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Long-Term Effectiveness of Cognitive Behavioral Therapy in Routine Outpatient Care for Youth with Anxiety Disorders. 认知行为疗法在焦虑症青少年常规门诊治疗中的长期疗效。
IF 22.8 1区 医学 Q1 Psychology Pub Date : 2024-04-12 DOI: 10.1159/000537932
K. Krause, Xiao Chi Zhang, Silvia Schneider
INTRODUCTIONThis study examined the long-term effectiveness of cognitive behavioral therapy (CBT) (≥ 2 years after the end of therapy) in the routine care of youth (mean 11.95 years; SD = 3.04 years) with primary anxiety disorder (AD).METHODSTwo hundred and ten children with any AD as a primary diagnosis and with any comorbidity were included in the "Kids Beating Anxiety (KibA)" clinical trial and received evidence-based CBT. Diagnoses, severity of diagnoses, and further dimensional outcome variables of symptoms and functioning were assessed before (baseline), after the last treatment session (POST), and at two follow-up (FU) assessments in the child and caregiver report: 6 months (6MONTHS-FU) and >2 years (mean 4.31; SD = 1.07 years) after the last treatment session (long-term FU).RESULTSAt POST, 61.38% showed total remission of all and any ADs. At long-term FU, the remission rate was 63.64%. Compared to baseline, ratings of severity, anxiety, impairment/burden, and life quality improved significantly after CBT in child and caregiver report. All pre-post/FU improvements and global success ratings were stable in child (Pre-Post: Hedges' g = 3.57; Pre-6MONTHS-FU: Hedges' g = 3.43; Pre-LT-FU: Hedges' g = 2.34) and caregiver report (Pre-Post: Hedges' g = 2.00; Pre-6MONTHS-FU: Hedges' g = 2.31; Pre-LT-FU: Hedges' g = 2.31) across all POST- and FU-assessment points. Some outcomes showed further significant improvement, and no deterioration was found over the course of time. Effect sizes calculated in the present study correspond to, or even exceed, effect sizes reported in previous meta-analysis.CONCLUSIONSStable long-term effects of "KibA" CBT for youth with ADs, comparable to those results from efficacy studies, were achieved in a routine practice setting by applying treatment manuals tested in randomized controlled trials. These findings are remarkable, as the patient group studied here consisted of an age group within the main risk phase of developing further mental disorders, and therefore an increase in new-onset anxiety and further mental disorders would be expected over the long time span studied here.
本研究探讨了认知行为疗法(CBT)在原发性焦虑症(AD)青少年(平均 11.95 岁;SD = 3.04 岁)常规治疗中的长期有效性(治疗结束后≥ 2 年)。方法210 名儿童被纳入 "儿童战胜焦虑(KibA)"临床试验,并接受了循证 CBT 治疗。诊断、诊断的严重程度以及症状和功能的其他维度结果变量分别在治疗前(基线)、最后一次治疗后(POST)和两次随访(FU)评估中进行了评估,并由儿童和照顾者进行报告:结果在最后一次治疗后的 6 个月(6 个月-FU)和 2 年以上(平均 4.31;SD = 1.07 年)(长期 FU)。在长期FU中,缓解率为63.64%。与基线相比,儿童和护理人员在接受 CBT 治疗后,对病情严重程度、焦虑、障碍/负担和生活质量的评分均有明显改善。在儿童中,所有治疗前/治疗后的改善和总体成功评分均保持稳定(治疗前-治疗后:Hedges' g = 3.5):前:海吉斯 g = 3.57;前-6 个月-FU:海吉斯 g = 3.43;前-LT-FU:海吉斯 g = 2.34)和照顾者报告(前-后:海吉斯 g = 2.34;前-6 个月-FU:海吉斯 g = 3.43;前-LT-FU:海吉斯 g = 2.34):在所有治疗后和治疗前评估点,护理人员的报告(治疗前:赫奇斯 g = 2.00;治疗前:赫奇斯 g = 2.31;治疗前:赫奇斯 g = 2.31)均有显著改善。一些结果显示出进一步的明显改善,没有发现随着时间的推移而恶化的情况。本研究计算出的效应大小与之前荟萃分析报告的效应大小相当,甚至超过了这些效应大小。结论通过应用在随机对照试验中测试过的治疗手册,"KibA" CBT 对患有注意力缺失症的青少年产生了可观的长期效果,与疗效研究的结果相当。这些研究结果令人瞩目,因为本文研究的患者群体属于罹患其他精神障碍的主要风险阶段,因此预计在本文研究的较长时间跨度内,新发焦虑症和其他精神障碍会有所增加。
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引用次数: 0
Indicated Stress Prevention Addressing Adolescents with High Stress Levels Based on Principles of Acceptance and Commitment Therapy: A Randomized Controlled Trial. 基于接纳与承诺疗法的原则,针对压力水平较高的青少年开展有针对性的压力预防:随机对照试验
IF 22.8 1区 医学 Q1 Psychology Pub Date : 2024-04-08 DOI: 10.1159/000537934
F. Binder, J. Koenig, Franz Resch, Michael Kaess
INTRODUCTIONStress affects many adolescents and is associated with physical and mental health symptoms that can have a negative impact on normative development. However, there are very few evidence-based, specific treatment approaches. The aim of the study was to investigate an eight-session group intervention using components of Acceptance and Commitment Therapy (ACT) enriched with elements of CBT (psychoeducation, problem solving) and art therapy, compared to a waitlist control (WLC) group, regarding its efficacy in reducing stress and associated symptoms.METHODSWe conducted a randomized controlled trial in eight cohorts. Eligible participants were 13-18 years old with elevated stress levels. Via block-randomization (n = 70), participants were allocated to receive ACT (n = 38) or WLC (n = 32) and subsequent ACT. We used a multimodal assessment (self-reports, interviews, ecological momentary assessment, physiological markers) before treatment (T1), after the training of the ACT group (T2) and after subsequent training in the WLC group (T3). Primary outcome was perceived stress at T2 assessed with the Perceived Stress Scale. The trial was preregistered at the German Clinical Trials Register (ID: DRKS00012778).RESULTSResults showed significantly lower levels of perceived stress in the ACT group at T2, illustrating superiority of ACT compared to WLC with a medium to large effect size (d = 0.77). Furthermore, the training was effective in the reduction of symptoms of school burnout and physical symptoms associated with stress.CONCLUSIONIndicated prevention, especially when based on the principles of ACT and CBT, seems efficient in significantly decreasing stress in adolescents with increased stress.
引言 压力影响着许多青少年,并与身心健康症状相关联,会对正常发育产生负面影响。然而,以证据为基础的具体治疗方法却寥寥无几。本研究的目的是调查一种为期八节的小组干预方法,该方法采用了接纳与承诺疗法(ACT)的内容,并加入了 CBT(心理教育、问题解决)和艺术疗法的元素,与候补对照组(WLC)进行比较,以了解其在减轻压力和相关症状方面的疗效。符合条件的参与者年龄为 13-18 岁,压力水平较高。通过整群随机分配(n = 70),参与者被分配接受 ACT(n = 38)或 WLC(n = 32)及随后的 ACT。我们在治疗前(T1)、ACT 组训练后(T2)和 WLC 组后续训练后(T3)采用了多模式评估(自我报告、访谈、生态瞬间评估、生理指标)。主要结果是在 T2 阶段使用感知压力量表评估感知压力。该试验已在德国临床试验注册中心进行了预先注册(ID:DRKS00012778)。结果表明,ACT 组在 T2 阶段的感知压力水平明显降低,说明 ACT 与 WLC 相比具有更优越的效果,效果大小为中到大 (d = 0.77)。此外,培训还能有效减少学校倦怠症状和与压力相关的身体症状。结论:有针对性的预防措施,尤其是以 ACT 和 CBT 原则为基础的预防措施,似乎能有效大幅减少压力增大的青少年的压力。
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引用次数: 0
Mortality and Lithium-Protective Effects after First-Episode Mania Diagnosis in Bipolar Disorder: A Nationwide Retrospective Cohort Study in Taiwan. 双相情感障碍首次发作躁狂诊断后的死亡率和锂的保护作用:台湾全国性回顾性队列研究》。
IF 22.8 1区 医学 Q1 Psychology Pub Date : 2024-01-01 Epub Date: 2024-01-09 DOI: 10.1159/000535777
Andre F Carvalho, Chih-Wei Hsu, Eduard Vieta, Marco Solmi, Wolfgang Marx, Michael Berk, Chih-Sung Liang, Ping-Tao Tseng, Liang-Jen Wang

Introduction: This study aimed to estimate all-cause mortality in patients after a first-episode mania (FEM) and examine whether six guideline-recommended medications can reduce mortality.

Methods: The cohort included population-based FEM samples and matched controls from Taiwan, spanning 2007 to 2018. The primary outcomes assessed were all-cause/suicide-related mortality, while the secondary outcome focused on mortality associated with pharmacological treatments. We compared mortality in post-FEM patients and age-/sex-matched controls without any diagnosed bipolar disorders and patients with and without psychopharmacological treatment using Cox regression analysis, respectively. Statistics were presented with time-to-event adjusted hazard ratios (AHRs) and 95% confidence intervals (CIs).

Results: The study included 54,092 post-FEM patients and 270,460 controls, totaling 2,467,417 person-years of follow-up. Post-FEM patients had higher risks of all-cause mortality (AHR 2.38, 95% CI: 2.31-2.45) and suicide death (10.80, 5.88-19.84) than controls. Lithium (0.62, 0.55-0.70), divalproex (0.89, 0.83-0.95), and aripiprazole (0.81, 0.66-1.00) were associated with reduced all-cause mortality compared to non-users. There were no significant all-cause mortality differences for quetiapine (0.95, 0.89-1.01), risperidone (0.92, 0.82-1.02), and paliperidone (1.24, 0.88-1.76) users. When accounting for drug action onset times in sensitivity analyses, only lithium significantly reduced all-cause mortality (AHR range 0.65-0.72). There were 35 and 16 suicide deaths in post-FEM patients and controls, respectively. No drug had a significant effect on suicide deaths (lithium: 6; divalproex: 7; aripiprazole: 0; quetiapine: 10; risperidone: 4; paliperidone: 1).

Conclusion: Post-FEM patients had a higher risk of all-cause/suicide-related mortality, and lithium treatment might reduce all-cause mortality.

简介:本研究旨在估算首次发病躁狂症(FEM)患者的全因死亡率,并研究指南推荐的六种药物是否能降低死亡率:本研究旨在估算首发躁狂症(FEM)患者的全因死亡率,并探讨指南推荐的六种药物是否能降低死亡率:研究队列包括来自台湾的基于人口的躁狂症样本和匹配对照,时间跨度为2007年至2018年。评估的主要结果是全因/自杀相关死亡率,次要结果侧重于与药物治疗相关的死亡率。我们采用 Cox 回归分析法,分别比较了未确诊双相情感障碍的 FEM 后患者和年龄/性别匹配的对照组的死亡率,以及接受和未接受精神药物治疗的患者的死亡率。统计数据以时间到事件调整后危险比(AHRs)和95%置信区间(CIs)表示:研究共纳入 54,092 名 FEM 后患者和 270,460 名对照者,随访时间共计 2,467,417 人年。FEM后患者的全因死亡风险(AHR 2.38,95% CI:2.31-2.45)和自杀死亡风险(10.80,5.88-19.84)高于对照组。与非使用者相比,锂(0.62,0.55-0.70)、二丙戊酸钠(0.89,0.83-0.95)和阿立哌唑(0.81,0.66-1.00)可降低全因死亡率。喹硫平(0.95,0.89-1.01)、利培酮(0.92,0.82-1.02)和帕利培酮(1.24,0.88-1.76)使用者的全因死亡率没有明显差异。在敏感性分析中考虑到药物起效时间时,只有锂能显著降低全因死亡率(AHR 范围为 0.65-0.72)。FEM后患者和对照组分别有35例和16例自杀死亡。没有一种药物对自杀死亡有明显影响(锂:6;二丙戊酸钠:7;阿立哌唑:0;喹硫平:0):0; quetiapine: 10; risperidone:4;帕利哌酮:1):结论结论:FEM 后患者全因/自杀相关死亡风险较高,锂治疗可降低全因死亡率。
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引用次数: 0
WFP News Section. 世界粮食计划署新闻科。
IF 22.8 1区 医学 Q1 Psychology Pub Date : 2024-01-01 Epub Date: 2024-05-21 DOI: 10.1159/000538579
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引用次数: 0
Restoring and Preserving the Clinical Interview. 恢复和保留临床访谈。
IF 22.8 1区 医学 Q1 Psychology Pub Date : 2024-01-01 Epub Date: 2024-03-15 DOI: 10.1159/000538076
Kurt Kroenke
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引用次数: 0
Enhanced Skills Training in Affective and Interpersonal Regulation versus Treatment as Usual for ICD-11 Complex PTSD: A Pilot Randomised Controlled Trial (The RESTORE Trial). 针对 ICD-11 复杂创伤后应激障碍的情感和人际关系调节强化技能培训与常规治疗:随机对照试验(RESTORE 试验)。
IF 16.3 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-04-30 DOI: 10.1159/000538428
Thanos Karatzias, Mark Shevlin, Marylène Cloitre, Walter Busuttil, Katherine Graham, Laura Hendrikx, Philip Hyland, Natasha Biscoe, Dominic Murphy

Introduction: Complex PTSD (CPTSD) is a relatively new condition in ICD-11. This pilot randomised controlled trial aimed to compare a four-module intervention developed to target all symptoms of ICD-11 CPTSD, namely Enhanced Skills in Affective and Interpersonal Regulation (ESTAIR) with treatment as usual (TAU). The purpose of the study was to assess feasibility, safety, acceptability, and preliminary outcomes at the end of treatment and 3-month follow-up.

Methods: A total of N = 56 eligible veterans with CPTSD were randomised to either ESTAIR (n = 28) or TAU (n = 28). Linear mixed models were conducted to assess CPTSD severity, the primary outcome, as measured by the International Trauma Questionnaire (ITQ).

Results: Treatment dropout in ESTAIR and TAU was low and equivalent (18% vs. 11%; χ2 (1) = 1.19, p = 0.275), and study retention was high, supporting the feasibility of the study. No serious adverse effects and very few adverse effects occurred, none of which were deemed related to the study. ESTAIR provided significantly greater reduction in CPTSD severity across time for ITQ PTSD (p < 0.001) and DSO (p < 0.001) symptoms. CPTSD pre-to-post effect sizes for ESTAIR were large (PTSD d = 1.78; DSO d = 2.00). Remission of probable CPTSD diagnosis at post-treatment was substantially greater in ESTAIR compared to TAU with only 13.6% versus 84% (p < 0.001) retaining the diagnosis.

Conclusion: A trial of ESTAIR versus TAU for the treatment of ICD-11 CPTSD indicates the potential efficacy of ESTAIR as well as its feasibility, safety, and acceptability.

导言:复杂创伤后应激障碍(CPTSD)在 ICD-11 中是一个相对较新的病症。这项随机对照试验旨在比较针对 ICD-11 CPTSD 所有症状而开发的四模块干预方法,即增强情感和人际关系调节技能(ESTAIR)与常规治疗(TAU)。研究的目的是评估治疗的可行性、安全性、可接受性以及治疗结束和 3 个月随访的初步结果:共有 N = 56 名符合条件的 CPTSD 退伍军人被随机分配到 ESTAIR(n = 28)或 TAU(n = 28)。采用线性混合模型来评估 CPTSD 的严重程度,这是主要结果,由国际创伤问卷(ITQ)来衡量:结果:ESTAIR 和 TAU 的治疗退出率较低且相当(18% vs. 11%; χ2 (1) = 1.19, p = 0.275),研究保留率较高,证明了研究的可行性。未出现严重不良反应,不良反应极少,且均与研究无关。在不同时间段,ESTAIR 对 ITQ PTSD(p < 0.001)和 DSO(p < 0.001)症状的 CPTSD 严重程度有明显降低。ESTAIR 的 CPTSD 前后效应大小较大(创伤后应激障碍 d = 1.78;创伤后应激障碍 d = 2.00)。ESTAIR与TAU相比,治疗后CPTSD可能诊断的缓解率要高得多,只有13.6%对84%(p <0.001)保留了诊断:ESTAIR与TAU治疗ICD-11 CPTSD的试验表明,ESTAIR具有潜在的疗效、可行性、安全性和可接受性。
{"title":"Enhanced Skills Training in Affective and Interpersonal Regulation versus Treatment as Usual for ICD-11 Complex PTSD: A Pilot Randomised Controlled Trial (The RESTORE Trial).","authors":"Thanos Karatzias, Mark Shevlin, Marylène Cloitre, Walter Busuttil, Katherine Graham, Laura Hendrikx, Philip Hyland, Natasha Biscoe, Dominic Murphy","doi":"10.1159/000538428","DOIUrl":"10.1159/000538428","url":null,"abstract":"<p><strong>Introduction: </strong>Complex PTSD (CPTSD) is a relatively new condition in ICD-11. This pilot randomised controlled trial aimed to compare a four-module intervention developed to target all symptoms of ICD-11 CPTSD, namely Enhanced Skills in Affective and Interpersonal Regulation (ESTAIR) with treatment as usual (TAU). The purpose of the study was to assess feasibility, safety, acceptability, and preliminary outcomes at the end of treatment and 3-month follow-up.</p><p><strong>Methods: </strong>A total of N = 56 eligible veterans with CPTSD were randomised to either ESTAIR (n = 28) or TAU (n = 28). Linear mixed models were conducted to assess CPTSD severity, the primary outcome, as measured by the International Trauma Questionnaire (ITQ).</p><p><strong>Results: </strong>Treatment dropout in ESTAIR and TAU was low and equivalent (18% vs. 11%; χ2 (1) = 1.19, p = 0.275), and study retention was high, supporting the feasibility of the study. No serious adverse effects and very few adverse effects occurred, none of which were deemed related to the study. ESTAIR provided significantly greater reduction in CPTSD severity across time for ITQ PTSD (p &lt; 0.001) and DSO (p &lt; 0.001) symptoms. CPTSD pre-to-post effect sizes for ESTAIR were large (PTSD d = 1.78; DSO d = 2.00). Remission of probable CPTSD diagnosis at post-treatment was substantially greater in ESTAIR compared to TAU with only 13.6% versus 84% (p &lt; 0.001) retaining the diagnosis.</p><p><strong>Conclusion: </strong>A trial of ESTAIR versus TAU for the treatment of ICD-11 CPTSD indicates the potential efficacy of ESTAIR as well as its feasibility, safety, and acceptability.</p>","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":null,"pages":null},"PeriodicalIF":16.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11152001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140871106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clinical Interviewing: An Essential but Neglected Method of Medicine. 临床访谈:一种重要但被忽视的医学方法。
IF 16.3 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-02-21 DOI: 10.1159/000536490
Giovanni A Fava, Nicoletta Sonino, David C Aron, Richard Balon, Carmen Berrocal Montiel, Jianxin Cao, John Concato, Ajandek Eory, Ralph I Horwitz, Chiara Rafanelli, Ulrich Schnyder, Hongxing Wang, Thomas N Wise, Jesse H Wright, Stephan Zipfel, Chiara Patierno

Clinical interviewing is the basic method to understand how a person feels and what are the presenting complaints, obtain medical history, evaluate personal attitudes and behavior related to health and disease, give the patient information about diagnosis, prognosis, and treatment, and establish a bond between patient and physician that is crucial for shared decision making and self-management. However, the value of this basic skill is threatened by time pressures and emphasis on technology. Current health care trends privilege expensive tests and procedures and tag the time devoted to interaction with the patient as lacking cost-effectiveness. Instead, the time spent to inquire about problems and life setting may actually help to avoid further testing, procedures, and referrals. Moreover, the dialogue between patient and physician is an essential instrument to increase patient's motivation to engage in healthy behavior. The aim of this paper was to provide an overview of clinical interviewing and its optimal use in relation to style, flow and hypothesis testing, clinical domains, modifications according to settings and goals, and teaching. This review points to the primacy of interviewing in the clinical process. The quality of interviewing determines the quality of data that are collected and, eventually, of assessment and treatment. Thus, interviewing deserves more attention in educational training and more space in clinical encounters than it is currently receiving.

临床问诊是了解患者感受和主诉、获取病史、评估与健康和疾病相关的个人态度和行为、向患者提供有关诊断、预后和治疗的信息,以及在患者和医生之间建立联系的基本方法,这种联系对于共同决策和自我管理至关重要。然而,这项基本技能的价值受到了时间压力和对技术重视程度的威胁。当前的医疗保健趋势将昂贵的检查和治疗程序视为特权,并将用于与患者互动的时间视为缺乏成本效益。相反,花时间询问病人的问题和生活环境,实际上可能有助于避免进一步的检查、手术和转诊。此外,病人与医生之间的对话也是提高病人参与健康行为积极性的重要手段。本文旨在概述临床问诊及其最佳使用方法,包括问诊风格、流程和假设检验、临床领域、根据环境和目标进行的修改以及教学。这篇综述指出了面谈在临床过程中的首要地位。面谈的质量决定了所收集数据的质量,并最终决定了评估和治疗的质量。因此,面谈在教育培训中应得到更多关注,在临床实践中也应得到比目前更多的空间。
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引用次数: 0
Selective Serotonin Reuptake Inhibitor and Serotonin-Noradrenaline Reuptake Inhibitor Withdrawal Changes DSM Presentation of Mental Disorders: Results from the Diagnostic Clinical Interview for Drug Withdrawal. 选择性5-羟色胺再摄取抑制剂和5-羟色胺-去甲肾上腺素再摄取抑制剂戒断改变DSM精神障碍的表述:戒毒诊断临床访谈的结果。
IF 16.3 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-07-23 DOI: 10.1159/000540031
Fiammetta Cosci, Virginie-Anne Chouinard, Guy Chouinard

Introduction: Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) may cause withdrawal at dose decrease, discontinuation, or switch. Current diagnostic methods (e.g., DSM) do not take such phenomenon into account. Using a new nosographic classification of withdrawal syndromes due to SSRI/SNRI decrease or discontinuation [by Psychother Psychosom. 2015;84(2):63-71], we explored whether DSM is adequate to identify DSM disorders when withdrawal occurs.

Methods: Seventy-five self-referred patients with a diagnosis of withdrawal syndrome due to discontinuation of SSRI/SNRI, diagnosed via the Diagnostic Clinical Interview for Drug Withdrawal 1 - New Symptoms of Selective Serotonin Reuptake Inhibitors or Serotonin-Norepinephrine Reuptake Inhibitors (DID-W1), and at least one DSM-5 diagnosis were analyzed.

Results: In 58 cases (77.3%), the DSM-5 diagnosis of current mental disorder was not confirmed when the DID-W1 diagnosis of current withdrawal syndrome was established. In 13 cases (17.3%), the DSM-5 diagnosis of past mental disorder was not confirmed when criteria for DID-W1 diagnosis of lifetime withdrawal syndrome were met. In 3 patients (4%), the DSM-5 diagnoses of current and past mental disorders were not confirmed when the DID-W1 diagnoses of current and lifetime withdrawal syndromes were taken into account. The DSM-5 diagnoses most frequently mis-formulated were current panic disorder (50.7%, n = 38) and past major depressive episode (18.7%, n = 14).

Conclusion: DSM needs to be complemented by clinimetric tools, such as the DID-W1, to detect withdrawal syndromes induced by SSRI/SNRI discontinuation, decrease, or switch, following long-term use.

简介:选择性血清素再摄取抑制剂(SSRIs)和血清素-去甲肾上腺素再摄取抑制剂(SNRIs)可能会在减少剂量、停药或换药时导致戒断。目前的诊断方法(如 DSM)没有考虑到这种现象。通过对SSRI/SNRI减量或停药导致的戒断综合征进行新的命名分类[by Psychother Psychosom. 2015;84(2):63-71],我们探讨了当发生戒断时,DSM是否足以识别DSM疾病:分析了75例因停用SSRI/SNRI而被诊断为戒断综合征的自荐患者,这些患者通过药物戒断诊断临床访谈1--选择性羟色胺再摄取抑制剂或羟色胺-去甲肾上腺素再摄取抑制剂的新症状(DID-W1)进行诊断,并至少有一项DSM-5诊断:在 58 个病例(77.3%)中,当 DID-W1 确诊为当前戒断综合征时,DSM-5 的当前精神障碍诊断并未得到确认。13例患者(17.3%)在符合DID-W1终生戒断综合征诊断标准的情况下,DSM-5对其过去精神障碍的诊断未得到证实。3名患者(4%)在考虑了DID-W1对当前和终生戒断综合征的诊断后,DSM-5对当前和过去精神障碍的诊断均未得到确认。最常被误诊的DSM-5诊断是当前惊恐障碍(50.7%,n = 38)和既往重度抑郁发作(18.7%,n = 14):结论:DSM需要辅以临床测量工具,如DID-W1,以检测长期使用SSRI/SNRI后因停用、减少或转换而诱发的戒断综合征。
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引用次数: 0
Adverse Events of Psychological Interventions: Definitions, Assessment, Current State of the Research and Implications for Research and Clinical Practice. 心理干预的不良事件:心理干预的不良事件:定义、评估、研究现状以及对研究和临床实践的影响》。
IF 16.3 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-07-29 DOI: 10.1159/000540212
Jan Philipp Klein, Alexander Rozental, Svenja Sürig, Steffen Moritz

Background: The effectiveness of psychological interventions is undisputed. But while in other fields of health care the safety of interventions is studied alongside effectiveness, adverse events (AEs) have only recently been assessed in clinical studies of psychological interventions. This critical review summarizes the definition, assessment and current research status of AEs of psychological interventions.

Summary: AEs are defined as any untoward event or unfavorable change that occurs in the course of a psychological intervention. AEs that are caused by the intervention can be classified into side effects of correctly applied treatment, malpractice (i.e., incorrectly applied treatment) and unethical conduct (e.g., sexual abuse). Ideally, they are assessed by independent raters or alternatively by self-report questionnaires that should also cover serious adverse events (SAEs, e.g., suicide attempts or self-injurious behaviors). About 1 to 2 in 3 patients report at least 1 AE and results of meta-analyses suggest that treatments might differ in frequency and/or severity of AE and in treatment acceptability (measured as dropout rates).

Key messages: Measures of AEs and SAEs as well as more nuanced descriptions of dropout should be included in all clinical studies of psychological interventions. If this happens, we might learn that psychological interventions differ with respect to AEs, SAEs and acceptability. As many psychological interventions are about equally effective, they might one day be chosen based on differences in their safety profile rather than their differential effectiveness. Ideally, reducing AEs might also lead to more effective interventions.

背景:心理干预的有效性毋庸置疑。但在其他医疗保健领域,在研究有效性的同时也会研究干预措施的安全性,而不良事件(AEs)直到最近才在心理干预的临床研究中得到评估。本评论总结了心理干预不良事件的定义、评估和研究现状。摘要:不良事件的定义是在心理干预过程中发生的任何意外事件或不利变化。由干预引起的AE可分为正确应用治疗的副作用、不当行为(即错误应用治疗)和不道德行为(如性虐待)。理想情况下,这些副作用由独立的评定人员进行评估,或者通过自我报告问卷进行评估,其中还应包括严重不良事件(SAE,如自杀企图或自伤行为)。大约每 3 名患者中就有 1 到 2 人报告至少 1 次不良反应,荟萃分析结果表明,治疗方法在不良反应发生频率和/或严重程度以及治疗可接受性(以辍药率衡量)方面可能存在差异:关键信息:在所有心理干预临床研究中,都应包括对AE和SAE的测量,以及对辍学率更细致的描述。如果这样做了,我们可能会了解到心理干预在AEs、SAEs和可接受性方面存在差异。由于许多心理干预措施的效果大致相同,有朝一日,人们可能会根据其安全性方面的差异,而不是疗效的差异来选择心理干预措施。理想的情况是,减少AEs也可能带来更有效的干预。
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引用次数: 0
Reducing Distress from Auditory Verbal Hallucinations: A Multicenter, Parallel, Single-Blind, Randomized Controlled Feasibility Trial of Relating Therapy. 减轻听觉幻觉带来的痛苦:关联疗法的多中心、平行、单盲、随机对照可行性试验。
IF 16.3 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-08-21 DOI: 10.1159/000539809
Tania Marie Lincoln, Björn Schlier, Rebecca Müller, Mark Hayward, Anne-Katharina Fladung, Niklas Bergmann, Kerem Böge, Jürgen Gallinat, Candelaria Mahlke, Uwe Gonther, Thomas Lang, Cornelia Exner, Anika Buchholz, Katharina Stahlmann, Antonia Zapf, Geraldine Rauch, Matthias Pillny

Introduction: There is a significant demand for interventions that reduce distress related to auditory verbal hallucinations (AVHs). AVH distress is associated with the way voice hearers relate with AVHs. We aimed to establish the feasibility of a randomized controlled trial to demonstrate that adding "Relating Therapy" (RT) to treatment as usual (TAU) is superior to TAU in reducing AVH distress.

Methods: We conducted a multicenter, parallel, single-blind, randomized controlled feasibility trial in five mental health centers in Germany. Participants were ≥19 years of age, had persistent and distressing AVHs, and had a diagnosis of a schizophrenia-spectrum disorder. RT was delivered over a maximum of 16 sessions within 5 months. Blind assessments were conducted at baseline and at 5 and 9 months. Feasibility outcomes were the number of patients recruited and retained, and safety and therapist adherence. The primary endpoint was the distress factor score of the AVH subscale of the Psychotic Symptoms Rating Scales at 9 months.

Results: Eighty-five of 177 enrolled participants were randomized into RT + TAU (n = 43) or TAU (n = 42). Feasibility was excellent with 87% retention at 9 months, 86% reaching treatment uptake criteria, 98% therapist adherence, and no unexpected serious adverse reactions. Compared to TAU, RT + TAU showed nonsignificant trends toward less AVH distress (b = -2.40, SE = 1.52, p = 0.121, 90% CI (-4.94 to 0.15) and stronger improvement on all but one of the secondary outcomes.

Conclusion: A randomized controlled trial of RT is feasible, safe, and well accepted. Our results provide an encouraging basis to further test the efficacy of RT in a definitive multicenter trial.

简介对于减少与听觉言语幻觉(AVHs)相关的痛苦的干预措施有很大的需求。幻听的痛苦与幻听者与幻听的关联方式有关。我们的目的是建立随机对照试验的可行性,以证明在常规治疗(TAU)的基础上增加 "关联疗法"(RT)在减轻听觉言语幻觉困扰方面优于TAU:我们在德国的五个心理健康中心开展了一项多中心、平行、单盲、随机对照的可行性试验。参与者年龄≥19岁,有持续性的房室震荡困扰,并被诊断为精神分裂症谱系障碍。RT 在 5 个月内最多进行 16 次治疗。在基线、5个月和9个月时进行盲法评估。可行性结果是招募和保留的患者人数,以及安全性和治疗师的依从性。主要终点是 9 个月时精神病症状评定量表 AVH 分量表的痛苦因子得分:在 177 名注册参与者中,有 85 人被随机分配到 RT + TAU(43 人)或 TAU(42 人)。该疗法的可行性极佳,9个月时的保留率为87%,86%的患者达到了治疗标准,98%的治疗师坚持治疗,没有出现意外的严重不良反应。与TAU相比,RT+TAU在减少AVH困扰(b = -2.40,SE = 1.52,p = 0.121,90% CI (-4.94 to 0.15)方面显示出非显著趋势,并且除一项次要结果外,所有次要结果都有更大改善:RT随机对照试验是可行的、安全的,也是被广泛接受的。我们的研究结果为在确定性多中心试验中进一步检验 RT 的疗效提供了令人鼓舞的依据。
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Psychotherapy and Psychosomatics
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