Focus (American Psychiatric Publishing)最新文献

In the 50 years since its establishment, the National Institute on Drug Abuse has made significant investment and strides toward improving individual and public health. Epidemiology serves as the foundation for understanding the how many, why, how, where, and who of drug use and its consequences, and effective epidemiology research and training are geared toward actionable findings that can inform real-world responses. Epidemiologic findings enhance clinicians' ability to provide ongoing care by incorporating information about the patterns and outcomes of drug use that their patients may experience. The goal of this article is to provide a context for epidemiology of substance use as a foundation for prevention, with examples of how epidemiology can provide targets for prevention, and to set the stage for addressing the importance of prevention in clinical settings.

Substance use and misuse remain formidable public health challenges and are intricately linked to social determinants of health (SDOH). Addressing SDOH requires structural interventions along with clinical support to change relevant policies. In this article, the authors review structural interventions known as prevention infrastructures and provide a framework for considering how different models of prevention infrastructures can be used to address SDOH that contribute to substance use. In particular, they introduce a typology of prevention infrastructures and explain how different infrastructure types can affect policy decision making across contexts and how these models can interact with each other. Furthermore, they consider the importance of cultural responsiveness in the creation of effective infrastructures to support communities and policy makers within organizations and government.

Increasing rates of overdose among U.S. adolescents and young adults, along with rising rates of emotional distress in these groups, are renewing the urgency for developmentally targeted and personalized substance use and other mental health prevention interventions. Most prevention programs recognize the unique vulnerability of childhood and adolescence and target parents and youths, addressing modifiable environmental risk and protective factors that affect behavior during periods when the brain is most susceptible to change. Until recently, a scarcity of comprehensive studies has limited a full understanding of the complexity of factors that may affect neurodevelopment, including substance exposure in pregnancy and/or subsequent substance use in adolescence, alongside their dynamic interactions with environmental factors and genetics. Two large longitudinal cohort studies funded by National Institutes of Health-the Adolescent Brain Cognitive Development (ABCD) Study and the HEALthy Brain and Child Development (HBCD) Study-are collecting data on neurodevelopment and a wide range of environmental and biological factors across the first two decades of life to build databases that will allow researchers to study how individual neurodevelopmental trajectories are influenced by drugs, adverse childhood experiences, and genetics, among other factors. These studies are already deepening the understanding of risk and resilience factors that prevention programs could target and will identify critical windows where interventions can have the most impact on an individual's neurodevelopmental trajectory. This article describes what is being learned from ABCD and expected from HBCD and how these studies might inform prevention as these children grow and more data are gathered.

Disparities in health care access and quality of care like affordability and the lack of a properly trained workforce are associated with a greater risk for substance misuse. In pursuing health equity, the behavioral health workforce must ensure interventions are accessible and meaningful to all populations and allocate resources to those with the highest burden of substance use-related consequences. Behavioral health clinicians can support efforts to achieve equity by engaging with upstream, community-level prevention efforts aimed at providing culturally responsive prevention services. Coordination across the continuum of care that includes cultural humility, trauma-informed approaches, diverse perspectives, and community engagement can lead to more equitable and accessible care. This article describes health equity in the context of substance misuse prevention, considers health equity across the continuum of behavioral health services, and provides an overview of promising practices that align clinical care with prevention work to promote healthy, equitable community conditions.

Over the last few decades, psychologists and other health professionals have called attention to the importance of considering cultural and ethnic-minority aspects in any psychosocial interventions. Although, at present, there are published guidelines on the practice of culturally competent psychology, there is still a lack of practical information about how to carry out appropriate interventions with specific populations of different cultural and ethnic backgrounds. In this article, the authors review relevant literature concerning the consideration of cultural issues in psychosocial interventions. They present arguments in favor of culturally centering interventions. In addition, they discuss a culturally sensitive framework that has shown to be effective for working with Latinos and Latinas. This framework may also be applicable to other cultural and ethnic groups. Reprinted from J Community Psychol 2006; 34:121-132, with permission from Wiley Periodicals, Inc. Copyright © 2006.

Objective: The main purpose was to evaluate the efficacy and tolerability of different medications used to treat bulimia nervosa (BN).

Methods: Randomized controlled trials (RCTs) were identified from published sources through searches in PubMed, Cochrane Library, Web of Science, and Embase from inception to November 2022. Primary outcomes were changes in the frequency of binge eating episodes and vomiting episodes from baseline to endpoint. Secondary outcomes were differences in the improvement of scores in depressive symptoms, tolerability (dropout due to adverse events) and weight change.

Results: The literature search ultimately included 11 drugs, 33 studies and 6 types of drugs, 8 trials with TCAs (imipra-mine, desipramine), 14 with SSRIs (fluoxetine, citalopram and fluvoxamine), 6 with MAOIs (phenelzine, moclobemide and brofaromine), 3 with antiepileptic drugs (topiramate), 1 with mood stabilizers (lithium), and 1 with amphetamine-type appetite suppressant (fenfluramine). The reduction in binge eating episodes was more likely due to these drugs than the placebo, and the SMD was -0.4 (95% CI -0.61 ∼ -0.19); the changes in the frequency of vomiting episodes (SMD = -0.16, 95% CI -0.3 ∼ -0.03); weight (WMD = -3.05, 95% CI -5.97 ∼ -0.13); and depressive symptoms (SMD =-0.32, 95% CI -0.51 ∼ -0.13). However, no significant difference was found in dropout due to adverse events (RR = 1.66, 95% CI 1.14 ∼ 2.41).

Conclusions: This meta-analysis indicates that most pharmacotherapies decreased the frequency of binge-eating and vomiting episodes, body weight, and depressive symptoms in BN patients, but the efficacy was not significant. In each drug the efficacy is different, treating different aspects, different symptoms to improve the clinical performance of bulimia nervosa.Appeared originally in BMC Pharmacol Toxicol 2023; 24:72.

Objective: This systematic review sought to understand the effectiveness of lived experience mentoring, by people recovered from an eating disorder, with clinical samples currently receiving eating disorder treatment.

Methods: The systematic review was conducted using PsycINFO, MEDLINE, Scopus, and ProQuest Dissertations and Theses Global and reviewing reference lists of included papers. Articles were included if they: (1) were intervention studies that included peer (recovered from an eating disorder) involvement, (2) delivered the intervention to clinical samples (or carers with direct involvement in treatment), (3) were in English, and (4) included quantitative results.

Results: Eleven studies were included across randomized control trials (RCTs), case series, and a case study; there was variation in quality. Findings varied considerably with some concluding that lived experience mentoring led to significant improvements for mentees, while other studies found no significant differences. Mentor outcomes were often not evaluated. Of those that did assess mentors, there is preliminary evidence for some benefits to participation but also the potential for harm.

Discussion: There is a need for further research in this area using high-quality RCTs that address the risk of bias. It is important that lived experience peer mentors are monitored on key outcomes, provided with adequate training and ongoing supervision, and are reimbursed for their involvement.

Public significance: This systematic review is the first review to focus on the use of peer mentors recovered from an eating disorder contributing to interventions for people receiving treatment for an eating disorder. All included studies present quantitative results. Given the emerging interest of lived experience mentoring, understanding its effectiveness for both mentees and impacts on mentors continues to be of critical importance. Resumen.

Objetivo: Esta revisión sistemática buscó comprender la efectividad de la consejería de la experiencia vivida por parte de personas recuperadas de un trastorno de la conducta alimentaria, con muestras clínicas que actualmente reciben tratamiento para el trastorno alimentario.

Método: La revisión sistemática se realizó utilizando PsycINFO, MEDLINE, Scopus y ProQuest Dissertations, and Theses Global y revisando las listas de referencias de los artículos incluidos. Los artículos se incluyeron si: (1) eran estudios de intervención que incluían la participación de pares (recuperados de un trastorno de la conducta alimentaria), (2) administraban la intervención a muestras clínicas (o cuidadores con participación directa en el tratamiento), (3) estaban en inglés y (4) incluían resultados cuantitativos.

Resultados: Se incluyeron once estudios en ensayos controlados aleatorios (ECA

When valued and recognized for the insights gained through direct lived experience, people in eating disorder recovery and their caregivers can improve treatment outcomes. From direct care delivery-in the form of peer support-to roles in leadership, program development, and research, individuals with lived experience can positively impact patient well-being, treatment outcomes, and the field as a whole. Peer supporters can inspire hope, build connections, share diverse experiences, and disseminate clinical insight and skills through a lived experience lens. These tools and the value of expertise by experience can lead to further clinical innovation when integrated into program development, research, and leadership roles in the eating disorder field. As rates of eating disorders continue to rise, it is more important than ever to integrate the voices of lived experience to enhance and strengthen existing treatment-and help create new approaches that could transform the healing process for countless individuals.