Ketamine Treatment in Depression: A Systematic Review of Clinical Characteristics Predicting Symptom Improvement

2020 ◽  
Vol 20 (15) ◽  
pp. 1398-1414 ◽  
Author(s):  
Darby J.E. Lowe ◽  
Daniel J. Müller ◽  
Tony P. George
Keyword(s):  
Clinical Features ◽  
Clinical Characteristics ◽  
Bipolar Depression ◽  
Antidepressant Effect ◽  
Future Research ◽  
Symptom Improvement ◽  
Randomized Controlled ◽  
Treatment Of Depression ◽  
Future Direction

Ketamine has been shown to be efficacious for the treatment of depression, specifically among individuals who do not respond to first-line treatments. There is still, however, a lack of clarity surrounding the clinical features and response periods across samples that respond to ketamine. This paper systematically reviews published randomized controlled trials that investigate ketamine as an antidepressant intervention in both unipolar and bipolar depression to determine the specific clinical features of the samples across different efficacy periods. Moreover, similarities and differences in clinical characteristics associated with acute versus longer-term drug response are discussed. Similarities across all samples suggest that the population that responds to ketamine’s antidepressant effect has experienced chronic, long-term depression, approaching ketamine treatment as a “last resort”. Moreover, differences between these groups suggest future research to investigate the potential of stronger efficacy towards depression in the context of bipolar disorder compared to major depression, and in participants who undergo antidepressant washout before ketamine administration. From these findings, suggestions for the future direction of ketamine research for depression are formed.

Pharmacotherapy Update: Quetiapine use in Bipolar Disorder—What does the evidence tell us?

2009 ◽  
Vol 1 ◽  
pp. CMT.S1136
Author(s):  
Mark Taylor ◽  
Kirsty Mackay ◽  
Polash Shajahan
Keyword(s):  
Bipolar Disorder ◽  
Weight Gain ◽  
Large Scale ◽  
Maintenance Treatment ◽  
Bipolar Depression ◽  
Mood Stabiliser ◽  
Serious Illness ◽  
Randomized Controlled ◽  
Second Generation Antipsychotic

Bipolar disorder is a common and serious illness usually requiring long term medication. We critically review the available evidence surrounding the increasing use of quetiapine, a second generation antipsychotic, in both the acute and maintenance phases of bipolar disorder. Large scale, randomized controlled data supports the use of quetiapine in both acute mania and acute bipolar depression, as a safe and effective treatment and probably best used in combination with a traditional ‘mood stabiliser’ such as lithium or divalproex. Also, quetiapine monotherapy has been shown to be effective in bipolar depression. Two recently published studies also confirm that quetiapine in combination with either lithium or divalproex ‘adds value’ to the maintenance treatment of bipolar disorder in terms of delaying relapse compared to either lithium or divalproex alone. Quetiapine is generally well tolerated, although further work on long term weight gain and emergent diabetes would be helpful.

Perinatal and Postpartum Obsessive-Compulsive Disorder

2021 ◽  
pp. 249-269
Author(s):  
Nichole Fairbrother ◽  
Fiona L. Challacombe ◽  
Fanie Collardeau ◽  
Thanh Thuy Truong
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Clinical Features ◽  
Clinical Characteristics ◽  
Rapid Onset ◽  
Future Research ◽  
Obsessive Compulsive ◽  
Compulsive Disorder

Postpartum obsessive-compulsive disorder can occur as a new disorder, as a preexisting condition, or can represent the exacerbation or recurrence of a prior condition. The presentation of postpartum OCD is often characterized by a rapid onset, and commonly includes obsessions of harm related to the newborn, typically around the time of birth. Symptoms of postpartum OCD can, however, persist long after the delivery of a baby. This chapter discusses the nature and clinical characteristics associated with perinatal and postpartum obsessive-compulsive disorder. Clinical features and appropriate diagnosis and assessment approaches are discussed. Data on psychiatric treatments are provided. The chapter concludes with a discussion of future research.

scholarly journals Design theories and maintenance technologies of slab tracks for high-speed railways in China: a review

2021 ◽  
Vol 3 (4) ◽  
Author(s):  
Juanjuan Ren ◽  
Shijie Deng ◽  
Kaiyao Zhang ◽  
Wei Du ◽  
Qinghong Wu
Keyword(s):  
High Speed ◽  
Field Tests ◽  
Research Trend ◽  
Future Research ◽  
Stable Operation ◽  
High Speed Railway ◽  
Slab Track ◽  
Design Theories ◽  
Future Direction

Abstract The durability and reliability of slab track structures are essential for the long-term safety and stable operation of high-speed railways. In order to provide a solid theoretical basis and technical reference for the advancement of high-speed railway quality, this paper comprehensively discusses design theories of slab track structures, service performance evolution and maintenance technologies, and reviews the innovation happening in the industry. On top of that, the damage evolution, fatigue features and durability of slab tracks, which are highly relevant to serviceability, are summarized, and the future research trend of slab track service behaviours is pointed out. In addition, this paper summarizes the rules of establishing standards for damage maintenance, typical solutions for repairing damage and methods of evaluating the maintenance outcomes that combine field tests and numerical simulations. It also envisions a future direction where advanced testing technologies would assist the evaluation of maintenance effects.

Advances in the therapeutic approach of pudendal neuralgia: a systematic review

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Sébastien Murer ◽  
Guillaume Polidori ◽  
Fabien Beaumont ◽  
Fabien Bogard ◽  
Élisa Polidori ◽  
...  
Keyword(s):  
Systematic Review ◽  
Therapeutic Approach ◽  
Future Research ◽  
Pudendal Neuralgia ◽  
Therapeutic Approaches ◽  
Randomized Controlled ◽  
Different Types ◽  
Long Term Follow Up

Abstract Context Although pudendal neuralgia (PN) has received growing interest over the last few years, diagnosis remains difficult, and many different therapeutic approaches can be considered. Objectives This article aims to provide an overview of the possible treatments of PN and investigate their efficacies. Methods Utilizing PubMed and ScienceDirect databases, a systematic review was carried out and allowed identification of studies involving patients with PN, as defined by Nantes criteria, and their associated treatments. Relevant data were manually reported. Results Twenty-eight articles were selected, totaling 1,013 patients (mean age, 49 years) and six different types of interventions. Clinical outcomes, most frequently quantified utilizing the Visual Analog Scale (VAS), vary greatly with both the therapy and time after intervention (from 100 to <10%). However, neither peri nor postoperative serious complications (grade > II of Clavien–Dindo classification) are reported. Although surgery seems to provide a higher proportion of long-term benefits, identifying the most efficient therapeutic approach is made impossible by the multitude of outcome measurements and follow-up frequencies. It should also be noted that literature is sparse regarding randomized controlled trials with long-term follow-up. Conclusions Although there are a number of modalities utilized for the treatment of PN, there are no current recommendations based on treatment efficacies. This seems to be largely in part caused by the lack of standardization in outcome quantification. Future research in this field should focus on prospective cohort studies with high levels of evidence, aimed at assessing the long-term, if not permanent, benefits of available therapies.

scholarly journals Accuracy and efficacy of diagnosis via integrated with metabolomics in patients with PCOS: study protocol for a randomized controlled trial

2019 ◽  
Author(s):  
Cheng-Ming Ni ◽  
Wen-Long Huang ◽  
Yan-min Jiang ◽  
Juan Xu ◽  
Ru Duan ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Clinical Characteristics ◽  
Controlled Trial ◽  
Clinical Signs ◽  
Individual Therapy ◽  
Diagnosis And Treatment ◽  
Laboratory Evaluation ◽  
Future Research ◽  
Control Group ◽  
Randomized Controlled

Abstract Background Polycystic ovary syndrome (PCOS) is defined as a complex endocrine syndrome and the mechanisms underlying its various clinical signs and symptoms are still poorly understood, brings huge difficulties for clinical diagnosis and treatment. General agreement based on several clinical guideline[1, 2] suggest that it is critical to precisely diagnose the phenotypes of PCOS and give them an individual therapy. However, the criteria for different phenotypes remains unclear, mostly based on symptoms, physical examination and laboratory evaluation. The aim of this study is to compare the accuracy and preciseness of metabolomics markers with common clinical characteristics to find a more effective way to diagnose and treat these two subgroups (based on our basic study[3]) of PCOS patients. What’s more, the effects of different interventions according to two subgroups will also be observed. Methods/design This is a prospective, multicenter, analyst-blinded and randomized controlled trial. One healthy control group and two parallel experiment arms will be proposed in this study: (1) people without PCOS (health control group); (2) PCOS patients diagnosed mainly based on clinical indexes (group one); (3) PCOS patients diagnosed mainly based on metabolomics indexes (group two). A total of 276 eligible people will be recruited, which includes 60 healthy people and 216 PCOS patients, which will be randomly assigned to different diagnosis groups in a 1:1 ratio. Patients in two different diagnosis groups will be divided into two different subgroups according to their clinical characteristics (group one based on clinical indexes, group two based on metabolomics indexes) and receive a 6-month corresponding treatment. The primary outcome for experiment groups will be the condition of PCOS. All data will be analyzed periodically. This trial will help us to clarify the value of metabolomics integrated with clinical characteristics in diagnosis and treatment of two PCOS subgroups. It will also highlight any differences in the accuracy and efficacy of these two techniques and it may provide a new specific direction of integrated method for the PCOS therapy. Discussion The purpose of this trial is to determine whether integrated metabolomics indexes is more accuracy and effective than clinical characteristics in diagnose the phenotypes of reproductive females with PCOS. This trial will, therefore, contribute to providing a solid foundation for clinical precise diagnosis of two PCOS subgroups, as well as future research in PCOS individual therapy.

Pediatric Acute-Onset Neuropsychiatric Syndrome

2021 ◽  
pp. 231-248
Author(s):  
Kirti Saxena ◽  
Sherin Kurian ◽  
Johanna Saxena ◽  
Eyal Muscal
Keyword(s):  
Clinical Features ◽  
Clinical Characteristics ◽  
Neuropsychiatric Disorders ◽  
Acute Onset ◽  
Future Research ◽  
Streptococcal Infections ◽  
Comorbid Conditions

This chapter discusses the nature and clinical characteristics associated with both pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and pediatric acute-onset neuropsychiatric syndrome (PANS). Clinical features, etiology and course, and appropriate diagnosis and assessment approaches are discussed. Common comorbid conditions, both psychiatric and medical, associated with PANS are also described. Syndromal features that uniquely characterize PANS presentations of OCD are illustrated. Extent data on immune-focused and psychiatric treatments are discussed, including means for addressing complex presentations and multiply comorbid cases, and interventions in multiple settings (such as school, clinic, and community). The chapter concludes with a discussion of future research.

scholarly journals Acute Bipolar Depression: A Review of the Use of Olanzapine/Fluoxetine

2010 ◽  
Vol 2 ◽  
pp. CMT.S1945 ◽  
Author(s):  
William V. Bobo ◽  
Richard A. Epstein ◽  
Richard C. Shelton
Keyword(s):  
Treatment Response ◽  
Mood State ◽  
Bipolar Depression ◽  
Term Treatment ◽  
Symptom Improvement ◽  
Course Of Illness ◽  
Increased Risk ◽  
Long Term Treatment ◽  
Depressive Episodes

Depression is the predominant mood state in patients with bipolar I or II disorder over the course of illness. In spite of this, relatively few pharmacological treatments have been shown to be effective for treating depressive episodes associated with bipolar disorder in adults. Combination therapy with olanzapine and fluoxetine (OFC) is approved in the US for the treatment of acute depressive episodes in adults with bipolar I disorder. The short-term efficacy and safety of OFC for the treatment of bipolar depression are supported by results of four randomized, acute-phase studies. OFC has been associated with significantly greater depressive symptom improvement than placebo, and with higher rates of treatment response and remission than placebo and olanzapine monotherapy. OFC has also been shown to improve depressive symptoms to a greater degree than modestly dosed lamotrigine, with similar rates of positive treatment response and remission. Although OFC was generally well tolerated in each of the reviewed studies, clinically significant weight gain, adverse changes in glycemic and lipid profile, and prolactin elevation may complicate both short- and long-term treatment. OFC was not associated with significantly increased risk of treatment-emergent mania in any of the reviewed studies. The broader effectiveness of OFC for the treatment of bipolar depression across clinically relevant subtypes (eg, patients with bipolar II disorder and comorbid substance abuse) and over long-term follow-up are needed. Comparative effectiveness studies of OFC and other available agents are also needed in order to determine its place among other available options for treating acute bipolar depressive episodes.

scholarly journals Pharmacological treatment of bipolar depression

2014 ◽  
Vol 20 (3) ◽  
pp. 193-201 ◽  
Author(s):  
Gustavo H. Vázquez ◽  
Leonardo Tondo ◽  
Juan Undurraga ◽  
Rodolfo Zaratiegui ◽  
Valerio Selle ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Excess Mortality ◽  
Bipolar Depression ◽  
Treatment Options ◽  
List Type ◽  
Short Term ◽  
Treatment Of Depression ◽  
Second Generation Antipsychotics ◽  
Multiple Drugs

SummaryBipolar depression remains a major challenge for psychiatric therapeutics. It is associated with disability and excess mortality, and accounts for three-quarters of the time spent in morbid states by treated patients with bipolar disorder. Major limitations of research on the treatment of depression in bipolar disorder include a paucity of short-term and lack of long-term trials, probably reflecting concern about inducing mania. In addition, polytherapy with multiple drugs appears to be widespread, but it is virtually untested for efficacy and safety. Here, we summarise the evidence concerning efficacy of treatment of bipolar depression with antidepressants, mood-stabilising anticonvulsants, lithium and second-generation antipsychotics.LEARNING OBJECTIVES•Gain critical appreciation of the paucity of research on the treatment of bipolar depression.•Rationally balance the benefits and risks of using antidepressants in patients with bipolar disorder.•Assess the evidence supporting a range of research-based treatment options for bipolar depression.

Physical and Psychological Benefits of Written Emotional Expression

2015 ◽  
Vol 20 (4) ◽  
pp. 242-251 ◽  
Author(s):  
Éva Kállay
Keyword(s):  
Mental Health ◽  
Expressive Writing ◽  
Mental Health Problems ◽  
Cost Effective ◽  
Health Problems ◽  
Future Research ◽  
Psychological Benefits ◽  
Cost Effective Treatment ◽  
Meta Analyses

Abstract. The last several decades have witnessed a substantial increase in the number of individuals suffering from both diagnosable and subsyndromal mental health problems. Consequently, the development of cost-effective treatment methods, accessible to large populations suffering from different forms of mental health problems, became imperative. A very promising intervention is the method of expressive writing (EW), which may be used in both clinically diagnosable cases and subthreshold symptomatology. This method, in which people express their feelings and thoughts related to stressful situations in writing, has been found to improve participants’ long-term psychological, physiological, behavioral, and social functioning. Based on a thorough analysis and synthesis of the published literature (also including most recent meta-analyses), the present paper presents the expressive writing method, its short- and long-term, intra-and interpersonal effects, different situations and conditions in which it has been proven to be effective, the most important mechanisms implied in the process of recovery, advantages, disadvantages, and possible pitfalls of the method, as well as variants of the original technique and future research directions.

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