The pursuit of euthymia

Fava, Giovanni A.; Guidi, Jenny

doi:10.1002/wps.20698

Cited by 122 publications

(155 citation statements)

References 116 publications

(143 reference statements)

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“…Kellner's SQ, in view of the data that are available and its high sensitivity to change [176,177], appears to be very suitable for this purpose. Transdiagnostic clinimetric indices that may assess other dimensions, such as psychological well-being and euthymia [163,[199][200][201] or mental pain [202,203], may also add valuable information.…”

Section: Discussionmentioning

confidence: 99%

The Hamilton Rating Scales for Depression: A Critical Review of Clinimetric Properties of Different Versions

Carrozzino

Patierno

Fava

et al. 2020

Psychother Psychosom

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178

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The format of the original Hamilton Rating Scale for Depression (HAM-D) was unstructured: only general instructions were provided for rating individual items. Over the years, a number of modified versions of the HAM-D have been proposed. They differ not only in the number of items, but also in modalities of administration. Structured versions, including item definitions, anchor points and semi-structured or structured interview questions, were developed. This comprehensive review was conducted to examine the clinimetric properties of the different versions of the HAM-D. The aim was to identify the HAM-D versions that best display the clinimetric properties of reliability, validity, and sensitivity to change. The search was conducted on MEDLINE, Scopus, Web of Science, and PubMed, and yielded a total of 35,473 citations, but only the most representative studies were in-cluded. The structured versions of the HAM-D were found to display the highest inter-rater and test-retest reliability. The Clinical Interview for Depression and the 6-item HAM-D showed the highest sensitivity in differentiating active treatment from placebo. The findings indicate that the HAM-D is a valid and sensitive clinimetric index, which should not be discarded in view of obsolete and not clinically relevant psychometric criteria. The HAM-D, however, requires an informed use: unstructured forms should be avoided and the type of HAM-D version that is selected should be specified in the registration of the study protocol and in the methods of the trial. scale exceeds 21,000 on Scopus. Hamilton himself recommended, however, to use only the first 17 items of the HAM-D 21 since the last 4 symptoms (i.e., diurnal variation, depersonalization/derealization, paranoid and obsessional/compulsive symptoms) were either not considered part of the disease, or they were relatively uncommon, or they were not considered features related to depression severity [2,3]. Over the years, a number of modifications of the scale have been proposed and several versions of the HAM-D have been developed and come into use [4,5].

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Section: Discussionmentioning

confidence: 99%

The Hamilton Rating Scales for Depression: A Critical Review of Clinimetric Properties of Different Versions

Carrozzino

Patierno

Fava

et al. 2020

Psychother Psychosom

Self Cite

178

110

View full text Add to dashboard Cite

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“…Traditional psychiatric nosology has been largely based on the idea that human psychological suffering reflects a latent disease. As Fava and Guidi note in their paper, this conception has interfered with a more balanced and positive approach. It is not just that the focus on psychological distress has overwhelmed needed attention to positive experience.…”

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confidence: 99%

Constructing a liberated and modern mind: six pathways from pathology to euthymia

Hayes

2020

World Psychiatry

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“…The importance of well-being during pharmacotherapy is receiving more and more attention [129] and is particularly relevant in explaining the high adherence of some patients to clozapine, demonstrated by the lower discontinuation rates in cohort studies [127,128]. Clozapine positive effects on well-being in some patients may be influenced by clozapine effects on extrapyramidal symptoms [130][131][132][133][134][135][136][137][138][139][140][141][142], hostility [143,144] and the "awakening" phenomenon [145][146][147] (online suppl.…”

Section: Clozapine and Well-beingmentioning

confidence: 99%

A Rational Use of Clozapine Based on Adverse Drug Reactions, Pharmacokinetics, and Clinical Pharmacopsychology

Leon

Ruan

Schoretsanitis

et al. 2020

Psychother Psychosom

121

113

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Using Richardson and Davidson's model and the sciences of pharmacokinetics and clinical pharmacopsychology, this article reviewed the: (1) poor life expectancy associated with treatment-resistant schizophrenia (TRS), which may be improved in patients who adhere to clozapine; (2) findings that clozapine is the best treatment for TRS (according to efficacy, effectiveness and well-being); and (3) potential for clozapine to cause vulnerabilities, including potentially lethal adverse drug reactions such as agranulocytosis, pneumonia, and myocarditis. Rational use requires: (1) modification of the clozapine package insert worldwide to include lower doses for Asians and to avoid the lethality associated with pneumonia, (2) the use of clozapine levels for personalizing dosing, and (3) the use of slow and personalized titration. This may make clozapine as safe as possible and contribute to increased life expectancy and well-being. In the absence of data on COVID-19 in clozapine patients, clozapine possibly impairs immunological mechanisms and may increase pneumonia risk in infected patients. Psychiatrists should call their clozapine patients and families and explain to them that if the patient develops fever or flu-like symptoms, the psychiatrist should be called and should consider halving the clozapine dose. If the patient is hospitalized with pneumonia, the treating physician needs to assess for symptoms of clozapine intoxication since halving the dose may not be enough for all patients; consider decreasing it to one-third or even stopping it. Once the signs of inflammation and fever have disappeared, the clozapine dose can be slowly increased to the prior dosage level. 46, 48, 52-67] describes the important pharmacokinetic variables for clozapine clearance. Higher clozapine C/D ratios, indicating lower clearance, are associated with females, non-smokers, Asians, genetic poor metabolizers, inhibitors, obesity, inflammation, and possibly with renal impairment and pregnancy. Lower clozapine C/D ratios indicate lack of adherence or higher clearance associated with males, smokers, non-Asians, and inducers.Two prior TDM review articles [68,69] are summarized in online supplementary Box S3 [31, 44, 50, 51, 55, 58-61, 63, 65, 68-91] which also describe our extensive experience with thousands of inpatient clozapine TDMs under standard conditions (trough and steady-state levels) in the US [44] and China [45,65]. Many of these inpatients were followed for months and/or years after changes in important pharmacokinetic variables [31, 44, 50, 58-61, 63, 65, 74, 79, 86-91].Published review articles [92][93][94] usually insist on the wide variability of clozapine TDM among individuals and the difficulty of interpreting a single clozapine level, but they fail to pay attention to findings from these two sciences: pharmacokinetics and clinical pharmacopsychology, which help in interpreting variability in clozapine levels. In inpatients, repeated measures allow the calculation of average clozapine clearance in an individual through a...

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The pursuit of euthymia

Cited by 122 publications

References 116 publications

The Hamilton Rating Scales for Depression: A Critical Review of Clinimetric Properties of Different Versions

The Hamilton Rating Scales for Depression: A Critical Review of Clinimetric Properties of Different Versions

Constructing a liberated and modern mind: six pathways from pathology to euthymia

A Rational Use of Clozapine Based on Adverse Drug Reactions, Pharmacokinetics, and Clinical Pharmacopsychology

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