The efficacy of psychotherapies and pharmacotherapies for mental disorders in adults: an umbrella review and meta‐analytic evaluation of recent meta‐analyses

World Psychiatry, Journal Year: 2022, Volume and Issue: 21(1), P. 133 - 145

Published: Jan. 11, 2022

Mental disorders represent a worldwide public health concern. Psychotherapies and pharmacotherapies are recommended as first line treatments. However, evidence has emerged that their efficacy may be overestimated, due to variety of shortcomings in clinical trials (e.g., publication bias, weak control conditions such waiting list). We performed an umbrella review recent meta-analyses randomized controlled (RCTs) psychotherapies for the main mental adults. selected formally assessed risk bias or quality studies, excluded comparators, used effect sizes target symptoms primary outcome. searched PubMed PsycINFO individual records Cochrane Library published between January 2014 March 2021 comparing with placebo treatment-as-usual (TAU), vs. head-to-head, combination psychotherapy pharmacotherapy either monotherapy. One hundred two meta-analyses, encompassing 3,782 RCTs 650,514 patients, were included, covering depressive disorders, anxiety post-traumatic stress disorder, obsessive-compulsive somatoform eating attention-deficit/hyperactivity substance use insomnia, schizophrenia spectrum bipolar disorder. Across treatments, majority small. A random meta-analytic evaluation reported by largest per disorder yielded standardized mean difference (SMD) 0.34 (95% CI: 0.26-0.42) 0.36 0.32-0.41) compared TAU. The SMD head-to-head comparisons was 0.11 -0.05 0.26). combined treatment monotherapy 0.31 0.19-0.44). Risk often high. After more than half century research, thousands millions invested funds, limited, suggesting ceiling research presently conducted. paradigm shift seems required achieve further progress.

Language: Английский

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Tobacco and nicotine use

Nature Reviews Disease Primers, Journal Year: 2022, Volume and Issue: 8(1)

Published: March 24, 2022

Language: Английский

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Novel Agents for the Pharmacological Treatment of Alcohol Use Disorder

Drugs, Journal Year: 2022, Volume and Issue: 82(3), P. 251 - 274

Published: Feb. 1, 2022

Alcohol use disorder (AUD) is a highly prevalent but severely under-treated disorder, with only three widely-approved pharmacotherapies. Given that AUD very heterogeneous it unlikely one single medication will be effective for all individuals an AUD. As such, there need to develop new, more effective, and diverse pharmacological treatment options the hopes of increasing utilization improving care. In this qualitative literature review, we discuss efficacy, mechanism action, tolerability approved, repurposed, novel pharmacotherapies clinical perspective. Pharmacotherapies discussed include: disulfiram, acamprosate, naltrexone, nalmefene, topiramate, gabapentin, varenicline, baclofen, sodium oxybate, aripiprazole, ondansetron, mifepristone, ibudilast, suvorexant, prazosin, doxazosin, N-acetylcysteine, GET73, ASP8062, ABT-436, PF-5190457, cannabidiol. Overall, many repurposed agents in review demonstrate effectiveness promise future treatment. Importantly, these medications also offer potential improvements towards advancement precision medicine personalized population. However, remains great improve access treatment, increase menu approved treatments, de-stigmatize treatment-seeking

Language: Английский

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Management of alcohol use disorder: a gastroenterology and hepatology-focused perspective

˜The œLancet. Gastroenterology & hepatology, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 1, 2025

Language: Английский

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Alcohol use disorders and ADHD

Neuroscience & Biobehavioral Reviews, Journal Year: 2021, Volume and Issue: 128, P. 648 - 660

Published: July 12, 2021

Language: Английский

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Which interventions for alcohol use should be included in a universal healthcare benefit package? An umbrella review of targeted interventions to address harmful drinking and dependence

BMC Public Health, Journal Year: 2023, Volume and Issue: 23(1)

Published: Feb. 23, 2023

Abstract Background This study aimed to identify targeted interventions for the prevention and treatment of harmful alcohol use. Umbrella review methodology was used summarise effectiveness across a broad range interventions, in order which should be considered inclusion within universal health coverage schemes low- middle-income countries. Methods findings We included systematic reviews with meta-analysis randomised controlled trials (RCTs) on addressing use drinkers or individuals disorder. only outcomes related consumption, heavy drinking, binge abstinence, alcohol-attributable accident, injury, morbidity mortality. PubMed, Embase, PsycINFO, Cochrane Database Systematic Reviews, International HTA were searched from inception 3 September 2021. Risk bias assessed using AMSTAR2 tool. After reviewing abstracts 9,167 articles, results summarised narratively certainty body evidence each intervention GRADE. In total, 86 studies met criteria, majority reported brief (30 studies) pharmacological (29 studies). Overall, methodological quality low. Conclusions For cognitive behavioural therapy, motivational interviewing showed small effect, whereas mentoring adolescents children may have significant long-term effect. disorder, social network approaches acamprosate durable More is required gamma-hydroxybutyric acid (GHB), nalmefene, quetiapine, as well optimal combinations psychosocial interventions. As an umbrella review, we unable extent variation between stemmed differences delivery country contexts. Further research applicability settings best practice implementation. Funded by Thai Health Promotion Foundation, grant number 61–00-1812.

Language: Английский

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Risk factors, preventive interventions, overlapping symptoms, and clinical measures of delirium in elderly patients

World Journal of Psychiatry, Journal Year: 2023, Volume and Issue: 13(12), P. 973 - 984

Published: Dec. 19, 2023

Delirium is an acute reversible neuropsychiatric syndrome caused by multiple factors. It associated with many adverse clinical outcomes including cognitive impairment, functional decline, prolonged hospitalization, and increased nursing service. The prevalence of delirium was high in department cardiology, geriatric, intensive care unit hospital. With the increase aged population, further increases seem likely. However, it remains poorly recognized practice. This article comprehensively discusses latest research perspectives on epidemiological data, risk factors, preventive interventions, overlapping symptoms, measures delirium, specific to manage real-world situations. helps readers improve their knowledge understanding clinicians quickly identify implement timely therapeutic address various subtypes that occur settings ensure patients are treated as aggressively possible.

Language: Английский

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Integrative Pharmacology in the Treatment of Substance Use Disorders

Journal of Dual Diagnosis, Journal Year: 2023, Volume and Issue: 20(2), P. 132 - 177

Published: Dec. 20, 2023

The detrimental physical, mental, and socioeconomic effects of substance use disorders (SUDs) have been apparent to the medical community for decades. However, it has become increasingly urgent in recent years develop novel pharmacotherapies treat SUDs. Currently, practitioners typically rely on monotherapy. Monotherapy shown be superior no treatment at all most classes. many randomized controlled trials (RCTs) revealed that monotherapy leads poorer outcomes when compared with combination specialties medicine. results RCTs suggest frequently fails since multiple dysregulated pathways, enzymes, neurotransmitters, receptors are involved pathophysiology As such, research is urgently needed determine how various neurobiological mechanisms can targeted by treatments create specific yet exceedingly comprehensive approaches SUD treatment. This article aims review neurobiology integrates pathophysiologic discuss integrative pharmacology developments may ultimately improve clinical patients Many known SUDs including dopaminergic, nicotinic, N-methyl-D-aspartate (NMDA), kynurenic acid (KYNA) mechanisms. Emerging evidence indicates KYNA, a tryptophan metabolite, modulates these major Therefore, achieving KYNA homeostasis harmonizing could prove better therapeutic approach We propose KYNA-NMDA-α7nAChRcentric pathophysiology, "conductor orchestra," as concurrently. KYNA-NMDA-α7nAChR "command center" neuropsychiatry. To date, extant equivocal findings across comparison conditions, possibly because investigators single mechanisms, hit wrong targets underlying tested inadequate provide examples potential simultaneously target addition KYNA. Kynurenine pathway metabolism demonstrates greatest neuropsychiatric diseases. investigational medications include memantine, galantamine, N-acetylcysteine. Future warranted Multicenter offer promising, potentially fruitful avenue therapeutics

Language: Английский

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Repurposing drugs for treatment of alcohol use disorder

International review of neurobiology, Journal Year: 2024, Volume and Issue: unknown, P. 153 - 185

Published: Jan. 1, 2024

Language: Английский

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Structural Features Influencing the Bioactive Conformation of Angiotensin II and Angiotensin A: Relationship between Receptor Desensitization, Addiction, and the Blood–Brain Barrier

International Journal of Molecular Sciences, Journal Year: 2024, Volume and Issue: 25(11), P. 5779 - 5779

Published: May 26, 2024

The N-terminal portion of the octapeptide angiotensin II (DRVYIHPF; AngII), a vasopressor peptide that favorably binds to, and activates, AngII type 1 receptor (AT1R), has an important role in maintaining bioactive conformation. It involves all three charged groups, namely (i) amino group cation, (ii) Asp sidechain anion (iii) Arg guanidino cation. Neutralization any one these groups results substantial reduction (<5%) bioactivity, implicating specialized function for this cluster. In contrast, A (ARVYIHPF; AngA) reduced bioactivity at AT1R; however, replacement with sarcosine (N-methyl-glycine) not only restores but increases activity agonist, antagonist, inverse agonist analogues. bend produced N-terminus by introduction secondary acid is thought to realign functional chaperone C-terminal AngII, allowing transfer negative charge originating C-terminus be transferred Tyr hydroxyl-forming tyrosinate anion, which required activate desensitizes (tachyphylaxis). Peptide (sarilesin) nonpeptide (sartans) moieties, are long-acting agonists, appear desensitize mechanism analogous tachyphylaxis. Sartans/bisartans were found bind alpha adrenergic receptors resulting structure-dependent desensitization or resensitization. These considerations have provided information on mechanisms desensitization/tolerance insights into possible avenues treating addiction. regard sartans, cross blood–brain barrier more readily than bisartans, preferred drug candidates.

Language: Английский

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