Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 49.670
Filtrar
1.
Rev Med Suisse ; 18(796): 1744-1748, 2022 Sep 21.
Artigo em Francês | MEDLINE | ID: mdl-36134628

RESUMO

This article presents basic notions of "Good Psychiatric Management" (GPM) for Borderline Personality Disorder (BPD). There have been several evidence-based psychotherapeutic treatments for BPD for several decades. Nevertheless, high requirements and motivation required sometimes have a discouraging effect for trainees. GPM aims at offering «good enough¼ and less difficult to implement care. This article presents the notion of Interpersonnal Hypersensitivity and its different attachment states (attached, threatened, abandoned, and desperate) describing internal coherence of BPD and founding therapeutic interventions. GPM is principle based, thus is highly adaptable, as can be seen in integration with other intervention models or implementation of stepped care.


Cet article présente les bases du «Good Psychiatric Management¼ (GPM) pour le trouble de la personnalité borderline. Il existe pour ce trouble différents traitements psychothérapeutiques fondés sur les preuves. Les exigences importantes que ceux-ci représentent en termes de formation et de motivation ont parfois comme effet de décourager les thérapeutes en formation. Le GPM décrit des soins «suffisamment bons¼, accessibles et moins difficiles à implanter. Cet article présente le concept d'hypersensibilité interpersonnelle qui décrit la cohérence interne du trouble et fonde les interventions thérapeutiques. Le GPM est basé sur l'application de principes, ce qui lui donne une adaptabilité importante, par exemple pour l'intégration avec d'autres modèles d'intervention ou des soins par paliers.


Assuntos
Transtorno da Personalidade Borderline , Transtorno da Personalidade Borderline/psicologia , Transtorno da Personalidade Borderline/terapia , Humanos , Motivação , Psicoterapia
2.
Int. j. clin. health psychol. (Internet) ; 22(3): 1-10, Sept. - dec. 2022. ilus, tab, graf
Artigo em Inglês | IBECS | ID: ibc-208423

RESUMO

Background/Objective: Obsessive compulsive disorder is a disorder of special relevance in mental health, however, not all patients respond adequately to traditional intervention systems. The present work aims to study the usefulness of mindfulness-based interventions in patients with obsessive compulsive disorder. Method: An exhaustive search of the literature between 1996 and 2021 allowed us to locate 11 published articles. The effect size was the pretest-posttest standardized mean change calculated for obsession-compulsion, as well as depression symptoms and conscious coping. Results: he results showed mean effect sizes for mindfulness in the reduction of obsessive-compulsive symptoms (d + = 0.648) and, to a lesser extent, depression (d + = 0.417) and the improvement in Mindfull coping (d + = 0.509). There was no significant decrease in effect size when mindfulness was applied in patients with residual symptoms from previous treatments. Conclusions: These results are promising regarding the usefulness of the application of intervention programs based on mindfulness in people with obsessive compulsive disorder, both as an alternative option and as a complementary treatment to more traditional intervention formats. (AU)


Assuntos
Humanos , Transtorno Obsessivo-Compulsivo , Atenção Plena , Psicoterapia
4.
Annu Int Conf IEEE Eng Med Biol Soc ; 2022: 2976-2982, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-36085677

RESUMO

In modern psychotherapy, digital health technology offers advanced and personalized therapy options, increasing availability as well as ecological validity. These aspects have proven to be highly relevant for children and adolescents with obsessive-compulsive disorder (OCD). Exposure and Response Prevention therapy, which is the state-of-the-art treatment for OCD, builds on the reconstruction of everyday life exposure to anxious situations. However, while compulsive behavior pre-dominantly occurs in home environments, exposure situations during therapy are limited to clinical settings. Telemedical treatment allows to shift from this limited exposure reconstruction to exposure situations in real life. In the SSTeP KiZ study (smart sensor technology in telepsychotherapy for children and adolescents with OCD), we combine video therapy with wearable sensors delivering physiological and behavioral measures to objectively determine the stress level of patients. The setup allows to gain information from exposure to stress in a realistic environment both during and outside of therapy sessions. In a first pilot study, we explored the sensitivity of individual sensor modalities to different levels of stress and anxiety. For this, we captured the obsessive-compulsive behavior of five adolescents with an ECG chest belt, inertial sensors capturing hand movements, and an eye tracker. Despite their prototypical nature, our results deliver strong evidence that the examined sensor modalities yield biomarkers allowing for personalized detection and quantification of stress and anxiety. This opens up future possibilities to evaluate the severity of individual compulsive behavior based on multi-variate state classification in real-life situations. Clinical Relevance- Our results demonstrate the potential for efficient personalized psychotherapy by monitoring physiological and behavioral changes with multiple sensor modalities in ecologically valid real-life scenarios.


Assuntos
Transtorno Obsessivo-Compulsivo , Telemedicina , Adolescente , Transtornos de Ansiedade , Proteínas de Ciclo Celular , Criança , Humanos , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno Obsessivo-Compulsivo/terapia , Projetos Piloto , Psicoterapia
5.
Artigo em Inglês | MEDLINE | ID: mdl-36078401

RESUMO

Underlying patterns and factors behind suicides of patients in treatment are still unclear and there is a pressing need for more studies to address this knowledge gap. We analysed 278 cases of suicide reported to The Norwegian System of Patient Injury Compensation, drawing on anonymised data, i.e., age group, gender, diagnostic category, type of treatment provided, inpatient vs. outpatient status, type of treatment facility, and expert assessments of medical errors. The data originated from compensation claim forms, expert assessments, and medical records. Chi-square tests for independence, multinominal logistic regression, and Bayes factors for independence were used to analyse whether the age group, gender, diagnostic category, inpatient/outpatient status, type of institution, and type of treatment received by patients that had died by suicide were associated with different types of medical errors. Patients who received medication tended to be proportionally more exposed to an insufficient level of observation. Those who received medication and psychotherapy tended to be proportionally more exposed to inadequate treatment, including inadequate medication. Inpatients were more likely to be exposed to inappropriate diagnostics and inadequate treatment and follow up while outpatients to insufficient level of observation and inadequate suicide risk assessment. We conclude that the patients who had received medication as their main treatment tended to have been insufficiently observed, while patients who had received psychotherapy and medication tended to have been provided insufficient treatment, including inadequate medication. These observations may be used as learning points for the suicide prevention of patients in treatment in Norwegian psychiatric services.


Assuntos
Suicídio , Teorema de Bayes , Humanos , Pacientes Internados/psicologia , Segurança do Paciente , Psicoterapia , Suicídio/prevenção & controle
6.
Medicine (Baltimore) ; 101(37): e30499, 2022 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-36123919

RESUMO

There has been an increasing demand for psychiatric care in recent decades, and "telepsychiatry" was developed to meet these demands. It is a type of telemedicine in which they provide many medical services virtually, such as therapy, counseling, and medication management. Telepsychiatry has numerous advantages, including lower costs, reduced stigma, and improved continuity of care. To the best of our knowledge, no previous studies in the western region of Saudi Arabia addressed patients satisfaction with telepsychiatry. This cross-sectional study aims to assess patient satisfaction in telepsychiatry in terms of accessibility and timeliness, appropriateness, effectiveness, and safety, and to see whether patient satisfaction affects their decision to use the service again in the future. A cross-sectional study was conducted using a prestructured survey on the basis of the Client Satisfaction Questionnaire-18, which is a validated questionnaire used to assess patients' satisfaction with the services provided to them. From January 2021 to July 2021, all male and female psychiatric patients over the age of 18 years who had psychiatric virtual appointments were included in this study. This study included 182 patients, of whom 106 were female. Patients were generally satisfied with the telepsychiatry services; 56.6%, 81.9%, 86.8%, and 91.2% of the participants were satisfied with the access and timeliness, appropriateness, effectiveness, and safety, respectively, and a total of 58.3% either strongly agree or agree of the overall satisfaction level. Depression and anxiety disorders were the most common psychiatric diseases. The statistical analysis revealed no significant relationships between patients' satisfaction and demographic characteristics. Telepsychiatry has been evaluated to meet the growing demand for psychiatric care; it also has significant advantages. Patients had an overall positive satisfaction level toward telepsychiatry service, and so the results of this study support the continuity of using telepsychiatry in the future. Further research area could include a comparison between patients' and providers' satisfaction levels with telepsychiatry.


Assuntos
Transtornos Mentais , Telemedicina , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Satisfação do Paciente , Psicoterapia , Telemedicina/métodos
7.
BMC Health Serv Res ; 22(1): 1177, 2022 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-36127689

RESUMO

BACKGROUND: Each year, millions of Americans receive evidence-based psychotherapies (EBPs) like cognitive behavioral therapy (CBT) for the treatment of mental and behavioral health problems. Yet, at present, there is no scalable method for evaluating the quality of psychotherapy services, leaving EBP quality and effectiveness largely unmeasured and unknown. Project AFFECT will develop and evaluate an AI-based software system to automatically estimate CBT fidelity from a recording of a CBT session. Project AFFECT is an NIMH-funded research partnership between the Penn Collaborative for CBT and Implementation Science and Lyssn.io, Inc. ("Lyssn") a start-up developing AI-based technologies that are objective, scalable, and cost efficient, to support training, supervision, and quality assurance of EBPs. Lyssn provides HIPAA-compliant, cloud-based software for secure recording, sharing, and reviewing of therapy sessions, which includes AI-generated metrics for CBT. The proposed tool will build from and be integrated into this core platform. METHODS: Phase I will work from an existing software prototype to develop a LyssnCBT user interface geared to the needs of community mental health (CMH) agencies. Core activities include a user-centered design focus group and interviews with community mental health therapists, supervisors, and administrators to inform the design and development of LyssnCBT. LyssnCBT will be evaluated for usability and implementation readiness in a final stage of Phase I. Phase II will conduct a stepped-wedge, hybrid implementation-effectiveness randomized trial (N = 1,875 clients) to evaluate the effectiveness of LyssnCBT to improve therapist CBT skills and client outcomes and reduce client drop-out. Analyses will also examine the hypothesized mechanism of action underlying LyssnCBT. DISCUSSION: Successful execution will provide automated, scalable CBT fidelity feedback for the first time ever, supporting high-quality training, supervision, and quality assurance, and providing a core technology foundation that could support the quality delivery of a range of EBPs in the future. TRIAL REGISTRATION: ClinicalTrials.gov; NCT05340738 ; approved 4/21/2022.


Assuntos
Inteligência Artificial , Terapia Cognitivo-Comportamental , Terapia Cognitivo-Comportamental/métodos , Retroalimentação , Humanos , Saúde Mental , Psicoterapia , Estados Unidos
8.
Praxis (Bern 1994) ; 111(12): 660-666, 2022 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-36102019

RESUMO

Quality Standards in Old Age Psychiatry Abstract. Quality standards and regulations are becoming increasingly important and are promoted in the context of the permission to treat, to bill and via financial incentives. In this context, the regulatory frameworks focus to varying degrees on structural, process or outcome criteria. On behalf of the Swiss Society for Old Age Psychiatry and Psychotherapy (SGAP), we summarize the quality elements in this document and group the requirements derived from them based on setting (outpatient, intermediate, inpatient) and structural quality criteria (staffing ratio, infrastructure). There is a very extensive requirements matrix, and its implementation requires considerable efforts, not least because of the shortage of specialists and limited financial resources of psychiatric institutions and medical practices. The criteria of the requirements, matrix must be further developed and anchored in a "competence-based training in old age psychiatry".


Assuntos
Psiquiatria , Psicoterapia , Humanos , Recursos Humanos
10.
BMC Psychiatry ; 22(1): 589, 2022 09 05.
Artigo em Inglês | MEDLINE | ID: mdl-36064337

RESUMO

BACKGROUND: Improving the quality of care in community settings for people with 'Complex Emotional Needs' (CEN-our preferred working term for services for people with a "personality disorder" diagnosis or comparable needs) is recognised internationally as a priority. Plans to improve care should be rooted as far as possible in evidence. We aimed to take stock of the current state of such evidence, and identify significant gaps through a scoping review of published investigations of outcomes of community-based psychosocial interventions designed for CEN. METHODS: We conducted a scoping review with systematic searches. We searched six bibliographic databases, including forward and backward citation searching, and reference searching of relevant systematic reviews. We included studies using quantitative methods to test for effects on any clinical, social, and functioning outcomes from community-based interventions for people with CEN. The final search was conducted in November 2020. RESULTS: We included 226 papers in all (210 studies). Little relevant literature was published before 2000. Since then, publications per year and sample sizes have gradually increased, but most studies are relatively small, including many pilot or uncontrolled studies. Most studies focus on symptom and self-harm outcomes of various forms of specialist psychotherapy: most result in outcomes better than from inactive controls and similar to other specialist psychotherapies. We found large evidence gaps. Adaptation and testing of therapies for significant groups (e.g. people with comorbid psychosis, bipolar disorder, post-traumatic stress disorder, or substance misuse; older and younger groups; parents) have for the most part only reached a feasibility testing stage. We found little evidence regarding interventions to improve social aspects of people's lives, peer support, or ways of designing effective services. CONCLUSIONS: Compared with other longer term mental health problems that significantly impair functioning, the evidence base on how to provide high quality care for people with CEN is very limited. There is good evidence that people with CEN can be helped when specialist therapies are available and when they are able to engage with them. However, a much more methodologically robust and substantial literature addressing a much wider range of research questions is urgently needed to optimise treatment and support across this group.


Assuntos
Transtorno Bipolar , Transtornos Psicóticos , Comportamento Autodestrutivo , Transtornos de Estresse Pós-Traumáticos , Humanos , Psicoterapia/métodos , Transtornos de Estresse Pós-Traumáticos/psicologia
11.
BMC Pregnancy Childbirth ; 22(1): 689, 2022 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-36068490

RESUMO

BACKGROUND: Perinatal mental health problems are prevalent, affecting up to 20% of women However, only 17-25% receive formal support during the perinatal period. In this qualitative study, we sought to examine women's experiences with peer support for mental health problems during the perinatal period. METHODS: Semi-structured interviews and focus groups were conducted with twenty-five mothers from the UK who had utilised peer support for a perinatal mental health problem. Data was analysed using thematic analysis. RESULTS: Seven major themes were identified in women's help seeking process and experience of peer support. These included; perinatal specific precipitating factors that contributed to their mental health problems, barriers in the form of unhelpful professional responses, feelings of isolation, acceptance of the problem and need to actively re-seek support, finding support either through luck or peer assistance. CONCLUSION: Peer support showed promise as an effective means to reduce perinatal mental health difficulties; either as a form of formal support or as an adjunct to formal support. The results highlight ways to improve perinatal women's access to mental health support through peer-based mechanisms.


Assuntos
Serviços de Saúde Mental , Saúde Mental , Feminino , Humanos , Mães/psicologia , Gravidez , Psicoterapia , Pesquisa Qualitativa
12.
Soins Psychiatr ; 43(340): 12-16, 2022.
Artigo em Francês | MEDLINE | ID: mdl-36109131

RESUMO

Bereavement has been debated among psychiatric experts since 2000. In addition to its precise manifestations, its duration is discussed: six months for the ICD-1, one year for the DSM-5-TR. Grief is not an illness but a process that can be blocked in the announcement phase of the death or in the depression phase following the absence. In all cases, acceptance of the loss is impossible. Psychiatric treatment can define a bereaved person who is suffering too much, and can reduce his or her suffering, but it cannot accelerate the process of remembering and then resuming a life without the loved one. Social rituals and psychosocial support have had this place for millennia in cultures throughout humanity.


Assuntos
Luto , Psiquiatria , Feminino , Pesar , Humanos , Masculino , Psicoterapia
15.
J Clin Psychiatry ; 83(6)2022 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-36112578

RESUMO

Objective: Research on mental health interventions, largely from observational studies, suggests that individuals who are Black, Indigenous, and People of Color (BIPOC) have lower treatment engagement than non-Latino Whites. This systematic review focuses on prospective, experimental treatment trials, which reduce variability in patient and intervention characteristics and some access barriers (eg, cost), to examine the association of race/ethnicity and engagement.Data Sources: A systematic search of PubMed and PsycINFO through May 2020 using terms covering mental health treatment, engagement, and race/ethnicity.Study Selection: US-based, English-language, prospective experimental (including quasi-experimental) trials of adults treated for DSM-defined mental disorders were included. Studies had to compare engagement (treatment initiation and retention, medication adherence) across 2 or more ethnoracial groups. Fifty-five of 2,520 articles met inclusion criteria.Data Extraction: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane Collaboration bias-risk assessment tool were used to report study findings.Results: Twenty-nine articles (53%) reported significant ethnoracial engagement differences, of which 93% found lower engagement among BIPOC groups compared largely to non-Latino Whites. The proportion of significant findings was consistent across quality of studies, covariate adjustments, ethnoracial groups, disorders, treatments, and 4 engagement definitions. Reporting limitations were found in covariate analyses and disaggregation of results across specific ethnoracial groups.Conclusions: Prospective experimental treatment trials reveal consistently lower BIPOC engagement, suggesting persisting disparities despite standardized study designs. Future research should improve inclusion of understudied groups, examine covariates systematically, and follow uniform reporting and analytic practices to elucidate reasons for these disparities.


Assuntos
Etnicidade , Transtornos Mentais , Adulto , Humanos , Transtornos Mentais/terapia , Saúde Mental , Estudos Prospectivos , Psicoterapia
16.
Artigo em Inglês | MEDLINE | ID: mdl-36078534

RESUMO

Attachment characteristics play a key role in mental health and in understanding mental disorders. The aim of this study was to gain insight into the role the attachment characteristics can play in treatment effects in adult patients with intrapsychic and interpersonal problems who underwent Equine-assisted Short-term Psychodynamic Psychotherapy (ESTPP). In the first part of the study, we compared the effects of ESTPP to treatment-as-usual from a previous dataset regarding psychological dysfunction. For this, an explorative experimental non-randomized pre-treatment and 1-year post-treatment design was used. A mixed model revealed a significant decline in psychological dysfunction for both conditions, with no significant difference between the two. In the second part of the study, we examined the course of ESTPP effects over the period of 1 year when controlled for attachment styles and, subsequently, for internal working models of self and others. To this end, measurements were taken at baseline, 2 months waiting time, one-week intensive module, 6 months, and one year after the start of the treatment. Mixed models accounted for repeated measures showed significant improvements in psychological dysfunction, remoralization, and depression for ESTPP patients over time. The study implies that models of self and others may be used to predict the course of effects, which is relevant in determining what works for whom. In particularly, duration and intensity of therapy and a focus on the Model of Self seem relevant for shaping a more personalized treatment. ESTPP seems beneficial for patients with low pre-treatment attachment security.


Assuntos
Terapia Assistida por Cavalos , Transtornos Mentais , Psicoterapia Psicodinâmica , Animais , Cavalos , Humanos , Transtornos Mentais/terapia , Saúde Mental , Psicoterapia , Resultado do Tratamento
17.
Artigo em Inglês | MEDLINE | ID: mdl-36078667

RESUMO

A significant proportion of adolescents suffering from major depressive disorder (MDD) are likely to have a co-morbid personality disorder (PD). Short-term psychoanalytic psychotherapy (STPP) was found to be one treatment of choice for adolescents suffering from MDD. BACKGROUND: The first experimental study of transference work-in teenagers (FEST-IT) demonstrated the efficaciousness of transference work in STPP with adolescents suffering from MDD. The usefulness of STPP may be enhanced by exploring possible moderators. METHODS: Depressed adolescents (N = 69), aged 16-18 years, were diagnosed with the structured interview for DSM-IV PDs and randomized to 28 weeks of STPP with or without transference work. A mixed linear model was applied. The moderator effect was investigated by a three-way interaction including "time", "treatment group" and "number of PD criteria". RESULTS: A small but significant moderator effect was found for cluster B personality pathology. Patients with a higher number of cluster B PD criteria at baseline did better up to one-year post-treatment where therapists encouraged patients to explore the patient-therapist relationship in the here and now. CONCLUSION: When treated with psychoanalytic psychotherapy for MDD, adolescents with cluster B PD symptoms seem to profit more from transference work than adolescents without such pathology.


Assuntos
Transtorno Depressivo Maior , Psicoterapia Breve , Adolescente , Transtorno Depressivo Maior/terapia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Transtornos da Personalidade/diagnóstico , Transtornos da Personalidade/terapia , Psicoterapia , Resultado do Tratamento
18.
J Am Psychoanal Assoc ; 70(4): 665-694, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-36047620

RESUMO

During the Covid-19 pandemic, psychotherapists quickly transitioned to provide online therapy, while facing many challenges. This study aimed to explore psychodynamic and psychoanalytically oriented therapists' (N = 1450) experiences with online therapy during the first weeks of the pandemic and two months later. Results showed that therapists had little pre-pandemic experience with providing online therapy and even less training in it, and that younger therapists reported more challenges in the transition to online therapy. During the first weeks of the pandemic, most therapists thought that online therapy was less effective than in-person therapy, and they reported a wide range of relational and technical challenges, feeling more tired, less confident and competent, and less connected and authentic in online sessions, compared to previous in-person sessions. At follow-up, therapists viewed online therapy as more comparable to in-person therapy; the majority felt connected and authentic as they had during the initial weeks of the pandemic, or more so, but were still as tired as before. The most challenging aspect of online therapy was distraction in sessions, which increased over time. This study demonstrates the professional adaptability of therapists and highlights the need for more training and professional support for clinicians providing remote psychotherapy.


Assuntos
COVID-19 , Psicanálise , Humanos , Pandemias , Psicoterapeutas , Psicoterapia/métodos
20.
J Psychiatr Pract ; 28(5): 409-420, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-36074111

RESUMO

The purpose of this review is to highlight the limitations of the traditional diagnosis/evidence-based symptom reduction paradigm and advocate for an individualized medicine approach that incorporates psychological and relational aspects of prescribing in addition to the objective patient presentation. Potential barriers, challenges, and proposed future directions for improving education in psychological and relational aspects of prescribing are discussed. Psychological aspects of prescribing, as recently spelled out in the field of psychodynamic psychopharmacology, are generally acknowledged as important, but they do not have a well-defined position in contemporary residency training throughout North America. While residents receive in-depth exposure to diverse aspects of what to prescribe in their psychopharmacological training, and they work with patients' subjective and relational meaning and the quality of the therapeutic alliance in their psychotherapy rotations, an integrated approach to how to prescribe is generally lacking. Despite many legitimate challenges, the authors suggest that teaching an integrated approach that incorporates objective, subjective, and relational factors in the provision of psychopharmacology and utilizing evidence-based principles of individualized care should be prioritized in both residency training and the provision of psychiatric treatment as a whole.


Assuntos
Internato e Residência , Psicofarmacologia , Algoritmos , Humanos , Medicina de Precisão , Psicofarmacologia/educação , Psicoterapia/educação
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...