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1.
Medicine (Baltimore) ; 98(39): e16720, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574792

RESUMO

BACKGROUND: Although chronic fatigue syndrome (CFS) sometimes referred to as myalgic encephalomyelitis (ME) is a very challenging condition to treat, there is evidence that individual cognitive behavioral therapy (ICBT) can be effective for treatment and management of its symptoms. Furthermore, group cognitive behavioral therapy (GCBT) is emerging as promising treatment for the condition.The aim of the present study was to explore further the effectiveness of GCBT in a routine clinical setting and to investigate associated positive psychological effects related to GCBT. METHODS: In this pragmatic, non-randomized, controlled trial, 28 people acted as their own waiting list control by completing a range of measures 8 weeks prior to taking part in the GCBT. The intervention consisted of 8 consecutive weeks of 2.5-hour sessions. RESULTS: Repeated measures analysis of covariance revealed significant improvements in physical fatigue (F = 28.31, P < .01, effect size d = 0.52), mental fatigue (F = 7.72, P < .01, effect size d = 0.22), and depressive symptoms (Beck depression inventory-fast screen for medical individuals [BDI-FS]: F = 11.43, P < .01, effect size d = 0.30; hospital anxiety and depression scale [HADS-D]: F = 16.72, P < .01, effect size d = 0.38) compared with the waiting list. Improvements in quality of life (F = 7.56, P < .01, effect size d = 0.23), hope (F = 15.15, P < .01, effect size d = 0.36), and optimism (F = 8.17, P < .01, effect size d = 0.23) were also identified, but no change was reported for anxiety levels. Global outcome measures revealed that the majority of the individuals found the treatment beneficial and were satisfied with the results. CONCLUSION: GCBT is a beneficial and cost-effective treatment that individuals find amenable in routine clinical practice for CFS. Additionally we have described important effects emerged on positive psychological dimensions such as hope and optimism potentially enhancing the overall benefit.


Assuntos
Terapia Cognitivo-Comportamental , Síndrome de Fadiga Crônica/psicologia , Síndrome de Fadiga Crônica/terapia , Listas de Espera , Adulto , Ansiedade/complicações , Ansiedade/terapia , Depressão/complicações , Depressão/terapia , Síndrome de Fadiga Crônica/complicações , Feminino , Esperança , Humanos , Masculino , Pessoa de Meia-Idade , Otimismo , Qualidade de Vida
2.
Psychiatr Danub ; 31(Suppl 3): 418-420, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488764

RESUMO

BACKGROUND: A reformation of psychiatry was set up in Belgium with the establishment of mobile crisis teams. SUBJECTS AND METHODS: We performed a retrospective analysis of the patients referred to the mobile team "Pharos" in the period between December 2013 and December 2018. RESULTS: The number of patients is growing over the years and the most common referral reasons are suicidal thoughts and depressive mood. We have a high percentage of inclusions, maybe because the main referrers are GPs. Alcohol withdrawal at home is feasable and safe. CONCLUSION: Many psychiatric crisis situations can be managed at home with support of mobile teams, but further research is needed to provide evidence on outcome and cost effectiveness.


Assuntos
Intervenção na Crise/estatística & dados numéricos , Serviços de Emergência Psiquiátrica/provisão & distribução , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Psiquiatria/métodos , Psiquiatria/organização & administração , Transtornos Relacionados ao Uso de Álcool/terapia , Bélgica/epidemiologia , Depressão/epidemiologia , Depressão/terapia , Humanos , Estudos Retrospectivos , Ideação Suicida
3.
Prax Kinderpsychol Kinderpsychiatr ; 68(6): 475-487, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31480944

RESUMO

Chances of Psychotherapeutic Interventions and Stabilization with Unaccompanied Minor Refugees During Clearing Procedure and During the Transition Phase to Youth Welfare In the present clinical report, the experiences with psychotherapeutic crisis intervention for unaccompanied refugee minors in an initial reception and clearing office in Berlin, which have been financed since December 2016 by the association Spatz e. V. from the St Joseph hospital in Berlin-Tempelhof, is reflected. The financing offer results due to the developments in 2015 - a year with an above-average increase in incoming refugees. The significant increase also led to significantly longer waiting times in the clearing process. The forced persistence in a provisional state often led to instability of the psychic coping capacity of the adolescents. However, although there is a high level of psychological distress, post-traumatic as well as depressive symptoms the refugee adolescents have no access to outpatient psychotherapy during the clearing procedure (or the financial coverage of the discussions by health insurance or youth welfare offices). Despite uncertain framework conditions by an unclear future perspective and the resulting lack of "external safety", psychotherapeutic sessions with a focus on stabilization, empowerment and psychoeducation is nevertheless helpful in order to support young people in crisis situation, to counteract acute crisis and to counteract chronification of existing symptoms.


Assuntos
Intervenção na Crise , Menores de Idade/psicologia , Psicoterapia , Refugiados/psicologia , Adolescente , Criança , Depressão/psicologia , Depressão/terapia , Humanos , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia
4.
Isr Med Assoc J ; 21(7): 449-453, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31507119

RESUMO

BACKGROUND: Fibromyalgia is a syndrome of unknown etiology that is characterized by widespread pain, which severely impairs quality of life. Several forms of occupational and alternative therapy have demonstrated beneficial effects in fibromyalgia patients. OBJECTIVES: To assess the effects of participation in a floral design course on physical and psychiatric symptoms in a cohort of fibromyalgia patients. METHODS: This study was conducted as an observational study. Women diagnosed with fibromyalgia over the age of 18 were recruited to participate in one of two 12-week flower design (floristry) courses. Demographic details, disease activity indices, and anxiety and depression scores were calculated for all participants at baseline, week 12, and study completion. Physical and mental health of the two groups were compared throughout the study time-points. RESULTS: The study was completed by 61 female fibromyalgia patients who were included in the final analyses; 31 patients participated in the first floristry course and 30 in the second. Significant improvements in the 36-Item Short Form Survey physical and mental health components, visual analog scale, Fibromyalgia Impact Questionnaire, Hamilton Anxiety Rating Scale, and Hamilton Depression Rating Scale scores for the entire study population and for each group separately could be seen following participation in each floristry course. CONCLUSIONS: Participation in a floristry course may lead to a significant improvement in pain and psychiatric symptoms in fibromyalgia patients. These findings highlight the potential benefit of utilizing occupational therapy programs, such as a floristry course, for improving quality of life in fibromyalgia.


Assuntos
Ansiedade/terapia , Terapias Complementares/métodos , Depressão/terapia , Fibromialgia/terapia , Qualidade de Vida , Adulto , Idoso , Ansiedade/psicologia , Estudos de Coortes , Depressão/psicologia , Feminino , Fibromialgia/fisiopatologia , Fibromialgia/psicologia , Flores , Humanos , Pessoa de Meia-Idade , Medição da Dor , Escalas de Graduação Psiquiátrica , Inquéritos e Questionários
5.
Am J Psychother ; 72(3): 59-66, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31533455

RESUMO

This study supports the efficacy of transdiagnostic behavior therapy across various affective disorders, including depression and PTSD. These findings suggest a possible reduction in the number of treatment protocols providers need to learn in order to treat patients with affective disorders.


Assuntos
Terapia Comportamental , Transtornos do Humor/terapia , Terapia Comportamental/educação , Protocolos Clínicos , Depressão/terapia , Transtorno Depressivo/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos do Humor/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Resultado do Tratamento
6.
Am J Psychother ; 72(3): 67-74, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31533456

RESUMO

Using data from 202 patients with depression, the authors conducted a psychometric evaluation of the Dutch translation of the Competencies of Cognitive Therapy Scale-Self-Report and an initial psychometric evaluation of the newly developed Interpersonal Psychotherapy Skills Scale-Self-Report.


Assuntos
Terapia Cognitivo-Comportamental/educação , Depressão/psicologia , Depressão/terapia , Transtorno Depressivo/psicologia , Transtorno Depressivo/terapia , Adulto , Feminino , Humanos , Masculino , Psicometria , Autorrelato
7.
Artigo em Russo | MEDLINE | ID: mdl-31464298

RESUMO

This literature review considers meta-analyzes, systematic reviews and original research over the last decade addressing a comprehensive analysis of the antidepressant effect of targeted physical exercise and physical activity in general. Exercise is a promising non-pharmacological treatment for depression, showing effects that are comparable or may even exceed other first-line treatments of depression. The article introduces modern ideas about the mechanisms of depression and mechanisms of exercise effects on depression manifestations. The structures of the central nervous system, changing with the effective exercise-based treatment of depression, are indicated. Physical activity stimulates the secretion of growth factors, maintenance of angio-, synapto-, and neurogenesis. The regulation of antioxidant protection of neuronal mitochondria, a decrease in pro-inflammatory reactions and stress reactivity are also observed in response to regular exercise. Physical activity has a multimodal effect that stimulates biochemical pathways and restores neuronal structures disturbed in depression.


Assuntos
Depressão , Transtorno Depressivo , Terapia por Exercício , Antidepressivos , Depressão/psicologia , Depressão/terapia , Transtorno Depressivo/psicologia , Transtorno Depressivo/terapia , Exercício , Humanos , Neurogênese
8.
Medicine (Baltimore) ; 98(33): e16803, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415391

RESUMO

BACKGROUND: This proposed study will systematically assess the effect and safety of cognitive-behavioral therapy (CBT) for heart failure (HF). METHODS: We will search the following electronic databases for randomized controlled trials assessing the effect of CBT in patients with HF: PUBMED, EMBASE, Cochrane Library, Web of Science, Scopus, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, VIP Information, and Wanfang Data from their inceptions to present without any language limitations. Two authors will independently conduct the study selection, data extraction, and methodological quality assessment. The methodological quality will be evaluated by Cochrane risk of bias tool. RESULTS: This study will assess the efficacy and safety of CBT for patients with HF. The primary outcomes consist of depression and anxiety. The secondary outcomes comprise of all-cause mortality, change in body weight, urine output, change in serum sodium; and any adverse events. CONCLUSION: The results of this study will summarize the up-to-date evidence on the effect and safety of CBT for HF. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42019135932.


Assuntos
Ansiedade/terapia , Terapia Cognitivo-Comportamental/métodos , Depressão/terapia , Insuficiência Cardíaca/psicologia , Adulto , Idoso , Ansiedade/etiologia , Depressão/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Revisão Sistemática como Assunto , Resultado do Tratamento
9.
Medicine (Baltimore) ; 98(31): e16631, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374032

RESUMO

BACKGROUND: This systematic review protocol describes the methods that will be used to evaluate the efficacy and safety of ear acupuncture for trauma-related disorders after large-scale disasters. METHODS AND ANALYSIS: The following electronic databases will be searched up to May 2019 without language or publication status restrictions: Medline, EMBASE, the Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, and PsycARTICLES. We will also search Korean, Chinese, and Japanese databases. Any clinical studies with original data related to ear acupuncture for trauma-related disorders after large-scale disaster will be included. Traumatic stress-related symptoms will be assessed as primary outcomes. Depression, anxiety, adverse events, and total effective rate will be evaluated as secondary outcomes. Two researchers will independently perform the study selection, data extraction, and assessment of study quality. Descriptive analyses of the details of participants, interventions, and outcomes for all included studies will be conducted. Data synthesis and analysis will be performed using RevMan version 5.3. The methodological quality of the included studies will be evaluated according to the study design. ETHICS AND DISSEMINATION: Ethical approval is not required because individual patient data are not included. The findings of this systematic review will be disseminated through a peer-reviewed publication or conference presentations. PROSPERO REGISTRATION NUMBER: CRD42019134658.


Assuntos
Acupuntura Auricular/métodos , Desastres , Saúde Mental , Trauma Psicológico/terapia , Acupuntura Auricular/efeitos adversos , Ansiedade/epidemiologia , Ansiedade/terapia , Dor Crônica/epidemiologia , Dor Crônica/terapia , Depressão/epidemiologia , Depressão/terapia , Humanos , Trauma Psicológico/epidemiologia , Projetos de Pesquisa
10.
Medicine (Baltimore) ; 98(32): e16820, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393414

RESUMO

BACKGROUND: Heart failure related depression is recently increased worldwide. Heart failure (HF) disease is identified as a critical cause of increasing morbidity, hospital readmission, and mortality. The most important purpose of treatment of HF disease is to relief disease problems, improve functional performance, and achieve better quality of life. OBJECTIVES: This study was proposed to evaluate the effects of low to moderate-intensity exercise program vs moderate-intensity continuous exercise program on the level of depressive disorder in heart failure patients. STUDY DESIGN: 12-week randomized controlled trial. METHODS: Sixty nine HF patients with mild to moderate level of depression and ejection fraction <40% were examined before and after 12-week intervention. Their age was ranged from 40 to 60 years. Patients were randomly classified into 3 groups. Group I (n = 23) received low to moderate intensity exercise program (LMIEP), group II (n = 23) received moderate-intensity exercise program (MICEP), and group III (n = 23) did not receive any exercise program (Non-exercised group). All patients were instructed to conduct home-based exercise with their pharmacological therapy. The level of depression was evaluated before and after 12 weeks of the intervention program. RESULTS: The 3 study groups were associated with significant decrease of depression level (P < .05). Significant differences were exhibited between the 3 groups in favor to both exercise programs (P < .05) with non-significant differences between the 2 exercise programs (P > .05). CONCLUSIONS: Both exercise programs had positive effects in reducing the severity of depression in HF patients. Low to moderate and moderate-intensity exercise programs should be proposed for depression illness specially patients with heart failure.


Assuntos
Depressão/etiologia , Depressão/terapia , Terapia por Exercício/métodos , Insuficiência Cardíaca/complicações , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Índice de Gravidade de Doença
11.
Int J Behav Med ; 26(4): 380-390, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31264101

RESUMO

BACKGROUND: Cognitive therapy (CT) and bright light therapy (BLT) have been found to be effective to treat depressive symptoms in breast cancer patients. No study has investigated the baseline patients' characteristics that are associated with better outcomes with CT vs. BLT in this population. This study aimed to assess, in breast cancer patients, the moderating role of eight clinical variables on the effects of CT and BLT on depressive symptoms. METHODS: This is a secondary analysis of a randomized controlled trial conducted in 59 women who received an 8-week CT or BLT and completed questionnaires evaluating depression and possible moderating variables. RESULTS: Patients benefited more from BLT when they had no prior history of major depressive disorder, higher depression scores on the Hospital Anxiety and Depression Scale (HADS-D) at baseline, a greater initial preference for BLT, and when they received BLT during spring or summer. Patients benefited more from CT when they had a lower initial preference for receiving CT, higher depression scores on the HADS-D, and seasonal depressive symptoms. CONCLUSIONS: Although replication is needed, findings of this study suggest the existence of different profiles of patients more likely to benefit from CT and BLT. TRIAL REGISTRATION: NCT01637103 https://clinicaltrials.gov/ct2/show/NCT01637103.


Assuntos
Neoplasias da Mama/psicologia , Terapia Cognitivo-Comportamental/métodos , Depressão/terapia , Fototerapia/métodos , Adulto , Depressão/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Estações do Ano , Resultado do Tratamento
12.
BMC Public Health ; 19(1): 941, 2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31300029

RESUMO

BACKGROUND: This study is a secondary analysis of the trial by Callaghan et al. (2011), which reported higher antidepressant effects for preferred intensity (n = 19) vs. prescribed intensity (n = 19) exercise of three sessions/week over four weeks in depressed women. In particular, the present study sought to examine whether greater clinically significant individual change/recovery was observed in the preferred compared to the prescribed exercise group. METHODS: The reliable change index and the Ccutoff score criteria described by Jacobson and Truax (1991) were employed to determine clinical significance. These criteria examined if individual change in depression scores from pre- to post-intervention in the preferred intensity group were statistically significant beyond the standard error of difference derived from the active comparator prescribed group, and subsequently within a normal population range. Patients fulfilling the first or both criteria were classified as improved or recovered, respectively. RESULTS: Post-intervention depression scores of six patients in the preferred intensity exercise group (32%) demonstrated statistically reliable improvement (p < 0.05) and recovery. Half of this subgroup started as moderately depressed. No patient demonstrated a reliable deterioration in depression. Due to a small sample size, it was impossible to determine whether patients on psychiatric medication or medication-free patients were equally benefited from preferred intensity exercise. Thirteen patients in the preferred intensity group (68%) displayed non-statistically significant change in post-intervention depression scores (p > 0.05), although eight of them showed a non-significant improvement in post-intervention depression scores and three could not technically show an improvement in depression due to floor effects (baseline depression within normal range). CONCLUSIONS: Preferred intensity exercise of three sessions/week over four weeks led almost a third of the patients to record scores consistent with recovery from depression. Health professionals may consider that short-term preferred intensity exercise provides clinically significant antidepressant effects comparing favourably to exercise on prescription.


Assuntos
Depressão/terapia , Terapia por Exercício , Exercício/psicologia , Individualidade , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento , Reino Unido
13.
Medicine (Baltimore) ; 98(26): e15947, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261500

RESUMO

To assess the hypothesis if tocilizumab (TCZ) is effective on disease activity, and also its effect in fatigue and other clinical and psychological disease-related factors in patients with rheumatoid arthritis (RA) treated with TCZ.A 24-week, multicenter, prospective, observational study in patients with moderate to severe RA receiving TCZ after failure or intolerance to disease-modifying antirheumatic drugs or tumor necrosis factor-alpha was conducted.Of the 122 patients included, 85 were evaluable for effectiveness (85% female, 51.9 ±â€Š12.5 years, disease duration 8.7 ±â€Š7.4 years). Mean change in C-reactive protein level from baseline to week 12 was -11.2 ±â€Š4.0 (P < .001). Mean Disease Activity Index score (DAS28) decreased from 5.5 ±â€Š1.0 at baseline to 2.7 ±â€Š1.3 (P < .001) at week 24. Mean change in Functional Assessment of Chronic Illness Therapy score was -5.4 ±â€Š11.2 points at week 24. Multiple regression analysis showed that the improvement in DAS28, sleep, and depression explained 56% and 47% of fatigue variance at week 12 and 24, respectively.Tocilizumab is effective in reducing disease activity and results in a clinically significant improvement in fatigue, pain, swollen joint count, morning stiffness, sleepiness, depression, and DAS28; the last 3 were specifically identified as factors explaining fatigue variance with the use of TCZ in RA patients.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Artrite Reumatoide/psicologia , Artrite Reumatoide/terapia , Fadiga/psicologia , Fadiga/terapia , Antirreumáticos/uso terapêutico , Artrite Reumatoide/fisiopatologia , Biomarcadores/metabolismo , Proteína C-Reativa/metabolismo , Depressão/fisiopatologia , Depressão/terapia , Fadiga/etiologia , Fadiga/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Retratamento , Sono , Resultado do Tratamento , Fator de Necrose Tumoral alfa/uso terapêutico
14.
Medicine (Baltimore) ; 98(30): e16477, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348252

RESUMO

BACKGROUND: Traditional Chinese medicine (TCM) therapy is effective for post-stroke depression (PSD). TCM therapy encompasses various forms of practices. However, the comparative effectiveness of these therapies is still not clear. Here, we provide a network meta-analysis protocol to compare the effects of different types of TCM therapy on PSD, using both direct and indirect evidence. METHODS: Twelve databases investigation will be conducted through the keywords from their inception to June 1, 2019. At least 2 independent reviewers will identify eligible articles. EndNote X7 software is utilized to manage the literatures and RevMan V.5.3 (The Cochrane Collaboration) software is for data processing throughout the review. The package "netmeta" (version 0.5-0) in R (version 3.0.2, The R Foundation for Statistical Computing) will be used to perform network meta-analysis (NMA). In addition, the overall quality of evidence is evaluated by GRADEPro software, and Cochrane Collaboration Risk of Bias Tool is employed for the methodological quality. Generally speaking, this review protocol is reported according to the preferred reporting items for systematic review and meta-analysis protocols 2015 guidelines. RESULTS: According to this protocol, it will provide evidence in support of, or against, the hypothesis that TCM therapy for PSD is more effective than pharmacotherapy. The results of this study will also provide evidence on relative efficacy of different forms of TCM. Furthermore, this analysis will show which form(s) of TCM therapy is (are) the most effective. CONCLUSION: The results will help PSD doctors and patients choose the treatment regimen which is effective, time-saving and economical. PROSPERO REGISTRATION NUMBER: CRD42016041594.


Assuntos
Depressão/etiologia , Depressão/terapia , Medicina Tradicional Chinesa/métodos , Acidente Vascular Cerebral/complicações , Antidepressivos/uso terapêutico , Humanos , Meta-Análise em Rede , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
15.
J Cancer Res Clin Oncol ; 145(8): 2141-2148, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31278473

RESUMO

PURPOSE: Many cancer patients (PTS) suffer from somatic or non-somatic symptoms. Studies have shown positive effects of music intervention (MI) on aspects of quality of life or symptom management. METHODS: Since there are poor data available about patient's needs regarding the use of MI as an adjunct to cancer treatment, n = 548 tumor PTS were polled anonymously at the outpatient department of the University Hospital Mannheim Tumor Center using a self-designed questionnaire. Univariate and multivariate analyses were performed. RESULTS: 486 data sets were eligible for analysis. 240 of the PTS were male and median age was 63 years. 38% had metastatic disease. 81% (n = 386) were currently receiving anti-tumor treatment. The majority of the PTS stated to have somatic symptoms. However, some of the PTS reported non-somatic symptoms like anxiety, loneliness, and depression. N = 187 (40%) of the PTS reported interest in complementary MI. In the univariate and multivariate analyses, especially PTS with non-somatic complaints and PTS, actively playing or making music showed significantly more interest in complementary MI, hoping for a relaxing therapeutic effect. PTS who play instruments would prefer more active forms of MI. CONCLUSION: 40% of PTS reported interest in additional MI during cancer treatment. PTS with non-somatic symptoms as well as patients affine to music might benefit from the use of MI potentially reducing their symptom burden. The inconsistent and heterogeneous data from randomized trials underline the importance of systematic research approaches with more relevant and standardized endpoints.


Assuntos
Terapias Complementares/métodos , Musicoterapia , Música , Neoplasias/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/complicações , Ansiedade/epidemiologia , Ansiedade/psicologia , Ansiedade/terapia , Terapias Complementares/psicologia , Terapias Complementares/estatística & dados numéricos , Depressão/complicações , Depressão/epidemiologia , Depressão/psicologia , Depressão/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Música/psicologia , Neoplasias/epidemiologia , Neoplasias/patologia , Neoplasias/psicologia , Qualidade de Vida , Estresse Psicológico/epidemiologia , Estresse Psicológico/etiologia , Estresse Psicológico/terapia , Inquéritos e Questionários , Adulto Jovem
17.
Manchester; The National Institute for Health and Care Excellence (NICE); June 2019. 44 p.
Monografia em Inglês | BIGG | ID: biblio-1014953

RESUMO

This guideline covers identifying and managing depression in children and young people aged 5 to 18 years. Based on the stepped-care model, it aims to improve recognition and assessment and promote effective treatments for mild and moderate to severe depression.


Assuntos
Humanos , Criança , Adulto , Depressão/diagnóstico , Depressão/psicologia , Depressão/terapia , Saúde Mental , Pessoal Técnico de Saúde/organização & administração , Anamnese
18.
Cochrane Database Syst Rev ; 7: CD012295, 2019 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-31264211

RESUMO

BACKGROUND: Migraine is a common neurological problem associated with the highest burden amongst neurological conditions in terms of years lived with disability. Medications can be used as prophylaxis or rescue medicines, but are costly and not always effective. A range of psychological interventions have been developed to manage migraine. OBJECTIVES: The objective was to evaluate the efficacy and adverse events of psychological therapies for the prevention of migraine in adults. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, PsycINFO and CINAHL from their inception until July 2018, and trials registries in the UK, USA, Australia and New Zealand for randomised controlled trials of any psychological intervention for adults with migraine. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of a psychological therapy for people with chronic or episodic migraine, with or without aura. Interventions could be compared to another active treatment (psychological or medical), an attention-placebo (e.g. supportive counselling) or other placebo, routine care, or waiting-list control. We excluded studies where fewer than 15 participants completed each arm. DATA COLLECTION AND ANALYSIS: We extracted study characteristics and outcome data at post-treatment and the longest available follow-up. We analysed intervention versus control comparisons for the primary outcome of migraine frequency. We measured migraine frequency using days with migraines or number of migraine attacks measured in the four weeks after treatment. In addition, we analysed the following secondary outcomes: responder rate (the proportion of participants with a 50% reduction in migraine frequency between the four weeks prior to and the four weeks after treatment); migraine intensity; migraine duration; migraine medication usage; mood; quality of life; migraine-related disability; and proportion of participants reporting adverse events during the treatment. We included these variables, where available, at follow-up, the timing of which varied between the studies. We used the GRADE approach to judge the quality of the evidence. MAIN RESULTS: We found 21 RCTs including 2482 participants with migraine, and we extracted meta-analytic data from 14 of these studies. The majority of studies recruited participants through advertisements, included participants with migraine according to the International Classification of Headache Disorders (ICHD) criteria and those with and without aura. Most intervention arms were a form of behavioural or cognitive-behavioural therapy. The majority of comparator arms were no treatment, routine care or waiting list. Interventions varied from one 20-minute session to 14 hours of intervention. No study had unequivocally low risk of bias; all had at least one domain at high risk of bias, and 20 had two to five domains at high risk. Reporting of randomisation procedures and allocation concealment were at high or unclear risk of bias. We downgraded the quality of evidence for outcomes to very low, due to very serious limitations in study quality and imprecision. Reporting in trials was poor; we found no preregistrations stipulating the outcomes, or demonstrating equivalent expectations between groups. Few studies reported our outcomes of interest, most only reported outcomes post treatment; follow-up data were sparse.Post-treatment effectsWe found no evidence of an effect of psychological interventions for migraine frequency in number of migraines or days with migraine (standardised mean difference (SMD) -0.02, 95% confidence interval (CI) -0.17 to 0.13; 4 studies, 681 participants; very low-quality evidence).The responder rate (proportion of participants with migraine frequency reduction of more than 50%) was greater for those who received a psychological intervention compared to control: 101/186 participants (54%) with psychological therapy; 37/152 participants (24%) with control (risk ratio (RR) 2.21, 95% CI 1.63 to 2.98; 4 studies, 338 participants; very low-quality evidence). We found no effect of psychological therapies on migraine intensity (SMD -0.13, 95% CI -0.28 to 0.02; 4 studies, 685 participants). There were no data for migraine duration (hours of migraine per day). There was no effect on migraine medication usage (SMD -0.06, 95% CI -0.35 to 0.24; 2 studies, 483 participants), mood (mean difference (MD) 0.08, 95% CI -0.33 to 0.49; 4 studies, 432 participants), quality of life (SMD -0.02, 95% CI -0.30 to 0.26; 4 studies, 565 participants), or migraine-related disability (SMD -0.67, 95% CI -1.34 to 0.00; 6 studies, 952 participants). The proportion of participants reporting adverse events did not differ between those receiving psychological treatment (9/107; 8%) and control (30/101; 30%) (RR 0.16, 95% CI 0.00 to 7.85; 2 studies, 208 participants). Only two studies reported adverse events and so we were unable to draw any conclusions.We rated evidence from all studies as very low quality.Follow-upOnly four studies reported any follow-up data. Follow-ups ranged from four months following intervention to 11 months following intervention. There was no evidence of an effect on any outcomes at follow-up (very low-quality evidence). AUTHORS' CONCLUSIONS: This review identified 21 studies of psychological interventions for the management of migraine. We did not find evidence that psychological interventions affected migraine frequency, a result based on four studies of primarily brief treatments. Those who received psychological interventions were twice as likely to be classified as responders in the short term, but this was based on very low-quality evidence and there was no evidence of an effect of psychological intervention compared to control at follow-up. There was no evidence of an effect of psychological interventions on medication usage, mood, migraine-related disability or quality of life. There was no evidence of an effect of psychological interventions on migraine frequency in the short-term or long-term. In terms of adverse events, we were unable to draw conclusions as there was insufficient evidence. High and unclear risk of bias in study design and reporting, small numbers of participants, performance and detection bias meant that we rated all evidence as very low quality. Therefore, we conclude that there is an absence of high-quality evidence to determine whether psychological interventions are effective in managing migraine in adults and we are uncertain whether there is any difference between psychological therapies and controls.


Assuntos
Transtornos de Enxaqueca/prevenção & controle , Psicoterapia/métodos , Ansiedade/terapia , Terapia Cognitivo-Comportamental , Depressão/terapia , Humanos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
19.
Medicine (Baltimore) ; 98(29): e16506, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335722

RESUMO

BACKGROUND: This study investigated the effects of multiple training modalities (MTM) on senior fitness and neuropsychiatric function in the elderly with subjective memory complaints (SMC). METHODS: This study was conducted in 24 elderly subjects with Clinical Dementia Rating (CDR) score of 0 and instrument of ascertainment of dementia 8 (AD8) score of <2. The participants were classified into SMC (n = 7) and non-SMC (n = 17).All were assigned to receive multiple training modalities (1 hour for each training: physical fitness activities, calligraphy or drawing, and meditation) twice a week over a 16-week period.A series of senior fitness test, and neuropsychiatric tests, namely the Traditional Chinese version Mini-Mental Status Examination (MMSE), Cognitive Assessment Screening Instrument (CASI), and the Center for Epidemiologic Studies Depression Scale (CESD), were conducted before and after the intervention. We compared the differences of pre/posttest-MTM and SMC/non-SMC in senior fitness and the neuropsychological tests. RESULTS: There was no significant difference between SMC and non-SMC groups in demographic characteristics. MTM showed significant improvement in senior fitness and CESD, but not in CASI and MMSE. Significant change in recent memory subscale of CASI was only observed in SMC group, whereas improvement of partial senior fitness and CESD were observed in both groups. CONCLUSION: MTM had effects in enhancing senior fitness and improving depressive syndromes in the elderly. MTM contributed to greater improvement in recent memory function in the SMC group than in the non-SMC group.


Assuntos
Terapia pela Arte , Terapia por Exercício , Meditação , Transtornos da Memória/terapia , Idoso , Terapia Combinada , Depressão/diagnóstico , Depressão/terapia , Feminino , Humanos , Masculino , Transtornos da Memória/diagnóstico , Testes de Estado Mental e Demência , Aptidão Física , Projetos Piloto
20.
Cochrane Database Syst Rev ; 6: CD009912, 2019 06 17.
Artigo em Inglês | MEDLINE | ID: mdl-31204791

RESUMO

BACKGROUND: Increasingly, cancer is recognised as a chronic condition with a growing population of informal caregivers providing care for cancer patients. Informal caregiving can negatively affect the health and well-being of caregivers. We need a synthesised account of best evidence to aid decision-making about effective ways to support caregivers for individuals 'living with cancer'. OBJECTIVES: To assess the effectiveness of psychosocial interventions designed to improve the quality of life (QoL), physical health and well-being of informal caregivers of people living with cancer compared with usual care. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, PsycINFO, ProQuest, Open SIGLE, Web of Science from inception up to January 2018, trial registries and citation lists of included studies. SELECTION CRITERIA: We included randomised and quasi-randomised controlled trials comparing psychosocial interventions delivered to adult informal caregivers of adults affected by cancer on a group or individual basis with usual care. Psychosocial interventions included non-pharmacological interventions that involved an interpersonal relationship between caregivers and healthcare professionals. We included interventions delivered also to caregiver-patient dyads. Interventions delivered to caregivers of individuals receiving palliative or inpatient care were excluded. Our primary outcome was caregiver QoL. Secondary outcomes included patient QoL, caregiver and patient depression, anxiety, psychological distress, physical health status and intervention satisfaction and adverse effects. DATA COLLECTION AND ANALYSIS: Pairs of review authors independently screened studies for eligibility, extracted data and conducted 'Risk of bias' assessments. We synthesised findings using meta-analysis, where possible, and reported remaining results in a narrative synthesis. MAIN RESULTS: Nineteen trials (n = 3, 725) were included in the review. All trials were reported in English and were undertaken in high-income countries. Trials targeted caregivers of patients affected by a number of cancers spanning newly diagnosed patients, patients awaiting treatment, patients who were being treated currently and individuals post-treatment. Most trials delivered interventions to caregiver-patient dyads (predominantly spousal dyads) and there was variation in intervention delivery to groups or individual participants. There was much heterogeneity across interventions though the majority were defined as psycho-educational. All trials were rated as being at 'high risk of bias'.Compared to usual care, psychosocial interventions may improve slightly caregiver QoL immediately post intervention (standardised mean difference (SMD) 0.29, 95% confidence interval (CI) 0.04 to 0.53; studies = 2, 265 participants) and may have little to no effect on caregiver QoL at 12 months (SMD 0.14, 95% CI - 0.11 to 0.40; studies = 2, 239 participants) post-intervention (both low-quality evidence).Psychosocial interventions probably have little to no effect on caregiver depression immediately to one-month post-intervention (SMD 0.01, 95% CI -0.14 to 0.15; studies = 9, 702 participants) (moderate-quality evidence). Psychosocial interventions may have little to no effect on caregiver anxiety immediately post-intervention (SMD -0.12, 95 % CI -0.33 to 0.10; studies = 5, 329 participants), depression three-to-six months (SMD 0.03, 95% CI -0.33 to 0.38; studies = 5. 379 participants) post-intervention and patient QoL six to 12 months (SMD -0.05, 95% CI -0.37 to 0.26; studies = 3, 294 participants) post-intervention (all low-quality evidence). There was uncertainty whether psychosocial interventions improve patient QoL immediately (SMD -0.03, 95 %CI -0.50 to 0.44; studies = 2, 292 participants) or caregiver anxiety three-to-six months (SMD-0.25, 95% CI -0.64 to 0.13; studies = 4, 272 participants) post-intervention (both very low-quality evidence). Two studies which could not be pooled in a meta-analysis for caregiver physical health status found little to no effect immediately post-intervention and a small intervention effect 12 months post-intervention. Caregiver or patient satisfaction or cost-effectiveness of interventions were not assessed in any studies. Interventions demonstrated good feasibility and acceptability.Psychosocial interventions probably have little to no effect on patient physical health status immediately post-intervention (SMD 0.17, 95 % CI -0.07 to 0.41; studies = 4, 461 participants) and patient depression three to six months post-intervention (SMD-0.11, 95% CI -0.33 to 0.12; studies = 6, 534 participants) (both moderate-quality evidence).Psychosocial interventions may have little to no effect on caregiver psychological distress immediately to one-month (SMD -0.08, 95% CI -0.42 to 0.26; studies = 3, 134 participants), and seven to 12 months (SMD 0.08, 95% CI -0.42 to 0.58; studies = 2, 62 participants) post-intervention; patient depression immediately (SMD -0.12, 95% CI -0.31 to 0.07; studies = 9, 852 participants); anxiety immediately (SMD -0.13, 95% CI -0.41 to 0.15;studies = 4, 422 participants), and three to six months (SMD -0.22, 95% CI -0.45 to 0.02; studies = 4, 370 participants); psychological distress immediately (SMD -0.02, 95% CI -0.47 to 0.44; studies = 2, 74 participants) and seven to 12 months (SMD -0.27, 95% CI -0.78 to 0.24; studies = 2, 61 participants); and physical health status six to 12 months (SMD 0.06, 95% CI -0.18 to 0.30; studies = 2, 275 participants) post-intervention (all low-quality evidence).Three trials reported adverse effects associated with the interventions, compared with usual care, including higher distress, sexual function-related distress and lower relationship satisfaction levels for caregivers, higher distress levels for patients, and that some content was perceived as insensitive to some participants.Trials not able to be pooled in a meta-analysis did not tend to report effect size and it was difficult to discern intervention effectiveness. Variable intervention effects were reported for patient and caregiver outcomes. AUTHORS' CONCLUSIONS: Heterogeneity across studies makes it difficult to draw firm conclusions regarding the effectiveness of psychosocial interventions for this population. There is an immediate need for rigorous trials with process evaluations and clearer, detailed intervention descriptions. Cost-effectiveness studies should be conducted alongside future trials.


Assuntos
Ansiedade , Cuidadores , Depressão , Neoplasias , Ansiedade/terapia , Cuidadores/psicologia , Depressão/terapia , Nível de Saúde , Humanos , Neoplasias/enfermagem , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
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