Annals of Clinical Psychiatry最新文献

Background: The aim of the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project was to examine the demographic and clinical features that distinguished depressed patients who did and did not indicate they deserved to feel better.

Methods: A total of 490 depressed patients completed a clinical history questionnaire that included a question about whether the patient thought they deserved to feel better, as well as a self-report questionnaire assessing symptoms, positive mental health, coping ability, functioning, and well-being.

Results: Approximately 20% of patients indicated they were unsure or undeserving of feeling better. Patients who did not believe they deserved to get better reported more cognitive symptoms of depression, were more likely to drop out of treatment due to nonattendance, more pessimistic about outcomes upon treatment initiation, more frequently reported suicidal ideation, more frequently reported a history of multiple suicide attempts, and experienced less improvement in their depressive symptoms during treatment.

Conclusions: A meaningful number of depressed patients seeking treatment did not assert that they deserved to feel better. Efforts to treat individuals who do not believe they deserve to feel better may be less productive if this perspective is not addressed.

Background: Substance use disorders (SUDs) are associated with high rates of comorbid depression. Finding effective treatments for many of the substances of abuse is still an area of developing research. Repetitive transcranial magnetic stimulation (rTMS) is an established treatment for depression, but its effects in SUDs are less conclusive. Therefore, we aimed to investigate the effect of rTMS in patients with SUDs and comorbid major depressive disorder (MDD).

Methods: We conducted a retrospective observational study of 55 patients with SUDs and comorbid MDD who were eligible for rTMS. Craving was measured using the Brief Substance Craving Scale (BSCS). Severity of MDD was measured using the Clinical Global Impression-Severity (CGI-S) scale.

Results: We found a statistically significant difference between baseline and posttreatment scores in patients receiving rTMS on both CGI-S scores and BSCS scores. The number of rTMS sessions significantly predicted increased days of abstinence in the community, even after controlling for confounders.

Conclusions: Patients with SUDs and MDD who received rTMS significantly improved in the areas of severity of depression and craving. The number of rTMS sessions significantly predicted increased abstinence.

Background: Gambling is common and there is growing concern about its public health implications. Little is known about how gambling differs in people with minority sexual identities. We sought to understand whether lesbian, gay, and bisexual (LGB) individuals differ from non-LGB individuals in terms of gambling and associated characteristics.

Methods: A total of 534 participants age 18 to 29 who gambled at least 5 times in the preceding year undertook clinical and neurocognitive evaluations. Those who identified as LGB were compared to heterosexuals on clinical and cognitive measures.

Results: Overall, 51 participants (9.6%) identified as LGB. These individuals showed significantly higher levels of problem gambling, suicide risk, substance use disorders, traits of obsessive-compulsive personality disorder (OCPD), higher errors on a set-shifting task, and higher rates of family history of addiction.

Conclusions: These results indicate that individuals with minority sexual orientations may be at higher risk of experiencing problem gambling and associated factors, such as increased suicidality, OCPD traits, and some degree of cognitive differences. Future studies should establish whether these associations also exist in clinical samples of people with full gambling disorder. Large-scale longitudinal research in neglected minority groups is needed to further explore these associations.

Background: Excessive alcohol use and alcohol use disorders (AUDs) are serious medical problems in general populations. Alcohol use is associated with stressful events. Thus it is possible that problems with alcohol use increase in association with disasters. It is important to know the extent to which disasters contribute to these problems in exposed populations.

Methods: This review focused on the associations of alcohol use, problematic alcohol use, and AUDs with disasters. Alcohol variables were examined for predisaster to postdisaster changes and differences between samples according to disaster exposures.

Results: In all, 44 studies were found that addressed the association of alcohol variables with disaster. Much of this research had substantive methodological difficulties limiting the conclusions. Most research examining changes in alcohol use after disasters reported increases, but the increases were clinically small, amounting to ≤1 drink per day, and alcohol use returned to predisaster levels over time. The research on problematic alcohol use provided little evidence of an association with disasters. The studies of AUDs did not support their association with disaster.

Conclusions: Even without clear evidence that disasters cause increases in alcohol use problems, it is important in the postdisaster setting to assess problems of alcohol use along with psychopathology.