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1.
Georgian Med News ; (312): 57-61, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33964827

RESUMEN

The spread of depressive disorders is extra high nowadays. Depressive disorders are widespread mental disorders in the structure of mental pathology, both causes of psychiatrists' visit, and causes of medical aid. The presence of depressive syndrome in patients with cardiovascular system leads to deterioration patient's condition and adaptive abilities and aggravates somatic abnormality. Adequate therapy causes their reduction, prevention of recurrence and decompansation of comorbid somatic pathology, and eliminates severe medical and prevents social consequences. The study of clinical aspects of depressive conditions which are accompanied with pathology is one of the direction not only psychiatric, but also common pharmacotherapeutic investigations. The aim of the investigation was to determine clinical, pharmacotherapeutic and biorhythmic peculiarities of depressive disorders in patients with comorbid cardiac pathology. And also assessment of efficacy of complex therapy based on chronotherapy principle was used. 50 patients (female patients) with depressive disorders were involved in this investigation. This was performed based on "Depressive disorders of organic genesis, characterized by somatic pathology" (F 06.35), "Somatoform disorder" of heart and cardiovascular system (F 45.30), "Mild depressive episode" (F 32.00), and also comorbid arterial hypertension confirmed by physician. Clinical, laboratory, clinical and psychopathological investigations using psychodiagnostic scales (scale HAMD-21, CGI-S, CGI-І) were used. Individual biorhythmic status was established and it requires medicamentous therapy. Comparing patients of both groups, it has been detected a group of patients in whom principles of chronotherapy, especially antihypertensive and antidepressive therapy were prescribed, dynamics of patient's improvement was better than in the investigated group where the principle of chronotherapy was observed.


Asunto(s)
Trastorno Depresivo , Comorbilidad , Trastorno Depresivo/tratamiento farmacológico , Trastorno Depresivo/epidemiología , Femenino , Humanos , Escalas de Valoración Psiquiátrica , Psicoterapia , Trastornos Somatomorfos
2.
Artículo en Ruso | MEDLINE | ID: mdl-33834723

RESUMEN

OBJECTIVE: To search for correlations between platelet cytochrome c-oxidase (COX) activity and the quality of therapeutic outcomes and other clinical parameters of depression in elderly patients. MATERIAL AND METHODS: Twenty elderly women, aged 55-78 years, with depressive episodes in recurrent depressive disorder (RDD) or bipolar affective disorder (BD) were studied. COX activity and severity of depression were evaluated twice: before the beginning of antidepressant treatment and at the 28-th day of the therapy, using the Hamilton Depression Rating Scale (HAMD-17) and the Hamilton Anxiety Rating Scale (HAM-A). RESULTS: Significant correlations were revealed between platelet COX activity and some clinical parameters of the disease and the severity of depression in patients after treatment. The baseline level of the platelet COX activity was correlated with the age of disease onset (R= -0.63, p=0.003) and its duration (R=0.55, p=0.010). Significant negative correlations were also found between the baseline level of COX activity and depression severity (HAMD-17 total score) (R= -0.48, p=0.032) and the severity of anxiety (HARSHAM-A total score) (R= -0.54, p=0.010) after 28-day treatment. CONCLUSION: This pilot study has revealed a link between platelet COX activity and the severity of depression and anxiety after a 28-day antidepressant therapy. The results indicate the prospects for further study of COX as a biomarker of therapeutic outcomes in elderly patients with depression.


Asunto(s)
Citocromos c , Depresión , Anciano , Trastornos de Ansiedad , Depresión/tratamiento farmacológico , Femenino , Humanos , Persona de Mediana Edad , Oxidorreductasas , Proyectos Piloto , Escalas de Valoración Psiquiátrica
3.
Medicine (Baltimore) ; 100(14): e25273, 2021 Apr 09.
Artículo en Inglés | MEDLINE | ID: mdl-33832092

RESUMEN

BACKGROUND: The optimal dose (number of pulses per session) of repetitive transcranial magnetic stimulation (rTMS), using the H-coil, in major depressive disorder (MDD) has not previously been reported. OBJECTIVE: To explore the relationship between rTMS dose and antidepressant effect, and collect data for the design of a definitive trial. METHODS: This was a double-blind, three-arm parallel-group, randomized [1:1:1], pilot trial conducted in Stockholm, Sweden (September 2014 to September 2016). The primary outcome was change in depression severity measured with the Montgomery Åsberg Depression Rating Scale (MADRS) after 4 weeks. Participants (n = 29) with MDD were randomized to 1000, 2000, or 4000 pulses of rTMS for 20 sessions during 4 weeks. RESULTS: At 4 weeks, the 3 treatment groups reduced the mean MADRS (95% CI) by 11.6 (4.0-19.2), 9.1 (5.0-13.3), and 11.3 (4.1-18.5) points respectively. Eleven participants met criteria for response and 10 for remission. No serious adverse events occurred. Ratings of subjective memory improved in all groups. Exploring the effect of dose and time, 4000 pulses had the largest reduction in MADRS during the first 2 weeks. A comparison of change in MADRS between 2000 and 4000 pulses after 2 weeks will require a sample size of 66 patients at power .80 and alpha .05. CONCLUSIONS: It is feasible to conduct a definitive trial investigating whether a higher number of magnetic pulses per treatment session gives a more rapid antidepressive response.


Asunto(s)
Trastorno Depresivo Mayor/terapia , Estimulación Magnética Transcraneal/métodos , Adulto , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Escalas de Valoración Psiquiátrica
4.
BMC Psychiatry ; 21(1): 197, 2021 04 19.
Artículo en Inglés | MEDLINE | ID: mdl-33874939

RESUMEN

BACKGROUND: The Centre for Epidemiologic Studies Depression Scale (CES-D) is a commonly used psychometric scale of depression. A four-factor structure (depressed affect, positive affect, somatic symptoms, and interpersonal difficulties) was initially identified in an American sample aged 18 to 65. Despite emerging evidence, a latent structure has not been established in adolescents. This review aimed to investigate the factor structure of the CES-D in adolescents. METHODS: We searched Web of Science, PsychINFO and Scopus and included peer-reviewed, original studies assessing the factor structure of the 20-item CES-D in adolescents aged ≤18. Two independent researchers screened results and extracted data. RESULTS: Thirteen studies met the inclusion criteria and were primarily from school-based samples in the USA or Asia. Studies that conducted confirmatory factor analysis (CFA; n = 9) reported a four-factor structure consistent with the original factor structure; these studies were primarily USA-based. Conversely, studies that conducted exploratory factor analysis (EFA) reported distinct two or three factor structures (n = 4) and were primarily based in Asia. LIMITATIONS: Studies in a non-English language and those that included individuals aged > 18 years were excluded. Ethnic or cultural differences as well as different analytical methods impacted generalisability of results. The use of CFA as the primary analysis may have biased towards a four-factor structure. CONCLUSIONS: A four-factor CES-D structure was an appropriate fit for adolescents in Western countries; further research is required to determine the fit in in Asian countries. This has important implications for clinical use of the scale. Future research should consider how cultural differences shape the experience of depression in adolescents.


Asunto(s)
Depresión , Grupos Étnicos , Adolescente , Adulto , Anciano , Asia , Depresión/diagnóstico , Depresión/epidemiología , Estudios Epidemiológicos , Análisis Factorial , Humanos , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica , Psicometría , Reproducibilidad de los Resultados , Adulto Joven
5.
BMC Psychiatry ; 21(1): 200, 2021 04 20.
Artículo en Inglés | MEDLINE | ID: mdl-33879130

RESUMEN

BACKGROUND: Perinatal common mental disorders are associated with significant adverse outcomes for women and their families, particularly in low- and middle-income settings. Early detection through screening with locally-validated tools can improve outcomes. METHODS: We searched MEDLINE, Embase, PsycINFO, Global Health, Cochrane Library, Web of Science and Google Scholar for articles on the validation of screening tools for common mental disorders in perinatal women in India, with no language or date restrictions. Quality was assessed using the QUADAS-2 tool. We used bivariate and hierarchical summary receiver operating characteristic models to calculate pooled summary estimates of sensitivity and specificity. Heterogeneity was assessed by visualising the distance of individual studies from the summary curve. RESULTS: Seven studies involving 1003 women were analysed. All studies assessed the validity of the Edinburgh Postnatal Depression Scale (EPDS) in identifying perinatal depression. No validation studies of any other screening tools were identified. Using a common threshold of ≥13 the EPDS had a pooled sensitivity and specificity of 88·9% (95%CI 77·4-94·9) and 93·4 (95%CI 81·5-97·8), respectively. Using optimal thresholds (range ≥ 9 to ≥13) the EPDS had a pooled sensitivity and specificity of 94·4% (95%CI 81·7-98·4) and 90·8 (95%CI 83·7-95·0), respectively. CONCLUSION: The EPDS is psychometrically valid in diverse Indian settings and its use in routine maternity care could improve detection of perinatal depression. Further research is required to validate screening tools for other perinatal common mental disorders in India.


Asunto(s)
Depresión Posparto , Servicios de Salud Materna , Depresión Posparto/diagnóstico , Femenino , Humanos , India , Tamizaje Masivo , Periodo Posparto , Embarazo , Escalas de Valoración Psiquiátrica
6.
Artículo en Inglés | MEDLINE | ID: mdl-33804879

RESUMEN

(1) Background: The Patient Health Questionnaire-9 (PHQ-9) is a tool that screens patients for depression in primary care settings. In this study, we evaluated the efficacy of PHQ-9 in evaluating suicidal ideation (2) Methods: A total of 8760 completed questionnaires collected from college students were analyzed. The PHQ-9 was scored in combination with and evaluated against four categories (PHQ-2, PHQ-8, PHQ-9, and PHQ-10). Suicidal ideations were evaluated using the Mini-International Neuropsychiatric Interview suicidality module. Analyses used suicide ideation as the dependent variable, and machine learning (ML) algorithms, k-nearest neighbors, linear discriminant analysis (LDA), and random forest. (3) Results: Random forest application using the nine items of the PHQ-9 revealed an excellent area under the curve with a value of 0.841, with 94.3% accuracy. The positive and negative predictive values were 84.95% (95% CI = 76.03-91.52) and 95.54% (95% CI = 94.42-96.48), respectively. (4) Conclusion: This study confirmed that ML algorithms using PHQ-9 in the primary care field are reliably accurate in screening individuals with suicidal ideation.


Asunto(s)
Cuestionario de Salud del Paciente , Ideación Suicida , Depresión/diagnóstico , Humanos , Aprendizaje Automático , Tamizaje Masivo , Escalas de Valoración Psiquiátrica , Encuestas y Cuestionarios
7.
Psychiatr Danub ; 33(1): 36-47, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33857038

RESUMEN

BACKGROUND: Previous studies reported deficits in pleasure experience in schizophrenia, but little is known about anhedonia in psychosis risk syndrome. Aim of this study was: (1) to assess anhedonia in distinct help-seeking subgroups of young people identified through the Ultra-High Risk (UHR) criteria, (2) to explore its association with functioning and psychopathology in the UHR group, and (3) to monitor longitudinally its stability in UHR individuals along 1-year follow-up period. SUBJECTS AND METHODS: All participants (78 UHR, 137 with a First Episode Psychosis (FEP), and 95 non-UHR/FEP), aged 13-35 years, completed the Comprehensive Assessment of At-Risk Mental States (CAARMS), the Beck Depression Inventory-II (BDI-II), the Schizotypal Personality Questionnaire - Brief version (SPQ-B), the Brief O-LIFE questionnaire (BOL), and the World Health Organization Quality of Life - Brief version (WHOQOL-BREF). We adopted two different indexes of anhedonia: i.e. CAARMS "Anhedonia" item 4.3 and BOL "Introvertive Anhedonia" subscale scores. RESULTS: In comparison with non-UHR/FEP, UHR individuals showed higher baseline CAARMS item 4.3 and BOL "Introvertive Anhedonia" subscale scores. No difference in anhedonia scores between UHR and FEP patients was found. After 1-year follow-up period, UHR subjects had a significant decrease in severity exclusively on CAARMS item 4.3 subscore. CONCLUSIONS: In the UHR group, CAARMS anhedonia showed significant correlations with functioning deterioration, negative symptoms, and comorbid depression (including suicide ideation), while BOL anhedonia with a poorer self-perceived quality of life and specific schizotypal personality traits (i.e. interpersonal deficits and disorganization). Anhedonia is prominent in the psychosis risk syndrome and its severity is indistinguishable from that of FEP patients.


Asunto(s)
Trastornos Psicóticos , Esquizofrenia , Adolescente , Adulto , Anhedonia , Humanos , Escalas de Valoración Psiquiátrica , Psicopatología , Trastornos Psicóticos/epidemiología , Calidad de Vida , Adulto Joven
8.
Wiad Lek ; 74(2): 257-262, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33813482

RESUMEN

OBJECTIVE: The aim: Our study aimed at evaluating the relationships between sleep disorders (SD), cognitive impairment (CI), anxiety and depression in patients with relapsing-remitting multiple sclerosis (RRMS). PATIENTS AND METHODS: Materials and methods: One hundred and five patients with RRMS (80 females and 25 males) aged from 22 to 67 years (mean age: 41,8±10,7; EDSS:3,5±1,6; disease duration (DD): 10,3±8,5 years) were enrolled into the study. All participants completed questionnaires on sleep (the Pittsburgh Sleep Quality Index /PSQI), cognitive functions (The Montreal Cognitive Assessment /MoCA), anxiety (Hamilton Anxiety Rating Scale /HAM-A), depression (Beck Depression Inventory/ BDI). RESULTS: Results: According to PSQI score the patients were divided into two groups: with (n=42) and without SD (n=63). The patients with SD were older (45,36±1,66 vs 39,41±1,27, p=0.005), had higher EDSS score (3,98±0,26 vs 3,14±0,19, p=0,008), BDI (13,79±1,14 vs 8,96±0,86, p=0,0009) and HAM-A (24,52±1,42 vs 16,56±0,99, p<0,0001) scales compared with patients without SD. The frequency of anxiety (p=0,0034) and depression (p=0,038) was significantly higher in RRMS patients with compared to those without SD. No significant difference was found in gender, DD and MoCA score. In patients with SD significant negative correlation between MoCA and BDI score (r = -0,42, p<0,005) was found. In the group of patients without SD significant negative correlation between MoCA and EDSS (r = -0,27, p=0,03), MoCA and BDI (r = -0,26, p=0,043),) MoCA and HAM-A (r = -0,25, p=0,041) score was detected. CONCLUSION: Conclusions: Insomnia type SD in RRMS patients were associated with older age, higher EDSS score and presence of anxiety and depression.


Asunto(s)
Disfunción Cognitiva , Esclerosis Múltiple Recurrente-Remitente , Esclerosis Múltiple , Trastornos del Sueño-Vigilia , Adulto , Anciano , Disfunción Cognitiva/epidemiología , Disfunción Cognitiva/etiología , Depresión/epidemiología , Depresión/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Esclerosis Múltiple Recurrente-Remitente/complicaciones , Escalas de Valoración Psiquiátrica , Trastornos del Sueño-Vigilia/epidemiología , Trastornos del Sueño-Vigilia/etiología
9.
Ann Clin Psychiatry ; 33(2): 101-107, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33878284

RESUMEN

BACKGROUND: The COVID-19 pandemic may adversely impact the mental health of health care workers (HCWs). To address this issue, it is essential to determine levels of anxiety, depression, and traumatic stress, and sources of stress, and to identify subgroups of HCWs at a higher risk of adverse mental health outcomes during the COVID-19 pandemic. METHODS: We conducted a cross-sectional study of symptoms of mental illness in HCWs in the area surrounding Detroit, Michigan. The online survey included questions about demographics, health and clinical factors, and sources of stress. Several tools were used to assess psychiatric symptoms among HCWs, including the Perceived Stress Scale, the Patient Health Questionnaire depression scale, the Generalized Anxiety Disorder 7-item assessment, and the Posttraumatic Stress Disorder Checklist for DSM-5. The adequacy of personal protective equipment, patient resources, and training for highly contagious diseases were rated. RESULTS: The sample (N = 129) was predominantly female (51.2%) and White (65.9%), with 30.2% screening positive for clinical follow-up to assess anxiety, 20.9% for moderate to severe depression, and 16.3% for elevated traumatic stress. Differences were found by self-reported psychiatric diagnosis and chronic conditions, and role on treatment teams. CONCLUSIONS: Frontline HCWs demonstrate high levels of stress and trauma symptoms. Timely screening and accommodations may be needed during health care crises, such as the COVID-19 pandemic.


Asunto(s)
Personal de Salud , Estrés Laboral , Estrés Psicológico , Adulto , Ansiedad/diagnóstico , Ansiedad/etiología , /psicología , Estudios Transversales , Depresión/diagnóstico , Depresión/etiología , Femenino , Personal de Salud/psicología , Personal de Salud/estadística & datos numéricos , Humanos , Masculino , Salud Mental/estadística & datos numéricos , Michigan/epidemiología , Evaluación de Necesidades , Salud Laboral/estadística & datos numéricos , Estrés Laboral/diagnóstico , Estrés Laboral/epidemiología , Estrés Laboral/etiología , Estrés Laboral/psicología , Escalas de Valoración Psiquiátrica , Trastornos de Estrés Traumático/etiología , Trastornos de Estrés Traumático/prevención & control , Estrés Psicológico/diagnóstico , Estrés Psicológico/epidemiología , Estrés Psicológico/etiología , Estrés Psicológico/psicología
10.
Int. j. clin. health psychol. (Internet) ; 21(1): 199-199, ene.-abr. 2021. graf
Artículo en Inglés | IBECS | ID: ibc-200211

RESUMEN

BACKGROUND/OBJECTIVE: Sluggish Cognitive Tempo (SCT) is an attentional disorder characterized by the symptoms of slowness in behavior or thinking, a lack of en.ergy, difficulty initiating and sustaining effort, daydreaming, and drowsiness. The aim of the present study was to investigate the distinctive attentional characteristics of SCT as compared to Attention-Deficit/Hyperactivity Disorder (ADHD). METHOD: A total of 110 adults were recruited and divided into four groups: SCT+ADHD, SCT, ADHD, and healthy controls. The Revised version of Attention Networks Test was used to investigate each group's attentional profile. RESULTS: The results revealed that the two SCT groups (SCT+ADHD and SCT) showed a significantly weaker orienting network due to the problems of engaging and disengaging attention than the other two groups. Additionally, the two ADHD groups (SCT+ADHD and ADHD) showed a significantly weaker executive control network than the other two groups. CONCLUSIONS: The findings demonstrate an attentional distinction between the SCT and the ADHD groups with a greater dysfunction in the orienting network in the SCT group as compared to the ADHD group. Furthermore, a greater executive control dysfunction was observed in the ADHD group as compared to the SCT group


ANTECEDENTES/OBJETIVO: El Tiempo Cognitivo Lento (TCL) es un trastorno atencional caracterizado por síntomas de lentitud en el comportamiento o pensamiento, falta de energía, dificultad para iniciar y mantener el esfuerzo, soñar despierto y somnolencia. El propósito de este estudio es investigar las características únicas de la atención de TCL en comparación con el Trastorno por Déficit de Atención/Hiperactividad (TDAH). MÉTODO: Se reclutaron 110 participantes y se dividieron en cuatro grupos: TCL+TDAH, TCL, TDAH y controles sanos. Se empleó la versión revisada del Attention Networks Test para investigar el perfil de atención de cada grupo. RESULTADOS: Los dos grupos de TCL (TCL+TDAH y TCL) mostraron una red de orientación significativamente más débil debido a los problemas de atraer y desconectar la atención que los otros dos grupos. Los grupos de TDAH (TCL+TDAH y TDAH) mostraron una red de control ejecutivo significativamente más débil que los otros dos grupos. CONCLUSIONES: Se demuestra una distinción atencional entre los grupos TCL y TDAH con mayor disfunción en la red de orientación en TCL en comparación con TDAH. Además, se observó una mayor disfunción del control ejecutivo en el grupo TDAH en comparación con el grupo TCL


Asunto(s)
Humanos , Masculino , Femenino , Adulto Joven , Adulto , Déficit de la Atención y Trastornos de Conducta Disruptiva/psicología , Función Ejecutiva , Orientación , Trastorno por Déficit de Atención con Hiperactividad/psicología , Escalas de Valoración Psiquiátrica , Pruebas de Inteligencia , Valores de Referencia , Estudios de Casos y Controles
11.
Int. j. clin. health psychol. (Internet) ; 21(1): 201-201, ene.-abr. 2021. graf, tab
Artículo en Inglés | IBECS | ID: ibc-200213

RESUMEN

BACKGROUND/OBJECTIVE: Long-term childhood cancer survivors (CCS) are at risk for adverse late effects. However, not all of them are well understood. The present study addressed loneliness, a previously under-researched mental health risk in cancer survivor populations. We assessed the prevalence of loneliness and its impact on psychological symptoms over time. METHOD: A registry-based sample of N=633 adult long-term CCS underwent medical and psychological assessments and took part in a follow-up survey 2.5 years later. Psychological symptoms (somatic, anxiety, depression symptoms, and suicidal ideation) were measured using the Patient Health Questionnaire. We calculated linear regression models of symptoms at follow-up to investigate the impact of loneliness over time (controlling for symptoms at baseline and relevant confounders). RESULTS: Loneliness was reported by 17.70% of CCS. In multivariate linear regression analyses, loneliness was still predictive of more severe anxiety symptoms and suicidal ideation over two years later. Loneliness did not predict somatic and depression symptoms at follow-up (which increased with age). CONCLUSIONS: Loneliness affected a significant number of CCS and was a risk factor for persistent anxiety symptoms and suicidal ideation. The extent to which young cancer patients' re-integration into society is successful could thus have important implications for well-being in adulthood


ANTECEDENTE/OBJETIVO: Los sobrevivientes a largo plazo de cáncer infantil (SCI) están en riesgo de sufrir efectos tardíos. Evaluamos la prevalencia de la soledad y su impacto en los síntomas psicológicos a lo largo del tiempo. MÉTODO: Una muestra de N=633 adultos con un pasado de SCI se sometió a evaluaciones médicas y psicológicas y participó en una encuesta de seguimiento 2,5 años después. Los síntomas psicológicos se midieron mediante el Patient Health Questionnaire. Calculamos modelos de regresión lineal de síntomas en el seguimiento para investigar el impacto de la soledad a lo largo del tiempo (controlando los síntomas al inicio y los factores de confusión relevantes). RESULTADOS: La soledad fue reportada por el 17,70% de SCI. La soledad seguía siendo predictiva de síntomas de ansiedad más graves e ideación suicida dos años después. La soledad no predijo los síntomas somáticos y de depresión durante el seguimiento (que aumentaron con la edad). CONCLUSIONES: La soledad fue un factor de riesgo para síntomas de ansiedad persistente e ideación suicida. La medida en que la reintegración de los pacientes jóvenes con cáncer en la sociedad tenga éxito podría tener importantes implicaciones para el bienestar en la edad adulta


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Adultos Sobrevivientes de Eventos Adversos Infantiles/psicología , Supervivientes de Cáncer/psicología , Soledad/psicología , Ideación Suicida , Ansiedad/psicología , Factores de Riesgo , Encuestas y Cuestionarios , Factores Socioeconómicos , Modelos Lineales , Escalas de Valoración Psiquiátrica , Alemania/epidemiología
12.
Int. j. clin. health psychol. (Internet) ; 21(1): 203-203, ene.-abr. 2021. tab, graf
Artículo en Inglés | IBECS | ID: ibc-200215

RESUMEN

BACKGROUND/OBJECTIVE: Brief transdiagnostic psychotherapies are a possible treatment for emotional disorders. We aimed to determine their efficacy on mild/moderate emotional disorders compared with treatment as usual (TAU) based on pharmacological interventions. METHOD: This study was a single-blinded randomized controlled trial with parallel design of three groups. Patients (N = 102) were assigned to brief individual psychotherapy (n = 34), brief group psychotherapy (n = 34) or TAU (n = 34). Participants were assessed before and after the interventions with the following measures: PHQ-15, PHQ-9, PHQ-PD, GAD-7, STAI, BDI-II, BSI-18, and SCID. We conducted per protocol and intention-to-treat analyses. RESULTS: Brief psychotherapies were more effective than TAU for the reduction of emotional disorders symptoms and diagnoses with moderate/high effect sizes. TAU was only effective in reducing depressive symptoms. CONCLUSIONS: Brief transdiagnostic psychotherapies might be the treatment of choice for mild/moderate emotional disorders and they seem suitable to be implemented within health care systems


ANTECEDENTES/OBJETIVO: Las psicoterapias breves son un posible tratamiento para los trastornos emocionales. Nuestro propósito fue determinar su eficacia en los trastornos emocionales leves/moderados en comparación con el tratamiento habitual basado en intervenciones farmacológicas. MÉTODO: Este estudio fue un ensayo clínico aleatorizado simple ciego con diseño paralelo de tres grupos. Los pacientes (N = 102) fueron asignados a psicoterapia breve individual (n = 34), psicoterapia breve grupal (n = 34) o tratamiento habitual (n = 34). Los participantes fueron evaluados antes y después del tratamiento con los siguientes instrumentos: PHQ-15, PHQ-9, PHQ-PD, GAD-7, STAI, BDI-II, BSI-18 y SCID. Se realizaron análisis por protocolo y por intención de tratar. RESULTADOS: Las psicoterapias breves fueron más efectivas que el tratamiento habitual para la reducción de síntomas y diagnósticos de los trastornos emocionales. El tratamiento habitual solo fue efectivo en reducir los síntomas depresivos. CONCLUSIONES: Las psicoterapias breves pueden ser el tratamiento de elección para los trastornos emocionales leves/moderados y podrían implementarse en los sistemas de salud


Asunto(s)
Humanos , Masculino , Femenino , Adulto Joven , Adulto , Persona de Mediana Edad , Psicoterapia Breve/métodos , Síntomas Afectivos/terapia , Atención Primaria de Salud , Índice de Severidad de la Enfermedad , Método Simple Ciego , Escalas de Valoración Psiquiátrica , Resultado del Tratamiento , Análisis de Intención de Tratar
13.
BMC Geriatr ; 21(1): 160, 2021 03 05.
Artículo en Inglés | MEDLINE | ID: mdl-33663416

RESUMEN

BACKGROUND: Studies reported the relationship between behavioural and psychological symptoms of dementia (BPSD), cognitive function, caregiver burden, and therapeutic effects. However, the causal relationship between BPSD in community-dwelling patients with Alzheimer's disease (AD) and caregiver burden is yet to be established. This study aimed to classify BPSD in patients with AD and identify the relationship between BPSD and the factors affecting family caregiver burden. METHODS: Path analysis was conducted at a neurology outpatient clinic of a tertiary general hospital in South Korea. The medical records of 170 patients, aged ≥50 years, diagnosed with or suspected for AD were retrospectively reviewed. We investigated cognitive function (Korean version of the Mini-Mental-State Exam), dementia stages (Korean version of the Expanded Clinical Dementia Rating scale), depression (Short-form Geriatric Depression Scale-Korea), activities of daily living (ADL; Korean version of the Barthel Activities of Daily Living index), instrumental activities of daily living (IADL; Seoul-Instrumental Activities of Daily Living), and BPSD and caregiver burden (Korean Neuropsychiatric Inventory). Considering the characteristic features of BPSD with various symptoms, BPSD was classified using factor analysis. Factor extraction was performed using principal component analysis, followed by Varimax factor rotation. RESULTS: Mean total BPSD score was 17.66 ± 20.67, and the mean score for family caregiver burden was 9.65 ± 11.12. Symptom cluster-1 (hyperactivity symptoms) included disinhibition, irritability, and agitation/aggression. Symptom cluster-2 (psychosis symptoms) included hallucinations, anxiety, elation/euphoria, delusions, and depression/dysphoria. Symptom cluster-3 (physical behaviour symptoms) included appetite and eating abnormalities, apathy/indifference, aberrant motor behaviour, sleep, and night-time behaviour disturbances. Dementia stages, ADL, and IADL had indirect effects on family caregiver burden through hyperactivity, psychosis, and physical behaviour symptoms, indicating that BPSD exerted a complete mediating effect. CONCLUSIONS: Unlike previous studies, we classified BPSD symptoms into similar symptom clusters to evaluate its effect on caregiver burden, rather than collectively investigating the 12 symptoms of BPSD. As the dementia stage worsens, symptom clusters in BPSD serve as a medium between ADL and IADL degradation and for the increase in caregivers' burden. The development and implementation of therapeutic, nursing interventions, and policies focusing on dementia stages, ADL, and IADL, delaying and preventing BPSD can alleviate family caregivers' burden.


Asunto(s)
Enfermedad de Alzheimer , Demencia , Actividades Cotidianas , Anciano , Enfermedad de Alzheimer/diagnóstico , Enfermedad de Alzheimer/terapia , Cuidadores , Demencia/diagnóstico , Humanos , Escalas de Valoración Psiquiátrica , República de Corea , Estudios Retrospectivos
14.
J Affect Disord ; 286: 58-63, 2021 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-33677183

RESUMEN

BACKGROUND: The Montgomery-Åsberg Depression Rating Scale (MADRS) is commonly used to assess depression symptom changes in clinical trials; however, the score itself can be difficult to interpret without clinical context. Categories of depression severity corresponding to MADRS total score have not been established for bipolar depression, which was the objective of this study. METHODS: Data were pooled from 3 randomized, double-blind, placebo-controlled trials of cariprazine in patients with bipolar I depression; placebo and cariprazine arms were pooled. An anchor-based approach was used to map MADRS total score to the clinician-rated, 7-category Clinical Global Impression of Severity scale (CGI-S). Spearman's correlation coefficient was used to assess associations between MADRS total and CGI-S scores. Optimal MADRS severity thresholds for each CGI-S category was determined via Youden index using receiver operating characteristic (ROC) analyses. RESULTS: Using data from 1523 patients with bipolar depression, mean MADRS total scores were positively correlated with mean CGI-S scores at week 6 (r = 0.87; P<.0001). Using ROC curves, MADRS severity thresholds corresponding to each CGI-S category were estimated with high sensitivity and specificity: 0-6 for "normal, not at all ill", 7-12 for "borderline mentally ill", 13-18 for "mildly ill", 19-23 for "moderately ill", 24-36 for "markedly ill", 37-39 for "severely ill", and ≥40 for "extremely ill". CONCLUSIONS: Utilizing data from 3 clinical trials of patients with bipolar depression, MADRS severity thresholds were identified. These empirical findings may help clinicians contextualize MADRS results from bipolar clinical research and apply to their practice. TRIAL REGISTRATION: clinicaltrials.gov NCT01396447, NCT02670538, NCT02670551.


Asunto(s)
Trastorno Bipolar , Trastorno Bipolar/tratamiento farmacológico , Método Doble Ciego , Humanos , Escalas de Valoración Psiquiátrica , Resultado del Tratamiento
15.
BMC Geriatr ; 21(1): 180, 2021 03 12.
Artículo en Inglés | MEDLINE | ID: mdl-33711938

RESUMEN

BACKGROUND: Caregiver burden affects the caregiver's health and is related to the quality of care received by patients. This study aimed to determine the extent to which caregivers feel burdened when caring for patients with Alzheimer's Disease (AD) and to investigate the predictors for caregiving burden. METHODS: A cross-sectional study was conducted. One hundred two caregivers of patients with AD at Maharaj Nakorn Chiang Mai Hospital, a tertiary care hospital, were recruited. Assessment tools included the perceived stress scale (stress), PHQ-9 (depressive symptoms), Zarit Burden Interview-12 (burden), Clinical Dementia Rating (disease severity), Neuropsychiatric Inventory Questionnaires (neuropsychiatric symptoms), and Barthel Activities Daily Living Index (dependency). The mediation analysis model was used to determine any associations. RESULTS: A higher level of severity of neuropsychiatric symptoms (r = 0.37, p < 0.01), higher level of perceived stress (r = 0.57, p < 0.01), and higher level of depressive symptoms (r = 0.54, p < 0.01) were related to a higher level of caregiver burden. The direct effect of neuropsychiatric symptoms on caregiver burden was fully mediated by perceived stress and depressive symptoms (r = 0.13, p = 0.177), rendering an increase of 46% of variance in caregiver burden by this parallel mediation model. The significant indirect effect of neuropsychiatric symptoms by these two mediators was (r = 0.21, p = 0.001). CONCLUSION: Caregiver burden is associated with patients' neuropsychiatric symptoms indirectly through the caregiver's depressive symptoms and perception of stress. Early detection and provision of appropriate interventions and skills to manage stress and depression could be useful in reducing and preventing caregiver burden.


Asunto(s)
Enfermedad de Alzheimer , Depresión , Enfermedad de Alzheimer/diagnóstico , Cuidadores , Costo de Enfermedad , Estudios Transversales , Depresión/diagnóstico , Depresión/epidemiología , Humanos , Escalas de Valoración Psiquiátrica
16.
BMC Psychiatry ; 21(1): 171, 2021 03 26.
Artículo en Inglés | MEDLINE | ID: mdl-33771109

RESUMEN

BACKGROUND: Although social anxiety disorder is one of the most frequent disorders, it often remained unrecognized. Utilizing brief, yet reliable screening tools, such as the Social Interaction Anxiety Scale (SIAS-6) and the Social Phobia Scale (SPS-6) are helping to solve this problem in parts of Western Europe and the US. Still some countries, like Hungary, lag behind. For this purpose, previous studies call for further evidence on the applicability of the scales in various populations and cultures, as well as the elaborative validity of the short forms. Here, we aimed to provide a thorough analysis of the scales in five studies. We employed item response theory (IRT) to explore the psychometric properties of the SIAS-6 and the SPS-6 in Hungarian adults (n = 3213, age range:19-80) and adolescents (n = 292, age range:14-18). RESULTS: In both samples, IRT analyses demonstrated that the items of SIAS-6 and SPS-6 had high discriminative power and cover a wide range of the latent trait. Using various subsamples, we showed that (1) the scales had excellent convergent and divergent validity in relation to domains of anxiety, depression, and cognitive emotion regulation in both samples. Further, that (2) the scales discriminated those with a history of fainting or avoidance from those without such history. Lastly, (3) the questionnaires can discriminate people diagnosed with social anxiety disorder (n = 30, age range:13-71) and controls. CONCLUSIONS: These findings suggest that the questionnaires are suitable for screening for SAD in adults and adolescents. Although the confirmation of the two-factor structure may be indicative of the validity of the "performance only" specifier of SAD in DSM-V, the high correlation between the factors and the similar patter of convergent validity might indicate that it is not a discrete entity but rather a part of SAD; and that SAD is latently continuous.


Asunto(s)
Fobia Social , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Ansiedad/diagnóstico , Europa (Continente) , Humanos , Hungría , Persona de Mediana Edad , Fobia Social/diagnóstico , Escalas de Valoración Psiquiátrica , Psicometría , Reproducibilidad de los Resultados , Adulto Joven
17.
Arch Psychiatr Nurs ; 35(2): 172-177, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33781396

RESUMEN

BACKGROUND: The COVID-19 pandemic seriously endangers the public's mental health, especially to pregnant and postpartum women. But little is known about postpartum depression and health care needs among Chinese postpartum women. AIM: To investigate the status and risk factors of postpartum depression and health care needs among Chinese postpartum women during the COVID-19 pandemic. METHODS: In this cross-sectional study, 209 Chinese postpartum women were recruited from May to July 2020 by convenience sampling and assessed online with self-designed Maternal General Information Questionnaire, Edinburgh Postpartum Depression Scale (EPDS) and Chinese Version of the Perceived Stress Scale (CPSS). Descriptive statistics, chi-square test, independent samples t-test, one-way ANOVA, Pearson correlation and multiple linear regression were used for data analysis. RESULTS: With the EPDS cut-off value of 10, the incidence of postpartum depressive symptoms was 56.9%. Age, history of abortion and perceived stress were the influencing factors of postpartum depression (adjusted R2 = 0.432, F = 23.611, p < .001). The top three health care needs were infant rearing guidance (78.0%), maternal and infant protection guidance (60.3%) and dietary guidance (45.0%). The proportion of psychological rehabilitation guidance needs in the depressed group was significantly higher than that in the non-depressed group (34.5% vs. 20.0%, p < .05). CONCLUSIONS: Maternal postpartum depression in China was at a high level during the COVID-19 pandemic. Women aged 25-34, with a history of abortion and high stress levels were at higher risk for postpartum depression. Timely psychological counselling, intervention and COVID-19-related health education are in great need for postpartum women.


Asunto(s)
/psicología , Depresión Posparto/epidemiología , Necesidades y Demandas de Servicios de Salud , Complicaciones del Embarazo/epidemiología , Adulto , China/epidemiología , Estudios Transversales , Femenino , Humanos , Incidencia , Embarazo , Escalas de Valoración Psiquiátrica , Factores de Riesgo , Encuestas y Cuestionarios
18.
J Med Syst ; 45(4): 48, 2021 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-33646459

RESUMEN

Early identification of patients with life-threatening risks such as delirium is crucial in order to initiate preventive actions as quickly as possible. Despite intense research on machine learning for the prediction of clinical outcomes, the acceptance of the integration of such complex models in clinical routine remains unclear. The aim of this study was to evaluate user acceptance of an already implemented machine learning-based application predicting the risk of delirium for in-patients. We applied a mixed methods design to collect opinions and concerns from health care professionals including physicians and nurses who regularly used the application. The evaluation was framed by the Technology Acceptance Model assessing perceived ease of use, perceived usefulness, actual system use and output quality of the application. Questionnaire results from 47 nurses and physicians as well as qualitative results of four expert group meetings rated the overall usefulness of the delirium prediction positively. For healthcare professionals, the visualization and presented information was understandable, the application was easy to use and the additional information for delirium management was appreciated. The application did not increase their workload, but the actual system use was still low during the pilot study. Our study provides insights into the user acceptance of a machine learning-based application supporting delirium management in hospitals. In order to improve quality and safety in healthcare, computerized decision support should predict actionable events and be highly accepted by users.


Asunto(s)
Algoritmos , Toma de Decisiones Clínicas , Delirio/diagnóstico , Errores Diagnósticos/estadística & datos numéricos , Aprendizaje Automático/estadística & datos numéricos , Australia , Diagnóstico Diferencial , Registros Electrónicos de Salud/normas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Escalas de Valoración Psiquiátrica
19.
Medicine (Baltimore) ; 100(11): e25186, 2021 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-33726008

RESUMEN

ABSTRACT: The objective of this study was to ascertain changes in symptoms of patients with borderline personality disorder undergoing psychodynamic day treatment with a duration of 9 months and the factors that predict clinical outcome or dropouts from the program.In an observational study, demographic characteristics (age, number of psychiatric hospitalizations, number of suicide attempts, current involvement in work or study activities), day doses of antipsychotic and antidepressant medication, psychiatric symptoms, and social functioning (Health of the Nation Outcome Scales), and symptoms of dissociation (Dissociative Experiences Scale) were assessed in patients at the beginning of treatment (N = 105). Further, psychiatric symptoms and social functioning were assessed at 3 stages: beginning of the program, end of the program, and 1-year follow-up. To study the differences between baseline values and values at the end of the treatment and follow-up values, the Wilcoxon signed-rank test was used. To discover baseline factors related to the effect of the treatment, Spearman correlation coefficients were calculated. To evaluate the differences between patients who completed the program (N = 67) and patients who dropped out (N = 38), differences in baseline factors between both groups were compared, using the Mann-Whitney test for independent samples.Improvement in symptoms (Health of the Nation Outcome Scales - version for external evaluators) at the end of the therapy (N = 67, P < .001) and at the 1-year follow-up (N = 46, P < .001) was found. Experience of an intimate relationship was positively related to clinical improvement at follow-up examinations (P < .001). Predictors of dropout included a higher number of psychiatric hospitalizations (P = .004), suicide attempts (P = .004), more severe pretreatment symptoms (P = .002), and symptoms of dissociation (P = .046).The results indicate that a psychodynamic day treatment is feasible for the treatment of less clinically disturbed patients with a history of intimate relationships. Patients with a higher number of previous psychiatric hospitalizations, more suicide attempts in the past, more severe pretreatment symptoms, and symptoms of dissociation are more likely not to complete the program.


Asunto(s)
Trastorno de Personalidad Limítrofe/terapia , Centros de Día/métodos , Pacientes Desistentes del Tratamiento/estadística & datos numéricos , Psicoterapia Psicodinámica/métodos , Adulto , Estudios de Factibilidad , Femenino , Humanos , Masculino , Escalas de Valoración Psiquiátrica , Análisis de Regresión , Factores de Riesgo , Estadísticas no Paramétricas , Intento de Suicidio/estadística & datos numéricos , Resultado del Tratamiento
20.
Trials ; 22(1): 186, 2021 Mar 05.
Artículo en Inglés | MEDLINE | ID: mdl-33673867

RESUMEN

BACKGROUND: Depression and anxiety impact up to 1 in 5 pregnant and postpartum women worldwide. Yet, as few as 20% of these women are treated with frontline interventions such as evidence-based psychological treatments. Major barriers to uptake are the limited number of specialized mental health treatment providers in most settings, and problems with accessing in-person care, such as childcare or transportation. Task sharing of treatment to non-specialist providers with delivery on telemedicine platforms could address such barriers. However, the equivalence of these strategies to specialist and in-person models remains unproven. METHODS: This study protocol outlines the Scaling Up Maternal Mental healthcare by Increasing access to Treatment (SUMMIT) randomized trial. SUMMIT is a pragmatic, non-inferiority test of the comparable effectiveness of two types of providers (specialist vs. non-specialist) and delivery modes (telemedicine vs. in-person) of a brief, behavioral activation (BA) treatment for perinatal depressive and anxiety symptoms. Specialists (psychologists, psychiatrists, and social workers with ≥ 5 years of therapy experience) and non-specialists (nurses and midwives with no formal training in mental health care) were trained in the BA protocol, with the latter supervised by a BA expert during treatment delivery. Consenting pregnant and postpartum women with Edinburgh Postnatal Depression Scale (EPDS) score of ≥ 10 (N = 1368) will be randomized to one of four arms (telemedicine specialist, telemedicine non-specialist, in-person specialist, in-person non-specialist), stratified by pregnancy status (antenatal/postnatal) and study site. The primary outcome is participant-reported depressive symptoms (EPDS) at 3 months post-randomization. Secondary outcomes are maternal symptoms of anxiety and trauma symptoms, perceived social support, activation levels and quality of life at 3-, 6-, and 12-month post-randomization, and depressive symptoms at 6- and 12-month post-randomization. Primary analyses are per-protocol and intent-to-treat. The study has successfully continued despite the COVID-19 pandemic, with needed adaptations, including temporary suspension of the in-person arms and ongoing randomization to telemedicine arms. DISCUSSION: The SUMMIT trial is expected to generate evidence on the non-inferiority of BA delivered by a non-specialist provider compared to specialist and telemedicine compared to in-person. If confirmed, results could pave the way to a dramatic increase in access to treatment for perinatal depression and anxiety. TRIAL REGISTRATION: ClinicalTrials.gov NCT04153864 . Registered on November 6, 2019.


Asunto(s)
Ansiedad/terapia , Depresión Posparto/terapia , Depresión/terapia , Accesibilidad a los Servicios de Salud , Complicaciones del Embarazo/terapia , Psicoterapia/métodos , Telemedicina/métodos , Prestación de Atención de Salud/métodos , Estudios de Equivalencia como Asunto , Femenino , Humanos , Servicios de Salud Materna , Servicios de Salud Mental/organización & administración , Partería , Enfermeras y Enfermeros , Ensayos Clínicos Pragmáticos como Asunto , Embarazo , Escalas de Valoración Psiquiátrica , Psiquiatría , Psicología , Trabajadores Sociales , Especialización
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