
Journal of Affective Disorders, Год журнала: 2024, Номер unknown
Опубликована: Окт. 1, 2024
Язык: Английский
Journal of Affective Disorders, Год журнала: 2024, Номер unknown
Опубликована: Окт. 1, 2024
Язык: Английский
World Psychiatry, Год журнала: 2023, Номер 22(3), С. 394 - 412
Опубликована: Сен. 15, 2023
Treatment-resistant depression (TRD) is common and associated with multiple serious public health implications. A consensus definition of TRD demonstrated predictive utility in terms clinical decision-making outcomes does not currently exist. Instead, a plethora definitions have been proposed, which vary significantly their conceptual framework. The absence hampers precise estimates the prevalence TRD, also belies efforts to identify risk factors, prevention opportunities, effective interventions. In addition, it results heterogeneity practice decision-making, adversely affecting quality care. US Food Drug Administration (FDA) European Medicines Agency (EMA) adopted most used (i.e., inadequate response minimum two antidepressants despite adequacy treatment trial adherence treatment). It estimated that at least 30% persons meet this definition. significant percentage are actually pseudo-resistant (e.g., due inadequacy trials or non-adherence Although sociodemographic, clinical, contextual factors known negatively moderate depression, very few regarded as non-response across modalities treatment. Intravenous ketamine intranasal esketamine (co-administered an antidepressant) established efficacious management TRD. Some second-generation antipsychotics aripiprazole, brexpiprazole, cariprazine, quetiapine XR) proven adjunctive treatments partial responders, but only olanzapine-fluoxetine combination has studied FDA-defined Repetitive transcranial magnetic stimulation (TMS) FDA-approved for individuals accelerated theta-burst TMS recently showing efficacy. Electroconvulsive therapy acute maintenance intervention preliminary evidence suggesting non-inferiority intravenous ketamine. Evidence extending antidepressant trial, medication switching combining mixed. Manual-based psychotherapies on own offer symptomatic relief when added conventional antidepressants. Digital therapeutics under study represent potential future vista population.
Язык: Английский
Процитировано
306The Lancet, Год журнала: 2022, Номер 399(10338), С. 1903 - 1916
Опубликована: Май 1, 2022
Язык: Английский
Процитировано
190Evidence-Based Mental Health, Год журнала: 2022, Номер 25(4), С. 148 - 155
Опубликована: Сен. 26, 2022
Question Effective prevention of suicide requires a comprehensive understanding risk factors. Study selection and analysis Five databases were systematically searched to identify psychological autopsy studies (published up February 2022) that reported on factors for mortality among adults in the general population. Effect sizes pooled as odds ratios (ORs) using random-effects models each factor examined at least three independent samples. Findings A total 37 case–control from 23 countries included, providing data 40 5633 cases 7101 controls. The magnitude effect varied substantially both between within domains. Clinical had strongest associations with suicide, including any mental disorder (OR=13.1, 95% CI 9.9 17.4) history self-harm (OR=10.1, 6.6 15.6). By comparison, smaller other domains relating sociodemographic status, family history, adverse life events (OR range 2–5). Conclusions wide predisposing precipitating are associated population, but clear differences their relative strength. PROSPERO registration number CRD42021232878.
Язык: Английский
Процитировано
175JAMA Network Open, Год журнала: 2021, Номер 4(6), С. e2113513 - e2113513
Опубликована: Июнь 14, 2021
Язык: Английский
Процитировано
122American Journal of Psychiatry, Год журнала: 2022, Номер 179(6), С. 422 - 433
Опубликована: Май 23, 2022
Suicide rates among ethnoracially minoritized youth (i.e., of color) peak before the age 30, and striking disparities in access to mental health services have been identified this group. However, suicide prevention strategies yet fully address structural racism as a mechanism producing risk, protective factors, quality effective intervention for color. Such an approach is critical provide more culturally responsive care. Through adapted socio-ecological model, authors propose Structural Racism Prevention Systems Framework illustrate pathways through which impacts color United States. The contextualize impact three key settings where occurs: services, schools, interface between crisis care law enforcement. posit that attention must be paid intersection mutually reinforcing, interdependent systems rather than isolation. then recommendations prevention, including macro-level interventions improve societal conditions, research inform solutions, training approaches institutional racism, clinical racial trauma on youths families.
Язык: Английский
Процитировано
84BMJ, Год журнала: 2023, Номер unknown, С. e073591 - e073591
Опубликована: Апрель 12, 2023
Abstract Bipolar disorders (BDs) are recurrent and sometimes chronic of mood that affect around 2% the world’s population encompass a spectrum between severe elevated excitable states (mania) to dysphoria, low energy, despondency depressive episodes. The illness commonly starts in young adults is leading cause disability premature mortality. clinical manifestations bipolar disorder can be markedly varied within individuals across their lifespan. Early diagnosis challenging misdiagnoses frequent, potentially resulting missed early intervention increasing risk iatrogenic harm. Over 15 approved treatments exist for various phases disorder, but outcomes often suboptimal owing insufficient efficacy, side effects, or lack availability. Lithium, first treatment continues most effective drug overall, although full remission only seen subset patients. Newer atypical antipsychotics increasingly being found depression; however, long term tolerability safety uncertain. For many with combination therapy adjunctive psychotherapy might necessary treat symptoms different illness. Several classes medications treating predicting which medication likely tolerable not yet possible. As pathophysiological insights into causes revealed, new era targeted aimed at causal mechanisms, they pharmacological psychosocial, will hopefully developed. time being, judgment, shared decision making, empirical follow-up remain essential elements care. This review provides an overview features, diagnostic subtypes, major modalities available people highlighting recent advances ongoing therapeutic challenges.
Язык: Английский
Процитировано
66The Lancet Psychiatry, Год журнала: 2023, Номер 10(6), С. 452 - 464
Опубликована: Май 11, 2023
Язык: Английский
Процитировано
64The Lancet Public Health, Год журнала: 2023, Номер 8(11), С. e868 - e877
Опубликована: Окт. 26, 2023
Deaths by suicide remain a major public health challenge worldwide. Identifying and targeting risk factors for mortality is potential approach to prevention. We aimed summarise current knowledge on the range magnitude of individual-level in general population evaluate quality evidence.
Язык: Английский
Процитировано
62Neuropharmacology, Год журнала: 2022, Номер 218, С. 109219 - 109219
Опубликована: Авг. 14, 2022
The N-methyl-d-aspartate receptor (NMDAR) antagonist (R,S)-ketamine causes rapid onset and sustained antidepressant actions in treatment-resistant patients with major depressive disorder (MDD) other psychiatric disorders, such as bipolar post-traumatic stress disorder. is a racemic mixture consisting of (R)-ketamine (or arketamine) (S)-ketamine esketamine), (S)-enantiomer having greater affinity for the NMDAR. In 2019, an esketamine nasal spray by Johnson & was approved USA Europe depression. contrast, increasing number preclinical studies show that arketamine has potency longer-lasting antidepressant-like effects than rodents, despite lower binding Importantly, side effects, i.e., psychotomimetic dissociative abuse liability, are less those animals humans. An open-label study demonstrated MDD. A phase 2 clinical trial MDD underway. This designed to review brief history novel arketamine, molecular mechanisms underlying its actions, future directions. article part Special Issue on 'Ketamine Metabolites'.
Язык: Английский
Процитировано
71JAMA Psychiatry, Год журнала: 2022, Номер 79(3), С. 219 - 219
Опубликована: Янв. 19, 2022
Although suicide attempts remain the strongest risk factor for future suicide, little is known about recent trends in prevalence of and factors past-year use services among adults who attempted suicide.To estimate annual rates mental health US from 2008 to 2019.This nationally representative cross-sectional study used National Survey Drug Use Health (NSDUH) through 2019. Participants included noninstitutionalized civilians 18 years or older (n = 484 732). The overall per 100 000 general population national 2019 were estimated, with defined as self-reported efforts kill one's self past 12 months. Subgroup analyses also performed by demographic characteristics clinical conditions. those reported then examined. Data analyzed October December 2021.Rate Multivariate-adjusted logistic regression determine whether adjusting sociodemographic associated could account change within period.Of 732 survey participants, most 35 younger (69.8%), women (51.8%), non-Hispanic White individuals (65.7%). From 2019, weighted unadjusted attempt rate increased 481.2 563.9 (odds ratio [OR], 1.17 [95% CI, 1.01-1.36]; P .04) remained significant after controlling (adjusted OR [aOR], 1.23 1.05-1.44]; .01). Rates particularly young aged 25 (aOR, 1.81 1.52-2.16]; < .001), 1.33 1.09-1.62]; .005), unemployed 2.22 1.58-3.12]; .001) never married 1.60 1.31-1.96]; substances 1.44 1.19-1.75]; .001). In multivariate analyses, temporal trend increasing even other 1.36 1.16-1.60]; Several subgroups independently attempts, especially serious psychological distress 7.51 6.49-8.68]; major depressive episodes 2.90 2.57-3.27]; alcohol disorder [95%CI, 1.61-2.04]; P< well being divorced separated 1.65 1.35-2.02]; 1.47 1.27-1.70]; identified Black 1.41 1.24-1.60]; American Indian Alaska Native, Asian, Native Hawaiian Other Pacific Islander 1.56 1.26-1.93]; Among a attempt, there was no likelihood receiving substance-related services. During period, 34.8% 45.5% needing but did not receive them, 2019.Although appear be increasing, has increased, suggesting need expand service accessibility and/or acceptability, population-wide prevention efforts.
Язык: Английский
Процитировано
54