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Clinical Effectiveness Telepsychotherapy for Depression Disorder: A Systematic Review
A840
VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 8 0 7 – A 9 1 8
Patients with mental disorders had a higher proportion of Medicare beneficiaries, following private insurance, Medicaid and self-pay. Conclusions: Recognizing the increase of mental disorders among hospitalized breast cancer patients is important. Research is needed to ascertain how co-existing mental health disorders would affect the quality of care and/or treatment strategies for hospitalized breast cancer patients. PMH3 Cross-Validation of A 7-Item Clinical Decision Rule for Detecting Panic-Related Anxiety in Emergency Medicine Patients Sung SC1, Rush AJ1, Earnest A2, Lim LE3, Lim SH3, Ong ME3 1Duke-NUS Medical School, Singapore, Singapore, 2Monash University, Melbourne, Australia, 3Singapore General Hospital, Singapore, Singapore
Objectives: Patients with panic-related anxiety frequently seek care in the Emergency Department (ED), but panic-related anxiety is rarely diagnosed by ED physicians due to limited time and a focus on stabilizing life-threatening conditions. We have previously developed a brief clinical decision rule (CDR) to help physicians quickly identify patients with panic-related anxiety in the ED setting. This study was undertaken to cross-validate the original CDR with a larger group of patients. Methods: English and Mandarin-speaking adult ED patients with a primary complaint of palpitations, chest pain, dizziness, or difficulty breathing were evaluated for the presence of panic-related anxiety (i.e., panic attacks or panic disorder) using the Structured Clinical Interview for DSM-IV. All 13 panic attack symptoms were entered into a multivariate model using stepwise selection with presence/absence of panic-related anxiety as the outcome variable. We compared receiver operating characteristics, sensitivity, and specificity for the original 7-item CDR created with our derivation sample (n= 200) versus an alternative 7-item CDR created with the validation sample (n= 321) using the same model selection procedure. Results: 46.5% of participants in the derivation sample and 39.3% of participants in the validation sample met criteria for panic-related anxiety. The original CDR showed excellent separation between those with panic-related anxiety and those without (AUC= 0.90) in the derivation sample. A cutoff score of 3 or greater retained good sensitivity (81.7%) and specificity (87.9%) while correctly classifying 85.0% of participants. The original CDR did not perform as well in the validation sample (AUC= 0.84, sensitivity= 78.1%, specificity= 89.3%, classified correctly= 77.9%). The alternative model performed slightly better (AUC= 0.88, sensitivity= 78.4%, specificity= 85.7%, classified correctly= 82.8%) in the validation sample. Conclusions: Panic-related anxiety is common and should be strongly considered in ED patients. A brief clinical decision rule may be useful for screening purposes. Which items to retain in the final CDR requires further investigation. PMH4 Somatic Symptoms in Patients with Undiagnosed Depression: Prevalence and Health Care Utilization In Japan Takahashi O, Ohde S St.Luke’s International University, Tokyo, Japan
Objectives: Depression is one of the most common mental disorders. However, depressed patients are underdiagnosed and undertreated in the general population. We aimed to evaluate the prevalence of undiagnosed depression in the general Japanese population, healthcare utilization and somatic symptoms among undiagnosed depressed patients. Methods: In a cross-sectional study, a populationweighted random sample from a nationally representative panel of adults was used to estimate health care utilization based on a prospective health diary recorded over one month. A baseline, pre-diary questionnaire was used to capture demographic data and symptoms. Depression was defined as a score of > 9 on the Patient Health Questionnaire (PHQ-9) and undiagnosed depressive patients were defined as those with a score of > 9 on the PHQ-9 who did not report the treatment of depression in hospital. Results: A total of 2,113 people were included in this study (mean age, 52 years (SD, 18); 1,236 (58.5%) women.) The prevalence of depression was 16.2% (n= 343), among whom 264 (12.5%) were undiagnosed. Incidence rate of any symptom over a one month period among non-depressive, undiagnosed depressive, and depressive patients was 3.29, 4.40, and 4.92, respectively (p= 0.1). The most common symptoms were headache (37.2%), followed by back pain (35.5%) and diarrhea (20.0%). Comparing the non-depressive, undiagnosed depressive, and depressive patient groups, the symptoms showing the largest difference in prevalence were nausea (3.7%, 6.8%, and 15.2%, respectively p< 0.01) and gastric pain (6.0%, 10.6%, and 12.7%, respectively p< 0.01). Healthcare utilization rates per month were 31.7%, 38.6%, and 31.6% (p= 0.08) for non-depressive, undiagnosed depressive, and depressive patients, respectively. Conclusions: Depressive disorders are prevalent in Japan and about 80% was undiagnosed. Screening for depression might be useful for those presenting with many symptoms including those of the gastrointestinal system.
(SMD -0.33, 95% CI –0.57 ~ -0.08, I2= 74%). Respectively, teleconferencing and webconferencing showed significant improvements by subgroup analysis. Especially, improvement of depressive symptom was significantly higher for telepsychotherapy in studies where telepsychotherapy was performed more than twice a month (SMD -0.48, 95% CI –0.72 ~ -0.25, I2= 16%), and the follow up period was between 4-11 months (SMD -0.36, 95% CI –0.57 ~ -0.16, I2= 31%). 2 articles compared telepsychotherapy and face-to-face psychotherapy, but each study had a different target population and intervention modality. They showed controversial results in depressive symptom score (Respectively, SMD 0.39, 95% CI 0.15 ~ 0.63, SMD -0.33, 95% CI -0.68 ~ 0.01). Conclusions: Telepsychotherapy may be effective than care as usual in depressive symptom improvement in patients with depressive disorder. However most of the articles were published before 2012 as telephone, so additional studies are needed to confirm the clinical effectiveness of telepsychotherapy, especially compare with face-to-face psychotherapy. PMH6 comparative Evaluation of Safety, Efficacy and Cognitive Profile of Amisulpride and Olanzapine in Schizophrenia Patients- A Prospective Study Ramesh S, Sivakumar P, Prashant C, Sivasankar M, Manikandhan C, Jai Ganesh KP Nehru College of Pharmacy, Thrissur District, India
Objectives: To determine and compare the efficacy, safety, and cognitive profile of Amisulpride and Olanzapine. To determine the types of symptoms experienced by schizophrenic patients. To determine and compare the weight of patients in 2 groups. Methods: Prospective comparative study. Six months duration. Safety assessment included adverse event reporting and abnormal involuntary movement scale (AIMS). Primary efficacy variable was the change from baseline in BPRS (Brief Psychiatric Rating Scale) score. Cognitive assessment involved token test, digit vigilance test and animal names test. Results: The total number of patients were also categorised on the basis of symptoms. Out of total 74 patients, 29 patients (39.19%) came with positive symptoms, 37 patients (50%) experience negative symptoms and 8 patients (10.81%) shows mixed symptoms During the study period, change observed in BPRS score in amisulpride group was 16.63±4.617 and in olanzapine group was 14.72 ±2.275 (Table 5). This improvement was similar in both groups and was statistically significant (P < 0.0001).Analysis was performed using Graph pad prism software version 6.07. To evaluate cognitive profile, three tests were used, namely, token test, digit vigilance test and animal names test. In all these test amisulpride perform significantly better than olanzapine and hence amisulpride gains an upper hand over olanzapine in improvement of cognitive function. Conclusions: The study showed that amisulpride and olanzapine were equally effective in the treatment of acute exacerbation of schizophrenia as shown by BPRS scores. To conclude, amisulpride and olanzapine show equivalent efficacy in improving psychotic symptoms of schizophrenia. When compared to Olanzapine, Amisulpride gains an upper hand in preserving body weight and in improvement of cognitive functions. PMH7 prevalence of Anticholinergic Drug Use in Older Adults With Dementia Ong YS, Fong TY, Chen LL, Chiang YY, Lim KW, Koh L, Mamun K Singapore General Hospital, Singapore, Singapore
Objectives: Anticholinergic usage is controversial in patients diagnosed with dementia due to increased risk of cognitive impairment and psychosis in this population. Yet the extent of anticholinergic drug use in Singapore General Hospital’s patient population is unknown. This study aims to determine the prevalence of anticholinergic drug use in older patients with dementia and evaluate the association between its use with mortality and morbidity outcomes in these patients. Methods: This is a retrospective cross-sectional analysis of patients aged 65 or older with dementia with at least one admission in 2013 (n = 460). Identified subjects were followed up prospectively for one year after first admission in 2013 for morbidity and mortality events. Data on exposure to anticholinergic drugs three months prior to admission were collected. Anticholinergic burden was determined using the Anticholinergic Drug Scale (ADS). Results: Most of the patients were female, Chinese with a mean age of 80.8 ± 8.4. Overall prevalence of anticholinergic drug use was 55.9% (n = 257). ADS level 1 drugs were most commonly prescribed (n = 234, 50.9%). Following this, ADS level 3 drug use was more prevalent (n = 73, 15.9%) than ADS level 2 drugs (n = 1, 0.2%). No association between anticholinergic drug use and mortality was found. However, it was significantly with associated morbidity outcomes. Conclusions: Anticholinergic drug use in patients with dementia is common. This may have contributed to increased morbidity for these patients. Prescribers and pharmacists should work together to monitor and optimize anticholinergic drug use in these patients.
PMH5 Clinical Effectiveness Telepsychotherapy for Depression Disorder: A Systematic Review Park JJ1, Kim S2, Park D2 Evidence-based Collaborating Agency, Seoul, South Korea, 2National Evidence-based Healthcare Collaborating Agency, Seoul, South Korea 1National
Mental Health – Cost Studies
Objectives: To evaluate the clinical effectiveness of telepsychotherapy compared to care as usual or face-to-face psychotherapy for depressive disorder. Methods: We searched 4 international electronic database including MEDLINE, Embase, CENTRAL, PsycINFO and 5 domestic electronic database from its inception to April 2015. Synchronous and interactive telepsychotherapy articles were included, and the study design was limited to RCT only. Two reviewers independently conducted the data extraction and quality assessment using the Cochrane Risk of Bias tool. Results: A total 12 articles (10 trials) with 2,562 patients were included. From the 10 trials, 7 were comparing with care as usual, and 3 were comparing with face-to-face psychotherapy. In comparison with telepsychotherapy and care as usual, depressive symptom score was significantly lower in the telepsychotherapy
PMH8 Estimating the Economic Burden of Treatment Resistant Depression in Taiwan using the NHIRD Klug J1, Yu F2, Chang C3, Juang H4, Wang M5, Fife D6, Liu C4, Wang BC7 Pacific, Kowloon, Hong Kong, 2Janssen Asia Pacific, Beijing, China, 3Chang Gung University, TaoYuan, Taiwan, 4Chang Gung Memorial Hospital, Tao-Yun, Taiwan, 5Janssen Taiwan, Taipei, Taiwan, 6Janssen, pharmaceutical company of Johnson and Johnson, Titusville, NJ, USA, 7Elysia Group Ltd, Taipei, Taiwan
1Janssen Asia
Objectives: Major depressive disorder (MDD) is a disabling mental disorder, and treatment-resistant depression (TRD) results in a substantial clinical and economic burden. We studied the direct medical costs and the healthcare utilization associated
VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 8 0 7 – A 9 1 8
Patients with mental disorders had a higher proportion of Medicare beneficiaries, following private insurance, Medicaid and self-pay. Conclusions: Recognizing the increase of mental disorders among hospitalized breast cancer patients is important. Research is needed to ascertain how co-existing mental health disorders would affect the quality of care and/or treatment strategies for hospitalized breast cancer patients. PMH3 Cross-Validation of A 7-Item Clinical Decision Rule for Detecting Panic-Related Anxiety in Emergency Medicine Patients Sung SC1, Rush AJ1, Earnest A2, Lim LE3, Lim SH3, Ong ME3 1Duke-NUS Medical School, Singapore, Singapore, 2Monash University, Melbourne, Australia, 3Singapore General Hospital, Singapore, Singapore
Objectives: Patients with panic-related anxiety frequently seek care in the Emergency Department (ED), but panic-related anxiety is rarely diagnosed by ED physicians due to limited time and a focus on stabilizing life-threatening conditions. We have previously developed a brief clinical decision rule (CDR) to help physicians quickly identify patients with panic-related anxiety in the ED setting. This study was undertaken to cross-validate the original CDR with a larger group of patients. Methods: English and Mandarin-speaking adult ED patients with a primary complaint of palpitations, chest pain, dizziness, or difficulty breathing were evaluated for the presence of panic-related anxiety (i.e., panic attacks or panic disorder) using the Structured Clinical Interview for DSM-IV. All 13 panic attack symptoms were entered into a multivariate model using stepwise selection with presence/absence of panic-related anxiety as the outcome variable. We compared receiver operating characteristics, sensitivity, and specificity for the original 7-item CDR created with our derivation sample (n= 200) versus an alternative 7-item CDR created with the validation sample (n= 321) using the same model selection procedure. Results: 46.5% of participants in the derivation sample and 39.3% of participants in the validation sample met criteria for panic-related anxiety. The original CDR showed excellent separation between those with panic-related anxiety and those without (AUC= 0.90) in the derivation sample. A cutoff score of 3 or greater retained good sensitivity (81.7%) and specificity (87.9%) while correctly classifying 85.0% of participants. The original CDR did not perform as well in the validation sample (AUC= 0.84, sensitivity= 78.1%, specificity= 89.3%, classified correctly= 77.9%). The alternative model performed slightly better (AUC= 0.88, sensitivity= 78.4%, specificity= 85.7%, classified correctly= 82.8%) in the validation sample. Conclusions: Panic-related anxiety is common and should be strongly considered in ED patients. A brief clinical decision rule may be useful for screening purposes. Which items to retain in the final CDR requires further investigation. PMH4 Somatic Symptoms in Patients with Undiagnosed Depression: Prevalence and Health Care Utilization In Japan Takahashi O, Ohde S St.Luke’s International University, Tokyo, Japan
Objectives: Depression is one of the most common mental disorders. However, depressed patients are underdiagnosed and undertreated in the general population. We aimed to evaluate the prevalence of undiagnosed depression in the general Japanese population, healthcare utilization and somatic symptoms among undiagnosed depressed patients. Methods: In a cross-sectional study, a populationweighted random sample from a nationally representative panel of adults was used to estimate health care utilization based on a prospective health diary recorded over one month. A baseline, pre-diary questionnaire was used to capture demographic data and symptoms. Depression was defined as a score of > 9 on the Patient Health Questionnaire (PHQ-9) and undiagnosed depressive patients were defined as those with a score of > 9 on the PHQ-9 who did not report the treatment of depression in hospital. Results: A total of 2,113 people were included in this study (mean age, 52 years (SD, 18); 1,236 (58.5%) women.) The prevalence of depression was 16.2% (n= 343), among whom 264 (12.5%) were undiagnosed. Incidence rate of any symptom over a one month period among non-depressive, undiagnosed depressive, and depressive patients was 3.29, 4.40, and 4.92, respectively (p= 0.1). The most common symptoms were headache (37.2%), followed by back pain (35.5%) and diarrhea (20.0%). Comparing the non-depressive, undiagnosed depressive, and depressive patient groups, the symptoms showing the largest difference in prevalence were nausea (3.7%, 6.8%, and 15.2%, respectively p< 0.01) and gastric pain (6.0%, 10.6%, and 12.7%, respectively p< 0.01). Healthcare utilization rates per month were 31.7%, 38.6%, and 31.6% (p= 0.08) for non-depressive, undiagnosed depressive, and depressive patients, respectively. Conclusions: Depressive disorders are prevalent in Japan and about 80% was undiagnosed. Screening for depression might be useful for those presenting with many symptoms including those of the gastrointestinal system.
(SMD -0.33, 95% CI –0.57 ~ -0.08, I2= 74%). Respectively, teleconferencing and webconferencing showed significant improvements by subgroup analysis. Especially, improvement of depressive symptom was significantly higher for telepsychotherapy in studies where telepsychotherapy was performed more than twice a month (SMD -0.48, 95% CI –0.72 ~ -0.25, I2= 16%), and the follow up period was between 4-11 months (SMD -0.36, 95% CI –0.57 ~ -0.16, I2= 31%). 2 articles compared telepsychotherapy and face-to-face psychotherapy, but each study had a different target population and intervention modality. They showed controversial results in depressive symptom score (Respectively, SMD 0.39, 95% CI 0.15 ~ 0.63, SMD -0.33, 95% CI -0.68 ~ 0.01). Conclusions: Telepsychotherapy may be effective than care as usual in depressive symptom improvement in patients with depressive disorder. However most of the articles were published before 2012 as telephone, so additional studies are needed to confirm the clinical effectiveness of telepsychotherapy, especially compare with face-to-face psychotherapy. PMH6 comparative Evaluation of Safety, Efficacy and Cognitive Profile of Amisulpride and Olanzapine in Schizophrenia Patients- A Prospective Study Ramesh S, Sivakumar P, Prashant C, Sivasankar M, Manikandhan C, Jai Ganesh KP Nehru College of Pharmacy, Thrissur District, India
Objectives: To determine and compare the efficacy, safety, and cognitive profile of Amisulpride and Olanzapine. To determine the types of symptoms experienced by schizophrenic patients. To determine and compare the weight of patients in 2 groups. Methods: Prospective comparative study. Six months duration. Safety assessment included adverse event reporting and abnormal involuntary movement scale (AIMS). Primary efficacy variable was the change from baseline in BPRS (Brief Psychiatric Rating Scale) score. Cognitive assessment involved token test, digit vigilance test and animal names test. Results: The total number of patients were also categorised on the basis of symptoms. Out of total 74 patients, 29 patients (39.19%) came with positive symptoms, 37 patients (50%) experience negative symptoms and 8 patients (10.81%) shows mixed symptoms During the study period, change observed in BPRS score in amisulpride group was 16.63±4.617 and in olanzapine group was 14.72 ±2.275 (Table 5). This improvement was similar in both groups and was statistically significant (P < 0.0001).Analysis was performed using Graph pad prism software version 6.07. To evaluate cognitive profile, three tests were used, namely, token test, digit vigilance test and animal names test. In all these test amisulpride perform significantly better than olanzapine and hence amisulpride gains an upper hand over olanzapine in improvement of cognitive function. Conclusions: The study showed that amisulpride and olanzapine were equally effective in the treatment of acute exacerbation of schizophrenia as shown by BPRS scores. To conclude, amisulpride and olanzapine show equivalent efficacy in improving psychotic symptoms of schizophrenia. When compared to Olanzapine, Amisulpride gains an upper hand in preserving body weight and in improvement of cognitive functions. PMH7 prevalence of Anticholinergic Drug Use in Older Adults With Dementia Ong YS, Fong TY, Chen LL, Chiang YY, Lim KW, Koh L, Mamun K Singapore General Hospital, Singapore, Singapore
Objectives: Anticholinergic usage is controversial in patients diagnosed with dementia due to increased risk of cognitive impairment and psychosis in this population. Yet the extent of anticholinergic drug use in Singapore General Hospital’s patient population is unknown. This study aims to determine the prevalence of anticholinergic drug use in older patients with dementia and evaluate the association between its use with mortality and morbidity outcomes in these patients. Methods: This is a retrospective cross-sectional analysis of patients aged 65 or older with dementia with at least one admission in 2013 (n = 460). Identified subjects were followed up prospectively for one year after first admission in 2013 for morbidity and mortality events. Data on exposure to anticholinergic drugs three months prior to admission were collected. Anticholinergic burden was determined using the Anticholinergic Drug Scale (ADS). Results: Most of the patients were female, Chinese with a mean age of 80.8 ± 8.4. Overall prevalence of anticholinergic drug use was 55.9% (n = 257). ADS level 1 drugs were most commonly prescribed (n = 234, 50.9%). Following this, ADS level 3 drug use was more prevalent (n = 73, 15.9%) than ADS level 2 drugs (n = 1, 0.2%). No association between anticholinergic drug use and mortality was found. However, it was significantly with associated morbidity outcomes. Conclusions: Anticholinergic drug use in patients with dementia is common. This may have contributed to increased morbidity for these patients. Prescribers and pharmacists should work together to monitor and optimize anticholinergic drug use in these patients.
PMH5 Clinical Effectiveness Telepsychotherapy for Depression Disorder: A Systematic Review Park JJ1, Kim S2, Park D2 Evidence-based Collaborating Agency, Seoul, South Korea, 2National Evidence-based Healthcare Collaborating Agency, Seoul, South Korea 1National
Mental Health – Cost Studies
Objectives: To evaluate the clinical effectiveness of telepsychotherapy compared to care as usual or face-to-face psychotherapy for depressive disorder. Methods: We searched 4 international electronic database including MEDLINE, Embase, CENTRAL, PsycINFO and 5 domestic electronic database from its inception to April 2015. Synchronous and interactive telepsychotherapy articles were included, and the study design was limited to RCT only. Two reviewers independently conducted the data extraction and quality assessment using the Cochrane Risk of Bias tool. Results: A total 12 articles (10 trials) with 2,562 patients were included. From the 10 trials, 7 were comparing with care as usual, and 3 were comparing with face-to-face psychotherapy. In comparison with telepsychotherapy and care as usual, depressive symptom score was significantly lower in the telepsychotherapy
PMH8 Estimating the Economic Burden of Treatment Resistant Depression in Taiwan using the NHIRD Klug J1, Yu F2, Chang C3, Juang H4, Wang M5, Fife D6, Liu C4, Wang BC7 Pacific, Kowloon, Hong Kong, 2Janssen Asia Pacific, Beijing, China, 3Chang Gung University, TaoYuan, Taiwan, 4Chang Gung Memorial Hospital, Tao-Yun, Taiwan, 5Janssen Taiwan, Taipei, Taiwan, 6Janssen, pharmaceutical company of Johnson and Johnson, Titusville, NJ, USA, 7Elysia Group Ltd, Taipei, Taiwan
1Janssen Asia
Objectives: Major depressive disorder (MDD) is a disabling mental disorder, and treatment-resistant depression (TRD) results in a substantial clinical and economic burden. We studied the direct medical costs and the healthcare utilization associated