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Review: Room for Improvement in Psychiatric Care

Combined modality research needed; well-designed direct comparisons need public funding

Review: Room for Improvement in Psychiatric Care

FRIDAY, May 2, 2014 (HealthDay News) -- Well-designed direct comparisons of pharmacotherapies and psychotherapies are scarce and need public funding, and because patients often benefit from both forms of therapy, research should also focus on how both modalities can be best combined to maximize synergy, according to a review published online April 30 in JAMA Psychiatry.

Maximilian Huhn, M.D., from the Technische Universität München in Germany, and colleagues conducted a systematic review of the literature to compare the efficacy of pharmacotherapies and psychotherapies for major psychiatric disorders. Sixty-one meta-analyses on 21 psychiatric disorders were included, with data on 852 individual trials and 137,126 participants.

The researchers observed a medium mean effect size for the meta-analyses (mean, 0.50). The effect sizes for psychotherapies versus placebo tended to be higher than those of medication, but there were no consistent differences in direct comparisons. Pharmacotherapy trials were more likely to be characterized by large sample sizes, blinding, control groups, and intention-to-treat analyses, while lower dropout rates and follow-up data were observed in psychotherapy trials. Wait-list designs showed larger effects than placebo comparisons in psychotherapy studies.

"Many pharmacotherapies and psychotherapies are effective, but there is a lot of room for improvement," the authors write. "Because patients often benefit from both forms of therapy, research should also focus on how both modalities can be best combined to maximize synergy rather than debate the use of one treatment over the other."

Several authors disclosed financial ties to the pharmaceutical industry.

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