Treatment‐resistant depression: definition, prevalence, detection, management, and investigational interventions

World Psychiatry, Год журнала: 2023, Номер 22(3), С. 394 - 412

Опубликована: Сен. 15, 2023

Treatment-resistant depression (TRD) is common and associated with multiple serious public health implications. A consensus definition of TRD demonstrated predictive utility in terms clinical decision-making outcomes does not currently exist. Instead, a plethora definitions have been proposed, which vary significantly their conceptual framework. The absence hampers precise estimates the prevalence TRD, also belies efforts to identify risk factors, prevention opportunities, effective interventions. In addition, it results heterogeneity practice decision-making, adversely affecting quality care. US Food Drug Administration (FDA) European Medicines Agency (EMA) adopted most used (i.e., inadequate response minimum two antidepressants despite adequacy treatment trial adherence treatment). It estimated that at least 30% persons meet this definition. significant percentage are actually pseudo-resistant (e.g., due inadequacy trials or non-adherence Although sociodemographic, clinical, contextual factors known negatively moderate depression, very few regarded as non-response across modalities treatment. Intravenous ketamine intranasal esketamine (co-administered an antidepressant) established efficacious management TRD. Some second-generation antipsychotics aripiprazole, brexpiprazole, cariprazine, quetiapine XR) proven adjunctive treatments partial responders, but only olanzapine-fluoxetine combination has studied FDA-defined Repetitive transcranial magnetic stimulation (TMS) FDA-approved for individuals accelerated theta-burst TMS recently showing efficacy. Electroconvulsive therapy acute maintenance intervention preliminary evidence suggesting non-inferiority intravenous ketamine. Evidence extending antidepressant trial, medication switching combining mixed. Manual-based psychotherapies on own offer symptomatic relief when added conventional antidepressants. Digital therapeutics under study represent potential future vista population.

Язык: Английский

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Future of mental health in the metaverse

General Psychiatry, Год журнала: 2022, Номер 35(4), С. e100825 - e100825

Опубликована: Июль 22, 2022

The metaverse and non-fungible tokens (NFTs) were some of the hottest tech terms in 2021, according to a Google Trends search. Our review aims describe NFTs context their potential application treatment mental health disorders. Advancements technology have been changing human lives at an ever-increasing pace. Metaverse, also known as three-dimensional (3D) internet, is convergence virtual reality (VR) physical digital space. It could potentially change internet we know it, with key building blocks new expansive ecosystem. This immersive 3D world boasts features real added ability surrounding environment individual needs requirements. VR, augmented (AR) mixed (MR) employed tools various disorders for past decade. Studies reported positive results on effectiveness diagnosis VR/AR/MR hailed solution acute shortage professionals lack access healthcare. But, flip side, young adults tend spend significant amount time playing games using social media, which can lead insecurity, anxiety, depression, behavioural addiction. Additionally, endless scrolling through media platforms negatively affects individuals' attention span well aggravating symptoms adolescents deficit hyperactivity disorder. We aimed explore ramifications expanding applications health. So far, no other has explored future metaverse.

Язык: Английский

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Psychiatric diagnosis and treatment in the 21st century: paradigm shifts versus incremental integration

World Psychiatry, Год журнала: 2022, Номер 21(3), С. 393 - 414

Опубликована: Сен. 8, 2022

Psychiatry has always been characterized by a range of different models and approaches to mental disorder, which have sometimes brought progress in clinical practice, but often also accompanied critique from within without the field. Psychiatric nosology particular focus debate recent decades; successive editions DSM ICD strongly influenced both psychiatric practice research, led assertions that psychiatry is crisis, advocacy for entirely new paradigms diagnosis assessment. When thinking about etiology, many researchers currently refer biopsychosocial model, this approach received significant critique, being considered some observers overly eclectic vague. Despite development evidence-based pharmacotherapies psychotherapies, current evidence points treatment gap research-practice health. In paper, after considering we discuss proposed novel perspectives recently achieved prominence may significantly impact research future: neuroscience personalized pharmacotherapy; statistical nosology, assessment research; deinstitutionalization community health care; scale-up psychotherapy; digital phenotyping therapies; global task-sharing approaches. We consider extent transitions practices reflect hype or hope. Our review indicates each contributes important insights allow hope future, provides only partial view, any promise paradigm shift field not well grounded. conclude there crucial advances that, despite progress, considerable need further improvements intervention; such will likely be specific shifts rather incremental iterative integration.

Язык: Английский

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Candidate biomarkers in psychiatric disorders: state of the field

World Psychiatry, Год журнала: 2023, Номер 22(2), С. 236 - 262

Опубликована: Май 9, 2023

The field of psychiatry is hampered by a lack robust, reliable and valid biomarkers that can aid in objectively diagnosing patients providing individualized treatment recommendations. Here we review critically evaluate the evidence for most promising psychiatric neuroscience literature autism spectrum disorder, schizophrenia, anxiety disorders post‐traumatic stress major depression bipolar substance use disorders. Candidate reviewed include various neuroimaging, genetic, molecular peripheral assays, purposes determining susceptibility or presence illness, predicting response safety. This highlights critical gap biomarker validation process. An enormous societal investment over past 50 years has identified numerous candidate biomarkers. However, to date, overwhelming majority these measures have not been proven sufficiently reliable, useful be adopted clinically. It time consider whether strategic investments might break this impasse, focusing on limited number candidates advance through process definitive testing specific indication. Some N170 signal, an event‐related brain potential measured using electroencephalography, subgroup identification within disorder; striatal resting‐state functional magnetic resonance imaging (fMRI) measures, such as connectivity index (SCI) abnormalities (FSA) index, prediction schizophrenia; error‐related negativity (ERN), electrophysiological first onset generalized structural connectomic social disorder. Alternate forms classification may conceptualizing Collaborative efforts allowing inclusion biosystems beyond genetics neuroimaging are needed, online remote acquisition selected naturalistic setting mobile health tools significantly field. Setting benchmarks well‐defined target application, along with development appropriate funding partnership mechanisms, would also crucial. Finally, it should never forgotten that, actionable, will need clinically predictive at individual level viable clinical settings.

Язык: Английский

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Mental health care for older adults: recent advances and new directions in clinical practice and research

World Psychiatry, Год журнала: 2022, Номер 21(3), С. 336 - 363

Опубликована: Сен. 8, 2022

The world's population is aging, bringing about an ever-greater burden of mental disorders in older adults. Given multimorbidities, the health care these people and their family caregivers labor-intensive. At same time, ageism a big problem for people, with without disorders. Positive elements such as resilience, wisdom prosocial behaviors, need to be highlighted promoted, both combat stigma help protect improve positive psychiatry aging not oxymoron, but scientific construct strongly informed by research evidence. We champion broader concept geriatric - one that encompasses well illness. In present paper, we address issues context four are greatest source years lived disability: neurocognitive disorders, major depression, schizophrenia, substance use emphasize implementation multidisciplinary team care, comprehensive assessment, clinical management, intensive outreach, coordination mental, physical social services. also underscore further into moderators mediators treatment response variability. Because optimal adults patient-focused family-centered, call enhancing well-being caregivers. To optimize safety efficacy pharmacotherapy, attention metabolic, cardiovascular neurological tolerability much needed, together development testing medications reduce risk suicide. normal cognitive antidote catalyst change way think per se late-life more specifically. It this provide directions future research.

Язык: Английский

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A systematic scoping review of research on COVID‐19 impacts on eating disorders: A critical appraisal of the evidence and recommendations for the field

International Journal of Eating Disorders, Год журнала: 2021, Номер 55(1), С. 3 - 38

Опубликована: Ноя. 13, 2021

Research investigating the effects of COVID-19 on eating disorders is growing rapidly. A comprehensive evaluation this literature needed to identify key findings and evidence gaps better inform policy decisions related management during after crisis. We conducted a systematic scoping review synthesizing appraising literature.Empirical research impacts disorder severity, prevalence, demand for treatment was searched. No sample restrictions were applied. Findings (n = 70 studies) synthesized across six themes: (a) suspected cases COVID-19; (b) perceived pandemic symptoms; (c) symptom severity pre versus pandemic; (d) pandemic-related correlates severity; (e) carers/parents; (f) experiences COVID-19.Pandemic rates probable disorders, deterioration, general mental health varied substantially. Symptom escalation worsening during-and due to-the commonly reported, those most susceptible included confirmed cases, at-risk populations (young women, athletes, parent/carers), individuals highly anxious or fearful COVID-19. Evidence emerged increased specialist services pandemic. The forced transition online challenging many, yet telehealth alternatives seemed feasible effective.Evidence mostly limited participant self-report retrospective recall, cross-sectional descriptive studies, samples convenience. Several novel pathways future that aim understand, monitor, support negatively affected by are formulated.La investigación que se hace sobre los efectos de en trastornos la conducta alimentaria está creciendo rápidamente. Se necesita una evaluación exhaustiva esta literatura para identificar hallazgos clave y evidenciar las brechas informar mejor decisiones políticas públicas relacionadas con el manejo durante después realizó revisión sistemática del alcance sintetizó valoró literatura. MÉTODO: buscó empírica impactos gravedad, prevalencia demanda tratamiento alimentaria. aplicaron restricciones muestra. Los estudios) sintetizaron seis temas: (1) casos sospechosos (2) impacto percibido síntomas; (3) gravedad síntomas antes pandemia; (4) correlatos relacionados pandemia (5) cuidadores/padres; (6) experiencias COVID-19.El tasas probables alimentaria, deterioro salud variaron sustancialmente. La escala empeoramiento debido fueron reportados comúnmente, más susceptibles incluyeron confirmados poblaciones riesgo (mujeres jóvenes, atletas, padres / cuidadores) e individuos altos niveles ansiedad o miedo Surgió alguna evidencia mayor servicios especializados pandemia. transición forzada al línea fue un desafío muchos, sin embargo, alternativas telesalud parecían factibles efectivas. Conclusiones. limita principalmente autoinforme participantes recuerdo retrospectivo, estudios transversales descriptivos, muestras conveniencia. formulan varias vías novedosas futuras investigaciones tienen como objetivo comprender, monitorear apoyar aquellos afectados negativamente por

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Substance use disorders: a comprehensive update of classification, epidemiology, neurobiology, clinical aspects, treatment and prevention

World Psychiatry, Год журнала: 2023, Номер 22(2), С. 203 - 229

Опубликована: Май 9, 2023

Substance use disorders (SUDs) are highly prevalent and exact a large toll on individuals’ health, well‐being, social functioning. Long‐lasting changes in brain networks involved reward, executive function, stress reactivity, mood, self‐awareness underlie the intense drive to consume substances inability control this urge person who suffers from addiction (moderate or severe SUD). Biological (including genetics developmental life stages) adverse childhood experiences) determinants of health recognized factors that contribute vulnerability for resilience against developing SUD. Consequently, prevention strategies target risk can improve outcomes and, when deployed adolescence, decrease these disorders. SUDs treatable, evidence clinically significant benefit exists medications (in opioid, nicotine alcohol disorders), behavioral therapies all SUDs), neuromodulation disorder). Treatment should be considered within context Chronic Care Model, with intensity intervention adjusted severity disorder concomitant treatment comorbid psychiatric physical conditions. Involvement care providers detection management SUDs, including referral cases specialized care, offers sustainable models further expanded telehealth. Despite advances our understanding individuals conditions continue stigmatized some countries, incarcerated, highlighting need dismantle policies perpetuate their criminalization instead develop ensure support access treatment.

Язык: Английский

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Towards a youth mental health paradigm: a perspective and roadmap

Molecular Psychiatry, Год журнала: 2023, Номер 28(8), С. 3171 - 3181

Опубликована: Авг. 1, 2023

Abstract Most mental disorders have a typical onset between 12 and 25 years of age, highlighting the importance this period for pathogenesis, diagnosis, treatment ill-health. This perspective addresses interactions risk protective factors brain development as key pillars accounting emergence psychopathology in youth. Moreover, we propose that novel approaches towards early diagnosis interventions are required reflect evolution emerging psychopathology, service models, knowledge exchange science practitioners. Taken together, transformative intervention paradigm research clinical care could significantly enhance health young people initiate shift prevention severe disorders.

Язык: Английский

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Emerging experience with selected new categories in the ICD‐11: complex PTSD, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder

World Psychiatry, Год журнала: 2022, Номер 21(2), С. 189 - 213

Опубликована: Май 7, 2022

Among the important changes in ICD-11 is addition of 21 new mental disorders. New categories are typically proposed to: a) improve usefulness morbidity statistics; b) facilitate recognition a clinically but poorly classified disorder order to provide appropriate management; and c) stimulate research into more effective treatments. Given major implications for field World Health Organization (WHO) member states, it examine impact these during early phase implementation. This paper focuses on four disorders: complex post-traumatic stress disorder, prolonged grief gaming compulsive sexual behaviour disorder. These were selected because they have been focus considerable activity and/or controversy their inclusion represents different decision than was made DSM-5. The lead authors invited experts each disorders insight why considered add ICD-11, care not having that diagnostic category, controversies about adding review evidence generated other developments related category since WHO signaled its intention include ICD-11. Each appears describe population with distinctive features had previously gone unrecognized as well specific treatment needs would otherwise likely go unmet. introduction has followed by substantial expansion area, which generally supported validity utility, significant increase availability services.

Язык: Английский

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Systematic review and meta-analysis of AI-based conversational agents for promoting mental health and well-being

npj Digital Medicine, Год журнала: 2023, Номер 6(1)

Опубликована: Дек. 19, 2023

Abstract Conversational artificial intelligence (AI), particularly AI-based conversational agents (CAs), is gaining traction in mental health care. Despite their growing usage, there a scarcity of comprehensive evaluations impact on and well-being. This systematic review meta-analysis aims to fill this gap by synthesizing evidence the effectiveness CAs improving factors influencing user experience. Twelve databases were searched for experimental studies CAs’ effects illnesses psychological well-being published before May 26, 2023. Out 7834 records, 35 eligible identified review, out which 15 randomized controlled trials included meta-analysis. The revealed that significantly reduce symptoms depression (Hedge’s g 0.64 [95% CI 0.17–1.12]) distress 0.7 0.18–1.22]). These more pronounced are multimodal, generative AI-based, integrated with mobile/instant messaging apps, targeting clinical/subclinical elderly populations. However, CA-based interventions showed no significant improvement overall 0.32 –0.13 0.78]). User experience was largely shaped quality human-AI therapeutic relationships, content engagement, effective communication. findings underscore potential addressing issues. Future research should investigate underlying mechanisms effectiveness, assess long-term across various outcomes, evaluate safe integration large language models (LLMs)

Язык: Английский

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