Focus (American Psychiatric Publishing)最新文献

College students are increasingly reporting higher rates of mental health concerns, creating significant demand for services at campus mental health centers and among community providers. As providers work to address this growing need, they may encounter challenges when considering whether to communicate with students' parents. This communication is often complicated by privacy laws, institutional policies, and the intricacies of family dynamics. Additionally, providers must balance students' rights to confidentiality with the potential benefits of parental involvement in their care. This review examines these complexities, exploring the legal, ethical, and practical considerations that shape communication between mental health providers and the parents of college students.

A major obstacle to mental health treatment for many Americans is accessibility: the United States faces a shortage of mental health providers, resulting in federally designated shortage areas. Although digital mental health treatments (DMHTs) are effective interventions for common mental disorders, they have not been widely adopted by the U.S. health care system. National and international expert stakeholders representing health care organizations, insurance companies and payers, employers, patients, researchers, policy makers, health economists, and DMHT companies and the investment community attended two Banbury Forum meetings. The Banbury Forum reviewed the evidence for DMHTs, identified the challenges to successful and sustainable implementation, investigated the factors that contributed to more successful implementation internationally, and developed the following recommendations: guided DMHTs should be offered to all patients experiencing common mental disorders, DMHT products and services should be reimbursable to support integration into the U.S. health care landscape, and an evidence standards framework should be developed to support decision makers in evaluating DMHTs. Reprinted from Psychiatr Serv 2021; 72:677-683, with permission from American Psychiatric Association. Copyright © 2021.

Mental health clinicians are increasingly engaging with a range of innovative, technology-driven approaches to care, from telehealth to digital therapeutics, given their potential to significantly increase access to care among patients with diagnoses of varying clinical severity. However, the continued integration of digital mental health interventions into mental health service delivery requires ongoing attention to their effectiveness, cultural and linguistic responsiveness, equitable accessibility, privacy and security, and safety. Ensuring these factors are addressed requires efforts from multiple entities, with mental health clinicians playing a particularly pivotal role. This article describes approaches mental health clinicians can take to advocate for effective, equitable, accessible, and safe digital mental health services. Recommendations include selecting digital interventions with demonstrated effectiveness and providing expertise to further the evidence base, collaborating with patients to provide culturally responsive care, advocating for expanded delivery and coverage of digital interventions, and openly discussing safety and privacy considerations with patients.

Mental health professionals must promote population mental health through a structural approach that extends beyond the clinical encounter. This includes incorporating policies that target social and structural drivers of health, such as income, education, housing, and health care access. In this article, the authors review historical and contemporary advocacy contributions by mental health professionals, policy areas that influence mental health services, potential targets for advocacy interventions, barriers to and facilitators of advocacy engagement, and advocacy-related incentives for mental health professionals. Drawing on a novel model of advocacy and a framework for advocacy action planning, the authors demonstrate how mental health professionals can advocate for systemic change as a professional responsibility. By leveraging advocacy strategies across the domains of practice, communities, and government, mental health professionals can drive policy changes that promote equitable health outcomes.

Background and objectives: Cannabis use is common in people with and mood and anxiety disorders (ADs), and rates of problematic use are higher than in the general population. Given recent policy changes in favor of cannabis legalization, it is important to understand how cannabis and cannabinoids may impact people with these disorders. We aimed to assess the effects of cannabis on the onset and course of depression, bipolar disorder, ADs, and post-traumatic stress disorder (PTSD), and also to explore the therapeutic potential of cannabis and cannabinoids for these disorders.

Methods: A systematic review of the literature was completed. The PubMed® database from January 1990 to May 2018 was searched. We included longitudinal cohort studies, and also all studies using cannabis or a cannabinoid as an active intervention, regardless of the study design.

Results: Forty-seven studies were included: 32 reported on illness onset, nine on illness course, and six on cannabinoid therapeutics. Cohort studies varied significantly in design and quality. The literature suggests that cannabis use is linked to the onset and poorer clinical course in bipolar disorder and PTSD, but this finding is not as clear in depression and anxiety disorders (ADs). There have been few high-quality studies of cannabinoid pharmaceuticals in clinical settings.

Conclusions and scientific significance: These conclusions are limited by a lack of well-controlled longitudinal studies. We suggest that future research be directed toward high-quality, prospective studies of cannabis in clinical populations with mood and ADs, in addition to controlled studies of cannabinoid constituents and pharmaceuticals in these populations.Reprinted from Am J Addict 2020; 29:9-26, with permission from American Academy of Addiction Psychiatry. Copyright © 2019.

Background: Anhedonia is apparent in different mental disorders and is suggested to be related to dysfunctions in the reward system and/or affect regulation. It may hence be a common underlying feature associated with symptom severity of mental disorders.

Methods: We constructed a cross-sectional graphical Least Absolute Shrinkage and Selection Operator (LASSO) network and a relative importance network to estimate the relationships between anhedonia severity and the severity of symptom clusters of major depressive disorder (MDD), anxiety sensitivity (AS), attention-deficit hyperactivity disorder (ADHD), and autism spectrum disorder (ASD) in a sample of Dutch adult psychiatric patients (N = 557).

Results: Both these networks revealed anhedonia severity and depression symptom severity as central to the network. Results suggest that anhedonia severity may be predictive of the severity of symptom clusters of MDD, AS, ADHD, and ASD. MDD symptom severity may be predictive of AS and ADHD symptom severity.

Conclusions: The results suggest that anhedonia may serve as a common underlying transdiagnostic psychopathology feature, predictive of the severity of symptom clusters of depression, AS, ADHD, and ASD. Thus, anhedonia may be associated with the high comorbidity between these symptom clusters and disorders. If our results will be replicated in future studies, it is recommended for clinicians to be more vigilant about screening for anhedonia and/or depression severity in individuals diagnosed with an anxiety disorder, ADHD and/or ASD.Appeared originally in Psychol Med 2023; 53:3908-3919.