The Journal of Clinical Psychiatry最新文献

{"title":"Patient Functioning, Life Engagement, and Treatment Goals in Major Depressive Disorder.","authors":"Christoph U Correll,&nbsp;Zahinoor Ismail,&nbsp;Roger S McIntyre,&nbsp;Roueen Rafeyan,&nbsp;Michael E Thase","doi":"10.4088/JCP.LU21112AH3","DOIUrl":"https://doi.org/10.4088/JCP.LU21112AH3","url":null,"abstract":"<p><p>Outcome measures in major depressive disorder have traditionally focused on characteristic symptoms included in the DSM-5 definition of major depressive disorder (MDD): depressed mood, lack of interest or pleasure in activities, fatigue, guilt, and change in weight/appetite. Addressing these symptoms is clearly a treatment priority, especially in the acute stages of the treatment process. However, patients express that, beyond symptom relief, they have additional goals: restoration of functioning and of the feeling that one can participate in, and engage with, their own life. Life engagement encompasses aspects of life experience relating to cognition (including cognition colored by emotion), vitality, motivation and reward, and the ability to feel pleasure. In a recent roundtable meeting, a panel of 5 experts discussed life engagement and its relationship to symptoms and functioning in patients with major depressive disorder and schizophrenia. This Academic Highlights, part 3 in a series, summarizes the experts' discussion of how life engagement can be integrated into patient-centered discussions of treatment goals, as well as how it can inform treatment selection in for those with MDD.</p>","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40356699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reasons for Antipsychotic Treatment Switch: A Systematic Retrospective Review of Prescription Records and Prescriber Notes.","authors":"Daniel Guinart,&nbsp;Kaksha Varma,&nbsp;Yarden Segal,&nbsp;Nahal Talasazana,&nbsp;Christoph U Correll,&nbsp;John M Kane","doi":"10.4088/JCP.21m14272","DOIUrl":"https://doi.org/10.4088/JCP.21m14272","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Switching of antipsychotic medications, which are used for many psychiatric conditions, is common. However, reasons and clinical documentation of such switches have scarcely been studied.</p><p><p><b><i>Methods:</i></b> A systematic, retrospective review of prescription records and prescriber notes was conducted to characterize reasons for and types of antipsychotic switches at one hospital during inpatient or outpatient care, starting August 1, 2017, until 270 antipsychotic switches with type and reasons were collected, as required by power analysis.</p><p><p><b><i>Results:</i></b> After removing 7 cases in which quetiapine was switched to a non-antipsychotic agent, 263 antipsychotic switches involving 195 unique subjects (median age = 31 [interquartile range, 24-47] years; schizophrenia = 36.9%, bipolar disorder = 27.7%, schizoaffective disorder = 18.5%) were analyzed. Frequent reasons for antipsychotic switch were intolerability (45.7%) and inefficacy/clinical worsening (17.6%). Reasons did not differ by race (<i>P</i> = .2644), age (<i>P</i> = .0621), or insurance type (<i>P</i> = .2970), but differed heterogeneously regarding different reasons by sex (<i>P</i> = .004). The most common reported switches were from second-generation oral antipsychotics (SGA-OAPs) to other SGA-OAPs (N = 155, 58.9%), mostly due to tolerability or inefficacy; second-generation long-acting injectable antipsychotics (SGA-LAIs) to SGA-OAPs (11%), mostly due to intolerability, patient preference, or insurance coverage problems; and SGA-OAPs to SGA-LAIs (10.7%) due to nonadherence. Reasons for antipsychotic switch were properly documented in 208 (79.1%) of the prescriber notes.</p><p><p><b><i>Conclusions:</i></b> In this retrospective chart review, switching varied by sex regarding reasons and occurred almost in half of the cases due to intolerability. Different reasons predominated in switches from SGA-OAP to SGA-OAP, SGA-LAI to SGA-OAP, and SGA-OAP to SGA-LAI. One in 5 switches were not properly documented, requiring attention.</p>","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40356698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Cannabis Use, Substance Use Disorders, and Psychiatric Diagnoses on COVID-19 Outcomes: A Retrospective Cohort Study.","authors":"Divya Ramakrishnan,&nbsp;Soundari Sureshanand,&nbsp;Brian Pittman,&nbsp;Rajiv Radhakrishnan","doi":"10.4088/JCP.21m14332","DOIUrl":"https://doi.org/10.4088/JCP.21m14332","url":null,"abstract":"<p><p><b><i>Objective:</i></b> While psychiatric disorders have been recognized as a risk factor for COVID-19 outcomes, the impact of substance use disorders (SUD) on COVID-19 outcomes has not, to date, been examined in a systematic manner. We examined the association between SUD (cannabis, cocaine, alcohol, opioid, and benzodiazepine) as well as psychiatric diagnoses (schizophrenia, mood disorders, anxiety disorders) and COVID-19 outcomes in a large, retrospective cohort study.</p><p><p><b><i>Methods:</i></b> COVID-19-positive patients admitted to a large health care system in the US between January and December 2020 were included in this study. SUD and psychiatric diagnoses were identified from urine toxicology reports and <i>ICD-10</i> diagnosis codes in the electronic medical record, respectively. Multivariable logistic regression was performed controlling for potential confounders such as age, race, sex, smoking status, and medical comorbidities. COVID-19-relevant outcomes included mortality, need for intensive care unit (ICU) admission, need for ventilatory support, length of hospitalization, and number of hospitalizations.</p><p><p><b><i>Results:</i></b> Among COVID-19 patients (N = 6,291), those with SUD were more likely to require ICU admission (adjusted odds ratio [AOR] = 1.46, <i>P</i> = .003) and ventilatory support (AOR = 1.49, <i>P</i> = .01). The association between SUD and ICU admission was driven by alcohol use disorder (AUD), whereas that between SUD and ventilatory support was driven by both AUD and opioid use disorder (OUD). Patients with SUD were more likely to have a longer mean maximum length of hospitalization (11.32 vs 8.62 days, <i>P</i> < .0001) and a greater mean number of hospital admissions in 2020 (2.96 vs 2.33, <i>P</i> < .0001). These associations were significant for cannabis use disorder, AUD, OUD, and benzodiazepine use disorder. The association with greater number of admissions was also significant for cocaine use disorder. Patients with psychiatric diagnoses were also more likely to have a greater maximum length of hospitalization (11.93 vs 8.39 days, <i>P</i> < .0001) and hospital admissions (2.72 vs 2.31, <i>P</i> < .0001). These associations were significant for schizophrenia, mood disorders, and anxiety disorders.</p><p><p><b><i>Conclusions:</i></b> COVID-19 patients with SUD had greater likelihood of requiring critical interventions, such as ICU admission and ventilatory support. SUD and psychiatric diagnoses were also associated with a longer duration of hospitalization and greater number of hospital admissions. These findings identify COVID-19 patients with SUD and psychiatric comorbidities as a high-risk group.</p>","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40334725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individual Prediction of Remission Based on Clinical Features Following Electroconvulsive Therapy: A Machine Learning Approach.","authors":"Kazuki Nakajima,&nbsp;Akihiro Takamiya,&nbsp;Takahito Uchida,&nbsp;Shun Kudo,&nbsp;Hana Nishida,&nbsp;Fusaka Minami,&nbsp;Yasuharu Yamamoto,&nbsp;Bun Yamagata,&nbsp;Masaru Mimura,&nbsp;Jinichi Hirano","doi":"10.4088/JCP.21m14293","DOIUrl":"https://doi.org/10.4088/JCP.21m14293","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Previous prediction models for electroconvulsive therapy (ECT) responses have predominantly been based on neuroimaging data, which has precluded widespread application for severe cases in real-world clinical settings. The aims of this study were (1) to build a clinically useful prediction model for ECT remission based solely on clinical information and (2) to identify influential features in the prediction model.</p><p><p><b><i>Methods:</i></b> We conducted a retrospective chart review to collect data (registered between April 2012 and March 2019) from individuals with depression (unipolar major depressive disorder or bipolar disorder) diagnosed via <i>DSM-IV-TR</i> criteria who received ECT at Keio University Hospital. Clinical characteristics were used as candidate features. A light gradient boosting machine was used for prediction, and 5-fold cross-validation was performed to validate our prediction model.</p><p><p><b><i>Results:</i></b> In total, 177 patients with depression underwent ECT during the study period. The remission rate was 63%. Our model predicted individual patient outcomes with 71% accuracy (sensitivity, 86%; specificity, 46%). A shorter duration of the current episodes, lower baseline severity, higher dose of antidepressant medications before ECT, and lower body mass index were identified as important features for predicting remission following ECT.</p><p><p><b><i>Conclusions:</i></b> We developed a prediction model for ECT remission based solely on clinical information. Our prediction model demonstrated accuracy comparable to that in previous reports. Our model suggests that introducing ECT earlier in the treatment course may contribute to improvements in clinical outcomes.</p>","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40638319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Positive Predictive Value: A Clinician's Guide to Avoid Misinterpreting the Results of Screening Tests.","authors":"Mark Zimmerman","doi":"10.4088/JCP.22com14513","DOIUrl":"https://doi.org/10.4088/JCP.22com14513","url":null,"abstract":"<p><p><b><i>Background:</i></b> Recent studies have used self-administered screening scales in community and clinical samples to identify individuals who probably or likely had the disorder of interest. A better understanding of the statistics of screening, specifically positive predictive value, would indicate that the conclusions drawn from these studies are not justified.</p><p><p><b><i>Methods:</i></b> The principles and statistics of diagnostic screening and how screening is distinguished from case-finding are reviewed, followed by a review of studies that have failed to consider the positive predictive value of the screening scales in the samples studied.</p><p><p><b><i>Results:</i></b> Multiple studies of both clinical and general population samples have used screening measures as case-finding instruments. For example, two recent studies of response to electroconvulsive therapy in depressed patients used a screening scale for borderline personality disorder (BPD) and concluded that the patients with and without BPD responded equally well to treatment. However, the positive predictive value of the screening scale in these studies was less than 50%, meaning the majority of patients considered to have BPD would not have been so diagnosed if interviewed. A similar problem has also been observed in studies using screening scales for bipolar disorder in general population and primary care settings.</p><p><p><b><i>Conclusions:</i></b> When studying a disorder with a relatively low prevalence, it is near impossible for a screening test to have sufficient positive predictive value to be used to validly compare the individuals who do and do not screen positive. Researchers using screening measures as diagnostic proxies need to discuss the issue of positive predictive value.</p>","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40638318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Omega-3 Fatty Acids for Major Depressive Disorder With High Inflammation: A Randomized Dose-Finding Clinical Trial.","authors":"David Mischoulon,&nbsp;Boadie W Dunlop,&nbsp;Becky Kinkead,&nbsp;Pamela J Schettler,&nbsp;Stefania Lamon-Fava,&nbsp;Jeffrey J Rakofsky,&nbsp;Andrew A Nierenberg,&nbsp;Alisabet J Clain,&nbsp;Tanja Mletzko Crowe,&nbsp;Andrea Wong,&nbsp;Jennifer C Felger,&nbsp;Lisa Sangermano,&nbsp;Thomas R Ziegler,&nbsp;Cristina Cusin,&nbsp;Lauren B Fisher,&nbsp;Maurizio Fava,&nbsp;Mark Hyman Rapaport","doi":"10.4088/JCP.21m14074","DOIUrl":"https://doi.org/10.4088/JCP.21m14074","url":null,"abstract":"<p><p><b><i>Objective:</i></b> This study compared the impact of 3 eicosapentaenoic acid (EPA) doses versus placebo on inflammatory biomarkers and depressive symptoms.</p><p><p><b><i>Methods:</i></b> Sixty-one unmedicated adults (75% female; 45.5 ± 13.8 years) with <i>DSM-5</i> major depressive disorder (MDD), body mass index > 25 kg/m², and plasma high-sensitivity C-reactive protein (hs-CRP) ≥ 3.0 mg/L were randomly assigned to receive EPA 1 g/d, 2 g/d, or 4 g/d or placebo for 12 weeks. Prespecified endpoints were a ≥ 0.40 effect size decrease in plasma interleukin (IL)-6, peripheral blood mononuclear cell (PBMC) cytokines, and lipopolysaccharide-stimulated tumor necrosis factor (TNF) production. Response was defined as a ≥ 50% decrease of Inventory of Depressive Symptomatology, Clinician-Rated version (IDS-C30) scores. We compared outcomes for the 3 EPA doses versus placebo.</p><p><p><b><i>Results:</i></b> In 45 completers, only median PBMC TNF decreased at 2 g/d EPA. No EPA dose produced a ≥ 0.35 effect size reduction in plasma IL-6 or mitogen-stimulated TNF. Response rates for EPA 4 g/d were 64%, versus 40% for placebo (odds ratio [OR] = 2.63; Cohen <i>d</i> = 0.53), 38% for EPA 1 g/d, and 36% for EPA 2 g/d (all <i>P</i> > .05). EPA 4 g/d showed a significant correlation between percent decrease in plasma hs-CRP and IDS-C30 symptom reduction at 12 weeks (Spearman ρ = 0.691, <i>P</i> = .019).</p><p><p><b><i>Conclusions:</i></b> EPA 4 g/d demonstrated a medium effect size for response rates versus placebo. This dose may alleviate MDD in overweight individuals with elevated inflammatory markers, and change in hs-CRP may be correlated with clinical response.</p><p><p><b><i>Trial Registration:</i></b> ClinicalTrials.gov identifier: NCT02553915.</p>","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40636835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Functioning, Life Engagement, and Treatment Goals in Schizophrenia.","authors":"Christoph U Correll,&nbsp;Zahinoor Ismail,&nbsp;Roger S McIntyre,&nbsp;Roueen Rafeyan,&nbsp;Michael E Thase","doi":"10.4088/JCP.LU21112AH2","DOIUrl":"https://doi.org/10.4088/JCP.LU21112AH2","url":null,"abstract":"<p><p>Unmet needs in the treatment of schizophrenia include nonadherence to treatment, symptom relapse, incomplete functional recovery, and poor quality of life. Incorporating the patient's perspective into the treatment plan and measuring treatment outcomes that are meaningful to patients is an important part of addressing these issues. Goal setting is associated with greater improvements in motivation and role functioning, but clinicians should keep in mind that their goals for treatment may not align with those of their patients. Patients tend to think about their lives more holistically than clinicians, with equal weight given to social and clinical needs, and improved functioning and engagement with life are likely to emerge as priorities, beyond the need for symptom control. In a recent roundtable meeting, a panel of 5 experts discussed life engagement and its relationship to symptoms and functioning in patients with major depressive disorder (MDD) and schizophrenia. This Academic Highlights, part 2 in a series, summarizes the experts' discussion of how life engagement can inform goal-setting and treatment selection in patients with schizophrenia.</p>","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40622684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Randomized Controlled Trial of Intravenous Scopolamine Versus Active-Placebo Glycopyrrolate in Patients With Major Depressive Disorder.","authors":"Joseph C C Chen,&nbsp;Rachael L Sumner,&nbsp;Venkat Krishnamurthy Naga,&nbsp;Nicholas Hoeh,&nbsp;Hafis Adetokunbo Ayeni,&nbsp;Vikrant Singh,&nbsp;Andrew Wilson,&nbsp;Douglas Campbell,&nbsp;Frederick Sundram,&nbsp;Suresh D Muthukumaraswamy","doi":"10.4088/JCP.21m14310","DOIUrl":"https://doi.org/10.4088/JCP.21m14310","url":null,"abstract":"<p><p><b><i>Objective:</i></b> To investigate scopolamine's rapid-acting antidepressant effects using an active placebo comparator. Most prior intravenous scopolamine studies reduced depressive symptomatologies compared to saline placebo infusions within 3 days. However, the confounding effect of placebo is unknown given that only saline placebo has been used in prior studies.</p><p><p><b><i>Methods:</i></b> In this trial, 40 patients with major depressive disorder were randomized to receive single intravenous doses of either scopolamine hydrobromide (4-6 µg/kg) or glycopyrronium bromide (4 µg/kg) between August 2019 and April 2021 in Auckland, New Zealand. Glycopyrronium was chosen as the active placebo due to its similar antimuscarinic properties to scopolamine but inability to cross the blood-brain barrier. The primary mood outcome measure was the Montgomery-Åsberg Depression Rating Scale (MADRS) administered pre-infusion and 1, 3, 7, 14, 28, and 42 days post-infusion.</p><p><p><b><i>Results:</i></b> Per protocol, this trial was abandoned for futility at n = 40. While scopolamine reduced MADRS scores by 12.6 (± 8.7 SD) points at day 3, glycopyrronium showed similar reductions (11.2 ± 9.6 SD). Frequentist linear mixed models showed no antidepressant effects of scopolamine versus placebo (<i>d</i> = 0.17), and Bayesian mixed effect models showed moderate evidence in favor of the null hypothesis at day 3 (Bayes factor = 0.32). Participants remained well-blinded to drug allocation, with 50% of participants correctly guessing their allocation.</p><p><p><b><i>Conclusions:</i></b> The observed MADRS improvement was larger than in prior studies, but no antidepressant effects were observed. This study using an active placebo confirms recent studies demonstrating the lack of antidepressant efficacy of scopolamine.</p><p><p><b><i>Trial Registration</i></b>: Australian New Zealand Clinical Trials Registry identifier: ACTRN12619000569101.</p>","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40636600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thyroid Hormone Use in Mood Disorders: Revisiting the Evidence.","authors":"Balwinder Singh,&nbsp;Vishnu Sundaresh","doi":"10.4088/JCP.22ac14590","DOIUrl":"https://doi.org/10.4088/JCP.22ac14590","url":null,"abstract":"","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2022-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40636599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remission Rates Following Electroconvulsive Therapy and Relation to Index Episode Duration in Patients With Psychotic Versus Nonpsychotic Late-Life Depression.","authors":"Margot J Wagenmakers, Mardien L Oudega, Filip Bouckaert, Didi Rhebergen, Aartjan T F Beekman, Dick J Veltman, Pascal Sienaert, Eric van Exel, Annemieke Dols","doi":"10.4088/JCP.21m14287","DOIUrl":"10.4088/JCP.21m14287","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Electroconvulsive therapy (ECT) is a safe and effective treatment, especially in psychotic late-life depression (LLD). However, it is not yet clear whether the greater efficacy seen in psychotic LLD is because of a shorter index episode duration. The first aim of this study was to substantiate the superior ECT remission rates in patients with psychotic LLD, as compared to patients with nonpsychotic LLD, and a second aim was to investigate whether this association is independent of the index duration.</p><p><p><b><i>Methods:</i></b> 186 patients with LLD treated with ECT were included in the study: 76 from the Valerius cohort (data collection from 2001 to 2006) and 110 from the Mood Disorders Treated with Electroconvulsive Therapy (MODECT) cohort (data collection from 2011 to 2013). The Montgomery-Asberg Depression Rating Scale (MADRS) was used to evaluate depression severity, with remission defined as 2 consecutive MADRS scores < 10. Diagnosis of depression was based on <i>DSM-IV</i> (Valerius) and <i>DSM-IV-TR</i> (MODECT) criteria. A stepwise logistic regression model was built to assess the association between psychotic symptoms, index duration, and remission.</p><p><p><b><i>Results:</i></b> Patients with psychotic LLD showed significantly higher remission rates compared to patients with nonpsychotic LLD (68.9% vs 51.0%), independent of index duration, additionally corrected for age, sex, and baseline depression severity (OR = 2.10 [95% CI, 1.07-4.10], <i>P</i> = .03).</p><p><p><b><i>Conclusions:</i></b> Patients with psychotic LLD treated with ECT show higher remission rates compared to patients with nonpsychotic LLD. The high remission rates in patients with psychotic LLD are not explained by a shorter index duration. Future studies focusing on neurobiological differences in psychotic versus nonpsychotic depression may indicate why this subtype of depression is very responsive to ECT.</p><p><p><b><i>Trial Registration:</i></b> ClinicalTrials.gov identifier: NCT02667353.</p>","PeriodicalId":516853,"journal":{"name":"The Journal of Clinical Psychiatry","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40686043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}