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Depressive disorders are among the leading causes of disability. The lifetime risk for developing clinically significant depression is estimated around 15%. Multiple studies have found female-male ratio of 2:1 across nations and cultures. The reason for this marked difference is still not clear, although several theories addressing social, biological, and environmental contributors have been suggested. Respond to anti-depressant treatment is considerably similar in both genders. However, several studies have shown worse outcomes among women during menopause.
In 2019, the US Food and Drug Administration (FDA) approved a nasal spray formulation of esketamine for the treatment of resistant depression (TRD) in adults, and the treatment has been approved to use by the ministry of health in Israel since 2020 . Recent studies found more than 50% response and 35% remission rates, when nasal esketamine was given as an add-on therapy.
to assess gender differences in response and remission rates among patients receiving esketamine as an add-on therapy for TRD in a real-world setting
23 female and 22 males received at least 12 weeks of esketamine treatment in a day-care setting. Data collected included depression, dissociation and quality of life scales.
Females tend to experience more severe dissociation during treatment. Average response and remission rates were similar in both groups (48% and 32% respectively), however females were less favorable to show rapid response (during the first 4 weeks). among responders no major differences in time to response has been found.
no major gender differences in response or remission rates have been found among patients receiving esketamine treatment for TRD aside from lower rates of rapid response. Additionally, Females report more severe dissociation during treatment.
The current stands of the medical establishment exclude usage of placebo in the clinical setting on ethical grounds. No attempt has been made to clarify the viewpoint of the psychiatric patient regarding the matter.
To compare the viewpoint of healthy subjects to that of patients who suffered from depressive episode.
1) Investigate the willingness of subjects in both groups to receive placebo for the treatment of depression, and
2) compare both groups’ views regarding the ethical aspect of placebo usage (e.g. doctor-patient relationship, patient's autonomy, etc).
We enrolled 81 patients and 107 healthy subjects. Patients were recruited from an out-patient clinic and were diagnosed, in the past or present, as suffering from a depressive episode. All subjects were briefed thoroughly about the efficacy, potential benefits and limitations of placebo in treating depression and then completed a self-report questionnaire.
64% of the patients (N = 50) expressed consent to use placebo in case they suffer again from depressive symptoms, compared to 79% (N = 85) of healthy subjects (p< 0.05). In both groups over 70% of the subjects do not perceive prescribing placebo as a deceit or as an act that diminishes the patients' autonomy (p>0.05).
The majority of patients agreed to receive placebo medication as a first line treatment, and do not feel that it will negatively affect their sense of autonomy or doctor-patient relationship. These findings question some of the ethical justification of excluding placebo from the clinical practice and call for further discussion in the subject.
Current clinical practice excludes placebo usage on ethical grounds. No attempt was made to clarify the viewpoint of the general population regarding the matter.
To evaluate the opinion of young-adults towards the use of Placebo in clinical practice.
1) Investigate the willingness of our study population to receive placebo for the treatment of depression or other general medical conditions, and
2) assess whether prescribing placebo would affect the study population's view regarding doctor-patient relationship or patient's autonomy.
We enrolled 344 students from five academic institutes in Israel, and briefed them thoroughly about the effects of placebo, its efficacy and limitations in treating depression. Understanding was verified and only then did the subjects complete a 32 item self-report questionnaire (include sociodemographic, health related data, past experience in medical encounters and willingness of subjects to be treated with Placebo medication).
In contrast to our main hypothesis 70% (N = 243) of the subjects expressed consent to be treated with placebo as a first line treatment had they suffered from depression, and 73% (N = 248) agreed to receive placebo for other general medical conditions. Eighty-eight percent of the subjects (N = 297) did not perceive a physician using placebo as a deceiver or the act of prescribing it a deceit.
The majority of our study population was willing to use placebo medication in general, and in particular, as first line treatment for depression. This study results should promote physicians to rethink and discuss the legitimacy of using placebo in clinical practice.
The influence of pharmaceutical industry (PI) on clinical practice and research in psychiatry has been considered a serious problem. Strict rules and guidelines were developed to regulate the interactions between doctors and PI. However, there is an ongoing debate whether these were thoroughly implemented in practice and internalized by physicians. The objective of our study was to assess the attitudes and behaviors of trainees in psychiatry and child & adolescent psychiatry toward PI across Europe. Methodologically, a validated questionnaire with additional items was administered to1444 trainees in 20 European countries. The minimum response rate was set at 60%. We found a high variation across countries in number of interactions between trainees and PI representatives; Portugal and Turkey had the highest number of interactions. The majority (59.76%) agreed that interactions with PI representatives have an impact on physicians’ prescribing behavior; whereas only 29.26% and 19.79% agreed interactions with PI representatives and gifts from PI have impact on their own prescribing behavior, respectively. Most of the gifts were considered appropriate by the majority, except tickets to vacation spot and social dinner at a restaurant. Of the sample, 70.76% think they have not been given sufficient training regarding how to interact with PI representatives. Only less than 20% indicated they have guidelines at institutional or national level. In conclusion, there is substantial interaction between trainees and PI across countries. The majority feel inadequately trained regarding professional interaction with PI, and believes they are immune to the influence of PI.
Interactions between the pharmaceutical industry (PI) and psychiatrists have been under scrutiny recently, though there is little empirical evidence on the nature of the relationship and its intensity at psychiatry trainee level. We therefore studied the level of PI interactions and the underlying beliefs and attitudes in a large sample of European psychiatric trainees.
One thousand four hundred and forty-four psychiatric trainees in 20 European countries were assessed cross-sectionally, with a 62-item questionnaire.
The total number of PI interactions in the preceding two months varied between countries, with least interactions in The Netherlands (M (Mean) = 0.92, SD = 1.44, range = 0–12) and most in Portugal (M = 19.06, SD = 17.44, range = 0–100). Trainees were more likely to believe that PI interactions have no impact on their own prescribing behaviour than that of other physicians (M = 3.30, SD = 1.26 vs. M = 2.39, SD = 1.06 on a 5-point Likert scale: 1 “completely disagree” to 5 “completely agree”). Assigning an educational role to the pharmaceutical industry was associated with more interactions and higher gift value (IRR (incidence rate ratio) = 1.21, 95%CI = 1.12–1.30 and OR = 1.18, 95%CI = 1.02–1.37).
There are frequent interactions between European psychiatric trainees and the PI, with significant variation between countries. We identified several factors affecting this interaction, including attribution of an educational role to the PI. Creating alternative educational opportunities and specific training dedicated to PI interactions may therefore help to reduce the impact of the PI on psychiatric training.
Phobic Postural Vertigo (PPV) is the 3rd most common cause for vertigo, characterized by the combination of a dizziness and subjective disturbance of balance in the absence of objective findings during routine Neurological evaluation. In most cases the clinical presentation is indistinguishable from agoraphobia. Despite this, most clinical data does not support direct correlation between anxiety disorder and PPV.
In this case series 10 patients who suffer from PPV went through psychiatry interview after a neurologist check up has been made to confirm the diagnosis of PPV. ACQ, BCQ and HDRS were filled for all patients.
According to this preliminary case series evidence for anxiety/somatization disorder were evident in 50% (5/10) before the development of PPV while in 30% (3/10) anxiety symptoms appeared in parallel or sequential to the development of PPV. In 20% (2/10), no signs for anxiety symptoms detected during evaluation.
The results of this case series suggest that PPV is a heterogeneous diagnosis that in part includes patient with previous anxiety/somatization disorder and patient in which vertigo is the presenting sign of anxiety disorder.
Farther research is needed in order to farther characterize PPV patients and promote suitable interventions.
Informed consent is required by law in medical treatment including dynamic psychotherapy, and has ethical implications. However, it is not clear whether informed consent as legally required is practiced, and what are therapists’ attitudes towards it.
This research examines common practice and therapists attitudes concerning application of informed consent to dynamic psychotherapy.
1. Examine therapists’ practice regarding application of different components, timing and methods of informed consent to dynamic psychotherapy.
2. Examine therapists’ attitudes towards this issue.
An anonymous online cross-sectional survey, completed by 177 psychodynamic oriented psychotherapists of diverse professions, experience, and other demographics.
Different Professional groups displayed statistically significant difference regarding application of informed consent to dynamic psychotherapy. Most specialist psychiatrists discuss most components of informed consent at the first session (therapy goals (59.1%), approach (72.7%), and alternatives (95.5%)) comparing to other therapists who provide this information later in therapy or not at all. Residents often don’t provide information concerning therapy approach (46.5%), and success chances (66.2%). Specialists had stronger positive opinion concerning the importance of informed consent.
Most therapists believe that applying informed consent to dynamic psychotherapy is important. However, opinions and practices differed regarding the components of informed consent, depending on professional background and experience. For example, specialist psychiatrists tended to implement more components at early stages of therapy than other professionals, maybe due to their medical and legal training. Residents provided less information concerning therapy alternatives and odds of success, maybe due to lack of experience, knowledge or confidence.
Recent data suggest that about 60% of depressed patients and more than 70% of healthy subjects agree to receive placebo as a first line treatment for depression. the effect of cultural background has not been studied.
To compare the viewpoint of healthy subjects from 3 different continents regarding the use of placebo for the treatment of depression.
1) Investigate the willingness of subjects in each group to receive placebo in a case of depression in the future,
2) Compare groups’ views regarding the possible effect of placebo use in clinical practice on doctor-patient relations and other ethical aspects.
350 health science students from three different countries (Romania, U.S.A., Israel) enrolled. All subjects were briefed thoroughly about the efficacy, potential benefits and limitations of placebo in treating depression and then completed a self-report questionnaire.
Both in Romania and U.S.A: 60% of the patients agreed to receive placebo as first line treatment and 70% agreed to receive placebo after a trail with SSRI. in Israel the tendency towards acceptance of placebo as first line treatment were higher (69%) (p > 0.05). in all groups over 70% of the subjects do not perceive prescribing placebo as a deceit or as an act that diminishes the patients' autonomy (p < 0.05).
The majority of participants agrees to receive placebo medication as a first line treatment, and do not feel that it will negatively affect their sense of autonomy or doctor-patient relationship. However, Cultural differences does exists and necessitate further research.
There is a shortage of psychiatrists worldwide. Within Europe, psychiatric trainees can move between countries, which increases the problem in some countries and alleviates it in others. However, little is known about the reasons psychiatric trainees move to another country.
Survey of psychiatric trainees in 33 European countries, exploring how frequently psychiatric trainees have migrated or want to migrate, their reasons to stay and leave the country, and the countries where they come from and where they move to. A 61-item self-report questionnaire was developed, covering questions about their demographics, experiences of short-term mobility (from 3 months up to 1 year), experiences of long-term migration (of more than 1 year) and their attitudes towards migration.
A total of 2281 psychiatric trainees in Europe participated in the survey, of which 72.0% have ‘ever’ considered to move to a different country in their future, 53.5% were considering it ‘now’, at the time of the survey, and 13.3% had already moved country. For these immigrant trainees, academic was the main reason they gave to move from their country of origin. For all trainees, the overall main reason for which they would leave was financial (34.4%), especially in those with lower (<500€) incomes (58.1%), whereas in those with higher (>2500€) incomes, personal reasons were paramount (44.5%).
A high number of psychiatric trainees considered moving to another country, and their motivation largely reflects the substantial salary differences. These findings suggest tackling financial conditions and academic opportunities.
Deep transcranial magnetic stimulation (dTMS) has been sanctioned by the United States Food and Drug Administration for treatment-resistant depression. In a retrospective cohort study, we evaluated response and effectiveness of dTMS in real-world practice, as an add-on treatment for resistant depression.
Forty adult outpatients suffering from depression, all taking psychiatric medications, underwent 20 dTMS treatments over a 4–6 week period. At baseline (T0), visit 10 (T1), and visit 20 (T2), the Clinical Global Impression-Severity (CGI-S) scale was administered, and the Clinical Global Impression Improvement (CGI-I) scale was completed at T1 and T2; the Hamilton Depression Rating Scale (HDRS-21) was administrated at T0 and T2 only. The patients also completed the Quick Inventory of Depressive Symptoms–Self-Report (QIDS-SR) at T0, T1, and T2.
Depressive symptoms (HDRS-21 total score) decreased significantly following treatment. The HDRS total score decreased from an average of 21.22 (± 6.09) at T0, to 13.95 (± 7.24) at T2. Correspondingly, at T2, 32.5% were responders to the treatment and 20% were in remission, based on the HDRS-21. Treatment was well tolerated, with a discontinuation rate of 7.5%. While depressive symptoms at baseline did not predict remission/response at T2, higher HDRS scores at T0 were associated with a larger decrease in depressive symptoms during the study.
Significant antidepressant effects were seen following 20 dTMS treatments, given as augmentation to ongoing medications in treatment-resistant depression. The findings suggest that among patients with TRD, the severity of the depressive episode (and not necessarily the number of failed antidepressant medication trials) is associated with a positive therapeutic effect of dTMS. Hence, the initial severity of the depressive episode may guide clinicians in referring patients for dTMS.
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