Search

QUESTION: Are mental health interventions for people with common somatic conditions effective? Can results from secondary care be extrapolated to primary care?Design:Systematic review with metes-analysis.Data sources:Studies were identified using PubMed, the Cochrane Library, PsychLit and Embase (1966 - September 2001); reference lists; key texts, and citations from experts.Study selection:Narrative systematic reviews, metes-analyses and randomised trials published in English were eligible if they assessed the effectiveness of primary or secondary care mental health interventions for chronic fatigue syndrome, irritable bowel syndrome or chronic back pain (where no physical cause was established). Eligible interventions included cognitive behavioural, cognitive, behaviour, brief interpersonal psychodynamic and antidepressant therapies. The authors identified 20 studies in primary care, 41 studies in secondary care and 2 metes-analyses.Data extraction:Reviewers extracted data on participant characteristics, sample size, sample source, intervention, outcomes, study dropouts and reasons for withdrawal. Main outcome measures were reported health status and functional outcomes, treatment effect size and disease severity. The authors calculated treatment effects using fixed and random effects models.Main results:Chronic fatigue syndrome: There is some evidence that cognitive behavioural therapy and behavioural therapy are effective in chronic fatigue syndrome. The authors found no evidence that brief psychodynamic interpersonal therapy or antidepressants improve symptoms in chronic fatigue syndrome.Irritable bowel syndrome: There is some evidence that antidepressants and brief interpersonal therapy are effective in irritable bowel syndrome. There is limited evidence for the effectiveness of relaxation training and mixed evidence about the benefits of cognitive behaviour therapy.Back Pain: There is some evidence that cognitive behaviour therapy and behaviour therapy are effective for people with back pain. The authors found insufficient evidence on antidepressants or brief interpersonal therapy.For all 3 syndromes, treatment effect sizes were largest in secondary care.Conclusions:Mental health interventions may be effective for chronic fatigue syndrome, irritable bowel syndrome and chronic back pain. There is more evidence for the effectiveness of secondary care interventions than interventions in primary care. [ABSTRACT FROM AUTHOR]

To examine race-ethnic differences in the lifetime prevalence rates of common anxiety disorders, we examined data from the Collaborative Psychiatric Epidemiology Studies. The samples included 6870 White Americans, 4598 African Americans, 3615 Hispanic Americans, and 1628 Asian Americans. White Americans were more likely to be diagnosed with social anxiety disorder, generalized anxiety disorder, and panic disorder than African Americans, Hispanic Americans, and Asian Americans. African Americans more frequently met criteria for post-traumatic stress disorder (PTSD) than White Americans, Hispanic Americans, and Asian Americans. Asian Americans were also less likely to meet the diagnoses for generalized anxiety disorder and PTSD than Hispanic Americans, and were less likely to receive social anxiety disorder, generalized anxiety disorder, panic disorder, and PTSD diagnoses than White Americans. The results suggest that race and ethnicity need to be considered when assigning an anxiety disorder diagnosis. Possible reasons for the observed differences in prevalence rates between racial groups are discussed. [ABSTRACT FROM AUTHOR]

Background: Biases in adverse effect reporting in randomized controlled trials (RCTs) [e.g. due to investigator expectations or assessment quality] can be quantified by studying the rates of adverse events reported in the placebo arms of such trials.Objective: We compared the rates of adverse effects reported in the placebo arms of tricyclic antidepressant (TCA) trials and placebo arms of selective serotonin reuptake inhibitor (SSRI) trials.Methods: We conducted a literature search for RCTs across PUBMED, Scopus and the Cochrane Central Register of Controlled Trials (CENTRAL). Only studies allowing adverse effect analysis were included. Publication year ranged from 1981 to 2007.Results: Our systematic review and meta-analysis included 143 placebocontrolled RCTs and data from 12,742 patients. Only 21% of studies used structured and systematic adverse effect ascertainment strategies. The way in which trials recorded adverse events influenced the rate of adverse effects substantially. Systematic assessment led to higher rates than less systematic assessment. Far more adverse effects were reported in TCA-placebo groups compared with SSRI-placebo groups, e.g. dry mouth (odds ratio [OR] = 3.5; 95% CI 2.9, 4.2); drowsiness (OR = 2.7; 95%CI 2.2, 3.4); constipation (OR= 2.7; 95%CI 2.1, 3.6); sexual problems (OR =2.3; 95%CI 1.5, 3.5). Regression analyses controlling for various influencing factors confirmed the results.Conclusion: Adverse effect profiles reported in clinical trials are strongly influenced by expectations from investigators and patients. This difference cannot be attributed to ascertainment methods. Adverse effect patterns of the drug group are closely related to adverse effects of the placebo group. These results question the validity of the assumption that adverse effects in placebo groups reflect the 'drug-unspecific effects'. [ABSTRACT FROM AUTHOR]

Background: The application of weekly doses of D-cycloserine (DCS) to the enhancement of exposure-based treatments has been a particular achievement of translational research. It is not known, however, whether this enhancement effect can be extended to other forms of learning. In this study, we investigated the relative benefit of DCS versus placebo for enhancing nonemotional verbal and nonverbal memory across weekly trials.Methods: We randomized healthy participants to weekly doses of 50 mg DCS or placebo, with 33 participants completing a 5-week protocol. Participants completed baseline neuropsychological evaluation and then 4 subsequent weeks of repeated learning tasks.Results: No improvement was found in immediate or delayed memory following single doses of DCS for the memory tasks repeated on a weekly basis. Trends for an advantage of DCS were evident for novel word lists given each week.Conclusions: The learning tasks in our study were particularly distinct from the extinction learning paradigms that have shown strong DCS effects, and we were unable to demonstrate useful DCS effects with these nonemotional stimuli. Additional research is needed to elucidate the bounds of DCS augmentation effects on therapeutic learning. [ABSTRACT FROM AUTHOR]