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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.
Poor adherence is a major obstacle in the management of patients suffering from schizophrenia. Previous studies on adherence have addressed the role of patients' subjective feelings and attitudes towards treatment. Rebelliousness is a more general cognitive-behavioral trait. No attempt has been made to investigate the correlation between rebelliousness and adherence to treatment.
To evaluate rebelliousness levels and their possible correlation with adherence among patients suffering from schizophrenia-spectrum disorders.
1) Compared rebelliousness levels among healthy subjects, patients suffering from schizophrenia spectrum disorders, and non-psychotic patients.
2) Examine the correlation between levels of rebelliousness and nonadherence among patients.
Rebelliousness was evaluated among 75 patients suffering from schizophrenia or schizoaffective disorder, 53 patients suffering from non-psychotic disorders, and 64 healthy subjects using the Rebelliousness Scale. Patients' adherence was evaluated using the Drug Attitude Inventory (DAI-10).
A significant negative correlation was found in the schizophrenia group between levels of rebelliousness and adherence (r = −.434, p < .001). In a regression model rebelliousness levels were found to be the strongest predictor of adherence (β = −0.236, p < .05) compared with other demographic variables. No significant difference was found in the levels of rebelliousness among the schizophrenia, non-psychotic disorders, or control groups.
Rebelliousness seems to be an independent predictor of adherence, specifically among patients suffering from schizophrenia. If future prospective studies replicate our results the Rebelliousness Scale might serve as an efficient tool to predict adherence.
Lack of adherence to recommended treatment poses major clinical and economic challenges for psychiatry, and requires further study.
Objectives and aims:
We aimed to prospectively investigate the association between the level of understanding of psychiatric emergency department (ED) discharge recommendations and presence of a companion with short term treatment adherence.
Sixty subjects were evaluated twice: upon ED discharge and a month later. Instruments included a structured questionnaire based on the MacArthur Competence Assessment Tool for Treatment, MMSE, and corroboration of data with the computerized hospital medical file.
There was a significant association between patient understanding and adherence with medication instructions (p< .01) and adherence to psychiatric follow-up (p< .05). There was also an association between the presence of a companion and adherence to medication instructions (x2(1)=7.0, p< .01).
Ensuring patients' understanding of treatment recommendations and encouraging the company of patients are achievable, practical strategies that may improve adherence and thereby promote better outcomes.
This study sought to determine the clinical correlates of adolescents with cannabis use and no additional drug use (CU) compared to adolescents with no drug use (NDU) among a group of adolescent psychiatric inpatients in Israel.
Two hundred and thirty-six patients consecutively admitted to an adolescent inpatient unit at a university-affiliated mental health center in Israel during a 3-year period were screened. Individuals with polydrug use were excluded from the study.
Prevalence of cannabis use was 13%. In the CU group, 39% were diagnosed with attention deficit and disruptive behavior disorders compared with 16% in the NDU group. Antipsychotics were the most common medications prescribed in both groups. Mood stabilizers were more frequently prescribed to CU than to NDU patients (39% vs 16%, respectively). A higher prevalence of alcohol abuse and criminal behaviors was found among CU compared to NDU patients (61% and 39% vs 6% and 4%, respectively).
The high prevalence of disruptive behaviors and frequent treatment with antipsychotics and mood stabilizers in the CU group may be related to the strong association between externalizing behavior and cannabis use and the non-specific pharmacological treatment of disruptive behaviors. Formal screening for cannabis use should be considered in psychiatric facilities. Specifically, adolescents with disruptive behaviors could benefit from early interventions, before and after cannabis initiation.
Individuals with schizophrenia suffer from deficits in social skills, lack of motivation and social rejection. Web-browsing seems to create opportunities to forge social ties, bypassing traditional social skills and rejection.
Assessing web-browsing habits and web based social interaction among individuals with schizophrenia.
1) Comparison of internet use for virtual relationships among patients suffering from psychotic spectrum disorders, non-psychotic patients and healthy subjects.
2) Examining correlation between creating virtual relationships and real-life social interactions among these groups.
The web-browsing habits, social skills and demographic data of 143 patients suffering from Psychotic spectrum disorders were evaluated via the use of self- administered questionnaires, clinical data and information from their computerized medical files. As control groups, similar data were collected from a group of Non-psychotic patients (n = 118) and healthy volunteers (n = 100).
When controlling the demographic data for the three groups, no difference was found in the extent of creating virtual and real-life social interactions via internet use. A trend association could be seen between the Psychotic group and creating virtual relationships. All groups exhibited significant correlations between creating virtual and real-life relationships through the internet. However, the Psychotic group exhibited a higher correlation (r = .76;p < 0.01) than the Non-psychotic group (r = .52;p < 0.01) and the Control group (r = .32;p < 0.01).
This study provides preliminary data regarding internet use for social interaction among individuals with schizophrenia. Our results suggest that these individuals do benefit from internet use, as it seems to enhance their social abilities.
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.
Every theory that explains psychopathology refers to different aspects of mental pain whether it regards annihilation anxiety, fragmentation of the self or feelings of intolerable anguish. The concept of mental pain has proved to be an important symptom in mood disorders in general and suicide in particular (Orbach et al., 2004; Levi et al., 2010; Levinger et al., 2015). Combining the understanding that mental pain is as a part of all forms of psychopathology with the growing interest in assessing therapeutic processes via outcome measures has led to the assumption that the tolerance and severity of mental pain could become powerful outcome measurement. The aim of this study is to assess the Mental Pain Scale (OMMP) and Tolerance to Mental Pain Scale (TMPS) as outcome measurement and to learn about their capabilities to distinguish between different psychopathologies.
The first objective would be to examine patterns of mental pain subscales in different psychopathologies. The second objective is to assess the OMMP and TMPS as outcome measurements.
Two hundred and thirty outpatients were administered a clinical questionnaire battery composed of eight questionnaires. The patients were to fill these questionnaires every 3 months for one year or until the end of their therapy.
We will present preliminary findings regarding the expressions of mental pain in different kinds of psychopathology and results of 3 months follow-up.
Tolerance and severity of mental pain are a vital to the assessment of psychopathology and should be used as outcome measurement of therapeutic process.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
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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