Anna Giménez-Palomo, Anjli K. Chamdal, Natalie Gottlieb, Mojtaba Lotfaliany, Tahir Jokinen, Eslam M. Bastawy, Katherine Adlington, Nawal Benachar, Seetal Dodd, Isabella Pacchiarotti, Eduard Vieta, Michael Berk, Paul R. A. Stokes
Background
Monoamine oxidase inhibitors (MAOIs) are considered third-line treatments for treatment resistant depression; however, they are underused in clinical practice.
Aims
This study aimed to assess the efficacy, tolerability, and acceptability of MAOIs for the treatment of depression in comparison with other antidepressant treatments.
Methods
A systematic review and network meta-analysis of randomised clinical trials was performed to compare the efficacy, tolerability and acceptability between MAOIs and other antidepressant treatments for the treatment of depressive episodes.
Results
A total of 83 double-blinded, randomised controlled trials were included in the analysis, with 7765 participants assigned to an active treatment and 1844 assigned to placebo. Several MAOIs, including isocarboxazid, phenelzine, tranylcypromine and moclobemide, showed significantly higher efficacy compared with placebo. The tolerability and acceptability of MAOIs was comparable to other antidepressants.
Limitations
A disproportionate number of studies investigating the most commonly used MAOIs, such as moclobemide and phenelzine, and a lack of specific studies focusing on treatment-resistant and atypical depression.
Conclusions
MAOIs are similar in efficacy to other antidepressants for the treatment of depression. However, more studies are needed comparing MAOI treatment in people with treatment-resistant, atypical and bipolar depression.
{"title":"Efficacy and tolerability of monoamine oxidase inhibitors for the treatment of depressive episodes in mood disorders: A systematic review and network meta-analysis","authors":"Anna Giménez-Palomo, Anjli K. Chamdal, Natalie Gottlieb, Mojtaba Lotfaliany, Tahir Jokinen, Eslam M. Bastawy, Katherine Adlington, Nawal Benachar, Seetal Dodd, Isabella Pacchiarotti, Eduard Vieta, Michael Berk, Paul R. A. Stokes","doi":"10.1111/acps.13728","DOIUrl":"10.1111/acps.13728","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Monoamine oxidase inhibitors (MAOIs) are considered third-line treatments for treatment resistant depression; however, they are underused in clinical practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This study aimed to assess the efficacy, tolerability, and acceptability of MAOIs for the treatment of depression in comparison with other antidepressant treatments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review and network meta-analysis of randomised clinical trials was performed to compare the efficacy, tolerability and acceptability between MAOIs and other antidepressant treatments for the treatment of depressive episodes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 83 double-blinded, randomised controlled trials were included in the analysis, with 7765 participants assigned to an active treatment and 1844 assigned to placebo. Several MAOIs, including isocarboxazid, phenelzine, tranylcypromine and moclobemide, showed significantly higher efficacy compared with placebo. The tolerability and acceptability of MAOIs was comparable to other antidepressants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Limitations</h3>\u0000 \u0000 <p>A disproportionate number of studies investigating the most commonly used MAOIs, such as moclobemide and phenelzine, and a lack of specific studies focusing on treatment-resistant and atypical depression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>MAOIs are similar in efficacy to other antidepressants for the treatment of depression. However, more studies are needed comparing MAOI treatment in people with treatment-resistant, atypical and bipolar depression.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 6","pages":"500-515"},"PeriodicalIF":5.3,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141597954","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}
Susana Gomes-da-Costa, Isabel Fernandéz-Pérez, Roger Borras, Noelia Lopez, Yudith Rivas, Victoria Ruiz, Maria Teresa Pons-Cabrera, Anna Giménez-Palomo, Gerard Anmella, Marc Valentí, Michael Berk, Eduard Vieta, Isabella Pacchiarotti
Background
Lifestyle factors are being increasingly studied in bipolar disorder (BD) due to their possible effects on both course of disease and physical health. The aim of this study was to jointly describe and explore the interrelations between diet patterns, exercise, pharmacological treatment with course of disease and metabolic profile in BD.
Methods
The sample consisted of 66 euthymic or mild depressive individuals with BD. Clinical and metabolic outcomes were assessed, as well as pharmacological treatment or lifestyle habits (diet and exercise). Correlations were explored for different interrelations and a factor analysis of dietary patterns was performed.
Results
Adherence to the Mediterranean diet was low, seen in 37.9% of the patients and was positively associated with perceived quality of life. The amount of exercise was negatively associated with cholesterol levels, with 32.8% of participants rated as low active by International Physical Activity Questionnaire. There was a high prevalence of obesity (40.6%) and metabolic syndrome (29.7%). Users of lithium showed the best metabolic profile. Interestingly, three dietary patterns were identified: “vegetarian,” “omnivore” and “Western.” The key finding was the overall positive impact of the “vegetarian” pattern in BD, which was associated with reduced depression scores, better psychosocial functioning, and perceived quality of life, decreased body mass index, cholesterol, LDL and diastolic blood pressure. Nuts consumption was associated with a better metabolic profile.
Conclusions
A vegetarian diet pattern was associated with both, better clinical and metabolic parameters, in patients with BD. Future studies should prioritize prospective and randomized designs to determine causal relationships, and potentially inform clinical recommendations.
{"title":"Is a vegetarian diet beneficial for bipolar disorder? Relationship between dietary patterns, exercise and pharmacological treatments with metabolic syndrome and course of disease in bipolar disorder","authors":"Susana Gomes-da-Costa, Isabel Fernandéz-Pérez, Roger Borras, Noelia Lopez, Yudith Rivas, Victoria Ruiz, Maria Teresa Pons-Cabrera, Anna Giménez-Palomo, Gerard Anmella, Marc Valentí, Michael Berk, Eduard Vieta, Isabella Pacchiarotti","doi":"10.1111/acps.13733","DOIUrl":"10.1111/acps.13733","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Lifestyle factors are being increasingly studied in bipolar disorder (BD) due to their possible effects on both course of disease and physical health. The aim of this study was to jointly describe and explore the interrelations between diet patterns, exercise, pharmacological treatment with course of disease and metabolic profile in BD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The sample consisted of 66 euthymic or mild depressive individuals with BD. Clinical and metabolic outcomes were assessed, as well as pharmacological treatment or lifestyle habits (diet and exercise). Correlations were explored for different interrelations and a factor analysis of dietary patterns was performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Adherence to the Mediterranean diet was low, seen in 37.9% of the patients and was positively associated with perceived quality of life. The amount of exercise was negatively associated with cholesterol levels, with 32.8% of participants rated as low active by International Physical Activity Questionnaire. There was a high prevalence of obesity (40.6%) and metabolic syndrome (29.7%). Users of lithium showed the best metabolic profile. Interestingly, three dietary patterns were identified: “vegetarian,” “omnivore” and “Western.” The key finding was the overall positive impact of the “vegetarian” pattern in BD, which was associated with reduced depression scores, better psychosocial functioning, and perceived quality of life, decreased body mass index, cholesterol, LDL and diastolic blood pressure. Nuts consumption was associated with a better metabolic profile.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A vegetarian diet pattern was associated with both, better clinical and metabolic parameters, in patients with BD. Future studies should prioritize prospective and randomized designs to determine causal relationships, and potentially inform clinical recommendations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 4","pages":"209-222"},"PeriodicalIF":5.3,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141588997","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}
Lisa-Marie Hartnagel, Ulrich W Ebner-Priemer, Jerome C Foo, Fabian Streit, Stephanie H Witt, Josef Frank, Matthias F Limberger, Andrea B Horn, Maria Gilles, Marcella Rietschel, Lea Sirignano
Background: Digital phenotyping and monitoring tools are the most promising approaches to automatically detect upcoming depressive episodes. Especially, linguistic style has been seen as a potential behavioral marker of depression, as cross-sectional studies showed, for example, less frequent use of positive emotion words, intensified use of negative emotion words, and more self-references in patients with depression compared to healthy controls. However, longitudinal studies are sparse and therefore it remains unclear whether within-person fluctuations in depression severity are associated with individuals' linguistic style.
Methods: To capture affective states and concomitant speech samples longitudinally, we used an ambulatory assessment approach sampling multiple times a day via smartphones in patients diagnosed with depressive disorder undergoing sleep deprivation therapy. This intervention promises a rapid change of affective symptoms within a short period of time, assuring sufficient variability in depressive symptoms. We extracted word categories from the transcribed speech samples using the Linguistic Inquiry and Word Count.
Results: Our analyses revealed that more pleasant affective momentary states (lower reported depression severity, lower negative affective state, higher positive affective state, (positive) valence, energetic arousal and calmness) are mirrored in the use of less negative emotion words and more positive emotion words.
Conclusion: We conclude that a patient's linguistic style, especially the use of positive and negative emotion words, is associated with self-reported affective states and thus is a promising feature for speech-based automated monitoring and prediction of upcoming episodes, ultimately leading to better patient care.
{"title":"Linguistic style as a digital marker for depression severity: An ambulatory assessment pilot study in patients with depressive disorder undergoing sleep deprivation therapy.","authors":"Lisa-Marie Hartnagel, Ulrich W Ebner-Priemer, Jerome C Foo, Fabian Streit, Stephanie H Witt, Josef Frank, Matthias F Limberger, Andrea B Horn, Maria Gilles, Marcella Rietschel, Lea Sirignano","doi":"10.1111/acps.13726","DOIUrl":"https://doi.org/10.1111/acps.13726","url":null,"abstract":"<p><strong>Background: </strong>Digital phenotyping and monitoring tools are the most promising approaches to automatically detect upcoming depressive episodes. Especially, linguistic style has been seen as a potential behavioral marker of depression, as cross-sectional studies showed, for example, less frequent use of positive emotion words, intensified use of negative emotion words, and more self-references in patients with depression compared to healthy controls. However, longitudinal studies are sparse and therefore it remains unclear whether within-person fluctuations in depression severity are associated with individuals' linguistic style.</p><p><strong>Methods: </strong>To capture affective states and concomitant speech samples longitudinally, we used an ambulatory assessment approach sampling multiple times a day via smartphones in patients diagnosed with depressive disorder undergoing sleep deprivation therapy. This intervention promises a rapid change of affective symptoms within a short period of time, assuring sufficient variability in depressive symptoms. We extracted word categories from the transcribed speech samples using the Linguistic Inquiry and Word Count.</p><p><strong>Results: </strong>Our analyses revealed that more pleasant affective momentary states (lower reported depression severity, lower negative affective state, higher positive affective state, (positive) valence, energetic arousal and calmness) are mirrored in the use of less negative emotion words and more positive emotion words.</p><p><strong>Conclusion: </strong>We conclude that a patient's linguistic style, especially the use of positive and negative emotion words, is associated with self-reported affective states and thus is a promising feature for speech-based automated monitoring and prediction of upcoming episodes, ultimately leading to better patient care.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141578333","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}
{"title":"Letter to the Editor concerning “Electroconvulsive therapy in the maintenance phase of psychotic unipolar depression”","authors":"Margarida Alves, Diana Durães, Pedro Afonso","doi":"10.1111/acps.13732","DOIUrl":"10.1111/acps.13732","url":null,"abstract":"","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 4","pages":"245-246"},"PeriodicalIF":5.3,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141578332","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}
Olivier Corbeil, Élizabeth Anderson, Laurent Béchard, Charles Desmeules, Maxime Huot-Lavoie, Lauryann Bachand, Sébastien Brodeur, Pierre-Hugues Carmichael, Christian Jacques, Marco Solmi, Isabelle Giroux, Michel Dorval, Marie-France Demers, Marc-André Roy
{"title":"Reply to: Why does problem gambling in psychotic disorders pose such a challenge for comprehension?","authors":"Olivier Corbeil, Élizabeth Anderson, Laurent Béchard, Charles Desmeules, Maxime Huot-Lavoie, Lauryann Bachand, Sébastien Brodeur, Pierre-Hugues Carmichael, Christian Jacques, Marco Solmi, Isabelle Giroux, Michel Dorval, Marie-France Demers, Marc-André Roy","doi":"10.1111/acps.13730","DOIUrl":"https://doi.org/10.1111/acps.13730","url":null,"abstract":"","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141544197","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}
This systematic review aimed to summarise and synthesise research conducted in psychiatric mother-baby units (MBUs) in relation to patients, their families, or staff, published from 1st January 2016 to 1st May 2024.
Method
Quantitative, qualitative, and mixed-method studies were included for review if they were published in peer-review journals in English and reported research on MBUs between January 2016 and May 2024. From the initial yield of 10,007 unique studies, 53 studies were included for review.
Results
MBU research was found to more frequently investigate maternal characteristics rather than the benefits of MBU treatment compared to studies conducted prior to 2016. Most studies that did investigate impact of admission showed favourable results, however few follow-up studies and studies comparing MBU outcomes to other clinical settings were undertaken. Little research has been conducted to investigate the differential impacts of MBU admission on different diagnoses and long-term (>1 year) patient outcomes. There was a dearth of research investigating partners of women in MBUs and few studies conducted on infant outcomes.
Conclusions
MBUs were consistently found to improve mental health systems and mother-infant attachment in patients after admission. More research investigating patient support networks and child health, impact of diagnosis on outcomes, and studies with adequate follow-up are required.
{"title":"A systematic review of research examining mothers, infants, family and staff in psychiatric mother-baby units","authors":"Sam Adhikary, Kerri Gillespie, Hayley Kimball, Lyndall Healey, Olivia Webb, Abha Balram, Grace Branjerdporn","doi":"10.1111/acps.13727","DOIUrl":"10.1111/acps.13727","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This systematic review aimed to summarise and synthesise research conducted in psychiatric mother-baby units (MBUs) in relation to patients, their families, or staff, published from 1st January 2016 to 1st May 2024.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Quantitative, qualitative, and mixed-method studies were included for review if they were published in peer-review journals in English and reported research on MBUs between January 2016 and May 2024. From the initial yield of 10,007 unique studies, 53 studies were included for review.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>MBU research was found to more frequently investigate maternal characteristics rather than the benefits of MBU treatment compared to studies conducted prior to 2016. Most studies that did investigate impact of admission showed favourable results, however few follow-up studies and studies comparing MBU outcomes to other clinical settings were undertaken. Little research has been conducted to investigate the differential impacts of MBU admission on different diagnoses and long-term (>1 year) patient outcomes. There was a dearth of research investigating partners of women in MBUs and few studies conducted on infant outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>MBUs were consistently found to improve mental health systems and mother-infant attachment in patients after admission. More research investigating patient support networks and child health, impact of diagnosis on outcomes, and studies with adequate follow-up are required.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 5","pages":"284-307"},"PeriodicalIF":5.3,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13727","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141490086","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}
Pelle Lau Ishøy, Kim Berg Engersgaard Johannessen, Tine Houmann, Eline Levin, Per Hove Thomsen
<div> <section> <h3> Introduction</h3> <p>Attention deficit hyperactivity disorder (ADHD) medication has proven effective for treating ADHD in adults, nonetheless previous studies have shown high rates of medication discontinuation.</p> </section> <section> <h3> Objective</h3> <p>To assess drug survival and identify risk factors associated with discontinuation of ADHD medication.</p> </section> <section> <h3> Methods</h3> <p>A nationwide registry-based cohort study in Danish adults who redeemed a prescription for ADHD medication for the first time between 2010 and 2015. All patients were followed for 5 years from the first redeemed prescription. Discontinuation was defined as a gap of 12 months between redemptions. Logistic regression analysis with odds ratio (OR) and Kaplan Meier analysis were used to examine risk factors (sex, age, socioeconomic status, substance use disorders, and comorbidities) associated with discontinuation.</p> </section> <section> <h3> Results</h3> <p>Twenty three thousand nine-hundred and sixteen patients with ADHD were identified. The 5-year overall drug survival was 29% in women vs. 23.5% in men. The risk of medication discontinuation was significantly higher in men compared to women, OR 1.26 (95% CI 1.19–1.34, <i>p</i> < 0.001). Adults aged 31–50 years had a significantly decreased risk of medication discontinuation compared to adults aged 18–30 years, OR 0.57 (95% CI 0.53–0.61, <i>p</i> < 0.001). Switching ADHD medication two times or three times or more significantly decreased the risk of discontinuation; OR 0.53 (95% CI 0.49–0.56, <i>p</i> < 0.001) and OR 0.26 (95% CI 0.23–0.30, <i>p</i> < 0.001), respectively. Substance use disorders and certain comorbidities were associated with medication discontinuation. Eating disorders, OR 0.71 (95% CI 0.64–0.78, <i>p</i> < 0.001), intellectual disabilities, OR 0.65 (95% CI 0.59–0.73, <i>p</i> < 0.001) and sleep disorders, OR 0.42 (95% CI 0.37–0.49, <i>p</i> < 0.001) were associated with continuation of ADHD medication.</p> </section> <section> <h3> Conclusions</h3> <p>The 5-year overall drug survival was longer in women compared to men. Women with ADHD; adults aged 31–50; and patients with comorbid eating disorder; intellectual disability; sleep disorder and medication switching were individually associated with continuation of ADHD medication. Various factors were associated with medication discontinuation. Discontinuation should be acknowledged as a comm
{"title":"Drug survival and risk factors for ADHD medication discontinuation in adults: A Danish Nationwide Registry-based cohort study","authors":"Pelle Lau Ishøy, Kim Berg Engersgaard Johannessen, Tine Houmann, Eline Levin, Per Hove Thomsen","doi":"10.1111/acps.13724","DOIUrl":"10.1111/acps.13724","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Attention deficit hyperactivity disorder (ADHD) medication has proven effective for treating ADHD in adults, nonetheless previous studies have shown high rates of medication discontinuation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess drug survival and identify risk factors associated with discontinuation of ADHD medication.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A nationwide registry-based cohort study in Danish adults who redeemed a prescription for ADHD medication for the first time between 2010 and 2015. All patients were followed for 5 years from the first redeemed prescription. Discontinuation was defined as a gap of 12 months between redemptions. Logistic regression analysis with odds ratio (OR) and Kaplan Meier analysis were used to examine risk factors (sex, age, socioeconomic status, substance use disorders, and comorbidities) associated with discontinuation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty three thousand nine-hundred and sixteen patients with ADHD were identified. The 5-year overall drug survival was 29% in women vs. 23.5% in men. The risk of medication discontinuation was significantly higher in men compared to women, OR 1.26 (95% CI 1.19–1.34, <i>p</i> < 0.001). Adults aged 31–50 years had a significantly decreased risk of medication discontinuation compared to adults aged 18–30 years, OR 0.57 (95% CI 0.53–0.61, <i>p</i> < 0.001). Switching ADHD medication two times or three times or more significantly decreased the risk of discontinuation; OR 0.53 (95% CI 0.49–0.56, <i>p</i> < 0.001) and OR 0.26 (95% CI 0.23–0.30, <i>p</i> < 0.001), respectively. Substance use disorders and certain comorbidities were associated with medication discontinuation. Eating disorders, OR 0.71 (95% CI 0.64–0.78, <i>p</i> < 0.001), intellectual disabilities, OR 0.65 (95% CI 0.59–0.73, <i>p</i> < 0.001) and sleep disorders, OR 0.42 (95% CI 0.37–0.49, <i>p</i> < 0.001) were associated with continuation of ADHD medication.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The 5-year overall drug survival was longer in women compared to men. Women with ADHD; adults aged 31–50; and patients with comorbid eating disorder; intellectual disability; sleep disorder and medication switching were individually associated with continuation of ADHD medication. Various factors were associated with medication discontinuation. Discontinuation should be acknowledged as a comm","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 3","pages":"160-173"},"PeriodicalIF":5.3,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13724","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141490103","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}
Noralie N. Schonewille, Monique J. M. van den Eijnden, Ruveyda Sahin, Nini H. Jonkman, Anne A. M. W. van Kempen, Maria G. van Pampus, Fedde Scheele, Odile A. van den Heuvel, Birit F. P. Broekman
Background
Reproductive health and mental health are intertwined, but studies investigating family planning needs and desire for children in mental healthcare are scarce.
Methods
We studied the experiences of (former) patients, those with close relationships with the (former) patients (close ones) and mental health professionals (MHP) on discussing family planning and desire for children in mental healthcare. We combined quantitative (two nationwide surveys) and qualitative data (four focus groups) in a mixed-methods approach with sequential analytical design.
Results
Combined data from focus groups (n = 19 participants) and two surveys (n = 139 MHPs and n = 294 (former) patients and close ones) showed that a considerable group of MHPs (64.0%), patients (40.9%) and close ones (50.0%) found that family planning should be discussed by a psychiatrist. However, several obstacles impeded a conversation, such as fear of judgment, lack of time and knowledge and limited opportunity for in-depth exploration of life themes in therapeutic relationships.
Conclusions
To increase the autonomy of patients in discussing family planning, we suggest MHPs explore the desire to discuss family planning with all patients in the reproductive phase of life, prior to discussing contraceptive care. MHPs should receive education about psychiatric vulnerability in relation to family planning and desire for children, and patients and close ones should be empowered to initiate a conversation themselves.
{"title":"The conversation about family planning and desire for children in mental healthcare: Patients' perspective versus Professionals' perspective in a mixed methods study","authors":"Noralie N. Schonewille, Monique J. M. van den Eijnden, Ruveyda Sahin, Nini H. Jonkman, Anne A. M. W. van Kempen, Maria G. van Pampus, Fedde Scheele, Odile A. van den Heuvel, Birit F. P. Broekman","doi":"10.1111/acps.13725","DOIUrl":"10.1111/acps.13725","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Reproductive health and mental health are intertwined, but studies investigating family planning needs and desire for children in mental healthcare are scarce.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We studied the experiences of (former) patients, those with close relationships with the (former) patients (close ones) and mental health professionals (MHP) on discussing family planning and desire for children in mental healthcare. We combined quantitative (two nationwide surveys) and qualitative data (four focus groups) in a mixed-methods approach with sequential analytical design.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Combined data from focus groups (<i>n</i> = 19 participants) and two surveys (<i>n</i> = 139 MHPs and <i>n</i> = 294 (former) patients and close ones) showed that a considerable group of MHPs (64.0%), patients (40.9%) and close ones (50.0%) found that family planning should be discussed by a psychiatrist. However, several obstacles impeded a conversation, such as fear of judgment, lack of time and knowledge and limited opportunity for in-depth exploration of life themes in therapeutic relationships.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>To increase the autonomy of patients in discussing family planning, we suggest MHPs explore the desire to discuss family planning with all patients in the reproductive phase of life, prior to discussing contraceptive care. MHPs should receive education about psychiatric vulnerability in relation to family planning and desire for children, and patients and close ones should be empowered to initiate a conversation themselves.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 5","pages":"320-333"},"PeriodicalIF":5.3,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13725","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141453797","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>The study conducted by Tapio Paljärvi et al., titled “Cardiovascular mortality in bipolar disorder: population-based cohort study,” sheds crucial light on the alarming rates of cardiovascular disease mortality among individuals with bipolar disorder.<span><sup>1</sup></span> The findings underscore a significant excess in mortality due to various cardiovascular causes, including coronary artery disease, cardiomyopathy, and hypertensive heart disease. This issue is part of a larger problem for people with severe mental illnesses (SMI), such as schizophrenia, bipolar disorders, and major depressive disorders. Individuals with SMI die up to 15 years earlier than the general population, and around 70% of this mortality gap is due to physical disorders.<span><sup>2</sup></span> Increased risk of physical disorders in those with mental disorders is due to reduced access to adequate physical health monitoring, care and prevention,<span><sup>3-5</sup></span> increased risk of adverse health behaviors<span><sup>6</sup></span> such as sedentary behavior, poor diet, and smoking, comorbid substance abuse, and side effects of psychiatric medications.<span><sup>7</sup></span></p><p>Despite the availability of clinical practice guidelines and evidence-based interventions aimed at reducing excess mortality rates due to physical comorbidities in persons with SMI, the problem still persists. There is a crucial need to better understand how to implement clinical practice guidelines and evidence-based interventions successfully in the real world. Individuals with comorbid mental and physical disorders face specific challenges in service organization, requiring complex treatment and intense resource utilization.<span><sup>8</sup></span> The management of multimorbidity is recognized to be complex, with a high treatment burden in terms of understanding and self-managing the conditions, attending multiple appointments, and managing complex drug regimens.<span><sup>9</sup></span> Evidence suggests that a key part of the problem is the lack of integration of care across service settings. There is major fragmentation in how care is coordinated between family doctors and hospitals, between physical and mental health care, and across health and social care. As proposed by Tapio Paljärvi et al.<span><sup>1</sup></span> and other authors,<span><sup>10</sup></span> person-centered and integrated care models are a critical step to support effective implementation approaches to translate evidence into practice.</p><p>However, despite local and innovative experiences in several countries, the large-scale implementation of integrated care models faces numerous barriers and conservatisms. These obstacles hinder progress and maintain the status quo, perpetuating major health inequalities in individuals with SMI. A call for action in Europe, similar to initiatives already established in the United States,<span><sup>11</sup></span> is necessary. Currently, there are two main types
{"title":"Call for action to address premature mortality due to physical illness in individuals with severe mental disorders","authors":"Laurent Boyer, Pierre-Michel Llorca, Guillaume Fond","doi":"10.1111/acps.13722","DOIUrl":"10.1111/acps.13722","url":null,"abstract":"<p>The study conducted by Tapio Paljärvi et al., titled “Cardiovascular mortality in bipolar disorder: population-based cohort study,” sheds crucial light on the alarming rates of cardiovascular disease mortality among individuals with bipolar disorder.<span><sup>1</sup></span> The findings underscore a significant excess in mortality due to various cardiovascular causes, including coronary artery disease, cardiomyopathy, and hypertensive heart disease. This issue is part of a larger problem for people with severe mental illnesses (SMI), such as schizophrenia, bipolar disorders, and major depressive disorders. Individuals with SMI die up to 15 years earlier than the general population, and around 70% of this mortality gap is due to physical disorders.<span><sup>2</sup></span> Increased risk of physical disorders in those with mental disorders is due to reduced access to adequate physical health monitoring, care and prevention,<span><sup>3-5</sup></span> increased risk of adverse health behaviors<span><sup>6</sup></span> such as sedentary behavior, poor diet, and smoking, comorbid substance abuse, and side effects of psychiatric medications.<span><sup>7</sup></span></p><p>Despite the availability of clinical practice guidelines and evidence-based interventions aimed at reducing excess mortality rates due to physical comorbidities in persons with SMI, the problem still persists. There is a crucial need to better understand how to implement clinical practice guidelines and evidence-based interventions successfully in the real world. Individuals with comorbid mental and physical disorders face specific challenges in service organization, requiring complex treatment and intense resource utilization.<span><sup>8</sup></span> The management of multimorbidity is recognized to be complex, with a high treatment burden in terms of understanding and self-managing the conditions, attending multiple appointments, and managing complex drug regimens.<span><sup>9</sup></span> Evidence suggests that a key part of the problem is the lack of integration of care across service settings. There is major fragmentation in how care is coordinated between family doctors and hospitals, between physical and mental health care, and across health and social care. As proposed by Tapio Paljärvi et al.<span><sup>1</sup></span> and other authors,<span><sup>10</sup></span> person-centered and integrated care models are a critical step to support effective implementation approaches to translate evidence into practice.</p><p>However, despite local and innovative experiences in several countries, the large-scale implementation of integrated care models faces numerous barriers and conservatisms. These obstacles hinder progress and maintain the status quo, perpetuating major health inequalities in individuals with SMI. A call for action in Europe, similar to initiatives already established in the United States,<span><sup>11</sup></span> is necessary. Currently, there are two main types ","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 2","pages":"53-55"},"PeriodicalIF":5.3,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13722","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141453796","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}
Megan M. Hare, Anita Barber, Scott A. Shaffer, Kristina M. Deligiannidis
Background
Perinatal depression (PND) is a debilitating condition affecting maternal well-being and child development. Allopregnanolone (ALLO) is important to perinatal neuroplasticity, however its relationship with depression severity and postpartum structural brain volume is unknown.
Method
We examined perinatal temporal dynamics and bidirectional associations between ALLO and depression severity and the association between these variables and postpartum gray matter volume, using a random intercept cross-lagged panel model.
Results
We identified a unidirectional predictive relationship between PND severity and ALLO concentration, suggesting greater depression severity early in the perinatal period may contribute to subsequent changes in ALLO concentration (β = 0.26, p = 0.009), while variations in ALLO levels during the perinatal period influences the development and severity of depressive symptoms later in the postpartum period (β = 0.38, p = 0.007). Antepartum depression severity (Visit 2, β = 0.35, p = 0.004), ALLO concentration (Visit 2, β = 0.37, p = 0.001), and postpartum depression severity (Visit 3, β = 0.39, p = 0.031), each predicted the right anterior cingulate volume. Antepartum ALLO concentration (Visit 2, β = 0.29, p = 0.001) predicted left suborbital sulcus volume. Antepartum depression severity (Visit 1, β = 0.39, p = 0.006 and Visit 2, β = 0.48, p < 0.001) predicted the right straight gyrus volume. Postpartum depression severity (Visit 3, β = 0.36, p = 0.001) predicted left middle-posterior cingulate volume.
Conclusion
These results provide the first evidence of bidirectional associations between perinatal ALLO and depression severity with postpartum gray matter volume.
{"title":"Bidirectional associations between perinatal allopregnanolone and depression severity with postpartum gray matter volume in adult women","authors":"Megan M. Hare, Anita Barber, Scott A. Shaffer, Kristina M. Deligiannidis","doi":"10.1111/acps.13723","DOIUrl":"10.1111/acps.13723","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Perinatal depression (PND) is a debilitating condition affecting maternal well-being and child development. Allopregnanolone (ALLO) is important to perinatal neuroplasticity, however its relationship with depression severity and postpartum structural brain volume is unknown.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>We examined perinatal temporal dynamics and bidirectional associations between ALLO and depression severity and the association between these variables and postpartum gray matter volume, using a random intercept cross-lagged panel model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified a unidirectional predictive relationship between PND severity and ALLO concentration, suggesting greater depression severity early in the perinatal period may contribute to subsequent changes in ALLO concentration (<i>β</i> = 0.26, <i>p</i> = 0.009), while variations in ALLO levels during the perinatal period influences the development and severity of depressive symptoms later in the postpartum period (<i>β</i> = 0.38, <i>p</i> = 0.007). Antepartum depression severity (Visit 2, <i>β</i> = 0.35, <i>p</i> = 0.004), ALLO concentration (Visit 2, <i>β</i> = 0.37, <i>p</i> = 0.001), and postpartum depression severity (Visit 3, <i>β</i> = 0.39, <i>p</i> = 0.031), each predicted the right anterior cingulate volume. Antepartum ALLO concentration (Visit 2, <i>β</i> = 0.29, <i>p</i> = 0.001) predicted left suborbital sulcus volume. Antepartum depression severity (Visit 1, <i>β</i> = 0.39, <i>p</i> = 0.006 and Visit 2, <i>β</i> = 0.48, <i>p</i> < 0.001) predicted the right straight gyrus volume. Postpartum depression severity (Visit 3, <i>β</i> = 0.36, <i>p</i> = 0.001) predicted left middle-posterior cingulate volume.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>These results provide the first evidence of bidirectional associations between perinatal ALLO and depression severity with postpartum gray matter volume.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"150 5","pages":"404-415"},"PeriodicalIF":5.3,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141453795","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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