ABSTRACT
BACKGROUND: Results from previous meta-analyses of the impact of comorbid personality disorders (PD's) on treatment outcomes for depressive disorder are contradictory and biased by methodological differences between included studies. AIM: To investigate the impact of comorbid PD on the outcome of depression treatments, using only studies with controlled treatments and structured measurement instruments (PROSPERO, CRD42019120200). METHOD: Studies were searched in PubMed, PsycINFO and Embase, and in reference lists of selected articles and previous meta-analyses. Treatment studies for depression with a subset of individuals with comorbid PD were included. Primary outcome was depression severity change during treatment. Effect sizes were estimated using random effect models, study-level variables were examined with meta-regression. Bias was assessed with the Risk of Bias tool. RESULTS: Six studies involving 942 individuals (447 with PD) were included. There was no significant difference in depression severity reduction between individuals with and without PD (g = 0.03, 95% CI -0.15-0.20, p = 0.27). Heterogeneity and risk of bias were low. The meta-regression did not yield significant results. CONCLUSION: Findings don't indicate an impact of comorbid PD on the outcome of acute phase treatment for depression. Depressed patients with and without comorbid PD should receive the same evidence-based depression treatments.
Subject(s)
Depression , Personality Disorders , Humans , Personality Disorders/epidemiology , Personality Disorders/therapy , Treatment OutcomeABSTRACT
BACKGROUND: Although the effectiveness of cognitive therapy (ct) and interpersonal psychotherapy (ipt) for depression has been well established, little is known about how, how long and for whom they work.
AIM: To summarize findings from a large rct to the (differential) effects and mechanisms of change of ct/ipt for depression.
METHOD: 182 adult depressed outpatients were randomized to ct (n = 76), ipt (n = 75), or a two-month wait-list-control condition (n = 31). Primary outcome was depression severity (bdi-ii). Other outcomes were quality of life, social and general psychological functioning and various potential process measures. Interventions were compared at the end of treatment, and up to 17 months follow-up.
RESULTS: Overall, ct and ipt were both superior to the wait-list, but did not differ significantly from one another. However, the pathway through which therapeutic change occurred appeared to be different for ct and ipt, and many patients were predicted to have a clinically meaningful advantage in one of the two interventions. We did not find empirical support for the theoretical models of change.
CONCLUSION: (Long-term) outcomes of ct and ipt appear to not differ significantly. The field would benefit from further refinement of research methods to disentangle mechanisms of change, and from advances in the field of personalized medicine.
Subject(s)
Cognitive Behavioral Therapy/methods , Depressive Disorder, Major/therapy , Psychotherapy/methods , Adult , Female , Humans , Interpersonal Psychotherapy , Male , Outpatients , Randomized Controlled Trials as Topic , Treatment Outcome , Waiting ListsABSTRACT
BACKGROUND: Anti-N-methyl-D-aspartate receptor encephalitis (anmdare) is a serious disease, that has only been known since 2007; movement disorders form part of the neuropsychiatric symptomatology. AIM: To provide an overview of movement disorders in anmdare and to emphasise the complexity of this disease with regard to diagnostics and treatment. METHOD: We searched the literature using PubMed, Medline and Cochrane and the search terms 'Anti-N-Methyl-D-Aspartate Receptor Encephalitis' OR 'anti-nmda receptor encephalitis' OR 'anti-nmdar encephalitis' AND 'movement disorders' OR 'catatonia'. RESULTS: Orofacial dyskinesia is the most characteristic movement disorder in anmdare. Dyskinesia was observed in 80% of the patients; young children (<12 years old) have movement disorders more often. CONCLUSION: Movement disorders are typical but aspecific symptoms of anmdare. More than one movement disorder is present in nearly all cases, a factor that can make early diagnosis difficult and can delay the start of appropriate treatment.
