Bea Campforts, Maarten Bak, Patrick Domen, Therese van Amelsvoort, Marjan Drukker
{"title":"Author's Response to Letter to the Editor Concerning \"Glucagon-Like Peptide Agonists for Weight Management in Antipsychotic-Induced Weight Gain: A Systematic Review and Meta-Analysis\" by Anders Fink-Jensen|Christoph U. Correll.","authors":"Bea Campforts, Maarten Bak, Patrick Domen, Therese van Amelsvoort, Marjan Drukker","doi":"10.1111/acps.13784","DOIUrl":"https://doi.org/10.1111/acps.13784","url":null,"abstract":"","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142875628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Iris Dalhuisen, Kim Bui, Anne Kleijburg, Iris van Oostrom, Jan Spijker, Eric van Exel, Hans van Mierlo, Dieuwertje de Waardt, Martijn Arns, Indira Tendolkar, Philip van Eijndhoven, Ben Wijnen
Background: Although repetitive transcranial magnetic stimulation (rTMS) is an effective and commonly used treatment option for treatment-resistant depression, its cost-effectiveness remains much less studied. In particular, the comparative cost-effectiveness of rTMS and other treatment options, such as antidepressant medication, has not been investigated.
Methods: An economic evaluation with 12 months follow-up was conducted in the Dutch care setting as part of a pragmatic multicenter randomized controlled trial, in which patients with treatment-resistant depression were randomized to treatment with rTMS or treatment with the next pharmacological step according to the treatment algorithm. Missing data were handled with single imputations using predictive mean matching (PMM) nested in bootstraps. Incremental cost-effectiveness and cost-utility ratios (ICERs/ICURs) were calculated, as well as cost-effectiveness planes and cost-effectiveness acceptability curves (CEACs).
Results: Higher QALYs, response, and remission rates were found for lower costs when comparing the rTMS group to the medication group. After 12 months, QALYs were 0.618 in the rTMS group and 0.545 in the medication group. The response was 27.1% and 24.4% and remission was 25.0% and 17.1%, respectively. Incremental costs for rTMS were -€2.280, resulting in a dominant ICUR for QALYs and ICER for response and remission.
Conclusion: rTMS appears to be a cost-effective treatment option for treatment-resistant depression when compared to the next pharmacological treatment step. The results support the implementation of rTMS as a step in the treatment algorithm for depression.
Trial registration: The trial is registered within the Netherlands Trial Register (code: NL7628, date: March 29, 2019).
{"title":"Cost-Effectiveness of rTMS as a Next Step in Antidepressant Non-Responders: A Randomized Comparison With Current Antidepressant Treatment Approaches.","authors":"Iris Dalhuisen, Kim Bui, Anne Kleijburg, Iris van Oostrom, Jan Spijker, Eric van Exel, Hans van Mierlo, Dieuwertje de Waardt, Martijn Arns, Indira Tendolkar, Philip van Eijndhoven, Ben Wijnen","doi":"10.1111/acps.13782","DOIUrl":"https://doi.org/10.1111/acps.13782","url":null,"abstract":"<p><strong>Background: </strong>Although repetitive transcranial magnetic stimulation (rTMS) is an effective and commonly used treatment option for treatment-resistant depression, its cost-effectiveness remains much less studied. In particular, the comparative cost-effectiveness of rTMS and other treatment options, such as antidepressant medication, has not been investigated.</p><p><strong>Methods: </strong>An economic evaluation with 12 months follow-up was conducted in the Dutch care setting as part of a pragmatic multicenter randomized controlled trial, in which patients with treatment-resistant depression were randomized to treatment with rTMS or treatment with the next pharmacological step according to the treatment algorithm. Missing data were handled with single imputations using predictive mean matching (PMM) nested in bootstraps. Incremental cost-effectiveness and cost-utility ratios (ICERs/ICURs) were calculated, as well as cost-effectiveness planes and cost-effectiveness acceptability curves (CEACs).</p><p><strong>Results: </strong>Higher QALYs, response, and remission rates were found for lower costs when comparing the rTMS group to the medication group. After 12 months, QALYs were 0.618 in the rTMS group and 0.545 in the medication group. The response was 27.1% and 24.4% and remission was 25.0% and 17.1%, respectively. Incremental costs for rTMS were -€2.280, resulting in a dominant ICUR for QALYs and ICER for response and remission.</p><p><strong>Conclusion: </strong>rTMS appears to be a cost-effective treatment option for treatment-resistant depression when compared to the next pharmacological treatment step. The results support the implementation of rTMS as a step in the treatment algorithm for depression.</p><p><strong>Trial registration: </strong>The trial is registered within the Netherlands Trial Register (code: NL7628, date: March 29, 2019).</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142875630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Lintunen et al. [<span>1</span>] publish in previous issue an article entitled <i>Dosing Levels of Antipsychotics and Mood Stabilizers in Bipolar Disorder: A Nationwide Cohort Study on Relapse Risk and Treatment Safety</i>. This nationwide study estimates doses of antipsychotics and mood stabilizers associated with the most favourable benefit–risk ratio. Benefit corresponded to a decreased risk of psychiatric hospitalization (prevention of relapse) and risk to an increase in non-psychiatric hospitalization (adverse events). The authors followed individuals with bipolar disorder from diagnosis over an average of 8 years. They compared outcomes over periods with and without antipsychotics or with and without mood stabilizers within individuals, by distinguishing low (< 0.9 DDD), standard (0.9– < 1.1 DDD) and high doses (≥ 1.1 DDD). Only monotherapies and individuals with both treatment changes and outcomes contributed to the findings. This design might have selected individuals with most severe disorders or those who did not receive an effective medication on a first line of treatment, but allowed comparing various treatment patterns.</p><p>Considering sensitivity analyses that omitted the 30-day period following treatment changes and selected stable treatments, among antipsychotics, only low and standard doses of aripiprazole (< 16.5 mg/day) were able to prevent relapse. High doses and quetiapine at any dose were associated with an increase in psychiatric hospitalization. While the association between high doses and relapse might be due to confounding by indication (relapse justifying the increase in dose), the absence of preventive effectiveness of antipsychotic monotherapies is alarming and contrasts with their extensive use [<span>2</span>]. Previous publications highlighted the lack of evidence of efficacy of antipsychotics in the maintenance treatment of bipolar disorders, RCTs showing selection bias (enrichment design limiting generalizability, inclusion of bipolar disorder type I only), attrition bias (considerable dropout levels), insufficient duration to demonstrate preventive efficacy, possible adverse effects of abrupt medication discontinuation in the placebo-group with beneficial effects of treatment and possible reporting bias [<span>3, 4</span>]. Parallelly, Lintunen et al. [<span>1</span>] found an increased risk of non-psychiatric hospitalization except for standard doses of olanzapine, risperidone and aripiprazole and low dose of aripiprazole, questioning the benefit–risk ratio of these monotherapies. These safety concerns are added to previous ones concerning mortality or cognitive functioning [<span>2, 5, 6</span>]. A real utility of antipsychotics was shown at short- and mid-term in acute bipolar episodes and in association with mood stabilizers with synergistic effects [<span>7, 8</span>]. Their place in the therapeutic strategy might be re-thought and, for example, re-focused on acute episodes and patients with d
{"title":"Antipsychotics or Mood Stabilizers in Bipolar Disorder: Towards Evidence-Based Personalised Medicine","authors":"Marie Tournier","doi":"10.1111/acps.13780","DOIUrl":"10.1111/acps.13780","url":null,"abstract":"<p>Lintunen et al. [<span>1</span>] publish in previous issue an article entitled <i>Dosing Levels of Antipsychotics and Mood Stabilizers in Bipolar Disorder: A Nationwide Cohort Study on Relapse Risk and Treatment Safety</i>. This nationwide study estimates doses of antipsychotics and mood stabilizers associated with the most favourable benefit–risk ratio. Benefit corresponded to a decreased risk of psychiatric hospitalization (prevention of relapse) and risk to an increase in non-psychiatric hospitalization (adverse events). The authors followed individuals with bipolar disorder from diagnosis over an average of 8 years. They compared outcomes over periods with and without antipsychotics or with and without mood stabilizers within individuals, by distinguishing low (< 0.9 DDD), standard (0.9– < 1.1 DDD) and high doses (≥ 1.1 DDD). Only monotherapies and individuals with both treatment changes and outcomes contributed to the findings. This design might have selected individuals with most severe disorders or those who did not receive an effective medication on a first line of treatment, but allowed comparing various treatment patterns.</p><p>Considering sensitivity analyses that omitted the 30-day period following treatment changes and selected stable treatments, among antipsychotics, only low and standard doses of aripiprazole (< 16.5 mg/day) were able to prevent relapse. High doses and quetiapine at any dose were associated with an increase in psychiatric hospitalization. While the association between high doses and relapse might be due to confounding by indication (relapse justifying the increase in dose), the absence of preventive effectiveness of antipsychotic monotherapies is alarming and contrasts with their extensive use [<span>2</span>]. Previous publications highlighted the lack of evidence of efficacy of antipsychotics in the maintenance treatment of bipolar disorders, RCTs showing selection bias (enrichment design limiting generalizability, inclusion of bipolar disorder type I only), attrition bias (considerable dropout levels), insufficient duration to demonstrate preventive efficacy, possible adverse effects of abrupt medication discontinuation in the placebo-group with beneficial effects of treatment and possible reporting bias [<span>3, 4</span>]. Parallelly, Lintunen et al. [<span>1</span>] found an increased risk of non-psychiatric hospitalization except for standard doses of olanzapine, risperidone and aripiprazole and low dose of aripiprazole, questioning the benefit–risk ratio of these monotherapies. These safety concerns are added to previous ones concerning mortality or cognitive functioning [<span>2, 5, 6</span>]. A real utility of antipsychotics was shown at short- and mid-term in acute bipolar episodes and in association with mood stabilizers with synergistic effects [<span>7, 8</span>]. Their place in the therapeutic strategy might be re-thought and, for example, re-focused on acute episodes and patients with d","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 2","pages":"107-108"},"PeriodicalIF":5.3,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13780","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142833221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Despite a growing recognition of mental health challenges worldwide, there remains a significant gap between the demand for and the availability of mental health services. The WHO estimates that globally, up to 71% of individuals with severe mental illnesses such as psychosis receive no treatment, and access is even more limited in low-income countries. Barriers such as stigma, resource shortages, and insufficiently trained professionals may exacerbate this issue [<span>1, 2</span>].</p><p>Given the limited resources available, a recent report by the World Health Organization stated that “the use of mobile and wireless technologies (mhealth) to support the achievement of health objectives has the potential to transform the face of health service delivery across the globe” [<span>3</span>]. On a global scale, it is not feasible to propose that practices based entirely on in-person care will ever be able to meet the demand and need for treatment. Thus, even before the emergence of the COVID-19 pandemic, there was growing interest in the potential role of new technologies to extend care.</p><p>The rapid advancement and integration of technology is transforming mental health care delivery, accessibility, and research methodologies. Digital tools, including wearable devices, telepsychiatric platforms, smartphone apps, virtual reality (VR), and electronic health record data are reshaping the landscape of clinical practice, research, and patient engagement [<span>4</span>]. Similarly, digital phenotyping, artificial intelligence (AI), and advanced machine learning methods offer deeper, real-time insights into patients' behaviors and symptoms, potentially leading to earlier diagnoses, prediction models, and more personalized treatment plans [<span>5, 6</span>]. AI-enabled programs can analyze and contextualize data to provide information or automatically trigger actions without human interference, where machine-learning methods learn insights and recognize patterns from data.</p><p>These innovations address critical challenges in mental health care, particularly the pervasive gap between the demand for treatment and the limited capacity of traditional systems to meet this need. Furthermore, digital solutions may empower patients to actively engage in their treatment through tools for self-monitoring, psychoeducation, and immersive, engaging interventions that may enhance their therapeutic experience.</p><p>The term “digital phenotyping” has been defined as the “moment-by-moment quantification of the individual-level human phenotype in situ using data from personal digital devices” [<span>7, 8</span>]. Although not unanimous, some authors [<span>9</span>] divide digital phenotyping into two subgroups, called “active data” and “passive data.” Active data refer to data that requires active input from the users to be generated, whereas passive data, such as sensor data and phone usage patterns, are collected without requiring any active participation from
{"title":"Editorial: Special Issue on Digital Psychiatry","authors":"Louise Birkedal Glenthøj, Maria Faurholt-Jepsen","doi":"10.1111/acps.13781","DOIUrl":"10.1111/acps.13781","url":null,"abstract":"<p>Despite a growing recognition of mental health challenges worldwide, there remains a significant gap between the demand for and the availability of mental health services. The WHO estimates that globally, up to 71% of individuals with severe mental illnesses such as psychosis receive no treatment, and access is even more limited in low-income countries. Barriers such as stigma, resource shortages, and insufficiently trained professionals may exacerbate this issue [<span>1, 2</span>].</p><p>Given the limited resources available, a recent report by the World Health Organization stated that “the use of mobile and wireless technologies (mhealth) to support the achievement of health objectives has the potential to transform the face of health service delivery across the globe” [<span>3</span>]. On a global scale, it is not feasible to propose that practices based entirely on in-person care will ever be able to meet the demand and need for treatment. Thus, even before the emergence of the COVID-19 pandemic, there was growing interest in the potential role of new technologies to extend care.</p><p>The rapid advancement and integration of technology is transforming mental health care delivery, accessibility, and research methodologies. Digital tools, including wearable devices, telepsychiatric platforms, smartphone apps, virtual reality (VR), and electronic health record data are reshaping the landscape of clinical practice, research, and patient engagement [<span>4</span>]. Similarly, digital phenotyping, artificial intelligence (AI), and advanced machine learning methods offer deeper, real-time insights into patients' behaviors and symptoms, potentially leading to earlier diagnoses, prediction models, and more personalized treatment plans [<span>5, 6</span>]. AI-enabled programs can analyze and contextualize data to provide information or automatically trigger actions without human interference, where machine-learning methods learn insights and recognize patterns from data.</p><p>These innovations address critical challenges in mental health care, particularly the pervasive gap between the demand for treatment and the limited capacity of traditional systems to meet this need. Furthermore, digital solutions may empower patients to actively engage in their treatment through tools for self-monitoring, psychoeducation, and immersive, engaging interventions that may enhance their therapeutic experience.</p><p>The term “digital phenotyping” has been defined as the “moment-by-moment quantification of the individual-level human phenotype in situ using data from personal digital devices” [<span>7, 8</span>]. Although not unanimous, some authors [<span>9</span>] divide digital phenotyping into two subgroups, called “active data” and “passive data.” Active data refer to data that requires active input from the users to be generated, whereas passive data, such as sensor data and phone usage patterns, are collected without requiring any active participation from","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 3","pages":"177-179"},"PeriodicalIF":5.3,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13781","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142811607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: There is growing interest in the use of psychedelic-assisted therapy (PAT) for major depressive disorder (MDD), including treatment-resistant depression. We used randomized controlled trial (RCT) data to compare summary estimates of change in depression ratings with PAT versus comparator treatments in MDD. We also compared response and remission rates, and adverse effects.
Methods: We searched MEDLINE, EMBASE, Cochrane Central Register for Controlled Trials (CENTRAL), and SCOPUS from inception till April 2024. Our primary efficacy outcome was 1-week (or nearest) between-group change in depression ratings. Secondary efficacy outcomes were changes in depression ratings at days 2, 14, and 42 (or nearest) and study-defined response and remission rates at week 1 (or nearest). Safety outcomes were reported adverse effects. We pooled outcomes in random-effects meta-analyses using standardized mean difference (SMD; Hedges g) for continuous outcomes and risk ratio (RR) for categorical outcomes.
Results: We found 6 eligible RCTs (pooled N = 427), all on psilocybin. The pooled SMD for 1-week between-group change in depression ratings was -0.72 [95% CI, -0.95 to -0.49; I2 = 17%; 5 RCTs; n = 403], favouring PAT; results were similar at days 2, 14, and 42. The response [RR = 3.42; 95% CI, 2.35-4.97; I2 = 0%; 4 RCTs; n = 373] and remission [RR = 3.66; 95% CI, 2.26-5.92; I2 = 0%; 4 RCTs; n = 373] rates also favored PAT. The PAT group had a small but significantly increased risk of developing any adverse event [RR = 1.20; 95% CI, 1.01-1.42; I2 = 43%; 4 RCTs; n = 373] and a significantly higher risk of experiencing headache [RR = 1.78; 95% CI, 1.10-2.86; I2 = 52%; 4 RCTs; n = 373] and dizziness [RR = 6.52; 95% CI, 1.19-35.87; I2 = 0%; 3 RCTs; n = 269]. Low heterogeneity characterized most analyses and findings were similar in sensitivity analyses.
Conclusion: Antidepressant effects of psilocybin-assisted therapy are superior (with at least medium effect sizes) to comparator interventions for at least up to 6 weeks postintervention.
{"title":"Randomized Controlled Trials of Psilocybin-Assisted Therapy in the Treatment of Major Depressive Disorder: Systematic Review and Meta-Analysis.","authors":"Vikas Menon, Parthasarathy Ramamurthy, Sandesh Venu, Chittaranjan Andrade","doi":"10.1111/acps.13778","DOIUrl":"https://doi.org/10.1111/acps.13778","url":null,"abstract":"<p><strong>Introduction: </strong>There is growing interest in the use of psychedelic-assisted therapy (PAT) for major depressive disorder (MDD), including treatment-resistant depression. We used randomized controlled trial (RCT) data to compare summary estimates of change in depression ratings with PAT versus comparator treatments in MDD. We also compared response and remission rates, and adverse effects.</p><p><strong>Methods: </strong>We searched MEDLINE, EMBASE, Cochrane Central Register for Controlled Trials (CENTRAL), and SCOPUS from inception till April 2024. Our primary efficacy outcome was 1-week (or nearest) between-group change in depression ratings. Secondary efficacy outcomes were changes in depression ratings at days 2, 14, and 42 (or nearest) and study-defined response and remission rates at week 1 (or nearest). Safety outcomes were reported adverse effects. We pooled outcomes in random-effects meta-analyses using standardized mean difference (SMD; Hedges g) for continuous outcomes and risk ratio (RR) for categorical outcomes.</p><p><strong>Results: </strong>We found 6 eligible RCTs (pooled N = 427), all on psilocybin. The pooled SMD for 1-week between-group change in depression ratings was -0.72 [95% CI, -0.95 to -0.49; I2 = 17%; 5 RCTs; n = 403], favouring PAT; results were similar at days 2, 14, and 42. The response [RR = 3.42; 95% CI, 2.35-4.97; I2 = 0%; 4 RCTs; n = 373] and remission [RR = 3.66; 95% CI, 2.26-5.92; I2 = 0%; 4 RCTs; n = 373] rates also favored PAT. The PAT group had a small but significantly increased risk of developing any adverse event [RR = 1.20; 95% CI, 1.01-1.42; I2 = 43%; 4 RCTs; n = 373] and a significantly higher risk of experiencing headache [RR = 1.78; 95% CI, 1.10-2.86; I2 = 52%; 4 RCTs; n = 373] and dizziness [RR = 6.52; 95% CI, 1.19-35.87; I2 = 0%; 3 RCTs; n = 269]. Low heterogeneity characterized most analyses and findings were similar in sensitivity analyses.</p><p><strong>Conclusion: </strong>Antidepressant effects of psilocybin-assisted therapy are superior (with at least medium effect sizes) to comparator interventions for at least up to 6 weeks postintervention.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Egsgaard et al. (2024) highlight the temporal patterns of postpartum depression (PPD) risk in twin parents versus singleton parents. However, additional factors such as social support systems, delivery mode, and cultural influences require exploration.
Purpose
To discuss the role of structured postpartum care, cesarean sections, and mother-infant bonding in moderating PPD risk, especially within cultural contexts.
Conclusion
These factors may explain the gender-specific temporal patterns observed by Egsgaard et al. Future research should integrate sociocultural and clinical variables to inform interventions for twin parents at risk of PPD.
{"title":"Social Support, Delivery Mode, and Cultural Factors in Twin Parents' Postpartum Depression: A Response to Egsgaard et al.","authors":"Yu-Ren Wen, Lien-Chung Wei","doi":"10.1111/acps.13775","DOIUrl":"10.1111/acps.13775","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Egsgaard et al. (2024) highlight the temporal patterns of postpartum depression (PPD) risk in twin parents versus singleton parents. However, additional factors such as social support systems, delivery mode, and cultural influences require exploration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To discuss the role of structured postpartum care, cesarean sections, and mother-infant bonding in moderating PPD risk, especially within cultural contexts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>These factors may explain the gender-specific temporal patterns observed by Egsgaard et al. Future research should integrate sociocultural and clinical variables to inform interventions for twin parents at risk of PPD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 2","pages":"173-174"},"PeriodicalIF":5.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maria Faurholt-Jepsen, Jonas Busk, Morten Lindberg Tønning, Darius Rohani, Jakob Eyvind Bardram, Lars Vedel Kessing
Background
Mood, activity, and instability in symptomatology hold significant roles in bipolar disorder (BD) and unipolar disorder (UD). The objectives were to examine disparities in these symptoms among patients with BD and UD.
Methods
Data from two studies including patients with BD and UD, respectively, were combined for exploratory analyses. Patients provided daily smartphone-based evaluations of mood and activity/energy for a 6-month period. A total of 47 patients with BD and 59 patients with UD were included in the analyses. The dataset contains more than 13,000 patient-reported evaluations of mood and activity. Daily mood and activity instability measures were calculated using the root squared successive difference method.
Results
In linear mixed effect regression models adjusted for age, sex, and work status, there were statistically significant lower levels of activity in patients with BD as compared with patients with UD overall, during euthymic states and during depressive states (B: −0.61, 95% CI: −0.98; −0.24, p = 0.001). There were no statistically significant differences in mood instability and activity instability between patients with BD and patients with UD overall, during euthymic states and during depressive states, when accounting for multiple testing (p > 0.012).
Limitations
Analyses were exploratory and post hoc. Findings should be interpreted with caution. The sample size was modest.
Conclusion
Patients with BD presented with lower level of activity as compared with patients with UD. There were no differences in mood and activity instability between these groups. Future studies including larger sample sizes should investigate differences between BD and UD.
背景：症状学中的情绪、活动和不稳定性在双相情感障碍（BD）和单相情感障碍（UD）中具有重要作用。目的是检查BD和UD患者在这些症状上的差异。方法：结合两项研究的数据，分别包括BD和UD患者，进行探索性分析。在6个月的时间里，患者每天都要提供基于智能手机的情绪和活动/能量评估。共有47例BD患者和59例UD患者被纳入分析。该数据集包含超过13,000名患者报告的情绪和活动评估。每日情绪和活动不稳定性测量采用平方根逐次差分法计算。结果：在调整了年龄、性别和工作状态的线性混合效应回归模型中，总体而言，在健康状态和抑郁状态下，BD患者的活动水平低于UD患者(B: -0.61, 95% CI: -0.98；-0.24, p = 0.001)。考虑到多重测试，BD患者和UD患者在情绪不稳定和活动不稳定方面的总体差异无统计学意义，在心境状态和抑郁状态期间（p > 0.012）。局限性：分析是探索性和事后分析。研究结果应谨慎解读。样本量不大。结论：BD患者的活动水平低于UD患者。两组之间的情绪和活动不稳定性没有差异。未来的研究包括更大的样本量应该调查BD和UD之间的差异。试验注册：ClinicalTrials.gov标识符：NCT03033420。
{"title":"Mood, Activity, and Instability in Bipolar Disorder and Unipolar Disorder—An Exploratory Post Hoc Study Using Digital Data","authors":"Maria Faurholt-Jepsen, Jonas Busk, Morten Lindberg Tønning, Darius Rohani, Jakob Eyvind Bardram, Lars Vedel Kessing","doi":"10.1111/acps.13771","DOIUrl":"10.1111/acps.13771","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Mood, activity, and instability in symptomatology hold significant roles in bipolar disorder (BD) and unipolar disorder (UD). The objectives were to examine disparities in these symptoms among patients with BD and UD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from two studies including patients with BD and UD, respectively, were combined for exploratory analyses. Patients provided daily smartphone-based evaluations of mood and activity/energy for a 6-month period. A total of 47 patients with BD and 59 patients with UD were included in the analyses. The dataset contains more than 13,000 patient-reported evaluations of mood and activity. Daily mood and activity instability measures were calculated using the root squared successive difference method.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In linear mixed effect regression models adjusted for age, sex, and work status, there were statistically significant lower levels of activity in patients with BD as compared with patients with UD overall, during euthymic states and during depressive states (<i>B</i>: −0.61, 95% CI: −0.98; −0.24, <i>p</i> = 0.001). There were no statistically significant differences in mood instability and activity instability between patients with BD and patients with UD overall, during euthymic states and during depressive states, when accounting for multiple testing (<i>p</i> > 0.012).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Limitations</h3>\u0000 \u0000 <p>Analyses were exploratory and post hoc. Findings should be interpreted with caution. The sample size was modest.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients with BD presented with lower level of activity as compared with patients with UD. There were no differences in mood and activity instability between these groups. Future studies including larger sample sizes should investigate differences between BD and UD.</p>\u0000 \u0000 <p>\u0000 <b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT03033420</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 3","pages":"426-433"},"PeriodicalIF":5.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I Odsbu, A Hamina, V Hjellvik, M Handal, M Haram, M Tesli, A Tanskanen, H Taipale
Background: Antipsychotics are recommended after first-episode psychosis. Knowledge on the current use patterns in real-world settings is thus important to inform clinical practice. We aimed to describe antipsychotic initiation during 1 year after first-episode psychosis and its associated factors.
Methods: Population-based cohort study using linked nationwide health and population registers from Norway. The study population comprised 8052 persons aged 16-45 years with first-episode psychosis diagnosed in secondary care (ICD-10 F20, F22-F29) in the period 2011-2019. Initiation of antipsychotic use was defined as being dispensed antipsychotics (ATC N05A, excl. lithium) at least once from -90 to +365 days from secondary care diagnosis of first-episode psychosis. Antipsychotic polypharmacy during follow-up was defined as having at least 90 days with overlapping drug use periods modeled using the Prescriptions to Drug Use Periods method. Adjusted risk ratios (aRRs) with 95% confidence intervals (CIs) for the association between socioeconomic and clinical factors and initiation of antipsychotic use were calculated using modified Poisson regression.
Results: In total, 4413 persons (54.8%) initiated antipsychotic use after first-episode psychosis with proportions ranging from 45.5% in 2012 to 62.1% in 2019. Oral formulations of olanzapine (34.9%), quetiapine (21.2%), and aripiprazole (11.6%) were most common at initiation, whereas long-acting injectables (LAIs) and clozapine were rarely used. Among the initiators, 13.8% started a polypharmacy period lasting more than 90 days. Factors associated with antipsychotic initiation were lower age (aRR 1.14, 95% CI 1.08-1.21; 26-35 years vs. 36-45 years), higher education (1.11, 1.05-1.18), being employed (1.04, 1.00-1.09), being hospitalized (1.13, 1.09-1.18), being diagnosed late in the study period (1.16, 1.11-1.22; 2017-2019 vs. 2011-2013), or with previously diagnosed bipolar disorder, depression, or anxiety disorders.
Conclusions: The antipsychotic use pattern is largely within the current clinical guideline. Primary non-compliance and disease severity may explain the socioeconomic and clinical differences related to initiation of antipsychotic use.
背景：首次精神病发作后推荐使用抗精神病药物。因此，了解现实世界中目前的使用模式对临床实践非常重要。我们的目的是描述首次精神病发作后1年内的抗精神病药物起始治疗及其相关因素。方法：基于人群的队列研究，使用挪威全国健康和人口登记。研究人群包括2011-2019年期间8052名年龄在16-45岁、在二级医疗诊断为首发精神病（icd - 10f20, F22-F29）的患者。开始使用抗精神病药物定义为在二级护理诊断为首发精神病后-90至+365天内至少使用一次抗精神病药物（ATC N05A，不包括锂）。随访期间的抗精神病药物多重用药定义为使用处方到用药周期方法建模的重叠用药期至少90天。使用修正泊松回归计算社会经济和临床因素与开始使用抗精神病药物之间关联的校正风险比（aRRs）和95%置信区间（CIs）。结果：共有4413人（54.8%）在首发精神病后开始使用抗精神病药物，比例从2012年的45.5%到2019年的62.1%不等。口服制剂奥氮平（34.9%）、喹硫平（21.2%）和阿立哌唑（11.6%）最常见，而长效注射剂（LAIs）和氯氮平很少使用。在发起者中，有13.8%的人开始了超过90天的多药期。与抗精神病药物起始相关的因素为年龄较低(aRR 1.14, 95% CI 1.08-1.21；26-35岁vs. 36-45岁)，高等教育（1.11,1.05-1.18），在职（1.04,1.00-1.09），住院（1.13,1.09-1.18），研究后期诊断(1.16,1.11-1.22；2017-2019年与2011-2013年)，或先前诊断为双相情感障碍、抑郁症或焦虑症的患者。结论：抗精神病药物的使用模式基本符合现行临床指南。原发性不依从性和疾病严重程度可以解释与开始使用抗精神病药物相关的社会经济和临床差异。
{"title":"Initiation of Antipsychotics During the First Year After First-Episode Psychosis: A Population-Based Study.","authors":"I Odsbu, A Hamina, V Hjellvik, M Handal, M Haram, M Tesli, A Tanskanen, H Taipale","doi":"10.1111/acps.13776","DOIUrl":"https://doi.org/10.1111/acps.13776","url":null,"abstract":"<p><strong>Background: </strong>Antipsychotics are recommended after first-episode psychosis. Knowledge on the current use patterns in real-world settings is thus important to inform clinical practice. We aimed to describe antipsychotic initiation during 1 year after first-episode psychosis and its associated factors.</p><p><strong>Methods: </strong>Population-based cohort study using linked nationwide health and population registers from Norway. The study population comprised 8052 persons aged 16-45 years with first-episode psychosis diagnosed in secondary care (ICD-10 F20, F22-F29) in the period 2011-2019. Initiation of antipsychotic use was defined as being dispensed antipsychotics (ATC N05A, excl. lithium) at least once from -90 to +365 days from secondary care diagnosis of first-episode psychosis. Antipsychotic polypharmacy during follow-up was defined as having at least 90 days with overlapping drug use periods modeled using the Prescriptions to Drug Use Periods method. Adjusted risk ratios (aRRs) with 95% confidence intervals (CIs) for the association between socioeconomic and clinical factors and initiation of antipsychotic use were calculated using modified Poisson regression.</p><p><strong>Results: </strong>In total, 4413 persons (54.8%) initiated antipsychotic use after first-episode psychosis with proportions ranging from 45.5% in 2012 to 62.1% in 2019. Oral formulations of olanzapine (34.9%), quetiapine (21.2%), and aripiprazole (11.6%) were most common at initiation, whereas long-acting injectables (LAIs) and clozapine were rarely used. Among the initiators, 13.8% started a polypharmacy period lasting more than 90 days. Factors associated with antipsychotic initiation were lower age (aRR 1.14, 95% CI 1.08-1.21; 26-35 years vs. 36-45 years), higher education (1.11, 1.05-1.18), being employed (1.04, 1.00-1.09), being hospitalized (1.13, 1.09-1.18), being diagnosed late in the study period (1.16, 1.11-1.22; 2017-2019 vs. 2011-2013), or with previously diagnosed bipolar disorder, depression, or anxiety disorders.</p><p><strong>Conclusions: </strong>The antipsychotic use pattern is largely within the current clinical guideline. Primary non-compliance and disease severity may explain the socioeconomic and clinical differences related to initiation of antipsychotic use.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142754364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Elkhan Tahmazov, Jordan Bosse, Benjamin Glemain, Patrice Nabbe, Morgane Guillou, Athéna Blachier, Michel Walter, Christophe Lemey
<div> <section> <h3> Introduction</h3> <p>Early-onset psychotic disorders include the prodromal phase and the first-episode psychosis (FEP). They constitute a high-risk period for suicidal behavior. Early intervention for psychosis (EIP) consists of intervening as early as possible. The effectiveness of early intervention on overall prognosis has been reported in numerous studies, and EIP services are emerging worldwide. Several authors report an improvement in suicidal behavior, but no study has looked at all the data.</p> </section> <section> <h3> Aims of the Study</h3> <p>The aim of work is to study whether early intervention for psychosis has an impact on deaths by suicide and suicide attempts, and study which intervention methods have an impact on suicidal behavior.</p> </section> <section> <h3> Methodology</h3> <p>By respecting the PRISMA criteria, previously declared on PROSPERO, by exploring 5 medical databases (PubMed, Cochrane, PsycINFO, Scopus, Embase), from their creation dates, published until 20/02/2023, in English, we carried out a meta-analysis. The articles selected had to deal with the EIP and deaths by suicide or suicide attempts. Our primary outcome is the deaths by suicide and the secondary outcome the suicide attempt.</p> </section> <section> <h3> Results</h3> <p>The exhaustive search identified a total of 2310 references. Nine articles were included. Their intervention modalities were pharmacotherapy, psychotherapy, case-management, or related services, and psycho-social therapies. Our meta-analysis shows that early intervention for early-onset psychotic disorders is associated with a statistically significant reduction by a third in deaths by suicide (ORa = 0.66 (0.49–0.88), <i>p</i> = 0.005) and by a third in suicide attempts (ORa = 0.66 (0.50–0.86), <i>p</i> = 0.002), with non-significant heterogeneity. Sensitivity analyses excluding the study with statistical difficulties due to the absence of an event and studies with a high risk of bias point in the same direction, that is a statistically significant reduction and non-significant heterogeneity.</p> </section> <section> <h3> Conclusion</h3> <p>The literature shows that early intervention programs are associated with positive impact on deaths by suicide and suicide attempt. This is the first meta-analysis of early intervention in early psychotic disorders and its impact on suicidal risk. The deployment of EIP should be supported worldwide in order to intervene as early as
{"title":"Impact of Early Intervention for Early Psychosis on Suicidal Behavior—A Meta-Analysis","authors":"Elkhan Tahmazov, Jordan Bosse, Benjamin Glemain, Patrice Nabbe, Morgane Guillou, Athéna Blachier, Michel Walter, Christophe Lemey","doi":"10.1111/acps.13773","DOIUrl":"10.1111/acps.13773","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Early-onset psychotic disorders include the prodromal phase and the first-episode psychosis (FEP). They constitute a high-risk period for suicidal behavior. Early intervention for psychosis (EIP) consists of intervening as early as possible. The effectiveness of early intervention on overall prognosis has been reported in numerous studies, and EIP services are emerging worldwide. Several authors report an improvement in suicidal behavior, but no study has looked at all the data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims of the Study</h3>\u0000 \u0000 <p>The aim of work is to study whether early intervention for psychosis has an impact on deaths by suicide and suicide attempts, and study which intervention methods have an impact on suicidal behavior.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methodology</h3>\u0000 \u0000 <p>By respecting the PRISMA criteria, previously declared on PROSPERO, by exploring 5 medical databases (PubMed, Cochrane, PsycINFO, Scopus, Embase), from their creation dates, published until 20/02/2023, in English, we carried out a meta-analysis. The articles selected had to deal with the EIP and deaths by suicide or suicide attempts. Our primary outcome is the deaths by suicide and the secondary outcome the suicide attempt.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The exhaustive search identified a total of 2310 references. Nine articles were included. Their intervention modalities were pharmacotherapy, psychotherapy, case-management, or related services, and psycho-social therapies. Our meta-analysis shows that early intervention for early-onset psychotic disorders is associated with a statistically significant reduction by a third in deaths by suicide (ORa = 0.66 (0.49–0.88), <i>p</i> = 0.005) and by a third in suicide attempts (ORa = 0.66 (0.50–0.86), <i>p</i> = 0.002), with non-significant heterogeneity. Sensitivity analyses excluding the study with statistical difficulties due to the absence of an event and studies with a high risk of bias point in the same direction, that is a statistically significant reduction and non-significant heterogeneity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The literature shows that early intervention programs are associated with positive impact on deaths by suicide and suicide attempt. This is the first meta-analysis of early intervention in early psychotic disorders and its impact on suicidal risk. The deployment of EIP should be supported worldwide in order to intervene as early as","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 2","pages":"127-141"},"PeriodicalIF":5.3,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11695091/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142724389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E Oostra, P Jazdzyk, V Vis, I Dalhuisen, A W Hoogendoorn, C H M Planting, P F van Eijndhoven, Y D van der Werf, O A van den Heuvel, E van Exel
Background: Repetitive transcranial magnetic stimulation (rTMS) is effective for treatment-resistant depression (TRD). Optimal rTMS parameters remain unclear, especially whether number of sessions or amount of pulses contribute more to treatment outcome. We hypothesize that treatment outcome depends on the number of sessions rather than on the amount of pulses.
Methods: We searched databases for randomized clinical trials (RCTs) on high-frequent (HF) or low-frequent (LF)-rTMS targeting the left or right DLPFC for TRD. Treatment efficacy was measured using standardized mean difference (SMD), calculated from pre- and post-treatment depression scores. Meta-regressions were used to explore linear associations between SMD and rTMS pulses, pulses/session and sessions for HF and LF-rTMS, separately for active and sham-rTMS. If these variables showed no linear association with SMD, we divided the data into quartiles and explored subgroup SMDs.
Results: Eighty-seven RCTs were included: 67 studied HF-rTMS, eleven studied LF-rTMS, and nine studied both. No linear association was found between SMD and amount of pulses or pulses/session for HF and LF-rTMS. Subgroup analyses showed the largest SMDs for 1200-1500 HF-pulses/session and 360-450 LF-pulses/session. The number of sessions was significantly associated with SMD for active HF (β = 0.09, p < 0.05) and LF-rTMS (β = 0.06, p < 0.01). Thirty was the maximal number of sessions, in the included RCTs.
Conclusion: More rTMS sessions, but not more pulses, were associated with improved treatment outcome, in both HF and LF-rTMS. Our findings suggest that 1200-1500 HF-pulses/session and 360-450 LF-pulses/session are already sufficient, and that a treatment course should consist of least 30 sessions for higher chance of response.
{"title":"More rTMS pulses or more sessions? The impact on treatment outcome for treatment resistant depression.","authors":"E Oostra, P Jazdzyk, V Vis, I Dalhuisen, A W Hoogendoorn, C H M Planting, P F van Eijndhoven, Y D van der Werf, O A van den Heuvel, E van Exel","doi":"10.1111/acps.13768","DOIUrl":"https://doi.org/10.1111/acps.13768","url":null,"abstract":"<p><strong>Background: </strong>Repetitive transcranial magnetic stimulation (rTMS) is effective for treatment-resistant depression (TRD). Optimal rTMS parameters remain unclear, especially whether number of sessions or amount of pulses contribute more to treatment outcome. We hypothesize that treatment outcome depends on the number of sessions rather than on the amount of pulses.</p><p><strong>Methods: </strong>We searched databases for randomized clinical trials (RCTs) on high-frequent (HF) or low-frequent (LF)-rTMS targeting the left or right DLPFC for TRD. Treatment efficacy was measured using standardized mean difference (SMD), calculated from pre- and post-treatment depression scores. Meta-regressions were used to explore linear associations between SMD and rTMS pulses, pulses/session and sessions for HF and LF-rTMS, separately for active and sham-rTMS. If these variables showed no linear association with SMD, we divided the data into quartiles and explored subgroup SMDs.</p><p><strong>Results: </strong>Eighty-seven RCTs were included: 67 studied HF-rTMS, eleven studied LF-rTMS, and nine studied both. No linear association was found between SMD and amount of pulses or pulses/session for HF and LF-rTMS. Subgroup analyses showed the largest SMDs for 1200-1500 HF-pulses/session and 360-450 LF-pulses/session. The number of sessions was significantly associated with SMD for active HF (β = 0.09, p < 0.05) and LF-rTMS (β = 0.06, p < 0.01). Thirty was the maximal number of sessions, in the included RCTs.</p><p><strong>Conclusion: </strong>More rTMS sessions, but not more pulses, were associated with improved treatment outcome, in both HF and LF-rTMS. Our findings suggest that 1200-1500 HF-pulses/session and 360-450 LF-pulses/session are already sufficient, and that a treatment course should consist of least 30 sessions for higher chance of response.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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