Psychosocial Interventions for Patients With Heart Failure and Their Impact on Depression, Anxiety, Quality of Life, Morbidity, and Mortality: A Systematic Review and Meta-Analysis.

OBJECTIVE: The purpose of this systematic review and meta-analysis was to evaluate the ability of psychosocial interventions to reduce depression and anxiety, improve quality of life, and reduce hospitalization and mortality rates in patients with heart failure. METHODS: Studies of psychosocial interventions published from 1970 to 2021 were identified through four databases (PubMed, Ovid MEDLINE, PsycINFO, Cochrane). Two authors independently conducted a focused analysis and reached a final consensus on the studies to include, followed by a quality check by a third author. A risk of bias assessment was conducted. RESULTS: Twenty-three studies were identified, but only 15 studies of mostly randomized controlled trials with a total of 1370 patients with heart failure were included in the meta-analysis. Interventions were either cognitive behavioral therapy (CBT) or stress management. The pooled intervention effect was in favor of the intervention for depression (combined difference in standardized mean change [DSMC]: -0.41; 95% confidence interval [CI] = -0.66 to -0.17; p = .001) and anxiety (combined DSMC: -0.33; 95% CI = -0.51 to -0.15; p < .001) but was only a trend for quality of life (combined DSMC: 0.14; 95% CI = -0.00 to 0.29; p = .053). Evidence was limited that interventions produced lower rates of hospitalization (5 of 5 studies showing a beneficial effect) or death (1 of 5 with a beneficial effect). CONCLUSIONS: CBT and stress management interventions significantly reduced depression and anxiety compared with control conditions. CBT significantly improved quality of life compared with controls, but stress management did not. Longer treatment duration seemed to be an important factor related to treatment success.

Polypharmacy in Maintenance of Bipolar Disorder.

OBJECTIVES: To track the outcomes of bipolar patients who had remitted from an acute manic episode on single- and multiple-drug regimens including lithium (LI), valproate (VPA), and carbamazepine (CBZ), in order to compare relapse rates on 1, 2, or 3 medications. METHODS: Following treatment of an acute manic episode and a 1-month period of no signs of mood episodes, patients were evaluated at 1- to 2-month intervals as to the kind of regimen required to maintain their stability while continuing on this regimen for 2 years. Medication regimens included 1, 2, or 3 of the following drugs: LI, VPA, and/or CBZ. The 3 medication groups were followed from entry into the study through 3 possible end points based on the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition checklist: "NO-Relapse," "Relapse," or "Dropped out." RESULTS: Of the 1312 patients included in the study and followed up for 2 years, 281 patients (21.4%) were maintained on a single drug (LI, VPA, or CBZ), 852 (65%) on 2 drugs, and 179 (13.6%) on 3 or more drugs. A smaller percentage of patients on 1 medication had NO-Relapse for 2 years (22.8%), compared with patients on 2 medications (43.9%) and patients on 3 or more medications (41.9%): χ2 = 40.3, P < 0.001. CONCLUSIONS: This study showed that overall, of the bipolar patients who were asymptomatic at 1 month, a smaller percentage of patients on 1 medication continued to be stable for 2 years, compared with patients on 2 medications and patients on 3 or more medications.

Maintenance treatment for obsessive-compulsive disorder: findings from a naturalistic setting.

BACKGROUND: Although the utility of medication in the acute treatment of adult obsessive-compulsive disorder (OCD) is well-established, the role of maintenance therapy is not as well-studied. This study examines the efficacy of long-term treatment for, and predictors of, stability in medicated patients with adult OCD. METHODS: Using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), we retrospectively evaluated 84 OCD patients who responded to a 10- to 12-week, open-label, acute treatment in a naturalistic clinic setting. Patients were followed based on their medication response for 1 to 92 months (mean 34.3), or until they terminated therapy. We evaluated Y-BOCS scores every 6 months or sooner, if clinically indicated. RESULTS: Of the 84 patients, 39 (46.4%) responded, having relapsed within a 5-year period. Predictors of longer duration of stability were adjunctive cognitive-behavioral therapy (CBT), lack of comorbid disorders, lower Y-BOCS score after treatment, and larger decrease in Y-BOCS score during treatment phase. CONCLUSIONS: Our results show the importance of maintenance treatment of OCD, noting the benefits of long-term response to adjunctive CBT and of achieving maximal acute response. It is becoming crucial to develop larger maintenance studies with more uniform design to better assess the natural course of treated OCD and improve treatment strategies.

Prophylactic efficacy of fluoxetine, escitalopram, sertraline, paroxetine, and concomitant psychotherapy in major depressive disorder: outcome after long-term follow-up.

The acute efficacy of selective serotonin reuptake inhibitors (SSRIs) in the treatment of major depressive disorder (MDD) is well established; however their role in longer-term prevention of recurrence remains unconfirmed. This study aims at examining: the prophylactic efficacy of four commonly used SSRIs in MDD in a naturalistic setting with long-term follow-up, the effect of concomitant cognitive behavioral therapy (CBT), and the predictors of outcome. In a prospective cohort study, 387 patients who either remitted or responded following treatment with four different SSRIs-fluoxetine, escitalopram, sertraline and paroxetine-were followed up over several years. During an average follow-up period of 34.5 months, 76.5% of patients experienced MDD recurrence. Escitalopram and fluoxetine showed a numerically higher prophylactic efficacy than paroxetine and sertraline but the difference was statistically insignificant. The prophylactic efficacy for SSRI-only treatment was limited, with a recurrence rate of 82.0%, compared to 59.0% of patient recurrence rate in concomitant Cognitive Behavioral Therapy (CBT). The relatively small size of the CBT group and the lack of randomization may undermine the extrapolation of its findings to clinical practice. Nevertheless, the study preliminary data may help in defining the clinical utility of antidepressants and CBT in the prophylaxis from MDD recurrence.