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1.
Curr Psychiatry Rep ; 23(11): 78, 2021 10 09.
Artigo em Inglês | MEDLINE | ID: mdl-34626258

RESUMO

PURPOSE OF REVIEW: In contrast to premenstrual dysphoric disorder (PMDD), premenstrual exacerbations (PMEs) of ongoing mood disorders are understudied. The aim of this review is to describe diagnostic issues, epidemiology, underlying mechanisms, and treatment for PME in unipolar depression and bipolar disorder, and to discuss clinical and research implications. RECENT FINDINGS: Community-based and clinical studies estimate that in women with mood disorders around 60% report PME, while some women with bipolar disorder also show symptom exacerbations around ovulation. In general, PME predicts a more severe illness course and an increased burden. While heightened sensitivity to fluctuations of sex hormone levels across the menstrual cycle appears to contribute to PME and PMDD, the overlap of their underlying biological mechanisms remains unclear. Beneficial treatments for PMDD show less or no efficacy in PME. Pharmacological treatments for PME in mood disorders predominantly seem to profit from adjustable augmentation of treatment dosages during the luteal phase for the underlying disorder. However, the evidence is sparse and mainly based on earlier small studies and case reports. Previous research is mainly limited by the lack of a clear differentiation between PME and PMDD comorbidity with mood disorders. More systematic research with uniformly defined and prospectively assessed subgroups of PME in larger epidemiological and clinical samples is needed to receive reliable prevalence estimates and information on the clinical impact of PME of mood disorders, and to uncover underlying mechanisms. In addition, larger randomized controlled trials are warranted to identify efficacious pharmacological and psychotherapeutic treatments for affected women.


Assuntos
Transtorno Disfórico Pré-Menstrual , Síndrome Pré-Menstrual , Feminino , Humanos , Fase Luteal , Ciclo Menstrual , Transtornos do Humor/epidemiologia , Transtornos do Humor/terapia , Transtorno Disfórico Pré-Menstrual/epidemiologia , Transtorno Disfórico Pré-Menstrual/terapia , Síndrome Pré-Menstrual/epidemiologia , Síndrome Pré-Menstrual/terapia
2.
Brain Nerve ; 73(8): 871-877, 2021 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-34376593

RESUMO

The intestinal flora plays a key role in the stress response and barrier function of the gut, both of which are closely associated with the pathophysiology of mental health conditions, such as mood disorders and autistic spectrum disorder through the phenomenon of brain-gut interaction. Despite increasing accumulation of empirical data regarding the contribution of the gut microbiota to these disorders, studies have reported inconsistent results. Notably, short chain fatty acid-producing bacteria and those implicated in the pathophysiology of metabolic diseases appear to be associated with the psychiatric conditions. Clinical trials have shown some evidence to suggest the beneficial effects of probiotics in depressive and neurodevelopmental disorders. Limited studies have discussed this subject; however, the role of the intestinal flora in the pathophysiology and treatment of mental disorders appears to be a promising field of research.


Assuntos
Transtorno do Espectro Autista , Microbioma Gastrointestinal , Transtornos Mentais , Probióticos , Transtorno do Espectro Autista/terapia , Humanos , Transtornos do Humor/terapia , Probióticos/uso terapêutico
3.
J Am Acad Child Adolesc Psychiatry ; 60(10): 1319, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34389440

RESUMO

The frustration of defining, understanding, and addressing irritability in child psychiatry and the difficulties that children with emotion dysregulation face on a daily basis can be seen as parallel processes. We know that irritability is one of the most common reasons for which children are referred for evaluation.1 We also know that the stakes are extremely high, with persistent irritability associated with suicidality.2 Despite this, we do not have a readily available nosological paradigm. Our current clinical approach remains muddled by outbursts' transdiagnostic nature. We find ourselves listing things such as posttraumatic stress disorder, disruptive mood dysregulation disorder, attention-deficit/hyperactivity disorder, anxiety, and depressive disorders in the chart, but feeling that we have not fully captured the unique neurobiological and subjective essence of a child's irritability syndrome.3 Furthermore, despite extensive research, we lack accessible diagnostic tools or effective treatment protocols to implement on a community-wide basis. So, we (JC, CU) think we have every right to be irritable as we experience frustrative non-reward (thinking and focusing on this issue with blocked goal attainment) and face existential threat (desperately wanting children and families to enjoy better developmental trajectories, and wanting it now!).4.


Assuntos
Transtornos de Deficit da Atenção e do Comportamento Disruptivo , Humor Irritável , Transtornos do Humor , Transtorno do Deficit de Atenção com Hiperatividade , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/terapia , Criança , Humanos , Transtornos do Humor/terapia
4.
Handb Clin Neurol ; 182: 49-61, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34266611

RESUMO

In this chapter, light therapy for mood disorders is discussed, including mood disorders during and after pregnancy. In the introduction, we discuss the symptomatology, etiology, and treatment of a specific type of mood disorder, seasonal affective disorder, since it kick-started the first clinical trials with light therapy. Second, we elaborate on the pathophysiology of mood disorders, in particular in the peripartum period. Next, we present an overview of the proposed working mechanisms of light therapy, followed by a discussion of the clinical trials that have followed after the initial research in seasonal affective disorder. Finally, we also focus on the limitations of these trials, such as considerable heterogeneity among studies and many methodological shortcomings. This is complemented by a number of suggestions for future research. Further studies are needed, which stems from the fact that the results have not always been consistent. Despite this, light therapy may be a promising treatment option for various types of mood disorders, since it shows a significant reduction in symptoms in many patients with few adverse effects.


Assuntos
Transtornos do Humor , Fototerapia , Feminino , Humanos , Transtornos do Humor/terapia , Gravidez
5.
J Geriatr Psychiatry Neurol ; 34(4): 280-288, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34219518

RESUMO

Mood disorders and anxiety significantly impact the prognosis and disease course of Parkinson's disease. Non-motor symptoms of Parkinson's disease such as apathy, anhedonia, and fatigue overlap with diagnostic criteria for anxiety and depression, thus making accurate diagnosis of mood disorders in Parkinson's disease patients difficult. Furthermore, treatment options for mood disorders can produce motor complications leading to poor adherence and impaired quality of life in Parkinson's disease patients. This review aims to clarify the current state of diagnostic and treatment options pertaining to anxiety and mood disorders in Parkinson's disease. It explores both the pharmacologic and non-pharmacologic treatment modalities for various mood disorders in comorbid Parkinson's disease with a brief discussion of the future outlook of the field given the current state of the literature.


Assuntos
Transtornos do Humor , Doença de Parkinson , Ansiedade/epidemiologia , Ansiedade/terapia , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/terapia , Humanos , Transtornos do Humor/epidemiologia , Transtornos do Humor/terapia , Doença de Parkinson/complicações , Doença de Parkinson/diagnóstico , Doença de Parkinson/epidemiologia , Qualidade de Vida
8.
Aust N Z J Psychiatry ; 55(6): 548-552, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34015972

RESUMO

The 2020 College guidelines for mood disorders banish bipolar II disorder - despite its formal status in Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases manuals for more than two decades - and argue that there is no need to partition bipolar disorder into separate sub-types. Their single-entity model is seemingly based on opinion rather than any support from referenced scientific studies. The author challenges the Committee's model of there being only one bipolar disorder and argues that it presents several clinical management risks, particularly of 'over-treatment'.


Assuntos
Transtorno Bipolar , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/terapia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Escolaridade , Humanos , Transtornos do Humor/diagnóstico , Transtornos do Humor/terapia
9.
J Affect Disord ; 291: 102-109, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34029880

RESUMO

BACKGROUND: Physical activity can mitigate the risk of cardiovascular diseases, but the presence of mood disorders makes it challenging to follow or develop a regular exercise habit. We conducted an online comparative effectiveness study (Healthy Hearts Healthy Minds) to evaluate whether an online psychosocial intervention adjunctive to an activity monitor (Fitbit) can improve adherence to physical activity among individuals with mood disorders who have or are at-risk for cardiovascular disease (CVD). METHODS: In this paper, we explore design considerations (including both procedural challenges and achievements) of relevance to our study. RESULTS: Challenges of this study included navigating a complex IRB review process, integrating two study platforms, automating study procedures, and optimizing participant engagement. Achievements of this study included building trust with collaborators, leveraging existing online communities, generating daily data reports, and conducting patient-centered research. LIMITATIONS: These design considerations are based on a single online comparative effectiveness study, and other online intervention studies may be presented with other unique challenges that are specific to their study format or aims. Consistent with some of the generalizability challenges facing other online studies, participants in this study were overall highly educated (most had at least a college degree). CONCLUSIONS: We successfully conducted a large-scale virtual online intervention to increase physical activity of participants with comorbid mood and cardiovascular disorders by overcoming substantial operational and technical challenges. We hope that this exploration of design considerations in the context of our online study can inform upcoming online intervention studies.


Assuntos
Doenças Cardiovasculares , Intervenção Baseada em Internet , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Exercício Físico , Humanos , Transtornos do Humor/epidemiologia , Transtornos do Humor/terapia
10.
Expert Opin Investig Drugs ; 30(7): 721-736, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33966550

RESUMO

INTRODUCTION: Mood disorders are severe yet frequent psychiatric disorders worldwide, comprising major depressive disorder (MDD) and bipolar disorders (BD). Their treatment remains poorly effective. Recently, growing evidence for epigenetic mechanisms has emerged. Consequently, a great interest in a novel pharmacological class arose: RNA therapeutics. AREAS COVERED: We conducted a systematic review of RNA therapeutics -antisense oligonucleotides (ASOs), small interfering RNAs (siRNAs), short hairpin RNAs (shRNAs), and micro-RNA (miRNA) therapeutics- for the treatment of mood disorders studied in pre-clinical animal models listed in PubMed, in clinical trials registered in ClinicalTrials.gov and available on the market by combining literature search and Food and Drug Administration and European Medicine Agency online databases. Eighteen pre-clinical studies investigated the antidepressant effects of RNA therapeutics. However, even though there is an increasing number of marketing authorizations and clinical trials for the past twenty years, no RNA therapeutic has reached the clinical development pipeline for the treatment of psychiatric disorders yet. EXPERT OPINION: Several promising RNA therapeutics have been tested in pre-clinical studies for MDD, whereas no molecule has been developed for BD. There are several issues to address before reaching clinical development and new challenges include stratifying patient population and predicting therapeutic response.


Assuntos
Transtorno Bipolar/terapia , Transtorno Depressivo Maior/terapia , RNA/administração & dosagem , Animais , Transtorno Bipolar/genética , Transtorno Bipolar/fisiopatologia , Ensaios Clínicos como Assunto , Transtorno Depressivo Maior/genética , Transtorno Depressivo Maior/fisiopatologia , Humanos , Transtornos do Humor/genética , Transtornos do Humor/fisiopatologia , Transtornos do Humor/terapia
11.
Child Adolesc Psychiatr Clin N Am ; 30(3): 611-622, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34053689

RESUMO

Family psychoeducation plus skill building is a class of interventions considered to be well-established for youth with mood disorders or emotion dysregulation. Psychoeducational psychotherapy (PEP) is an example of this class of interventions. PEP provides psychoeducation for parents and children, skill building to help children better regulate emotions and behaviors, and strategies for parents to better facilitate school-based interventions, develop specific symptom management techniques, and generate coping strategies for the entire family. Evidence is summarized supporting the efficacy of PEP for reducing rage, overall mood symptom severity, disruptive behavior, and executive functioning deficits in youth. Long-term benefits of PEP are discussed.


Assuntos
Transtornos do Humor , Comportamento Problema , Adolescente , Criança , Emoções , Humanos , Transtornos do Humor/terapia , Pais , Psicoterapia
12.
J Psychiatr Pract ; 27(3): 212-223, 2021 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-33939376

RESUMO

Chronic mood disorders pose an important mental health problem. Individuals with these disorders experience a significant impairment, often fail to seek help, and their illnesses frequently do not respond to treatment. It is therefore important to develop innovative and attractive treatments for these disorders. Mindful yoga represents a promising treatment approach. This pilot study tested the feasibility of a 9-week manualized mindful yoga intervention for patients with chronic mood disorders. Eleven patients receiving standard treatment were recruited to complete a 9-week mindful yoga intervention. Qualitative methods were used to assess patients' experiences of the intervention and quantitative methods were used to assess psychological distress and mechanisms that play a role in chronic mood disorders. Eight patients completed the intervention and rated the overall quality of the intervention with a mean score of 8.8 (range of 8 to 9, using a scale of 1 to 10). All participants reported a reduction in psychological distress and no adverse events. Among the mechanisms that play a role in chronic mood disorders, the most potentially promising effects from the intervention were found for worry, fear of depression and anxiety, rumination, and areas related to body awareness, such as trusting bodily experiences and not distracting from sensations of discomfort. A 9-week mindful yoga intervention appears to be a feasible and attractive treatment when added to treatment as usual for a group of patients with chronic mood disorders. A randomized controlled trial to study the effects of mindful yoga is recommended.


Assuntos
Transtornos do Humor/psicologia , Transtornos do Humor/terapia , Ioga/psicologia , Adulto , Idoso , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Qualidade de Vida , Adulto Jovem
13.
Psychiatr Q ; 92(4): 1439-1457, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-33904123

RESUMO

The study was designed to investigate the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on mental health and perceived psychosocial support for elderly psychiatric patients in a longitudinal design. n = 32 patients with affective or anxiety disorders aged ≥60 years were included. Telephone interviews were conducted in April/May 2020 (T1) and August 2020 (T2). The psychosocial impact (PSI) of the pandemic and psychopathology were measured. Changes between T1 and T2 were examined. Patients' psychosocial support system six months before the pandemic and at T1/T2 was assessed. We found a significant positive correlation between general PSI and depression as well as severity of illness. General PSI differed significantly depending on social contact. Neither general PSI nor psychopathology changed significantly between T1 and T2. At T1, patients' psychosocial support systems were reduced as compared to six months before. Patients reported an increase in psychosocial support between T1 and T2 and high demand for additional support (sports, arts/occupational therapy, physiotherapy, psychotherapy). Elderly psychiatric patients show a negative PSI of the pandemic. They are likely to suffer from an impaired psychosocial situation, emphasizing the importance of developing concepts for sufficient psychosocial support during a pandemic.


Assuntos
Transtornos de Ansiedade , COVID-19 , Transtornos do Humor , Pandemias , Pacientes , Idoso , Idoso de 80 Anos ou mais , Transtornos de Ansiedade/psicologia , Transtornos de Ansiedade/terapia , COVID-19/epidemiologia , COVID-19/psicologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Transtornos do Humor/psicologia , Transtornos do Humor/terapia , Pacientes/psicologia , Pacientes/estatística & dados numéricos
14.
Int J Mol Sci ; 22(7)2021 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-33805219

RESUMO

Adult neurogenesis is a highly regulated process during which new neurons are generated from neural stem cells in two discrete regions of the adult brain: the subventricular zone of the lateral ventricle and the subgranular zone of the dentate gyrus in the hippocampus. Defects of adult hippocampal neurogenesis have been linked to cognitive decline and dysfunction during natural aging and in neurodegenerative diseases, as well as psychological stress-induced mood disorders. Understanding the mechanisms and pathways that regulate adult neurogenesis is crucial to improving preventative measures and therapies for these conditions. Accumulating evidence shows that mitochondria directly regulate various steps and phases of adult neurogenesis. This review summarizes recent findings on how mitochondrial metabolism, dynamics, and reactive oxygen species control several aspects of adult neural stem cell function and their differentiation to newborn neurons. It also discusses the importance of autophagy for adult neurogenesis, and how mitochondrial and autophagic dysfunction may contribute to cognitive defects and stress-induced mood disorders by compromising adult neurogenesis. Finally, I suggest possible ways to target mitochondrial function as a strategy for stem cell-based interventions and treatments for cognitive and mood disorders.


Assuntos
Autofagia , Encéfalo/fisiopatologia , Mitocôndrias/metabolismo , Neurogênese , Animais , Diferenciação Celular , Proliferação de Células , Transtornos Cognitivos/terapia , Giro Denteado/metabolismo , Hipocampo/metabolismo , Humanos , Ventrículos Laterais/metabolismo , Lisossomos/metabolismo , Transtornos do Humor/terapia , Células-Tronco Neurais/citologia , Neurônios/metabolismo , Espécies Reativas de Oxigênio/metabolismo , Células-Tronco/citologia
16.
Aust N Z J Psychiatry ; 55(4): 349-354, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33797285

RESUMO

Clinical practice guidelines are important documents as they have the capacity to significantly influence and shape clinical practice in important areas of therapeutics. As such, they need to be developed informed by comprehensive and quality-based systematic reviews, involve consensus deliberations representative of the appropriate experts in the field and be subject to thorough critical review. A revised clinical practice guideline for the management of patients with mood disorders was recently published under the auspices of the Royal Australian and New Zealand College of Psychiatrists. However, this clinical practice guideline was not developed in a manner that reflects the appropriate standards that should apply to clinical practice guideline development and it has critical flaws, especially as it pertains to the use of repetitive transcranial magnetic stimulation treatment for patients with depression. The revision of the college clinical practice guideline has explicitly removed clear and unequivocal evidence-based recommendations that were found in a previous version of the clinical practice guideline and replaced these with consensus-based recommendations. However, the consensus-based recommendations were developed without consultation of the appropriate expert body within the college and contradict the scientific literature. There is substantive and unequivocal evidence supporting the antidepressant use of repetitive transcranial magnetic stimulation in the treatment of patients with depression and its use after a patient with depression has failed a limited number (typically around two) of antidepressant medication trials. Readers should refer to the college Professional Practice Guidelines for repetitive transcranial magnetic stimulation published in 2018 for thorough information about the use of this important new treatment.


Assuntos
Transtornos do Humor , Guias de Prática Clínica como Assunto , Estimulação Magnética Transcraniana , Antidepressivos/uso terapêutico , Austrália , Encéfalo , Humanos , Transtornos do Humor/terapia , Sociedades Médicas
17.
Clin Child Psychol Psychiatry ; 26(4): 924-937, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33736503

RESUMO

OBJECTIVES: Mood disorders in youth are associated with social and academic impairment, and difficulties within the family system. Engagement in sleep hygiene, and family- and technology-based treatment models can address these impairments. The current study evaluates changes in functioning for youth who participated in a family-based partial hospitalization program (PHP) for mood disorders. Child and parent views of the importance and application of sleep hygiene and utilization of technology-based interventions were also evaluated. METHODS: 474 youth diagnosed with a primary mood disorder and their caregivers participated in a family-based PHP that addressed the role of sleep hygiene, technology use for symptom management, and components of evidence-based treatments in ameliorating mood disorders. Participants were evaluated 1-, 3-, and 6-month following treatment. RESULTS: Participants demonstrated improved functioning in social, home, and school domains. The majority of participants and parents found the sleep hygiene content and application important or very important as a component of treatment. Parents were significantly more likely than youth to be interested in using technology to access after care resources. CONCLUSIONS: Findings revealed significantly less impairment in functioning at follow-up. Parents and youth reported interest in sleep hygiene strategies as part of a comprehensive treatment for mood disorders as well as the use of technology-based resources to assist with treatment. Limitations include sample demographics and follow-up sample size.


Assuntos
Afeto , Transtornos do Humor , Adolescente , Criança , Família , Humanos , Transtornos do Humor/terapia , Sono , Tecnologia
18.
Nutrients ; 13(3)2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33652997

RESUMO

This narrative review was conducted using searches of the PubMed/Medline and Google Scholar databases from inception to November 2019. Clinical trials and relevant articles were identified by cross-referencing major depressive disorder (and/or variants) with the following terms: folate, homocysteine, S-adenosylmethionine (SAMe), L-acetylcarnitine, alpha-lipoic acid, N-acetylcysteine, L-tryptophan, zinc, magnesium, vitamin D, omega-3 fatty acids, coenzyme Q10, and inositol. Manual reviews of references were also performed using article reference lists. Abnormal levels of folate, homocysteine, and SAMe have been shown to be associated with a higher risk of depression. Numerous studies have demonstrated antidepressant activity with L-methylfolate and SAMe supplementation in individuals with depression. Additionally, the amino acids L-acetylcarnitine, alpha-lipoic acid, N-acetylcysteine, and L-tryptophan have been implicated in the development of depression and shown to exert antidepressant effects. Other agents with evidence for improving depressive symptoms include zinc, magnesium, omega-3 fatty acids, and coenzyme Q10. Potential biases and differences in study designs within and amongst the studies and reviews selected may confound results. Augmentation of antidepressant medications with various supplements targeting nutritional and physiological factors can potentiate antidepressant effects. Medical foods, particularly L-methylfolate, and other supplements may play a role in managing depression in patients with inadequate response to antidepressant therapies.


Assuntos
Suplementos Nutricionais , Transtornos do Humor/terapia , Terapia Nutricional/métodos , Oligoelementos/uso terapêutico , Vitaminas/uso terapêutico , Adulto , Antidepressivos/uso terapêutico , Terapia Combinada , Transtorno Depressivo Maior/terapia , Feminino , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto
19.
BMJ Open ; 11(3): e039169, 2021 03 10.
Artigo em Inglês | MEDLINE | ID: mdl-33692176

RESUMO

INTRODUCTION: Irritability is defined as a tendency towards anger in response to frustration. Clinically, impairing irritability is a significant public health problem. There is a need for mechanism-based psychotherapies targeting severe irritability as it manifests in the context of disruptive mood dysregulation disorder (DMDD). This study protocol describes a randomised multiple baseline design testing the preliminary efficacy of a new treatment, exposure-based cognitive-behavioral therapy for severe irritability in youth, which also integrates components of parent management training. We will investigate associations of this intervention with primary clinical measures, as well as ecological momentary assessment measures. METHODS AND ANALYSIS: Forty youth will be enrolled. Participants, aged 8-17 years, must present at least one of two core symptoms of DMDD: abnormal mood or increased reactivity to negative emotional stimuli, with severe impairment in one domain (home, school, peers) and moderate in another, or moderate impairment in at least two domains. Each participant is randomised to a 2-week, 4-week or 6-week baseline observation period, followed by 12 active treatment sessions. Clinical ratings are conducted at baseline, biweekly (clinician), weekly (parent/child) throughout treatment, post-treatment, and 3-month and 6-month follow-up (clinician). Clinician ratings on the Affective Reactivity Index and Clinical Global Impressions-Improvement scale for DMDD are our primary outcome measures. Secondary outcome measures include parent and child reports of irritability. Post hoc additional symptom measures include clinician, parent and self-ratings of depression, anxiety and overall functional impairment. Prospective, digitally based event sampling of symptoms is acquired for a week pre-treatment, mid-treatment and post-treatment. Based on our pathophysiological model of irritability implicating frustrative non-reward, aberrant threat processing and instrumental learning, we probe these three brain-based targets using functional MRI paradigms to assess target engagement. ETHICS AND DISSEMINATION: The research project and all related materials were submitted and approved by the appropriate Institutional Review Board (IRB) of the National Institute of Mental Health (NIMH). TRIAL REGISTRATION NUMBERS: NCT02531893 and NCT00025935.


Assuntos
Terapia Cognitivo-Comportamental , Humor Irritável , Adolescente , Transtornos de Deficit da Atenção e do Comportamento Disruptivo , Criança , Humanos , Transtornos do Humor/terapia , Estudos Prospectivos
20.
Psychiatr Serv ; 72(6): 691-703, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33765863

RESUMO

An ongoing need exists for innovation in service delivery to ensure that mental health services deliver high-quality treatment and prevention in the population. This Special Article proposes the adoption of "staged care" as a population health-oriented service delivery model for packages of specialized services delivered largely in ambulatory care settings for individuals with common affective disorders. Staged care integrates measures of clinical need alongside clinical stage and personal choice to select hierarchically arranged service packages for individuals. Packages then vary according to the intensity, duration, and mix of treatment options. This Special Article describes five levels of care in staged care: self- or family-directed monitoring and management, low-intensity services, moderate-intensity services, high-intensity services, and acute and specialist community mental health services. The care environment, treatment team, and length of treatment are also described, and provisional criteria are specified for assigning individuals to different care levels on the basis of current clinical need and clinical stage. Staged care is presented as a model that guides treatment selection and health service delivery to ensure that the high-quality care aims of "right care first time" and prevention are achieved and optimal use of available resources is considered.


Assuntos
Serviços Comunitários de Saúde Mental , Serviços de Saúde Mental , Atenção à Saúde , Humanos , Transtornos do Humor/terapia , Qualidade da Assistência à Saúde
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