Predicting the onset of psychosis in patients at clinical high risk: practical guide to probabilistic prognostic reasoning
Prediction of psychosis in patients at clinical high risk (CHR) has become a mainstream focus of clinical and research interest worldwide. When using CHR instruments for clinical purposes, the predicted outcome is but only a probability; and, consequently, any therapeutic action following the assessment is based on probabilistic prognostic reasoning. Yet, probabilistic reasoning makes considerable demands on the clinicians. We provide here a scholarly practical guide summarising the key concepts to support clinicians with probabilistic prognostic reasoning in the CHR state. We review risk or cumulative incidence of psychos...
Source: Evidence-Based Mental Health - January 21, 2016 Category: Psychiatry & Psychology Authors: Fusar-Poli, P., Schultze-Lutter, F. Tags: Editor's choice, End of life decisions (ethics) Clinical review Source Type: research
Vitamin D in schizophrenia: a clinical review
Vitamin D (vitD) is known for its essential role in calcium homeostasis and bone health. VitD is made endogenously in the skin from UVB radiation from sunlight. VitD is now considered as a potent neurosteroid hormone, critical to brain development and normal brain function, and is known for its anti-inflammatory property affecting various aspects of human health. VitD ligand-receptor, a receptor that mediates much of vitD's biological actions, has been found throughout the body including the central nervous system. VitD deficiency is common in patients with severe mental illness such as schizophrenia. Schizophrenia is a de...
Source: Evidence-Based Mental Health - January 21, 2016 Category: Psychiatry & Psychology Authors: Chiang, M., Natarajan, R., Fan, X. Tags: Neurology, Schizophrenia spectrum Clinical review Source Type: research
Antidepressant use with D-Cycloserine may block fear extinction
This study, which examined the efficacy of DCS augmentation of a validated internet-based cognitive–behavioural therapy (ICBT) for OCD, is the first large-scale trial on DCS augmentation of CBT for OCD, and contributes to a growing... (Source: Evidence-Based Mental Health)
Source: Evidence-Based Mental Health - January 21, 2016 Category: Psychiatry & Psychology Authors: Fang, A., Wilhelm, S. Tags: Electronic pages Source Type: research
Promoting multilevel primary prevention of depression and diabetes during midlife may protect against dementia
ABSTRACT FROM: Katon W, Pedersen HS, Ribe AR, et al. Effect of depression and diabetes mellitus on the risk for dementia: a national population-based cohort study. JAMA Psychiatry 2015;72:612–9. What is already known on this topic Three of the 15 major contributors to disease burden in older people are diabetes, major depressive disorder and dementia.1 Diabetes and depression occur before the onset of risk factors for all-cause dementia, Alzheimer disease and vascular dementia.2 Moreover, depression and diabetes have also been shown to have a bidirectional risk effect. While diabetes may increase the risk of depressi...
Source: Evidence-Based Mental Health - January 21, 2016 Category: Psychiatry & Psychology Authors: Mejia, S. Tags: Electronic pages Source Type: research
Control or overcontrol for covariates?
Covariate adjustment can adjust for baseline differences in randomised controlled trials (RCTs) that may have arisen by chance. Furthermore, even if the groups do not differ significantly on any factors, using baseline variables that may be related to the outcome as covariates can reduce the within-group variance, thus increasing the accuracy of the estimates of treatment effects and the power of the statistical test. However, improper use of covariate adjustment can either magnify or diminish the difference between the groups. In RCTs, covariates must be chosen carefully and should not include variables that may have been...
Source: Evidence-Based Mental Health - January 21, 2016 Category: Psychiatry & Psychology Authors: Streiner, D. L. Tags: Clinical trials (epidemiology), Epidemiologic studies, Epidemiology Perspective Source Type: research
Dropout in self-guided web-based interventions for depression can be predicted by several variables
ABSTRACT FROM: Karyotaki E, Kleiboer A, Smit F, et al. Predictors of treatment dropout in self-guided web-based interventions for depression: an ‘individual patient data’ meta-analysis. Psychol Med 2015;45:2717–26. What is already known on this topic Web-based interventions may constitute an effective form of treatment for depression compared with face-to-face treatments.1 However, self-guided interventions show less-promising results and higher dropout rates than guided web-based interventions,2 since human support increases treatment adherence through accountability to a therapist. It is therefore essen...
Source: Evidence-Based Mental Health - January 21, 2016 Category: Psychiatry & Psychology Authors: Lara, M. A., Tiburcio Sainz, M. Tags: Electronic pages Source Type: research
Cognitive-behavioural therapy for insomnia: effective, long-lasting and safe
ABSTRACT FROM: Trauer JM, Qian MY, Doyle JS, et al. Cognitive behavioral therapy for chronic insomnia: a systematic review and meta-analysis. Ann Intern Med 2015;163:191–204. What is already known on this topic Numerous well-conducted randomised controlled studies of cognitive–behavioural therapy for insomnia (CBT-I) have demonstrated that it is efficacious in both the immediate post-treatment and long terms in a wide variety of patient populations.1–3 This includes individuals with uncomplicated chronic insomnia1 and those whose chronic insomnia is comorbid with medical or psychiatric disorders.2 3 Truae...
Source: Evidence-Based Mental Health - January 21, 2016 Category: Psychiatry & Psychology Authors: Vitiello, M. V. Tags: Electronic pages Source Type: research
Mediterranean diet and treating diabetes and depression in old age may reduce dementia risk
ABSTRACT FROM: Cooper C, Sommerlad A, Lyketsos CG, et al. Modifiable predictors of dementia in mild cognitive impairment: a systematic review and meta-analysis. Am J Psychiatry 2015;172:323–34. What is already known on this topic The long ‘preclinical’ phase including mild cognitive impairment-stage (MCI) in the course of Alzheimer's disease (AD) provide the opportunity for preventive interventions to reduce the risk for conversion to dementia or rather slow disease progression.1 Currently, neither psychopharmacological nor non-pharmacological strategies turned out to prevent patients with MCI from conver...
Source: Evidence-Based Mental Health - January 21, 2016 Category: Psychiatry & Psychology Authors: Defrancesco, M. Tags: Electronic pages Source Type: research
Is treatment-resistant depression a useful concept?
The term treatment-resistant depression (TRD) is widely used in the context of managing mood disorders, but defining it, both conceptually and in practice, has proven difficult. Most definitions have focused on pharmacotherapy but even these have struggled to capture the complexity of varying response and duration of treatment. Both clinically and for research studies a meaningful definition of TRD is necessary because it may lead to the development of ‘therapy-defined depressive subtypes’ and the discovery of novel antidepressants. This brief perspective critically reviews the concept of treatment resistance a...
Source: Evidence-Based Mental Health - January 21, 2016 Category: Psychiatry & Psychology Authors: Malhi, G. S., Byrow, Y. Tags: Editor's choice, Depressive disorder Perspective Source Type: research
Further evidence to support weight loss and lifestyle interventions for people taking antipsychotic medications
ABSTRACT FROM: Green CA, Yarborough BJ, Leo MC, et al. The STRIDE weight loss and lifestyle intervention for individuals taking antipsychotic medications: a randomized trial. Am J Psychiatry 2015;172:71–81. What is already known on this topic Increasing weight is the leading risk factor for many life-shortening illnesses such as cardiovascular disease, stroke and diabetes.1 Individuals with serious mental illness (SMI) such as schizophrenia are at increased risk of medical comorbidities, including metabolic syndrome, leading to an increased risk for cardiovascular disease and diabetes. As a result, life expectancy is...
Source: Evidence-Based Mental Health - October 22, 2015 Category: Psychiatry & Psychology Authors: Park, T., Workun, B. Tags: Miscellaneous Source Type: research
Multielement psychosocial interventions for first-episode psychosis are feasible and show promise in generic mental health services
This study is aimed at evaluating the effectiveness of multielement psychosocial interventions delivered within generic mental... (Source: Evidence-Based Mental Health)
Source: Evidence-Based Mental Health - October 22, 2015 Category: Psychiatry & Psychology Authors: Alvarez-Jimenez, M., Gleeson, J. F. Tags: Miscellaneous Source Type: research
Mindfulness-based cognitive therapy as an alternative to maintenance antidepressant medication to prevent relapse and recurrence in depression
ABSTRACT FROM: Kuyken W, Hayes R, Barrett B, et al. Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT): a randomised controlled trial. Lancet 2015;386:63–73. What is already known on this topic Patients with major depressive disorder have a high risk of relapse/recurrence.1 Maintenance antidepressant medication (mADM) is typically recommended to prevent relapse/recurrence, but many individuals prefer psychosocial interventions.2 Previous studies have indicated that mindfulness-ba...
Source: Evidence-Based Mental Health - October 22, 2015 Category: Psychiatry & Psychology Authors: Huijbers, M., Speckens, A. Tags: Miscellaneous Source Type: research
Group cognitive-behavioural therapy may reduce symptoms and impairment in adolescents with attention-deficit/hyperactivity disorder
ABSTRACT FROM: Vidal R, Castells J, Richarte V, et al. Group therapy for adolescents with attention-deficit/hyperactivity disorder: a randomized controlled trial. J Am Acad Child Adolesc Psychiatry 2015;54:275–82. What is already known on this topic Persistence of attention-deficit hyperactivity disorder (ADHD) into adolescence is associated with a broad range of negative outcomes1 and high rates of treatment discontinuation.2 While clinical guidelines recommend non-pharmacological therapies as the first-line treatment for adolescents with ADHD3 the evidence to support this recommendation is sparse and generally not ...
Source: Evidence-Based Mental Health - October 22, 2015 Category: Psychiatry & Psychology Authors: Coghill, D. Tags: Clinical trials (epidemiology), Attention-deficit hyperactivity disorder, Other psychotherapies, Epidemiology, Guidelines Psychological interventions Source Type: research
Can mindfulness groups treat common mental health problems? Problematic design and short follow-up fails to answer the question
ABSTRACT FROM: Sundquist J, Lilja Å, Palmér K, et al. Mindfulness group therapy in primary care patients with depression, anxiety and stress and adjustment disorders: randomised controlled trial. Br J Psychiatry 2015;206:128–35. What is already known on this topic It is important to increase the capacity to treat anxiety and depression1 and group treatments may offer effective intervention.2 Mindfulness-based cognitive therapy (MBCT) is currently recommended to prevent relapse in people who have had 2+ episodes of depression.2 There is a lack of research addressing whether mindfulness groups can be succe...
Source: Evidence-Based Mental Health - October 22, 2015 Category: Psychiatry & Psychology Authors: Williams, C., Mercer, S. Tags: Clinical trials (epidemiology), General practice / family medicine, Nursing, Adjustment disorders, Cagnitive behavioural psychotherapy, Suicide (psychiatry), Epidemiology Psychological interventions Source Type: research
Randomised controlled trial of facilitated exercise plus usual care versus usual care only as a treatment for women with a depressive disorder in the first six postnatal months
ABSTRACT FROM: Daley AJ, Blamey RV, Jolly K, et al. A pragmatic randomized controlled trial to evaluate the effectiveness of a facilitated exercise intervention as a treatment for postnatal depression: the PAM-PeRS trial. Psychol Med 2015;45:2413–25. What is already known on this topic Up to 10% of women have a depressive disorder in the first 6 months after birth.1 Many mothers are not effectively treated, largely due to reluctance to accept medication at this time and limited availability of timely psychological treatment.1 Physical activity is a potential intervention for postnatal depression (PND). However, ...
Source: Evidence-Based Mental Health - October 22, 2015 Category: Psychiatry & Psychology Authors: Howard, L. M., Khalifeh, H. Tags: Clinical trials (epidemiology), General practice / family medicine, Neurology, Depressive disorder, Epidemiology, Screening (epidemiology) Psychological interventions Source Type: research
