Treatment Moderators and Predictors of Outcome in the Treatment of Early Age Mania (TEAM) Study

ScienceDirect.com – Journal of the American Academy of Child & Adolescent Psychiatry – Treatment Moderators and Predictors of Outcome in the Treatment of Early Age Mania (TEAM) Study.

Objective

Both the diagnosis and treatment of bipolar disorder in youth remain the subject of debate. In the Treatment of Early Age Mania (TEAM) study, risperidone was more effective than lithium or divalproex in children diagnosed with bipolar mania and highly comorbid with attention-deficit/hyperactivity disorder (ADHD). We searched for treatment moderators and predictors of outcome.

Method

TEAM was a multi-site, 8-week, randomized clinical trial of risperidone, lithium, or divalproex in 279 medication-naïve patients, aged 6 through 15 years, with a DSM-IV diagnosis of bipolar disorder currently in manic or mixed phase. Outcome measures included binary end-of-treatment responder status and change in the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) Mania Rating Scale (KMRS). Baseline demographics and clinical characteristics were tested as modifiers of treatment effect and as overall predictors of outcome.

Results

Moderator effects were detected for site, ADHD, and obesity. Across sites, the response ratio (RR) for risperidone versus lithium ranged from 1.2 (95% confidence interval [CI] = 0.8-1.7) to 8.3 (95% CI = 1.1-60.8), and for risperidone versus divalproex from 1.3 (95% CI = 0.8-2.2) to 10.5 (95% CI = 1.4-77.7). The RR for risperidone versus lithium was 2.1 for patients with ADHD, but 1.0 for those without ADHD, and 2.3 (95% CI = 1.6-3.3) for nonobese patients, but 1.1 (95% CI = 0.6-2.0) for obese ones. Older age and less severe ADHD symptoms were associated with greater improvement on the KMRS.

Conclusions

Risperidone was more effective than lithium or divalproex across the demographics and clinical characteristics of the sample, but the magnitude of its effect was influenced by site-related characteristics and presence of ADHD. Clinical trial registration information—Treatment of Early Age Mania;http://clinicaltrials.gov/; NCT00057681.

Longer term outcome of cognitive-behavioural and psychodynamic psychotherapy in routine mental health care: Randomised controlled trial

Behaviour Research and Therapy

Volume 50, Issue 9, September 2012, Pages 580–587

ScienceDirect.com – Behaviour Research and Therapy – Longer term outcome of cognitive-behavioural and psychodynamic psychotherapy in routine mental health care: Randomised controlled trial.

• Birgit Watzke^a, , ,
• Heinz Rüddel^b,
• Ralph Jürgensen^b,
• Uwe Koch^a,
• Levente Kriston^a,
• Barbara Grothgar^b,
• Holger Schulz^a

• ^a Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Germany
• ^b St. Franziska-Stift, Bad Kreuznach, Germany

• Abstract

  We investigated the comparative effectiveness of cognitive-behavioural (CBT) and psychodynamic therapy (PDT) under clinically representative conditions as a subtrial of a prior study (Watzke et al., 2010, BJP). A consecutive sample of 147 patients with common mental disorders was randomised to either CBT or PDT in routine mental health care. In a primary per-protocol analysis patients randomised to CBT had a significantly better longer term outcome in the primary outcome symptom severity (General Severity Index of the SCL-14;p = .001; partial η² = 0.073) as well as in health related quality of life (Mental Component Summary of the SF-8; p = .013; partial η² = .041) and concerning interpersonal issues (Inventory of Interpersonal Problems, IIP-C; p = .001; partial η² = .070) 6 months after treatment than patients randomised to PDT. These results could be confirmed in intention-to-treat analyses (n = 180) suggesting that there was no substantial attrition bias due to drop outs at the follow-up assessment. Thus, the so called equivalence outcome paradox was not replicated in this study.

A randomized pilot trial comparing videoconference versus face-to-face delivery of behavior therapy for childhood tic disorders

Behaviour Research and Therapy

Volume 50, Issue 9, September 2012, Pages 565–570

ScienceDirect.com – Behaviour Research and Therapy – A randomized pilot trial comparing videoconference versus face-to-face delivery of behavior therapy for childhood tic disorders.

• Michael B. Himle^a, , ,
• Malinda Freitag^a,
• Michael Walther^b,
• Shana A. Franklin^b,
• Laura Ely^b,
• Douglas W. Woods^b

• ^a University of Utah, USA
• ^b University of Wisconsin-Milwaukee, USA

Abstract

Comprehensive Behavioral Intervention for Tics (CBIT) has been shown to be effective for reducing tics in children with chronic tic disorder. Unfortunately, there remain significant barriers to dissemination. The aim of the current study was to examine the effectiveness of CBIT delivered over videoconference. Twenty children were randomly assigned to receive CBIT over videoconference or via traditional face-to-face delivery. Results show that both treatment delivery modalities resulted in significant tic reduction with no between group differences. Furthermore, acceptability and therapist-client alliance ratings were strong for both groups. Together, these results suggest that videoconference is a viable option for disseminating CBIT.