M. Piras, C. Dubath, M. Gholam, N. Laaboub, C. Grosu, F. Gamma, A. Solida, K. Plessen, A. von Gunten, Philippe Conus, C. Eap
Background: Atypical antipsychotics can induce metabolic side effects, but whether they are dose-dependent remains unclear. Objective: To assess the effect of risperidone and/or paliperidone dosing on weight gain and blood lipids, glucose, and blood pressure alterations. Methods: Data for 438 patients taking risperidone and/or its metabolite (paliperidone) for up to 1 year were obtained between 2007 and 2018 from a longitudinal study monitoring metabolic parameters. Results: For each milligram increase in dose, we observed a weight increase of 0.16% at 1 month of treatment (P = .002) and increases of 0.29%, 0.21%, and 0.25% at 3, 6, and 12 months of treatment, respectively (P < .001 for each). Moreover, dose increases of 1 mg raised the risk of a ≥ 5% weight gain after 1 month (OR = 1.18; P = .012), a strong predictor of important weight gain in the long term. When we split the cohort into age categories, the dose had an effect on weight change after 3 months of treatment (up to 1.63%, P = .008) among adolescents (age ≤ 17 years), at 3 (0.13%, P = .013) and 12 (0.13%, P = .036) months among adults (age > 17 and < 65 years), and at each timepoint (up to 1.58%, P < .001) among older patients (age ≥ 65 years). In the whole cohort, for each additional milligram we observed a 0.05 mmol/L increase in total cholesterol (P = .018) and a 0.04 mmol/L increase in LDL cholesterol (P = .011) after 1 year. Conclusions: Although of small amplitude, these results show an effect of daily risperidone dose on weight gain and blood cholesterol levels. Particular attention should be given to the decision of increasing the drug dose, and minimum effective dosages should be preferred.
{"title":"Daily Dose Effects of Risperidone on Weight and Other Metabolic Parameters: A Prospective Cohort Study.","authors":"M. Piras, C. Dubath, M. Gholam, N. Laaboub, C. Grosu, F. Gamma, A. Solida, K. Plessen, A. von Gunten, Philippe Conus, C. Eap","doi":"10.4088/jcp.21m14110","DOIUrl":"https://doi.org/10.4088/jcp.21m14110","url":null,"abstract":"Background: Atypical antipsychotics can induce metabolic side effects, but whether they are dose-dependent remains unclear.\u0000Objective: To assess the effect of risperidone and/or paliperidone dosing on weight gain and blood lipids, glucose, and blood pressure alterations.\u0000Methods: Data for 438 patients taking risperidone and/or its metabolite (paliperidone) for up to 1 year were obtained between 2007 and 2018 from a longitudinal study monitoring metabolic parameters.\u0000Results: For each milligram increase in dose, we observed a weight increase of 0.16% at 1 month of treatment (P = .002) and increases of 0.29%, 0.21%, and 0.25% at 3, 6, and 12 months of treatment, respectively (P < .001 for each). Moreover, dose increases of 1 mg raised the risk of a ≥ 5% weight gain after 1 month (OR = 1.18; P = .012), a strong predictor of important weight gain in the long term. When we split the cohort into age categories, the dose had an effect on weight change after 3 months of treatment (up to 1.63%, P = .008) among adolescents (age ≤ 17 years), at 3 (0.13%, P = .013) and 12 (0.13%, P = .036) months among adults (age > 17 and < 65 years), and at each timepoint (up to 1.58%, P < .001) among older patients (age ≥ 65 years). In the whole cohort, for each additional milligram we observed a 0.05 mmol/L increase in total cholesterol (P = .018) and a 0.04 mmol/L increase in LDL cholesterol (P = .011) after 1 year.\u0000Conclusions: Although of small amplitude, these results show an effect of daily risperidone dose on weight gain and blood cholesterol levels. Particular attention should be given to the decision of increasing the drug dose, and minimum effective dosages should be preferred.","PeriodicalId":20409,"journal":{"name":"Primary care companion to the Journal of clinical psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85374147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Zeifman, Dengdeng Yu, Nikhita Singhal, Guan Wang, Sandeep M. Nayak, C. Weissman
{"title":"Corrigendum to \"Decreases in Suicidality Following Psychedelic Therapy: A Meta-Analysis of Individual Patient Data Across Clinical Trials\".","authors":"R. Zeifman, Dengdeng Yu, Nikhita Singhal, Guan Wang, Sandeep M. Nayak, C. Weissman","doi":"10.4088/jcp.22l14505","DOIUrl":"https://doi.org/10.4088/jcp.22l14505","url":null,"abstract":"","PeriodicalId":20409,"journal":{"name":"Primary care companion to the Journal of clinical psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73337804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Prioritizing Patient Preferences: A Practical Guide for Tailoring Treatment Choices in Interventional Psychiatry.","authors":"Joshua Berman, A. J. Ambrose","doi":"10.4088/JCP.22ac14436","DOIUrl":"https://doi.org/10.4088/JCP.22ac14436","url":null,"abstract":"","PeriodicalId":20409,"journal":{"name":"Primary care companion to the Journal of clinical psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76458590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Basma Akrout Brizard, P. Courtet, I. Jaussent, J. López-Castromán, M. Leboyer, J. Kahn, C. Baeza-Velasco
Background: Suicidal behaviors are known to be increased in people with epilepsy compared to the general population. However, few studies have explored the frequency of epilepsy in a large sample of suicide attempters, and scarce data exist about differences and similarities between epileptic attempters (EA) and nonepileptic attempters (NEA). The aim of this study was to explore the frequency of epilepsy as well as psychopathological and somatic factors among suicide attempters. Methods: In this multicenter cross-sectional study, 1,229 adults hospitalized for attempted suicide were included during the period between July 2001 and December 2015. They were assessed with the Mini-International Neuropsychiatric Interview for DSM-IV Axis I mental disorders. Data concerning sociodemographic and somatic diseases, including epilepsy, were collected. Results: Sixty-five patients (5.3%) had epilepsy. EA had significantly fewer mean ± SD years of education compared with NEA (11.2 ± 3.2 vs 12.1 ± 2.9; P = .011) as well as increased rates of head trauma (29.2% for EA vs 16.2% for NEA; P = .007), antiepileptic use (35.4% for EA vs 23.8% for NEA; P = .036), and lifetime substance abuse and/or dependance (49.2% for EA vs 36.1% for NEA; P = .034). Multivariate analyses showed that years of education, head trauma, and panic disorder with agoraphobia predicted belonging to the EA group. Conclusions: These results suggest that epilepsy is overrepresented among suicide attempters. Few psychopathological differences as well as differences in somatic comorbidities except head trauma were observed between EA and NEA in this sample. These results contribute to draw a clinical profile of people with epilepsy in the population of suicide attempters.
{"title":"Epilepsy and Associated Factors Among Adults Hospitalized for Attempted Suicide.","authors":"Basma Akrout Brizard, P. Courtet, I. Jaussent, J. López-Castromán, M. Leboyer, J. Kahn, C. Baeza-Velasco","doi":"10.4088/JCP.21m14207","DOIUrl":"https://doi.org/10.4088/JCP.21m14207","url":null,"abstract":"Background: Suicidal behaviors are known to be increased in people with epilepsy compared to the general population. However, few studies have explored the frequency of epilepsy in a large sample of suicide attempters, and scarce data exist about differences and similarities between epileptic attempters (EA) and nonepileptic attempters (NEA). The aim of this study was to explore the frequency of epilepsy as well as psychopathological and somatic factors among suicide attempters.\u0000Methods: In this multicenter cross-sectional study, 1,229 adults hospitalized for attempted suicide were included during the period between July 2001 and December 2015. They were assessed with the Mini-International Neuropsychiatric Interview for DSM-IV Axis I mental disorders. Data concerning sociodemographic and somatic diseases, including epilepsy, were collected.\u0000Results: Sixty-five patients (5.3%) had epilepsy. EA had significantly fewer mean ± SD years of education compared with NEA (11.2 ± 3.2 vs 12.1 ± 2.9; P = .011) as well as increased rates of head trauma (29.2% for EA vs 16.2% for NEA; P = .007), antiepileptic use (35.4% for EA vs 23.8% for NEA; P = .036), and lifetime substance abuse and/or dependance (49.2% for EA vs 36.1% for NEA; P = .034). Multivariate analyses showed that years of education, head trauma, and panic disorder with agoraphobia predicted belonging to the EA group.\u0000Conclusions: These results suggest that epilepsy is overrepresented among suicide attempters. Few psychopathological differences as well as differences in somatic comorbidities except head trauma were observed between EA and NEA in this sample. These results contribute to draw a clinical profile of people with epilepsy in the population of suicide attempters.","PeriodicalId":20409,"journal":{"name":"Primary care companion to the Journal of clinical psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84747746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Tomfohr-Madsen, L. Roos, Joshua W. Madsen, Jennifer Leason, D. Singla, Jaime Charlebois, Patricia Tomasi, K. Chaput
{"title":"Peer-Led Psychotherapy","authors":"L. Tomfohr-Madsen, L. Roos, Joshua W. Madsen, Jennifer Leason, D. Singla, Jaime Charlebois, Patricia Tomasi, K. Chaput","doi":"10.4088/jcp.21lr14366","DOIUrl":"https://doi.org/10.4088/jcp.21lr14366","url":null,"abstract":"","PeriodicalId":20409,"journal":{"name":"Primary care companion to the Journal of clinical psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83918082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Peer-Delivered Psychotherapy for Postpartum Depression: Has Its Time Come? Not Yet-Reply to Tomfohr-Madsen et al.","authors":"Michael W O'Hara","doi":"10.4088/jcp.21lr14366a","DOIUrl":"https://doi.org/10.4088/jcp.21lr14366a","url":null,"abstract":"","PeriodicalId":20409,"journal":{"name":"Primary care companion to the Journal of clinical psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79115838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Davis, J. Schein, M. Cloutier, P. Gagnon-Sanschagrin, J. Maitland, A. Urganus, A. Guerin, P. Lefebvre, C. Houle
Objective: To estimate the economic burden of posttraumatic stress disorder (PTSD) in the United States civilian and military populations from a societal perspective. Methods: A prevalence-based and human capital approach was used to estimate the total excess costs of PTSD in 2018 from insurance claims data, academic literature, and governmental publications. Excess direct health care costs (pharmacy, medical), direct non-health care costs (research and training, substance use, psychotherapy, homelessness, disability), and indirect costs (unemployment, productivity loss, caregiving, premature mortality) associated with PTSD were compared between adults with PTSD and adults without PTSD, or the general population if information was not available for adults without PTSD. Results: The total excess economic burden of PTSD in the US was estimated at $232.2 billion for 2018 ($19,630 per individual with PTSD). Total excess costs were $189.5 billion (81.6%) in the civilian population and $42.7 billion (18.4%) in the military population, corresponding to $18,640 and $25,684 per individual with PTSD in the civilian and military populations, respectively. In the civilian population, the excess burden was driven by direct health care ($66.0 billion) and unemployment ($42.7 billion) costs. In the military population, the excess burden was driven by disability ($17.8 billion) and direct health care ($10.1 billion) costs. Conclusions: The economic burden of PTSD goes beyond direct health care costs and has been found to rival costs for other costly mental health conditions. Increased awareness of PTSD, development of more effective therapies, and expansion of evidence-based interventions may be warranted to reduce the large clinical and economic burden of PTSD.
{"title":"The Economic Burden of Posttraumatic Stress Disorder in the United States From a Societal Perspective.","authors":"L. Davis, J. Schein, M. Cloutier, P. Gagnon-Sanschagrin, J. Maitland, A. Urganus, A. Guerin, P. Lefebvre, C. Houle","doi":"10.4088/jcp.21m14116","DOIUrl":"https://doi.org/10.4088/jcp.21m14116","url":null,"abstract":"Objective: To estimate the economic burden of posttraumatic stress disorder (PTSD) in the United States civilian and military populations from a societal perspective.\u0000Methods: A prevalence-based and human capital approach was used to estimate the total excess costs of PTSD in 2018 from insurance claims data, academic literature, and governmental publications. Excess direct health care costs (pharmacy, medical), direct non-health care costs (research and training, substance use, psychotherapy, homelessness, disability), and indirect costs (unemployment, productivity loss, caregiving, premature mortality) associated with PTSD were compared between adults with PTSD and adults without PTSD, or the general population if information was not available for adults without PTSD.\u0000Results: The total excess economic burden of PTSD in the US was estimated at $232.2 billion for 2018 ($19,630 per individual with PTSD). Total excess costs were $189.5 billion (81.6%) in the civilian population and $42.7 billion (18.4%) in the military population, corresponding to $18,640 and $25,684 per individual with PTSD in the civilian and military populations, respectively. In the civilian population, the excess burden was driven by direct health care ($66.0 billion) and unemployment ($42.7 billion) costs. In the military population, the excess burden was driven by disability ($17.8 billion) and direct health care ($10.1 billion) costs.\u0000Conclusions: The economic burden of PTSD goes beyond direct health care costs and has been found to rival costs for other costly mental health conditions. Increased awareness of PTSD, development of more effective therapies, and expansion of evidence-based interventions may be warranted to reduce the large clinical and economic burden of PTSD.","PeriodicalId":20409,"journal":{"name":"Primary care companion to the Journal of clinical psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83540602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Barnett, J. Biederman, A. Doyle, J. Hess, M. DiSalvo, S. Faraone
Objective: Mood disorders often co-occur with attention-deficit/hyperactive disorder (ADHD), disruptive behavior disorders (DBDs), and aggression. We aimed to determine if polygenic risk scores (PRSs) based on external genome-wide association studies (GWASs) of these disorders could improve genetic identification of mood disorders. Methods: We combined 6 independent family studies that had genetic data and diagnoses for mood disorders that were made using different editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM). We identified mood disorders, either concurrently or in the future, in participants between 6 and 17 years of age using PRSs calculated using summary statistics of GWASs for ADHD, ADHD with DBD, major depressive disorder (MDD), bipolar disorder (BPD), and aggression to compute PRSs. Results: In our sample of 485 youths, 356 (73%) developed a subthreshold or full mood disorder and 129 (27%) did not. The cross-validated mean areas under the receiver operating characteristic curve (AUCs) for the 7 models identifying participants with any mood disorder ranged from 0.552 in the base model of age and sex to 0.648 in the base model + all 5 PRSs. When included in the base model individually, the ADHD PRS (OR = 1.65, P < .001), Aggression PRS (OR = 1.27, P = .02), and MDD PRS (OR = 1.23, P = .047) were significantly associated with the development of any mood disorder. Conclusions: Using PRSs for ADHD, MDD, BPD, DBDs, and aggression, we could modestly identify the presence of mood disorders. These findings extend evidence for transdiagnostic genetic components of psychiatric illness and demonstrate that PRSs calculated using traditional diagnostic boundaries can be useful within a transdiagnostic framework.
目的:情绪障碍通常与注意缺陷/多动障碍(ADHD)、破坏性行为障碍(DBDs)和攻击行为共存。我们的目的是确定基于这些疾病的外部全基因组关联研究(GWASs)的多基因风险评分(prs)是否可以改善情绪障碍的遗传鉴定。方法:我们结合了6个独立的家庭研究，这些研究有基因数据，并使用不同版本的《精神障碍诊断与统计手册》(DSM)对情绪障碍进行诊断。我们通过对ADHD、ADHD合并DBD、重度抑郁障碍(MDD)、双相情感障碍(BPD)和攻击行为的GWASs汇总统计计算PRSs，确定了6 - 17岁参与者的并发或未来情绪障碍。结果:在我们的485名青少年样本中，356名(73%)发展为阈下或完全情绪障碍，129名(27%)没有。对于识别任何情绪障碍参与者的7个模型，交叉验证的受试者工作特征曲线(auc)下的平均面积范围从年龄和性别基本模型的0.552到基本模型+所有5个PRSs的0.648。当单独纳入基础模型时，ADHD PRS (OR = 1.65, P < .001)、攻击性PRS (OR = 1.27, P = .02)和MDD PRS (OR = 1.23, P = .047)与任何情绪障碍的发展均显著相关。结论:使用PRSs治疗ADHD、MDD、BPD、dbd和攻击性，我们可以适度地识别情绪障碍的存在。这些发现扩展了精神疾病的跨诊断遗传成分的证据，并证明使用传统诊断边界计算的PRSs在跨诊断框架内是有用的。
{"title":"Identifying Pediatric Mood Disorders From Transdiagnostic Polygenic Risk Scores: A Study of Children and Adolescents.","authors":"E. Barnett, J. Biederman, A. Doyle, J. Hess, M. DiSalvo, S. Faraone","doi":"10.4088/jcp.21m14180","DOIUrl":"https://doi.org/10.4088/jcp.21m14180","url":null,"abstract":"Objective: Mood disorders often co-occur with attention-deficit/hyperactive disorder (ADHD), disruptive behavior disorders (DBDs), and aggression. We aimed to determine if polygenic risk scores (PRSs) based on external genome-wide association studies (GWASs) of these disorders could improve genetic identification of mood disorders.\u0000Methods: We combined 6 independent family studies that had genetic data and diagnoses for mood disorders that were made using different editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM). We identified mood disorders, either concurrently or in the future, in participants between 6 and 17 years of age using PRSs calculated using summary statistics of GWASs for ADHD, ADHD with DBD, major depressive disorder (MDD), bipolar disorder (BPD), and aggression to compute PRSs.\u0000Results: In our sample of 485 youths, 356 (73%) developed a subthreshold or full mood disorder and 129 (27%) did not. The cross-validated mean areas under the receiver operating characteristic curve (AUCs) for the 7 models identifying participants with any mood disorder ranged from 0.552 in the base model of age and sex to 0.648 in the base model + all 5 PRSs. When included in the base model individually, the ADHD PRS (OR = 1.65, P < .001), Aggression PRS (OR = 1.27, P = .02), and MDD PRS (OR = 1.23, P = .047) were significantly associated with the development of any mood disorder.\u0000Conclusions: Using PRSs for ADHD, MDD, BPD, DBDs, and aggression, we could modestly identify the presence of mood disorders. These findings extend evidence for transdiagnostic genetic components of psychiatric illness and demonstrate that PRSs calculated using traditional diagnostic boundaries can be useful within a transdiagnostic framework.","PeriodicalId":20409,"journal":{"name":"Primary care companion to the Journal of clinical psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75770457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Peter J. Na, Jennifer Scodes, M. Fishman, J. Rotrosen, E. Nunes
Objective: The concept of "deaths of despair" (suicide, overdose, and alcohol-related liver disease) highlights the importance of detecting and understanding the course of co-occurring depression in patients with opioid use disorder (OUD). Methods: In a 24-week trial of 570 patients with DSM-5-defined OUD randomized to buprenorphine-naloxone (BUP-NX) or extended-release naltrexone (XR-NTX) from January 2014 to January 2017, the prevalence of depression (assessed with Hamilton Depression Rating Scale [HDRS]) was examined at baseline and after 4 weeks of treatment, and the association between depression and relapse to opioid use was explored using logistic regression. Results: Among 473 patients who initiated medication, 14.2% (67/473) had moderate/severe depression (HDRS ≥ 17) and 34.9% (165/473) had mild depression (8 ≤ HDRS ≤ 16) at baseline. Patients with moderate/severe depression had more frequent histories of anxiety disorders and suicidal ideation. After 4 weeks of treatment, approximately two-thirds of participants with depression either responded (HDRS reduced ≥ 50% from baseline) or remitted (HDRS ≤ 7), with no significant differences between medication treatment groups. Those with moderate/severe depression were less likely to remit (52.8%; 28/53) compared to those with mild depression (76%; 98/129) at week 4 (OR = 0.43, 95% CI = 0.21-0.89, P = .02). Further, those who remitted at week 4 had lower, but not significantly different, risk of relapse to opioids compared to those who did not remit (OR = 0.55, 95% CI = 0.28-1.08, P = .08). Conclusions: Depression is common among patients with OUD and often remits after initiation of BUP-NX or XR-NTX, although when it does not remit it may be associated with worse opioid use outcome. Depression should be screened and followed during initiation of treatment and, when it does not remit, specific depression treatment should be considered. Trial Registration: ClinicalTrials.gov identifier: NCT02032433.
目的:“绝望死亡”(自杀、服药过量和酒精相关肝病)的概念强调了检测和了解阿片类药物使用障碍(OUD)患者共发生抑郁过程的重要性。方法:在2014年1月至2017年1月的一项为期24周的试验中，570名患有dsm -5定义的OUD患者随机分配到丁丙诺啡-纳洛酮(BUP-NX)或缓释纳曲酮(XR-NTX)，在基线和治疗4周后检查抑郁患病率(用汉密尔顿抑郁评定量表[HDRS]评估)，并使用logistic回归探讨抑郁与阿片类药物复发之间的关系。结果:在473例开始用药的患者中，14.2%(67/473)的患者在基线时有中度/重度抑郁(HDRS≥17)，34.9%(165/473)的患者有轻度抑郁(8≤HDRS≤16)。中度/重度抑郁症患者有更频繁的焦虑障碍和自杀意念史。治疗4周后，大约三分之二的抑郁症患者有反应(HDRS较基线降低≥50%)或缓解(HDRS≤7)，药物治疗组之间无显著差异。中度/重度抑郁症患者缓解抑郁的可能性较小(52.8%;28/53)，而轻度抑郁症患者(76%;98/129)在周4(或= 0.43,95% CI = 0.21 - -0.89, P = .02点)。此外，在第4周缓解的患者与未缓解的患者相比，阿片类药物复发的风险较低，但无显著差异(OR = 0.55, 95% CI = 0.28-1.08, P = .08)。结论:抑郁症在OUD患者中很常见，并且在开始BUP-NX或XR-NTX后通常会缓解，尽管当它没有缓解时可能与更糟糕的阿片类药物使用结果相关。抑郁症应在治疗开始时进行筛查和随访，如果没有缓解，应考虑进行特定的抑郁症治疗。试验注册:ClinicalTrials.gov标识符:NCT02032433。
{"title":"Co-occurring Depression and Suicidal Ideation in Opioid Use Disorder: Prevalence and Response During Treatment With Buprenorphine-Naloxone and Injection Naltrexone.","authors":"Peter J. Na, Jennifer Scodes, M. Fishman, J. Rotrosen, E. Nunes","doi":"10.4088/jcp.21m14140","DOIUrl":"https://doi.org/10.4088/jcp.21m14140","url":null,"abstract":"Objective: The concept of \"deaths of despair\" (suicide, overdose, and alcohol-related liver disease) highlights the importance of detecting and understanding the course of co-occurring depression in patients with opioid use disorder (OUD).\u0000Methods: In a 24-week trial of 570 patients with DSM-5-defined OUD randomized to buprenorphine-naloxone (BUP-NX) or extended-release naltrexone (XR-NTX) from January 2014 to January 2017, the prevalence of depression (assessed with Hamilton Depression Rating Scale [HDRS]) was examined at baseline and after 4 weeks of treatment, and the association between depression and relapse to opioid use was explored using logistic regression.\u0000Results: Among 473 patients who initiated medication, 14.2% (67/473) had moderate/severe depression (HDRS ≥ 17) and 34.9% (165/473) had mild depression (8 ≤ HDRS ≤ 16) at baseline. Patients with moderate/severe depression had more frequent histories of anxiety disorders and suicidal ideation. After 4 weeks of treatment, approximately two-thirds of participants with depression either responded (HDRS reduced ≥ 50% from baseline) or remitted (HDRS ≤ 7), with no significant differences between medication treatment groups. Those with moderate/severe depression were less likely to remit (52.8%; 28/53) compared to those with mild depression (76%; 98/129) at week 4 (OR = 0.43, 95% CI = 0.21-0.89, P = .02). Further, those who remitted at week 4 had lower, but not significantly different, risk of relapse to opioids compared to those who did not remit (OR = 0.55, 95% CI = 0.28-1.08, P = .08).\u0000Conclusions: Depression is common among patients with OUD and often remits after initiation of BUP-NX or XR-NTX, although when it does not remit it may be associated with worse opioid use outcome. Depression should be screened and followed during initiation of treatment and, when it does not remit, specific depression treatment should be considered.\u0000Trial Registration: ClinicalTrials.gov identifier: NCT02032433.","PeriodicalId":20409,"journal":{"name":"Primary care companion to the Journal of clinical psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75639822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Research Design and Overfitting: Reply to Jelovac and McLoughlin.","authors":"C. Andrade","doi":"10.4088/jcp.21lr14371a","DOIUrl":"https://doi.org/10.4088/jcp.21lr14371a","url":null,"abstract":"","PeriodicalId":20409,"journal":{"name":"Primary care companion to the Journal of clinical psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86842705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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