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Aim: Live two‐way video, easily accessible from home via smartphones and other devices, is becoming a new way of providing psychiatric treatment. However, lack of evidence for real‐world clinical setting effectiveness hampers its approval by medical insurance in some countries. Here, we conducted the first large‐scale pragmatic, randomized controlled trial to determine the effectiveness of long‐term treatment for multiple psychiatric disorders via two‐way video using smartphones and other devices, which are currently the primary means of telecommunication. Methods: This randomized controlled trial compared two‐way video versus face‐to‐face treatment for depressive disorder, anxiety disorder, and obsessive‐compulsive disorder in the subacute/maintenance phase during a 24‐week period. Adult patients with the above‐mentioned disorders were allocated to either a two‐way video group (≥50% video sessions) or a face‐to‐face group (100% in‐person sessions) and received standard treatment covered by public medical insurance. The primary outcome was the 36‐Item Short‐Form Health Survey Mental Component Summary (SF‐36 MCS) score. Secondary outcomes included all‐cause discontinuation, working alliance, adverse events, and the severity rating scales for each disorder. Results: A total of 199 patients participated in this study. After 24 weeks of treatment, two‐way video treatment was found to be noninferior to face‐to‐face treatment regarding SF‐36 MCS score (48.50 vs 46.68, respectively; p < 0.001). There were no significant differences between the groups regarding most secondary end points, including all‐cause discontinuation, treatment efficacy, and satisfaction. Conclusion: Two‐way video treatment using smartphones and other devices, was noninferior to face‐to‐face treatment in real‐world clinical settings. Modern telemedicine, easily accessible from home, can be used as a form of health care. [ABSTRACT FROM AUTHOR]

Aim: Pharmacotherapy is the primary treatment strategy in major depression. However, two‐thirds of patients remain depressed after the initial antidepressant treatment. Augmented cognitive behavioral therapy (CBT) for pharmacotherapy‐resistant depression in primary mental health care settings proved effective and cost‐effective. Although we reported the clinical effectiveness of augmented CBT in secondary mental health care, its cost‐effectiveness has not been evaluated. Therefore, we aimed to compare the cost‐effectiveness of augmented CBT adjunctive to treatment as usual (TAU) and TAU alone for pharmacotherapy‐resistant depression at secondary mental health care settings. Methods: We performed a cost‐effectiveness analysis at 64 weeks, alongside a randomized controlled trial involving 80 patients who sought depression treatment at a university hospital and psychiatric hospital (one each). The cost‐effectiveness was assessed by the incremental cost‐effectiveness ratio (ICER) that compared the difference in costs and quality‐adjusted life years, and other clinical scales, between the groups. Results: The ICERs were JPY −15 278 322 and 2 026 865 for pharmacotherapy‐resistant depression for all samples and those with moderate/severe symptoms at baseline, respectively. The acceptability curve demonstrates a 0.221 and 0.701 probability of the augmented CBT being cost‐effective for all samples and moderate/severe depression, respectively, at the threshold of JPY 4.57 million (GBP 30 000). The sensitivity analysis supported the robustness of our results restricting for moderate/severe depression. Conclusion: Augmented CBT for pharmacotherapy‐resistant depression is not cost‐effective for all samples including mild depression. In contrast, it appeared to be cost‐effective for the patients currently manifesting moderate/severe symptoms under secondary mental health care. [ABSTRACT FROM AUTHOR]

Aim: The primary objective of this study was to examine the effectiveness of mindfulness‐based cognitive therapy (MBCT) in secondary‐care settings where the vast majority of the patients have already undergone pharmacotherapy but have not remitted. Methods: Eligible participants were aged between 20 and 75 years and met the criteria for panic disorder/agoraphobia or social anxiety disorder specified in the DSM‐IV. They were randomly assigned to either the MBCT group (n = 20) or the wait‐list control group (n = 20). The primary outcome was the difference in mean change scores between pre‐ and post‐intervention assessments on the State–Trait Anxiety Inventory (STAI). The outcome was analyzed using an intent‐to‐treat approach and a mixed‐effect model repeated measurement. Results: We observed significant differences in mean change scores for the STAI State Anxiety subscale (difference, −10.1; 95% confidence interval, −16.9 to −3.2; P < 0.005) and STAI Trait Anxiety subscale (difference, −11.7; 95% confidence interval, −17.0 to −6.4; P < 0.001) between the MBCT and control groups. Conclusion: MBCT is effective in patients with anxiety disorders in secondary‐care settings where the vast majority of patients are treatment‐resistant to pharmacotherapy. [ABSTRACT FROM AUTHOR]

Aim: Previous studies indicate that mirtazapine is unique in its quick responsiveness compared to other antidepressants. Although some other studies have evaluated its cost‐effectiveness, they have not considered its early stage remission rate. The aim of this study was to address this research gap by using precise clinical data to evaluate the cost‐effectiveness of mirtazapine in Japan. Methods: We developed a Markov model to reflect the week‐by‐week transition probabilities. The Markov cycle was set as 1 week. While our clinical parameters were obtained largely from existing meta‐analyses, cost data were derived from government reports. Cost‐effectiveness was evaluated by incremental cost‐effectiveness ratios (ICERs) per quality‐adjusted life year estimated based on the probability sensitivity analyses. The ICERs were estimated at 2, 8, 26, and 52 weeks. Results: In severe depression, the ICERs ranged between JPY 872 153 and 1 772 723. The probability of mirtazapine being cost‐effective ranged from 0.75 to 0.99 when the ICER threshold was JPY 5 000 000. In moderate depression, the ICERs ranged between JPY 2 356 499 and 4 770 145. The probability of mirtazapine being cost‐effective ranged from 0.55 to 0.83 when the ICER threshold was JPY 5 000 000. Conclusion: When considering the early stage efficacy of mirtazapine, it appeared to be cost‐effective compared to selective serotonin reuptake inhibitors, especially for severe depression and in the early stage treatment in the Japanese setting. However, our study has some limitations. First, mirtazapine is compared with batched selective serotonin reuptake inhibitors rather than individual ones. Second, we did not consider antidepressant combination therapy as treatment options. [ABSTRACT FROM AUTHOR]

Aims A review of the published work on treatments for major depressive disorder suggests that there is an alarming gap between guideline recommendations and actual clinical practices worldwide. The purpose of this study was to compare early-career psychiatrists' selections of treatment for mild to moderate major depression in Japan and the USA. Methods The authors surveyed 120 early-career psychiatrists from two residency programs in Japan and the USA using web-based questionnaires. In response to two case vignettes of mild to moderate major depression, the subjects selected treatment modalities and first- and second-line pharmacotherapy. Results Eighty-one psychiatrists (68%) returned surveys, of whom 42 (52%) were Japanese and 39 (48%) American. Fewer Japanese subjects selected psychotherapy than Americans. The Japanese psychiatrists favored benzodiazepine monotherapy for the treatment of mild depression, whereas the American psychiatrists favored antidepressant monotherapy. For the initial treatment of moderate depression, approximately half of the Japanese selected antidepressant monotherapy, and a quarter selected benzodiazepine monotherapy, whereas the Americans unanimously selected selective serotonin reuptake inhibitors monotherapy. As a second-line strategy, the Japanese were more likely to augment medication and less likely to increase dosage for moderate depression than their American counterparts. Conclusions Differences were found between the treatment selections of early-career psychiatrists in Japan and the USA, despite comparable guidelines and postgraduate training. The results suggest that the gap between guidelines and practice may also be shaped by physician workload, attitudes toward side-effects, and the sociocultural contexts in which clinical decisions are made. [ABSTRACT FROM AUTHOR]

Aim Although the efficacy of cognitive behavioral therapy for insomnia has been confirmed, dissemination depends on the balance of benefits and costs. This study aimed to examine the cost-effectiveness of cognitive behavioral therapy for insomnia consisting of four weekly individual sessions. Methods We conducted a 4-week randomized controlled trial with a 4-week follow up in outpatient clinics in Japan. Thirty-seven patients diagnosed as having major depressive disorder according to DSM-IV and suffering from chronic insomnia were randomized to receive either treatment as usual ( TAU) alone or TAU plus cognitive behavioral therapy for insomnia. Effectiveness was evaluated as quality-adjusted life years ( QALY) over 8 weeks' time, estimated by bootstrapping of the observed total scores of the Hamilton Depression Rating Scale. Direct medical costs for cognitive behavioral therapy for insomnia and TAU were also evaluated. We calculated the incremental cost-effectiveness ratio. Results Over the 8 weeks of the study, the group receiving cognitive behavioral therapy for insomnia plus TAU had significantly higher QALY ( P = 0.002) than the TAU-alone group with an incremental value of 0.019 ( SD 0.006), and had non-significantly higher costs with an incremental value of 254 ( SD 203) USD in direct costs. The incremental cost-effectiveness ratio was 13 678 USD (95% confidence interval: −5691 to 71 316). Adding cognitive behavioral therapy for insomnia demonstrated an approximately 95% chance of gaining one more QALY if a decision-maker was willing to pay 60 000 USD, and approximately 90% for 40 000 USD. Conclusion Adding cognitive behavioral therapy for insomnia is highly likely to be cost-effective for patients with residual insomnia and concomitant depression. [ABSTRACT FROM AUTHOR]

Aim: Major depression is expected to become the leading contributor to disease burden worldwide by 2020. Previous studies have shown that the societal cost of depression is not less than that of other major illnesses, such as cardiovascular diseases or AIDS. Nevertheless, the cost of depression in Japan has never been examined. The goal of the present study was to estimate the total cost of depression in Japan and to clarify the characteristics of this burden. Methods: A prevalence-based approach was adopted to measure the total cost of depression. The total cost of depression was regarded as being comprised of the direct cost, morbidity cost and mortality cost. Diagnoses included in this study were depressive episodes and recurrent depressive disorder according to the ICD-10 or major depressive disorder according to the DSM-IV. Data were collected from publicly available statistics and the World Mental Health Japan Survey database. Results: The total cost of depression among adults in Japan in 2005 was estimated to be ¥2.0 trillion. The direct cost was ¥0.18 trillion. The morbidity cost was ¥0.92 trillion, while the mortality cost was ¥0.88 trillion. Conclusion: The societal costs caused by depression in Japan are enormous, as in other developed countries. Low morbidity costs and extremely high mortality costs are characteristic in Japan. Effective interventions for preventing suicide could reduce the societal costs of depression. [ABSTRACT FROM AUTHOR]

This study aimed to test reliability and validity of the Japanese-version Cognitive Therapy Awareness Scale, a self-rating scale that measures basic knowledge of cognitive behavioral therapy (CBT) concepts and methodology. Furthermore, we explored optimal cutoff score to demonstrate required standard of CBT competency. The reliability and validity of the scale was tested among 252 mental health professionals. The participants' number of readings relevant to CBT, as well as their experience in training and practice in CBT were used as external standards of competency. The scale has good internal consistency (the Kuder-Richardson formula 20 = 0.76). The total score of the scale was significantly correlated with experience in training and practice in cognitive behavioral therapy, and the number of relevant readings (Spearman's rho = 0.27, 0.28 and 0.44, respectively, P < 0.001). No significant correlation was found between the total score of the scale and experience in general psychosocial care (Spearman's rho = −0.02, P = 0.76). The receiver operating characteristics curve analysis produced the area under curve (AUC) of 0.77 (SD = 0.05, P < 0.001), and a cutoff score of 31/32 produced sensitivity of 0.81 and specificity of 0.64 to discriminate trainees who have experience of 40 h or more of CBT training and five or more of relevant readings, from those who do not meet this standard. The Japanese-version Cognitive Therapy Awareness Scale was successfully validated. It has been demonstrated that the scale specifically assess knowledge in cognitive behavioral therapy. This scale would serve as a rough guide to assess competencies among beginner cognitive behavior therapists. [ABSTRACT FROM AUTHOR]