Lack of improvement at week 2 predicts later antipsychotic non-response in people with acute exacerbations of schizophrenia or schizophrenia-like psychosis
ABSTRACT FROM: Samara MT, Leucht C, Leeflang MM, et al. Early improvement as a predictor of later response to antipsychotics in schizophrenia: a diagnostic test review. Am J Psychiatry 2015;172:617–29. What is already known on this topic? Because there is no conclusive evidence on whether early signs of improvement predict later non-response to antipsychotics in patients with schizophrenia spectrum disorders, the treatment guidelines for schizophrenia, such as those from National Institute for Health and Care Excellence,1 remain unclear as to when a treatment should be changed if patients are unresponsive to a recent...
Source: Evidence-Based Mental Health - April 20, 2016 Category: Psychiatry & Psychology Authors: Kishi, T. Tags: Drugs: psychiatry, Schizophrenia spectrum, Guidelines Pharmacological interventions Source Type: research
Alpha-7 nicotinic agonist improves cognition in schizophrenia
ABSTRACT FROM: Keefe RS, Meltzer HA, Dgetluck N, et al. Randomized, double-blind, placebo-controlled study of encenicline, an α7 nicotinic acetylcholine receptor agonist, as a treatment for cognitive impairment in schizophrenia. Neuropsychopharmacology 2015;40:3053–60. What is already known on this topic The cognitive impairments that are common in schizophrenia are associated with impairments across multiple domains, including attention/vigilance, verbal learning and memory, executive functioning, verbal fluency, and speed of processing. As a result, they are targets for drug development. There is a clear need...
Source: Evidence-Based Mental Health - April 20, 2016 Category: Psychiatry & Psychology Authors: Marder, S. R. Tags: Neurology, Drugs: psychiatry, Schizophrenia spectrum Pharmacological interventions Source Type: research
A negative randomised sham-controlled trial of ventral capsule/ventral striatum stimulation in treatment-resistant depression: an unsuccessful trial or treatment?
ABSTRACT FROM: Dougherty DD, Rezai AR, Carpenter LL, et al. A randomized sham-controlled trial of deep brain stimulation of the ventral capsule/ventral striatum for chronic treatment-resistant depression. Biol Psychiatry 2014. Published Online First. What is already known on this topic The evidence from multiple open-label trials documents the efficacy and safety of Deep brain stimulation (DBS) in the treatment of refractory depression (TRD).1 Nonetheless, randomised sham-control trials are required to determine whether the effect is directly related to active electrical stimulation or to the non-stimulation effects. Meth...
Source: Evidence-Based Mental Health - April 20, 2016 Category: Psychiatry & Psychology Authors: Ramasubbu, R. Tags: Miscellaneous Source Type: research
Psychotic disorders cause the greatest mortality disparity among mental disorders, though more deaths are attributable overall to mood and anxiety disorders
ABSTRACT FROM: Walker ER, McGee RE, Druss BG. Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. JAMA Psychiatry 2015;72:334–41. What is already known on this topic It is of great concern to clinicians, patients and policymakers internationally that individuals with mental disorders experiencing worse overall health and earlier death than those without these disorders. The difference in populations studied and methods used has produced substantial variability in estimates of mortality ratios and years of life lost in those with mental disorders. For example, o...
Source: Evidence-Based Mental Health - April 20, 2016 Category: Psychiatry & Psychology Authors: Bradford, D. W., Cunningham, N. Tags: Epidemiologic studies, Neurology, Substance dependence, Bipolar disorder, Epidemiology Outcomes Source Type: research
Treatment of maternal perinatal depression in a low-income setting does not lead to improved outcomes for children
ABSTRACT FROM: Maselko J, Sikander S, Bhalotra S, et al. Effect of an early perinatal depression intervention on long-term child development outcomes: follow-up of the Thinking Healthy Programme randomised controlled trial. Lancet Psychiatry 2015;2:609–17. What is already known on this topic Perinatal depression is common; in high-income countries the point prevalence is approximately 13%, with higher rates estimated in low-income and middle-income countries.1 Furthermore, perinatal depression is associated with an increased risk of adverse child outcomes, including behavioural, emotional and cognitive difficulties,2...
Source: Evidence-Based Mental Health - April 20, 2016 Category: Psychiatry & Psychology Authors: Ramchandani, P. G., King, D. X. Tags: Clinical trials (epidemiology), Neurology, Depressive disorder, Epidemiology Outcomes Source Type: research
Support for the link between adolescent mental health problems and subsequent perinatal depression: a 20-year prospective cohort study
ABSTRACT FROM: Patton GC, Romaniuk H, Spry E, et al. Prediction of perinatal depression from adolescence and before conception (VIHCS): 20-year prospective cohort study. Lancet 2015;386:875–83. What is already known on this topic Depression is one of the leading contributors to the global burden of disease,1 with an increased vulnerability for women during adolescence2 and the perinatal period.3 Although former studies indicate that perinatal depression has a unique profile without history of mental health disorders,4 there is a lack of studies that prospectively and robustly examine the link between mental health be...
Source: Evidence-Based Mental Health - April 20, 2016 Category: Psychiatry & Psychology Authors: Nilsen, W. Tags: Epidemiologic studies, Depressive disorder, Epidemiology Causes and risk factors Source Type: research
Impact of additive alcohol and substance use disorders on the mortality of people with schizophrenia and mood disorders
ABSTRACT FROM: Hjorthøj C, Østergaard ML, Benros ME, et al. Association between alcohol and substance use disorders and all-cause and cause-specific mortality in schizophrenia, bipolar disorder, and unipolar depression: a nationwide, prospective, register-based study. Lancet Psychiatry 2015;2:801–8. What is already known on this topic Excess mortality has been well described among people with severe mental illness (SMI) or substance use disorders (SUDs) in various settings.1 However, research about how SUDs impact mortality for people with SMI is scarce.2 To further address the issues on the potential c...
Source: Evidence-Based Mental Health - April 20, 2016 Category: Psychiatry & Psychology Authors: Chang, C.-K. Tags: Epidemiologic studies, Neurology, Bipolar disorder, Depressive disorder, Schizophrenia spectrum, Epidemiology Causes and risk factors Source Type: research
High-potency cannabis increases the risk of psychosis
ABSTRACT FROM: Di Forti M, Marconi A, Carra, E, et al. Proportion of patients in south London with first-episode psychosis attributable to use of high potency cannabis: a case-control study. Lancet Psychiatry 2015;2:233–38. What is already known on this topic Existing evidence suggests cannabis is a contributory (but not necessary) risk factor for psychosis.1 However, the increasing percentage of tetrahydrocannabinol (THC) in cannabis has further complicated this contentious debate. The risk attributable to cannabis with high levels of THC (high-potency cannabis) may require consideration separately from milder forms...
Source: Evidence-Based Mental Health - April 20, 2016 Category: Psychiatry & Psychology Authors: Barkus, E. Tags: Epidemiologic studies, Neurology, Schizophrenia spectrum, Epidemiology Causes and risk factors Source Type: research
Economic evaluation of mental health interventions: an introduction to cost-utility analysis
Finite resources need to be allocated over an ever-increasing range of competing health policies and interventions. Economic evaluation has been developed as a methodology to inform decision makers on the efficiency of particular resource allocations. In this paper we summarize cost-utility analysis, one of the most widely-used forms of economic evaluation in healthcare. We discuss its main elements, interpretation, limitations and relevance to the domain of mental health. (Source: Evidence-Based Mental Health)
Source: Evidence-Based Mental Health - April 20, 2016 Category: Psychiatry & Psychology Authors: Luyten, J., Naci, H., Knapp, M. Tags: Editor's choice, EBMH Statistics in Practice Source Type: research
Diagnosing autism spectrum disorder (ASD) among adults
Clinical casePatient: 18-year-old man Present illness: The patient was brought to your department of psychiatry by his worried mother. While the patient sat still on the chair, directing an unmoving suspicious gaze towards you, his mother explained in a hurried, high-pitched voice, as follows: "Adam (the patient's name) has always been an odd boy. We've recently heard a lot about Asperger's syndrome and autism in the newspapers and on TV. I'm convinced that he suffers from them and told our family doctor, but he wasn't sure and sent us to you. Adam was very difficult to raise from the very beginning. Maybe he was a bit lat...
Source: Evidence-Based Mental Health - April 20, 2016 Category: Psychiatry & Psychology Authors: Furukawa, T. A. Tags: General practice / family medicine, Neurology, EBMH Evidence-Based Case Conference, Autism, Pervasive developmental disorder, Epidemiology, Screening (epidemiology) Source Type: research
Computerised cognitive behaviour therapy for major depression: a reply to the REEACT trial
We present the results and discuss possible explanations for these findings. In all 3 groups, usual care was extensive (9 visits in 12 months, 80% on medication, 8–23% getting psychological sessions). Adherence to CCBT courses was very poor (17%). Perhaps the surfeit of services meant there was no need for CCBT. Perhaps neither of the 2 CCBT courses encouraged adherence. What is certain is that this study did not test the potential of these CCBT courses to produce change in patients with depression presenting in primary care. (Source: Evidence-Based Mental Health)
Source: Evidence-Based Mental Health - April 20, 2016 Category: Psychiatry & Psychology Authors: Andrews, G., Hobbs, M. J., Newby, J. M. Tags: General practice / family medicine, Depressive disorder Clinical review Source Type: research
Are all psychotherapies equally effective in the treatment of adult depression? The lack of statistical power of comparative outcome studies
More than 100 comparative outcome trials, directly comparing 2 or more psychotherapies for adult depression, have been published. We first examined whether these comparative trials had sufficient statistical power to detect clinically relevant differences between therapies of d=0.24. In order to detect such an effect size, power calculations showed that a trial would need to include 548 patients. We selected 3 recent meta-analyses of psychotherapies for adult depression (cognitive behaviour therapy (CBT), interpersonal psychotherapy and non-directive counselling) and examined the number of patients included in the trials d...
Source: Evidence-Based Mental Health - April 20, 2016 Category: Psychiatry & Psychology Authors: Cuijpers, P. Tags: Editor's choice, Depressive disorder Clinical review Source Type: research
Ketamine for treatment-resistant depression: recent developments and clinical applications
Approximately one-third of patients with major depressive disorder (MDD) do not respond to existing antidepressants, and those who do generally take weeks to months to achieve a significant effect. There is a clear unmet need for rapidly acting and more efficacious treatments. We will review recent developments in the study of ketamine, an old anaesthetic agent which has shown significant promise as a rapidly acting antidepressant in treatment-resistant patients with unipolar MDD, focusing on clinically important aspects such as dose, route of administration and duration of effect. Additional evidence suggests ketamine may...
Source: Evidence-Based Mental Health - April 20, 2016 Category: Psychiatry & Psychology Authors: Schwartz, J., Murrough, J. W., Iosifescu, D. V. Tags: Editor's choice, Neurology, Post-traumatic stress disorder, Bipolar disorder, Depressive disorder Clinical review Source Type: research
mHealth in psychiatry: time for methodological change
A multitude of mental health apps are available to consumers through the Apple and Google app stores. However, evidence supporting the effectiveness of mHealth is scant. We argue this gap between app availability and research evidence is primarily due to unsuitable knowledge translation practices and therefore suggest abandoning the randomised controlled trial as the primary app evaluation paradigm. Alternative evaluation methodologies such as iterative participatory research and single case designs are better aligned with mHealth translational needs. A further challenge to the use of mobile technology in mental health is ...
Source: Evidence-Based Mental Health - April 20, 2016 Category: Psychiatry & Psychology Authors: Nicholas, J., Boydell, K., Christensen, H. Tags: Perspective Source Type: research
Clonidine: new use of an old medication to reduce stress-related substance use
ABSTRACT FROM: Kowalczyk WJ, Phillips KA, Jobes ML, et al. Lonidine maintenance prolongs opioid abstinence and decouples stress from craving in daily life: a randomized controlled trial with ecological momentary assessment. Am J Psychiatry 2015;172:760–7. What is already known on this topic Alcohol, marijuana and opioids can reduce anxiety, elevate one's mood and people sometimes turn to them for relief from stress.1 This self-medication can lead to a substance use disorder in someone that has never had one; precipitate a relapse; compromise treatment response; or result in a fatal overdose. Relief is typically short...
Source: Evidence-Based Mental Health - April 20, 2016 Category: Psychiatry & Psychology Authors: Woody, G. Tags: Electronic pages Source Type: research
