Focus (American Psychiatric Publishing)最新文献

Anhedonia is a key psychiatric symptom that has seen significant advances in its understanding in both clinical practice and research over the past few decades. Once considered primarily a feature of depression, recent studies have shown that anhedonia is also a core element of other psychiatric disorders and contributes to considerable morbidity, mortality, and suicidality. Emerging models of psychopathology and illness emphasize the transdiagnostic relevance of anhedonia. At the same time, neuroimaging research has provided deeper insights into its underlying pathophysiology, and several assessment scales with strong psychometric properties have been developed. Various treatment strategies-including psychopharmacology, neuromodulation, and psychotherapy-have demonstrated varying degrees of effectiveness. This review discusses the evolving understanding of anhedonia, its significance as both a symptom and a diagnostic marker, its prevalence, and its pathophysiological underpinnings. Additionally, the authors provide an overview of key assessment tools and explore the range of treatment approaches studied to date.

[This corrects the article DOI: 10.1176/appi.focus.20240017.].

Adolescents and young adults with bipolar disorder often experience cognitive deficits that hinder academic performance and social interactions, affecting long-term outcomes. Identifying cognitive impairments is crucial for improving clinical management of bipolar disorder. Use of cognitive screeners is recommended to identify cognitive difficulties and for ongoing assessment. Although cognitive screeners are effective with adults, their use with adolescents and young adults is limited. This project assessed clinicians' attitudes and practices regarding cognitive screening of adolescents and young adults with bipolar disorder. The National Network of Depression Centers (NNDC) Child and Adolescent Mood Disorders Task Group developed a survey for clinicians treating adolescents and young adults (ages 14-25) with bipolar disorder, evaluating their knowledge of and attitudes toward cognitive screening and barriers to implementation. A total of 163 clinicians across 23 NNDC sites completed the survey. Most recognized the impact of cognitive deficits on functioning (87%) and treatment response (76%). More than 90% reported that cognitive assessments would be beneficial; however, 78% were unaware of available tools, and 64% reported barriers to implementation. Findings highlight a need for clinician education and addressing barriers to implementation. This article outlines the importance of using screeners in treatment of adolescents and young adults with bipolar disorder and provides practical information for using screeners and recommendations for implementation.

Adolescence is a unique developmental period marked by increased exploration and risk-taking, as well as important brain development milestones. Many people who use substances will begin using during adolescence, and cannabis is the most commonly used illicit substance among adolescents. For adolescents with mood disorders, cannabis use (and, by extension, cannabis use disorder) is even more likely, and the associated consequences are even more significant. In this review, we explore the assessment of cannabis use disorder among adolescents, the impact of cannabis use on mood symptoms, level-of-care recommendations for adolescents with comorbid cannabis use and mood disorders, and effective treatment options.

Background: 'Intersectional stigma' is a concept that has emerged to characterize the convergence of multiple stigmatized identities within a person or group, and to address their joint effects on health and wellbeing. While enquiry into the intersections of race, class, and gender serves as the historical and theoretical basis for intersectional stigma, there is little consensus on how best to characterize and analyze intersectional stigma, or on how to design interventions to address this complex phenomenon. The purpose of this paper is to highlight existing intersectional stigma literature, identify gaps in our methods for studying and addressing intersectional stigma, provide examples illustrating promising analytical approaches, and elucidate priorities for future health research.

Discussion: Evidence from the existing scientific literature, as well as the examples presented here, suggest that people in diverse settings experience intersecting forms of stigma that influence their mental and physical health and corresponding health behaviors. As different stigmas are often correlated and interrelated, the health impact of intersectional stigma is complex, generating a broad range of vulnerabilities and risks. Qualitative, quantitative, and mixed methods approaches are required to reduce the significant knowledge gaps that remain in our understanding of intersectional stigma, shared identity, and their effects on health.

Conclusions: Stigmatized identities, while often analyzed in isolation, do not exist in a vacuum. Intersecting forms of stigma are a common reality, yet they remain poorly understood. The development of instruments and methods to better characterize the mechanisms and effects of intersectional stigma in relation to various health conditions around the globe is vital. Only then will healthcare providers, public health officials, and advocates be able to design health interventions that capitalize on the positive aspects of shared identity, while reducing the burden of stigma.Appeared originally in BMC Medicine 2019; 17:7.

Background: Increasing rates of mental health problems among adolescents are of concern. Teens who are most in need of mental health attention are reluctant to seek help. A better understanding of the help-seeking in this population is needed to overcome this gap.

Methods: Five databases were searched to identify the principal barriers, facilitators and interventions targeting help-seeking for common mental health problems in adolescents aged 10-19 years. The search was performed in June 2018 and updated in April 2019. Two independent screening processes were made using the eligibility criteria. Quality assessment of each study was performed, and findings summarised using a narrative synthesis.

Results: Ninety studies meet the inclusion criteria for this review for barrier and facilitators (n = 54) and interventions (n = 36). Stigma and negative beliefs towards mental health services and professionals were the most cited barriers. Facilitators included previous positive experience with health services and mental health literacy. Most interventions were based on psychoeducation, which focused on general mental health knowledge, suicide and self-harm, stigma and depression. Other types of interventions included the use of multimedia and online tools, peer training and outreach initiatives. Overall, the quality of studies was low to medium and there was no general agreement regarding help-seeking definition and measurements.

Conclusion: Most of the interventions took place in an educational setting however, it is important to consider adolescents outside the educational system. Encouraging help-seeking should come with the increased availability of mental health support for all adolescents in need, but this is still a major challenge for Child and Adolescent Mental Health Services. There is also a need to develop shared definitions, theoretical frameworks and higher methodological standards in research regarding help-seeking behaviours in adolescents. This will allow more consistency and generalisability of findings, improving the development of help-seeking interventions and ensuring timely access to mental health treatments.Appeared originally in BMC Psychiatry 2020; 20:293.