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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
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 PSYCHIATRY 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
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
Restoring and Preserving the Clinical Interview. 恢复和保留临床访谈。
IF 22.8 1区 医学 Q1 PSYCHIATRY 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":" ","pages":"203-215"},"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
WFP News Section. 世界粮食计划署新闻科。
IF 22.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-05-21 DOI: 10.1159/000538579
{"title":"WFP News Section.","authors":"","doi":"10.1159/000538579","DOIUrl":"10.1159/000538579","url":null,"abstract":"","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":"93 3","pages":"216-218"},"PeriodicalIF":22.8,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141076401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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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引用次数: 0
One-Day Peer-Delivered Cognitive Behavioral Therapy-Based Workshops for Postpartum Depression: A Randomized Controlled Trial. 基于认知行为疗法的产后抑郁研讨会:随机对照试验
IF 22.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-01-25 DOI: 10.1159/000536040
Zoryana Babiy, Haley Layton, Calan D Savoy, Feng Xie, June S L Brown, Peter J Bieling, David L Streiner, Mark A Ferro, Ryan J Van Lieshout

Introduction: Myriad treatment barriers prevent birthing parents with postpartum depression (PPD) from receiving timely treatment. We aimed to determine whether a peer-delivered online 1-day cognitive behavioral therapy (CBT)-based workshop added to treatment as usual (TAU) improves PPD and its comorbidities and is more cost-effective than TAU alone.

Methods: This parallel-group, randomized controlled trial took place in Ontario, Canada (June 7, 2021, to February 18, 2022). Participants were ≥18 years old, had an infant ≤12 months old, and an Edinburgh Postnatal Depression Scale (EPDS) score ≥10. Participants were allocated to receive the workshop plus TAU (n = 202) or TAU and waitlisted to complete the workshop 12 weeks later (n = 203). The primary outcome was change in PPD (EPDS score) from enrollment to 12 weeks later. The secondary outcome was cost-effectiveness and tertiary outcomes included anxiety, social support, partner relationship quality, the mother-infant relationship, parenting stress, and infant temperament.

Results: Participants had a mean age of 32.3 years (SD = 4.30) and 65% were White. The workshop led to a significant reduction in EPDS scores (15.95-11.37; d = 0.92, p < 0. 01) and was associated with higher odds of exhibiting a clinically significant decrease in EPDS scores (OR = 2.03; 95% CI: 1.26-3.29). The workshop plus TAU was more cost-effective than TAU alone. It also led to improvements in postpartum anxiety, infant-focused anxiety, parenting stress, and infant temperament.

Conclusions: Peer-delivered 1-day CBT-based workshops can improve PPD and are a potentially scalable low-intensity treatment that could help increase treatment access.

导言:各种治疗障碍阻碍了患有产后抑郁症(PPD)的分娩父母及时接受治疗。我们的目的是确定在常规治疗(TAU)的基础上增加一个由同伴提供的、基于认知行为疗法(CBT)的为期 1 天的在线研讨会,是否能改善产后抑郁症及其合并症,是否比单独使用常规治疗更具成本效益:这项平行分组随机对照试验在加拿大安大略省进行(2021 年 6 月 7 日至 2022 年 2 月 18 日)。参与者年龄≥18岁,婴儿≤12个月,爱丁堡产后抑郁量表(EPDS)评分≥10分。参加者被分配接受工作坊加TAU(n = 202)或TAU并等待12周后完成工作坊(n = 203)。主要结果是入学至12周后PPD(EPDS评分)的变化。第二结果是成本效益,第三结果包括焦虑、社会支持、伴侣关系质量、母婴关系、养育压力和婴儿气质:参与者的平均年龄为 32.3 岁(SD = 4.30),65% 为白人。工作坊显著降低了 EPDS 分数(15.95-11.37;d = 0.92,p < 0. 01),而且 EPDS 分数出现临床显著下降的几率更高(OR = 2.03;95% CI:1.26-3.29)。工作坊加 TAU 比单独使用 TAU 更具成本效益。它还能改善产后焦虑、婴儿焦虑、养育压力和婴儿脾气:由同伴提供的为期一天的基于 CBT 的工作坊可以改善 PPD,是一种潜在的可扩展低强度治疗方法,有助于提高治疗的可及性。
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引用次数: 0
Longitudinal Clusters of Long-Term Trajectories in Patients with Early-Onset Chronic Depression: 2 Years of Naturalistic Follow-Up after Extensive Psychological Treatment. 早发慢性抑郁症患者的长期轨迹纵向集群:广泛心理治疗后两年的自然随访。
IF 22.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2023-12-28 DOI: 10.1159/000535005
Moritz Elsaesser, Bernd Feige, Levente Kriston, Lea Schumacher, Jasmin Peifer, Martin Hautzinger, Martin Härter, Elisabeth Schramm

Introduction: In clinical trials, mostly group-level treatment effects of repeated cross-sectional measures are analyzed. However, substantial heterogeneity regarding individual symptom profiles and the variability of treatment effects are often neglected, especially over the long-term course. To provide effective personalized treatments, investigations of these characteristics are urgently needed.

Methods: Depression severity ratings over 104 weeks of follow-up after year-long treatment with the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) or Supportive Psychotherapy (SP) were analyzed. Longitudinal cluster analysis and multinomial logistic regression analysis were conducted to investigate intraindividual trajectories from one of the largest psychotherapy trials in early-onset chronic depression.

Results: Two-year post-study-treatment trajectories of N = 188 patients with early-onset chronic depression were grouped into four prototypical clusters. Overall, 16.0% of patients remitted (cluster 1) and most of them did not receive any treatment during the 2-year follow-up. However, 84.0% of patients continued to experience subthreshold (37.2% cluster 2) or major depressive symptoms (46.8% clusters 3-4) and spent on average more than half of the follow-up in pharmacological and psychological treatment. Hierarchical regression analysis indicated that previous study treatment with CBASP or SP did not significantly predict cluster allocation, while baseline variables accounted for a large proportion of explained variance (R2 N = 0.64).

Conclusion: While some patients experienced stable remission over 2 years of follow-up, the majority of patients experienced subthreshold or major depressive symptoms regardless of former study treatment with CBASP or SP. This calls for a long-term perspective implementing staging and innovative treatment approaches such as the sequential model or modular psychotherapy.

简介在临床试验中,分析的大多是重复横断面测量的组级治疗效果。然而,个体症状特征的实质性异质性和治疗效果的可变性往往被忽视,尤其是在长期病程中。为了提供有效的个性化治疗,迫切需要对这些特征进行研究:方法:对认知行为分析系统心理疗法(CBASP)或支持性心理疗法(SP)治疗一年后,随访104周的抑郁严重程度评分进行分析。通过纵向聚类分析和多项式逻辑回归分析,研究了早发性慢性抑郁症最大心理疗法试验之一的个体内部轨迹:N = 188 名早发慢性抑郁症患者的两年治疗后轨迹被分为四个原型群组。总体而言,16.0%的患者病情得到缓解(第 1 组),其中大部分患者在两年随访期间没有接受任何治疗。然而,84.0%的患者仍有阈下抑郁症状(第 2 组,37.2%)或重度抑郁症状(第 3-4 组,46.8%),平均一半以上的随访时间用于药物和心理治疗。分层回归分析表明,之前接受过CBASP或SP治疗的研究并不能显著预测群组分配,而基线变量占解释变异的很大比例(R2 N = 0.64):结论:虽然一些患者在两年的随访中病情得到稳定缓解,但无论之前是否接受过CBASP或SP的研究治疗,大多数患者都会出现阈值以下或重度抑郁症状。这就需要从长远角度出发,实施分期和创新治疗方法,如序贯模式或模块化心理疗法。
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引用次数: 0
Effectiveness of Schema Therapy versus Cognitive Behavioral Therapy versus Supportive Therapy for Depression in Inpatient and Day Clinic Settings: A Randomized Clinical Trial. 住院和日间诊所抑郁症患者接受模式疗法与认知行为疗法和支持疗法的疗效对比:随机临床试验
IF 22.8 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-01-04 DOI: 10.1159/000535492
Johannes Kopf-Beck, Celina L Müller, Jeanette Tamm, Julia Fietz, Nils Rek, Leah Just, Zoe Ilona Spock, Katharina Weweck, Keisuke Takano, Martin Rein, Martin E Keck, Samy Egli

Introduction: Schema therapy (ST) reduces depressive symptoms, but clinical trials have not investigated its effectiveness for patients suffering from severe forms of depression and high rates of comorbidities. There is high demand for exploring and improving treatments for this patient group. The objective of the current study was to evaluate whether ST is more effective than individual supportive therapy (IST) and noninferior compared with cognitive behavioral therapy (CBT) in treating depression.

Methods: For this clinical trial, medicated patients were recruited in inpatient and day clinic settings. The major inclusion criteria were age between 18 and 75 years and primary diagnosis of depression without psychotic symptoms. A total of 292 participants were randomized to ST, CBT, or IST and received 7 weeks of psychotherapy (up to 14 individual and 14 group sessions). The primary outcome was change in depression severity after treatment measured by Beck Depression Inventory-II. Primary test for efficacy was superiority of ST over IST. Secondary test was noninferiority of ST compared with CBT. Multilevel modeling was conducted. The results at 6-month follow-up were explored.

Results: Across treatment, ST was not superior to IST. Secondary outcome analyses and completer analyses showed similar results. However, ST showed clinically relevant noninferiority compared with CBT.

Conclusion: ST for depression as part of a psychiatric care program showed clinical noninferiority compared to CBT, without being superior to IST. ST represents a potentially useful addition to the therapeutic repertoire for the treatment of depression but its efficacy, including long-term efficacy, should be evaluated further.

简介模式疗法(ST)可减轻抑郁症状,但临床试验尚未研究其对严重抑郁症和高合并症患者的疗效。针对这一患者群体,探索和改进治疗方法的需求很高。本研究的目的是评估 ST 在治疗抑郁症方面是否比个体支持疗法(IST)更有效,以及与认知行为疗法(CBT)相比是否不具劣势:这项临床试验招募了住院和日间诊所的药物治疗患者。主要纳入标准为年龄在 18 岁至 75 岁之间,主要诊断为无精神病症状的抑郁症。共有 292 名参与者被随机分配到 ST、CBT 或 IST,并接受了为期 7 周的心理治疗(最多 14 次个人治疗和 14 次小组治疗)。主要结果是治疗后抑郁严重程度的变化,由贝克抑郁量表-II测量。主要疗效检验是 ST 优于 IST。次要检验是 ST 与 CBT 相比的非劣效性。进行了多层次建模。结果:结果:在所有治疗中,ST 并不优于 IST。次要结果分析和完成者分析显示了相似的结果。然而,与 CBT 相比,ST 显示出临床相关的非劣势:作为精神病治疗项目的一部分,ST治疗抑郁症的临床效果不优于CBT,但也不优于IST。ST是对抑郁症治疗的一种潜在有益补充,但其疗效(包括长期疗效)仍有待进一步评估。
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Psychotherapy and Psychosomatics
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