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teaching:landmark-studies [on April 25, 2020]
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-====== Landmark Psychiatric Research Studies ======+====== Landmark Psychiatric Research Studies ​and Papers ​======
 {{INLINETOC}} {{INLINETOC}}
 +===== Primer =====
 +There are many **landmark psychiatric studies** in psychiatry that clinicians should be aware of. Key studies are listed below (work in progress).
 +
 +<WRAP group>
 +<WRAP half column>
 +<​HTML>​
 +<div id="​amazon">​
 +<div class="​ribbon"><​i class="​fa fa-star"></​i>​ Recommended Reading</​div><​a href="​https://​amzn.to/​3vY2asG"​ target="​_blank"><​img style="​max-width:​ 50%" border="​0"​ src="
 +https://​www.psychdb.com/​amazon_aff/​50_studies.jpg"​ ></​a>​
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 +PsychDB is an Amazon Associate and earns from qualifying purchases. Thank you for supporting our site!
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 +<div class="​ribbon"><​i class="​fa fa-star"></​i>​ Recommended Reading</​div><​a href="​https://​amzn.to/​3HIWLIB"​ target="​_blank"><​img style="​max-width:​ 50%" border="​0"​ src="
 +https://​www.psychdb.com/​amazon_aff/​landmark.jpg"​ ></​a>​
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 +<span class="​bs-wrap bs-wrap-button"​ data-btn-type="​default"​ data-btn-size="​lg"​ data-btn-icon="​fa fa-amazon"><​a href="​https://​amzn.to/​3HIWLIB"​ rel="​nofollow"​ role="​button">​Buy on Amazon</​a></​span>​
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 +PsychDB is an Amazon Associate and earns from qualifying purchases. Thank you for supporting our site!
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 +
 =====STAR*D===== =====STAR*D=====
-[[https://www.madinamerica.com/​2011/​03/​%EF%BB%BFan-introduction-the-story-of-bias-in-the-stard-trial-more/|An Introduction:​ The Story of Bias in the STAR*D Trial and More]]+==== Level 1 ==== 
 +**STAR*D (Sequenced Treatment Alternatives to Relieve Depression)** was an NIMH study that compared the effectiveness of various antidepressants. STAR*D was actually a multi-level study, with 4 levels. In Level 1 of STAR*D, patients with [[mood:1-depression:​home|major depressive disorder]] were treated on citalopramRemission and response rates, treatment length, and features associated with remission were investigatedcomorbidities. 
 +<WRAP group> 
 +<WRAP half column>​ 
 +<panel type="​info"​ title="​STAR*D (Level 1) Design"​ subtitle=""​ no-body="​true"​ footer="">​ 
 +<​mobiletable 1> 
 +^ Design ​             | Open-label, pragmatic ​                                                                                                                         | 
 +^ Year                | 2006                                                                                                                                           | 
 +^ Sample size         | N = 2876                                                                                                                                       | 
 +^ Population ​         | Ages 18-75, non-psychotic major depressive disorder (Hamilton Depression Rating Scale [HAM-D] ≥14) ​                                            | 
 +^ Sites/Locations ​    Clinical sites across ​the United States providing primary or psychiatric care.                                                                 | 
 +^ Allocation ​         | All patients received citalopram (open label), with **no placebo control** ​                                                                    | 
 +^ Follow up           | Up to 14 weeks                                                                                                                                 | 
 +^ Primary outcome ​    | Remission (HAM-≤7)                                                                                                                           | 
 +^ Secondary outcomes ​ | Remission (Quick Inventory of Depressive Symptomatology,​ Self-Report [QIDS-SR]≤5), or response (QIDS-SR reduction of ≥50% in baseline score). ​ | 
 +</​mobiletable>​ 
 +</​panel>​
  
-[[https://​www.ncbi.nlm.nih.gov/​pmc/​articles/​PMC4314061/​|Lam,​ R. W., & Kennedy, S. H. (2015). STAR* D and Measurement-Based Care for Depression: Don't Toss Out the Baby!.]]+</​WRAP>​ 
 +<WRAP half column>​ 
 +== Key Findings == 
 +  * Remission rates were about 30%, and required at least 8 weeks of citalopram. 
 +  * Higher remission rates were in patients who were caucasian, female, employed, had higher level of education, and had less psychiatric comorbidity. 
 + 
 +== Reading == 
 +  * [[https://​www.ncbi.nlm.nih.gov/​pmc/​articles/​PMC4314062/​|Pigott,​ H. E. (2015). The STAR* D trial: it is time to reexamine the clinical beliefs that guide the treatment of major depression. The Canadian Journal of Psychiatry, 60(1), 9-13.]] 
 +  * [[https://​www.ncbi.nlm.nih.gov/​pmc/​articles/​PMC4314061/​|Lam,​ R. W., & Kennedy, S. H. (2015). STAR* D and Measurement-Based Care for Depression: Don't Toss Out the Baby!.]] 
 +  * [[https://​www.ncbi.nlm.nih.gov/​pubmed/​20370962|Sinyor,​ M., Schaffer, A., & Levitt, A. (2010). The sequenced treatment alternatives to relieve depression (STAR* D) trial: a review. The Canadian Journal of Psychiatry, 55(3), 126-135.]] 
 +  * [[https://​www.madinamerica.com/​2011/​03/​%EF%BB%BFan-introduction-the-story-of-bias-in-the-stard-trial-more/​|Mad In America: An Introduction:​ The Story of Bias in the STAR*D Trial and More]] 
 +  * [[https://​pubmed.ncbi.nlm.nih.gov/​37491091/​|Pigott,​ H. E., Kim, T., Xu, C., Kirsch, I., & Amsterdam, J. (2023). What are the treatment remission, response and extent of improvement rates after up to four trials of antidepressant therapies in real-world depressed patients? A reanalysis of the STAR* D study’s patient-level data with fidelity to the original research protocol. BMJ open, 13(7), e063095.]] 
 +</​WRAP>​ 
 +</​WRAP>​
  
-[[https://​www.ncbi.nlm.nih.gov/​pubmed/​20370962|Sinyor,​ M., Schaffer, A., & Levitt, A. (2010). The sequenced treatment alternatives to relieve depression (STAR* D) trial: a review. The Canadian Journal of Psychiatry, 55(3), 126-135.]] 
  
 =====CATIE===== =====CATIE=====
-[[http://​www.nejm.org/​doi/​full/​10.1056/​NEJMoa051688#​t=article|Lieberman,​ J. A., Stroup, T. S., McEvoy, J. P., Swartz, M. S., Rosenheck, R. A., Perkins, D. O., ... & Severe, J. (2005). Effectiveness ​of antipsychotic drugs in patients ​with chronic ​schizophrenia. ​N Engl j Med, 2005(353), 1209-1223.]]+**Clinical Antipsychotic Trials of Intervention Effectiveness ​(CATIE)** was an NIMH study designed to compare the effectiveness ​of antipsychotic drugs in adults ​with schizophrenia ​in the United States
  
 +<WRAP group>
 +<WRAP half column>
 +<panel type="​info"​ title="​CATIE Study Design"​ subtitle=""​ no-body="​true"​ footer="">​
 +<​mobiletable 1>
 +^ Design ​             | Randomized Controlled Trial                                                                                                                                                   |
 +^ Year                | 2005                                                                                                                                                                          |
 +^ Sample size         | N=1,​493 ​                                                                                                                                                                      |
 +^ Population ​         | Adults with schizophrenia,​ ages 18-65                                                                                                                                         |
 +^ Sites/​Locations ​    | 57 sites in the United States ​                                                                                                                                                |
 +^ Allocation ​         | Participants were randomly assigned to receive 1 of 5 antipsychotics:​ olanzapine, perphenazine,​ quetiapine, risperidone,​ and ziprasidone. ​                                    |
 +^ Follow up           | Patients were followed for 18 months or until treatment was discontinued ​                                                                                                     |
 +^ Primary outcome ​    | Discontinuation of treatment for any cause                                                                                                                                    |
 +^ Secondary outcomes ​ | Inefficacy, intolerability due to weight gain, extrapyramidal side effects, sedation, Positive and Negative Syndrome Scale (PANSS), Clinical Global Impressions (CGI) Scale. ​ |
 +</​mobiletable>​
 +</​panel>​
 +
 +</​WRAP>​
 +<WRAP half column>
 +== Key Findings ==
 +  * Rates of discontinuation were high for all antipsychotics (64%-82%)
 +  * Risperidone was significantly associated with [[meds:​antipsychotics:​hyperprolactinemia|hyperprolactinemia]]
 +  * Patients on olanzapine experienced a longer time to discontinuation (i.e. - stayed on it the longest), but they also had greater weight gain, hyperglycemia,​ and hyperlipidemia (compared to every other antipsychotic in the trial)
 +
 +== Reading ==
 +  * [[http://​www.nejm.org/​doi/​full/​10.1056/​NEJMoa051688#​t=article|Lieberman,​ J. A., Stroup, T. S., McEvoy, J. P., Swartz, M. S., Rosenheck, R. A., Perkins, D. O., ... & Severe, J. (2005). Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl j Med, 2005(353), 1209-1223.]]
 +</​WRAP>​
 +</​WRAP>​
 +===== TDCRP =====
 +The **National Institute of Mental Health (NIMH) Treatment of Depression Collaborative Research Program (TDCRP)** was a multisite RCT that compared medication, CBT, IPT, pharmacotherapy with clinical management, and clinical management alone. High baseline depression severity in patients showed that those receiving medication did best followed by patients receiving IPT which outperformed CBT in this study
 +
 +  * [[https://​pubmed.ncbi.nlm.nih.gov/​2684085/​|Elkin,​ I., Shea, M. T., Watkins, J. T., Imber, S. D., Sotsky, S. M., Collins, J. F., ... & Fiester, S. J. (1989). National Institute of Mental Health treatment of depression collaborative research program: General effectiveness of treatments. Archives of general psychiatry, 46(11), 971-982.]]
 ===== Resources ===== ===== Resources =====
 +==== Books ====
 +  * [[https://​oxfordmedicine.com/​view/​10.1093/​med/​9780198836506.001.0001/​med-9780198836506|Ryznar,​ E., Pederson, A. B., Csernansky, J. G., & Reinecke, M. A. (Eds.). (2020). Landmark Papers in Psychiatry. Oxford University Press, USA.]]
 +
 +==== Apps ====
 +  * [[http://​www.psychjournalclub.com/​|Psych Journal Club]]
 +
 +==== Critiques ====
   * [[https://​www.ncbi.nlm.nih.gov/​pubmed/​28003469|Murray,​ R. M. (2017). Mistakes I have made in my research career. Schizophrenia bulletin, 43(2), 253-256.]]   * [[https://​www.ncbi.nlm.nih.gov/​pubmed/​28003469|Murray,​ R. M. (2017). Mistakes I have made in my research career. Schizophrenia bulletin, 43(2), 253-256.]]
 +
 +
  
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