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At the Head and Heart of Oxytocin's Stress-Regulatory Neural and Cardiac Effects: A Chronic Administration RCT in Children with Autism. 催产素应激调节神经和心脏作用的头部和心脏:自闭症儿童的慢性给药随机对照试验。
IF 22.8 1区 医学 Q1 Psychology Pub Date : 2023-01-01 Epub Date: 2023-10-11 DOI: 10.1159/000534114
Kaat Alaerts, Nicky Daniels, Matthijs Moerkerke, Margaux Evenepoel, Tiffany Tang, Stephanie Van der Donck, Viktoria Chubar, Stephan Claes, Jean Steyaert, Bart Boets, Jellina Prinsen

Introduction: Intranasal administration of oxytocin presents a promising new approach to reduce disability associated with an autism spectrum disorder diagnosis. Previous investigations have emphasized the amygdala as the neural foundation for oxytocin's acute effects. However, to fully understand oxytocin's therapeutic potential, it is crucial to gain insight into the neuroplastic changes in amygdala circuitry induced from chronic oxytocin administrations, particularly in pediatric populations.

Objective: We aimed to examine the impact of a 4-week course of intranasal oxytocin on amygdala functional connectivity in children with autism, compared to placebo. Additionally, we investigated whether oxytocin improves cardiac autonomic arousal, as indexed by high-frequency heart rate variability.

Methods: Fifty-seven children with autism aged 8-12 years (45 boys, 12 girls) participated in a double-blind, randomized pharmaco-neuroimaging trial involving twice-daily administrations of intranasal oxytocin or placebo. Resting-state fMRI scans and simultaneous, in-scanner heart rate recordings were obtained before, immediately after, and 4 weeks after the nasal spray administration period.

Results: Significant reductions in intrinsic amygdala-orbitofrontal connectivity were observed, particularly at the 4-week follow-up session. These reductions were correlated with improved social symptoms and lower cardiac autonomic arousal. Further, oxytocin's neural and cardiac autonomic effects were modulated by epigenetic modifications of the oxytocin receptor gene. The effects were more pronounced in children with reduced epigenetic methylation, signifying heightened expression of the oxytocin receptor.

Conclusion: These findings underscore that a 4-week oxytocin administration course decreases amygdala connectivity and improves cardiac autonomic balance. Epigenetic modulators may explain inter-individual variation in responses to oxytocin.

引言:经鼻给予催产素是一种很有前途的新方法,可以减少与自闭症谱系障碍诊断相关的残疾。先前的研究强调杏仁核是催产素急性作用的神经基础。然而,为了充分了解催产素的治疗潜力,深入了解长期使用催产素引起的杏仁核回路的神经可塑性变化至关重要,尤其是在儿科人群中。目的:与安慰剂相比,我们旨在研究为期4周的鼻内催产素疗程对自闭症儿童杏仁核功能连接的影响。此外,我们还研究了催产素是否能改善心脏自主神经唤醒,这是以高频心率变异性为指标的。方法:57名8-12岁的自闭症儿童(45名男孩,12名女孩)参加了一项双盲、随机的药物神经成像试验,每天两次鼻内注射催产素或安慰剂。在鼻喷雾剂给药前、给药后立即和给药后4周获得静息状态fMRI扫描和同时的扫描内心率记录。结果:观察到杏仁核眶额固有连接显著降低,尤其是在4周的随访中。这些减少与社会症状的改善和心脏自主神经觉醒的降低有关。此外,催产素受体基因的表观遗传学修饰调节了催产素的神经和心脏自主作用。这种影响在表观遗传学甲基化减少的儿童中更为明显,这意味着催产素受体的表达增加。结论:这些发现强调了为期4周的催产素给药过程会降低杏仁核连接,改善心脏自主神经平衡。表观遗传学调节剂可能解释个体对催产素反应的差异。
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引用次数: 0
Antidepressants and Social Functioning in Patients with Major Depressive Disorder: Systematic Review and Meta-Analysis of Double-Blind, Placebo-Controlled RCTs. 重度抑郁症患者的抗抑郁药和社会功能:双盲安慰剂对照随机对照试验的系统评价和荟萃分析。
IF 22.8 1区 医学 Q1 Psychology Pub Date : 2023-01-01 Epub Date: 2023-09-19 DOI: 10.1159/000533494
Stefanie Kremer, Teresa Wiesinger, Tom Bschor, Christopher Baethge

Introduction: Social functioning (SF) is the ability to fulfil one's social obligations and a key outcome in treatment.

Objective: The aim of the study was to estimate the effects of antidepressants on SF in patients with major depressive disorder (MDD).

Methods: This meta-analysis and its reporting are based on Cochrane Collaboration's Handbook of Systematic Reviews and Meta-Analyses and PRISMA guidelines (protocol registration at OSF). We systematically searched CENTRAL, Medline, PubMed Central, and PsycINFO for double-blind RCTs comparing antidepressants with placebo and reporting on SF. We computed standardized mean differences (SMDs) with 95% CIs and prediction intervals.

Results: We selected 40 RCTs out of 1,188 records screened, including 16,586 patients (mean age 46.8 years, 64.2% women). In 27 studies investigating patients with MDD (primary depression), antidepressants resulted in a SMD of 0.25 compared to placebo ([95% CI: 0.21; 0.30] I2: 39%). In 13 trials with patients suffering from MDD comorbid with physical conditions or disorders, the summary estimate was 0.24 ([0.10; 0.37] I2: 75%). In comorbid depression, studies with high/uncertain risk of bias had higher SMDs than low-risk studies: 0.29 [0.13; 0.44] versus 0.04 [-0.16; 0.24]; no such effect was evident in primary depression. There was no indication of sizeable reporting bias. SF efficacy correlated with efficacy on depression scores, Spearman's rho 0.67 (p < 0.001), and QoL, 0.63 (p < 0.001).

Conclusions: The effect of antidepressants on SF is small, similar to its effect on depressive symptoms in primary MDD, and doubtful in comorbid depression. Strong correlations with both antidepressive and QoL effects suggest overlap among domains.

引言:社会功能(SF)是履行社会义务的能力,也是治疗的关键结果。目的:本研究旨在评估抗抑郁药对重度抑郁障碍(MDD)患者SF的影响。方法:本荟萃分析及其报告基于Cochrane Collaboration的《系统评价和荟萃分析手册》和PRISMA指南(在OSF注册)。我们系统地搜索了CENTRAL、Medline、PubMed CENTRAL和PsycINFO的双盲随机对照试验,比较了抗抑郁药和安慰剂,并报告了SF。我们计算了95%置信区间和预测区间的标准化平均差(SMD)。结果:我们从1188份筛查记录中选择了40份随机对照试验,其中16586名患者(平均年龄46.8岁,64.2%为女性)。在27项调查MDD(原发性抑郁症)患者的研究中,与安慰剂相比,抗抑郁药的SMD为0.25([95%CI:0.21;0.30]I2:39%)。在13项患有MDD合并身体状况或疾病的患者的试验中,总估计值为0.24([0.10;0.37]I2:75%)。在共病抑郁症中,具有高/不确定偏倚风险的研究的SMD高于低风险研究:0.29[0.13;0.44]对0.04[0.16;0.24];在原发性抑郁症中没有明显的这种作用。没有迹象表明报告存在相当大的偏见。SF疗效与抑郁评分的疗效相关,Spearman的rho 0.67(p<0.001)和QoL 0.63(p<001)。结论:抗抑郁药对SF的影响很小,与它对原发性MDD抑郁症状的影响相似,在共病抑郁症中值得怀疑。与抗抑郁和生活质量效应的强相关性表明领域之间存在重叠。
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引用次数: 0
Psychological Interventions for Adult Post-Traumatic Stress Disorder Are Effective Irrespective of Concurrent Psychotropic Medication Intake: A Meta-Analysis of Randomized Controlled Trials. 心理干预对成人创伤后应激障碍是有效的,与同时服用精神药物无关:一项随机对照试验的荟萃分析。
IF 22.8 1区 医学 Q1 Psychology Pub Date : 2023-01-01 DOI: 10.1159/000527850
Thole H Hoppen, Nexhmedin Morina

Background: Participants are allowed to stay on their prescribed psychotropic medication in most trials examining psychological interventions for adult post-traumatic stress disorder (PTSD).

Objectives: We aimed to conduct the first meta-analysis investigating the potential influence of such concurrent medication on efficacy.

Method: To this end, we searched Medline, PsycINFO, Web of Science, and PTSDpubs from inception to April 21, 2022, for trials meeting the following criteria: (1) randomized controlled trial (RCT), (2) PTSD as primary treatment focus, (3) interview-based PTSD baseline rate ≥70%, (4) N ≥ 20, (5) mean age ≥18 years. Trials were excluded when intake of psychotropics was not (sufficiently) reported.

Results: Most published trials did not report on the intake of psychotropic medication. A total of 75 RCTs (N = 4,901 patients) met inclusion criteria. Trauma-focused cognitive behavior therapy (TF-CBT) was the most well-researched intervention. Short-term efficacy of psychological treatments did not differ by the proportion of participants taking concurrent psychotropic medication during psychological treatment in all but one analysis. In trials comparing TF-CBT and active control conditions at posttreatment, TF-CBT was more effective when most participants were concurrently medicated (g = 0.87, 95% CI 0.53-1.22) rather than unmedicated (g = 0.27; 95% CI 0.01-0.54, p = 0.017), with younger age (b1 = -0.04, p = 0.008) and higher proportion of females (b1 = 0.01, p = 0.014) being associated with higher efficacy only in trials with high proportions of medicated participants. No differences in efficacy by proportions of participants taking concurrent psychotropic medication were found at follow-up.

Conclusions: Results suggest that psychological interventions are effective for PTSD irrespective of concurrent intake of psychotropics.

背景:在大多数检查成人创伤后应激障碍(PTSD)心理干预的试验中,参与者被允许继续服用处方精神药物。目的:我们的目的是进行第一次荟萃分析,调查这种同时用药对疗效的潜在影响。方法:为此,我们检索Medline, PsycINFO, Web of Science和ptsdbars,从成立到2022年4月21日,满足以下标准的试验:(1)随机对照试验(RCT),(2)创伤后应激障碍作为主要治疗重点,(3)基于访谈的创伤后应激障碍基线率≥70%,(4)N≥20,(5)平均年龄≥18岁。当精神药物的摄入没有(充分)报道时,试验被排除。结果:大多数已发表的试验没有报道精神药物的摄入。共有75项rct (N = 4,901例患者)符合纳入标准。以创伤为中心的认知行为疗法(TF-CBT)是研究最充分的干预手段。除一项分析外,心理治疗的短期疗效并没有因参与者在心理治疗期间同时服用精神药物的比例而有所不同。在比较治疗后TF-CBT和主动对照条件的试验中,当大多数参与者同时用药时(g = 0.87, 95% CI 0.53-1.22), TF-CBT比未用药时更有效(g = 0.27;95% CI 0.01-0.54, p = 0.017),只有在药物参与者比例高的试验中,较年轻的年龄(b1 = -0.04, p = 0.008)和较高的女性比例(b1 = 0.01, p = 0.014)与较高的疗效相关。在随访中没有发现同时服用精神药物的参与者比例的疗效差异。结论:结果表明心理干预对创伤后应激障碍是有效的,与同时服用精神药物无关。
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引用次数: 0
Psychotherapy for Chronic In- and Outpatients with Common Mental Disorders: The "Choose Change" Effectiveness Trial. 常见病慢性住院和门诊患者的心理治疗:“选择改变”效果试验。
IF 22.8 1区 医学 Q1 Psychology Pub Date : 2023-01-01 DOI: 10.1159/000529411
Andrew T Gloster, Elisa Haller, Jeanette Villanueva, Victoria Block, Charles Benoy, Andrea H Meyer, Sandra Brogli, Veronika Kuhweide, Maria Karekla, Klaus Bader, Marc Walter, Undine Lang

Introduction: Treatment non-response occurs regularly, but psychotherapy is seldom examined for such patients. Existing studies targeted single diagnoses, were relatively small, and paid little attention to treatment under real-world conditions.

Objective: The Choose Change trial tested whether psychotherapy was effective in treating chronic patients with treatment non-response in a transdiagnostic sample of common mental disorders across two variants of treatment delivery (inpatient and outpatient).

Methods: The controlled nonrandomized effectiveness trial was conducted between May 2016 and May 2021. The study took place in two psychiatric clinics with N = 200 patients (n = 108 inpatients and n = 92 outpatients). Treatment variants were integrated inpatient care versus outpatient care based on acceptance and commitment therapy (ACT) for approximately 12 weeks. Therapists delivered individualized and non-manualized ACT. Main outcome measures were symptoms (Brief Symptom Checklist [BSCL]); well-being (Mental Health Continuum-Short Form [MHC-SF]), and functioning (WHO Disability Assessment Schedule [WHO-DAS]).

Results: Both inpatients and outpatients showed decreases in symptomatology (i.e., BSCL: d = 0.68) and increases in well-being and functioning (MHC-SF: d = 0.60 and WHO-DAS: d = 0.70), with more improvement in the inpatients during treatment. Both groups maintained gains 1 year following treatment, and the groups did not significantly differ from each other at this timepoint. Psychological flexibility moderated impact of stress on outcomes.

Conclusions: Psychotherapy as practiced under routine conditions is effective for a sample of patients with common mental disorders, a long history of treatment experience and burden of disease, in both inpatient and outpatient settings.

Trial registration: This study was registered in the ISRCTN registry on May 20, 2016, with the registration number ISRCTN11209732.

引言:治疗无反应时有发生,但很少对此类患者进行心理治疗检查。现有的研究针对单一诊断,相对较小,并且很少关注现实世界条件下的治疗。目的:选择改变试验测试了在两种治疗方式(住院和门诊)的常见精神障碍的跨诊断样本中,心理治疗对治疗无反应的慢性患者是否有效。方法:2016年5月- 2021年5月进行对照非随机疗效试验。该研究在两家精神病诊所进行,共有200名患者(108名住院患者和92名门诊患者)。治疗变体是基于接受和承诺治疗(ACT)的住院治疗与门诊治疗的综合治疗,持续约12周。治疗师提供个性化和非手动ACT。主要结局指标为症状(简要症状检查表[BSCL]);健康(精神健康连续简表[MHC-SF])和功能(世卫组织残疾评估表[WHO- das])。结果:住院患者和门诊患者均表现出症状减轻(即BSCL: d = 0.68),幸福感和功能改善(MHC-SF: d = 0.60, WHO-DAS: d = 0.70),住院患者在治疗期间改善较多。两组在治疗后1年均保持获益,在此时间点各组间无显著差异。心理灵活性调节压力对结果的影响。结论:在常规条件下进行心理治疗对住院和门诊有长期治疗经验和疾病负担的常见精神障碍患者样本有效。试验注册:本研究于2016年5月20日在ISRCTN注册中心注册,注册号为ISRCTN11209732。
{"title":"Psychotherapy for Chronic In- and Outpatients with Common Mental Disorders: The \"Choose Change\" Effectiveness Trial.","authors":"Andrew T Gloster,&nbsp;Elisa Haller,&nbsp;Jeanette Villanueva,&nbsp;Victoria Block,&nbsp;Charles Benoy,&nbsp;Andrea H Meyer,&nbsp;Sandra Brogli,&nbsp;Veronika Kuhweide,&nbsp;Maria Karekla,&nbsp;Klaus Bader,&nbsp;Marc Walter,&nbsp;Undine Lang","doi":"10.1159/000529411","DOIUrl":"https://doi.org/10.1159/000529411","url":null,"abstract":"<p><strong>Introduction: </strong>Treatment non-response occurs regularly, but psychotherapy is seldom examined for such patients. Existing studies targeted single diagnoses, were relatively small, and paid little attention to treatment under real-world conditions.</p><p><strong>Objective: </strong>The Choose Change trial tested whether psychotherapy was effective in treating chronic patients with treatment non-response in a transdiagnostic sample of common mental disorders across two variants of treatment delivery (inpatient and outpatient).</p><p><strong>Methods: </strong>The controlled nonrandomized effectiveness trial was conducted between May 2016 and May 2021. The study took place in two psychiatric clinics with N = 200 patients (n = 108 inpatients and n = 92 outpatients). Treatment variants were integrated inpatient care versus outpatient care based on acceptance and commitment therapy (ACT) for approximately 12 weeks. Therapists delivered individualized and non-manualized ACT. Main outcome measures were symptoms (Brief Symptom Checklist [BSCL]); well-being (Mental Health Continuum-Short Form [MHC-SF]), and functioning (WHO Disability Assessment Schedule [WHO-DAS]).</p><p><strong>Results: </strong>Both inpatients and outpatients showed decreases in symptomatology (i.e., BSCL: d = 0.68) and increases in well-being and functioning (MHC-SF: d = 0.60 and WHO-DAS: d = 0.70), with more improvement in the inpatients during treatment. Both groups maintained gains 1 year following treatment, and the groups did not significantly differ from each other at this timepoint. Psychological flexibility moderated impact of stress on outcomes.</p><p><strong>Conclusions: </strong>Psychotherapy as practiced under routine conditions is effective for a sample of patients with common mental disorders, a long history of treatment experience and burden of disease, in both inpatient and outpatient settings.</p><p><strong>Trial registration: </strong>This study was registered in the ISRCTN registry on May 20, 2016, with the registration number ISRCTN11209732.</p>","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":null,"pages":null},"PeriodicalIF":22.8,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9949312","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: 2
Real-Time fMRI Functional Connectivity Neurofeedback Reducing Repetitive Negative Thinking in Depression: A Double-Blind, Randomized, Sham-Controlled Proof-of-Concept Trial. 实时fMRI功能连接神经反馈减少抑郁症的重复性消极思维:一项双盲,随机,假对照的概念验证试验。
IF 22.8 1区 医学 Q1 Psychology Pub Date : 2023-01-01 DOI: 10.1159/000528377
Aki Tsuchiyagaito, Masaya Misaki, Namik Kirlic, Xiaoqian Yu, Stella M Sánchez, Gabe Cochran, Jennifer L Stewart, Ryan Smith, Kate D Fitzgerald, Michael L Rohan, Martin P Paulus, Salvador M Guinjoan

Introduction: Repetitive negative thinking (RNT) is a cognitive process focusing on self-relevant and negative experiences, leading to a poor prognosis of major depressive disorder (MDD). We previously identified that connectivity between the precuneus/posterior cingulate cortex (PCC) and right temporoparietal junction (rTPJ) was positively correlated with levels of RNT.

Objective: In this double-blind, randomized, sham-controlled, proof-of-concept trial, we employed real-time functional magnetic resonance imaging neurofeedback (rtfMRI-nf) to delineate the neural processes that may be causally linked to RNT and could potentially become treatment targets for MDD.

Methods: MDD-affected individuals were assigned to either active (n = 20) or sham feedback group (n = 19). RNT was measured by the Ruminative Response Scale-brooding subscale (RRS-B) before and 1 week after the intervention.

Results: Individuals in the active but not in the sham group showed a significant reduction in the RRS-B; however, a greater reduction in the PCC-rTPJ connectivity was unrelated to a greater reduction in the RRS-B. Exploratory analyses revealed that a greater reduction in the retrosplenial cortex (RSC)-rTPJ connectivity yielded a more pronounced reduction in the RRS-B in the active but not in the sham group.

Conclusions: RtfMRI-nf was effective in reducing RNT. Considering the underlying mechanism of rtfMIR-nf, the RSC and rTPJ could be part of a network (i.e., default mode network) that might collectively affect the intensity of RNT. Understanding the relationship between the functional organization of targeted neural changes and clinical metrics, such as RNT, has the potential to guide the development of mechanism-based treatment of MDD.

重复性消极思维(RNT)是一种专注于自我相关和消极体验的认知过程,导致重度抑郁症(MDD)预后不良。我们之前发现楔前叶/后扣带皮层(PCC)和右颞顶交界处(rTPJ)之间的连通性与RNT水平呈正相关。目的:在这项双盲、随机、假对照、概念验证的试验中,我们采用实时功能磁共振成像神经反馈(rtfMRI-nf)来描绘可能与RNT有因果关系的神经过程,并可能成为重度抑郁症的治疗靶点。方法:将受mdd影响的个体分为主动反馈组(n = 20)和虚假反馈组(n = 19)。干预前和干预后1周采用反刍反应量表-沉思子量表(RRS-B)测量RNT。结果:运动组个体RRS-B明显降低,而假手术组个体RRS-B明显降低;然而,PCC-rTPJ连通性的较大降低与RRS-B的较大降低无关。探索性分析显示,活跃组脾后皮质(RSC)-rTPJ连通性的更大减少导致RRS-B的更明显减少,而假手术组则没有。结论:RtfMRI-nf可有效降低RNT。考虑到rtfMIR-nf的潜在机制,RSC和rTPJ可能是一个网络(即默认模式网络)的一部分,可能共同影响RNT的强度。了解靶向神经变化的功能组织与临床指标(如RNT)之间的关系,有可能指导基于机制的重度抑郁症治疗的发展。
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引用次数: 5
Front & Back Matter 正面和背面事项
IF 22.8 1区 医学 Q1 Psychology Pub Date : 2023-01-01 DOI: 10.1159/000529257
J. Guidi, G. Fava, J. Leon
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引用次数: 0
Management of Depression in Medical Patients: The Role of Clinical Evaluation. 医疗病人抑郁症的治疗:临床评估的作用。
IF 22.8 1区 医学 Q1 Psychology Pub Date : 2023-01-01 Epub Date: 2023-10-20 DOI: 10.1159/000533954
Giovanni A Fava, Jenny Guidi
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引用次数: 0
ICPM News Section. ICPM新闻部分。
IF 22.8 1区 医学 Q1 Psychology Pub Date : 2023-01-01 Epub Date: 2023-11-20 DOI: 10.1159/000534795
{"title":"ICPM News Section.","authors":"","doi":"10.1159/000534795","DOIUrl":"10.1159/000534795","url":null,"abstract":"","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":null,"pages":null},"PeriodicalIF":22.8,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138177166","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
Depression and Anxiety Trajectories in Chronic Disease: A Systematic Review and Meta-Analysis. 慢性病患者的抑郁和焦虑轨迹:系统综述和荟萃分析。
IF 16.3 1区 医学 Q1 PSYCHIATRY Pub Date : 2023-01-01 Epub Date: 2023-08-22 DOI: 10.1159/000533263
Amelia J Scott, Ashleigh B Correa, Madelyne A Bisby, Blake F Dear

Introduction: People living with chronic diseases are at an increased risk of anxiety and depression, which are associated with poorer medical and psychosocial outcomes. Many studies have examined the trajectories of depression and anxiety in people with specific diseases, including the predictors of these trajectories. This is valuable for understanding the process of adjustment to diseases and informing treatment planning. However, no review has yet synthesised this information across chronic diseases.

Methods: Electronic databases were searched for studies reporting trajectories of depression or anxiety in chronic disease samples. Data extracted included sample characteristics, results from trajectory analyses, and predictors of trajectories. Meta-analysis of the overall pooled prevalence of depression and anxiety trajectories was conducted, and qualitative synthesis of disease severity predictors was undertaken.

Results: Following search and screening, 67 studies were included (N = 61,201 participants). Most participants followed a stable nonclinical trajectory for depression (69.0% [95% CI: 65.6, 72.2]) and anxiety (73.4% [95% CI: 66.3, 79.5]). Smaller but meaningful subsamples followed a trajectory of depression and anxiety symptoms consistently in the clinical range (11.8% [95% CI: 9.2, 14.8] and 13.7% [95% CI: 9.3, 19.7], respectively). Several clinical and methodological moderators emerged, and qualitative synthesis suggested that few aspects of disease severity were associated with participants' trajectories.

Conclusion: Most people with chronic disease follow a trajectory of distress that is low and stable, suggesting that most people psychologically adjust to living with chronic disease. Evidence also suggests that the nature and severity of the disease are not meaningful predictors of psychological distress.

引言:患有慢性病的人患焦虑和抑郁的风险增加,这与较差的医疗和心理社会结果有关。许多研究已经检查了患有特定疾病的人的抑郁和焦虑的轨迹,包括这些轨迹的预测因素。这对于理解疾病的适应过程和为治疗计划提供信息是很有价值的。然而,还没有任何综述综合了慢性病的这些信息。方法:在电子数据库中搜索报告慢性病样本中抑郁或焦虑轨迹的研究。提取的数据包括样本特征、轨迹分析结果和轨迹预测因素。对抑郁和焦虑轨迹的总体合并患病率进行了荟萃分析,并对疾病严重程度预测因素进行了定性综合。结果:经过搜索和筛选,纳入了67项研究(N=61201名参与者)。大多数参与者在抑郁(69.0%[95%CI:65.6,72.2])和焦虑(73.4%[95%CI=66.3,79.5])方面遵循稳定的非临床轨迹。较小但有意义的子样本在临床范围内始终遵循抑郁和焦虑症状的轨迹(分别为11.8%[95%CI:9.2,14.8]和13.7%[95%CI:9.3,19.7])。出现了几个临床和方法论调节因子,定性综合表明,疾病严重程度的几个方面与参与者的轨迹有关。结论:大多数慢性病患者的痛苦轨迹是低而稳定的,这表明大多数人在心理上适应了慢性病的生活。证据还表明,疾病的性质和严重程度并不是心理困扰的有意义的预测因素。
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引用次数: 0
Behavioural Activation versus Treatment as Usual for Depressed Older Adults in Primary Care: A Pragmatic Cluster-Randomised Controlled Trial. 初级保健中抑郁老年人的行为激活与常规治疗:一项实用的聚类随机对照试验。
IF 22.8 1区 医学 Q1 Psychology Pub Date : 2023-01-01 Epub Date: 2023-06-29 DOI: 10.1159/000531201
Noortje P Janssen, Peter Lucassen, Marcus J H Huibers, David Ekers, Theo Broekman, Judith E Bosmans, Harm Van Marwijk, Jan Spijker, Richard Oude Voshaar, Gert-Jan Hendriks

Introduction: Effective non-pharmacological treatment options for depression in older adults are lacking.

Objective: The effectiveness of behavioural activation (BA) by mental health nurses (MHNs) for depressed older adults in primary care compared with treatment as usual (TAU) was evaluated.

Methods: In this multicentre cluster-randomised controlled trial, 59 primary care centres (PCCs) were randomised to BA and TAU. Consenting older (≥65 years) adults (n = 161) with clinically relevant symptoms of depression (PHQ-9 ≥ 10) participated. Interventions were an 8-week individual MHN-led BA programme and unrestricted TAU in which general practitioners followed national guidelines. The primary outcome was self-reported depression (QIDS-SR16) at 9 weeks and 3, 6, 9, and 12-month follow-up.

Results: Data of 96 participants from 21 PCCs in BA and 65 participants from 16 PCCs in TAU, recruited between July 4, 2016, and September 21, 2020, were included in the intention-to-treat analyses. At post-treatment, BA participants reported significantly lower severity of depressive symptoms than TAU participants (QIDS-SR16 difference = -2.77, 95% CI = -4.19 to -1.35), p < 0.001; between-group effect size = 0.90; 95% CI = 0.42-1.38). This difference persisted up to the 3-month follow-up (QIDS-SR16 difference = -1.53, 95% CI = -2.81 to -0.26, p = 0.02; between-group effect size = 0.50; 95% CI = 0.07-0.92) but not up to the 12-month follow-up [QIDS-SR16 difference = -0.89 (-2.49 to 0.71)], p = 0.28; between-group effect size = 0.29 (95% CI = -0.82 to 0.24).

Conclusions: BA led to a greater symptom reduction of depressive symptoms in older adults, compared to TAU in primary care, at post-treatment and 3-month follow-up, but not at 6- to 12-month follow-up.

引言:老年人抑郁症缺乏有效的非药物治疗方案。目的:与常规治疗(TAU)相比,评估心理健康护士(MHN)在初级保健中对抑郁的老年人进行行为激活(BA)的有效性。方法:在这项多中心集群随机对照试验中,59个初级保健中心(PCCs)被随机分为BA和TAU。有临床相关抑郁症状(PHQ-9≥10)的同意老年(≥65岁)成年人(n=161)参与了研究。干预措施是由MHN领导的为期8周的个人BA计划和不受限制的TAU,全科医生遵循国家指导方针。主要结果是9周和3、6、9和12个月随访时的自我报告抑郁(QIDS-SR16)。结果:2016年7月4日至2020年9月21日期间招募的来自BA 21个PCC的96名参与者和来自TAU 16个PCC的65名参与者的数据被纳入意向治疗分析。在治疗后,BA参与者报告的抑郁症状严重程度显著低于TAU参与者(QIDS-SR16差异=-2.77,95%CI=-4.19至-1.35),p<;0.001;组间效应大小=0.90;95%可信区间=0.42-1.38)。这种差异持续到3个月随访(QIDS-SR16差异=1.53,95%可信区间-2.81至-0.26,p=0.02;组间效应大小=0.50;95%可信区间0.07-0.92),但没有持续到12个月随访[QIDS-SR16=-0.89(-2.49至0.71)],p=0.28;组间效应大小=0.29(95%CI=0.82-0.24)。结论:与初级保健、治疗后和3个月随访中的TAU相比,BA能更大程度地减轻老年人的抑郁症状,但在6至12个月随访时没有。
{"title":"Behavioural Activation versus Treatment as Usual for Depressed Older Adults in Primary Care: A Pragmatic Cluster-Randomised Controlled Trial.","authors":"Noortje P Janssen,&nbsp;Peter Lucassen,&nbsp;Marcus J H Huibers,&nbsp;David Ekers,&nbsp;Theo Broekman,&nbsp;Judith E Bosmans,&nbsp;Harm Van Marwijk,&nbsp;Jan Spijker,&nbsp;Richard Oude Voshaar,&nbsp;Gert-Jan Hendriks","doi":"10.1159/000531201","DOIUrl":"10.1159/000531201","url":null,"abstract":"<p><strong>Introduction: </strong>Effective non-pharmacological treatment options for depression in older adults are lacking.</p><p><strong>Objective: </strong>The effectiveness of behavioural activation (BA) by mental health nurses (MHNs) for depressed older adults in primary care compared with treatment as usual (TAU) was evaluated.</p><p><strong>Methods: </strong>In this multicentre cluster-randomised controlled trial, 59 primary care centres (PCCs) were randomised to BA and TAU. Consenting older (≥65 years) adults (n = 161) with clinically relevant symptoms of depression (PHQ-9 ≥ 10) participated. Interventions were an 8-week individual MHN-led BA programme and unrestricted TAU in which general practitioners followed national guidelines. The primary outcome was self-reported depression (QIDS-SR16) at 9 weeks and 3, 6, 9, and 12-month follow-up.</p><p><strong>Results: </strong>Data of 96 participants from 21 PCCs in BA and 65 participants from 16 PCCs in TAU, recruited between July 4, 2016, and September 21, 2020, were included in the intention-to-treat analyses. At post-treatment, BA participants reported significantly lower severity of depressive symptoms than TAU participants (QIDS-SR16 difference = -2.77, 95% CI = -4.19 to -1.35), p &lt; 0.001; between-group effect size = 0.90; 95% CI = 0.42-1.38). This difference persisted up to the 3-month follow-up (QIDS-SR16 difference = -1.53, 95% CI = -2.81 to -0.26, p = 0.02; between-group effect size = 0.50; 95% CI = 0.07-0.92) but not up to the 12-month follow-up [QIDS-SR16 difference = -0.89 (-2.49 to 0.71)], p = 0.28; between-group effect size = 0.29 (95% CI = -0.82 to 0.24).</p><p><strong>Conclusions: </strong>BA led to a greater symptom reduction of depressive symptoms in older adults, compared to TAU in primary care, at post-treatment and 3-month follow-up, but not at 6- to 12-month follow-up.</p>","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":null,"pages":null},"PeriodicalIF":22.8,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9699118","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: 1
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Psychotherapy and Psychosomatics
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