Waguih William IsHak

Quality of Life: The Ultimate Outcome Measure of Interventions in Major Depressive Disorder

Background: Quality‐of‐life (QOL) assessment and improvement have recently been recognized as important components of health care, in general, and mental health care, in particular. Patients with major depressive disorder (MDD) have a significantly diminished QOL. Methods: Using a Medline search of relevant keywords for the past 26 years, this article reviews the empirical literature to provide information regarding QOL measurement, impairment, impact of comorbidity, and treatment effects in MDD. Results: Studies showed that QOL is greatly affected by depression. Severity of depression is also a major contributor to further reduction in QOL when depression is comorbid with other psychiatric and medical disorders. Treatment for MDD has been shown to improve QOL in the acute treatment phase, but QOL remains low compared to healthy controls even when symptoms are in remission following treatment. Conclusions: Patients with MDD suffer from poor QOL even after reduction of symptom severity. Clinicians should therefore include QOL assessment as an important part of treating depression. More research is needed to examine the factors contributing to poor QOL in MDD and to develop interventions to ameliorate it. Additionally, future treatment studies of MDD with or without comorbid disorders should track QOL as the ultimate outcome measure of treatment success.

Burnout in medical students: a systematic review

Background  Burnout is a state of mental and physical exhaustion related to work or care‐giving activities. Distress during medical school can lead to burnout, with significant consequences, particularly if burnout continues into residency and beyond. The authors reviewed literature pertaining to medical student burnout, its prevalence, and its relationship to personal, environmental, demographic and psychiatric factors. We ultimately offer some suggestions to address and potentially ameliorate the current dilemma posed by burnout during medical education.

Health-related quality of life in bipolar disorder

IsHak WW, Brown K, Aye SS, Kahloon M, Mobaraki S, Hanna R. Health‐related quality of life in bipolar disorder. 
Bipolar Disord 2012: 14: 6–18.

Male Anorgasmia Treated with Oxytocin

Introduction. This is a case report on male anorgasmia that was successfully treated with oxytocin. Oxytocin is increased during arousal and peaks during orgasm. More recently, a study on humans published in Nature has shown its value in social bonding, increasing trust, and enhancing the sense of well-being. Aim. To test the effectiveness of administering oxytocin in a case of treatment-resistant anorgasmia. Methods. The patient underwent a biopsychosocial evaluation by a psychiatrist trained in sexual medicine and sex therapy for male orgasmic disorder, acquired type. Medical conditions, effect of substances, and psychological issues were ruled out. The patient was properly consented to using oxytocin as an off-label trial. Oxytocin was administered using a nasal spray intracoitally because of its ultra-short half-life. Results. Oxytocin was effective in restoring ejaculation. Conclusions. A case of treatment-resistant male anorgasmia was successfully treated with intracoital administration of intranasal oxytocin.

Incorporating multidimensional patient-reported outcomes of symptom severity, functioning, and quality of life in the Individual Burden of Illness Index for Depression to measure treatment impact and recovery in MDD.

CONTEXT The National Institute of Mental Health Affective Disorders Workgroup identified the assessment of an individuals burden of illness as an important need. The Individual Burden of Illness Index for Depression (IBI-D) metric was developed to meet this need. OBJECTIVE To assess the use of the IBI-D for multidimensional assessment of treatment efficacy for depressed patients. DESIGN, SETTING, AND PATIENTS Complete data on depressive symptom severity, functioning, and quality of life (QOL) from depressed patients (N = 2280) at entry and exit of level 1 of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study (12-week citalopram treatment) were used as the basis for calculating IBI-D and self-rating scale changes. RESULTS Principal component analysis of patient responses at the end of level 1 of STAR*D yielded a single principal component, IBI-D, with a nearly identical eigenvector to that previously reported. While changes in symptom severity (Quick Inventory of Depressive Symptomatology-Self Report) accounted for only 50% of the variance in changes in QOL (Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form) and 47% of the variance in changes in functioning (Work and Social Adjustment Scale), changes in IBI-D captured 83% of the variance in changes in QOL and 80% in functioning, while also capturing 79% of the variance in change in symptom severity (Quick Inventory of Depressive Symptomatology-Self Report). Most importantly, the changes in IBI-D of the 36.6% of remitters who had abnormal QOL and/or functioning (mean [SD], 2.98 [0.35]) were significantly less than the changes in IBI-D of those who reported normal QOL and functioning (IBI-D = 1.97; t = 32.6; P < 10(-8)) with an effect size of a Cohen d of 2.58. In contrast, differences in symptom severity, while significant, had a Cohen d of only 0.78. CONCLUSIONS Remission in depressed patients, as defined by a reduction in symptom severity, does not denote normal QOL or functioning. By incorporating multidimensional patient-reported outcomes, the IBI-D provides a single measure that adequately captures the full burden of illness in depression both prior to and following treatment; therefore, it offers a more accurate metric of recovery. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00021528.

Treating Major Depression by Creating Positive Expectations for the Future: A Pilot Study for the Effectiveness of Future-Directed Therapy (FDT) on Symptom Severity and Quality of Life

Introduction: This nonrandomized pilot study assesses the efficacy of a new future‐oriented form of therapy, known as future‐directed therapy (FDT), as a treatment for patients with Major Depressive Disorder (MDD) in a naturalistic hospital‐based outpatient psychiatry clinic. The study measured symptom severity of depression and anxiety, in addition to quality of life pre‐ and posttreatment.

Quality of Life and Smoking

BACKGROUND AND OBJECTIVES Smoking tobacco is the leading cause of preventable illness in the United States and around the world. However, much remains unknown about the factors that motivate individuals to smoke. Quality of life (QoL) has become an important measure of outcomes across all medical specialties, in both research and clinical settings. To date, there has not been a critical review of the research relevant to QoL in smokers. In this review, we describe which scales are used to quantify the QoL of smokers, the relationship between smoking and QoL and the positive impact of smoking cessation. METHODS Fifty-four relevant studies are included in our review. RESULTS Low QoL and depression are associated with higher odds of smoking initiation and lower odds of successful smoking cessation. There is a negative relationship between smoking and QoL and the magnitude of this association is related to the number of cigarettes smoked. Secondhand smoke also appears to be negatively associated with QoL. Smoking cessation significantly improves QoL. These findings have been replicated across populations with diverse socioeconomic and cultural groups around the world. DISCUSSION AND CONCLUSIONS QoL data promotes smokers and practitioners to become more sensitive to the sub-clinical adverse effects of cigarette smoking, thereby improving motivation to quit, cessation rates, and treatment outcomes. SCIENTIFIC SIGNIFICANCE Understanding the relationship between QoL and tobacco smoking is important for patients, clinicians, and researchers.

DSM-5 Changes in Diagnostic Criteria of Sexual Dysfunctions

The Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria proved to be in a constant of evolution [1]. The first edition of the DSM, in 1952, catalogued 60 categories of abnormal behavior. By 1994, the fourth edition (DSM-IV) listed 297 separate disorders and over 400 specific psychiatric diagnoses [2]. As with other disorders, DSM criteria for sexual dysfunctions reflect the prevailing psychiatric thinking of the time of publication; they have thus evolved throughout the years, reflecting advancements in the understanding of sexual disorders. For instance, in the first edition of the DSM, in 1952, impotence” and “frigidity were listed under “psychophysiological autonomic and visceral disorders” [3]. Likewise, diagnostic categories of female sexual interest as described in the DSM IV 1994 [4] were based on the model of human sexual response proposed by Masters and Johnson [5], and further developed by Kaplan [6]. However, recent research has put into question the validity of that model; both the strict distinction between different phases of arousal and the linear model of sexual response were found to inadequately explain sexual behavior, particularly in women [7-9]. This has in turn led to several proposed changes in sexual dysfunction diagnostic criteria [1,10].

The Impact of Psychotherapy, Pharmacotherapy, and Their Combination on Quality of Life in Depression

Background: Quality of life (QOL) is known to be negatively affected during the course of major depressive disorder. Various studies have documented the benefits of pharmacotherapy or psychotherapy alone on QOL in depression, with few studies examining combined treatment. This review will examine the evidence for the impact of each modality, as well as their combination, on QOL in depression. Methods: Using the key terms depression, depress*, major depress*, quality of life, antidepressant*, and psychotherapy, MEDLINE and PsycINFO searches were conducted to identify treatment‐outcome studies that used known QOL measurements over the past twenty‐six years (1984 to 2010). Results: Significant improvements in depressive symptomatology and QOL measurements were found with pharmacotherapy, psychotherapy, and their combination, with some studies showing greater improvement following combined treatment than with either intervention alone. Conclusions: Substantial evidence suggests that psychotherapy, pharmacotherapy, and their combination have favorable effects on QOL in depression. While some studies have shown that combined therapy is superior than either of the two forms alone in improving QOL, additional research is needed to elucidate this effect. QOL measurement is an important dimension of treatment‐outcome assessment in patients with depression.

The importance of quality of life in patients with alcohol abuse and dependence.

Learning ObjectivesAfter participating in this educational activity, the reader should be better able to identify the instruments that are currently being used to measure quality of life (QoL) in alcohol abuse and dependence; determine the impact of alcohol abuse and dependence on QoL; and evaluate the impact of treating alcohol abuse and dependence on QoL. ObjectiveQuality of life, which consists of the physical, mental, and social domains, has been shown to be negatively affected by alcohol abuse and dependence. This review aims to examine QoL in alcohol abuse and dependence by reviewing the instruments used to measure it and by analyzing the impact of alcohol abuse and dependence and of treatment on QoL. MethodsStudies were identified using a database search of PubMed and PsycINFO from the past 40 years (1971–2011) using the following keywords: abuse OR dependence, OR use AND alcohol, AND Quality of Life, QoL, Health-related quality of life, HRQOL. Two authors agreed independently on including 50 studies that met specific selection criteria. ResultsAlthough several global measures of QoL have established reliability and validity, many alcohol-specific measures of QoL have not yet been validated. Nevertheless, QoL has been shown to be significantly impaired in those with alcohol abuse and dependence, particularly in the domains of mental health and social functioning, the very areas that show the greatest improvement with abstinence and its maintenance. Moreover, the literature demonstrates the utility of using QoL measures throughout assessment and treatment as a motivational tool and as a marker for treatment efficacy. ConclusionsMeasuring and monitoring QoL during assessment and treatment can add important value to patient recovery, for QoL improves with treatment and successful abstinence. Therefore, targeted, disease-specific assessments of QoL are warranted to address the impairments in the physical, mental, and social domains in alcohol abuse and dependence, thereby improving long-term outcomes.