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Brain Sciences
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The Advantages of Combining Therapies in Treating Psychiatric Patients
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The Advantages of Combining Therapies in Treating Psychiatric Patients

A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Psychiatric Diseases".

Deadline for manuscript submissions: closed (3 March 2024) | Viewed by 13070

Special Issue Editor

Dr. Ravi Philip Rajkumar

E-Mail Website
Guest Editor
Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605 006, India
Interests: comorbidity and dual diagnosis in psychiatry; psychopharmacology; attachment theory; social and cultural factors in mental health

Special Issue Information

Dear Colleagues,

Existing treatment modalities in psychiatry, whether biological or psychosocial in nature, are not universally effective. A wide range of variations are observed in the response to these treatments, from complete symptomatic remission to non-response. Due to this, there has been a growing interest in combining different modalities of treatment, both within and across these classes, to optimize mental health outcomes and cost-effectiveness while minimizing adverse events. Recent research has shed light on genetic, biological, and psychosocial factors that may help in predicting treatment response. The purpose of the current Special Issue is to highlight both existing knowledge and cutting-edge research in this field. Both original research and well-conducted reviews on various forms of combined treatment in psychiatry, covering issues such as the efficacy, safety, and prediction of treatment outcomes, will be considered for publication. Emphasis will be placed on work that is innovative in nature and that has well-defined implications for clinical practice or future research in this field.

Dr. Ravi Philip Rajkumar
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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Keywords

  • psychopharmacology
  • psychotherapy
  • neuromodulation
  • combined therapy
  • polypharmacy
  • polytherapy

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Published Papers (7 papers)

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Editorial

Jump to: Research, Review, Other

6 pages, 201 KiB  
Editorial
The Advantages of Combining Therapies in Treating Psychiatric Patients
by Ravi Philip Rajkumar
Brain Sci. 2024, 14(7), 708; https://doi.org/10.3390/brainsci14070708 - 15 Jul 2024
Viewed by 1170
Abstract
Mental illnesses are among the leading causes of morbidity and disability worldwide, and the burden associated with these disorders has increased steadily over the past three decades [...] Full article
(This article belongs to the Special Issue The Advantages of Combining Therapies in Treating Psychiatric Patients)

Research

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11 pages, 956 KiB  
Article
Impact of Adjunctive VNS on Drug Load, Depression Severity, and Number of Neuromodulatory Maintenance Treatments
by Erhan Kavakbasi, Helen Bauermeister, Lars Lemcke and Bernhard T. Baune
Brain Sci. 2024, 14(2), 159; https://doi.org/10.3390/brainsci14020159 - 4 Feb 2024
Viewed by 1483
Abstract
Vagus nerve stimulation (VNS) is a long-term adjunctive treatment option in patients with difficult-to-treat depression (DTD). A total of n = 20 patients (mean age 52.6 years) were included in the multicenter, prospective, observational, naturalistic RESTORE-LIFE study and were treated with adjunctive VNS [...] Read more.
Vagus nerve stimulation (VNS) is a long-term adjunctive treatment option in patients with difficult-to-treat depression (DTD). A total of n = 20 patients (mean age 52.6 years) were included in the multicenter, prospective, observational, naturalistic RESTORE-LIFE study and were treated with adjunctive VNS as an add-on to treatment as usual. Exploratory and secondary outcome parameters from a single center were investigated for this present analysis. The overall mean drug load slightly decreased from 4.5 at baseline to 4.4 at 12 months (Z = −0.534, p = 0.594). The drug load was lower in previous electroconvulsive therapy (ECT) responders than in non-responders. There was a reduction in the mean number of hospitalizations per month after VNS implantation (Z = 1.975, p = 0.048) and a significant decrease in the mean Montgomery Åsberg Depression Rating Scale (MADRS) score from 27.3 at baseline to 15.3 at 12 months (T = 4.230, degree of freedom (df) = 19, p = 0.001). A history of ECT response at baseline was associated with greater improvement in the MADRS score after 12 months of VNS (F = 8.171, p = 0.013). The number of neuromodulatory maintenance treatments decreased during the follow-up period. In summary, there was an alleviation in the burden of illness among DTD patients treated with VNS. Full article
(This article belongs to the Special Issue The Advantages of Combining Therapies in Treating Psychiatric Patients)
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13 pages, 3093 KiB  
Article
Evaluation of Psychological and Physical Violence towards Children and Adolescents before and during the COVID-19 Pandemic in the Lodz Voivodship
by Jagoda Grzejszczak, Agata Gabryelska, Magdalena Kotlicka-Antczak and Dominik Strzelecki
Brain Sci. 2024, 14(1), 24; https://doi.org/10.3390/brainsci14010024 - 25 Dec 2023
Cited by 1 | Viewed by 1493
Abstract
Background: It has been shown that the course of COVID-19 infection in the under-18 population was in many cases sparsely symptomatic. In contrast, the impact of the pandemic on the psychological state is quite different. The risk of psychopathological symptoms in children and [...] Read more.
Background: It has been shown that the course of COVID-19 infection in the under-18 population was in many cases sparsely symptomatic. In contrast, the impact of the pandemic on the psychological state is quite different. The risk of psychopathological symptoms in children and adolescents increased and the course of already present psychiatric disorders has often been exacerbated. Objectives: Thus, this study aimed to evaluate the prevalence of psychological and physical violence among children and adolescents and its change during the COVID-19 pandemic, as well as to investigate various factors that might affect violence. Methods: In this survey study, 782 responses were included, with 480 collected during the second and 302 during the fourth wave of COVID-19. In this cross-sectional study, an anonymous questionnaire was used to collect demographic data, medical history, mental state, psychopathological symptoms, as well as the presence of psychological, physical violence, and suicidal self-harm behaviors before (retrospectively) and during the COVID-19 pandemic in the under-18 population of the Lodz Voivodship. The survey was prepared using Google Forms. Results: A decrease in the prevalence of physical violence during both waves of the pandemic has been observed (6.39% vs. 3.45%; p < 0.001), with only a similar trend present for psychological violence 16.75% vs. 14.71%; p = 0.081). No difference between physical and psychological violence was present in different pandemic waves, type of flat or house individuals lived in, availability of one’s room, number of people living in the house, number of siblings, and type of school classes (p > 0.050). Older children (>15 years old) were more likely to be victims of psychological violence before and during the pandemic (both p < 0.001). A statistically significant model was obtained for psychological violence before (p < 0.001, R2 = 0.011) and during the pandemic (p = 0.007, R2 = 0.032). Risk factors for psychological violence before the pandemic included male gender (B = 0.531, p = 0.009, OR = 1.700), older age (B = 0.869, p = 0.001, OR = 2.385), and smaller city size (B = −0.187, p = 0.004, OR = 0.829), while for psychological violence during the pandemic, the risk factors were only male gender (B = 0.482, p = 0.022, OR = 1.620) and older age (B = 0.555, p = 0.046, OR = 1.742). No statistically significant models were created for physical violence (p > 0.050). Conclusions: The observed decrease in physical violence during the COVID-19 pandemic suggests that in the studied group, home environment was not the main source of physical violence. Yet, we did not find any predicting factors for this form of violence. Violence, both physical and psychological, is a dangerous phenomenon in the under-18 population both in the pre-pandemic period and in crisis situations such as the pandemic. Full article
(This article belongs to the Special Issue The Advantages of Combining Therapies in Treating Psychiatric Patients)
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Review

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29 pages, 1166 KiB  
Review
Are There Biological Correlates of Response to Yoga-Based Interventions in Depression? A Critical Scoping Review
by Ravi Philip Rajkumar
Brain Sci. 2024, 14(6), 543; https://doi.org/10.3390/brainsci14060543 - 25 May 2024
Cited by 1 | Viewed by 1234
Abstract
Depression is the most common mental disorder worldwide. Both antidepressants and psychotherapy are effective in treating depression, but the response to these treatments is often incomplete. Yoga-based interventions (YBIs) have been advocated by some researchers as a promising form of alternative treatment for [...] Read more.
Depression is the most common mental disorder worldwide. Both antidepressants and psychotherapy are effective in treating depression, but the response to these treatments is often incomplete. Yoga-based interventions (YBIs) have been advocated by some researchers as a promising form of alternative treatment for depression. Recent research has attempted to identify the biological mechanisms associated with the antidepressant actions of YBIs. In this scoping review, conducted according to the PRISMA-ScR guidelines, the PubMed and Scopus databases were searched to retrieve research on biomarkers of response to YBIs in patients with depression. These studies were also critically reviewed to evaluate their methodological quality and any sources of bias. Nineteen studies were included in the review. Based on these studies, there is preliminary evidence that YBIs may be associated with increased serum brain-derived neurotrophic factor (BDNF) and reduced serum cortisol and interleukin-6 (IL-6) in patients with depression. However, many of these changes were also observed in the control arms, and the overall quality of the research was low. At present, it cannot be concluded that there are reliable biomarkers of response to YBIs in depression, though there are some potential biological correlates. Further advances in this field will depend critically on improvements in study design, particularly the minimization of sources of bias and the selection of more specific and sensitive biomarkers based on existing evidence from other treatment modalities. Full article
(This article belongs to the Special Issue The Advantages of Combining Therapies in Treating Psychiatric Patients)
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14 pages, 599 KiB  
Review
Auditory Steady-State Responses in Schizophrenia: An Updated Meta-Analysis
by Inès Zouaoui, Alexandre Dumais, Marc E. Lavoie and Stéphane Potvin
Brain Sci. 2023, 13(12), 1722; https://doi.org/10.3390/brainsci13121722 - 16 Dec 2023
Cited by 2 | Viewed by 1651
Abstract
This meta-analysis investigates auditory steady-state responses (ASSRs) as potential biomarkers of schizophrenia, focusing on previously unexplored clinical populations, frequencies, and variables. We examined 37 studies, encompassing a diverse cohort of 1788 patients with schizophrenia, including 208 patients with first-episode psychosis, 281 at-risk individuals, [...] Read more.
This meta-analysis investigates auditory steady-state responses (ASSRs) as potential biomarkers of schizophrenia, focusing on previously unexplored clinical populations, frequencies, and variables. We examined 37 studies, encompassing a diverse cohort of 1788 patients with schizophrenia, including 208 patients with first-episode psychosis, 281 at-risk individuals, and 1603 healthy controls. The results indicate moderate reductions in 40 Hz ASSRs in schizophrenia patients, with significantly greater reductions in first-episode psychosis patients and minimal changes in at-risk individuals. These results call into question the expected progression of ASSR alterations across all stages of schizophrenia. The analysis also revealed the sensitivity of ASSR alterations at 40 Hz to various factors, including stimulus type, level of analysis, and attentional focus. In conclusion, our research highlights ASSRs, particularly at 40 Hz, as potential biomarkers of schizophrenia, revealing varied implications across different stages of the disorder. This study enriches our understanding of ASSRs in schizophrenia, highlighting their potential diagnostic and therapeutic relevance, particularly in the early stages of the disease. Full article
(This article belongs to the Special Issue The Advantages of Combining Therapies in Treating Psychiatric Patients)
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Other

25 pages, 770 KiB  
Systematic Review
Combination of Two Long-Acting Antipsychotics in Schizophrenia Spectrum Disorders: A Systematic Review
by Salvatore Cipolla, Pierluigi Catapano, Daniela D’Amico, Rocchina Monda, Nunzia Paola Sallusto, Francesco Perris, Valeria De Santis, Francesco Catapano, Mario Luciano and Andrea Fiorillo
Brain Sci. 2024, 14(5), 433; https://doi.org/10.3390/brainsci14050433 - 26 Apr 2024
Viewed by 2739
Abstract
Background: Up to 34% of patients with schizophrenia are resistant to several treatment trials. Lack of continuous and adequate treatment is associated with relapse, rehospitalization, a lower effect of antipsychotic therapy, and higher risk of side effects. Long-acting injectables antipsychotics (LAI APs) enhance [...] Read more.
Background: Up to 34% of patients with schizophrenia are resistant to several treatment trials. Lack of continuous and adequate treatment is associated with relapse, rehospitalization, a lower effect of antipsychotic therapy, and higher risk of side effects. Long-acting injectables antipsychotics (LAI APs) enhance compliance and improve clinical outcomes and quality of life in patients with schizophrenia, and thus it may be advisable to administer two LAI APs at the same time in cases of treatment-resistant schizophrenia. The purpose of this review is to summarize the available literature regarding the combined use of two LAI APs in patients with schizophrenia or other psychotic spectrum disorders. Methods: An extensive literature search for relevant articles regarding any combination of two long-acting injectable antipsychotics has been performed from inception up to 9 February 2024, on PubMed, Scopus and APA PsycInfo, according to the PRISMA statement. Only studies reporting combination of two LAI APs and its clinical outcome in patients with schizophrenia and related disorders were selected. Results: After the selection process, nine case reports, four case series and two observational retrospective studies were included in the final analysis. All patients treated with dual LAI APs reported a good response, and no new or unexpected adverse effects due to the combination of two LAIs were reported. Different drug combinations were used, and the most frequent association resulted in aripiprazole monohydrate + paliperidone palmitate once monthly (32 times). Conclusions: Our review highlights that the treatment regimen with two concurrent LAI APs is already widely used in clinical practice and is recognized as providing a promising, effective, and relatively safe therapeutic strategy for treating the schizophrenia spectrum disorders. Full article
(This article belongs to the Special Issue The Advantages of Combining Therapies in Treating Psychiatric Patients)
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18 pages, 576 KiB  
Systematic Review
The Role of Lurasidone in Managing Depressive Symptoms in People with Schizophrenia: A Review
by Andrea Fiorillo, Gaia Sampogna, Umberto Albert, Emi Bondi, Serafino De Giorgi, Andrea Fagiolini, Maurizio Pompili, Gianluca Serafini, Umberto Volpe and Antonio Vita
Brain Sci. 2024, 14(3), 225; https://doi.org/10.3390/brainsci14030225 - 28 Feb 2024
Cited by 1 | Viewed by 2349
Abstract
Background: Schizophrenia is a severe mental disorder characterized by positive, negative, affective, and cognitive symptoms. Affective symptoms in patients with schizophrenia have traditionally been overlooked or even neglected because they are not considered as fundamental as positive and negative symptoms in the choice [...] Read more.
Background: Schizophrenia is a severe mental disorder characterized by positive, negative, affective, and cognitive symptoms. Affective symptoms in patients with schizophrenia have traditionally been overlooked or even neglected because they are not considered as fundamental as positive and negative symptoms in the choice of medication. Methods: This paper aims to systematically evaluate the efficacy and safety of lurasidone in the treatment of depressive symptoms of schizophrenia. Results: Lurasidone appears to be particularly effective on the depressive symptomatology of schizophrenia while also alleviating the positive and negative symptoms associated with the illness. Conclusions: The efficacy of lurasidone in treating patients with first-episode psychosis who present with predominant depressive symptoms suggests that this medication may be a valuable treatment option not only for established cases of schizophrenia but also for individuals in the early stages of the illness. The good tolerability of lurasidone is an important factor that may positively influence treatment decisions. Full article
(This article belongs to the Special Issue The Advantages of Combining Therapies in Treating Psychiatric Patients)
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