摘要:

Placebo response magnitude is suspected to affect the outcome of antidepressant clinical trials. To evaluate this, 52 randomized, double-blind, placebo-controlled clinical trials obtained from the FDA were examined to correlate placebo response magnitude with trial outcome. The magnitude of symptom reduction, percentage mean change from baseline in the Hamilton Depression Rating Scale (HAM-D), was assessed for patients assigned to placebo or an antidepressant. Correlation coefficients between symptom reduction with placebo and antidepressants and between symptom reduction with placebo and magnitude of advantage of antidepressants over placebo were assessed. A statistically significant positive correlation was seen between placebo and antidepressant response magnitude (r= .40,p< .001) and between placebo response magnitude and the advantage of antidepressants over placebo (r= −.592,p< .0001). Only 21.1% of antidepressant treatment arms in trials with high placebo response (>30% mean change from baseline) showed statistical superiority over placebo compared with 74.2% in trials with a low placebo response (≤30). Response magnitude varies and has an important effect on antidepressant clinical trials, illustrating the need for a placebo arm to determine if the trial was sensitive to treatment differences and highlighting the dangers of cross-study comparisons.

ISSN:0022-3018    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The Soteria project (1971–1983) compared residential treatment in the community and minimal use of antipsychotic medication with “usual” hospital treatment for patients with early episode schizophrenia spectrum psychosis. Newly diagnosed DSM-II schizophrenia subjects were assigned consecutively (1971 to 1976,N= 79) or randomly (1976 to 1979,N= 100) to the hospital or Soteria and followed for 2 years. Admission diagnoses were subsequently converted to DSM-IV schizophrenia and schizophreniform disorder. Multivariate analyses evaluated hypotheses of equal or better outcomes in Soteria on eight individual outcome measures and a composite outcome scale in three ways: for endpoint subjects (N= 160), for completing subjects (N= 129), and for completing subjects corrected for differential attrition (N= 129). Endpoint subjects exhibited small to medium effect size trends favoring experimental treatment. Completing subjects had significantly better composite outcomes of a medium effect size at Soteria (+.47 SD,p= .03). Completing subjects with schizophrenia exhibited a large effect size benefit with Soteria treatment (+.81 SD,p= .02), particularly in domains of psychopathology, work, and social functioning. Soteria treatment resulted in better 2-year outcomes for patients with newly diagnosed schizophrenia spectrum psychoses, particularly for completing subjects and for those with schizophrenia. In addition, only 58% of Soteria subjects received antipsychotic medications during the follow-up period, and only 19% were continuously maintained on antipsychotic medications.

ISSN:0022-3018    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Despite increased awareness of the prevalence and morbidity of psychiatric illnesses, relatively few studies have been undertaken in primary care settings in the African context. The authors determined the prevalence of trauma exposure and posttraumatic stress disorder (PTSD) in a South African township primary health care clinic and assessed associated demographic factors, comorbidity, service use, service satisfaction, and quality of life. Subjects were directly interviewed using translated, standardized instruments to assess variables described. Retrospective chart analysis assessed clinician case identification and psychotropic drug-prescribing habits. Of the 201 participants, 94% reported exposure to traumatic events (mean, 3.8). Trauma was associated with single status (p= .01), and PTSD was associated with poverty and single status (p= .04). Both sexes were equally likely to develop PTSD. PTSD (current; 19.9%), depression (37%), and somatization disorder (18.4%) were the most common diagnoses. Comorbidity with PTSD was high and included depression (75%,p< .01), somatization (35%,p< .01), and panic disorder (25%,p< .01). Levels of functional impairment were higher for subjects with PTSD, depression, and somatization than for those without (p< .05). PTSD comorbid with depression compounded impairment (p= .04). Levels of trauma, PTSD, and depression did not increase service use or dissatisfaction with services. Clinicians did not identify trauma (0%) or psychopathology (0%), and psychotropic medication was prescribed for only 1% of participants. In this population, trauma and PTSD were highly prevalent and associated with significant unidentified morbidity and comorbidity. Patients remain untreated for years in the current system of primary care consultations.

ISSN:0022-3018    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

South African Security Force (SASF) members have been exposed to violence and unrest for many years. However, an alarming recent increase in retirement on psychiatric grounds has coincided with sociopolitical transformation of these services. This study investigated 124 SASF members who were medically retired as a result of posttraumatic stress disorder (PTSD). The most striking finding was the long duration of exposure to duty-related incidents (16.9 ± 7.0 years) that preceded the onset of significant symptoms. Ninety percent (N= 112) of members displayed a negative attitude toward their work, and 54% (N= 67) believed that issues related to transformation of the services had played a significant role in their disorder. These findings suggest that posttrauma factors may be as important as pretrauma and peritrauma variables in the development of PTSD.

ISSN:0022-3018    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The authors investigated the frequency and correlates of déjà vu experiences in 386 healthy adult volunteers recruited from several areas in Japan. Déjà vu experiences and related experiences were evaluated using the Inventory of Déjà vu Experiences Assessment. Déjà vu experiences were observed by 294 (76.2%) of the 386 participants. Persons who experienced déjà vu were younger and more educated than persons who had not experienced it. There were no differences in the frequency of déjà vu experiences based on sex, hand preference, or area of residence. Subsequent factor analysis associated déjà vu with precognitive dreams and remembering dreams as dream- and memory-related factors rather than with the dissociation-related factors of depersonalization, derealization, jamais vu, and daydreams or with mental activity-related factors such as paranormal quality and travel frequency. Results suggest that déjà vu experiences are associated with good memory function.

ISSN:0022-3018    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The considerable heterogeneity of symptomatology in persons with borderline personality disorder (BPD) has led some to suggest the existence of subtypes within this diagnosis. However, no study to date has examined subtypes according to differences in interpersonal functioning, despite the central role of interpersonal problems in the BPD diagnosis. The interpersonal problems of 95 patients with BPD were investigated using the German version of the Inventory of Interpersonal Problems, a self-report measure based on a circumplex model of interpersonal functioning. Data were analyzed by means of cluster analysis. The results supported the existence of two distinct subtypes of persons with BPD, labeled “autonomous” and “dependent.” Four-month longitudinal assessment indicated that these types were stable over time, suggesting the categorization reflected trait, as opposed to state, patterns of interpersonal behavior. Implications of these findings for future research and management of BPD are discussed.

ISSN:0022-3018    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

This study was designed to test the High Risk Model of Threat Perception in a family practice population. Predisposing, triggering, and buffering factors were assessed in 165 patients using psychological inventories. The relationship between these factors and self-reported symptoms, diagnosed chronic problems, and utilization was assessed. Negative affect and number and intensity of life events increased the risk for chronic illness and reported symptoms, while social support and approach style of coping decreased the apparent risk. The numbers of encounters and telephone calls to the office, obtained from the office database, were statistically correlated with negative affect and inversely with social support. The regression analysis predicted 27% of the variance in reported symptoms with negative affect, life events, and avoidance coping as significant predictors. Only 8% and 16% of the variance of telephone calls and office visits, respectively, could be predicted with a similar regression model. These results emphasize the importance of psychosocial factors in medical illness. Routine assessment of psychosocial risk factors in family practice patients is suggested.

ISSN:0022-3018    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0022-3018    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0022-3018    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0022-3018    

出版商:OVID    

年代:2003

数据来源: OVID