ABSTRACTS - World Psychiatric Association

RS6.3.
THE TREATMENT OF SSRI-RESISTANT
DEPRESSION IN ADOLESCENTS (TORDIA)
G. Emslie, G. Clarke, K. Wagner, J. Asarnow, M. Keller,
B. Vitiello, L. Ritz, D. Brent
University of Texas, Southwestern Medical Center, Dallas, TX,
USA; Kaiser Foundation, Vancouver, Canada; University of Texas,
Galveston, TX, USA; University of California, Los Angeles, CA,
USA; Brown University, Providence, RI, USA; National Institute
of Mental Health; Bethesda, MD, USA; University of Pittsburgh,
PA, USA
The Treatment of SSRI-Resistant Depression in Adolescents (TOR-
DIA) was a multisite clinical trial of treatment interventions for adolescents
with major depressive disorder who had not improved after
an adequate course of serotonin reuptake inhibitor antidepressant
(SSRI). A total of 334 adolescents (age 12-17) were randomized to
one of the following four treatments in a 2 by 2 balanced design:
switch to another SSRI; switch to another class of medication (venlafaxine);
switch to another SSRI + cognitive behavior therapy (CBT);
or switch to venlafaxine plus CBT. The primary outcomes were: a rating
of much or very much improved on the Clinical Global Impression-Improvement
Subscale and a Child Depression Rating Scale-
Revised decline over baseline >50%, plus a change in CDRS-R over
time. Rate of clinical response and improvement in functional status
was greater in the CBT cells than on medication alone, without any
difference between the SSRI and venlafaxine conditions. In all treatments
groups, there was a reduction of CDRS-R, self-reported depression,
and suicidal ideation, but without differential treatment effects,
nor were there treatment differences with regard to the rate of suicidal
adverse events. Thus, in this clinical trial of depressed adolescents
who have not shown an adequate clinical response to an SSRI, a
combination of a switch in antidepressant and CBT was superior to a
medication switch alone, but a switch to a second SSRI was just as
efficacious as a switch to venlafaxine, and resulted in fewer side
effects. These results have important implications for second step
treatment of adolescent depression.
RS6.4.
CHILD/ADOLESCENT ANXIETY MULTIMODAL
STUDY (CAMS)
J. Walkup, A.M. Albano, J. March, P. Kendall, B. Birmaher,
J. Piacentini, J. Sherrill
Johns Hopkins University Hospital, Baltimore, MD; Columbia
University and New York State Psychiatric Institute, New York,
NY; Duke University, Durham, NC; Temple University,
Philadelphia, PA; University of Pittsburgh, PA; University of
California, Los Angeles, CA; National Institute of Mental Health,
Bethesda, MA, USA
This paper reviews the study design, method and primary and longterm
outcomes of the Child/Adolescent Anxiety Multimodal Study
(CAMS). Subjects aged 7-17 (n=488) with separation, social, and generalized
anxiety disorders from six sites were randomized (2:2:2:1) to
12-weeks of cognitive behavioral therapy (CBT), sertraline (SRT),
combination treatment (COMB) or pill placebo (PBO). Treatment
responders received maintenance treatment for 6 months. The relative
efficacy of the active treatments to PBO was evaluated using Clinical
Global Impression-Improvement (CGI-I) and Pediatric Anxiety
Rating Scale (PARS). For the intent-to-treat with last observation carried
forward analysis, the response rate based on the CGI-I for combination
treatment (81%) was superior to both of the monotherapies
(CBT=61%; SRT=56%) and pill placebo (26%). The monotherapies
were both superior to placebo, but not significantly different from
each other. The week 12 pairwise contrasts of the random regression
models of the PARS document the same pattern of response: COMB
> CBT = SRT > PBO. Long-term outcome data are currently being
analyzed. Thus, the study outcome, regardless of method of assessment
(categorical or continuous) documented the same pattern of
outcome, with all active treatments significantly better than placebo.
Perhaps the greatest challenge at this point in the dissemination of
these findings is the improved recognition of these very common, but
often underdiagnosed conditions.
RS7.
EVIDENCE-BASED PSYCHOTHERAPIES
FOR PERSONALITY DISORDERS
RS7.1.
LEVELS OF CHANGE IN THE TREATMENT
OF PERSONALITY DISORDERS
C. Maffei
Vita-Salute San Raffaele University, Milan, Italy
Empirical research shows that personality disorders are treatable
diagnostic entities and that both psychological and biological interventions
can be useful. However, important questions are still open
and consequent problems are unresolved. The most basic ones concern
the level of improvement. Indeed, personality pathology and its
effects on people can be described at different levels: a) symptoms
and reactions (state-related dysfunctional mental and behavioural
phenomena); b) personality traits (dysfunctional dispositions stable
over time); c) social adjustment (relational, affective, economic adaptation);
d) quality of life (objective and subjective existential satisfaction).
Up to now studies on the effectiveness of treatment of personality
disorders seem more interested in the first and third level: for
instance, if subjects reduce their self-aggressive behaviours and consequently
the number of hospitalizations decreases, does it depend
on change of dysfunctional personality traits This is controversial.
What seems clear is that treatment can improve quality of life only
marginally. Precise data is still unavailable; however, it seems that it is
very difficult to help patients with personality disorders to achieve an
acceptable feeling of satisfaction about the meaningfulness and fullness
of experience of their lives.
RS7.2.
MENTALIZATION BASED THERAPY
FOR BORDERLINE PERSONALITY DISORDER:
RECENT DEVELOPMENTS
A.W. Bateman
Halliwick Unit, St. Ann’s Hospital, London, UK
Mentalization is the process by which we implicitly and explicitly
interpret the actions of ourselves and others as meaningful on the
basis of intentional mental states (e.g., desires, needs, feelings, beliefs,
and reasons). We mentalize interactively and emotionally when with
others. Each person has the other person’s mind in mind (as well as
his/her own), leading to self-awareness and other awareness. We
have to be able to continue to do this in the midst of emotional states,
but borderline personality disorder (BPD) is characterised by a loss of
capacity to mentalize when emotionally charged attachment relationships
are stimulated. The aim of mentalization based therapy (MBT)
is to increase this capacity in order to ensure better regulation of
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