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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Therapist‐supported Internet‐based cognitive behaviour therapy yields similar effects as face‐to‐face therapy for psychiatric and somatic disorders: an updated systematic review and meta‐analysis

World Psychiatry, Год журнала: 2023, Номер 22(2), С. 305 - 314

Опубликована: Май 9, 2023

Providing therapist-guided cognitive behaviour therapy via the Internet (ICBT) has advantages, but a central research question is to what extent similar clinical effects can be obtained as with gold-standard face-to-face (CBT). In previous meta-analysis published in this journal, which was updated 2018, we found evidence that pooled for two formats were equivalent treatment of psychiatric and somatic disorders, number randomized trials relatively low (n=20). As field moves rapidly, aim current study conduct an update our systematic review ICBT vs. CBT disorders adults. We searched PubMed database relevant studies from 2016 2022. The main inclusion criteria had compare using controlled design targeting adult populations. Quality assessment made Cochrane risk bias (Version 1), outcome estimate standardized effect size (Hedges' g) random model. screened 5,601 records included 11 new trials, adding them 20 previously identified ones (total n=31). Sixteen different conditions targeted studies. Half fields depression/depressive symptoms or some form anxiety disorder. across all g=0.02 (95% CI: -0.09 0.14) quality acceptable. This further supports notion therapist-supported yields CBT.

Язык: Английский

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Treatment of Posttraumatic Stress Disorder: A State-of-the-art Review

Current Neuropharmacology, Год журнала: 2023, Номер 22(4), С. 557 - 635

Опубликована: Май 3, 2023

Abstract: This narrative state-of-the-art review paper describes the progress in understanding and treatment of Posttraumatic Stress Disorder (PTSD). Over last four decades, scientific landscape has matured, with many interdisciplinary contributions to its diagnosis, etiology, epidemiology. Advances genetics, neurobiology, stress pathophysiology, brain imaging have made it apparent that chronic PTSD is a systemic disorder high allostatic load. The current state includes wide variety pharmacological psychotherapeutic approaches, which are evidence-based. However, myriad challenges inherent disorder, such as individual barriers good outcome, comorbidity, emotional dysregulation, suicidality, dissociation, substance use, trauma-related guilt shame, often render response suboptimal. These discussed drivers for emerging novel including early interventions Golden Hours, interventions, medication augmentation use psychedelics, well targeting nervous system. All this aims improve symptom relief clinical outcomes. Finally, phase orientation recognized tool strategize position step progression pathophysiology. Revisions guidelines systems care will be needed incorporate innovative treatments evidence emerges they become mainstream. generation well-positioned address devastating disabling impact traumatic events through holistic, cutting-edge efforts research.

Язык: Английский

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Evolutionary psychiatry: foundations, progress and challenges

World Psychiatry, Год журнала: 2023, Номер 22(2), С. 177 - 202

Опубликована: Май 9, 2023

Evolutionary biology provides a crucial foundation for medicine and behavioral science that has been missing from psychiatry. Its absence helps to explain slow progress; its advent promises major advances. Instead of offering new kind treatment, evolutionary psychiatry scientific useful all kinds treatment. It expands the search causes mechanistic explanations disease in some individuals traits make members species vulnerable disease. For instance, capacities symptoms such as pain, cough, anxiety low mood are universal because they certain situations. Failing recognize utility is at root many problems Determining if an emotion normal it requires understanding individual's life situation. Conducting review social systems, parallel systems rest medicine, can help achieve understanding. Coping with substance abuse advanced by acknowledging how substances available modern environments hijack chemically mediated learning mechanisms. Understanding why eating spirals out control aided recognizing motivations caloric restriction arouses famine protection mechanisms induce binge eating. Finally, explaining persistence alleles cause serious mental disorders intrinsically failure. The thrill finding functions apparent diseases psychiatry's greatest strength weakness. Recognizing bad feelings evolved adaptations corrects pervasive mistake viewing were manifestations. However, panic disorder, melancholia schizophrenia equally Progress will come framing testing specific hypotheses about natural selection left us disorders. efforts people over years be needed before we know provide paradigm treating

Язык: Английский

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Philosophy of psychiatry: theoretical advances and clinical implications

World Psychiatry, Год журнала: 2024, Номер 23(2), С. 215 - 232

Опубликована: Май 10, 2024

Work at the intersection of philosophy and psychiatry has an extensive influential history, received increased attention recently, with emergence professional associations a growing literature. In this paper, we review key advances in work on psychiatry, their related clinical implications. First, understanding categorizing mental disorder, both naturalist normativist considerations are now viewed as important – psychiatric constructs necessitate consideration facts values. At conceptual level, integrative view encourages moving away from strict scientism to soft naturalism, while practice facilitates evidence‐based values‐based health care. Second, considering nature science, there is increasing emphasis pluralist approach, including ontological, explanatory value pluralism. Conceptually, approach acknowledges multi‐level causal interactions that give rise psychopathology, clinically it emphasizes importance broad range “difference‐makers”, well “lived experience” research practice. Third, questions about brain‐mind, how somatic psychic factors contribute development maintenance disorders, empirical embodied cognition provides increasingly valuable approach. Viewing brain‐mind embodied, embedded enactive offers mind‐body problem integration cognitive‐affective neuroscience phenomenological psychopathology.

Язык: Английский

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The need for a new generation of digital mental health tools to support more accessible, effective and equitable care

World Psychiatry, Год журнала: 2023, Номер 22(1), С. 1 - 2

Опубликована: Янв. 14, 2023

The potential of digital mental health to increase access and quality care has gained traction with the rise smartphones accelerated spread telehealth during COVID-19 pandemic. With at least 80% global population now owning a device able capture phenotyping signals, analyze data, run apps, excitement about imminent arrival personalized, preventive precision psychiatry is understandable. Yet, by nearly all outcome metrics, not transforming care1. Whether measured in trends deaths from suicide or rising rates depression, especially among young­er people who are often first use tools, it clear that proclaimed paradigm shift paused2. very require most, underserved populations, have experienced boon outcomes, burden illness low- middle-income countries remains as high ever. Billions dollars resources been poured into algorithms devices assumption later, simple step, would "cross over" "trickle across" divide catch up. However, variety disparities emerging, which troubling but perhaps also addressable. A focus on supporting literacy, improving privacy/evidence for these creating clinical connections each provides tangible steps more equitable impactful health. As smartphone penetration around world, blaming lack become untenable. This narrative covers Internet access, rural areas. While this indeed barrier still requiring work today3, one can will probably be quickly addressed. But, behind Internet, lies challenging inequity – concerning self-determination. Just self-determination theory highlights need autonomy, competence connection psychological thriving, same necessary any they anything apps virtual reality headsets. data remain aloof topic yet well explored, related sub-component literacy underdeveloped populations greatest needs4. People may today, there concomitant investment themselves ensure equitably engage benefit tools. Evidence older adults find tools challenging, backgrounds less certainly, reflects issues flawed designs technology community engagement, reflect deeper inequities educational opportunities today's approaches addressed5. Digital means say "no" using their health, we should honor choices voices. leading reason why today privacy practices compounded limited evidence efficacy. One clearest examples offered most apps. report Mozilla Foundation March 2022 highlighted ongoing risks well-known Around time 2022, hotline service Crisis Textline agreed stop sharing users' text messages an outside company after public outcry. finding than 15% US UK willing share anonymized personal information purposes target improvement6. trust engendered must reversed, occur better app developers, demands patients clinicians, regulation governments. Without trust, no understandable do want private vulnerable shared ecosystem. Furthermore, despite bold claims efficacy websites, studies field recruit sample highest unmet needs7. representativeness explain many technologies fail offer impressive results real world when deployed trial conditions. perceived second-class treatments utilized clinician available, strive excellence exceeds current standards care. subtle equally insidious bias rests magnifying inequalities machine learning artificial intelligence trained non-representative populations. think next generation help reverse inequities, critical justify lower-quality research intervention nothing. If phone, free effective interventions serve active control condition (or placebo) enable actual assessment Coming third above-mentioned inequity, matter. isolation loneliness recognized threats, form strong social instead motivating them continue focusing inward. full remote monitoring innovations, such wearable sensors, behavioral interventions, only realized integrated treatment plans. That programs transfer electronic medical records workers workflow part design process. 25% even allow interoperabil­ity8, and, supported major academic hospital, 1% chose link record9. Related, clinicians training support incorporate new workforce necessary, peer mirror impacted and/or comfortability technology, ready provide skill support. Achieving optimal including address social/political determinants Technology considered determinant It impacts important aspects people's lives, competitive employment, education, supportive services housing other people, clearly emerging All directly impact critically clinical-focused use. Acknowledgment integration make relevant useful broader swath need. Thus, priority, create demand protections, inform how generate representative research, created needs. Developing tools/services accessible, true innovation stoked person becomes empowered connect, set up, engage, start/stop, technology.

Язык: Английский

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World Psychiatric Association-Asian Journal of Psychiatry Commission on Psychiatric Education in the 21st century

Asian Journal of Psychiatry, Год журнала: 2023, Номер 88, С. 103739 - 103739

Опубликована: Авг. 12, 2023

Psychiatric practice faces many challenges in the first quarter of 21st century. Society has transformed as have training requirements and patient expectations, underlining an urgent need to look at educational programmes. Meanwhile, awareness grown around psychiatric disorders there are evolving workforce trends, with more women going medical school specialising psychiatry. Trainee psychiatrists carry different expectations for work-life balance increasingly becoming conscious their own mental health. A tendency see health a commodity litigious nature society elicited additional pressures healthcare professionals. Cartesian mind-body dualism created further complexity this can often be frustrating patients care-partners alike. In cultures across Asia beyond, present physical symptoms express underlying psychological distress increasing investigations. Simultaneously, various countries, shift from asylums community-based interventions then home treatments changed care remarkable ways. These changes added faced by However, trainees other professionals continue receive similar they did generation ago. The tensions differences ideology/orientation between branches psychiatry made responses needs challenging. Recognising that it is difficult predict future, World Association-Asian Journal Psychiatry Commission makes recommendations could help institutions individuals enhance education. This draws existing resources recent developments propose framework future psychiatrists.

Язык: Английский

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MENTAL HEALTH AND DIGITAL TECHNOLOGY: A PUBLIC HEALTH REVIEW OF CURRENT TRENDS AND RESPONSES

International Medical Science Research Journal, Год журнала: 2024, Номер 4(2), С. 108 - 125

Опубликована: Фев. 2, 2024

The intersection of mental health and digital technology has become a critical focus in the realm public health. This paper provides concise overview current trends responses within this evolving landscape. widespread integration into daily life both positive negative implications for On one hand, platforms offer innovative tools support, including virtual therapy, apps, online communities. These resources enhance accessibility reduce barriers to seeking help. Conversely, concerns have arisen regarding adverse impact excessive screen time, social media use, cyberbullying on well-being. explores prevalence interventions, emphasizing need evidence-based practices regulatory frameworks ensure their efficacy user safety. Additionally, it addresses growing recognition divide disparities access resources, importance inclusivity initiatives. Responses these challenges involve collaborative efforts among professionals, developers, policymakers, practitioners. highlights research understanding nuanced relationship between health, informing development targeted interventions. Furthermore, emphasizes comprehensive strategies that prioritize literacy, education, promotion behaviors. underscores multifaceted nature technology, calling holistic approach address opportunities dynamic landscape. Keywords: Mental Digital technologies, Public Trends, Review.

Язык: Английский

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Psychiatric Diagnosis

The Journal of Nervous and Mental Disease, Год журнала: 2024, Номер 212(8), С. 445 - 454

Опубликована: Авг. 1, 2024

Abstract The controversies surrounding the Diagnostic and Statistical Manual of Mental Disorders International Classification Diseases have generated significant debate across psy-sciences. This has been further fueled by launch Research Domain Criteria as a framework to facilitate advances in neuroscientific research, renewed emphasis on dimensional models psychopathology, currently exemplified Hierarchical Taxonomy Psychopathology, development Psychodynamic psychodynamic community. In this article, we provide clinical overview recent debates categorical approaches psychiatric diagnosis, offer critical assessment proposed alternatives, discuss how clinicians can navigate plurality diagnostic frameworks. Our discussion emphasizes that frameworks need be contextualized within process comprehensive evaluation, their advantages disadvantages should understood relationship theoretical orientations practical needs clinicians.

Язык: Английский

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Ethical challenges in contemporary psychiatry: an overview and an appraisal of possible strategies and research needs

World Psychiatry, Год журнала: 2024, Номер 23(3), С. 364 - 386

Опубликована: Сен. 16, 2024

Psychiatry shares most ethical issues with other branches of medicine, but also faces special challenges. The Code Ethics the World Psychiatric Association offers guidance, many mental health care professionals are unaware it and principles supports. Furthermore, following codes ethics is not always sufficient to address dilemmas arising from possible clashes among their principles, continuing changes in knowledge, culture, attitudes, socio‐economic context. In this paper, we identify topics that pose difficult challenges contemporary psychiatry; may have a significant impact on clinical practice, education research activities; require revision profession's ethics. These include: relationships between human rights care, training; legislation; digital early intervention end‐of‐life decisions by people conditions; conflicts interests training research; role lived experience family/informal supporters shaping agenda policy, training. For each topic, highlight concerns, suggest strategies them, call attention risks these entail, gaps be narrowed further research. We conclude that, order effectively current psychiatry, need rethink policies, services, training, methods ethics, concurrent input range stakeholders, open minded discussions, new models an adequate organizational capacity roll‐out implementation across routine contexts,

Язык: Английский

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