Tricia L. da Silva

Yoga in the treatment of mood and anxiety disorders: A review

BACKGROUND Patient use of complementary and alternative treatments, including yoga, to manage mood and anxiety disorders, has been well documented. Despite research interest, there are few recent reviews of the evidence of the benefit of yoga in these conditions. METHOD The PubMed, Medline and PsycInfo databases were searched for literature published up to July 2008, relating to yoga and depressive and anxiety disorders. RESULTS The paucity of reported studies and several methodological constraints limit data interpretation. In depressive disorders, yoga may be comparable to medication and the combination superior to medication alone. There is reasonable evidence for its use as second-line monotherapy or augmentation to medication in mild to moderate major depression and dysthymia, with early evidence of benefit in more severe depression. In anxiety disorders, yoga may be superior to medication for a subgroup of patients, but its benefits in specific conditions are still largely unknown. Second-line monotherapy is indicated in performance or test anxiety, but only preliminary evidence exists for obsessive-compulsive disorder and post-traumatic stress disorder. Yoga appears to be superior to no treatment and progressive relaxation for both depression and anxiety, and may benefit mood and anxiety symptoms associated with medical illness. It shows good safety and tolerability in short-term treatment. CONCLUSION Reasonable evidence supports the benefit of yoga in specific depressive disorders. The evidence is still preliminary in anxiety disorders. Given its patient appeal and the promising findings thus far, further research on yoga in these conditions is encouraged.

Comparative efficacy, acceptability, and tolerability of augmentation agents in treatment-resistant depression: systematic review and network meta-analysis.

OBJECTIVE To comparatively analyze the efficacy, acceptability, and tolerability of various augmentation agents in adult patients with treatment-resistant depression. DATA SOURCES An electronic literature search of PubMed, EMBASE, the Cochrane Library, Web of Science, EBSCO, PsycINFO, EAGLE, and NTIS for trials published up to December 2013 was conducted. Several clinical trial registry agencies and US Food and Drug Administration reports were also reviewed. No language, publication date, or publication status restrictions were imposed. STUDY SELECTION Randomized controlled trials comparing 11 augmentation agents (aripiprazole, bupropion, buspirone, lamotrigine, lithium, methylphenidate, olanzapine, pindolol, quetiapine, risperidone, and thyroid hormone) with each other and with placebo for adult treatment-resistant depression were included. DATA EXTRACTION The proportion of patients who responded to treatment was defined as primary efficacy, and the proportion of all-cause discontinuation and side-effects discontinuation were respectively defined as acceptability and tolerability, which were assessed with odds ratios (ORs) and a Bayesian random-effects model with 95% credible intervals (CrIs). RESULTS A total of 48 trials consisting of 6,654 participants were eligible. In terms of the primary efficacy, quetiapine (OR = 1.92; 95% CrI, 1.39-3.13), aripiprazole (OR = 1.85; 95% CrI, 1.27-2.27), thyroid hormone (OR = 1.84; 95% CrI, 1.06-3.56), and lithium (OR = 1.56; 95% CrI, 1.05-2.55) were significantly more effective than placebo. Sensitivity analyses indicated that efficacy estimates for aripiprazole and quetiapine were more robust than those for thyroid hormone and lithium. In terms of acceptability, no significant difference was found between active agents and placebo. In terms of tolerability, compared to placebo, quetiapine (OR = 3.85; 95% CrI, 1.92-8.33), olanzapine (OR = 3.36; 95% CrI, 1.60-8.61), aripiprazole (OR = 2.51; 95% CrI, 1.11-7.69), and lithium (OR = 2.30; 95% CrI, 1.04-6.03) were significantly less well tolerated. CONCLUSIONS Quetiapine and aripiprazole appear to be the most robust evidence-based options for augmentation therapy in patients with treatment-resistant depression, but clinicians should interpret these findings cautiously in light of the evidence of potential treatment-related side effects.

Obsessive-Compulsive Spectrum Disorders: A Review of the Evidence-Based Treatments

Objective: To provide a review of the evidence-based treatments for Obsessive-Compulsive spectrum disorders (OCSD), a group of conditions related to Obsessive-Compulsive disorder (OCD) by phenomenological and etiological similarities, the morbidity of which is increasingly recognized. Method: Literature relating to the following disorders: body dysmorphic disorder, hypochondriasis, trichotillomania, onychophagia, psychogenic excoriation, compulsive buying, kleptomania, and pathological gambling, and published between January 1965 and October 2007, was found using PubMed. Included in this review were 107 treatment reports. Results: Serotonin reuptake inhibitors (SRIs) have shown benefits as first-line, short-term treatments for body dysmorphic disorder, hypochondriasis, onychophagia, and psychogenic excoriation, with some benefits in trichotillomania, pathological gambling, and compulsive buying. There are also suggested benefits for several atypical antipsychotics in disorders with a high degree of impulsivity, including trichotillomania and pathological gambling, and to a lesser extent, kleptomania and psychogenic excoriation. Cognitive-behavioural interventions have generally shown evidence for use as first-line treatment across the spectrum, with some variability in degree of benefit. Conclusions: As in OCD, several conditions in the proposed OCSD benefit from SRIs and (or) cognitive-behavioural interventions. However, the treatment literature is generally limited, and more randomized controlled trials (RCTs) are needed to evaluate individual and combination treatments, for short-term use and as maintenance.

Novel uses for risperidone: focus on depressive, anxiety and behavioral disorders

Risperidone has been shown to be a safe and effective atypical antipsychotic agent. It was initially approved for the treatment of schizophrenia, and now, in many countries, is used to treat other conditions, including bipolar disorder, dementia and behavior problems in a range of age groups. Yet, frequent off-label use by clinicians to treat other mood and anxiety disorders and behavioral disorders is common and requires an examination of the risks and benefits in such populations. A review of the literature provides varying levels of evidence supporting its use in a range of depressive and anxiety disorders, and in special populations, including children and the elderly. Most reports are based on short-term studies and include its use both as monotherapy and as an augmenting agent to other psychotropics, and in a range of doses. Further randomized controlled trials are needed to confirm the efficacy and tolerability of risperidone, both short- and long-term, in many of these conditions. The published evidence is summarized, with recommendations and suggestions for its use.

Paroxetine in the treatment of dysthymic disorder without co-morbidities: A double-blind, placebo-controlled, flexible-dose study

Few published studies have evaluated selective serotonin reuptake inhibitors in dysthymia without current co-morbid major depression. In this 12-week study, 40 dysthymic patients were randomly assigned to either placebo (n=19) or 20-40 mg/day of paroxetine (n=21). At endpoint, the paroxetine group showed significantly greater improvement on the Clinical Global Impression Scale, Beck Depression Inventory, and Quality of Life Enjoyment and Satisfaction Questionnaire (p<0.05), and a trend to superiority over placebo on the Hamilton Depression Rating Scale. Response and remission were significantly higher with paroxetine than placebo (p<0.05). There were no significant differences in drop out rates or frequency of adverse effects, except for excessive sweating (greater with paroxetine, p=0.04). Reporting of multiple side effects was also higher with paroxetine than with placebo (p=0.02). Paroxetine is more effective than placebo in improving symptoms and quality of life in dysthymia, and is generally tolerable.

DEPRESSION, ANXIETY, AND POST-TRAUMATIC STRESS DISORDER AMONG YOUTH IN LOW AND MIDDLE INCOME COUNTRIES: A REVIEW OF PREVALENCE AND TREATMENT INTERVENTIONS

BACKGROUND Low and middle income countries (LMICs) not only have the majority of the worlds population but also the largest proportion of youth. Poverty, civil conflict and environmental stressors tend to be endemic in these countries and contribute to significant psychiatric morbidity, including depression, anxiety and post-traumatic stress disorder (PTSD). However, mental health data from LMICs is scarce, particularly data on youth. Evaluation of such information is crucial for planning services and reducing the burden of disability. This paper reviews the published data on the prevalence and randomized trials of interventions for depression, anxiety and PTSD in youth in LMICs. METHODS PubMed and Google Scholar were searched for articles published in English up to January 2017, using the keywords: Low/middle income country, depression, anxiety, post-traumatic stress disorder, child, youth, adolescent, prevalence, treatment, intervention, and outcomes. RESULTS The few prevalence studies in LMICs reported rates of up to 28% for significant symptoms of depression or anxiety among youth, and up to 87% for symptoms of PTSD among youth exposed to traumatic experienences, though these rates varied widely depending on several factors, including the assessments tools used. Most rigorous interventions employed some form or variation of CBT, with mixed results. Studies using other forms of psychosocial interventions appear to be heterogeneous and less rigorous. CONCLUSIONS The mental health burden due to depression and anxiety disorders in youth is substantial in LMICs, with high needs but inadequate services. Youth specific services for early detection and cost-effective interventions are needed.

Evaluating the benefits of a youth mental health curriculum for students in Nicaragua: a parallel-group, controlled pilot investigation

Background. High rates of mental illness and addictions are well documented among youth in Nicaragua. Limited mental health services, poor mental health knowledge and stigma reduce help-seeking. The Mental Health Curriculum (MHC) is a Canadian school-based program that has shown a positive impact on such contributing factors. This pilot project evaluated the impact of the MHC on mental wellness and functioning among youth in Leon, Nicaragua. Methods. High school and university students (aged 14–25 years) were assigned to intervention (12-week MHC; n = 567) and control (wait-list; n = 346) groups in a non-randomized design. Both groups completed measures of mental health knowledge, stigma and function at baseline and 12 weeks. Multivariate analyses and repeated measures analyses were used to compare group outcomes. Results. At baseline, intervention students showed higher substance use (mean difference [MD] = 0.24) and lower perceived stress (MD = −1.36) than controls (p < 0.05); there were no other group differences in function. At 12 weeks, controlling for baseline differences, intervention students reported significantly higher mental health knowledge (MD = 1.75), lower stigma (MD = 1.78), more adaptive coping (MD = 0.82), better lifestyle choices (MD = 0.06) and lower perceived stress (MD = −1.63) (p < 0.05) than controls. The clinical significance as measured by effect sizes was moderate for mental health knowledge, small to moderate for stigma and modest for the other variables. Substance use also decreased among intervention students to similar levels as controls (MD = 0.03) (p > 0.05). Conclusions. This pilot investigation demonstrates the benefits of the MHC in a low-and-middle-income youth population. The findings replicate results found in Canadian student populations and support its cross-cultural applicability.

Compulsive Buying: Psychopathological Condition, Coping Strategy or Sociocultural Phenomenon? A Review

Compulsive Buying: Psychopathological Condition, Coping Strategy or Sociocultural Phenomenon? A Review Objectives: Compulsive buying (CB) has been conceptualized variously as an obsessive-compulsive, impulse control, or addictive spectrum condition; as a coping strategy for negative mood; and as a mere phenomenon of materialistic societies. The objective of this review was to evaluate the published literature on CB from a biopsychosocial perspective, for support for its classification among these options. Methods: A search of the psychiatric literature was conducted, using PubMed, ProQuest and EBSCOHOST, for all articles containing the terms “compulsive buying” or “compulsive shopping” and published in English up to February 2015. Articles were also obtained from secondary search engines like Google Scholar, and the citation lists of sourced articles were also searched for additional references.

Trajectory of Illness and Treatment Outcomes among First-Episode Psychosis Patients in Sri Lanka

Abstract: Investigation of the factors that influence illness severity and outcomes in first-episode psychosis and provision of early intervention programs to improve prognosis are highly common in high-income countries. However, few such assessment and treatment services are available in developing nations like Sri Lanka, where this population remains understudied. The aim of this study was to investigate course of illness and outcomes in a Sri Lankan first-episode psychosis population. A detailed, retrospective chart review was conducted of the demographics, course of illness, time to diagnosis, treatment plan, and treatment outcomes of first-episode psychosis patients treated at the National Hospital of Sri Lanka from August 2011 to October 2012. Discharged patients were contacted for a follow-up telephone interview to assess their current health status and association of these factors with continued remission or with relapse. The charts of 60 patients were reviewed. Schizophrenia was the most common diagnosis. The average duration of untreated illness was five weeks, and the average hospital stay was 12 days. Of the 25 patients reached for follow-up, 56% were still in remission. As in Western studies, continued remission was strongly associated with female sex, education level, and medication compliance. Remission rates and medication compliance rates were similar to those reported in Western studies. This is the first study to examine patient profiles and post-treatment outcomes in first-episode psychosis in Sri Lanka. Limitations of the study include the small sample size and reliance on retrospective and self-report data.

Herbal Remedies and Nutraceuticals as Augmentation or Adjunct for Mood and Anxiety Disorders: Evidence for Benefit and Risk

Background: Complementary and alternative medicine (CAM) therapies have considerable patient appeal. Perceived as better, safer and more economical than conventional treatments, such as pharmacotherapy and psychotherapy, they are often used by patients to self-treat symptoms of depression and anxiety, usually in combination with existing medications and without medical supervision. CAM therapies include physical therapies (e.g. exercise), herbal remedies (e.g. St. John’s wort) and nutraceuticals/dietary supplements (e.g. omega-3 fatty acids). This chapter will review the published evidence for the use of herbal and dietary supplements as augmenting or adjunctive agents in depressive and anxiety disorders.