Less Is More

Simpler & Better Medicine

Primary Care–Based Psychological Intervention and Symptoms of Common Mental Disorders in Zimbabwe. — March 10, 2017

Primary Care–Based Psychological Intervention and Symptoms of Common Mental Disorders in Zimbabwe.

Summary: For patients in low-income settings facing depression or anxiety, an intervention consisting of individual problem-solving therapy plus peer support may lead to a lower likelihood of depression and fewer overall symptoms than a “usual care” intervention consisting of counseling, information, education, and support plus an option for medications. 

https://www.ncbi.nlm.nih.gov/m/pubmed/28027368/

Strength of Recommendation = B

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Oral Risperidone, Haloperidol, or Placebo for Symptoms of in Palliative Care. — February 24, 2017

Oral Risperidone, Haloperidol, or Placebo for Symptoms of in Palliative Care.

Summary: For older patients in palliative care for a life-limiting illness, management of delirium with supportive care and individualized treatment of delirium precipitants may lead to improved delirium scores and fewer extra-pyramidal side effects compared to management with supportive care plus haloperidol or risperidone, and management with supportive care alone may lead to improved overall survival compared to management with supportive care plus haloperidol.

https://www.ncbi.nlm.nih.gov/m/pubmed/27918778/

Strength of Recommendation = B

Antipsychotic Medication for Prevention and Treatment of Delirium in Hospitalized Adults: A Systematic Review and Meta-Analysis. — September 13, 2016

Antipsychotic Medication for Prevention and Treatment of Delirium in Hospitalized Adults: A Systematic Review and Meta-Analysis.

Summary: For older patients hospitalized for surgery, an approach of not using anti-psychotic medications post-operatively for delirium prevention may be associated with the same incidence of delirium as an approach of administering antipsychotic medications for delirium prevention.

Additionally, for hospitalized older patients who develop delirium, an approach of not using anti-psychotic medications for treatment of delirium may be associated with the same duration and severity of delirium, as well as hospital and ICU length of stay and mortality, as an approach of administering antipsychotic medications for delirium prevention.

http://www.ncbi.nlm.nih.gov/m/pubmed/27004732/

Strength of Recommendation = A

Cardiovascular safety of methylphenidate among children and young people with ADHD — June 17, 2016

Cardiovascular safety of methylphenidate among children and young people with ADHD

Summary: While stimulant medications can be effective for reducing impulsiveness and hyperactivity in children, for patients with attention-deficit & hyperactivity disorder (especially those with congenital heart disease), avoidance of methylphenidate may be associated with a lower risk of arrhythmia compared to starting treatment with methylphenidate.

http://www.ncbi.nlm.nih.gov/m/pubmed/27245699/

Strength of Recommendation = B

Long-Acting Opioids and Mortality in Patients With Chronic Noncancer Pain — June 15, 2016
Association of Proton Pump Inhibitors With Risk of Dementia: A Pharmacoepidemiological Claims Data Analysis. — April 8, 2016
Comparative benefits and harms of second generation antidepressants and cognitive behavioral therapies in initial treatment of major depressive disorder: systematic review and meta-analysis. — March 22, 2016

Comparative benefits and harms of second generation antidepressants and cognitive behavioral therapies in initial treatment of major depressive disorder: systematic review and meta-analysis.

Summary: For adults with major depression, cognitive-behavior therapy (CBT) may provide the same results for treatment response, remission, and improvement in Hamilton Rating Scale for Depression score as second generation anti-depressants, and may possibly be associated with a lower risk of adverse events.

http://www.ncbi.nlm.nih.gov/m/pubmed/26645251/

Strength of Recommendation = B

Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports. — February 1, 2016

Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports.

Summary: For children and adolescents, avoiding use of selective serotonin and serotonin-norepinephrine reuptake inhibitor antidepressants (specifically, duloxetine, fluoxetine, paroxetine, sertraline, or venlafaxine) may be associated with a lower risk of adverse outcomes (specifically, suicidality or aggression) compared to treatment with these antidepressants.

http://www.ncbi.nlm.nih.gov/m/pubmed/26819231/

Strength of Recommendation = A

Randomized Trial of Cognitive-Behavioral Therapy Versus Light Therapy for Seasonal Affective Disorder: Acute Outcomes. — January 22, 2016

Randomized Trial of Cognitive-Behavioral Therapy Versus Light Therapy for Seasonal Affective Disorder: Acute Outcomes.

Summary: For patients with winter seasonal affective disorder (SAD), 6 weeks of photo-therapy (with a dedicated photo-therapy device) may provide the same improvement in depression scores as 6 weeks of cognitive behavior therapy targeted at SAD (CBT-SAD), at potentially a lower cost (As of January 2016, the retail cost for the photo therapy unit used in this study was ~ $360).

http://www.ncbi.nlm.nih.gov/m/pubmed/25859764/

Strength of Recommendation = B

Simplified sleep restriction for insomnia in general practice: a randomised controlled trial. — November 27, 2015
Restoring Study 329: efficacy and harms of paroxetine and imipramine in treatment of major depression in adolescence. — September 17, 2015

Restoring Study 329: efficacy and harms of paroxetine and imipramine in treatment of major depression in adolescence.

Summary: For adolescents with major depression, patients who do not take paroxetine and imipramine may do just as well with their depression as those to take either medication, without the increased risks of suicidal ideation and behaviour associated with paroxetine, or the increased risk of cardiovascular problems associated with imipramine. (In other words, in this re-analysis study, adolescents with depression treated with paroxetine or imipramine did not have any significant improvement in depression measures than those treated with placebo, but they did have an increased risk of side effects)

http://www.ncbi.nlm.nih.gov/m/pubmed/26376805/

Strength of Recommendation = B

Physical fitness exercise versus cognitive behavior therapy on reducing the depressive symptoms among community-dwelling elderly adults: A randomized controlled trial. — July 17, 2015

Physical fitness exercise versus cognitive behavior therapy on reducing the depressive symptoms among community-dwelling elderly adults: A randomized controlled trial.

Summary: For elderly adults with depressive symptoms, participation in group exercise three times weekly may result in longer lasting improvement in depressive symptoms and quality-of-life ratings than participation in cognitive-behavior therapy.

http://www.ncbi.nlm.nih.gov/m/pubmed/26105535/

Strength of Recommendation = B

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