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Effects of Direct-To-Consumer Advertising on Patient Prescription Requests and Physician Prescribing: A Systematic Review of Psychiatry-Relevant Studies.

Effects of Direct-To-Consumer Advertising on Patient Prescription Requests and Physician Prescribing: A Systematic Review of Psychiatry-Relevant Studies.

J Clin Psychiatry. 2016 Sep 13;

Authors: Becker SJ, Midoun MM

Abstract
OBJECTIVE: To systematically analyze the effects of direct-to-consumer advertising (DTCA) on patient requests for medication and physician prescribing across psychiatry-relevant studies.
DATA SOURCES: MEDLINE, PsycINFO, Thomson Reuters' ISI Web of Knowledge, and Google Scholar were searched (1999-2014) using variations of the terms direct-to-consumer advertising and psychiatric. Reference lists and an online repository of DTCA manuscripts were also scrutinized.
STUDY SELECTION: English-language studies collecting data at the point of service, focusing on or including psychiatric medication, and assessing the effects of DTCA on patient and/or physician behavior were included. Of 989 articles identified, 69 received full-text review. Four studies across 5 manuscripts met inclusion criteria.
DATA EXTRACTION: Data were extracted on participants, study design, methodological quality, and results. Methodological quality of individual studies was assessed using adapted criteria from the Effective Public Health Practice Project. Confidence in conclusions across studies was determined using principles from the well-established GRADE system.
FINDINGS: Due to lack of replication across strong randomized controlled trials (RCTs), no conclusions merited high confidence. With moderate confidence, we concluded that DTCA requests (1) are granted most of the time (1 RCT, 3 observational), (2) prompt higher prescribing volume (1 RCT, 1 observational), (3) promote greater adherence to minimally acceptable treatment guidelines for patients with depression (1 RCT), and (4) stimulate overprescribing among patients with an adjustment disorder (1 RCT).
CONCLUSIONS: Findings suggest that DTCA requests are typically accommodated, promote higher prescribing volume, and have competing effects on treatment quality. More methodologically strong studies are needed to increase confidence in conclusions.

PMID: 27631149 [PubMed - as supplied by publisher]




Probable Posttraumatic Stress Disorder in the US Veteran Population According to DSM-5: Results From the National Health and Resilience in Veterans Study.

Probable Posttraumatic Stress Disorder in the US Veteran Population According to DSM-5: Results From the National Health and Resilience in Veterans Study.

J Clin Psychiatry. 2016 Sep 13;

Authors: Wisco BE, Marx BP, Miller MW, Wolf EJ, Mota NP, Krystal JH, Southwick SM, Pietrzak RH

Abstract
OBJECTIVE: With the publication of DSM-5, important changes were made to the diagnostic criteria for posttraumatic stress disorder (PTSD), including the addition of 3 new symptoms. Some have argued that these changes will further increase the already high rates of comorbidity between PTSD and other psychiatric disorders. This study examined the prevalence of DSM-5 PTSD, conditional probability of PTSD given certain trauma exposures, endorsement of specific PTSD symptoms, and psychiatric comorbidities in the US veteran population.
METHODS: Data were analyzed from the National Health and Resilience in Veterans Study (NHRVS), a Web-based survey of a cross-sectional, nationally representative, population-based sample of 1,484 US veterans, which was fielded from September through October 2013. Probable PTSD was assessed using the PTSD Checklist-5.
RESULTS: The weighted lifetime and past-month prevalence of probable DSM-5 PTSD was 8.1% (SE = 0.7%) and 4.7% (SE = 0.6%), respectively. Conditional probability of lifetime probable PTSD ranged from 10.1% (sudden death of close family member or friend) to 28.0% (childhood sexual abuse). The DSM-5 PTSD symptoms with the lowest prevalence among veterans with probable PTSD were trauma-related amnesia and reckless and self-destructive behavior. Probable PTSD was associated with increased odds of mood and anxiety disorders (OR = 7.6-62.8, P < .001), substance use disorders (OR = 3.9-4.5, P < .001), and suicidal behaviors (OR = 6.7-15.1, P < .001).
CONCLUSIONS: In US veterans, the prevalence of DSM-5 probable PTSD, conditional probability of probable PTSD, and odds of psychiatric comorbidity were similar to prior findings with DSM-IV-based measures; we found no evidence that changes in DSM-5 increase psychiatric comorbidity. Results underscore the high rates of exposure to both military and nonmilitary trauma and the high public health burden of DSM-5 PTSD and comorbid conditions in veterans.

PMID: 27631148 [PubMed - as supplied by publisher]




Disability and Functioning of Patients Who Use Psychiatric Hospital Emergency Services.

Disability and Functioning of Patients Who Use Psychiatric Hospital Emergency Services.

J Clin Psychiatry. 2016 Sep 13;

Authors: Shield KD, Kurdyak P, Shuper PA, Rehm J

Abstract
OBJECTIVE: First, to compare the level of disability and functioning of patients who access psychiatric emergency services by diagnosis and service use frequency. Second, to compare patients who access psychiatric emergency services to the general population in terms of demographics and the level of disability and functioning.
METHODS: Data from 420 patients were obtained by time-based sampling from August 2011 to February 2012 in the emergency department of a psychiatric hospital that provides services to adolescents and adults. The 2011 and 2012 Centre for Addiction and Mental Health Monitor surveys were used as a representative adult general population sample. Disability and functioning were measured using the World Health Organization Disability Assessment Schedule (WHODAS).
RESULTS: Variation in WHODAS scores among psychiatric emergency patients was observed within but not between diagnostic categories and within frequency of use of these services categories. Psychiatric emergency patients had a mean WHODAS score of 38.0, significantly higher (P < .001) than the mean score of 5.0 for the general population; however, there was overlap in the distribution of WHODAS scores. Compared to the general population, psychiatric emergency patients were more likely to be men, younger in age, never married, and unemployed or a student.
CONCLUSIONS: Psychiatric emergency patients are demographically different when compared to the general population. Furthermore, since disability and functioning are highly variable within but not between psychiatric diagnostic categories, data on disability and functioning should be collected for psychiatric emergency patients, in addition to diagnosis data, to more accurately align patients with the appropriate intensity of services.

PMID: 27631147 [PubMed - as supplied by publisher]




Tic-Related Versus Tic-Free Obsessive-Compulsive Disorder: Clinical Picture and 2-Year Natural Course.

Tic-Related Versus Tic-Free Obsessive-Compulsive Disorder: Clinical Picture and 2-Year Natural Course.

J Clin Psychiatry. 2016 Sep 13;

Authors: de Vries FE, Cath DC, Hoogendoorn AW, van Oppen P, Glas G, Veltman DJ, van den Heuvel OA, van Balkom AJ

Abstract
OBJECTIVE: The tic-related subtype of obsessive-compulsive disorder (OCD) has a distinct clinical profile. The course of tic-related OCD has previously been investigated in treatment studies, with inconclusive results. This study aimed to compare clinical profiles between tic-related and tic-free OCD patients and to establish the influence of tics on the 2-year natural course in adult OCD patients.
METHODS: Within the Netherlands OCD Association cohort, 377 patients with a current DSM-IV diagnosis of OCD were divided into a tic-related group (28%) and a tic-free group and compared on clinical variables with t tests or χ² tests. Linear mixed-model analyses were used to compare the 2-year course between the groups, with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) as primary outcome measure. Data were collected from 2005 to 2007 and from 2007 to 2009.
RESULTS: Compared to patients with tic-free OCD, those with tic-related OCD reported earlier disease onset (P = .009) and more symmetry/ordering symptoms (P = .002). Overall symptom severity was similar in both groups. Patients with tic-related OCD reported increased traits of attention-deficit hyperactivity (P < .001) and autism (P = .005) compared to the tic-free OCD group. Clinical improvement at 2-year follow-up (mean = 5.3-point decrease on the Y-BOCS, P < .001, 95% CI = 4.3 to 6.3) was not significantly moderated by tic status (P = .24). This remained unchanged after correcting for baseline differences.
CONCLUSIONS: Tics do not critically affect the 2-year course of adult OCD, but tic-related OCD shows differences from tic-free OCD, such as early onset and increased autism and ADHD traits, that may indicate a neurodevelopmental subtype.

PMID: 27631146 [PubMed - as supplied by publisher]




Association Between Stigma and Depression Outcomes Among Chinese Immigrants in a Primary Care Setting.

Association Between Stigma and Depression Outcomes Among Chinese Immigrants in a Primary Care Setting.

J Clin Psychiatry. 2016 Sep 13;

Authors: Chen JA, Shapero BG, Trinh NT, Chang TE, Parkin S, Alpert JE, Fava M, Yeung AS

Abstract
OBJECTIVE: Stigma has been proposed to be a major underlying factor contributing to lower rates of mental health service utilization among racial/ethnic minorities in the United States. Yet, surprisingly little research has specifically explored associations between stigma, race/ethnicity, and psychiatric morbidity. This study aims to assess the impact of stigmatizing attitudes on depression outcomes among a psychiatrically underserved, immigrant Chinese population.
METHODS: Between 2009 and 2012, 190 Chinese immigrants with major depressive disorder as diagnosed by the Mini International Neuropsychiatric Interview were enrolled in a trial of culturally sensitive collaborative care for depression. Participants' self-reported stigma regarding their symptoms was assessed at study entry using the Explanatory Model Interview Catalogue, and depressive symptoms were assessed with the Hamilton Depression Rating Scale (HDRS) at baseline and follow-up. Hierarchical linear regression was used to assess the association between baseline stigma score and change in HDRS score, adjusting for potential confounders.
RESULTS: Higher stigma scores at baseline were significantly associated with attenuated improvement in both HDRS score and quality of life at 6 months (P < .05 for both).
CONCLUSIONS: Stigma has a directly harmful effect on depression outcomes, even after individuals have been accurately diagnosed within a culturally sensitive community health center and agreed to treatment. These results support further research into interventions targeting stigma to improve mental health outcomes among minority populations.
TRIAL REGISTRATION: This study is a secondary analysis of prospectively collected data from the randomized controlled trial registered by ClinicalTrials.gov identifier: NCT00854542.

PMID: 27631145 [PubMed - as supplied by publisher]




Functional Recovery After Postpartum Psychosis: A Prospective Longitudinal Study.

Functional Recovery After Postpartum Psychosis: A Prospective Longitudinal Study.

J Clin Psychiatry. 2016 Sep 13;

Authors: Burgerhout KM, Kamperman AM, Roza SJ, Lambregtse-Van den Berg MP, Koorengevel KM, Hoogendijk WJ, Kushner SA, Bergink V

Abstract
OBJECTIVE: Postpartum psychosis is an acute and severe mood disorder. Although the prognosis is generally good, postpartum psychosis is a highly stressful life-event presumed to have a major impact on functioning and well-being beyond the acute stage of the illness. We studied functional recovery, including psychosocial functioning and the presence of psychological distress, in patients with a recent diagnosis of postpartum psychosis.
METHODS: Seventy-eight patients with postpartum psychosis consecutively admitted for inpatient hospitalization between 2005 and 2011 were assessed 9 months postpartum. Included were patients with DSM-IV-TR diagnoses of psychotic disorder not otherwise specified, brief psychotic disorder, or mood disorder with psychotic features, each requiring the additional specifier "with postpartum onset." Functioning was assessed in 4 domains by the Longitudinal Interval Follow-up Evaluation-Range of Impaired Functioning Tool (LIFE-RIFT). Symptomatology was measured by the Brief Symptom Inventory and compared to a matched population-based cohort.
RESULTS: Nine months postpartum, 74% (58/78) of women with postpartum psychosis reported good functioning on the domains of work, interpersonal relations, recreation, and global satisfaction. Moreover, 88% (69/78) of patients with postpartum psychosis had resumed their premorbid employment and household responsibilities. Compared to the general population, patients with postpartum psychosis reported a higher burden of depression and anxiety (effect sizes r ≤ 0.14). Patients who had a relapse episode (18%) experienced considerable functional impairments across several domains.
CONCLUSIONS: Nine months postpartum, the majority of patients with postpartum psychosis reported good functional recovery. Our relatively improved functional outcomes compared to nonpostpartum onset could be attributed to the postpartum onset and/or more favorable risk factor profile.

PMID: 27631144 [PubMed - as supplied by publisher]




Behavioral Effects of Neurofeedback Compared to Stimulants and Physical Activity in Attention-Deficit/Hyperactivity Disorder: A Randomized Controlled Trial.

Behavioral Effects of Neurofeedback Compared to Stimulants and Physical Activity in Attention-Deficit/Hyperactivity Disorder: A Randomized Controlled Trial.

J Clin Psychiatry. 2016 Sep 13;

Authors: Geladé K, Janssen TW, Bink M, van Mourik R, Maras A, Oosterlaan J

Abstract
OBJECTIVE: The efficacy of neurofeedback as a treatment for attention-deficit/hyperactivity disorder (ADHD), and whether neurofeedback is a viable alternative for stimulant medication, is still an intensely debated subject. The current randomized controlled trial compared neurofeedback to (1) optimally titrated methylphenidate and (2) a semi-active control intervention, physical activity, to account for nonspecific effects.
METHODS: A multicenter 3-way parallel-group study with balanced randomization was conducted. Children with a DSM-IV-TR diagnosis of ADHD, aged 7-13 years, were randomly allocated to receive neurofeedback (n = 39), methylphenidate (n = 36), or physical activity (n = 37) over a period of 10-12 weeks. Neurofeedback comprised theta/beta training on the vertex (Cz). Physical activity consisted of moderate to vigorous intensity exercises. Neurofeedback and physical activity were balanced in terms of number (~30) and duration of sessions. A double-blind pseudorandomized placebo-controlled crossover titration procedure was used to determine an optimal dose in the methylphenidate intervention. Parent and teacher ratings on the Strengths and Difficulties Questionnaire (SDQ) and Strengths and Weaknesses of ADHD Symptoms and Normal Behavior (SWAN) were used to assess intervention outcomes. Data collection took place between September 2010 and March 2014.
RESULTS: Intention-to-treat analyses revealed an improvement in parent-reported behavior on the SDQ and the SWAN Hyperactivity/Impulsivity scale, irrespective of received intervention (ηp² = 0.21-0.22, P ≤ .001), whereas the SWAN Inattention scale revealed more improvement in children who received methylphenidate than neurofeedback and physical activity (ηp² = 0.13, P ≤ .001). Teachers reported a decrease of ADHD symptoms on all measures for methylphenidate, but not for neurofeedback or physical activity (range of ηp² = 0.14-0.29, P < .001).
CONCLUSIONS: The current study found that optimally titrated methylphenidate is superior to neurofeedback and physical activity in decreasing ADHD symptoms in children with ADHD.
TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01363544.

PMID: 27631143 [PubMed - as supplied by publisher]




Time Course and Predictors of Suicidal Ideation During Citalopram Treatment in the STAR*D Trial.

Time Course and Predictors of Suicidal Ideation During Citalopram Treatment in the STAR*D Trial.

J Clin Psychiatry. 2016 Sep 13;

Authors: Coughlin CG, Jakubovski E, Bloch MH

Abstract
OBJECTIVE: Selective serotonin reuptake inhibitors are first-line treatment for major depressive disorder (MDD), but their impact on suicidal ideation is equivocal. Our goal is to examine the time course and clinical predictors of citalopram-induced suicidal ideation during phase 1 of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial.
METHODS: Of the 4,041 subjects with DSM-IV nonpsychotic MDD in the STAR*D trial phase 1 (2001-2006), we included in our analysis 3,577 subjects who reported side-effect data and had received citalopram (20-60 mg/d) for 8-14 weeks. Suicidal ideation was reported on item 12 of the Quick Inventory of Depressive Symptomatology, Self-Report. Survival analysis and receiver operating characteristic analysis were used to assess baseline characteristics associated with emergence and worsening of suicidal ideation.
RESULTS: Suicidal ideation was more likely to occur early in citalopram treatment, with few subjects showing emergence or worsening occurring after 6 weeks of treatment. Clinical variables explained very little of the variance in worsening or emergence of suicidal ideation with citalopram treatment (generalized R² ≤ 2% in survival analysis). Being Hispanic, taking sedative medications, increased depression severity, absence of hypersomnia, and cardiac comorbidity were significantly (P ≤ .04) associated with greater likelihood of emergence of suicidal ideation in patients without suicidal ideation at baseline. Being widowed, better work performance, weight loss at baseline, and the presence of vascular or neurologic comorbidities were associated with a greater likelihood of worsening of suicidal ideation.
CONCLUSIONS: Baseline clinical variables were poor predictors of emergence or worsening of suicidal ideation. As such, increased research focusing on clinical correlates rather than clinical predictors of suicidal ideation may be useful, as intervening events may be crucial in bringing about increased suicidality.
TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00021528.

PMID: 27631142 [PubMed - as supplied by publisher]




Age at Onset of Bipolar Disorder Related to Parental and Grandparental Illness Burden.

Age at Onset of Bipolar Disorder Related to Parental and Grandparental Illness Burden.

J Clin Psychiatry. 2016 Sep 13;

Authors: Post RM, Altshuler LL, Kupka R, McElroy SL, Frye MA, Rowe M, Grunze H, Suppes T, Keck PE, Leverich GS, Nolen WA

Abstract
OBJECTIVE: The age at onset of bipolar disorder varies greatly in different countries and continents. The association between load of family history of psychiatric illness and age at onset has not been adequately explored.
METHODS: 979 outpatients with bipolar disorder (from 4 sites in the United States and 3 in the Netherlands and Germany) gave informed consent and completed a questionnaire about their demographics, age at onset of illness, and family history of unipolar and bipolar disorder, alcohol and substance abuse comorbidity, suicide attempts, and "other" illnesses in their parents, 4 grandparents, and any offspring. We examined how the parental and grandparental burden of these illnesses related to the age at onset of the patients' bipolar disorder.
RESULTS: The burden of family psychiatric history was strongly related to an earlier age at onset of illness in both US and European patients (F₃,₉₀₆ = 35.42, P < .0001). However, compared to the Europeans, patients in the United States had both more family history of most difficulties and notably earlier age at onset. Earlier age at onset was associated with a greater illness burden in the patient's offspring (t₅₆₈ = 4.1, P < .0001).
CONCLUSIONS: More parental and grandparental psychiatric illness was associated with an earlier age at onset of bipolar disorder, which is earlier in the United States compared with Europe and is strongly related to a poor long-term prognosis. This apparent polygenic contribution to early onset deserves further study and therapeutic attempts at ameliorating the transgenerational impact.

PMID: 27631141 [PubMed - as supplied by publisher]




Omega-3 and Omega-6 Polyunsaturated Fatty Acids in Bipolar Disorder: A Review of Biomarker and Treatment Studies.

Omega-3 and Omega-6 Polyunsaturated Fatty Acids in Bipolar Disorder: A Review of Biomarker and Treatment Studies.

J Clin Psychiatry. 2016 Sep 13;

Authors: Saunders EF, Ramsden CE, Sherazy MS, Gelenberg AJ, Davis JM, Rapoport SI

Abstract
OBJECTIVE: There is growing evidence that inflammation is an important mediator of pathophysiology in bipolar disorder. The omega-3 (n-3) and omega-6 (n-6) polyunsaturated fatty acid (PUFA) metabolic pathways participate in several inflammatory processes and have been linked through epidemiologic and clinical studies to bipolar disorder and its response to treatment. We review the data on PUFAs as biomarkers in bipolar disorder and n-3 PUFA used as treatment for bipolar disorder.
DATA SOURCES: PubMed and CINAHL were searched for articles on PUFA and bipolar disorder published in the English language through November 6, 2013, with an updated search conducted on August 20, 2015. Keywords searched included omega 3 fatty acids and bipolar disorder, omega 3 fatty acids and bipolar mania, omega 3 fatty acids and bipolar depression, omega 3 fatty acids and mania, omega 3 fatty acids and cyclothymia, omega 3 fatty acids and hypomania, fatty acids and bipolar disorder, essential fatty acids and bipolar disorder, polyunsaturated fatty acids and bipolar disorder, DHA and bipolar disorder, and EPA and bipolar disorder.
STUDY SELECTION: Studies selected measured PUFAs as biomarkers or introduced n-3 PUFA as treatment.
RESULTS: We identified 17 relevant human clinical articles that either compared PUFA levels between a bipolar disorder group and a control group or used a PUFA intervention to treat depression or mania in bipolar disorder. Human studies suggest low n-3 red blood cell PUFA concentrations and correlations with clinical severity in studies of plasma concentrations in symptomatic bipolar disorder. Results of published n-3 PUFA dietary supplementation trials for bipolar disorder indicate efficacy in treatment for mania or depression in 5 of 5 open-label trials, efficacy in treatment of depression in 1 of 7 randomized controlled trials, and a signal for treatment of depression in 1 meta-analysis.
CONCLUSIONS: Biomarker studies of PUFA and treatment studies of n-3 PUFA in bipolar disorder show promise for indicating a way forward in the study of PUFA in bipolar disorder. Investigation of the intake and metabolism of the n-3 and n-6 PUFA when supplementation is provided in treatment trials might offer clues for identification of when and how PUFA may be important for treatment in bipolar disorder.

PMID: 27631140 [PubMed - as supplied by publisher]