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Neuromodulations in Psychiatric Disorders: Emerging Lines of Definition. 精神病的神经调节:新的定义。
IF 16.3 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-11-14 DOI: 10.1159/000542163
Xiaolei Liu, Hongxing Wang
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引用次数: 0
Karl Rickels Centenarian: Celebration of a Clinician-Scientist. 卡尔-里克尔斯百岁老人:纪念一位临床科学家。
IF 16.3 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-11-13 DOI: 10.1159/000542265
Richard Balon
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引用次数: 0
The Power of a Good Word: Enhancing the Efficacy of Analgesics in Clinical Settings. 好话的力量:在临床环境中提高镇痛药的疗效。
IF 16.3 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-11-04 DOI: 10.1159/000541810
Roi Treister, Vered Cohen, Limor Issa, Karine Beiruti Wiegler, Alexander Izakson, Mariana Agostinho

Introduction: Communication between medical staff and patients about treatment efficacy elicits expectations of benefit and improves treatment outcomes. While demonstrated in multiple studies via different research methodologies, uniform communication protocols have not been adopted in clinical practice. Here, we summarize the results of two sister studies aimed at bridging this gap.

Methods: Women undergoing C-section (study 1, randomized controlled trial) and patients undergoing general or otolaryngologic surgeries (study 2, control group design) were recruited and assigned to the "regular communication" (RC) or "enhanced communication" (EC) arms. The EC arm received positive information about treatment, while the RC arm received no such information. In both studies, the primary outcome was change in pain intensity; in study 2, an additional outcome was morphine consumption.

Results: Eighty women successfully completed study 1, and 102 patients successfully completed study 2. In both studies, significant time*group interactions were observed (p < 0.001). The analgesic effect was virtually twice as large in the EC arm compared to the RC arm. In study 2, in the last two timepoints of assessment, participants in the EC arm also consumed fewer doses of opioids than participants in the RC arm (p < 0.001). No significant differences were found in vital signs.

Conclusions: We provide ecological evidence that positive information about treatment significantly decreases pain and opioid consumption during routine clinical care. This study and others could encourage healthcare providers to harness the powerful effects of patients' expectations of benefit to improve analgesics outcomes and, potentially, the outcomes of other symptoms.

导言:医务人员与患者就治疗效果进行沟通,可激发患者对治疗效果的期望,并改善治疗效果。虽然多项研究通过不同的研究方法证明了这一点,但临床实践中尚未采用统一的沟通协议。在此,我们总结了两项姐妹研究的结果,旨在缩小这一差距:方法:我们招募了接受剖腹产手术的妇女(研究 1,随机对照试验)和接受普通外科或耳鼻喉科手术的患者(研究 2,对照组设计),并将她们分配到 "常规沟通"(RC)或 "强化沟通"(EC)组。加强沟通 "组接受有关治疗的正面信息,而 "常规沟通 "组则不接受此类信息。两项研究的主要结果都是疼痛强度的变化;研究 2 的附加结果是吗啡消耗量:结果:80 名女性成功完成了研究 1,102 名患者成功完成了研究 2。在这两项研究中,都观察到了明显的时间*组间相互作用(p < 0.001)。EC组的镇痛效果几乎是RC组的两倍。在研究 2 中,在评估的最后两个时间点,EC 组参与者的阿片类药物用量也少于 RC 组参与者(p < 0.001)。生命体征方面没有发现明显差异:我们提供的生态学证据表明,在常规临床护理过程中,有关治疗的积极信息能显著减少疼痛和阿片类药物的消耗。这项研究和其他研究可以鼓励医疗服务提供者利用患者对获益预期的强大作用来改善镇痛效果,并有可能改善其他症状的治疗效果。
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引用次数: 0
Reconsidering Persistent Somatic Symptoms: A Transdiagnostic and Transsymptomatic Approach. 重新考虑持续性躯体症状:跨诊断和跨症状方法。
IF 16.3 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-10-29 DOI: 10.1159/000541741
Bernd Löwe, Stephan Zipfel, Omer van den Bergh, Peter Henningsen
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引用次数: 0
Developing and Testing Complex Interventions in Psychosomatic Medicine. 开发和测试心身医学中的复杂干预措施。
IF 16.3 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-10-25 DOI: 10.1159/000541742
Christopher Burton
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引用次数: 0
Erratum. 勘误。
IF 16.3 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-10-24 DOI: 10.1159/000542083
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引用次数: 0
Efficacy of a Standalone Smartphone Application to Treat Postnatal Depression: A Randomized Controlled Trial. 独立智能手机应用程序治疗产后抑郁症的效果:随机对照试验
IF 22.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-10-23 DOI: 10.1159/000541311
Pedro F Zuccolo,André R Brunoni,Tatiane Borja,Alicia Matijasevich,Guilherme V Polanczyk,Daniel Fatori
INTRODUCTIONSmartphone app interventions based on cognitive-behavioral therapy (CBT) are promising scalable alternatives for treating mental disorders, but the evidence of their efficacy for postpartum depression is limited. We assessed the efficacy of Motherly, a standalone CBT-based smartphone app, in reducing symptoms of postpartum depression.METHODSWomen aged 18-40 with symptoms of postpartum depression were randomized either to intervention (Motherly app) or active control (COMVC app). The primary outcome was symptoms of depression measured by the Edinburgh Postnatal Depression Scale (EPDS) at post-treatment. Secondary outcomes were anxiety symptoms, parental stress, quality of sleep, behavioral activation, availability of response-contingent positive reinforcement, and clinical improvement at post-treatment and 1-month follow-up. Exploratory analyses were performed to investigate if app engagement was associated with treatment response.RESULTSFrom November 2021 to August 2022, 1,751 women volunteered, of which 264 were randomized, and 215 provided primary outcome data. No statistically significant differences were found between groups at post-treatment: intervention: mean (SD): 12.75 (5.52); active control: 13.28 (5.32); p = 0.604. There was a statistically significant effect of the intervention on some of the secondary outcomes. Exploratory analyses suggest a dose-response relationship between Motherly app engagement and outcomes.CONCLUSIONOur standalone app intervention did not significantly reduce postnatal depression symptoms when compared to active control. Exploratory findings suggest that negative findings might be associated with insufficient app engagement. Consistent with current literature, our findings suggest that standalone app interventions for postpartum depression are not ready to be implemented in clinical practice.
简介:基于认知行为疗法(CBT)的智能手机应用干预是治疗精神障碍的一种很有前景的可扩展替代方法,但其对产后抑郁症的疗效证据却很有限。我们评估了基于 CBT 的独立智能手机应用程序 Motherly 在减轻产后抑郁症状方面的疗效。方法:年龄在 18-40 岁、有产后抑郁症状的女性被随机分配到干预组(Motherly 应用程序)或积极对照组(COMVC 应用程序)。主要结果是治疗后通过爱丁堡产后抑郁量表(EPDS)测量的抑郁症状。次要结果包括焦虑症状、父母压力、睡眠质量、行为激活、反应定向正强化的可用性,以及治疗后和 1 个月随访时的临床改善情况。结果从 2021 年 11 月到 2022 年 8 月,共有 1751 名女性自愿参与,其中 264 人被随机分配,215 人提供了主要结果数据。治疗后各组间无统计学差异:干预组:平均(标清):12.75 (5.52);积极对照组:13.28 (5.32);P = 0.604。干预对一些次要结果的影响具有统计学意义。探索性分析表明,Motherly 应用程序参与度与结果之间存在剂量反应关系。探索性研究结果表明,负面结果可能与应用参与不足有关。与目前的文献一致,我们的研究结果表明,针对产后抑郁的独立应用程序干预还不能在临床实践中实施。
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引用次数: 0
Challenges for the Moral Injury Construct. 道德伤害结构面临的挑战。
IF 22.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-10-23 DOI: 10.1159/000541281
Richard A Bryant
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引用次数: 0
Evolution of Psychotropic Medication Prescription in Young People: Reflection from the Quebec Experience. 青少年精神药物处方的演变:魁北克经验的反思。
IF 22.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-10-22 DOI: 10.1159/000541555
Joël Monzée
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引用次数: 0
Inference-Based Cognitive Behavioral Therapy versus Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder: A Multisite Randomized Controlled Non-Inferiority Trial. 基于推理的认知行为疗法与认知行为疗法治疗强迫症:多点随机对照非劣效性试验》(Multisite Randomized Controlled Non-Inferiority Trial)。
IF 22.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-10-18 DOI: 10.1159/000541508
Nadja Wolf,Patricia van Oppen,Adriaan W Hoogendoorn,Odile A van den Heuvel,Harold J G M van Megen,Aniek Broekhuizen,Mirjam Kampman,Daniëlle C Cath,Koen R J Schruers,Saskia M van Es,Tamara Opdam,Anton J L M van Balkom,Henny A D Visser
INTRODUCTIONAlthough cognitive behavioral therapy (CBT) effectively treats obsessive-compulsive disorder (OCD), many patients refuse CBT or drop out prematurely, partly because of anxiety regarding exposure and response prevention (ERP) exercises. Inference-based cognitive behavioral therapy (I-CBT) focuses on correcting distorted inferential thinking patterns, enhancing reality-based reasoning, and addressing obsessional doubt by targeting underlying dysfunctional reasoning, without incorporating an ERP component. We hypothesized that I-CBT would be non-inferior to CBT. Additionally, we hypothesized that I-CBT would be more tolerable than CBT.METHODS197 participants were randomly assigned to 20 sessions CBT or I-CBT and assessed at baseline, posttreatment, and 6 and 12 months' follow-up. The primary outcome was OCD symptom severity measured using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS; non-inferiority margin: 2 points). The secondary outcome, treatment tolerability, was assessed using the Treatment Acceptability/Adherence Scale (TAAS). A linear mixed-effects model was used to assess the non-inferiority of the primary outcome and superiority of secondary outcomes.RESULTSStatistically significant within-group improvements in the primary and secondary outcomes were observed in both treatments. No statistically significant between-group differences in Y-BOCS were found at any assessment point, but the confidence intervals exceeded the non-inferiority threshold, making the results inconclusive. The estimated mean posttreatment TAAS score was significantly higher in the I-CBT group than in the CBT group.CONCLUSIONWhile both CBT and I-CBT are effective for OCD, whether I-CBT is non-inferior to CBT in terms of OCD symptom severity remains inconclusive. Nevertheless, I-CBT offers better tolerability and warrants consideration as an alternative treatment for OCD.
简介虽然认知行为疗法(CBT)能有效治疗强迫症(OCD),但许多患者拒绝接受 CBT 或过早放弃,部分原因是对暴露和反应预防(ERP)练习感到焦虑。基于推理的认知行为疗法(I-CBT)侧重于纠正扭曲的推理思维模式,增强基于现实的推理能力,并通过针对潜在的功能障碍推理来解决强迫症疑虑,但不包含ERP成分。我们假设 I-CBT 不会劣于 CBT。此外,我们还假设 I-CBT 比 CBT 更易忍受。方法 197 名参与者被随机分配到 20 个疗程的 CBT 或 I-CBT,并在基线、治疗后、6 个月和 12 个月的随访中接受评估。主要结果是使用耶鲁-布朗强迫症量表(Y-BOCS;非劣效差:2 分)测量的强迫症症状严重程度。次要结果是治疗耐受性,采用治疗可接受性/依从性量表(TAAS)进行评估。采用线性混合效应模型评估主要结果的非劣效性和次要结果的优效性。在任何评估点,Y-BOCS 均未发现具有统计学意义的组间差异,但置信区间超过了非劣效性阈值,因此结果尚无定论。虽然 CBT 和 I-CBT 对强迫症都有效,但就强迫症症状的严重程度而言,I-CBT 是否不劣于 CBT 仍无定论。然而,I-CBT具有更好的耐受性,值得考虑作为强迫症的替代治疗方法。
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引用次数: 0
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Psychotherapy and Psychosomatics
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