In Routine Outcome Monitoring (ROM) there is a high demand for short assessments. Computerized Adaptive Testing (CAT) is a promising method for efficient assessment. In this article, the efficiency of a CAT version of the Mood and Anxiety Symptom Questionnaire, - Anhedonic Depression scale (MASQ-AD) for use in ROM was scrutinized in a simulation study. The responses of a large sample of patients (N = 3,597) obtained through ROM were used. The psychometric evaluation showed that the items met the requirements for CAT. In the simulations, CATs with several measurement precision requirements were run on the item responses as if they had been collected adaptively. CATs employing only a small number of items gave results which, both in terms of depression measurement and criterion validity, were only marginally different from the results of a full MASQ-AD assessment. It was concluded that CAT improved the efficiency of the MASQ-AD questionnaire very much. The strengths and limitations of the application of CAT in ROM are discussed.
<b><i>Background:</i></b> Results from randomized controlled trials (RCTs) are considered to give the most reliable information on treatment outcome (efficacy). Yet, the generalizability of efficacy results to daily practice (effectiveness) might be diminished by the design of RCTs. The STAR*D trial approached daily practice as much as possible, but still has some properties of an RCT. In this study, we compare results from treatment of major depressive disorder (MDD) in routine clinical practice to those of RCTs and STAR*D. <b><i>Methods:</i></b> Effectiveness in routine clinical practice was compared with efficacy results from 15 meta-analyses on antidepressant, psychotherapeutic and combination treatment and results from STAR*D. Data on daily practice patients and treatments were derived from a routine outcome monitoring (ROM) system. Treatment outcome was defined as proportion of remitters (MADRS ≤10) and within-group effect size. <b><i>Results:</i></b> From ROM, 598 patients suffering from a MDD episode according to the MINI-plus were included. Remission percentages were lower in routine practice than in meta-analyses for all treatment modalities (32 vs.40–74%). Differences were less explicit for antidepressants (21 vs. 34–47%) than for individual psychotherapy (27 vs. 34–58%; effect size 0.85 vs. 1.71) and combination therapy (21 vs. 45–63%), since only 60% of the meta-analyses for antidepressants showed significant differences with ROM, while for psychotherapy and combination treatment almost all meta-analyses showed significant differences. No differences in effectiveness were found between routine practice and STAR*D (antidepressants 27 vs. 28%; individual psychotherapy 27 vs. 25%; combination treatment 21 vs. 23%, respectively). <b><i>Conclusions:</i></b> Effectiveness of treatment for mild-to-moderate MDD in daily practice is similar to STAR*D and significantly lower than efficacy results from RCTs.
Abstract Seventy‐one subjects with Down's syndrome (DS), between the ages of 29 and 68 years, and 46 matched controls (without DS) were examined for intelligence, memory (short‐ and long‐term memory, and spatial and temporal orientation), communication (receptive, expressive and written language) and daily living skills (personal, domestic and community daily living skills). All subjects were screened on hearing and visual functions, thyroid functions; depression and dementia. DS‐subjects and controls were matched on chronological age, mental age, living conditions and male/female ratio. Comparisons were made between five subgroups (I) non‐demented institutionalized subjects with DS (DSI‐group; n =35); (2) non‐demented institutionalized controls without DS (Ci‐group; n =22); (3) demented institutionalized subjects with DS ( n = 10); (4) non‐demented subjects with DS living in group homes (DSg; n =26); and (5) non‐demented controls without DS living in group homes (Cg; n=24). Institutionalized and non‐institutionalized subjects, as well as demented and non‐demented subjects differed significantly on all functions measured. Multiple regression analysis was performed to examine the influence of age and sensory deficits on adaptive and cognitive functioning. In DSg subjects, significant associations were found between age and mental age, and between age and performances on written language. In (non‐demented) DSi subjects, significant relations were found between age and memory functions observed in daily circumstances. Moreover, in the (non‐demented) DSi elderly, visual impairment was significantly related to depressed performance on daily living skills. No age effects were seen in control subjects. Infirmities of old age like dementia and sensory deficits were far more common in people with DS than in controls. Psychiatric and diagnostic aspects of clinical depression and dementia were emphasized in particular.
BACKGROUND: Research is needed into ways of reducing patients' dependence on benzodiazepine. So far, dose reduction has never been compared with reduction without intervention. Furthermore, the added value of combining treatment with psychotherapy has never been evaluated in a randomised controlled study. AIM: To evaluate the efficacy and feasibility of controlled dose reduction with and without the help of group cognitive behavioural therapy (CBT) in primary care. METHOD: One hundred and eighty chronic users of benzodiazepine unable to stop taking the drug on their own accord participated in a randomised controlled trial. They were assigned to 3 groups: a controlled dose-reduction group; a controlled dose-reduction group receiving group-CBT; and a group receiving usual care. RESULTS: Of the patients subjected to controlled reduction 62% stopped taking benzodiazepine entirely, which significantly differed from the control group (21%). Adding group-CBT did not increase the success rate in the controlled dose-reduction group. The intention to participate in the controlled reduction programme motivated 1 in 5 patients to stop taking benzodiazepine on their own accord. Neither discontinuation nor the type of intervention had any influence on patients' psychological functioning. Both intervention programmes could be performed successfully by family doctors although only 17% of the 1036 eligible benzodiazepine users agreed to participate in this study. CONCLUSION: In primary care controlled dose reduction is an effective way of helping motivated long-term users of benzodiazepine to stop taking the drug. The addition of group-CBT, however, provides no added value. No definitive conclusions can be drawn until long-term follow-up data recording relapse rates become available.
Major depressive disorder (MDD), panic disorder, and social anxiety disorder are among the most prevalent and frequently co-occurring psychiatric disorders in adults and may have, at least in part, a common etiology.
Objective
To identify the unique and shared neuroanatomical profile of depression and anxiety, controlling for illness severity, medication use, sex, age of onset, and recurrence.
Design
Cross-sectional study.
Setting
Netherlands Study of Depression and Anxiety.
Participants
Outpatients with MDD (n = 68), comorbid MDD and anxiety (n = 88), panic disorder, and/or social anxiety disorder without comorbid MDD (n = 68) and healthy controls (n = 65).
Main Outcome Measures
Volumetric magnetic resonance imaging was conducted for voxel-based morphometry analyses. We tested voxelwise for the effects of diagnosis, age at onset, and recurrence on gray matter density. Post hoc, we studied the effects of use of medication, illness severity, and sex.
Results
We demonstrated lower gray matter volumes of the rostral anterior cingulate gyrus extending into the dorsal anterior cingulate gyrus in MDD, comorbid MDD and anxiety, and anxiety disorders without comorbid MDD, independent of illness severity, sex, and medication use. Furthermore, we demonstrated reduced right lateral inferior frontal volumes in MDD and reduced left middle/superior temporal volume in anxiety disorders without comorbid MDD. Also, patients with onset of depression before 18 years of age showed lower volumes of the subgenual prefrontal cortex.
Conclusions
Our findings indicate that reduced volume of the rostral-dorsal anterior cingulate gyrus is a generic effect in depression and anxiety disorders, independent of illness severity, medication use, and sex. This generic effect supports the notion of a shared etiology and may reflect a common symptom dimension related to altered emotion processing. Specific involvement of the inferior frontal cortex in MDD and lateral temporal cortex in anxiety disorders without comorbid MDD, on the other hand, may reflect disorder-specific symptom clusters. Early onset of depression is associated with a distinct neuroanatomical profile that may represent a vulnerability marker of depressive disorder.
