Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.976
Filtrar
1.
Int J Methods Psychiatr Res ; 33(S1): e2012, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38726880

RESUMO

OBJECTIVES: To estimate 12-month prevalence, persistence, severity, and treatment of mental disorders and socio-demographic correlates in Qatar. METHODS: We conducted the first national population-based telephone survey of Arab adults between 2019 and 2022 using the Composite International Diagnostic Interview and estimated 12-month DSM-5 mood and anxiety disorders and their persistence (the proportion of lifetime cases who continue to meet 12-month criteria). RESULTS: The 12-month prevalence of any disorder was 21.1% (10.4% mild, 38.7% moderate, and 50.9% severe) and was associated with: younger age, female, previously married, and with persistence of any disorder. Persistence was 74.7% (64.0% mood and 75.6% anxiety) and was significantly associated with secondary education or lower. Minimally adequate treatment received among those with any 12-month mental disorder was 10.6% (74.6% in healthcare and 64.6% non-healthcare sectors). Severity and the number of disorders significantly associated with each other and with treatment received (χ2 = 7.24, p = 0.027) including adequate treatment within the mental health specialty sector (χ2 = 21.42, p < 0.001). CONCLUSIONS: Multimorbidity and sociodemographics were associated with 12-month mental disorder. Treatment adequacy in Qatar are comparable to high-income countries. Low treatment contact indicate need for population-wide mental health literacy programes in addition to more accessible and effective mental health services.


Assuntos
Transtornos de Ansiedade , Transtornos do Humor , Índice de Gravidade de Doença , Humanos , Catar/epidemiologia , Feminino , Adulto , Masculino , Pessoa de Meia-Idade , Prevalência , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/terapia , Transtornos de Ansiedade/diagnóstico , Adulto Jovem , Transtornos do Humor/epidemiologia , Transtornos do Humor/terapia , Transtornos do Humor/diagnóstico , Adolescente , Inquéritos Epidemiológicos , Idoso
2.
Int J Methods Psychiatr Res ; 33(S1): e2011, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38726890

RESUMO

OBJECTIVES: To estimate lifetime prevalence, risk, and treatment for mental disorders and their correlates in Qatar's general population for the first time. METHODS: We conducted a national phone survey of 5,195 Qatari and Arab residents in Qatar (2019-2022) using the Composite International Diagnostic Interview Version 3.3 and estimated lifetime mood and anxiety defined diagnoses. Survival-based discrete time models, lifetime morbid risk, and treatment projections were estimated. RESULTS: Lifetime prevalence of any disorder was 28.0% and was associated with younger cohorts, females, and migrants, but lower formal education. Treatment contact in the year of disorder onset were 13.5%. The median delay in receiving treatment was 5 years (IQR = 2-13). Lifetime treatment among those with a lifetime disorder were 59.9% for non-healthcare and 63.5% for healthcare; it was 68.1% for any anxiety and 80.1% for any mood disorder after 50 years of onset. Younger cohorts and later age of onset were significantly predictors of treatment. CONCLUSIONS: Lifetime prevalence of mental disorders in Qatar is comparable to other countries. Treatment is significantly delayed and delivered largely in non-healthcare sectors thus the need for increased literacy of mental illness to reduce stigma and improve earlier help-seeking in healthcare settings.


Assuntos
Transtornos de Ansiedade , Transtornos do Humor , Humanos , Catar/epidemiologia , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Prevalência , Transtornos do Humor/epidemiologia , Transtornos do Humor/terapia , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/terapia , Adulto Jovem , Adolescente , Idoso
4.
Clin Psychol Psychother ; 31(3): e2984, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38706159

RESUMO

This study examined whether goal-directed treatment leads to improved treatment outcomes for patients with a primary mood or anxiety disorder and whether beneficial outcomes are achieved sooner compared to treatment as usual. In a quasi-experimental controlled study with a nested design, 17 therapists received training in goal-directed treatment and treated 105 patients with anxiety or mood disorders using principles of goal-directed treatment. Treatment results on a generic self-report instrument were compared with two control groups: a historical control group consisting of 16 of the 17 participating therapists, who provided treatment as usual to 97 patients before having received training in goal-directed treatment, and a parallel control group consisting of various therapists, who provided treatment as usual to 105 patients. Symptom reduction on a self-report measure was compared using multilevel analysis. A survival analysis was performed to assess whether a satisfactory end state had been reached sooner after goal-directed treatment. The results of this study show that goal-directed treatment only led to a significantly better overall treatment outcome compared to the parallel treatment as usual group. Furthermore, goal-directed treatment was significantly shorter than both treatment as usual groups. In conclusion, this research suggest that goal-directed treatment led to a similar or better treatment outcome in a shorter amount of time.


Assuntos
Transtornos de Ansiedade , Objetivos , Transtornos do Humor , Humanos , Feminino , Masculino , Transtornos de Ansiedade/terapia , Transtornos de Ansiedade/psicologia , Transtornos do Humor/terapia , Transtornos do Humor/psicologia , Adulto , Resultado do Tratamento , Pessoa de Meia-Idade , Psicoterapia/métodos
5.
Semin Perinatol ; 48(3): 151906, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38664078

RESUMO

Parental mental health is an essential sixth vital sign that, when taken into consideration, allows clinicians to improve clinical outcomes for both parents and infants. Although standards exist for screening, referral, and treatment for perinatal mood and anxiety disorders (PMADs), they are not reliably done in practice, and even when addressed, interventions are often minimal in scope. Quality improvement methodology can accelerate the implementation of interventions to address PMADs, but hurdles exist, and systems are not well designed, particularly in pediatric inpatient facilities. In this article, we review the effect of PMADs on parents and their infants and identify quality improvement interventions that can increase screening and referral to treatment of parents experiencing PMADs.


Assuntos
Saúde Mental , Pais , Assistência Perinatal , Melhoria de Qualidade , Humanos , Feminino , Pais/psicologia , Gravidez , Recém-Nascido , Assistência Perinatal/normas , Assistência Perinatal/métodos , Transtornos de Ansiedade/terapia , Transtornos do Humor/terapia
6.
Schizophr Res ; 267: 273-281, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38581831

RESUMO

Existing work indicates that there is unmet need for care in those at clinical high risk (CHR) for psychosis. However, research on the factors that drive treatment seeking behaviors in this population is limited. Further, it is unknown how help-seeking behavior in CHR individuals compares to those seen in mood disorders, who have a higher rate of treatment seeking behavior. Participants (n = 559) completed an assessment of their intent to seek mental health treatment, attenuated psychosis-risk symptoms, and psychiatric symptoms and diagnoses. Participants were divided into CHR (n = 91), Mood Disorders (MD) (n = 72), or Community Controls (CC) groups (n = 396), whose intent to seek treatment was compared. Associations between intent to seek treatment with past treatment, depression, anxiety, positive and negative symptoms, distress from symptoms, intelligence quotient (IQ) estimates, and insight were assessed in CHR individuals. Further, it was assessed how this differs for the MD group. The MD group reported higher intent to seek treatment than CHR individuals, which reported higher intent to seek treatment than the CC group. In those at CHR, previous treatment, greater depression and anxiety severity, and higher distress all independently predicted higher intent to seek treatment. Depression predicted intent to seek treatment in both MD and CHR individuals. Previous treatment predicted intent to seek treatment in those at CHR. Our findings suggest that depression and past treatment utilization are critical factors in increasing intent to seek treatment in those at CHR, potentially serving as important targets for engaging this population in treatment.


Assuntos
Intenção , Aceitação pelo Paciente de Cuidados de Saúde , Transtornos Psicóticos , Humanos , Transtornos Psicóticos/terapia , Masculino , Feminino , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto Jovem , Sintomas Prodrômicos , Adulto , Transtornos do Humor/terapia , Risco , Depressão/terapia , Ansiedade/terapia
7.
Nord J Psychiatry ; 78(4): 272-280, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38385357

RESUMO

PURPOSE: Smoking is the single factor with the highest impact on reducing life expectancy of patients with mental illness. Patients experience difficulty in participating in smoking cessation programs but are concerned about the impact of tobacco on their health and finances. Smoking cessation advice via videoconferencing might be an alternative to an ordinary in-person consultation. MATERIAL AND METHOD: Randomized controlled trial with follow-up at 6 months. We included patients with diagnoses of schizophrenia and affective disorder from psychiatric outpatient clinics. Intervention 1 involved daily video consultations; intervention 2 was treatment as usual. RESULTS: Seventy patients were included. For both/all groups/interventions, rates of smoking cessation were 45% and predictors for a 50% reduction in smoking were antipsychotic medication load [odds ratio (OR) 0.54; p = 0.045] and number of nicotine patches (OR 1.02; p = 0.06). Predictors for a reduction in the number of cigarettes to < 10 were antipsychotic medication load (OR 0.52; p = 0.04), number of nicotine patches (OR 1.01; p = 0.02) and number of cigarettes at baseline [OR 0.95 (p = 0.09); adjusted OR 0.94 (p = 0.02)]. Patients prevented weight gain during the cessation period. CONCLUSION: The smoking cessation rate was high. One of the reasons for the high cessation rate was that the intervention was carried out by highly experienced and professionally qualified staff. In addition, we used free nicotine patches to increase the patients' motivation to quit smoking. It is very important that we introduce these results into our clinical work with the patients.


Assuntos
Esquizofrenia , Abandono do Hábito de Fumar , Comunicação por Videoconferência , Humanos , Abandono do Hábito de Fumar/métodos , Masculino , Feminino , Adulto , Esquizofrenia/terapia , Pessoa de Meia-Idade , Dispositivos para o Abandono do Uso de Tabaco , Transtornos do Humor/terapia , Antipsicóticos/uso terapêutico , Resultado do Tratamento , Aumento de Peso , Seguimentos
8.
Clin Rehabil ; 38(6): 811-823, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38385341

RESUMO

OBJECTIVE: Post-stroke mental health impairments are common, but under-assessed and under-treated. We aim to describe trends in the provision of mood management to patients with stroke, and describe factors associated with adoption of national mood management recommendations for stroke within Australian hospitals. DESIGN: Secondary analysis of cross-sectional data from the biennial Stroke Foundation Audit Program. SETTING: Participating acute (2011-2021) and rehabilitation hospitals (2012-2020) in Australia. PARTICIPANTS: In the acute audit, 22,937 stroke cases were included from 133 hospitals. In the rehabilitation audit, 15,891 stroke cases were included from 127 hospitals. MAIN MEASURES: Hospital- and patient-level mood management processes. RESULTS: Among 133 acute hospitals (22,937 stroke episodes), improvements were made between 2011 and 2021 in utilization of mood screening (17% [2011], 33% [2021]; p < 0.001) and access to psychologists during hospital stay (18% [2011], 45% [2021]; p < 0.001). There was no change in access to a psychologist among those with a mood impairment (p = 0.34). Among 127 rehabilitation hospitals (15,891 stroke episodes) improvements were observed for mood screening (35% [2012], 61% [2020]; p < 0.001), and access to a psychologist during hospital stay (38% [2012], 68% [2020]; p < 0.001) and among those with a mood-impairment (30% [2012], 50% [2020]; p < 0.001). Factors associated with receiving mood management processes included: younger age, not requiring an interpreter and longer length of stay. CONCLUSIONS: Adherence to mood management recommendations has improved over 10 years within Australian hospitals. Those aged over 65, requiring an interpreter, or with shorter hospital stays are at risk of missing out on appropriate mood management.


Assuntos
Hospitais de Reabilitação , Transtornos do Humor , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Humanos , Austrália , Masculino , Feminino , Estudos Transversais , Acidente Vascular Cerebral/complicações , Idoso , Pessoa de Meia-Idade , Transtornos do Humor/etiologia , Transtornos do Humor/reabilitação , Transtornos do Humor/terapia , Acessibilidade aos Serviços de Saúde , Pacientes Internados , Idoso de 80 Anos ou mais
9.
BMC Psychol ; 12(1): 63, 2024 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-38326847

RESUMO

BACKGROUND: Childhood emotional disorders (EDs; i.e., anxiety and depressive disorders) are currently a public health concern. Their high prevalence, long-term effects, and profound influence on the lives of children and families highlight the need to identify and treat these disorders as early and effectively as possible. This clinical trial will examine the efficacy of a blended version (i.e., combining face-to-face and online sessions into one treatment protocol) of the Unified Protocol for Children (the "Emotion Detectives In-Out" program). This program is a manualized cognitive-behavioral therapy for the transdiagnostic treatment of EDs in children aged 7 to 12 years that aims to reduce the intensity and frequency of strong and aversive emotional experiences by helping children learn how to confront those emotions and respond to them in more adaptive ways. METHODS: This study is designed as a multicenter equivalence randomized controlled parallel-group two-arm trial comparing the Emotion Detectives In-Out program with an evidenced-based group intervention for children with anxiety disorders (the Coping Cat program). Participants will be children aged between 7 and 12 years with an anxiety disorder or with clinically significant anxiety symptoms as well as one of their parents or a legal representative. A minimum sample size of 138 children (69 per group) is needed to test whether the efficacy of the proposed intervention is equivalent to that of the well-established Coping Cat intervention. DISCUSSION: We expect Emotion Detectives In-Out to be a feasible and efficacious alternative intervention for treating children's EDs by allowing for a greater increase in children's access to care. A blended format is expected to overcome common barriers to treatment (e.g., parents´ lack of time to attend regular sessions) and make the intervention more accessible to families. TRIAL REGISTRATION: The clinical trial is registered at ClinicalTrials.gov (Identifier: NCT05747131, date assigned February 28, 2023).


Assuntos
Transtornos de Ansiedade , Emoções , Transtornos do Humor , Criança , Humanos , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/terapia , Transtornos do Humor/diagnóstico , Transtornos do Humor/terapia , Portugal , Resultado do Tratamento , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Multicêntricos como Assunto
10.
Aust N Z J Psychiatry ; 58(5): 404-415, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38343153

RESUMO

OBJECTIVE: This analysis estimated 2013 annual healthcare costs associated with the common mental disorders of mood and anxiety disorders and psychological symptoms within a representative sample of Australian women. METHODS: Data from the 15-year follow-up of women in the Geelong Osteoporosis Study were linked to 12-month Medicare Benefits Schedule and Pharmaceutical Benefits Scheme data. A Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Non-patient edition identified common mental disorders and the General Health Questionnaire 12 assessed psychological symptoms. Participants were categorised into mutually exclusive groups: (1) common mental disorder (past 12 months), (2) subthreshold (no common mental disorder and General Health Questionnaire 12 score ⩾4) or (3) no common mental disorder and General Health Questionnaire 12 score <4. Two-part and hurdle models estimated differences in service use, and adjusted generalised linear models estimated mean differences in costs between groups. RESULTS: Compared to no common mental disorder, women with common mental disorders utilised more Medicare Benefits Schedule services (mean 26.9 vs 20.0, p < 0.001), had higher total Medicare Benefits Schedule cost ($1889 vs $1305, p < 0.01), received more Pharmaceutical Benefits Scheme prescriptions (35.8 vs 20.6, p < 0.001), had higher total Pharmaceutical Benefits Scheme cost ($1226 vs $740, p < 0.05) and had significantly higher annual out-of-pocket costs for Pharmaceutical Benefits Scheme prescriptions ($249 vs $162, p < 0.001). Compared to no common mental disorder, subthreshold women were less likely to use any Medicare Benefits Schedule service (89.6% vs 97.0%, p < 0.01), but more likely to use mental health services (11.4% vs 2.9%, p < 0.01). The subthreshold group received more Pharmaceutical Benefits Scheme prescriptions (mean 43.3 vs 20.6, p < 0.001) and incurred higher total Pharmaceutical Benefits Scheme cost ($1268 vs $740, p < .05) compared to no common mental disorder. CONCLUSIONS: Common mental disorders and subthreshold psychological symptoms place a substantial economic burden on Australian healthcare services and consumers.


Assuntos
Custos de Cuidados de Saúde , Humanos , Feminino , Austrália , Idoso , Pessoa de Meia-Idade , Custos de Cuidados de Saúde/estatística & dados numéricos , Osteoporose/economia , Transtornos Mentais/economia , Transtornos Mentais/terapia , Transtornos Mentais/epidemiologia , Transtornos de Ansiedade/economia , Transtornos de Ansiedade/epidemiologia , Serviços de Saúde Mental/economia , Serviços de Saúde Mental/estatística & dados numéricos , Idoso de 80 Anos ou mais , Transtornos do Humor/economia , Transtornos do Humor/epidemiologia , Transtornos do Humor/terapia
11.
Am J Psychiatry ; 181(4): 275-290, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38419494

RESUMO

Irritability, defined as proneness to anger that may impair an individual's functioning, is common in youths. There has been a recent upsurge in relevant research. The authors combine systematic and narrative review approaches to integrate the latest clinical and translational findings and provide suggestions for addressing research gaps. Clinicians and researchers should assess irritability routinely, and specific assessment tools are now available. Informant effects are prominent, are stable, and vary by age and gender. The prevalence of irritability is particularly high among individuals with attention deficit hyperactivity disorder, autism spectrum disorder, and mood and anxiety disorders. Irritability is associated with impairment and suicidality risk independent of co-occurring diagnoses. Developmental trajectories of irritability (which may begin early in life) have been identified and are differentially associated with clinical outcomes. Youth irritability is associated with increased risk of anxiety, depression, behavioral problems, and suicidality later in life. Irritability is moderately heritable, and genetic associations differ based on age and comorbid illnesses. Parent management training is effective for treating psychological problems related to irritability, but its efficacy in treating irritability should be tested rigorously, as should novel mechanism-informed interventions (e.g., those targeting exposure to frustration). Associations between irritability and suicidality and the impact of cultural context are important, underresearched topics. Analyses of large, diverse longitudinal samples that extend into adulthood are needed. Data from both animal and human research indicate that aberrant responses to frustration and threat are central to the pathophysiology of irritability, revealing important translational opportunities.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Transtorno do Espectro Autista , Animais , Humanos , Adolescente , Humor Irritável/fisiologia , Transtornos de Ansiedade/terapia , Transtornos de Ansiedade/tratamento farmacológico , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno do Deficit de Atenção com Hiperatividade/genética , Ansiedade/psicologia , Transtornos do Humor/terapia , Transtornos de Deficit da Atenção e do Comportamento Disruptivo
12.
Psychiatr Clin North Am ; 47(1): 255-272, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38302210

RESUMO

This article reviews the literature on mood disorders and sleep disorders among children and adolescents. Research suggests that sleep plays an important role in the development, progression, and maintenance of mood disorder symptoms among children and adolescents. Sleep problems as early as maternal perinatal insomnia may predict and predate depression among youth. Children and adolescents who develop comorbid mood disorders and sleep problems represent a particularly high-risk group with more severe mood episode symptoms, higher rates of self-harm and suicidality, and less responsivity to treatment. Treatment research supports the idea that sleep problems can be improved through behavioral interventions.


Assuntos
Distúrbios do Início e da Manutenção do Sono , Transtornos do Sono-Vigília , Feminino , Gravidez , Criança , Humanos , Adolescente , Transtornos do Humor/epidemiologia , Transtornos do Humor/terapia , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Distúrbios do Início e da Manutenção do Sono/terapia , Sono , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/terapia , Ideação Suicida
13.
BMJ Open ; 14(1): e077740, 2024 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-38176876

RESUMO

INTRODUCTION: Mood disorders can have a negative impact on daily functioning because cognitive deficits are exacerbated when individuals experience associated symptoms. Nevertheless, yoga therapy has been found to have enhancing features to well-being and quality of life. Occupational therapists are well positioned to include yoga as a modality to benefit clients experiencing mood disorders. However, literature on yoga interventions for mood disorders is underdeveloped causing an inadequate understanding of the health benefits. Thus, the aim of this study is to gain further knowledge associated with the implications of yoga as an intervention to increase participation in activities of daily living and enhance the quality of life of individuals experiencing mood disorders. This review will answer the following research question: can yoga therapy be used as an effective modality in occupational therapy practice to manage symptomatology related to mood disorders through increasing engagement in daily tasks? METHODS AND ANALYSIS: OVID Medline, Embase as well as CINAHL Plus, Cochrane Library (Wiley), APA PsycINFO and Scopus will be explored to adhere to the following criteria: (1) studies discussing adults diagnosed with mood disorders, specifically bipolar and related disorders or depressive disorders as stated in the Diagnostic Statistical Manual of Mental Disorders-5; (2) studies discussing implementation of yoga therapy; (3) a correlation between mood disorders and effectiveness of yoga therapy. ETHICS AND DISSEMINATION: Ethics approval is not applicable for this study, due to obtaining data from existing research articles. The completed manuscript will be submitted in a peer-reviewed journal for publication. PROSPERO REGISTRATION NUMBER: CRD42021283157.


Assuntos
Terapia Ocupacional , Yoga , Adulto , Humanos , Atividades Cotidianas , Transtornos do Humor/terapia , Qualidade de Vida , Revisões Sistemáticas como Assunto/métodos
14.
Sci Rep ; 14(1): 1937, 2024 01 22.
Artigo em Inglês | MEDLINE | ID: mdl-38253678

RESUMO

Emotional and mood disturbances are common in people with dementia. Non-pharmacological interventions are beneficial for managing these disturbances. However, effectively applying these interventions, particularly in the person-centred approach, is a complex and knowledge-intensive task. Healthcare professionals need the assistance of tools to obtain all relevant information that is often buried in a vast amount of clinical data to form a holistic understanding of the person for successfully applying non-pharmacological interventions. A machine-readable knowledge model, e.g., ontology, can codify the research evidence to underpin these tools. For the first time, this study aims to develop an ontology entitled Dementia-Related Emotional And Mood Disturbance Non-Pharmacological Treatment Ontology (DREAMDNPTO). DREAMDNPTO consists of 1258 unique classes (concepts) and 70 object properties that represent relationships between these classes. It meets the requirements and quality standards for biomedical ontology. As DREAMDNPTO provides a computerisable semantic representation of knowledge specific to non-pharmacological treatment for emotional and mood disturbances in dementia, it will facilitate the application of machine learning to this particular and important health domain of emotional and mood disturbance management for people with dementia.


Assuntos
Ontologias Biológicas , Demência , Humanos , Emoções , Transtornos do Humor/terapia , Pessoal de Saúde , Demência/terapia
15.
Early Interv Psychiatry ; 18(2): 82-93, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37192756

RESUMO

OBJECTIVE: To evaluate the effectiveness of small-group nurse-administered cognitive behavioural therapy for insomnia (CBTI) as an early intervention of mood disorders with comorbid insomnia. METHODS: A total of 200 patients with first-episode depressive or bipolar disorders and comorbid insomnia were randomized in a ratio of 1:1 to receiving 4-session CBTI or not in a routine psychiatric care setting. Primary outcome was Insomnia Severity Index. Secondary outcomes included response and remission status; daytime symptomatology and quality of life; medication burden; sleep-related cognitions and behaviours; and the credibility, satisfaction, adherence and adverse events of CBTI. Assessments were conducted at baseline, 3, 6, and 12-month. RESULTS: Only a significant time-effect but no group-by-time interaction was found in the primary outcome. Several secondary outcomes had significantly greater improvements in CBTI group, including higher depression remission at 12-month (59.7% vs. 37.9%, χ2 = 6.57, p = .01), lower anxiolytic use at 3-month (18.1% vs. 33.3%, χ2 = 4.72, p = .03) and 12-month (12.5% vs. 25.8%, χ2 = 3.26, p = .047), and lesser sleep-related dysfunctional cognitions at 3 and 6-month (mixed-effects model, F = 5.12, p = .001 and .03, respectively). Depression remission rate was 28.6%, 40.3%, and 59.7% at 3, 6, and 12-month, respectively in CBTI group and 28.4%, 31.1%, and 37.9%, respectively in no CBTI group. CONCLUSION: CBTI may be a useful early intervention to enhance depression remission and reduce medication burden in patients with first-episode depressive disorder and comorbid insomnia.


Assuntos
Terapia Cognitivo-Comportamental , Distúrbios do Início e da Manutenção do Sono , Humanos , Distúrbios do Início e da Manutenção do Sono/complicações , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Distúrbios do Início e da Manutenção do Sono/terapia , Transtornos do Humor/complicações , Transtornos do Humor/epidemiologia , Transtornos do Humor/terapia , Qualidade de Vida , Resultado do Tratamento
16.
Soc Psychiatry Psychiatr Epidemiol ; 59(4): 631-642, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-37117785

RESUMO

PURPOSE: Public mental health services (MHS) are crucial in preventing psychiatric disability pensions (DP). We studied the associations between mood disorder DP risk and the characteristics of Finnish municipalities' MHS provision using the ESMS-R mapping tool and Finnish population registers, based on first-time granted mood disorder DPs between 2010 and 2015. METHODS: The final data set included 13,783 first-time mood disorder DP recipients and 1088 mental health service units in 104 municipalities. We focused on five different MHS types: all MHS, outpatient care provision, local services without and with gatekeeping, and centralized services. Three factors for each MHS type were studied: service resources, richness, and diversity index. Negative binomial regression models were used in the analysis. RESULTS: In all the municipalities, higher service richness and diversity regarding all MHS, outpatient care and local services with gatekeeping were associated with a lower DP risk. In urban municipalities, service richness was mainly associated with lower DP risk, and in semi-urban municipalities service diversity and resources were primarily associated with lower DP risk in outpatient care and local services with gatekeeping. In rural municipalities, DP risk indicated no association with MHS factors. CONCLUSION: The organization and structure of MHS play a role in psychiatric disability pensioning. MHS richness and diversity are associated with lower mood disorder DP in specific societal contexts indicating their role as quality indicators for regional MHS. The diversity of service provision should be accounted for in MHS planning to offer services matching population needs.


Assuntos
Pessoas com Deficiência , Transtornos Mentais , Serviços de Saúde Mental , Humanos , Finlândia/epidemiologia , Transtornos Mentais/psicologia , Transtornos do Humor/epidemiologia , Transtornos do Humor/terapia , Pensões
17.
J ECT ; 40(1): 31-36, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-37530796

RESUMO

PURPOSE: Electroconvulsive therapy (ECT), an effective treatment for bipolar and major depressive disorder, is underused. Little information is available on use of ECT in potentially less costly outpatient settings, possibly reducing cost barriers. METHODS: Insurance claims from the 2008 to 2017 MarketScan Commercial Database for patients diagnosed with mood disorders were used to compare 4 groups of ECT users in each year: those receiving (1) exclusively outpatient ECT, (2) first inpatient and subsequently outpatient, (3) outpatient and subsequently inpatient, and (4) exclusively inpatient ECT. Groups were compared on the proportion receiving ECT in each group over time as well as on the total numbers of treatments received along with group differences in sociodemographic and diagnostic characteristics and health care costs. RESULTS: Among 2.9 million patients diagnosed with mood disorders, the proportion who received ECT (n = 8859) was small (0.30%) and declined over the decade to 0.17%. Among those who received ECT, most did so exclusively as outpatients (52.3%), the group with fewest comorbidities and lowest costs. This proportion increased by 19.7% over the decade, whereas the proportion receiving ECT exclusively in an inpatient setting (12.1%) fell by 30.6%. The total number of treatments per patient averaged 11.7 per year and increased by 28.0% over the decade, with outpatients decreasing to slightly less than average. Health care costs were greatest for those who started ECT as inpatients. CONCLUSIONS: Although the proportion of privately insured patients receiving ECT in outpatient settings has increased, reducing cost barriers, the use of ECT continued to be extremely limited and declining.


Assuntos
Transtorno Depressivo Maior , Eletroconvulsoterapia , Humanos , Transtornos do Humor/terapia , Transtorno Depressivo Maior/terapia , Pacientes Ambulatoriais , Hospitalização , Seguro Saúde
18.
Expert Rev Neurother ; 24(1): 11-24, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38037329

RESUMO

INTRODUCTION: Deep brain stimulation (DBS) is an emerging therapy for mood disorders, particularly treatment-resistant depression (TRD). Different brain areas implicated in depression-related brain networks have been investigated as DBS targets and variable clinical outcomes highlight the importance of target identification. Tractography has provided insight into how DBS modulates disorder-related brain networks and is being increasingly used to guide DBS for psychiatric disorders. AREAS COVERED: In this perspective, an overview of the current state of DBS for TRD and the principles of tractography is provided. Next, a comprehensive review of DBS targets is presented with a focus on tractography. Finally, the challenges and future directions of tractography-guided DBS are discussed. EXPERT OPINION: Tractography-guided DBS is a promising tool for improving DBS outcomes for mood disorders. Tractography is particularly useful for targeting patient-specific white matter tracts that are not visible using conventional structural MRI. Developments in tractography methods will help refine DBS targeting for TRD and may facilitate symptom-specific precision neuromodulation. Ultimately, the standardization of tractography methods will be essential to transforming DBS into an established therapy for mood disorders.


Assuntos
Estimulação Encefálica Profunda , Transtornos do Humor , Humanos , Transtornos do Humor/terapia , Imagem de Tensor de Difusão , Imageamento por Ressonância Magnética , Encéfalo/diagnóstico por imagem
20.
Curr Opin Psychiatry ; 37(1): 9-17, 2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-37972954

RESUMO

Digital therapeutics (DTx) offer evidence-based digitally-delivered high quality standards applications and/or softwares in the prevention, management and treatment of several medical conditions, including mood disorders. Nowadays, there are only three DTx officially approved by the Food and Drug Administration for mental conditions and there are still very few DTx developed in the context of mood disorders. The current comprehensive overview aims at providing a summary of currently published studies on DTx clinical applications in major depressive disorder (MDD), depressive symptomatology and bipolar disorder (BD), by using PubMed/MEDLINE and Scopus databases. Fifteen studies have been selected (10 on DTx in depressive symptomatology and/or MDD; 4 on BD; 1 on MDD and BD). Literature on DTx in mood disorders is still lacking, being mostly constituted by feasibility and acceptability rather than efficacy/effectiveness outcomes, particularly in BD. More studies focused on MDD compared to BD. Most DTx on MDD have been developed based on cognitive behaviour therapy interventions while on BD are based on psychoeducation. All studies assessing symptom severity improvement pre- vs. postinterventions demonstrated a significant postintervention improvement. Therefore, despite the preliminary encouraging results of studies here retrieved, their methodology is still too heterogeneous to allow comparisons and the generalizability of their findings. Further studies are warranted, in more larger samples involving multiple sites, including measures of both specific symptom effects as well as acceptability, feasibility and effectiveness in the real-world settings.


Assuntos
Transtorno Bipolar , Terapia Cognitivo-Comportamental , Transtorno Depressivo Maior , Humanos , Transtorno Bipolar/terapia , Transtorno Depressivo Maior/psicologia , Transtornos do Humor/terapia , Transtornos do Humor/psicologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...