Part 2. Improvement criteria in drug trials with neurotic patients

Kellner, Robert

doi:10.1017/s0033291700045645

Cited by 92 publications

(57 citation statements)

References 115 publications

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“…The intermediate scores reflect worsening (8-6) or improvement (4-2) of symptoms. This scale was found to be a sensi tive and reliable method of detecting changes in response to treat ment [19].…”

Section: Methodsmentioning

confidence: 97%

Course of Depression in Cushing’s Syndrome: Response to Treatment and Comparison with Graves’ Disease

et al. 1993

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Depression is a common, life-threatening complication of Cushing’s syndrome and may occur in several other endocrine disorders. It is not clear, however, whether distinct features pertain to hypercortisohsm. We studied depression in Cushing’s syndrome differentiating pituitary-dependent and pituitary-independent forms, its incidence compared to Graves’ disease, and its appearance in the prodromal phase of both conditions. To 66 consecutive patients with Cushing’s syndrome and 70 with Graves’ disease, after treatment, a semistructured interview for depressive symptoms based on Paykel’s clinical interview for depression was administered. In Cushing’s syndrome, the response of depression to normalization of urinary cortisol levels was evaluated by Kellner’s global rating method. There was a significant difference in the occurrence of depression (p < 0.001) between Cushing’s syndrome (62%) and Graves’ disease (23%). Depression appeared in the prodromal phase in 27% of patients with Cushing’s syndrome and in 14% of those with Graves’ disease, but the difference was not significant. In Cushing’s syndrome, there were no significant differences in depression between patients with pituitary-dependent (n = 41) and pituitary-independent (n = 20) forms, or in their response to treatment. About 70% of patients fully recovered from their depression, whereas there was no substantial change in the others and even worsening in 2. Our findings in Cushing’s syndrome and Graves’ disease are in agreement with previous investigations using specific diagnostic criteria for depression. We found a tendency for this symptom to manifest in the prodromal phase of both illnesses. An endocrine etiology should be, therefore, considered in depressed patients not responding to standard psychiatric treatment.

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Section: Methodsmentioning

confidence: 97%

Course of Depression in Cushing’s Syndrome: Response to Treatment and Comparison with Graves’ Disease

et al. 1993

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“…In 1951, Shapiro [32] outlined the methodological difficulties in applying psychometric principles to diagnostic psychological testing. In the early 1970s, Kellner [33, 34] discussed the psychometric problems related to the assessment of changes in distress and introduced the concept of sensitivity, the ability of a rating or self-rating scale to discriminate between different groups of patients suffering from the same illness (e.g., depressed inpatients and outpatients) and to reflect changes in therapeutics, such as drug trials. In the past decade there has been an increasing number of trials in psychiatry that have failed to display significant differences between psychotropic drugs and placebo [35,36,37].…”

Section: The Misleading Effects Of Psychometric Theory On Clinical Asmentioning

confidence: 99%

The Intellectual Crisis of Psychiatric Research

Fava¹

2006

Psychother Psychosom

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The aim of this paper was to examine the intellectual crisis and the potential sources of reveille in clinical research in psychiatry. Current prevailing conceptual models in psychiatry are critically examined, with particular reference to neurobiology, clinical psychopharmacology, assessment, and the therapeutic process. Biological reductionism, neglect of individual responses to treatment, massive propaganda from the pharmaceutical industry, misleading effects of psychometric theory on clinical assessment, and lack of consideration of multiple therapeutic ingredients and of the role of psychological well-being are identified as major sources of an intellectual crisis in psychiatric research. The conceptual crisis of psychiatry is shared by other areas of clinical medicine and stems from a narrow concept of science that neglects clinical observation, the basic method of medicine. A unified concept of health and disease may yield new clinical insights in psychiatric disorders, and may result in therapeutic efforts of more enduring quality than current strategies.

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“…who had evaluated them on intake but who did not take part in the treatment. Only patients rated as "better" or "much better" according to a global scale of improvement 15 and as being in full remission 19 were included in the study. Patients also had to show no evidence of depressed mood after treatment according to a modified version of the Paykel Clinical Interview for Depression (CID).…”

Section: Patientsmentioning

confidence: 99%

Prevention of Recurrent Depression With Cognitive Behavioral Therapy

Fava

Rafanelli²,

Grandi³

et al. 1998

Arch Gen Psychiatry

469

318

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Part 2. Improvement criteria in drug trials with neurotic patients

Abstract: SYNOPSISBased on the available research evidence, several rating and self-rating methods are recommended which appear to be suitable for the measurement of changes in distress in drug trials with neurotic patients.

Cited by 92 publications

References 115 publications

Course of Depression in Cushing’s Syndrome: Response to Treatment and Comparison with Graves’ Disease

Course of Depression in Cushing’s Syndrome: Response to Treatment and Comparison with Graves’ Disease

The Intellectual Crisis of Psychiatric Research

Prevention of Recurrent Depression With Cognitive Behavioral Therapy

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Part 2. Improvement criteria in drug trials with neurotic patients

Abstract: SYNOPSISBased on the available research evidence, several rating and self-rating methods are recommended which appear to be suitable for the measurement of changes in distress in drug trials with neurotic patients.

Cited by 92 publications

References 115 publications

Course of Depression in Cushing&rsquo;s Syndrome: Response to Treatment and Comparison with Graves&rsquo; Disease

Course of Depression in Cushing&rsquo;s Syndrome: Response to Treatment and Comparison with Graves&rsquo; Disease

The Intellectual Crisis of Psychiatric Research

Prevention of Recurrent Depression With Cognitive Behavioral Therapy

Contact Info

Product

Resources

About

Course of Depression in Cushing’s Syndrome: Response to Treatment and Comparison with Graves’ Disease

Course of Depression in Cushing’s Syndrome: Response to Treatment and Comparison with Graves’ Disease