Dismantling cognitive-behaviour therapy for panic disorder: a systematic review and component network meta-analysis.

Cognitive-behaviour therapy (CBT) for panic disorder may consist of different combinations of several therapeutic components such as relaxation, breathing retraining, cognitive restructuring, interoceptive exposure and/or in vivo exposure. It is therefore important both theoretically and clinically to examine whether specific components of CBT or their combinations are superior to others in the treatment of panic disorder. Component network meta-analysis (NMA) is an extension of standard NMA that can be used to disentangle the treatment effects of different components included in composite interventions. We searched MEDLINE, EMBASE, PsycINFO and Cochrane Central, with supplementary searches of reference lists and clinical trial registries, for all randomized controlled trials comparing different CBT-based psychological therapies for panic disorder with each other or with control interventions. We applied component NMA to disentangle the treatment effects of different components included in these interventions. After reviewing 2526 references, we included 72 studies with 4064 participants. Interoceptive exposure and face-to-face setting were associated with better treatment efficacy and acceptability. Muscle relaxation and virtual-reality exposure were associated with significantly lower efficacy. Components such as breathing retraining and in vivo exposure appeared to improve treatment acceptability while having small effects on efficacy. The comparison of the most v. the least efficacious combination, both of which may be provided as 'evidence-based CBT,' yielded an odds ratio for the remission of 7.69 (95% credible interval: 1.75 to 33.33). Effective CBT packages for panic disorder would include face-to-face and interoceptive exposure components, while excluding muscle relaxation and virtual-reality exposure

Factors associated with motivation and hesitation to work among health professionals during a public crisis: a cross sectional study of hospital workers in Japan during the pandemic (H1N1) 2009

<p>Abstract</p> <p>Background</p> <p>The professionalism of hospital workers in Japan was challenged by the pandemic (H1N1) 2009. To maintain hospital function under critical situations such as a pandemic, it is important to understand the factors that increase and decrease the willingness to work. Previous hospital-based studies have examined this question using hypothetical events, but so far it has not been examined in an actual pandemic. Here, we surveyed the factors that influenced the motivation and hesitation of hospital workers to work in Japan soon after the pandemic (H1N1) 2009.</p> <p>Methods</p> <p>Self-administered anonymous questionnaires about demographic character and stress factors were distributed to all 3635 employees at three core hospitals in Kobe city, Japan and were collected from June to July, 2009, about one month after the pandemic (H1N1) in Japan.</p> <p>Results</p> <p>Of a total of 3635 questionnaires distributed, 1693 (46.7%) valid questionnaires were received. 28.4% (N = 481) of workers had strong motivation and 14.7% (N = 249) had strong hesitation to work. Demographic characters and stress-related questions were categorised into four types according to the odds ratios (OR) of motivation and hesitation to work: some factors increased motivation and lowered hesitation; others increased motivation only; others increased hesitation only and others increased both motivation and hesitation. The strong feeling of being supported by the national and local governments (Multivariate OR: motivation; 3.5; CI 2.2-5.4, hesitation; 0.2; CI 0.1-0.6) and being protected by hospital (Multivariate OR: motivation; 2.8; CI 2.2-3.7, hesitation; 0.5; CI 0.3-0.7) were related to higher motivation and lower hesitation. Here, protection included taking precautions to prevent illness among workers and their families, providing for the care of those who do become ill, reducing malpractice threats, and financial support for families of workers who die on duty. But 94.1% of the respondents answered protection by the national and local government was weak and 79.7% answered protection by the hospital was weak.</p> <p>Conclusions</p> <p>Some factors have conflicting effects because they increase both motivation and hesitation. Giving workers the feeling that they are being protected by the national and local government and hospital is especially valuable because it increases their motivation and lowers their hesitation to work.</p

Overstatements in abstract conclusions claiming effectiveness of interventions in psychiatry: A study protocol for a meta-epidemiological investigation

Introduction: Abstracts are the major and often the most important source of information for readers of the medical literature. However, there is mounting criticism that abstracts often exaggerate the positive findings and emphasise the beneficial effects of intervention beyond the actual findings mentioned in the corresponding full texts. In order to examine the magnitude of this problem, we will introduce a systematic approach to detect overstated abstracts and to quantify the extent of their prevalence in published randomised controlled trials (RCTs) in the field of psychiatry. Methods and analysis: We will source RCTs published in 2014 from the Cochrane Register of Controlled Trials (CENTRAL) that claim effectiveness of any intervention for mental disorders. The abstract conclusions will be categorised into three types: superior (only stating significant superiority of intervention to control), limited (suggesting that intervention has limited superiority to control) and equal (claiming equal effectiveness of intervention as control). The full texts will also be classified as one of the following based on the primary outcome results: significant (all primary outcomes were statistically significant in favour of the intervention), mixed (primary outcomes included both significant and non-significant results) or all non-significant results. By comparing the abstract conclusion classification and that of the corresponding full text, we will assess whether each study exhibited overstatements in its abstract conclusion. Ethics and dissemination: This trial requires no ethical approval. We will publish our findings in a peer-reviewed journal. Trial registration number: UMIN000018668; Pre-results

Antidepressants, benzodiazepines and azapirones for panic disorder in adults:a network meta-analysis

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To compare individual active drugs (antidepressants, benzodiazepines and azapirones) and placebo in terms of efficacy and acceptability in the acute treatment of panic disorder, with or without agoraphobia. To rank treatments for panic disorder (antidepressants, benzodiazepines, azapirones and placebo) according to their effectiveness and acceptability

Cardiovascular adverse reactions associated with escitalopram in patients with underlying cardiovascular diseases: a systematic review and meta-analysis

BackgroundDespite the anticipated efficacy of escitalopram in treating depression and anxiety in individuals with preexisting cardiovascular conditions, persistent concerns regarding its adverse effects have emerged. In this systematic review, we aimed to evaluate the cardiovascular safety profile of escitalopram compared with that of placebo in patients with underlying cardiovascular disease.MethodsWe used a predefined search strategy in PubMed, Cochrane Central Register of Controlled Trials, Embase, International Clinical Trials Registry Platform, and ClinicalTrials.gov to identify studies evaluating adverse cardiovascular reactions to escitalopram in patients with underlying cardiovascular disease. Randomized controlled trials (RCTs) that provided results on cardiovascular safety outcomes were included. Two independent reviewers screened the abstracts and full texts of the individual studies. The risk of bias was assessed using version 2 of the Cochrane risk-of-bias tool for randomized trials. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach.ResultsThe primary outcomes were the frequency of major adverse cardiovascular events (MACE), QTc prolongation, and discontinuation of study medication. We identified 5 RCTs with 773 participants who met the inclusion criteria. Escitalopram was not associated with significantly increased risk of MACE (risk ratio [RR] = 1.85; 95% confidence interval [CI] 0.80 to 4.26; I2 0%; 5 RCTs; n = 773, moderate certainty of evidence), discontinuation of study medication (RR = 1.03; 95% CI 0.84–1.26; I2 0%; 5 RCTs; n = 773, low certainty of evidence), and QTc prolongation (RR = 1.20; 95% CI 0.76–1.90; I2 0%; 4 RCTs; n = 646, low certainty of evidence).ConclusionEscitalopram does not significantly increase the risk of cardiovascular adverse reactions compared with placebo in patients with underlying cardiovascular disease. However, the presence of wide CIs and the limited number of included studies highlight the need for further studies with larger sample sizes to enhance the precision and reliability of these findings.Systematic review registration: International Prospective Register of Systematic Reviews [CRD42022298181]

Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder:a systematic review and network meta-analysis

Background Major depressive disorder is one of the most common, burdensome and costly psychiatric disorders worldwide in adults. Both pharmacological and non-pharmacological treatments are available, however, because of lack of resources, antidepressants are used more frequently. Prescription of these agents should be informed by the best available evidence. Consequently, we aimed to update and expand our previous work to compare and rank antidepressants for major depressive disorder in adults. Methods We searched Cochrane CENTRAL, CINAHL, EMBASE, LiLACS, MEDLINE, PSYCINFO, regulatory agencies' websites, and international registers for published and unpublished, double-blind randomised controlled trials up to January 8th 2016, for the acute treatment of major depressive disorder diagnosed according to standard operationalised criteria. We included placebo-controlled and head-to-head trials of 21 antidepressants in adults. We assessed the certainty of evidence using GRADE. Primary outcomes were efficacy (response rate) and acceptability (discontinuations due to any cause). Secondary outcomes included symptom severity, remission rate and discontinuations due to adverse events. We estimated summary odds ratios (OR) and standardised mean differences (with 95% credibility intervals - 95% CrIs) using pairwise and network meta-analysis with random effects. This study is registered with PROSPERO (CRD42012002291). Findings We included 522 trials with 116,477 participants. The certainty of evidence was moderate to very low. In terms of efficacy, all antidepressants were more effective than placebo, with OR ranging between 2·13 (95% CrI 1·89 to 2·41) for amitriptyline and 1·38 (95% CrI 1·16 to 1·63) for reboxetine. For acceptability, agomelatine and fluoxetine were associated with fewer dropouts than placebo (OR 0·84, 95% CrI 0·72 to 0·97 and 0·88, 95% CrI 0·80 to 0·96, respectively), while clomipramine was worse than placebo (OR 1.31, 95% CrI 1·01 to 1·68). When all trials were considered, differences in OR between antidepressants ranged from 1·15 (95% CrI 1·04 to 1·27) to 1·55 (95% CrI 1·27 to 1·91) for efficacy and from 0.64 (95% CrI 0·48 to 0·86) to 0.85 (95% CrI 0·75 to 0·96) for acceptability, with wide confidence intervals on most of the comparative analyses. In head-to-head studies, agomelatine, amitriptyline, escitalopram, mirtazapine, paroxetine, sertraline, venlafaxine and vortioxetine were more effective than other antidepressants (OR range: 1.12 [95% CrI 1·00 to 1·32] to 1.96 [95% CrI 1·09 to 3·57]), while fluoxetine, reboxetine and trazodone were the least efficacious drugs (OR range: 0.51 [95% CrI 0·72 to 0·97] to 0.89 [95% CrI 0·72 to 0·97]). For acceptability, agomelatine, citalopram, escitalopram, fluoxetine, sertraline and vortioxetine were the best drugs (OR range: 0.42 [95% CrI 0·72 to 0·97] to 0.81 [95% CrI 0·72 to 0·97]), while amitriptyline, clomipramine, duloxetine, fluvoxamine, reboxetine, trazodone and venlafaxine had the highest dropout rates (OR range: 1.23 [95% CrI 1·00 to 1·32] to 2.37 [95% CrI 1·00 to 1·32]). Interpretation All antidepressants were more efficacious than placebo in adults with major depressive disorder. Smaller differences between active drugs were found when placebo-controlled trials were included in the analysis, while there was more variability in efficacy and rate of drop out in head-to-head trials. These results should serve evidence-based practice and inform patients, physicians, guideline developers and policy-makers on the relative merits of the different antidepressants.</p

日本語版老年期うつ病尺度の因子構造とクオリティオブライフおよび日常生活機能との関連

京都大学0048新制・課程博士博士(医学)甲第18858号医博第3969号新制||医||1008(附属図書館)31809京都大学大学院医学研究科医学専攻(主査)教授 福原 俊一, 教授 古川 壽亮, 教授 村井 俊哉学位規則第4条第1項該当Doctor of Medical ScienceKyoto UniversityDFA

Motivation and hesitation of healthcare workers to work during the H1N1 influenza and COVID‐19 pandemics: An exploratory single‐centered repeated cross‐sectional study

Abstract Aim Pandemics of life‐threatening viruses have detrimental impacts on the motivation of healthcare workers to work. However, no study has examined this impact during different pandemics with the same setting and design. This study aimed to reveal similarities and differences in factors associated with willingness and hesitation to work between two recent pandemics, H1N1 influenza and COVID‐19, in the same hospital, using the same questionnaire. Methods Healthcare workers in one hospital in Japan completed a questionnaire on basic characteristics and stress‐related questions during the H1N1 influenza (n = 1061) and the COVID‐19 (n = 1111) pandemics. Logistic regressions were performed to ascertain the effect of personal characteristics and stress‐related questions on the likelihood that employees showed strong or weak motivation or hesitation to work. Results The feeling of being protected by the hospital was the only factor that significantly decreased hesitation and increased motivation to work, and females felt significantly more hesitation to work than males did in both pandemics. Conclusions Hospital managers and government officers should focus on increasing organizational support and caring for female workers to maintain healthcare workers' motivation to work during future pandemics