Acta Psychiatrica Scandinavica最新文献

{"title":"Antipsychotics or Mood Stabilizers in Bipolar Disorder: Towards Evidence-Based Personalised Medicine","authors":"Marie Tournier","doi":"10.1111/acps.13780","DOIUrl":"10.1111/acps.13780","url":null,"abstract":"<p>Lintunen et al. [<span>1</span>] publish in previous issue an article entitled <i>Dosing Levels of Antipsychotics and Mood Stabilizers in Bipolar Disorder: A Nationwide Cohort Study on Relapse Risk and Treatment Safety</i>. This nationwide study estimates doses of antipsychotics and mood stabilizers associated with the most favourable benefit–risk ratio. Benefit corresponded to a decreased risk of psychiatric hospitalization (prevention of relapse) and risk to an increase in non-psychiatric hospitalization (adverse events). The authors followed individuals with bipolar disorder from diagnosis over an average of 8 years. They compared outcomes over periods with and without antipsychotics or with and without mood stabilizers within individuals, by distinguishing low (< 0.9 DDD), standard (0.9– < 1.1 DDD) and high doses (≥ 1.1 DDD). Only monotherapies and individuals with both treatment changes and outcomes contributed to the findings. This design might have selected individuals with most severe disorders or those who did not receive an effective medication on a first line of treatment, but allowed comparing various treatment patterns.</p><p>Considering sensitivity analyses that omitted the 30-day period following treatment changes and selected stable treatments, among antipsychotics, only low and standard doses of aripiprazole (< 16.5 mg/day) were able to prevent relapse. High doses and quetiapine at any dose were associated with an increase in psychiatric hospitalization. While the association between high doses and relapse might be due to confounding by indication (relapse justifying the increase in dose), the absence of preventive effectiveness of antipsychotic monotherapies is alarming and contrasts with their extensive use [<span>2</span>]. Previous publications highlighted the lack of evidence of efficacy of antipsychotics in the maintenance treatment of bipolar disorders, RCTs showing selection bias (enrichment design limiting generalizability, inclusion of bipolar disorder type I only), attrition bias (considerable dropout levels), insufficient duration to demonstrate preventive efficacy, possible adverse effects of abrupt medication discontinuation in the placebo-group with beneficial effects of treatment and possible reporting bias [<span>3, 4</span>]. Parallelly, Lintunen et al. [<span>1</span>] found an increased risk of non-psychiatric hospitalization except for standard doses of olanzapine, risperidone and aripiprazole and low dose of aripiprazole, questioning the benefit–risk ratio of these monotherapies. These safety concerns are added to previous ones concerning mortality or cognitive functioning [<span>2, 5, 6</span>]. A real utility of antipsychotics was shown at short- and mid-term in acute bipolar episodes and in association with mood stabilizers with synergistic effects [<span>7, 8</span>]. Their place in the therapeutic strategy might be re-thought and, for example, re-focused on acute episodes and patients with d","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 2","pages":"107-108"},"PeriodicalIF":5.3,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13780","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142833221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial: Special Issue on Digital Psychiatry","authors":"Louise Birkedal Glenthøj, Maria Faurholt-Jepsen","doi":"10.1111/acps.13781","DOIUrl":"10.1111/acps.13781","url":null,"abstract":"<p>Despite a growing recognition of mental health challenges worldwide, there remains a significant gap between the demand for and the availability of mental health services. The WHO estimates that globally, up to 71% of individuals with severe mental illnesses such as psychosis receive no treatment, and access is even more limited in low-income countries. Barriers such as stigma, resource shortages, and insufficiently trained professionals may exacerbate this issue [<span>1, 2</span>].</p><p>Given the limited resources available, a recent report by the World Health Organization stated that “the use of mobile and wireless technologies (mhealth) to support the achievement of health objectives has the potential to transform the face of health service delivery across the globe” [<span>3</span>]. On a global scale, it is not feasible to propose that practices based entirely on in-person care will ever be able to meet the demand and need for treatment. Thus, even before the emergence of the COVID-19 pandemic, there was growing interest in the potential role of new technologies to extend care.</p><p>The rapid advancement and integration of technology is transforming mental health care delivery, accessibility, and research methodologies. Digital tools, including wearable devices, telepsychiatric platforms, smartphone apps, virtual reality (VR), and electronic health record data are reshaping the landscape of clinical practice, research, and patient engagement [<span>4</span>]. Similarly, digital phenotyping, artificial intelligence (AI), and advanced machine learning methods offer deeper, real-time insights into patients' behaviors and symptoms, potentially leading to earlier diagnoses, prediction models, and more personalized treatment plans [<span>5, 6</span>]. AI-enabled programs can analyze and contextualize data to provide information or automatically trigger actions without human interference, where machine-learning methods learn insights and recognize patterns from data.</p><p>These innovations address critical challenges in mental health care, particularly the pervasive gap between the demand for treatment and the limited capacity of traditional systems to meet this need. Furthermore, digital solutions may empower patients to actively engage in their treatment through tools for self-monitoring, psychoeducation, and immersive, engaging interventions that may enhance their therapeutic experience.</p><p>The term “digital phenotyping” has been defined as the “moment-by-moment quantification of the individual-level human phenotype in situ using data from personal digital devices” [<span>7, 8</span>]. Although not unanimous, some authors [<span>9</span>] divide digital phenotyping into two subgroups, called “active data” and “passive data.” Active data refer to data that requires active input from the users to be generated, whereas passive data, such as sensor data and phone usage patterns, are collected without requiring any active participation from","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 3","pages":"177-179"},"PeriodicalIF":5.3,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13781","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142811607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Randomized Controlled Trials of Psilocybin-Assisted Therapy in the Treatment of Major Depressive Disorder: Systematic Review and Meta-Analysis.","authors":"Vikas Menon, Parthasarathy Ramamurthy, Sandesh Venu, Chittaranjan Andrade","doi":"10.1111/acps.13778","DOIUrl":"https://doi.org/10.1111/acps.13778","url":null,"abstract":"<p><strong>Introduction: </strong>There is growing interest in the use of psychedelic-assisted therapy (PAT) for major depressive disorder (MDD), including treatment-resistant depression. We used randomized controlled trial (RCT) data to compare summary estimates of change in depression ratings with PAT versus comparator treatments in MDD. We also compared response and remission rates, and adverse effects.</p><p><strong>Methods: </strong>We searched MEDLINE, EMBASE, Cochrane Central Register for Controlled Trials (CENTRAL), and SCOPUS from inception till April 2024. Our primary efficacy outcome was 1-week (or nearest) between-group change in depression ratings. Secondary efficacy outcomes were changes in depression ratings at days 2, 14, and 42 (or nearest) and study-defined response and remission rates at week 1 (or nearest). Safety outcomes were reported adverse effects. We pooled outcomes in random-effects meta-analyses using standardized mean difference (SMD; Hedges g) for continuous outcomes and risk ratio (RR) for categorical outcomes.</p><p><strong>Results: </strong>We found 6 eligible RCTs (pooled N = 427), all on psilocybin. The pooled SMD for 1-week between-group change in depression ratings was -0.72 [95% CI, -0.95 to -0.49; I2 = 17%; 5 RCTs; n = 403], favouring PAT; results were similar at days 2, 14, and 42. The response [RR = 3.42; 95% CI, 2.35-4.97; I2 = 0%; 4 RCTs; n = 373] and remission [RR = 3.66; 95% CI, 2.26-5.92; I2 = 0%; 4 RCTs; n = 373] rates also favored PAT. The PAT group had a small but significantly increased risk of developing any adverse event [RR = 1.20; 95% CI, 1.01-1.42; I2 = 43%; 4 RCTs; n = 373] and a significantly higher risk of experiencing headache [RR = 1.78; 95% CI, 1.10-2.86; I2 = 52%; 4 RCTs; n = 373] and dizziness [RR = 6.52; 95% CI, 1.19-35.87; I2 = 0%; 3 RCTs; n = 269]. Low heterogeneity characterized most analyses and findings were similar in sensitivity analyses.</p><p><strong>Conclusion: </strong>Antidepressant effects of psilocybin-assisted therapy are superior (with at least medium effect sizes) to comparator interventions for at least up to 6 weeks postintervention.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social Support, Delivery Mode, and Cultural Factors in Twin Parents' Postpartum Depression: A Response to Egsgaard et al.","authors":"Yu-Ren Wen,&nbsp;Lien-Chung Wei","doi":"10.1111/acps.13775","DOIUrl":"10.1111/acps.13775","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Egsgaard et al. (2024) highlight the temporal patterns of postpartum depression (PPD) risk in twin parents versus singleton parents. However, additional factors such as social support systems, delivery mode, and cultural influences require exploration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To discuss the role of structured postpartum care, cesarean sections, and mother-infant bonding in moderating PPD risk, especially within cultural contexts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>These factors may explain the gender-specific temporal patterns observed by Egsgaard et al. Future research should integrate sociocultural and clinical variables to inform interventions for twin parents at risk of PPD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 2","pages":"173-174"},"PeriodicalIF":5.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mood, Activity, and Instability in Bipolar Disorder and Unipolar Disorder—An Exploratory Post Hoc Study Using Digital Data","authors":"Maria Faurholt-Jepsen,&nbsp;Jonas Busk,&nbsp;Morten Lindberg Tønning,&nbsp;Darius Rohani,&nbsp;Jakob Eyvind Bardram,&nbsp;Lars Vedel Kessing","doi":"10.1111/acps.13771","DOIUrl":"10.1111/acps.13771","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Mood, activity, and instability in symptomatology hold significant roles in bipolar disorder (BD) and unipolar disorder (UD). The objectives were to examine disparities in these symptoms among patients with BD and UD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from two studies including patients with BD and UD, respectively, were combined for exploratory analyses. Patients provided daily smartphone-based evaluations of mood and activity/energy for a 6-month period. A total of 47 patients with BD and 59 patients with UD were included in the analyses. The dataset contains more than 13,000 patient-reported evaluations of mood and activity. Daily mood and activity instability measures were calculated using the root squared successive difference method.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In linear mixed effect regression models adjusted for age, sex, and work status, there were statistically significant lower levels of activity in patients with BD as compared with patients with UD overall, during euthymic states and during depressive states (<i>B</i>: −0.61, 95% CI: −0.98; −0.24, <i>p</i> = 0.001). There were no statistically significant differences in mood instability and activity instability between patients with BD and patients with UD overall, during euthymic states and during depressive states, when accounting for multiple testing (<i>p</i> &gt; 0.012).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Limitations</h3>\u0000 \u0000 <p>Analyses were exploratory and post hoc. Findings should be interpreted with caution. The sample size was modest.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients with BD presented with lower level of activity as compared with patients with UD. There were no differences in mood and activity instability between these groups. Future studies including larger sample sizes should investigate differences between BD and UD.</p>\u0000 \u0000 <p>\u0000 <b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT03033420</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 3","pages":"426-433"},"PeriodicalIF":5.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Initiation of Antipsychotics During the First Year After First-Episode Psychosis: A Population-Based Study","authors":"I. Odsbu,&nbsp;A. Hamina,&nbsp;V. Hjellvik,&nbsp;M. Handal,&nbsp;M. Haram,&nbsp;M. Tesli,&nbsp;A. Tanskanen,&nbsp;H. Taipale","doi":"10.1111/acps.13776","DOIUrl":"10.1111/acps.13776","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Antipsychotics are recommended after first-episode psychosis. Knowledge on the current use patterns in real-world settings is thus important to inform clinical practice. We aimed to describe antipsychotic initiation during 1 year after first-episode psychosis and its associated factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Population-based cohort study using linked nationwide health and population registers from Norway. The study population comprised 8052 persons aged 16–45 years with first-episode psychosis diagnosed in secondary care (ICD-10 F20, F22–F29) in the period 2011–2019. Initiation of antipsychotic use was defined as being dispensed antipsychotics (ATC N05A, excl. lithium) at least once from −90 to +365 days from secondary care diagnosis of first-episode psychosis. Antipsychotic polypharmacy during follow-up was defined as having at least 90 days with overlapping drug use periods modeled using the Prescriptions to Drug Use Periods method. Adjusted risk ratios (aRRs) with 95% confidence intervals (CIs) for the association between socioeconomic and clinical factors and initiation of antipsychotic use were calculated using modified Poisson regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 4413 persons (54.8%) initiated antipsychotic use after first-episode psychosis with proportions ranging from 45.5% in 2012 to 62.1% in 2019. Oral formulations of olanzapine (34.9%), quetiapine (21.2%), and aripiprazole (11.6%) were most common at initiation, whereas long-acting injectables (LAIs) and clozapine were rarely used. Among the initiators, 13.8% started a polypharmacy period lasting more than 90 days. Factors associated with antipsychotic initiation were lower age (aRR 1.14, 95% CI 1.08–1.21; 26–35 years vs. 36–45 years), higher education (1.11, 1.05–1.18), being employed (1.04, 1.00–1.09), being hospitalized (1.13, 1.09–1.18), being diagnosed late in the study period (1.16, 1.11–1.22; 2017–2019 vs. 2011–2013), or with previously diagnosed bipolar disorder, depression, or anxiety disorders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The antipsychotic use pattern is largely within the current clinical guideline. Primary non-compliance and disease severity may explain the socioeconomic and clinical differences related to initiation of antipsychotic use.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 4","pages":"537-547"},"PeriodicalIF":5.3,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13776","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142754364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Early Intervention for Early Psychosis on Suicidal Behavior—A Meta-Analysis","authors":"Elkhan Tahmazov,&nbsp;Jordan Bosse,&nbsp;Benjamin Glemain,&nbsp;Patrice Nabbe,&nbsp;Morgane Guillou,&nbsp;Athéna Blachier,&nbsp;Michel Walter,&nbsp;Christophe Lemey","doi":"10.1111/acps.13773","DOIUrl":"10.1111/acps.13773","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Early-onset psychotic disorders include the prodromal phase and the first-episode psychosis (FEP). They constitute a high-risk period for suicidal behavior. Early intervention for psychosis (EIP) consists of intervening as early as possible. The effectiveness of early intervention on overall prognosis has been reported in numerous studies, and EIP services are emerging worldwide. Several authors report an improvement in suicidal behavior, but no study has looked at all the data.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Aims of the Study&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The aim of work is to study whether early intervention for psychosis has an impact on deaths by suicide and suicide attempts, and study which intervention methods have an impact on suicidal behavior.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methodology&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;By respecting the PRISMA criteria, previously declared on PROSPERO, by exploring 5 medical databases (PubMed, Cochrane, PsycINFO, Scopus, Embase), from their creation dates, published until 20/02/2023, in English, we carried out a meta-analysis. The articles selected had to deal with the EIP and deaths by suicide or suicide attempts. Our primary outcome is the deaths by suicide and the secondary outcome the suicide attempt.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The exhaustive search identified a total of 2310 references. Nine articles were included. Their intervention modalities were pharmacotherapy, psychotherapy, case-management, or related services, and psycho-social therapies. Our meta-analysis shows that early intervention for early-onset psychotic disorders is associated with a statistically significant reduction by a third in deaths by suicide (ORa = 0.66 (0.49–0.88), &lt;i&gt;p&lt;/i&gt; = 0.005) and by a third in suicide attempts (ORa = 0.66 (0.50–0.86), &lt;i&gt;p&lt;/i&gt; = 0.002), with non-significant heterogeneity. Sensitivity analyses excluding the study with statistical difficulties due to the absence of an event and studies with a high risk of bias point in the same direction, that is a statistically significant reduction and non-significant heterogeneity.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The literature shows that early intervention programs are associated with positive impact on deaths by suicide and suicide attempt. This is the first meta-analysis of early intervention in early psychotic disorders and its impact on suicidal risk. The deployment of EIP should be supported worldwide in order to intervene as early as","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 2","pages":"127-141"},"PeriodicalIF":5.3,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11695091/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142724389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"More rTMS pulses or more sessions? The impact on treatment outcome for treatment resistant depression","authors":"E. Oostra,&nbsp;P. Jazdzyk,&nbsp;V. Vis,&nbsp;I. Dalhuisen,&nbsp;A. W. Hoogendoorn,&nbsp;C. H. M. Planting,&nbsp;P. F. van Eijndhoven,&nbsp;Y. D. van der Werf,&nbsp;O. A. van den Heuvel,&nbsp;E. van Exel","doi":"10.1111/acps.13768","DOIUrl":"10.1111/acps.13768","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Repetitive transcranial magnetic stimulation (rTMS) is effective for treatment-resistant depression (TRD). Optimal rTMS parameters remain unclear, especially whether number of sessions or amount of pulses contribute more to treatment outcome. We hypothesize that treatment outcome depends on the number of sessions rather than on the amount of pulses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched databases for randomized clinical trials (RCTs) on high-frequent (HF) or low-frequent (LF)-rTMS targeting the left or right DLPFC for TRD. Treatment efficacy was measured using standardized mean difference (SMD), calculated from pre- and post-treatment depression scores. Meta-regressions were used to explore linear associations between SMD and rTMS pulses, pulses/session and sessions for HF and LF-rTMS, separately for active and sham-rTMS. If these variables showed no linear association with SMD, we divided the data into quartiles and explored subgroup SMDs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eighty-seven RCTs were included: 67 studied HF-rTMS, eleven studied LF-rTMS, and nine studied both. No linear association was found between SMD and amount of pulses or pulses/session for HF and LF-rTMS. Subgroup analyses showed the largest SMDs for 1200–1500 HF-pulses/session and 360–450 LF-pulses/session. The number of sessions was significantly associated with SMD for active HF (<i>β</i> = 0.09, <i>p</i> &lt; 0.05) and LF-rTMS (<i>β</i> = 0.06, <i>p</i> &lt; 0.01). Thirty was the maximal number of sessions, in the included RCTs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>More rTMS sessions, but not more pulses, were associated with improved treatment outcome, in both HF and LF-rTMS. Our findings suggest that 1200–1500 HF-pulses/session and 360–450 LF-pulses/session are already sufficient, and that a treatment course should consist of least 30 sessions for higher chance of response.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 4","pages":"485-505"},"PeriodicalIF":5.3,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13768","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor Concerning “Glucagon-Like Peptide Agonists for Weight Management in Antipsychotic-Induced Weight Gain: A Systematic Review and Meta-Analysis”","authors":"Anders Fink-Jensen,&nbsp;Christoph U. Correll","doi":"10.1111/acps.13772","DOIUrl":"10.1111/acps.13772","url":null,"abstract":"","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 4","pages":"548-549"},"PeriodicalIF":5.3,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of electroconvulsive therapy outcome: A network analysis approach","authors":"Tessa F. Blanken,&nbsp;Rob Kok,&nbsp;Jasmien Obbels,&nbsp;Simon Lambrichts,&nbsp;Pascal Sienaert,&nbsp;Esmée Verwijk","doi":"10.1111/acps.13770","DOIUrl":"10.1111/acps.13770","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>While electroconvulsive therapy (ECT) for the treatment of major depressive disorder is effective, individual response is variable and difficult to predict. These difficulties may in part result from heterogeneity at the symptom level. We aim to predict remission using baseline depression symptoms, taking the associations among symptoms into account, by using a network analysis approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>We combined individual patient data from two randomized controlled trials (total <i>N</i> = 161) and estimated a Mixed Graphical Model to estimate which baseline depression symptoms (corresponding to HRSD-17 items) uniquely predicted remission (defined as either HRSD≤7 or MADRS&lt;10). We included study as moderator to evaluate study heterogeneity. For symptoms directly predictive of remission we computed odds ratios.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Three baseline symptoms were uniquely predictive of remission: suicidality negatively predicted remission (OR = 0.75; bootstrapped confidence interval (bCI) = 0.44–1.00) whereas retardation (OR = 1.21; bCI = 1.00–2.02) and hypochondriasis (OR = 1.31; bCI = 1.00–2.25) positively predicted remission. The estimated effects did not differ across trials as no moderation effects were found.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>By using a network analysis approach this study identified that the presence of suicidal ideation predicts an overall worse treatment outcome. Psychomotor retardation and hypochondriasis, on the other hand, seem to be associated with a better outcome.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 4","pages":"521-528"},"PeriodicalIF":5.3,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13770","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}