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1.
Phys Med Rehabil Clin N Am ; 32(2): 405-418, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33814065

RESUMEN

With the evolution of the COVID-19 pandemic in the United States in March 2020, most ambulatory care environments rapidly pivoted to extensive use to telehealth to protect patients and providers while continuing to provide care. This shift resulted in the expansion of telehealth platforms and workflows. Many behavioral health services can be provided in a telehealth format. The case example in this article illustrates that transition to telehealth is feasible and sustainable. Limitations include preoperative psychological assessments and certain neuropsychological tests requiring material manipulation. Careful consideration of risk factors should be exerted for more vulnerable patient populations.


Asunto(s)
Accesibilidad a los Servicios de Salud , Trastornos Mentales/terapia , Psicoterapia/métodos , Telemedicina/métodos , /epidemiología , Humanos , Pruebas Neuropsicológicas , Pandemias
2.
Medicine (Baltimore) ; 100(14): e25443, 2021 Apr 09.
Artículo en Inglés | MEDLINE | ID: mdl-33832148

RESUMEN

OBJECTIVE: There is no systematic review or meta-analysis to evaluate the efficacy of adjuvant psychotherapy in early-stage bipolar disorder. Therefore, the goal of this meta-analysis is to examine the evidence supporting psychotherapy as an efficacious approach to treating bipolar disorder. METHODS: Seven electronic databases including Web of Science, Embase, PubMed, Wanfang Data, Scopus, Science Direct, Cochrane Library were searched in March 2021 by two independent reviewers. Data extraction was performed independently, and any conflict was resolved before final analysis. Only randomized clinical trials were included in this study. The trial entails 1 primary outcome measure (relapse) and several secondary outcome measures: time to relapse, relapse rate, days missed at work/school (record, interview), and social functioning level. The risk of bias assessment of the included studies was performed by 2 authors independently using the tool recommended in the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS: We hypothesized that combined psychotherapy and pharmacological interventions would be superior to pharmacological interventions alone regarding the time to relapse into a manic or depressive episode. CONCLUSION: This study expects to provide credible and scientific clinical evidence for the efficacy and safety of combined psychotherapy and pharmacological interventions in the treatment of bipolar disorder. OSF REGISTRATION NUMBER: 10.17605/OSF.IO/ZGS6W.


Asunto(s)
Trastorno Bipolar/terapia , Psicoterapia , Psicotrópicos/uso terapéutico , Protocolos Clínicos , Terapia Combinada , Humanos , Modelos Estadísticos , Resultado del Tratamiento
3.
BMC Psychol ; 9(1): 64, 2021 Apr 27.
Artículo en Inglés | MEDLINE | ID: mdl-33906688

RESUMEN

BACKGROUND: The prevalence of mental distress among university students in low- and middle-income countries (LMICs) is increasing; however, the majority do not receive evidence-based psychological intervention. This calls for the provision of culturally adapted psychological therapy in higher education institutions in LMICs. The aim of this pilot study is to evaluate the feasibility and acceptability of Interpersonal Psychotherapy adapted for Ethiopia (IPT-E) among Wolaita Sodo University students and to assess the preliminary outcomes of IPT-E in reducing symptoms of mental distress and in improving functioning. METHODS: We used a quasi-experimental single-group pre-post-test study design. As indicators of feasibility of IPT-E, we used consent, treatment completion and attrition. We used Client Satisfaction Questionnaire and semi-structured interview to measure the acceptability of the intervention, self-reporting IPT-E checklist to assess treatment adherence and World Health Organization Disability Assessment and Self-Reporting Questionnaire-20 tools to assess functional impairment and mental distress, respectively. We used percentage, frequency, mean and standard deviation to summarize the demographic variables, feasibility and acceptability of IPT-E. We analyzed changes from pre- to post-tests of mental distress and functioning results using paired t-test and Wilcoxon signed-rank tests. Independent sample t-test and one way-ANOVA used to assess the difference in mean score of in demographic variables at baseline and eight weeks. The qualitative data was analyzed with the support of open code 4.02. RESULTS: IPT-E was feasible (consent rate = 100%; completion rate = 92.31%; attrition rate = 7.69%; mean score of the sessions = 8 and mode of the session = 8). The total mean score of treatment satisfaction was 27.83 (SD = 4.47). After the delivery of IPT-E, symptoms of mental distress were decreased, functioning was improved and therapist adherence to the treatment model was 100% (i.e. treatment delivered according to the IPT-E guideline). CONCLUSION: IPT-E was feasible and acceptable to treat university students with mental distress in low-income country setting. The preliminary results also suggest promising viability of IPT-E in higher education institutions of low-income country setting for students with symptoms of anxiety and depression.


Asunto(s)
Psicoterapia Interpersonal , Etiopía , Estudios de Factibilidad , Humanos , Proyectos Piloto , Psicoterapia , Estudiantes , Universidades
4.
Artículo en Inglés | MEDLINE | ID: mdl-33802328

RESUMEN

Domestic abuse of women is a serious problem worldwide that has economic, physical, and psychological consequences, yet in many countries and cultures, victims often have little access to psychological support. Using a pre-post design, we investigated the effects of psychological intervention using an imagery-based therapy in women showing post-traumatic stress disorder (PTSD) resulting from spousal domestic abuse. Forty women, referred from outpatient clinics in Pakistan and meeting inclusion criteria, underwent individual trauma counseling for 10-12 weeks using the principles of Eidetic Therapy, an imagery-based therapy that circumvents heavy reliance on verbal skills and narratives. Women showed significant reductions in PTSD by the end of treatment. Predictors of treatment gains included type of abuse, PTSD level at the outset of therapy, and years in the relationship. Neither economic resources or literacy, nor abuser or victim characteristics, predicted the amount of improvement. In conclusion, therapy was associated with a reduction in PTSD symptoms regardless of literacy level of participants. This reduction in PTSD was notable because, unlike many situations involving spousal abuse, these women were generally not in a position to leave their relationship, and hence the women might have experienced continued exposure to abuse. Context/cultural-based explanations for these findings are presented and discussed.


Asunto(s)
Víctimas de Crimen , Trastornos por Estrés Postraumático , Femenino , Humanos , Pakistán , Proyectos Piloto , Psicoterapia , Trastornos por Estrés Postraumático/terapia
6.
Psychiatr Hung ; 36(2): 225-227, 2021.
Artículo en Húngaro | MEDLINE | ID: mdl-33870909

RESUMEN

No abstract available.


Asunto(s)
Psicoanálisis , Humanos , Psicoterapia
7.
Washington, D.C.; OPAS; 2021-03-09. (OPAS-W/FPL/IM/21-0007).
en Portugués | PAHO-IRIS | ID: phr-53357

RESUMEN

O Programa de Atenção Integrada para a Pessoa Idosa (ICOPE) foi desenvolvido pela Organização Mundial da Saúde (OMS) para atender às necessidades e demandas de saúde das populações idosas em todo o mundo. Em 2050, a proporção da população global com 60 anos ou mais quase dobrará. Nas Américas, a expectativa de vida aumentou 21,6 anos nas últimas seis décadas. No entanto, viver mais frequentemente significa enfrentar problemas de saúde acumulados durante a velhice. A transição demográfica afetará quase todos os aspectos da sociedade e criará novos e complexos desafios para os sistemas de saúde e assistência social. Portanto, é necessária uma abordagem transformadora na maneira como os sistemas de saúde e os serviços dentro deles são estruturados - para garantir cuidados de alta qualidade que sejam integrados, acessíveis e com foco nas necessidades e direitos das pessoas idosas. A atenção integrada, especialmente para as pessoas idosas e com condições crônicas de saúde, é amplamente aceita como um mecanismo para melhorar os resultados de saúde e a eficiência do sistema. O Manual ICOPE fornece orientações detalhadas para ajudar os profissionais de saúde e cuidadores da comunidade a colocar em prática a atenção integrada para a pessoa idosa, através do desenvolvimento de um plano de cuidados. Dessa forma, o manual auxilia na definição de metas centradas na pessoa e na integração de abordagens nos diferentes níveis de atenção. O plano de cuidados pode incluir várias intervenções para gerenciar declínios na capacidade intrínseca, fornecer assistência e apoio social, desenvolver capacidade para o automanejo e apoiar os cuidadores. A brochura ICOPE apresenta os destaques da abordagem ICOPE para facilitar a sua divulgação e favorecer uma ampla apresentação do método.


Asunto(s)
Anciano , Envejecimiento , Disciplinas de las Ciencias Biológicas , Dinámica Poblacional , Envejecimiento Saludable , Salud del Anciano , Personal de Salud , Servicios de Salud para Ancianos , Fenómenos Fisiológicos Nutricionales del Anciano , Cognición , Disfunción Cognitiva , Orientación , Psicoterapia , Remediación Cognitiva , Terapia Cognitivo-Conductual , Pruebas de Estado Mental y Demencia , Geriatría , Incontinencia Urinaria , Sensación , Suplementos Dietéticos , Accidentes por Caídas , Prevención y Mitigación , Prevención de Accidentes
8.
Lancet Digit Health ; 3(4): e231-e240, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33766287

RESUMEN

BACKGROUND: Common mental disorders can be effectively treated with psychotherapy, but some patients do not respond well and require timely identification to prevent treatment failure. We aimed to develop and validate a dynamic model to predict psychological treatment outcomes, and to compare the model with currently used methods, including expected treatment response models and machine learning models. METHODS: In this prediction model development and validation study, we obtained data from two UK studies including patients who had accessed therapy via Improving Access to Psychological Therapies (IAPT) services managed by ten UK National Health Service (NHS) Trusts between March, 2012, and June, 2018, to predict treatment outcomes. In study 1, we used data on patient-reported depression (Patient Health Questionnaire 9 [PHQ-9]) and anxiety (Generalised Anxiety Disorder 7 [GAD-7]) symptom measures obtained on a session-by-session basis (Leeds Community Healthcare NHS Trust dataset; n=2317) to train the Oracle dynamic prediction model using iterative logistic regression analysis. The outcome of interest was reliable and clinically significant improvement in depression (PHQ-9) and anxiety (GAD-7) symptoms. The predictive accuracy of the model was assessed in an external test sample (Cumbria Northumberland Tyne and Wear NHS Foundation Trust dataset; n=2036) using the area under the curve (AUC), positive predictive values (PPVs), and negative predictive values (NPVs). In study 2, we retrained the Oracle algorithm using a multiservice sample (South West Yorkshire Partnership NHS Foundation Trust, North East London NHS Foundation Trust, Cheshire and Wirral Partnership NHS Foundation Trust, and Cambridgeshire and Peterborough NHS Foundation Trust; n=42 992) and compared its performance with an expected treatment response model and five machine learning models (Bayesian updating algorithm, elastic net regularisation, extreme gradient boosting, support vector machine, and neural networks based on a multilayer perceptron algorithm) in an external test sample (Whittington Health NHS Trust; Barnet Enfield and Haringey Mental Health Trust; Pennine Care NHS Foundation Trust; and Humber NHS Foundation Trust; n=30 026). FINDINGS: The Oracle algorithm trained using iterative logistic regressions generalised well to external test samples, explaining up to 47·3% of variability in treatment outcomes. Prediction accuracy was modest at session one (AUC 0·59 [95% CI 0·55-0·62], PPV 0·63, NPV 0·61), but improved over time, reaching high prediction accuracy (AUC 0·81 [0·77-0·86], PPV 0·79, NPV 0·69) as early as session seven. The performance of the Oracle model was similar to complex (eg, including patient profiling variables) and computationally intensive machine learning models (eg, neural networks based on a multilayer perceptron algorithm, extreme gradient boosting). Furthermore, the predictive accuracy of a more simple dynamic algorithm including only baseline and index-session scores was comparable to more complex algorithms that included additional predictors modelling sample-level and individual-level variability. Overall, the Oracle algorithm significantly outperformed the expected treatment response model (mean AUC 0·80 vs 0·70, p<0·0001]). INTERPRETATION: Dynamic prediction models using sparse and readily available symptom measures are capable of predicting psychotherapy outcomes with high accuracy. FUNDING: University of Sheffield.


Asunto(s)
Algoritmos , Trastornos de Ansiedad/terapia , Depresión/terapia , Valor Predictivo de las Pruebas , Psicoterapia , Resultado del Tratamiento , Adolescente , Adulto , Femenino , Humanos , Aprendizaje Automático , Masculino , Persona de Mediana Edad , Programas Nacionales de Salud , Cuestionario de Salud del Paciente , Reino Unido , Adulto Joven
9.
Cochrane Database Syst Rev ; 3: CD013667, 2021 03 07.
Artículo en Inglés | MEDLINE | ID: mdl-33677832

RESUMEN

BACKGROUND: Self-harm (SH; intentional self-poisoning or self-injury regardless of degree of suicidal intent or other types of motivation) is a growing problem in most countries, often repeated, and associated with suicide. Evidence assessing the effectiveness of interventions in the treatment of SH in children and adolescents is lacking, especially when compared with the evidence for psychosocial interventions in adults. This review therefore updates a previous Cochrane Review (last published in 2015) on the role of interventions for SH in children and adolescents. OBJECTIVES: To assess the effects of psychosocial interventions or pharmacological agents or natural products for SH compared to comparison types of care (e.g. treatment-as-usual, routine psychiatric care, enhanced usual care, active comparator, placebo, alternative pharmacological treatment, or a combination of these) for children and adolescents (up to 18 years of age) who engage in SH. SEARCH METHODS: We searched the Cochrane Common Mental Disorders Specialized Register, the Cochrane Library (Central Register of Controlled Trials [CENTRAL] and Cochrane Database of Systematic Reviews [CDSR]), together with MEDLINE, Ovid Embase, and PsycINFO (to 4 July 2020). SELECTION CRITERIA: We included all randomised controlled trials (RCTs) comparing specific psychosocial interventions or pharmacological agents or natural products with treatment-as-usual (TAU), routine psychiatric care, enhanced usual care (EUC), active comparator, placebo, alternative pharmacological treatment, or a combination of these, in children and adolescents with a recent (within six months of trial entry) episode of SH resulting in presentation to hospital or clinical services. The primary outcome was the occurrence of a repeated episode of SH over a maximum follow-up period of two years. Secondary outcomes included treatment adherence, depression, hopelessness, general functioning, social functioning, suicidal ideation, and suicide. DATA COLLECTION AND ANALYSIS: We independently selected trials, extracted data, and appraised trial quality. For binary outcomes, we calculated odds ratios (ORs) and their 95% confidence internals (CIs). For continuous outcomes, we calculated the mean difference (MD) or standardised mean difference (SMD) and 95% CIs. The overall quality of evidence for the primary outcome (i.e. repetition of SH at post-intervention) was appraised for each intervention using the GRADE approach. MAIN RESULTS: We included data from 17 trials with a total of 2280 participants. Participants in these trials were predominately female (87.6%) with a mean age of 14.7 years (standard deviation (SD) 1.5 years). The trials included in this review investigated the effectiveness of various forms of psychosocial interventions. None of the included trials evaluated the effectiveness of pharmacological agents in this clinical population. There was a lower rate of SH repetition for DBT-A (30%) as compared to TAU, EUC, or alternative psychotherapy (43%) on repetition of SH at post-intervention in four trials (OR 0.46, 95% CI 0.26 to 0.82; N = 270; k = 4; high-certainty evidence). There may be no evidence of a difference for individual cognitive behavioural therapy (CBT)-based psychotherapy and TAU for repetition of SH at post-intervention (OR 0.93, 95% CI 0.12 to 7.24; N = 51; k = 2; low-certainty evidence). We are uncertain whether mentalisation based therapy for adolescents (MBT-A) reduces repetition of SH at post-intervention as compared to TAU (OR 0.70, 95% CI 0.06 to 8.46; N = 85; k = 2; very low-certainty evidence). Heterogeneity for this outcome was substantial ( I² = 68%). There is probably no evidence of a difference between family therapy and either TAU or EUC on repetition of SH at post-intervention (OR 1.00, 95% CI 0.49 to 2.07; N = 191; k = 2; moderate-certainty evidence). However, there was no evidence of a difference for compliance enhancement approaches on repetition of SH by the six-month follow-up assessment, for group-based psychotherapy at the six- or 12-month follow-up assessments, for a remote contact intervention (emergency cards) at the 12-month assessment, or for therapeutic assessment at the 12- or 24-month follow-up assessments. AUTHORS' CONCLUSIONS: Given the moderate or very low quality of the available evidence, and the small number of trials identified, there is only uncertain evidence regarding a number of psychosocial interventions in children and adolescents who engage in SH. Further evaluation of DBT-A is warranted. Given the evidence for its benefit in adults who engage in SH, individual CBT-based psychotherapy should also be further developed and evaluated in children and adolescents.


Asunto(s)
Mentalización , Psicoterapia/métodos , Conducta Autodestructiva/terapia , Adolescente , Sesgo , Niño , Terapia Cognitivo-Conductual/métodos , Intervalos de Confianza , Depresión/terapia , Terapia Conductual Dialéctica/métodos , Terapia Familiar , Femenino , Humanos , Masculino , Oportunidad Relativa , Cooperación del Paciente , Ensayos Clínicos Controlados Aleatorios como Asunto , Recurrencia , Prevención Secundaria/métodos , Conducta Autodestructiva/prevención & control , Conducta Autodestructiva/psicología , Ideación Suicida , Resultado del Tratamiento
10.
Biol Psychiatry ; 89(9): 847-856, 2021 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-33691931

RESUMEN

Brain systems that promote maintenance of homeostasis in the face of stress have significant adaptive value. A growing body of work across species demonstrates a critical role for the amygdala in promoting homeostasis by regulating physiological and behavioral responses to stress. This review focuses on an emerging body of evidence that has begun to delineate the contribution of specific long-range amygdala circuits in mediating the effects of stress. After summarizing the major anatomical features of the amygdala and its connectivity to other limbic structures, we discuss recent findings from rodents showing how stress causes structural and functional remodeling of amygdala neuronal outputs to defined cortical and subcortical target regions. We also consider some of the environmental and genetic factors that have been found to moderate how the amygdala responds to stress and relate the emerging preclinical literature to the current understanding of the pathophysiology and treatment of stress-related neuropsychiatric disorders. Future effort to translate these findings to clinics may help to develop valuable tools for prevention, diagnosis, and treatment of these diseases.


Asunto(s)
Trastornos por Estrés Postraumático , Amígdala del Cerebelo , Encéfalo , Corteza Cerebral , Humanos , Psicoterapia
11.
Value Health ; 24(3): 421-430, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33641777

RESUMEN

OBJECTIVES: Recent evidence suggests that e-mental health interventions can be effective at improving mental health but that there is still a notable hesitation among patients to use them. Previous research has revealed that they are perceived by patients as being less helpful than face-to-face psychotherapy. The reasons for this unfavorable perception are, however, not yet well understood. The aim of our study was to address this question by eliciting preferences for individual components of e-mental health interventions in a discrete choice experiment. METHODS: Using a stepwise qualitative approach, we developed the following 5 attributes of eMHIs: introductory training, human contact, peer support, proven effectiveness, content delivery, and price. Additionally, we asked questions about respondents' demographics, attitudes, and previous experience of traditional psychotherapy, as well as their distress level. RESULTS: A total of 1984 respondents completed the survey. Using mixed logit models, we found that personal contact with a psychotherapist in blended care, proven effectiveness, and low price were highly valued by participants. Participants were indifferent toward the mode of content delivery but showed a slight preference for introductory training via phone, as well as for peer support via online forum alongside coach-led group meetings on site. DISCUSSION: Our results suggest a clear preference for blended care that includes face-to-face contact with a psychotherapist. This preference remained stable irrespective of sociodemographics, previous experience of psychotherapy, distress level, and the 2 context scenarios used in our discrete choice experiment. Further investigations looking at the potential benefits and risks of blended care are needed.


Asunto(s)
Trastornos Mentales/terapia , Prioridad del Paciente/psicología , Psicoterapia/organización & administración , Telemedicina/organización & administración , Adulto , Anciano , Actitud Frente a la Salud , Conducta de Elección , Técnicas de Apoyo para la Decisión , Femenino , Humanos , Aprendizaje , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Grupo Paritario , Factores Socioeconómicos
12.
Psychiatr Hung ; 36(1): 81-90, 2021.
Artículo en Húngaro | MEDLINE | ID: mdl-33686017

RESUMEN

The purpose of this study is to provide insight into the work of the art therapy groups in the Tündérhegy Psychotherapy Department, the possibilities of integrating images into the therapeutic process. It covers questions such as: How can art therapy fit into the work of a Department of Psychotherapy? How do psychodynamic processes appear in art therapy groups? How can the image help to understand and explore something? Why is it important to include in a Department's psychotherapeutic work non-verbal therapies as well as verbal therapies? I would also like to present my own observations, namely that in the case of patients with a personality disorder, body image plays a prominent role in the process of art therapy. In their case, the body plays a central role in self-represen - tations due to the impairment of the mentalization ability, and experiences are often written on the body. I present the above mentioned questions and the role of body image in the art therapy process on two case studies.


Asunto(s)
Terapia con Arte , Psicoterapia , Imagen Corporal , Humanos , Sensación
13.
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
14.
Artículo en Inglés | MEDLINE | ID: mdl-33671189

RESUMEN

Background: Individuals suffering from major depressive disorder (MDD) often describe workplace-related stress as one of the main causes of their disorder. Here, we present the story of a 33 year old "Bob" (a pseudonym) who suffered from a moderate (Hamilton-21 = 18) major depressive episode. Workplace-related stress seemed to be the main stressor for Bob at the time. We were interested in long-lasting effects of a newly established group called "work-related interpersonal Psychotherapy, W-IPT". W-IPT consists of eight weekly 90 min sessions. The follow-ups were 12 weeks after the group-treatment and 18 months later. Bob was chosen because he agreed in advance to participate in a follow-up. We were interested if the group-treatment of W-IPT also has a persistent positive effect. Case presentation: We present the case of a 33-year-old man "Bob". He was included in our previous published pilot-study 2020 with diagnosed moderate MDD, and he attended the group treatment. This case report focuses on a follow-up period of 18 months. A structured clinical interview for DSM-IV was carried out in order to be included in the study, and no comorbid diagnoses were detected. Conclusions: However, the psychotherapeutic effects in this case seem enduring and prolonged. Of course, additional research to study the long-term effects of W-IPT is needed, and more patients need to be included.


Asunto(s)
Trastorno Depresivo Mayor , Psicoterapia de Grupo , Adulto , Trastorno Depresivo Mayor/terapia , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Humanos , Masculino , Proyectos Piloto , Psicoterapia , Resultado del Tratamiento
15.
J Psychiatr Pract ; 27(2): 121-125, 2021 03 05.
Artículo en Inglés | MEDLINE | ID: mdl-33656818

RESUMEN

There have been shifts over time in the value placed on long-term psychotherapeutic modalities even though they can be life-saving. For example, the province of Ontario in Canada has been dealing with a government proposal put forward in 2019 to limit the length of psychotherapy treatment. In response, stakeholders from numerous groups came together to advocate for the importance of continuing unrestricted access to long-term psychotherapy. Approaches to this advocacy then had to unexpectedly adapt to the Coronavirus Disease 2019 (COVID-19) pandemic that came to the forefront in 2020 and will continue to develop in response to this changing landscape.


Asunto(s)
Defensa del Consumidor , Política de Salud/legislación & jurisprudencia , Salud Mental/legislación & jurisprudencia , Psicoterapia/legislación & jurisprudencia , Psicoterapia/métodos , Humanos , Ontario , Pandemias , Factores de Tiempo
16.
JAMA ; 325(9): 865-877, 2021 Mar 02.
Artículo en Inglés | MEDLINE | ID: mdl-33651094

RESUMEN

Importance: The prevalence of irritable bowel syndrome (IBS) in the United States is between 7% and 16%, most common in women and young people, with annual direct costs estimated at more than $1 billion dollars in the United States. Traditionally, the diagnosis of IBS has been based on the positive identification of symptoms that correlate with several different syndromes associated with disorders such as IBS diarrhea, IBS constipation, functional diarrhea, functional constipation, chronic functional abdominal pain, or bloating. Several peripheral and central mechanisms initiate gastrointestinal motor and sensory dysfunctions leading to IBS symptoms. Those dysfunctions may require evaluation in patients whose symptoms do not respond to first-line treatments. Observations: Validation studies of consensus symptom-based criteria have identified deficiencies that favor a simpler identification of the predominant symptoms of abdominal pain, bowel dysfunction, and bloating and exclusion of alarm symptoms such as unintentional weight loss, rectal bleeding, or recent change in bowel function. Symptom-based diagnosis of IBS is enhanced with additional history for symptoms of somatoform and psychological disorders and alarm symptoms, physical examination including digital rectal examination, and screening tests to exclude organic disease (by measuring hemoglobin and C-reactive protein concentrations). The initial treatment plan should include patient education, reassurance, and first-line treatments such as fiber and osmotic laxatives for constipation, opioids for diarrhea, antispasmodics for pain and for management of associated psychological disorders. For patients who do not respond to those IBS treatments, testing for specific functional disorders may be required in a minority of patients with IBS. These disorders include rectal evacuation disorder, abnormal colonic transit, and bile acid diarrhea. Their identification is followed by individualized treatment, such as pelvic floor retraining for rectal evacuation disorders, sequestrants for bile acid diarrhea, and secretory agents for constipation, although there is only limited evidence that this individualized management approach is effective. Conclusions and Relevance: Advances in the identification of specific dysfunctions as causes of individual symptoms in the "IBS spectrum" leads to the potential to enhance the diagnosis and management of symptoms for the majority of patients for whom first-line therapies of IBS and management of comorbid psychological disorders are insufficient.


Asunto(s)
Síndrome del Colon Irritable/diagnóstico , Síndrome del Colon Irritable/terapia , Dolor Abdominal/tratamiento farmacológico , Analgésicos Opioides/uso terapéutico , Antidiarreicos/uso terapéutico , Diagnóstico Diferencial , Dietoterapia , Fibras de la Dieta/uso terapéutico , Suplementos Dietéticos , Humanos , Laxativos/uso terapéutico , Psicoterapia
17.
J Affect Disord ; 286: 340-350, 2021 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-33773217

RESUMEN

BACKGROUND: Many depressed patients are treated in institutional settings. The number of studies focusing on psychotherapies for depressed patients in institutional settingsis limited, and only a few up-to-date meta-analyses have integrated the results of these studies. METHODS: We conducted a meta-analysis of 32 randomized trials with 37 comparisons between psychotherapy and control conditions, examining the effects of psychotherapy for adult patients in institutional settings with depressive disorders. RESULTS: We found that psychotherapy had a significant, small to moderate effect on depressive symptoms (g=0.42; 95% CI: 0.29~0.56), with low to moderate heterogeneity (I2=33; 95% CI: 0~55). The effects remained small but significant after adjustment for publication bias (g=0.27; 95% CI: 0.12~0.42) and in the studies with low risk of bias (g=0.32; 95% CI: 0.11~0.52). The effects were largely retained at 9 to 15 months follow-up and still significant, again after adjustment for publication bias and in studies with low risk of bias. We found no significant difference across types of institutional settings, including psychiatric inpatient settings and nursing homes, although no studies with a low risk of bias were available in nursing homes. LIMITATIONS: We included different types of institutional settings, although we did not find a significant difference between settings. The number of studies was small and risk of bias was high in a considerable number of trials. CONCLUSIONS: This meta-analysis provides evidence for a small to moderate and sustained effect of psychotherapy in patients in institutional settings with depression.


Asunto(s)
Depresión , Psicoterapia , Adulto , Sesgo , Depresión/terapia , Humanos
19.
Sr Care Pharm ; 36(4): 191-206, 2021 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-33766192

RESUMEN

OBJECTIVE: To review the clinical manifestations and treatment of post-traumatic stress disorder (PTSD) in adults and older people. DATA SOURCES: Articles indexed in PubMed, Embase, psychology databases, and the Cochrane library over the past 10 years using the key words "post-traumatic stress disorder," "stress disorders," and "post-traumatic stress disorder and treatment." STUDY SELECTION AND DATA EXTRACTION: Sixty-seven publications were reviewed and criteria supporting the primary objective were used to identify useful resources. DATA SYNTHESIS: The literature included practice guidelines; review articles; original research articles; and product prescribing information for the clinical manifestations, diagnosis, and treatment of PTSD. CONCLUSION: Psychotherapy is the first-line therapy for PTSD. Pharmacologic therapy is recommended, as second-line therapy, for adults living with PTSD who do not have access to psychotherapy or refuse psychotherapy. Pharmacologic therapy may also be considered in cases of partial, or no, response to psychotherapy. Current guidelines recommend prescribing one of 3 selective serotonin-reuptake inhibitors, either fluoxetine, paroxetine, or sertraline, or prescribing the serotonin norepinephrine reuptake inhibitor venlafaxine, for adult patients who do not have access to psychotherapy or prefer not to use psychotherapy. Unfortunately, these recommended medications have additional cautions for use in older people so may not be appropriate for many older people living with PTSD. Therapy for older people should be tailored to patient-specific symptoms, with careful consideration of the potential benefits and risks of the therapy and coexisting medical conditions of each patient.


Asunto(s)
Psicoterapia/métodos , Inhibidores de la Captación de Serotonina/uso terapéutico , Inhibidores de Captación de Serotonina y Norepinefrina/uso terapéutico , Trastornos por Estrés Postraumático/terapia , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/epidemiología , Resultado del Tratamiento
20.
Am Fam Physician ; 103(7): 417-421, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33788523

RESUMEN

Suicide rates in the United States increased from 20% to 30% between 2005 and 2015, and family physicians need evidence-based resources to address this growing clinical concern. Asking high-risk patients (e.g., patients with previous suicide attempts, substance misuse, low social support) about suicidal intent leads to better outcomes and does not increase the risk of suicide. There is insufficient evidence to support routine screening. Important elements of the patient history include the intent, plan, and means; availability of social support; previous attempts; and the presence of comorbid psychiatric illness or substance misuse. After intent has been established, inpatient and outpatient management should include ensuring patient safety and medical stabilization, activating support networks, and initiating therapy for psychiatric diseases. Care plans for patients with chronic suicidal ideation include these same steps and referral for specialty care. In the event of a completed suicide, physicians should provide support for family members who may be experiencing grief complicated by guilt, while also activating support networks and risk management systems.


Asunto(s)
Guías de Práctica Clínica como Asunto , Ideación Suicida , Suicidio/prevención & control , Antidepresivos/uso terapéutico , Antimaníacos/uso terapéutico , Antipsicóticos/uso terapéutico , Clozapina/uso terapéutico , Medicina Familiar y Comunitaria , Humanos , Compuestos de Litio/uso terapéutico , Tamizaje Masivo , Planificación de Atención al Paciente , Psicoterapia , Medición de Riesgo , Suicidio/estadística & datos numéricos
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