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JAMA Psychiatry May 2024Placebo is the only substance systematically evaluated across common psychiatric diagnoses, but comprehensive cross-diagnostic comparisons are lacking.
IMPORTANCE
Placebo is the only substance systematically evaluated across common psychiatric diagnoses, but comprehensive cross-diagnostic comparisons are lacking.
OBJECTIVE
To compare changes in placebo groups in recent high-quality randomized clinical trials (RCTs) across a broad spectrum of psychiatric disorders in adult patients.
DATA SOURCES
MEDLINE and the Cochrane Database of Systematic Reviews were systematically searched in March 2022 for the latest systematic reviews meeting predetermined high-quality criteria for 9 major psychiatric diagnoses.
STUDY SELECTION
Using these reviews, the top 10 highest-quality (ie, lowest risk of bias, according to the Cochrane Risk of Bias tool) and most recent placebo-controlled RCTs per diagnosis (totaling 90 RCTs) were selected, adhering to predetermined inclusion and exclusion criteria.
DATA EXTRACTION AND SYNTHESIS
Following the Cochrane Handbook, 2 authors independently carried out the study search, selection, and data extraction. Cross-diagnosis comparisons were based on standardized pre-post effect sizes (mean change divided by its SD) for each placebo group. This study is reported following the Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline.
MAIN OUTCOME AND MEASURE
The primary outcome, pooled pre-post placebo effect sizes (dav) with 95% CIs per diagnosis, was determined using random-effects meta-analyses. A Q test assessed statistical significance of differences across diagnoses. Heterogeneity and small-study effects were evaluated as appropriate.
RESULTS
A total of 90 RCTs with 9985 placebo-treated participants were included. Symptom severity improved with placebo in all diagnoses. Pooled pre-post placebo effect sizes differed across diagnoses (Q = 88.5; df = 8; P < .001), with major depressive disorder (dav = 1.40; 95% CI, 1.24-1.56) and generalized anxiety disorder (dav = 1.23; 95% CI, 1.06-1.41) exhibiting the largest dav. Panic disorder, attention-deficit/hyperactivity disorder, posttraumatic stress disorder, social phobia, and mania showed dav between 0.68 and 0.92, followed by OCD (dav = 0.65; 95% CI, 0.51-0.78) and schizophrenia (dav = 0.59; 95% CI, 0.41-0.76).
CONCLUSION AND RELEVANCE
This systematic review and meta-analysis found that symptom improvement with placebo treatment was substantial in all conditions but varied across the 9 included diagnoses. These findings may help in assessing the necessity and ethical justification of placebo controls, in evaluating treatment effects in uncontrolled studies, and in guiding patients in treatment decisions. These findings likely encompass the true placebo effect, natural disease course, and nonspecific effects.
PubMed: 38809560
DOI: 10.1001/jamapsychiatry.2024.0994 -
Psychiatry and Clinical... Sep 2023Gray matter alterations play a role in the panic disorder's pathophysiology origin. However, the current literature seemed inadequate to reach a consistent conclusion....
BACKGROUND
Gray matter alterations play a role in the panic disorder's pathophysiology origin. However, the current literature seemed inadequate to reach a consistent conclusion. Therefore, we conducted this gray matter meta-analysis on panic disorder.
METHODS
A systematic review and a voxel-wise meta-analysis based on voxel-based morphometry were conducted for the gray matter studies in patients with panic disorder. The Seed-based d Mapping toolbox was applied for the voxel-wise meta-analysis. Fourteen gray matter studies (954 subjects) were enrolled in the current meta-analysis. The subgroup analysis of typical-onset versus late-onset patients was also performed. At last, the clinical severity was meta-regressed with gray matter alterations.
RESULTS
Significant gray matter alterations were found in the left para-cingulate gyrus and the right amygdala of panic disorder patients. The subgroup analysis of typical-onset panic disorder patients showed a similar pattern. However, gray matter alterations were demonstrated in the bilateral opercular cortex of late-onset panic disorder patients. A significant association between the clinical severity and the gray matter alterations was found in the fronto-cingulate regions of panic disorder patients.
CONCLUSION
Gray matter alterations might represent a significant pillar of panic disorder's neurobiology, especially for the amygdala, cingulate, and frontal regions. Future gray matter studies in panic disorder should be needed to reconfirm this pattern of gray matter alterations.
PubMed: 38765308
DOI: 10.5152/pcp.2023.23684 -
World Psychiatry : Official Journal of... Jun 2024Psychotherapies are first-line treatments for most mental disorders, but their absolute outcomes (i.e., response and remission rates) are not well studied, despite the...
Psychotherapies are first-line treatments for most mental disorders, but their absolute outcomes (i.e., response and remission rates) are not well studied, despite the relevance of such information for health care users, providers and policy makers. We aimed to examine absolute and relative outcomes of psychotherapies across eight mental disorders: major depressive disorder (MDD), social anxiety disorder, panic disorder, generalized anxiety disorder (GAD), specific phobia, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and borderline personality disorder (BPD). We used a series of living systematic reviews included in the Metapsy initiative (www.metapsy.org), with a common strategy for literature search, inclusion of studies and extraction of data, and a common format for the analyses. Literature search was conducted in major bibliographical databases (PubMed, PsycINFO, Embase, and the Cochrane Register of Controlled Trials) up to January 1, 2023. We included randomized controlled trials comparing psychotherapies for any of the eight mental disorders, established by a diagnostic interview, with a control group (waitlist, care-as-usual, or pill placebo). We conducted random-effects model pairwise meta-analyses. The main outcome was the absolute rate of response (at least 50% symptom reduction between baseline and post-test) in the treatment and control conditions. Secondary outcomes included the relative risk (RR) of response, and the number needed to treat (NNT). Random-effects meta-analyses of the included 441 trials (33,881 patients) indicated modest response rates for psychotherapies: 0.42 (95% CI: 0.39-0.45) for MDD; 0.38 (95% CI: 0.33-0.43) for PTSD; 0.38 (95% CI: 0.30-0.47) for OCD; 0.38 (95% CI: 0.33-0.43) for panic disorder; 0.36 (95% CI: 0.30-0.42) for GAD; 0.32 (95% CI: 0.29-0.37) for social anxiety disorder; 0.32 (95% CI: 0.23-0.42) for specific phobia; and 0.24 (95% CI: 0.15-0.36) for BPD. Most sensitivity analyses broadly supported these findings. The RRs were significant for all disorders, except BPD. Our conclusion is that most psychotherapies for the eight mental disorders are effective compared with control conditions, but absolute response rates are modest. More effective treatments and interventions for those not responding to a first-line treatment are needed.
PubMed: 38727072
DOI: 10.1002/wps.21203 -
Frontiers in Psychiatry 2024Moyamoya disease (MMD) is a life-threatening condition characterized by stenosis of intracranial arteries. Despite the frequency and the impact of psychiatric symptoms...
INTRODUCTION
Moyamoya disease (MMD) is a life-threatening condition characterized by stenosis of intracranial arteries. Despite the frequency and the impact of psychiatric symptoms on the long-term prognosis and quality of life of MMD patients, no systematic review on this topic exists.
METHODS
This systematic review and meta-analysis included 41 studies (29 being case reports), from PubMed, Scopus, Embase until 27/3/2023, on MMD patients exhibiting psychiatric symptoms.
RESULTS
Despite a fair average quality of the articles, quantitative synthesis through logistic regression was possible only for case reports, due to heterogeneity between the other studies. Psychosis, the most frequent psychiatric symptom reported in case reports, was more frequent in MMD patients with left hemisphere involvement. Neurological symptoms occurrence increased the odds of MMD diagnosis preceding psychiatric symptoms. Psychiatric symptoms are highly prevalent in MMD patients and are relatively often the only presenting symptoms.
DISCUSSION
We discuss the diagnostic, therapeutic, and prognostic implications of recognizing and characterizing specific psychiatric symptoms in MMD, outlining preliminary guidelines for targeted pharmacological and psychotherapeutic interventions. Lastly, we outline future research and clinical perspectives, striving to enhance the oft-overlooked psychiatric care for MMD patients and to ameliorate their long-term outcome.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023406303.
PubMed: 38585478
DOI: 10.3389/fpsyt.2024.1371763 -
Neuroradiology Jul 2024We reviewed 33 original research studies assessing brain perfusion, using consensus guidelines from a "white paper" issued by the International Society for Magnetic... (Review)
Review
We reviewed 33 original research studies assessing brain perfusion, using consensus guidelines from a "white paper" issued by the International Society for Magnetic Resonance in Medicine Perfusion Study Group and the European Cooperation in Science and Technology Action BM1103 ("Arterial Spin Labelling Initiative in Dementia"; https://www.cost.eu/actions/BM1103/ ). The studies were published between 2011 and 2023 and included participants with subjective cognitive decline plus; neurocognitive disorders, including mild cognitive impairment (MCI), Alzheimer's disease (AD), frontotemporal lobar degeneration (FTLD), dementia with Lewy bodies (DLB) and vascular cognitive impairment (VCI); as well as schizophrenia spectrum disorders, bipolar and major depressive disorders, autism spectrum disorder, attention-deficit/hyperactivity disorder, panic disorder and alcohol use disorder. Hypoperfusion associated with cognitive impairment was the major finding across the spectrum of cognitive decline. Regional hyperperfusion also was reported in MCI, AD, frontotemporal dementia phenocopy syndrome and VCI. Hypoperfused structures found to aid in diagnosing AD included the precunei and adjacent posterior cingulate cortices. Hypoperfused structures found to better diagnose patients with FTLD were the anterior cingulate cortices and frontal regions. Hypoperfusion in patients with DLB was found to relatively spare the temporal lobes, even after correction for partial volume effects. Hyperperfusion in the temporal cortices and hypoperfusion in the prefrontal and anterior cingulate cortices were found in patients with schizophrenia, most of whom were on medication and at the chronic stage of illness. Infratentorial structures were found to be abnormally perfused in patients with bipolar or major depressive disorders. Brain perfusion abnormalities were helpful in diagnosing most neurocognitive disorders. Abnormalities reported in VCI and the remaining mental disorders were heterogeneous and not generalisable.
Topics: Humans; Spin Labels; Mental Disorders; Magnetic Resonance Imaging; Cerebrovascular Circulation; Cognitive Dysfunction
PubMed: 38536448
DOI: 10.1007/s00234-024-03323-0 -
Brain and Behavior Jan 2024The existing literature on the association between brain-derived neurotrophic factor (BDNF) protein levels and panic disorder presents inconsistent findings. This... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The existing literature on the association between brain-derived neurotrophic factor (BDNF) protein levels and panic disorder presents inconsistent findings. This systematic review and meta-analysis aim to synthesize the available evidence and determine the overall effect of BDNF protein levels in individuals diagnosed with panic disorder.
METHODS
A comprehensive literature search was conducted using electronic databases (PubMed, Embase, Scopus, PsycINFO, and Web of Science) from inception to April 21, 2023. The search strategy included relevant keywords and medical subject headings terms related to BDNF, panic disorder, and protein levels. A random-effects model was used for the meta-analysis, and subgroup analyses were performed to explore heterogeneity. Publication bias was assessed using funnel plots and statistical tests.
RESULTS
A total of 12 studies met the inclusion criteria. The meta-analysis demonstrated a significant decrease in BDNF protein levels in individuals with panic disorder (SMD = -.53, 95% CI: -1.02 to -.04, p < .001; I : 92%). The results of subgroup and meta-regression analyses were not statistically significant. No significant publication bias was observed based on the results of Egger's regression test (p-value = .3550).
CONCLUSION
This systematic review and meta-analysis provide evidence of lower BDNF protein levels in individuals diagnosed with panic disorder compared to healthy controls. The findings suggest a potential role for BDNF dysregulation in the pathophysiology of panic disorder. Further research is warranted to elucidate the underlying mechanisms and potential therapeutic implications.
Topics: Humans; Panic Disorder; Brain-Derived Neurotrophic Factor; Regression Analysis
PubMed: 38376041
DOI: 10.1002/brb3.3349 -
Progress in Neuro-psychopharmacology &... Apr 2024As an important neurotrophic factor in the central nervous system, Brain-derived Neurotrophic Factor (BDNF) has been implicated in the pathophysiology of psychiatric... (Meta-Analysis)
Meta-Analysis Review
As an important neurotrophic factor in the central nervous system, Brain-derived Neurotrophic Factor (BDNF) has been implicated in the pathophysiology of psychiatric disorders in many studies. However, its value as a biomarker for the diagnosis and differential diagnosis of mental disorders is still controversial, and its change patterns among different mental disorders have not been compared. We conducted a network meta-analysis of BDNF levels in different psychiatric disorders including schizophrenia(SCZ), major depressive disorder(MDD), bipolar disorder(BD), panic disorder(PD), post-traumatic stress disorder(PTSD), obsessive-compulsive disorder(OCD), generalized anxiety disorder(GAD) and insomnia. Studies were identified by searching electronic databases through 31/05/2023. BDNF levels decreased in patients with BD, MDD, OCD, PD, SCZ compared with controls, while significantly increased in patients with PTSD. According to the network meta-analysis, BDNF levels were significantly decreased in MDD and SCZ compared with BD (-2.6, 95% CIs [-5.32 to -0.15] and - 2.68 95% CIs [-5.18 to -0.23] respectively). However, in the traditional meta-analysis, there was a trend towards lower BDNF levels in SCZ compared to BD, with no significant difference (SMD = -0.20, 95% CIs [-0.49 to 0.08]). In conclusion, abnormal BDNF levels have been found in psychiatric disorders, and the changes in peripheral BDNF levels in patients with psychiatric disorders were reconfirmed in this study, which suggests BDNF exhibits promising clinical utility and may hold diagnostic value in distinguishing between MDD and BD.
Topics: Humans; Depressive Disorder, Major; Brain-Derived Neurotrophic Factor; Network Meta-Analysis; Bipolar Disorder; Obsessive-Compulsive Disorder
PubMed: 38286331
DOI: 10.1016/j.pnpbp.2024.110954 -
Frontiers in Human Neuroscience 2023This systematic review examined the existing literature to determine the evidence supporting the efficacy of online group treatments for anxiety-, obsessive-compulsive-...
BACKGROUND
This systematic review examined the existing literature to determine the evidence supporting the efficacy of online group treatments for anxiety-, obsessive-compulsive- and trauma-related disorders (AOTDs).
METHODS
A systematic review using the PUBMED, PsycInfo, Web of Science, and ClinicalTrials databases with no language, date, or study design filters was performed. The inclusion criteria comprised studies that examined individuals who had received a formal diagnosis of AOTDs, were aged 18 years or older, and had baseline and endpoint assessments of symptom severity using formal tools.
RESULTS
Five studies on social anxiety disorder (SAD), four on post-traumatic stress disorder (PTSD) and one on tic disorders (TDs) were found. The studies were open-label ( = 2) and randomized controlled trials (RCTs) ( = 8), with five of the RCTs being non-inferiority trials. Most studies were conducted in the US and investigated psychological CBT based interventions via internet-based therapies (IBT: = 4), video teleconferencing (VTC: = 5) or a combination of both ( = 1). In SAD, IBT studies associated with a clinician assisted web-based forum (here termed "forum-enhanced" studies) were superior to waiting lists and not inferior to similar versions that were also "forum enhanced" but self-guided, "telephone enhanced" by a contact with a non-specialist, and "email enhanced" by a contact with a clinician individually. Studies involving VTC have shown comparable effectiveness to in-person interventions across some online group CBT based treatments for PTSD. Two open trials also demonstrated symptoms reductions of social anxiety and tics through VTC.
CONCLUSION
There is evidence supporting the effectiveness of online group treatments for SAD and PTSD. Further studies from different research groups may be needed to replicate the use of these and other forms of online treatments in individuals with SAD, PTSD, and other clinical populations, such as OCD, panic disorder, agoraphobia and specific phobias.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/, identifier CRD42023408491.
PubMed: 38273884
DOI: 10.3389/fnhum.2023.1286865 -
Frontiers in Psychology 2023The objective of this review was to provide a comprehensive summary and analysis of the risk factors associated with suicidal ideation among cancer patients.
OBJECTIVE
The objective of this review was to provide a comprehensive summary and analysis of the risk factors associated with suicidal ideation among cancer patients.
METHODS
This review adhered to the PICO/S framework and guidelines outlined in the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) framework (PROSPERO CRD42023433639). We searched Web of Science, PubMed, Embase, Scopus, PsycINFO, and Cochrane Library from the establishment date of the databases until June 9, 2023 for observational studies that reveal risk factors associated with suicidal ideation among cancer patients. Software Review Manager 5 (vision 5.4) was used for Meta-analyses.
RESULTS
4,921 studies were obtained through the search of the databases, 40 of which were eligible. Meta-analysis revealed that suicidal ideation in cancer patients was significantly associated with marital status, living alone, post-traumatic stress disorder (PTSD), panic disorder, education, psychiatric illness history, social functioning, childhood adversity experience, financial problems, pain, depression, demoralization, vomiting, residence and anxiety.
CONCLUSION
Being unmarried, living alone, less educated, living in rural, financial problems, pain, vomiting, PTSD, psychiatric illness history, lower social functioning, childhood adversity experience, anxiety, depression, demoralization, panic disorder were risk factors for suicidal ideation among cancer patients. This review provided evidence-based information for identifying and reducing the risk of suicide in cancer survivors.: https://www.crd.york.ac.uk/PROSPERO/, CRD42023433639.
PubMed: 38259550
DOI: 10.3389/fpsyg.2023.1287290 -
Public Health Feb 2024To update an earlier review, published in 2016, on the health and other outcomes associated with children and young people's consumption of energy drinks (EDs). (Review)
Review
OBJECTIVE
To update an earlier review, published in 2016, on the health and other outcomes associated with children and young people's consumption of energy drinks (EDs).
STUDY DESIGN
Review article.
SYSTEMATIC REVIEW
Systematic searches of nine databases (ASSIA, CINAHL, Cochrane Library, DARE, Embase, ERIC, MEDLINE, PsycINFO and Web of Science) retrieved original articles reporting the effects of EDs experienced by children and young people up to the age of 21 years. Searches were restricted by publication dates (January 2016 to July 2022) and language (English). Studies assessed as being weak were excluded from the review. Included studies underwent narrative synthesis.
RESULTS
A total of 57 studies were included. Boys consumed EDs more than girls. Many studies reported a strong positive association between ED consumption and smoking, alcohol use, binge drinking, other substance use and the intentions to initiate these behaviours. Sensation-seeking and delinquent behaviours were positively associated with ED consumption, as were short sleep duration, poor sleep quality and low academic performance. Additional health effects noted in the updated review included increased risk of suicide, psychological distress, attention-deficit hyperactivity disorder symptoms, depressive and panic behaviours, allergic diseases, insulin resistance, dental caries and erosive tooth wear.
CONCLUSIONS
This review adds to the growing evidence that ED consumption by children and young people is associated with numerous adverse physical and mental health outcomes. Where feasible and ethical, additional longitudinal studies are required to ascertain causality. The precautionary principle should be considered in regulatory policy and restriction of ED sales to this population.
PROSPERO REGISTRATION
CRD42021255484.
Topics: Child; Male; Female; Humans; Adolescent; Young Adult; Adult; Energy Drinks; Dental Caries; Alcohol Drinking; Substance-Related Disorders; Smoking
PubMed: 38228408
DOI: 10.1016/j.puhe.2023.08.024