Residual or re-emergent impaired insight into delusions following remission is unrelated to later relapse during a randomized clinical trial of continuation pharmacotherapy for psychotic depression - The STOP-PD II Study.

Autor: Song J; Centre for Addiction & Mental Health, Toronto, ON, Canada; Institute of Medical Science, School of Graduate Studies, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada., Mulsant BH; Centre for Addiction & Mental Health, Toronto, ON, Canada; Institute of Medical Science, School of Graduate Studies, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada., Sanches M; Biostatistics Core, Centre for Addiction and Mental Health, Toronto, ON, Canada., Alexopoulos GS; Department of Psychiatry, Weill Cornell Medicine of Cornell University & New York Presbyterian Hospital, Westchester Division, NY, United States., Marino P; Department of Psychiatry, Weill Cornell Medicine of Cornell University & New York Presbyterian Hospital, Westchester Division, NY, United States., Meyers BS; Department of Psychiatry, Weill Cornell Medicine of Cornell University & New York Presbyterian Hospital, Westchester Division, NY, United States., Rothschild AJ; University of Massachusetts Chan Medical School & UMass Memorial Health Care, Worcester, MA, United States., Voineskos AN; Centre for Addiction & Mental Health, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada., Whyte EM; Department of Psychiatry, University of Pittsburgh School of Medicine & UPMC Western Psychiatric Hospital, Pittsburgh, PA, United States., Flint AJ; Institute of Medical Science, School of Graduate Studies, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Centre for Mental Health, University Health Network, Toronto, ON, Canada., Gerretsen P; Centre for Addiction & Mental Health, Toronto, ON, Canada; Institute of Medical Science, School of Graduate Studies, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada. Electronic address: philip.gerretsen@camh.ca.
Jazyk: angličtina
Zdroj: Journal of affective disorders [J Affect Disord] 2023 Mar 15; Vol. 325, pp. 29-34. Date of Electronic Publication: 2022 Dec 30.
DOI: 10.1016/j.jad.2022.12.078
Abstrakt: Background: Impaired insight into delusions is associated with a lower probability of remission of psychotic depression, independent of illness severity. The relationship between participant characteristics and impaired insight into delusions in remitted psychotic depression, and whether impaired insight is associated with risk of relapse of psychotic depression during continuation pharmacotherapy were examined.
Methods: Data were analyzed from 126 participants in the STOP-PD II study who experienced sustained remission of psychotic depression during 8-week stabilization treatment with sertraline plus olanzapine and were then randomized to 36 weeks of continuation treatment with sertraline plus either olanzapine or placebo. Insight into delusions was assessed with the Resolution of Delusions Scale (RODS). Linear regression analyses examined the associations between participant characteristics and insight into delusions. Cox proportional-hazards models examined whether i) change in RODS during stabilization treatment; or ii) RODS at the end of stabilization treatment predicted risk of relapse during 36 weeks of continuation treatment.
Results: Severity of psychosis before initiation of treatment was the only participant characteristic associated with the change in insight during stabilization treatment. Neither change in insight during stabilization treatment nor insight at the end of stabilization treatment was associated with risk of relapse.
Limitations: Insufficient statistical power and the lack of variability in RODS scores at the time of randomization may have contributed to the absence of a relationship between RODS and risk of relapse.
Conclusion: Residual or reemergent insight impairment following acute treatment does not preclude patients from sustaining remission of psychotic depression in a randomized placebo-controlled trial.
Competing Interests: Conflict of interest J. Song has no disclosures. B.H. Mulsant holds and receives support from the Labatt Family Chair in Biology of Depression in Late-Life Adults at the University of Toronto. He currently receives research support from Brain Canada, the Canadian Institutes of Health Research, the CAMH Foundation, the Patient-Centered Outcomes Research Institute (PCORI), the US National Institute of Health (NIH), Capital Solution Design LLC (software used in a study founded by CAMH Foundation), and HAPPYneuron (software used in a study founded by Brain Canada). He has been an unpaid consultant to Myriad Neuroscience. M. Sanches has no disclosures. G.S. Alexopoulos has received NIMH grants and has served in the speakers bureau of Takeda, Lundbeck, Otsuka, Alergan, and participated in advisory boards of Eisai and Janssen. P. Marino received research support from the NIMH at the time this work was done. B.S. Meyers received research support from the NIMH at the time this work was done. A.J. Rothschild has received grant or research support from Janssen, the National Institute of Mental Health, Otsuka, and Praxis, and the Irving S. and Betty Brudnick Endowed Chair in Psychiatry, is a consultant to Alkermes, Sage Therapeutics, Xenon Pharmaceuticals, and several generic medication companies, has received royalties for the Rothschild Scale for Antidepressant Tachyphylaxis (RSAT)®; Clinical Manual for the Diagnosis and Treatment of Psychotic Depression, American Psychiatric Press, 2009; The Evidence-Based Guide to Antipsychotic Medications, American Psychiatric Press, 2010; The Evidence-Based Guide to Antidepressant Medications, American Psychiatric Press, 2012; and, UpToDate® and has received honorarium from Wolters Kluwer (Journal Editor). A.N. Voineskos has received funding from the NIMH, Canadian Institutes of Health Research, Canada Foundation for Innovation, CAMH Foundation, and the University of Toronto. E.M. Whyte received grant support from the NIMH and HRSA at the time that this work was done. A.J. Flint has received grant support from the U.S. National Institutes of Health, Patient-Centered Outcomes Research Institute, Canadian Institutes of Health Research, Brain Canada, Ontario Brain Institute, Alzheimer's Association, AGE-WELL, and the Canadian Foundation for Healthcare Improvement. P. Gerretsen reports receiving research support from the Canadian Institute of Health Research (CIHR), Ontario Ministry of Health and Long-Term Care, Ontario Mental Health Foundation (OMHF), the Centre for Addiction and Mental Health (CAMH), CAMH Foundation, and an Academic Scholars Award from the Department of Psychiatry, University of Toronto.
(Copyright © 2022. Published by Elsevier B.V.)
Databáze: MEDLINE
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