Josué Bacaltchuk

A systematic review of research findings on the efficacy of interpersonal therapy for depressive disorders.

AbstractObjectiveInterpersonal psychotherapy (IPT) is a time–limited psychotherapy for major depression. The aim of this study is to summarize findings from controlled trials of the efficacy of IPT in the treatment of depressive spectrum disorders (DSD) using a meta–analytic approach.MethodsStudies of randomized clinical trials of IPT efficacy were located by searching all available data bases from 1974 to 2002. The searches employed the following MeSH categories: Depression/ Depressive Disorder; Interpersonal therapy; Outcome/Adverse Effects/Efficacy; in the identified studies. The efficacy outcomes were: remission; clinical improvement; the difference in depressive symptoms between the two arms of the trial at endpoint, and no recurrence. Drop out rates were used as an index of treatment acceptability.ResultsThirteen studies fulfilled inclusion criteria and four meta–analyses were performed. IPT was superior in efficacy to placebo in nine studies (Weight Mean Difference (WMD) – 3.57 [–5.9, –1.16]). The combination of IPT and medication did not show an adjunctive effect compared to medication alone for acute treatment (RR 0.78 [0.30, 2.04]), for maintenance treatment (RR 1.01 [0.81, 1.25]), or for prophylactic treatment (RR 0.70 [0.30, 1.65]). IPT was significantly better than CBT (WMD –2.16 [–4.16,–0.15]).ConclusionThe efficacy of IPT proved to be superior to placebo, similar to medication and did not increase when combined with medication. Overall, IPT was more efficacious than CBT. Current evidence indicates that IPT is an efficacious psychotherapy for DSD and may be superior to some other manualized psychotherapies.

Antidepressants versus placebo for the treatment of bulimia nervosa: a systematic review

OBJECTIVE The objective of this study was to valuate the effectiveness, tolerability and acceptability of various classes of antidepressants compared with placebo in the treatment of bulimia nervosa. METHOD A meta-analysis including 16 randomised controlled trials and 1300 bulimic patients was performed. Dichotomous outcomes were analysed by calculating relative risks, and continuous outcomes by calculating effect sizes. Methodological quality, heterogeneity in the results and selective publication were assessed. RESULTS Short-term remission in bulimic symptoms was statistically more likely on antidepressants than placebo (Relative Risk=0.88, 95% CI=0.83-0.94, p<0.0001). Drop-out rates were high but no statistical difference was found between treatment groups (34.6% and 31.4% for drug and placebo; RR=1.03, 95% CI=0.80-1.32, p=0.8). No difference in efficacy could be demonstrated among different classes of antidepressants. CONCLUSIONS The use of a single antidepressant agent was clinically effective for the treatment of bulimia nervosa when compared with placebo, with an overall greater remission rate and a higher rate of drop-outs. No differential effect regarding efficacy and tolerability among the various classes of antidepressants could be demonstrated.

Self-help treatments for disorders of recurrent binge eating: a systematic review.

Objective:  To evaluate self‐help interventions for patients with binge eating disorder (BED) and bulimia nervosa (BN), tested in randomized controlled trials, and compared with waiting list or any other type of control group.

Combination of antidepressants and psychological treatments for bulimia nervosa: a systematic review.

Bacaltchuk J, Trefiglio RP, Oliveira IR, Hay P, Lima MS, Mari JJ. Combination of antidepressants and psychological treatments for bulimia nervosa: a systematic review.

Efficacy and safety of risperidone oral solution in agitation associated with dementia in the elderly

BACKGROUND Behavioral and psychological symptoms in dementia (BPSD) contribute to caregiver burden and institutionalization of elderly. Neuroleptics are prescribed to control agitation. Side effects of typical neuroleptics are harmful, making atypical neuroleptics an indication. OBJECTIVES To evaluate efficacy and tolerability of risperidone oral solution (ROS) given once daily to demented elderly outpatients with BPSD (agitation). METHOD Patients (n=26), 76.35+/-8.63 years, Diagnostic and Statistical Manual of Mental Disorders 4th ed. (DSM-IV) criteria for dementia. RSO was given, starting dose of 0.25 mg and increments of 0.25 mg every week. Mini-Mental State Examination (MMSE) assessed cognitive status, Behavioral and Emotional Activities Manifested in Dementia (BEAM-D) and Clinical Global Impression (CGI) measured BPSD, Extrapiramidal Symptom Rating Scale (ESRS) evaluated extrapyramidal symptoms. Cardiovascular side effects were evaluated clinically. RESULTS There was a 26% reduction in agitation and no cardiovascular side effects in the range from 1.0 to 1.25 mg. Side effects were more prevalent above 2.5 mg. CONCLUSION Risperidone oral solution improved agitation with good tolerability from 0.5 to 1.25 mg. A single dose with increments of 0.25 mg may be more acceptable to patients and caregivers.

Psiquiatria baseada em evidências

The unnecessary variability often seen in the clinical practice can be related to both the absence of reliable evidence and unawareness of the existence of good quality evidence. Evidence-Based Medicine (EBM) is a set of linked strategies designed to assist clinicians in keeping themselves up-to-date with the best available evidence. Such evidence must be incorporated into the clinical practice. EBM concepts are discussed here through common aspects and challenges doctors face when treating patients with dysthymia, bulimia nervosa, and schizophrenia. In the light of some results from three systematic reviews it is concluded that Evidence-Based Psychiatry strategies, rather than replacing the traditional ones, may be a valuable tool to improving quality in a good clinical practice.

Antidepressants versus psychotherapy for bulimia nervosa : a systematic review

Objective: To assess the efficacy and acceptability of antidepressants compared to psychotherapy as single approaches for the treatment of bulimia nervosa.

Extracts from "Clinical Evidence" Bulimia nervosa

Competing interests: PJH has received reimbursement for attending symposiums from Solvay Pharmaceuticals, Bristol-Myers Squibb, and Pfizer Pharmaceuticals and for educational training of family doctors from Bristol-Myers Squibb. JB has received fees from Janssen-Cilag Farmaceutica. If you are interested in being a contributor or peer reviewer for Clinical Evidence please visit the Clinical Evidence website (www.clinicalevidence.org) Clinical Evidence is published by BMJ Publishing Group. The fifth issue is available now, and Clinical Evidence will be updated and expanded every six months. Individual subscription rate, issues 5 and 6 £75/

Tratamento da bulimia nervosa: síntese das evidências

110; institutional rate £160/

Tratamento farmacológico dos transtornos alimentares

240; student rate £55/