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Caredda M, Vescera L, Picardi A, Tarolla E, Pancheri C, Biondi M, Tondo L. Positive psychological functioning, resilience and styles of coping as buffers against suicidal behaviours. A case-control study. J Affect Disord 2024:S0165-0327(24)01463-0. [PMID: 39226939 DOI: 10.1016/j.jad.2024.08.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 08/22/2024] [Accepted: 08/31/2024] [Indexed: 09/05/2024]
Abstract
BACKGROUND Studies in the literature mainly focus on understanding the risk factors for suicide, giving little relevance to protective variables. This study aimed at exploring the specific contribution of protective variables (resilience, coping and psychological well-being) in hospitalized suicide attempt (SA) makers. METHODS We recruited 50 inpatients who made a SA before admission and 50 inpatients with no history of SA matched for DSM-5 diagnosis, gender and age. Protective variables were evaluated with: Brief COPE questionnaire, Dispositional Resilience Scale (DRS-15), Psychological Well-Being Scale (PWB-18). Psychopathological features and symptom severity were assessed with: Global Assessment of Functioning Scale (GAF), Rapid Dimensional Assessment Scale (SVARAD), Brief Psychiatric Rating Scale (BPRS), Clinical Global Impressions (CGI), Hamilton Depression Rating Scale (HDRS17). RESULTS The DRS-15 total score was significantly lower in SA makers. SA makers displayed significantly lower scores on the Engagement and Cognitive Restructuring subscales of the Brief COPE. On the PWB-18, the Self-Acceptance subscale score was lower in SA makers. LIMITATIONS The small sample size suggests the need for caution in interpreting the results. Matching was carried out by excluding diagnoses of personality disorders. CONCLUSIONS Patients hospitalized following a SA are more often diagnosed with personality disorders, have deficit areas concerning resilience and coping, and lower psychological well-being compared to patients without a SA. When approaching a patient who has committed a SA, it may be useful to evaluate protective variables as well as risk factors, and encourage the development of adaptive coping mechanisms and positive self-evaluation through more dynamic therapeutic paths.
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Affiliation(s)
- Maria Caredda
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Italy
| | - Loris Vescera
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Italy; Department of Mental Health, Rome 2 Local Health Unit, Italy
| | - Angelo Picardi
- Centre for Behavioural Sciences and Mental Health, Italian National Institute of Health, Rome, Italy
| | | | - Corinna Pancheri
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Italy; Department of Mental Health, Rome 1 Local Health Unit, Italy.
| | - Massimo Biondi
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Italy
| | - Leonardo Tondo
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; International Consortium for Mood & Psychotic Disorder Research, McLean Hospital, Belmont, MA, USA; Lucio Bini Mood Disorder Centers, Cagliari and Rome, Italy
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2
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Fiorindi C, Giudici F, Testa GD, Foti L, Romanazzo S, Tognozzi C, Mansueto G, Scaringi S, Cuffaro F, Nannoni A, Soop M, Baldini G. Multimodal Prehabilitation for Patients with Crohn's Disease Scheduled for Major Surgery: A Narrative Review. Nutrients 2024; 16:1783. [PMID: 38892714 PMCID: PMC11174506 DOI: 10.3390/nu16111783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/25/2024] [Accepted: 06/05/2024] [Indexed: 06/21/2024] Open
Abstract
Approximately 15-50% of patients with Crohn's disease (CD) will require surgery within ten years following the diagnosis. The management of modifiable risk factors before surgery is essential to reduce postoperative complications and to promote a better postoperative recovery. Preoperative malnutrition reduced functional capacity, sarcopenia, immunosuppressive medications, anemia, and psychological distress are frequently present in CD patients. Multimodal prehabilitation consists of nutritional, functional, medical, and psychological interventions implemented before surgery, aiming at optimizing preoperative status and improve postoperative recovery. Currently, studies evaluating the effect of multimodal prehabilitation on postoperative outcomes specifically in CD are lacking. Some studies have investigated the effect of a single prehabilitation intervention, of which nutritional optimization is the most investigated. The aim of this narrative review is to present the physiologic rationale supporting multimodal surgical prehabilitation in CD patients waiting for surgery, and to describe its main components to facilitate their adoption in the preoperative standard of care.
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Affiliation(s)
- Camilla Fiorindi
- Department of Health Science, University of Firenze, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy; (S.R.); (C.T.); (G.M.); (F.C.); (A.N.); (G.B.)
- Multimodal Prehabilitation Center, Azienda Ospedaliera Universitaria Careggi, Largo Brambilla 6, 50135 Florence, Italy; (G.D.T.); (L.F.)
| | - Francesco Giudici
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 6, 50135 Florence, Italy; (F.G.); (S.S.)
| | - Giuseppe Dario Testa
- Multimodal Prehabilitation Center, Azienda Ospedaliera Universitaria Careggi, Largo Brambilla 6, 50135 Florence, Italy; (G.D.T.); (L.F.)
- Division of Geriatric and Intensive Care Medicine, University of Florence, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy
| | - Lorenzo Foti
- Multimodal Prehabilitation Center, Azienda Ospedaliera Universitaria Careggi, Largo Brambilla 6, 50135 Florence, Italy; (G.D.T.); (L.F.)
- Section of Anesthesiology and Intensive Care, University of Florence, Largo Brambilla 3, 50139 Florence, Italy
| | - Sara Romanazzo
- Department of Health Science, University of Firenze, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy; (S.R.); (C.T.); (G.M.); (F.C.); (A.N.); (G.B.)
- Multimodal Prehabilitation Center, Azienda Ospedaliera Universitaria Careggi, Largo Brambilla 6, 50135 Florence, Italy; (G.D.T.); (L.F.)
| | - Cristina Tognozzi
- Department of Health Science, University of Firenze, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy; (S.R.); (C.T.); (G.M.); (F.C.); (A.N.); (G.B.)
- Multimodal Prehabilitation Center, Azienda Ospedaliera Universitaria Careggi, Largo Brambilla 6, 50135 Florence, Italy; (G.D.T.); (L.F.)
| | - Giovanni Mansueto
- Department of Health Science, University of Firenze, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy; (S.R.); (C.T.); (G.M.); (F.C.); (A.N.); (G.B.)
- Multimodal Prehabilitation Center, Azienda Ospedaliera Universitaria Careggi, Largo Brambilla 6, 50135 Florence, Italy; (G.D.T.); (L.F.)
| | - Stefano Scaringi
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 6, 50135 Florence, Italy; (F.G.); (S.S.)
| | - Francesca Cuffaro
- Department of Health Science, University of Firenze, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy; (S.R.); (C.T.); (G.M.); (F.C.); (A.N.); (G.B.)
| | - Anita Nannoni
- Department of Health Science, University of Firenze, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy; (S.R.); (C.T.); (G.M.); (F.C.); (A.N.); (G.B.)
| | - Mattias Soop
- Department for IBD and Intestinal Failure Surgery, Karolinska University Hospital, SE 177 76 Stockholm, Sweden;
| | - Gabriele Baldini
- Department of Health Science, University of Firenze, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy; (S.R.); (C.T.); (G.M.); (F.C.); (A.N.); (G.B.)
- Multimodal Prehabilitation Center, Azienda Ospedaliera Universitaria Careggi, Largo Brambilla 6, 50135 Florence, Italy; (G.D.T.); (L.F.)
- Section of Anesthesiology and Intensive Care, University of Florence, Largo Brambilla 3, 50139 Florence, Italy
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Olivero A, Cuniberti F, Leombruni P. Well-Being Therapy for Fibromyalgia: A Case Report. J Nerv Ment Dis 2024; 212:352-357. [PMID: 38810099 DOI: 10.1097/nmd.0000000000001773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
ABSTRACT Fibromyalgia syndrome (FMS) is characterized by chronic widespread pain, fatigue, anxiety, depression, and sleep disturbances, significantly impairing quality of life and psychological well-being. Well-being therapy (WBT) is a brief psychotherapeutic intervention aimed at increasing well-being and optimizing functioning, which has proven effective in treating various conditions involving pain and psychological or psychiatric symptoms. We describe a case study of a 22-year-old university student experiencing FMS, highlighting the far-reaching effects of the condition on her quality of life. After eight sessions of WBT, there was a marked improvement in subjective well-being and euthymia, as well as a decrease in pain perception, improved ability to manage stress, reduced allostatic overload despite the presence of stressors, improved social relationships, and increased self-efficacy. The positive effects of WBT continued at 3-month follow-up, suggesting that WBT may represent a short-term effective intervention for patients with FMS.
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Affiliation(s)
- Alberto Olivero
- "Rita Levi Montalcini" Department of Neuroscience, Università degli Studi di Torino, Torino, Italy
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Muzi L, Carone N, Mirabella M, Franco A, Rugo MA, Mazzeschi C, Lingiardi V. Direct and indirect effects of psychological well-being and therapeutic alliance on therapy outcome in eating disorders. Front Psychol 2024; 15:1392887. [PMID: 38855305 PMCID: PMC11162114 DOI: 10.3389/fpsyg.2024.1392887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/13/2024] [Indexed: 06/11/2024] Open
Abstract
Introduction Outcome research in eating disorders (EDs) is commonly focused on psychopathological dysfunction. However, Ryff's model of psychological well-being (PWB) has shown promising-yet preliminary-results with ED patients. Additionally, despite substantial evidence highlighting the association between the therapeutic alliance and treatment outcome, findings in ED samples remain unclear. The present study aimed at exploring the direct effect of PWB dimensions and the early therapeutic alliance on ED patients' individual treatment responses, as well as the mediating role played by the early therapeutic alliance in the relationship between PWB dimensions and overall pre-post symptom change. Methods A sample of N = 165 ED patients assigned female at birth, who were receiving treatment in a residential program, completed the Psychological Well-Being Scale at treatment intake and the Working Alliance Inventory after the first four psychotherapy sessions. Patients also completed the Outcome Questionnaire-45.2 at the same time point and during the week prior to discharge. Results The PWB dimensions of autonomy, positive relations, and self-acceptance were associated with clinically significant change, while the dimensions of personal growth and self-acceptance were associated with reliable change. The early therapeutic alliance showed both direct and indirect effects on therapy outcome, predicting clinically significant and reliable symptom reduction. It also emerged as a significant mediator in the relationship between all PWB dimensions and overall symptomatic change. Conclusion The identification of individual, adaptive characteristics in ED patients that might influence their development of an early therapeutic alliance may help therapists to predict relationship ruptures and tailor their interventions to enhance treatment effectiveness.
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Affiliation(s)
- Laura Muzi
- Department of Philosophy, Social Sciences, Humanities and Education, University of Perugia, Perugia, Italy
| | - Nicola Carone
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Marta Mirabella
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Anna Franco
- Eating Disorder Clinic “Residenza Gruber”, Bologna, Italy
| | | | - Claudia Mazzeschi
- Department of Philosophy, Social Sciences, Humanities and Education, University of Perugia, Perugia, Italy
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
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Burns RA, Windsor T, Butterworth P, Anstey KJ. The protective effects of wellbeing and flourishing on long-term mental health risk. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2021.100052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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The impulsiveness level influences the salivary cortisol response and social stress sensitivity in suicidal patients. J Psychiatr Res 2022; 156:159-167. [PMID: 36252345 DOI: 10.1016/j.jpsychires.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 08/06/2022] [Accepted: 10/03/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Suicide attempters (SA) are more vulnerable to social stress and show disturbed cortisol response in stressful conditions compared with psychiatric and healthy controls. Recent data suggest that this dysregulation might be related to impulsivity traits. However, little is known about the emotional consequences of social stress in SA exposed to stress. OBJECTIVES The aim of our study was to evaluate the cortisol and emotional responses to social stress in patients with depression with and without suicide attempt, by taking into account impulsivity traits and depression severity. METHODS 67 adult women (41 SA and 26 affective controls (AC,i.e. without suicide attempt history)) with lifetime history of major depressive episode were included. Patients performed the Trier Social Stress Test (TSST), a well-validated social stress task. Patients provided seven saliva samples, to measure the cortisol response, and filled in questionnaires to assess psychological pain, positive and negative mood, and anxiety at different time points (from 10 min before to 120 min after the TSST). Moderated regression models were used including suicide attempt history, depression severity, and impulsivity as independent variables and their interactions. RESULTS In patients with low depression and high impulsivity, salivary cortisol response during the TSST was higher in SA than in AC (p < .001). Psychological pain, negative mood, and anxiety were increased in all patients just after the TSST, followed by a decrease at 120 min. Positive mood recovery was slower in SA, and in patients with high impulsivity and low depression level (p < .001). CONCLUSIONS Impulsivity traits have an important role in suicidal vulnerability in stress conditions. Impulsivity traits might help to differentiate patients at risk of suicide who are highly sensitive to stress when depression level is low. Higher impulsiveness may increase the sensitivity to emotional distress that translates into inadequate physiological responses.
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Abstract
BACKGROUND Mental pain has been proposed as a global person-centered outcome measure. The aim of this cross-sectional study was to test an essential requisite of such a measure, namely that mental pain incorporates independent contributions from a range of discrete but disparate outcome measures. METHODS Two hundred migraine patients were assessed concerning migraine disability, psychosomatic syndromes, mental pain, depression, anxiety, and psychosocial dimensions. General linear models were tested to verify which measures would individually make unique contributions to overall mental pain. RESULTS The final model, accounting for 44% of variance, identified that higher mental pain was associated with more severe depressive symptoms, higher migraine disability, lower well-being, and poorer quality of life. CONCLUSION In this sample, mental pain was shown to behave as expected of a global outcome measure, since multiple measures of symptomatology and quality of life showed modest but significant bivariate correlations with mental pain and some of these measures individually made unique contributions to overall mental pain.
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Farb NAS, Desormeau P, Anderson AK, Segal ZV. Static and treatment-responsive brain biomarkers of depression relapse vulnerability following prophylactic psychotherapy: Evidence from a randomized control trial. Neuroimage Clin 2022; 34:102969. [PMID: 35367955 PMCID: PMC8978278 DOI: 10.1016/j.nicl.2022.102969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 01/18/2022] [Accepted: 02/17/2022] [Indexed: 12/18/2022]
Abstract
A prospective study of neural biomarkers of relapse in remitted depressed patients. Assessed neural response to dysphoric mood-induction before and after psychotherapy. Relapse over a 2-year follow-up linked to dysphoria-evoked sensory inhibition. Relapse risk was lower when dorsolateral prefrontal reactivity decreased over time. Depression prophylaxis may involve reducing dysphoria-evoked sensory inhibition.
Background Neural reactivity to dysphoric mood induction indexes the tendency for distress to promote cognitive reactivity and sensory avoidance. Linking these responses to illness prognosis following recovery from Major Depressive Disorder informs our understanding of depression vulnerability and provides engagement targets for prophylactic interventions. Methods A prospective fMRI neuroimaging design investigated the relationship between dysphoric reactivity and relapse following prophylactic intervention. Remitted depressed outpatients (N = 85) were randomized to 8 weeks of Cognitive Therapy with a Well-Being focus or Mindfulness Based Cognitive Therapy. Participants were assessed before and after therapy and followed for 2 years to assess relapse status. Neural reactivity common to both assessment points identified static biomarkers of relapse, whereas reactivity change identified dynamic biomarkers. Results Dysphoric mood induction evoked prefrontal activation and sensory deactivation. Controlling for past episodes, concurrent symptoms and medication status, somatosensory deactivation was associated with depression recurrence in a static pattern that was unaffected by prophylactic treatment, HR 0.04, 95% CI [0.01, 0.14], p < .001. Treatment-related prophylaxis was linked to reduced activation of the left lateral prefrontal cortex (LPFC), HR 3.73, 95% CI [1.33, 10.46], p = .013. Contralaterally, the right LPFC showed dysphoria-evoked inhibitory connectivity with the right somatosensory biomarker Conclusions These findings support a two-factor model of depression relapse vulnerability, in which: enduring patterns of dysphoria-evoked sensory deactivation contribute to episode return, but vulnerability may be mitigated by targeting prefrontal regions responsive to clinical intervention. Emotion regulation during illness remission may be enhanced by reducing prefrontal cognitive processes in favor of sensory representation and integration.
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Affiliation(s)
- Norman A S Farb
- Department of Psychology, University of Toronto Mississauga, 3359 Mississauga Road, Mississauga, Ontario L5L 1C6, Canada; Graduate Department of Psychological Clinical Science, University of Toronto Scarborough, 1265 Military Trail, Toronto, ON M1C 1A4, Canada.
| | - Philip Desormeau
- Graduate Department of Psychological Clinical Science, University of Toronto Scarborough, 1265 Military Trail, Toronto, ON M1C 1A4, Canada
| | - Adam K Anderson
- College of Human Ecology, Cornell University, Ithaca, NY 14853, USA
| | - Zindel V Segal
- Graduate Department of Psychological Clinical Science, University of Toronto Scarborough, 1265 Military Trail, Toronto, ON M1C 1A4, Canada
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Fassnacht DB, Ali K, van Agteren J, Iasiello M, Mavrangelos T, Furber G, Kyrios M. A Group-Facilitated, Internet-Based Intervention to Promote Mental Health and Well-Being in a Vulnerable Population of University Students: Randomized Controlled Trial of the Be Well Plan Program. JMIR Ment Health 2022; 9:e37292. [PMID: 35471196 PMCID: PMC9084447 DOI: 10.2196/37292] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/15/2022] [Accepted: 03/31/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND A growing literature supports the use of internet-based interventions to improve mental health outcomes. However, most programs target specific symptoms or participant groups and are not tailored to facilitate improvements in mental health and well-being or do not allow for needs and preferences of individual participants. The Be Well Plan, a 5-week group-facilitated, internet-based mental health and well-being group intervention addresses these gaps, allowing participants to select a range of activities that they can tailor to their specific characteristics, needs, and preferences. OBJECTIVE This study aims to test whether the Be Well Plan program was effective in improving primary outcomes of mental well-being, resilience, anxiety, and depression compared to a waitlist control group during the COVID-19 pandemic; secondary outcomes included self-efficacy, a sense of control, and cognitive flexibility. The study further seeks to examine participants' engagement and satisfaction with the program. METHODS A randomized controlled trial (RCT) was conducted with 2 parallel arms, an intervention and a waitlist control group. The intervention involved 5 weekly 2-hour sessions, which were facilitated in group format using Zoom videoconferencing software. University students were recruited via social media posts, lectures, emails, flyers, and posters. RESULTS Using an intentional randomization 2:1 allocation strategy, we recruited 215 participants to the trial (n=126, 58.6%, intervention group; n=89, 41.4%, waitlist control group). Of the 126 participants assigned to the intervention group, 75 (59.5%) commenced the program and were included in modified intention-to-treat (mITT) analyses. mITT intervention participants attended, on average, 3.41 sessions (SD 1.56, median 4); 55 (73.3%) attended at least 4 sessions, and 25 (33.3%) attended all 5 sessions. Of the 49 intervention group participants who completed the postintervention assessment, 47 (95.9%) were either very satisfied (n=31, 66%) or satisfied (n=16, 34%). The mITT analysis for well-being (F1,162=9.65, P=.002, Cohen d=0.48) and resilience (F1,162=7.85, P=.006, Cohen d=0.44) showed significant time × group interaction effects, suggesting that both groups improved over time, but the Be Well Plan (intervention) group showed significantly greater improvement compared to the waitlist control group. A similar pattern of results was observed for depression and anxiety (Cohen d=0.32 and 0.37, respectively), as well as the secondary outcomes (self-efficacy, Cohen d=0.50; sense of control, Cohen d=0.42; cognitive flexibility, Cohen d=0.65). Larger effect sizes were observed in the completer analyses. Reliable change analysis showed that the majority of mITT participants (58/75, 77.3%) demonstrated a significant reliable improvement in at least 1 of the primary outcomes. CONCLUSIONS The Be Well Plan program was effective in improving mental health and well-being, including mental well-being, resilience, depression, and anxiety. Participant satisfaction scores and attendance indicated a high degree of engagement and satisfaction with the program. TRIAL REGISTRATION Australian New Zealand Clinical Trial Registry ACTRN12621000180819; https://tinyurl.com/2p8da5sk.
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Affiliation(s)
- Daniel B Fassnacht
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia.,Órama Institute for Mental Health and Wellbeing, Flinders University, Adelaide, Australia.,Wellbeing and Resilience Centre, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Kathina Ali
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia.,Órama Institute for Mental Health and Wellbeing, Flinders University, Adelaide, Australia.,Wellbeing and Resilience Centre, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Joep van Agteren
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia.,Órama Institute for Mental Health and Wellbeing, Flinders University, Adelaide, Australia.,Wellbeing and Resilience Centre, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Matthew Iasiello
- Wellbeing and Resilience Centre, South Australian Health and Medical Research Institute, Adelaide, Australia.,College of Nursing and Health Science, Flinders University, Adelaide, Australia
| | - Teri Mavrangelos
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia
| | - Gareth Furber
- Health, Counselling & Disability Services, Flinders University, Adelaide, Australia
| | - Michael Kyrios
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia.,Órama Institute for Mental Health and Wellbeing, Flinders University, Adelaide, Australia
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Otto MW, Birk JL, Fitzgerald HE, Chauvin GV, Gold AK, Carl JR. Stage models for major depression: Cognitive behavior therapy, mechanistic treatment targets, and the prevention of stage transition. Clin Psychol Rev 2022; 95:102172. [DOI: 10.1016/j.cpr.2022.102172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/12/2022] [Accepted: 05/18/2022] [Indexed: 11/17/2022]
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Romanazzo S, Mansueto G, Cosci F. Anxiety in the Medically Ill: A Systematic Review of the Literature. Front Psychiatry 2022; 13:873126. [PMID: 35722552 PMCID: PMC9203680 DOI: 10.3389/fpsyt.2022.873126] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although anxiety is highly represented in the medically ill and its occurrence has relevant clinical implications, it often remains undetected and not properly treated. This systematic review aimed to report on anxiety, either symptom or disorder, in patients who suffer from a medical illness. METHODS English-language papers reporting on anxiety in medically ill adults were evaluated. PubMed, PsycINFO, Web of Science, and Cochrane databases were systematically searched from inception to June 2021. Search term was "anxiety" combined using the Boolean "AND" operator with "medically ill/chronic illness/illness/disorder/disease." Risk of bias was assessed via the Joanna Briggs Institute (JBI) Critical Appraisal Tools-Checklist for Prevalence Studies. The PRISMA guidelines were followed. RESULTS Of 100,848 citations reviewed, 329 studies met inclusion criteria. Moderate or severe anxious symptoms were common among patients with cardiovascular, respiratory, central nervous system, gastrointestinal, genitourinary, endocrine, musculoskeletal system or connective tissue, dermatological diseases, cancer, AIDS and COVID-19 infections. The most common anxiety disorder was generalized anxiety disorder, observed among patients with cardiovascular, respiratory, central nervous system, dermatologic diseases, cancer, primary aldosteronism, amenorrhea, and COVID-19 infection. Panic disorder was described for cardiovascular, respiratory, dermatology diseases. Social anxiety was found for cardiovascular, respiratory, rheumatoid diseases. Specific phobias were relatively common in irritable bowel syndrome, gastroesophageal reflux, end-stage renal disease. CONCLUSION Anxiety is a major challenge in medical settings. Recognition and proper assessment of anxiety in patients who suffer from a medical illness is necessary for an appropriate management. Future reviews are warranted in order also to clarify the causal and temporal relationship between anxiety and organic illness.
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Affiliation(s)
- Sara Romanazzo
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giovanni Mansueto
- Department of Health Sciences, University of Florence, Florence, Italy.,Clinical Pharmacopsychology Laboratory, University of Florence, Florence, Italy
| | - Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy.,Clinical Pharmacopsychology Laboratory, University of Florence, Florence, Italy.,Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands
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Quang AMT, Van Pham M, Mai TT, Le GNH, Song GAN. Self-compassion and Students' Well-Being Among Vietnamese Students: Chain Mediation Effect of Narcissism and Anxiety. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2021. [DOI: 10.1007/s10942-021-00431-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Saunders R, Buckman JE, Stott J, Leibowitz J, Aguirre E, John A, Lewis G, Cape J, Pilling S. Older adults respond better to psychological therapy than working-age adults: evidence from a large sample of mental health service attendees. J Affect Disord 2021; 294:85-93. [PMID: 34274792 PMCID: PMC8411661 DOI: 10.1016/j.jad.2021.06.084] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Older adults commonly experience depression and anxiety, yet are under-represented in psychological treatment services. There is uncertainty about the outcomes from psychological therapies for older adults relative to working-age adults. This study explored: pre-treatment differences between older and working-age patients with depression or anxiety disorders; whether outcomes from psychological therapy differ between groups controlling for pre-treatment clinical severity, functioning, and socio-demographics; and whether the impact of a long-term health condition (LTC) on outcome differs by age. METHODS Data on >100,000 patients treated with psychological therapies in eight Improving Access to Psychological Therapies services were analyzed. We compared pre-treatment characteristics and therapy outcomes for older (≥65 years) and working-age (18-64 years) patients, and investigated associations between age and outcomes. RESULTS Older adults had less severe clinical presentations pre-treatment. In adjusted models older adults were more likely to reliably recover (OR=1.33(95%CI=1.24-1.43)), reliably improve (OR=1.34(95%CI =1.24-1.45)), and attrition was less likely (OR=0.48(95%CI =0.43-0.53)). Effects were more pronounced in patients with anxiety disorders compared to depression. Having an LTC was associated with a much lower likelihood of reliable recovery for working-age patients but had only a modest effect for older adults. LIMITATIONS There are potential selection biases affecting the characteristics of older people attending these services. Residual confounding cannot be ruled out due to limits on data available. CONCLUSIONS Older adults experienced better outcomes from psychological treatments than working-age adults. Given the deleterious effects if mental health conditions go untreated, increasing access to psychological therapies for older people should be an international priority.
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Affiliation(s)
- Rob Saunders
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, UK.
| | - Joshua E.J. Buckman
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, UK,iCope – Camden and Islington Psychological Therapies Services, Camden & Islington NHS Foundation Trust, London, UK
| | - Joshua Stott
- ADAPT lab, Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, UK
| | - Judy Leibowitz
- iCope – Camden and Islington Psychological Therapies Services, Camden & Islington NHS Foundation Trust, London, UK
| | | | - Amber John
- ADAPT lab, Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, W1T 7NF, UK
| | - John Cape
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, UK
| | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, UK,Camden & Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London, UK
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Abstract
BACKGROUND Pain has been qualified under four categories: nociception, perception of pain, suffering, and pain behaviors. Most of the literature on migraine has devoted attention to the first two. The aim of the present cohort study was to investigate patients with migraine enrolled at a tertiary care unit to study suffering and mental pain and identify potential risk factors for migraine. METHODS An observational cross-sectional study was carried out on patients with chronic migraine (CM) and episodic migraine (EM), and healthy subjects (HS). The three groups were matched for age and sex. A comprehensive assessment of migraine disability, pain, psychiatric disorders, psychosomatic syndromes, depressive and anxious symptoms, euthymia, psychosocial variables, mental pain, and pain-proneness (PP) was performed. RESULTS Three hundred subjects were enrolled (100 CM, 100 EM, and 100 HS). Based on the multiple regression analyses, those presenting PP (social impairment: odds ratio [OR] = 3.59, 95% confidence interval [CI] = 1.14-11.29; depressive symptoms: OR = 3.82, 95% CI = 1.74-8.41) were more likely to be CM than HS. Those with higher levels of PP (social impairment: OR = 4.04, 95% CI = 1.60-10.22; depressive symptoms: OR = 2.02, 95% CI = 1.26-3.24) were more likely to be EM than HS. Those presenting higher levels of mental pain were more likely to be CM than EM (OR = 1.45, 95% CI = 1.02-2.07). CONCLUSION Migraine is an unpleasant sensory and emotional experience associated with psychosocial manifestations that might contribute to the level of suffering of the individuals. Mental pain resulted to be the variable that most differentiated patients with CM from EM.
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15
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Mental Pain in Eating Disorders: An Exploratory Controlled Study. J Clin Med 2021; 10:jcm10163584. [PMID: 34441880 PMCID: PMC8397208 DOI: 10.3390/jcm10163584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 12/12/2022] Open
Abstract
Mental pain (MP) is a transdiagnostic feature characterized by depression, suicidal ideation, emotion dysregulation, and associated with worse levels of distress. The study explores the presence and the discriminating role of MP in EDs in detecting patients with higher depressive and ED-related symptoms. Seventy-one ED patients and 90 matched controls completed a Clinical Assessment Scale for MP (CASMP) and the Mental Pain Questionnaire (MPQ). ED patients also completed the Beck Depression Inventory-II (BDI-II), Clinical Interview for Depression (CID-20), and Eating Attitudes Test (EAT-40). ED patients exhibited significantly greater severity and higher number of cases of MP than controls. Moreover, MP resulted the most important cluster predictor followed by BDI-II, CID-20, and EAT-40 in discriminating between patients with different ED and depression severity in a two-step cluster analysis encompassing 87.3% (n = 62) of the total ED sample. Significant positive associations have been found between MP and bulimic symptoms, cognitive and somatic-affective depressive symptoms, suicidal tendencies, and anxiety-related symptoms. In particular, those presenting MP reported significantly higher levels of depressive and anxiety-related symptoms than those without. MP represents a clinical aspect that can help to detect more severe cases of EDs and to better understand the complex interplay between ED and mood symptomatology.
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16
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Sensky T. Mental Pain and Suffering: The "Universal Currencies" of the Illness Experience? PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 89:337-344. [PMID: 32781446 DOI: 10.1159/000509587] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/18/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Tom Sensky
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom,
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17
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Javida Z, Prior KN, Bond MJ. Predictive Validity of Resilience in the Treatment of Individuals With Anxiety and Depressive Disorders. J Psychosoc Nurs Ment Health Serv 2021; 59:35-41. [PMID: 34228571 DOI: 10.3928/02793695-20210322-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The current study sought to evaluate the predictive validity of resilience among individuals with anxiety and/or depressive disorders. Receiver operating characteristics were calculated for each of the 25-item and 10-item versions of the Connor-Davidson Resilience Scale, evaluated against psychological distress and treatment response, at screening and post-treatment. New referrals to an anxiety and related disorders clinic were recruited for this purpose (N = 672 at screening, N = 349 post-treatment). Robust cross-sectional associations between resilience and psychological distress and treatment response were noted and were strongest at post-treatment. However, the related sensitivity (63% to 66% at screening, 69% to 76% post-treatment), specificity (78% to 83% at screening, approximately 73% post-treatment), and areas under the curve (AUC; approximately 73% at screening, 78% to 82% post-treatment) were modest. Furthermore, there was minimal support for resilience as a predictor of recovery using the longitudinal data (sensitivity and specificity could not be determined, with AUC of approximately 68% for psychological distress and 56% for treatment response). Although a relatively large homogeneous sample was available for this study, analyses of specific diagnostic subgroups may offer valuable further insight. [Journal of Psychosocial Nursing and Mental Health Services, 59(7), 35-41.].
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18
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Well-being Therapy in Depressive Disorders. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1305:351-374. [PMID: 33834409 DOI: 10.1007/978-981-33-6044-0_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
A specific brief psychotherapeutic intervention aimed at empowering psychological well-being, the so-called Well-Being Therapy (WBT), has been manualized in 2016 by Giovanni Fava and has shown to be effective in randomized controlled trials. WBT is based on the multidimensional model of psychological well-being developed by Marie Jahoda which encompasses environmental mastery, personal growth, purpose in life, autonomy, self-acceptance, positive relations with others, and balance of psychic forces. WBT aims at promoting the achievement of an optimal-balanced functioning between the dimensions of psychological well-being, and such a balance is subsumed under the rubric of euthymia. There are evidences that WBT may be a suited clinical approach for second- or third-line treatment of depressive disorders with particular reference to decreasing vulnerability to relapse and modulating psychological well-being and mood. It has been also proposed a role of WBT in depressive disorders in clinical conditions such as treatment resistance, loss of antidepressant clinical efficacy, persistent post-withdrawal disorders, trauma exposure, and medical disease comorbidity. The present chapter provides an overview of the possible applications of WBT as treatment of depressive disorders.
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19
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Sink CA, Lemich G. A Primer on Celtic Spirituality With Recommendations for Counseling Practice. COUNSELING AND VALUES 2021. [DOI: 10.1002/cvj.12143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Gregory Lemich
- Department of Counseling and Human Services Old Dominion University
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20
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Fava GA, Tomba E, Brakemeier EL, Carrozzino D, Cosci F, Eöry A, Leonardi T, Schamong I, Guidi J. Mental Pain as a Transdiagnostic Patient-Reported Outcome Measure. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 88:341-349. [PMID: 31665739 DOI: 10.1159/000504024] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 10/10/2019] [Indexed: 11/19/2022]
Abstract
Patient-reported outcomes (PROs) refer to any report coming directly from patients about how they function or feel in relation to a health condition or its therapy. PROs have been applied in medicine for the assessment of the impact of clinical phenomena. Self-report scales and procedures for assessing physical pain in adults have been developed and used in clinical trials. However, insufficient attention has been dedicated to the assessment of mental pain. The aim of this paper is to outline the implications that assessment of mental pain may entail in psychiatry and medicine, with particular reference to a clinimetric index. A simple 10-item self-rating questionnaire, the Mental Pain Questionnaire (MPQ), encompasses the specific clinical features of mental pain and shows good clinimetric properties (i.e., sensitivity, discriminant and incremental validity). The preliminary data suggest that the MPQ may qualify as a PRO measure to be included in clinical trials. Assessment of mental pain may have important clinical implications in intervention research, both in psychopharmacology and psychotherapy. The transdiagnostic features of mental pain are supported by its association with a number of psychiatric disorders, such as depression, anxiety, eating disorders, as well as borderline personality disorder. Further, addressing mental pain may be an important pathway to prevent and diminish the opioid epidemic. The data summarized here indicate that mental pain can be incorporated into current psychiatric assessment and included as a PRO measure in treatment outcome studies.
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Affiliation(s)
- Giovanni A Fava
- Department of Psychiatry, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Elena Tomba
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Eva-Lotta Brakemeier
- Department of Clinical Psychology and Psychotherapy, Universitat Greifswald, Greifswald, Germany.,Department of Clinical Psychology and Psychotherapy and Center for Mind, Brain and Behavior (CMBB), Phillips Universität Marburg, Marburg, Germany
| | - Danilo Carrozzino
- Department of Psychological, Health and Territorial Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Ajándék Eöry
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Tommaso Leonardi
- Clinical Trials Network and Institute (CTNI), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Isabel Schamong
- Department of Clinical Psychology and Psychotherapy and Center for Mind, Brain and Behavior (CMBB), Phillips Universität Marburg, Marburg, Germany
| | - Jenny Guidi
- Department of Psychology, University of Bologna, Bologna, Italy,
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21
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Thompson BA, Schary DP. Well-Being Therapy: An Approach to Increase Athlete Well-Being and Performance. JOURNAL OF SPORT PSYCHOLOGY IN ACTION 2020. [DOI: 10.1080/21520704.2020.1750516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Guidi J, Lucente M, Piolanti A, Roncuzzi R, Rafanelli C, Sonino N. Allostatic overload in patients with essential hypertension. Psychoneuroendocrinology 2020; 113:104545. [PMID: 31862612 DOI: 10.1016/j.psyneuen.2019.104545] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/09/2019] [Accepted: 12/09/2019] [Indexed: 02/06/2023]
Abstract
The role of psychosocial stress in the development of essential hypertension has attracted increasing attention in the last decades, even though research findings have been often inconclusive. We specifically investigated allostatic overload (AO) in hypertensive patients using a clinimetric approach. Allostatic overload was assessed by a semi-structured research interview based on clinimetric criteria in 80 consecutive outpatients with essential hypertension (46.3 % females; mean age 62.18 ± 8.59 years; age range 47-74 years) and 80 normotensive matched controls. Three clinical interviews and two self-rating questionnaires for assessing psychological distress and well-being were also administered. Cardiac variables were collected. AO was present in 26 (32.5 %) of the hypertensive patients based on clinical interviewing, and in only 6 normotensive controls (p < .001). Hypertensive patients with AO had significantly higher levels of psychological distress than those without. Further, patients with AO displayed significantly lower levels of well-being and quality of life (p < .001). A significantly greater prevalence of psychosomatic syndromes was found to be associated with the presence of AO (p < .05), whereas no significant association was detected as to psychiatric diagnoses. Significantly greater cardiovascular risk was found among hypertensive patients reporting AO compared to those without (p < .05). The results of this study support the clinical relevance of a psychological assessment of hypertensive patients, with important implications for the non-pharmacological management of hypertension.
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Affiliation(s)
- Jenny Guidi
- Department of Psychology, University of Bologna, Bologna, Italy.
| | | | | | - Renzo Roncuzzi
- Division of Cardiology, Bellaria Hospital, Bologna, Italy
| | | | - Nicoletta Sonino
- Department of Statistical Sciences, University of Padova, Padova, Italy; Department of Psychiatry, State University of New York at Buffalo, Buffalo, NY, USA
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23
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Meaning in life moderates hopelessness, suicide ideation, and borderline psychopathology in participants with eating disorders: A longitudinal study. Clin Psychol Psychother 2020; 27:146-158. [DOI: 10.1002/cpp.2414] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 01/09/2023]
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Well-Being Therapy in Anxiety Disorders. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020. [PMID: 32002942 DOI: 10.1007/978-981-32-9705-0_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
In almost all treatments for prevalent psychiatric conditions, particular attention has been devoted to stress and its consequences; this has led to an involuntary and unavoidable reinforcement of negative aspects of life. Because of the important influence of individual and cultural influences on positive health, well-being is a challenge from a clinical and scientific perspective and interventions aimed at enhancing it represent an area of growing interest for the future of clinical practice and research. Well-being therapy (WBT) is a short-term psychotherapeutic strategy aimed at enhancing well-being based on the model originally developed in 1958 by Marie Jahoda. It emphasizes self-observation, with the use of a structured diary, interaction between patients and therapists, and homework. WBT may be used as the only therapeutic strategy or in sequential combination with other psychotherapeutic strategies, mainly cognitive behavioral therapy. WBT can be differentiated from positive interventions based on several features which are described in detail in the present chapter. We also report the clinical use of WBT in the treatment of anxiety disorders, mainly generalized anxiety disorder, panic disorder, and agoraphobia. Potential further clinical application of WBT is withdrawal after antidepressants discontinuation and side effects during long-term antidepressant treatment.
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25
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Bieg M, Ross T, Bulla J, Kluttig T, Fontao MI. Well-Being as a Precursor and Consequence of Micro-Processes in a Group Psychotherapy With Forensic Patients. Front Psychiatry 2020; 11:409. [PMID: 32581857 PMCID: PMC7283614 DOI: 10.3389/fpsyt.2020.00409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 04/22/2020] [Indexed: 12/03/2022] Open
Abstract
Psychotherapy is an important approach for the treatment of psychiatric disorders. Apart from treating disorders as such, psychotherapy aims at increasing patients' well-being. The Therapeutic Cycles Model (TCM) is a process-oriented theoretical model that makes predictions about the psychotherapeutic progress based on verbatim content. The model helps to identify therapeutic factors on a language level. The present study aims at analyzing transcripts of group therapy sessions with forensic psychiatric patients using the rationale of the TCM. Furthermore, the relationship between linguistic features of psychotherapy sessions and patients' well-being before and after therapy are investigated. In order to identify therapeutic factors, a group psychotherapy with nine drug addicted forensic psychiatric patients was videotaped and transcripts of N = 16 sessions were analyzed. Process-oriented measures were rated by the patients, their therapists, and an external observer. Patients' self-reported well-being before therapy was negatively related to Connecting (indicating emotional insight), and the frequency of therapeutic cycles, which are both thought of as key moments in therapy. Well-being of forensic patients is not necessarily a helpful precursor for insightful and productive events in therapy to occur. The findings help to better understand psychotherapeutic micro-processes throughout forensic therapies, and their relationship with patients' well-being. Implications for research and the forensic practice are discussed.
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Affiliation(s)
- Madeleine Bieg
- Department of Forensic Psychiatry and Psychotherapy, Centre for Psychiatry Reichenau, Reichenau, Germany.,Department of Empirical Educational Research, University of Konstanz, Konstanz, Germany
| | - Thomas Ross
- Department of Forensic Psychiatry and Psychotherapy, Centre for Psychiatry Reichenau, Reichenau, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Ulm University, Ulm, Germany
| | - Jan Bulla
- Department of Forensic Psychiatry and Psychotherapy, Centre for Psychiatry Reichenau, Reichenau, Germany.,Department of Forensic Psychiatry and Psychotherapy, Ulm University, Günzburg, Germany
| | - Tilman Kluttig
- Department of Forensic Psychiatry and Psychotherapy, Centre for Psychiatry Reichenau, Reichenau, Germany
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Widnall E, Price A, Trompetter H, Dunn BD. Routine Cognitive Behavioural Therapy for Anxiety and Depression is More Effective at Repairing Symptoms of Psychopathology than Enhancing Wellbeing. COGNITIVE THERAPY AND RESEARCH 2019. [DOI: 10.1007/s10608-019-10041-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Abstract
The primary focus of classic cognitive behavioural therapy (CBT) for depression and anxiety is on decreasing symptoms of psychopathology. However, there is increasing recognition that it is also important to enhance wellbeing during therapy. This study investigates the extent to which classic CBT for anxiety and depression leads to symptom relief versus wellbeing enhancement, analysing routine outcomes in patients receiving CBT in high intensity Improving Access to Psychological Therapy (IAPT) Services in the UK. At intake, there were marked symptoms of anxiety and depression (a majority of participants scoring in the severe range) and deficits in wellbeing (a majority of participants classified as languishing, relative to general population normative data). CBT was more effective at reducing symptoms of anxiety and depression than repairing wellbeing. As a result, at the end of treatment, a greater proportion of participants met recovery criteria for anxiety and depression than had moved from languishing into average or flourishing levels of wellbeing. Given the importance of wellbeing to client definitions of recovery, the present results suggest a greater emphasis should be placed on enhancing wellbeing in classic CBT.
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27
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Mental Pain Questionnaire: An item response theory analysis. J Affect Disord 2019; 249:226-233. [PMID: 30776664 DOI: 10.1016/j.jad.2019.02.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 01/27/2019] [Accepted: 02/11/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND The Mental Pain Questionnaire (MPQ) is a self-report questionnaire developed to assess mental pain. The aim of the present study was to test the clinimetric properties of the MPQ. METHODS A sample of 200 migraine outpatients were enrolled; homogeneity of MPQ was assessed by Mokken Analysis; item-level severity and item-level sensitivity were calculated via Two-Parameter Logistic model; Total Information Function was evaluated to assess reliability of MPQ; internal consistency was calculated via Cronbach's alpha and Sijtsma and Molenaar rho; sensitivity and specificity were assessed via Receiver Operating Characteristic curves. RESULTS The MPQ showed unidimensional factor structure; satisfactory homogeneity of the item and total score, except items 4 ("my pain is everywhere") and 6 ("I cannot understand why I feel this pain"); good discrimination, except item 7 ("I feel empty"); low information provided by items 4, 6, 7; good reliability for mild and high levels of mental pain; poor reliability for low levels of mental pain; acceptable internal consistency; acceptable sensitivity and specificity. LIMITATIONS The sample size is barely sufficient to calculate item parameters; it is a monocentric study that enrolled outpatients from a tertiary facility; the study enrolled migraine outpatients not affected by other medical disease. CONCLUSIONS The MPQ showed good psychometric properties. Items 4, 6, 7 should be considered with caution when migraine patients are evaluated. A score of at least 3 indicates mental pain clinically relevant, a score of at least 2 indicates distress. These data are preliminary and refer to migraine patients, results might be different in psychiatric populations.
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Favrod J, Nguyen A, Chaix J, Pellet J, Frobert L, Fankhauser C, Ismailaj A, Brana A, Tamic G, Suter C, Rexhaj S, Golay P, Bonsack C. Improving Pleasure and Motivation in Schizophrenia: A Randomized Controlled Clinical Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2019; 88:84-95. [PMID: 30783071 PMCID: PMC6518864 DOI: 10.1159/000496479] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 12/30/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Negative symptoms are frequent in patients with schizophrenia and are associated with marked impairments in social functioning. The efficacy of drug-based treatments and psychological interventions on primary negative symptoms remains limited. The Positive Emotions Programme for Schizophrenia (PEPS) is designed to improve pleasure and motivation in schizophrenia patients by targeting emotion regulation and cognitive skills relevant to apathy and anhedonia. The main hypothesis of this study is that patients who attend 8 one-hour sessions of PEPS and treatment as usual (TAU) will have lower total apathy-avolition and anhedonia-asociality composite scores on the Scale for the Assessment of Negative Symptoms (SANS) than patients who attend only TAU. METHODS Eighty participants diagnosed with schizophrenia or schizoaffective disorder were randomized to receive either TAU or PEPS + TAU. The participants were assessed by independent evaluators before randomization (T0), in a post-test after 8 weeks of treatment (T1) and at a 6-month follow-up (T2). RESULTS The post-test results and 6-month follow-up assessments according to an intention-to-treat analysis showed that the apathy and anhedonia composite scores on the SANS indicated statistically greater clinical improvements in PEPS participants than in non-PEPS participants. In the post-test, anhedonia but not apathy was significantly improved, thus favouring the PEPS condition. These results were sustained at the 6-month follow-up. CONCLUSIONS PEPS is an effective intervention to reduce anhedonia in schizophrenia. PEPS is a short, easy-to-use, group-based, freely available intervention that is easy to implement in a variety of environments (ClinicalTrials.gov ID: NCT02593058).
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Affiliation(s)
- Jérôme Favrod
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland,
| | - Alexandra Nguyen
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland
| | - Joséphine Chaix
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland
| | - Joanie Pellet
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland
| | - Laurent Frobert
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland
| | - Caroline Fankhauser
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland,Community Psychiatry Service, Department of Psychiatry, University Hospital Centre, Lausanne, Switzerland
| | | | | | | | - Caroline Suter
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland
| | - Shyhrete Rexhaj
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland
| | - Philippe Golay
- Community Psychiatry Service, Department of Psychiatry, University Hospital Centre, Lausanne, Switzerland
| | - Charles Bonsack
- Community Psychiatry Service, Department of Psychiatry, University Hospital Centre, Lausanne, Switzerland
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Fava GA, Carrozzino D, Lindberg L, Tomba E. The Clinimetric Approach to Psychological Assessment: A Tribute to Per Bech, MD (1942-2018). PSYCHOTHERAPY AND PSYCHOSOMATICS 2019; 87:321-326. [PMID: 30269137 DOI: 10.1159/000493746] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Giovanni A Fava
- Department of Psychology, University of Bologna, Bologna, .,Department of Psychiatry, State University of New York at Buffalo, Buffalo, New York,
| | - Danilo Carrozzino
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Lone Lindberg
- Psychiatric Research Unit, Psychiatric Centre North Zealand, Copenhagen University Hospital, Hillerød, Denmark
| | - Elena Tomba
- Department of Psychology, University of Bologna, Bologna, Italy
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Protocol and methods for testing the efficacy of well-being therapy in chronic migraine patients: a randomized controlled trial. Trials 2018; 19:561. [PMID: 30326932 PMCID: PMC6192307 DOI: 10.1186/s13063-018-2944-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 09/26/2018] [Indexed: 01/03/2023] Open
Abstract
Background Chronic migraine is a chronic medical condition associated with resistance to pharmacological treatment and poor benefits from the psychological interventions studied to date, including acceptance and commitment therapy or mindfulness. This manuscript describes the rationale and methods for a pilot feasibility study designed to (1) establish and (2) evaluate the feasibility and acceptability of research procedures and interventions to investigate whether well-being therapy improves outcomes relative to a control condition. Methods The current intervention will use a randomized controlled trial design, wherein 30 outpatients with chronic migraine will be randomized (1:1) to well-being therapy (n = 15) or to a control condition (n = 15). Primary outcomes include the level of disability caused by migraine and the frequency, duration, and intensity of migraine attacks; the secondary outcomes focus on anxiety, depression, psychological well-being, euthymia, and distress. Primary and secondary outcomes will be assessed at baseline, after sessions 4 and 8, and at 3-month follow-up. The Ethical Review Boards at the University-Hospital Careggi has approved the study (5th December 2017). Discussion Identifying medium-term interventions able to improve chronic migraine is relevant to manage this illness. The present randomized trial might represent a step forward for managing chronic migraine by means of psychological interventions. Trial registration ClinicalTrial.gov Identifier: NCT03404336. Registered on 19 January 2018. Electronic supplementary material The online version of this article (10.1186/s13063-018-2944-5) contains supplementary material, which is available to authorized users.
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Berle D, Hilbrink D, Russell-Williams C, Kiely R, Hardaker L, Garwood N, Gilchrist A, Steel Z. Personal wellbeing in posttraumatic stress disorder (PTSD): association with PTSD symptoms during and following treatment. BMC Psychol 2018; 6:7. [PMID: 29499738 PMCID: PMC5833065 DOI: 10.1186/s40359-018-0219-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 02/22/2018] [Indexed: 11/15/2022] Open
Abstract
Background It remains unclear to what extent treatment-related gains in posttraumatic stress disorder (PTSD) symptoms translate to improvements in broader domains of personal wellbeing, such as community connectedness, life achievement and security. We sought to determine whether: 1. personal wellbeing improves during the course of a treatment program and 2. changes in core symptom domains (PTSD, anxiety and depression) were associated with improvements in overall personal wellbeing. Methods Participants (N = 124) completed the PTSD Checklist, the Depression and Anxiety Stress Scales and the Personal Wellbeing Index at the start and end of a 4-week Trauma Focused CBT residential program, as well as 3- and 9-months post-treatment. Results Personal wellbeing improved significantly across the 9-months of the study. Generalised estimating equations analyses indicated that (older) age and improvements in PTSD and depressive symptoms were independent predictors of personal wellbeing across time. Conclusions Although personal wellbeing improved in tandem with PTSD symptoms, the magnitude of improvement was small. These findings highlight a need to better understand how improvements in personal wellbeing can be optimised following PTSD treatment. Electronic supplementary material The online version of this article (10.1186/s40359-018-0219-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David Berle
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Building 7, 67 Thomas Street, Ultimo, NSW, 2007, Australia. .,School of Psychiatry, UNSW, Sydney, Australia.
| | - Dominic Hilbrink
- St John of God Health Care, Richmond Hospital, Richmond, Australia
| | | | - Rachael Kiely
- St John of God Health Care, Richmond Hospital, Richmond, Australia
| | - Laura Hardaker
- St John of God Health Care, Richmond Hospital, Richmond, Australia
| | - Natasha Garwood
- St John of God Health Care, Richmond Hospital, Richmond, Australia
| | - Anne Gilchrist
- St John of God Health Care, Richmond Hospital, Richmond, Australia
| | - Zachary Steel
- School of Psychiatry, UNSW, Sydney, Australia.,St John of God Health Care, Richmond Hospital, Richmond, Australia
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González-Robles A, García-Palacios A, Baños R, Quero S, Botella C. Upregulating Positive Affectivity in the Transdiagnostic Treatment of Emotional Disorders: A Randomized Pilot Study. Behav Modif 2017; 43:26-55. [PMID: 29047288 DOI: 10.1177/0145445517735631] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Transdiagnostic cognitive-behavioral therapy for emotional disorders (ED) has proven to be effective. However, current transdiagnostic treatment protocols address only the regulation of negative affectivity, and they do not include treatment components to more directly target the regulation of positive affectivity. In this study, we propose to evaluate the preliminary efficacy and acceptability of a transdiagnostic treatment protocol for ED that includes, as an innovative feature, a specific treatment component to directly upregulate positive affectivity based on positive psychology interventions. A total of 24 participants were randomized to either a transdiagnostic treatment protocol ( n = 12) or a transdiagnostic treatment protocol with an additional component designed to regulate positive affectivity ( n = 12). Participants completed measures of anxiety, depression, positive and negative affectivity, and quality of life, as well as treatment acceptability at pre- and posttreatment and at the 3-month follow-up. Both interventions led to improvements in all measures at posttreatment, and these outcomes were maintained at the 3-month follow-up, with large effect sizes for all measures. The effect sizes for positive affect were larger in the condition that included the component to upregulate positive affectivity. Attrition rate was low, and both treatment protocols were well accepted by participants. The results obtained in this study indicate the feasibility of testing the treatment protocol in a larger, randomized, controlled trial, and they suggest the potential of including treatment components for directly upregulating positive affectivity in future research on transdiagnostic treatment protocols for ED.
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Affiliation(s)
| | - Azucena García-Palacios
- 1 Universitat Jaume I, Castelló de la Plana, Spain.,3 Instituto Salud Carlos III, Madrid, Spain
| | - Rosa Baños
- 2 Universidad de Valencia, Valencia, Spain.,3 Instituto Salud Carlos III, Madrid, Spain
| | - Soledad Quero
- 1 Universitat Jaume I, Castelló de la Plana, Spain.,3 Instituto Salud Carlos III, Madrid, Spain
| | - Cristina Botella
- 1 Universitat Jaume I, Castelló de la Plana, Spain.,3 Instituto Salud Carlos III, Madrid, Spain
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Fava GA, Cosci F, Guidi J, Tomba E. Well-being therapy in depression: New insights into the role of psychological well-being in the clinical process. Depress Anxiety 2017; 34:801-808. [PMID: 28419611 DOI: 10.1002/da.22629] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 03/21/2017] [Accepted: 03/21/2017] [Indexed: 12/30/2022] Open
Abstract
A specific psychotherapeutic strategy for increasing psychological well-being and resilience, well-being therapy (WBT), has been developed and validated in a number of randomized controlled trials. The findings indicate that flourishing and resilience can be promoted by specific interventions leading to a positive evaluation of one's self, a sense of continued growth and development, the belief that life is purposeful and meaningful, the possession of quality relations with others, the capacity to manage effectively one's life, and a sense of self-determination. The evidence supporting the use of WBT and its specific contribution when it is combined with other psychotherapeutic techniques is still limited. However, the insights gained by the use of WBT may unravel innovative approaches to assessment and treatment of mood and anxiety disorders, to be confirmed by controlled studies, with particular reference to decreasing vulnerability to relapse and modulating psychological well-being and mood. An important characteristic of WBT is self-observation of psychological well-being associated with specific homework. Such perspective is different from interventions that are labeled as positive but are actually distress oriented. Another important feature of WBT is the assumption that imbalances in well-being and distress may vary from one illness to another and from patient to patient. Customary clinical taxonomy and evaluation do not include psychological well-being, which may demarcate major prognostic and therapeutic differences among patients who otherwise seem to be deceptively similar since they share the same diagnosis.
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Affiliation(s)
- Giovanni A Fava
- Department of Psychology, University of Bologna, Bologna, Italy.,Department of Psychiatry, State University of New York at Buffalo, Buffalo, NY, USA
| | - Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Jenny Guidi
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Elena Tomba
- Department of Psychology, University of Bologna, Bologna, Italy
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Somatization in Parkinson's Disease: A systematic review. Prog Neuropsychopharmacol Biol Psychiatry 2017; 78:18-26. [PMID: 28522290 DOI: 10.1016/j.pnpbp.2017.05.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 04/25/2017] [Accepted: 05/13/2017] [Indexed: 11/21/2022]
Abstract
The current systematic review study is aimed at critically analyzing from a clinimetric viewpoint the clinical consequence of somatization in Parkinson's Disease (PD). By focusing on the International Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a comprehensive electronic literature research strategy on ISI Web-of-Science, PsychINFO, PubMed, EBSCO, ScienceDirect, MEDLINE, Scopus, and Google Scholar databases. Out of 2.926 initial records, only a total of 9 studies were identified as clearly relevant and analyzed in this systematic review. The prevalence of somatization in PD has been found to range between 7.0% and 66.7%, with somatoform disorders acting as clinical factor significantly contributing to predict a progressive cognitive impairment. We highlighted that somatization is a highly prevalent comorbidity affecting PD. However, the clinical consequence of such psychiatric symptom should be further evaluated by replacing the clinically inadequate diagnostic label of psychogenic parkinsonism with the psychosomatic concept of persistent somatization as conceived by the Diagnostic Criteria for Psychosomatic Research (DCPR).
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Hasler G. Well-Being: An Important Concept for Psychotherapy and Psychiatric Neuroscience. PSYCHOTHERAPY AND PSYCHOSOMATICS 2017; 85:255-61. [PMID: 27509027 DOI: 10.1159/000447268] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 05/29/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Gregor Hasler
- Division of Molecular Psychiatry, Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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Fava GA, Cosci F, Sonino N. Current Psychosomatic Practice. PSYCHOTHERAPY AND PSYCHOSOMATICS 2017; 86:13-30. [PMID: 27884006 DOI: 10.1159/000448856] [Citation(s) in RCA: 160] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 08/03/2016] [Indexed: 11/19/2022]
Abstract
Psychosomatic research has advanced over the past decades in dealing with complex biopsychosocial phenomena and may provide new effective modalities of patient care. Among psychosocial variables affecting individual vulnerability, course, and outcome of any medical disease, the role of chronic stress (allostatic load/overload) has emerged as a crucial factor. Assessment strategies include the Diagnostic Criteria for Psychosomatic Research. They are presented here in an updated version based on insights derived from studies carried out so far and encompass allostatic overload, type A behavior, alexithymia, the spectrum of maladaptive illness behavior, demoralization, irritable mood, and somatic symptoms secondary to a psychiatric disorder. Macroanalysis is a helpful tool for identifying the relationships between biological and psychosocial variables and the individual targets for medical intervention. The personalized and holistic approach to the patient includes integration of medical and psychological therapies in all phases of illness. In this respect, the development of a new psychotherapeutic modality, Well-Being Therapy, seems to be promising. The growth of subspecialties, such as psychooncology and psychodermatology, drives towards the multidisciplinary organization of health care to overcome artificial boundaries. There have been major transformations in health care needs in the past decades. From psychosomatic medicine, a land of innovative hypotheses and trends, many indications for changes in the current practice of medicine are now at hand. The aim of this critical review is to outline current and potential clinical applications of psychosomatic methods.
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Affiliation(s)
- Giovanni A Fava
- Department of Psychology, University of Bologna, Bologna, Italy
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Minichino A, Ando' A, Francesconi M, Salatino A, Delle Chiaie R, Cadenhead K. Investigating the link between drug-naive first episode psychoses (FEPs), weight gain abnormalities and brain structural damages: Relevance and implications for therapy. Prog Neuropsychopharmacol Biol Psychiatry 2017; 77:9-22. [PMID: 28363765 DOI: 10.1016/j.pnpbp.2017.03.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 03/08/2017] [Accepted: 03/20/2017] [Indexed: 02/08/2023]
Abstract
Evidence suggests that obesity and overweight may be associated with severe brain structural abnormalities and poor cognitive and functional outcomes in the general population. Despite these observations and the high prevalence of weight gain abnormalities in patients with psychosis spectrum disorders (PSDs), no studies have investigated the impact that these metabolic disturbances may have on brain structures and development in the earliest stages of PSDs. In the present review we shed light on the association between weight gain and brain structural abnormalities that may affect the course of illness in drug-naïve FEPs. Given the lack of studies directly investigating this issue, we firstly identified and critically evaluated the literature assessing weight gain abnormalities and gray or white matter (GM, WM) volumes (either globally or in specific regions of interest) in otherwise healthy obese/overweight adolescents and young adults. We then compared the results of this systematic review with those of two recent meta-analysis investigating GM and WM abnormalities in drug-naïve FEPs. Weight gain in otherwise healthy subjects was consistently associated with frontal and temporal GM atrophy and with reduced integrity of WM in the corpus callosum. Of relevance, all these brain regions are affected in drug-naïve FEPs, and their integrity is associated with clinical, cognitive and functional outcomes. The underlying mechanisms that may explain the association between weight gain, adiposity, and brain damage in both healthy subjects and drug-naïve FEPs are widely discussed. On the basis of this knowledge, we tried: a) to deduce an integrative model for the development of obesity in psychosis spectrum disorders; b) to identify the key vulnerability factors underlying the association between weight gain and psychosis; c) to provide information on new potential targets of intervention.
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Affiliation(s)
- Amedeo Minichino
- Department of Neurology and Psychiatry, Sapienza University of Rome, Italy; Department of Psychiatry, UCSD, La Jolla, CA, United States.
| | - Agata Ando'
- Department of Psychology, University of Turin, Italy
| | - Marta Francesconi
- Department of Neurology and Psychiatry, Sapienza University of Rome, Italy; Department of Psychiatry, UCSD, La Jolla, CA, United States
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Marco JH, Cañabate M, Pérez S, Llorca G. Associations Among Meaning in Life, Body Image, Psychopathology, and Suicide Ideation in Spanish Participants With Eating Disorders. J Clin Psychol 2017; 73:1768-1781. [PMID: 28419452 DOI: 10.1002/jclp.22481] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 02/06/2017] [Accepted: 03/05/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aims of this study were to (a) analyze whether participants with eating disorders have lower meaning in life than the nonclinical population; (b) discover whether participants with eating disorders with low meaning in life have more body image disturbances, more psychopathology, and higher suicide ideation than participants with high meaning in life; (c) analyze whether meaning in life is associated with eating disorder psychopathology; and (d) analyze whether meaning in life is able to predict eating disorder psychopathology and suicide ideation, when body image is controlled. METHOD The clinical sample comprised 247 Spanish participants diagnosed with eating disorders, and the nonclinical sample comprised Spanish 227 participants. RESULTS Participants with eating disorders had lower meaning in life than the nonclinical population. Patients with low meaning in life had higher psychopathology and suicide ideation than participants with high meaning in life. Meaning in life was a significant predictor of the eating disorder psychopathology and suicide ideation. CONCLUSION Low meaning in life is associated with eating disorder psychopathology in a Spanish sample with eating disorders.
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Affiliation(s)
- José H Marco
- Universidad Católica de Valencia San Vicente Mártir
| | | | - Sandra Pérez
- Universidad Católica de Valencia San Vicente Mártir
| | - Ginés Llorca
- Consorcio Hospitalario Provincial de Castellón
- Universitat Jaume I
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De Las Cuevas C, de Leon J. Reviving Research on Medication Attitudes for Improving Pharmacotherapy: Focusing on Adherence. PSYCHOTHERAPY AND PSYCHOSOMATICS 2017; 86:73-79. [PMID: 28183085 DOI: 10.1159/000450830] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 09/14/2016] [Indexed: 12/20/2022]
Abstract
There is little current interest in research into patients' attitudes toward medications. In the 1960s, psychiatric researchers including Uhlenhuth, Rickels and Covi focused on this area, but this research topic needs to be revived in the 21st century. The Health Belief Model may hold potential for doing this. This model was initially developed by 2 health psychologists, Rosenstock and Becker, to explain why patients did not follow medical interventions. The application of this model to study medication adherence in psychiatric outpatients has provided multiple findings including the conclusions that adherence is associated with: (1) the balance between internal and external health control beliefs, (2) psychological reactance, (3) patients' attitudes toward prescribed drug treatment in general and (4) the balance between the necessity of taking medications versus the concerns derived from adverse drug reactions (ADRs). Poor adherence is associated with several cognitive styles of patients, including: (1) high internal and external health control beliefs (patients who feel that their health is controlled both by external factors and their own beliefs), (2) higher psychological reactance, (3) pharmacophobia (present in 1/6 patients) and (4) skepticism about medications (a high concern for ADRs and a low belief in the necessity of taking medications). All of these findings suggest that shared decision-making is particularly important in fostering adherence in psychiatric patients. Two wider applications of this article can be made: (1) opening psychiatry to advances in clinical psychology and (2) expanding studies on attitudes toward medications to other medical disciplines.
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Bassi M, Delle Fave A, Cetin I, Melchiorri E, Pozzo M, Vescovelli F, Ruini C. Psychological well-being and depression from pregnancy to postpartum among primiparous and multiparous women. J Reprod Infant Psychol 2017. [PMID: 29517362 DOI: 10.1080/02646838.2017.1290222] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The bulk of research on motherhood has focused on perinatal depression, largely overlooking indicators of women's positive mental health which can likewise have pervasive consequences on family functioning. OBJECTIVE The aim of the present study was to address this issue by exploring the impact of parity and childbirth on both women's perinatal depression and psychological well-being. METHODS A convenience sample of 81 women was followed during pregnancy (Time 1) and postpartum (Time 2). At both times, participants completed the Edinburgh Depression Scale and the Psychological Well-being Scales, measuring perceived autonomy, environmental mastery, personal growth, positive relations, purpose in life, and self-acceptance. RESULTS Significant negative correlations were observed between depression and psychological well-being dimensions. ANCOVA and mixed ANOVA analyses showed that depression levels did not differ between primiparous and multiparous women, or between pre- and postpartum assessments. By contrast, after childbirth, primiparous women reported higher values of environmental mastery and self-acceptance than multiparous women. In addition, levels of self-acceptance and personal growth increased from pregnancy to postpartum among primiparous women, while no differences were detected over time in the scores of all the psychological well-being dimensions among multiparous women. CONCLUSIONS This study highlighted some dimensions of positive psychological functioning that specifically contribute to women's well-being in the transition to motherhood, and their different relevance for primiparous and multiparous mothers. Future trials are needed to integrate this information in tailored intervention for the promotion of mothers' complete mental health.
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Affiliation(s)
- Marta Bassi
- a Department of Biomedical and Clinical Sciences , University of Milano , Milano , Italy
| | - Antonella Delle Fave
- b Department of Pathophysiology and Transplantation , University of Milano , Milano , Italy
| | - Irene Cetin
- a Department of Biomedical and Clinical Sciences , University of Milano , Milano , Italy
| | - Erika Melchiorri
- c Department of Psychology , University of Bologna , Bologna , Italy
| | - Melissa Pozzo
- a Department of Biomedical and Clinical Sciences , University of Milano , Milano , Italy
| | | | - Chiara Ruini
- c Department of Psychology , University of Bologna , Bologna , Italy
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