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Related Concept Videos

Treatment Strategies for Psychological Disorders01:24

Treatment Strategies for Psychological Disorders

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Treatment approaches for psychological disorders fall into three main categories: psychological, biological, and sociocultural. Each approach targets different aspects of mental health, requiring varying levels of education and training.
Psychological therapies focus on modifying emotions, thoughts, and behaviors through talking, interpreting, listening, rewarding, challenging, and modeling. Clinical psychologists, counselors, and social workers commonly practice psychotherapy. Clinical...
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Electroconvulsive therapy (ECT), or shock therapy, remains a critical biomedical intervention for severe, treatment-resistant depression. While its origins can be traced back to Hippocrates' observations that malaria-induced convulsions alleviated mental illness, modern ECT has evolved significantly from its earlier, more primitive applications. First introduced in 1938 by Ugo Cerletti and his colleagues, ECT involves inducing controlled seizures using electrical currents. In its early...
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Cognitive therapy, pioneered by Aaron T. Beck in the 1960s, is a structured approach to addressing psychological distress by focusing on the influence of thoughts on emotions and behaviors. All cognitive therapies involve the basic assumption that human beings have control over their feelings, and that how individuals feel about something depends on how they think about it. Unlike psychoanalytic methods that delve into unconscious processes or humanistic approaches emphasizing...
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Atypical antidepressants, including bupropion (Wellbutrin), mirtazapine (Remeron), nefazodone (Serzone), trazodone (Desyrel), and vilazodone (Viibryd), offer unique mechanisms of action. Bupropion weakly inhibits dopamine and norepinephrine reuptake, aiding depression treatment and smoking cessation, with a low risk of sexual dysfunction. Mirtazapine enhances serotonin and norepinephrine neurotransmission, leading to sedation, increased appetite, and weight gain. As a result, it helps treat...
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Conventional Repetitive Transcranial Magnetic Stimulation for Depression: A Step-by-Step Protocol
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How Effective Is Algorithm-Guided Treatment for Depressed Inpatients? Results from the Randomized Controlled

Mazda Adli1, Katja Wiethoff1, Thomas C Baghai1

  • 1Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany; Universität Regensburg, Department of Psychiatry and Psychotherapy, Regensburg, Germany; East London NHS Foundation Trust, City and Hackney Centre for Mental Health, Donald Winnicott Centre, London, United Kingdom; kbo-Lech-Mangfall-Klinik Garmisch-Partenkirchen, Department of Psychiatry and Psychotherapy, Garmisch-Partenkirchen, Germany; Ludwig-Maximilians-Universität, Department of Psychiatry and Psychotherapy, München, Germany; kbo-Isar-Amper-Klinikum, Department of Psychiatry and Psychotherapy, München, Germany; Heinrich-Heine-Universität Düsseldorf, Department of Psychiatry and Psychotherapy, Düsseldorf, Germany; Institut für Psychologische Medizin, Haag, Germany; St. Joseph-Krankenhaus, Department of Psychiatry and Psychotherapy, Berlin, Germany; LWL-Klinikum Gütersloh, Department of Psychiatry and Psychotherapy, Gütersloh, Germany; Universitätsklinikum Carl Gustav Carus, Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany; Jena University Hospital, Department of Medical Statistics, Informatics and Documentation, Friedrich-Schiller-Universität Jena, Jena, Germany; Fliedner Klinik Berlin, Center for Psychiatry, Psychotherapy and Psychosomatic Medicine.

The International Journal of Neuropsychopharmacology
|June 25, 2017
PubMed
Summary

Algorithm-guided treatment significantly speeds remission for major depressive disorder inpatients. This approach requires fewer medication adjustments compared to standard care or computerized guidance.

Keywords:
German Algorithm Projectantidepressantsmedical decision makingtreatment algorithmstreatment-resistant depression

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Area of Science:

  • Psychiatry
  • Clinical Psychology
  • Pharmacology

Background:

  • Treatment algorithms aim to enhance care quality and improve patient outcomes.
  • This study is the first randomized controlled trial assessing algorithm-guided treatment for major depressive disorder inpatients.

Purpose of the Study:

  • To evaluate the clinical effectiveness of algorithm-guided treatment strategies compared to usual care and a computerized system for major depressive disorder.
  • To determine the impact of different algorithmic approaches on time to remission and medication usage.

Main Methods:

  • A randomized controlled study involving 18-70 year old inpatients with major depressive disorder across 10 German psychiatric departments.
  • Five treatment arms were compared: three standardized stepwise drug treatment algorithms (ALGO), a computerized documentation and expert system (CDES), and treatment as usual (TAU).
  • ALGO strategies included lithium augmentation (ALGO LA), antidepressant dose-escalation (ALGO DE), and switching antidepressants (ALGO SW). Time to remission was the primary outcome.

Main Results:

  • Algorithm-guided dose-escalation (ALGO DE) and switching (ALGO SW) significantly reduced time to remission compared to TAU and CDES.
  • ALGO LA and ALGO DE required fewer antidepressant medications for remission than CDES or TAU.
  • Remission rates at discharge were highest in ALGO DE (89.2%) and lowest in TAU (66.2%).

Conclusions:

  • Highly structured algorithm-guided treatment accelerates remission and reduces medication changes in depressed inpatients.
  • Algorithm-guided treatment demonstrates superior outcomes compared to treatment as usual and computerized medication guidance.