scholarly journals Effects of stimulants and atomoxetine on emotional lability in adults: A systematic review and meta-analysis

2017 ◽  
Vol 44 ◽  
pp. 198-207 ◽  
Author(s):  
T.R. Moukhtarian ◽  
R.E. Cooper ◽  
E. Vassos ◽  
P. Moran ◽  
P. Asherson
Keyword(s):  
Systematic Review ◽  
Effect Size ◽  
Meta Analysis ◽  
Emotional Lability ◽  
Adhd Symptoms ◽  
Double Blind ◽  
Hyperactivity Disorder ◽  
Ovid Medline ◽  
Weighted Effect ◽  
The Difference

AbstractBackground:Emotional lability (EL) is an associated feature of attention-deficit/hyperactivity disorder (ADHD) in adults, contributing to functional impairment. Yet the effect of pharmacological treatments for ADHD on EL symptoms is unknown. We conducted a systematic review and meta-analysis to examine the effects of stimulants and atomoxetine on symptoms of EL and compare these with the effects on core ADHD symptoms.Methods:A systematic search was conducted on the databases Embase, PsychInfo, and Ovid Medline®and the clinicaltrials.gov website. We included randomised, double-blind, placebo-controlled trials of stimulants and atomoxetine in adults aged 18–60 years, with any mental health diagnosis characterised by emotional or mood instability, with at least one outcome measure of EL. All identified trials were on adults with ADHD. A random-effects meta-analysis with standardised mean difference and 95% confidence intervals was used to investigate the effect size on EL and compare this to the effect on core ADHD symptoms.Results:Of the 3,864 publications identified, nine trials met the inclusion criteria for the meta-analysis. Stimulants and atomoxetine led to large mean weighted effect-sizes for on ADHD symptoms (n= 9, SMD = −0.8, 95% CI:−1.07 to −0.53). EL outcomes showed more moderate but definite effects (n= 9, SMD = −0.41, 95% CI:−0.57 to −0.25).Conclusions:In this meta-analysis, stimulants and atomoxetine were moderately effective for EL symptoms, while effect size on core ADHD symptoms was twice as large. Methodological issues may partially explain the difference in effect size. Reduced average effect size could also reflect heterogeneity of EL with ADHD pharmacotherapy responsive and non-responsive sub-types. Our findings indicate that EL may be less responsive than ADHD symptoms overall, perhaps indicating the need for adjunctive psychotherapy in some cases. To clarify these questions, our findings need replication in studies selecting subjects for high EL and targeting EL as the primary outcome.

Efficacy, Acceptability, and Tolerability of Lisdexamfetamine, Mixed Amphetamine Salts, Methylphenidate, and Modafinil in the Treatment of Attention-Deficit Hyperactivity Disorder in Adults: A Systematic Review and Meta-analysis

2018 ◽  
Vol 53 (2) ◽  
pp. 121-133 ◽  
Author(s):  
Matej Stuhec ◽  
Petar Lukić ◽  
Igor Locatelli
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Clinical Trials ◽  
Effect Size ◽  
Attention Deficit ◽  
Data Extraction ◽  
Meta Analysis ◽  
Sole Source ◽  
Adhd Symptoms ◽  
Double Blind ◽  
Hyperactivity Disorder

Objective: Psychostimulants are the first-line treatment in adults with attention-deficit hyperactivity disorder (ADHD). This meta-analysis aimed to evaluate the efficacy, acceptability, and tolerability of lisdexamfetamine (LDX), mixed amphetamine salts (MASs), modafinil (MDF), and methylphenidate (MPH) in comparison with placebo. Data Sources: We systematically searched PubMed/MEDLINE and Clinicaltrials.gov in May 2016, along with CENTRAL and EU Clinical Trials Register in February 2016, for the randomized, double-blind, placebo-controlled, parallel-group clinical trials conducted on adults diagnosed with ADHD. Study Selection and Data Extraction: Substantial comorbidity, substance abuse or dependence, and nonpharmacological interventions represented grounds for exclusion. Published reports were the sole source for data extraction. Improvement in ADHD symptoms was the primary outcome. Random-effects model meta-analysis was applied to calculate the standardized mean difference (SMD) with 95% CIs. Data Synthesis: The search retrieved 701 records, of which 20 studies were eligible for analysis. High effect size (expressed as SMD) in reducing ADHD symptoms was observed for LDX (−0.89; 95% CI = −1.09, −0.70), whereas MASs (−0.64; 95% CI = −0.83, −0.45) and MPH (−0.50; 95% CI = −0.58, −0.41) reduced symptoms moderately compared with placebo. No efficacy was shown for MDF (0.08; 95% CI; −0.18, 0.34). Relevance to Patient Care and Clinical Practice: In this meta-analysis, the efficacy, tolerability, and acceptability of psychostimulants were compared with that for placebo. Five of the included trials have not been evaluated in any of the previously published meta-analyses. Conclusions: The results suggest that LDX has the largest effect size and has a promising potential for treating adults with ADHD.

Differences of energy expenditure while sitting versus standing: A systematic review and meta-analysis

2018 ◽  
Vol 25 (5) ◽  
pp. 522-538 ◽  
Author(s):  
Farzane Saeidifard ◽  
Jose R Medina-Inojosa ◽  
Marta Supervia ◽  
Thomas P Olson ◽  
Virend K Somers ◽  
...  
Keyword(s):  
Systematic Review ◽  
Energy Expenditure ◽  
Energy Content ◽  
Meta Analysis ◽  
Experimental Studies ◽  
Final Analysis ◽  
Ovid Medline ◽  
The Difference ◽  
Mean Differences

Background Replacing sitting with standing is one of several recommendations to decrease sedentary time and increase the daily energy expenditure, but the difference in energy expenditure between standing versus sitting has been controversial. This systematic review and meta-analysis aimed to determine this difference. Designs and methods We searched Ovid MEDLINE, Ovid Embase Scopus, Web of Science and Google Scholar for observational and experimental studies that compared the energy expenditure of standing versus sitting. We calculated mean differences and 95% confidence intervals using a random effects model. We conducted different predefined subgroup analyses based on characteristics of participants and study design. Results We identified 658 studies and included 46 studies with 1184 participants for the final analysis. The mean difference in energy expenditure between sitting and standing was 0.15 kcal/min (95% confidence interval (CI) 0.12–0.17). The difference among women was 0.1 kcal/min (95% CI 0.0–0.21), and was 0.19 kcal/min (95% CI 0.05–0.33) in men. Observational studies had a lower difference in energy expenditure (0.11 kcal/min, 95% CI 0.08–0.14) compared to randomised trials (0.2 kcal/min, 95% CI 0.12–0.28). By substituting sitting with standing for 6 hours/day, a 65 kg person will expend an additional 54 kcal/day. Assuming no increase in energy intake, this difference in energy expenditure would be translated into the energy content of about 2.5 kg of body fat mass in 1 year. Conclusions The substitution of sitting with standing could be a potential solution for a sedentary lifestyle to prevent weight gain in the long term. Future studies should aim to assess the effectiveness and feasibility of this strategy.

scholarly journals Shared Care Models in the Treatment of Pediatric Attention-Deficit/Hyperactivity Disorder (ADHD)

2018 ◽  
Vol 5 ◽  
pp. 233339281876288 ◽  
Author(s):  
Meshal A. Sultan ◽  
Carlos S. Pastrana ◽  
Kathleen A. Pajer
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Attention Deficit Hyperactivity Disorder ◽  
Effect Size ◽  
Attention Deficit ◽  
Collaborative Care ◽  
Meta Analysis ◽  
Care Providers ◽  
Hyperactivity Disorder ◽  
Care Models

Objectives: The aim of this review is to evaluate the effectiveness of shared/collaborative care between mental health-care providers and primary care providers (PCPs) on the outcomes of children and adolescents with attention-deficit/hyperactivity disorder (ADHD). This evaluation will be very helpful in the allocation of ADHD resources for models with the strongest evidence. Methods: Using the Preferred Reporting Items for Systematic Review and Meta-analysis statement, we searched for randomized controlled trials, cohort, case–control, and cross-sectional studies on shared/collaborative care models in the treatment of ADHD. Using MEDLINE, PsycINFO, and CENTRAL databases from January 2000 to December 2016, we retrieved English language articles for review. The validation search identified 75 records. Five studies met the inclusion criteria and were analyzed in this systematic review. There were insufficient data for a meta-analysis. The included studies involved 655 children and adolescents who had a diagnosis of ADHD. The Cochrane Collaboration’s tool for assessing risk of bias was used to estimate bias. Results: Overall, the results show that the effects of shared/collaborative care models were small to moderate (effect size: 0.1-0.6, P = .04) on symptom rating scales, but all positively affected functional outcomes (effect size: 0.3-0.7, P = .04-.01). The data indicated that the models were associated with increased PCPs’ comfort levels, but the evidence for increased capacity for diagnosing and managing ADHD was weaker. Conclusions: This review concludes that the current studies do not show strong evidence for the outcome of collaboration between PCPs and mental health professionals on ADHD management. Future research should consider providing education to PCPs on management guidelines prior to conducting the trials, and more innovation is needed to discover methods of collaboration that affect the direct care of ADHD.

Biofeedback in pediatric populations: a systematic review and meta-analysis of treatment outcomes

2019 ◽  
Author(s):  
Katherine E Darling ◽  
Ethan R Benore ◽  
Erin E Webster
Keyword(s):  
Systematic Review ◽  
Effect Size ◽  
Meta Analysis ◽  
Small Body ◽  
Large Effect Size ◽  
Positive Effects ◽  
Ovid Medline ◽  
Current Systematic Review ◽  
Associated Conditions ◽  
Pediatric Populations

Abstract Biofeedback is commonly used for both pediatric and adult patients with a myriad of diagnoses in clinical settings. The majority of previous research has focused on the use of biofeedback in adults, with only a small body of literature examining the usefulness of biofeedback in treating children. The current systematic review and meta-analysis seeks to quantitatively examine the usefulness of biofeedback in addressing pediatric conditions. A systematic review of biofeedback interventions in children was conducted using four databases (Ovid MEDLINE, EMBASE, PsycINFO, and Cochrane CENTRAL). Outcomes included changes in symptoms of associated conditions or changes in physiological functioning. Out of 3,128 identified articles, 23 studies (with 24 effect sizes) were eligible for inclusion in the meta-analysis. Using a random effects model, the overall effect of pediatric biofeedback was statistically significant with a large effect size. Despite the large effect size, general study quality was low, limiting interpretation of findings. Despite widespread clinical use of biofeedback in pediatric populations, research is still limited concerning the efficacy of biofeedback in children. While findings suggest potential positive effects of biofeedback to address pediatric conditions, high-quality studies are necessary to fully support the use of biofeedback in children.

scholarly journals Effects of Dance on Pain in Patients with Fibromyalgia: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 2018 ◽  
pp. 1-16 ◽  
Author(s):  
Álvaro Murillo-García ◽  
Santos Villafaina ◽  
José C. Adsuar ◽  
Narcis Gusi ◽  
Daniel Collado-Mateo
Keyword(s):  
Systematic Review ◽  
Effect Size ◽  
Data Extraction ◽  
Meta Analysis ◽  
Extraction Process ◽  
Cochrane Library ◽  
Level Of Evidence ◽  
Double Blind ◽  
Evidence Database ◽  
The Cochrane Library

Objective. The aim of this study was to perform a systematic review on the effectiveness of dance-based programs in patients with fibromyalgia, as well as calculate the overall effect size of the improvements, through a meta-analysis. Methods. The Cochrane Library, Physiotherapy Evidence Database (PEDro), PubMed, TRIP, and Web of Science (WOS) were selected to identify the articles included in this systematic review and meta-analysis. A total of seven articles fulfilled all inclusion and exclusion criteria. PRISMA guidelines were followed in the data extraction process. The level of evidence was established following guidelines from the Dutch Institute for Healthcare Improvement (CBO). Results. The studies were all randomized controlled trials, but not double-blind. Duration of dance programs ranged from 12 to 24 weeks. Sessions lasted between 60 and 120 minutes and were performed 1-2 times per week. The overall effect size for pain was -1.64 with a 95% CI from -2.69 to -0.59 which can be interpreted as large. In addition, significant improvements were observed in quality of life, depression, impact of the disease, anxiety, and physical function. Conclusion. Dance-based intervention programs can be an effective intervention for people suffering from fibromyalgia, leading to a significant reduction of the level of pain with an effect size that can be considered as large. However, findings and conclusions from this meta-analysis must be taken with caution due to the small number of articles and the large heterogeneity.

scholarly journals Repetitive transcranial magnetic stimulation treatment for peripartum depression: systematic review & meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hyune June Lee ◽  
Sung Min Kim ◽  
Ji Yean Kwon
Keyword(s):  
Systematic Review ◽  
Transcranial Magnetic Stimulation ◽  
Side Effects ◽  
Electroconvulsive Therapy ◽  
Effect Size ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Peripartum Depression

Abstract Background Peripartum depression is a common disorder with very high potential hazards for both the patients and their babies. The typical treatment options include antidepressants and electroconvulsive therapy. However, these treatments do not ensure the safety of the fetus. Recently, repetitive transcranial magnetic stimulation has emerged as a promising treatment for neuropathies as well as depression. Nevertheless, many studies excluded pregnant women. This systematic review was conducted to confirm whether repetitive transcranial magnetic stimulation was a suitable treatment option for peripartum depression. Methods We performed a systematic review that followed the PRISMA guidelines. We searched for studies in the MEDLINE, PsycINFO, EMBASE, and Cochrane library databases published until the end of September 2020. Eleven studies were selected for the systematic review, and five studies were selected for quantitative synthesis. Data analysis was conducted using Comprehensive Meta-Analysis 3 software. The effect size was analyzed using the standardized mean difference, and the 95% confidence interval (CI) was determined by the generic inverse variance estimation method. Results The therapeutic effect size of repetitive transcranial magnetic stimulation for peripartum depression was 1.394 (95% CI: 0.944–1.843), and the sensitivity analysis effect size was 1.074 (95% CI: 0.689–1.459), indicating a significant effect. The side effect size of repetitive transcranial magnetic stimulation for peripartum depression was 0.346 (95% CI: 0.214–0.506), a meaningful result. There were no severe side effects to the mothers or fetuses. Conclusions From various perspectives, repetitive transcranial magnetic stimulation can be considered an alternative treatment to treat peripartum depression to avoid exposure of fetuses to drugs and the severe side effects of electroconvulsive therapy. Further research is required to increase confidence in the results.

scholarly journals The Relationship Between a Lifetime History of Sexual Victimization and Perinatal Depression: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 152483802110216
Author(s):  
Brooke N. Lombardi ◽  
Todd M. Jensen ◽  
Anna B. Parisi ◽  
Melissa Jenkins ◽  
Sarah E. Bledsoe
Keyword(s):  
Systematic Review ◽  
Effect Size ◽  
Sexual Victimization ◽  
Perinatal Depression ◽  
Meta Analysis ◽  
Effect Size Estimate ◽  
Lifetime History ◽  
Size Estimate ◽  
History Of ◽  
Size Estimates

Background: The association between a lifetime history of sexual victimization and the well-being of women during the perinatal period has received increasing attention. However, research investigating this relationship has yet to be systematically reviewed or quantitatively synthesized. Aim: This systematic review and meta-analysis aims to calculate the pooled effect size estimate of the statistical association between a lifetime history of sexual victimization and perinatal depression (PND). Method: Four bibliographic databases were systematically searched, and reference harvesting was conducted to identify peer-reviewed articles that empirically examined associations between a lifetime history of sexual victimization and PND. A random effects model was used to ascertain an overall pooled effect size estimate in the form of an odds ratio and corresponding 95% confidence intervals (CIs). Subgroup analyses were also conducted to assess whether particular study features and sample characteristic (e.g., race and ethnicity) influenced the magnitude of effect size estimates. Results: This review included 36 studies, with 45 effect size estimates available for meta-analysis. Women with a lifetime history of sexual victimization had 51% greater odds of experiencing PND relative to women with no history of sexual victimization ( OR = 1.51, 95% CI [1.35, 1.67]). Effect size estimates varied considerably according to the PND instrument used in each study and the racial/ethnic composition of each sample. Conclusion: Findings provide compelling evidence for an association between a lifetime history of sexual victimization and PND. Future research should focus on screening practices and interventions that identify and support survivors of sexual victimization perinatally.

scholarly journals Person-Centered Care in Persons Living with Dementia: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Kyung Hee Lee ◽  
Ji Yeon Lee ◽  
Bora Kim
Keyword(s):  
Systematic Review ◽  
Cognitive Function ◽  
Effect Size ◽  
Psychological Symptoms ◽  
Meta Analysis ◽  
Healthcare Providers ◽  
Clinical Excellence ◽  
Dementia Care ◽  
Person Centered Care ◽  
Centered Care

Abstract Background and Objectives The concept of person-centered care has been utilized/adapted to various interventions to enhance health-related outcomes and ensure the quality of care delivered to persons living with dementia. A few systematic reviews have been conducted on the use of person-centered interventions in the context of dementia care, but to date, none have analyzed intervention effect by intervention type and target outcome. This study aimed to review person-centered interventions used in the context of dementia care and examine their effectiveness. Research Design and Methods A systematic review and meta-analysis were conducted. We searched through five databases for randomized controlled trials that utilized person-centered interventions in persons living with dementia from 1998 to 2019. Study quality was assessed using the National Institute for Health and Clinical Excellence. The outcomes of interest for the meta-analysis were behavioral and psychological symptoms in dementia (BPSD) and cognitive function assessed immediately after the baseline measurement. Results In total, 36 studies were systematically reviewed. Intervention types were: reminiscence, music, and cognitive therapies, and multisensory stimulation. Thirty studies were included in the meta-analysis. Results showed a moderate effect size for overall intervention, a small one for music therapy, and a moderate one for reminiscence therapy on BPSD and cognitive function. Discussion and Implications Generally speaking, person-centered interventions showed immediate intervention effects on reducing BPSD and improving cognitive function, although the effect size and significance of each outcome differed by intervention type. Thus, healthcare providers should consider person-centered interventions as a vital element in dementia care.

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