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1.
Medicine (Baltimore) ; 99(11): e19527, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32176105

RESUMEN

OBJECTIVE: Cognitive enhancers, including cholinesterase inhibitors and memantine, are used to treat dementia, but their effect for reducing post-electroconvulsive therapy (post-ECT) cognitive side effects is unclear. We conducted a systematic review and meta-analysis to assess the effectiveness of cognitive enhancers in the prevention of cognitive side effects due to ECT. METHODS: We identified relevant studies by searching electronic databases (e.g., PubMed, EMBASE, Web of Science, Cochrane Library). Only studies published up to October 2019 comparing cognitive enhancer vs placebo for cognitive function after ECT were included. The primary outcome extracted from the studies was cognitive function score. RESULTS: Five studies with 202 patients were included in this study. The cognitive enhancer group (CEG) had a significantly higher cognitive function score. Moreover, sensitivity analysis showed that no individual study had a significant impact on the overall results. CONCLUSIONS: This meta-analysis revealed that cognitive enhancers might improve cognitive function and reduce ECT-induced cognitive side effects. Nevertheless, more high-quality randomized controlled trials (RCTs) with long-term follow-up are still needed to make the final conclusion.


Asunto(s)
Trastornos del Conocimiento/prevención & control , Cognición , Trastorno Depresivo/terapia , Terapia Electroconvulsiva/efectos adversos , Nootrópicos/administración & dosificación , Humanos , Periodo Preoperatorio , Sustancias Protectoras/administración & dosificación
2.
PLoS One ; 15(2): e0228749, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32023308

RESUMEN

More than 10% of the population will suffer from a depressive disorder during their lifetime, which represents a substantial economic and social burden for healthcare systems and societies. Nonetheless, studies suggest that an important percentage of patients receive inadequate treatment. This study aimed to evaluate the characteristics of patients with depressive disorder in Spain, the current management of these disorders and the costs of specialised care. A retrospective multicentre study was designed including admission records from patients admitted due to a depressive disorder between 2011 and 2016, extracted from a Spanish claims database. The records obtained corresponded to 306,917 patients attended in primary care centres and 27,963 patients registered in specialised care settings. The number of admissions per patient progressively increased over the study period. A correlation was found with socioeconomic factors as the unemployment rate, increased versus the general population (OR = 1.41; 95%CI = 1.38-1.43). Equally, comorbid conditions as hypertension, disorders of lipoid metabolism, diabetes type II, other mood disorders and thyroid disorders were associated with severe presentations of a depressive disorder. In terms of disease management, patients with a severe disorder were the majority in specialised care settings, and most admissions were urgent and inpatient admissions. The use of both electroconvulsive therapy and drug therapy increased during the study period. In terms of costs, specialised care represented an annual cost of €9,654 per patient, and a total annual cost of €44,839,196. Altogether, improved detection and treatment protocols could contribute in reducing the burden that depressive disorders represent for the Spanish National Healthcare System.


Asunto(s)
Trastorno Depresivo/economía , Costos de la Atención en Salud/estadística & datos numéricos , Medicina/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Trastorno Depresivo/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , España
3.
Am J Psychother ; 73(1): 22-28, 2020 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-32050785

RESUMEN

Family-based interpersonal psychotherapy (FB-IPT) is an evidence-based psychosocial intervention for depression in preadolescents (ages 8-12 years). Adapted from interpersonal psychotherapy for adolescents with depression and modified for younger children, this therapy includes structured dyadic sessions with preadolescents and their parents, guidance for parents in supporting their children and decreasing negative parent-child interactions, and a focus on preadolescents' comorbid anxiety and peer relationships. This article reviews the conceptual foundations and risk factors related to preadolescent depression and the rationale for focusing on improving preadolescents' interpersonal relationships to decrease depressive symptoms and risk for depression during adolescence. The structure and goals for the initial, middle, and termination phases of FB-IPT are described, as well as the specific communication and problem-solving strategies presented to preadolescents and parents. Last, research on the efficacy of FB-IPT is summarized, as are future directions for implementing this promising psychosocial intervention for preadolescent depression in community settings.


Asunto(s)
Depresión/terapia , Trastorno Depresivo/terapia , Terapia Familiar , Psicoterapia Interpersonal , Ansiedad/complicaciones , Niño , Depresión/complicaciones , Depresión/psicología , Trastorno Depresivo/complicaciones , Trastorno Depresivo/psicología , Humanos , Relaciones Interpersonales , Grupo Paritario
4.
Medicine (Baltimore) ; 99(6): e18480, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32028385

RESUMEN

This study aimed to synthetically evaluate the impact of intensive patients' education program (IEP) on anxiety, depression and patient global assessment (PGA) in diabetic foot ulcer (DFU) patients.One hundred eighty DFU patients with Wagner grade 1 and Wagner grade 2 were consecutively recruited in this randomized, controlled study and randomly assigned to IEP group (N = 90) or control group (N = 90) as 1:1 ratio. In the IEP group, patients received the IEP and usual care, and patients in the control group received usual care only. IEP included educating patients and their family members, supervising patients' harmful habits and diets, psychological care for the patients and establishing a patient-physician-nurse WeChat group. Hospital Anxiety and Depression Scale-anxiety/depression (HADS-A/D) and Zung Self-Rating Anxiety/depression Scale (SAS/SDS) were applied to assess anxiety/depression at M0-M3. PGA score was also assessed at M0-M3.For anxiety assessment, IEP group presented decreased HADS-A/SAS scores at M2/M3 and increased HADS-A/SAS score changes (M3-M0) compared to control group. For depression assessment, IEP group displayed reduced HADS-D/SDS scores at M2/M3 and raised SDS score change (M3-M0) compared to control group. Moreover, IEP group exhibited reduced PGA score at M1/M2/M3 and elevated PGA score change (M3-M0) compared to control group. Further subgroup analyses disclosed that IEP reduced HADS-A/SAS/HADS-D/PGA scores at M3 and elevated these score changes (M3-M0) in patients with Wagener grade 2 but not Wagener grade 1.IEP ameliorates anxiety, depression and PGA in DFU patients with Wagner grade 2 but not Wagner grade 1.


Asunto(s)
Trastornos de Ansiedad/terapia , Trastorno Depresivo/terapia , Pie Diabético/psicología , Educación del Paciente como Asunto , Pie Diabético/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Psicometría , Índice de Severidad de la Enfermedad , Resultado del Tratamiento
5.
Medicine (Baltimore) ; 99(6): e18774, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32028389

RESUMEN

BACKGROUND/OBJECTIVE: The study's objective was to determine the efficacy of guided internet-assisted intervention (GIAI) on depression reduction among educational technology students of Nigerian universities. METHODS: The design of the study was a 10-weeks group-randomized trial (GRT) which involved a pre-test, post-test, and follow-up assessment. A total of 192 educational technology students who were identified as having depression formed the sample of the study. Beck's Depression Inventory-II (BDI-II) was the measure used for data collection in the study. Data collected were analyzed using ANOVA with repeated measures. RESULTS: The initial assessment results showed that the participants in both treatment and usual-care control groups had depression. After 10-weeks participation in GIAI, the assessment results showed a significant reduction in depression among students in the treatment group when compared to those in the usual-care control group. The follow-up assessment indicated a further significant reduction in the depression among participants in the treatment group when compared to those in the usual-care control group. CONCLUSION: The authors concluded that GIAI was significantly effective in reducing depression among university students in the treatment group compared to those in the usual-care control group. Therefore, educational technologists, counselors, psychologists, health workers, and other social workers should adopt educational intervention using GIAI in helping university students undergo depression reduction.


Asunto(s)
Trastorno Depresivo/terapia , Estudiantes/psicología , Telemedicina , Adolescente , Adulto , Terapia Cognitivo-Conductual , Tecnología Educacional , Femenino , Humanos , Internet , Masculino , Nigeria , Psicometría , Resultado del Tratamiento , Universidades , Adulto Joven
6.
Cochrane Database Syst Rev ; 1: CD003437, 2020 01 28.
Artículo en Inglés | MEDLINE | ID: mdl-31989584

RESUMEN

BACKGROUND: Depression is an important morbidity associated with stroke that impacts on recovery yet often undetected or inadequately treated. This is an update and expansion of a Cochrane Review first published in 2004 and updated in 2008. OBJECTIVES: Primary objective • To determine whether pharmacological therapy, non-invasive brain stimulation, psychological therapy, or combinations of these interventions reduce the prevalence of diagnosable depression after stroke Secondary objectives • To determine whether pharmacological therapy, non-invasive brain stimulation, psychological therapy, or combinations of these interventions reduce levels of depressive symptoms, improve physical and neurological function and health-related quality of life, and reduce dependency after stroke • To assess the safety of and adherence to such treatments SEARCH METHODS: We searched the Specialised Registers of Cochrane Stroke and Cochrane Depression Anxiety and Neurosis (last searched August 2018), the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 1), in the Cochrane Library, MEDLINE (1966 to August 2018), Embase (1980 to August 2018), the Cumulative Index to Nursing and Alllied Health Literature (CINAHL) (1982 to August 2018), PsycINFO (1967 to August 2018), and Web of Science (2002 to August 2018). We also searched reference lists, clinical trial registers (World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) to August 2018; ClinicalTrials.gov to August 2018), and conference proceedings, and we contacted study authors. SELECTION CRITERIA: Randomised controlled trials comparing (1) pharmacological interventions with placebo; (2) one of various forms of non-invasive brain stimulation with sham stimulation or usual care; (3) one of various forms of psychological therapy with usual care and/or attention control; (4) pharmacological intervention and various forms of psychological therapy with pharmacological intervention and usual care and/or attention control; (5) non-invasive brain stimulation and pharmacological intervention with pharmacological intervention and sham stimulation or usual care; (6) pharmacological intervention and one of various forms of psychological therapy with placebo and psychological therapy; (7) pharmacological intervention and non-invasive brain stimulation with placebo plus non-invasive brain stimulation; (8) non-invasive brain stimulation and one of various forms of psychological therapy versus non-invasive brain stimulation plus usual care and/or attention control; and (9) non-invasive brain stimulation and one of various forms of psychological therapy versus sham brain stimulation or usual care plus psychological therapy, with the intention of treating depression after stroke. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies, assessed risk of bias, and extracted data from all included studies. We calculated mean difference (MD) or standardised mean difference (SMD) for continuous data, and risk ratio (RR) for dichotomous data, with 95% confidence intervals (CIs). We assessed heterogeneity using the I² statistic and certainty of the evidence according to GRADE. MAIN RESULTS: We included 49 trials (56 comparisons) with 3342 participants. Data were available for: (1) pharmacological interventions with placebo (with 20 pharmacological comparisons); (2) one of various forms of non-invasive brain stimulation with sham stimulation or usual care (with eight non-invasive brain stimulation comparisons); (3) one of various forms of psychological therapy with usual care and/or attention control (with 16 psychological therapy comparisons); (4) pharmacological intervention and various forms of psychological therapy with pharmacological intervention and usual care and/or attention control (with two comparisons); and (5) non-invasive brain stimulation and pharmacological intervention with pharmacological intervention and sham stimulation or usual care (with 10 comparisons). We found no trials for the following comparisons: (6) pharmacological intervention and various forms of psychological therapy interventions versus placebo and psychological therapy; (7) pharmacological intervention and non-invasive brain stimulation versus placebo plus non-invasive brain stimulation; (8) non-invasive brain stimulation and one of various forms of psychological therapy versus non-invasive brain stimulation plus usual care and/or attention control; and (9) non-invasive brain stimulation and one of various forms of psychological therapy versus sham brain stimulation or usual care plus psychological therapy. Treatment effects observed: very low-certainty evidence from eight trials suggests that pharmacological interventions decreased the number of people meeting study criteria for depression (RR 0.70, 95% CI 0.55 to 0.88; 1025 participants) at end of treatment, and very low-certainty evidence from six trials suggests that pharmacological interventions decreased the number of people with less than 50% reduction in depression scale scores at end of treatment (RR 0.47, 95% CI 0.32 to 0.69; 511 participants) compared to placebo. No trials of non-invasive brain stimulation reported on meeting study criteria for depression at end of treatment. Only one trial of non-invasive brain stimulation reported on the outcome <50% reduction in depression scale scores; thus, we were unable to perform a meta-analysis for this outcome. Very low-certainty evidence from six trials suggests that psychological therapy decreased the number of people meeting the study criteria for depression at end of treatment (RR 0.77, 95% CI 0.62 to 0.95; 521 participants) compared to usual care/attention control. No trials of combination therapies reported on the number of people meeting the study criteria for depression at end of treatment. Only one trial of combination (non-invasive brain stimulation and pharmacological intervention) therapy reported <50% reduction in depression scale scores at end of treatment. Thus, we were unable to perform a meta-analysis for this outcome. Five trials reported adverse events related to the central nervous system (CNS) and noted significant harm in the pharmacological interventions group (RR 1.55, 95% CI 1.12 to 2.15; 488 participants; very low-certainty evidence). Four trials found significant gastrointestinal adverse events in the pharmacological interventions group (RR 1.62, 95% CI 1.19 to 2.19; 473 participants; very low-certainty evidence) compared to the placebo group. No significant deaths or adverse events were found in the psychological therapy group compared to the usual care/attention control group. Non-invasive brain stimulation interventions and combination therapies resulted in no deaths. AUTHORS' CONCLUSIONS: Very low-certainty evidence suggests that pharmacological or psychological therapies can reduce the prevalence of depression. This very low-certainty evidence suggests that pharmacological therapy, psychological therapy, non-invasive brain stimulation, and combined interventions can reduce depressive symptoms. Pharmacological intervention was associated with adverse events related to the CNS and the gastrointestinal tract. More research is required before recommendations can be made about the routine use of such treatments.


Asunto(s)
Antidepresivos/uso terapéutico , Trastorno Depresivo/terapia , Terapia por Estimulación Eléctrica/métodos , Psicoterapia/métodos , Accidente Cerebrovascular/psicología , Trastorno Depresivo/etiología , Humanos , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto
7.
Lancet Psychiatry ; 7(2): 173-190, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31981539

RESUMEN

BACKGROUND: Evidence on the effectiveness of psychological interventions for women with common mental disorders (CMDs) who also experience intimate partner violence is scarce. We aimed to test our hypothesis that exposure to intimate partner violence would reduce intervention effectiveness for CMDs in low-income and middle-income countries (LMICs). METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PsycINFO, Web of Knowledge, Scopus, CINAHL, LILACS, ScieELO, Cochrane, PubMed databases, trials registries, 3ie, Google Scholar, and forward and backward citations for studies published between database inception and Aug 16, 2019. All randomised controlled trials (RCTs) of psychological interventions for CMDs in LMICs which measured intimate partner violence were included, without language or date restrictions. We approached study authors to obtain unpublished aggregate subgroup data for women who did and did not report intimate partner violence. We did separate random-effects meta-analyses for anxiety, depression, post-traumatic stress disorder (PTSD), and psychological distress outcomes. Evidence from randomised controlled trials was synthesised as differences between standardised mean differences (SMDs) for change in symptoms, comparing women who did and who did not report intimate partner violence via random-effects meta-analyses. The quality of the evidence was assessed with the Cochrane risk of bias tool. This study is registered on PROSPERO, number CRD42017078611. FINDINGS: Of 8122 records identified, 21 were eligible and data were available for 15 RCTs, all of which had a low to moderate risk of overall bias. Anxiety (five interventions, 728 participants) showed a greater response to intervention among women reporting intimate partner violence than among those who did not (difference in standardised mean differences [dSMD] 0·31, 95% CI 0·04 to 0·57, I2=49·4%). No differences in response to intervention were seen in women reporting intimate partner violence for PTSD (eight interventions, n=1436; dSMD 0·14, 95% CI -0·06 to 0·33, I2=42·6%), depression (12 interventions, n=2940; 0·10, -0·04 to 0·25, I2=49·3%), and psychological distress (four interventions, n=1591; 0·07, -0·05 to 0·18, I2=0·0%, p=0·681). INTERPRETATION: Psychological interventions treat anxiety effectively in women with current or recent intimate partner violence exposure in LMICs when delivered by appropriately trained and supervised health-care staff, even when not tailored for this population or targeting intimate partner violence directly. Future research should investigate whether adapting evidence-based psychological interventions for CMDs to address intimate partner violence enhances their acceptability, feasibility, and effectiveness in LMICs. FUNDING: UK National Institute for Health Research ASSET and King's IoPPN Clinician Investigator Scholarship.


Asunto(s)
Trastornos de Ansiedad/terapia , Trastorno Depresivo/terapia , Países en Desarrollo/estadística & datos numéricos , Violencia de Pareja/estadística & datos numéricos , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Psicoterapia/estadística & datos numéricos , Trastornos por Estrés Postraumático/terapia , Estrés Psicológico/terapia , Femenino , Humanos
9.
J Consult Clin Psychol ; 88(2): 119-127, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31894994

RESUMEN

OBJECTIVE: We examined individual overall trajectories of change and the occurrence of sudden gains in daily self-rated problem severity and the relation of these patterns to treatment response. METHOD: Mood disorder patients (N = 329, mean age = 44, 55% women) completed daily self-ratings about the severity of their complaints as a standard part of treatment, using the Therapy Process Questionnaire (TPQ). Per individual, the best-fitting defined (linear, log-linear, 1-step) trajectory was tested for significance: for change over time, and for specificity of the best-fitting trajectory. Two-hundred and three cases had ICD-10 Symptom Rating (ISR) depression scores posttreatment: a score ≤1 identified 114 treatment responders. Relation to response was examined for sudden gains and type of change trajectory. RESULTS: 138 cases (42%) had a significant decrease in problem severity, of which 54 cases (16%) had a defined trajectory: 50 cases with one-step improvement, and 4 with a linear improvement in daily problem severity. Sudden gains occurred in 28% of the total sample, and within 58% of improvement patterns. Specifically, sudden gains occurred in 68% of significant 1-step trajectories and 25% of the linear cases. Sudden gains and nonspecific change trajectories were significantly more frequent for treatment responders. CONCLUSIONS: At the day-level, patterns of improvement are nonlinear for most patients. Sudden gains occur within various forms of overall change and are associated with treatment response. Clinically relevant improvements in depression occur both gradually and abruptly, and this finding allows for the possibility that the remission process functions according to dynamical systems principles. (PsycINFO Database Record (c) 2020 APA, all rights reserved).


Asunto(s)
Afecto , Trastorno Depresivo/terapia , Adulto , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Resultado del Tratamiento
10.
Z Kinder Jugendpsychiatr Psychother ; 48(1): 33-46, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30422059

RESUMEN

This meta-review integrates the current meta-analysis literature on the efficacy of internet- and mobile-based interventions (IMIs) for mental disorders and somatic diseases in children and adolescents. Further, it summarizes the moderators of treatment effects in this age group. Using a systematic literature search of PsycINFO and MEDLINE/PubMed, we identified eight meta-analyses (N = 8,417) that met all inclusion criteria. Current meta-analytical evidence of IMIs exists for depression (range of standardized mean differences, SMDs = .16 to .76; 95 % CI: -.12 to 1.12; k = 3 meta-analyses), anxiety (SMDs = .30 to 1.4; 95 % CI: -.53 to 2.44; k = 5) and chronic pain (SMD = .41; 95 % CI: .07 to .74; k = 1) with predominantly nonactive control conditions (waiting-list; placebo). The effect size for IMIs across mental disorders reported in one meta-analysis is SMD = 1.27 (95 % CI: .96 to 1.59; k = 1), the effect size of IMIs for different somatic conditions is SMD = .49 (95 % CI: .33 to .64; k = 1). Moderators of treatment effects are age (k = 3), symptom severity (k = 1), and source of outcome assessment (k = 1). Quality ratings with the AMSTAR-2-checklist indicate acceptable methodological rigor of meta-analyses included. Taken together, this meta-review suggests that IMIs are efficacious in some health conditions in youths, with evidence existing primarily for depression and anxiety so far. The findings point to the potential of IMIs to augment evidence based mental healthcare for children and adolescents.


Asunto(s)
Trastornos de Ansiedad/terapia , Teléfono Celular , Trastorno Depresivo/terapia , Internet , Adolescente , Ansiedad/terapia , Niño , Depresión/terapia , Humanos , Resultado del Tratamiento
11.
Gesundheitswesen ; 82(1): e1-e8, 2020 Jan.
Artículo en Alemán | MEDLINE | ID: mdl-30332707

RESUMEN

BACKGROUND: Revision of the evaluation concept of Germany's sixth national health target entitled "Depressive illnesses - prevention, early diagnosis, sustainable treatment" developed in 2006. OBJECTIVES: Analysis of available of data since 2006 to determine if the objectives of the health target and its sub-goals (awareness, prevention, diagnosis/indication/therapy, health care structure, patient empowerment, rehabilitation) were achieved. MATERIALS AND METHODS: The 6 sub-goals were screened in terms of indicators of progress towards goal over the last decade, and then examined for accessible data sources. RESULTS: The sub-goal prevention yielded routine data from t0 onwards (start of activities). The other sub-goals awareness, diagnosis, and health care provided selective data sources, generated mostly by scientific studies. An important milestone within the sub-goal of diagnosis/indication/therapy was the development of the National Clinical Practice guideline for depression. Data were sparse in the areas rehabilitation and patient empowerment. CONCLUSIONS: The six sub-goals are still valid. Yet, the validity of the data in terms of the evaluation of the health target is limited mainly because of the cross-sectional designs of studies. Prospective systematic surveys are required to further evaluate the national health target and its implementation for both qualitative and quantitative longitudinal indicators.


Asunto(s)
Trastorno Depresivo , Programas Nacionales de Salud , Estudios Transversales , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/terapia , Diagnóstico Precoz , Alemania , Objetivos , Implementación de Plan de Salud , Humanos , Estudios Prospectivos
12.
13.
Clin Child Psychol Psychiatry ; 25(1): 119-132, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31266347

RESUMEN

Depression in young people is common and impairing. There have been significant service changes in the United Kingdom in the last decade, aiming to improve access to evidence-based interventions for depression. However, it is unclear whether youth with depression, first, access services and, second, receive appropriate interventions. In the current study, anonymised data from child and adolescent mental health services were extracted from a 1-year period at two time points (time 1: n = 770; time 2: n = 733). First, these were compared with prevalence and population data. Second, a subsample (n = 45 at each time point) was evaluated against National Institute for Clinical Excellence (NICE) guidelines. Approximately, one-quarter of the expected number of cases (according to population and prevalence data) were seen in the 12 to 18-years age group, and only 2% of expected cases were seen in the 0 to 11-years age group. This was consistent across time points. Adherence to NICE guidance was mostly good at both time points, but there were concerns raised by this evaluation, in particular the use of medication in this population. From time 1 to 2, there was an increase in use of questionnaire measures, but a decrease in the correct completion of risk assessments.


Asunto(s)
Trastorno Depresivo/diagnóstico , Accesibilidad a los Servicios de Salud , Servicios de Salud Mental , Adolescente , Niño , Trastorno Depresivo/epidemiología , Trastorno Depresivo/terapia , Femenino , Humanos , Masculino , Prevalencia , Encuestas y Cuestionarios , Reino Unido/epidemiología
14.
Clin Child Psychol Psychiatry ; 25(1): 174-188, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31431049

RESUMEN

Outcome measures are increasingly being used to index change in service users' presentation. However, within Child and Adolescent Mental Health Services (CAMHS), these raise questions around what should be measured, who should be asked to rate outcome and what constitutes progress. This study sought to audit the value of two self-report measures within the inpatient adolescent setting. An admission sample of 67 young people completed the Revised Child Anxiety and Depression Scale (RCADS) and Young Person's Clinical Outcomes in Routine Evaluation (YP CORE), with clinicians completing the Children's Global Assessment Scale (CGAS) and Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA). A follow-up dataset consisted of 20 young people who completed the measures on two occasions, with clinician ratings completed on admission and discharge. The RCADS and YP CORE measures showed discriminant and convergent reliability and appeared to index change in the current inpatient sample of adolescents. Self-report of symptoms and general functioning were closely related. There was little relationship between self-report and clinician ratings, emphasising the importance of collating self-report in addition to clinician ratings.


Asunto(s)
Servicios de Salud del Adolescente , Trastornos de Ansiedad/terapia , Servicios de Salud del Niño , Trastorno Depresivo/terapia , Servicios de Salud Mental , Adolescente , Niño , Femenino , Humanos , Pacientes Internos , Masculino , Medición de Resultados Informados por el Paciente , Reproducibilidad de los Resultados , Autoinforme
15.
J Consult Clin Psychol ; 88(1): 14-24, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31841021

RESUMEN

OBJECTIVE: Depression is a highly common mental disorder and a major cause of disability worldwide. Several psychological interventions are available, but there is a lack of evidence to decide which treatment works best for whom. This study aimed to identify subgroups of patients who respond differentially to cognitive-behavioral therapy (CBT) or person-centered counseling for depression (CfD). METHOD: This was a retrospective analysis of archival routine practice data for 1,435 patients who received either CBT (N = 1,104) or CfD (N = 331) in primary care. The main outcome was posttreatment reliable and clinically significant improvement (RCSI) in the PHQ-9 depression measure. A targeted prescription algorithm was developed in a training sample (N = 1,085) using a supervised machine learning approach (elastic net with optimal scaling). The clinical utility of the algorithm was examined in a statistically independent test sample (N = 350) using chi-square analysis and odds ratios. RESULTS: Cases in the test sample that received their model-indicated "optimal" treatment had a significantly higher RCSI rate (62.5%) compared to those who received the "suboptimal" treatment (41.7%); χ2(df = 1) = 4.79, p = .03, OR = 2.33 (95% CI [1.09, 5.02]). CONCLUSION: Targeted prescription has the potential to make best use of currently available evidence-based treatments, improving outcomes for patients at no additional cost to psychological services. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Asunto(s)
Terapia Cognitivo-Conductual/métodos , Consejo/métodos , Trastorno Depresivo/terapia , Aprendizaje Automático/estadística & datos numéricos , Adulto , Terapia Cognitivo-Conductual/estadística & datos numéricos , Consejo/estadística & datos numéricos , Femenino , Humanos , Masculino , Atención Primaria de Salud , Proyectos de Investigación , Estudios Retrospectivos , Resultado del Tratamiento
16.
J Consult Clin Psychol ; 88(1): 25-38, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31841022

RESUMEN

OBJECTIVE: Research on predictors of treatment outcome in depression has largely derived from randomized clinical trials involving strict standardization of treatments, stringent patient exclusion criteria, and careful selection and supervision of study clinicians. The extent to which findings from such studies generalize to naturalistic psychiatric settings is unclear. This study sought to predict depression outcomes for patients seeking treatment within an intensive psychiatric hospital setting and while comparing the performance of a range of machine learning approaches. METHOD: Depressed patients (N = 484; ages 18-72; 89% White) receiving treatment within a psychiatric partial hospital program delivering pharmacotherapy and cognitive behavioral therapy were split into a training sample and holdout sample. First, within the training sample, 51 pretreatment variables were submitted to 13 machine learning algorithms to predict, via cross-validation, posttreatment Patient Health Questionnaire-9 depression scores. Second, the best performing modeling approach (lowest mean squared error; MSE) from the training sample was selected to predict outcome in the holdout sample. RESULTS: The best performing model in the training sample was elastic net regularization (ENR; MSE = 20.49, R2 = .28), which had comparable performance in the holdout sample (MSE = 11.26; R2 = .38). There were 14 pretreatment variables that predicted outcome. To demonstrate the translation of an ENR model to personalized prediction of treatment outcome, a patient-specific prognosis calculator is presented. CONCLUSIONS: Informed by pretreatment patient characteristics, such predictive models could be used to communicate prognosis to clinicians and to guide treatment planning. Identified predictors of poor prognosis may suggest important targets for intervention. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Asunto(s)
Antidepresivos/uso terapéutico , Terapia Cognitivo-Conductual/métodos , Trastorno Depresivo/terapia , Hospitales Psiquiátricos , Aprendizaje Automático/estadística & datos numéricos , Medicina de Precisión/métodos , Adolescente , Adulto , Anciano , Trastorno Depresivo/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Reproducibilidad de los Resultados , Resultado del Tratamiento , Adulto Joven
17.
Am J Psychother ; 72(4): 88-94, 2019 Dec 01.
Artículo en Inglés | MEDLINE | ID: mdl-31813228

RESUMEN

OBJECTIVE: As a sequel to the Depression in Later Life trial of lay counselor-delivered problem-solving therapy for depression prevention among older adults in Goa, India, this qualitative study aimed to explore participant experiences to illuminate the reasons for the trial's positive findings and implications for further efforts at depression prevention in low-resource settings. METHODS: In-depth interviews were conducted with 19 participants (21% of those randomly assigned to the original intervention). Two independent raters coded the data and organized narratives according to broad themes. RESULTS: Most participants valued their relationship with the lay counselor, learned self-care strategies to cope with illnesses, and increased engagement in pleasurable social and physical activities. Some participants reported needing assistance with managing financial strain and family conflicts. CONCLUSIONS: The lay-counselor-delivered intervention was well received. The relationship with the counselor and behavioral activation toward better self-care and more-pleasurable activities may have been keys to the intervention's success.


Asunto(s)
Depresión/psicología , Depresión/terapia , Psicoterapia , Anciano , Trastorno Depresivo/psicología , Trastorno Depresivo/terapia , Femenino , Humanos , India , Masculino , Investigación Cualitativa
18.
Am J Psychother ; 72(4): 101-122, 2019 Dec 01.
Artículo en Inglés | MEDLINE | ID: mdl-31813229

RESUMEN

OBJECTIVES: This paper aimed to synthesize empirical findings of patient extratherapeutic interpersonal variables associated with individual psychotherapy treatment outcomes in adult outpatients with depression. METHODS: A systematic search strategy was used to identify relevant studies. Thematic analysis was used to identify recurring themes in the findings. RESULTS: Forty studies met search criteria. Three themes of patient extratherapeutic interpersonal variables were identified: capacity to engage with others, capacity to navigate relationships, and capacity to achieve intimacy, progressing from basic to advanced levels of interpersonal interaction. Interpersonal variables such as interpersonal distress and style, attachment orientation, and quality of object relations were particularly useful in predicting treatment outcomes, whereas access to social support and marital status provided mixed results, likely because they do not account for relationship quality. CONCLUSIONS: Recognizing variables associated with treatment response can help clinicians identify patients at risk for nonresponse and guide efforts for adapting existing therapies and developing new ones.


Asunto(s)
Depresión/psicología , Depresión/terapia , Trastorno Depresivo/psicología , Trastorno Depresivo/terapia , Relaciones Interpersonales , Psicoterapia , Adulto , Humanos , Apego a Objetos , Resultado del Tratamiento
19.
Pan Afr Med J ; 34: 37, 2019.
Artículo en Francés | MEDLINE | ID: mdl-31803341

RESUMEN

Introduction: In Cameroon, there is medical scepticism and negligence towards patients with mental disorders. Objective assessment might be the solution. Depressive disorders are the most common form of mental disorders and Douala has the second largest group of general practitioners in the country. Thus, the purpose of this study was to evaluate the attitude of general practitioners of Douala towards patients with depressive disorders. Method: We conducted a cross-sectional descriptive study of general outpatient services from February to June 2017. We asked 3 patients of each general practitioner enrolled in the study to fill the Patient Health Questionnaire version-9 (HQP-9) to assess if they were depressed. During each consultation, we filled a clinical information form to know whether the general practitioner had diagnosed a depressive disorder and, if so, which treatment he had adopted. Finally, we administered to general practitioner a questionnaire to know their challenges of treating depression. Results: The prevalence of depressive disorders in general practice consultations was estimated to be 32.5% in the city of Douala and the rate of diagnoses made by general practitioners was 1.92%. Diagnosed patients only received some. Conclusion: Despite the low interest in depressive disorders, in Cameroon they are a public health problem due to their frequency and to depression-related morbi-mortality.


Asunto(s)
Actitud del Personal de Salud , Trastorno Depresivo/terapia , Médicos Generales/estadística & datos numéricos , Camerún , Estudios Transversales , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/epidemiología , Encuestas de Atención de la Salud , Humanos , Prevalencia
20.
Adv Exp Med Biol ; 1180: 219-232, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31784966

RESUMEN

The goal of treatment for depressive disorders is complete remission of depressive symptoms with full recovery of social function and prevention of recurrence. However, a large proportion of patients do not experience symptomatic remission after the initial treatment, with even lower rates of remission in the longer treatment term. The main objective of individualized treatment applied in psychiatry is to improve precision in disease diagnosis, prognosis, treatment choices, and treatment response. Diverse approaches and techniques, such as genomics, epigenomics, other omics, neural circuit, and artificial intelligence are related to precision psychiatry. Using biology and computational psychiatry tools to find potential biomarkers, and based on precision psychiatry, patients considered to belong to the same endophenotype will be possible to receive biomarkers-based treatment and better prognosis. Especially in the choice of intervention, individualized treatment should be considered. In this review, we present the development of precise treatment in depressive disorders and introduce advances in several domains toward precision medicine and individualized treatment. We pay particular attention to biomarkers and the development of new technologies in depressive disorders, which will help disease complete remission and functional recovery, seek better lives for patients suffered with depressive disorders.


Asunto(s)
Trastorno Depresivo/terapia , Medicina de Precisión , Biomarcadores , Trastorno Depresivo/diagnóstico , Epigenómica , Humanos , Fenotipo , Psiquiatría
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