Objective Models of evidence-based practice emphasize the consideration of treatment efficacy/effectiveness, clinical expertise, and patient preference in treatment selection and implementation. However, patient preference for psychiatric treatment has been understudied. The aim of this meta-analytic review was to provide an estimate of the proportion of patients preferring psychological treatment relative to medication for psychiatric disorders. Data Sources A literature search was conducted using PubMed, PsycINFO, and the Cochrane Collaboration Library through August, 2011 for studies written in English that assessed patient preferences for the treatment of psychiatric disorders. Study Selection Studies assessing the preferred type of treatment including at least one psychological treatment and one pharmacological treatment were included. Of the 641 articles initially identified, 34 met criteria for inclusion. Data Extraction Authors extracted relevant data including the proportion of participants reporting preference for psychological and pharmacological treatment. Results Across studies, the proportion preferring psychological treatment was 0.75 (95% CI: 0.69 to 0.80), which was significantly higher than equivalent preference (i.e., higher than 0.50, p < .001). Sensitivity analyses suggested that younger patients (p < .05) and women (p < .01) were significantly more like to choose psychological treatment. A preference for psychological treatment was consistently evident in both treatment-seeking and unselected samples (ps < .05), but was somewhat stronger for the unselected samples. Conclusions Aggregation of patient preferences across diverse settings yielded a significant three-fold preference for psychological treatment relative to medication. Given the similar efficacy of these treatments for depression and anxiety, improving access to evidence-based psychological treatment is needed to connect more patients to their preferred treatment.

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BackgroundReproductive function in women with end stage renal disease generally improves after kidney transplant. However, pregnancy remains challenging due to the risk of adverse clinical outcomes.MethodsWe searched PubMed/MEDLINE, Elsevier EMBASE, Scopus, BIOSIS Previews, ISI Science Citation Index Expanded, and the Cochrane Central Register of Controlled Trials from date of inception through August 2017 for studies reporting pregnancy with kidney transplant.ResultsOf 1343 unique studies, 87 met inclusion criteria, representing 6712 pregnancies in 4174 kidney transplant recipients. Mean maternal age was 29.6 ± 2.4 years. The live-birth rate was 72.9% (95% CI, 70.0–75.6). The rate of other pregnancy outcomes was as follows: induced abortions (12.4%; 95% CI, 10.4–14.7), miscarriages (15.4%; 95% CI, 13.8–17.2), stillbirths (5.1%; 95% CI, 4.0–6.5), ectopic pregnancies (2.4%; 95% CI, 1.5–3.7), preeclampsia (21.5%; 95% CI, 18.5–24.9), gestational diabetes (5.7%; 95% CI, 3.7–8.9), pregnancy induced hypertension (24.1%; 95% CI, 18.1–31.5), cesarean section (62.6, 95% CI 57.6–67.3), and preterm delivery was 43.1% (95% CI, 38.7–47.6). Mean gestational age was 34.9 weeks, and mean birth weight was 2470 g. The 2–3-year interval following kidney transplant had higher neonatal mortality, and lower rates of live births as compared to > 3 year, and < 2-year interval. The rate of spontaneous abortion was higher in women with mean maternal age < 25 years and > 35 years as compared to women aged 25–34 years.ConclusionAlthough the outcome of live births is favorable, the risks of maternal and fetal complications are high in kidney transplant recipients and should be considered in patient counseling and clinical decision making.Electronic supplementary materialThe online version of this article (10.1186/s12882-019-1213-5) contains supplementary material, which is available to authorized users.

Objective. To assess the efficacy and safety of gabapentin in patients with fibromyalgia.Methods. A 12-week, randomized, double-blind study was designed to compare gabapentin (1,200-2,400 mg/day) (n ‫؍‬ 75 patients) with placebo (n ‫؍‬ 75 patients) for efficacy and safety in treating pain associated with fibromyalgia. The primary outcome measure was the Brief Pain Inventory (BPI) average pain severity score (range 0-10, where 0 ‫؍‬ no pain and 10 ‫؍‬ pain as bad as you can imagine). Response to treatment was defined as a reduction of >30% in this score. The primary analysis of efficacy for continuous variables was a longitudinal analysis of the intent-to-treat sample, with treatment-by-time interaction as the measure of effect.Results. Gabapentin-treated patients displayed a significantly greater improvement in the BPI average pain severity score (P ‫؍‬ 0.015; estimated difference between groups at week 12 ‫؍‬ ؊0.92 [95% confidence interval ؊1.75, ؊0.71]). A significantly greater proportion of gabapentin-treated patients compared with placebo-treated patients achieved response at end point (51% versus 31%; P ‫؍‬ 0.014). Gabapentin compared with placebo also significantly improved the BPI average pain interference score, the Fibromyalgia Impact Questionnaire total score, the Clinical Global Impression of Severity, the Patient Global Impression of Improvement, the Medical Outcomes Study (MOS) Sleep Problems Index, and the MOS Short Form 36 vitality score, but not the mean tender point pain threshold or the Montgomery Asberg Depression Rating Scale. Gabapentin was generally well tolerated.Conclusion. Gabapentin (1,200-2,400 mg/day) is safe and efficacious for the treatment of pain and other symptoms associated with fibromyalgia.Fibromyalgia is a common, chronic musculoskeletal pain disorder that is characterized by widespread pain and tenderness and is frequently accompanied by fatigue, insomnia, depression, and anxiety (1,2). Fibromyalgia occurs in ϳ2% of the US general population, is more common in women (3.4% of women and 0.5% of men) (3), and is associated with substantial morbidity and disability.

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Background Randomized, controlled trials have demonstrated that antidepressants are efficacious in the treatment of anxiety disorders in youth. However, there are no recent, systematic analyses of the efficacy, safety or tolerability of these medications in pediatric anxiety disorders. With this in mind, we sought to systematically review and conduct a meta-analysis of double-blind, placebo-controlled-trials of antidepressants in these conditions. Methods A systematic review and meta-analysis of prospective, randomized, parallel-group, controlled trials of selective serotonin reuptake inhibitors (SSRIs) and selective serotonin-norepinephrine reuptake inhibitors (SSNRIs) in pediatric patients with non-OCD anxiety disorders was undertaken using a search of PubMed/Medline (1966–2014). The meta-analysis utilized random-effects models to evaluate change in the Pediatric Anxiety Rating Scale or similar anxiety scale, suicidality and adverse events. Additionally, a series of pharmacologic variables (e.g., serotonin binding) were explored with regard to effect size. Results Data were included from 9 trials involving 1,673 patients and 6 medications, including 5 SSRIs and 3 SSNRI trials. All SSRI/SSNRIs evaluated demonstrated significant efficacy, and the meta-analytic summary estimate was of moderate magnitude (Cohen's d=0.64, confidence interval [CI]: 0.34–0.96, p=0.0017) and there was evidence of modest heterogenity (I2=0.26, p=0.107). Activation trended towards being more likely with antidepressant treatment (OR: 1.86, CI: 0.98–3.53, p=.054), but no increased risk was observed for nausea/abdominal symptoms (p=0.262) or discontinuation as a result of an adverse event (p=0.132). Treatment-emergent suicidality did not differ between antidepressant-treated youth and those who received placebo (OR: 1.3, CI: 0.53–3.2, p=0.514). Conclusions Data for 9 SSRI/SSNRIs suggest superiority to placebo for the treatment of pediatric anxiety disorders with a moderate effect size and a non-significant risk of suicidality.

Background Bipolar I disorder is defined by the occurrence of mania. The presence of mania, coupled with a course of illness characterized by waxing and waning of affective symptoms, suggests that bipolar disorder arises from dysfunction of neural systems that maintain emotional arousal and homeostasis. We used functional magnetic resonance imaging (fMRI) to study manic bipolar subjects as they performed a cognitive task designed to examine the ventrolateral prefrontal emotional arousal network. Methods We used fMRI to study regional brain activation in 40 DSM-IV manic bipolar I patients and 36 healthy subjects while they performed a continuous performance task with emotional and neutral distracters. Event-related region-of-interest analyses were performed to test the primary hypothesis. Voxelwise analyses were also completed. Results Compared with healthy subjects, the manic subjects exhibited blunted activation to emotional and neutral images, but not targets, across most of the predefined regions of interest. Several additional brain regions identified in the voxelwise analysis also exhibited similar differences between groups, including right parahippocampus, right lingual gyrus, and medial thalamus. In addition to these primary findings, the manic subjects also exhibited increased activation in response to targets in number of brain regions that were primarily associated with managing affective stimuli. Group differences did not appear to be secondary to medication exposure or other confounds. Conclusions Bipolar manic subjects exhibit blunted brain fMRI response to emotional cues throughout the ventrolateral prefrontal emotional arousal network. Disruption of this emotional network may contribute to the mood dysregulation of bipolar disorder.

HIV RNA level was associated with increased FIB-4 score in the absence of hepatitis B, hepatitis C, ART, or alcohol use, suggesting a potential relationship between HIV infection and hepatic fibrosis in vivo. A better understanding of the various demographic and virologic variables that contribute to hepatic fibrosis may lead to more effective treatment of HIV infection and its co-morbid conditions.