1,721,381 research outputs found
Attention-deficit/hyperactivity disorder (ADHD): from randomised controlled trials to evidence-based clinical services
No full textDrug epidemiology in Italy: methods and ethical issues. The example of psychiatry
No full textPurpose. These notes aim at analysing current methods, ethical issues and major legislation changes related to drug epidemiology in Italy. Methods. The design and conduct of two pharmacoepidemiological surveys carried out in the context of recent law dispositions on psychiatric care and confidentiality are presented. Results. In 1978 law 180 stated that no more patients had to be admitted to psychiatric hospitals, and no more psychiatric hospitals had to be built. Chronic long-stay patients were allowed to remain in hospitals. In 1994, however, financial law 724 established a deadline for the final closure of Italian psychiatric hospitals. A survey of more than 1000 patients living in eight state psychiatric hospitals was carried out to describe the social and clinical characteristics of the inpatient population and to monitor their community placement. In 1996 law 675 established that private and confidential information could not be used for any purpose without the patient's informed consent. However, this law was not implemented that year. A survey of benzodiazepine use among general practice patients was conducted without written informed consent. Conclusions. The Italian legislation has been changing for some years, and regulations might still be modified in the near future. To increase ethical practices in pharmacoepidemiology scientists and clinical researchers should guarantee high standards in terms of research objectives, design and analyses. Potential conflict of interest should always be declared. Copyright © 2001 John Wiley & Sons, Ltd
Adding aripiprazole improves major depressive disorder following incomplete response to antidepressants alone
No full textIdentification and management of depression in primary care settings. A meta-review of evidence
No full textAim - The purpose of this review is to summarize the evidence base on the effectiveness of (a) screening for depression in primary care; (b) managing depression in primary care employing specific management strategies; (c) treating primary care depressive patients with antidepressants. Methods - Meta-review of all available reviews of the evidence. Results - Screening alone does not improve the recognition, management and outcome of depression in primary care settings. Management strategies, including (a) training primary care staff, (b) consultation-liaison, (c) collaborative care, (d) replacement/referral are supported by insufficient evidence to provide a definite answer as to the clinical effectiveness of individual models. Robust evidence exists to encourage physicians to prescribe effective doses of antidepressants in patients with moderate to severe depression who seek treatment in primary care settings. Conclusion - Population-level screening campaigns have a negative ratio of costs to benefits. However, at an individual-level of care increasing the ability of primary care physicians in recognising depression remains a relevant factor. Primary care physicians should consider whether depression is mild, moderate or severe. This patient categorisation help develop appropriate management and therapeutic strategies
Interferon-Induced Depression: when a randomized trial is not a randomized controlled trial. Reply
No full textPsychotropic drug epidemiology. The road travelled, the road ahead
No full textPsychotropic drug epidemiology is a discipline developed to study the use and the effects of drugs in large numbers of individuals. It describes how drugs are prescribed and utilized, investigates reasons underlying prescriptions, and monitors outcomes and variables which may affect these outcomes. In this article the main purposes, study designs and limitations of current pharmacoepidemiological approaches are reviewed with the aim of assessing whether this discipline can constitute a permanent link between the experimental world of clinical trials and the real world of everyday prescribing. We support the notion that evidence generated in clinical practice, by means of pharmacoepidemiological studies, should increasingly be used to develop and suggest innovative research hypotheses to be subsequently tested in pragmatic experimental studies. © 2005 Institute of Psychiatry
Medicine-based evidence: the case of antidepressants in patients with coronary artery disease
No full textIn individuals with coronary artery disease and concurrent depressive symptomatology, the evidence on the beneficial and harmful effects of antidepressants is very limited. Recently, a study was carried out to describe depressive symptoms and the treatments provided under real-world circumstances to cardiac patients who entered the Mayo Clinic cardiac rehabilitation program. Antidepressant use was associated with reductions in depressive symptoms, but also with poorer cardiovascular outcomes. In this commentary, the results of this study are discussed in view of their clinical implications for everyday clinical practice and for the production of knowledge
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