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Rucker JJ. Evidence versus expectancy: the development of psilocybin therapy. BJPsych Bull 2024; 48:110-117. [PMID: 37246405 PMCID: PMC10985726 DOI: 10.1192/bjb.2023.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/07/2023] [Accepted: 04/02/2023] [Indexed: 05/30/2023] Open
Abstract
SUMMARY Although the development of psilocybin therapy has come as a surprise to many, modern research with the drug has been ongoing for 25 years. Psilocybin therapy is composed of psilocybin dosing sessions embedded within a wider process of psychoeducation, psychological support and integration. Early phase clinical trial evidence is promising, particularly for treatment-resistant depression. However, masking probably fails and expectancy effects may be a part of the mechanism of change. Disambiguating between drug and expectancy effects is a necessary part of the development process, yet this is difficult if masking fails. Hitherto, masking and expectancy have not been routinely measured in psilocybin or other medication trials. Doing so represents an opportunity for research and may influence psychiatry more widely. In this opinion piece I summarise the clinical development process of psilocybin therapy thus far, discussing the hope, the hype, the challenges and the opportunities along the way.
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Affiliation(s)
- James J. Rucker
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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2
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Anderson D, Jones V. Psychological interventions for cancer-related post-traumatic stress disorder: narrative review. BJPsych Bull 2024; 48:100-109. [PMID: 37288666 PMCID: PMC10985725 DOI: 10.1192/bjb.2023.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 03/31/2023] [Accepted: 04/23/2023] [Indexed: 06/09/2023] Open
Abstract
AIMS AND METHOD This narrative review updates the evidence base for cancer-related post-traumatic stress disorder (PTSD). Databases were searched in December 2021, and included EMBASE, Medline, PsycINFO and PubMed. Adults diagnosed with cancer who had symptoms of PTSD were included. RESULTS The initial search identified 182 records, and 11 studies were included in the final review. Psychological interventions were varied, and cognitive-behavioural therapy and eye movement desensitisation and reprocessing were perceived to be most efficacious. The studies were also independently rated for methodological quality, which was found to be hugely variable. CLINICAL IMPLICATIONS There remains a lack of high-quality intervention studies for PTSD in cancer, and there is a wide range of approaches to managing these conditions, with a large heterogeneity in the cancer populations examined and methodologies used. Specific studies designed with patient and public engagement and that tailor the PTSD intervention to particular cancer populations under investigation are required.
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Affiliation(s)
| | - Victoria Jones
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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3
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Borissova A, Rucker JJ. The development of psilocybin therapy for treatment-resistant depression: an update. BJPsych Bull 2024; 48:38-44. [PMID: 37357767 PMCID: PMC10801413 DOI: 10.1192/bjb.2023.25] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 03/14/2023] [Accepted: 04/02/2023] [Indexed: 06/27/2023] Open
Abstract
Psilocybin is a classic psychedelic drug that has attracted increasing research interest over the past 10 years as a possible treatment for mood, anxiety and related conditions. Initial phase 2 clinical trials of psilocybin given alongside psychological support for major depression and treatment-resistant depression (TRD) demonstrated encouraging signs of basic safety, further confirmed by a large study in groups of healthy volunteers. The first international multi-centre randomised controlled trial was published in 2022, with signs of efficacy for the 25 mg dose condition in people with TRD when compared with an active placebo. Phase 3 trials in TRD are scheduled to start in 2023. Early evidence suggests that single doses of psilocybin given with psychological support induce rapid improvement in depressive symptoms that endure for some weeks. We therefore provide a timely update to psychiatrists on what psilocybin therapy is, what it is not, and the current state of the evidence-base.
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Affiliation(s)
- Anya Borissova
- Centre for Neuroimaging Sciences, King's College London, UK
| | - James J. Rucker
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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4
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Bosmans JE, Bruijniks SJE, El Alili M, Hollon SD, Peeters FPML, Arntz A, Cuijpers P, Lemmens LHJM, Dingemanse P, Willems L, van Oppen P, van den Boogaard M, Spijker J, Twisk JWR, Huibers MJH. Cost-effectiveness of twice-weekly versus once-weekly sessions of cognitive-behavioural therapy and interpersonal psychotherapy for depression at 12 months after start of treatment: randomised controlled trial. BJPsych Open 2023; 9:e186. [PMID: 37830493 PMCID: PMC10594223 DOI: 10.1192/bjo.2023.548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Cost-effective treatments are needed to reduce the burden of depression. One way to improve the cost-effectiveness of psychotherapy might be to increase session frequency, but keep the total number of sessions constant. AIM To evaluate the cost-effectiveness of twice-weekly compared with once-weekly psychotherapy sessions after 12 months, from a societal perspective. METHOD An economic evaluation was conducted alongside a randomised controlled trial comparing twice-weekly versus once-weekly sessions of psychotherapy (cognitive-behavioural therapy or interpersonal psychotherapy) for depression. Missing data were handled by multiple imputation. Statistical uncertainty was estimated with bootstrapping and presented with cost-effectiveness acceptability curves. RESULTS Differences between the two groups in depressive symptoms, physical and social functioning, and quality-adjusted life-years (QALY) at 12-month follow-up were small and not statistically significant. Total societal costs in the twice-weekly session group were higher, albeit not statistically significantly so, than in the once-weekly session group (mean difference €2065, 95% CI -686 to 5146). The probability that twice-weekly sessions are cost-effective compared with once-weekly sessions was 0.40 at a ceiling ratio of €1000 per point improvement in Beck Depression Inventory-II score, 0.32 at a ceiling ratio of €50 000 per QALY gained, 0.23 at a ceiling ratio of €1000 per point improvement in physical functioning score and 0.62 at a ceiling ratio of €1000 per point improvement in social functioning score. CONCLUSIONS Based on the current results, twice-weekly sessions of psychotherapy for depression are not cost-effective over the long term compared with once-weekly sessions.
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Affiliation(s)
- Judith E. Bosmans
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Sanne J. E. Bruijniks
- Department of Clinical Psychology and Psychotherapy, University of Freiburg, Germany; and Department of Clinical Psychology, Utrecht University, The Netherlands
| | - Mohamed El Alili
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | | | - Frenk P. M. L. Peeters
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Lotte H. J. M. Lemmens
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands
| | - Pieter Dingemanse
- Division of Affective Disorders, Mental Health Care Altrecht, The Netherlands
| | - Linda Willems
- Department of Mood Disorders, GGZ Oost-Brabant, The Netherlands
| | - Patricia van Oppen
- Department of Research and Innovation, GGZ InGeest Specialized Mental Health Care, The Netherlands; and Department of Psychiatry, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | | | - Jan Spijker
- Depression Expertise Centre, Pro Persona Mental Health Care, The Netherlands; and Behavioral Science Institute, Radboud University, The Netherlands
| | - Jos W. R. Twisk
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Marcus J. H. Huibers
- Department of Clinical Psychology and Psychotherapy, University of Freiburg, Germany; and Department of Clinical Psychology, Utrecht University, The Netherlands
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Rafferty G, Brar G, Petrut M, Meagher D, O'Connell H, St John-Smith P. Banging the drum: evolutionary and cultural origins of music and its implications for psychiatry. BJPsych Bull 2023; 47:251-254. [PMID: 37313980 PMCID: PMC10764840 DOI: 10.1192/bjb.2023.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/23/2023] [Indexed: 06/15/2023] Open
Abstract
SUMMARY There is growing interest in music-based therapies for mental/behavioural disorders. We begin by reviewing the evolutionary and cultural origins of music, proceeding then to discuss the principles of evolutionary psychiatry, itself a growing a field, and how it may apply to music. Finally we offer some implications for the role of music and music-based therapies in clinical practice.
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6
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Penadés R, Wykes T. Use of cognitive remediation to treat negative symptoms in schizophrenia: is it time yet? Br J Psychiatry 2023:1-2. [PMID: 37194957 DOI: 10.1192/bjp.2023.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Cognitive remediation is currently recommended to treat cognitive and functional impairments in patients with schizophrenia. Recently, treatment of negative symptoms has been proposed as a new target for cognitive remediation. Evidence of reductions in negative symptoms has been described in different meta-analyses. However, treating primary negative symptoms is still an open question. Despite some emerging evidence, more research focused on individuals with primary negative symptoms is indispensable. In addition, more attention to the role of moderators and mediators and the use of more specific assessments is necessary. Nevertheless, cognitive remediation could be considered as one promising option to treat primary negative symptoms.
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Affiliation(s)
- Rafael Penadés
- Barcelona Clinic Schizophrenia Unit, Hospital Clínic Barcelona Spain; Department of Clinical Psychology and Psychobiology, University of Barcelona, Sain IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Til Wykes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London. South London and Maudsley NHS Foundation Trust, London, UK
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Bauer-Staeb C, Griffith E, Faraway JJ, Button KS. Personalised psychotherapy in primary care: evaluation of data-driven treatment allocation to cognitive-behavioural therapy versus counselling for depression. BJPsych Open 2023; 9:e46. [PMID: 36861260 PMCID: PMC10044179 DOI: 10.1192/bjo.2022.628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Various effective psychotherapies exist for the treatment of depression; however, only approximately half of patients recover after treatment. In efforts to improve clinical outcomes, research has focused on personalised psychotherapy - an attempt to match patients to treatments they are most likely to respond to. AIM The present research aimed to evaluate the benefit of a data-driven model to support clinical decision-making in differential treatment allocation to cognitive-behavioural therapy versus counselling for depression. METHOD The present analysis used electronic healthcare records from primary care psychological therapy services for patients receiving cognitive-behavioural therapy (n = 14 544) and counselling for depression (n = 4725). A linear regression with baseline sociodemographic and clinical characteristics was used to differentially predict post-treatment Patient Health Questionnaire (PHQ-9) scores between the two treatments. The benefit of differential prescription was evaluated in a held-out validation sample. RESULTS On average, patients who received their model-indicated optimal treatment saw a greater improvement (by 1.78 PHQ-9 points). This translated into 4-10% more patients achieving clinically meaningful changes. However, for individual patients, the estimated differences in benefits of treatments were small and rarely met the threshold for minimal clinically important differences. CONCLUSION Precision prescription of psychotherapy based on sociodemographic and clinical characteristics is unlikely to produce large benefits for individual patients. However, the benefits may be meaningful from an aggregate public health perspective when applied at scale.
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Affiliation(s)
| | - Emma Griffith
- Department of Psychology, University of Bath, UK.,Avon and Wiltshire Mental Health Partnership NHS Trust, UK
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8
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Rocheteau E. On the role of artificial intelligence in psychiatry. Br J Psychiatry 2023; 222:54-57. [PMID: 36093950 DOI: 10.1192/bjp.2022.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Recently, there has been growing interest in artificial intelligence (AI) to improve efficiency and personalisation of mental health services. So far, the progress has been slow, however, advancements in deep learning may change this. This paper discusses the role for AI in psychiatry, in particular (a) diagnosis tools, (b) monitoring of symptoms, and (c) delivering personalised treatment recommendations. Finally, I discuss ethical concerns and technological limitations.
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Affiliation(s)
- Emma Rocheteau
- School of Clinical Medicine, University of Cambridge, UK; and Department of Computer Science and Technology, University of Cambridge, UK
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9
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Sokol Y, Levin C, Linzer M, Rosensweig C, Hubner S, Gromatsky M, Walsh S, Dixon L, Goodman M. Theoretical model of recovery following a suicidal episode (COURAGE): scoping review and narrative synthesis. BJPsych Open 2022; 8:e200. [PMID: 36384945 PMCID: PMC9707512 DOI: 10.1192/bjo.2022.599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite a significant need, there are currently no rigorously developed empirically based models for what personal recovery from a suicidal episode looks like. AIMS To develop a theoretical model of personal recovery after a suicidal episode, based on a comprehensive literature review and stakeholder feedback. METHOD A scoping review of all empirical studies on this topic was conducted, followed by a thematic analysis to create a preliminary framework. Consultation-based revisions were then made based on feedback from a stakeholder panel to develop the final theoretical model. RESULTS The final model comprised seven themes: choosing life, optimising identity, understanding oneself, rediscovering meaning, acceptance, growing connectedness and empowerment (acronym 'COURAGE'). Although there are some similarities between COURAGE and other models of personal recovery, there are components, such as 'choosing life' and 'understanding oneself', that are specific to recovery after an acute suicidal episode. CONCLUSIONS To our knowledge, this is the first study to use a comprehensive literature review with stakeholder feedback to develop a conceptual model of personal recovery after an acute suicidal episode. This model has important implications for both researchers and clinicians to consider. Looking ahead, COURAGE can inform the reconceptualisation of assessment, research and clinical care of individuals who have experienced a suicidal episode.
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Affiliation(s)
- Yosef Sokol
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Psychology, School of Health Sciences, Touro University, New York, New York, USA; and VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, New York, New York, USA
| | - Chynna Levin
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, New York, New York, USA; and Teacher's College, Columbia University, New York, New York, USA
| | - Mairav Linzer
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, New York, New York, USA; and School of Health Professions and Nursing, Long Island University, New York, New York, USA
| | - Chayim Rosensweig
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, New York, New York, USA; and Ferkauf Graduate School of Psychology, Yeshiva University, New York, New York, USA
| | - Shifra Hubner
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, New York, New York, USA; and School of Health Sciences, Touro College, New York, New York, USA
| | - Molly Gromatsky
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, New York, New York, USA; and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samantha Walsh
- Levy Library, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lisa Dixon
- New York State Psychiatric Institute, New York, New York, USA; Vagelos College of Physicians and Surgeons, Columbia University/New York-Presbyterian, New York, New York, USA
| | - Marianne Goodman
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, New York, New York, USA; and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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10
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Tyler E, Lobban F, Sutton C, Hadarag B, Johnson S, Depp C, Duncan D, Jones SH. A pilot randomised controlled trial to assess the feasibility and acceptability of recovery-focused therapy for older adults with bipolar disorder. BJPsych Open 2022; 8:e191. [PMID: 36278451 PMCID: PMC9634560 DOI: 10.1192/bjo.2022.582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Despite increasing evidence for the effectiveness of individual psychological interventions for bipolar disorder, research on older adults is lacking. We report the first randomised controlled trial of psychological therapy designed specifically for older adults with bipolar disorder. AIMS To evaluate the feasibility and acceptability of recovery-focused therapy, designed in collaboration with older people living with bipolar disorder. METHOD A parallel, two-armed, randomised controlled trial comparing treatment as usual with up to 14 sessions of recovery-focused therapy plus treatment as usual, for older adults with bipolar disorder. RESULTS Thirty-nine participants (67% female, mean age 67 years) were recruited over a 17-month period. Feasibility and acceptability of recruitment, retention (>80% observer-rated outcomes at both 24 and 48 weeks) and intervention processes were demonstrated. The majority of participants started therapy when offered, adhered to the intervention (68% attended all sessions and 89% attended six or more sessions) and reported positive benefits. Clinical assessment measures provide evidence of a signal for effectiveness on a range of outcomes including mood symptoms, time to relapse and functioning. No trial-related serious adverse events were identified. CONCLUSIONS Recovery-focused therapy is feasible, acceptable and has the potential to improve a range of outcomes for people living with bipolar disorder in later life. A large-scale trial is warranted to provide a reliable estimate of its clinical and cost-effectiveness.
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Affiliation(s)
- Elizabeth Tyler
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, UK
| | - Fiona Lobban
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, UK
| | - Christopher Sutton
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, UK
| | | | - Sheri Johnson
- Department of Psychology, University of California, Berkeley, USA
| | - Colin Depp
- Department of Psychiatry, UC San Diego School of Medicine, University of California, San Diego, USA
| | | | - Steven H Jones
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, UK
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Shin G, Jang B, Bae G, Jeon HL, Bae S. The Impact of Payment Scheme Changes on Medication Adherence and Persistence of Patients Diagnosed with Depression in Korea. Int J Environ Res Public Health 2022; 19:11100. [PMID: 36078819 PMCID: PMC9517799 DOI: 10.3390/ijerph191711100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/27/2022] [Accepted: 08/30/2022] [Indexed: 06/15/2023]
Abstract
As of 1 July 2018, the Korean National Health Insurance Service (NHIS) changed the fee schedule for individual psychotherapy (IP). We sought to analyze the impact of the IP payment scheme changes on the medication adherence and persistence of patients diagnosed with depression in Korea. We utilized the NHIS claims database from 2017 to 2019. Patients who were newly diagnosed with depression and utilized IP and were prescribed antidepressants during the study period were included. Adherence was measured using the medication possession ratio (MPR), and persistence was measured using the length of therapy (LOT) during the follow-up period. Adherence and persistence during the pre-policy period (before the change of the payment scheme, from January 2018 until June 2018) and the post-policy period (after the change, from July 2018 until December 2019) were compared. During the study period, a total of 176,740 patients with depression were identified. The average MPR significantly increased from 0.20 to 0.33 in the pre- and post-policy periods, respectively (p < 0.001). The average LOT of the patients improved considerably from 36 to 56 days in the pre- and post-policy periods, respectively (p < 0.001). Poisson regression analysis showed that patients with depression who were female, 19-34 years of age (vs. 50-64 years or over 64 years), and in the post-policy period were significantly associated with greater adherence and persistence rates. Payment scheme changes were associated with an increased adherence and persistence of medication use among patients diagnosed with depression.
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Affiliation(s)
- Gyeongseon Shin
- College of Pharmacy, Ewha Womans University, Seoul 03760, Korea
| | - Bohwa Jang
- College of Pharmacy, Ewha Womans University, Seoul 03760, Korea
| | - Green Bae
- College of Pharmacy, Ewha Womans University, Seoul 03760, Korea
| | - Ha-Lim Jeon
- School of Pharmacy, Jeonbuk National University, Jeonju 54896, Korea
| | - SeungJin Bae
- College of Pharmacy, Ewha Womans University, Seoul 03760, Korea
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Jacobsen P, Haddock G, Raphael J, Peak C, Winter R, Berry K. Recruiting and retaining participants in three randomised controlled trials of psychological interventions conducted on acute psychiatric wards: top ten tips for success. BJPsych Open 2022; 8:e125. [PMID: 35796538 PMCID: PMC9301765 DOI: 10.1192/bjo.2022.527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND It is essential to conduct randomised controlled trials of psychological interventions on acute psychiatric wards to build a robust evidence base for clinical practice. AIMS This paper aims to share strategies from three different in-patient trials that successfully recruited and retained participants, to disseminate good practice for the conduct of future trials in this challenging and complex clinical setting. METHOD We present strategies from three in-patient trials of psychological interventions: TULIPS (Talk, Understand, Listen for Inpatient Settings), amBITION (Brief Talking Therapies on Wards) and INSITE (Inpatient Suicide Intervention and Therapy Evaluation). All studies recruited participants from acute in-patient wards, initiated therapy within the in-patient setting and followed up on participants post-discharge. RESULTS We summarise our recommendations for good practice in the form of ten top tips for success, based on our collective experience of conducting trials on psychiatric wards. Key themes relate to the importance of relationships between the research team and clinical staff; good stakeholder involvement and getting early buy-in from the team; and adapting to the particular demands of the clinical setting. CONCLUSIONS Sharing good practice recommendations can help reduce research waste arising from poor recruitment and/or retention in future in-patient clinical trials.
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Affiliation(s)
- Pamela Jacobsen
- Department of Psychology, University of Bath, UK; and Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK; Manchester Academic Health Sciences Centre, UK; and Greater Manchester Mental Health NHS Foundation Trust, UK
| | | | - Craig Peak
- Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Rachel Winter
- Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK; Manchester Academic Health Sciences Centre, UK; and Greater Manchester Mental Health NHS Foundation Trust, UK
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Carles MÉ, de Bucy C, Blanchet C, Radjack R. [Temporality of individual psychotherapy in adolescents with anorexia nervosa]. Soins 2022; 67:46-49. [PMID: 35148857 DOI: 10.1016/j.soin.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The management of patients suffering from anorexia nervosa involves the intervention of several professionals in a complementary manner. Within the framework of the multidisciplinary approach (somatic, psychiatric, dietetic, family, etc.), several factors must be taken into account in the clinical evolution to establish the indication of an individual psychotherapy in the most efficient way possible.
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Affiliation(s)
- Marie-Émilie Carles
- Maison de Solenn-Maison des adolescents de l'hôpital Cochin, AP-HP, 97 boulevard de Port-Royal, 75014 Paris, France; Université Paris-Saclay, UVSQ, Inserm, Centre de recherche en épidémiologie et santé des populations, Team DevPsy, 16 avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France
| | - Charlotte de Bucy
- Maison de Solenn-Maison des adolescents de l'hôpital Cochin, AP-HP, 97 boulevard de Port-Royal, 75014 Paris, France
| | - Corinne Blanchet
- Maison de Solenn-Maison des adolescents de l'hôpital Cochin, AP-HP, 97 boulevard de Port-Royal, 75014 Paris, France; Université Paris-Saclay, UVSQ, Inserm, Centre de recherche en épidémiologie et santé des populations, Team DevPsy, 16 avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France; Fédération française anorexie boulimie, c/o Fondation santé des étudiants de France, 8 rue Émile-Deutsch-de-la-Meurthe, 75014 Paris, France
| | - Rahmeth Radjack
- Maison de Solenn-Maison des adolescents de l'hôpital Cochin, AP-HP, 97 boulevard de Port-Royal, 75014 Paris, France; Université Paris-Saclay, UVSQ, Inserm, Centre de recherche en épidémiologie et santé des populations, Team DevPsy, 16 avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France.
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Abstract
Referrals (particularly natal female) to gender identity clinics have increased significantly in recent years. Understanding the reasons for this increase, and how to respond, is hampered by a politically charged debate regarding gender identity. This article starts with a discussion of the so-called 'affirmative approach' to gender dysphoria and considers the implications of the Memorandum of Understanding on conversion therapy. I then say something about the relationship between gender dysphoria and the developmental problems that are characteristic of adolescence. Finally, I outline what changes to the current approach are needed to do our best to ensure these patients receive the appropriate treatment.
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Levin Y, Bachem R, Karatzias T, Shevlin M, Maercker A, Ben-Ezra M. Network structure of ICD-11 adjustment disorder: a cross-cultural comparison of three African countries. Br J Psychiatry 2021; 219:557-564. [PMID: 35048882 DOI: 10.1192/bjp.2021.46] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Adjustment disorder is one of the most widespread mental disorders worldwide. In ICD-11, adjustment disorder is characterised by two main symptom clusters: preoccupation with the stressor and failure to adapt. A network analytic approach has been applied to most ICD-11 stress-related disorders. However, no study to date has explored the relationship between symptoms of adjustment disorder using network analysis. AIMS We aimed to explore the network structure of adjustment disorder symptoms and whether its structure replicates across questionnaire versions and samples. METHOD A network analysis was conducted on adjustment disorder symptoms as assessed by the Adjustment Disorder-New Module (ADNM-8) and an ultra-brief version (ADNM-4) using data from 2524 participants in Nigeria (n = 1006), Kenya (n = 1018) and Ghana (n = 500). RESULTS There were extensive connections between items across all samples in both ADNM versions. Results highlight that preoccupation symptoms seem to be more prominent in terms of edges strengths (i.e. connections) and had the highest centrality in all networks across samples and ADNM versions. Comparisons of network structure invariance revealed one difference between Nigeria and Ghana in both ADNM versions. Importantly, the ADNM-8 global strength was similar in all networks whereas in the ADNM-4 Kenya had a higher global strength score compared with Nigeria. CONCLUSIONS Results provide evidence of the coherence of adjustment disorder in ICD-11 as assessed by the ADNM questionnaire. The prominence of preoccupation symptoms in adjustment disorder highlights a possible therapeutic target to alleviate distress. There is a need to further replicate the network structure of adjustment disorder in non-African samples.
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Affiliation(s)
- Yafit Levin
- Department of Psychology, Division of Psychopathology and Clinical Intervention, University of Zurich, Switzerland
| | - Rahel Bachem
- Department of Psychology, Division of Psychopathology and Clinical Intervention, University of Zurich, Switzerland
| | - Thanos Karatzias
- Edinburgh Napier University, Scotland, UK; and NHS Lothian, Rivers Centre for Traumatic Stress, Scotland, UK
| | - Mark Shevlin
- Psychology Research Institute, School of Psychology, Ulster University, Northern Ireland, UK
| | - Andreas Maercker
- Department of Psychology, Division of Psychopathology and Clinical Intervention, University of Zurich, Switzerland
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16
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Askeland IR, Birkeland MS, Lømo B, Tjersland OA. Changes in Violence and Clinical Distress Among Men in Individual Psychotherapy for Violence Against Their Female Partner: An Explorative Study. Front Psychol 2021; 12:710294. [PMID: 34367034 PMCID: PMC8342763 DOI: 10.3389/fpsyg.2021.710294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 06/21/2021] [Indexed: 11/13/2022] Open
Abstract
Most interventions for men who have acted violently toward their partner have been conducted as group interventions within a criminal justice context. Therefore, few studies have examined individual psychotherapy and how such interventions may reduce partner violence. In this study, we aimed to describe changes in violence, and changes in clinical distress in men undergoing individual psychotherapy targeting their use of partner violence, at a clinic organized within a psychosocial health care context. This is a naturalistic prospective study of men voluntarily receiving individual psychotherapy for their use of violence against their female partner. Participants were 84 male clients, and data on their use of physical violence, physical controlling violence, property violence and psychological violence were collected pretreatment, posttreatment and at follow-up 1.5 years after treatment from both the men, and their partners (n = 58). The percentage of use of all types of violence during a typical month the last year decreased from pretreatment to follow-up, according to both the men, and their partners. Over the course of treatment, use of all types of self-reported violence during the last month was reduced, however, this was only partially confirmed by their partners. Number of sessions was associated with a lower risk of having used physical and physically controlling violence 1.5 years after treatment. Alcohol abuse or dependency, or qualifying for one or more psychiatric diagnoses, were not associated with levels or change in use of violence. On average, the men's clinical distress declined over the course of psychotherapy. The findings suggest that individual psychotherapy may be a promising and worthwhile intervention for intimate partner violence. Studies with more elaborate designs are needed to identify the core mechanisms of psychotherapy for violence, and to corroborate these results with higher levels of evidence.
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Affiliation(s)
- Ingunn Rangul Askeland
- Norwegian Centre for Violence and Traumatic Stress Studies, NKVTS, Oslo, Norway
- Alternative to Violence-ATV, Oslo, Norway
| | | | - Bente Lømo
- Norwegian Centre for Violence and Traumatic Stress Studies, NKVTS, Oslo, Norway
- Alternative to Violence-ATV, Oslo, Norway
| | - Odd Arne Tjersland
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
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Hoeboer CM, De Kleine RA, Molendijk ML, Schoorl M, Oprel DAC, Mouthaan J, Van der Does W, Van Minnen A. Impact of dissociation on the effectiveness of psychotherapy for post-traumatic stress disorder: meta-analysis. BJPsych Open 2020; 6:e53. [PMID: 32423501 PMCID: PMC7345665 DOI: 10.1192/bjo.2020.30] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Many patients with post-traumatic stress disorder (PTSD) experience dissociative symptoms. The question of whether these dissociative symptoms negatively influence the effectiveness of psychotherapy for PTSD is unresolved. AIMS To determine the influence of dissociative symptoms on psychotherapy outcome in PTSD. METHOD We conducted a systematic search in Cochrane, Embase, PILOTS, PsycINFO, PubMed and Web of Science for relevant clinical trials. A random-effects meta-analysis examined the impact of dissociation on psychotherapy outcome in PTSD (pre-registered at Prospero CRD42018086575). RESULTS Twenty-one trials (of which nine were randomised controlled trials) with 1714 patients were included. Pre-treatment dissociation was not related to treatment effectiveness in patients with PTSD (Pearson's correlation coefficient 0.04, 95% CI -0.04 to 0.13). Between-study heterogeneity was high but was not explained by moderators such as trauma focus of the psychotherapy or risk of bias score. There was no indication for publication bias. CONCLUSIONS We found no evidence that dissociation moderates the effectiveness of psychotherapy for PTSD. The quality of some of the included studies was relatively low, emphasising the need for high-quality clinical trials in patients with PTSD. The results suggest that pre-treatment dissociation does not determine psychotherapy outcome in PTSD.
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Affiliation(s)
- C M Hoeboer
- Leiden University, Institute of Psychology; and Parnassiagroep, PsyQ, The Hague, the Netherlands
| | - R A De Kleine
- Leiden University, Institute of Psychology, the Netherlands
| | - M L Molendijk
- Leiden University, Institute of Psychology, the Netherlands
| | - M Schoorl
- Leiden University, Institute of Psychology; and Parnassiagroep, PsyQ, The Hague, the Netherlands
| | - D A C Oprel
- Leiden University, Institute of Psychology; and Parnassiagroep, PsyQ, The Hague, the Netherlands
| | - J Mouthaan
- Leiden University, Institute of Psychology, the Netherlands
| | - W Van der Does
- Leiden University, Institute of Psychology; Parnassiagroep, PsyQ The Hague, the Netherlands; and Department of Psychiatry, Leiden University Medical Center, the Netherlands
| | - A Van Minnen
- PSYTREC, Bilthoven; and Radboud University, Behavioural Science Institute, the Netherlands
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18
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Bruijniks SJE, Lemmens LHJM, Hollon SD, Peeters FPML, Cuijpers P, Arntz A, Dingemanse P, Willems L, van Oppen P, Twisk JWR, van den Boogaard M, Spijker J, Bosmans J, Huibers MJH. The effects of once- versus twice-weekly sessions on psychotherapy outcomes in depressed patients. Br J Psychiatry 2020; 216:222-230. [PMID: 32029012 DOI: 10.1192/bjp.2019.265] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND It is unclear what session frequency is most effective in cognitive-behavioural therapy (CBT) and interpersonal psychotherapy (IPT) for depression. AIMS Compare the effects of once weekly and twice weekly sessions of CBT and IPT for depression. METHOD We conducted a multicentre randomised trial from November 2014 through December 2017. We recruited 200 adults with depression across nine specialised mental health centres in the Netherlands. This study used a 2 × 2 factorial design, randomising patients to once or twice weekly sessions of CBT or IPT over 16-24 weeks, up to a maximum of 20 sessions. Main outcome measures were depression severity, measured with the Beck Depression Inventory-II at baseline, before session 1, and 2 weeks, 1, 2, 3, 4, 5 and 6 months after start of the intervention. Intention-to-treat analyses were conducted. RESULTS Compared with patients who received weekly sessions, patients who received twice weekly sessions showed a statistically significant decrease in depressive symptoms (estimated mean difference between weekly and twice weekly sessions at month 6: 3.85 points, difference in effect size d = 0.55), lower attrition rates (n = 16 compared with n = 32) and an increased rate of response (hazard ratio 1.48, 95% CI 1.00-2.18). CONCLUSIONS In clinical practice settings, delivery of twice weekly sessions of CBT and IPT for depression is a way to improve depression treatment outcomes.
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Affiliation(s)
- Sanne J E Bruijniks
- Postdoctoral Researcher, Department of Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands; and Department of Clinical Psychology and Psychotherapy, University of Freiburg, Germany
| | - Lotte H J M Lemmens
- Assistant Professor, Department of Clinical Psychological Science, Maastricht University, The Netherlands
| | - Steven D Hollon
- Professor, Department of Psychology, Vanderbilt University, Tennessee, USA
| | - Frenk P M L Peeters
- Professor, Department of Clinical Psychological Science, Maastricht University, The Netherlands
| | - Pim Cuijpers
- Professor, Department of Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Arnoud Arntz
- Professor, Department of Clinical Psychology, University of Amsterdam, The Netherlands
| | - Pieter Dingemanse
- Clinical Psychologist, Department of Mood Disorders, Altrecht Mental Health Institute, The Netherlands
| | - Linda Willems
- Health Care Psychologist, Department of Mood Disorders, GGZ Oost Brabant, The Netherlands
| | - Patricia van Oppen
- Professor, Department of Psychiatry, Amsterdam UMC, Vrije Universiteit/GGZ inGeest and Public Health Research Institute, The Netherlands
| | - Jos W R Twisk
- Professor, Department of Epidemiology and Biostatistics, VU University Medical Center, The Netherlands
| | | | - Jan Spijker
- Professor, Center of Depression Expertise, Pro Persona Mental Health Care; and Behavioural Science Institute, Radboud University Nijmegen, The Netherlands
| | - Judith Bosmans
- Associate Professor, Department of Health Sciences, Amsterdam Public Health Research Institute, Faculty of Earth and Life Sciences, Section of Health Economics & Health Technology Assessment, Vrije Universiteit Amsterdam, The Netherlands
| | - Marcus J H Huibers
- Professor, Department of Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands; and Department of Psychology, University of Pennsylvania, Philadelphia, USA
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19
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Serfaty M, King M, Nazareth I, Moorey S, Aspden T, Mannix K, Davis S, Wood J, Jones L. Effectiveness of cognitive-behavioural therapy for depression in advanced cancer: CanTalk randomised controlled trial. Br J Psychiatry 2020; 216:213-221. [PMID: 31566164 DOI: 10.1192/bjp.2019.207] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Depression is one of the most common mental disorders in people with advanced cancer. Although cognitive-behavioural therapy (CBT) has been shown to be effective for depression in people with cancer, it is unclear whether this is the case for people with advanced cancer and depression. AIMS We sought to determine whether CBT is more clinically effective than treatment as usual (TAU) for treating depression in people with advanced cancer (trial registration number ISRCTN07622709). METHOD A multi-centre, parallel-group single-blind randomised controlled trial comparing TAU with CBT (plus TAU). Participants (n = 230) with advanced cancer and depression were randomly allocated to (a) up to 12 sessions of individual CBT or (b) TAU. The primary outcome measure was the Beck Depression Inventory-II (BDI-II). Secondary outcome measures included the Patient Health Questionnaire-9, the Eastern Cooperative Oncology Group Performance Status, and Satisfaction with Care. RESULTS Multilevel modelling, including complier-average intention-to-treat analysis, found no benefit of CBT. CBT delivery was proficient, but there was no treatment effect (-0.84, 95% CI -2.76 to 1.08) or effects for secondary measures. Exploratory subgroup analysis suggested an effect of CBT on the BDI-II in those widowed, divorced or separated (-7.21, 95% CI -11.15 to -3.28). CONCLUSIONS UK National Institute for Health and Care Excellence (NICE) guidelines recommend CBT for treating depression. Delivery of CBT through the Improving Access to Psychological Therapies (IAPT) programme has been advocated for long-term conditions such as cancer. Although it is feasible to deliver CBT through IAPT proficiently to people with advanced cancer, this is not clinically effective. CBT for people widowed, divorced or separated needs further exploration. Alternate models of CBT delivery may yield different results.
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Affiliation(s)
- Marc Serfaty
- Associate Professor in Psychiatry, Division of Psychiatry, University College London, UK
| | - Michael King
- Professorial Research Associate, Division of Psychiatry, University College London, UK
| | - Irwin Nazareth
- Professor of Primary Care and Population Science, Research Department of Primary Care and Population Health, University College London, UK
| | - Stirling Moorey
- Consultant Psychiatrist in CBT, South London and Maudsley NHS Foundation Trust, King's College London, UK
| | - Trefor Aspden
- Senior Research Associate, Division of Psychiatry, University College London, UK
| | - Kathryn Mannix
- Consultant in Palliative Medicine and Cognitive Behaviour Therapist, Palliative Care Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Sarah Davis
- Senior Research Nurse, Marie Curie Palliative Care Research Department, University College London, UK
| | - John Wood
- Principle Research Associate, Research Department of Primary Care and Population Health, University College London, UK
| | - Louise Jones
- Honorary Clinical Senior Lecturer, Marie Curie Palliative Care Research Department, University College London, UK
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20
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Abstract
ICD-11 complex post-traumatic stress disorder (PTSD) is a new disorder that describes the more complex reactions that are typical of individuals exposed to chronic trauma. The addition of this disorder as distinct from PTSD is expected to provide greater precision in the diagnosis of trauma populations and more personalised and effective treatment.
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Affiliation(s)
- Marylène Cloitre
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, USA; and Department of Psychiatry and Behavioural Sciences, Stanford University, USA
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21
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Abstract
The forthcoming National Institute for Health and Care Excellence depression guideline reviews short-term outcomes for long-term depression. We present effect sizes for long-term outcomes in trials that report these data. Psychological therapies become more effective, whereas antidepressants become less effective over the long term. We review other forms of longitudinal research that support these findings.
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Affiliation(s)
- Susan McPherson
- Researcher, School of Health and Social Care, University of Essex, UK
| | - Michael P Hengartner
- Senior Lecturer and Researcher, School of Applied Psychology, Zurich University of Applied Sciences, Switzerland
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22
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Abstract
The intensive treatment of a patient presenting with major depression, chronic suicidal ideation, and a borderline personality disorder with narcissistic features is described as it developed over an 18-month treatment. The treatment approach is a transdiagnostic one with an emphasis on change in the patient's representation of self and others, identity and interpersonal functioning. The intended change is not only in the reduction of depression and suicidal ideation but also an improvement in interactions with others at work and intimate relations. The combination of rich clinical information from the therapist and independent research ratings of patient progress provide a complex picture of the treatment.
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Affiliation(s)
- John F Clarkin
- Department of Psychiatry, Weill Cornell Medical College, New York City, New York
| | - Mark Petrini
- Department of Psychiatry, Columbia University Medical Center, New York City, New York
| | - Diana Diamond
- New York University Postdoctoral Program in Psychotherapy and Psychoanalysis, Weill Cornell Medical College, City University of New York, New York City, New York
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Cheston R, Ivanecka A. Individual and group psychotherapy with people diagnosed with dementia: a systematic review of the literature. Int J Geriatr Psychiatry 2017; 32:3-31. [PMID: 27388259 DOI: 10.1002/gps.4529] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 05/16/2016] [Accepted: 05/27/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Psychotherapy provides a means of helping participants to resolve emotional threats and play an active role in their lives. Consequently, psychotherapy is increasingly used within dementia care. This paper reviews the existing evidence base for individual and group psychotherapy with people affected by dementia. DESIGN The protocol was registered. We searched electronic databases, relevant websites and reference lists for records of psychotherapy with people affected by Alzheimer's Disease, Vascular dementia, Lewy-body dementia or a mixed condition between 1997 and 2015. We included studies of therapies which met British Association of Counselling and Psychotherapy definitions (e.g. occurs regularly, focuses on talking about life events and facilitates understand of the illness). Art therapy, Cognitive Stimulation and Rehabilitation, Life Review, Reminiscence Therapy and family therapy were excluded. Studies which included people with frontal-temporal dementia and mild cognitive impairment were excluded. Data was extracted using a bespoke form, and risk of bias assessments were carried out independently by both authors. Meta-analysis was not possible because of the heterogeneity of data. RESULTS A total of 1397 papers were screened with 26 papers using randomised, non-randomised controlled trials or repeated measured designs being included. A broad mix of therapeutic modalities, types, lengths and settings were described, focussing largely on people with mild levels of cognitive impairment living in the community. CONCLUSIONS This study was limited to only those studies published in English. The strongest evidence supported the use of short-term group therapy after diagnosis and an intensive, multi-faceted intervention for Nursing Home residents. Many areas of psychotherapy need further research. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Richard Cheston
- University of the West of England, Faculty of Health and Applied Sciences, Bristol, UK
| | - Ada Ivanecka
- University of the West of England, Faculty of Health and Applied Sciences, Bristol, UK
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24
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Constantino MJ, Morrison NR, Coyne AE, Goodwin BJ, Santorelli GD, Angus L. Patients' Perceptions of Corrective Experiences in Naturalistically Delivered Psychotherapy. J Clin Psychol 2016; 73:139-152. [PMID: 27879998 DOI: 10.1002/jclp.22428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Corrective experiences (CEs), which suggest transformative experience(s) for the psychotherapy patient, have a rich theoretical history; yet there is little empirical information on patients' own perceptions of what gets "corrected" from therapy, and what is "corrective" (i.e., the mechanisms driving the CE). To address this gap, we investigated 14 patients' posttreatment accounts of both CE elements in the context of naturalistically delivered individual psychotherapy, using a consensual qualitative research methodology. Extending prior research focused on patients' accounts of CEs while still engaged in treatment (Heatherington et al., 2012), the present results revealed that patients retrospectively identified an array of categories that were deemed corrected, such as positive changes in cognitions, interpersonal problems, self-concepts, symptoms, and behaviors. Patients also identified CEs that may have led to those shifts/transformations, including their therapist's actions (especially giving feedback), their own agentic actions (especially engaging in the therapeutic process), and the patient-therapist collaborative and engaged relationship. Clinical practice implications are discussed.
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25
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Lemmens LHJM, Arntz A, Peeters F, Hollon SD, Roefs A, Huibers MJH. Clinical effectiveness of cognitive therapy v. interpersonal psychotherapy for depression: results of a randomized controlled trial. Psychol Med 2015; 45:2095-2110. [PMID: 25640151 DOI: 10.1017/s0033291715000033] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Although both cognitive therapy (CT) and interpersonal psychotherapy (IPT) have been shown to be effective treatments for major depressive disorder (MDD), it is not clear yet whether one therapy outperforms the other with regard to severity and course of the disorder. This study examined the clinical effectiveness of CT v. IPT in a large sample of depressed patients seeking treatment in a Dutch outpatient mental health clinic. We tested whether one of the treatments was superior to the other at post-treatment and at 5 months follow-up. Furthermore, we tested whether active treatment was superior to no treatment. We also assessed whether initial depression severity moderated the effect of time and condition and tested for therapist differences. METHOD Depressed adults (n = 182) were randomized to either CT (n = 76), IPT (n = 75) or a 2-month waiting list control (WLC) condition (n = 31). Main outcome was depression severity, measured with the Beck Depression Inventory - II (BDI-II), assessed at baseline, 2, 3, and 7 months (treatment phase) and monthly up to 5 months follow-up (8-12 months). RESULTS No differential effects between CT and IPT were found. Both treatments exceeded response in the WLC condition, and led to considerable improvement in depression severity that was sustained up to 1 year. Baseline depression severity did not moderate the effect of time and condition. CONCLUSIONS Within our power and time ranges, CT and IPT appeared not to differ in the treatment of depression in the acute phase and beyond.
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Affiliation(s)
- L H J M Lemmens
- Department of Clinical Psychological Science,Faculty of Psychology and Neuroscience,Maastricht University,Maastricht,The Netherlands
| | - A Arntz
- Department of Clinical Psychological Science,Faculty of Psychology and Neuroscience,Maastricht University,Maastricht,The Netherlands
| | - F Peeters
- Department of Psychiatry and Neuropsychology,Maastricht University Medical Centre,Maastricht,The Netherlands
| | - S D Hollon
- Department of Psychology,Vanderbilt University,Nashville,TN,USA
| | - A Roefs
- Department of Clinical Psychological Science,Faculty of Psychology and Neuroscience,Maastricht University,Maastricht,The Netherlands
| | - M J H Huibers
- Department of Clinical Psychological Science,Faculty of Psychology and Neuroscience,Maastricht University,Maastricht,The Netherlands
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