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1.
Medicine (Baltimore) ; 99(45): e22958, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33157937

RESUMO

INTRODUCTION: Treatment-resistant depression (TRD) has a high prevalence and can be exacerbated by poor physical health and economic hardships, which have become common stressors during the current COVID-19 pandemic. The therapeutic approaches used to treat these patients are not always available, may be not be accepted by some patients, and often require face-to-face interactions. OBJECTIVE: The main aim of this study will be to evaluate the effectiveness of an Internet-based adjuvant lifestyle-based intervention for patients with TRD. METHODS: This will be a parallel, randomized, and controlled clinical trial. A total of 180 patients with TRD will be randomly allocated (1:1:1) to 1 of 3 groups: treatment prescribed by the mental health team and written suggestions for lifestyle changes (placebo control group); treatment prescribed by the mental health team, written suggestions for lifestyle changes, and an 8-week mindfulness-based cognitive therapy program (active control group); or treatment prescribed by the mental health team, written suggestions for lifestyle changes, and an 8-week lifestyle change promotion program (intervention group). We will perform this study during the COVID-19 pandemic, and will administer interventions by teletherapy, and contact participants by telephone calls, text messages, and/or teleconferences. We will collect patient data using questionnaires administered at baseline, immediately after the intervention, and after 6 and 12 months. The primary outcome will be score on the Beck Depression Inventory-II. The secondary outcomes will be score on the Clinical Global Impressions Scale (used to quantify and track patient progress and treatment response over time) and health-related quality of life measured using the European Quality of Life-5 Dimensions Questionnaire. DISCUSSION: Patients with TRD are especially vulnerable when face-to-face psychotherapy is unavailable. The main strength of the proposed study is the novelty of the intervention to be used as an adjuvant therapy. Our results may provide guidance for treatment of patients with TRD in future situations that require lockdown measures. CLINICALTRIALS REGISTRATION NUMBER: NCT04428099.


Assuntos
Infecções por Coronavirus/epidemiologia , Transtorno Depressivo Resistente a Tratamento/terapia , Estilo de Vida Saudável , Pneumonia Viral/epidemiologia , Telemedicina , Terapia Cognitivo-Comportamental , Promoção da Saúde , Humanos , Atenção Plena , Pandemias , Ensaios Clínicos Pragmáticos como Assunto , Qualidade de Vida , Inquéritos e Questionários
2.
Fortschr Neurol Psychiatr ; 88(11): 730-744, 2020 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-33187009

RESUMO

Fears of getting a severe disease (health anxiety) are widespread and their pathological manifestation as Hypochondriacal disorder (ICD-10) is cost-intensive for the health care system. In recent years advances in the research on and development of effective psychotherapeutic treatments have been made. Cognitive-behavioral therapy concepts currently are treatments of choice for Hypochondriacal disorder.


Assuntos
Terapia Cognitivo-Comportamental , Hipocondríase , Ansiedade , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/terapia , Medo , Humanos , Hipocondríase/diagnóstico , Hipocondríase/terapia
3.
JMIR Mhealth Uhealth ; 8(11): e19836, 2020 11 12.
Artigo em Inglês | MEDLINE | ID: mdl-33180027

RESUMO

BACKGROUND: A growing number of psychological interventions are delivered via smartphones with the aim of increasing the efficacy and effectiveness of these treatments and providing scalable access to interventions for improving mental health. Most of the scientifically tested apps are based on cognitive behavioral therapy (CBT) principles, which are considered the gold standard for the treatment of most mental health problems. OBJECTIVE: This review investigates standalone smartphone-based ecological momentary interventions (EMIs) built on principles derived from CBT that aim to improve mental health. METHODS: We searched the MEDLINE, PsycINFO, EMBASE, and PubMed databases for peer-reviewed studies published between January 1, 2007, and January 15, 2020. We included studies focusing on standalone app-based approaches to improve mental health and their feasibility, efficacy, or effectiveness. Both within- and between-group designs and studies with both healthy and clinical samples were included. Blended interventions, for example, app-based treatments in combination with psychotherapy, were not included. Selected studies were evaluated in terms of their design, that is, choice of the control condition, sample characteristics, EMI content, EMI delivery characteristics, feasibility, efficacy, and effectiveness. The latter was defined in terms of improvement in the primary outcomes used in the studies. RESULTS: A total of 26 studies were selected. The results show that EMIs based on CBT principles can be successfully delivered, significantly increase well-being among users, and reduce mental health symptoms. Standalone EMIs were rated as helpful (mean 70.8%, SD 15.3; n=4 studies) and satisfying for users (mean 72.6%, SD 17.2; n=7 studies). CONCLUSIONS: Study quality was heterogeneous, and feasibility was often not reported in the reviewed studies, thus limiting the conclusions that can be drawn from the existing data. Together, the studies show that EMIs may help increase mental health and thus support individuals in their daily lives. Such EMIs provide readily available, scalable, and evidence-based mental health support. These characteristics appear crucial in the context of a global crisis such as the COVID-19 pandemic but may also help reduce personal and economic costs of mental health impairment beyond this situation or in the context of potential future pandemics.


Assuntos
Terapia Cognitivo-Comportamental , Avaliação Momentânea Ecológica , Transtornos Mentais/terapia , Saúde Mental , Aplicativos Móveis , Smartphone , Telemedicina/métodos , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Feminino , Humanos , Masculino , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia
4.
Rev Infirm ; 69(264): 16-18, 2020 Oct.
Artigo em Francês | MEDLINE | ID: mdl-33129470

RESUMO

A cognitive therapy program based on mindfulness meditation has been offered at the "maison des adolescents" of Cochin Hospital for the past year and a half. After their participation, the adolescents were able to talk about their experiences in this group. The latter allows a different, innovative and interesting approach to clinical nursing.


Assuntos
Meditação , Atenção Plena , Adolescente , Terapia Cognitivo-Comportamental , Humanos , Adulto Jovem
5.
Medicine (Baltimore) ; 99(41): e22677, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031335

RESUMO

BACKGROUND: Extensive review of literature showed that no available study in Nigeria has explored the impact of cognitive behavior therapy (CBT) on the management of occupational stress among open and distance learning (ODL) centers science and social science education facilitators. Thus, this study determined the impacts of CBT on the management of occupational stress among science and social science education facilitators in ODL centers in South-South Nigeria. METHODS: A randomized controlled trial experimental design was adopted for the study with a sample size of 68 science and social science education facilitators in ODL centers in South-South states, Nigeria. Perceived stress scale (PSS) and Occupational stress index (OSI) were used for data collection. Using Cronbach alpha method, internal consistency reliability indices of 0.81 and 0.85 for PSS and OSI respectively were obtained in the Nigerian context. A 12-week cognitive behavior therapy intervention was conducted after which the participants in both the intervention group and the non-intervention group were administered posttest, while a follow-up assessment was administered after 2 months. Data collected were analyzed using mixed-design repeated-measures analysis of variance for the within-groups and between-groups effects. RESULTS: It was found that CBT intervention led to a significant decrease in the occupational stress among science and social science education facilitators in ODL in the South-South region of Nigeria. CONCLUSION: Cognitive behavior therapy is effective in the management of occupational stress among science and social science education facilitators in distance learning centers.


Assuntos
Terapia Cognitivo-Comportamental , Pessoal de Educação/psicologia , Estresse Ocupacional/terapia , Adulto , Educação a Distância , Feminino , Humanos , Masculino , Adulto Jovem
6.
Cochrane Database Syst Rev ; 10: CD006237, 2020 10 13.
Artigo em Inglês | MEDLINE | ID: mdl-33052607

RESUMO

BACKGROUND: Work disability such as sickness absence is common in people with depression. OBJECTIVES: To evaluate the effectiveness of interventions aimed at reducing work disability in employees with depressive disorders. SEARCH METHODS: We searched CENTRAL (The Cochrane Library), MEDLINE, Embase, CINAHL, and PsycINFO until April 4th 2020. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and cluster-RCTs of work-directed and clinical interventions for depressed people that included days of sickness absence or being off work as an outcome. We also analysed the effects on depression and work functioning. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted the data and rated the certainty of the evidence using GRADE. We used standardised mean differences (SMDs) or risk ratios (RR) with 95% confidence intervals (CI) to pool study results in studies we judged to be sufficiently similar.  MAIN RESULTS: In this update, we added 23 new studies. In total, we included 45 studies with 88 study arms, involving 12,109 participants with either a major depressive disorder or a high level of depressive symptoms. Risk of bias The most common types of bias risk were detection bias (27 studies) and attrition bias (22 studies), both for the outcome of sickness absence. Work-directed interventions Work-directed interventions combined with clinical interventions A combination of a work-directed intervention and a clinical intervention probably reduces days of sickness absence within the first year of follow-up (SMD -0.25, 95% CI -0.38 to -0.12; 9 studies; moderate-certainty evidence). This translates back to 0.5 fewer (95% CI -0.7 to -0.2) sick leave days in the past two weeks or 25 fewer days during one year (95% CI -37.5 to -11.8). The intervention does not lead to fewer persons being off work beyond one year follow-up (RR 0.96, 95% CI 0.85 to 1.09; 2 studies, high-certainty evidence). The intervention may reduce depressive symptoms (SMD -0.25, 95% CI -0.49 to -0.01; 8 studies, low-certainty evidence) and probably has a small effect on work functioning (SMD -0.19, 95% CI -0.42 to 0.06; 5 studies, moderate-certainty evidence) within the first year of follow-up.  Stand alone work-directed interventions A specific work-directed intervention alone may increase the number of sickness absence days compared with work-directed care as usual (SMD 0.39, 95% CI 0.04 to 0.74; 2 studies, low-certainty evidence) but probably does not lead to more people being off work within the first year of follow-up (RR 0.93, 95% CI 0.77 to 1.11; 1 study, moderate-certainty evidence) or beyond (RR 1.00, 95% CI 0.82 to 1.22; 2 studies, moderate-certainty evidence). There is probably no effect on depressive symptoms (SMD -0.10, 95% -0.30 CI to 0.10; 4 studies, moderate-certainty evidence) within the first year of follow-up and there may be no effect on depressive symptoms beyond that time (SMD 0.18, 95% CI -0.13 to 0.49; 1 study, low-certainty evidence). The intervention may also not lead to better work functioning (SMD -0.32, 95% CI -0.90 to 0.26; 1 study, low-certainty evidence) within the first year of follow-up.   Psychological interventions A psychological intervention, either face-to-face, or an E-mental health intervention, with or without professional guidance, may reduce the number of sickness absence days, compared with care as usual (SMD -0.15, 95% CI -0.28 to -0.03; 9 studies, low-certainty evidence). It may also reduce depressive symptoms (SMD -0.30, 95% CI -0.45 to -0.15, 8 studies, low-certainty evidence). We are uncertain whether these psychological interventions improve work ability (SMD -0.15 95% CI -0.46 to 0.57; 1 study; very low-certainty evidence). Psychological intervention combined with antidepressant medication Two studies compared the effect of a psychological intervention combined with antidepressants to antidepressants alone. One study combined psychodynamic therapy with tricyclic antidepressant (TCA) medication and another combined telephone-administered cognitive behavioural therapy (CBT) with a selective serotonin reuptake inhibitor (SSRI). We are uncertain if this intervention reduces the number of sickness absence days (SMD -0.38, 95% CI -0.99 to 0.24; 2 studies, very low-certainty evidence) but found that there may be no effect on depressive symptoms (SMD -0.19, 95% CI -0.50 to 0.12; 2 studies, low-certainty evidence). Antidepressant medication only Three studies compared the effectiveness of SSRI to selective norepinephrine reuptake inhibitor (SNRI) medication on reducing sickness absence and yielded highly inconsistent results. Improved care Overall, interventions to improve care did not lead to fewer days of sickness absence, compared to care as usual (SMD -0.05, 95% CI -0.16 to 0.06; 7 studies, moderate-certainty evidence). However, in studies with a low risk of bias, the intervention probably leads to fewer days of sickness absence in the first year of follow-up (SMD -0.20, 95% CI -0.35 to -0.05; 2 studies; moderate-certainty evidence). Improved care probably leads to fewer depressive symptoms (SMD -0.21, 95% CI -0.35 to -0.07; 7 studies, moderate-certainty evidence) but may possibly lead to a decrease in work-functioning (SMD 0.5, 95% CI 0.34 to 0.66; 1 study; moderate-certainty evidence). Exercise Supervised strength exercise may reduce sickness absence, compared to relaxation (SMD -1.11; 95% CI -1.68 to -0.54; one study, low-certainty evidence). However, aerobic exercise probably is not more effective than relaxation or stretching (SMD -0.06; 95% CI -0.36 to 0.24; 2 studies, moderate-certainty evidence). Both studies found no differences between the two conditions in depressive symptoms. AUTHORS' CONCLUSIONS: A combination of a work-directed intervention and a clinical intervention probably reduces the number of sickness absence days, but at the end of one year or longer follow-up, this does not lead to more people in the intervention group being at work. The intervention may also reduce depressive symptoms and probably increases work functioning more than care as usual. Specific work-directed interventions may not be more effective than usual work-directed care alone. Psychological interventions may reduce the number of sickness absence days, compared with care as usual. Interventions to improve clinical care probably lead to lower sickness absence and lower levels of depression, compared with care as usual. There was no evidence of a difference in effect on sickness absence of one antidepressant medication compared to another. Further research is needed to assess which combination of work-directed and clinical interventions works best.


Assuntos
Absenteísmo , Depressão/terapia , Transtorno Depressivo Maior/terapia , Saúde do Trabalhador , Retorno ao Trabalho/psicologia , Adulto , Antidepressivos/uso terapêutico , Viés , Terapia Cognitivo-Comportamental , Humanos , Exercícios de Alongamento Muscular , Ensaios Clínicos Controlados Aleatórios como Assunto , Licença Médica , Desempenho Profissional
7.
Artigo em Inglês | MEDLINE | ID: mdl-33114136

RESUMO

Objectives: COVID-19 has led to changes in the provision in mental health services. The current study investigated influencing factors on: (i) the comparability of psychotherapy via internet/telephone with psychotherapy in face-to-face contact as well as (ii) the actual experience with psychotherapy via internet/telephone compared to respective prior expectations in CBT therapists. Methods: A quantitative cross-sectional study was conducted in the form of an online survey. The research samples, registered cognitive-behavioral therapy (CBT) psychotherapists in Austria and Germany, were contacted by e-mail. Results: One hundred and ninety CBT therapists were analyzed in this study. The total number of patients treated via telephone/internet is a decisive factor for the subjective evaluation of the comparability of psychotherapy via telephone/internet and psychotherapy in personal contact. This factor also influences the extent (positive/negative) of the assessment of the actual experience with psychotherapy via internet/telephone compared to previous expectations. Neither age nor gender were associated with comparability of psychotherapy via internet/telephone with psychotherapy in face-to-face contact or the actual experience with psychotherapy via internet/telephone compared to respective prior expectations. Conclusions: Implications of the results are that attitudes towards remote psychotherapy might be increased in CBT therapists when they treat more patients remotely and experiences with remote psychotherapies should be included in psychotherapy training.


Assuntos
Terapia Cognitivo-Comportamental , Infecções por Coronavirus , Motivação , Pandemias , Pneumonia Viral , Psicoterapia , Telemedicina , Áustria , Betacoronavirus , Estudos Transversais , Alemanha , Humanos , Internet , Telefone
8.
Rev Prat ; 70(5): 509-513, 2020 May.
Artigo em Francês | MEDLINE | ID: mdl-33058636

RESUMO

What prescription for psychostimulants in children? The Attention Deficit and Hyperactivity Disorder (ADHD) is a frequent disorder in children and adolescents. The diagnosis is clinical with the input of several informants (child, family, teachers…). ADHD is a risk factor for academic difficulties, school dropout, social isolation, injury, oppositional behaviour. In school-age children and adolescents having moderate to high or persistent impairment despite psycho-educational support and environmental modification, the first-line treatment is methylphenidate. Group or individual cognitive behavioural therapy for parents and/or children and adolescents is recommended for co-occurring disorders and persistent impairment. In France, the initiation of methylphenidate requires an annual hospital prescription by a paediatrician or psychiatrist, and a regular medical supervision (weight, heart rate, blood pressure…). At least once a year, the indication of methyphenidate needs to be re-evaluated and confirmed at the hospital. In case of lack of efficiency and/or poor tolerance, therapeutic alternatives including non-psychostimulants should be considered.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Estimulantes do Sistema Nervoso Central , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Estimulantes do Sistema Nervoso Central/uso terapêutico , Criança , Terapia Cognitivo-Comportamental , França/epidemiologia , Humanos , Pais
9.
Trials ; 21(1): 870, 2020 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-33087178

RESUMO

BACKGROUND: The acknowledgment of the mental health toll of the COVID-19 epidemic in healthcare workers has increased considerably as the disease evolved into a pandemic status. Indeed, high prevalence rates of depression, sleep disorders, and post-traumatic stress disorder (PTSD) have been reported in Chinese healthcare workers during the epidemic peak. Symptoms of psychological distress are expected to be long-lasting and have a systemic impact on healthcare systems, warranting the need for evidence-based psychological treatments aiming at relieving immediate stress and preventing the onset of psychological disorders in this population. In the current COVID-19 context, internet-based interventions have the potential to circumvent the pitfalls of face-to-face formats and provide the flexibility required to facilitate accessibility to healthcare workers. Online cognitive behavioral therapy (CBT) in particular has proved to be effective in treating and preventing a number of stress-related disorders in populations other than healthcare workers. The aim of our randomized controlled trial study protocol is to evaluate the efficacy of the 'My Health too' CBT program-a program we have developed for healthcare workers facing the pandemic-on immediate perceived stress and on the emergence of psychiatric disorders at 3- and 6-month follow-up compared to an active control group (i.e., bibliotherapy). METHODS: Powered for superiority testing, this six-site open trial involves the random assignment of 120 healthcare workers with stress levels > 16 on the Perceived Stress Scale (PSS-10) to either the 7-session online CBT program or bibliotherapy. The primary outcome is the decrease of PSS-10 scores at 8 weeks. Secondary outcomes include depression, insomnia, and PTSD symptoms; self-reported resilience and rumination; and credibility and satisfaction. Assessments are scheduled at pretreatment, mid-treatment (at 4 weeks), end of active treatment (at 8 weeks), and at 3-month and 6-month follow-up. DISCUSSION: This is the first study assessing the efficacy and the acceptability of a brief online CBT program specifically developed for healthcare workers. Given the potential short- and long-term consequences of the COVID-19 pandemic on healthcare workers' mental health, but also on healthcare systems, our findings can significantly impact clinical practice and management of the ongoing, and probably long-lasting, health crisis. TRIAL REGISTRATION: ClinicalTrials.gov NCT04362358 , registered on April 24, 2020.


Assuntos
Betacoronavirus/genética , Terapia Cognitivo-Comportamental/métodos , Infecções por Coronavirus/terapia , Pessoal de Saúde/psicologia , Intervenção Baseada em Internet/estatística & dados numéricos , Pneumonia Viral/terapia , Adulto , Idoso , Biblioterapia/métodos , Estudos de Casos e Controles , Terapia Cognitivo-Comportamental/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Infecções por Coronavirus/virologia , Assistência à Saúde/estatística & dados numéricos , Depressão/epidemiologia , Depressão/prevenção & controle , Feminino , França/epidemiologia , Humanos , Masculino , Saúde Mental/normas , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Pneumonia Viral/virologia , Prevalência , Estudos Prospectivos , Resiliência Psicológica , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/prevenção & controle , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/prevenção & controle , Resultado do Tratamento
10.
Medicine (Baltimore) ; 99(40): e22501, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019447

RESUMO

BACKGROUND: Tinnitus is a common disease in otolaryngology. In China, acupuncture has been used as a promising treatment for tinnitus. Yet, the specific effect and safety of acupuncture are still disputable. The ultimate goal of this paper is to formulate a protocol for systematic review and meta-analysis, which can be employed in assessing the benefits and safety of acupuncture on tinnitus. METHODS: Seven databases should be retrieved from their establishment until June 2020, including PubMed, Cochrane Central Register of Controlled Trials, Excerpt Medical Database, Chinese Biomedical Literature Database, Chinese Science and Technology Periodical Database, China National Knowledge Infrastructure and Wan Fang Database. Randomized controlled trials of acupuncture treatment of tinnitus will be included. The experimental group is acupuncture or combined with additional treatment measures, and the control group is a placebo, sham acupuncture, Cognitive Behavioral Therapy, sound therapy, conventional medication, or same additional treatment. The clinical efficacy rate, Tinnitus Handicap Inventory, Tinnitus Questionnaire, visual analogue scale or other indicators are all concerned in the systematic evaluation of the program. Data collection, selection and extraction should be made separately by different researchers. The quality of the literature will be evaluated by the bias analysis table in the Cochrane Handbook, and Review Manager 5.3 software shall be applied to data analysis. RESULTS: This protocol has made a concrete plan to evaluate whether acupuncture is effective and safe in curing tinnitus. CONCLUSION: This protocol is suitable for evaluating the effectiveness and safety of acupuncture in curing tinnitus, and is helpful for subsequent evaluation.Open Science Framework Registration DOI: 10.17605/OSF.IO/85FCS.


Assuntos
Terapia por Acupuntura/métodos , Zumbido/terapia , Terapia por Acupuntura/efeitos adversos , Terapia Cognitivo-Comportamental/métodos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
11.
Interv. psicosoc. (Internet) ; 29(3): 153-164, sept. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-194492

RESUMO

The inconsistency in the results both internally and between of previous meta-analyses on batterer intervention program efficacy, and the publication of new batterer interventions underscored the need for an up-to-date meta-analyticalreview. A total of 25 primary studies were found from literature search, obtaining 62 effect sizes, and a total sample of 20,860 intervened batterers. The results of a global meta-analysis showed a positive, significant, and of a mediummagnitude effect size for batterer interventions, but not generalizable. Nevertheless, the results exhibited a significantly higher rate of recidivism measured in couple reports (CRs) than in official records (ORs). As a consequence, intervention efficacy measuring in CRs was null, whilst in ORs was positive and significant. As for the intervention model, positive andsignificant effects were observed under the Duluth Model and cognitive-behavioural treatment programs (CBTPs), but a higher effect size was obtained with CBTPs in comparison to the Duluth Model (under this model, interventions may have negative effects, i.e., an increase in recidivism rate). In relation to intervention length, short interventions failed to reduce recidivism in ORs and may have negative effects, while long interventions were effective in reducing recidivism rate in ORs without negative effects. Efficacy evaluations in short follow-ups were invalid as artificially boosted recidivismreduction rate. Limitations of ORs and short follow-ups as measures of the intervention efficacy and implications of results for batterer intervention are discussed


La inconsistencia interna y entre las revisiones metaanalíticas en los resultados sobre la eficacia de los programas de intervención con maltratadores, así como la publicación de nuevos estudios, pone de manifiesto la necesidad de llevar a cabo una revisión metaanalítica actualizada. Se encontró un total de 25 estudios primarios, de los que se obtuvieron 62 tamaños del efecto para una muestra total de 20,860 maltratadores intervenidos. Los resultados del metaanálisis global mostraron un tamaño del efecto promedio positivo, significativo y de una magnitud moderada para la intervención con maltratadores, pero no generalizable. Sin embargo, los resultados revelaron una tasa de reincidencia mayor medida en los informes de las parejas (IPs) que en los registros oficiales (ROs). Como consecuencia, la eficacia de la intervención medida en los IPs resultó nula, mientras que en los ROs fue positiva y significativa. En relación al modelo de intervención, se encontraron tamaños del efecto positivos y significativos con el Modelo Duluth y los programas de tratamiento cognitivo-conductuales (PTC-Cs), pero el tamaño del efecto obtenido con los PTC-Cs era significativamente mayor que con el Modelo Duluth (con este modelo las intervenciones pueden tener efectos negativos, es decir, unincremento en la tasa de reincidencia). En relación a la longitud de la intervención, las intervenciones breves fallaron en la reducción de la reincidencia en los ROs y pueden tener efectos negativos, en tanto que las intervenciones largas fueron eficaces en la reducción de la tasa de reincidencia en los ROs y no dan lugar a efectos negativos. Las evaluacionesde la eficacia de la intervención en períodos cortos de seguimiento resultaron no válidas al incrementar artificialmente la tasa de reducción de la reincidencia. Se discuten las limitaciones de la medida de la eficacia de la intervención en los ROs y en períodos cortos de seguimiento, así como las implicaciones para la intervención con maltratadores


Assuntos
Humanos , Metanálise como Assunto , Exposição à Violência/psicologia , Violência/psicologia , Teoria Psicológica , Modelos Psicológicos , Terapia Cognitivo-Comportamental/métodos , Maus-Tratos Conjugais/psicologia
12.
Psychiatr Danub ; 32(Suppl 1): 75-78, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32890367

RESUMO

Panic Disorder is often associated with low quality of life. Brief Strategic Therapy aims to reduce PD symptoms in the first sessions giving patient the ability to improve his life as soon as possible. For its brevity and cost-effectiveness, it might be suggested as a first-choice treatment for PD.


Assuntos
Transtorno de Pânico , Terapia Cognitivo-Comportamental , Humanos , Transtorno de Pânico/diagnóstico , Transtorno de Pânico/terapia , Qualidade de Vida
13.
Prax Kinderpsychol Kinderpsychiatr ; 69(5): 443-462, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32886045

RESUMO

Supporting Children of Parents With a Mental Illness: State of Research and Two Practice Approaches and Claims for the Government Children of parents with a mental illness (COPMI) are at an increased risk to develop (severe) mental disorders (SMI) themselves. Estimates for Germany result in about 25 % of COPMI. This is thus a large and high risk group. On the other hand, prevention programs for COPMI are still scarce, especially in Germany, and central features of the transgenerational transmission of mental disorders have not been studied in conjunction to shed light on potential transmission mechanisms. The current article presents two current research projects on COPMI focusing on preventive approaches. The BMBF funded project "Children of Parents with a Mental Illness At Risk Evaluation" (COMPARE) targets parents of children aged 1.5 to 16 years of age. Parents need to fulfil a current DSM-5 based diagnosis of a mental disorder and then receive either 25-45 sessions gold standard cognitive behavioural therapy (CBT) or CBT plus 10 sessions Positive Parenting Program (PPP) to test the effects of parental therapy on the children and whether an additional parent training results in incremental effects above and beyond CBT alone. The project "The Village" is a model project in the region Tyrol, Austria, targeting the improved identification and collaborative care of COPMI.


Assuntos
Filho de Pais Incapacitados/psicologia , Terapia Cognitivo-Comportamental , Governo , Transtornos Mentais/prevenção & controle , Transtornos Mentais/terapia , Pais/psicologia , Adolescente , Adulto , Áustria , Criança , Pré-Escolar , Suscetibilidade a Doenças , Alemanha , Humanos , Lactente , Transtornos Mentais/diagnóstico , Poder Familiar/psicologia
14.
Lancet Psychiatry ; 7(10): 893-910, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32949521

RESUMO

Mental illness and substance use disorders in the workplace have been increasingly recognised as a problem in most countries; however, evidence is scarce on which solutions provide the highest return on investment. We searched academic and grey literature databases and additional sources for studies that included a workplace intervention for mental health or substance abuse, or both, and that did an economic analysis. We analysed the papers we found to identify the highest yielding and most cost-effective interventions by disorder. On the basis of 56 studies, we found moderate strength of evidence that cognitive behavioural therapy is cost-saving (and in some cases cost-effective) to address depression. We observed strong evidence that regular and active involvement of occupational health professionals is cost-saving and cost-effective in reducing sick leave related to mental health and in encouraging return to work. We identified moderate evidence that coverage for pharmacotherapy and brief counselling for smoking cessation are both cost-saving and cost-effective. Addressing mental health and substance misuse in the workplace improves workers' wellbeing and productivity, and benefits employers' bottom line (ie, profit). Future economic analyses would benefit from the consideration of subgroup analyses, examination of longer follow-ups, inclusion of statistical and sensitivity analyses and discussion around uncertainty, and consideration of potential for bias.


Assuntos
Serviços de Saúde do Trabalhador/economia , Serviços de Saúde do Trabalhador/métodos , Terapia Ocupacional/economia , Terapia Ocupacional/métodos , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Terapia Cognitivo-Comportamental/economia , Terapia Cognitivo-Comportamental/métodos , Análise Custo-Benefício , Economia Médica , Humanos , Saúde Mental , Ensaios Clínicos Controlados Aleatórios como Assunto , Licença Médica/estatística & dados numéricos , Local de Trabalho
15.
Cochrane Database Syst Rev ; 9: CD007668, 2020 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-32880104

RESUMO

BACKGROUND: Antisocial personality disorder (AsPD) is associated with poor mental health, criminality, substance use and relationship difficulties. This review updates Gibbon 2010 (previous version of the review). OBJECTIVES: To evaluate the potential benefits and adverse effects of psychological interventions for adults with AsPD. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, 13 other databases and two trials registers up to 5 September 2019. We also searched reference lists and contacted study authors to identify studies. SELECTION CRITERIA: Randomised controlled trials of adults, where participants with an AsPD or dissocial personality disorder diagnosis comprised at least 75% of the sample randomly allocated to receive a psychological intervention, treatment-as-usual (TAU), waiting list or no treatment. The primary outcomes were aggression, reconviction, global state/functioning, social functioning and adverse events. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. MAIN RESULTS: This review includes 19 studies (eight new to this update), comparing a psychological intervention against TAU (also called 'standard Maintenance'(SM) in some studies). Eight of the 18 psychological interventions reported data on our primary outcomes. Four studies focussed exclusively on participants with AsPD, and 15 on subgroups of participants with AsPD. Data were available from only 10 studies involving 605 participants. Eight studies were conducted in the UK and North America, and one each in Iran, Denmark and the Netherlands. Study duration ranged from 4 to 156 weeks (median = 26 weeks). Most participants (75%) were male; the mean age was 35.5 years. Eleven studies (58%) were funded by research councils. Risk of bias was high for 13% of criteria, unclear for 54% and low for 33%. Cognitive behaviour therapy (CBT) + TAU versus TAU One study (52 participants) found no evidence of a difference between CBT + TAU and TAU for physical aggression (odds ratio (OR) 0.92, 95% CI 0.28 to 3.07; low-certainty evidence) for outpatients at 12 months post-intervention. One study (39 participants) found no evidence of a difference between CBT + TAU and TAU for social functioning (mean difference (MD) -1.60 points, 95% CI -5.21 to 2.01; very low-certainty evidence), measured by the Social Functioning Questionnaire (SFQ; range = 0-24), for outpatients at 12 months post-intervention. Impulsive lifestyle counselling (ILC) + TAU versus TAU One study (118 participants) found no evidence of a difference between ILC + TAU and TAU for trait aggression (assessed with Buss-Perry Aggression Questionnaire-Short Form) for outpatients at nine months (MD 0.07, CI -0.35 to 0.49; very low-certainty evidence). One study (142 participants) found no evidence of a difference between ILC + TAU and TAU alone for the adverse event of death (OR 0.40, 95% CI 0.04 to 4.54; very low-certainty evidence) or incarceration (OR 0.70, 95% CI 0.27 to 1.86; very low-certainty evidence) for outpatients between three and nine months follow-up. Contingency management (CM) + SM versus SM One study (83 participants) found evidence that, compared to SM alone, CM + SM may improve social functioning measured by family/social scores on the Addiction Severity Index (ASI; range = 0 (no problems) to 1 (severe problems); MD -0.08, 95% CI -0.14 to -0.02; low-certainty evidence) for outpatients at six months. 'Driving whilst intoxicated' programme (DWI) + incarceration versus incarceration One study (52 participants) found no evidence of a difference between DWI + incarceration and incarceration alone on reconviction rates (hazard ratio 0.56, CI -0.19 to 1.31; very low-certainty evidence) for prisoner participants at 24 months. Schema therapy (ST) versus TAU One study (30 participants in a secure psychiatric hospital, 87% had AsPD diagnosis) found no evidence of a difference between ST and TAU for the number of participants who were reconvicted (OR 2.81, 95% CI 0.11 to 74.56, P = 0.54) at three years. The same study found that ST may be more likely to improve social functioning (assessed by the mean number of days until patients gain unsupervised leave (MD -137.33, 95% CI -271.31 to -3.35) compared to TAU, and no evidence of a difference between the groups for overall adverse events, classified as the number of people experiencing a global negative outcome over a three-year period (OR 0.42, 95% CI 0.08 to 2.19). The certainty of the evidence for all outcomes was very low. Social problem-solving (SPS) + psychoeducation (PE) versus TAU One study (17 participants) found no evidence of a difference between SPS + PE and TAU for participants' level of social functioning (MD -1.60 points, 95% CI -5.43 to 2.23; very low-certainty evidence) assessed with the SFQ at six months post-intervention. Dialectical behaviour therapy versus TAU One study (skewed data, 14 participants) provided very low-certainty, narrative evidence that DBT may reduce the number of self-harm days for outpatients at two months post-intervention compared to TAU. Psychosocial risk management (PSRM; 'Resettle') versus TAU One study (skewed data, 35 participants) found no evidence of a difference between PSRM and TAU for a number of officially recorded offences at one year after release from prison. It also found no evidence of difference between the PSRM and TAU for the adverse event of death during the study period (OR 0.89, 95% CI 0.05 to 14.83, P = 0.94, 72 participants (90% had AsPD), 1 study, very low-certainty evidence). AUTHORS' CONCLUSIONS: There is very limited evidence available on psychological interventions for adults with AsPD. Few interventions addressed the primary outcomes of this review and, of the eight that did, only three (CM + SM, ST and DBT) showed evidence that the intervention may be more effective than the control condition. No intervention reported compelling evidence of change in antisocial behaviour. Overall, the certainty of the evidence was low or very low, meaning that we have little confidence in the effect estimates reported. The conclusions of this update have not changed from those of the original review, despite the addition of eight new studies. This highlights the ongoing need for further methodologically rigorous studies to yield further data to guide the development and application of psychological interventions for AsPD and may suggest that a new approach is required.


Assuntos
Transtorno da Personalidade Antissocial/terapia , Psicoterapia/métodos , Adulto , Agressão/psicologia , Transtorno da Personalidade Antissocial/mortalidade , Transtornos Relacionados ao Uso de Cocaína/terapia , Terapia Cognitivo-Comportamental/métodos , Dirigir sob a Influência , Feminino , Humanos , Masculino , Prisioneiros/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto , Reincidência/estatística & dados numéricos , Recompensa , Resultado do Tratamento
16.
Cochrane Database Syst Rev ; 9: CD010022, 2020 09 21.
Artigo em Inglês | MEDLINE | ID: mdl-32960976

RESUMO

BACKGROUND: High blood pressure constitutes one of the leading causes of mortality and morbidity all over the world. At the same time, heavy drinking increases the risk for developing cardiovascular diseases, including cardiomyopathy, hypertension, atrial arrhythmias, or stroke. Several studies have already assessed specifically the relationship between alcohol intake and hypertension. However, the potential effect on blood pressure of alcohol intake reduction interventions is largely unknown. OBJECTIVES: To assess the effect of any intervention to reduce alcohol intake in terms of blood pressure decrease in hypertensive people with alcohol consumption compared to a control intervention or no intervention at all. To determine additional effects related to mortality, major cardiovascular events, serious adverse events, or quality of life. SEARCH METHODS: The Cochrane Hypertension Information Specialist searched the following databases for randomised controlled trials up to June 2020: the Cochrane Hypertension Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 5, 2020), MEDLINE Ovid (from 1946), MEDLINE Ovid Epub Ahead of Print, and MEDLINE Ovid In-Process, Embase Ovid (from 1974), ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform. Trial authors were contacted when needed and no language restrictions were applied. SELECTION CRITERIA: We included randomised controlled trials with minimum 12 weeks duration and including 50 or more subjects per group with quantitative measurement of alcohol consumption and/or biological measurement of the outcomes of interest. Participants were adults (16 years of age or older) with systolic blood pressure (SBP) greater than 140 mmHg and diastolic blood pressure (DBP) greater than 90 mmHg, and SBP ≥ 130 or DBP ≥ 80 mmHg in participants with diabetes. We included any intervention implemented to reduce their alcohol intake. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed search results and extracted data using standard methodological procedures adopted by Cochrane. MAIN RESULTS: A total of 1210 studies were screened. We included one randomised controlled trial involving a total of 269 participants with a two-year follow-up. Individual patient data for all participants were provided and used in this review. No differences were found between the cognitive-behavioural intervention group and the control group for overall mortality (RR 0.72, 95% CI 0.16 to 3.17; low-certainty evidence), cardiovascular mortality (not estimable) and cardiovascular events (RR 0.80, 95% CI 0.36 to 1.79; very low-certainty evidence). There was no statistical difference in systolic blood pressure (SBP) reduction (Mean Difference (MD) -0.92 mmHg, 95% confidence interval (CI) -5.66 to 3.82 mmHg; very low-certainty evidence) or diastolic blood pressure (DBP) decrease (MD 0.98 mmHg, 95% CI -1.69 to 3.65 mmHg; low-certainty evidence) between the cognitive-behavioural intervention group and the control group. We also did not find any differences in the proportion of subjects with SBP < 140 mmHg and DBP < 90 mmHg (Risk Ratio (RR) 1.21, 95% CI 0.88 to 1.65; very low-certainty evidence). Concerning secondary outcomes, the alcohol intake was significantly reduced in the cognitive-behavioural intervention compared with the control group (MD 191.33 g, 95% CI 85.36 to 297.30 g). We found no differences between the active and control intervention in the proportion of subjects with lower-risk alcohol intake versus higher-risk and extreme drinkers at the end of the study (RR 1.04, 95% CI 0.68 to 1.60). There were no estimable results for the quality of life outcome. AUTHORS' CONCLUSIONS: An intervention for decreasing alcohol intake consumption did not result in differences in systolic and diastolic blood pressure when compared with a control intervention, although there was a reduction in alcohol intake favouring the active intervention. No differences were found either for overall mortality, cardiovascular mortality or cardiovascular events. No data on serious adverse events or quality of life were available to assess. Adequate randomised controlled trials are needed to provide additional evidence on this specific question.


Assuntos
Consumo de Bebidas Alcoólicas/prevenção & controle , Terapia Cognitivo-Comportamental , Hipertensão/prevenção & controle , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/mortalidade , Viés , Pressão Sanguínea , Doenças Cardiovasculares/epidemiologia , Feminino , Humanos , Hipertensão/etiologia , Hipertensão/mortalidade , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
J Trauma Stress ; 33(5): 623-633, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32865850

RESUMO

The COVID-19 pandemic presents major challenges for mental health care providers. In particular, providers who treat posttraumatic stress disorder (PTSD) are now tasked with determining whether to initiate trauma-focused therapy during the pandemic and, if so, whether and how to adapt treatment. The purpose of this communication is to identify and organize key considerations for whether and how to deliver commonly used evidence-supported therapy protocols for trauma treatment-specifically, cognitive processing therapy (CPT) and prolonged exposure (PE) therapy-during the ongoing COVID-19 pandemic for adults who currently meet the criteria for PTSD. Based on relevant public health and clinical literature, we present a structured guide that can be used by treatment teams and individual providers to evaluate whether initiating CPT or PE is indicated given a particular patient-provider pair and system context amidst pandemic conditions. In addition, we suggest appropriate action steps, including problem-solving strategies, evidence-informed modifications to CPT and PE, and alternative intervention approaches.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Infecções por Coronavirus/psicologia , Assistência à Saúde/organização & administração , Terapia Implosiva/métodos , Pneumonia Viral/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Atitude do Pessoal de Saúde , Betacoronavirus , Continuidade da Assistência ao Paciente , Humanos , Pandemias , Cooperação do Paciente , Transtornos de Estresse Pós-Traumáticos/psicologia
18.
Br J Clin Psychol ; 59(4): 552-564, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32920864

RESUMO

BACKGROUND: Cognitive behavioural analysis system of psychotherapy (CBASP) is an effective individual treatment for persistent depressive disorder (PDD), but evidence on group treatment (Group-CBASP) is limited. Our aim was to review the effect of Group-CBASP on self-report depression severity in outpatients with PDD, overall and by age of depression-onset. METHODS: A retrospective chart review study (November 2011-March 2017) in 54 patients with PDD (29 late-onset, 25 early-onset). Patients were previously treated by pharmacotherapy (92.6%), psychotherapy (98.1%) and/or electroconvulsive therapy (11.1%). Group-CBASP involved 24 weekly sessions during 6 months, followed by individual appointments over 6 months. The Inventory of Depressive Symptoms -self rating(IDS-SR) was used at baseline and after 3, 6, 9 and 12 months, computing mean differences and response rates. RESULTS: The mean IDS-SR score decreased significantly from 39.83 at baseline to 33.78 at 6 months: a decrease from severe to moderate depression after 24 weeks of Group-CBASP, with a medium effect size (Cohen's d = .49). At 12 months, the mean IDS-SR score was 32.81, indicating moderate symptom levels remained. At 6 and 12 months, mean IDS-SR scores were similar among late- versus early-onset patients, but at 12 months response rates were higher among late-onset patients. LIMITATIONS: Although results of our study provide valuable input for future prospective studies, limitations were the use of a retrospective design and the small group size. CONCLUSION: Group-CBASP offered to an outpatient population with PDD was associated with clinically relevant decrease in self-reported symptom severity, and with sustained response particularly in patients with late onset of depression. PRACTITIONER POINTS: Group-CBASP seems to be a good alternative for CBASP in individual setting. Patients with late age of depression-onset seem to benefit more from Group-CBASP. This study shows that clinical relevant effects of Group-CBASP, followed by individual contacts, remain at least for 6 months. Research on personalizing treatment strategies is needed to improve patient assignment for Group-CBASP.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Depressão/terapia , Psicoterapia de Grupo/métodos , Adulto , Doença Crônica , Cognição , Depressão/psicologia , Transtorno Depressivo/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
19.
Dtsch Arztebl Int ; 117(24): 412-419, 2020 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-32865492

RESUMO

BACKGROUND: The lifetime prevalence of schizophrenia is 1%. Schizophrenia is among the most severe mental illnesses and gives rise to the highest treatment costs per patient of any disease. It is characterized by frequent relapses, marked impairment of quality of life, and reduced social and work participation. METHODS: The group entrusted with the creation of the German clinical practice guideline was chosen to be representative and pluralistic in its composition. It carried out a systematic review of the relevant literature up to March 2018 and identified a total of 13 389 publications, five source guidelines, three other relevant German clinical practice guidelines, and four reference guidelines. RESULTS: As the available antipsychotic drugs do not differ to any great extent in efficacy, it is recommended that acute antipsychotic drug therapy should be sideeffect- driven, with a number needed to treat (NNT) of 5 to 8. The choice of treatment should take motor, metabolic, sexual, cardiac, and hematopoietic considerations into account. Ongoing antipsychotic treatment is recommended to prevent relapses (NNT: 3) and should be re-evaluated on a regular basis in every case. It is also recommended, with recommendation grades ranging from strong to intermediate, that disorder- and manifestation-driven forms of psychotherapy and psychosocial therapy, such as cognitive behavioral therapy for positive or negative manifestations (effect sizes ranging from d = 0.372 to d = 0.437) or psycho-education to prevent relapses (NNT: 9), should be used in combination with antipsychotic drug treatment. Further aspects include rehabilitation, the management of special treatment situations, care coordination, and quality management. A large body of evidence is available to provide a basis for guideline recommendations, particularly in the areas of pharmacotherapy and cognitive behavioral therapy. CONCLUSION: The evidence-based diagnosis and treatment of persons with schizophrenia should be carried out in a multiprofessional process, with close involvement of the affected persons and the people closest to them.


Assuntos
Antipsicóticos , Terapia Cognitivo-Comportamental , Psicoterapia , Esquizofrenia , Antipsicóticos/uso terapêutico , Humanos , Qualidade de Vida , Esquizofrenia/terapia
20.
Behav Cogn Psychother ; 48(6): 745-750, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32744221

RESUMO

BACKGROUND: Our aim was to develop a brief cognitive behavioural therapy (CBT) protocol to augment treatment for social anxiety disorder (SAD). This protocol focused specifically upon fear of positive evaluation (FPE). To our knowledge, this is the first protocol that has been designed to systematically target FPE. AIMS: To test the feasibility of a brief (two-session) CBT protocol for FPE and report proof-of-principle data in the form of effect sizes. METHOD: Seven patients with a principal diagnosis of SAD were recruited to participate. Following a pre-treatment assessment, patients were randomized to either (a) an immediate CBT condition (n = 3), or (b) a comparable wait-list (WL) period (2 weeks; n = 4). Two WL patients also completed the CBT protocol following the WL period (delayed CBT condition). Patients completed follow-up assessments 1 week after completing the protocol. RESULTS: A total of five patients completed the brief, FPE-specific CBT protocol (two of the seven patients were wait-listed only and did not complete delayed CBT). All five patients completed the protocol and provided 1-week follow-up data. CBT patients demonstrated large reductions in FPE-related concerns as well as overall social anxiety symptoms, whereas WL patients demonstrated an increase in FPE-related concerns. CONCLUSIONS: Our brief FPE-specific CBT protocol is feasible to use and was associated with large FPE-specific and social anxiety symptom reductions. To our knowledge, this is the first treatment report that has focused on systematic treatment of FPE in patients with SAD. Our protocol warrants further controlled evaluation.


Assuntos
Terapia Cognitivo-Comportamental , Fobia Social , Medo , Humanos , Fobia Social/terapia , Listas de Espera
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