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Tickell A, Byng R, Crane C, Gradinger F, Hayes R, Robson J, Cardy J, Weaver A, Morant N, Kuyken W. Recovery from recurrent depression with mindfulness-based cognitive therapy and antidepressants: a qualitative study with illustrative case studies. BMJ Open 2020; 10:e033892. [PMID: 32075835 PMCID: PMC7044862 DOI: 10.1136/bmjopen-2019-033892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study aimed to describe the recovery journeys of people with a history of recurrent depression who took part in a psychosocial programme designed to teach skills to prevent depressive relapse (mindfulness-based cognitive therapy (MBCT)), alongside maintenance antidepressant medication (ADM). DESIGN A qualitative study embedded within a multicentre, single blind, randomised controlled trial (the PREVENT trial). SETTING Primary care urban and rural settings in the UK. PARTICIPANTS 42 people who participated in the MBCT arm of the parent trial were purposively sampled to represent a range of recovery journeys. INTERVENTIONS MBCT involves eight weekly group sessions, with four refresher sessions offered in the year following the end of the programme. It was adapted to offer bespoke support around ADM tapering and discontinuation. METHODS Written feedback and structured in-depth interviews were collected in the 2 years after participants undertook MBCT. Data were analysed using thematic analysis and case studies constructed to illustrate the findings. RESULTS People with recurrent depression have unique recovery journeys that shape and are shaped by their pharmacological and psychological treatment choices. Their journeys typically include several over-arching themes: (1) beliefs about the causes of depression, both biological and psychosocial; (2) personal agency, including expectations about their role in recovery and treatment; (3) acceptance, both of depression itself and the recovery journey; (4) quality of life; (5) experiences and perspectives on ADM and ADM tapering-discontinuation; and (6) the role of general practitioners, both positive and negative. CONCLUSIONS People with recurrent depression describe unique, complex recovery journeys shaped by their experiences of depression, treatment and interactions with health professionals. Understanding how several themes coalesce for each individual can both support their recovery and treatment choices as well as health professionals in providing more accessible, collaborative, individualised and empowering care. TRIAL REGISTRATION NUMBER Clinical trial number ISRCTN26666654; post results.
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Affiliation(s)
- Alice Tickell
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Richard Byng
- Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, UK
| | | | - Felix Gradinger
- Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Rachel Hayes
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - James Robson
- Department of Education, University of Oxford, Oxford, UK
| | - Jessica Cardy
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Alice Weaver
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Nicola Morant
- Department of Psychiatry, University College London, London, UK
| | - Willem Kuyken
- Department of Psychiatry, University of Oxford, Oxford, UK
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Husain MI, Strawbridge R, Carter B, Jones BDM, Young A, Carvalho AF. Efficacy and acceptability of adjunctive psychological and pharmacological interventions for treatment-resistant depression: protocol for a systematic review and network meta-analysis. BMJ Open 2019; 9:e028538. [PMID: 31092667 PMCID: PMC6530376 DOI: 10.1136/bmjopen-2018-028538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Major depressive disorder (MDD) is a common debilitating illness worldwide. The vast majority of patients with MDD will not achieve remission with first-line treatment and despite the availability of different treatment modalities, at least one-third of patients experience treatment-resistant depression (TRD). There continues to be a paucity of research focused on treatment options for patients with TRD thus treatment decisions are largely based on patient and clinician preference as opposed to evidence-based practice. Herein we propose a systematic review and network meta-analysis (NMA) of available pharmacological and psychological augmentation treatments for TRD, to inform evidence-based management of TRD. METHODS AND ANALYSIS We plan to conduct a search of electronic databases (MEDLINE and ISIWEB) of all dates from inception for randomised controlled trials of pharmacological and psychological augmentation interventions for adults with TRD. Articles for review will be included based upon consensus from two authors. Pharmaceutical companies will be contacted for access to any unpublished data. An NMA will compare the effectiveness pharmacological adjunctive agents for TRD using preanalysis/postanalysis, assuming consistency and transitivity. ETHICS AND DISSEMINATION This project does not require research ethics board approval. The dissemination plan is to present findings at international scientific meetings and publishing results in a peer-reviewed academic journal. PROSPERO REGISTRATION NUMBER CRD42019132588.
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Affiliation(s)
- Muhammad Ishrat Husain
- General Psychiatry and Health Systems Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | - Ben Carter
- Biostatistics & Health Informatics, King's College London, London, UK
| | - Brett D M Jones
- General Psychiatry and Health Systems Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Allan Young
- Department of Psychological Medicine, King's College London, London, UK
| | - Andre F Carvalho
- General Psychiatry and Health Systems Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Puschner B, Repper J, Mahlke C, Nixdorf R, Basangwa D, Nakku J, Ryan G, Baillie D, Shamba D, Ramesh M, Moran G, Lachmann M, Kalha J, Pathare S, Müller-Stierlin A, Slade M. Using Peer Support in Developing Empowering Mental Health Services (UPSIDES): Background, Rationale and Methodology. Ann Glob Health 2019; 85:53. [PMID: 30951270 PMCID: PMC6634474 DOI: 10.5334/aogh.2435] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Peers are people with lived experience of mental illness. Peer support is an established intervention in which peers offer support to others with mental illness. A large proportion of people living with severe mental illness receive no care. The care gap is largest in low- and middle-income countries, with detrimental effects on individuals and societies. The global shortage of human resources for mental health is an important driver of the care gap. Peers are an under-used resource in global mental health. OBJECTIVES To describe rationale and methodology of an international multicentre study which will scale-up peer support for people with severe mental illness in high-, middle-, and low-income countries through mixed-methods implementation research. METHODS UPSIDES is an international community of research and practice for peer support, including peer support workers, mental health researchers, and other relevant stakeholders in eight study sites across six countries in Europe, Africa, and Asia. During the first two years of UPSIDES, a series of qualitative studies and systematic reviews will explore stakeholders' perceptions and the current state of peer support at each site. Findings will be incorporated into a conceptual framework to guide the development of a culturally appropriate peer support intervention to be piloted across all study sites. All intervention and study materials will be translated according to internationally recognised guidelines.Expected Impact: UPSIDES: will leverage the unique expertise of people with lived experience of mental illness to strengthen mental health systems in high-, middle- and low-income countries. UPSIDES will actively involve and empower service users and embed patient-centeredness, recovery orientation, human rights approaches, and community participation into services. The focus on capacity-building of peers may prove particularly valuable in low-resource settings in which shortages of human capital are most severe.
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Affiliation(s)
- Bernd Puschner
- Department of Psychiatry and Psychotherapy II, Ulm University, DE
| | - Julie Repper
- ImROC (Implementing Recovery through Organisational Change), Department of Learning and Organisational Development, Nottinghamshire Healthcare Foundation NHS Trust, Nottingham, UK
| | - Candelaria Mahlke
- Department of Psychiatry, University Medical Centre Hamburg-Eppendorf, DE
| | - Rebecca Nixdorf
- Department of Psychiatry, University Medical Centre Hamburg-Eppendorf, DE
| | | | - Juliet Nakku
- Butabika National Referral Hospital, Kampala, UG
| | - Grace Ryan
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, UK
| | | | | | | | - Galia Moran
- Department of Social Work, Ben Gurion University of the Negev, Beer Sheva, IL
| | - Max Lachmann
- Department of Social Work, Ben Gurion University of the Negev, Beer Sheva, IL
| | - Jasmine Kalha
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, IN
| | - Soumitra Pathare
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, IN
| | | | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, UK
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Frühauf A, Sevecke K, Kopp M. [Current state of the scientific literature on effects of therapeutic climbing on mental health - conclusion: a lot to do]. Neuropsychiatr 2019; 33:1-7. [PMID: 30128657 DOI: 10.1007/s40211-018-0283-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/02/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Therapeutic Climbing is applied in physiological as well as in psychological rehabilitation programs. Systematic reviews have been conducted, evaluating the physiological effects of therapeutic climbing. The aim of the following article is a review on existing literature about the psychological effects of climbing therapy. METHODS We searched the databases of PubMed, Scholar and ScienceDirect up to December 2017 in German and English language. Trials were included if they assessed psychological variables in climbing interventions. RESULTS Seven articles were included in the following review. Effectiveness of climbing therapy was studied in a) adult inpatients with mental disorders (n = 3), b) adult outpatients with mental disorders (n = 1), c) children with motoric deficits and disabilities (n = 2), d) healthy adults (n = 1). All trials had major methodological limitations. Control groups if present, were defined differently. Three trials assessed self-efficacy and revealed enhanced self-efficacy after the climbing intervention. No psychological differences were seen between aerobic exercise and climbing therapy in healthy adults. Acute positive affective changes were seen in in-patients with major depressive disorders after a climbing session compared to a relaxation session. CONCLUSION The effectiveness of climbing therapy on psychological outcomes remains unclear. Limited evidence with varying age groups (children and adults) and a high risk of bias shows enhanced self-efficacy through climbing therapy. There is a need for further studies in children and adults on psychological outcomes through climbing therapy, especially in comparison with aerobic activity interventions.
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Affiliation(s)
- Anika Frühauf
- Institut für Sportwissenschaft, Universität Innsbruck, Fürstenweg 185, 6020, Innsbruck, Österreich.
| | - Kathrin Sevecke
- Universitätsklinik für Psychiatrie, Psychotherapie und Psychosomatik im Kindes- und Jugendalter, Innsbruck, Österreich
| | - Martin Kopp
- Institut für Sportwissenschaft, Universität Innsbruck, Fürstenweg 185, 6020, Innsbruck, Österreich
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Aschbrenner KA, Naslund JA, Gorin AA, Mueser KT, Scherer EA, Viron M, Kinney A, Bartels SJ. Peer support and mobile health technology targeting obesity-related cardiovascular risk in young adults with serious mental illness: Protocol for a randomized controlled trial. Contemp Clin Trials 2018; 74:97-106. [PMID: 30316998 PMCID: PMC6217796 DOI: 10.1016/j.cct.2018.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/29/2018] [Accepted: 10/10/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Individuals with serious mental illness (SMI) such as schizophrenia and bipolar disorder face a higher risk of early death due to cardiovascular disease and other preventable chronic illnesses. Young adulthood is a critical window of development for lifestyle interventions to improve the long-term health and quality of life in this population. Fit Forward is an NIH-funded randomized clinical trial examining the effectiveness of a group lifestyle intervention (PeerFIT) enhanced with mobile health technology compared to one-on-one mobile lifestyle coaching with Basic Education in fitness and nutrition supported by a wearable Activity Tracking device (BEAT) in achieving clinically significant weight loss and improved cardiorespiratory fitness in young adults with SMI. METHODS Fit Forward targets 144 young adults (18 to 35 years) with SMI and a body mass index (BMI) of ≥25 receiving public mental health services. In a two-arm randomized clinical trial, participants will be randomly assigned with equal probability to PeerFIT or BEAT, stratified by birth sex and psychiatric diagnosis. Participants will be assessed at baseline, 6, and 12 months. The primary outcome is cardiovascular risk reduction indicated by either clinically significant weight loss (5% or greater) or increased fitness (>50 m on the 6-Minute Walk Test). Secondary outcomes include change in BMI, lipids, and hemoglobin A1c. Perceived self-efficacy for exercise and peer support will be evaluated as mechanisms underlying intervention effects. CONCLUSION If effective, PeerFIT will provide a potentially scalable approach to addressing health risks among young adults with SMI in mental health settings. TRIALS REGISTRATION ClinicalTrials.gov, NCT02815813.
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Affiliation(s)
- Kelly A Aschbrenner
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, United States.
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, United States
| | - Amy A Gorin
- Department of Psychology, University of Connecticut, Storrs, CT, United States
| | - Kim T Mueser
- Department of Occupational Therapy, Boston University, Boston, MA, United States
| | - Emily A Scherer
- Biomedical Data Sciences, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Mark Viron
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Allison Kinney
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, United States
| | - Stephen J Bartels
- The Mongan Institute, Massachusetts General Hospital, Cambridge, MA, United States
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Naslund JA, Aschbrenner KA, Marsch LA, McHugo GJ, Bartels SJ. Facebook for Supporting a Lifestyle Intervention for People with Major Depressive Disorder, Bipolar Disorder, and Schizophrenia: an Exploratory Study. Psychiatr Q 2018; 89:81-94. [PMID: 28470468 PMCID: PMC5758428 DOI: 10.1007/s11126-017-9512-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
To examine whether Facebook could support a community-based group lifestyle intervention for adults with serious mental illness. Participants with serious mental illness and obesity enrolled in a 6-month group lifestyle program were invited to join a secret Facebook group to support their weight loss and physical activity goals. Two peer co-facilitators moderated the Facebook group. The proportion of participants who achieved ≥5% weight loss or improved fitness was measured at follow-up. The relationship between this outcome and participants' interactions in the Facebook group was examined. Interactions were defined as active contributions including posts, comments, or likes. Content of participants' Facebook posts was also explored. Participants (n = 25) had major depression (44%), bipolar disorder (36%), and schizophrenia (20%). Nineteen (76%) participants joined the Facebook group, and contributed 208 interactions (70 posts; 81 comments; 57 likes). Participants who achieved ≥5% weight loss or improved fitness contributed more interactions in the Facebook group (mean = 19.1; SD = 20.5) compared to participants who did not (mean = 3.9; SD = 6.7), though this relationship approached statistical significance (t = -2.1; Welch's df = 13.1; p = 0.06). Participants' posts containing personal sharing of successes or challenges to adopting healthy behaviors generated more interaction compared to posts containing program reminders (p < 0.01), motivational messages (p < 0.01), and healthy eating content (p < 0.01). Facebook appears promising for supporting health behavior change among people with serious mental illness. These findings can inform social media initiatives to scale up health promotion efforts targeting this at-risk group.
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Affiliation(s)
- John A Naslund
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA.
- Health Promotion Research Center at Dartmouth, Lebanon, NH, USA.
- The Center for Technology and Behavioral Health, Dartmouth College, Lebanon, NH, USA.
| | - Kelly A Aschbrenner
- Health Promotion Research Center at Dartmouth, Lebanon, NH, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Lisa A Marsch
- The Center for Technology and Behavioral Health, Dartmouth College, Lebanon, NH, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Gregory J McHugo
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Stephen J Bartels
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
- Health Promotion Research Center at Dartmouth, Lebanon, NH, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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Sun M, Lanctot K, Herrmann N, Gallagher D. Exercise for Cognitive Symptoms in Depression: A Systematic Review of Interventional Studies. Can J Psychiatry 2018; 63:115-128. [PMID: 29186973 PMCID: PMC5788135 DOI: 10.1177/0706743717738493] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 12/11/2022]
Abstract
OBJECTIVE To explore the effect of exercise on cognition in depression as well as the impact of potential moderators and intervention type. METHOD Controlled and uncontrolled interventional studies that described an exercise intervention and cognitive outcomes in participants with major depressive disorder (MDD) were included following a search of Pubmed, Ovid Medline, PsycInfo and Embase from inception to January 2017. Meta-analyses were conducted to calculate Hedges' g using a random-effects model. Meta-regression explored the relationships among age, baseline cognition, frequency and duration of exercise, and cognitive outcomes. Subgroup analyses were also conducted according to type and intensity of exercise interventions. RESULTS Of 12 controlled studies and 3 uncontrolled studies that met inclusion criteria, 9 (642 patients) were included in the meta-analysis. No significant effect of exercise was found on global cognition (Hedges' g = 0.08, P = 0.33, I2 = 0%) or on individual cognitive domains. Meta-regression analyses failed to find significant relationships among participant age, baseline cognition, number of exercise sessions per wk, duration of exercise per wk, total duration of exercise during the intervention, or improvement in global cognition. Interventions combining physical with cognitive activity significantly improved global cognition ( P = 0.048), whereas low-intensity interventions were also positive ( P = 0.048). CONCLUSIONS No impact of physical exercise was found on cognition in MDD overall. However, we found that interventions combining physical and cognitive activities had a positive impact, and that lower-intensity interventions, where adherence was improved, also impacted positively. There remains a lack of high-quality data in this population.
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Affiliation(s)
- Meng Sun
- Department of Psychiatry, The Second Xianga Hospital, Central South University, Changsha, Hunan, China
- China National Clinical Research Center on Mental Health Disorders (Xiangya), Changsha, Hunan, China
- China National Technology Institute on Mental Disorders, Changsha, Hunan, China
- Hunan Technology Institute of Psychiatry, Changsha, Hunan, China
- Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan, China
- Mental Health Institute of Central South University, Changsha, Hunan, China
- Division of Geriatric Psychiatry, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Krista Lanctot
- Medical Outcome and Research in Economics Group (MORE), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry and Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Nathan Herrmann
- Division of Geriatric Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Damien Gallagher
- Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Dix-Peek D, Dix-Peek D, Werbeloff M. Evaluation of the efficacy of a South African psychosocial model for the rehabilitation of torture survivors. Torture 2018; 28:34-57. [PMID: 30047490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
UNLABELLED To address the consequences of past torture experiences as well as current traumas and daily stressors, the Centre for the Study of Violence and Reconciliation (CSVR) developed a contextually appropriate psychosocial framework for the rehabilitation of individuals who have been affected by torture. METHOD To test the efficacy of this framework, a quasiexperimental study was conducted with torture survivor clients of the CSVR who met the 1985 United Nations Convention Against Torture (UNCAT) definition. A comparison group of clients (n=38) was initially included on a waiting list and thereafter received treatment, whilst the treatment group of clients (n=44) entered straight into treatment. RESULTS Baseline t-test comparisons conducted on 13 outcome indicators revealed significantly better initial psychological health and functioning of clients in the treatment group than those in the comparison group, with moderately large differences on PTSD, trauma and anxiety, and strong difference in depression scores. Three-month follow-up comparisons using the conservative Wilcoxon test revealed significantly greater improvement on the functioning and anxiety indicators of the treatment group relative to the waiting-list comparison group (odds ratios = 2.49 and 2.61 respectively). After a further three months, when treatment was based on the CSVR framework for both groups, fewer than half the respondents remained in the study (n=20 in the treatment group; n=16 in the comparison group), and the Wilcoxon repeated measures test results on changes since baseline were counter-intuitive: for these remaining clients, there were now more significant outcome improvements for the comparison group than for the treatment group. However, the relative odds ratios for the groups were not significant for these indicators. Furthermore, the clients who dropped out from the treatment group had shown overall improvement in their psychological health and functioning in the initial three months of the study, whereas those who dropped out from the comparison group had shown improvements on fewer indicators. Thus, the research findings on the efficacy of the framework are inconclusive. DISCUSSION We suggest that this inconclusiveness can be explained by the severe challenges and ethical complexities of psychosocial research on vulnerable groups. The study highlights the serious problem of attrition of participants in the treatment programme which affected the overall study, and which may explain findings that at first appear counter-intuitive.
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Affiliation(s)
- Dominique Dix-Peek
- Centre for the Study of Violence and Reconciliation (CSVR), South Africa. Correspondence to:
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Young KD, Misaki M, Harmer CJ, Victor T, Zotev V, Phillips R, Siegle GJ, Drevets WC, Bodurka J. Real-Time Functional Magnetic Resonance Imaging Amygdala Neurofeedback Changes Positive Information Processing in Major Depressive Disorder. Biol Psychiatry 2017; 82:578-586. [PMID: 28476207 PMCID: PMC5610066 DOI: 10.1016/j.biopsych.2017.03.013] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 03/08/2017] [Accepted: 03/15/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND In participants with major depressive disorder who are trained to upregulate their amygdalar hemodynamic responses during positive autobiographical memory recall with real-time functional magnetic resonance imaging neurofeedback (rtfMRI-nf) training, depressive symptoms diminish. This study tested whether amygdalar rtfMRI-nf also changes emotional processing of positive and negative stimuli in a variety of behavioral and imaging tasks. METHODS Patients with major depressive disorder completed two rtfMRI-nf sessions (18 received amygdalar rtfMRI-nf, 16 received control parietal rtfMRI-nf). One week before and following rtfMRI-nf training, participants performed tasks measuring responses to emotionally valenced stimuli including a backward-masking task, which measures the amygdalar hemodynamic response to emotional faces presented for traditionally subliminal duration and followed by a mask, and the Emotional Test Battery in which reaction times and performance accuracy are measured during tasks involving emotional faces and words. RESULTS During the backward-masking task, amygdalar responses increased while viewing masked happy faces but decreased to masked sad faces in the experimental versus control group following rtfMRI-nf. During the Emotional Test Battery, reaction times decreased to identification of positive faces and during self-identification with positive words and vigilance scores increased to positive faces and decreased to negative faces during the faces dot-probe task in the experimental versus control group following rtfMRI-nf. CONCLUSIONS rtfMRI-nf training to increase the amygdalar hemodynamic response to positive memories was associated with changes in amygdalar responses to happy and sad faces and improved processing of positive stimuli during performance of the Emotional Test Battery. These results may suggest that amygdalar rtfMRI-nf training alters responses to emotional stimuli in a manner similar to antidepressant pharmacotherapy.
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Affiliation(s)
- Kymberly D Young
- Laureate Institute for Brain Research, Tulsa, Oklahoma; Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
| | - Masaya Misaki
- Laureate Institute for Brain Research, Tulsa, Oklahoma
| | - Catherine J Harmer
- Department of Psychiatry, University of Oxford, Medical Sciences Division, Oxford, United Kingdom
| | - Teresa Victor
- Laureate Institute for Brain Research, Tulsa, Oklahoma
| | - Vadim Zotev
- Laureate Institute for Brain Research, Tulsa, Oklahoma
| | | | - Greg J Siegle
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Wayne C Drevets
- Janssen Research & Development, LLC, Johnson & Johnson, Inc., Titusville, New Jersey
| | - Jerzy Bodurka
- Laureate Institute for Brain Research, Tulsa, Oklahoma; Stephenson School of Biomedical Engineering, University of Oklahoma College of Engineering, Norman, Oklahoma
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Lepièce B, Reynaert C, Jacques D, Zdanowicz N. Returning to Work after a Common Mental Health Disorder: a New Preoccupation for Mental Health Professionals? Psychiatr Danub 2017; 29:262-266. [PMID: 28953774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Since 2010, the Belgian mental healthcare system has been involved in a structural reform: the main objective of this reorganisation is to foster the reintegration in the community of patients suffering from a mental health disorder. In parallel, the role of mental health professionals has evolved these last years: from a strictly clinical role, to the preoccupation with the rehabilitation of social competencies such as enhancing patients' abilities to return to work. The aim of this paper is to explore, specifically for patients hospitalized for a common mental health disorder, the predictive variables of returning to work within 6 months after hospitalization (RTW6). SUBJECTS AND METHODS Our sample was extracted from routinely collected data during the patients' hospital stay (10 days) at the Psychosomatic Rehabilitation Day Centre of CHU Godinne. A sample of 134 patients participated in our study. Those patients were contacted 6 months after their hospitalization to assess resumption of work. RESULTS We found that a patient's sociodemographicand socioeconomic variables, and depressive symptoms at the beginning of hospitalization were not predictive of return to work within 6 months (RTW6). On the other hand, duration of absence from work before hospitalization and the diagnosis of a major depression in particular were negatively associated with RTW6, whereas improvement of depressive symptoms during hospitalization stay was positively associated to RTW6. CONCLUSION Our study identified the diagnosis of major depression and the duration of absence from work before hospitalization as two important risk factors impeding a fast return to work for patients hospitalised for a common mental health disorder. As the preoccupation with patients' abilities to return to work is now on the agenda of mental health professionals, special support and supervision should be dedicated to the more vulnerable patients.
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Affiliation(s)
- Brice Lepièce
- Université Catholique de Louvain, Institute of Health and Society (IRSS, UCL Brussel), CHU UCL Namur, Psychopathology and Psychosomatic Department, avenue Dr G. Therasse n°1, 5530 Yvoir, Belgium,
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Adams H, Thibault P, Ellis T, Moore E, Sullivan M. The Relation Between Catastrophizing and Occupational Disability in Individuals with Major Depression: Concurrent and Prospective Associations. J Occup Rehabil 2017; 27:405-412. [PMID: 27770242 DOI: 10.1007/s10926-016-9669-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 06/06/2023]
Abstract
Background Catastrophic thinking has been associated with occupational disability in individuals with debilitating pain conditions. The relation between catastrophic thinking and occupational disability has not been previously examined in individuals with debilitating mental health conditions. The present study examined the relation between catastrophic thinking and occupational disability in individuals with major depression. Methods The study sample consisted of 80 work-disabled individuals with major depressive disorder (MDD) who were referred to an occupational rehabilitation service. Participants completed measures of depressive symptom severity, catastrophic thinking and occupational disability at admission and termination of a rehabilitation intervention. Return-to-work outcomes were assessed 1 month following the termination of the rehabilitation intervention. Results Cross-sectional analyses of admission data revealed that catastrophic thinking contributed significant variance to the prediction of self-reported occupational disability, beyond the variance accounted for by depressive symptom severity. Prospective analyses revealed that reductions in catastrophic thinking predicted successful return to work following the rehabilitation intervention, beyond the variance accounted for by reductions in depressive symptom severity. Conclusions The findings suggest that catastrophic thinking is a determinant of occupational disability in individuals with major depressive disorder. The findings further suggest that interventions designed to reduce catastrophic thinking might promote occupational re-integration in individuals with debilitating mental health conditions.
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Affiliation(s)
- Heather Adams
- Recover Injury Research Centre, The University of Queensland, Herston, QLD, Australia
| | - Pascal Thibault
- Department of Psychology, McGill University, Montréal, Canada
| | - Tamra Ellis
- Centre for Rehabilitation and Health, Toronto, Canada
| | - Emily Moore
- Department of Psychology, McGill University, Montréal, Canada
| | - Michael Sullivan
- Faculty of Health and Behavioural Sciences, Recover Injury Research Centre, The University of Queensland, 288 Herston Road, Level 7, Herston, QLD, 4006, Australia.
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Uebelacker LA, Tremont G, Gillette LT, Epstein-Lubow G, Strong DR, Abrantes AM, Tyrka AR, Tran T, Gaudiano BA, Miller IW. Adjunctive yoga v. health education for persistent major depression: a randomized controlled trial. Psychol Med 2017; 47:2130-2142. [PMID: 28382883 PMCID: PMC5548599 DOI: 10.1017/s0033291717000575] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The objective of this study was to determine whether hatha yoga is an efficacious adjunctive intervention for individuals with continued depressive symptoms despite antidepressant treatment. METHOD We conducted a randomized controlled trial of weekly yoga classes (n = 63) v. health education classes (Healthy Living Workshop; HLW; n = 59) in individuals with elevated depression symptoms and antidepressant medication use. HLW served as an attention-control group. The intervention period was 10 weeks, with follow-up assessments 3 and 6 months afterwards. The primary outcome was depression symptom severity assessed by blind rater at 10 weeks. Secondary outcomes included depression symptoms over the entire intervention and follow-up periods, social and role functioning, general health perceptions, pain, and physical functioning. RESULTS At 10 weeks, we did not find a statistically significant difference between groups in depression symptoms (b = -0.82, s.e. = 0.88, p = 0.36). However, over the entire intervention and follow-up period, when controlling for baseline, yoga participants showed lower levels of depression than HLW participants (b = -1.38, s.e. = 0.57, p = 0.02). At 6-month follow-up, 51% of yoga participants demonstrated a response (⩾50% reduction in depression symptoms) compared with 31% of HLW participants (odds ratio = 2.31; p = 0.04). Yoga participants showed significantly better social and role functioning and general health perceptions over time. CONCLUSIONS Although we did not see a difference in depression symptoms at the end of the intervention period, yoga participants showed fewer depression symptoms over the entire follow-up period. Benefits of yoga may accumulate over time.
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Affiliation(s)
- Lisa A. Uebelacker
- Butler Hospital, Providence, RI
- Alpert Medical School of Brown University, Providence, RI
| | - Geoffrey Tremont
- Alpert Medical School of Brown University, Providence, RI
- Rhode Island Hospital, Providence, RI
| | | | - Gary Epstein-Lubow
- Butler Hospital, Providence, RI
- Alpert Medical School of Brown University, Providence, RI
| | | | - Ana M. Abrantes
- Butler Hospital, Providence, RI
- Alpert Medical School of Brown University, Providence, RI
| | - Audrey R. Tyrka
- Butler Hospital, Providence, RI
- Alpert Medical School of Brown University, Providence, RI
| | - Tanya Tran
- Alpert Medical School of Brown University, Providence, RI
- Rhode Island Hospital, Providence, RI
| | - Brandon A. Gaudiano
- Butler Hospital, Providence, RI
- Alpert Medical School of Brown University, Providence, RI
| | - Ivan W. Miller
- Butler Hospital, Providence, RI
- Alpert Medical School of Brown University, Providence, RI
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13
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Dong L, Lee JY, Harvey AG. Do improved patient recall and the provision of memory support enhance treatment adherence? J Behav Ther Exp Psychiatry 2017; 54:219-228. [PMID: 27614662 PMCID: PMC5558150 DOI: 10.1016/j.jbtep.2016.08.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 08/29/2016] [Accepted: 08/30/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Patient adherence to psychosocial treatment is an important but understudied topic. The aim of this study was to examine whether better patient recall of treatment contents and therapist use of memory support (MS) were associated with better treatment adherence. METHODS Data were drawn from a pilot randomized controlled trial. Participants were 48 individuals (mean age = 44.27 years, 29 females) with Major Depressive Disorder randomized to receive either Cognitive Therapy (CT) with an adjunctive Memory Support Intervention (CT + Memory Support) or CT-as-usual. Therapist and patient ratings of treatment adherence were collected during each treatment session. Patient recall was assessed at mid-treatment. Therapist use of MS was manually coded for a random selection of sessions. RESULTS Patient recall was significantly associated with better therapist and patient ratings of adherence. Therapist use of Application, a specific MS strategy, predicted higher therapist ratings of adherence. Attention Recruitment, another specific MS strategy, appeared to attenuate the positive impact of session number on patient ratings of adherence. Treatment groups, MS summary scores and other specific MS strategies were not significantly associated with adherence. LIMITATIONS The measure for treatment adherence is in the process of being formally validated. Results were based on small sample. CONCLUSIONS These results support the importance of patient recall in treatment adherence. Although collectively the effects of MS on treatment adherence were not significant, the results support the use of certain specific MS strategy (i.e., application) as a potential pathway to improve treatment adherence. Larger-scale studies are needed to further examine these constructs.
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Affiliation(s)
- Lu Dong
- University of California, Berkeley, United States
| | - Jason Y Lee
- University of California, Berkeley, United States
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14
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IsHak WW, Bonifay W, Collison K, Reid M, Youssef H, Parisi T, Cohen RM, Cai L. The recovery index: A novel approach to measuring recovery and predicting remission in major depressive disorder. J Affect Disord 2017; 208:369-374. [PMID: 27810720 DOI: 10.1016/j.jad.2016.08.081] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 07/26/2016] [Accepted: 08/24/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Clinicians view "recovery" as the reduction in severity of symptoms over time, whereas patients view it as the restoration of premorbid functioning level and quality of life (QOL). The main purpose of this study is to incorporate patient-reported measures of functioning and QOL into the assessment of patient outcomes in MDD and to use this data to define recovery. METHOD Using the STAR*D study of patients diagnosed with MDD, this present analysis grades patients' MDD severity, functioning level, and QOL at exit from each level of the study, as well as at follow-up. Using Item Response Theory, we combined patient data from functioning and QOL measures (WSAS, Q-LES-Q) in order to form a single latent dimension named the Recovery Index. RESULTS Recovery Index - a latent measure assessing impact of illness on functioning and QOL - is able to predict remission of MDD in patients who participated in the STAR*D study. CONCLUSIONS By incorporating functioning and quality of life, the Recovery index creates a new dimension towards measuring restoration of health, in order to move beyond basic symptom measurement.
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Affiliation(s)
- Waguih William IsHak
- Department of Psychiatry at Cedars-Sinai Medical Center and David Geffen School of Medicine at UCLA, Los Angeles, California, United States.
| | - Wes Bonifay
- College of Education, University of Missouri, United States
| | | | - Mark Reid
- Department of Psychiatry at Cedars-Sinai Medical Center, United States
| | - Haidy Youssef
- Department of Psychiatry at Cedars-Sinai Medical Center, United States
| | - Thomas Parisi
- Department of Psychiatry at Cedars-Sinai Medical Center, United States
| | - Robert M Cohen
- Department of Psychiatry at Emory University School of Medicine, United States
| | - Li Cai
- UCLA Graduate School of Education and Information Studies, United States
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Cole JC, Grossman I, Prilliman C, Hunsaker E. Multimethod Validation of the Beck Depression Inventory—II and Grossman-Cole Depression Inventory with an Inpatient Sample. Psychol Rep 2016; 93:1115-29. [PMID: 14765580 DOI: 10.2466/pr0.2003.93.3f.1115] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Psychometric examination of the Beck Depression Inventory–II has been adequate and varied for outpatient and nonclinical samples, but is still comparatively scant for inpatient psychiatric samples. In particular, important factor analytic questions have not been assessed on inpatient samples at all. Given that over time alone (regardless of symptom change) test scores on depression measures can spuriously drop, a convergent psychometric analysis of the Beck Depression Inventory–II was undertaken with a new measure of depression severity, the Grossman-Cole Depression Inventory. A sample of 101 psychiatric inpatients was administered both tests. Item and scale level psychometrics were reviewed for each measure. Results were highly consistent with previous findings, providing support for the use of the Beck Depression Inventory–II with inpatient samples. Moreover, the new inventory performed quite well, suggesting it has promise as another measure for self-reported depression symptom severity. The Beck Depression Inventory–II appears appropriately considered as a single-factor hierarchical measure of depression with the current inpatient sample. Moreover, the Grossman-Cole Depression Inventory is related enough to the Beck inventory to provide adequate similarity without being so similar the measures duplicate each other.
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Affiliation(s)
- Jason C Cole
- University of California, Los Angeles, 90095, USA.
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16
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Hitchcock C, Mueller V, Hammond E, Rees C, Werner-Seidler A, Dalgleish T. The effects of autobiographical memory flexibility (MemFlex) training: An uncontrolled trial in individuals in remission from depression. J Behav Ther Exp Psychiatry 2016; 52:92-98. [PMID: 27058165 DOI: 10.1016/j.jbtep.2016.03.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 02/11/2016] [Accepted: 03/22/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Impaired cognitive processing is a key feature of depression. Biases in autobiographical memory retrieval (in favour of negative and over-general memories) directly impact depression symptoms, but also influence downstream cognitive factors implicated in the onset and maintenance of the disorder. We introduce a novel cognitive intervention, MemFlex, which aims to correct these biases in memory retrieval and thereby modify key downstream cognitive risk and maintenance factors: rumination, impaired problem solving, and cognitive avoidance. METHOD Thirty eight adults with remitted Major Depressive Disorder completed MemFlex in an uncontrolled clinical trial. This involved an orientation session, followed by self-guided completion of six workbook-based sessions over one-month. Assessments of cognitive performance and depression symptoms were completed at pre- and post-intervention. RESULTS Results demonstrated medium-sized effects of MemFlex in improving memory specificity and problem solving, and decreasing rumination, and a small effect in reducing cognitive avoidance. No significant change was observed in residual symptoms of depression. LIMITATIONS This study was an uncontrolled trial, and has provided initial evidence to support a larger-scale, randomized controlled trial. CONCLUSIONS These findings provide promising evidence for MemFlex as a cost-effective, low-intensity option for reducing cognitive risk associated with depression.
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Affiliation(s)
- Caitlin Hitchcock
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, United Kingdom; The Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom.
| | - Viola Mueller
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, United Kingdom
| | - Emily Hammond
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, United Kingdom
| | - Catrin Rees
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, United Kingdom
| | - Aliza Werner-Seidler
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, United Kingdom; The Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, United Kingdom; The Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom.
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Ramano E, Buys T, De Beer M. Formulating a return-to-work decision for employees with major depressive disorders: occupational therapists' experiences. Afr J Prim Health Care Fam Med 2016; 8:e1-5. [PMID: 27380839 PMCID: PMC4851116 DOI: 10.4102/phcfm.v8i2.954] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 11/30/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is worldwide one of the most concerning health problems as it is associated with reduced work productivity and permanent disability. Occupational therapists are often called upon to make a return-to-work decision on employees with MDD in order to facilitate continued employment. Sustaining employment is in alignment with achieving the Millennium Development Goal 1: Eradicating extreme poverty, as it is known that people suffering from mental health disorders are frequently denied employment opportunities leading to reduced financial resources and therefore possible poverty. AIM This study described occupational therapists' experiences of formulating a return-to workdecision on employees with MDD. It formed part of a larger study. SETTING Occupational therapists working in vocational rehabilitation or mental health in South Africa with a postgraduate qualification in vocational rehabilitation or mental health participated in the study. METHOD A qualitative research design was used. Two separate focus groups explored 11 occupational therapists' experiences of formulating a return-to-work decision on employees with MDD. Ethics clearance number: S34/2007. RESULTS Seven themes emerged, which were, (1) the biographical profile of the employee, (2) point of view of employer, (3) point of view of employee, (4) point of view of occupational therapist, (5) declaring the employee as temporary incapacitated, (6) declaring the employee as permanently incapacitated and (7) employee's level of motivation. CONCLUSION Occupational therapists ought to have sound knowledge, skill, experience and the ability to collaborate with employees and employers in formulating a return-to-work decision.
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Affiliation(s)
| | | | - Marianne De Beer
- Department of Occupational Therapy, School of Health Care Sciences, Faculty of Health Sciences, University of Pretoria.
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18
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Park GY, Im S, Oh CH, Lee SJ, Pae CU. The association between the severity of poststroke depression and clinical outcomes after first-onset stroke in Korean patients. Gen Hosp Psychiatry 2015; 37:245-50. [PMID: 25817322 DOI: 10.1016/j.genhosppsych.2015.02.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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] [Received: 09/16/2014] [Revised: 02/26/2015] [Accepted: 02/27/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of the present study is to evaluate the association between poststroke depression (PSD) and clinical outcomes in first-onset stroke patients who are undergoing a rehabilitation program. METHODS The present study included 180 inpatients that were recruited consecutively and followed up over a 6-month observational period. Poststroke depression was diagnosed using the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Symptoms of depression and clinical outcomes were assessed using the Beck Depression Inventory, the modified Barthel Index (MBI) and the Mini Mental State Examination (MMSE). All patients were assessed at baseline and at the end of the 6-month observational period. RESULTS Of the 180 patients, 127 (70.6%) were diagnosed with minimal-to-mild depression (MMD), and 53 (29.4%) were diagnosed with moderate-to-severe depression (MSD). The mean change in MBI scores from baseline to 6 months was significantly higher (P=.029) in the MMD group (23.8) than in the MSD group (8.6). The odds ratio for an unfavorable outcome (MBI score <60) in patients with MSD was approximately 3.5 in relation to patients with MMD. The mean change in MMSE score (4.4 versus 7.4) was not significantly different between the MMD and MSD groups. CONCLUSION The present findings suggest that the severity of PSD may be associated with clinical outcomes in Korean patients 6 months after a first-onset stroke. Our data agree with previous findings, which indicate that clinicians should carefully evaluate symptoms of depression in stroke patients during routine clinical practice. The methodological shortcomings of the present study may require further studies with adequate power and improved design to clarify the association between PSD and clinical outcomes following stroke.
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Affiliation(s)
- Geun-Young Park
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sun Im
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chang Hoon Oh
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soo-Jung Lee
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chi-Un Pae
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Department of Psychiatry and Behavioural Sciences, Duke University Medical Center, Durham, NC, USA.
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Abstract
OBJECTIVE Stable housing is a fundamental human right, and an important element for both mental health recovery and social inclusion among people with serious mental illness. This article reports findings from a study on the recovery orientation of structured congregate community housing services using the Recovery Self-Assessment Questionnaire (RSA) adapted for housing (O'Connell, Tondora, Croog, Evans, & Davidson, 2005). METHODS The RSA questionnaires were administered to 118 residents and housing providers from 112 congregate housing units located in Montreal, Canada. RESULTS Residents rated their homes as significantly less recovery-oriented than did proprietors, which is contrary to previous studies of clinical services or Assertive Community Treatment where RSA scores for service users were significantly higher than service provider scores. Findings for both groups suggest the need for improvement on 5 of 6 RSA factors. While proprietors favored recovery training and education, and valued resident opinion and experience, vestiges of a traditional medical model governing this housing emerged in other findings, as in agreement between the 2 groups that residents have little choice in case management, or in the belief among proprietors that residents are unable to manage their symptoms. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE This study demonstrates that the RSA adapted for housing is a useful tool for creating recovery profiles of housing services. The findings provide practical guidance on how to promote a recovery orientation in structured community housing, as well as a novel approach for reaching a common understanding of what this entails among stakeholders. (PsycINFO Database Record
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Affiliation(s)
- Myra Piat
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University
| | - Richard Boyer
- Department of Psychiatry, Mental Health University Institute of Montreal, University of Montreal
| | - Marie-Josée Fleury
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University
| | - Alain Lesage
- Department of Psychiatry, Mental Health University Institute of Montreal, University of Montreal
| | - Maria O'Connell
- Department of Psychiatry, Center for Community Health and Recovery, Yale University
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20
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Bartels SJ, Pratt SI, Mueser KT, Forester BP, Wolfe R, Cather C, Xie H, McHugo GJ, Bird B, Aschbrenner KA, Naslund JA, Feldman J. Long-term outcomes of a randomized trial of integrated skills training and preventive healthcare for older adults with serious mental illness. Am J Geriatr Psychiatry 2014; 22:1251-61. [PMID: 23954039 PMCID: PMC3836872 DOI: 10.1016/j.jagp.2013.04.013] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 03/28/2013] [Accepted: 04/24/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This report describes 1-, 2-, and 3-year outcomes of a combined psychosocial skills training and preventive healthcare intervention (Helping Older People Experience Success [HOPES]) for older persons with serious mental illness. METHODS A randomized controlled trial compared HOPES with treatment as usual (TAU) for 183 older adults (age ≥ 50 years [mean age: 60.2]) with serious mental illness (28% schizophrenia, 28% schizoaffective disorder, 20% bipolar disorder, 24% major depression) from two community mental health centers in Boston, Massachusetts, and one in Nashua, New Hampshire. HOPES comprised 12 months of weekly skills training classes, twice-monthly community practice trips, and monthly nurse preventive healthcare visits, followed by a 1-year maintenance phase of monthly sessions. Blinded evaluations of functioning, symptoms, and service use were conducted at baseline and at a 1-year (end of the intensive phase), 2-year (end of the maintenance phase), and 3-year (12 months after the intervention) follow-up. RESULTS HOPES compared with TAU was associated with improved community living skills and functioning, greater self-efficacy, lower overall psychiatric and negative symptoms, greater acquisition of preventive healthcare (more frequent eye exams, visual acuity, hearing tests, mammograms, and Pap smears), and nearly twice the rate of completed advance directives. No differences were found for medical severity, number of medical conditions, subjective health status, or acute service use at the 3-year follow-up. CONCLUSION Skills training and nurse facilitated preventive healthcare for older adults with serious mental illness was associated with sustained long-term improvement in functioning, symptoms, self-efficacy, preventive healthcare screening, and advance care planning.
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Affiliation(s)
- Stephen J Bartels
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH; The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH.
| | - Sarah I Pratt
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH; The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH
| | - Kim T Mueser
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH; Dartmouth Psychiatric Research Center, Lebanon, NH; Center for Psychiatric Rehabilitation, Boston University, Boston, MA
| | - Brent P Forester
- Department of Psychiatry, Harvard University, Cambridge, MA; Geriatric Psychiatry Research Program, McLean Hospital, Belmont, MA
| | | | - Corinne Cather
- Schizophrenia Program, Massachusetts General Hospital, Boston, MA
| | - Haiyi Xie
- Dartmouth Psychiatric Research Center, Lebanon, NH
| | | | | | - Kelly A Aschbrenner
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - John A Naslund
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH
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21
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Stürz K, Günther V. Letter to the editor: Comments on 'Cognitive remediation improves memory and psychosocial functioning in first-episode psychiatric out-patients'. Psychol Med 2014; 44:671. [PMID: 24286514 DOI: 10.1017/s0033291713002675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- K Stürz
- Innsbruck Medical University, Innsbruck, Austria
| | - V Günther
- Innsbruck Medical University, Innsbruck, Austria
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22
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Lee RSC, Redoblado-Hodge MA, Naismith SL, Hermens DF, Porter MA, Hicki E IB. Letter to the editor: Comments on 'Cognitive remediation improves memory and psychosocial functioning in first-episode psychiatric out-patients': a reply. Psychol Med 2014; 44:671-672. [PMID: 24524170 DOI: 10.1017/s0033291713002687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Payzieva S, Maxmudova D. NIRS Study of the Effects of Computerized Brain Training Games for Cognitive Rehabilitation of Major Depressive Disorder Patients in Remission: A Pilot Study. Stud Health Technol Inform 2014; 199:163-167. [PMID: 24875713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We used functional Near-Infrared Spectroscopy (fNIRS) to estimate brain activity in Major Depressive Disorder (MDD) patients (in remission), while they played a computerized brain training games for cognitive rehabilitation. MDD is characterized by marked deterioration in affect as well as significant impairment in cognitive function. It was found, that depressed patients showed long-lasting impaired cognitive performance on cognitive demanding tasks despite significant improvement in the depression symptoms. Previous studies have shown that video games can improve cognitive functions. But assessment was made only with cognitive tests. The main objective of this research was to study the effects of brain training games on cognitive functions of MDD patients in remission with objective instrumental NIRS method. Tissue oxygen saturation (StO2) and absolute concentrations of oxyhemoglobin ([O2Hb]), deoxyhemoglobin ([HHb]) and total hemoglobin ([tHb]) were measured by functional near-infrared spectroscopy (fNIRS) - Oxyprem (BORL, Zurich, Switzerland). Preliminary results are discussed.
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Affiliation(s)
- Shaira Payzieva
- Psychology center of NTM Be Smart Educational Institution, Tashkent, Uzbekistan
| | - D Maxmudova
- Department of Applied Psychology, Tashkent Pedagogical University, Uzbekistan
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Townley G, Miller H, Kloos B. A little goes a long way: the impact of distal social support on community integration and recovery of individuals with psychiatric disabilities. Am J Community Psychol 2013; 52:84-96. [PMID: 23689965 DOI: 10.1007/s10464-013-9578-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Although an extensive body of literature highlights the important role of social support for individuals with psychiatric disabilities, definitions of support tend to be restricted-focusing on intimate relationships such as friend and family networks and ignoring the role of casual relationships existing naturally in the community. This mixed-methods study of 300 consumers of mental health services in the Southeastern US aims to better understand the impact of community supports, termed distal supports, on community integration and recovery from mental illness. Qualitative content analysis, tests of group mean differences, and hierarchical linear regression analyses revealed the following: (1) participants primarily reported receiving tangible support (e.g., free medication/discounted goods) from distal supports rather than emotional support (e.g., displays of warmth/affection) or informational support (e.g., provision of advice); (2) women and older participants reported more distal supports than men or younger participants; and (3) distal supports played a unique role in predicting community integration and recovery even after accounting for the influence of traditional support networks. Results highlight the importance of considering diverse types of social support in naturally occurring settings when designing treatment plans and interventions aimed at encouraging community participation and adaptive functioning for individuals with psychiatric disabilities.
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Affiliation(s)
- Greg Townley
- Department of Psychology, Portland State University, P.O. Box 751, Portland, OR 97207-0751, USA.
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Lee RSC, Redoblado-Hodge MA, Naismith SL, Hermens DF, Porter MA, Hickie IB. Cognitive remediation improves memory and psychosocial functioning in first-episode psychiatric out-patients. Psychol Med 2013; 43:1161-1173. [PMID: 23237010 PMCID: PMC3642720 DOI: 10.1017/s0033291712002127] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 06/27/2012] [Accepted: 08/13/2012] [Indexed: 01/22/2023]
Abstract
BACKGROUND Cognitive remediation (CR) is an effective treatment for several psychiatric disorders. To date, there have been no published studies examining solely first-episode psychiatric cohorts, despite the merits demonstrated by early intervention CR studies. The current study aimed to assess the effectiveness of CR in patients with a first-episode of either major depression or psychosis. Method Fifty-five patients (mean age = 22.8 years, s.d. = 4.3) were randomly assigned to either CR (n = 28) or treatment as usual (TAU; n = 27). CR involved once-weekly 2-h sessions for a total of 10 weeks. Patients were comprehensively assessed before and after treatment. Thirty-six patients completed the study, and analyses were conducted using an intent-to-treat (ITT) approach with all available data. RESULTS In comparison to TAU, CR was associated with improved immediate learning and memory controlling for diagnosis and baseline differences. Similarly, CR patients demonstrated greater improvements than TAU patients in psychosocial functioning irrespective of diagnosis. Delayed learning and memory improvements mediated the effect of treatment on psychosocial functioning at a marginal level. CONCLUSIONS CR improves memory and psychosocial outcome in first-episode psychiatric out-patients for both depression and psychosis. Memory potentially mediated the functional gains observed. Future studies need to build on the current findings in larger samples using blinded allocation and should incorporate longitudinal follow-up and assessment of potential moderators (e.g. social cognition, self-efficacy) to examine sustainability and the precise mechanisms of CR effects respectively.
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Affiliation(s)
- R S C Lee
- Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, Sydney, Australia.
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Hooper SR, Curtiss K, Schoch K, Keshavan MS, Allen A, Shashi V. A longitudinal examination of the psychoeducational, neurocognitive, and psychiatric functioning in children with 22q11.2 deletion syndrome. Res Dev Disabil 2013; 34:1758-1769. [PMID: 23506790 PMCID: PMC3783943 DOI: 10.1016/j.ridd.2012.12.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 12/02/2012] [Accepted: 12/04/2012] [Indexed: 06/01/2023]
Abstract
The present study sought to examine the longitudinal psychoeducational, neurocognitive, and psychiatric outcomes of children and adolescents with chromosome 22q11.2 deletion syndrome (22q11DS), a population with a high incidence of major psychiatric illnesses appearing in late adolescence/early adulthood. Little is known of the developmental changes that occur in the early teen years, prior to the age of highest psychosis risk. Data were collected from 71 participants (42 subjects with 22q11DS and 29 control subjects) at Time 1 (T1) and Time 2 (T2), approximately 3.5 years later. The 22q11DS group was significantly lower functioning than controls on IQ, neurocognition, and academic achievement at both T1 and T2. Children with 22q11DS also showed significantly greater social-behavioral difficulties and psychiatric symptoms, and were more likely to meet criteria for psychiatric disorders at both time points. In evaluating change over time from T1 to T2, the 22q11DS group did not show significant changes in psychoeducational or psychiatric outcomes relative to the controls, however, lack of expected age-related gains in attention regulation were noted. Within the 22q11DS group, an increase in the Attenuated Prodrome for Schizophrenia (number of psychiatric symptoms) was noted from T1 to T2 and four children with 22q11DS met criteria for Psychosis for the first time. Predictors at T1 that uncovered psychopathology symptoms at T2 included full-scale IQ, externalizing symptoms, and problem social behaviors. Overall, younger adolescent and preadolescent children with 22q11DS in this study exhibited slowed growth in attention regulation, with an increase in subclinical symptoms of schizophrenia, suggestive of increasing impairments in domains that are relevant to the high risk of Schizophrenia. Early predictors of later psychopathology included both cognitive and behavioral abnormalities. These findings begin to elucidate the trajectory of changes in psychopathology in children with 22q11DS in the years leading up to the onset of major psychiatric illnesses.
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Affiliation(s)
- Stephen R Hooper
- Department of Psychiatry and The Carolina Institute for Developmental Disabilities, University of North Carolina School of Medicine, CB# 7255, Chapel Hill, NC 27599-7255, USA
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Abstract
The literature suggests that women are at higher risk for negative consequences from alcohol use than men and that these risks are compounded by age. The current study investigated how alcohol-dependent women from different age groups might differ in terms of baseline functioning and treatment response. The sample consisted of 181 participants drawn from two randomized clinical trials of cognitive-behavioral treatments for alcohol-dependent women. Demographic and psychopathology data were obtained at baseline using the SCID (Structured Clinical Interview for DSM disorders) I for Axis I disorders and the SCID II or Personality Disorders Questionnaire for Axis II disorders. Social networks data were collected using the Important People and Activities Interview. Drinking data were collected at baseline and follow-up using the Timeline Follow Back Interview. ANOVAs revealed that older women had better psychosocial functioning in terms of being better educated and reporting fewer Axis I disorders. Also, older women had more supportive social networks in terms of more people, a smaller percentage of heavy drinkers, and a nondrinking spouse. Older women reported a less severe lifetime substance use history with a later age of first drink, later onset of alcohol use disorders, fewer lifetime abuse/dependence items, and less drug use. However, they reported drinking more frequently and more heavily over the 90 days prior to treatment. Finally, older women were more compliant with treatment and responded better by reducing drinking frequency and percentage of heavy drinking days. Suggestions to enhance treatment efficacy for younger women are made as well as suggestions for future research.
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Affiliation(s)
- Zayed Al-Otaiba
- Psychology Department, Rutgers-The State University of New Jersey, Piscataway, NJ 08854, USA.
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Mata J, Thompson RJ, Jaeggi SM, Buschkuehl M, Jonides J, Gotlib IH. Walk on the bright side: physical activity and affect in major depressive disorder. J Abnorm Psychol 2012; 121:297-308. [PMID: 21553939 PMCID: PMC3982878 DOI: 10.1037/a0023533] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Although prescribed exercise has been found to improve affect and reduce levels of depression, we do not know how self-initiated everyday physical activity influences levels of positive affect (PA) and negative affect (NA) in depressed persons. Fifty-three individuals diagnosed with Major Depressive Disorder (MDD) and 53 never-depressed controls participated in a seven-day experience sampling study. Participants were prompted randomly eight times per day and answered questions about their physical activity and affective state. Over the week, the two groups of participants did not differ in average level of physical activity. As expected, participants with MDD reported lower average PA and higher average NA than did never-depressed controls. Both participants with MDD and controls reported higher levels of PA at prompts after physical activity than at prompts after inactive periods; moreover, for both groups of participants, PA increased from a prompt after an inactive period to a subsequent prompt at which activity was reported. Depressed participants in particular showed a dose-response effect of physical activity on affect: longer duration and/or higher intensity of physical activity increased their PA significantly more than did short duration and/or lower intensity physical activity. Physical activity did not influence NA in either group. In contrast to previous treatment studies that examined the effects of prescribed structured exercise, this investigation showed that self-initiated physical activity influences PA. These findings also underscore the importance of distinguishing between PA and NA to gain a more comprehensive understanding of the effects of physical activity on affect in MDD.
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Affiliation(s)
- Jutta Mata
- Department of Psychology, Stanford University, USA.
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González HM, Tarraf W, Whitfield K, Gallo JJ. Vascular depression prevalence and epidemiology in the United States. J Psychiatr Res 2012; 46:456-61. [PMID: 22277303 PMCID: PMC3447181 DOI: 10.1016/j.jpsychires.2012.01.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 12/16/2011] [Accepted: 01/05/2012] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To examine and describe vascular depression epidemiology in the United States. METHODS Cross-sectional data from a national probability sample of household resident adults (18-years and older; N = 16,423) living in the 48 coterminous United States were analyzed to calculate prevalence estimates of vascular depression, associated disability and treatment rates. In this study, vascular depression was defined as the presence of cardiovascular and cerebrovascular disease (CVD) and CVD major risk factors (e.g., diabetes, hypertension, heart disease, and obesity) among adults 50-years and older who also met 12-month DSM-IV major depression criteria. RESULTS We estimated that about 3.4% or approximately 2.64 million American adults 50-years and older met our criteria for vascular depression. Among adults who met criteria for lifetime major depression, over one-in-five (22.1%) were considered to have the vascular depression subtype. Secondly, vascular depression was associated with significantly increased functional impairment relative to the non-depressed population and adults meeting criteria for major depression alone. Although depression care use was significantly higher among vascular depression respondents relative to those with major depression alone, practice guideline concordant therapy use was not. CONCLUSIONS Vascular depression appears to be an important public health problem that affects a large portion of the U.S. adult population with major depression, and that it is associated with excess functional impairment without concomitant better depression care.
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Affiliation(s)
- Hector M González
- Wayne State University, Institute of Gerontology, Department of Family Medicine and Public Health Sciences, 87 East Ferry Street, 226 Knapp Building, Detroit, MI 48202, USA.
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Woodside A. Disclosure dilemma. Ment Health Today 2011:10-11. [PMID: 22216595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Knekt P, Lindfors O, Laaksonen MA, Renlund C, Haaramo P, Härkänen T, Virtala E. Quasi-experimental study on the effectiveness of psychoanalysis, long-term and short-term psychotherapy on psychiatric symptoms, work ability and functional capacity during a 5-year follow-up. J Affect Disord 2011; 132:37-47. [PMID: 21316768 DOI: 10.1016/j.jad.2011.01.014] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 01/17/2011] [Accepted: 01/17/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND Psychotherapy is apparently an insufficient treatment for some patients with mood or anxiety disorder. In this study the effectiveness of short-term and long-term psychotherapies was compared with that of psychoanalysis. METHODS A total of 326 psychiatric outpatients with mood or anxiety disorder were randomly assigned to solution-focused therapy, short-term psychodynamic and long-term psychodynamic psychotherapies. Additionally, 41 patients suitable for psychoanalysis were included in the study. The patients were followed from the start of the treatment and assessed 9 times during a 5-year follow-up. The primary outcome measures on symptoms were the Beck Depression Inventory, the Hamilton Depression and Anxiety Rating Scales, and the Symptom Check List, anxiety scale. Primary work ability and functional capacity measures were the Work Ability Index, the Work-subscale of the Social Adjustment Scale, and the Perceived Psychological Functioning Scale. RESULTS A reduction in psychiatric symptoms and improvement in work ability and functional capacity was noted in all treatment groups during the 5-year follow-up. The short-term therapies were more effective than psychoanalysis during the first year, whereas the long-term therapy was more effective after 3years of follow-up. Psychoanalysis was most effective at the 5-year follow-up, which also marked the end of the psychoanalysis. CONCLUSIONS Psychotherapy gives faster benefits than psychoanalysis, but in the long run psychoanalysis seems to be more effective. Results from trials, among patients suitable for psychoanalysis and with longer follow-up, are needed before firm conclusions about the relative effectiveness of psychoanalysis and psychotherapy in the treatment of mood and anxiety disorders can be drawn.
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Affiliation(s)
- Paul Knekt
- Social Insurance Institution, Helsinki, Finland.
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Abstract
OBJECTIVE To determine whether deficits in prospective memory (i.e., "remembering to remember") confer an increased risk of unemployment in individuals living with chronic HIV infection. METHODS Fifty-nine Unemployed and 49 Employed individuals with HIV infection underwent comprehensive neuropsychological and medical evaluations, including measures of prospective memory. RESULTS The Unemployed participants demonstrated significantly lower performance on time- and event-based prospective memory, which was primarily characterized by errors of omission. Importantly, prospective memory impairment was an independent predictor of unemployment when considered alongside other neurocognitive abilities, mood disturbance, and HIV disease severity. CONCLUSIONS Prospective memory impairment is a salient predictor of unemployment in persons living with HIV infection and might be considered in screening for unemployment risk and developing vocational rehabilitation plans.
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Mehta S, Orenczuk S, Hansen KT, Aubut JAL, Hitzig SL, Legassic M, Teasell RW. An evidence-based review of the effectiveness of cognitive behavioral therapy for psychosocial issues post-spinal cord injury. Rehabil Psychol 2011; 56:15-25. [PMID: 21401282 PMCID: PMC3206089 DOI: 10.1037/a0022743] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Systematic review. OBJECTIVE To examine the evidence supporting the effectiveness of cognitive behavioral therapy (CBT) for improving psychosocial outcomes in individuals with spinal cord injury (SCI). METHOD Electronic databases (MEDLINE, CINAHL, EMBASE, and PsycINFO) were searched for studies published between 1990 and October 2010. Randomized control trials (RCTs) and nonrandomized control trials (non-RCTs) utilizing a CBT intervention to improve psychosocial outcomes (depressive symptomatology, anxiety, coping, and adjustment to disability) in outpatient persons with SCI were included for review. Levels of evidence were assigned to each study using a modified Sackett scale. Effect size calculations for the interventions were provided where possible. RESULTS Nine studies met the inclusion criteria. The studies reviewed included two RCTs, six prospective controlled trials (PCTs) and one cohort study. All studies examined at least two groups. There is Level 1 and Level 2 evidence supporting the use of specialized CBT protocols in persons with SCI for improving outcomes related to depression, anxiety, adjustment, and coping. CONCLUSIONS CBT holds promise as an effective approach for persons with SCI experiencing depression, anxiety, adjustment, and coping problems. As CBT may involve many different components, it is important in the future to determine which of these elements alone or in combination is most effective in treating the emotional consequences of SCI.
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Affiliation(s)
- Swati Mehta
- Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London ON
- St. Joseph’s Parkwood Hospital, London ON
| | | | | | - Jo-Anne L. Aubut
- Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London ON
- St. Joseph’s Parkwood Hospital, London ON
| | | | - Matthew Legassic
- Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London ON
- St. Joseph’s Parkwood Hospital, London ON
| | - Robert W. Teasell
- Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London ON
- St. Joseph’s Parkwood Hospital, London ON
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, University of Western Ontario, London ON
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Freeman J, Maxwell JC, Davey J. Unraveling the complexity of driving while intoxicated: a study into the prevalence of psychiatric and substance abuse comorbidity. Accid Anal Prev 2011; 43:34-39. [PMID: 21094294 DOI: 10.1016/j.aap.2010.06.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Revised: 05/31/2010] [Accepted: 06/08/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Research is beginning to provide an indication of the co-occurring substance abuse and mental health needs for the driving under the influence (DUI) population. This study aimed to examine the extent of such psychiatric problems among a large sample size of DUI offenders entering treatment in Texas. METHODS This is a study of 36,373 past year DUI clients and 308,714 non-past year DUI clients admitted to Texas treatment programs between 2005 and 2008. Data were obtained from the State's administrative dataset. RESULTS Analysis indicated that non-past year DUI clients were more likely to present with more severe illicit substance use problems, while past year DUI clients were more likely to have a primary problem with alcohol. Nevertheless, a cannabis use problem was also found to be significantly associated with DUI recidivism in the last year. In regards to mental health status, a major finding was that depression was the most common psychiatric condition reported by DUI clients, including those with more than one DUI offence in the past year. This cohort also reported elevated levels of Bipolar Disorder compared to the general population, and such a diagnosis was also associated with an increased likelihood of not completing treatment. Additionally, female clients were more likely to be diagnosed with mental health problems than males, as well as more likely to be placed on medications at admission and more likely to have problems with methamphetamine, cocaine, and opiates. CONCLUSIONS DUI offenders are at an increased risk of experiencing comorbid psychiatric disorders, and thus, corresponding treatment programs need to cater for a range of mental health concerns that are likely to affect recidivism rates.
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Affiliation(s)
- James Freeman
- Centre for Accident Research and Road Safety - Queensland, Queensland University of Technology, Institute of Health and Biological, Innovation, K Block, 130 Victoria Rd Kelvin Grove Campus, Victoria Park Road, Kelvin Grove 4059, QLD 4059, Australia.
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Mueser KT, Pratt SI, Bartels SJ, Swain K, Forester B, Cather C, Feldman J. Randomized trial of social rehabilitation and integrated health care for older people with severe mental illness. J Consult Clin Psychol 2010; 78:561-73. [PMID: 20658812 DOI: 10.1037/a0019629] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The Helping Older People Experience Success (HOPES) program was developed to improve psychosocial functioning and reduce long-term medical burden in older people with severe mental illness (SMI) living in the community. HOPES includes 1 year of intensive skills training and health management, followed by a 1-year maintenance phase. METHOD To evaluate effects of HOPES on social skills and psychosocial functioning, we conducted a randomized controlled trial with 183 older adults with SMI (58% schizophrenia spectrum) age 50 and older at 3 sites who were assigned to HOPES or treatment as usual with blinded follow-up assessments at baseline and 1- and 2-year follow-up. RESULTS Retention in the HOPES program was high (80%). Intent-to-treat analyses showed significant improvements for older adults assigned to HOPES compared to treatment as usual in performance measures of social skill, psychosocial and community functioning, negative symptoms, and self-efficacy, with effect sizes in the moderate (.37-.63) range. Exploratory analyses indicated that men improved more than women in the HOPES program, whereas benefit from the program was not related to psychiatric diagnosis, age, or baseline levels of cognitive functioning, psychosocial functioning, or social skill. CONCLUSIONS The results support the feasibility of engaging older adults with SMI in the HOPES program, an intensive psychiatric rehabilitation intervention that incorporates skills training and medical case management, and improves psychosocial functioning in this population. Further research is needed to better understand gender differences in benefit from the HOPES program.
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Affiliation(s)
- Kim T Mueser
- Department of Psychiatry, Dartmouth Psychiatric Research Center, Dartmouth Medical School, 105 Pleasant Street, Concord, NH 03301, USA.
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Lexis MAS, Jansen NWH, Huibers MJH, van Amelsvoort LGPM, Berkouwer A, Tjin A Ton G, van den Brandt PA, Kant I. Prevention of long-term sickness absence and major depression in high-risk employees: a randomised controlled trial. Occup Environ Med 2010; 68:400-7. [PMID: 20924024 DOI: 10.1136/oem.2010.057877] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Monique A S Lexis
- CAPHRI School for Public Health and Primary Care, Maastricht University, Department of Epidemiology, PO Box 616, 6200 MD Maastricht, The Netherlands.
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Pandya A, Katz CL, Smith R, Ng AT, Tafoya M, Holmes A, North CS. Services provided by volunteer psychiatrists after 9/11 at the New York City family assistance center: September 12-November 20, 2001. J Psychiatr Pract 2010; 16:193-9. [PMID: 20485109 PMCID: PMC3086595 DOI: 10.1097/01.pra.0000375717.77831.83] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To characterize the experience of volunteer disaster psychiatrists who provided pro bono psychiatric services to 9/11 survivors in New York City, from September 12, 2001 to November 20, 2001. METHOD Disaster Psychiatry Outreach (DPO) is a non-profit organization founded in 1998 to provide volunteer psychiatric care to people affected by disasters and to promote education and research in support of this mission. Data for this study were collected from one-page clinical encounter forms completed by 268 DPO psychiatrists for 2 months after 9/11 concerning 848 patients served by the DPO 9/11 response program at the New York City Family Assistance Center. RESULTS In this endeavor, 268 psychiatrist volunteers evaluated 848 individuals and provided appropriate interventions. The most commonly recorded clinical impressions indicated stress-related and adjustment disorders, but other conditions such as bereavement, major depression, and substance abuse/dependence were also observed. Free samples were available for one sedative and one anxiolytic agent; not surprisingly, these were the most commonly prescribed medications. Nearly half of those evaluated received psychotropic medications. CONCLUSIONS In the acute aftermath of the attacks of September 11, 2001, volunteer psychiatrists were able to provide services in a disaster response setting, in which they were co-located with other disaster responders. These services included psychiatric assessment, provision of medication, psychological first aid, and referrals for ongoing care. Although systematic diagnoses could not be confirmed, the fact that most patients were perceived to have a psychiatric diagnosis and a substantial proportion received psychotropic medication suggests potential specific roles for psychiatrists that are unique and different from roles of other mental health professionals in the early post-disaster setting. In addition to further characterizing post-disaster mental health needs and patterns of service provision, future research should focus on the short- and long-term effects of psychiatric interventions, such as providing acute psychotropic medication services and assessing the effectiveness of traditional acute post-disaster interventions including crisis counseling and psychological first aid.
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MESH Headings
- Adjustment Disorders/diagnosis
- Adjustment Disorders/epidemiology
- Adjustment Disorders/psychology
- Adjustment Disorders/rehabilitation
- Adolescent
- Adult
- Aged
- Alcoholism/diagnosis
- Alcoholism/epidemiology
- Alcoholism/psychology
- Alcoholism/rehabilitation
- Anti-Anxiety Agents/therapeutic use
- Bereavement
- Child
- Child, Preschool
- Crisis Intervention/statistics & numerical data
- Cross-Sectional Studies
- Depressive Disorder, Major/epidemiology
- Depressive Disorder, Major/rehabilitation
- Family/psychology
- Female
- Health Services Needs and Demand
- Humans
- Hypnotics and Sedatives/therapeutic use
- Male
- Middle Aged
- New York City
- Patient Care Team
- Psychiatry
- Referral and Consultation
- Relief Work
- September 11 Terrorist Attacks/psychology
- Stress Disorders, Post-Traumatic/diagnosis
- Stress Disorders, Post-Traumatic/epidemiology
- Stress Disorders, Post-Traumatic/psychology
- Stress Disorders, Post-Traumatic/rehabilitation
- Stress Disorders, Traumatic, Acute/diagnosis
- Stress Disorders, Traumatic, Acute/epidemiology
- Stress Disorders, Traumatic, Acute/psychology
- Stress Disorders, Traumatic, Acute/rehabilitation
- Substance-Related Disorders/diagnosis
- Substance-Related Disorders/epidemiology
- Substance-Related Disorders/psychology
- Substance-Related Disorders/rehabilitation
- Survivors/psychology
- Survivors/statistics & numerical data
- Volunteers
- Young Adult
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Affiliation(s)
- Anand Pandya
- University of California Los Angeles, Los Angeles, California
- Disaster Psychiatry Outreach, New York, New York
| | - Craig L. Katz
- Disaster Psychiatry Outreach, New York, New York
- Mount Sinai School of Medicine, New York, New York
| | - Rebecca Smith
- Disaster Psychiatry Outreach, New York, New York
- Mount Sinai School of Medicine, New York, New York
| | - Anthony T. Ng
- Disaster Psychiatry Outreach, New York, New York
- Uniformed Services University of Health Sciences, Psychiatry, Odenton, Maryland
| | - Michael Tafoya
- Disaster Psychiatry Outreach, New York, New York
- Mount Sinai School of Medicine, New York, New York
| | | | - Carol S. North
- Disaster Psychiatry Outreach, New York, New York
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Department of Psychiatry and Department of Surgery/Division of Emergency Medicine, Dallas, TX
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Gao Y. "Hospital length of stay for children and adolescents diagnosed with depression: is primary payer an influencing factor?" by Sclar et al. Gen Hosp Psychiatry 2010; 32:229; author reply 229-30. [PMID: 20303006 DOI: 10.1016/j.genhosppsych.2009.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Accepted: 11/19/2009] [Indexed: 11/18/2022]
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Shankman SA, Nelson BD, Harrow M, Faull R. Does physical anhedonia play a role in depression? A 20-year longitudinal study. J Affect Disord 2010; 120:170-6. [PMID: 19467713 PMCID: PMC2794988 DOI: 10.1016/j.jad.2009.05.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Revised: 04/14/2009] [Accepted: 05/04/2009] [Indexed: 11/24/2022]
Abstract
BACKGROUND Anhedonia towards physical or sensory experiences (i.e., physical anhedonia) has most often been examined as a differentia of schizophrenia and not depression, despite the fact that general anhedonia is a core feature of many models of Major Depressive Disorder (MDD). METHODS Forty-nine participants with non-psychotic MDD were recruited from inpatient settings and followed-up six times over 20 years. The three aims of the study was to assess a) the stability of physical anhedonia over time, b) whether physical anhedonia relates to the course of depressive symptoms over time, and c) whether physical anhedonia relates to three domains of functioning - work, social functioning, or re-hospitalizations. RESULTS We found that over time physical anhedonia was relatively stable and related to depressive symptoms (both between and within person). Physical anhedonia was also related to certain aspects of functioning, though less robustly than depressive symptoms. LIMITATIONS Because depressive symptoms, functioning, and physical anhedonia were measured concurrently at each follow-up, the direction of causality among these variables could not be assessed. Additionally, because our sample was recruited from inpatient settings, our findings may not generalize to individuals with less severe depression. CONCLUSIONS A trait tendency to experience decreased pleasure to positive physical stimuli is a clinically meaningful variable for those with MDD and may be a behavioral endophenotype for a more severe form of depression.
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Papakostas GI. Major depressive disorder: psychosocial impairment and key considerations in functional improvement. Am J Manag Care 2009; 15:S316-S321. [PMID: 20088627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Patients with major depressive disorder (MDD) can experience persistent and substantial functional impairment, and the extent of psychosocial impairment often varies with symptom severity. Factors that may contribute to restoration of psychosocial functioning include the patient's lifetime functional trajectory, the overall effectiveness of depression therapy, and the duration and quality of remission. Patients who achieve full asymptomatic remission from depressive symptoms can still experience functional impairment; thus, restoring psychosocial functioning is increasingly being identified as an important goal of depression therapy. The more effective the therapeutic approach employed to resolve symptoms of depression (eg, long-term duration of treatment, monitoring of patient adherence to treatment, maintenance of asymptomatic remission), the more likely it is that patients with MDD will experience a full restoration of premorbid psychosocial functioning. The goals of this article are to discuss the potential origins of psychosocial impairment, provide literature-based evidence that achieving asymptomatic remission (ie, remission without residual symptoms) is crucial so that functional improvement continues beyond acute-phase treatment, and emphasize the need for an expanded assessment of the illness that fundamentally includes an evaluation of psychosocial functioning, since the restoration of psychosocial functioning does not always accompany the resolution of symptoms in MDD.
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Affiliation(s)
- George I Papakostas
- Treatment-Resistant Depression Studies, Massachusetts General Hospital, Harvard Medical School, 15 Parkman St, WACC#812, Boston, MA 02114, USA.
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Endicott J, Dorries KM. Functional outcomes in MDD: established and emerging assessment tools. Am J Manag Care 2009; 15:S328-S334. [PMID: 20088629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Currently, the primary efficacy measures for antidepressant clinical trials predominantly assess changes in mood symptoms in patients with major depressive disorder (MDD). When considering treatment options, however, patients and clinicians value improvement in function in important life domains as highly as symptom reduction. MDD patients report that they consider a return to normal functioning an important indicator of remission from depressive episodes. Indeed, many researchers now regard assessment of both mood symptoms and functional outcomes essential to measuring treatment-related improvement and remission from MDD. However, function is a very broad concept. Investigators must consider multiple issues in designing or selecting an instrument that measures function adequately and appropriately in their particular study population. The assessment tool should include dimensions of functioning that are relevant and likely to improve with the treatment, and the instrument should have demonstrated reliability and validity, good discrimination among patients, and sensitivity to meaningful improvement in functioning. The inclusion of well-chosen functional outcome measures in clinical trials will improve the assessment of impairment and improvement with treatment, and provide patients and clinicians with important information about the efficacy of antidepressant treatments.
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Affiliation(s)
- Jean Endicott
- Department of Psychiatry, Columbia University, NYSPI-Unit 123, 1051 Riverside Dr, New York, NY 10032, USA.
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Gustafsson G, Lira CM, Johansson J, Wisén A, Wohlfart B, Ekman R, Westrin A. The acute response of plasma brain-derived neurotrophic factor as a result of exercise in major depressive disorder. Psychiatry Res 2009; 169:244-8. [PMID: 19729204 DOI: 10.1016/j.psychres.2008.06.030] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2007] [Revised: 01/19/2008] [Accepted: 06/13/2008] [Indexed: 12/18/2022]
Abstract
Brain-derived neurotrophic factor (BDNF) and other neurotrophins are believed to play an important role in affective disorders. In this study we investigated plasma-BDNF response during an incremental exercise test in 18 patients suffering from moderate major depressive disorder (MDD) and 18 controls. The patients were not treated with antidepressants or neuroleptics. Possible associations between plasma plasma-BDNF levels, dexamethasone suppression test cortisol levels and Montgomery-Asberg Depression Rating Scale (MADRS) scores were also tested. No difference in basal BDNF levels between patients and controls was found. BDNF increased significantly during exercise in both male and female patients as well as in male controls, with no significant differences between the groups. BDNF levels declined after exercise, but after 60 min of rest BDNF levels showed tendencies to increase again in male patients. No correlation between BDNF and cortisol or MADRS scores was found. We conclude that unmedicated patients with moderate depression and normal activity of the hypothalamic-pituitary-adrenal axis do not have a disturbed peripheral BDNF release during exercise. The BDNF increase 60 min after interruption of exercise in male patients might indicate up-regulated BDNF synthesis, but this needs to be further investigated in future studies.
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Teesson M, Havard A, Ross J, Darke S. Outcomes after detoxification for heroin dependence: findings from the Australian Treatment Outcome Study (ATOS). Drug Alcohol Rev 2009; 25:241-7. [PMID: 16753648 DOI: 10.1080/09595230600657733] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
As part of the Australian Treatment Outcome Study (ATOS), 177 (88%) heroin users entering detoxification (DTX) and 66 (83%) heroin users not in treatment (NT) were interviewed at baseline and 3 months to examine drug use, risk-taking, overdose, crime and psychopathology outcomes. The majority (76%) of the DTX group had entered additional treatment at 3 months, mainly further detoxification, and 54% were currently in treatment, mainly maintenance and residential rehabilitation. There were reductions in heroin use and other drug use in those entering detoxification. Forty-two per cent were abstinent at 3 months compared to 20% in the NT group. There were also reductions in crime among those entering DTX, and less marked reductions in the NT group. Psychopathology showed less change. Detoxification may, in some part, function as a gateway to further treatment and those entering DTX showed modest but significant improvements across drug use and crime at 3 months.
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Affiliation(s)
- Maree Teesson
- National Drug and Alcohol Research Centre, University of New South Wales, Australia
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Nakajima S, Shirai A, Maki S, Ishii Y, Nagamine M, Tatsuno B, Konishi S. [Mental health of the families of crime victims and factors related to their recovery]. Seishin Shinkeigaku Zasshi 2009; 111:423-429. [PMID: 19681239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Abstract
BACKGROUND The treatment of depression in Australian aged psychiatry units has been found to be effective in terms of symptom improvement and readmission rates. There is little information, however, about how such hospitalization is viewed by the patients themselves. While users' views are increasingly seen as important for the evaluation of mental health services and for improving outcomes, the views of older patients are less likely to be sought. In this study, former patients were asked about their experience of admission, which aspects were helpful and which were not. Negative experiences have been described in an earlier paper. This paper focuses on what study participants considered to be the positive aspects of their time in hospital. METHODS Fifty former patients from three Melbourne hospitals were interviewed in their own homes using a semi-structured, open-ended questionnaire. RESULTS Forty-six percent expressed an overall favorable view of their hospital stay; 34% had some reservations; and 20% had a poor overall view. Favorable views did not necessarily preclude distressing incidents or complaints but were associated with the ward environment, experienced as a safe haven; the re-evaluation of negative experiences; and, in most but not all cases, recovery. CONCLUSIONS Retrospective accounts are useful for understanding the ways in which hospital experience is processed. Remembering the experience as positive is, in itself, a good therapeutic outcome. In addition, it may influence readiness to seek future treatment, help prevent relapse, and, indirectly, be helpful to others with similar problems.
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Abstract
Efficient, organized assessment of substance use disorders is essential for clinical research, treatment planning, and referral to adjunctive services. In this article, we discuss the basic concepts of formalized assessment for substance abuse and addiction, as established by the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision, and describe six widely used structured assessment instruments. Our aim is to help researchers and clinical programs identify the instruments that best suit their particular situations and purposes.
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Affiliation(s)
- Sharon Samet
- New York State Psychiatric Institute, New York, New York 10032, USA.
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Ruggero CJ, Chelminski I, Young D, Zimmerman M. Psychosocial impairment associated with bipolar II disorder. J Affect Disord 2007; 104:53-60. [PMID: 17337067 PMCID: PMC2147679 DOI: 10.1016/j.jad.2007.01.035] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Revised: 01/31/2007] [Accepted: 01/31/2007] [Indexed: 11/18/2022]
Abstract
BACKGROUND Significant research has looked at the psychosocial impairment associated with bipolar I disorder and major depressive disorder. Far less is known about the impact of bipolar II disorder. The present study assessed the social and work impairment associated with bipolar II disorder and whether these are more or less severe than those associated with bipolar I disorder or major depressive disorder. METHODS Psychiatric outpatients with bipolar II disorder (n=89), bipolar I disorder (n=45) and major depressive disorder (n=1251) were assessed cross-sectionally by highly trained raters using semi-structured interviews. Participants were in a major depressive episode. Groups were compared on a series of indicators of psychosocial functioning. RESULTS Bipolar I and II disorder were associated with greater absenteeism from work due to psychopathology compared to major depressive disorder. The bipolar disorders also had higher rates of hospitalization and suicide attempts. Bipolar II disorder had fewer hospitalization than bipolar I disorder which may have led to slightly less severe work impairment. Both conditions had similar rates of serious suicide attempts. LIMITATIONS The study was cross-sectional and retrospective. Furthermore, the sample consisted of outpatients seeking treatment, limiting generalizability to other settings. CONCLUSION Bipolar II disorder is associated with serious work impairment and a high number of serious suicide attempts. The level of impairment is more similar than it is different from that associated with bipolar I disorder. Clinicians would be mistaken to presume that the "softer" bipolar spectrum, specifically bipolar II disorder, is less impairing than bipolar I disorder.
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Affiliation(s)
- Camilo J Ruggero
- Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, RI, United States.
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Gaudiano BA, Miller IW, Herbert JD. The treatment of psychotic major depression: is there a role for adjunctive psychotherapy? Psychother Psychosom 2007; 76:271-7. [PMID: 17700047 DOI: 10.1159/000104703] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Psychotic depression is a relatively prevalent mood disorder associated with greater symptom severity, a poorer course of illness and higher levels of functional impairment compared with nonpsychotic depression. Separate lines of investigation suggest that various forms of cognitive-behavioral therapy are efficacious for treating severe forms of nonpsychotic depression as well as primary psychotic disorders. However, there currently are no empirically supported psychotherapies specifically designed for treating psychotic depression. METHOD We review the efficacy of current somatic treatments for the disorder and discuss the limited data to date on potentially useful psychotherapeutic approaches. In particular, we describe the clinical improvement observed in a subgroup of hospitalized patients with psychotic depression treated with Acceptance and Commitment Therapy as part of a larger clinical trial. RESULTS Pilot results demonstrated that Acceptance and Commitment Therapy was associated with clinically significant reductions in acute symptom severity and impairment compared with treatment as usual. CONCLUSION The findings suggest that patients with psychotic depression can benefit from psychotherapy. Clinical and research recommendations in this area are presented.
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Affiliation(s)
- Brandon A Gaudiano
- Department of Psychiatry and Human Behavior, Brown Medical School and Butler Hospital, Providence, RI 02906, USA.
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Abstract
The vast majority of drug users smoke cigarettes. Most use marijuana and no other illicit drug. We analyzed adult responses to the 1997 NHSDA (n = 16,661) to explore relationships between marijuana use and cigarette smoking. Multivariate analyses controlled for other illicit drug use and other potential covariates. Nearly three-quarters of current marijuana users (74%) smoked cigarettes. Compared to nonusers, the adjusted odds of being a smoker were 5.43 for current marijuana users, 3.58 for past year marijuana users, and 2.02 for former marijuana users. Odds for cigarette smoking among current poly-drug users, compared to nonusers, were 2.3 to 1. Level of cigarette smoking was directly associated with frequency of marijuana use. Nationwide, an estimated 7 million adults smoke both substances and are at increased risk for respiratory illnesses and mortality. Cigarette smoking is a major co-morbidity of marijuana use and smoking cessation should be addressed among marijuana users in addition to their other illicit drug involvement.
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Affiliation(s)
- Kimber P Richter
- Department of Preventive Medicine and Public Health, University of Kansas Medical Cetner, 3901 Rainbow Boulevard, Mail Stop 1008, Kansas City, KS 66160-7313, USA.
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Glasner-Edwards S, Tate SR, McQuaid JR, Cummins K, Granholm E, Brown SA. Mechanisms of Action in Integrated Cognitive-Behavioral Treatment Versus Twelve-Step Facilitation for Substance-Dependent Adults With Comorbid Major Depression. J Stud Alcohol Drugs 2007; 68:663-72. [PMID: 17690799 DOI: 10.15288/jsad.2007.68.663] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE In a population of veterans with co-occurring substance use disorders and concomitant major depressive disorder, the current study compared mechanisms of change and therapeutic effects relevant to both disorders between integrated, dual disorder-specific cognitive behavioral therapy (ICBT) and twelve-step facilitation (TSF). METHOD Veterans (N = 148) were given standard pharmacotherapy for depression and were randomly assigned to receive 24 weeks of either TSF or ICBT. Process measures were selected to quantify (1) changes in self-efficacy in ICBT, (2) changes in ability to terminate negative affect in ICBT, (3) twelve-step affiliation (TSA) in TSF, and (4) changes in social support in both conditions. Measures of depression and substance use were administered to all participants before treatment, during treatment, and at the end of treatment. RESULTS Self-efficacy increased among both TSF and ICBT participants during treatment, whereas self-reported ability to regulate negative affect did not change. Consistent with predictions, TSF participants increased community TSA during treatment, whereas those receiving ICBT reduced TSA. Changes in self-efficacy and TSA were associated with improvement in substance use outcomes at the end of treatment. Hypothesized changes in social support were not supported. CONCLUSIONS Both ICBT and TSF produce improvements in self-efficacy, and these changes are related to substance use outcomes for depressed substance abusers. In TSF, intervention-specific changes in TSA occur during the course of treatment and are related to substance use outcomes.
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Affiliation(s)
- Suzette Glasner-Edwards
- Veterans Affairs San Diego Healthcare System and University of California, San Diego, 3350 La Jolla Village Drive, San Diego, California 92161-2002,USA
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