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1.
Medicine (Baltimore) ; 98(21): e15452, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31124928

RESUMO

OBJECTIVE: To analyze clinical and sociodemographic properties of the patients as measured by the "Hospital Anxiety and Depression Scale-HADS" including the subscale regarding anxiety (HAD-A) in emergency department (ED) and to detect the effect of a session of Benson relaxation method (BRM) on high anxiety level. METHODS: Adult patients presented to the state hospital ED in seven days were recruited in this prospective study. Patients with high (≥8) scores were randomized to the treatment or control groups. They were asked to pursue BRM to alleviate anxiety. RESULTS: Six hundred thirty-four patients were recruited (mean age 44.1 and 52% were female). Patients with acute exacerbation or with psychiatric illness, with a systemic disease and higher acuity level had higher HAD-A scores (P < .05). BRM group had a mean score change higher than controls (7.2 ±â€Š2.9 vs 3.4 ±â€Š2.6, t test, P = .026). CONCLUSIONS: Patients who underwent BRM had larger decreases in HAD-A scores than others.


Assuntos
Doença Aguda/psicologia , Ansiedade/terapia , Serviços Médicos de Emergência/métodos , Psicoterapia Breve/métodos , Terapia de Relaxamento/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/etiologia , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Resultado do Tratamento , Adulto Jovem
2.
Sleep Med Clin ; 14(2): 235-243, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31029189

RESUMO

Cognitive behavioral treatment for insomnia (CBTI) is an effective treatment of insomnia; however, there are insufficient CBTI providers for the 10% to 25% of the population who have insomnia. Brief behavioral treatment for insomnia (BBTI) is a 4-session manualized treatment paradigm administrable in medical settings by nonpsychologist health professionals. BBTI is effective in reducing symptoms of insomnia, such as sleep onset latency, wake after sleep onset, and sleep efficiency. In some cases, BBTI resulted in full remission from insomnia. Ongoing clinical trials are further testing the efficacy of BBTI using alternative treatment deliveries and in primary medical care settings.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Psicoterapia Breve/métodos , Distúrbios do Início e da Manutenção do Sono/terapia , Humanos
3.
Lancet ; 393(10182): 1733-1744, 2019 04 27.
Artigo em Inglês | MEDLINE | ID: mdl-30948286

RESUMO

BACKGROUND: Many women are affected by anxiety and depression after armed conflict in low-income and middle-income countries, yet few scalable options for their mental health care exist. We aimed to establish the effectiveness of a brief group psychological intervention for women in a conflict-affected setting in rural Swat, Pakistan. METHODS: In a single-blind, cluster, randomised, controlled trial, 34 community clusters in two union councils of rural Swat, Pakistan, were randomised using block permutation at a 1:1 ratio to intervention (group intervention with five sessions incorporating behavioural strategies facilitated by non-specialists) or control (enhanced usual care) groups. Researchers responsible for identifying participants, obtaining consent, enrolment, and outcome assessments were masked to allocation. A community cluster was defined as neighbourhood of about 150 households covered by a lady health worker. Women aged 18-60 years who provided written informed consent, resided in the participating cluster catchment areas, scored at least 3 on the General Health Questionnaire-12, and at least 17 on the WHO Disability Assessment Schedule were recruited. The primary outcome, combined anxiety and depression symptoms, was measured 3 months after the intervention with the Hospital Anxiety and Depression Scale (HADS). Modified intention-to-treat analyses were done using mixed models adjusted for covariates and clusters defined a priori. The trial is registered with the Australian New Zealand Clinical Trials Registry, number 12616000037404, and is now closed to new participants. FINDINGS: From 34 eligible community clusters, 306 women in the intervention group and 306 women in the enhanced usual care (EUC) group were enrolled between Jan 11, 2016, and Aug 21, 2016, and the results of 288 (94%) of 306 women in the intervention group and 290 (95%) of 306 women in the EUC group were included in the primary endpoint analysis. At 3 months, women in the intervention group had significantly lower mean total scores on the HADS than women in the control group (10·01 [SD 7·54] vs 14·75 [8·11]; adjusted mean difference [AMD] -4·53, 95% CI -7·13 to -1·92; p=0·0007). Individual HADS anxiety scores were also significantly lower in the intervention group than in the control group (5·43 [SD 4·18] vs 8·02 [4·69]; AMD -2·52, 95% CI -4·04 to -1·01), as were depression scores (4·59 [3·87] vs 6·73 [3·91]; AMD -2·04, -3·19 to -0·88). No adverse events were reported in either group. INTERPRETATION: Our group psychological intervention resulted in clinically significant reductions in anxiety and depressive symptoms at 3 months, and might be a feasible and effective option for women with psychological distress in rural post-conflict settings. FUNDING: WHO through a grant from the Office for Foreign Disaster Assistance.


Assuntos
Transtornos de Ansiedade/terapia , Conflitos Armados/psicologia , Transtorno Depressivo/terapia , Psicoterapia Breve/métodos , Adolescente , Adulto , Transtornos de Ansiedade/etiologia , Análise por Conglomerados , Transtorno Depressivo/etiologia , Exposição à Violência/psicologia , Feminino , Humanos , Pessoa de Meia-Idade , Paquistão , Saúde da População Rural , Método Simples-Cego , Resultado do Tratamento , Adulto Jovem
4.
Trials ; 20(1): 196, 2019 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-30953536

RESUMO

BACKGROUND: Psychotherapy for borderline personality disorder is often lengthy and resource-intensive. However, the current length of outpatient treatments is arbitrary and based on trials that never tested if the treatment intensity could be reduced. As a result, there is insufficient evidence to inform the decision between short-term and long-term psychotherapy for borderline personality disorder. Mentalization-based therapy is one treatment option for borderline personality disorder and consists traditionally of an 18-month treatment program. METHODS/DESIGN: This trial is an investigator-initiated single-center randomized clinical superiority trial of short-term (20 weeks) compared to long-term (14 months) mentalization-based therapy for outpatients with subthreshold or diagnosed borderline personality disorder. Participants will be recruited from the Outpatient Clinic for Personality Disorders at Stolpegaard Psychotherapy Centre, Mental Health Services, Capital Region of Denmark. Participants will be included if they meet a minimum of four DSM-V criteria for borderline personality disorder. Participants will be assessed before randomization, and at 8, 16, and 24 months after randomization. The primary outcome is severity of borderline symptomatology assessed with the Zanarini Rating Scale for borderline personality disorder. Secondary outcomes include self-harm incidents, functional impairment (Work and Social Adjustment Scale, Global Assessment of Functioning) and quality of life (Short-Form Health Survey 36). Severity of psychiatric symptoms (Symptom Checklist 90-R) will be included as an exploratory outcome. Measures of personality functioning, attachment, borderline symptoms, group alliance, and mentalization skills will be included to explore potential predictors and mechanisms of change. DISCUSSION: This trial will provide evidence of the beneficial and harmful effects of short-term compared to long-term mentalization-based therapy for outpatients with subthreshold or diagnosed borderline personality disorder. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03677037 . Registered on September 19, 2018.


Assuntos
Assistência Ambulatorial , Transtorno da Personalidade Borderline/terapia , Mentalização , Psicoterapia Breve , Psicoterapia/métodos , Transtorno da Personalidade Borderline/diagnóstico , Transtorno da Personalidade Borderline/psicologia , Dinamarca , Estudos de Equivalência como Asunto , Humanos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
5.
J Consult Clin Psychol ; 87(6): 501-509, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31008637

RESUMO

OBJECTIVE: Two decades of empirical research suggest that changes in symptoms are not linear, and many patients gain much of their symptom reduction in one between-sessions interval. Theoretically, such gains are expected to be manifested in the working alliance as well, following a rupture session; however, no study to date has directly examined between-sessions sudden gains in the alliance. In the present study we examined whether ruptures predict subsequent sudden gains in the alliance, which in turn show an effect on outcome that is specific to the treatment in which the alliance is conceptualized as an active mechanism of change. METHOD: In a sample of 241 patient-therapist dyads, patients received either brief relational therapy (BRT), in which the alliance is conceptualized as an active mechanism of change, or cognitive-behavioral therapy (CBT), in which it is not. We examined whether patient and therapist reports of ruptures predicted sudden gains in alliance in the subsequent session, and whether early sudden gains in alliance were significantly associated with treatment outcome in BRT versus CBT. RESULTS: Rupture sessions, as reported by therapists but not by patients, predicted a sudden gain in both patient and therapist-reported alliance in the subsequent session. Findings revealed a moderating effect of treatment condition on the association between sudden gains and treatment outcome, in which gains in alliance were associated with better treatment outcome in BRT than in CBT. CONCLUSIONS: The findings support the potential role of gains in alliance as a specific mechanism of change in BRT versus CBT. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Terapia Cognitivo-Comportamental/métodos , Transtornos Mentais/terapia , Relações Profissional-Paciente , Psicoterapia Breve/métodos , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tempo , Resultado do Tratamento , Adulto Jovem
6.
Pap. psicol ; 40(1): 15-20, ene.-abr. 2019. graf
Artigo em Espanhol | IBECS | ID: ibc-181994

RESUMO

El tratamiento de los trastornos de ansiedad ha demostrado su eficacia y efectividad. Sin embargo, no siempre se consiguen los resultados deseados. Estudiar aquellos factores que interfieren en el curso natural del tratamiento contribuirá a tomar medidas oportunas. Dos de estos factores son la prolongación innecesaria de los tratamientos y el fenómeno de la terminación prematura. Como es esperable, la duración del tratamiento depende de la naturaleza del problema y de la existencia de problemas comórbidos, pero también de planificaciones demasiado ambiciosas (exceso de técnicas) o la combinación con psicofármacos (con incrementos de hasta un 21% de sesiones). La terminación prematura se sitúa entorno al 30-35% y los pacientes "anuncian el desenlace" con peor ejecución de tareas y asistencias más irregulares desde el principio. Aproximadamente 50% de los abandonos ocurren antes de la sesión 8 y entorno al 80% de los tratamientos completados exitosamente concluyen antes de la sesión 20


The efficacy and the effectiveness of anxiety disorder treatments have been proven. However, the desired results are not always achieved. Studying the factors that interfere with the natural course of the treatments could help to correct and to adapt them. Two of these factors are the unnecessary prolongation of treatments and premature termination. As expected, the duration of the treatment depends on the nature of the problem and the existence of comorbid problems, however also treatments that are too ambitious (an excess of techniques) or combined with pharmacological treatments (increasing sessions by up to 21%) have a longer duration. Premature termination was around 30-35% and patients "announce" their drop-out by displaying poorer task performance and more irregular attendance from the beginning. More than 50% of the therapeutic dropout occurs before the eighth session and 80% of successful treatments were completed before the 20th session


Assuntos
Humanos , Transtornos de Ansiedade/psicologia , Psicoterapia/métodos , Resultado do Tratamento , Psicoterapia Breve/instrumentação
7.
Psychodyn Psychiatry ; 47(1): 99-112, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30840559

RESUMO

The aim of this study was to evaluate changes in long-term health care costs and symptom severity after adjunctive intensive short-term dynamic psychotherapy (ISTDP) individually tailored and administered to patients with bipolar disorder undergoing standard psychiatric care. Eleven therapists with different levels of expertise delivered an average of 4.6 one-hour sessions of ISTDP to 29 patients with bipolar disorders. Health care service costs were compiled for a one-year period prior to the start of ISTDP along with four one-year periods after termination. Two validated self-report scales, the Brief Symptom Inventory and the Inventory of Interpersonal Problems, were administered at intake and termination of ISTDP. Hospital cost reductions were significant for the one-year post-treatment period relative to baseline year, and all cost reductions were sustained for the follow-up period of four post-treatment years. Self-reported psychiatric symptoms and interpersonal problems were significantly reduced. These preliminary findings suggest that this brief adjunctive psychotherapy may be beneficial and cost-effective in select patients with bipolar disorders, and that gains may be sustained in long-term followup. Future research directions are discussed.


Assuntos
Transtorno Bipolar/terapia , Custos de Cuidados de Saúde/estatística & dados numéricos , Avaliação de Resultados (Cuidados de Saúde)/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Psicoterapia Breve/estatística & dados numéricos , Psicoterapia Psicodinâmica/estatística & dados numéricos , Adulto , Transtorno Bipolar/economia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Escócia , Avaliação de Resultados (Cuidados de Saúde)/economia , Medidas de Resultados Relatados pelo Paciente , Psicoterapia Breve/economia , Psicoterapia Psicodinâmica/economia
8.
J Nurs Educ ; 58(3): 165-168, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30835804

RESUMO

BACKGROUND: This exploratory study investigated the effectiveness of a shortened version of an 8-week mindfulness-based stress reduction (MBSR) intervention with a small sample of after-degree nursing students for managing stress during their practicum. METHOD: A qualitative evaluation design with a purposive criterion sample (n = 5) was used to investigate the impact of a Brief Mindfulness-Based Stress Reduction (MBSR-B) intervention on the experience of stress in after-degree nursing students. RESULTS: Thematic analysis of participants' narratives resulted in the identification of four categories: (a) hitting a reset button, (b) self-compassion, (c) avoiding a downward spiral, and (d) using an internal coping mechanism. These findings suggested a metatheme of self-awareness involving more efficient and effective detection and management of stress. CONCLUSION: The positive impact for participants in this study suggests that stress management for after-degree nursing students through the use of an MBSR-B intervention is worthy of nurse educators' consideration. [J Nurs Educ. 2019;58(3):165-168.].


Assuntos
Ansiedade/prevenção & controle , Depressão/prevenção & controle , Atenção Plena/métodos , Estresse Ocupacional/prevenção & controle , Psicoterapia Breve/métodos , Estudantes de Enfermagem/psicologia , Adulto , Feminino , Humanos , Masculino , Meditação , Resultado do Tratamento
9.
Psychiatry Res ; 272: 774-783, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30832198

RESUMO

The evidence on potentially greater benefits of psychoanalysis (PA) vs. long-term psychodynamic psychotherapy (LPP) is scarce. This study compared the effectiveness of PA and LPP on personality and social functioning during a 10-year follow-up from the beginning of the treatments. The eligible patients, 41 self-selected for PA and 128 assigned to LPP, were 20-45 years of age and had anxiety or mood disorder. Outcomes were analyzed using ten standard measures of personality and social functioning, carried out 5-9 times during the follow-up. Different change patterns by time in PA and LPP emerged, suggesting less benefit of PA during the first years of follow-up and more benefit in most outcomes thereafter. Greater post-treatment improvement in PA than in LPP was seen up to 1-2 years after PA had ended in more mature defense style (DSQ), level of personality organization (LPO), more positive self-concept (SASB), more improved social adjustment (SAS-SR) and sense of coherence (SOC). However, at the 10-year follow-up the differences were non-significant. In conclusion, PA may give some additional benefits when long-term aims are linked to personality and social functioning. The relatively small differences and higher costs in comparison to LPP may restrict the feasibility of PA.


Assuntos
Personalidade , Terapia Psicanalítica/métodos , Psicoterapia Psicodinâmica/métodos , Ajustamento Social , Adulto , Feminino , Seguimentos , Humanos , Masculino , Personalidade/fisiologia , Terapia Psicanalítica/tendências , Psicoterapia Breve/métodos , Psicoterapia Breve/tendências , Psicoterapia Psicodinâmica/tendências , Autoimagem , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
10.
Nord J Psychiatry ; 73(3): 185-194, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30888233

RESUMO

PURPOSE: Behavioural activation and motivational interviewing, both evidence-based treatments (EBTs), were implemented in secondary psychiatric care. This longitudinal evaluation of a real-world programme focused on the penetration of EBT adoption and its associations with therapist-related and perceived intervention-related variables. The implementation plan was also compared to sub-processes of Normalization Process Theory. MATERIAL AND METHODS: Six participating units employed 72 therapists regularly and they comprise the target group. Due to staff turnover, a total of 84 therapists were trained stepwise. Three survey points (q1, q2, q3) were set for a four-year cycle beginning a year after the initial training and completed 4-5 months after closing patient recruitment. The implementation plan included two workshop days, one for each EBT, and subsequent case consultation groups and other more general strategies. RESULTS: Fifty-seven (68%) of programme-trained therapists responded to one or more of three questionnaires. The self-reported penetration covers about a third of the target group a few months after the completion of the programme. Therapists' favourable perceptions of the EBTs regarding relative advantage, compatibility and complexity were associated with their sustained adoption. Therapists' background factors (e.g. work experience) and positive adoption intention at q1 did not predict the actual adoption of the EBTs at q3. No specific sustainment strategies were included in the implementation plan. CONCLUSION: Brief but multi-faceted training with subsequent case consultations promoted the adoption of EBTs in a real-world setting. Adding specific sustainment strategies to the implementation plan is proposed to ensure the long-term survival of the implementation outcomes.


Assuntos
Psicoterapia Breve/organização & administração , Atitude do Pessoal de Saúde , Prática Clínica Baseada em Evidências , Finlândia , Humanos , Avaliação de Programas e Projetos de Saúde , Psicoterapia Breve/educação , Autorrelato , Inquéritos e Questionários
11.
J Gambl Stud ; 35(2): 635-651, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30701377

RESUMO

Self-directed treatments for gambling disorder have been developed to attract individuals who are reluctant to seek formal treatment. Self-directed treatments provide individuals with information and support to initiate a recovery program without attending formal treatment. In this study, an online version of a previously evaluated telephone-based intervention package is compared to a brief online normative feedback intervention called Check Your Gambling. In a randomized controlled trial design, participants with gambling problems who were not interested in formal treatment (N = 181) were recruited through media announcements. After a baseline telephone assessment, participants were assigned to have access to either the brief Check Your Gambling, or the extended self-management tools intervention. Follow-up assessments were conducted at 3, 6, and 12 months post baseline by blinded interviewers. Participant nominated collaterals were contacted to validate self-reported gambling involvement. The follow-up rate at 12 months was 78%. Participants in both conditions showed significant reductions in days of gambling and problem severity but no differences between conditions were found, contrary to the primary hypothesis. Lack of previous treatment for gambling and higher baseline self-efficacy predicted fewer days of gambling in both conditions. Self-efficacy increased over time but did not appear to mediate changes in gambling. Participants who were most engaged in the extended online program showed better outcomes. Those with low engagement showed a slower trajectory of change but equivalent improvements by 12 months. The extended online intervention was not associated with better outcomes than the brief Check Your Gambling intervention. Future research needs to explore the attractiveness, uptake, and effectiveness of online interventions with and without therapist support to understand their potential role in gambling disorder treatment systems.Trial Registration ISRCTN06220098.


Assuntos
Jogo de Azar/terapia , Internet , Psicoterapia Breve/métodos , Autocuidado/métodos , Adulto , Idoso , Feminino , Jogo de Azar/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Autoeficácia
13.
J Affect Disord ; 245: 1168-1186, 2019 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-30699860

RESUMO

BACKGROUND: Depressive and anxiety disorders are highly prevalent and detrimental in primary care settings. However, there are gaps in the literature concerning effectiveness and generalizability of empirically supported interventions and treatment of both depression and anxiety in primary care settings. The aim of this review is to systematically assess and meta-analyze the effectiveness of brief empirically-supported psychotherapies for treating depression and/or anxiety in primary care. METHODS: Seven electronic databases, five professional websites and manual search of reference lists were searched through April 2017 for randomized controlled trials (RCTs) of four psychotherapies treating primary care depression and anxiety: cognitive-behavior therapy (CBT), problem-solving therapy (PST), motivational interviewing (MI), and solution-focused brief therapy (SFBT). RESULTS: From an initial pool of 1140 articles, 179 articles were eligible for full-text review and 65 articles were included for final analysis. Sixty-five articles containing 198 effect sizes reported an overall treatment effect size of d = 0.462, p < 0.001. Single-predictor meta-regression indicated that marital status, treatment modality (individual versus group), and treatment composition were significant moderators. Multiple-predictor meta-regression discovered treatment setting (inside versus outside primary care) significantly moderated treatment effect, b = -0.863, p = 0.039 after controlling for other intervention characteristics. CONCLUSION: Treatment effects were found for CBT and PST, both for depressive and anxiety disorders. Interventions delivered outside primary care settings were more effective than those within, individual treatment had greater treatment effects compared to group treatment, and both technology-assisted and in-person treatments were found to be effective.


Assuntos
Transtornos de Ansiedade/terapia , Transtorno Depressivo/terapia , Atenção Primária à Saúde , Psicoterapia/métodos , Terapia Cognitivo-Comportamental/métodos , Humanos , Entrevista Motivacional/métodos , Resolução de Problemas , Psicoterapia Breve/métodos
14.
Br J Nurs ; 28(1): 20-21, 2019 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-30620655

RESUMO

Emma Senior, Senior Lecturer/Programme Lead, Adult Nursing ( emma.senior@northumbria.ac.uk ), and Lynn Craig, Subject Lead, Adult Nursing, and Senior Lecturer, Northumbria University, Newcastle upon Tyne, discuss how nurses can use brief interventions during their interactions with patients.


Assuntos
Relações Enfermeiro-Paciente , Psicoterapia Breve , Saúde Pública , Humanos , Papel do Profissional de Enfermagem
15.
Hormones (Athens) ; 18(1): 75-84, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30644069

RESUMO

AIM: The objective of this study was to investigate the effect of implementation of short-term patient empowerment as applied to Mediterranean diet (MD) adherence on metabolic and anthropometric parameters in prediabetic overweight or obese subjects. METHODS: The sample included 42 subjects with prediabetes, aged 18-75 years and with body mass index (BMI) > 25 kg/m2, who received dietary advice on MD by nutritionists during session groups every 2 weeks for 4 months. Data on energy caloric intake and macronutrient consumption were collected using a 7-day food diary record. Adherence to MD was investigated through the PREvención con DIeta MEDiterránea (PREDIMED) questionnaire. No advice was given regarding caloric restriction and physical activity. At baseline and at the end of the study, each subject underwent anthropometric, metabolic, and nutritional assessments. RESULTS: Approximately 40.5% of subjects had achieved restoration of normal glucose tolerance by the end of the study. Fasting plasma glucose, glycated hemoglobin (HbA1C), BMI, waist circumference, blood pressure, visceral adiposity index, triglycerides, and total and LDL cholesterol levels were significantly decreased, while HDL cholesterol had significantly increased by the end of the study. The subjects significantly increased adherence to MD, as assessed by the PREDIMED questionnaire at follow-up. A reduction of prevalence of the metabolic syndrome was also reported. Interestingly, the PREDIMED score correlated with HbA1C values at follow-up, after adjusting for BMI and total caloric intake. CONCLUSIONS: Implementation of short-term patient empowerment as applied to MD adherence was shown to improve anthropometric and metabolic parameters in prediabetic overweight or obese subjects. This is of considerable importance, given that diet must be the cornerstone of treatment in patients at high risk of developing type 2 diabetes.


Assuntos
Dieta Mediterrânea , Avaliação de Resultados (Cuidados de Saúde) , Sobrepeso/dietoterapia , Cooperação do Paciente/psicologia , Participação do Paciente/métodos , Estado Pré-Diabético/dietoterapia , Psicoterapia Breve/métodos , Adolescente , Adulto , Idoso , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/dietoterapia , Projetos Piloto , Adulto Jovem
16.
J Affect Disord ; 246: 754-762, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30623821

RESUMO

BACKGROUND: While family interventions have shown efficacy in improving mood symptoms and family functioning in pediatric bipolar disorder, few studies have examined the effects of comorbid psychiatric conditions on patients' symptomatic or functional responses to treatment. METHODS: 145 adolescents with bipolar I or II disorder were randomly assigned to family-focused therapy (FFT-A) or a brief psychoeducational therapy (enhanced care; EC) and followed over 2 years. Participants received pharmacotherapy for the study's duration. We examined whether comorbid anxiety disorders, attention-deficit/hyperactivity disorder (ADHD), and disruptive behavior disorders (DBDs; i.e., oppositional defiant and conduct disorder) predicted the proportion of weeks that participants experienced mood symptoms during follow-up, and whether comorbid disorders moderated the effects of treatment assignment on mood symptoms and family conflict. RESULTS: Comorbid anxiety was associated with a greater proportion of weeks with depressive symptoms, more severe (hypo)manic symptoms during follow-up, and greater family conflict over the 2-year study. Comorbid ADHD was associated with a greater proportion of weeks with (hypo)manic symptoms, more severe (hypo)manic symptoms, and greater family conflict. Additionally, youth with comorbid ADHD who received FFT-A had more favorable trajectories of (hypo)manic symptoms and family functioning than youth with comorbid ADHD who received EC. Comorbid DBDs were consistently associated with more severe depressive symptoms and greater family conflict throughout the study. LIMITATIONS: Randomization to treatments was not stratified on comorbid disorders. The longitudinal trajectories of anxiety, attentional, and disruptive behavior symptoms were not examined. CONCLUSIONS: The course of bipolar disorder in adolescents is strongly affected by comorbid disorders. Future research should examine whether adolescents with more complex presentations of bipolar disorder should be treated with different or more intensive psychosocial protocols than adolescents without these presentations.


Assuntos
Transtornos de Ansiedade/psicologia , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/psicologia , Transtorno Bipolar/terapia , Terapia Familiar/métodos , Psicoterapia Breve/métodos , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Transtorno Bipolar/psicologia , Criança , Comorbidade , Depressão/psicologia , Conflito Familiar/psicologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Resultado do Tratamento
17.
Nord J Psychiatry ; 73(1): 58-63, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30636466

RESUMO

BACKGROUND: Panic disorder, with or without agoraphobia (PDA or PD, respectively), is a major public health problem. After having established a PD diagnosis based on the DSM or the ICD systems, the Panic Disorder Severity Scale (PDSS) is the most widely used interview-based instrument for assessing disorder severity. There is also a self-report version of the instrument (PDSS-SR); both exist in a Swedish translation but their psychometric properties remain untested. METHODS: We studied 221 patients with PD/PDA recruited to a randomized controlled preference trial of cognitive-behavioral and brief panic-focused psychodynamic psychotherapy. In addition to PDSS and PDSS-SR the participants completed self-reports including the Clinical Outcome in Routine Evaluation - Outcome Measure, Montgomery Åsberg Depression Rating Scale, Sheehan Disability Scale, Bodily Sensations Questionnaire and the Mobility Inventory for Agoraphobia. RESULTS: PDSS and PDSS-SR possessed excellent psychometric properties (internal consistency, test-retest reliability) and convergent validity. A single factor structure for both versions was not confirmed. In terms of clinical utility, the PDSS had very high inter-rater reliability and correspondence with PD assessed via structured diagnostic interview. Both versions were sensitive to the effects of PD-focused treatment, although subjects scored systematically lower on the self-report version. CONCLUSIONS: The study confirmed the reliability and validity of the Swedish versions of PDSS and PDSS-SR. Both versions were highly sensitive to the effects of two PD-focused treatments and can be used both in clinical and research settings. However, further investigation of the factor structures of both the PDSS and PDSS-SR is warranted. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01606592.


Assuntos
Transtorno de Pânico/classificação , Escalas de Graduação Psiquiátrica , Psicometria , Índice de Gravidade de Doença , Adulto , Idoso , Agorafobia/classificação , Agorafobia/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados (Cuidados de Saúde) , Transtorno de Pânico/terapia , Psicoterapia Breve , Psicoterapia Psicodinâmica , Reprodutibilidade dos Testes , Autorrelato , Inquéritos e Questionários , Suécia , Traduções
18.
Encephale ; 45 Suppl 1: S27-S31, 2019 Jan.
Artigo em Francês | MEDLINE | ID: mdl-30551792

RESUMO

INTRODUCTION: Suicide prevention is a major objective in public health. The development of alternative approaches to the prevention of suicide, such as monitoring systems, is growing quickly. The results are encouraging, but the analysis of the effectiveness remains complex. The objective of this study is to evaluate the medico-economic impact of the ALGOS brief contact intervention (BCI) on the consumption of medical care. METHOD: ALGOS is a prospective, comparative, multicentre, single-blind, randomized, controlled trial, which compared two groups after a suicide attempt (SA). The ALGOS algorithm assigned each BCI to the subgroup of participants. The medico-economic impact of each intervention was evaluated at 6 and 13 months after inclusion. RESULTS: In all, 987 patients were included. There was no significant difference between the two groups at 6 months and at 13 months after SA in the total number of patients who had been hospitalized in psychiatry or other care services. However, the average number of rheumatology visits was significantly higher in the control group (P=0.01) at 13 months. The total number of rheumatologist and physiotherapist visits was significantly higher in the control group at 6 and 13 months. CONCLUSION: Our results suggest that the use of a BCI after SA does not lead to increased consumption of medical care.


Assuntos
Custos de Cuidados de Saúde , Recursos em Saúde/economia , Recursos em Saúde/estatística & dados numéricos , Vigilância da População , Psicoterapia Breve , Suicídio/prevenção & controle , Adulto , Feminino , França/epidemiologia , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Entrevistas como Assunto/normas , Entrevistas como Assunto/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Vigilância da População/métodos , Psiquiatria Preventiva/economia , Psiquiatria Preventiva/métodos , Psiquiatria Preventiva/estatística & dados numéricos , Psicoterapia Breve/economia , Psicoterapia Breve/métodos , Psicoterapia Breve/estatística & dados numéricos , Método Simples-Cego , Suicídio/economia , Suicídio/psicologia , Tentativa de Suicídio/economia , Tentativa de Suicídio/prevenção & controle , Tentativa de Suicídio/psicologia , Tentativa de Suicídio/estatística & dados numéricos , Adulto Jovem
19.
Encephale ; 45 Suppl 1: S32-S34, 2019 Jan.
Artigo em Francês | MEDLINE | ID: mdl-30554771

RESUMO

In France, one adolescent out of ten has already attempted suicide. In this population, suicide reattempts are frequent and significantly impact the vital, morbid and functional long-term prognosis. For about fifteen years, surveillance and brief contact intervention systems (SBCIS) have been used to complete the French suicide reattempt prevention arsenal for youth. The relevance of such strategy appears once the mental health service gap observed at this period of life is considered. In addition to prompting better coordination between the different professional stakeholders, the SBCIS help to alleviate the adolescent's help-seeking barriers, especially the ambivalence between conquest of autonomy and need for help. The first results from the French SBCIS dedicated to children and adolescents are encouraging. Although they have to deal with specific challenges, we argue that they relevantly complement and potentiate the already available prevention resources, thus optimizing the whole prevention system for suffering youth.


Assuntos
Monitorização Fisiológica , Psiquiatria Preventiva , Psicoterapia Breve , Prevenção Secundária , Tentativa de Suicídio/prevenção & controle , Adolescente , Adulto , Criança , Feminino , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Monitorização Fisiológica/normas , Psiquiatria Preventiva/métodos , Psiquiatria Preventiva/organização & administração , Psiquiatria Preventiva/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Psicologia do Adolescente/métodos , Psicologia do Adolescente/organização & administração , Psicologia do Adolescente/normas , Psicologia da Criança/métodos , Psicologia da Criança/organização & administração , Psicologia da Criança/normas , Psicoterapia Breve/métodos , Psicoterapia Breve/organização & administração , Psicoterapia Breve/normas , Psicoterapia Breve/estatística & dados numéricos , Recidiva , Estudos Retrospectivos , Prevenção Secundária/métodos , Prevenção Secundária/organização & administração , Prevenção Secundária/normas , Prevenção Secundária/estatística & dados numéricos , Tentativa de Suicídio/psicologia , Tentativa de Suicídio/estatística & dados numéricos , Resultado do Tratamento
20.
Asian J Surg ; 42(1): 148-154, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30585169

RESUMO

BACKGROUND/OBJECTIVE: Despite extensive published research, the surgical approach to penetrating abdominal trauma patients is still under debate. Computed tomography-guided tractography (CTT) is an imaging modality in which water soluble iodinated contrast medium is administered into the site of the injury in the CT unit. The aim of this study was to determine the diagnostic accuracy of the CTT. METHODS: A retrospective evaluation was made of patients admitted to the Emergency Department with penetrating abdominal trauma and who underwent CTT. Contrast enhanced abdominal CT and CTT reports, surgical findings and clinical results were examined. RESULTS: Evaluation was made of a total of 101 patients comprising 89 males (88.1%) and 12 females (11.9%). CTT was determined to have 92.8% sensitivity, 93.6% specificity, 97% positive predictive value, and 85.5% negative predictive value. In 27 patients (26.7%) where the CTT indicated passage through the peritoneum, no parenchymal organ injury was present. Only one patient (2.9%) without peritoneal penetration on CTT had organ injury at exploration. No procedure-related morbidities developed. CONCLUSION: CTT is a safe imaging modality for the evaluation of hemodynamically stable patients. Compared to other imaging modalities, there is clearer demonstration of whether or not the peritoneum is intact. However penetration on CTT does not exactly correlate with organ injury.


Assuntos
Traumatismos Abdominais/diagnóstico por imagem , Imagem de Tensor de Difusão/métodos , Tomografia Computadorizada por Raios X/métodos , Traumatismos Abdominais/cirurgia , Adulto , Meios de Contraste/administração & dosagem , Feminino , Humanos , Iodo/administração & dosagem , Laparotomia , Masculino , Pessoa de Meia-Idade , Peritônio/diagnóstico por imagem , Valor Preditivo dos Testes , Psicoterapia Breve , Estudos Retrospectivos , Sensibilidade e Especificidade , Água , Adulto Jovem
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