The efficacy of psychotherapies and pharmacotherapies for mental disorders in adults: an umbrella review and meta-analytic evaluation of recent meta-analyses

Acculturation stress and mental health outcomes in a sample of migrant inpatients: Findings from a naturalistic study

INTRODUCTION

Migrants face numerous risk factors for mental disorders, including stressors and traumatic events during the pre-, peri-, and post-migratory phases. Acculturation stress, a significant post-migratory stressor, can adversely affect mental health during the cultural adaptation process. This study aims to assess the clinical implications of acculturation stress in migrants admitted to a psychiatric intensive care unit, with a focus on identifying predictors of acculturative stress and their impact on clinical outcomes.

METHODS

We conducted a retrospective study of 268 immigrant patients hospitalized between 2004 and 2019 at the psychiatric inpatient unit of the University of Foggia. We collected socio-demographic and clinical data using ad hoc schedules and validated assessment instruments, including the Brief Psychiatric Rating Scale (BPRS), the Global Assessment of Functioning (GAF), and the Clinical Global Impression (CGI). Diagnoses were based on DSM-IV-TR/DSM-5 criteria. We analyzed associations between demographic and clinical characteristics of patients reporting acculturative stress and those not reporting it, using appropriate statistical methods.

RESULTS

The majority of patients were diagnosed with affective (45.1%) or psychotic disorders (31.7%), with 57.1% experiencing their first psychiatric episode. Acculturation stress was reported by 51.9% of patients (N = 139), predominantly among males (71.9%), single individuals (80.9%), and those of Islamic faith (56.8%). Patients experiencing acculturation stress were more likely to be unemployed (57.6%) and without a residence permit (63.3%). This stress was particularly prevalent among patients with psychotic disorders (25.9%) and first-episode psychiatric cases (64.7%). At discharge, patients with acculturation stress showed less improvement on CGI, GAF, and BPRS scores compared to those without such stress.

CONCLUSIONS

Acculturation stress is influenced by several socio-demographic factors and is crucial for the full symptomatic remission of migrant patients. Culturally-oriented mental health services, including language and cultural integration programs, are essential in reducing acculturative stress and improving the overall well-being of immigrants.

Is metacognitive therapy really non-inferior to exposure with response prevention in obsessive-compulsive disorder? - Methodological issues of non-inferiority testing

There is evidence that exposure and response prevention (ERP) is efficacious in the treatment of obsessive-compulsive disorder (OCD). As an alternative to ERP metacognitive therapy (MCT) was developed. Two previous randomized controlled trials (RCTs) did not find significant differences between MCT and ERP. However, from non-significant results, non-inferiority of a treatment cannot be concluded. For this purpose, non-inferiority studies are required. Exner and colleagues carried out such a non-inferiority study whose results were recently published in this journal. The authors concluded from their results that MCT is a viable alternative treatment with efficacy similar to the standard ERP. However, this study raises several concerns, among them problems of transparency and of non-inferiority testing. These issues are critically discussed here in more detail. Taking all of these issues into account, the conclusions that can be drawn from the available studies are less clear. Further research is needed to decide whether MCT can really be considered as non-inferior to ERP or even as efficacious at all. Future studies need to fulfill the criteria of non-inferiority trials, that is (a) a priori define and (b) empirically justify a non-inferiority margin, (c) a preregistered sample size calculation ensuring a sufficient statistical power to confirm non-inferiority of the test treatment and (d) include a non-active control condition against which the standard and the test treatment are tested. Recommending a treatment prematurely as non-inferior to a standard treatment may prevent patients from receiving the most efficacious treatment.

Antidepressant efficacy of administering repetitive transcranial magnetic stimulation (rTMS) with psychological and other non-pharmacological methods: a scoping review and meta-analysis

To optimize the antidepressant efficacy of repetitive transcranial magnetic stimulation (rTMS), it is important to examine the impact of brain state during therapeutic rTMS. Evidence suggests that brain state can modulate the brain's response to stimulation, potentially diminishing antidepressant efficacy if left uncontrolled or enhancing it with inexpensive psychological or other non-pharmacological methods. Thus, we conducted a PRISMA-ScR-based scoping review to pool studies administering rTMS with psychological and other non-pharmacological methods. PubMed and Web of Science databases were searched from inception to 10 July 2024. Inclusion criteria: neuropsychiatric patients underwent rTMS; studies assessed depressive symptom severity; non-pharmacological tasks or interventions were administered during rTMS, or did not include a wash-out period. Of 8,442 studies, 20 combined rTMS with aerobic exercise, bright light therapy, cognitive training or reactivation, psychotherapy, sleep deprivation, or a psychophysical task. Meta-analyses using random effects models were conducted based on change scores on standardized scales. The effect size was large and therapeutic for uncontrolled pretest-posttest comparisons (17 studies, Hedges' g = -1.91, (standard error) SE = 0.45, 95% (confidence interval) CI = -2.80 to -1.03, p < 0.01); medium when studies compared active combinations with sham rTMS plus active non-pharmacological methods (8 studies, g = -0.55, SE = 0.14, 95% CI = -0.82 to -0.28, p < 0.01); and non-significant when active combinations were compared with active rTMS plus sham psychological methods (4 studies, p = 0.96). Attempts to administer rTMS with non-pharmacological methods show promise but have not yet outperformed rTMS alone.

Efficacy of brain stimulation therapies across psychiatric, movement, and cognitive disorders: an umbrella review synthesizing meta-analyses of randomized controlled trials

Background

Brain stimulation therapy (BST) has significant potential in treating psychiatric, movement, and cognitive disorders. Given the high prevalence of comorbidities among these disorders, we conducted an umbrella review to comprehensively assess the efficacy of BSTs in treating the core symptoms across these three categories of disorders.

Methods

We systematically searched for meta-analyses and network meta-analyses of randomized controlled trials with sham controls up to September 25, 2024, from databases including PubMed, PsycINFO, Embase, and the Cochrane Library. Our primary outcome was improvements in core symptoms. We evaluated quality using 11 criteria. We calculated pooled effect estimates for core symptoms based on the largest meta-analyses, then conducted sensitivity and subgroup analyses, and assessed heterogeneity, publication bias, and small-study effects. Finally, we synthesized effect sizes from all meta-analyses to provide a comprehensive overview of BSTs' efficacy. PROSPERO registration: CRD42023439090.

Findings

We included 198 articles with 108,377 patients evaluating 14 BSTs across 21 disorders. The largest meta-analysis showed a moderate standardized mean difference (SMD) of 0.56 (95% CI: 0.49, 0.64; I2 = 70%). Subgroup analyses revealed significant SMDs for psychiatric disorders (0.60; 95% CI: 0.49, 0.71; I2 = 66%), movement disorders (0.56; 95% CI: 0.42, 0.69; I2 = 79%), and cognitive disorders (0.46; 95% CI: 0.32, 0.61; I2 = 48%). SMDs were 0.44 (95% CI: 0.23, 0.65; I2 = 70%) for follow-up ≤1 month and 0.69 (95% CI: 0.43, 0.94; I2 = 84%) for follow-up >1 month. Compared to other conditions, BSTs show better therapeutic effects in treating depression, post-traumatic stress disorder, obsessive-compulsive disorder, pain, fibromyalgia, and post-stroke motor recovery.

Interpretation

This review explored the potential of BSTs for comorbidities of the three disorders from a disorder-specific perspective, providing a roadmap for their clinical application and future research.

Funding

This work was supported by the Anhui Natural Science Foundation (2023AH040086), Key Laboratory of Philosophy and Social Science of Anhui Province on Adolescent Mental Health and Crisis Intelligence Intervention (SYS2023B08), and the Joint Funds of the National Natural Science Foundation of China (U23A20424).

Physiological synchronization and innovative moments in psychotherapy: A single-case study of micro-process

OBJECTIVE

Interpersonal synchronization is increasingly studied as a biomarker of empathy, therapeutic alliance, and treatment outcome. However, most studies average data over sessions, leaving associations between synchrony and actual interactions largely unexplored. We aim to showcase a novel approach examining synchronization during specific micro-processes: Innovative Moments (IM) as markers of exceptions to clients' problematic patterns of meaning.

METHODS

Electrodermal activity was recorded over 15 sessions of a psychodynamic psychotherapy single case. Moment-to-moment patient-therapist synchrony was calculated using the Adaptive Matching Interpolated Correlations (AMICo) algorithm. The Innovative Moments Coding System was utilized to identify IMs within session transcripts with precise timing. Monte-Carlo permutation tests were conducted to examine the association between physiological synchrony and IM Levels of increasing complexity (Levels 1-3).

RESULTS

Higher-than-random synchronization emerged during Level 3 IMs (p = 0.046; d = 0.21) but not in lower Levels. Post-hoc qualitative analyses linked high synchrony to sub-processes of Level 3 IMs, such as positive contrasts and attributions for change.

CONCLUSION

Our findings show it is possible to link moment-by-moment physiological co-regulation to theoretically identified meaning-making processes. While generalization of these observations is undue, this work demonstrates a robust and promising application of a multimodal approach to investigating psychotherapy, providing insights into both the clinical case and the theoretical model adopted.

Gaps in psychiatric care before and after the COVID-19 pandemic among patients with depression using electronic health records

The COVID-19 pandemic caused disruption to health services. It is unclear if there were inequalities in the continuity of mental health care in the years around the COVID-19 pandemic. We used electronic health records (EHR) to detect mental health care gaps of more than six months in psychiatric appointments across demographic and socioeconomic characteristics among patients with depression. The analysis included patients with depression who were seen at one of two mental health clinics every year of 2018, 2019, 2021, and 2022 (n = 783 patients). First, we found that the odds of mental health care gaps significantly decreased in the post-pandemic period (2021-2022) relative to the pre-pandemic period (2018-2019). Second, in the pre-pandemic period, patients who lived in areas in the highest tertile of deprivation had greater odds of gaps in mental health care relative to those in the lowest tertile (aOR: 2.18 [95 % CI: 1.02, 4.68]). Males had higher odds of gaps in care than females in the post-pandemic period (aOR: 2.22 [1.13, 4.37]) and the pooled pre- and post-pandemic study period (aOR: 1.58 [1.04, 2.40]). Third, interactions between patient characteristics and time were not significant, suggesting that the change in the odds of gaps of mental health care before relative to after the COVID-19 pandemic did not differ significantly based on patient characteristics. Overall, gaps in care decreased in the post-pandemic period relative to the pre-pandemic period among almost all patient groups.

Mostly harmless? Clinical practice guidelines need further consideration of psychotherapy adverse effects

The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines on mood disorders recommend psychotherapy as foundational care for patients with acute depression with minimal discussion of any potential adverse effects. Randomised controlled trial evidence on psychotherapy adverse effects is limited. This is problematic because clinicians must balance the benefits of treatment against the harms, and clinical decisions become skewed without data on adverse effects. We suggest that clinical practice guidelines should be more guarded about recommending psychotherapy and add consensus statements on adverse effects for informed consent and clinical decision-making.

Reflection on the RANZCP position on the adverse effects of psychotherapy

OBJECTIVE

In this perspective, we investigate how the Royal Australian and New Zealand College of Psychiatrists' (RANZCP) position statement on psychotherapy takes the potential for adverse effects into account.

CONCLUSIONS

Psychotherapy has two critical outcomes - efficacy and adverse effects. Evidence-based psychotherapy is significantly more effective than care-as-usual for about one in 10 psychotherapy patients. However, a similar proportion also reports adverse effects. Despite this, the RANZCP position statement on psychotherapy focuses on efficacy with minimal discussion of the adverse effects. This is an oversight because psychiatrists have legal and ethical obligations to consider the adverse effects as well as the benefits of any treatment. We therefore reflect on the RANZCP's six recommendations in light of the adverse effects of psychotherapy.

Efficacy and safety of home-based transcranial direct current stimulation as adjunct treatment for cognitive improvement in major depressive disorder: A double-blind, randomized, multi-site clinical trial

BACKGROUND

Transcranial direct current stimulation (tDCS) is a promising treatment for major depressive disorder (MDD). This study evaluated its antidepressant and cognitive effects as a safe, effective, home-based therapy for MDD.

METHODS

This double-blind, sham-controlled, randomized trial divided participants into low-intensity (1 mA, n = 47), high-intensity (2 mA, n = 49), and sham (n = 45) groups, receiving 42 daily tDCS sessions, including weekends and holidays, targeting the dorsolateral prefrontal cortex for 30 minutes. Assessments were conducted at baseline and weeks 2, 4, and 6. The primary outcome was cognitive improvement assessed by changes in total accuracy on the 2-back test from baseline to week 6. Secondary outcomes included changes in depressive symptoms (HAM-D), anxiety (HAM-A), and quality of life (QLES). Adverse events were monitored. This trial was registered with ClinicalTrials.gov (NCT04709952).

RESULTS

In the tDCS study, of 141 participants (102 [72.3%] women; mean age 35.7 years, standard deviation 12.7), 95 completed the trial. Mean changes in the total accuracy scores from baseline to week 6 were compared across the three groups using an F-test. Linear mixed-effects models examined the interaction of group and time. Results showed no significant differences among groups in cognitive or depressive outcomes at week 6. Active groups experienced more mild adverse events compared to sham but had similar rates of severe adverse events and dropout.

CONCLUSIONS

Home-based tDCS for MDD demonstrated no evidence of effectiveness but was safe and well-tolerated. Further research is needed to address the technical limitations, evaluate broader cognitive functions, and extend durations to evaluate its therapeutic potential.

From Serendipity to Precision: Integrating AI, Multi-Omics, and Human-Specific Models for Personalized Neuropsychiatric Care

Background/Objectives: The dual forces of structured inquiry and serendipitous discovery have long shaped neuropsychiatric research, with groundbreaking treatments such as lithium and ketamine resulting from unexpected discoveries. However, relying on chance is becoming increasingly insufficient to address the rising prevalence of mental health disorders like depression and schizophrenia, which necessitate precise, innovative approaches. Emerging technologies like artificial intelligence, induced pluripotent stem cells, and multi-omics have the potential to transform this field by allowing for predictive, patient-specific interventions. Despite these advancements, traditional methodologies such as animal models and single-variable analyses continue to be used, frequently failing to capture the complexities of human neuropsychiatric conditions. Summary: This review critically evaluates the transition from serendipity to precision-based methodologies in neuropsychiatric research. It focuses on key innovations such as dynamic systems modeling and network-based approaches that use genetic, molecular, and environmental data to identify new therapeutic targets. Furthermore, it emphasizes the importance of interdisciplinary collaboration and human-specific models in overcoming the limitations of traditional approaches. Conclusions: We highlight precision psychiatry's transformative potential for revolutionizing mental health care. This paradigm shift, which combines cutting-edge technologies with systematic frameworks, promises increased diagnostic accuracy, reproducibility, and efficiency, paving the way for tailored treatments and better patient outcomes in neuropsychiatric care.

Application of GWAS summary data and drug-induced gene expression profiles of neural progenitor cells in psychiatric drug prioritization analysis

Common psychiatric disorders constitute one of the most substantial healthcare burdens worldwide. However, drug development in psychiatry remains hampered partially due to the lack of approaches to estimating drugs that can simultaneously modulate the expression of a nontrivial fraction of disease susceptibility genes. We proposed a new drug prioritization strategy under the framework of our previously proposed phenotype-associated tissues estimation approach (DESE) by investigating the drugs' selective perturbation effect on disease susceptibility genes. Based on the genome-wide association study summary data and drug-induced gene expression profiles of neural progenitor cells, we applied this strategy to prioritize candidate drugs for schizophrenia, depression and bipolar I disorder and identified several known therapeutic drugs among the top-ranked drug candidates. Also, our results revealed that the disease susceptibility genes involved in the selective gene perturbation analysis were enriched with many biologically sensible function terms and interacted with known therapeutic drugs. Our results suggested that selective gene perturbation analysis could be a promising starting point to prioritize biologically sensible drug candidates under the "one drug, multiple targets" paradigm for the drug development of common psychiatric disorders.

Boosting Psychotherapy With Noninvasive Brain Stimulation: The Whys and Wherefores of Modulating Neural Plasticity to Promote Therapeutic Change

The phenomenon of neural plasticity pertains to the intrinsic capacity of neurons to undergo structural and functional reconfiguration through learning and experiential interaction with the environment. These changes could manifest themselves not only as a consequence of various life experiences but also following therapeutic interventions, including the application of noninvasive brain stimulation (NIBS) and psychotherapy. As standalone therapies, both NIBS and psychotherapy have demonstrated their efficacy in the amelioration of psychiatric disorders' symptoms, with a certain variability in terms of effect sizes and duration. Consequently, scholars suggested the convenience of integrating the two interventions into a multimodal treatment to boost and prolong the therapeutic outcomes. Such an approach is still in its infancy, and the physiological underpinnings substantiating the effectiveness and utility of combined interventions are still to be clarified. Therefore, this opinion paper aims to provide a theoretical framework consisting of compelling arguments as to why adding NIBS to psychotherapy can promote therapeutic change. Namely, we will discuss the physiological effects of the two interventions, thus providing a rationale to explain the potential advantages of a combined approach.

Evidence for music therapy and music medicine in psychiatry: transdiagnostic meta-review of meta-analyses

BACKGROUND

Music therapy is a commonly used intervention added to usual care for psychiatric disorders.

AIMS

We review the evidence for music therapy and assess its efficacy as an adjunct therapy across psychiatric disorders.

METHOD

A systematic literature search was conducted in four scientific databases to identify relevant meta-analyses. Articles were assessed with the AMSTAR-2 tool. The results of the high-quality articles were recalculated with the data from the primary studies. We decided to add the results of the lower-rated articles, using a narrative approach. We pooled the primary studies and calculated standardised mean differences (SMD) for the transdiagnostic outcomes of depression, anxiety and quality of life. We used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool to assess the level of evidence.

RESULTS

Meta-analyses were available for autism, dementia, depression, insomnia, schizophrenia and substance use disorders. We identified 40 relevant articles. One article per domain was identified as high quality. Music therapy added to treatment as usual showed therapeutic value in each disorder. The transdiagnostic results showed a positive effect of music therapy on depression (SMD = 0.57, 95% CI 0.36-0.78), anxiety (SMD = 0.47, 95% CI 0.27-0.66) and quality of life (SMD = 0.47, 95% CI 0.24-0.71). However, these effects were not maintained at follow-up, and all results were based on low or very low evidence.

CONCLUSIONS

Music therapy shows promising potential as an adjunctive treatment for psychiatric disorders, but methodological weaknesses and variability limit the evidence. More high-quality, well-powered studies are needed to reliably confirm its effect size.

The effects of L-theanine supplementation on the outcomes of patients with mental disorders: a systematic review

BACKGROUND

When utilized as an adjunct with antidepressants, antipsychotics, and other psychopharmacological drugs, certain amino acids, such as L-Theanine (LT), have shown potential effectiveness in enhancing the symptomatic outcomes of patients with mental disorders. Despite this, there is a lack of previous systematic reviews examining these associations. Therefore, we conducted a systematic review of randomized controlled trials examining these relationships.

METHODS

A comprehensive systematic review was conducted, scouring six electronic databases (PubMed, Scopus, PsycINFO, Web of Science, CINAHL Complete, and Cochrane) from their inception up to June 2023, specifically focusing on randomized controlled trials that investigated the effects of LT supplementation on the outcomes of patients with mental health disorders. The Cochrane Risk of Bias Tool for Randomized Trials was employed to assess the quality of the included studies.

RESULTS

Among the 419 publications identified, 11 studies from six countries - Israel, Iran, the USA, Japan, Australia, and Italy - were included in the final analysis. These studies covered a range of mental disorders, including schizophrenia, Attention-Deficit/Hyperactivity Disorder (ADHD), Obsessive-Compulsive Disorder (OCD), Major Depressive Disorder (MDD), sleep disorders, Generalized Anxiety Disorder (GAD), and Tourette syndrome. The findings demonstrated that LT supplementation reduced psychiatric symptoms more effectively than control conditions in individuals with schizophrenia, anxiety disorders, and ADHD.

CONCLUSIONS

The findings from this systematic review suggest that LT supplementation significantly reduced psychiatric symptoms more effectively than control conditions in individuals with schizophrenia, anxiety disorders, and ADHD. However, further studies are essential to validate these findings, deepen the understanding of the observed effects, and explore the mechanisms underlying these associations.

Taking stock to move forward: Where the field of developmental psychopathology might be heading

In this paper, dedicated to Dante Cicchetti's contributions and enduring influence, we explore the prospective directions of developmental psychopathology. Our focus centers on key domains where Cicchetti's significant achievements have continually shaped our evolving thinking about psychological development. These domains include (a) the concepts of equifinality and multifinality, along with the challenges in predicting developmental trajectories, (b) the imperative to integrate wider sociocultural viewpoints into developmental psychopathology frameworks, (c) the interplay of genetic and environmental influences in developmental courses, (d) the significance of mental state language, and (e) the progress, or its absence, in the development of prevention and intervention tactics for children, adolescents, and their caregivers. While many of our forecasts regarding the future of developmental psychopathology may not materialize, we maintain optimistic that the essential ideas presented will influence the research agenda in this field and contribute to its growth over the next fifty years.

Enduring effects of psychotherapy, antidepressants and their combination for depression: a systematic review and meta-analysis

Introduction

Although depressive disorders are frequently associated with relapses, the sustained efficacy of therapies after their termination has been insufficiently investigated.

Objective

The aim of this study was to evaluate the current evidence of enduring effects of psychotherapy, antidepressants and their combination after the end of treatment.

Methods

PubMed and PsychINFO were systematically screened according to PRISMA guidelines (except for preregistration). Only randomized controlled trials (RCTs) between 1980 and 2022 comparing the efficacy of psychotherapy, antidepressants and their combination in adult depression at follow-up at least 12 months after termination of therapy, which could be acute phase, maintenance or relapse prevention therapy, were included. Risk of bias was assessed by using the Cochrane risk of bias tool.

Results

In total 19 RCTs with a total of 1154 participants were included. Psychotherapy was significantly superior to pharmacotherapy regarding relapse rates and Beck Depression Inventory scores at follow-up after acute treatment in two of nine RCTs. Combined treatment performed significantly better than pharmacotherapy, but not psychotherapy, regarding relapse and remission in five out of nine RCTs at least 12 months after treatment termination. Pairwise meta-analyses indicated a superiority of combined treatment compared to pharmacotherapy alone regarding relapse, recurrence, and rehospitalization rates (RR=0.60, 95%-CI: 0.37-0.97, p=.041) and for psychotherapy compared to pharmacotherapy alone regarding relapse and recurrence rates (RR=0.58, 95%-CI: 0.38-0.89, p=.023), however comparative treatment effects between psychotherapy and combined treatment were insignificant.

Conclusions

Current findings suggest a superiority of psychotherapy and combined treatment over pharmacotherapy alone in major depressive disorder depression. Major limitations were a low number of studies reporting follow-up data after termination of study periods and a heterogeneity in definitions of treatment outcomes. Practice guidelines and participatory decision-making processes for the choice of treatment should consider the current knowledge on long-term effects of antidepressant therapy methods more than has been the case to date.

Intermittent theta burst stimulation over the left prefrontal cortex: no additional effect for virtual reality exposure therapy in acrophobia-a randomized trial

Anxiety disorders are the most prevalent mental health conditions. Besides psycho-pharmacotherapy, cognitive behavioral therapy with an exposure-based approach is considered the gold standard. However, not all patients benefit from this approach. Here, we aimed to translate laboratory findings on enhanced fear extinction with repetitive transcranial magnetic stimulation (TMS) to the clinic. In this double-blind, randomized, placebo-controlled clinical trial, 76 participants with acrophobia received an activating intermittent theta burst stimulation (iTBS) targeting the left posterior prefrontal cortex immediately before two virtual reality exposure therapy sessions. Phobic symptoms were assessed at baseline, post-intervention, and a 6-month follow-up. Results revealed a significant reduction in phobic symptoms from baseline to post-assessment and follow-up and confirmed the efficacy of virtual reality exposure therapy as a treatment for specific phobias. Interestingly, no additional effect was observed for active iTBS compared to sham iTBS. Our post-hoc analyses argue for an individualized TMS application. Further research is needed to determine optimal TMS parameters and validate these results in clinical trials, accounting for methodological and inter- and intra-individual variability, as well as alternative therapeutic processes.

Characterisation and quantification of phenolic, anthocyanidin and terpene species in plant foods and plant food-based complementary products with antioxidant and neuroprotective properties

Phytochemicals, including phenolic compounds and terpenes, are of interest for the treatment and prevention of conditions with oxidative stress, inflammatory and neurodegenerative pathologies. Certain plant foods have shown beneficial effects for the brain; however, the specific phenolic and terpene species in these foods are unclear. The present study aimed to characterise and quantify the phenolic, anthocyanidin and terpene species in six plant foods (Queen Garnet plum (QGP, Prunus salicina); black pepper (BPF, Piper nigrum); clove (CF, Syzygium aromaticum); elderberry (EF, Sambucus nigra); lemon balm (LBF, Melissa officinalis); and sage (SF, Salvia officinalis)) and six plant food-based complementary products (clove (CC), elderberry (EC), lemon balm (LBC), and sage (SC), plus two blends (Astragalus membranaceus and lemon balm-rich, WC and R8)). The relationships between the concentration of phytochemical species in these samples and their antioxidant capacities (i.e. oxygen and nitrogen free radical scavenging, Cu2+ and Fe2+ chelating capacities, and the ability to prevent H2O2-induced oxidative stress in neuroblast-like SH-SY5Y cells, in vitro) were also examined. WC had the highest concentration of phenolics, followed by QGP, EF, CC and CF. BPF had the highest total terpene concentration followed by CC, CF and SF. Correlations between certain compounds and antioxidant capacity were demonstrated. The results provide insight into the potential functional capabilities of species of phenolics and terpenes. Understanding the phytochemical profile of plant foods and their correlations may be important in understanding their potential therapeutic benefits for brain health.

Effectiveness of a three-component intervention supporting unemployed individuals with mental health issues in their job search and mental health recovery (3for1): study protocol of a non-randomized controlled study

BACKGROUND

There is a vicious cycle between unemployment and mental health issues. Unemployed individuals with mental health issues require individualized support at multiple levels in order to promote their mental health, and obtain and retain employment. The 3for1-intervention program aims to provide such support with three components (short-term psychotherapy, job coaching based on the Individual Placement and Support approach, and peer support). This study protocol outlines how the effectiveness of this three-component intervention program in terms of re-employment, mental health, and psychosocial outcomes will be evaluated.

METHODS

The 3for1-intervention program will be evaluated with a non-randomized controlled trial design in a multi-center study. 500 eligible participants aged between 18 and 60 years from six job centers in Southern Germany will be allocated to a control group or an intervention group. Allocation is time-based, with the control group being recruited first, followed by recruitment of the intervention group. The control group will receive treatment as usual, whereas the intervention group will receive treatment as usual as well as access to the three intervention components over a period of 12 months. Assessment will be conducted at baseline (t0), and 12 (t1) and 18 (t3) months later. The primary outcome will be the proportion of participants who are in employment subject to social insurance contributions at t1. Differences between control and intervention group will be tested with logistic regression analysis, controlling for relevant covariates. Analyses of secondary outcomes will relate to group differences regarding re-employment, health and well-being, social integration, help-seeking, and self-stigma at t1 and t2, applying logistic regression analysis or analysis of covariance. Additionally, usage of health services will be measured to evaluate the intervention program's cost effectiveness.

DISCUSSION

The 3for1-intervention aims to improve employability and mental health outcomes of a vulnerable population with high need for assistance. Improvements for this population would benefit the German welfare state as well. This study could provide valuable insights into the feasibility, implementation, and sustainability of this individualized, multi-level support program within German job centers.

TRIAL REGISTRATION

This trial is registered with the German Clinical Trials Register: DRKS00029002 (registered on 11 May 2022).

Towards an ontology of mental health: Protocol for developing an ontology to structure and integrate evidence regarding anxiety, depression and psychosis

Background

Research about anxiety, depression and psychosis and their treatments is often reported using inconsistent language, and different aspects of the overall research may be conducted in separate silos. This leads to challenges in evidence synthesis and slows down the development of more effective interventions to prevent and treat these conditions. To address these challenges, the Global Alliance for Living Evidence on aNxiety, depressiOn and pSychosis (GALENOS) Project is conducting a series of living systematic reviews about anxiety, depression and psychosis. An ontology (a classification and specification framework) for the domain of mental health is being created to organise and synthesise evidence within these reviews and present them in a structured online data repository.

Aim

This study aims to develop an ontology of mental health that includes entities with clear labels and definitions to describe and synthesise evidence about mental health, focusing on anxiety, depression and psychosis.

Methods

We will develop and apply the GALENOS Mental Health Ontology through eight steps: (1) defining the ontology's scope; (2) identifying, labelling and defining the ontology's entities for the GALENOS living systematic reviews; (3) structuring the ontology's upper level (4) refining entities via iterative stakeholder consultations regarding the ontology's clarity and scope; (5) formally specifying the relationships between entities in the Mental Health Ontology; (6) making the ontology machine-readable and available online; (7) integrating the ontology into the data repository; and (8) exploring the ontology-structured repository's usability.

Conclusion and discussion

The Mental Health Ontology supports the formal representation of complex upper-level entities within mental health and their relationships. It will enable more explicit and precise communication and evidence synthesis about anxiety, depression and psychosis across the GALENOS Project's living systematic reviews. By being computer readable, the ontology can also be harnessed within algorithms that support automated categorising, linking, retrieving and synthesising evidence.

Prevalence of mental disorders and related risk factors in refugees and asylum seekers in Campania

Introduction

In recent years, the increasing presence of refugees and asylum seekers displaced from their country of origin, determined significant social, economic, humanitarian and public health implications in host countries, including Italy. These populations are exposed to several potential stressful experiences which make them vulnerable to psychological distress. In fact, the majority of studies addressing the topic found a higher prevalence of mental disorders, especially post-traumatic stress disorder and major depressive disorder, in refugees and asylum seekers with respect to the general population. However, heterogeneous prevalence rates have been reported among studies, due to methodological factor as well as to the impact of a variety of risk factors related to stressful experiences lived in the country of origin, during the migration journey and in the host country.

Objectives

The aim of the present study was to assess the prevalence of the main psychiatric diagnoses in a large group of adult refugees and asylum seekers (N=303) in the reception centers of two provinces of the Campania region, as well as to investigate the impact of potential risk factors on the occurrence of psychiatric disorders.

Methods

The diagnosis of psychiatric disorders and the identification of subjects at high risk to develop psychosis were carried out by means of structured diagnostic interviews. The following variables were explored as potential risk/protective factors to the occurrence of psychiatric disorders: socio-demographic variables, migration status (refugees/asylum seekers) and characteristics of the reception center,assessed by means of an ad hoc questionnaire; cognitive indices assessed by using standardized neuropsychological tests; traumatic experiences and level of political terror in the country of origin, assessed by means of reliable and valid self-report questionnaires.

Results

At least one mental disorder was found in 29.7% of the sample. Most prevalent diagnoses were depressive disorders, anxiety disorders and PTSD. Women showed, with respect to men, a higher prevalence of anxiety disorders, higher trauma levels, and came from more at-risk countries. Higher trauma levels, better cognitive abilities and unemployment and refugee status were associated to the presence of a current psychiatric disorder in the whole sample.

Conclusions

Our findings showed a higher prevalence of depressive disorders and PTSD in the sample of refugees and asylum seekers with respect to the general population and highlighted the role of potential risk factors whose identification may guide the implementation of preventive strategies and early treatments in these people.

Facilitating Thought Progression to Reduce Depressive Symptoms: Randomized Controlled Trial

BACKGROUND

The constant rise in the prevalence of major depressive disorder calls for new, effective, and accessible interventions that can rapidly and effectively reach a wide range of audiences. Recent developments in the digital health domain suggest that dedicated online platforms may potentially address this gap. Focusing on targeting ruminative thought, a major symptomatic hallmark of depression, in this study we hypothesized that delivering a digital health-based intervention designed to systematically facilitate thought progression would substantially alleviate depression.

OBJECTIVE

The study aims to investigate the efficacy of a novel digital intervention on the reduction of depressive symptoms. This intervention was designed as an easy-to-use gamified app specifically aimed to facilitate thought progression through intense practicing of associative, semantically broad, fast, and creative thought patterns.

METHODS

A randomized clinical trial was conducted, comparing changes in depression symptoms between participants who used the app in the intervention group (n=74) and waitlist control group (n=27) over the course of 8 weeks. All participants filled out a battery of clinical questionnaires to assess the severity of depression at baseline and 4 and 8 weeks after starting the study. These primarily included the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Patient Health Questionnaire-9 as well as the Positive Affect Negative Affect Scale-Negative Affect Score, Ruminative Response Scale, and Symptoms of Depression Questionnaire. Additional questionnaires were implemented to assess anxiety, positive affect, anhedonia, and quality of life.

RESULTS

The results indicate that across multiple clinical measurements, participants in the intervention group who played the gamified app showed greater and faster improvement in depressive symptoms compared with their waitlist control counterparts. The difference between the groups in MADRS improvement was -7.01 points (95% CI -10.72 to -3.29; P<.001; Cohen d=0.67). Furthermore, the difference in improvement between groups persisted up to 4 weeks posttrial (MADRS differences at week 12: F49,2=6.62; P=.003; ηp2=0.21). At the end of the trial, participants who played the app showed high interest in continuing using the app.

CONCLUSIONS

The results demonstrate that a gamified app designed to facilitate thought progression is associated with improvement in depressive symptoms. Given its innovative and accessibility features, this gamified method aiming to facilitate thought progression may successfully complement traditional treatments for depression in the future, providing a safe and impactful way to enhance the lives of individuals experiencing depression and anxiety.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05685758; https://clinicaltrials.gov/study/NCT05685758.

The Role of Shyness and Fear of Negative Evaluation in Predicting the Mental Health of Academic Staff: A Cross-Sectional Study

This study aimed to predict mental health based on shyness and fear of negative evaluation in academic staff. The research employed an applied methodology, utilizing quantitative and descriptive (correlational) methods for data collection. The study's temporal framework is cross-sectional. The statistical population comprises all educational staff at the Islamic Azad University, Ardabil branch, totaling 400 individuals employed in 2019. According to Morgan's table, the statistical sample includes 196 educational-administrative staff members, selected through stratified random sampling. For this research, we utilized three mental health questionnaires (depression, anxiety, and stress) by Lovibond and Lovibond, the Fear of Negative Evaluation Scale by Watson and Friend, and the Shyness Scale by Cheek and Buss to explore the relationships between variables. Pearson's correlation test and multiple linear regression analysis were employed. The results indicated that the relationships between mental health and its components (depression, anxiety, and stress) are positive and significant, with shyness and anxiety accounting for 54% of the variance in mental health. Additionally, the study found that the effects of shyness and fear of negative evaluation on depression, anxiety, and stress were 41%, 43%, and 39%, respectively. Based on these findings, we conclude that shyness and fear of negative evaluation can predict mental health in academic staff.

No Magic Pill: A Systematic Review of the Pharmacological Treatments for Compulsive Sexual Behavior Disorder

Compulsive sexual behavior disorder (CSBD) is a burgeoning diagnostic construct. No systematic reviews of CSBD pharmacotherapy interventions have been conducted. We addressed this gap using a three-aim approach. We reviewed researchers' theoretical arguments for various pharmacotherapies, outcomes from pharmacotherapy trials, and the generalizability of the extant findings. Our review included k = 13 studies, with n = 141 participants. An opioid model of reward seeking was the most popular framework, though inconsistently specified. A serotonin model was also documented, though with few details. Naltrexone was the most prominently examined pharmacotherapy and the only medication that reliably demonstrated a therapeutic effect for some (but not all) indicators compared to placebo. Paroxetine and citalopram were also documented in placebo-controlled trials, though their incremental benefit compared to placebo is suspect. Several additional pharmacotherapies have been documented in case series contexts. Across studies, only one female participant was identified. All trials were conducted in developed nations, and race was rarely assessed. We conclude that the case for pharmacotherapy for CSBD is limited and should preferably not occur outside of clinical trial contexts. Naltrexone offers the best evidence for a potential research program, though new theoretically informed approaches are welcome. Finally, we call for additional pharmacotherapy research in women and non-White populations.

Effectiveness and predictors of psychotherapy in eating disorders: state-of-the-art and future directions

PURPOSE OF REVIEW

Psychotherapy is the cornerstone of the multidisciplinary treatment approach for eating disorders. This review examines recent evidence regarding effectiveness, predictors, and mechanisms of change of psychotherapy in eating disorders, providing a road map for clinicians and researchers.

RECENT FINDINGS

Family-based treatments (FBT) are effective in adolescents with anorexia nervosa and bulimia nervosa. Evidence-based psychotherapies for anorexia nervosa have no evidence of superiority compared with treatment as usual (TAU) in adults with anorexia nervosa. Cognitive-behavioural therapy (CBT) is the first-choice psychotherapy recommended for adults with bulimia nervosa and binge-eating disorder (BED). Self-help interventions have some evidence of effectiveness in nonunderweight individuals with eating disorders. Early symptom improvement and adolescent age predict more favourable outcomes.

SUMMARY

Evidence-based psychotherapies can be suggested for eating disorders, although follow-up data are needed. Beyond anorexia nervosa, bulimia nervosa, and BED, there is no evidence of psychotherapy effectiveness in other eating disorders. The effectiveness of novel (e.g. 'third-wave') psychotherapies, treatment delivery modality (e.g. internet-delivered), and adjunctive interventions (e.g. virtual reality) needs to be further explored. A broader definition of recovery is recommended, including behavioural, physical, and psychological criteria. Predictors and mechanisms of changes have not been studied enough: quantitative and qualitative studies are needed to promote more tailored and individualized psychotherapy interventions.

Coercive Measures in Psychiatry Can Hardly Be Justified in Principle Any Longer-Ethico-Legal Requirements Versus Empirical Research Data and Conceptual Issues

AIM

To review the scientific and empirical evidence that is usually accepted for the ethical and legal justification of coercion in psychiatry.

METHOD

Five key criteria are examined as follows: (1) the demonstrable existence of a mental disorder; (2) the effectiveness of psychiatric measures; (3) the use of coercion as last resort and as least possible restriction; (4) the benefit of the person affected by the coercive measure and (5) the restoration of the affected person's autonomy.

RESULTS

(1) The existence of a demarcation between a mentally ill and a mentally healthy state cannot be confirmed; (2) Pharmacological and psychotherapeutic interventions in psychiatry are not even moderately effective; (3) Coercive measures are usually not used as last resort and as least restrictive measure; (4) Most people affected by psychiatric coercion do not benefit from the measures; (5) It is at least unclear whether autonomy is affected by a mental illness and whether it can be restored through a coercive psychiatric measure.

DISCUSSION

None of the central ethical and legal criteria for the use of coercion in psychiatry are clearly and unambiguously fulfilled according to current research.

IMPLICATIONS

Psychiatric coercion can hardly be justified any longer.

Anxious/depressed individuals exhibit disrupted frontotemporal synchrony during cognitive conflict encoding

Anxiety and depressive disorders are associated with cognitive control deficits, yet their underlying neural mechanisms remain poorly understood. Here, we used high-resolution stereotactic EEG (sEEG) to determine how anxiety and/or depression modulates neural and behavioral responses when cognitive control is engaged in individuals with medically refractory epilepsy undergoing sEEG monitoring for surgical evaluation. We analyzed sEEG data recorded from frontotemporal regions of 29 participants (age range: 19-55, mean age: 35.5, female: 16/29) while they performed a Multi-Source Interference Task (MSIT) designed to elicit cognitive conflict. Neurobehavioral interviews, symptom rating scales, and clinical documentation were used to categorize participants as demonstrating anxiety and/or depression symptoms (A/D, n=13) or as epilepsy controls (EC, n=16). Generalized linear mixed-effects (GLME) models were used to analyze behavioral and neural data. Models of oscillatory power were used to identify brain regions within conflict-encoding networks in which coherence and phase locking values (PLV) were examined in A/D and EC. A/D participants demonstrated a greater conflict effect (response time slowing with higher cognitive load), without impairment in response time (RT) or accuracy compared to EC. A/D participants also showed significantly enhanced conflict-evoked theta (4-8Hz) and alpha (8-15Hz) power in the dorsolateral prefrontal cortex (dlPFC) and amygdala as well as widespread broadband activity in the lateral temporal lobe (LTL) compared to EC. Additionally, theta coherence and PLV between dlPFC-LTL and dlPFC-amygdala were reduced by conflict in A/D. Our findings suggest individuals with anxiety/depression symptoms exhibit heightened frontotemporal oscillatory activity and disrupted frontotemporal synchrony during cognitive conflict encoding, which may indicate a greater need for cognitive resources due to ineffective cognitive processing. These results highlight a potential role of frontotemporal circuits in conflict encoding that are altered in anxiety/depression, and may further inform future therapeutic interventions aimed at enhancing cognitive control in these populations.

A Cellulose-Rich Diet Disrupts Gut Homeostasis and Leads to Anxiety through the Gut-Brain Axis

It is widely said that a healthy intestinal environment plays an essential role in better mental condition. One known dietary nutrient that maintains the intestinal environment is dietary fiber. A recent study showed that maintaining the intestinal environment with dietary fiber alleviated symptoms of psychiatric disorders in animals. However, such effects have only been reported with soluble fiber, which is highly fermentable and promotes short-chain fatty acid (SCFA) production, and not with insoluble fiber. Therefore, we aimed to verify whether insoluble fiber, such as cellulose, can alter emotion via changes in the gut. We divided mice into two groups and fed either a standard diet (SD, which contains both insoluble and soluble dietary fibers) or a cellulose-rich diet (CRD, which contains cellulose alone as the dietary fibers). We found that CRD-fed mice display increased anxiety-like behavior. CRD-fed animals also showed decreased intestinal SCFA levels along with increased intestinal permeability, dysmotility, and hypersensitivity. This behavioral and physiological effect of CRD has been completely abolished in vagotomized mice, indicating the direct link between intestinal environment exacerbation to the emotion through the gut-brain axis. Additionally, we found that amygdalar dopamine signaling has been modified in CRD-fed animals, and the opioid antagonist abolished this dopaminergic modification as well as CRD-induced anxiety. Altogether, our findings indicate that consumption of cellulose alone as the dietary fiber may evoke intestinal abnormalities, which fire the vagus nerve, then the opioidergic system, and amygdalar dopamine upregulation, resulting in the enhancement of anxiety.

First impressions count: Therapists' impression on patients' motivation and helping alliance predicts psychotherapy dropout

OBJECTIVE

With meta-analytically estimated rates of about 25%, dropout in psychotherapies is a major concern for individuals, clinicians, and the healthcare system at large. To be able to counteract dropout in psychotherapy, accurate insights about its predictors are needed.

METHOD

We compared logistic regression models with two machine learning algorithms (elastic net regressions and gradient boosting machines) in the prediction of therapy dropout in two large inpatient samples (N = 1,691 and N = 12,473) using baseline and initial process variables reported by patients and therapists.

RESULTS

Predictive accuracies of the two machine learning algorithms were similar and higher than for logistic regressions: Therapy dropout could be predicted with an AUC of .73 and .83 for Sample 1 and 2, respectively. The initial evaluation of patients' motivation and the therapeutic alliance rated by the respective therapist were the most important predictors of dropout.

CONCLUSIONS

Therapy dropout in naturalistic inpatient settings can be predicted to a considerable degree by using baseline indicators and therapists' first impressions. Feature selection via regularization leads to higher predictive performances whereas non-linear or interaction effects are dispensable. The most promising point of intervention to reduce therapy dropouts seems to be patients' motivation and the therapeutic alliance.

Impact of emotional abuse on eating disorder psychopathology: A multiple mediation analysis

INTRODUCTION

Childhood maltreatment, particularly emotional abuse (EA), has been identified as a significant risk factor for the development of eating disorders (EDs). This study investigated the association between EA and ED symptoms while considering multiple potential mediators.

METHODS

Participants included 151 individuals with Anorexia Nervosa (AN), 115 with Bulimia Nervosa (BN), and 108 healthy controls. The Childhood trauma questionnaire, the Toronto Alexithymia scale, the Behavioral inhibition System, and the Eating Disorder Inventory 2 scale were completed before treatment. A mediator path model was conducted in each group: EA was set as independent variable, eating symptoms as dependent variables and ineffectiveness, sensitivity to punishment, alexithymia, and impulsivity as mediators.

RESULTS

In individuals with AN, impulsivity emerged as a significant mediator between EA and desire for thinness and bulimic behaviors. Conversely, in individuals with BN, sensitivity to punishment was found to mediate the association between EA and dissatisfaction with one's body. Ineffectiveness and difficulty identifying emotions were identified as transdiagnostic mediators in both clinical groups. No mediation effect was found in healthy individuals.

DISCUSSION

The simultaneous assessment of multiple mediators in a unique model outlines the complex interplay between childhood EA and ED psychopathology. Improving ineffectiveness, emotion identification, sensitivity to punishment and impulsivity and exploring their relations with early emotional abuse may represent treatment targets in individuals with EDs and childhood trauma.

The relationship between self-reported antipsychotics side effects and depression in Saudi Arabia

Background

The utilization rate of antipsychotics to treat different mental disorders is rising. However, little is known about their side effects' impact on depression levels. Therefore, the objective of this study was to examine the association between antipsychotic side effects and depression among psychiatric patients treated with antipsychotics.

Methods

This is a prospective, single-center, interview-based, cross-sectional study that examined the association between antipsychotic side effects and depression among adult patients (e.g., ≥18 yrs.) with psychiatric illnesses (e.g., depression, schizophrenia, bipolar disorder) visiting outpatient clinics in a university-affiliated tertiary care center. Antipsychotic side effects were assessed using the Arabic version of the Glasgow Antipsychotic Side-effect Scale (GASS), while depression was assessed using the Arabic version of the 9-item Patient Health Questionnaire (PHQ-9). Univariate and multiple linear regressions were conducted to examine the association between the PHQ-9 and GASS scores.

Results

One hundred patients met the inclusion criteria and consented to participate. Most of the patients were females (72 %) with a mean age of 38 years. Schizophrenia (37 %) and bipolar disorder (54 %) were the most common mental disorders among the recruited patients. The majority of patients were treated with atypical (e.g., second-generation) antipsychotics (88 %) for at least six months (74 %). Controlling for age, gender, annual family income, education, employment status, marital status, number of comorbidities, duration of treatment with antipsychotics, the type of antipsychotic, and psychiatric illness, higher GASS scores, which indicate more severe antipsychotic side effects, predicted higher PHQ-9 score (e.g., higher levels of depression) (β = 0.419, 95 % CI=[0.307-0.532], p-value < 0.0001).

Conclusion

Early identification and management of antipsychotic side effects among psychiatric patients should enhance patient adherence and improve treatment outcomes. Future studies should verify the findings of this study using more robust study designs.

Predicting the outcome of psychotherapy for chronic depression by person-specific symptom networks

Psychotherapies are efficacious in the treatment of depression, albeit only with a moderate effect size. It is hoped that personalization of treatment can lead to better outcomes. The network theory of psychopathology offers a novel approach suggesting that symptom interactions as displayed in person-specific symptom networks could guide treatment planning for an individual patient. In a sample of 254 patients with chronic depression treated with either disorder-specific or non-specific psychotherapy for 48 weeks, we investigated if person-specific symptom networks predicted observer-rated depression severity at the end of treatment and one and two years after treatment termination. Person-specific symptom networks were constructed based on a time-varying multilevel vector autoregressive model of patient-rated symptom data. We used statistical parameters that describe the structure of these person-specific networks to predict therapy outcome. First, we used symptom centrality measures as predictors. Second, we used a machine learning approach to select parameters that describe the strength of pairwise symptom associations. We found that information on person-specific symptom networks strongly improved the accuracy of the prediction of observer-rated depression severity at treatment termination compared to common covariates recorded at baseline. This was also shown for predicting observer-rated depression severity at one- and two-year follow-up. Pairwise symptom associations were better predictors than symptom centrality parameters for depression severity at the end of therapy and one year later. Replication and external validation of our findings, methodological developments, and work on possible ways of implementation are needed before person-specific networks can be reliably used in clinical practice. Nevertheless, our results indicate that the structure of person-specific symptom networks can provide valuable information for the personalization of treatment for chronic depression.

Traditional healing practices, factors influencing to access the practices and its complementary effect on mental health in sub-Saharan Africa: a systematic review

OBJECTIVES

In areas with limited and unaffordable biomedical mental health services, such as sub-Saharan Africa (SSA), traditional healers are an incredibly well-used source of mental healthcare. This systematic review synthesises the available evidence on traditional healing practices, factors to access it and its effectiveness in improving people's mental health in SSA.

DESIGN

Systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach.

DATA SOURCES

PubMed, MEDLINE, CINAHL and Scopus studies published before 1 December 2022.

ELIGIBILITY CRITERIA

Qualitative and quantitative studies reported traditional healing practices to treat mental health problems in SSA countries published in English before 1 December 2022.

DATA EXTRACTION AND SYNTHESIS

Data were extracted using Covidence software, thematically analysed and reported using tables and narrative reports. The methodological quality of the included papers was evaluated using Joanna Briggs Institute quality appraisal tools.

RESULTS

In total, 51 studies were included for analysis. Traditional healing practices included faith-based (spiritual or religious) healing, diviner healing practices and herbal therapies as complementary to other traditional healing types. Objectively measured studies stated that people's mental health improved through collaborative care of traditional healing and biomedical care services. In addition, other subjectively measured studies revealed the effect of traditional healing in improving the mental health status of people. Human rights abuses occur as a result of some traditional practices, including physical abuse, chaining of the patient and restriction of food or fasting or starving patients. Individual, social, traditional healers, biomedical healthcare providers and health system-related factors were identified to accessing traditional healing services.

CONCLUSION

Although there is no conclusive, high-level evidence to support the effectiveness of traditional healing alone in improving mental health status. Moreover, the included studies in this review indicated that traditional healing and biomedical services collaborative care improve people's mental health.

PROSPERO REGISTRATION NUMBER

CRD42023392905.

Model of integrated mental health video consultations for people with depression or anxiety in primary care (PROVIDE-C): assessor masked, multicentre, randomised controlled trial

OBJECTIVE

To evaluate whether an integrated mental health video consultation approach (PROVIDE model) can improve symptoms compared with usual care in adults with depression and anxiety disorders attending primary care.

DESIGN

Assessor masked, multicentre, randomised controlled trial (PROVIDE-C).

SETTING

In 29 primary care practices in Germany, working remotely online from one trial hub.

PARTICIPANTS

376 adults (18-81 years) who presented to their general practitioner (GP) with depression or anxiety, or both.

INTERVENTION

Participants were randomised (1:1) to receive the PROVIDE model (n=187) or usual care (n=189). Usual care was provided by GPs through interventions such as brief counselling and psychotropic medication prescriptions and may or may not have included referrals to mental health specialists. The PROVIDE model comprised transdiagnostic treatment provided through five real-time video sessions between the patient at the primary care practice and a mental health specialist at an offsite location.

MAIN OUTCOME MEASURES

The primary outcome was the absolute change in the mean severity of depressive and anxiety symptoms measured using the patient health questionnaire anxiety and depression scale (PHQ-ADS) at six months, in the intention-to-treat population. Secondary outcomes, measured at six and 12 months, included PHQ-ADS subscores, psychological distress related to somatic symptoms, recovery, health related quality of life, quality and patient centredness of chronic illness care, and adverse events.

RESULTS

Between 24 March 2020 and 23 November 2021, 376 patients were randomised into treatment groups. Mean age was 45 years (standard deviation (SD) 14), 63% of the participants were female, and mean PHQ-ADS-score was 26 points (SD 7.6). Compared with usual care, the PROVIDE intervention led to improvements in severity of depressive and anxiety symptom (adjusted mean change difference in the PHQ-ADS score -2.4 points (95% confidence interval -4.5 to -0.4), P=0.02) at six months. The effects were sustained at 12 months (-2.9 (-5.0 to -0.7), P<0.01). No serious adverse events were reported in either group.

CONCLUSIONS

Through relatively low intensity treatment, the PROVIDE model led to a decrease in depressive and anxiety symptoms with small effects in the short and long term. Depression and anxiety disorders are prevalent and therefore the small effect might cumulatively impact on population health in this population.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04316572.

The Role of Therapists' Attachment and Introject in Their Treatment Process and Outcome: A Systematic Review

Previous reviews have examined empirical evidence of the relationship between therapists' internalized relational models, including therapists' attachment styles and Sullivan's notion of introject, and the therapeutic relationship. This review expands upon previous reviews by examining the effect of therapists' internalized relational models on the treatment process (e.g., therapeutic alliance and countertransference) and treatment outcomes (e.g., symptoms and functioning) more broadly. Our systematic search identified 42 empirical studies measuring therapist's internalized relational models, defined as therapist attachment style (i.e., the way the therapist relates to others) and/or introject (i.e., the way the therapist relates to themselves), in relation to therapy process and outcome, including 35 studies on attachment, nine studies on introject and two that examined both constructs. A rigorous quality assessment was conducted; two studies were rated as 'moderate', and 40 were rated as 'weak' in quality. Based on the study findings, it appears that more securely attached therapists may have stronger working alliances and more positive therapeutic processes with their patients. Contrary to expectations, therapist attachment security does not appear to impact treatment outcomes. Therapists who relate to themselves in a more affirming way may have stronger working alliances and better treatment outcomes, but very few studies have addressed this question thus far. More rigorous research, especially on the effect of therapists' introject, is needed. Therapists may consider the potential impact of their internalized relational models on the working alliance and other treatment processes that influence therapeutic outcomes.

Childhood Trauma Questionnaire-based child maltreatment profiles to predict efficacy of the Cognitive Behavioral Analysis System of Psychotherapy versus non-specific psychotherapy in adults with early-onset chronic depression: cluster analysis of data from a randomised controlled trial

BACKGROUND

Child maltreatment is a broadly confirmed risk factor for mental and physical illness. Some psychological treatments specifically target mental health conditions associated with child maltreatment. For example, the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) focuses on maladaptive interpersonal behaviours in chronic depression. However, how the assessment of child maltreatment could inform personalised treatment is unclear. We used data from a previously published clinical trial to investigate whether a pre-established child maltreatment clustering approach predicts differential outcomes after CBASP versus non-specific supportive psychotherapy in patients with early-onset chronic depression.

METHODS

We did a cluster analysis of data from a previous randomised controlled trial of unmedicated adult outpatients with early-onset chronic depression who were treated at eight university clinics and psychological institutes in Germany with 32 sessions of CBASP or non-specific supportive psychotherapy. Participants were eligible for the original trial if they were aged 18-65 years; had major depressive disorder (MDD) with an early onset and duration of at least 2 years, current MDD superimposed on a pre-existing dysthymic disorder, or recurrent MDD with incomplete remission between episodes as defined by DSM-IV; and had a score of at least 20 points on the 24-item Hamilton Rating Scale for Depression (HRSD-24). Participants were included in the current study if they had completed the short form of the Childhood Trauma Questionnaire (CTQ) at trial baseline. We used an agglomerative hierarchical clustering approach to derive child maltreatment clusters from individual patterns across the five domains of the CTQ. We used linear mixed models to investigate whether clustering could predict differential clinical outcomes (change in symptom severity on the HRSD-24) up to 2 years after treatment onset. People with lived experience were involved in the current study.

FINDINGS

253 patients (129 [51%] treated with CBASP and 124 [49%] with supportive psychotherapy) had complete CTQ records and were included in the analysis. 169 (67%) participants were women, 84 (33%) were men, and the mean age was 45·9 years (SD 11·7). We identified seven child maltreatment clusters and found significant differences in treatment effects of CBASP and supportive psychotherapy between the clusters (F(6,948·76)=2·47; p=0·023); differences were maintained over the 2-year follow-up. CBASP was superior in distinct clusters of co-occurring child maltreatment: predominant emotional neglect (change in β -6·02 [95% CI -11·9 to -0·13]; Cohen's d=-0·98 [95% CI -1·94 to -0·02]; p=0·045), predominant emotional neglect and abuse (-6·39 [-10·22 to -2·56]; -1·04 [-1·67 to -0·42]; p=0·0011), and emotional neglect and emotional and physical abuse (-9·41 [-15·91 to -2·91]; -1·54 [-2·6 to -0·47]; p=0·0046).

INTERPRETATION

CTQ-based cluster analysis can facilitate identification of patients with early-onset chronic depression who would specifically benefit from CBASP. Child maltreatment clusters could be implemented in clinical assessments and serve to develop and personalise trauma-informed care in mental health.

FUNDING

The German Research Foundation and the German Federal Ministry of Education and Research.

Drug development in psychopharmacology: Insights from evolutionary psychiatry

In the last decade, no other branch of clinical pharmacology has been subject to as much criticism of failed innovation and unsatisfactory effectiveness as psychopharmacology. Evolutionary psychiatry can offer original insights on the problems that complicate pharmacological research. Considering that invalid phenotyping is a major obstacle to drug development, an evolutionary perspective suggests targeting clinical phenotypes related to evolved behavior systems because they are more likely to map onto the underlying biology than constructs based on predetermined diagnostic criteria. Because of their emphasis on symptom remission, pharmacological studies of psychiatric populations rarely include functional capacities as the primary outcome measure and neglect the impact of social context on the effects of psychiatric drugs. Evolutionary psychiatry explains why it is appropriate to replace symptoms with functional capacities as the primary target of psychiatric therapies and why social context should be a major focus of studies assessing the effectiveness of drugs currently used and new drugs under development. When the focus of research shifts to those questions that go beyond the "disease-based" concept of drug action, evolutionary psychiatry clearly emerges as a reference framework to assess drug effectiveness and to optimize clinicians' decisions about prescribing, deprescribing, and non-prescribing.

A consulting room with a view: Psychotherapy and the ecological context

BACKGROUND

The field of psychotherapy is witnessing a lively debate today. The literature on the efficacy of psychological interventions has grown exponentially, but the assumptions of the prevailing research paradigms have been criticised from many points of view. One of the main concerns is that of a too often simplistic conception of psychotherapy, viewed as a set of specific methods for the treatment of point-like problems or symptoms.

LITERATURE REVIEW ON MENTAL HEALTH AND THE ECOLOGICAL CONTEXT

Instead, emerging perspectives are trying to promote a more complex view on psychotherapy, as a process based on the therapeutic potential of relationships, which takes place in relevant social and cultural contexts. Even the ecological context is taken in greater consideration, as growing evidence exists about the detrimental effects of ecological threats-such as climate change and other environmental challenges-on mental health.

CONCLUSIONS

Psychotherapists and psychotherapy associations are now paying due attention to such issues, as well as to social justice and other dimensions that no longer can be thought of as mere elements of the scenario in which psychotherapy is practiced. Rather they are dimensions that exert a strong influence on psychological well-being, and thus must be properly acknowledged and assessed to connect clinical work with the communities and ecological contexts in which people live.

Facing the Next "Geriatric Giant"-A Systematic Literature Review and Meta-Analysis of Interventions Tackling Loneliness and Social Isolation Among Older Adults

OBJECTIVES

Loneliness and social isolation are associated with adverse health outcomes, especially within the older adult population, underlining the need for effective interventions. This systematic review and meta-analysis aims to summarize all available evidence regarding the effectiveness of interventions for loneliness and social isolation, to map out their working mechanisms, and to give implications for policy and practice.

DESIGN

Systematic literature review and meta-analysis.

SETTING AND PARTICIPANTS

Older adults (≥65 years).

METHODS

A systematic search was conducted in MEDLINE, PsycINFO, and CINAHL for studies quantitively or qualitatively assessing effects of interventions for loneliness and social isolation in older adults, following predefined selection criteria. Risk of bias as well as small study effects were assessed and, wherever appropriate, information about effect sizes of individual studies pooled using random-effects meta-analyses. Sources for between-study heterogeneity were explored using meta-regression.

RESULTS

Of n = 2223 identified articles, n = 67 were eventually included for narrative synthesis. Significant intervention effects were reported for a proportion of studies (55.9% and 50.0% for loneliness and social isolation, respectively) and 57.6% of studies including a follow-up measure (n = 29) reported sustained intervention effects. Meta-analysis of n = 27 studies, representing n = 1756 participants, suggested a medium overall effect of loneliness interventions (d = -0.47; 95% CI, -0.62 to -0.32). Between-study heterogeneity was substantial and could not be explained by differences in study design, year of publication, outcome measures, intervention length, participant demographics, setting, baseline level of loneliness, or geographic location. However, non-technology-based interventions reported larger effect sizes on average (Δd = -0.35; 95% CI, -0.66 to -0.04; P = .029) and were more often significant. Qualitative assessment of potential intervention mechanisms resulted in 3 clusters of effective components: "promoting social contact," "transferring knowledge and skills," and "addressing social cognition".

CONCLUSIONS AND IMPLICATIONS

Interventions for loneliness and social isolation can generally be effective, although some unexplained between-study heterogeneity remains. Further research is needed regarding the applicability of interventions across different settings and countries, also considering their cost-effectiveness.

10-year outcome trajectories of people with mental illness and their families who receive services from multidisciplinary case management and outreach teams: protocol of a multisite longitudinal study

INTRODUCTION

Individuals with mental illness and their families often undergo their recovery process in their communities. This study explored the long-term outcome trajectories of individuals and families who received case management services provided by multidisciplinary outreach teams in a community setting. The primary objective of this study was to determine whether trajectories of subjective quality of life (QoL) related to personal recovery were linked to those clinical and societal outcomes and changes in outreach service frequency.

METHODS AND ANALYSIS

The protocol of this 10-year multisite cohort study was collaboratively developed with individuals with lived experience of psychiatric disorders who had received services from participating outreach teams, and with family members in Japanese family associations. The participants in the study include patients and their key family members who receive services from 23 participating multidisciplinary outreach teams. The participant recruitment period is set from 1 October 2023 to 30 September 2025. If necessary, the recruitment period may be extended and the number of participating teams may be increased. The study will annually evaluate the following outcomes after participants' initial utilisation of services from each team: QoL related to personal recovery, personal agency, feelings of loneliness, well-being and symptom and functional assessments. The family outcomes encompass QoL, well-being, care burden and family relationships. Several meetings will be held to monitor progress and manage issues during the study. Multivariate analyses with repeated measures will be performed to investigate factors influencing changes in the patients' QoL scores as the dependent variable.

ETHICS AND DISSEMINATION

The study protocol was approved by the ethical committee of the National Center of Neurology and Psychiatry (no. A2023-065). The study findings will be reported in peer-reviewed publications and presented at relevant scientific conferences.

TRIAL REGISTRATION NUMBER

UMIN-CTR, No. UMIN000052275.

Individualized EEG-Based Neurofeedback Targeting Auditory Steady-State Responses: A Proof-of-Concept Study

Gamma-band (> 30 Hz) brain oscillatory activity is linked with sensory and cognitive processes and exhibits abnormalities in neuropsychiatric disorders. Therefore, neuromodulation techniques targeting gamma activity are being developed. One promising approach is neurofeedback (NFB) which is based on the alteration of brain responses via online feedback. However, the existing gamma-based NFB systems lack individualized approach. In the present work, we developed and tested an individualized EEG-NFB system. 46 healthy volunteers participated in three sessions on separate days. Before NFB training, individual gamma frequency (IGF) was estimated using chirp-modulated auditory stimulation (30-60 Hz). Participants were subjected to IGF-increase (if IGF was ≤ 45 Hz) or IGF-decrease conditions (if IGF was > 45 Hz). Gamma-band responses were targeted during NFB training, in which participants received auditory steady-state stimulation at frequency slightly above or below IGF and were instructed to try to increase their response while receiving real-time visual feedback. Each time a pre-defined response goal was reached, stimulation frequency was either increased or decreased. After training, IGF was reassessed. Experimental group participants were divided into equal groups based on the median success rate during NFB training. The results showed that high-responders had a significantly higher IGF modulation compared to control group, while low-responders did not differ from controls. No differences in IGF modulation were found between sessions and between NFB repetitions in all participant groups. The initial evaluation of the proposed EEG-NFB system showed potential to modulate IGF. Future studies could investigate longer-lasting electrophysiological and behavioural effects of the application of ASSR/IGF-based NFB system in clinical populations.

Living beings, coevolution and psychotherapy: The legacy of Humberto Maturana

Recently died at the age of 92, Humberto Maturana has exerted a deep influence on the field of psychotherapy. Systemic and cognitive‐constructivist approaches are those that mostly—or more explicitly—have absorbed his theories, but in a wider perspective, all the field could benefit from the rediscovery of such a significant scientific background. Building on some of the main themes of Maturana's research and theories—such as autopoiesis, structural coupling and consensual domains of knowledge—the present article aims at discussing some of the most topical implications for psychotherapy today. A special focus is placed on how some crucial findings of the research on psychotherapy process and outcomes could be better understood considering Maturana's teachings and on the role of psychotherapy in our social and cultural worlds.

Status and trends of TMS research in depressive disorder: a bibliometric and visual analysis

Background

Depression is a chronic psychiatric condition that places significant burdens on individuals, families, and societies. The rapid evolution of non-invasive brain stimulation techniques has facilitated the extensive clinical use of Transcranial Magnetic Stimulation (TMS) for depression treatment. In light of the substantial recent increase in related research, this study aims to employ bibliometric methods to systematically review the global research status and trends of TMS in depression, providing a reference and guiding future studies in this field.

Methods

We retrieved literature on TMS and depression published between 1999 and 2023 from the Science Citation Index Expanded (SCIE) and Social Science Citation Index (SSCI) databases within the Web of Science Core Collection (WoSCC). Bibliometric analysis was performed using VOSviewer and CiteSpace software to analyze data on countries, institutions, authors, journals, keywords, citations, and to generate visual maps.

Results

A total of 5,046 publications were extracted covering the period from 1999 to 2023 in the field of TMS and depression. The publication output exhibited an overall exponential growth trend. These articles were published across 804 different journals, BRAIN STIMULATION is the platform that receives the most articles in this area. The literature involved contributions from over 16,000 authors affiliated with 4,573 institutions across 77 countries. The United States contributed the largest number of publications, with the University of Toronto and Daskalakis ZJ leading as the most prolific institution and author, respectively. Keywords such as "Default Mode Network," "Functional Connectivity," and "Theta Burst" have recently garnered significant attention. Research in this field primarily focuses on TMS stimulation patterns, their therapeutic efficacy and safety, brain region and network mechanisms under combined brain imaging technologies, and the modulation effects of TMS on brain-derived neurotrophic factor (BDNF) and neurotransmitter levels.

Conclusion

In recent years, TMS therapy has demonstrated extensive potential applications and significant implications for the treatment of depression. Research in the field of TMS for depression has achieved notable progress. Particularly, the development of novel TMS stimulation patterns and the integration of TMS therapy with multimodal techniques and machine learning algorithms for precision treatment and investigation of brain network mechanisms have emerged as current research hotspots.

Prevalence of anxiety, depression, sleeping problems, cognitive impairment, and suicidal ideation in people with autoimmune skin diseases

BACKGROUND

Autoimmune skin diseases (ASDs) such as psoriasis and vitiligo, in addition to causing visible skin symptoms, are closely associated with psychological health issues. However, a comprehensive understanding of the prevalence of these psychological comorbidities in affected individuals is lacking. This study aims to identify the prevalence of anxiety, depression, sleeping problems, cognitive impairment, and suicidal ideation in people with ASDs.

METHOD

PubMed, MEDLINE, Web of Science, and Cochrane Library searches were conducted from 1993 to May 2024. Observational studies reporting prevalence data for anxiety, depression, sleeping problems, cognitive impairment, and suicidal ideation among people with ASDs were included in the analysis. The Newcastle-Ottawa scale was used to evaluate the quality of studies.

RESULTS

The study included 114 studies from 37 countries including 823,975 participants. The estimated pooled prevalence of anxiety in patients with ASDs was 33.3% (95% CI: 27.3-29.3%). The estimated pooled prevalence of depression was 33.7% (95% CI: 29.2-38.1%). The estimated pooled prevalence of sleeping problems was 45.0% (95% CI:31.6-58.4%). The estimated pooled prevalence of cognitive impairment and suicidal ideation was 30.8% (95% CI:15.0-46.7%) and 21.6% (95% CI:13.4-29.8%), respectively. The most common mental disorder in patients with systemic lupus erythematosus and psoriasis was sleeping problems at 55.9% (95% CI: 35.6-76.1%, I2 = 97%) and 39.0% (95% CI: 21.1-56.9%, I2 = 99%).

CONCLUSION

Among patients with ASDs, anxiety, depression, sleeping problems, cognitive impairment, and suicidal ideation were common. The most prevalent mental disorder among patients with systemic lupus erythematosus and psoriasis was sleeping problems. Those with ASDs may experience considerable psychological burdens, and integrated mental health support is necessary for their treatment.

Nominating novel proteins for anxiety via integrating human brain proteomes and genome-wide association study

BACKGROUND

The underlying pathogenesis of anxiety remain elusive, making the pinpointing of potential therapeutic and diagnostic biomarkers for anxiety paramount to its efficient treatment.

METHODS

We undertook a proteome-wide association study (PWAS), fusing human brain proteomes from both discovery (ROS/MAP; N = 376) and validation cohorts (Banner; N = 152) with anxiety genome-wide association study (GWAS) summary statistics. Complementing this, we executed transcriptome-wide association studies (TWAS) leveraging human brain transcriptomic data from the Common Mind Consortium (CMC) to discern the confluence of genetic influences spanning both proteomic and transcriptomic levels. We further scrutinized significant genes through a suite of methodologies.

RESULTS

We discerned 14 genes instrumental in the genesis of anxiety through their specific cis-regulated brain protein abundance. Out of these, 6 were corroborated in the confirmatory PWAS, with 4 also showing associations with anxiety via their cis-regulated brain mRNA levels. A heightened confidence level was attributed to 5 genes (RAB27B, CCDC92, BTN2A1, TMEM106B, and DOC2A), taking into account corroborative evidence from both the confirmatory PWAS and TWAS, coupled with insights from mendelian randomization analysis and colocalization evaluations. A majority of the identified genes manifest in brain regions intricately linked to anxiety and predominantly partake in lysosomal metabolic processes.

LIMITATIONS

The limited scope of the brain proteome reference datasets, stemming from a relatively modest sample size, potentially curtails our grasp on the entire gamut of genetic effects.

CONCLUSION

The genes pinpointed in our research present a promising groundwork for crafting therapeutic interventions and diagnostic tools for anxiety.

The absurdity of the latent disease model in mental health: 10,130,814 ways to have a DSM-5-TR psychological disorder

BACKGROUND

Latent disease classification is currently the accepted approach to mental illness diagnosis. In the United States, this takes the form of the Diagnostic and Statistical Manual of Mental Disorders-5-Text Revision (DSM-5-TR). Latent disease classification has been criticized for reliability and validity problems, particularly regarding diagnostic heterogeneity. No authors have calculated the scope of the heterogeneity problem of the entire DSM-5-TR.

AIMS

We addressed this issue by calculating the unique diagnostic profiles that exist for every DSM-5-TR diagnosis.

METHODS

We did this by applying formulas previously used in smaller heterogeneity analyses to all diagnoses within the DSM-5-TR.

RESULTS

We found that there are 10,130,814 ways to be diagnosed with a mental illness using DSM-5-TR criteria. When specifiers are considered, this number balloons to over 161 septillion unique diagnostic presentations (driven mainly by bipolar II disorder). Additionally, there are 1,951,065 ways to present with psychiatric symptoms, yet not meet diagnostic criteria.

CONCLUSIONS

Latent disease classification leads to considerable heterogeneity in possible presentations. We provide examples of how latent disease classification harms research and treatment programs. We echo recommendations for the dismissal of latent disease classification as a mental illness diagnostic program.

Assessing the effectiveness of internet-based interventions for mental health outcomes: an umbrella review

Internet-based interventions (IBIs) for behavioural health have been prevalent for over two decades, and a growing proportion of individuals with mental health concerns prefer these emerging digital alternatives. However, the effectiveness and acceptability of IBIs for various mental health disorders continue to be subject to scholarly debate. We performed an umbrella review of meta-analyses (MAs), conducting literature searches in PubMed, Web of Science, Embase, Cochrane and Ovid Medline from their inception to 17 January 2023. A total of 87 MAs, reporting on 1683 randomised controlled trials and 295 589 patients, were included. The results indicated that IBIs had a moderate effect on anxiety disorder (standardised mean difference (SMD)=0.53, 95% CI 0.44 to 0.62) and post-traumatic stress disorder (PTSD) (SMD=0.63, 95% CI 0.38 to 0.89). In contrast, the efficacy on depression (SMD=0.45, 95% CI 0.39 to 0.52), addiction (SMD=0.23, 95% CI 0.16 to 0.31), suicidal ideation (SMD=0.23, 95% CI 0.16 to 0.30), stress (SMD=0.41, 95% CI 0.33 to 0.48) and obsessive-compulsive disorder (SMD=0.47, 95% CI 0.22 to 0.73) was relatively small. However, no significant effects were observed for personality disorders (SMD=0.07, 95% CI -0.13 to 0.26). Our findings suggest a significant association between IBIs and improved mental health outcomes, with particular effectiveness noted in treating anxiety disorders and PTSD. However, it is noteworthy that the effectiveness of IBIs was impacted by high dropout rates during treatment. Furthermore, our results indicated that guided IBIs proved to be more effective than unguided ones, playing a positive role in reducing dropout rates and enhancing patient adherence rates. PROSPERO registration number: CRD42023417366.