Browsing by Author "Ipser J.C."
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- Item1H-MRS in autism spectrum disorders: A systematic meta-analysis(2012) Ipser J.C.; Syal S.; Bentley J.; Adnams C.M.; Steyn B.; Stein D.J.We conducted a systematic review and metaanalysis of proton magnetic resonance spectroscopy (1HMRS) studies comparing autism spectrum disorder (ASD) patients with healthy controls, with the aim of profiling ASD-associated changes in the metabolites N-acetylaspartate (NAA) and Creatine (Cr). Meta-regression models of NAA and Cr levels were employed, using data from 20 eligible studies (N0852), to investigate age-dependent differences in both global brain and region-specific metabolite levels, while controlling for measurementmethod (Cr-ratio versus absolute concentrations). Decreased NAA concentrations that were specific to children were found for whole-brain grey and white matter. In addition, a significant decrease in NAA was evident across age categories in the parietal cortex, the cerebellum, and the anterior cingulate cortex. Higher levels of Cr were observed for ASD adults than children in global grey matter, with specific increases for adults in the temporal lobe and decreased Cr in the occipital lobe in children. No differences were found for either NAA or Cr in the frontal lobes. These data provide some evidence that ASD is characterized by age-dependent fluctuations in metabolite levels across the whole brain and at the level of specific regions thought to underlie ASD-associated behavioural and affective deficits. Differences in Cr as a function of age and brain region suggests caution in the interpretation of Cr-based ratio measures of metabolites. Despite efforts to control for sources of heterogeneity, considerable variability in metabolite levels was observed in frontal and temporal regions, warranting further investigation. © Springer Science+Business Media, LLC 2012.
- ItemAugmentation of psychotherapy with d-cycloserine for anxiety disorders(2009) Ipser J.C.; Sander C.; Seifan A.; Stein D.J.[No abstract available]
- ItemInterventions for educating traditional healers about STD and HIV medicine(2009) Sorsdahl K.; Ipser J.C.; Stein D.J.Background: For the treatment of HIV/AIDS, individuals may consult traditional healers because they possess a shared sociocultural background, meet the needs and expectations of the patients, and pay special attention to social and spiritual matters. Various intervention strategies have been adopted to educate traditional healers in various aspects of Western medicine, with a particular focus on HIV/AIDS. Objectives: To evaluate the effectiveness of interventions for educating traditional healers in the fundamentals of sexually transmitted infection (STI) and HIV medicine. Search strategy: We searched the Cochrane Register of Controlled Trials, Pubmed, Embase, Gatway and AIDSearch from the period of 1980 to 2008. We also handsearched the reference lists of the retrieved articles, located conference proceedings of international conferences related to AIDS studies and contacted key personnel and organizations working in HIV/AIDS intervention programs in developing countries. Selection criteria: All intervention studies using a controlled design that have evaluated the effect of educational interventions on any one of the outcome measures specified were included. Data collection and analysis: Two reviewers independently assessed the eligibility of potentially relevant studies and extracted data from and assessed study quality of included studies. A meta-analysis of study outcomes was not possible given the small number of included studies and the heterogeneity in methodological designs and outcome measures. Main results: We included two studies (one RCT and one CBA study) in this review (n = 311). Both of these studies indicated that a training workshop increased the knowledge about HIV/AIDS of traditional healers. With regards to behaviour change, Peltzer 2006 detected a significant difference in traditional healers' reports of managing their patients; however, there was no evidence of a reduction of HIV/STI risk behaviours and referral practices, as assessed by self-report. The study by Poudyal 2003 did not assess this outcome. Authors' conclusions: Two studies met the inclusion criteria for this review. Although these studies reported some positive outcomes, the few studies and methodological heterogeneity limits the conclusions that can be drawn about the effectiveness of HIV training programs aimed at traditional healers. More rigorous studies (i.e. those employing rigorous randomisation procedures, reliable outcome measures and larger sample sizes) are needed to provide better evidence of the impact of HIV training programs aimed at traditional healers. Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
- ItemNewer anticonvulsants in the treatment of anxiety disorders(2006) Ipser J.C.; Stein D.J.This is the protocol for a review and there is no abstract. The objectives are as follows: 1) To use evidence from RCTs in providing an estimate of the overall effects of the newer anticonvulsants in improving treatment response and reducing symptom severity in the treatment of anxiety disorders. 2) To determine whether particular anticonvulsants are more effective and tolerable than others in the treatment of anxiety disorders. 3) To determine whether the particular anxiety disorder treated predicts the effectiveness of anticonvulsants in terms of efficacy and tolerability. 4) To identify which factors (clinical, methodological) predict response to pharmacotherapy. Copyright © 2006 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
- ItemPharmacotherapy and psychotherapy for body dysmorphic disorder(2009) Ipser J.C.; Sander C.; Stein D.J.Background: Body dysmorphic disorder (BDD) is a prevalent and disabling preoccupation with a slight or imagined defect in appearance. Trials have investigated the use of serotonin reuptake inhibitors (SRIs) and cognitive behaviour therapy (CBT) for BDD. Objectives: To assess the efficacy of pharmacotherapy, psychotherapy or a combination of both treatment modalities for body dysmorphic disorder. Search strategy: We searched the Cochrane Depression, Anxiety and Neurosis Trial Register (December 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2007), MEDLINE (January 1966 to December 2007), and PsycINFO (1967 to December 2007). Ongoing and unpublished trials were located through searching the metaRegister of Controlled Trials, the CRISP and WHO ICTRP search portals (databases searched in December 2007), and through contacting key researchers and pharmaceutical companies. Additional studies were located through study reference lists. Selection criteria: Randomised controlled trials (RCTs) of patients meeting DSM or ICD diagnostic criteria for BDD, in which the trials compare pharmacotherapy, psychotherapy or multi-modal treatment groups with active or non-active control groups. Short or long-term trials were eligible. Data collection and analysis: Two review authors independently assessed RCTs for inclusion in the review, collated trial data, and assessed trial quality. Investigators were contacted to obtain missing data. Summary effect sizes for dichotomous and continuous outcomes were calculated using a random effects model and heterogeneity was assessed. Main results: Two pharmacotherapy and three psychotherapy trials were eligible for inclusion in the review, with data from four short-term RCTs (169 participants) available for analysis. Response data from a single placebo-controlled trial of fluoxetine suggested overall superiority of medication relative to placebo (relative risk (RR) 3.07, 95% CI 1.4 to 6.72, n = 67). Symptom severity was also significantly reduced in the RCTs of fluoxetine and clomipramine (relative to desipramine), as well as in the two CBT trials (WMD -44.96, 95% CI -54.43 to -35.49, n = 73). A low relapse rate (4/22) was demonstrated in one trial of CBT. Authors' conclusions: Results from the small number of available RCTs suggest that SRIs and CBT may be useful in treating patients with BDD. The findings of these studies need to be replicated. In addition, future controlled studies in other samples, such as adolescents, and using other selective SRIs, as well as a range of psychological therapy approaches and modalities (alone and in combination), are essential in supplementing the sparse data currently available. Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
- ItemPharmacotherapy augmentation strategies in treatment-resistant anxiety disorders(2006) Ipser J.C.; Carey P.; Dhansay Y.; Fakier N.; Seedat S.; Stein D.J.Background: A large proportion of patients with anxiety disorders fail to respond to first-line medication interventions, despite evidence of the effectiveness of these agents. Objectives: To assess the effects of medication versus placebo augmentation in the treatment of patients with anxiety disorders who have failed to respond adequately to first-line drug therapies. Search strategy: The Cochrane Depression, Anxiety & Neurosis Group (CCDAN) specialised registers (CCDANCTR-Studies and CCDANCTR-References) were searched on 3/8/2005, MEDLINE (January 1966 to July 2005) and PsycINFO (1966 to 2005, Part A). Unpublished trials were identified through the Controlled Trials database and the National Institute of Health's Computer Retrieval of Information on Scientific Projects (CRISP) service (1972 to 2005). Additional studies in any language were sought in reference lists of retrieved articles. Selection criteria: All randomised controlled trials (RCTs) of the medication augmentation of pharmacotherapy for treatment resistant anxiety disorders. Data collection and analysis: Two raters independently assessed RCTs for inclusion in the review, collated trial data, and assessed trial quality. Investigators were contacted to obtain missing data. Summary statistics were stratified by class of augmentation agent and anxiety disorder. Overall effect estimates were calculated using a random-effects model, heterogeneity was assessed and subgroup/sensitivity analyses were undertaken. Main results: Twenty eight short-term (average of seven weeks) randomised controlled trials (740 participants) were included in the review, 20 of which investigated augmentation of medication for treatment-resistant obsessive compulsive disorder (OCD). Summary statistics for responder status from nine trials demonstrate overall superiority of a variety of medication agents to placebo (relative risk of nonresponse (RR) 3.16, 95% CI 1.08 to 9.23). Similarly, symptom severity was significantly reduced in the medication groups, relative to placebo (number of trials (N) = 14, standardised mean difference (SMD) -0.87, 95% CI -1.37 to -0.36). There is no evidence of a difference between medication and placebo in total dropout rate, or in the number of dropouts due to adverse events. Authors' conclusions Medication augmentation can be an effective and well-tolerated short-term treatment strategy for non-responders to first-line pharmacotherapy of anxiety disorders. However, any conclusions must be tentative in view of methodological and clinical heterogeneity, and the fact that much of the relevant database is based on antipsychotic augmentation trials in OCD patients resistant to serotonin reuptake inhibitors (SRIs). Additional data are needed to address several areas, including the efficacy of augmentation over the longerterm, and the value of medication augmentation in comparison to other strategies (eg switching medication, adding psychotherapy). Copyright © 2006 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
- ItemPharmacotherapy for anxiety disorders and comorbid alcohol dependency(2008) Wilson D.; Ipser J.C.; Stein D.J.[No abstract available]
- ItemPharmacotherapy for anxiety disorders in children and adolescents(2009) Ipser J.C.; Stein D.J.; Hawkridge S.; Hoppe L.Background: Anxiety disorders are a potentially disabling group of disorders which are prevalent in childhood and adolescence. The recognition of the early onset of anxiety disorders, and their successful treatment with medication in adults, has led to the growing interest in using medication for paediatric anxiety disorders. Objectives: To assess the efficacy and tolerability of medication for treating paediatric anxiety disorders. Search strategy: We searched the Cochrane Depression, Anxiety & Neurosis Group specialised register (CCDANCTR-Studies), MEDLINE (via PubMed 1966 to August 2008), EMBASE (1966 to August 2008), and PsycINFO (1972 to August 2008). Various electronic registers were searched for unpublished studies. Reference lists of retrieved articles were searched for additional studies. Selection criteria: All randomised controlled trials (RCTs) of pharmacotherapy in childhood/adolescent anxiety disorders. Data collection and analysis: Two raters independently assessed RCTs for inclusion in the review, collated trial data, and assessed trial quality. Investigators were contacted to obtain missing data. Summary statistics were stratified by medication class, and by medication agent for the selective serotonin reuptake inhibitors (SSRIs). Dichotomous and continuous measures were calculated using a random effects model, heterogeneity was assessed, and subgroup/sensitivity analyses were undertaken. Main results: 22 short-term (<= 16 weeks) RCTs were included in the analysis (2519 participants). The majority of the trials assessed the efficacy of the SSRIs (N = 15). Medication and placebo response occurred in 58.1% and 31.5% of patients, respectively (Number of studies (N) = 14, Number needed to treat (NNT) = 4). Medication was more effective than placebo in reducing overall symptom severity in OCD in a post-hoc comparison (N = 7, Weighted Mean Difference (WMD) = -4.45, 95%CI = -5.94, -2.97, n = 765). Medication was less well tolerated than placebo overall, though the absolute proportion of participants who withdrew due to drug-related adverse events was low (4.9%). Authors' conclusions: Medication treatments can be effective in paediatric anxiety disorders, acting to reduce core symptoms, and should be considered as part of the treatment of these disorders. The greatest number of trials showing efficacy to date have assessed the SSRIs in treating paediatric OCD. There is no clear evidence to show that any particular class of medication is more effective or better tolerated than any other. As quantitative data was only available for the SSRIs and venlafaxine the routine use of benzodiazepines cannot be recommended, especially given concerns of dependency and treatment -related emergent adverse events associated with this class of drugs. Future RCTs could help identify potential clinical moderators of treatment efficacy. Studies of the long-term efficacy of medication treatment, optimal dosage, as well as direct comparisons of pharmacotherapy and psychotherapy are also warranted. Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
- ItemPharmacotherapy for prevention of post-traumatic stress disorder(2006) Ipser J.C.; Seedat S.; Stein D.J.This is the protocol for a review and there is no abstract. The objectives are as follows: 1) To provide an estimate of the efficacy of medication in preventing the development of post-traumatic stress disorder following exposure to a traumatic event. The efficacy of medication in reducing symptom severity for those individuals who subsequently develop PTSD will also be considered. 2) To determine whether particular classes of medication are more effective and/or acceptable than others in the prevention of PTSD. 3) To assess whether depression is a predictor of treatment response in the prevention of PTSD. Copyright © 2006 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
- ItemPharmacotherapy for trichotillomania(2009) Hoppe L.; Ipser J.C.; Fineberg N.; Chamberlain S.; Stein D.J.[No abstract available]
- ItemTranscranial magnetic stimulation for post-traumatic stress disorder(2007) Ipser J.C.; Pillay N.S.; Stein D.J.; Van Honk J.[No abstract available]