Trends in Psychiatry and Psychotherapy最新文献

Background: The increasing prevalence of anxiety disorders underscores the critical importance of effective assessment and management strategies. While established questionnaires like the Hamilton Anxiety Rating Scale (HARS) and the Beck Anxiety Inventory (BAI) are widely used, there remains a need for instruments that explore the nuanced, qualitative features of anxiety, which are essential for personalized treatment approaches.

Methods: This study presents findings based on the Brief Anxiety Structure Questionnaire (BASQ), which is designed to evaluate behavioral manifestations, cognitive aspects, and personality traits associated with generalized anxiety disorder (GAD). Data from a Phase III clinical trial of the anxiolytic Aviandr (maritupirdine) were analyzed using machine learning techniques to develop predictive models and construct an "ideal patient profile".

Results: Among the tested algorithms of machine learning, the decision tree model demonstrated the highest accuracy in identifying the most influential BASQ questions for therapy selection. The BASQ questionnaire revealed qualitative aspects of anxiety and personality traits, providing a deeper understanding of the structure of anxiety and supporting more personalized treatment strategies. Specific questions most strongly correlated with the effectiveness of Aviandr treatment were also identified.

Conclusion: The findings from this study suggest that integrating qualitative parameters into clinical assessment may optimize therapy for anxiety disorders. Future research will focus on further elucidating the relationship between patient anxiety characteristics and treatment effectiveness.

Objective: Sleep health has evolved from focusing on specific disorders, such as insomnia and sleep apnea, to a broader perspective that includes regularity, efficiency, and socio-environmental influences. Psychological flexibility, particularly the acceptance process, has been identified as a key protective factor for sleep health. Therefore, assessing acceptance of sleep difficulties is essential for both research and clinical practice, as it provides insights into adaptive coping and informs interventions. The Sleep Problem Acceptance Questionnaire (SPAQ) is the only validated instrument for assessing acceptance of sleep difficulties, making it a valuable tool for interventions based on Acceptance and Commitment Therapy (ACT). This study aimed to adapt the SPAQ for Brazilian Portuguese, ensuring both semantic and psychometric equivalence.

Methods: The adaptation process included translation, back-translation, expert review, and pilot testing. The final version was validated in a sample of 1,352 participants, including individuals with insomnia and healthy controls.

Results: Confirmatory factor analysis supported the original two-factor structure (Activity Engagement and Willingness) with good model fit indices. We found evidence for stability of measurement properties across 14 days, but inconclusive evidence regarding the structural invariance between groups of good and poor sleepers. Reliability was high for both factors. Convergent validity was confirmed, showing negative correlations between acceptance and insomnia severity, psychological inflexibility, anxiety, and depression.

Conclusion: The Brazilian adaptation of the SPAQ shows adequate psychometric properties and is a valuable tool for clinicians and researchers. However, caution is needed when comparing scores across groups of good and bad sleepers, as item-level differences may affect structural comparability.

Introduction: The COVID-19 pandemic has significantly impacted mental health, particularly among frontline professionals. In response to the associated social isolation, short-term and remote service alternatives became essential. This study aimed to investigate the predictors of perceived improvement following the single session intervention with enhanced psychoeducation (SSI-EP), which included support videos, for frontline professionals during the COVID-19 pandemic.

Methods: This study analyzed data from a large trial involving frontline workers conducted from April 2020 to December 2021. All participants were randomized to receive the SSI-EP with videos and were included in the analysis.

Results: The final sample included 709 participants - 82.8 % health‑care professionals and 87.8 % women. One month after the intervention, 558 individuals (78.7 %) showed improved emotional symptoms. Greater improvement was associated with viewing more intervention videos and self-medication. In contrast, excessive carbohydrate and fat intake was linked to poorer outcomes.

Conclusion: This study underscores the significance of the SSI and the role of psychoeducational videos in enhancing participants' perceptions of improvement. Further research is necessary to examine these elements and determine which individuals might gain from this cost-effective, scalable intervention.

Objective: This systematic review aims to assess the effects of transcranial electrical stimulation (tES) on adults with anxiety. It focuses on evaluating physiological markers like heart rate variability (HRV), electroencephalogram (EEG), cortisol, and Interleukin-6 (IL-6) levels alongside various rating scales.

Methods: The review process, adhering to PRISMA guidelines, involved a thorough literature search across databases such as Embase, Scopus, PsycINFO, PubMed, and Web of Science. The risk of bias and quality of studies was evaluated using the JADAD scale. In total, 34 articles were meticulously chosen and analyzed by independent reviewer pairs.

Results: The review included 34 studies, encompassing 1567 participants aged between 18 to 65. The findings were mixed: while 19 studies reported a reduction in anxiety symptoms, 10 found no significant differences, and 4 did not report changes in anxiety. Two studies were inconclusive.

Conclusions: The review highlights a lack of standardized protocols for using tDCS in treating anxiety. The methodological quality of most studies was critically low, per PRISMA guidelines. There was considerable variation in methodological approaches across the studies, indicating a need for standardization in the research of anxiety treatment using tES.

Background: Cognitive Behavioral Therapy (CBT) is an effective treatment for Skin Picking Disorder (SPD). However, since individuals have limited access to CBT, telepsychotherapy can overcome this barrier.

Objective: Evaluate the efficacy of a self-guided digital CBT intervention for SPD.

Methods: This controlled clinical trial randomized 163 patients with SPD to receive 4 weeks of online CBT (SOSkin) or a control intervention (videos about quality of life). Primary outcome was the improvement in the Skin Picking Scale-Revised (SPS-R) and secondary outcomes were the improvement in Dermatology Life Quality Index Scale (DLQI), Generalized Anxiety Disorder Assessment Scale (GAD-7), and Patient Health Questionnaire-9 Scale (PHQ-9). Instruments were applied at baseline, middle and end of intervention and at 1 and 3 months of follow up. SOSkin usability was evaluated using the System Usability Scale (SUS). Data were analyzed using the Generalized Estimating Equations model (GEE).

Conclusion: There was no difference between groups in completion rates. SOSkin has excellent usability. Both groups improved the SPS-R and the DLQI scores after treatment and at the follow-up assessments. We found a significant time*group interaction in favor of CBT on SPS-R. Effect size of the intervention compared to control over SPS-R was small after treatment and at the follow-ups; over the DLQI was moderate after treatment and small at the follow-ups. CBT was superior to control on SPS-R when we compared the percentage of change from baseline. CBT was superior to control condition over DLQI at the end of treatment and at 1 month follow-up.

Background: Despite the global burden of cocaine use, no pharmacological agent has received regulatory approval for the treatment of cocaine use disorder (CUD). This study aims to systematically evaluate efficacy and safety of topiramate, with a focus on its impact on treatment retention, cocaine use and abstinence, craving reduction, and safety in individuals diagnosed with CUD.

Methods: To identify all relevant studies, a comprehensive search strategy was employed across several electronic databases. The search strategy focused on terms related to CUD and topiramate from January 1, 2000, to December 31, 2024. Eligible studies included randomized controlled trials comparing topiramate with placebo, standard treatments, or non-pharmacological interventions.

Results: Ten studies were included in the current review. Meta-analysis revealed a statistically significant benefit of topiramate compared to control in promoting cocaine abstinence (Risk Ratio [95% Confidence Interval] = 2.83 [1.68-4.76]; p<0.05). However, no statistically significant difference was observed between topiramate and control groups regarding craving reduction (standardized mean difference = -0.28 [-1.92-1.36]). Overall, treatment retention outcomes across the included studies were mixed favoring topiramate with no statistical difference between two cohorts in dropout rates (RR = 0.94 [0.69 - 1.28]). The risk of adverse events was comparable between the topiramate and control groups (RR = 1.06 [0.91-1.23]; p = 0.44).

Conclusion: Topiramate may aid early abstinence and reduce cocaine use in individuals with CUD, with generally favorable treatment retention and tolerability. However, its effect on craving reduction appears limited, and further robust studies are needed to confirm its long-term efficacy and safety.

Objective: A substantial proportion of the incarcerated population is imprisoned for substance-related offenses, including illegal possession and drug-induced violent crimes. Given this context, this study aimed to investigate, through a systematic review of the literature, the relationship between impulsivity and the use of alcohol and other drugs among incarcerated adults, considering the contributions of cognitive neuroscience to understanding this association in populations characterized by deviant behavior.

Methods: This systematic review, conducted in accordance with PRISMA guidelines, examined 547 studies retrieved from PsycInfo, PubMed/Medline, Embase, SCOPUS, and Web of Science.

Results: After applying the inclusion and exclusion criteria, nine studies were selected for full analysis. The findings revealed a significant association between impulsivity and a history of substance use, especially in cases involving higher levels of consumption. Low educational attainment was also a prevalent characteristic among the analyzed samples.

Conclusions: These findings underscore the importance of prevention and intervention strategies that integrate neuropsychological and educational components as fundamental elements of treatment and social reintegration efforts.

Objective: The clinical overlap between autism spectrum disorder (ASD) and Personality Disorders (PDs) poses significant diagnostic challenges. Shared features-such as social communication difficulties, rigidity, and emotional dysregulation-often lead to misdiagnosis or delayed diagnosis, especially in adults and underrepresented populations (e.g., women).

Methods: This narrative review synthesizes current evidence on the differential diagnosis and comorbidity of ASD and PDs to guide clinical practice.

Results: Findings highlight substantial symptom overlap, particularly in social cognition and emotional regulation. For instance, both ASD and Schizotypal PD may exhibit social withdrawal, while ASD and Borderline PD share impulsivity and identity disturbances-though with distinct etiologies (neurodevelopmental vs. trauma-related).

Conclusions: Clinicians must adopt a developmental perspective to disentangle ASD from PDs, integrating longitudinal history, neuropsychological testing, and multidisciplinary evaluations. Future research should prioritize biomarker-based diagnostics and tailored interventions for comorbid presentations.

Background: Recent evidence regarding the multifactorial etiology of psychosis suggests that it can be trauma-induced. Therefore, there is a growing interest in using trauma-focused interventions to treat patients with psychosis and a history of traumatic events. Eye Movement Desensitization and Reprocessing (EMDR) is an approved, effective therapy for post-traumatic stress disorder (PTSD), but its use in the presence of psychotic features is still under scrutiny.

Objectives: To assess the safety of EMDR in individuals with psychosis and co-morbid PTSD and evaluate its effectiveness in reducing psychotic and trauma-related symptoms.

Methods: Relevant randomized controlled trials (RCTs) were obtained from six databases using an extensive search strategy. Eligible studies were identified based on our inclusion and exclusion criteria, and then quality was assessed. Data was extracted from each study and narratively synthesized.

Results: : Four RCTs were included in our review, with an additional report for one. EMDR was generally superior to TAU and the WL condition in improving symptoms of psychosis and PTSD. It led to consistent improvements in clinician and patient-rated PTSD symptoms and was particularly effective in reducing psychotic negative symptoms (PANSS-N) and paranoid thinking (GPTS). However, improvements in delusions and auditory hallucinations (PSYRATS-D and AH) were mostly insignificant. No serious adverse events related to the therapy itself were reported in any of the trials.

Conclusion: Overall, EMDR promises to be a safe and effective therapy in people with psychosis and PTSD. Large-scale trials with longer follow-up periods are needed to confirm our findings.

Background: Major Depressive Disorder (MDD) is a leading cause of global disability, contributing to substantial individual, social, and economic burdens. While antidepressant therapy remains the cornerstone of treatment, complementary lifestyle-based interventions, such as multimodal exercise and mindfulness, have shown promise in alleviating mood symptoms. However, their specific impact on sleep quality, a critical therapeutic target in MDD, remains underexplored.

Methods: In a 12-week randomized controlled trial, 88 patients with MDD were assigned to three groups: pharmacotherapy alone (control group-CG), pharmacotherapy plus home-based multimodal exercise (exercise group-EG), or pharmacotherapy plus home-based mindfulness training (mindfulness group-MF). Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI) at baseline, week 5, and week 12.

Results: A Linear Mixed-Model (LMM) was performed, and significant group-by-time interactions were observed. At baseline, the EG exhibited lower PSQI scores compared to the MF (p=.002, d=.75) and CG (p=.001, d=.83). At week 5, the EG continued to show superior sleep quality relative to mindfulness (p=.018, d=.64) and CG (p=.001, d=.89). At week 12, the MF also demonstrated better sleep quality than the CG (p=.002, d=.80). All groups improved over time, with exercise yielding rapid benefits and MF showing progressive, sustained improvements.

Conclusion: Lifestyle-based interventions enhance sleep quality in MDD when combined with antidepressant therapy. Multimodal exercise offers immediate improvements, while mindfulness provides gradual, long-term benefits. These findings underscore the value of adjunctive lifestyle interventions in MDD management and highlight the need for further research into their long-term efficacy and potential synergistic effects.