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2.
Z Kinder Jugendpsychiatr Psychother ; 48(1): 33-46, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30422059

RESUMO

This meta-review integrates the current meta-analysis literature on the efficacy of internet- and mobile-based interventions (IMIs) for mental disorders and somatic diseases in children and adolescents. Further, it summarizes the moderators of treatment effects in this age group. Using a systematic literature search of PsycINFO and MEDLINE/PubMed, we identified eight meta-analyses (N = 8,417) that met all inclusion criteria. Current meta-analytical evidence of IMIs exists for depression (range of standardized mean differences, SMDs = .16 to .76; 95 % CI: -.12 to 1.12; k = 3 meta-analyses), anxiety (SMDs = .30 to 1.4; 95 % CI: -.53 to 2.44; k = 5) and chronic pain (SMD = .41; 95 % CI: .07 to .74; k = 1) with predominantly nonactive control conditions (waiting-list; placebo). The effect size for IMIs across mental disorders reported in one meta-analysis is SMD = 1.27 (95 % CI: .96 to 1.59; k = 1), the effect size of IMIs for different somatic conditions is SMD = .49 (95 % CI: .33 to .64; k = 1). Moderators of treatment effects are age (k = 3), symptom severity (k = 1), and source of outcome assessment (k = 1). Quality ratings with the AMSTAR-2-checklist indicate acceptable methodological rigor of meta-analyses included. Taken together, this meta-review suggests that IMIs are efficacious in some health conditions in youths, with evidence existing primarily for depression and anxiety so far. The findings point to the potential of IMIs to augment evidence based mental healthcare for children and adolescents.


Assuntos
Transtornos de Ansiedade/terapia , Telefone Celular , Transtorno Depressivo/terapia , Internet , Adolescente , Ansiedade/terapia , Criança , Depressão/terapia , Humanos , Resultado do Tratamento
3.
Gesundheitswesen ; 82(1): e1-e8, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-30332707

RESUMO

BACKGROUND: Revision of the evaluation concept of Germany's sixth national health target entitled "Depressive illnesses - prevention, early diagnosis, sustainable treatment" developed in 2006. OBJECTIVES: Analysis of available of data since 2006 to determine if the objectives of the health target and its sub-goals (awareness, prevention, diagnosis/indication/therapy, health care structure, patient empowerment, rehabilitation) were achieved. MATERIALS AND METHODS: The 6 sub-goals were screened in terms of indicators of progress towards goal over the last decade, and then examined for accessible data sources. RESULTS: The sub-goal prevention yielded routine data from t0 onwards (start of activities). The other sub-goals awareness, diagnosis, and health care provided selective data sources, generated mostly by scientific studies. An important milestone within the sub-goal of diagnosis/indication/therapy was the development of the National Clinical Practice guideline for depression. Data were sparse in the areas rehabilitation and patient empowerment. CONCLUSIONS: The six sub-goals are still valid. Yet, the validity of the data in terms of the evaluation of the health target is limited mainly because of the cross-sectional designs of studies. Prospective systematic surveys are required to further evaluate the national health target and its implementation for both qualitative and quantitative longitudinal indicators.


Assuntos
Transtorno Depressivo , Programas Nacionais de Saúde , Estudos Transversais , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/terapia , Diagnóstico Precoce , Alemanha , Metas , Implementação de Plano de Saúde , Humanos , Estudos Prospectivos
4.
Adv Exp Med Biol ; 1180: 219-232, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31784966

RESUMO

The goal of treatment for depressive disorders is complete remission of depressive symptoms with full recovery of social function and prevention of recurrence. However, a large proportion of patients do not experience symptomatic remission after the initial treatment, with even lower rates of remission in the longer treatment term. The main objective of individualized treatment applied in psychiatry is to improve precision in disease diagnosis, prognosis, treatment choices, and treatment response. Diverse approaches and techniques, such as genomics, epigenomics, other omics, neural circuit, and artificial intelligence are related to precision psychiatry. Using biology and computational psychiatry tools to find potential biomarkers, and based on precision psychiatry, patients considered to belong to the same endophenotype will be possible to receive biomarkers-based treatment and better prognosis. Especially in the choice of intervention, individualized treatment should be considered. In this review, we present the development of precise treatment in depressive disorders and introduce advances in several domains toward precision medicine and individualized treatment. We pay particular attention to biomarkers and the development of new technologies in depressive disorders, which will help disease complete remission and functional recovery, seek better lives for patients suffered with depressive disorders.


Assuntos
Transtorno Depressivo/terapia , Medicina de Precisão , Biomarcadores , Transtorno Depressivo/diagnóstico , Epigenômica , Humanos , Fenótipo , Psiquiatria
5.
Adv Exp Med Biol ; 1180: 233-265, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31784967

RESUMO

Depression is highly prevalent and causes unnecessary human suffering and economic loss. Therefore, its treatment and prevention are of utmost importance. There are several advantages of using psychotherapy either by itself or combined with pharmacological treatment methods in the treatment of depression. First, it is well known that combining biological treatment with psychosocial methods increases the chances of recovery. Second, in some individuals, psychotherapy continues to be the only solution. Third, the use of antidepressants contains some safety risks and side effects, but psychotherapy does not. Fourth, clinically, depressive patients prefer psychotherapy to drug therapy. Use of a depression-focused psychotherapy alone is recommended as an initial treatment choice for patients with mild to moderate depression, with clinical evidence supporting the use of cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPT), psychodynamic psychotherapy (PDP), and problem-solving therapy (PST) in individual and group formats. Important developments took place within the past 20 years in the psychotherapy of depression. In the present chapter, we introduced several key issues, such as, Are all psychotherapies equally effective? Who benefits from psychotherapies? Is telepsychotherapy effective? Finally, we introduce the psychotherapy for special populations.


Assuntos
Transtorno Depressivo/terapia , Psicoterapia/métodos , Antidepressivos , Terapia Cognitivo-Comportamental , Humanos , Resolução de Problemas , Psicoterapia Psicodinâmica
6.
Adv Exp Med Biol ; 1180: 267-276, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31784968

RESUMO

The advances in the Internet and related technologies may lead to changes in professional roles of psychiatrists and psychotherapists. The application of artificial intelligence (AI) and electronic measurement-based care (eMBC) in the treatment of depressive disorder has addressed more interest. AI could play a role in population health management and patient administration as well as assist physicians to make a decision in the real-world clinical practice. The eMBC strengthens MBC through web/mobile devices and telephone consulting services, to monitor disease progression, and customizes the MBC interface in electronic medical record systems (EMRs).


Assuntos
Inteligência Artificial , Transtorno Depressivo/terapia , Internet , Tomada de Decisão Clínica , Registros Eletrônicos de Saúde , Humanos
7.
Zh Nevrol Psikhiatr Im S S Korsakova ; 119(9. Vyp. 2): 60-67, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31825392

RESUMO

Depression often complicates the course of the post-stroke period, adversely affecting the functional recovery and quality of life of patients, and is associated with an increased risk of mortality. Over the recent years, the role of inflammatory processes, genetics, white matter damage, cerebrovascular reactivity disorders, changes in the level of monoamines and cortisol, impaired neuroplasticity and glutamate neurotransmission in the pathophysiological mechanisms of post-stroke depression (PSD) is increasingly discussed. Randomized clinical trials (RCTs) have shown that antidepressants are highly effective in the treatment and prevention of PSD. The action of antidepressants, in particular selective serotonin reuptake inhibitors (SSRIs), can be directed to the main pathophysiological processes of post-stroke depression. Treatment of PSD with antidepressants not only reduces the severity of depression, but also improves the functional state, rehabilitation and quality of life of patients.


Assuntos
Transtorno Depressivo , Acidente Vascular Cerebral , Antidepressivos/uso terapêutico , Depressão , Transtorno Depressivo/tratamento farmacológico , Transtorno Depressivo/terapia , Humanos , Qualidade de Vida , Inibidores de Captação de Serotonina , Acidente Vascular Cerebral/complicações
8.
Pan Afr Med J ; 34: 37, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31803341

RESUMO

Introduction: In Cameroon, there is medical scepticism and negligence towards patients with mental disorders. Objective assessment might be the solution. Depressive disorders are the most common form of mental disorders and Douala has the second largest group of general practitioners in the country. Thus, the purpose of this study was to evaluate the attitude of general practitioners of Douala towards patients with depressive disorders. Method: We conducted a cross-sectional descriptive study of general outpatient services from February to June 2017. We asked 3 patients of each general practitioner enrolled in the study to fill the Patient Health Questionnaire version-9 (HQP-9) to assess if they were depressed. During each consultation, we filled a clinical information form to know whether the general practitioner had diagnosed a depressive disorder and, if so, which treatment he had adopted. Finally, we administered to general practitioner a questionnaire to know their challenges of treating depression. Results: The prevalence of depressive disorders in general practice consultations was estimated to be 32.5% in the city of Douala and the rate of diagnoses made by general practitioners was 1.92%. Diagnosed patients only received some. Conclusion: Despite the low interest in depressive disorders, in Cameroon they are a public health problem due to their frequency and to depression-related morbi-mortality.


Assuntos
Atitude do Pessoal de Saúde , Transtorno Depressivo/terapia , Clínicos Gerais/estatística & dados numéricos , Camarões , Estudos Transversais , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/epidemiologia , Pesquisas sobre Serviços de Saúde , Humanos , Prevalência
9.
Am J Psychother ; 72(4): 88-94, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31813228

RESUMO

OBJECTIVE: As a sequel to the Depression in Later Life trial of lay counselor-delivered problem-solving therapy for depression prevention among older adults in Goa, India, this qualitative study aimed to explore participant experiences to illuminate the reasons for the trial's positive findings and implications for further efforts at depression prevention in low-resource settings. METHODS: In-depth interviews were conducted with 19 participants (21% of those randomly assigned to the original intervention). Two independent raters coded the data and organized narratives according to broad themes. RESULTS: Most participants valued their relationship with the lay counselor, learned self-care strategies to cope with illnesses, and increased engagement in pleasurable social and physical activities. Some participants reported needing assistance with managing financial strain and family conflicts. CONCLUSIONS: The lay-counselor-delivered intervention was well received. The relationship with the counselor and behavioral activation toward better self-care and more-pleasurable activities may have been keys to the intervention's success.


Assuntos
Depressão/psicologia , Depressão/terapia , Psicoterapia , Idoso , Transtorno Depressivo/psicologia , Transtorno Depressivo/terapia , Feminino , Humanos , Índia , Masculino , Pesquisa Qualitativa
10.
Am J Psychother ; 72(4): 101-122, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31813229

RESUMO

OBJECTIVES: This paper aimed to synthesize empirical findings of patient extratherapeutic interpersonal variables associated with individual psychotherapy treatment outcomes in adult outpatients with depression. METHODS: A systematic search strategy was used to identify relevant studies. Thematic analysis was used to identify recurring themes in the findings. RESULTS: Forty studies met search criteria. Three themes of patient extratherapeutic interpersonal variables were identified: capacity to engage with others, capacity to navigate relationships, and capacity to achieve intimacy, progressing from basic to advanced levels of interpersonal interaction. Interpersonal variables such as interpersonal distress and style, attachment orientation, and quality of object relations were particularly useful in predicting treatment outcomes, whereas access to social support and marital status provided mixed results, likely because they do not account for relationship quality. CONCLUSIONS: Recognizing variables associated with treatment response can help clinicians identify patients at risk for nonresponse and guide efforts for adapting existing therapies and developing new ones.


Assuntos
Depressão/psicologia , Depressão/terapia , Transtorno Depressivo/psicologia , Transtorno Depressivo/terapia , Relações Interpessoais , Psicoterapia , Adulto , Humanos , Apego ao Objeto , Resultado do Tratamento
11.
Presse Med ; 48(12): 1507-1519, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31767248

RESUMO

Vagus nerve stimulation (VNS) is an old, yet new, option for treatment-resistant depression. Despite several clinical trials over the last 15 years showing a consistent benefit-risk balance of the technic, VNS still struggles to find its place in our therapeutic algorithms. This is especially true in France, where only a few surgeries have been performed nationwide, all in the last year. The reasons behind this lag are manifolds; (1) psychiatrists usually do not consider surgical treatments, even when they are minimally invasive and reversible, (2) early VNS trials stumbled on methodological difficulties that are common to all invasive neurostimulation technics, and initially failed to provide strong evidence for its efficacy, and (3) VNS requires multidisciplinary teams involving psychiatrists and neurosurgeons that did not exist then. Nevertheless, studies of the past twenty years support VNS as a treatment of depression endowed with a unique efficacy profile: a long runner best at maintaining remission in hard-to-stabilize depression, even in the context of ECT withdrawal, and irrespective of whether it is unipolar or bipolar. Thus, VNS potentially addresses the unmet medical needs of some of the most severe and chronic patients with depression. This review aims at introducing VNS as a treatment option for depression, summarizing available evidence for its efficacy and tolerance, and delineating patient profiles that might benefit the most of such treatment.


Assuntos
Depressão/terapia , Estimulação do Nervo Vago , Depressão/epidemiologia , Depressão/etiologia , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/etiologia , Transtorno Depressivo/terapia , França/epidemiologia , Humanos , Resultado do Tratamento , Nervo Vago/fisiologia , Estimulação do Nervo Vago/efeitos adversos , Estimulação do Nervo Vago/métodos , Estimulação do Nervo Vago/tendências
13.
Prax Kinderpsychol Kinderpsychiatr ; 68(7): 639-653, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31711401

RESUMO

Shame and Compassion: Potential Mechanisms Behind Bullying and Depressive Symptoms With a prevalence of 11 % depression is a relevant topic for child- and adolescent-psychiatry. Different factors play a role in genesis and maintenance of depressive symptoms. Shame-proneness and experience with bullying are discussed as reinforcing factors. On the other hand self-compassion is considered to be a protective factor. In this study it is analyzed, whether shame-proneness and self-compassion moderate the influence of bully-experience on depressive symptoms. Data of depressive adolescent in-patients (n = 37) and healthy controls (n = 19) is analyzed. It could be shown that high shame-proneness reinforces the influence of bully-experience on depressive symptoms. General self-compassion has no moderating influence. However, self-kindness is a protective factor against the negative impact of bully-experience on depressive symptoms. Results are discussed regarding their relevance for therapy and prevention.


Assuntos
Bullying/psicologia , Depressão/psicologia , Empatia , Fatores de Proteção , Vergonha , Adolescente , Depressão/prevenção & controle , Depressão/terapia , Transtorno Depressivo/prevenção & controle , Transtorno Depressivo/psicologia , Transtorno Depressivo/terapia , Humanos
14.
Lakartidningen ; 1162019 Nov 01.
Artigo em Sueco | MEDLINE | ID: mdl-31688945

RESUMO

By strengthening accessibility and continuity and support via a care manager for primary care patients with depression corresponding to 20-30% of a nursing service, patients recovered significantly faster and to a greater extent than in primary care-as-usual. Return to work occurred significantly earlier in the first three months, and net sick leave period was significantly shorter during the following 4-6 months. To introduce a collaborative care organizational change where the care manager is the hub and coordinates care for the patient and makes it possible to adapt the care according to the patient's needs throughout the care process, is thus the individual effort shown to have the greatest efficiency in Swedish primary care to increase the quality of care of depression. This approach, where the clinic and academy work closely and continuously in the development and evaluation phases, makes it possible to rapidly develop new ways of working where consideration is given to the complexity of primary care and the complexity of care needs and care efforts.


Assuntos
Administração de Caso , Depressão/terapia , Transtorno Depressivo/terapia , Administração dos Cuidados ao Paciente , Assistência ao Convalescente , Atitude do Pessoal de Saúde , Continuidade da Assistência ao Paciente , Análise Custo-Benefício , Depressão/economia , Transtorno Depressivo/economia , Progressão da Doença , Humanos , Atenção Primária à Saúde , Qualidade da Assistência à Saúde , Retorno ao Trabalho , Licença Médica , Suécia , Resultado do Tratamento
16.
Rev Prat ; 69(6): 649-651, 2019 Jun.
Artigo em Francês | MEDLINE | ID: mdl-31626427

RESUMO

Fibromyalgia is a frequent pain condition. The main symptom is chronic widespread pain during at least 3 months. Many other comorbidities and symptoms are also present. Diagnosis has been revised at multiple occasions during the past 2 decades. The concept is still discussed considering fibromyalgia as a unique diagnosis or a condition including multiple ilnesses. The recent revision in 2016 provides an update of the criteria in order to avoid misclassification (depression). Indeed, applying the previous criteria to regional pain syndromes led to over diagnosis. However, the criteria are not sufficient to diagnose fibromyalgia; complete medical history and physical examination are necessary. There are also diagnostic confounders which should be identified. Morover, some of these confounders may also be associated in some cases with fibromyalgia. Treatments recommended combines multidisciplinary approaches including education, exercises, stress adjustment and if necessary cognitive behavioral therapies. If insufficient, medications such as antidepressents and/or antiepileptics, may be recommended.


Assuntos
Dor Crônica , Transtorno Depressivo , Fibromialgia , Terapia Cognitivo-Comportamental , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/terapia , Diagnóstico Diferencial , Fibromialgia/diagnóstico , Fibromialgia/terapia , Humanos
17.
BMC Health Serv Res ; 19(1): 686, 2019 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-31597555

RESUMO

BACKGROUND: Low-intensity treatments imply reduced therapist contact due to an emphasis on self-help and the use of technologies to deliver treatment. The role of the remoteness, the reduced therapist contact, and the interplay of these components has not been differentiated from a patients' perspective so far. This study's purpose is to capture patients' experiences with telephone-based self-help cognitive behavioural therapy (tel-CBT). METHODS: A subsample of mildly to moderately depressed patients (N = 13) who finished tel-CBT as part of a larger randomised controlled trial (RCT) in routine care were interviewed using a semi-structured questionnaire. Interviews were audiotaped, transcribed verbatim, and independently coded by two coders blind to treatment outcome. Using qualitative content analysis with deductive and inductive procedures, a two-level category system was established. RESULTS: The category system contains four category clusters regarding expectations, self-help related aspects, telephone-related aspects, and implications for patients' treatment pathway, and subsumes a total of 15 categories. Self-help related aspects circulate around the interplay between written materials and professional input, trust and support in the therapeutic relationship and its relation to the initial personal contact, as well as CBT principles. Telephone-related aspects entail perceived advantages and disadvantages of the telephone on an organisational and content level as well as a discourse around distance and closeness in the interaction. Although patients raised doubts regarding the long-term effect of the intervention on symptomatology, patients expressed satisfaction with the treatment and reported an immediate as well as a longer lasting personal impact of the treatment. These results indicate user acceptance with tel-CBT. CONCLUSIONS: This qualitative analysis captures patients' experiences with tel-CBT and the perceived helpfulness of the diverse treatment components. This can facilitate refining aspects of low-intensity treatments and might improve dissemination. TRIAL REGISTRATION: ClinicalTrials.gov NCT02667366. Registered on 3 December 2015.


Assuntos
Atitude Frente a Saúde , Terapia Cognitivo-Comportamental/métodos , Transtorno Depressivo/terapia , Adulto , Idoso , Transtorno Depressivo/psicologia , Feminino , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Relações Profissional-Paciente , Pesquisa Qualitativa , Projetos de Pesquisa , Telemedicina/métodos , Telefone , Resultado do Tratamento
18.
Am J Psychother ; 72(3): 59-66, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31533455

RESUMO

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


Assuntos
Terapia Comportamental , Transtornos do Humor/terapia , Terapia Comportamental/educação , Protocolos Clínicos , Depressão/terapia , Transtorno Depressivo/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos do Humor/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Resultado do Tratamento
19.
Am J Psychother ; 72(3): 67-74, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31533456

RESUMO

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


Assuntos
Terapia Cognitivo-Comportamental/educação , Depressão/psicologia , Depressão/terapia , Transtorno Depressivo/psicologia , Transtorno Depressivo/terapia , Adulto , Feminino , Humanos , Masculino , Psicometria , Autorrelato
20.
Postgrad Med ; 131(7): 438-444, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31482756

RESUMO

Pain is a subjective experience that is influenced by genetics, gender, social, cultural and personal parameters. Opposed to chronic pain, which by definition has to last for at least 3 months, acute pain is mostly because of trauma, acute medical conditions or treatment. The link between mood disorders and acute pain has proven to be increasingly significant since the link is bi-directional, and both act as risk factors for each other. Depression and anxiety are associated with increased perception of pain severity, whereas prolonged duration of acute pain leads to increased mood dysregulation. Although both depression and anxiety have a proven association with acute pain, the link between depression and acute pain is more thoroughly studied. Pain can be the presenting or sole complaint in depressed patients who present to primary care practices and is often overlooked by clinicians. However, reports on the perception of experimentally-induced pain in depressed patients are mixed, showing both an increased and decreased pain threshold and pain tolerance across various studies. Although less data is published about anxiety and pain, the relationship is consistent across studies as increased anxiety leads to increased severity of pain perceived and decreased pain tolerance. Anxiety as well as fear, stress, and catastrophizing are also shown to be mediators in the causal pathway between pain and disability.


Assuntos
Dor Aguda/psicologia , Transtornos de Ansiedade/psicologia , Transtorno Depressivo/psicologia , Dor Aguda/epidemiologia , Dor Aguda/fisiopatologia , Dor Aguda/terapia , Analgésicos/uso terapêutico , Antidepressivos/uso terapêutico , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/fisiopatologia , Transtornos de Ansiedade/terapia , Catastrofização/epidemiologia , Catastrofização/fisiopatologia , Catastrofização/psicologia , Terapia Cognitivo-Comportamental , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/fisiopatologia , Transtorno Depressivo/terapia , Humanos , Manejo da Dor , Limiar da Dor , Índice de Gravidade de Doença
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