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- Bejerot, Susanne, 1955-, et al.
(författare)
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Two-year outcome of treatment with central stimulant medication in adult attention-deficit/hyperactivity disorder : a prospective study
- 2010
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Ingår i: Journal of Clinical Psychiatry. - Memphis, USA : Physicians Postgraduate Press, Inc.. - 0160-6689 .- 1555-2101. ; 71:12, s. 1590-1597
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Tidskriftsartikel (refereegranskat)abstract
- Background: Given that adults with ADHD continue to use stimulants for extended periods of time, studies on the long-term effectiveness and adverse events are warranted. The aims of this study were to investigate factors associated with persistence in treatment in an exploratory manner and to document side effects and reasons for discontinuation.Method: The current study describes the systematic follow-up of 133 psychiatric patients with DSM-IV-diagnosed ADHD treated with central stimulants at a specialized outpatient unit between January 1, 2001, and August 31, 2006. A standardized questionnaire, derived from the Targeted Attention-deficit Disorder Symptoms Rating Scale, was used in order to measure improvement of the following target symptoms: hyperactivity, impulsivity, irritability, distractibility, structure/organization problems, inattention, and restlessness.Results: Eighty percent of the patients were successfully treated with stimulants at the 6- to 9-month follow-up. Fifty percent remained in treatment after 2 years or more. Forty-five percent were treated for comorbid anxiety and/or depression during the study period. Only 15% dropped out because of lack of efficacy. The amount of clinical response over the first 6 to 9 months (but not at 6 weeks) predicted adherence to treatment at 2 years. The patients' heart rate increased from a least squares mean ± SE of 70 ± 2.2 to 80 ± 2.1 bpm (P = .00003) while blood pressure remained unchanged at the ≥ 2-year follow-up. Severe side effects or drug abuse were not detected in this cohort.Conclusions: The long-term treatment outcome shows that stimulants are effective in adult ADHD and side effects tend to be mild.
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- Buerger, Katharina, et al.
(författare)
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Prediction of Alzheimer's disease using midregional proadrenomedullin and midregional proatrial natriuretic peptide: a retrospective analysis of 134 patients with mild cognitive impairment.
- 2011
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Ingår i: The Journal of clinical psychiatry. - 1555-2101 .- 0160-6689. ; 72:4, s. 556-63
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Development of biomarkers for early detection of Alzheimer's disease (AD) is a major clinical research goal. On the basis of the hypothesis that cardiovascular risk factors contribute to the pathogenesis of AD, we investigated whether the cardiovascular risk markers midregional proadrenomedullin (MR-proADM) and midregional proatrial natriuretic peptide (MR-proANP) predict a major clinical milestone, ie, conversion from predementia mild cognitive impairment (MCI) to manifest AD. METHOD: A group of 134 MCI patients, among 137 originally prospectively recruited at the memory disorder clinic at Malmö University Hospital, Malmö, Sweden, between July 1998 and June 2001, was clinically followed for 4-6 years. We determined whether plasma concentrations of MR-proADM and MR-proANP at baseline predicted time to conversion from MCI to clinically diagnosed AD (DSM-III-R). MCI was diagnosed according to Petersen criteria. RESULTS: During follow-up, 41.8% of MCI patients remained cognitively stable, 42.5% converted to possible and probable AD, and 15.7% converted to other forms of dementia (MCI-other). MCI converters and MCI-other patients showed increased concentrations of MR-proANP and MR-proADM compared to the stable MCI patients (P = .0001). At a cutoff of 87 pmol/L, MR-proANP yielded a sensitivity of 73.7% and a specificity of 64.3% for predicting conversion to AD. The survival analysis showed that higher values of MR-proANP and MR-proADM were associated with progression to AD. In a multivariate Cox regression model including known risk factors, MR-proANP and MR-proADM remained independent risk factors for conversion to AD for patients below the age of 72 years. CONCLUSIONS: Our study shows that plasma concentrations of MR-proANP and MR-proADM have predictive value in the progression from predementia MCI to clinical AD. Sensitivity was particularly high, which may recommend this test for first-stage screening in patients at risk for AD.
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- Colins, Olivier F., 1978-, et al.
(författare)
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Informant agreement in the assessment of disruptive behavior disorders in detained minors in Belgium : a diagnosis-level and symptom-level examination
- 2008
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Ingår i: Journal of Clinical Psychiatry. - : Physicians Postgraduate Press, Inc. - 0160-6689 .- 1555-2101. ; 69:1, s. 141-148
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Because diagnostic assessment of children emphasizes information from multiple informants, the reliability of findings in detained and incarcerated samples may be hampered. The objective of the current study was to examine parent-child agreement with regard to disruptive behavior disorders (with or without impairment) and disorder-related symptoms in detained male youths.METHOD: Between January 2005 and February 2007, a representative sample of 150 detainees, 12 to 17 years old, from the 3 Youth Detention Centers for boys in Flanders, Belgium, and 1 parent of each were interviewed with the Diagnostic Interview Schedule for Children, Version IV (DISC-IV). Interviewees were selected consecutively on the basis of Belgian origin for practical, financial, and time-related reasons. Of the 150 participants, 9 were excluded and the parents of 26 could not be included for various reasons, and thus full data were obtained for 115 parents.RESULTS: Overall poor parent-child agreement at the disorder and symptom level was found, which is consistent with previous studies. Parents reported significantly more unique information on attention-deficit/hyperactivity disorder (ADHD) (p < .001) and oppositional defiant disorder (ODD) (p < .001), while youths reported significantly more unique conduct disorder (CD)-related information (p = .01).CONCLUSION: The large proportion of parents uniquely reporting ADHD and ODD supports previous concerns about the reliability of self-reported ADHD and ODD and suggests an essential contribution by parents to the accurate assessment of these disorders in adolescent detainees. With regard to CD, it may be appropriate to rely on youth self-report.
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- Cuijpers, Pim, et al.
(författare)
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Adding Psychotherapy to Pharmacotherapy in the Treatment of Depressive Disorders in Adults : A Meta-Analysis
- 2009
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Ingår i: JOURNAL OF CLINICAL PSYCHIATRY. - 0160-6689 .- 1555-2101. ; 70:9, s. 1219-1229
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Tidskriftsartikel (refereegranskat)abstract
- Objective: A considerable number of studies has examined whether adding psychotherapy to pharmacotherapy results in stronger effects than pharmacotherapy alone. However, earlier meta-analyses in this field have included only a limited number of available studies and did not conduct extended subgroup analyses to examine possible sources of heterogeneity. Data Sources: We used a database derived from a comprehensive literature search in Pubmed, PsycINFO, EMBASE, and the Cochrane Central Register of Controlled Trials for studies published from 1966 to January 2008 that examined the psychological treatment of depression. The abstracts of these studies were identified by combining terms indicative of psychological treatment and depression. Study Selection: We included randomized trials in which the effects of a pharmacologic treatment were compared to the effects of a combined pharmacologic and psychological treatment in adults with a depressive disorder. Data Extraction: For each of the studies, we calculated a standardized mean effect size indicating the difference between pharmacotherapy and the combined treatment at posttest. We also coded major characteristics of the population, the interventions, and the quality and design of the study. Data Synthesis: Twenty-five randomized trials, with a total of 2,036 patients, were included. A mean effect size of d=0.31 (95% CI, 0.20 similar to 0.43) was found for the 25 included studies, indicating a small effect in favor of the combined treatment over pharmacotherapy alone. Studies aimed at patients with dysthymia resulted in significantly lower effect sizes compared to studies aimed at patients with major depression, a finding that suggests that the added value of psychotherapy is less in patients with dysthymia. The dropout rate was significantly lower in the combined treatment group compared to the pharmacotherapy only group (OR = 0.65; 95% CI, 0.50 similar to 0.83). Conclusions: Psychotherapy seems to have an additional value compared to pharmacotherapy alone for depression.
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- Cuijpers, Pim, et al.
(författare)
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Are Psychological and Pharmacologic Interventions Equally Effective in the Treatment of Adult Depressive Disorders? : A Meta-Analysis of Comparative Studies
- 2008
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Ingår i: Journal of Clinical Psychiatry. - 0160-6689 .- 1555-2101. ; 69:11, s. 1675-1685
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Tidskriftsartikel (refereegranskat)abstract
- Objective: A large number of studies suggest that both psychological and pharmacologic therapies are effective in the treatment of mild-to-moderate depressive disorders. Whether both types of intervention are equally effective has not been established definitively. Data Sources: A database was developed through a comprehensive literature search (from 1966 to May 2007) in which 6947 abstracts in PubMed (1244 abstracts), PsycINFO (1736), EMBASE (1911), and the Cochrane Central Register of Controlled Trials (2056) were examined. Abstracts were identified by combining terms indicative of psychological treatment and depression (both MeSH terms and text words). For this database, the primary studies from 22 meta-analyses of psychological treatment for depression were also collected. Study Selection: For the current study, the abstracts of 832 studies were examined. Data Extraction: Thirty randomized trials were included in a meta-analysis that compared the effects of a psychological treatment for 3178 adults with a diagnosed depressive disorder (major depressive disorder, dysthymia, minor depressive disorder) with the effects of a pharmacologic treatment. Data Synthesis: In studies of patients with dysthymia, pharmacotherapy was significantly more effective than psychotherapy (d = -0.28, 95% CI = -0.47 to -0.10). In patients with major depressive disorder, treatments with selective serotonin reuptake inhibitors (SSRIs) were significantly more effective than psychological treatments, while treatment with other antidepressants did not differ significantly. Subgroup and metaregression analyses did not show that pretest severity of depressive symptoms was associated with differential effects of psychological and pharmacologic treatments of major depressive disorder. Dropout rates were smaller in psychological interventions compared with pharmacologic treatments (odds ratio = 0.66, 95% CI = 0.47 to 0.92). Conclusions: Pharmacologic treatments may be more effective than psychological interventions in the treatment of dysthymia. Pharmacologic treatment with SSRIs may also be more effective in the treatment of major depressive disorder, although these differences are small and probably have little meaning from a clinical point of view. We can conclude that both psychological and pharmacologic therapies are effective in the treatment of depressive disorders and that each has its own merits.
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