at specific times during the day. The system has been applied across a number of different populations, for the reporting of mood, anxiety, substance use, eating and personality disorders, psychosis, self-harm, and inflammatory bowel disease, and it has shown good compliance. Over the past decade, there have been over 36,000 registered True Colours patients and participants in the United Kingdom, with more than 20 deployments of the system supporting clinical service and research delivery. The system has been adopted for routine clinical care in mental health services, supporting more than 3000 adult patients in secondary care, and 27,263 adolescent patients are currently registered within Oxfordshire and Buckinghamshire. The system has also proven to be an invaluable scientific resource as a platform for research into mood instability and as an electronic outcome measure in randomized controlled trials. This paper aimed to report on the existing applications of the system, setting out lessons learned, and to discuss the implications for tailored symptom monitoring, as well as the barriers to implementation at a larger scale.
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Affiliation(s)
- Sarah M Goodday
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- 4YouandMe, Seattle, WA, United States
| | - Lauren Atkinson
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Center for Human Brain Activity, University of Oxford, Oxford, United Kingdom
| | - Guy Goodwin
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Kate Saunders
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Matthew South
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Clare Mackay
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Mike Denis
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Chris Hinds
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Big Data Institute, University of Oxford, Oxford, United Kingdom
| | - Mary-Jane Attenburrow
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Jim Davies
- Big Data Institute, University of Oxford, Oxford, United Kingdom
- Department of Computer Science, University of Oxford, Oxford, United Kingdom
| | - James Welch
- Big Data Institute, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - William Stevens
- Department of Computer Science, University of Oxford, Oxford, United Kingdom
| | - Karen Mansfield
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Juulia Suvilehto
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - John Geddes
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
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Tunbridge EM, Attenburrow MJ, Gardiner A, Rendell JM, Hinds C, Goodwin GM, Harrison PJ, Geddes JR. Biochemical and genetic predictors and correlates of response to lamotrigine and folic acid in bipolar depression: Analysis of the CEQUEL clinical trial. Bipolar Disord 2017; 19:477-486. [PMID: 28833962 PMCID: PMC5697684 DOI: 10.1111/bdi.12531] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 07/06/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVES CEQUEL (Comparative Evaluation of QUEtiapine plus Lamotrigine combination versus quetiapine monotherapy [and folic acid versus placebo] in bipolar depression) was a double-blind, randomized, placebo-controlled, parallel group, 2×2 factorial trial that examined the effect of adding lamotrigine and/or folic acid (FA) to quetiapine in bipolar depression. Lamotrigine improved depression, but its effectiveness was reduced by FA. We investigated the baseline predictors and correlates of clinical response, and the possible basis of the interaction. METHODS The main outcome was change in depressive symptoms at 12 weeks, measured using the Quick Inventory for Depressive Symptoms-self report version 16 (QIDS-SR16). We examined the relationship between symptoms and lamotrigine levels, and biochemical measures of one-carbon metabolism and functional polymorphisms in catechol-O-methyltransferase (COMT), methylene tetrahydrofolate reductase (MTHFR) and folate hydrolase 1 (FOLH1). RESULTS Lamotrigine levels were unaffected by FA and did not differ between those participants who achieved remission and those with persisting symptoms. When participants with subtherapeutic serum levels were excluded, there was a main effect of lamotrigine on the main outcome, although this remained limited to those randomized to FA placebo. None of the biochemical measures correlated with clinical outcome. The negative impact of FA on lamotrigine response was limited to COMT Met carriers. FOLH1 and MTHFR had no effect. CONCLUSIONS Our results clarify that FA's inhibition of lamotrigine's efficacy is not a pharmacokinetic effect, and that low serum lamotrigine levels contributed to lamotrigine's lack of a main effect at 12 weeks. We were unable to explain the lamotrigine-FA interaction, but our finding that it is modulated by the COMT genotype provides a starting point for follow-on neurobiological investigations. More broadly, our results highlight the value of including biochemical and genetic indices in randomized clinical trials.
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Affiliation(s)
- EM Tunbridge
- Department of PsychiatryUniversity of OxfordOxfordUK,Oxford Health NHS Foundation TrustOxfordUK,National Institute for Health Research (NIHR) Oxford Health Biomedical Research CentreOxfordUK
| | - MJ Attenburrow
- Department of PsychiatryUniversity of OxfordOxfordUK,Oxford Health NHS Foundation TrustOxfordUK
| | - A Gardiner
- NIHR CLAHRC OxfordOxford Health NHS Foundation TrustOxfordUK,Department of Primary CareUniversity of OxfordOxfordUK
| | - JM Rendell
- Department of PsychiatryUniversity of OxfordOxfordUK,Oxford Health NHS Foundation TrustOxfordUK
| | - C Hinds
- Oxford University Big Data InstituteUniversity of OxfordOxfordUK
| | - GM Goodwin
- Department of PsychiatryUniversity of OxfordOxfordUK,Oxford Health NHS Foundation TrustOxfordUK
| | - PJ Harrison
- Department of PsychiatryUniversity of OxfordOxfordUK,Oxford Health NHS Foundation TrustOxfordUK,National Institute for Health Research (NIHR) Oxford Health Biomedical Research CentreOxfordUK
| | - JR Geddes
- Department of PsychiatryUniversity of OxfordOxfordUK,Oxford Health NHS Foundation TrustOxfordUK,National Institute for Health Research (NIHR) Oxford Health Biomedical Research CentreOxfordUK
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5
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Henshall C, Marzano L, Smith K, Attenburrow MJ, Puntis S, Zlodre J, Kelly K, Broome MR, Shaw S, Barrera A, Molodynski A, Reid A, Geddes JR, Cipriani A. A web-based clinical decision tool to support treatment decision-making in psychiatry: a pilot focus group study with clinicians, patients and carers. BMC Psychiatry 2017; 17:265. [PMID: 28732477 PMCID: PMC5521138 DOI: 10.1186/s12888-017-1406-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 06/27/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Treatment decision tools have been developed in many fields of medicine, including psychiatry, however benefits for patients have not been sustained once the support is withdrawn. We have developed a web-based computerised clinical decision support tool (CDST), which can provide patients and clinicians with continuous, up-to-date, personalised information about the efficacy and tolerability of competing interventions. To test the feasibility and acceptability of the CDST we conducted a focus group study, aimed to explore the views of clinicians, patients and carers. METHODS The CDST was developed in Oxford. To tailor treatments at an individual level, the CDST combines the best available evidence from the scientific literature with patient preferences and values, and with patient medical profile to generate personalised clinical recommendations. We conducted three focus groups comprising of three different participant types: consultant psychiatrists, participants with a mental health diagnosis and/or experience of caring for someone with a mental health diagnosis, and primary care practitioners and nurses. Each 1-h focus group started with a short visual demonstration of the CDST. To standardise the discussion during the focus groups, we used the same topic guide that covered themes relating to the acceptability and usability of the CDST. Focus groups were recorded and any identifying participant details were anonymised. Data were analysed thematically and managed using the Framework method and the constant comparative method. RESULTS The focus groups took place in Oxford between October 2016 and January 2017. Overall 31 participants attended (12 consultants, 11 primary care practitioners and 8 patients or carers). The main themes that emerged related to CDST applications in clinical practice, communication, conflicting priorities, record keeping and data management. CDST was considered a useful clinical decision support, with recognised value in promoting clinician-patient collaboration and contributing to the development of personalised medicine. One major benefit of the CDST was perceived to be the open discussion about the possible side-effects of medications. Participants from all the three groups, however, universally commented that the terminology and language presented on the CDST were too medicalised, potentially leading to ethical issues around consent to treatment. CONCLUSIONS The CDST can improve communication pathways between patients, carers and clinicians, identifying care priorities and providing an up-to-date platform for implementing evidence-based practice, with regard to prescribing practices.
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Affiliation(s)
- Catherine Henshall
- 0000 0001 0726 8331grid.7628.bOxINMAHR, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK ,0000 0004 0641 5119grid.416938.1Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Lisa Marzano
- 0000 0001 0710 330Xgrid.15822.3cDepartment of Psychology, Middlesex University, London, UK
| | - Katharine Smith
- 0000 0004 0641 5119grid.416938.1Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK ,0000 0004 1936 8948grid.4991.5Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX UK
| | - Mary-Jane Attenburrow
- 0000 0004 0641 5119grid.416938.1Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK ,0000 0004 1936 8948grid.4991.5Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX UK
| | - Stephen Puntis
- 0000 0004 1936 8948grid.4991.5Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX UK
| | - Jakov Zlodre
- 0000 0004 0641 5119grid.416938.1Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Kathleen Kelly
- 0000 0004 0641 5119grid.416938.1Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Matthew R Broome
- 0000 0004 0641 5119grid.416938.1Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK ,0000 0004 1936 8948grid.4991.5Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX UK
| | - Susan Shaw
- 0000 0004 0641 5119grid.416938.1Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Alvaro Barrera
- 0000 0004 0641 5119grid.416938.1Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Andrew Molodynski
- 0000 0004 0641 5119grid.416938.1Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Alastair Reid
- 0000 0004 0641 5119grid.416938.1Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - John R Geddes
- 0000 0004 0641 5119grid.416938.1Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK ,0000 0004 1936 8948grid.4991.5Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX UK
| | - Andrea Cipriani
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK. .,Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.
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Saunders KEA, Cipriani A, Rendell J, Attenburrow MJ, Nelissen N, Bilderbeck AC, Vasudevan SR, Churchill G, Goodwin GM, Nobre AC, Harmer CJ, Harrison PJ, Geddes JR. Oxford Lithium Trial (OxLith) of the early affective, cognitive, neural and biochemical effects of lithium carbonate in bipolar disorder: study protocol for a randomised controlled trial. Trials 2016; 17:116. [PMID: 26936776 PMCID: PMC4776410 DOI: 10.1186/s13063-016-1230-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 02/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite lithium's being the most effective drug for bipolar disorder and in clinical use for decades, we still know very little about its early effects relevant to its mode of action. METHODS/DESIGN The Oxford Lithium Trial is a double-blind, randomised, placebo-controlled study of 6-week lithium treatment in participants with bipolar disorder and mood instability. Its aim is to identify early clinical, neurocognitive and biological effects. Participants (n = 40) will undergo an intensive battery of multi-modal investigations, including remote monitoring of mood, activity and physiology, as well as cognitive testing, fMRI and magnetoencephalography, together with biochemical and gene expression measurements to assess renal, inflammatory and circadian effects. DISCUSSION The findings derived from this trial may be of value in predicting subsequent therapeutic response or side effects, not only relevant to the use of lithium but also providing a potential signature to help in more rapid evaluation of novel mood stabilisers. In this respect, OxLith is a step towards the development of a valid experimental medicine model for bipolar disorder. TRIAL REGISTRATION ISRCTN91624955 . Registered on 22 January 2015.
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Affiliation(s)
- Kate E A Saunders
- Department of Psychiatry, Oxford University, Oxford Health NHS Foundation Trust , Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
| | - Andrea Cipriani
- Department of Psychiatry, Oxford University, Oxford Health NHS Foundation Trust , Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
| | - Jennifer Rendell
- Department of Psychiatry, Oxford University, Oxford Health NHS Foundation Trust , Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
| | - Mary-Jane Attenburrow
- Department of Psychiatry, Oxford University, Oxford Health NHS Foundation Trust , Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
| | - Natalie Nelissen
- Department of Psychiatry, Oxford University, Oxford Health NHS Foundation Trust , Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
| | - Amy C Bilderbeck
- Department of Psychiatry, Oxford University, Oxford Health NHS Foundation Trust , Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
| | - Sridhar R Vasudevan
- Department of Pharmacology, Oxford University, Mansfield Road, Oxford, OX1 3QT, United Kingdom.
| | - Grant Churchill
- Department of Pharmacology, Oxford University, Mansfield Road, Oxford, OX1 3QT, United Kingdom.
| | - Guy M Goodwin
- Department of Psychiatry, Oxford University, Oxford Health NHS Foundation Trust , Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
| | - Anna C Nobre
- Department of Psychiatry, Oxford University, Oxford Health NHS Foundation Trust , Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
| | - Catherine J Harmer
- Department of Psychiatry, Oxford University, Oxford Health NHS Foundation Trust , Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
| | - Paul J Harrison
- Department of Psychiatry, Oxford University, Oxford Health NHS Foundation Trust , Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
| | - John R Geddes
- Department of Psychiatry, Oxford University, Oxford Health NHS Foundation Trust , Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
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7
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Geddes JR, Gardiner A, Rendell J, Voysey M, Tunbridge E, Hinds C, Yu LM, Hainsworth J, Attenburrow MJ, Simon J, Goodwin GM, Harrison PJ. Comparative evaluation of quetiapine plus lamotrigine combination versus quetiapine monotherapy (and folic acid versus placebo) in bipolar depression (CEQUEL): a 2 × 2 factorial randomised trial. Lancet Psychiatry 2016; 3:31-39. [PMID: 26687300 DOI: 10.1016/s2215-0366(15)00450-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [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: 07/30/2015] [Revised: 09/11/2015] [Accepted: 09/17/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Depressive symptoms are a major cause of disability in bipolar disorder and there are few safe and effective treatments. The combination of lamotrigine plus quetiapine potentially offers improved outcomes for people with bipolar depression. We aimed to determine if combination therapy with quetiapine plus lamotrigine leads to greater improvement in depressive symptoms over 12 weeks than quetiapine monotherapy plus lamotrigine placebo. METHODS In this double-blind, randomised, placebo-controlled, parallel group, 2 × 2 factorial trial (CEQUEL), patients with DSM-IV bipolar disorder I or II, who were aged 16 years or older, and required new treatment for a depressive episode, were enrolled from 27 sites in the UK. Patients were randomly assigned (1:1) by an adaptive minimisation algorithm to lamotrigine or placebo and to folic acid or placebo. Participants and investigators were masked to the treatment groups. The primary outcome was improvement in depressive symptoms at 12 weeks with the Quick Inventory of Depressive Symptomatology-self report version 16 (QIDS-SR16). Analysis was by modified intention-to-treat. This trial is registered with EUdraCT, number 2007-004513-33. FINDINGS Between Oct 21, 2008, and April 27, 2012, 202 participants were randomly assigned; 101 to lamotrigine and 101 to placebo. The mean difference in QIDS-SR16 total score between the group receiving lamotrigine versus the placebo group at 12 weeks was -1·73 ([95% CI -3·57 to 0·11]; p=0·066) and at 52 weeks was -2·69 ([-4·89 to -0·49]; p=0·017). Folic acid was not superior to placebo. There was a significant interaction (p=0·028), with folic acid reducing the effectiveness of lamotrigine at 12 weeks. The mean difference on QIDS-SR16 was -4·14 ([95% CI -6·90 to -1·37]; p=0·004) for patients receiving lamotrigine without folic acid compared with 0·12 ([-2·58 to 2·82]; p=0·931) for those receiving lamotrigine and folic acid. INTERPRETATION Addition of lamotrigine to quetiapine treatment improved outcomes. Folic acid seems to nullify the effect of lamotrigine. CEQUEL should encourage clinicians and patients to consider lamotrigine for bipolar depression, but also to be aware that concurrent folic acid might reduce its effectiveness. FUNDING Medical Research Council.
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Affiliation(s)
- John R Geddes
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Alexandra Gardiner
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jennifer Rendell
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Merryn Voysey
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Elizabeth Tunbridge
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Christopher Hinds
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Ly-Mee Yu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jane Hainsworth
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | | | - Judit Simon
- Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | - Guy M Goodwin
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Paul J Harrison
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
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Smith K, Attenburrow MJ. Sleep problems in Alzheimer's disease: does drug treatment help or harm? BJPsych advances 2015. [DOI: 10.1192/apt.21.4.219] [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: 11/23/2022]
Abstract
SummaryDrug treatments are commonly used for sleep disturbance in Alzheimer's disease, although none have a specific licence for this indication. This month's Cochrane review assessed the available evidence of benefit or harm in the use of these medications. The review identified two studies of melatonin, which did not show significant improvement in sleep over placebo. One study of trazodone suggested a beneficial effect on sleep, but its small sample size limits the generalisability of the results. Larger studies are needed, with careful assessment of the evidence for possible improvements in sleep but also of important side-effects such as falls and increased confusion.
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Craddock N, Antebi D, Attenburrow MJ, Bailey A, Carson A, Cowen P, Craddock B, Eagles J, Ebmeier K, Farmer A, Fazel S, Ferrier N, Geddes J, Goodwin G, Harrison P, Hawton K, Hunter S, Jacoby R, Jones I, Keedwell P, Kerr M, Mackin P, McGuffin P, Macintyre DJ, McConville P, Mountain D, O'Donovan MC, Owen MJ, Oyebode F, Phillips M, Price J, Shah P, Smith DJ, Walters J, Woodruff P, Young A, Zammit S. Wake-up call for British psychiatry. Br J Psychiatry 2008; 193:6-9. [PMID: 18700211 DOI: 10.1192/bjp.bp.108.053561] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The recent drive within the UK National Health Service to improve psychosocial care for people with mental illness is both understandable and welcome: evidence-based psychological and social interventions are extremely important in managing psychiatric illness. Nevertheless, the accompanying downgrading of medical aspects of care has resulted in services that often are better suited to offering non-specific psychosocial support, rather than thorough, broad-based diagnostic assessment leading to specific treatments to optimise well-being and functioning. In part, these changes have been politically driven, but they could not have occurred without the collusion, or at least the acquiescence, of psychiatrists. This creeping devaluation of medicine disadvantages patients and is very damaging to both the standing and the understanding of psychiatry in the minds of the public, fellow professionals and the medical students who will be responsible for the specialty's future. On the 200th birthday of psychiatry, it is fitting to reconsider the specialty's core values and renew efforts to use psychiatric skills for the maximum benefit of patients.
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Affiliation(s)
- Nick Craddock
- Department of Psychological Medicine, Medical School, Cardiff University, Heath Park, Cardiff, UK.
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Abstract
Acute oral administration of selective serotonin re-uptake inhibitors (SSRIs) increases plasma cortisol by facilitating brain serotonin activity. Recently, salivary cortisol sampling has grown in popularity as a noninvasive means of assessing HPA axis activity. The aim of the present study was to find out whether acute oral administration of the SSRI, citalopram, increases salivary cortisol in healthy volunteers and whether the increase produced by an equivalent dose of its active isomer, escitalopram, is greater. A total of 15 healthy subjects were tested on three occasions receiving either oral citalopram (20 mg), escitalopram (10 mg), or placebo in a double-blind, randomized, crossover design. Salivary cortisol and plasma cortisol and prolactin were measured for 240 min after each treatment. Relative to placebo, both citalopram and escitalopram increased salivary and plasma cortisol levels with no evidence of consistent differences between them. Plasma prolactin concentration was not altered by either active treatment. Plasma and salivary cortisol responses after citalopram but not escitalopram correlated significantly. The present study does not support an enhanced effect of escitalopram on 5-HT-mediated neuroendocrine responses.
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Affiliation(s)
- Haitham S Nadeem
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
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Attenburrow MJ, Williams C, Odontiadis J, Powell J, Van de Ouderaa F, Williams M, Cowen PJ. The effect of a nutritional source of tryptophan on dieting-induced changes in brain 5-HT function. Psychol Med 2003; 33:1381-1386. [PMID: 14672246 DOI: 10.1017/s0033291703008547] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Dieting in healthy women results in a decrease in the availability of tryptophan (TRP), the amino-acid precursor of serotonin (5-HT), for brain 5-HT synthesis. This is associated with increases in the prolactin response to 5-HT drug challenge suggesting a 'supersensitivity' of 5-HT neuroendocrine responses. The aim of the study was to assess whether increased TRP intake during dieting would prevent the changes in TRP availability and 5-HT neuroendocrine function. METHOD Fifty female subjects underwent a 1000 kcal daily diet for 3 weeks. In the final week of the diet subjects were randomly allocated to receive either nutritionally-sourced TRP (1.8 g daily) or placebo in a double-blind, parallel group, design. RESULTS TRP supplementation failed to modify the dieting-induced reduction in fasting TRP availability to the brain. However, in contrast to placebo-treated subjects, subjects receiving additional TRP did not show enhanced prolactin responses to intravenous TRP challenge. CONCLUSIONS The decrease in TRP availability produced by dieting may be due to increased TRP metabolism rather than decreased TRP intake. While TRP treatment did not increase fasting TRP availability it may have modified the effect of dieting on brain 5-HT function. Further studies will be needed to see if this effect of TRP has consequences for the effectiveness of dieting as means of weight control.
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Affiliation(s)
- M J Attenburrow
- University Department of Psychiatry, Warneford Hospital, Oxford
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13
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Abstract
RATIONALE Intravenous administration of the selective serotonin re-uptake inhibitor, citalopram (20 mg), is known to increase plasma prolactin (PRL) and cortisol in human subjects. This suggests that citalopram may be a useful tool to probe brain serotonin function. OBJECTIVE To find out whether lower doses of intravenous citalopram would be sufficient to increase plasma prolactin and cortisol. METHODS Eleven subjects were tested on three occasions in a double-blind, cross-over design receiving: (a) placebo, (b) citalopram 5 mg and (c) citalopram 10 mg infused intravenously over a 30-min period. A further six subjects received intravenous citalopram (10 mg) on two occasions receiving in addition the 5-HT2A2C receptor antagonist, cyproheptadine (4 mg orally) or placebo, 6 h before each infusion in a double-blind, randomised, cross-over design. Plasma PRL and cortisol levels were measured before and for 150 min after the infusion. RESULTS Citalopram increased plasma PRL and cortisol in a dose-related manner. Cyproheptadine lowered baseline PRL and cortisol but did not attenuate the endocrine responses to citalopram. Citalopram infusions were well-tolerated. CONCLUSIONS Low-dose citalopram has potential utility as a neuroendocrine challenge test. The endocrine responses to citalopram are probably not mediated predominantly by 5-HT2A/2C receptors.
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Affiliation(s)
- M J Attenburrow
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
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Abstract
We studied the effects of the 5-HT2 receptor antagonists, ritanserin and ketanserin, on the sleep of healthy volunteers in order to clarify the role of 5-HT2A and 5-HT2C receptors in the regulation of slow wave sleep (SWS) in humans. Ritanserin, 5 mg, produced a substantially larger increase in SWS (51.4%) than either ketanserin, 20 mg (17.2%) or ketanserin, 40 mg (24.4%). Ritanserin has a significantly higher affinity than ketanserin for 5-HT2C receptor binding sites in the human brain and, based on estimates of per cent occupancy by the two compounds at brain 5-HT2A and 5-HT2C receptors, we conclude that SWS in humans is primarily regulated by 5-HT2C receptors.
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Affiliation(s)
- A L Sharpley
- Psychopharmacology Research Unit, Littlemore Hospital, Oxford, U.K
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Silverstone PH, Attenburrow MJ, Robson P. The calcium channel antagonist nifedipine causes confusion when used to treat opiate withdrawal in morphine-dependent patients. Int Clin Psychopharmacol 1992; 7:87-90. [PMID: 1487626] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Several animal studies have suggested that calcium channel antagonists may be clinically effective in the treatment of opiate withdrawal. In this study we aimed to examine whether the alpha 2-adrenoceptor agonist clonidine and the calcium channel antagonist nifedipine were equally effective in attenuating the naltrexone-precipitated opiate withdrawal syndrome. We planned to study 16 morphine-dependent in-patients in a double-blind trial. However, the study had to be abandoned after only four patients were entered into it because the first two patients treated with nifedipine became severely confused following naltrexone. The mechanism underlying the development of delirium in these two patients is uncertain, but might possibly relate to a large unopposed release of noradrenaline within the central nervous system. These findings suggest that the calcium channel antagonist nifedipine is not effective in the clinical treatment of opiate withdrawal. Whether other calcium channel antagonists also cause confusion when used in this clinical condition is uncertain at present, but in any future studies investigating their efficacy considerable care is required in their use.
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Affiliation(s)
- P H Silverstone
- Psychopharmacology Research Unit, Littlemore Hospital, Oxford, UK
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