Latent classes of nonresponders, rapid responders, and gradual responders in depressed outpatients receiving antidepressant medication and psychotherapy

BackgroundWe used growth mixture modeling (GMM) to identify subsets of patients with qualitatively distinct symptom trajectories resulting from treatment. Existing studies have focused on 12-week antidepressant trials. We used data from a concurrent antidepressant and psychotherapy trial over a 6-month period. MethodEight hundred twenty-one patients were randomized to receive either fluoxetine or tianepine and received cognitive-behavioral therapy, supportive therapy, or psychodynamic therapy. Patients completed the Montgomery-angstrom sberg depression rating scale (MADRS) at the 0, 1, 3, and 6-month periods. Patients also completed measures of dysfunctional attitudes, functioning, and personality. GMM was conducted using MADRS scores and the number of growth classes to be retained was based on the Bayesian information criterion. ResultsCriteria supported the presence of four distinct latent growth classes representing gradual responders of high severity (42% of sample), gradual responders of moderate severity (31%), nonresponders (15%), and rapid responders (11%). Initial severity, greater use of emotional coping strategies, less use of avoidance coping strategies, introversion, and less emotional stability predicted nonresponder status. Growth classes were not associated with different treatments or with proportion of dropouts. ConclusionsThe longer time period used in this study highlights potential overestimates of nonresponders in previous research and the need for continued assessments. Our findings demonstrate distinct growth trajectories that are independent of treatment modality and generalizable to most psychotherapy patients. The correlates of class membership provide directions for future studies, which can refine methods to predict likely nonresponders as a means to facilitate personalized treatments

Benchmarking clinical management of spinal and non-spinal disorders using quality of life: results from the EPI3-LASER survey in primary care

Concerns have been raised regarding sub-optimal utilization of analgesics and psychotropic drugs in the treatment of patients with chronic musculoskeletal disorders (MSDs) and their associated co-morbidities. The objective of this study was to describe drug prescriptions for the management of spinal and non-spinal MSDs contrasted against a standardized measure of quality of life. A representative population sample of 1,756 MSDs patients [38.5% with spinal disorder (SD) and 61.5% with non-spinal MSDs (NS-MSD)] was drawn from the EPI3-LASER survey of 825 general practitioners (GPs) in France. Physicians recorded their diagnoses and prescriptions on that day. Patients provided information on socio-demographics, lifestyle and quality of life using the Short Form 12 (SF-12) questionnaire. Chronicity of MSDs was defined as more than 12 weeks duration of the current episode. Chronic SD and NS-MSD patients were prescribed less analgesics and non-steroidal anti-inflammatory drugs than their non-chronic counterpart [odds ratios (OR) and 95% confidence intervals (CI), respectively: 0.4, 0.2–0.7 and 0.5, 0.3–0.6]. They also had more anxio-depressive co-morbidities reported by their physicians (SD: 16.1 vs.7.4%; NS-MSD: 21.6 vs. 9.5%) who prescribed more antidepressants and anxiolytics with a difference that was statistically significant only for spinal disorder patients (OR, 95% CI: 2.0, 1.1–3.6). Psychotropic drugs were more often prescribed in patients in the lower quartile of SF-12 mental score and prescriptions of analgesics in the lower quartile of SF-12 physical score (P < 0.001). In conclusion, anxiety and depressive disorders were commonly reported by GPs among chronic MSD patients. Their prescriptions of psychotropic and analgesic drugs were consistent with patients’ self-rated mental and physical health

Subjective motives for requesting in-patient treatment in female with anorexia nervosa: a qualitative study.

BACKGROUND: Anorexia nervosa is a severe psychiatric disorder mainly affecting women. Its treatment is long and accepted with much difficulty, in particular in-patient treatment. AIMS: To describe the subjective motives of women with anorexia nervosa for requesting in-patient admission, from a qualitative analysis of application letters. METHODS: Participants were adult women (18 years and older) with anorexia nervosa who were admitted as in-patients in a referral hospital unit in France from January 2008 to December 2010. The application letters, prerequisites to admission, were studied by the interpretative phenomenological method of content analysis. RESULTS: 63 letters have been analysed, allowing the identification of six themes related to requests for in-patient care: loss of control of behaviour, and of thoughts, mental exhaustion, isolation, inner struggle and fear of recovery. CONCLUSIONS: Requests for in-patient admission were motivated by very personal, subjective experiences, unrelated to medical reasons for admission. These results may help improve pre-admission motivational work with individuals, by basing it on their subjective experience

Physicochemical characterisation of calcium phosphatesprepared from milk ultrafiltrates: Effect of the mineralcomposition

This study deals with the precipitation of calcium phosphate in permeates removed from milks at differentpH (6.7, 5.2 and 4.6). An overall high yield of precipitation of calcium and phosphate (70–80%, respectively)was obtained for all precipitates with Ca⁄P molar ratios close to 1.5. The suspended milk-derivedcalcium phosphate (MDCP) precipitates had 8–14 lm size and )14 to )28 mV zeta potential. The driedMDCP precipitates were identified as amorphous calcium phosphate (ACP), stable over 18 months ofstorage at room temperature

Effects of citrate and NaCl on size, morphology, crystallinity and microstructure of calcium phosphates obtained from aqueous solutions at acidic or near-neutral pH

Precipitation of calcium phosphates occurs in dairy products and depending on pH and ionic environment, several salts with different crystallinity can form. The present study aimed to investigate the effects of NaCl and citrate on the characteristics of precipitates obtained from model solutions of calcium phosphate at pH 6·70 maintained constant or left to drift. The ion speciation calculations showed that all the starting solutions were supersaturated with respect to dicalcium phosphate dihydrate (DCPD), octacalcium phosphate (OCP) and hydroxyapatite (HAP) in the order HAP>OCP>DCPD. X-ray diffraction (XRD) and Fourier transform infrared (FTIR) analyses of the precipitates showed that DCPD was formed at drifting pH (acidic final pH) whereas poor crystallised calcium deficient apatite was mainly formed at constant pH (6·70). Laser light scattering measurements and electron microscopy observations showed that citrate had a pronounced inhibitory effect on the crystallisation of calcium phosphates both at drifting and constant pH. This resulted in the decrease of the particle sizes and the modification of the morphology and the microstructure of the precipitates. The inhibitory effect of citrate mainly acted by the adsorption of the citrate molecules onto the surfaces of newly formed nuclei of calcium phosphate, thereby changing the morphology of the growing particles. These findings are relevant for the understanding of calcium phosphate precipitation from dairy byproducts that contain large amounts of NaCl and citrate

The structure of the Montgomery-Asberg depression rating scale over the course of treatment for depression

International audienceThe Montgomery-Åsberg Depression Rating Scale (MADRS) is a widely used clinician-rated measure of depressive severity. Empirical support for the factor structure of the MADRS is mixed; further, the comparison of MADRS scores within and between patients requires the demonstration of consistent instrument properties. The objective of the current investigation was to evaluate MADRS factor structure as well as MADRS factorial invariance across time and gender. The MADRS was administered to 821 depressed outpatients participating in a large-scale effectiveness study of combined pharmacotherapy and psychotherapy for depression. Treatment outcome did not differ across treatment groups. Factor structure and invariance was evaluated via confirmatory factor analysis. A four-factor model consisting of Sadness, Negative Thoughts, Detachment and Neurovegetative symptoms demonstrated a good fit to the data. This four-factor structure was invariant across time and gender. A hierarchical model, in which these four factors served as indicators of a general depression factor, was also supported. A limitation of the current study is the lack of comprehensive characterization of patient clinical features; results need to be replicated in more severely depressed or treatment refractory patients. Overall, evidence supported the use of the MADRS total score as well as subscales focused on affective, cognitive, social and somatic aspects of depression in male and female outpatients

Attention-Déficit Hyperactivity Disorder Symptoms and Psychological Comorbidity in Eating Disorder Patients.

International audience[No abstract