Treatment Evidence - Eppp Knowledge

1. In MTA acute-phase results, which treatment had the strongest effect on core ADHD symptoms?

   Medication management (and combined) outperformed behavior alone. MTA results highlighted medication's superior impact on ADHD symptoms, with combined treatment showing similar efficacy.

2. What does the Treatment of Resistant Depression in Adolescents (TORDIA) study evaluate?

   Switching antidepressants with or without CBT after SSRI failure. TORDIA tested augmentation strategies for teens with treatment-resistant depression post-SSRI failure.

3. Which result most strongly supports clinical significance: $p<.05$ with NNT $=4$, or $p<.05$ with NNT $=20$?

   $p<.05$ with NNT $=4$. Lower NNT reflects greater clinical impact, making this result more meaningful for real-world application.

4. In MTA, what was a common advantage of combined treatment over medication alone?

   Better outcomes in non-core domains and lower medication doses. Combined treatment in MTA enhanced functioning in areas like social skills while allowing reduced stimulant usage.

5. What is the key clinical implication of TDCRP regarding treatment intensity for severe depression?

   More intensive active treatment is favored over placebo+CM. TDCRP findings emphasize that severe depression benefits from more robust interventions beyond minimal clinical management.

6. In TDCRP, which condition generally showed the weakest outcomes for more severe depression?

   Placebo plus clinical management. For severely depressed patients, this control condition yielded inferior results compared to active treatments in TDCRP.

7. What does the NIMH Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study examine?

   Stepwise treatment strategies after inadequate antidepressant response. STAR*D investigated sequential options to optimize outcomes for patients not responding to initial antidepressants.

8. Identify the correct interpretation: an effect size of $d=0.2$ for medication vs placebo indicates what magnitude?

   Small treatment effect. Cohen's conventions classify $d=0.2$ as a small effect, indicating minimal practical difference despite significance.

9. In CATIE, what did high discontinuation rates most strongly indicate about antipsychotic treatment?

   Limited tolerability/effectiveness in real-world use. CATIE's high dropout rates underscored challenges in antipsychotic adherence and efficacy outside controlled settings.

10. What does the Treatment for Adolescents with Depression Study (TADS) compare?

    Fluoxetine, CBT, combined, and placebo in adolescent MDD. TADS examined these treatments to guide management of major depressive disorder in teenagers.

11. What does the NIMH Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) primarily assess?

    Comparative effectiveness of antipsychotics in schizophrenia. CATIE compared first- and second-generation antipsychotics for long-term outcomes in schizophrenia patients.

12. What is a key STAR*D conclusion about remission probability across successive steps?

    Remission rates generally decrease with each additional step. STAR*D showed diminishing remission likelihood as treatment resistance increases across levels.

13. Which option best matches a typical RCT finding: meds act faster, CBT has more durable gains after stopping?

    CBT tends to show lower relapse after discontinuation than medication. Typical findings in panic RCTs show medication's quicker onset but CBT's sustained effects post-treatment.

14. In STEP-BD, what is a key caution regarding antidepressants in bipolar disorder?

    Risk of mood destabilization; use carefully with mood stabilizers. STEP-BD findings warn of potential manic switches from antidepressants, recommending adjunctive mood stabilization.

15. In TADS, which treatment typically produced the fastest symptom improvement early in treatment?

    Fluoxetine (often comparable to combined early). TADS early-phase data showed rapid antidepressant effects, sometimes matching combined treatment initially.

16. What does the NIMH Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) evaluate?

    Effectiveness of treatments for bipolar disorder in clinical practice. STEP-BD assessed various interventions to inform evidence-based management of bipolar disorder in routine care.

17. In CAMS, which treatment showed the highest response rates for pediatric anxiety?

    Combined CBT plus sertraline. CAMS data indicated superior remission rates with integrated psychotherapy and pharmacotherapy for anxious children.

18. What does the NIMH Treatment of Depression Collaborative Research Program (TDCRP) primarily compare?

    CBT, IPT, imipramine+CM, and placebo+CM. TDCRP evaluated these four conditions to assess psychotherapy and pharmacotherapy efficacy in major depression.

19. In TADS, what is a key safety-related finding about combined treatment vs medication alone?

    Combined treatment may reduce suicidality risk relative to medication alone. TADS suggested that adding CBT to medication mitigates suicidal ideation risks in depressed adolescents.

20. What does the NIMH Child/Adolescent Anxiety Multimodal Study (CAMS) compare?

    CBT, sertraline, combined CBT+sertraline, and placebo. CAMS tested these modalities to evaluate monotherapy and combination efficacy for youth with anxiety disorders.

21. What does it imply if combined treatment is not superior to the best monotherapy in an RCT?

    No additive benefit beyond the strongest single treatment. Lack of superiority in combined arms suggests the modalities may not synergize beyond optimal individual therapy.

22. What does the NIMH Multimodal Treatment Study of ADHD (MTA) primarily compare?

    Medication management, behavior therapy, combined, and community care. MTA compared these approaches to determine optimal interventions for children with ADHD in a large-scale trial.

23. In TORDIA, which strategy improved response rates compared with medication switch alone?

    Adding CBT to the medication switch. TORDIA demonstrated enhanced efficacy when psychotherapy augments pharmacological changes in resistant cases.

Study these flashcards