Ronald C Kessler, Alan E Kazdin, Sergio Aguilar-Gaxiola, Ali Al-Hamzawi, Jordi Alonso, Yasmin A Altwaijri, Laura H Andrade, Corina Benjet, Chrianna Bharat, Guilherme Borges, Ronny Bruffaerts, Brendan Bunting, José Miguel Caldas de Almeida, Graça Cardoso, Wai Tat Chiu, Alfredo Cía, Marius Ciutan, Louisa Degenhardt, Giovanni de Girolamo, Peter de Jonge, Ymkje Anna de Vries, Silvia Florescu, Oye Gureje, Josep Maria Haro, Meredith G Harris, Chiyi Hu, Aimee N Karam, Elie G Karam, Georges Karam, Norito Kawakami, Andrzej Kiejna, Viviane Kovess-Masfety, Sing Lee, Victor Makanjuola, John J McGrath, Maria Elena Medina-Mora, Jacek Moskalewicz, Fernando Navarro-Mateu, Andrew A Nierenberg, Daisuke Nishi, Akin Ojagbemi, Bibilola D Oladeji, Siobhan O'Neill, José Posada-Villa, Victor Puac-Polanco, Charlene Rapsey, Ayelet Meron Ruscio, Nancy A Sampson, Kate M Scott, Tim Slade, Juan Carlos Stagnaro, Dan J Stein, Hisateru Tachimori, Margreet Ten Have, Yolanda Torres, Maria Carmen Viana, Daniel V Vigo, David R Williams, Bogdan Wojtyniak, Miguel Xavier, Zahari Zarkov, Hannah N Ziobrowski
Patient-reported helpfulness of treatment is an important indicator of quality in patient-centered care. We examined its pathways and predictors among respondents to household surveys who reported ever receiving treatment for major depression, generalized anxiety disorder, social phobia, specific phobia, post-traumatic stress disorder, bipolar disorder, or alcohol use disorder. Data came from 30 community epidemiological surveys - 17 in high-income countries (HICs) and 13 in low- and middle-income countries (LMICs) - carried out as part of the World Health Organization (WHO)'s World Mental Health (WMH) Surveys. Respondents were asked whether treatment of each disorder was ever helpful and, if so, the number of professionals seen before receiving helpful treatment. Across all surveys and diagnostic categories, 26.1% of patients (N=10,035) reported being helped by the very first professional they saw. Persisting to a second professional after a first unhelpful treatment brought the cumulative probability of receiving helpful treatment to 51.2%. If patients persisted with up through eight professionals, the cumulative probability rose to 90.6%. However, only an estimated 22.8% of patients would have persisted in seeing these many professionals after repeatedly receiving treatments they considered not helpful. Although the proportion of individuals with disorders who sought treatment was higher and they were more persistent in HICs than LMICs, proportional helpfulness among treated cases was no different between HICs and LMICs. A wide range of predictors of perceived treatment helpfulness were found, some of them consistent across diagnostic categories and others unique to specific disorders. These results provide novel information about patient evaluations of treatment across diagnoses and countries varying in income level, and suggest that a critical issue in improving the quality of care for mental disorders should be fostering persistence in professional help-seeking if earlier treatments are not helpful.
{"title":"Patterns and correlates of patient-reported helpfulness of treatment for common mental and substance use disorders in the WHO World Mental Health Surveys.","authors":"Ronald C Kessler, Alan E Kazdin, Sergio Aguilar-Gaxiola, Ali Al-Hamzawi, Jordi Alonso, Yasmin A Altwaijri, Laura H Andrade, Corina Benjet, Chrianna Bharat, Guilherme Borges, Ronny Bruffaerts, Brendan Bunting, José Miguel Caldas de Almeida, Graça Cardoso, Wai Tat Chiu, Alfredo Cía, Marius Ciutan, Louisa Degenhardt, Giovanni de Girolamo, Peter de Jonge, Ymkje Anna de Vries, Silvia Florescu, Oye Gureje, Josep Maria Haro, Meredith G Harris, Chiyi Hu, Aimee N Karam, Elie G Karam, Georges Karam, Norito Kawakami, Andrzej Kiejna, Viviane Kovess-Masfety, Sing Lee, Victor Makanjuola, John J McGrath, Maria Elena Medina-Mora, Jacek Moskalewicz, Fernando Navarro-Mateu, Andrew A Nierenberg, Daisuke Nishi, Akin Ojagbemi, Bibilola D Oladeji, Siobhan O'Neill, José Posada-Villa, Victor Puac-Polanco, Charlene Rapsey, Ayelet Meron Ruscio, Nancy A Sampson, Kate M Scott, Tim Slade, Juan Carlos Stagnaro, Dan J Stein, Hisateru Tachimori, Margreet Ten Have, Yolanda Torres, Maria Carmen Viana, Daniel V Vigo, David R Williams, Bogdan Wojtyniak, Miguel Xavier, Zahari Zarkov, Hannah N Ziobrowski","doi":"10.1002/wps.20971","DOIUrl":"10.1002/wps.20971","url":null,"abstract":"<p><p>Patient-reported helpfulness of treatment is an important indicator of quality in patient-centered care. We examined its pathways and predictors among respondents to household surveys who reported ever receiving treatment for major depression, generalized anxiety disorder, social phobia, specific phobia, post-traumatic stress disorder, bipolar disorder, or alcohol use disorder. Data came from 30 community epidemiological surveys - 17 in high-income countries (HICs) and 13 in low- and middle-income countries (LMICs) - carried out as part of the World Health Organization (WHO)'s World Mental Health (WMH) Surveys. Respondents were asked whether treatment of each disorder was ever helpful and, if so, the number of professionals seen before receiving helpful treatment. Across all surveys and diagnostic categories, 26.1% of patients (N=10,035) reported being helped by the very first professional they saw. Persisting to a second professional after a first unhelpful treatment brought the cumulative probability of receiving helpful treatment to 51.2%. If patients persisted with up through eight professionals, the cumulative probability rose to 90.6%. However, only an estimated 22.8% of patients would have persisted in seeing these many professionals after repeatedly receiving treatments they considered not helpful. Although the proportion of individuals with disorders who sought treatment was higher and they were more persistent in HICs than LMICs, proportional helpfulness among treated cases was no different between HICs and LMICs. A wide range of predictors of perceived treatment helpfulness were found, some of them consistent across diagnostic categories and others unique to specific disorders. These results provide novel information about patient evaluations of treatment across diagnoses and countries varying in income level, and suggest that a critical issue in improving the quality of care for mental disorders should be fostering persistence in professional help-seeking if earlier treatments are not helpful.</p>","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":"272-286"},"PeriodicalIF":60.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9077614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45958830","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}
{"title":"Reasons why people may refuse COVID‐19 vaccination (and what can be done about it)","authors":"M. Hornsey","doi":"10.1002/wps.20990","DOIUrl":"https://doi.org/10.1002/wps.20990","url":null,"abstract":"","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":"21 1","pages":"217 - 218"},"PeriodicalIF":73.3,"publicationDate":"2022-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44037982","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}
G. Ostuzzi, F. Bertolini, F. Tedeschi, Giovanni Vita, P. Brambilla, L. Fabro, C. Gastaldon, D. Papola, M. Purgato, Guido Nosari, C. Del Giovane, C. Correll, C. Barbui
According to current evidence and guidelines, continued antipsychotic treatment is key for preventing relapse in people with schizophrenia‐spectrum disorders, but evidence‐based recommendations for the choice of the individual antipsychotic for maintenance treatment are lacking. Although oral antipsychotics are often prescribed first line for practical reasons, long‐acting injectable antipsychotics (LAIs) are a valuable resource to tackle adherence issues since the earliest phase of disease. Medline, EMBASE, PsycINFO, CENTRAL and CINAHL databases and online registers were searched to identify randomized controlled trials comparing LAIs or oral antipsychotics head‐to‐head or against placebo, published until June 2021. Relative risks and standardized mean differences were pooled using random‐effects pairwise and network meta‐analysis. The primary outcomes were relapse and dropout due to adverse events. We used the Cochrane Risk of Bias tool to assess study quality, and the CINeMA approach to assess the confidence of pooled estimates. Of 100 eligible trials, 92 (N=22,645) provided usable data for meta‐analyses. Regarding relapse prevention, the vast majority of the 31 included treatments outperformed placebo. Compared to placebo, “high” confidence in the results was found for (in descending order of effect magnitude) amisulpride‐oral (OS), olanzapine‐OS, aripiprazole‐LAI, olanzapine‐LAI, aripiprazole‐OS, paliperidone‐OS, and ziprasidone‐OS. “Moderate” confidence in the results was found for paliperidone‐LAI 1‐monthly, iloperidone‐OS, fluphenazine‐OS, brexpiprazole‐OS, paliperidone‐LAI 1‐monthly, asenapine‐OS, haloperidol‐OS, quetiapine‐OS, cariprazine‐OS, and lurasidone‐OS. Regarding tolerability, none of the antipsychotics was significantly worse than placebo, but confidence was poor, with only aripiprazole (both LAI and OS) showing “moderate” confidence levels. Based on these findings, olanzapine, aripiprazole and paliperidone are the best choices for the maintenance treatment of schizophrenia‐spectrum disorders, considering that both LAI and oral formulations of these antipsychotics are among the best‐performing treatments and have the highest confidence of evidence for relapse prevention. This finding is of particular relevance for low‐ and middle‐income countries and constrained‐resource settings, where few medications may be selected. Results from this network meta‐analysis can inform clinical guidelines and national and international drug regulation policies.
{"title":"Oral and long‐acting antipsychotics for relapse prevention in schizophrenia‐spectrum disorders: a network meta‐analysis of 92 randomized trials including 22,645 participants","authors":"G. Ostuzzi, F. Bertolini, F. Tedeschi, Giovanni Vita, P. Brambilla, L. Fabro, C. Gastaldon, D. Papola, M. Purgato, Guido Nosari, C. Del Giovane, C. Correll, C. Barbui","doi":"10.1002/wps.20972","DOIUrl":"https://doi.org/10.1002/wps.20972","url":null,"abstract":"According to current evidence and guidelines, continued antipsychotic treatment is key for preventing relapse in people with schizophrenia‐spectrum disorders, but evidence‐based recommendations for the choice of the individual antipsychotic for maintenance treatment are lacking. Although oral antipsychotics are often prescribed first line for practical reasons, long‐acting injectable antipsychotics (LAIs) are a valuable resource to tackle adherence issues since the earliest phase of disease. Medline, EMBASE, PsycINFO, CENTRAL and CINAHL databases and online registers were searched to identify randomized controlled trials comparing LAIs or oral antipsychotics head‐to‐head or against placebo, published until June 2021. Relative risks and standardized mean differences were pooled using random‐effects pairwise and network meta‐analysis. The primary outcomes were relapse and dropout due to adverse events. We used the Cochrane Risk of Bias tool to assess study quality, and the CINeMA approach to assess the confidence of pooled estimates. Of 100 eligible trials, 92 (N=22,645) provided usable data for meta‐analyses. Regarding relapse prevention, the vast majority of the 31 included treatments outperformed placebo. Compared to placebo, “high” confidence in the results was found for (in descending order of effect magnitude) amisulpride‐oral (OS), olanzapine‐OS, aripiprazole‐LAI, olanzapine‐LAI, aripiprazole‐OS, paliperidone‐OS, and ziprasidone‐OS. “Moderate” confidence in the results was found for paliperidone‐LAI 1‐monthly, iloperidone‐OS, fluphenazine‐OS, brexpiprazole‐OS, paliperidone‐LAI 1‐monthly, asenapine‐OS, haloperidol‐OS, quetiapine‐OS, cariprazine‐OS, and lurasidone‐OS. Regarding tolerability, none of the antipsychotics was significantly worse than placebo, but confidence was poor, with only aripiprazole (both LAI and OS) showing “moderate” confidence levels. Based on these findings, olanzapine, aripiprazole and paliperidone are the best choices for the maintenance treatment of schizophrenia‐spectrum disorders, considering that both LAI and oral formulations of these antipsychotics are among the best‐performing treatments and have the highest confidence of evidence for relapse prevention. This finding is of particular relevance for low‐ and middle‐income countries and constrained‐resource settings, where few medications may be selected. Results from this network meta‐analysis can inform clinical guidelines and national and international drug regulation policies.","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2022-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47199809","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}
{"title":"The “Meet the WPA Council” Panel at the 21st World Congress of Psychiatry","authors":"A. Okasha","doi":"10.1002/wps.20957","DOIUrl":"https://doi.org/10.1002/wps.20957","url":null,"abstract":"","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2022-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44067894","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}
{"title":"The need for a rights‐based approach to acute models of care","authors":"G. Newton-Howes, Sarah E. Gordon","doi":"10.1002/wps.20965","DOIUrl":"https://doi.org/10.1002/wps.20965","url":null,"abstract":"","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2022-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48181144","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}
327 H. Herrman’s speech dealt with future prospects for women in psychiatry. She emphasized that deep-seated gender biases per sist across the world. The Lancet Commission on Gender and Global Health 2020 6 contends that gender intersects with other social factors to drive health inequities. It notes that, whereas 70% of health workers globally are female, 70% of health-care leaders are male. In psychiatry, women are still relatively scarce in the leadership of the profession, even though they are entering in higher numbers. The full involvement of women is critical for psychiatry. Women can bring a special contribution and different perspectives. However, professional barriers and problems for women persist. Mentoring and support of various kinds, flexible career paths, monitoring needs and experiences, and working with educators, employers, professional societies and policy makers are all needed. The WPA has worked to ensure that women colleagues are invited to participate fully and equally in the Association’s activities. It supports women in different places to share experiences and work together. Above all, it aims to foster an open and optimistic view among women of working in the profession. D. Bhugra’s presentation summarized the outcome of the work of the WPA-Lancet Psychiatry Commission on the future of psychiatry. In six potential themes, the Commission suggested that patients’ needs and treatments are likely to change. Laws supporting patients also need to change, as a survey of laws of 193 countries showed wide spread discrimination. The use of digital technology has been successfully demonstrated in the COVID-19 pandemic and this is likely to continue. However, ethical, confidentiality and privacy issues need to be addressed by the profession. Societal expectations will need to be taken into account when training the psychiatrists of the future. D. Wasserman’s speech dealt with suicidal behaviours during the COVID-19 pandemic. She reported that, compared to previous years, suicide rates have remained largely unchanged globally or declined in the early phase of the pandemic. However, increased suicide rates have been reported among non-white residents and Afro-American groups in the US, as well as among adolescents in China. Among adolescents, there have been no significant changes in suicide rates during the period of school closure, but an increase has been observed in the period after coming back to schools. No change in the number of suicide-related emergency department visits has been reported in many countries in the early phase of the pandemic. However, an increase in suicide-related emergency visits by females and youths has been identified since the summer of 2020 in the US. The assessment of suicidal thoughts and attempts during the pandemic showed significant increases, particularly in females and the young. As suicide attempts are the foremost predictor of completed suicides, vigorous preventive measures should be taken,
H. Herrman的演讲谈到了女性在精神病学领域的未来前景。她强调，根深蒂固的性别偏见在世界各地都存在。《柳叶刀性别与全球健康委员会2020》认为，性别与其他社会因素相互交织，导致卫生不平等。报告指出，尽管全球70%的卫生工作者是女性，但70%的卫生保健负责人是男性。在精神病学领域，女性在该行业的领导层中仍然相对稀少，尽管她们的人数正在增加。妇女的全面参与对精神病学至关重要。女性可以带来特殊的贡献和不同的观点。然而，女性面临的职业障碍和问题依然存在。各种指导和支持、灵活的职业道路、监测需求和经验，以及与教育工作者、雇主、专业协会和政策制定者合作都是必要的。妇女协会努力确保邀请女同事充分和平等地参加协会的活动。它支持不同地方的女性分享经验，共同努力。最重要的是，它的目的是在从事这一职业的女性中培养一种开放和乐观的观点。Bhugra博士的发言总结了wpa -柳叶刀精神病学委员会关于精神病学未来的工作成果。在六个潜在主题中，委员会建议患者的需求和治疗可能会发生变化。支持患者的法律也需要改变，因为一项对193个国家法律的调查显示，歧视普遍存在。数字技术的使用在2019冠状病毒病大流行中得到了成功的证明，这种情况可能会继续下去。然而，职业道德、保密和隐私问题需要解决。在培训未来的精神科医生时，需要考虑到社会期望。沃瑟曼博士的演讲涉及2019冠状病毒病大流行期间的自杀行为。她报告说，与前几年相比，全球自杀率基本保持不变，或者在大流行的早期阶段有所下降。然而，据报道，美国非白人居民和非裔美国人群体以及中国青少年的自杀率有所上升。在青少年中，在学校关闭期间，自杀率没有显著变化，但在返回学校后的时期，自杀率有所上升。据报告，在大流行的早期阶段，许多国家与自杀有关的急诊就诊人数没有变化。然而，自2020年夏天以来，美国女性和青少年与自杀有关的紧急就诊有所增加。在大流行期间，对自杀念头和企图的评估显示出显著增加，特别是在女性和年轻人中。由于自杀企图是自杀完成的最重要的预测因素，应采取有力的预防措施，包括卫生保健和公共精神卫生倡议。会议虽然简短，但很生动，内容丰富。我希望今后世界精神病学大会也能定期组织类似的小组讨论。
{"title":"The WPA Working Group on Intellectual Developmental Disorders: the need for a second paradigm shift","authors":"K. Munir, A. Roy, A. Javed","doi":"10.1002/wps.20979","DOIUrl":"https://doi.org/10.1002/wps.20979","url":null,"abstract":"327 H. Herrman’s speech dealt with future prospects for women in psychiatry. She emphasized that deep-seated gender biases per sist across the world. The Lancet Commission on Gender and Global Health 2020 6 contends that gender intersects with other social factors to drive health inequities. It notes that, whereas 70% of health workers globally are female, 70% of health-care leaders are male. In psychiatry, women are still relatively scarce in the leadership of the profession, even though they are entering in higher numbers. The full involvement of women is critical for psychiatry. Women can bring a special contribution and different perspectives. However, professional barriers and problems for women persist. Mentoring and support of various kinds, flexible career paths, monitoring needs and experiences, and working with educators, employers, professional societies and policy makers are all needed. The WPA has worked to ensure that women colleagues are invited to participate fully and equally in the Association’s activities. It supports women in different places to share experiences and work together. Above all, it aims to foster an open and optimistic view among women of working in the profession. D. Bhugra’s presentation summarized the outcome of the work of the WPA-Lancet Psychiatry Commission on the future of psychiatry. In six potential themes, the Commission suggested that patients’ needs and treatments are likely to change. Laws supporting patients also need to change, as a survey of laws of 193 countries showed wide spread discrimination. The use of digital technology has been successfully demonstrated in the COVID-19 pandemic and this is likely to continue. However, ethical, confidentiality and privacy issues need to be addressed by the profession. Societal expectations will need to be taken into account when training the psychiatrists of the future. D. Wasserman’s speech dealt with suicidal behaviours during the COVID-19 pandemic. She reported that, compared to previous years, suicide rates have remained largely unchanged globally or declined in the early phase of the pandemic. However, increased suicide rates have been reported among non-white residents and Afro-American groups in the US, as well as among adolescents in China. Among adolescents, there have been no significant changes in suicide rates during the period of school closure, but an increase has been observed in the period after coming back to schools. No change in the number of suicide-related emergency department visits has been reported in many countries in the early phase of the pandemic. However, an increase in suicide-related emergency visits by females and youths has been identified since the summer of 2020 in the US. The assessment of suicidal thoughts and attempts during the pandemic showed significant increases, particularly in females and the young. As suicide attempts are the foremost predictor of completed suicides, vigorous preventive measures should be taken, ","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2022-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45128394","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}
{"title":"The alliance construct in psychotherapies: from evolution to revolution in theory and research","authors":"J. Muran","doi":"10.1002/wps.20973","DOIUrl":"https://doi.org/10.1002/wps.20973","url":null,"abstract":"","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2022-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43503565","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}
{"title":"Post‐traumatic stress disorder as moderator of other mental health conditions","authors":"R. Bryant","doi":"10.1002/wps.20975","DOIUrl":"https://doi.org/10.1002/wps.20975","url":null,"abstract":"","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2022-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45485083","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}
Post-traumatic stress disorder (PTSD) entered the DSM just over 40 years ago. Since then, there have been more than 300 completed randomized controlled trials (RCTs) of therapies for this condition, about two thirds of which have included one or more psychotherapies. It is therefore not surprising that there is a robust evidence base of effective psychotherapies for PTSD. Trauma-focused psychotherapies, in which processing memories and emotions related to the traumatic event is a primary focus throughout the treatment, have emerged as the most effective. Meta-analyses generally show large effect sizes for PTSD symptom reduction and high rates of loss of diagnosis or remission for these treatments. Among trauma-focused psychotherapies, prolonged exposure (PE) therapy, cognitive processing therapy (CPT), cognitive therapy, and eye movement desensitization and reprocessing stand out as having the strongest evidence, because they have been studied the most, by investigators different from those who developed the treatments, and with the broadest variety of populations and comorbidities. All involve manualized protocols usually completed in about 12 sessions, most often delivered weekly. While there have been few direct comparisons of psychotherapies and pharmacotherapies for PTSD, a meta-analysis that compared effect sizes across studies found larger effects for psychotherapies (g=1.14) than medications (g=0.42). There is also evidence that PTSD can be treated effectively with nontrauma-focused psychotherapies, which generally aim to improve specific skills, but effect sizes are generally smaller than for trauma-focused psychotherapies. The availability of effective treatments has fundamentally shifted our view of PTSD from a chronic condition that we can at best hope to manage, to a condition from which it is possible to recover. While this is tremendously good news, there is still a great deal of work left to do. Not everyone with PTSD is willing or able to engage in a trauma-focused psychotherapy; dropout from PTSD treatment remains high (this is true across PTSD treatment types, in part because a hallmark symptom of PTSD is avoidance); and a number of people who engage in these treatments remain partial responders or non-responders. Ongoing work to further improve the effectiveness of psychotherapies for PTSD can be divided broadly into two categories: a) research to improve engagement in and outcomes of existing trauma-focused psychotherapies, and b) research to develop and evaluate novel psychotherapies. A delivery adaptation that is promising in terms of improving engagement in existing psychotherapies is massed treatment, that is, psychotherapy sessions offered on consecutive days or multiple times per week. This format allows patients to complete treatment in 2-4 weeks, rather than in 3-4 months as is usually the case with weekly sessions. Field studies and a small number of RCTs show treatment completion rates upward of 85%, with effectiven
{"title":"Effectiveness of currently available psychotherapies for post‐traumatic stress disorder and future directions","authors":"S. Norman","doi":"10.1002/wps.20974","DOIUrl":"https://doi.org/10.1002/wps.20974","url":null,"abstract":"Post-traumatic stress disorder (PTSD) entered the DSM just over 40 years ago. Since then, there have been more than 300 completed randomized controlled trials (RCTs) of therapies for this condition, about two thirds of which have included one or more psychotherapies. It is therefore not surprising that there is a robust evidence base of effective psychotherapies for PTSD. Trauma-focused psychotherapies, in which processing memories and emotions related to the traumatic event is a primary focus throughout the treatment, have emerged as the most effective. Meta-analyses generally show large effect sizes for PTSD symptom reduction and high rates of loss of diagnosis or remission for these treatments. Among trauma-focused psychotherapies, prolonged exposure (PE) therapy, cognitive processing therapy (CPT), cognitive therapy, and eye movement desensitization and reprocessing stand out as having the strongest evidence, because they have been studied the most, by investigators different from those who developed the treatments, and with the broadest variety of populations and comorbidities. All involve manualized protocols usually completed in about 12 sessions, most often delivered weekly. While there have been few direct comparisons of psychotherapies and pharmacotherapies for PTSD, a meta-analysis that compared effect sizes across studies found larger effects for psychotherapies (g=1.14) than medications (g=0.42). There is also evidence that PTSD can be treated effectively with nontrauma-focused psychotherapies, which generally aim to improve specific skills, but effect sizes are generally smaller than for trauma-focused psychotherapies. The availability of effective treatments has fundamentally shifted our view of PTSD from a chronic condition that we can at best hope to manage, to a condition from which it is possible to recover. While this is tremendously good news, there is still a great deal of work left to do. Not everyone with PTSD is willing or able to engage in a trauma-focused psychotherapy; dropout from PTSD treatment remains high (this is true across PTSD treatment types, in part because a hallmark symptom of PTSD is avoidance); and a number of people who engage in these treatments remain partial responders or non-responders. Ongoing work to further improve the effectiveness of psychotherapies for PTSD can be divided broadly into two categories: a) research to improve engagement in and outcomes of existing trauma-focused psychotherapies, and b) research to develop and evaluate novel psychotherapies. A delivery adaptation that is promising in terms of improving engagement in existing psychotherapies is massed treatment, that is, psychotherapy sessions offered on consecutive days or multiple times per week. This format allows patients to complete treatment in 2-4 weeks, rather than in 3-4 months as is usually the case with weekly sessions. Field studies and a small number of RCTs show treatment completion rates upward of 85%, with effectiven","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2022-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48810551","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}
{"title":"Subjectivity, psychosis and the science of psychiatry","authors":"Louis Sass","doi":"10.1002/wps.20986","DOIUrl":"https://doi.org/10.1002/wps.20986","url":null,"abstract":"","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2022-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49127611","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}
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