kenneth Pages - Academia.edu (original) (raw)

Papers by kenneth Pages

Biological psychiatry, May 1, 2024

Brain Stimulation, Jun 30, 2023

Brain stimulation, Mar 1, 2024

The Journal of Clinical Psychiatry

Objective: To determine the extent that treatment with transcranial magnetic stimulation (TMS) in... more Objective: To determine the extent that treatment with transcranial magnetic stimulation (TMS) in diverse clinical settings has anxiolytic and antidepressant effects in patients with major depressive disorder (MDD) and moderate-to-severe anxiety symptoms and to contrast anxious and nonanxious depression subgroups in antidepressant effects. Methods: Within the NeuroStar Advanced Therapy System Clinical Outcomes Registry, 1,820 patients were identified with a diagnosis of MDD (using ICD-9, ICD-10, or DSM-IV) who completed the Patient Health Questionnaire-9 (PHQ-9) and Global Anxiety Disoder-7 scale (GAD-7) at baseline and following at least 1 TMS treatment between May 2016 and January 2021. Anxious depression was defined as a baseline GAD-7 score of 10 or greater (n = 1,514) and nonanxious depression by GAD-7 scores below this threshold (n = 306). Intent-to-treat and Completer samples were defined for patients treated with any TMS protocol and for the subgroup treated only with high-frequency left dorsolateral prefrontal cortex stimulation. Results: Patients with anxious depression showed clinically meaningful anxiolytic and antidepressant effects, averaging approximately 50% or greater reductions in both GAD-7 and PHQ-9 scores following TMS in all samples. The anxious and nonanxious depression groups had equivalent absolute improvement in PHQ-9 scores (P values ≥ .29). However, the anxious group had higher scores both at baseline and following TMS resulting in significantly lower categorical rates of response (P values < .02) and remission (P values < .001) in depressive symptoms. Among those with anxious depression, the change in anxiety and depression symptoms strongly covaried (r 1512 = 0.75, P < .001). Conclusions: Routine TMS delivered in diverse clinical settings results in marked anxiolytic and antidepressant effects in patients with anxious depression. The extent of improvement in anxiety and depression symptoms strongly covaries.

Brain Stimulation, 2022

BACKGROUND It has been suggested that sequential bilateral (SBL) TMS, combining high frequency, l... more BACKGROUND It has been suggested that sequential bilateral (SBL) TMS, combining high frequency, left dorsolateral prefrontal cortex (DLPFC) stimulation and low frequency, right DLPFC stimulation, is more effective than unilateral TMS. OBJECTIVE To contrast treatment outcomes of left unilateral (LUL) and SBL protocols. METHODS Registry data were collected at 111 practice sites. Of 10,099 patients, 3,871 comprised a modified intent-to-treat (mITT) sample, defined as a primary MDD diagnosis, age ≥18, and PHQ-9 completion before TMS and at least one PHQ-9 assessment after baseline. The mITT sample received high frequency (10 Hz) LUL TMS exclusively (N = 3,327) or SBL TMS in at least 90% of sessions (N = 544). Completers (N = 3,049) were responders or had received ≥20 sessions and had an end of acute treatment PHQ-9 assessment. To control for site effects, a Matched sample (N = 653) included Completers at sites that used both protocols. To control for selection bias, the SBL group was also compared to a Restricted LUL group, drawn from sites where no patient switched to SBL after substantial exposure to LUL TMS. Secondary analyses were conducted on CGI-S ratings. RESULTS The LUL group had superior outcomes compared to the SBL group for multiple PHQ-9 and CGI-S continuous and categorical measures in the mITT, Completer and Matched samples, including in the specified primary analyses. However, outcome differences were not observed when comparing the Restricted LUL and SBL groups. Within SBL protocols, the LUL-RUL order had superior outcomes compared to the RUL-LUL order in all CGI-S, but not PHQ-9, measures. CONCLUSIONS While limited by the naturalistic design, there was no evidence that SBL TMS was superior to LUL TMS. The sequential order of RUL TMS followed by LUL TMS may have reduced efficacy compared to LUL TMS followed by RUL TMS.

Psychiatric Services, 1998

The study examined predictors of discharge against medical advice (AMA) and outcomes of psychiatr... more The study examined predictors of discharge against medical advice (AMA) and outcomes of psychiatric patients with AMA discharges, as measured by poorer symptom ratings at discharge and higher rates of rehospitalization. A total of 195 patients discharged AMA from general hospital psychiatric units were compared retrospectively with 2,230 regularly discharged patients. AMA status was defined as signing out against medical advice, being absent without leave, or being administratively discharged. All patients received standardized assessments within 24 hours of admission and at discharge. Demographic characteristics, psychiatric history, DSA-IV psychiatric and substance use diagnoses, and scores on an expanded 32-item version of the Psychiatric Symptom Assessment Scale were compared. The groups did not differ in primary psychiatric diagnoses. Patients discharged AMA were significantly less likely to be Caucasian or to be functionally impaired due to physical illness. They were more likely to live alone, have a substance use diagnosis, use more psychoactive substances, and have more previous hospitalizations. Patients discharged AMA had significantly shorter lengths of stay, higher rehospitalization rates, and more severe symptoms at discharge, even when length of stay was taken into account. The differences between the groups in male gender and young age were better accounted for by a greater likelihood of substance abuse in these groups. The results suggest a profile of patients who may be discharged AMA. Such patients have worse outcomes and are more likely to be high utilizers of inpatient resources. Aggressive identification of patients likely to be discharged AMA and early discharge planning for appropriate outpatient treatment are recommended.

Journal of Clinical Psychopharmacology, 2000

Depression is the most common comorbid psychiatric illness in patients with alcohol dependence. T... more Depression is the most common comorbid psychiatric illness in patients with alcohol dependence. This double-blind study tested the efficacy of nefazodone versus placebo for the treatment of depression in actively drinking alcohol-dependent patients who were also participating in weekly group treatment for alcoholism. Sixty-four subjects with major depression disorder and alcohol dependence with a history of at least one prior episode of depression when not drinking were randomly assigned to receive 12 weeks of either nefazodone or placebo and participated in a weekly psychoeducational group on alcoholism. Subjects were assessed every 2 weeks for depression, anxiety, side effects, and drinking frequency. Subjects taking nefazodone were significantly more likely to complete the study (62%) than those taking placebo (34%). Analyses of covariance using drinks per week as a time-dependent covariate showed lower Hamilton Rating Scale for Depression scores at week 8 for end-point analysis and at weeks 8 and 12 for completers. The endpoint analysis demonstrated a significantly greater response in the nefazodone group (48%) than in the placebo group (16%). Both groups showed a similarly significant decrease in the average number of alcoholic drinks consumed per day over the course of the study. Although the number of adverse effects was significantly greater for the nefazodone group, there were no severe adverse events, and nefazodone was well tolerated. Nefazodone is a safe and effective antidepressant to use in a population of alcohol-dependent patients with depression who have a high degree of comorbidity. Nefazodone treatment was superior to placebo in alleviating depression in these patients but did not add any advantage over the psychoeducational group in terms of drinking outcomes.

The American Journal on Addictions, 1998

t\nxioI!,tics and sedati\e/liypnotic agents have broad therapeutic uses. including treatment for ... more t\nxioI!,tics and sedati\e/liypnotic agents have broad therapeutic uses. including treatment for anxiety disorders. insomnia. alcohol withdrawal s)-ndronies, muscle relaxition, and seizure control. Although the sedative and hypnotic class includes barbiturates and zolpiclem, the focus of this article is on benzodiazepines (BZI's). Rarbituratcs have a well-established liability for ps)~choactive dependence m d a wellrstabiizhed withdrawal s>.ndromc. ' ' ZoIpitiem. ;t selective omega 1 13ZP receptor ago-iii4t. ii~etl ;is :I Inpnotic. does not he a cleari!, identified potential for abuse o r ;i \vitlidr:inxl s!mironie th;it has been slion-n in controlled studies, but there have been case reports of individual patients experiencing withdrawal upon discontinuation of zolpidem .' "' The Gtriety of therapeutic indications and the relative safety and efficacy of BZPs Iias made them among the most prescribed medications. "' Along with widespread use has come the problem of BZP dependence, abuse. and withdrmd. ' I-' ' The symptoms arising in the context of BZP withdrawal may result from several sources: 1) return of the original sjmptoms being treated by the BZPs (recurrence). 2) a worsening o r rebound of the original symptoms, or 3) a unique withdrawal syndrome associated with dependence on the BZPs. This paper is limited to ;I discussion of the withdrawal

Journal of Affective Disorders

CNS Spectrums

The NeuroStar Outcomes RegistryObjectiveNeuroStar transcranial magnetic stimulation (TMS) is an e... more The NeuroStar Outcomes RegistryObjectiveNeuroStar transcranial magnetic stimulation (TMS) is an effective acute treatment for patients with major depressive disorder (MDD). In order to further understand use of the NeuroStar in a clinical setting, Neuronetics has established a patient treatment and outcomes registry to collect and analyze utilization information on patients receiving treatment with the NeuroStar.MethodsIndividual NeuroStar providers are invited to participate in the registry and agree to provide their de-identified patient treatment data. The NeuroStar has an integrated electronic data management system (TrakStar) which allows for the data collection to be automated. The data collected for the registry include Demographic Elements (age, gender), Treatment Parameters, and Clinical Ratings. Clinical assessments are: Clinician Global Impression - Severity of Illness (CGI-S) and thePatient Health Questionnaire 9-item (PHQ-9). De-identified patient data is uploaded to Re...

The Journal of Clinical Psychiatry, Dec 15, 1996

This study identified factors associated with medically serious suicide attempts (requiring medic... more This study identified factors associated with medically serious suicide attempts (requiring medical hospitalization). Demographic information, current psychiatric mental state, suicide attempt and psychiatric history characteristics, and DSM-IV diagnoses were compared between 65 patients hospitalized for a medically serious suicide attempt (MSSA) and 32 patients seen in the emergency room for suicide attempt but not medically hospitalized (NMSSA). Those with MSSAs had a higher rate of substance-induced mood disorder (but not substance abuse or dependence), while those with NMSSA had more attempts, more years since first attempt, and a higher rate of sexual and physical abuse, traumatic life events, borderline personality disorder, and bipolar disorder. Substance-induced mood disorder is an important diagnosis in the evaluation of suicidal patients. The vulnerability of mood effects caused by substance abuse may lead to a more serious suicide attempt despite less extensive psychiatric problems. The most important early psychiatric intervention may be the immediate recognition and aggressive treatment of an individual's affective and substance use disorders.

The Journal of clinical psychiatry, 1997

This study tested the hypothesis that the amount of psychoactive substance consumed (frequency an... more This study tested the hypothesis that the amount of psychoactive substance consumed (frequency and/or quantity), life problems resulting from this use, and a DSM-IV diagnosis of substance abuse/dependence are independent risk factors associated with increased suicidal ideation in a population of psychiatric inpatients with major depressive disorder. 891 hospitalized patients with a primary diagnosis of nonpsychotic major depressive disorder (MDD) received a standardized, psychiatrist-administered assessment battery. To examine the relationship between admission suicidality and demographic, psychiatric history, and admission variables, chi-square analyses were used for categorical data and one-way ANOVAs were used for continuous indices. Stepwise hierarchical multiple regression analyses were performed to determine the set of variables that was independently related to admission suicidality level. There was general agreement between our findings and previous literature in regard to t...

Hospital & community psychiatry, 1994