RESUMO
BACKGROUND: Mindfulness-based interventions (MBIs) have emerged as secular practices, including elements of mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT). While MBIs have been widely adopted for physical and mental illness, only a few available programs are explicitly adapted for psychosis. However, previous reviews have reported the vital heterogeneity regarding treatment program structure. Therefore, this review aims to compare the structure of different mindfulness protocols applied to patients with schizophrenia spectrum disorder (SSD). METHODS: A systematic search was conducted up to March 2023 in PubMed, Embase and PsycInfo. Following our protocol (CRD 42023253356), we followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist. RESULTS: We included 22 randomized controlled trials (RCTs) involving 1500 patients SSD. All programs varied in structure, session components, duration, and instructor experience. While MBSR-like programs focused on stress reactivity, MBCT-like programs addressed primary symptoms of psychosis and relapse prevention. Despite the heterogeneity of programs, some common mechanisms emerged, including attention training, emotion and stress regulation, decentering, self-compassion, and cognitive restructuring. CONCLUSIONS: The critical heterogeneity found limits the interpretation of results. However, most recent trials present fewer risks of bias and more homogenous programs. Findings suggested potential benefits, such as reduced negative symptoms, increased well-being, and decreased hospitalization rates. For future studies, authors should align on more congruent MBIs programs for patients with SSD. Further research is needed to identify optimal mindfulness teaching approaches for patients with psychosis and investigate specific mechanisms of action, relevant processes, and optimal doses in varying settings.
Assuntos
Atenção Plena , Esquizofrenia , Humanos , Atenção Plena/métodos , Esquizofrenia/terapia , Transtornos Psicóticos/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Terapia Cognitivo-Comportamental/métodosRESUMO
INTRODUCTION: University students' psychological health is linked to their academic satisfaction. This study aimed to investigate students' psychological health and academic satisfaction in the context of COVID-19 and academic year-end stress. MATERIALS AND METHODS: Standardized self-filled scales for anxiety, depression, stress, psychological well-being, academic satisfaction (subjective assessment of students' quality of life in their educational setting), and an ad-hoc scale for stress on the learning experience due to COVID-19 were used in this cross-sectional study. Participants were first- to third-year students of eight different health-related tracks in Geneva, Switzerland. Descriptive statistics and hierarchical regression analyses were applied. RESULTS: In June 2020, out of 2835 invited students, 433 (15%) completed the survey. Academic satisfaction was a stronger mental health predictor than COVID-19 stress on the learning experience, which mainly predicted stress and anxiety. Lower academic satisfaction scores were significantly associated with stress (ß = -0.53, p < 0.001), depression (ß = -0.26, p < 0.001), anxiety (ß = -0.20, p < 0.001), while higher scores with psychological well-being (ß = 0.48, p < 0.001). Identifying as female was strongly associated with anxiety and stress but not with depression or psychological well-being. Lower age was associated with stress only. The nature of the academic training had a lesser impact on mental health and the academic year had no impact. CONCLUSIONS: Academic satisfaction plays a more substantial role than COVID-19 stress on the learning experience in predicting students' overall mental health status. Training institutions should address the underlying factors that can enhance students' academic satisfaction, especially during the COVID-19 period, in addition to ensuring that they have a continuous and adequate learning experience, as well as access to psychosocial services that help them cope with mental distress and enhance their psychological well-being.
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COVID-19 , Angústia Psicológica , Ansiedade/epidemiologia , COVID-19/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Feminino , Humanos , Satisfação Pessoal , Qualidade de Vida , SARS-CoV-2 , Estresse Psicológico/epidemiologia , Estudantes/psicologia , Suíça/epidemiologia , UniversidadesRESUMO
The ability to retrieve specific, single-incident autobiographical memories has been consistently posited as a predictor of recurrent depression. Elucidating the role of autobiographical memory specificity in patient-response to depressive treatments may improve treatment efficacy and facilitate use of science-driven interventions. We used recent methodological advances in individual patient data meta-analysis to determine a) whether memory specificity is improved following mindfulness-based cognitive therapy (MBCT), relative to control interventions, and b) whether pre-treatment memory specificity moderates treatment response. All bar one study evaluated MBCT for relapse prevention for depression. Our initial analysis therefore focussed on MBCT datasets only(n = 708), then were repeated including the additional dataset(n = 880). Memory specificity did not significantly differ from baseline to post-treatment for either MBCT and Control interventions. There was no evidence that baseline memory specificity predicted treatment response in terms of symptom-levels, or risk of relapse. Findings raise important questions regarding the role of memory specificity in depressive treatments.
Assuntos
Terapia Cognitivo-Comportamental , Transtorno Depressivo Maior , Memória Episódica , Atenção Plena , Transtorno Depressivo Maior/psicologia , Humanos , Resultado do TratamentoRESUMO
PURPOSE: Diminished quality of life (QoL) has been reported in patients with mood disorders. QoL has also been shown to be decreased by sleep disturbances. Since sleep disorders are common in mood disorders, the aim of this study was to determine whether sleep characteristics are associated to QoL among patients with Bipolar Disorder (BD) and unipolar Major Depressive Disorders (MDD). METHODS: QoL was assessed in 170 patients with mood disorders (61 BD and 109 MDD), who also completed questionnaires measuring the severity of insomnia, sleepiness, chronotype preference and obstructive sleep apnea (OSA) probability index. RESULTS: Analyses showed that BD and MDD groups had similar QoL and sleep measures but the MDD group had higher OSA scores. In BD, correlations indicated a relationship between QoL and insomnia complaints and sleepiness, whereas in MDD, correlations indicated an association between QoL and insomnia complaints and OSA score. In both groups, QoL was related to depressive symptomatology. Linear regressions showed that, in BD, QoL was related to insomnia complaints and sleepiness even in the euthymic state, whereas in MDD, QoL was related to insomnia complaints but not in euthymic patients. CONCLUSION: QoL is related to sleep differently in BD and MDD. The results suggest that insomnia and sleepiness are particularly high in BD even when patients are euthymic. These findings suggest that focusing on insomnia and sleepiness during different mood states of BD could increase QoL.
Assuntos
Transtorno Bipolar , Transtorno Depressivo Maior , Transtornos do Sono-Vigília , Transtorno Bipolar/complicações , Transtorno Depressivo Maior/epidemiologia , Humanos , Qualidade de Vida/psicologia , Sono , Transtornos do Sono-Vigília/epidemiologiaRESUMO
BACKGROUND: Research on the mental health of students in health disciplines mainly focuses on psychological distress and nursing and medical students. This study aimed to investigate the psychological well-being and distress and related factors among undergraduate students training in eight different health-related tracks in Geneva, Switzerland. METHODS: This cross-sectional study used established self-filled scales for anxiety, depression, stress, psychological well-being, and study satisfaction. Descriptive statistics and hierarchical regression analyses were applied. RESULTS: In October 2019, out of 2835 invited students, 915 (32%) completed the survey. Lower academic satisfaction scores were strongly associated with depression (ß = -0.26, p < 0.001), anxiety (ß = -0.27, p < 0.001), and stress (ß = -0.70, p < 0.001), while higher scores were associated with psychological well-being (ß = 0.70, p < 0.001). Being female was strongly associated with anxiety and stress but not with depression or psychological well-being. Increased age was associated with enhanced psychological well-being. The nature of the academic training had a lesser impact on mental health and the academic year had none. CONCLUSION: Academic satisfaction strongly predicts depression, anxiety, stress, and psychological well-being. Training institutions should address the underlying factors that can improve students' satisfaction with their studies while ensuring that they have access to psychosocial services that help them cope with mental distress and enhance their psychological well-being.
Assuntos
Angústia Psicológica , Estudantes de Medicina , Ansiedade/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Feminino , Humanos , Satisfação Pessoal , Estresse Psicológico/epidemiologia , Inquéritos e Questionários , Suíça/epidemiologiaRESUMO
Introduction: Mindfulness-based programs are a promising option for patients with attention-deficit/hyperactivity disorder (ADHD), who face attention, hyperactivity, and emotion dysregulation issues in their daily life. Objective: To examine the implementation and impact of specific mindfulness training for adults with ADHD in a French-speaking unit. Methods: Thirty-eight adults with ADHD were included in an 8-week Mindful Awareness Practices (MAPs) program. Patients were assessed for ADHD symptoms, anxiety, depression, and mindfulness skills, before (T1) and after (T2) the eight sessions, and then 2 months later (T3). Results: The patients adhered to the program as the majority of them completed it. A significant decrease in ADHD, depression, and anxiety symptoms was found between T1 and T2. Regarding mindfulness skills, a significant increase was observed between T1 and T2 in Observing, Describing and Nonreactivity to inner experience cores, but not Acting with awareness and Nonjudging of inner experience scores. There was no significant change between T2 and T3. Conclusion: The MAPs program was successfully implemented and showed promising effects on ADHD symptomatology and related symptoms.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/terapia , Atenção Plena , Adulto , Atenção/fisiologia , Depressão , Feminino , Unidades Hospitalares , Humanos , Masculino , Pessoa de Meia-Idade , SuíçaRESUMO
BACKGROUND: A rapid antidepressant effect of ketamine has repeatedly been documented in the literature, and identifying clinical features associated with a better response to this treatment is currently an essential question. Considering the relationship between rumination and depression and the need to identify potential predictors of response to ketamine, we analyzed the effect of a single injection of ketamine 0.5 mg/kg on rumination in treatment-resistant depressive (TRD) patients and explored whether baseline ruminative style and early improvements of rumination would predict a greater antidepressant effect of ketamine. METHODS: Ten TRD outpatients who participated in a 4-week open study on the antidepressant effect of ketamine also completed the Ruminative Response Scale the day before, the day after, and a week after ketamine administration. RESULTS: We found that in our patients, a single rapid 1-minute intravenous injection of ketamine 0.5 mg/kg was efficacious in reducing rumination, but neither severity of rumination at baseline nor early improvements of rumination after ketamine injection predicted antidepressant response. CONCLUSIONS: Our preliminary data suggest that a single injection of ketamine 0.5 mg/kg can be efficacious in reducing rumination in TRD patients but rumination does not seem to be a useful clinical predictor of response to ketamine. Larger studies are necessary to confirm these results.
Assuntos
Afeto/efeitos dos fármacos , Antidepressivos/administração & dosagem , Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico , Ketamina/administração & dosagem , Ruminação Cognitiva/efeitos dos fármacos , Adulto , Antidepressivos/efeitos adversos , Transtorno Depressivo Resistente a Tratamento/diagnóstico , Transtorno Depressivo Resistente a Tratamento/psicologia , Feminino , Humanos , Injeções Intravenosas , Ketamina/efeitos adversos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do TratamentoRESUMO
Circadian rhythmicity generated by the biological clock structures the functioning of human beings over a period of almost 24 hours. This clock is entrained daily by internal and external cues among which light is the most powerful. Several disturbances, whether clinical or biological, observed in bipolar disorders are suggestive of a disruption of the circadian rhythm. Thus, treatments that modulate the biological clock have been developed. So far, the results of light therapy are not unanimous and invite us to better specify the treatment modalities. Dark therapy is a promising intervention that is still not much studied nowadays and therefore opens up great prospects for research in the future.
Le rythme circadien généré par l'horloge biologique structure le fonctionnement de l'être humain sur une période de presque 24 heures. Cette horloge est quotidiennement «â mise à l'heureâ ¼ par des synchronisateurs internes et externes parmi lesquels la lumière est la plus puissante. Plusieurs perturbations tant cliniques que biologiques observées chez les personnes souffrant d'un trouble bipolaire sont évocatrices d'un dérèglement du rythme circadien. Ainsi, des traitements permettant de moduler l'horloge biologique ont été développés. Actuellement, les résultats de la luminothérapie ne sont pas unanimes et cela nous invite à mieux préciser les modalités du traitement. La thérapie par l'obscurité est une intervention prometteuse, peu étudiée et ouvre donc de belles perspectives de recherche.
Assuntos
Transtorno Bipolar/psicologia , Escuridão , Luz , Fotoperíodo , Relógios Biológicos/efeitos da radiação , Ritmo Circadiano/efeitos da radiação , HumanosRESUMO
This qualitative study investigated subjective experiences of self-stigmatization and self-destigmatization among people living with bipolar disorder (BD). We conducted in-depth interviews focusing on self-stigmatization and self-destigmatization with 22 individuals living with BD. The interview transcripts were thematically analyzed using a mixed inductive and deductive approach. Thirty-six codes were extracted and organized into six themes: language, behaviors, relationships, personal experience, identity, and healthcare. Each theme was characterized by an evolution process, and the codes were distributed in a step-by-step order as landmarks. The process begins with the experience of self-stigmatization, and develops toward self-destigmatization. This study presents a new six-dimension process called the "self-destigmatization process" (SDP), a personal and interrelational process that deconstructs self-stigmatization. Clinicians can use the landmarks of the process for clinical assessment and therapeutic interventions to increase recovery orientation.
Assuntos
Transtorno Bipolar , Humanos , Pesquisa Qualitativa , EstereotipagemRESUMO
INTRODUCTION: Internalized stigma constitutes a major concern in mental health illness. It has numerous repercussions on patients, including poor self-esteem, higher illness severity, poor adherence to care and reduced global functioning. The goal of this study was to compare internalized stigma between three diagnoses frequently seen in psychiatric practice: Borderline personality disorder (BPD), Attention deficit-hyperactivity disorder (ADHD) and Bipolar disorder (BD). METHODS: A total of 244 French-speaking patients were recruited in a specialized psychiatric center at University Hospitals of Geneva, Switzerland. 39 patients had a diagnosis of BPD, 136 had ADHD and 69 had BD. Every subjects completed the Internalized Stigma of Mental Illness (ISMI) scale, which is the most widely used scale employed to measure of internalized stigma. One way ANOVA analysis with adjustment on age and gender was done to compare the three groups (BPD, ADHD, BD). RESULTS: Participants with BPD reported higher ISMI score than subjects with ADHD and BD. BD experienced more internalized-stigma than ADHD. Higher ISMI score was also associated with higher severity of the respective disorder, poorer quality of life and unemployment. LIMITATIONS: Limitations of this research include the small sample, especially in BPD group. A disequilibrium between male and female subjects can also impact our results. Observational nature of our study mean that we can only make correlation between variables and not infer causality. Finally, other confounding factors not taken into account in this study may have had influence on stigma. CONCLUSIONS: Our findings are coherent with recent literature on BPD reporting high level of distress and of stigmatization. This has serious consequences on provided care and need to be address by mental health professionals to assure the optimal service to this population.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Transtorno Bipolar/psicologia , Transtorno da Personalidade Borderline/psicologia , Mecanismos de Defesa , Estigma Social , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , SuíçaRESUMO
BACKGROUND: Ketamine has been documented for its rapid antidepressant effects. However, optimal dose and delivery route have not yet been thoroughly investigated. The objectives of this study were to document the safety and test the antidepressant and antisuicidal effects of a single rapid 1-minute injection of ketamine 0.5 mg/kg in treatment-resistant depression (TRD). METHODS: Ten patients with TRD were included in an open, noncontrolled 4-week study and received a rapid intravenous dose of ketamine 0.5 mg/kg. Main outcome measure was the Montgomery-Åsberg Depression Rating Scale and suicidality was assessed using the Scale for Suicide Ideation. RESULTS: Rapid injection of ketamine elicited transient increase of blood pressure and altered states of consciousness in all patients and mild psychotomimetic effects in 4 patients, which all resolved without any intervention. Decrease of depression severity was observed from 40-minute postinjection until day 15. Eight patients became responders within 1 day and all were nonresponders after 4 weeks. The decrease of suicidal ideation was significant until day 7. Analysis indicated that higher severity of depression and anxiety at baseline predicted a larger Montgomery-Åsberg Depression Rating Scale decrease after 4 weeks. CONCLUSIONS: This study suggests that in well-controlled medical settings with adequate monitoring, a single rapid 1-minute injection of ketamine 0.5 mg/kg can be well tolerated and is efficacious in rapidly reducing depression symptoms and suicidal thoughts in outpatients with TRD. These findings are relevant to the practice of general clinical psychiatry and emergency departments were ketamine can have a place in acute management of TRD. Larger studies are necessary to confirm these results.
Assuntos
Antidepressivos/farmacologia , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico , Ketamina/farmacologia , Avaliação de Resultados em Cuidados de Saúde , Ideação Suicida , Adulto , Antidepressivos/administração & dosagem , Antidepressivos/efeitos adversos , Feminino , Humanos , Injeções Intravenosas , Ketamina/administração & dosagem , Ketamina/efeitos adversos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVES: Many adults with attention-deficit/hyperactivity disorder (ADHD) report sleeping difficulties. The relationship between sleep and ADHD is poorly understood, and shows discrepancies between subjective and objective measures. In order to determine the specificity of sleep-associated symptoms in ADHD, subjective sleep assessments among ADHD adult patients were compared with control subjects and with individuals suffering from borderline personality disorder (BPD). METHODS: 129 outpatients with ADHD, 70 with BPD (including 17 patients with BPD and ADHD comorbidity), and 65 control participants were assessed for sleep quality, insomnia, and sleepiness, using the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), and the Epworth Sleepiness Scale (ESS). RESULTS: ADHD- and BPD-sufferers achieved higher insomnia and lower sleep quality scores than control subjects. Clinical groups did not differ in terms of sleep quality, although insomnia was more severe among BPD patients. Depression scores explained most of sleep symptoms, but even when controlling for depression, ADHD sufferers showed higher sleep latency. Inattentive symptoms were associated with somnolence, while hyperactive/impulsive symptoms were associated with insomnia and lower sleep efficiency. CONCLUSION: Sleep-related symptoms associated with ADHD were partly explained by non-specific factors, especially depression symptoms. In a dimensional perspective, hyperactive and inattentive symptoms were associated with specific sleep symptoms.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno da Personalidade Borderline/epidemiologia , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Adulto , Estudos de Casos e Controles , Comorbidade , Feminino , Humanos , Masculino , Suíça/epidemiologia , Adulto JovemRESUMO
OBJECTIVES: This study focused on patients with bipolar disorder (BD), several years after their participation in mindfulness-based cognitive therapy (MBCT). It aimed at documenting sustained mindfulness practice, perceived long-term benefit from the program, and changes regarded as direct consequences of the intervention. DESIGN: This cross-sectional survey took place at least 2 years after MBCT for 70.4% of participants. LOCATION: It was conducted in two specialized outpatient units for BDs that are part of the Geneva University Hospitals (Switzerland) and the Sainte-Anne Hospital in Paris (France). SUBJECTS: Eligibility criteria were a diagnosis of BD according to DSM-IV and participation in at least four MBCT sessions. Response rate was 66.4%. The final sample included 71 outpatients (71.8% bipolar I, 28.2% bipolar II). OUTCOME MEASURES: A questionnaire retrospectively assessed patient-perceived change, benefit from MBCT, and current mindfulness practice. RESULTS: Proportions of respondents who practiced mindfulness at least once a week were 54.9% for formal practice (body scan, sitting meditation, mindful walking, or movements) and 57.7% for informal practice (mindful daily activities). Perceived benefit for the prevention of relapse was moderate, but patients acknowledged long-lasting effects and persistent changes in their way of life. Formal mindfulness practice at least once a week tended to be associated with increased long-lasting effects (p = 0.052), whereas regular informal practice and mindful breathing were significantly associated with persistent changes in daily life (p = 0.038) and better prevention of depressive relapse (p = 0.035), respectively. The most frequently reported positive change was increased awareness of being able to improve one's health. CONCLUSIONS: Despite methodological limitations, this survey allowed documenting mindfulness practice and perceived sustained benefit from MBCT in patients with BD. Participants particularly valued increased awareness that they can influence their own health. Both informal and formal practices, when sustained in the long term, might promote long-lasting changes.
Assuntos
Transtorno Bipolar/psicologia , Transtorno Bipolar/terapia , Terapia Cognitivo-Comportamental/métodos , Atenção Plena/métodos , Adulto , Idoso , Estudos Transversais , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Prevenção Secundária , Autorrelato , Inquéritos e Questionários , Suíça , Resultado do TratamentoRESUMO
Chronic diseases and their associated biopsychosocial adjustements tax the limits of modern conventional medicine, with the need then to turn towards new resources. Among these, Mindfulness-Based Stress Reduction (MBSR) is a therapeutic approach developed more than 30 years ago. Designed as an adjuvant to medical care, in particular in the case of chronic pain which is the scope of our article, MBSR is usually provided in group format and based on a meditative practice. Simple, brief and cost-limited, MBSR can potentially be offered to a wide variety of chronic diseases and is part of participatory medicine. After having presented this approach, several results from studies confirming the legitimacy of MBSR as a nonreligious and nonesoteric scientific approach for the treatment of various diseases will be reported.
Assuntos
Meditação , Relações Metafísicas Mente-Corpo , Dor/prevenção & controle , Estresse Psicológico/prevenção & controle , Doença Crônica , Humanos , Dor/complicações , Estresse Psicológico/etiologiaRESUMO
OBJECTIVE: One of the components of dialectical behavior therapy (DBT) is the use of mindfulness skills as a core component of treatment for subjects with borderline personality disorder (BPD). In this study, we investigated changes in and correlates of mindfulness skills over a 1-year follow-up including a 4-week session of intensive DBT followed by 10 months of standard DBT. METHODS: Fifty-two BPD subjects were assessed several times using the Kentucky Inventory of Mindfulness Skills (KIMS) which describes mindfulness in four discrete dimensions: observing (Obs), describing (Des), acting with awareness (AwA) and accepting without judgment (AwJ). RESULTS: AwJ was the only dimension that increased significantly over time after adjustment for potential confounding factors (ß = 0.24; P = 0.0002). Increases in AwJ correlated with improvement in BPD symptoms. CONCLUSIONS: This study highlights the usefulness of investigating changes in mindfulness dimensions during DBT. AwJ is a possible mechanism for positive change. Encouraging this skill should lead to a more adaptive response to problematic situations and counteract impulsive and problematic behaviors. The lack of specific control groups means that these findings are preliminary and replication is required.
Assuntos
Terapia Comportamental/métodos , Transtorno da Personalidade Borderline/terapia , Meditação/métodos , Adulto , Conscientização , Transtorno da Personalidade Borderline/psicologia , Inteligência Emocional , Feminino , Seguimentos , Humanos , Julgamento , Modelos Lineares , Masculino , Meditação/psicologia , Escalas de Graduação Psiquiátrica , Autorrelato , Fatores de Tempo , Resultado do TratamentoRESUMO
PURPOSE: To describe the weight gain-related side-effects of psychotropic drugs and their consequences on metabolic complications (hypercholesterolemia, obesity) in a Swiss cohort of psychiatric patients. METHOD: This cross-sectional observational study was performed in an out-patient psychiatric division with patients having received for more than 3 months the following drugs: clozapine, olanzapine, quetiapine, risperidone, lithium, and/or valproate. Clinical measures and lifestyle information (smoking behaviour, physical activity) were recorded. RESULTS: 196 inclusions were completed. Weight gain (≥10% of initial weight) following drug treatment was reported in 47% of these patients. Prevalence of obesity (BMI ≥ 30), hypercholesterolemia (≥6.2 mmol/L) and low HDL-cholesterol (<1.0 mmol/L in men, <1.3 mmol/L in women) were present in 38%, 21%, and 27% of patients, respectively. A higher standardised dose, an increase of appetite following medication introduction, the type of medication (clozapine or olanzapine > quetiapine or risperidone > lithium or valproate), and the gender were shown to be significantly associated with evolution of BMI. CONCLUSION: High prevalence of obesity and hypercholesterolemia was found in an out-patient psychiatric population and confirms drug-induced weight gain complications during long-term treatment. The results support the recently published recommendations of monitoring of metabolic side-effects during treatment with atypical antipsychotics. Moreover, the weight gain predictors found in the present study could help to highlight patients with special health care management requirement.
Assuntos
Peso Corporal/efeitos dos fármacos , Hipercolesterolemia/induzido quimicamente , Transtornos Mentais/tratamento farmacológico , Obesidade/induzido quimicamente , Psicotrópicos/efeitos adversos , Adolescente , Adulto , Idoso , Apetite/efeitos dos fármacos , Índice de Massa Corporal , Estudos de Coortes , Feminino , Humanos , Hipercolesterolemia/epidemiologia , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Obesidade/epidemiologia , Prevalência , Estatísticas não Paramétricas , Suíça/epidemiologia , Fatores de Tempo , Adulto JovemRESUMO
Few studies have examined changes of diurnal cortisol profiles prospectively, in relation to non-pharmacological interventions such as mindfulness-based cognitive therapy (MBCT). Fifty-six patients remitted from recurrent depression (≥3 episodes) were included in an 8-week randomized controlled trial comparing MBCT plus treatment as usual (TAU) with TAU for depression relapse prophylaxis. Saliva samples (0, 15, 30, 45, 60 min post-awakening, 3 PM, 8 PM) were collected on six occasions (pre- and post-intervention, 3-, 6-, 9-, 12-month follow-up). Cortisol awakening response (CAR), average day exposure (AUCday) and diurnal slope were analyzed with mixed effects models (248 profiles, 1-6 per patient). MBCT (n = 28) and TAU groups (n = 28) did not significantly differ with respect to baseline variables. Intra-individual variability exceeded inter-individual variability for the CAR (62.2% vs. 32.5%), AUC(day) (30.9% vs. 23.6%) and diurnal slope (51.0% vs. 34.2%). No time, group and time by group effect was observed for the CAR and diurnal slope. A significant time effect (p = 0.003) was detected for AUCday, which was explained by seasonal variations (p = 0.012). Later wake-up was associated with lower CAR (-11.7% per 1-hour later awakening, p < 0.001) and lower AUCday (-4.5%, p = 0.014). Longer depression history was associated with dampened CAR (-15.2% per 10-year longer illness, p = 0.003) and lower AUCday (-8.8%, p = 0.011). Unchanged cortisol secretion patterns following participation in MBCT should be interpreted with regard to large unexplained variability, similar relapse rates in both groups and study limitations. Further research is needed to address the scar hypothesis of diminished HPA activity with a longer, chronic course of depression.
Assuntos
Terapia Cognitivo-Comportamental/métodos , Depressão/metabolismo , Depressão/reabilitação , Hidrocortisona/metabolismo , Saliva/química , Adulto , Idoso , Área Sob a Curva , Feminino , Seguimentos , Humanos , Técnicas In Vitro , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Radioimunoensaio , Recidiva , Fatores de Tempo , Resultado do Tratamento , Vigília , Adulto JovemRESUMO
An impressive number of data has been accumulated on dysfunctions of the hypothalamo-pituitary-adrenal (HPA) axis and cortisol hypersecretion in depression. To assess the dynamic HPA functioning, the cortisol awakening response (CAR) is an easily accessible and reliable approach. Some data suggest that elevated CAR in depressed patients has trait-like characteristics. Therefore we investigated whether patients in remission from a depressive episode have elevated CAR compared to control subjects. CAR of thirty-eight patients in remission from depression (11 men, 27 women, age range 24-66) and 52 control participants were analyzed (18 men, 34 women, age range 24-63). All patients had experienced ≥3 previous depressive episodes and were off psychotropic medication since at least 3 months. Saliva samples were collected only once, at home, either on weekend or weekday at 0, 15, 30, 45 and 60 min post-awakening. The area under the curve (AUC) above minimum cortisol concentration displayed large interindividual variability (6.4-fold in remitted patients and 8.1-fold in controls, based on 80% range). Investigation of possible variability factors showed that percent explained variance increased from 3.9% when group was considered alone to 8.8%, 12.3% and 19.2% after adjusting for significant effects of weekday vs. weekend, wake-up time and sleep duration, respectively. According to the latter model, AUC was estimated to be 51% higher in remitted patients than in controls (p = 0.007), while a 21% AUC decrease was associated with a 1-h longer sleep duration (p<0.001). In future studies, detection of between-group differences might benefit from adjusting for sleep duration and other possible confounders.
Assuntos
Depressão/metabolismo , Hidrocortisona/metabolismo , Saliva/metabolismo , Vigília , Adulto , Idoso , Área Sob a Curva , Depressão/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radioimunoensaio/métodos , Sono/fisiologia , Fatores de Tempo , Adulto JovemRESUMO
This article explores mindfulness skills in community and borderline personality disorder (BPD) samples. Study 1 includes 173 community volunteers and explores the psychometric properties of the French version of the Kentucky Inventory of Mindfulness Skills (KIMS). Study 2 explores the KIMS factor structure in 130 BPD patients and compares KIMS scores of this sample with those of the community sample from Study 1. Study 3 investigates the changes in KIMS scores in a BPD sample (n = 82) treated with Intensive Dialectical Behavior Therapy (I-DBT). Results suggest that the psychometric properties of the French KIMS are comparable with those of the original version in the community and the BPD samples. Moreover, fewer mindfulness skills were found in BPD patients than in control participants. It was also observed that the ability to describe and to act with awareness increased in BPD patients after I-DBT. The present work makes a French instrument measuring mindfulness in daily activities available for clinical practice and research.
Assuntos
Atenção , Conscientização , Terapia Comportamental , Transtorno da Personalidade Borderline/diagnóstico , Serviços Comunitários de Saúde Mental/estatística & dados numéricos , Psicometria , Características de Residência/estatística & dados numéricos , Adolescente , Adulto , Transtorno da Personalidade Borderline/psicologia , Transtorno da Personalidade Borderline/terapia , Intervalos de Confiança , Análise Fatorial , Feminino , França , Humanos , Kentucky , Idioma , Masculino , Saúde Mental , Pessoa de Meia-Idade , Modelos Psicológicos , Testes Psicológicos , Reprodutibilidade dos Testes , Estatística como Assunto , Inquéritos e Questionários , Estados Unidos , Adulto JovemRESUMO
BACKGROUND: Mindfulness-Based Cognitive Therapy (MBCT) is a group intervention that integrates elements of Cognitive Behavioural Therapy (CBT) with components of mindfulness training to prevent depressive relapse. The efficacy of MBCT compared to Treatment As Usual (TAU), shown in two randomized controlled trials indicates a significant decrease in 1-year relapse rates for patients with at least three past depressive episodes. The present study is the first independent replication trial comparing MBCT+TAU to TAU alone across both language and culture (Swiss health care system). METHODS: Sixty unmedicated patients in remission from recurrent depression (>or=3 episodes) were randomly assigned to MBCT+TAU or TAU. Relapse rate and time to relapse were measured over a 60 week observation period. The frequency of mindfulness practices during the study was also evaluated. RESULTS: Over a 14-month prospective follow-up period, time to relapse was significantly longer with MBCT+TAU than TAU alone (median 204 and 69 days, respectively), although both groups relapsed at similar rates. Analyses of homework adherence revealed that following treatment termination, the frequency of brief and informal mindfulness practice remained unchanged over 14 months, whereas the use of longer formal meditation decreased over time. LIMITATIONS: Relapse monitoring was 14months in duration and prospective reporting of mindfulness practice would have yielded more precise frequency estimates compared to the retrospective methods we utilized. CONCLUSIONS: Further studies are required to determine which patient characteristics, beyond the number of past depressive episodes, may predict differential benefits from this therapeutic approach.