Fiammetta Cosci1, Guy Chouinard2, Virginie-Anne Chouinard3, Giovanni Andrea Fava4. 1. Department of Health Sciences, University of Florence, Italy - Department of Psychiatry & Neuropsychology, Maastricht University, The Netherlands. 2. Clinical Psychopharmacology and Therapeutics Unit, Montréal, Québec, Canada - University Mental Health Institute of Montreal, Research Center Fernand Seguin, University of Montréal, Québec, Canada. 3. Psychotic Disorders Division, McLean Hospital, Harvard Medical School, Belmont, USA. 4. Department of Psychology, University of Bologna, Italy - State University of New York at Buffalo, Buffalo, New York, USA.
Abstract
Aim: A wide range of clinical phenomena have been reported with dose reduction or drug discontinuation of Selective Serotonin Reuptake Inhibitors (SSRIs) or Serotonin Norepinephrine Reuptake Inhibitors (SNRIs). In 2015, a new classification of SRIs/SNRIs withdrawal (i.e., new withdrawal symptoms, rebound symptoms withdrawal, persistent post-withdrawal disorders) was outlined on the basis of the literature and clinical observations. A semistructured clinical interview, the Diagnostic clinical Interview for Drug Withdrawal 1 - New Symptoms of SSRI and SNRI (DID-W1), was developed for identifying and differentiating such syndromes. Its inter-rater reliability has been tested. Methods: Seventeen consecutive outpatients with a history of SSRI or SNRI dose reduction or discontinuation were assessed independently by 2 clinicians at different times during the same day. Percent agreement, Cohen’s kappa, and the squared correlation coefficient were used to measure inter-rater reliability. Results: The percent agreement for the whole interview was 97.06%, the Cohen’s kappa 0.85 (95% CI of 0.61-1.08), the squared correlation coefficient 0.72. Discussion and conclusions: The kappa values indicated excellent inter-rater agreement. Validity evaluation and comparison with other instruments need to be performed. The DID-W1 may help diagnosing the clinical phenomena related to SSRI and SNRI discontinuation, their differentiation from relapse, and the potential iatrogenic origin of psychiatric symptoms in clinical practice.
Aim: A wide range of clinical phenomena have been reported with dose reduction or drug discontinuation of Selective Serotonin Reuptake Inhibitors (SSRIs) or Serotonin Norepinephrine Reuptake Inhibitors (SNRIs). In 2015, a new classification of SRIs/SNRIs withdrawal (i.e., new withdrawal symptoms, rebound symptoms withdrawal, persistent post-withdrawal disorders) was outlined on the basis of the literature and clinical observations. A semistructured clinical interview, the Diagnostic clinical Interview for Drug Withdrawal 1 - New Symptoms of SSRI and SNRI (DID-W1), was developed for identifying and differentiating such syndromes. Its inter-rater reliability has been tested. Methods: Seventeen consecutive outpatients with a history of SSRI or SNRI dose reduction or discontinuation were assessed independently by 2 clinicians at different times during the same day. Percent agreement, Cohen’s kappa, and the squared correlation coefficient were used to measure inter-rater reliability. Results: The percent agreement for the whole interview was 97.06%, the Cohen’s kappa 0.85 (95% CI of 0.61-1.08), the squared correlation coefficient 0.72. Discussion and conclusions: The kappa values indicated excellent inter-rater agreement. Validity evaluation and comparison with other instruments need to be performed. The DID-W1 may help diagnosing the clinical phenomena related to SSRI and SNRI discontinuation, their differentiation from relapse, and the potential iatrogenic origin of psychiatric symptoms in clinical practice.
Authors: Marlies E Brouwer; Nina M Molenaar; Huibert Burger; Alishia D Williams; Casper J Albers; Mijke P Lambregtse-van den Berg; Claudi L H Bockting Journal: Front Psychiatry Date: 2020-10-22 Impact factor: 4.157