The Canadian Network for Mood and Anxiety Treatments published guidelines for the management of bipolar disorder in 2005, with updates in 2007 and 2009. This third update, in conjunction with the International Society for Bipolar Disorders, reviews new evidence and is designed to be used in conjunction with the previous publications.The recommendations for the management of acute mania remain largely unchanged. Lithium, valproate, and several atypical antipsychotic agents continue to be first-line treatments for acute mania. Monotherapy with asenapine, paliperidone extended release (ER), and divalproex ER, as well as adjunctive asenapine, have been added as first-line options.For the management of bipolar depression, lithium, lamotrigine, and quetiapine monotherapy, as well as olanzapine plus selective serotonin reuptake inhibitor (SSRI), and lithium or divalproex plus SSRI/bupropion remain first-line options. Lurasidone monotherapy and the combination of lurasidone or lamotrigine plus lithium or divalproex have been added as a second-line options. Ziprasidone alone or as adjunctive therapy, and adjunctive levetiracetam have been added as not-recommended options for the treatment of bipolar depression. Lithium, lamotrigine, valproate, olanzapine, quetiapine, aripiprazole, risperidone long-acting injection, and adjunctive ziprasidone continue to be first-line options for maintenance treatment of bipolar disorder. Asenapine alone or as adjunctive therapy have been added as third-line options.

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Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013.

Background: Depression and anxiety disorders are common and treatable with cognitive behavior therapy (CBT), but access to this therapy is limited. Objective: Review evidence that computerized CBT for the anxiety and depressive disorders is acceptable to patients and effective in the short and longer term. Method: Systematic reviews and data bases were searched for randomized controlled trials of computerized cognitive behavior therapy versus a treatment or control condition in people who met diagnostic criteria for major depression, panic disorder, social phobia or generalized anxiety disorder. Number randomized, superiority of treatment versus control (Hedges g) on primary outcome measure, risk of bias, length of follow up, patient adherence and satisfaction were extracted. Principal Findings: 22 studies of comparisons with a control group were identified. The mean effect size superiority was 0.88 (NNT 2.13), and the benefit was evident across all four disorders. Improvement from computerized CBT was maintained for a median of 26 weeks follow-up. Acceptability, as indicated by adherence and satisfaction, was good. Research probity was good and bias risk low. Effect sizes were non-significantly higher in comparisons with waitlist than with active treatment control conditions. Five studies comparing computerized CBT with traditional face-to-face CBT were identified, and both modes of treatment appeared equally beneficial. Conclusions: Computerized CBT for anxiety and depressive disorders, especially via the internet, has the capacity to provide effective acceptable and practical health care for those who might otherwise remain untreated.

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Computer Therapy for the Anxiety and Depressive Disorders Is Effective, Acceptable and Practical Health Care: A Meta-Analysis

http://www.tara.tcd.ie/bitstream/handle/2262/63861/Computer-based%20psychological%20treatments%20for%20depression-%20A%20systematic%20review%20and%20meta-analysis.pdf?sequence=1

Computer-based psychological treatments for depression: a systematic review and meta-analysis.

Background: Although web-based interventions for promoting health and health-related behavior can be effective, poor adherence is a common issue that needs to be addressed Technology as a means to communicate the content in web-based interventions has been neglected in research Indeed, technology is often seen as a black-box, a mere tool that has no effect or value and serves only as a vehicle to deliver intervention content In this paper we examine technology from a holistic perspective We see it as a vital and inseparable aspect of web-based interventions to help explain and understand adherence
Objective: This study aims to review the literature on web-based health interventions to investigate whether intervention characteristics and persuasive design affect adherence to a web-based intervention
Methods: We conducted a systematic review of studies into web-based health interventions Per intervention, intervention characteristics, persuasive technology elements and adherence were coded We performed a multiple regression analysis to investigate whether these variables could predict adherence
Results: We included 101 articles on 83 interventions The typical web-based intervention is meant to be used once a week, is modular in set-up, is updated once a week, lasts for 10 weeks, includes interaction with the system and a counselor and peers on the web, includes some persuasive technology elements, and about 50% of the participants adhere to the intervention Regarding persuasive technology, we see that primary task support elements are most commonly employed (mean 29 out of a possible 70) Dialogue support and social support are less commonly employed (mean 15 and 12 out of a possible 70, respectively) When comparing the interventions of the different health care areas, we find significant differences in intended usage (p = 004), setup (p < 001), updates (p < 001), frequency of interaction with a counselor (p < 001), the system (p = 003) and peers (p = 017), duration (F = 6068, p = 004), adherence (F = 4833, p = 010) and the number of primary task support elements (F = 5631, p = 005) Our final regression model explained 55% of the variance in adherence In this model, a RCT study as opposed to an observational study, increased interaction with a counselor, more frequent intended usage, more frequent updates and more extensive employment of dialogue support significantly predicted better adherence
Conclusions: Using intervention characteristics and persuasive technology elements, a substantial amount of variance in adherence can be explained Although there are differences between health care areas on intervention characteristics, health care area per se does not predict adherence Rather, the differences in technology and interaction predict adherence The results of this study can be used to make an informed decision about how to design a web-based intervention to which patients are more likely to adhere

Persuasive System Design Does Matter: A Systematic Review of Adherence to Web-Based Interventions

https://onlinelibrary.wiley.com/doi/epdf/10.1002/wps.20151

Guided Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders : a systematic review and meta-analysis

Objective: To determine the efficacy of an Internet-based clinician-assisted cognitive behavioural treatment program (the Panic program) for panic disorder (with or without agoraphobia).Method: Fifty-nine individuals meeting diagnostic criteria for panic disorder with agoraphobia were randomly assigned to a treatment group or to a waitlist control group. Treatment group participants completed the Panic program, comprising six on-line lessons, weekly homework assignments, received weekly email contact from a psychiatry registrar, and contributed to a moderated online discussion forum with other participants. An intention-to-treat model was used for data analyses.Results: Twenty-three (79%) of treatment group participants completed all lessons within the 8-week program, and post-treatment data were collected from 22/29 treatment group and 22/25 waitlist group participants. Compared to the control group, treatment group participants reported significantly reduced symptoms of panic as measured by the Panic Di...

Clinician-assisted Internet-based treatment is effective for panic: A randomized controlled trial.

Objective: In two previous randomized controlled trials Titov et al. demonstrated significant benefit from an Internet- and email-based treatment programme for social phobia. The present study (Shy...

Shyness 3: Randomized Controlled Trial of Guided Versus Unguided Internet-Based CBT for Social Phobia

Objective: The aim of the present study was to determine the efficacy of an Internet-based clinician-assisted computerized cognitive behavioural treatment (CaCCBT) programme for generalized anxiety...

Clinician-Assisted Internet-Based Treatment is Effective for Generalized Anxiety Disorder: Randomized Controlled Trial

Objective: The aim of the present study was (Shyness 4) to determine which level of reminder best facilitated a clinician-free Internet treatment for social phobia.Method: A pragmatic randomized controlled trial of an enhanced Internet treatment, with and without weekly telephone reminders, was done. Participants consisted of 163 volunteers with social phobia, who completed six lessons of computerized cognitive behaviour therapy for social phobia with complex automated reminders. Main outcome measures were the Social Interaction Anxiety Scale and Social Performance Scale.Results: Social phobia improved in both groups. Adherence (68% vs 81%) and improvement in social phobia (effect size = 0.86 vs 1.15) was better in the group with the added telephone reminders.Conclusions: Enhanced Internet-based cognitive behaviour therapy without clinician guidance is a strong treatment for social phobia. Telephone reminders further improve outcome. Because both interventions are effective, it is a pragmatic decision for...

Randomized Controlled Trial of Web-Based Treatment of Social Phobia Without Clinician Guidance

Objective: In two randomized controlled trials Titov et al. demonstrated significant benefit from an Internet- and email-based treatment programme for social phobia: the Shyness programme. Data are presented about the longer term outcomes (6 months after treatment), cost-effectiveness relative to face-to-face treatment, and the acceptability of the programme to participants.Method: Participants completed outcome and acceptability questionnaires at 6 months after treatment. Repeated measures analyses of variance were calculated using an intention-to-treat design. Cost-effectiveness in years lived with disability averted were calculated based on between-group effect sizes.Results: A total of 59% of treatment group participants completed the 6 month follow-up questionnaires. Between post-treatment and 6 month follow up participants continued to make improvements in symptoms of social phobia, while maintaining improvements in mood, psychological distress, and disability. At 6 month follow up the mean within-g...

Isabella Choi

Papers

Clinician-assisted Internet-based treatment is effective for panic: A randomized controlled trial.

Shyness 3: Randomized Controlled Trial of Guided Versus Unguided Internet-Based CBT for Social Phobia

Clinician-Assisted Internet-Based Treatment is Effective for Generalized Anxiety Disorder: Randomized Controlled Trial

Randomized Controlled Trial of Web-Based Treatment of Social Phobia Without Clinician Guidance

Shyness programme: longer term benefits, cost-effectiveness, and acceptability