Single i.v. ketamine augmentation of newly initiated escitalopram for major depression: results from a randomized, placebo-controlled 4-week study

2015 ◽  
Vol 46 (3) ◽  
pp. 623-635 ◽  
Author(s):  
Y.-D. Hu ◽  
Y.-T. Xiang ◽  
J.-X. Fang ◽  
S. Zu ◽  
S. Sha ◽  
...  
Keyword(s):  
Single Dose ◽  
Rating Scale ◽  
Depressive Symptomatology ◽  
Self Report ◽  
Young Mania ◽  
Double Blind ◽  
Brief Psychiatric Rating Scale ◽  
Antidepressant Efficacy ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale

BackgroundWhile oral antidepressants reach efficacy after weeks, single-dose intravenous (i.v.) ketamine has rapid, yet time-limited antidepressant effects. We aimed to determine the efficacy and safety of single-dose i.v. ketamine augmentation of escitalopram in major depressive disorder (MDD).MethodThirty outpatients with severe MDD (17-item Hamilton Rating Scale for Depression total score ⩾24) were randomized to 4 weeks double-blind treatment with escitalopram 10 mg/day+single-dose i.v. ketamine (0.5 mg/kg over 40 min) or escitalopram 10 mg/day + placebo (0.9% i.v. saline). Depressive symptoms were measured using the Montgomery–Asberg Depression Rating Scale (MADRS) and the Quick Inventory of Depressive Symptomatology – Self-Report (QIDS-SR). Suicidal ideation was evaluated with the QIDS-SR item 12. Adverse psychopathological effects were measured with the Brief Psychiatric Rating Scale (BPRS)-positive symptoms, Young Mania Rating Scale (YMRS) and Clinician Administered Dissociative States Scale (CADSS). Patients were assessed at baseline, 1, 2, 4, 24 and 72 h and 7, 14, 21 and 28 days. Time to response (⩾50% MADRS score reduction) was the primary outcome.ResultsBy 4 weeks, more escitalopram + ketamine-treated than escitalopram + placebo-treated patients responded (92.3% v. 57.1%, p = 0.04) and remitted (76.9% v. 14.3%, p = 0.001), with significantly shorter time to response [hazard ratio (HR) 0.04, 95% confidence interval (CI) 0.01–0.22, p < 0.001] and remission (HR 0.11, 95% CI 0.02–0.63, p = 0.01). Compared to escitalopram + placebo, escitalopram + ketamine was associated with significantly lower MADRS scores from 2 h to 2 weeks [(peak = 3 days–2 weeks; effect size (ES) = 1.08–1.18)], QIDS-SR scores from 2 h to 2 weeks (maximum ES = 1.27), and QIDS-SR suicidality from 2 to 72 h (maximum ES = 2.24). Only YMRS scores increased significantly with ketamine augmentation (1 and 2 h), without significant BPRS or CADSS elevation.ConclusionsSingle-dose i.v. ketamine augmentation of escitalopram was safe and effective in severe MDD, holding promise for speeding up early oral antidepressant efficacy.

The Efficacy of Electroconvulsive Therapy in the Treatment of Schizophrenia

1987 ◽  
Vol 151 (2) ◽  
pp. 152-155 ◽  
Author(s):  
K. R. Abraham ◽  
P. Kulhara
Keyword(s):  
Electroconvulsive Therapy ◽  
Rating Scale ◽  
Double Blind Trial ◽  
Double Blind ◽  
Blind Trial ◽  
Brief Psychiatric Rating Scale ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale ◽  
To Receive

The efficacy of ECT was investigated in a double-blind trial. Twenty-two patients with schizophrenia received trifluoperazine and were randomly allocated to receive eight real or eight simulated ECTs. In the first eight weeks, the group receiving real ECTs showed significantly more improvement as measured on the Brief Psychiatric Rating Scale. However, the groups showed no significant differences from the twelfth week onwards. The superiority of real ECT was not confirmed at the end of six months.

An Open-Label Trial of Aripiprazole Monotherapy in Children and Adolescents with Bipolar Disorder

CNS Spectrums ◽  
2007 ◽  
Vol 12 (9) ◽  
pp. 683-689 ◽  
Author(s):  
Joseph Biederman ◽  
Eric Mick ◽  
Thomas Spencer ◽  
Robert Doyle ◽  
Gagan Joshi ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Rating Scale ◽  
Vital Signs ◽  
Pediatric Bipolar Disorder ◽  
Open Label ◽  
Young Mania ◽  
Double Blind ◽  
Scale Scores ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale

ABSTRACTIntroduction: Aripiprazole is a novel second-generation antipsychotic approved for the treatment of bipolar disorder in adults but there is no systematic data available in pediatric bipolar disorder.Methods: This was an 8-week, open-label, prospective study of aripiprazole 9.4±4.2 mg/day monotherapy to assess the efficacy and tolerability of this compound in treating pediatric bipolar disorder. Assessments included the Young Mania Rating Scale, Clinical Global Impressions-Improvement scale, and Brief Psychiatric Rating Scale. Adverse events were assessed through spontaneous self-reports, vital signs weight monitoring, and laboratory analysis.Results: Fifteen of the 19 bipolar youth (79%) completed the study. Aripiprazole treatment was associated with clinically and statistically significant improvement in mean Young Mania Rating Scale scores (−18.0±6.9, P<.0001). With the important exception of two cases of extrapyramidal symptoms that precipitated dropout, aripiprazole was well tolerated with no statistically significant increase in body weight (1.8±1.7 kg, P=.2).Conclusion: Open-label aripiprazole treatment was beneficial in the treatment of mania in youth with bipolar disorder. Future placebo-controlled, double blind studies are warranted.

Treatment of Acute Mania with Ambient Air Anionization: Variants of Climactic Heat Stress and Serotonin Syndrome

2007 ◽  
Vol 100 (1) ◽  
pp. 157-163 ◽  
Author(s):  
A. James Giannini ◽  
Steven Melemis ◽  
Jocelyn D. Giannini ◽  
Juliette N. Giannini
Keyword(s):  
Serotonin Syndrome ◽  
Rating Scale ◽  
Ambient Air ◽  
Crossover Design ◽  
Double Blind ◽  
Brief Psychiatric Rating Scale ◽  
Psychiatric Rating ◽  
Male Patients ◽  
High Concentrations ◽  
Psychiatric Rating Scale

High concentrations of ambient anions (O2−) were used to augment treatment for 20 acutely manic male patients. Anions were produced by an anion generator in a sealed room. A double-blind crossover design was used, and responses were evaluated with the Brief Psychiatric Rating Scale by 2 blinded raters. This produced a significant antimanic effect: total rating scores declined with anion treatment. Presham and postsham total scores for these 5 were 31.3 and 31.6, respectively. Pretreatment and posttreatment total scores were 31.6 and 26.3, respectively. Previous research indicates a role for serotonin in producing this antimanic effect.

A preliminary naturalistic study of low-dose ketamine for depression and suicide ideation in the emergency department

2011 ◽  
Vol 26 (S2) ◽  
pp. 1607-1607 ◽  
Author(s):  
G.L. Larkin ◽  
A.L. Beautrais ◽  
R.R. Turelli ◽  
G. Sanacora ◽  
S. Powsner ◽  
...  
Keyword(s):  
Suicide Ideation ◽  
Rating Scale ◽  
Rapid Onset ◽  
Open Label ◽  
Young Mania ◽  
Brief Psychiatric Rating Scale ◽  
Kaplan Meier ◽  
Scale Scores ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale

BackgroundRapid-onset antidepressants could have important clinical impact if their benefits extended to ED patients. We examined preliminary feasibility, tolerability and efficacy of single-dose IV ketamine in depressed ED patients with suicide ideation (SI).MethodsFourteen depressed ED patients with SI received a single IV bolus of ketamine (0.2 mg/kg) over 1–2 minutes. Patients were monitored for 4 hours, then re-contacted daily for 10 days. Treatment response and time to remission were evaluated using the Montgomery-Asberg Depression Rating Scale (MADRS) and Kaplan Meier survival analysis, respectively.ResultsBrief Psychiatric Rating Scale and Young Mania Rating Scale scores transiently increased in two subjects, consistent with ketamine's cognitive/behavioral effects in other populations. Mean MADRS scores fell significantly from 40.4 (SEM:1.8) at baseline to 11.5 (2.2) at 240 minutes. Median time to MADRS score ≤10 was 80 minutes (Interquartile Range: 0.67–24 hours). Suicide ideation scores (MADRS item 10) decreased significantly from 3.9 (SEM:0.4) at baseline to 0.6 (SEM:0.2) at 40 minutes post-administration, with improvements sustained over 10 days.ConclusionsThese data provide preliminary, open-label support for the feasibility and efficacy of ketamine as a rapid-onset antidepressant in the ED.

Investigation of medical effect of multiple ketamine infusions on patients with major depressive disorder

2019 ◽  
Vol 33 (4) ◽  
pp. 494-501 ◽  
Author(s):  
Wei Zheng ◽  
Yan-Ling Zhou ◽  
Wei-Jian Liu ◽  
Cheng-Yu Wang ◽  
Yan-Ni Zhan ◽  
...  
Keyword(s):  
Major Depressive Disorder ◽  
Single Dose ◽  
Depressive Disorder ◽  
Rating Scale ◽  
Major Depressive ◽  
Ketamine Infusion ◽  
Brief Psychiatric Rating Scale ◽  
Psychiatric Rating ◽  
Dissociative States ◽  
Psychiatric Rating Scale

Objective: Single-dose intravenous ketamine has rapid but time-limited antidepressant effects. We aimed to examine the sustained effects of six consecutive ketamine infusions in Chinese patients with major depressive disorder. Methods: Seventy-seven patients with major depressive disorder were eligible to receive augmentation with six ketamine infusions (0.5 mg/kg over 40 min) administered over the course of 12 days (Monday–Wednesday–Friday). The coprimary outcome measures were the rates of response and remission as measured on the 10-item Montgomery-Asberg Depression Rating Scale. Psychotomimetic and dissociative symptoms were measured with the Brief Psychiatric Rating Scale-positive symptoms and the Clinician Administered Dissociative States Scale, respectively. Results: After the first ketamine infusion, only 10 (13.0%) and 6 (7.8%) patients responded and remitted, respectively; after six ketamine infusions, 52 (67.5%) patients responded and 37 (48.1%) remitted. There was a significant mean decrease in Montgomery-Asberg Depression Rating Scale score at four hours after the first ketamine infusion (7.0±7.5, p<0.001), and this decrease was maintained for the duration of the infusion period. The response to ketamine treatment was positively associated with no history of psychiatric hospitalization (odds ratio=3.56, p=0.009). Suicidal ideation rapidly decreased across the entire study sample, even among the nonresponder group. No significant differences were found regarding Brief Psychiatric Rating Scale and Clinician Administered Dissociative States Scale scores from the first infusion at baseline to four hours post-infusion. Conclusion: Six ketamine infusions increased rates of response and remission when compared to a single-dose ketamine infusion in patients with major depressive disorder. Future controlled studies are warranted to confirm and expand these findings.

Comparison of Three Depression Rating Scales

1992 ◽  
Vol 75 (1) ◽  
pp. 144-146 ◽  
Author(s):  
Geoffrey M. Margo ◽  
Mantosh J. Dewan ◽  
Seymour Fisher ◽  
Roger P. Greenberg
Keyword(s):  
Rating Scales ◽  
Rating Scale ◽  
The Self ◽  
Self Report ◽  
Check List ◽  
Extra Effort ◽  
Brief Psychiatric Rating Scale ◽  
Symptom Check List ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale

We directly compared scores on the self-rated Beck Depression Inventory with two other common rating scales that assess a wider range of psychopathology, including depression, the self-rated Symptom Check List-90—R (SCL-90—R), and the clinician-rated Brief Psychiatric Rating Scale for 71 inpatients who suffered from depression ( n = 50) and other disorders. All measures of depression showed robust correlations among themselves. The self-rated scales correlated better between themselves than with the clinician-rated scale. Since the SCL-90—R assesses depression as well as the Beck inventories, is also a self-report instrument, yet provides a richer description of psychopathology with little extra effort, it may have some advantage over the latter.

Loxapine versus Thioridazine in the Treatment of Organic Psychosis

1980 ◽  
Vol 8 (1) ◽  
pp. 22-30 ◽  
Author(s):  
Marcio Versiani ◽  
J A R da Silva ◽  
F D Mundim
Keyword(s):  
Rating Scale ◽  
Adult Males ◽  
Double Blind ◽  
Diagnostic Categories ◽  
Brief Psychiatric Rating Scale ◽  
Observation Scale ◽  
Sedative Effects ◽  
Psychiatric Rating ◽  
Organic Brain ◽  
Psychiatric Rating Scale

Two double-blind trials comparing loxapine and thioridazine were conducted in hospitalized adult males diagnosed as having symptoms of chronic psychosis associated with organic brain syndrome or mental retardation. The drugs were administered orally in the ranges of loxapine 10–150 mg/day and thioridazine 150–750 mg/day for 13 weeks. In the first trial loxapine was found to be generally superior to thioridazine on the Brief Psychiatric Rating Scale, Nurses Observation Scale for Inpatient Evaluation and Clinical Global Impression. The second trial failed to confirm this superiority. The heterogeneity of diagnostic categories included may explain the discrepancy. Extra-pyramidal symptoms and sedative effects were common to both groups and consistent with the pharmacologic profiles of the study drugs.

scholarly journals Κλινική και νευροψυχολογική διερεύνηση της λειτουργίας της θεωρίας του νου κατά την πορεία της διπολικής συναισθηματικής διαταραχής

2019 ◽  
Author(s):  
Νικολέτα Ιωαννίδη
Keyword(s):  
Rating Scale ◽  
Young Mania ◽  
Brief Psychiatric Rating Scale ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale

Η Θεωρία του Νου (ΘτΝ) είναι η ικανότητα να συμπεραίνουμε και να προβλέπουμε την ψυχική κατάσταση των άλλων ανθρώπων. Προηγούμενες μελέτες παρείχαν ευρήματα υπέρ της ύπαρξης δυσλειτουργίας της ΘτΝ στη διπολική διαταραχή (ΔΔ) τόσο στην οξεία φάση της νόσου όσο και στην ύφεση. Ωστόσο, οι περισσότερες μελέτες ήταν συγχρονικές ενώ τα υπολειπόμενα συμπτώματα, το ιστορικό των ψυχωσικών συμπτωμάτων καθώς και συνυπάρχοντα ελλείμματα άλλων νοητικών λειτουργιών αποτελούν πιθανούς συγχυτικούς παράγοντες των μελετών αυτών. Η παρούσα μελέτη αποτελεί την πρώτη προοπτική μελέτη με σκοπό τη διερεύνηση της επίδρασης της ύφεσης στη ΘτΝ σε ασθενείς με ΔΔ συνεξετάζοντας κλινικές παραμέτρους και άλλες νοητικές λειτουργίες. Η ΘτΝ αξιολογήθηκε σε 71 ασθενείς με ΔΔ Ι, (32 ΔΔ-Κ και 39 ΔΔ-ΜΑ), κατά τη διάρκεια επεισοδίου και κατά την ύφεση της συμπτωματολογίας, καθώς και σε 48 υγιείς μάρτυρες. Οι δύο ομάδες εναρμονίστηκαν ως προς το φύλο, την ηλικία και το επίπεδο εκπαίδευσης. Χρησιμοποιήθηκαν τρεις δοκιμασίες αξιολόγησης της ΘτΝ με διαφορετικά επίπεδα πολυπλοκότητας: Δοκιμασία Εσφαλμένης Πεποίθησης, Δοκιμασία Υπαινιγμού και Δοκιμασία Αναγνώρισης Ατοπήματος. Αξιολογήθηκαν παράλληλα με συστοιχία νευροψυχολογικών δοκιμασιών το γενικό νοητικό δυναμικό, η μνήμη εργασίας, η προσοχή, η ταχύτητα επεξεργασίας, η λεκτική μνήμη και μάθηση και οι εκτελεστικές λειτουργίες. Για την κλινική εκτίμηση χορηγήθηκαν στους ασθενείς οι κλίμακες: Ηamilton Depression Rating Scale, Young Mania Rating Scale και Brief Psychiatric Rating Scale. Τα ευρήματα δείχνουν την ύπαρξη σοβαρής δυσλειτουργίας της ΘτΝ μέσω και των τριών δοκιμασιών αξιολόγησης που χορηγήθηκαν και στις δύο συνιστώσες της ΘτΝ (νοητική και συναισθηματική) στην οξεία φάση της νόσου. Τα ελλείμματα της ΘτΝ παρέμειναν και στην ύφεση του επεισοδίου, με μόνη εξαίρεση τα ελλείμματα στην ικανότητα αναγνώρισης της εσφαλμένης πεποίθησης του άλλου ατόμου. Ωστόσο, ο τύπος και η βαρύτητα της δυσλειτουργίας της ΘτΝ στην ύφεση διαφέρει από αυτήν της οξείας φάσης. Επιπρόσθετα, οι δύο τύποι επεισοδίων διαφέρουν ως προς τη συσχέτιση της κλινικής βαρύτητάς τους με τη δυσλειτουργία της ΘτΝ. Η βαρύτητα των κλινικών συμπτωμάτων κατά τη διάρκεια του επεισοδίου σχετίζεται με τη δυσλειτουργία της ΘτΝ μόνο σε μανιακό και όχι σε καταθλιπτικό επεισόδιο. Επιπλέον, υπάρχει κάποια μικρής ισχύος επίδραση των κλινικών συμπτωμάτων στην επίδοση των ασθενών στις δοκιμασίες της ΘτΝ, κυρίως στην ύφεση. O τύπος του επεισοδίου (κατάθλιψη ή μανία) βρέθηκε ότι δεν σχετίζεται με τη δυσλειτουργία της ΘτΝ. Το ιστορικό ψυχωσικών συμπτωμάτων δεν βρέθηκε να σχετίζεται με καμία επίδοση της ΘτΝ ούτε στο επεισόδιο ούτε στη νορμοθυμία. Όσον αφορά την επίδραση των γενικών νοητικών λειτουργιών, βρέθηκαν μόνο μεσαίας ισχύος συσχετίσεις που αφορούσαν όλες τις δοκιμασίες της ΘτΝ με τις περισσότερες νοητικές λειτουργίες και στις δύο φάσεις της νόσου. Εφόσον καμία νευροψυχολογική δοκιμασία δεν σχετιζόταν ισχυρά με τις επιδόσεις στις δοκιμασίες της ΘτΝ, φαίνεται ότι η δυσλειτουργία της ΘτΝ στη ΔΔ δεν προκύπτει εξ ολοκλήρου αλλά σαφώς επηρεάζεται από ελλείμματα σε άλλες βασικές νοητικές λειτουργίες. Ωστόσο, η δυσλειτουργία της ΘτΝ στην ύφεση επηρεάζεται – εν μέρει – από ελλείμματα στη λεκτική μνήμη και μάθηση, την προσοχή, τις εκτελεστικές λειτουργίες, τη μνήμη εργασίας και την ταχύτητα επεξεργασίας. Τα ευρήματα της παρούσας μελέτης συνηγορούν υπέρ της ύπαρξης ενός ειδικού και μόνιμου ελλείμματος της ΘτΝ (trait), καθώς δεν δικαιολογείται πλήρως από την επίδραση των υποκείμενων νοητικών ελλειμμάτων που συνεκτιμήθηκαν. Ωστόσο, οι επιδόσεις στις δοκιμασίες της ΘτΝ επηρεάζονται σε άλλοτε διαφορετικό βαθμό – αναλόγως και τις απαιτήσεις της συγκεκριμένης δοκιμασίας – από ελλείμματα σε άλλες νοητικές λειτουργίες.

scholarly journals Which biological and self-report measures of cannabis use predict cannabis dependency and acute psychotic-like effects?

2018 ◽  
Vol 49 (09) ◽  
pp. 1574-1580 ◽  
Author(s):  
H. Valerie Curran ◽  
Chandni Hindocha ◽  
Celia J. A. Morgan ◽  
Natacha Shaban ◽  
Ravi K. Das ◽  
...  
Keyword(s):  
Rating Scale ◽  
Drug Effects ◽  
Adverse Outcomes ◽  
Cannabis Use ◽  
Self Report ◽  
Brief Psychiatric Rating Scale ◽  
Three Samples ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale ◽  
Drug Free

AbstractBackgroundChanges in cannabis regulation globally make it increasingly important to determine what predicts an individual's risk of experiencing adverse drug effects. Relevant studies have used diverse self-report measures of cannabis use, and few include multiple biological measures. Here we aimed to determine which biological and self-report measures of cannabis use predict cannabis dependency and acute psychotic-like symptoms.MethodIn a naturalistic study, 410 young cannabis users were assessed once when intoxicated with their own cannabis and once when drug-free in counterbalanced order. Biological measures of cannabinoids [(Δ9-tetrahydrocannabinol(THC),cannabidiol(CBD),cannabinol(CBN) and their metabolites)] were derived from three samples: each participant's own cannabis (THC, CBD), a sample of their hair (THC, THC-OH, THC-COOH, CBN, CBD) and their urine (THC-COOH/creatinine). Comprehensive self-report measures were also obtained. Self-reported and clinician-rated assessments were taken for cannabis dependency [Severity of Dependence Scale (SDS), DSM-IV-TR] and acute psychotic-like symptoms [Psychotomimetic State Inventory (PSI) and Brief Psychiatric Rating Scale (BPRS)].ResultsCannabis dependency was positively associated with days per month of cannabis use on both measures, and with urinary THC-COOH/creatinine for the SDS. Acute psychotic-like symptoms were positively associated with age of first cannabis use and negatively with urinary THC-COOH/creatinine; no predictors emerged for BPRS.ConclusionsLevels of THC exposure are positively associated with both cannabis dependency and tolerance to the acute psychotic-like effects of cannabis. Combining urinary and self-report assessments (use frequency; age first used) enhances the measurement of cannabis use and its association with adverse outcomes.

Commentary

2008 ◽  
Vol 13 (6) ◽  
pp. 8-8
Author(s):  
Richard T. Katz
Keyword(s):  
Mental Illness ◽  
Behavioral Disorders ◽  
Rating Scale ◽  
Behavioral Disorder ◽  
Sixth Edition ◽  
Diagnostic And Statistical Manual ◽  
Brief Psychiatric Rating Scale ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale ◽  
Mental And Behavioral Disorders

Abstract The author, who is the editor of the Mental and Behavioral Disorders chapter of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, comments on the previous article, Assessing Mental and Behavioral Disorder Impairment: Overview of Sixth Edition Approaches in this issue of The Guides Newsletter. The new Mental and Behavioral Disorders (M&BD) chapter, like others in the AMA Guides, is a consensus opinion of many authors and thus reflects diverse points of view. Psychiatrists and psychologists continue to struggle with diagnostic taxonomies within the Diagnostic and Statistical Manual of Mental Disorders, but anxiety, depression, and psychosis are three unequivocal areas of mental illness for which the sixth edition of the AMA Guides provides M&BD impairment rating. Two particular challenges faced the authors of the chapter: how could M&BD disorders be rated (and yet avoid an onslaught of attorney requests for an M&BD rating in conjunction with every physical impairment), and what should be the maximal impairment rating for a mental illness. The sixth edition uses three scales—the Psychiatric Impairment Rating Scale, the Global Assessment of Function, and the Brief Psychiatric Rating Scale—after careful review of a wide variety of indices. The AMA Guides remains a work in progress, but the authors of the M&BD chapter have taken an important step toward providing a reasonable method for estimating impairment.

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