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8 results

  • PW01-101 - From Diagnosis To Treatment - An Analysis Of Access To Depression-Specific Outpatient Treatment For Patients With Depression

  • S. Bönisch, R. Mergl, H. Matschinger, C. Wimmer-Brunauer, M. Tauscher, D. Kramer, U. Hegerl, A. Bramesfeld, R.-D. Kocalevent
  • Journal:
    European Psychiatry / Volume 25 / Issue S1 / 2010
    Published online by Cambridge University Press:
    17 April 2020, 25-E1497
    • Article
      • You have access
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  • Background

    Former studies show low treatment rates of outpatients with a diagnosis of depression. The aims of this study are to examine

    1. (1) the rate of diagnosed depression in outpatient care,

    2. (2) rates of treatment of depression according to individual and regional characteristics and

    3. (3) effects of individual and regional characteristics on getting depression-specific treatment in the federal state of Bavaria.

    Methods

    Prevalence of depression and outpatient treatment for depression as well as individual and regional characteristics of outpatients diagnosed with depression were analysed based on secondary data from the Association of Statutory Health Insurance Physicians Bavaria in 2006 (N=780,226). Descriptive analyses were followed by logistic regression analysis (STATA, PASW) to examine predictive effects of individual and regional characteristics on getting depression-specific treatment.

    Results

    Prevalence of diagnosed depression is 9.2% for persons who are statutory health insured and older than 17 years. 55% of diagnosed depressed patients do not get a depression-specific treatment within one year. Rates of a depression-specific treatment are higher for persons who are female, of middle age, with a moderate or severe depression, with a psychiatric comorbidity, without somatic comorbidity, who live in more rural areas.

    Conclusions

    The access to depression-specific treatment after a diagnosis of depression must be facilitated. Training for physicians, psychoeducation for patients and anti-stigma campaigns are necessary measures to reach this goal. The knowledge about influence of individual characteristics on getting a depression-specific treatment is important to reach the groups who get least depression-specific treatment.

  • FC23-06 - Analysis of outpatient care received by over 780,000 statutory health insured individuals diagnosed with depression

  • R.D. Kocalevent, S. Bönisch, R. Mergl, H. Matschinger, C. Wimmer-Brunauer, M. Tauscher, D. Kramer, U. Hegerl, A. Bramesfeld
  • Journal:
    European Psychiatry / Volume 26 / Issue S2 / March 2011
    Published online by Cambridge University Press:
    16 April 2020, p. 1944
    • Article
      • You have access
    • PDF
    • Export citation
  • Introduction

    Former studies show low treatment rates of outpatients with a diagnosis of depression. Various characteristics influence these treatment rates.

    Objectives/aims

    To examine the effects of individual and regional characteristics on getting depression-specific treatment in the federal state of Bavaria.

    Methods

    Outpatient treatment for depression as well as individual and regional characteristics of outpatients diagnosed with depression were analyzed based on secondary data from the Association of Statutory Health Insurance Physicians Bavaria in 2006 (N = 780,226). Depression-specific treatment was classified in “Threshold” and “Subthreshold” treatment according to its intensity. Descriptive analyses were followed by logistic regression analysis (STATA, PASW).

    Results

    More than half of the patients diagnosed with depression did not use any depression-specific treatment within one year. Individual factors which heighten the rates of a depression-specific treatment were female gender, middle age, a moderate or severe depression, a psychiatric comorbidity and no somatic comorbidity. Interestingly, living in a more rural area increased the chance of using “Threshold” treatment.

    Conclusions

    The knowledge about the influence of individual characteristics on getting a depression-specific treatment is important to reach the risk groups. A possible reason for higher rates of “Threshold” treatment in rural areas is the higher rate of pharmacotherapy in rural areas, which was more often classified as “Threshold” treatment than psychotherapy according to our classification.

  • IBZM-SPECT imaging of dopamine D2 receptors with typical and atypical antipsychotics

  • S Kasper, J Tauscher, E Küfferle, B Hesselmann, C Barnas, T Brücke
  • Journal:
    European Psychiatry / Volume 13 / Issue S1 / 1998
    Published online by Cambridge University Press:
    16 April 2020, pp. 9s-14s

  • Considerable progress has been achieved over the past 15 years in uncovering the biological basis of major psychiatric disorders. Since psychopharmacological treatment is thought tc act on the underlying biological basis of the disease, brain imaging techniques enable us to understand the mechanism of action of such compounds. One important tool used to determine patterns of brain dysfunction and how psychopharmacological agents such as antipsychotic compounds work is single-photon emission computerised tomography (SPECT). This technique allows determination of striatal D2 receptor occupancy rates, which are associated with the extrapyramidal side effects (EPS) of antipsychotic drugs. Studies have confirmed that atypical antipsychotic agents have lower occupancy rates than typical agents. No association has been found between D2 receptor occupancy rates n the striatum and antipsychotic efficacy, and it therefore appears that striatal D2 receptor occupancy rates are not necessary for the antipsychotic effect of such agents in schizophrenia. The availability of more refined radioligands will help us not only to understand the action of antipsychotics but also the pathophysiology of schizophrenia.

  • Therapy of Treatment Resistant Depression: Focus on the Management of TRD with Atypical Antipsychotics

  • Nikolas Klein, Julia Sacher, Helene Wallner, Johannes Tauscher, Siegfried Kasper
  • Journal:
    CNS Spectrums / Volume 9 / Issue 11 / November 2004
    Published online by Cambridge University Press:
    07 November 2014, pp. 823-832

  • Treatment-resistant depression (TRD) represents a significant challenge for physicians. About one third of patients with major depressive disorder fail to experience sufficient symptom improvement despite adequate treatment. Despite this high occurrence of TRD there was no general consensus on diagnosis criteria for TRD until 1997 when researchers proposed a model of defining and staging TRD. In 1999, others defined operational criteria for the definition of TRD. Treatment of TRD is commonly separated into pharmacologic and nonpharmacologic methods. This review gives a short overview of these two methods. The nonpharmacologic methods include psychotherapy, electroconvulsive therapy, and vagus nerve stimulation. Pharmacologic methods include switching to another antidepressant monotherapy, and augmentation or combination with two or more antidepressants or other agents. This review especially focuses on the augmentation of the antidepressant therapy with atypical antipsychotics.

  • 9 - IMAGING BIOMARKERS IN DRUG DEVELOPMENT: CASE STUDIES

  • Edited by Bruce H. Littman, Rajesh Krishna
  • Book:
    Translational Medicine and Drug Discovery
    Published online:
    04 April 2011
    Print publication:
    31 January 2011, pp 222-264

  • Summary

    Introduction

    The discovery and development of novel treatments is a lengthy and costly endeavor: for drug candidates entering clinical trials between 1989 and 2002, the estimated cost per new drug varied from approximately 500 million to more than 2 billion U.S. dollars. Biomarkers – objective and measurable responses to a putative drug candidate – have been heralded as one potential solution to the ever-increasing expenditure of developing new medicines, and anatomical or functional medical imaging can be one tool in the armamentarium of biomarkers. Conceptually, the utility of imaging biomarkers for facilitating drug development, especially go/no go decisions in early development, includes the following:

    • confirming the presence of a drug target in a (sub)population entering a clinical trial (e.g., accumulation of β-amyloid, as measured with positron emission tomography [PET] and a specific ligand for β-amyloid in the brain of patients entering a clinical trial for a novel Alzheimer's drug candidate);

    • assessing target engagement of a novel drug candidate (e.g., confirmation of dopamine-2 [D2]) receptor antagonism of antipsychotics using PET imaging of [C]-raclopride displacement);

    • demonstrating a functional effect of a drug on a mechanism- or disease-relevant biological parameter (e.g., blockade of ketamine-induced functional magnetic resonance imaging [fMRI] signal in the central nervous system [CNS] by antipsychotics or glutamate-normalizing compounds);

    • […]

  • Evaluating suicide-related adverse events in clinical trials of fluoxetine treatment in adults for indications other than major depressive disorder

  • SITRA TAUSCHER-WISNIEWSKI, DAMON DISCH, JOHN PLEWES, SUSAN BALL, CHARLES M. BEASLEY, Jr
  • Journal:
    Psychological Medicine / Volume 37 / Issue 11 / November 2007
    Published online by Cambridge University Press:
    20 July 2007, pp. 1585-1593
  • Background

    The association between treatment-emergent suicidality as an adverse event and fluoxetine treatment was examined using a fluoxetine double-blind placebo-controlled database of clinical trials for indications other than major depressive disorder.

    Method

    The database consisted of 53 trials for 16 different indications (14 psychiatric, two non-psychiatric). Within each study, patient adverse event reports and narratives were searched extensively for treatment-emergent thoughts and behaviors associated with suicide. The incidence of adverse events was classified using Food and Drug Administration (FDA) codes for completed suicide, preparatory acts, suicidal ideation and the summary category of ‘all suicidality.’ The risk difference and risk ratios between fluoxetine and placebo treatment arms were compared using Mantel–Haenszel methods.

    Results

    Within this large database, patients were randomly assigned to receive treatment with either fluoxetine (n=7066) or placebo (n=4382). Treatment groups did not differ in their risk for the emergence of suicidality for any FDA code; the risk ratio for ‘all suicidality’ was 0·82 (p=0·406), and there were no completed suicides in either group. Analyses based on treatment indication (bulimia, obsessive-compulsive disorder, other psychiatric and non-psychiatric illness) also showed no significant difference in risk between treatment groups. When examined by age categories (18–24, 25–30, 31–65, and ⩾65 years), fluoxetine and placebo treatments did not result in significant risk difference for the emergence of suicidality.

    Conclusions

    The risk of treatment-emergent suicidality does not appear to be associated with fluoxetine treatment for adults with various non-MDD conditions.