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1.
J Affect Disord ; 320: 656-666, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36162692

RESUMO

BACKGROUND: This study compared the "next day appointment" (NDA) use of the Collaborative Assessment and Management of Suicidality (CAMS) to treatment as usual (TAU) for individuals discharged from the hospital following a suicide-related crisis. We hypothesized that CAMS would significantly reduce suicidal thoughts and behaviors as well as improve psychological distress, quality of life/overall functioning, treatment retention and patient satisfaction. METHODS: Participants were 150 individuals who had at least one lifetime actual, aborted, or interrupted attempt and were admitted following a suicide-related crisis. There were 75 participants in the experimental condition who received adherent CAMS and 75 participants who received TAU. Suicidal thoughts and behaviors, psychological distress, and quality of life/overall functioning were assessed at baseline and at 1, 3, 6, and 12 months post-baseline. Treatment retention and patient satisfaction were assessed at post-treatment. RESULTS: Participants in both conditions improved from baseline to 12 months but CAMS was not superior to TAU for the primary outcomes. A small but significant improvement was found in probability of suicidal ideation at 3 months favoring TAU and amount of suicidal ideation at 12 months favoring CAMS. CAMS participants experienced less psychological distress at 12 months compared to baseline. LIMITATIONS: The study was limited by only one research clinic, lower than expected recruitment, and imbalance of suicidal ideation at baseline. CONCLUSIONS: All participants improved but CAMS was not more effective than TAU. The NDA clinic was feasible and acceptable to clients and staff in both conditions and future research should investigate its potential benefit.


Assuntos
Ideação Suicida , Suicídio , Humanos , Suicídio/prevenção & controle , Suicídio/psicologia , Qualidade de Vida , Psicoterapia , Hospitalização
2.
J Affect Disord ; 320: 474-498, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36174787

RESUMO

BACKGROUND: Symptoms of depression are commonly experienced by informal caregivers of older adults, however there is uncertainty concerning effectiveness of psychological interventions targeting symptoms of depression in this population. Further, there is uncertainty concerning important clinical moderators, including intervention type and care recipient health condition. This review examined the effectiveness of psychological interventions targeting symptoms of depression in informal caregivers of older adults. METHODS: PubMed, CINAHL, Embase, PsycINFO, Cochrane Library and Web of Science were searched. Risk of bias was assessed using the Cochrane Risk of Bias tool version 2. RESULTS: Fifteen studies were identified and twelve (1270 participants) provided data for the meta-analysis. Interventions included cognitive behavioral therapy (4 studies), problem-solving therapy (4 studies); non-directive supportive therapy (4 studies) and behavioral activation (3 studies). A small effect size favouring the intervention was found for symptoms of depression (g = -0.49, CI = -0.79, -0.19, I2 = 83.42 %) and interventions were effective in reducing incidence of major depression (OR = 0.177, CI = 0.08, 0.38), caregiver burden (g = -0.35, CI = -0.55, -0.15) and psychological distress (g = -0.49, CI = -0.70, -0.28). Given high heterogeneity, findings should be interpreted with caution. Overall risk of bias was high. LIMITATIONS: Studies were limited to those in English or Swedish. CONCLUSION: Psychological interventions may be effective in reducing symptoms of depression among informal caregivers of older adults. However, evidence is inconclusive due to heterogeneity, high risk of bias, and indirectness of evidence.


Assuntos
Cuidadores , Depressão , Humanos , Idoso , Cuidadores/psicologia , Depressão/terapia , Intervenção Psicossocial , Ensaios Clínicos Controlados Aleatórios como Assunto , Psicoterapia , Qualidade de Vida
3.
J Affect Disord ; 320: 319-329, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36183818

RESUMO

BACKGROUND: Social and interpersonal context are associated with the onset and persistence of psychiatric disorders. We compared the effects of short-term interpersonal psychotherapy (IPT) on weight loss, binge eating behaviors, and depressive symptoms against cognitive-behavioral therapy (CBT), health education (HE), and behavioral weight loss (BWL). METHODS: We searched until May 28th, 2022 following databases: PubMed, CINAHL, Science Direct, Web of Science, EMBASE, and Scopus. Articles on parallel randomized clinical trials were included. Outcomes were body mass index (BMI), binge days (bulimic episode), and depressive symptoms. These outcomes were self-reported or measured with specific scales (BMI) or instrument (depressive symptoms). RESULTS: The initial search retrieved 820 articles, a total of 10 studies met the eligibility criteria, and seven were included in the meta-analysis. Participants with overweight/obesity were women (62-100 %), aged between 11 and 50 years. There was a trivial to small effect on BMI favoring IPT over other interventions (standardized mean difference [SMD] = -0.10; 95%CI: -0.27 to 0.07, I2 = 0 %), especially when compared to health education (SMD = -0.21; 95%CI: -0.54 to 0.12, I2 = 0 %); no effect on number of binge days (SMD = -0.09; 95%CI: -0.30 to 0.11, I2 = 0 %); and a small effect on depressive symptoms (SMD = -0.25, 95%CI = -0.50 to 0.00, I2 = 0 %). LIMITATIONS: Small number of studies, the discrepancy in age cohorts, and racial diversity. Psychotherapeutic protocols and assessment tools had to be adapted across studies. CONCLUSIONS: Patients with overweight/obesity and depression had some benefit from IPT when compared with other interventions. In view of existing evidence, an IPT program adapted to obesity could help to achieve reliable and long-term effects.


Assuntos
Psicoterapia Interpessoal , Psicoterapia , Humanos , Feminino , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Masculino , Psicoterapia/métodos , Sobrepeso/terapia , Obesidade/terapia , Obesidade/psicologia , Redução de Peso
4.
J Affect Disord ; 320: 230-240, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36183821

RESUMO

BACKGROUND: Interpersonal psychotherapy (IPT) has been widely used for depression. However, current studies of IPT have been restricted to depressive symptoms, and the results for improving social functioning were controversial. METHODS: A comprehensive literature search of randomized controlled trials (RCTs) was conducted through eleven databases. Data analysis was performed by RevMan5.3, and effects were summarized by using a random effects model of mean differences with 95 % confidence intervals. RESULTS: From 2443 records, eleven studies met inclusion and exclusion criteria were used for meta-analysis. The results showed that IPT had significant effects on improving social functioning (SMD: -0.53, 95 % CI: -0.80 to -0.26), reducing depression (SMD: -0.49, 95 % CI: -0.80 to -0.19) and anxiety (SMD: -0.90, 95 % CI: -1.28 to -0.52), but the effect on the overall functioning (SMD: -0.37, 95 % CI: -0.73 to -0.01) is not obvious. Moreover, subgroup analysis showed that IPT was effective in improving social functioning in adolescent depression (SMD: -0.35, 95 % CI: -0.58 to -0.13) and perinatal depression (SMD: -1.01, 95 % CI: -1.35 to -0.67), while there was no significant difference in the adult depression group (SMD: -0.39, 95 % CI: -1.05 to 0.27). LIMITATION: The blind method cannot be carried out in most studies due to the particularity of psychotherapy, heterogeneity in some results. CONCLUSION: IPT has a significant effect on improving social functioning and reducing depression and anxiety, while the effect on overall functioning requires further research. Overall, IPT is one of the effective nonpharmacological treatments for depression.


Assuntos
Psicoterapia Interpessoal , Humanos , Adulto , Adolescente , Gravidez , Feminino , Depressão/terapia , Interação Social , Psicoterapia/métodos , Ansiedade
5.
J Affect Disord ; 320: 348-352, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36183823

RESUMO

BACKGROUND: This epidemiological study described changes in the estimated prevalence of current pharmacological and/or psychotherapy-based treatment utilization among college students with depression only, anxiety only, or comorbid depression & anxiety. METHODS: A sample of 190,500 weighted responses was collected through the 2013-2019 Healthy Minds Study questionnaires. Annual prevalence estimates of depression only, anxiety only, or comorbid depression & anxiety were computed. Current use of therapy, pharmacological services, or dual treatment among students with depression and/or anxiety were examined via descriptive statistics. RESULTS: Estimated prevalence of college students who screened positive for depression only, anxiety only, and comorbid depression & anxiety escalated from 2013 to 2018-2019. When assessed individually, rates of currently using any psychiatric medication, participating in therapy, and engaging in concurrent medication & therapy services significantly rose among students with depression and/or anxiety. However, temporal trends in the current use of specific classes of psychiatric medications among young adults with depression only, anxiety only, or comorbid depression & anxiety differed by medication class. LIMITATIONS: This study was unable to assess psychiatric prescribing practices, depression or anxiety diagnoses, and prior mental health treatment. CONCLUSIONS: An increasing proportion of college students are reporting depression and/or anxiety symptoms as well as pharmacological and/or psychotherapy service utilization when comparing rates from 2013 to 2018-19. Although this may indicate increasing acceptability to disclose and seek treatment for problematic symptomology, continued surveillance of college populations is needed to identify students at risk for adverse psychiatric health outcomes, especially during the coronavirus disease 2019 pandemic.


Assuntos
COVID-19 , Depressão , Humanos , Adulto Jovem , Depressão/epidemiologia , Depressão/terapia , Depressão/psicologia , Ansiedade/epidemiologia , Ansiedade/terapia , Ansiedade/psicologia , Estudantes/psicologia , Universidades , Psicoterapia
6.
Neuropharmacology ; 222: 109305, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36354092

RESUMO

Depression is a well-known serious mental illness, and the onset of treatment using traditional antidepressants is frequently delayed by several weeks. Moreover, numerous patients with depression fail to respond to therapy. One major breakthrough in antidepressant therapy is that subanesthetic ketamine doses can rapidly alleviate depressive symptoms within hours of administering a single dose, even in treatment-resistant patients. However, specific mechanisms through which ketamine exerts its antidepressant effects remain elusive, leading to concerns regarding its rapid and long-lasting antidepressant effects. N-methyl-d-aspartate receptor (NMDAR) antagonists like ketamine are reportedly associated with serious side effects, such as dissociative symptoms, cognitive impairment, and abuse potential, limiting the large-scale clinical use of ketamine as an antidepressant. Herein, we reviewed the pharmacological properties of ketamine and the mechanisms of action underlying the rapid antidepressant efficacy, including the disinhibition hypothesis and synaptogenesis, along with common downstream effector pathways such as enhanced brain-derived neurotrophic factor and tropomyosin-related kinase B signaling, activation of the mechanistic target of rapamycin complex 1 and transforming growth factor ß1. We focused on evidence supporting the relevance of these potential mechanisms of ketamine and its metabolites in mediating the clinical efficacy of the drug. Given its reported antidepressant efficacy in preclinical studies and limited undesirable adverse effects, (R)-ketamine may be a safer, more controllable, rapid antidepressant. Overall, understanding the potential mechanisms of action of ketamine and its metabolites in combination with pharmacology may help develop a new generation of rapid antidepressants that maximize antidepressant effects while avoiding unfavorable adverse effects. This article is part of the Special Issue on 'Ketamine and its Metabolites'.


Assuntos
Disfunção Cognitiva , Ketamina , Humanos , Ketamina/farmacologia , Ketamina/uso terapêutico , Depressão , Psicoterapia , Transtornos Dissociativos
7.
Syst Rev ; 11(1): 239, 2022 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-36371235

RESUMO

BACKGROUND: Depression is common among patients with cancer and is associated with lower treatment participation, lower satisfaction with care, poorer quality of life, greater symptom burden and higher healthcare costs. Various types of interventions (e.g. pharmacological, psychotherapy) are used for the treatment of depression. However, evidence for these among patients with cancer is limited. Furthermore, the relative effectiveness and acceptability of different approaches are unknown because a direct comparison between all available treatments has not been carried out. We will address this by conducting a network meta-analysis (NMA) of interventions for depression among people with cancer using a hybrid overview of reviews and systematic review methodology. METHODS: We will search for and extract data from systematic reviews of randomised controlled trials (RCTs) of depression interventions for patients with cancer from inception, before performing a supplemental search for more recent RCTs. We will include RCTs comparing pharmacological, psychotherapy, exercise, combination therapy, collaborative care or complementary and alternative medicine interventions with pill placebo, no treatment, waitlist, treatment as usual or minimal treatment control groups, or directly in head-to-head trials, among adults who currently have cancer or have a history of any cancer and elevated depressive symptoms (scores above a cut-off on validated scales or meeting diagnostic criteria). Our primary outcomes will be change in depressive symptoms (standardised mean difference) and intervention acceptability (% who withdrew). Our secondary outcomes will be 6-month change in depressive symptoms, health-related quality of life, adverse events and mortality. We will independently screen for eligibility, extract data and assess risk of bias using the RoB 2 tool. We will use frequentist random-effects multivariate NMA in Stata, rankograms and surface under the cumulative ranking curves to synthesise evidence and obtain a ranking of intervention groups. We will explore heterogeneity and inconsistency using local and global measures and evaluate the credibility of results using the Confidence in NEtwork Meta-Analysis (CINeMA) framework. DISCUSSION: Our findings will provide the best available evidence for managing depression among patients with cancer. Such information will help to inform clinical guidelines, evidence-based treatment decisions and future research by identifying gaps in the current literature. SYSTEMATIC REVIEW REGISTRATION: Submitted to PROSPERO (record number: 290145), awaiting registration.


Assuntos
Depressão , Neoplasias , Adulto , Humanos , Metanálise em Rede , Depressão/etiologia , Psicoterapia/métodos , Qualidade de Vida , Neoplasias/complicações , Neoplasias/terapia , Metanálise como Assunto , Revisões Sistemáticas como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto
8.
Hist Psychiatry ; 33(4): 446-458, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36408553

RESUMO

The British government in Malaya conducted treatment for women suffering mental illness in an effort to deal with the increasing number of cases in the Federated Malay States in 1930-57. This paper explores the role of mental asylums and society in contributing to methods of treatment during the twentieth century.


Assuntos
Transtornos Mentais , Pessoas Mentalmente Doentes , Humanos , Feminino , Malásia , Psicoterapia , Hospitais Psiquiátricos/história , Transtornos Mentais/terapia , Transtornos Mentais/história
9.
Prax Kinderpsychol Kinderpsychiatr ; 71(7): 658-676, 2022 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-36382739

RESUMO

Adolescents and young adults with mental illness have an increased risk of long-term unfavourable development and show high clinical severity and multiple psychosocial needs at an early age. In this context, several specific transitional psychiatric treatment services have been developed during the last years. The experience gained so far in adolescent psychiatry shows that a close interdisciplinary cooperation of child and adolescent psychiatry and adult psychiatry is necessary to address interface problems with the aim of a successful transition, as well as to prevent the development of severe and chronicmental illnesses. At the same time, there are many structural and content-related challenges that need to be integrated and addressed. In this review, different treatment models are presented and the requirements for successful transition psychiatry are discussed in the context of the existing evidence.


Assuntos
Psiquiatria Infantil , Transtornos Mentais , Transtornos Psicóticos , Criança , Adulto Jovem , Adolescente , Humanos , Psiquiatria do Adolescente , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia , Transtornos Mentais/psicologia , Psicoterapia
10.
Cien Saude Colet ; 27(12): 4553-4558, 2022 Dec.
Artigo em Português, Inglês | MEDLINE | ID: mdl-36383868

RESUMO

This text discusses people with mental disorders in conflict with the law in Brazil and the Custody and Psychiatric Treatment Hospitals, institutions included in the prison system and considered a hybrid between health and justice. When we present the reality in the national context, we show that the Psychiatric Reform did not reach these institutions, and these individuals continue to be stigmatized, and their human rights are violated. We substantiate the need to advance the debate and raise some questions to establish new solutions to tackle the issue and ensure well-structured, scientific evidence-based health care.


Este texto apresenta uma discussão a respeito das pessoas com transtorno mental em conflito com a lei no Brasil e os Hospitais de Custódia e Tratamento Psiquiátrico, instituições inseridas no sistema prisional e consideradas híbridas entre a saúde e a justiça. Ao apresentarmos a realidade no contexto nacional, evidenciamos que a Reforma Psiquiátrica não alcançou essas instituições e esses indivíduos seguem estigmatizados, tendo os seus direitos humanos violados. Fundamentamos a necessidade de avançarmos o debate e trazemos alguns questionamentos na tentativa de fomentar a criação de novas saídas para o enfrentamento do problema, bem como a garantia de cuidado em saúde bem estruturado e baseado em evidências científicas.


Assuntos
Transtornos Mentais , Prisioneiros , Humanos , Prisões , Hospitais Psiquiátricos , Transtornos Mentais/terapia , Direitos Humanos , Psicoterapia
11.
J Anxiety Disord ; 92: 102645, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36334317

RESUMO

Although improving residential PTSD care is a priority for the Department of Veterans Affairs, previous evaluations have been limited by a lack of systematic data collection across more than two timepoints. This study used recently available data to assess symptom trajectories in a large, national sample of veterans who engaged in residential PTSD treatment. Group-based trajectory analysis PROC TRAJ was used to identify PTSD residential treatment response in a national cohort of veterans (n = 10,832) and the subset of veterans (n = 6515) receiving evidence-based psychotherapy (EBP). PTSD symptoms were assessed at intake, discharge, and 4-month follow-up. Predictors of trajectory membership were estimated using multinomial models. For the full cohort, a three-group trajectory model provided the best fit with the following identified groups: "Severe/Stable" (51.8%), "Moderate/Rebound" (40.1%), and "Mild/Rebound" (8.1%). For the EBP sub-cohort, a three-group trajectory model was selected with the following groups: "Severe/Stable" (58.5%), "Moderate/Rebound" (34.1%), and "Mild/Rebound" (7.4%). Across all trajectories, psychological distress, pain severity, substance use, Iraq/Afghanistan combat era, non-White race, and treatment dropout were associated with poorer treatment response. In the EBP sub-cohort, homelessness and unemployment at the time of admission were also associated with poorer treatment outcomes to varying degrees. This study demonstrates that residential treatment for PTSD is associated with heterogeneous treatment trajectories which highlight the need to continue to explore and improve residential PTSD treatment outcomes. Our results underscore the importance of obtaining follow-up data and identifying ways to maintain therapeutic gains following discharge.


Assuntos
Transtornos de Estresse Pós-Traumáticos , Veteranos , Estados Unidos , Humanos , Transtornos de Estresse Pós-Traumáticos/terapia , Psicoterapia , Tratamento Domiciliar , Estudos de Coortes
14.
Psychoanal Q ; 91(3): 495-497, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36346759
18.
Int J Geriatr Psychiatry ; 37(12)2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36317445

RESUMO

OBJECTIVES: Personality disorders (PDs) are often conceptualised as impacting individuals throughout their life. However, there has been limited study of the disorders in those over the age of 65. We have used the psychiatric secondary care medical records of 21,971 individuals over the age of 65 from Cambridgeshire, UK, who received care between 2014 and 2021 to characterise older patients with a PD diagnosis. METHODS: The data from all patients >65 with a diagnosis of personality disorder (PD) was extracted (n = 217) along with two comparison groups (n = 2170); patients <65 with a diagnosis of PD and patients >65 with a psychiatric diagnosis other than PD or dementia. RESULTS: Compared to younger patients with PD, older patients were more likely to be male, married, suffering from a mixed PD and live in less deprived areas. Compared to patients >65 with diagnoses other than PD, older patients were more likely to be female, single or divorced and had a higher level of social deprivation. Our most striking finding was that older patients with PDs were more likely to experience polypharmacy. A mean of 18.48 different drugs had been prescribed over their lifetime, compared to 9.51 for patients >65 with other mental health diagnoses. CONCLUSION: Here we present the largest ever description of this group of patients and provide insights that could inform clinical practice and future research.


Assuntos
Transtornos da Personalidade , Atenção Secundária à Saúde , Humanos , Masculino , Feminino , Transtornos da Personalidade/epidemiologia , Transtornos da Personalidade/psicologia , Psicoterapia
20.
Epidemiol Psychiatr Sci ; 31: e81, 2022 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-36377410

RESUMO

AIMS: There is increasing evidence that brief psychological interventions delivered by lay providers can reduce common mental disorders in the short-term. This study evaluates the longer-term impact of a brief, lay provider delivered group psychological intervention (Group Problem Management Plus; gPM+) on the mental health of refugees and their children's mental health. METHODS: This single-blind, parallel, controlled trial randomised 410 adult Syrians in Azraq Refugee Camp in Jordan who screened positive for distress and impaired functioning to either five sessions of gPM+ or enhanced usual care (EUC). Primary outcomes were scores on the Hopkins Symptom Checklist-25 (HSCL-25; depression and anxiety scales) assessed at baseline, 6 weeks, 3 months and 12 months Secondary outcomes included disability, posttraumatic stress, personally identified problems, prolonged grief, prodromal psychotic symptoms, parenting behaviour and children's mental health. RESULTS: Between 15 October 2019 and 2 March 2020, 204 participants were assigned to gPM + and 206 to EUC, and 307 (74.9%) were retained at 12 months. Intent-to-treat analyses indicated that although participants in gPM + had greater reductions in depression at 3 months, at 12 months there were no significant differences between treatment arms on depression (mean difference -0.9, 95% CI -3.2 to 1.3; p = 0.39) or anxiety (mean difference -1.7, 95% CI -4.8 to -1.3; p = 0.06). There were no significant differences between conditions for secondary outcomes except that participants in gPM + had greater increases in positive parenting. CONCLUSIONS: The short-term benefits of a brief, psychological programme delivered by lay providers may not be sustained over longer time periods, and there is a need for sustainable programmes that can prolong benefits gained through gPM + .


Assuntos
Transtornos Mentais , Refugiados , Humanos , Adulto , Criança , Refugiados/psicologia , Intervenção Psicossocial , Síria , Psicoterapia , Método Simples-Cego , Seguimentos , Jordânia , Transtornos Mentais/terapia
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