Stress and craving reduction under treatment with heart rate variability biofeedback and the Phramongkutklao model among patients with alcohol use disorder.

BACKGROUND AND OBJECTIVE: Stress is an environmental cue, which may lead to increased alcohol craving, and vulnerability to relapse. Heart rate variability (HRV) biofeedback, a supplement standard for inpatient rehabilitation, has been applied for treatment and has been shown to effectively reduce craving and anxiety, increase HRV, and improve vasomotor function, among patients who have alcohol dependence problems. Therefore, the purpose of this study was to investigate the impact of HRV biofeedback and the Phramongkutklao model (PMK model) as an intensive inpatient rehabilitation program concerning stress and craving reduction of inpatients with alcohol use disorder. The findings could benefit treatment design to increase the effectiveness regarding stress and craving reduction among patients with alcohol use disorder and may also reduce rehabilitation costs. METHODS: We conducted this study as a randomized controlled intervention trial, which was also performed single blinded. In all, 35 patients with alcohol use disorder were recruited and randomly assigned in two groups. Patients in the intervention group (n=17) were treated under the PMK model and underwent 16 sessions of the HRV biofeedback program, which included 30 minute long sessions, 4 days per week, for 4 weeks continuously. Patients in the control group (n=18) received PMK model treatment only. Participants were asked to complete a Stress Test (ST-5) and the Penn Alcohol-Craving Scale at baseline, after completing treatment, and at one month afterward (follow-up). RESULTS: The study showed decreased stress and craving in the intervention group immediately after treatment and at one-month follow-up, whereas the control group had reduced stress and craving only immediately after treatment. Furthermore, we found a significant effect concerning stress and craving between baseline and at one-month follow-up that showed the intervention group exhibited higher difference of scores than the control group. CONCLUSION: The study results showed that applying HRV biofeedback may be considered beneficial for standard rehabilitation inpatients to reduce stress and craving for patients with alcohol use disorder.

The effectiveness of military hospital-based drug treatment program (PMK) when compared with the traditional community-based drug treatment program (FAST).

BACKGROUND: In Thailand, two community-based drug treatment approaches are common. The first one is the traditional community-based treatment program (FAST) which brings the principles of community therapy as a guideline for treatment. The second one is the military hospital-based drug treatment program (PMK), derived from the basic military training, the Buddhist Twelve Steps, CBT and the Minnesota Rehabilitation Model. This study aimed to investigate and compare the efficacy of PMK vs. FAST. METHOD: The experiment was conducted from January-March 2016 at the rehabilitation center for patients with drug addiction in Thailand. Quasi-experimental methods were introduced, and ASSIST, WHOQOL-BRIEF-THAI and self-efficacy interview form were applied. After completing the drug rehabilitation program at a total duration of 120 days, the researcher continued at follow up times at 3 and 6 months. RESULTS: Compared with baseline scores, both programs significantly reduced the severity of drugs and increased self-efficacy at 6-month follow-up. PMK had better improved scores in the relationship and environment dimensions of quality of life at 3-month follow-up (P = 0.026, 0.006). The mean quality of life scores in PMK at 3 and 6 months showed better results than mean scores at baseline (P = < 0.001). CONCLUSION: Both community-based programs in Thailand significantly reduced the severity of drugs and increased self-efficacy scores at 6-month follow-up. PMK and FAST has not shown any significant difference in treatment outcome results in the aspects of self-efficacy and reduced severity of drugs used. However, PMK had significant positive effects on the quality of life.

Time to relapse and remission of bipolar disorder: findings from a 1-year prospective study in Thailand.

BACKGROUND AND METHODS: This study aimed to determine time to relapse and remission of mood episodes in Thai patients with bipolar disorder (BD). The Thai Bipolar Disorder Registry was a multicenter, prospective, naturalistic, observational study conducted in Thailand. Participants were adult inpatients or outpatients with Diagnostic and Statistical Manual of Mental Disorders bipolar disorder. The diagnosis of bipolar disorder, current psychiatric comorbidity, mood relapse, and mood remission were determined by using the Mini International Neuropsychiatric Interview. Relapse and remission were assessed every 2 months. RESULTS: Of 424 BD participants, 404 (95.3%) were BD I, and 258 (60.8%) were female. At entry, 260 (61.3%) had recovered, and 49 (11.6%) were recovering. During 1-year follow-up (381.7 person-years), 92 participants (21.7%) had 119 relapses or 0.31 (95% confidence interval 0.25-0.35) episodes per person-year. Among 119 relapses, 58 (48.7%), 39 (32.7%), and 21 (17.6%) of them were depressive, hypomanic, and manic episodes, respectively. Using the Kaplan-Meier method, we found that 25% of the participants relapsed in 361 days. Of the 400 participants who reached remission, 113 (28.2%) had mood relapses. Of 173 mood events accountable for remission analysis, the median time to remission was 67.5 days (72.5 days for depressive episodes versus 58.0 days for manic episodes, log rank P = 0.014). CONCLUSIONS: The 1-year relapse rate in Thai patients with BD was 21.7% or 0.31 episodes per person-year. About one-fifth of recovered patients had mood relapses within 371 days. On average, a mood episode would remit in 67.5 days.

Switching to sertraline or venlafaxine after failure of SSRIs treatment in major depressive disorder: an economic evaluation of the STAR*D trial.

BACKGROUND: Switching to another antidepressant is one of the alternative treatment strategies employed in major depressive disorder (MDD) patients who have no remission despite an adequate trial of an antidepressant. The aim of the present study was to present an economic evaluation of sertraline compared with venlafaxine after unsuccessful treatment for depression with citalopram. MATERIAL AND METHOD: An economic model was constructed in line with the design of the sequenced treatment alternatives to relieve depression (STAR*D) study. MDD patients who did not have a remission with or who had an intolerance to citalopram were randomly assigned to be switched to either sertraline or venlafaxine. Patients who had no remission at the end of the switching treatment phase still continued the antidepressants and received an adjunctive treatment with aripiprazole. The event probabilities were used to derive the transitional probabilities use in the model. The primary model outcome was remission of symptoms and the secondary outcome was quality-adjusted life-years (QALYs). Incremental cost-effectiveness ratios (ICEs) were estimated for the costs per unit of effectiveness. Sensitivity analyses were done to assess the effects of model assumptions. RESULTS: The total direct costs per remission were 27,830 Baht for sertraline and 30,147 Baht for venlafaxine. Sertraline had lower total costs per QALY than venlafaxine (34,788 Baht vs. 37,683 Baht). The more cost-effectiveness of sertraline resulted in 7.68% of cost saving. The incremental cost of venlafaxine compared with sertraline was 2,316 Baht per remission gained and 2895 Baht per QALY gained. By varying the remission rate of venlafaxine from 20% to 40%, the sensitivity analysis results in a decrease in total costs of venlafaxine from 31,926 Baht to 24,808 Baht. In addition, incremental cost per remission gained changed from 4096 Baht in favour of sertraline to 3023 Baht in favour of venlafaxine. Similarly, incremental cost per QALY gained changedfrom in favour of sertraline to in favour of venlafaxine. CONCLUSION: Based on the STAR*D trial, the results of the economic study indicate that a switch to sertraline is a cost-effectiveness treatment option compared with a switch to venlafaxine in MDD patients who have no remission or cannot tolerate citalopram.

Developing thai economic model to study cost-effectiveness of switching to bupropion compared to combination with bupropion after the failure of an SSRI for major depressive disorder.

OBJECTIVE: To present an economic model and cost-effectiveness estimates of switching to bupropion compared to combination with bupropion after failure of an SSRI for major depressive disorder (MDD). MATERIAL AND METHOD: An economic model was developed to simulate the transitions of Thai outpatients with nonpsychotic MDD who had no remission or could not tolerate the SSRI citalopram and received either sustained-release bupropion monotherapy as switching strategy or sustained-release bupropion plus citalopram as combination strategy. Clinical data were obtained form 2 trials of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. The four event probabilities: remission rates, rates of non-remission, discontinuation rates due to intolerance, and incidence of serious adverse events were estimated. Direct costs included drug cost, hospitalizations, and electroconvulsive therapy (ECT). The primary outcome considered in the model was a remission of symptoms. Outputs were measured in terms of costs per remission and costs per quality-adjusted life-years (QALYs). RESULTS: In the base-case analysis, the total direct costs with a bupropion switch were 22,937 THB per remission and 29,346 THB per remission with a bupropion combination. Compared with combination option, switching to bupropion also had lower total cost per QALY (28,672 THB vs. 36,682 THB) and had cost saving of 21.8%. The incremental cost-effectiveness of the combination regimen compared with the switching regimen was 6,409 THB per remission gained and 8,011 THB per QALY gained. In a sensitivity analysis, combination strategy dominated switching strategy if the value of the transitional probability of remission changed to a value of greater than 0.547. CONCLUSION: The economic model indicated that treatment of MDD patients who fail to achieve remission from an SSRI with a switch to bupropion is a cost-effectiveness treatment option compared with a combination of SSRI with bupropion.

The cost-effectiveness of aripiprazole as adjunctive therapy in major depressive disorder: Thai economic model.

BACKGROUND: Aripiprazole is the first atypical antipsychotic approved for adjunctive treatment to antidepressant therapy in patients with major depressive disorder (MDD). The current study aims to present an economic model and cost-effectiveness estimates for aripiprazole compared with placebo as adjunctive therapy to antidepressant treatment in patients with MDD who showed an incomplete response to a prospective 8-week trial of antidepressant therapy. MATERIAL AND METHOD: An economic model of MDD treatment was developed to estimate the clinical and economic outcomes in Thai patients. Efficacy data were derived from a pooled analysis of two studies. A cost-effectiveness analysis was constructed in simulate the impact of treatment outcomes and costs over a 6-week time horizon. The primary outcome of the model was remission of symptoms. Quality-adjusted life-year (QALYs) was the secondary outcome. The event probabilities were used to derive the transitional probability used in the model and to calculate the weighted cost of each treatment outcome. Only direct costs were considered. One-way sensitivity analysis was performed to test the sensitivity of the model outputs. RESULTS: Treatment with aripiprazole came at the total costs per remission of 30,970 Baht while treatment with placebo came at the total costs per remission of 28,409 Baht. Placebo had lower total costs per QALY than aripiprazole (35,511 Baht vs. 38,713 Baht). The incremental cost-effectiveness ratio (ICER) of augmentation with aripiprazole compared with placebo was 2,561 Baht per remission gained and 3,201 Baht per QALY gained. Aripiprazole dominated placebo if the value of transitional probability of remission changed to a value of greater than 0.348 from the base-case value of 0.257. Aripiprazole was more cost-effective than placebo as adjunctive therapy if the unit cost of aripiprazole is more than 48.9% discount. CONCLUSIONS: Adjunctive aripiprazole is not more cost-effective than adjunctive placebo in Thai patients with MDD who showed an inadequate response to at least one prospective antidepressant therapy. Remission rates and unit cost are the key parameters involving the cost-effectiveness of aripiprazole.

The prevalence of common mental disorders among outpatient Thai army personnel.

BACKGROUND: The purpose of the present study was to determine the prevalence of common mental disorders among Thai army personnel who attended the outpatient clinic, Department of Psychiatry and Neurology, Phramongkutklao Hospital in 2005. MATERIAL AND METHOD: The authors retrospectively reviewed and analyzed all outpatient medical records in 2005 of Thai army personnel who received treatment at the outpatient clinic, Department of Psychiatry and Neurology, Phramongkutklao Hospital from January 2005 to December 2005. RESULTS: Altogether 1,729 Thai army personnel were enrolled in the present study. They were 1,546 males and 183 females. The most common age range was 41-50 years (27.8%) and most of them were married. The prevalence of the first ten rank of mental disorders among Thai army personnel were schizophrenia (30.5%), alcohol dependence (18.21%), major depressive disorder (10.75%), generalized anxiety disorder (6.88%), panic disorder (6.13%), acute stress reaction (4.22%), adjustment disorder (4.1%), dysthymia (3.12%), insomnia (3%) and bipolar disorder (2.48%), respectively. CONCLUSION: The three most common prevalence of mental disorders among Thai army personnel who attended in the year 2005 were schizophrenia, alcohol dependence, and major depressive disorder.

A 4-week, double-blind comparison of olanzapine with haloperidol in the treatment of amphetamine psychosis.

OBJECTIVE: To compare the efficacy and tolerability of olanzapines and haloperidol in treating patients with amphetamine psychosis. MATERIAL AND METHOD: Fifty-eight patients experiencing episode of amphetamine psychosis were randomly assigned to olanzapine (N=29) or haloperidol (N=29) in 1:1 (olanzapine: haloperidol) ratio. All patients started with 5-10 mg/day of the study drug; after each 7-day period, the study drug could be adjusted in 5-mg increments or decrements within the allowed dose range of 5-20 mg/day during the 4-week double-blind period. RESULTS: Clinical response was seen in both treatment groups since the first week. Ninety three percent of the olanzapine patients (N=27 of 29) and 79.3% of the haloperidol patients (N=23 of 27) were clinically improved at endpoint. These differences were not statistically significant (p=0.25). The Simpson-Angus total score change from baseline to endpoint reflected no extrapyramidal symptoms among the olanzapine-treated patients (median=0.0, range=0.0). In contrast, worsening occurred among the haloperidol-treated patients (median=0.2, range=0.0-3.1). The differences of mean change in Simpson Angus Scale significantly favored olanzapine (p<0.01). Change to endpoint on the Barnes Akathisia Scale showed that olanzapine-treated patients' scores were close to the baseline (median=0.0, range=-1.0-0.0), whereas haloperidol-treated patients' scores worsened from the baseline (median=0.0, range=-1.0-3.0). This difference was statistically significant (p=0.02). CONCLUSION: Both olanzapine and haloperidol were efficacious in the treatment of patients with amphetamine psychosis. Olanzapine was superior to conventional neuroleptic haloperidol in treatment safety with lower frequency and severity of extrapyramidal symptoms.

Cost analysis of the treatment of schizophrenia in Thailand: a simulation model comparing olanzapine, risperidone, quetiapine, ziprasidone and haloperidol.

OBJECTIVES: To compare the annual costs of treating schizophrenia with four atypical antipsychotics-olanzapine, risperidone, quetiapine and ziprasidone and one typical antipsychotic: haloperidol in Thailand MATERIAL AND METHOD: The present study used a cost analysis model. The model simulated treatment of schizophrenics for 12 months with the data from international literature review. A comprehensive search of pharmacoeconomic literature was carried out in order to identify studies to be included in the present review. Model parameter used data from the searches of 1175 publications but merely 31 of them were relevant to the objectives of the present study. Costs associated with olanzapine, risperidone, quetiapine, ziprasidone and haloperidol therapy were calculated over a period of 12-months. This analysis included health care costs and costs associated with productivity losses. RESULTS: The total cost from the cost analysis was as follows: Haloperidol gives the lowest annual cost of THB 86,004, within the atypical antipsychotics, Olanzapine produces an annual cost of THB 103,225 compared to THB 104,564 with risperidone, 118,314 with ziprazidone. The cost ranges up to THB 146,526 for quetiapine therapy. CONCLUSION: Treatment with olanzapine appears to be more cost-effective than that with the other atypical antipsychotics in Thai schizophrenic patients.