Interventions to prevent self-harm: what does the evidence say?
Self-harm is a major public health concern and a risk factor for future suicide. It predominantly occurs in young people with around 65% of self-harm occurring before the age of 35. Self-harm causes distress to families and is associated with poorer educational outcomes as well as increased health and social care costs. Repetition is common with a quarter of individuals presenting to hospital with a further episode of self-harm within a year. We review the evidence from randomised controlled trials of treatments for self-harm, focusing on pharmacological and psychological approaches. We then contrast this with the current ...
Source: Evidence-Based Mental Health - July 20, 2016 Category: Psychiatry & Psychology Authors: Saunders, K. E., Smith, K. A. Tags: Clinical review Source Type: research
Recent developments in the treatment of anxiety disorders in children and adolescents
Anxiety disorders are among the most common emotional difficulties experienced by children and young people. They cause significant disturbance to the lives of young people and their families and present a risk for lifelong psychological disturbance. Effective psychological (ie, cognitive–behaviour therapy (CBT)) and pharmacological interventions (eg, selective serotonin reuptake inhibitors (SSRIs)) have been established. However, the risk of adverse effects and unknown long-term effects of using SSRIs has led to recommendations that CBT is delivered as a first-line intervention. Recent innovations have included the ...
Source: Evidence-Based Mental Health - July 20, 2016 Category: Psychiatry & Psychology Authors: Creswell, C., Waite, P. Tags: Editor's choice Clinical review Source Type: research
Treating seasonal affective disorder with cognitive behavioural therapy is comparable to light therapy
ABSTRACT FROM: Rohan KJ, Mahon JN, Evans M, et al. Randomized trial of cognitive-behavioral therapy versus light therapy for seasonal affective disorder: acute outcomes. Am J Psychiatry 2015;172(9):862–9. What is already known on this topic? The overall lifetime prevalence of seasonal affective disorder (SAD) ranges as high as 9.7%.1 Light therapy, where bright artificial light is used to replace diminished sunlight, can be an effective non-drug treatment for SAD.2 However, alternative non-drug treatment approaches are also needed. Cognitive behavioural therapy (CBT) is an established and effective treatment for depr...
Source: Evidence-Based Mental Health - July 20, 2016 Category: Psychiatry & Psychology Authors: Melrose, S. Tags: Electronic pages Source Type: research
Long-term benefits of cognitive-behavioural prevention for adolescents at risk of depression but not if parents are depressed at the onset of the programme
ABSTRACT FROM: Brent DA, Brunwasser SM, Hollon SD, et al. Effect of a cognitive-behavioral prevention program on depression 6 years after implementation among at-risk adolescents: a randomized clinical trial. JAMA Psychiatry 2015;72:1110–18. What is already known on this topic Adolescent depression has an adverse effect on school, social and family functioning, and increases the risk of suicide and substance misuse in young adulthood.1 Parental depression is an important risk factor for the development of adolescent depression.2 Children of parents with depression have a twofold to threefold increased risk of de...
Source: Evidence-Based Mental Health - July 20, 2016 Category: Psychiatry & Psychology Authors: Stallard, P. Tags: Electronic pages Source Type: research
SSRIs and birth defects: can a new statistical approach resolve old controversies?
ABSTRACT FROM: Reefhuis J, Devine O, Friedman JM, et al. Specific SSRI and birth defects: Bayesian analysis to interpret new data in the context of previous reports. BMJ 2015;350:h3190. What is already known on this topic Several observational studies have been conducted on the use of selective serotonin reuptake inhibitors (SSRIs) in pregnancy and the risk of congenital malformations, providing conflicting results.1 Conflicting results among studies can be easily explained by methodological shortcomings that are often inherent to the clinical setting.2 For instance, since the outcomes are very rare, aggregate end points (...
Source: Evidence-Based Mental Health - July 20, 2016 Category: Psychiatry & Psychology Authors: Tuccori, M., Blandizzi, C. Tags: Electronic pages Source Type: research
Childhood trauma predicts onset and recurrence of depression, and comorbid anxiety and depressive disorders
ABSTRACT FROM: Hovens JG, Giltay EJ, Spinhoven P, et al. Impact of childhood life-events and childhood trauma on the onset and recurrence of depressive and anxiety disorders. J Clin Psychiatry 2015;76:931–8. What is already known on this topic? In the general population, prevalence rates of childhood trauma range from 8.4% for physical abuse, to 17.5% for psychological abuse, with much higher rates in patient samples.1 Trauma in childhood is a developmental risk factor with a negative impact across adulthood and substantially contributes to the burden of disease worldwide.2 Childhood trauma is not only associated wit...
Source: Evidence-Based Mental Health - July 20, 2016 Category: Psychiatry & Psychology Authors: Batelaan, N. Tags: Electronic pages Source Type: research
Clarifying the nuances in ADHD and health outcomes: a case of overweight and obesity
ABSTRACT FROM: Cortese S, Moreira-Maia CR, St Fleur D, et al. Association between ADHD and obesity: a systematic review and meta-analysis. Am J Psychiatry 2016;173:34–43. What is already known on this topic? Children with attention-deficit/hyperactivity disorder (ADHD) are at elevated risk of a host of negative life outcomes, including both psychiatric and health complications.1 While the psychiatric complications are well established, the question of physical health outcomes is in need of clarification.1 As obesity becomes epidemic in our society, the question of whether ADHD, with its association of impulsivity, co...
Source: Evidence-Based Mental Health - July 20, 2016 Category: Psychiatry & Psychology Authors: Nigg, J. Tags: Electronic pages Source Type: research
Screening for bipolar disorder: lessons not yet learned
ABSTRACT FROM: Kung S, Palmer BA, Lapid MI, et al. Screening for bipolar disorders: clinical utilization of the Mood Disorders Questionnaire on an inpatient mood disorders unit. J Affect Disord 2015;188:97–100. What is already known on this topic When presenting for treatment, patients with bipolar disorder are more likely to experience symptoms of depression and anxiety than symptoms of mania or hypomania. Bipolar disorder is therefore prone to being overlooked because its diagnosis is more often based on retrospective report than cross-sectional assessment. Recommendations for improving the detection of bipolar dis...
Source: Evidence-Based Mental Health - July 20, 2016 Category: Psychiatry & Psychology Authors: Zimmerman, M. Tags: Electronic pages Source Type: research
Improving outcome of bipolar disorder when considering glucose metabolism
ABSTRACT FROM: Calkin CV, Ruzickova M, Uher R, et al. Insulin resistance and outcome in bipolar disorder. Br J Psychiatry 2015;206:52–7. What is already known on this topic? Patients with bipolar disorder have a three times increased risk of type 2 diabetes (T2D) compared with the general population.1 This is of clinical significance, because bipolar disorder complicated by T2D is associated with greater morbidity, and greater chronicity and disability.2 However, little is known about the impact of insulin resistance on course of illness. Methods of the study A cross-sectional study considered 121 participants affec...
Source: Evidence-Based Mental Health - July 20, 2016 Category: Psychiatry & Psychology Authors: Benedetti, F., Dallaspezia, S. Tags: Electronic pages Source Type: research
Hospital management of self-harm and later risk of suicide and overall mortality
ABSTRACT FROM: Kapur N, Steeg S, Turnbull P, et al. Hospital management of suicidal behaviour and subsequent mortality: a prospective cohort study. Lancet Psychiatry 2015;2:809–16. What is already known on this topic? People with a history of mental disorders account for half—or more—of all suicides.1 Mental disorders and self-harm are some of the strongest predictors of suicide.2 Yet, we have only sparse indications that the offered support actually helps reduce their risk of suicide. Methods of the study In this cohort study, hospital management after self-harm at one of five emergency departments (ED)...
Source: Evidence-Based Mental Health - July 20, 2016 Category: Psychiatry & Psychology Authors: Erlangsen, A. Tags: Electronic pages Source Type: research
Three simple questions have high utility for diagnosing dementia in the primary care setting
ABSTRACT FROM: Creavin S, Fish M, Gallacher J, et al. Clinical history for diagnosis of dementia in men: Caerphilly Prospective Study. Br J Gen Pract 2015;65:e489–99. What is already known on this topic Dementia prevalence is anticipated to increase with ageing of the population since age is a risk factor for dementia. The diagnosis of dementia in primary care settings has been encouraged in the UK by national directives1 and financial incentives2 in the hope that this will facilitate earlier therapeutic intervention. However, a significant ‘dementia diagnosis gap’ (the difference between expected and obs...
Source: Evidence-Based Mental Health - July 20, 2016 Category: Psychiatry & Psychology Authors: Larner, A. J. Tags: Electronic pages Source Type: research
Movement towards transdiagnostic psychotherapeutic practices for the affective disorders
Evidence-based cognitive behavioural therapy (CBT) practices were first developed in the 1960s. Over the decades, refinements and alternative symptom foci resulted in the development of several CBT protocols/manuals for each of the many disorders, especially in the affective disorders. Although shown to be effective in highly trained providers, the proliferation of CBT protocols also has shown to demonstrate challenges in dissemination and implementation efforts due to the sheer number of CBT protocols and their related training requirements (eg, 6 months per protocol) and their related cost (eg, over US$2000 each; lo...
Source: Evidence-Based Mental Health - July 20, 2016 Category: Psychiatry & Psychology Authors: Gros, D. F., Allan, N. P., Szafranski, D. D. Tags: Electronic pages Source Type: research
Psychodynamic therapy: a well-defined concept with increasing evidence
The efficacy of psychodynamic therapy (PDT) is well established1 2 and has been acknowledged by independent review committees.3 4 Stefan Hofmann, however, again questioned the empirical status of PDT.4 When confronted with evidence refuting his claims,4 Hofmann ignored the data and repeated his critique in this journal.5 We again address Hofmann’s claims. Definition of PDT Hofmann criticised PDT as a ‘poorly defined concept’, claiming that all therapies including cognitive–behavioural therapy (CBT) would meet its definition.5 However, there is evidence that PDT and CBT can be significantly different...
Source: Evidence-Based Mental Health - April 20, 2016 Category: Psychiatry & Psychology Authors: Leichsenring, F., Abbass, A., Gottdiener, W., Hilsenroth, M., Keefe, J. R., Luyten, P., Rabung, S., Steinert, C. Tags: Letter Source Type: research
Psychodynamic therapy: a poorly defined concept with questionable evidence
ABSTRACT FROM: Leichsenring F, Luyten P, Hilsenroth M, et al. Psychodynamic therapy meets evidence-based medicine: a systematic review using updated criteria. Lancet Psychiatry 2015;2:648–60. What is already known on this topic Psychodynamic therapy (PDT) is widely practiced, but the empirical evidence for it is unclear.1 As relatively few well-controlled studies exist, some authors resort to meta-analyses that include numerous poorly controlled and underpowered clinical trials in order to support their claim that PDT is efficacious.2 Methods of the study After reviewing the distinction between superiority, non-infe...
Source: Evidence-Based Mental Health - April 20, 2016 Category: Psychiatry & Psychology Authors: Hofmann, S. G. Tags: Clinical trials (epidemiology), Drugs: psychiatry, Epidemiology, Guidelines Psychological interventions Source Type: research
Unnecessary psychotropic drug prescription in primary care for people with intellectual disability
ABSTRACT FROM: Sheehan R, Hassiotis A, Walters K, et al. Mental illness, challenging behaviour, and psychotropic drug prescribing in people with intellectual disability: UK population based cohort study. BMJ 2015;351:h4326. What is already known on this topic People with intellectual disability experience high rates of mental disorders and challenging behaviour, but representative data are hard to obtain for this population. Concerns have previously been raised about the difficulty this group experience in accessing quality mental health services1 and the morbidity associated with high rates of psychotropic drug prescripti...
Source: Evidence-Based Mental Health - April 20, 2016 Category: Psychiatry & Psychology Authors: Trollor, J., Salomon, C. Tags: Epidemiologic studies, General practice / family medicine, Neurology, Autism, Pervasive developmental disorder, Drugs: psychiatry, Epidemiology Pharmacological interventions Source Type: research
