Purpose of review
Despite a significant body of literature related to the treatment of gambling disorder, there are still an insufficient number of evaluation studies regarding their effectiveness or ...firm conclusions on specific treatment elements that contribute to it. The aim of this article was to provide a review of scientific results regarding the treatment of gambling disorder, to present the most commonly applied modalities of treatment and to explore the elements of the most successful therapeutic interventions.
Recent findings
A substantial body of literature has shown that the most successful therapeutic protocols are psychological interventions, especially based on cognitive-behavioral therapy/methods and/or motivational interviewing. Other interventions with promising results include different self-help interventions and mindfulness. Interventions such as couples therapy and support groups, may have positive effects in terms of increasing therapeutic adherence and retention, while pharmacotherapy is especially useful in patients with comorbidities.
Summary
Gambling disorder is a complex mental health problem caused by a wide spectrum of different biological, psychological, and social risk factors. Treatment options for gambling disorder need to be wide, flexible, accessible, and economically justified, providing early inclusion, retention, and sustainability of long-term effects of the treatment, that is, abstinence and higher quality of psychosocial functioning.
PURPOSE OF REVIEWDespite of the heightened risks and burdens of physical comorbidities across the entire spectrum of mental disorders, relatively little is known about physical multimorbidity in this ...population. The aim of this narrative review is to present recent data regarding the onset and accumulation of physical multimorbidity and to assess its impact on the onset, course, treatment, and outcomes of mental disorders.
RECENT FINDINGSA substantial body of literature shows increased risk of physical multimorbidity among people with mental disorders. The disparity in physical multimorbidity occurs even before the diagnosis of mental disorder, and the younger age group appears to be at particular risk. Numerous patterns of association between mental disorders and medical disorders involving multiple organ systems have been identified. Physical multimorbidity affects people with mental disorders across their life spans, is associated with a wide range of unfavorable outcomes and presents significant clinical and public health concerns.
SUMMARYTo address physical health inequalities among people with mental disorders compared with the general population, we must focus on the physical health from the very first point of contact with a mental health service. Treatment of mental disorders must be customized to meet the needs of patients with different physical multimorbidity patterns. Future work is needed to clarify how physical multimorbidity influences mental disorder treatment outcomes.
A growing body of evidence has demonstrated the high prevalence and complexity of chronic physical multimorbidity defined as ≥2 chronic physical illness in people with psychiatric disorders. The ...present study aimed to assess differences in the prevalence and patterns of self-reported chronic physical illness and multimorbidity in the general and psychiatric populations.
We performed a latent class analysis of 15 self-reported chronic physical illnesses on a sample of 1060 psychiatric patients and 837 participants from the general population.
Self-reported chronic physical illness and multimorbidity were significantly more prevalent in the population of psychiatric patients than in the general population (P < .001). Psychiatric patients had 27% (CI95% 24% - 30%) higher age-standardized relative risk for chronic physical illness and a 31% (CI95% 28% - 34%) higher for multimorbidity (P < .001). The number of chronic physical illnesses combinations was 52% higher in the psychiatric than in general population (255 vs 161 combinations respectively; P < .001). We identified four distinct latent classes: “Relatively healthy”, “Musculoskeletal”, “Hypertension and obesity”, and “Complex multimorbidity” with no significant differences in the nature of multimorbidity latent classes patterns. The class “Relatively healthy” was significantly less (ARI = −25% (CI95% -30% -21%), and the class “Hypertension and obesity” was significantly more prevalent in the population of psychiatric patients (ARI = 20% (CI95% 17% - 23%).
These findings indicate that mental disorders are associated with an increased risk of a wide range of chronic physical illnesses and multimorbidity. There is an urgent need for the development of the guidelines regarding the physical healthcare of all individuals with mental disorders with multimorbidity in focus.
•Prevalence of chronic physical illnesses and multimorbidity is higher in the psychiatric than in the general population.•The population of psychiatric patients had a 27% higher relative risk for chronic physical illnesses.•The relative risk for chronic physical multimorbidities is 31% higher in the psychiatric population.•Chronic physical multimorbidity patterns are not significantly different between the psychiatric and general population.•The primary prevention of chronic physical illnesses should be integrated into the psychiatric treatment.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPUK, ZRSKP
Repetitive transcranial magnetic stimulation (rTMS) is an evidence-based treatment option for major depressive disorder (MDD). However, comparisons of efficacy between the two FDA-approved protocols ...of rTMS modalities are lacking. The aim of this industry-independent, randomized-controlled, single-blind trial was to evaluate clinical outcome of the two FDA-approved rTMS protocols delivered by H1-coil and the figure-8-coil, in MDD patients. A total of 228 MDD patients were randomized to 20 sessions of H1-coil or 8-coil as an adjunct to standard-of-care pharmacotherapy, or standard-of-care pharmacotherapy alone. Baseline MDD symptom severity was almost the same in the three groups. Hamilton depression rating scale (HAM-D17) mean score was 17 (5.3) in H1-coil, 17 (5.4) in 8-coil, and 19 (6.1) in control group. The primary outcome was the proportion of patients achieving remission defined as HAM-D17 score ≤7 at end-of-treatment at week-4. In the intention-to-treat analysis odds ratio for remission was 1.74 (CI95% 0.79–3.83) in H1-coil compared to the 8-coil group. The difference between two rTMS protocols was not significant. Remission rate was significantly greater in both HF-rTMS groups compared to the control: 60% (CI95% 48–71%), 43% (CI95% 31–55%) and 11% (CI95% 5–20%) respectively. The response was significantly better in H1-coil, than in 8-coil group OR = 2.33; CI95% 1.04–5.21 (P = 0.040). The HAM-D17 was lowered by 59% in the H1-coil, 41% in the 8-coil (P = 0.048), and 17% in the control group (P < 0.001 vs H1-coil; P = 0.003 vs 8-coil). Safety, tolerability, and the changes in quality of life were comparable. We confirmed the safety and efficacy of both FDA-approved protocols as adjunctive treatments of MDD. Better response rate and greater reduction of depression severity were observed in the H1-coil group, but without a significant difference in the remission rate between the two rTMS modalities.
Clinicaltrials.govNCT02917499
•Remission rate was significantly greater in HF-rTMS groups compared to the control.•Main-analyses showed no difference in remission rate between H1-coil, and 8-coil group.•Better response rate and reduction of depression severity was observed in H1-coil, than in 8-coil group.•Both rTMS modalities ware equally safe and well tolerated.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPUK, ZAGLJ, ZRSKP
Accelerated repetitive transcranial magnetic stimulation (rTMS) protocols are being increasingly studied because of their potential to provide quicker and enhanced treatment efficacy. However, there ...is a lack of accelerated deep TMS with H1-coil (adTMS) treatment research. This randomized pilot study investigated the efficacy and safety of adTMS protocols. Twenty-eight TRD patients received 20-min sessions twice daily for 10 or 15 days. Primary outcomes were changes in Hamilton Depression Rating Scale (HDRS) scores and discontinuation because of adverse events (AE). Secondary outcomes were response, remission, daily changes in Beck Depression Inventory-II (BDI-II) scores, and AE incidence. HDRS scores decreased by 13 (95% CI 11–17; 59%, 95% CI 45–73%) and 13 (95% CI 11–14; 62%, 95% CI 54–69%) points in the 10- and 15-day protocols, respectively. The adjusted difference between the two protocols was not significant or clinically relevant. Remission was achieved by 38% and 42% after 10-day and 15-day protocols, respectively. The intervention was discontinued because of AEs in 3/33 (9%) patients. The BDI-II decreases were significant and clinically relevant during the first 8 days. Twice-daily adTMS for 10 days seems to be safe and effective, with rapid clinical benefits during the first week of treatment. These promising results warrant further investigation in larger randomized clinical trials comparing adTMS with the standard dTMS protocol.
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DOBA, EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, IZUM, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UILJ, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
BACKGROUND This study aimed to identify the clustering of comorbidities, cognitive, and mental factors associated with increased risk of pre-frailty and frailty in patients ≥60 years in a primary ...healthcare setting in eastern Croatia. MATERIAL AND METHODS There were 159 patients included in the cluster analysis who were ≥60 years and who underwent four-month follow-up. The first cluster contained 50 patients, the second cluster contained 74 patients, and the third cluster contained 35 patients. Clinical parameters were identified from electronic health records and patient questionnaires. Laboratory tests, anthropometric measurements, the number of chronic diseases, the number of prescribed medications were recorded. Frailty was determined using the five criteria of Fried's phenotype -model. Levels of anxiety and depression were recorded using the Geriatric Anxiety Scale (GAS) and the Geriatric Depression Scale (GDS), and the Mini-Mental State Examination (MMSE) score assessed cognitive impairment. Logistic regression models were used to identify predictors of frailty and pre-frailty. RESULTS Three overlapping clusters of phenotypes predicted frailty, and included obesity (n=50), multimorbidity with mental impairment (n=74), and decline in renal function with cognitive impairment (n=35). The predictors of outcome included increasing age, number of chronic diseases, inflammation, anemia, anxiety, and cognitive impairment, and reduced muscle mass. CONCLUSIONS In patients ≥60 years in a primary healthcare setting, multimorbidity predictors of pre-frailty and frailty included a decline in cognitive function and renal function.
PURPOSE OF REVIEWAfter three decades of clinical research on repetitive transcranial magnetic stimulation (rTMS), major depressive disorder (MDD) has proven to be the primary field of application. ...MDD poses a major challenge for health systems worldwide, emphasizing the need for improving clinical efficacy of existing rTMS applications and promoting the development of novel evidence-based rTMS treatment approaches.
RECENT FINDINGSSeveral promising new avenues have been proposednovel stimulation patterns, targets, and coils; combinatory treatments and maintenance; and personalization and stratification of rTMS parameters, and treatment of subpopulations.
SUMMARYThis opinion review summarizes current knowledge in the field and addresses the future direction of rTMS treatment in MDD, facilitating the establishment of this clinical intervention method as a standard treatment option and continuing to improve response and remission rates, and take the necessary steps to personalize rTMS-based treatment approaches.
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