Category: Mental Health Treatment

What is the Impact of Onset of Psychiatric Disorders & Psychiatric Treatment on Mortality Among Patients with Cancer?

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Research Paper Title

Impact of Onset of Psychiatric Disorders and Psychiatric Treatment on Mortality Among Patients with Cancer.

Background

Psychiatric disorders are common in patients with cancer.

The impact of both psychiatric disorders and psychiatric treatment on mortality in patients with cancer needs to be established.

Methods

Nationwide claims data were analysed.

To investigate the association between psychiatric disorders and mortality, 6,292 male and 4,455 female patients with cancer who did not have a record of psychiatric disorders before cancer onset were included.

To examine the association between psychiatric treatment and mortality, 1,467 male and 1,364 female patients with cancer were included.

Incident psychiatric disorder and receipt of psychiatric treatment within 30 days from the onset of a psychiatric disorder were the main independent variables.

Dependent variables were all-cause and cancer-related mortality. Cox proportional hazards regression with time-dependent covariates was used.

Results

The onset of psychiatric disorders was associated with a significantly increased risk of mortality in both male (all-cause hazard ratio [HR]: 1.55; cancer-related HR: 1.47) and female patients with cancer (all-cause HR: 1.50; cancer-related HR: 1.44) compared with patients with cancer without psychiatric disorders.

Both male and female patients who received psychiatric treatment within 30 days of diagnosis of a psychiatric disorder had a lower risk of cancer-related mortality (males, HR: 0.73; females, HR: 0.71) compared with patients with cancer with psychiatric disorders who did not receive psychiatric treatment.

Conclusions

Patients with cancer with newly diagnosed psychiatric disorders had a higher mortality rate.

Among these, those who received psychiatric treatment showed lower rates of mortality.

Thus, early detection and early treatment of psychiatric disorders in patients with cancer is needed.

Implications for Practice

The current study supplements the body of evidence supporting the association of psychiatric disorders onset and treatment with cancer outcomes.

Patients with cancer showed an increased risk of both all-cause and cancer-related mortality upon psychiatric disorder onset.

Among patients with newly diagnosed psychiatric disorders, those who received psychiatric treatment showed lower cancer-related mortality.

Thus, raising awareness of both the risk of psychiatric disorders and the positive effects of psychiatric treatment on cancer outcomes is necessary among patients with cancer, caregivers, and oncologists.

Furthermore, it is necessary to adopt a multidisciplinary approach, encouraging patients with cancer to undergo a neuropsychological assessment of their mental health status and receive appropriate and timely psychological interventions.

Reference

Lee, S.A., Nam, C.M., Kim, Y.H., Kim, T.H., Jang, S.I., Park, E.C. (2020) Impact of Onset of Psychiatric Disorders and Psychiatric Treatment on Mortality Among Patients with Cancer. The Oncologist. doi: 10.1634/theoncologist.2019-0396. [Epub ahead of print].

What is the Potential Utility of EEG as a Treatment Planning Tool for Escitalopram Therapy?

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Research Paper Title

Use of Machine Learning for Predicting Escitalopram Treatment Outcome From Electroencephalography Recordings in Adult Patients With Depression.

Background

Social and economic costs of depression are exacerbated by prolonged periods spent identifying treatments that would be effective for a particular patient. Thus, a tool that reliably predicts an individual patient’s response to treatment could significantly reduce the burden of depression.

To estimate how accurately an outcome of escitalopram treatment can be predicted from electroencephalographic (EEG) data on patients with depression.

Methods

This prognostic study used a support vector machine classifier to predict treatment outcome using data from the first Canadian Biomarker Integration Network in Depression (CAN-BIND-1) study.

The CAN-BIND-1 study comprised 180 patients (aged 18-60 years) diagnosed with major depressive disorder who had completed 8 weeks of treatment. Of this group, 122 patients had EEG data recorded before the treatment; 115 also had EEG data recorded after the first 2 weeks of treatment.

All participants completed 8 weeks of open-label escitalopram (10-20 mg) treatment.

The ability of EEG data to predict treatment outcome, measured as accuracy, specificity, and sensitivity of the classifier at baseline and after the first 2 weeks of treatment.

The treatment outcome was defined in terms of change in symptom severity, measured by the Montgomery-Åsberg Depression Rating Scale, before and after 8 weeks of treatment.

A patient was designated as a responder if the Montgomery-Åsberg Depression Rating Scale score decreased by at least 50% during the 8 weeks and as a nonresponder if the score decrease was less than 50%.

Results

Of the 122 participants who completed a baseline EEG recording (mean [SD] age, 36.3 [12.7] years; 76 [62.3%] female), the classifier was able to identify responders with an estimated accuracy of 79.2% (sensitivity, 67.3%; specificity, 91.0%) when using only the baseline EEG data.

For a subset of 115 participants who had additional EEG data recorded after the first 2 weeks of treatment, use of these data increased the accuracy to 82.4% (sensitivity, 79.2%; specificity, 85.5%).

Conclusions

These findings demonstrate the potential utility of EEG as a treatment planning tool for escitalopram therapy.

Further development of the classification tools presented in this study holds the promise of expediting the search for optimal treatment for each patient.

Reference

Zhdanov, A., Atluri, S., Wong, W., Vaghei, Y., Daskalakis, Z.J., Blumberger, D.M., Frey, B.N., Giacobbe, P., Lam, R.W., Milev, R., Mueller, D.J., Turecki, G., Parikh, S.V., Rotzinger, S., Soares, C.N., Brenner, C.A., Vila-Rodriguez, F., McAndrews, M.P., Kleffner, K., Alonso-Prieto, E., Arnott, S.R., Foster, J.A., Strother, S.C., Uher, R., Kennedy, S.H. & Farzan, F. (2020) Use of Machine Learning for Predicting Escitalopram Treatment Outcome From Electroencephalography Recordings in Adult Patients With Depression. JAMA Network Open. 3(1):e1918377. doi: 10.1001/jamanetworkopen.2019.18377.

Should we use tRNS (with the Current Stimulation Parameters) as a Therapeutic Intervention for the Treatment of Depression?

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Research Paper Title

Transcranial random noise stimulation for the acute treatment of depression: a randomised controlled trial.

Background

Transcranial electrical stimulation has broad potential as a treatment for depression.

Transcranial random noise stimulation (tRNS), which delivers randomly fluctuating current intensities, may have greater cortical excitatory effects compared to other forms of transcranial electrical stimulation.

The researchers therefore aimed to investigate the antidepressant efficacy of tRNS.

Methods

Depressed participants were randomly assigned by computer number generator to receive 20 sessions of either active or sham tRNS over four weeks in a double-blinded, parallel group randomised-controlled trial.

tRNS was delivered for 30mins with a direct current offset of 2mA and a random noise range of 2mA. Primary analyses assessed changes in depression severity using the Montgomery-Asperg Depression Rating Scale (MADRS).

Neuroplasticity, neuropsychological, and safety outcomes were analysed as secondary measures.

Results

69 participants were randomised, of which three discontinued treatment early leaving 66 (sham n = 34, active n = 32) for per-protocol analysis.

Depression severity scores reduced in both groups (MADRS reduction in sham = 7.0 [95%CI 5.0-8.9]; and active = 5.2 [95%CI 3.2-7.3]).

However, there were no differences between active and sham groups in the reduction of depressive symptoms, or the number of participants meeting response (sham = 14.7%; active = 3.1%) and remission criteria (sham = 5.9%; active = 0%).

Erythema, paraesthesia, fatigue, and dizziness/light-headedness occurred more frequently in the active tRNS group.

Neuroplasticity, neuropsychological and acute cognitive effects were comparable between groups.

Conclusions

The researchers suggest the results do not support the use of tRNS with the current stimulation parameters as a therapeutic intervention for the treatment of depression.

Reference

Nikolin, S., Alonzo, A., Martin, D., Gálvez, V., Buten, S., Taylor, R., Goldstein, J., Oxley, C., Hadzi-Pavlovic, D. & Loo, C.K. (2020) Transcranial random noise stimulation for the acute treatment of depression: a randomized controlled trial. The International Journal of Neuropsychopharmacology. pii: pyz072. doi: 10.1093/ijnp/pyz072. [Epub ahead of print].

Reviewing Discontinuation Rates of Antidepressant Use by Dutch Soldiers

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Research Paper Title

Discontinuation Rates of Antidepressant Use by Dutch Soldiers.

Background

Soldiers have a higher risk for developing psychiatric disorders that require treatment; often with antidepressants.

However, antidepressants as well as the psychiatric disorder, may influence military readiness in several ways.

In the general population, early discontinuation of antidepressant treatment is often seen. It is yet unknown whether this occurs to a similar extent in soldiers.

The objective of this study was to evaluate discontinuation of antidepressant use by Dutch soldiers in the first 12 months after start and determinants thereof.

Methods

Data were obtained from the military pharmacy. All Dutch soldiers who started using an antidepressant between 2000 and 2014 were included.

Kaplan-Meier curves were constructed to estimate the discontinuation rate over time and the influence of each determinant on discontinuation rate was estimated using Cox regression.

Results

About 25.9% of de 2479 starters had discontinued their antidepressant use after 1 month; after 3 and 6 months this number increased to 52.7% and 70.3%, respectively.

Early discontinuation was higher in soldiers who received their first prescription from a neurologist or rehabilitation specialist (HR 1.85, 95% CI 1.55-2.21, HR 2.66 95% CI 1.97-3.58) compared to soldiers with a first prescription from a general practitioner.

In addition, early discontinuation was lower in soldiers who were prescribed serotonin reuptake inhibitors and other antidepressants (HR 0.57, 95% CI 0.51-0.60, HR 0.63, 95% CI 0.55-0.73) and in soldiers between 40 and 50 years of age (HR 0.79, 95% CI 0.70-0.89).

Conclusions

More than half of the soldiers discontinued their prescribed antidepressant within 3 months and after 6 months, only 30% were still on antidepressants.

Reference

Janssen, D.G.A., Vermetten, E., Egberts, T.C.G. & Heerdink, E.R. (2019) Discontinuation Rates of Antidepressant Use by Dutch Soldiers. Military Medicine. 184(11-12), pp.868-874. doi: 10.1093/milmed/usz060.

Depression: Obstetric Mental Health Clinics & Outpatient Psychiatric Services

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Research Paper Title

Depression Outcomes From a Fully Integrated Obstetric Mental Health Clinic: A 10-Year Examination.

Background

A fully integrated Obstetric Mental Health Clinic (OBMHC) was established in 2007 in the rural northwest United States to address perinatal depression.

The purpose of this mixed methods study was to examine depression outcomes in women receiving outpatient psychiatric services between 2007 and 2017 at a fully integrated OBMHC and to explore patient and obstetric team perceptions of OBMHC experiences.

Methods

A retrospective database study was employed; depression was measured at baseline and follow-up visits using the Edinburgh Postnatal Depression Scale.

Descriptive statistics, regression models, and trend analysis were employed to determine effectiveness.

A subset of patients participated in telephone interviews; the obstetric team was surveyed regarding perceptions of the service.

Results

The sample included 192 women (195 pregnancies). Approximately 72% experienced less depression by the first follow-up visit.

Patients taking three or more psychiatric medications attended more OBMHC visits.

Trend analysis indicated that women with the highest levels of depression had the best response to the intervention.

Three qualitative themes emerged:

  • Safe Place;
  • Mental/Emotional Stability; and
  • Integrated Personalised Approach.

Obstetric team members (n = 11) perceived the clinic to be helpful and noted improved access to mental health care.

Conclusions

OBMHCs can be effective when psychiatric nurses are embedded within an outpatient obstetric service.

Improved access, timely services, and patient reassurance can lead to an improved pregnancy experience and reduced depressive symptoms.

The longevity of this clinic’s experience serves as a role model for other centres to replicate this successful integrated model of care.

Reference

Goedde, D., Zidack, A., Li, Y.H., Arkava, D., Mullette, E., Mullowney, Y. & Brant, J.M. (2020) Depression Outcomes From a Fully Integrated Obstetric Mental Health Clinic: A 10-Year Examination. Journal of the American Psychiatric Nurses Association. doi: 10.1177/1078390319897311. [Epub ahead of print].

Qualified Withdrawal Treatment (QWT) & Alcohol Use Disorders (AUD)

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Research Paper Title

The potential effects of an extended alcohol withdrawal treatment programme on morbidity and mortality among inpatients in the German city of Bremen: a simulation study.

Background

According to the German guidelines, people with severe alcohol use disorders (AUDs) should receive withdrawal treatment.

Compared to somatic withdrawal treatment (SWT), extended duration and psychosocial elements of so-called “qualified withdrawal treatment” (QWT) aim to reduce relapse rates.

Despite promising results of prospective studies on QWT, only few German inpatients seeking withdrawal treatment receive QWT.

The researchers estimated the potential effects on mortality and morbidity for higher proportions of treatment-seeking patients receiving QWT rather than SWT in the German city of Bremen.

Methods

In 2016 and 2017, 2051 inpatients were admitted to two specialised hospitals for withdrawal treatment.

The potential beneficial effects of QWT over SWT were estimated by simulating treatment outcomes taken from two prospective studies.

Outcomes comprised number and length of all-cause hospitalisations within 5 years, as well as abstinence and all-cause mortality rates within 28 months.

Outcomes were estimated for actual and increased rates of QWT (25, 50%) among inpatients seeking alcohol treatment.

Results

In the selected hospitals, 170 patients (8%) received QWT. If 25% of AUD inpatients were to receive QWT, benefits in abstinence rates (+ 18%), the total number of hospitalisations (- 9%) and hospital days (- 10%) could be expected.

If 50% of AUD inpatients were to receive QWT, benefits in abstinence rates (+ 45%), the total number of hospitalisations (- 23%) and hospital days (- 26%) were more pronounced, in addition to reductions in mortality (- 20%).

Conclusions

Increasing the proportion of people with severe AUD enrolled in extended withdrawal treatment programmes (such as QWT) may contribute to reduce overall alcohol-attributable burden of disease.

Randomised controlled trials or other prospective studies controlling for confounding factors are needed to determine the potential at the population level.

Reference

Manthey, J., Lindemann, C., Kraus, L., Reimer, J., Verthein, U., Schulte, B. & Rehm, J. (2020) The potential effects of an extended alcohol withdrawal treatment programme on morbidity and mortality among inpatients in the German city of Bremen: a simulation study. Substance Abuse Treatment, Prevention, and Policy. 15(1):1. doi: 10.1186/s13011-019-0249-7.

Testing the Effectiveness of Smartphone Apps Delivered to School Students to Prevent Depression at Scale.

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Research Paper Title

A trial protocol for the effectiveness of digital interventions for preventing depression in adolescents: The Future Proofing Study.

Background

Depression frequently first emerges during adolescence, and one in five young people will experience an episode of depression by the age of 18 years.

Despite advances in treatment, there has been limited progress in addressing the burden at a population level.

Accordingly, there has been growing interest in prevention approaches as an additional pathway to address depression.

Depression can be prevented using evidence-based psychological programmes. However, barriers to implementing and accessing these programmes remain, typically reflecting a requirement for delivery by clinical experts and high associated delivery costs.

Digital technologies, specifically smartphones, are now considered a key strategy to overcome the barriers inhibiting access to mental health programmes.

The Future Proofing Study is a large-scale school-based trial investigating whether cognitive behaviour therapies (CBT) delivered by smartphone application can prevent depression.

Methods

A randomised controlled trial targeting up to 10,000 Year 8 Australian secondary school students will be conducted.

In Stage I, schools will be randomised at the cluster level either to receive the CBT intervention app (SPARX) or to a non-active control group comparator.

The primary outcome will be symptoms of depression, and secondary outcomes include psychological distress, anxiety and insomnia.

At the 12-month follow-up, participants in the intervention arm with elevated depressive symptoms will participate in an individual-level randomised controlled trial (Stage II) and be randomised to receive a second CBT app which targets sleep difficulties (Sleep Ninja) or a control condition.

Assessments will occur post intervention (both trial stages) and at 6, 12, 24, 36, 48 and 60 months post baseline.

Primary analyses will use an intention-to-treat approach and compare changes in symptoms from baseline to follow-up relative to the control group using mixed-effect models.

Results & Conclusions

This is the first trial testing the effectiveness of smartphone apps delivered to school students to prevent depression at scale.

Results from this trial will provide much-needed insight into the feasibility of this approach.

They stand to inform policy and commission decisions concerning if and how such programmes should be deployed in school-based settings in Australia and beyond.

Reference

Werner-Seidler, A., Huckvale, K., Larsen, M.E., Calear, A.L., Maston, K., Johnston, L., Torok, M., O’Dea, B., Batterham, P.J., Schweizer, S., Skinner, S.R., Steinbeck, K., Ratcliffe, J., Oei, J.L., Patton, G., Wong, I., Beames, J., Wong, Q.J.J., Lingam, R., Boydell, K., Salmon, A.M., Cockayne, N., Mackinnon, A. & Christensen, H. (2020) A trial protocol for the effectiveness of digital interventions for preventing depression in adolescents: The Future Proofing Study. Trials. 21(1), pp.2. doi: 10.1186/s13063-019-3901-7.

Quality of Life: Psychosocial Intervention in Men with Advanced Prostate Cancer

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Research Paper Title

Technology-Based Psychosocial Intervention to Improve Quality of Life and Reduce Symptom Burden in Men with Advanced Prostate Cancer: Results from a Randomized Controlled Trial.

Background

Men with advanced prostate cancer (APC) face multiple challenges including poor prognosis, poor health-related quality of life (HRQOL), and elevated symptom burden.

This study sought to establish the efficacy of a tablet-delivered, group-based psychosocial intervention for improving HRQOL and reducing symptom burden in men with APC.

The researchers hypothesised that men randomised to cognitive-behavioural stress management (CBSM) would report improved HRQOL and reduced symptom burden relative to men randomised to an active control health promotion (HP) condition.

Condition effects on intervention targets and moderators of these effects were explored.

Methods

Men with APC (N = 192) were randomised (1:1) to 10-week tablet-delivered CBSM or HP, and followed for 1 year.

Multilevel modelling was used to evaluate condition effects over time.

Results

Changes in HRQOL and symptom burden did not differ between groups.

Men in both groups improved across several intervention targets; men in the CBSM condition reported greater increases in self-reported ability to relax, and both conditions showed improvements in cancer-related anxiety, cancer-related distress, and feelings of cohesiveness with other patients over time.

Moderating factors included baseline interpersonal disruption, fatigue, and sexual functioning.

Conclusions

Tablet-delivered CBSM and HP were well received by men with APC.

The hypothesised effects of CBSM on HRQOL and symptom burden were not supported, though improvements in intervention targets were observed across conditions.

Participants reported high-baseline HRQOL relative to cancer and general population norms, possibly limiting intervention effects.

The identified moderating factors should be considered in the development and implementation of interventions targeting HRQOL and symptom burden.

Reference

Penedo, F.J., Fox, R.S., Oswald, L.B., Moreno, P.I., Boland, C.L., Estabrook, R., McGinty, H.L., Mohr, D.C., Begale, M.J., Dahn, J.R., Flury, S.C., Perry, K.T., Kundu, S.D. & Yanez, B. (2020) Technology-Based Psychosocial Intervention to Improve Quality of Life and Reduce Symptom Burden in Men with Advanced Prostate Cancer: Results from a Randomized Controlled Trial. International Journal of Behavioral Medicine. doi: 10.1007/s12529-019-09839-7. [Epub ahead of print].

Considering Drug-Associated Contexts in Substance Use Disorders and Treatment Development.

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Research Paper Title

Considering Drug-Associated Contexts in Substance Use Disorders and Treatment Development.

Background

Environmental contexts that are reliably associated with the use of pharmacologically active substances are hypothesized to contribute to substance use disorders.

In this review, the researchers provide an updated summary of parallel pre-clinical and human studies that support this hypothesis.

Methods

Research conducted in rats shows that environmental contexts that are reliably paired with drug use can renew extinguished drug-seeking behaviour and amplify responding elicited by discrete, drug-predictive cues.

Akin to drug-associated contexts, interoceptive drug stimuli produced by the psychopharmacological effects of drugs can also influence learning and memory processes that play a role in substance use disorders.

Results

Findings from human laboratory studies show that drug-associated contexts, including social stimuli, can have profound effects on cue reactivity, drug use, and drug-related cognitive expectancies.

This translationally relevant research supports the idea that treatments for substance use disorders could be improved by considering drug-associated contexts as a factor in treatment interventions.

The researchers conclude this review with ideas for how to integrate drug-associated contexts into treatment-oriented research based on 4 approaches:

  • Pharmacology;
  • Brain stimulation;
  • Mindfulness-based relapse prevention; and
  • Cognitive behavioural group therapy.

Throughout, the researchers focus on alcohol- and tobacco-related research, which are two of the most prevalent and commonly misused drugs worldwide for which there are known treatments.

Reference

LeCocq, M.R., Randall, P.A., Besheer, J. & Chaudhri, N. (2020) Considering Drug-Associated Contexts in Substance Use Disorders and Treatment Development. Neurotherapeutics. 17(1), pp.43-54. doi: 10.1007/s13311-019-00824-2.

What Psychiatric Inpatients Needs when Approaching Discharge?

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Research Paper Title

Identifying profiles of need among psychiatric inpatients approaching discharge in New York City: a latent class analysis.

Background

Understanding the needs of individuals transitioning to the community following a psychiatric hospitalisation can inform community service planning.

This study is among the first to examine the needs of a sample of psychiatric inpatients approaching discharge in a large urban area in the USA.

Methods

Representative data were drawn from 1129 acutely hospitalised psychiatric inpatients from eight New York City hospitals.

Descriptive statistics were used to estimate patient needs at discharge across nine domains: housing, employment, income, transportation, education, time use, social support, and help accessing medical and mental health care.

Latent class analysis (LCA) was applied to identify subgroups of patients based on needs profiles.

Multinomial logistic regression was used to investigate socio-demographic associations with class membership.

Results

Respondents were most likely to have needs related to income (50.7%), housing (49.2%), and employment (48.7%).

Results from the LCA suggested a five class solution of patient needs:

  • Three domain-specific classes whose members endorsed needs for ‘housing and employment’ (22.5%), ‘social support and time use’ (15.0%) and ‘access to care’ (6.4%); and
  • Two classes where overall member needs were high (‘high needs,’18.4%) or low (‘low needs,’ 37.7%) across all needs.

Compared to the ‘low needs’ class, members of the ‘high needs’ class had significantly greater odds of being black or Latino, male, uninsured, and parents of a child under 18 years.

Conclusions

Patients have unique profiles of need that are significantly associated with the socio-demographic characteristics.

These findings may help practitioners and policymakers improve mental health services.

Reference

McDonald, K.L., Hoenig, J.M. & Norman, C.C. (2020) Identifying profiles of need among psychiatric inpatients approaching discharge in New York City: a latent class analysis. Social Psychiatry and Psychiatric Epidemiology. doi: 10.1007/s00127-019-01817-4. [Epub ahead of print].