Group items tagged

"Major depressive disorder is a common global disease that causes a significant societal burden. Most interventional studies of depression provide a limited assessment of the interventions on mortality and suicide risks. This study utilizes data from an observational registry of patients with major depressive disorder to determine the impact of intervention (vagus nerve stimulation or standard pharmacological/non-pharmacological therapy) and a latent factor, patient trajectory toward response, on mortality, suicide and suicidal ideation. A total of 636 patients were available for an intent-to-treat analysis of all-cause mortality, suicide and suicidal ideation. Patients treated with vagus nerve stimulation in addition to standard therapies experienced lower, but not statistically significant, all-cause mortality (vagus nerve stimulation 4.93 per 1,000 person-years vs. 10.02 per 1,000 patient years for treatment as usual) and suicide rates (vagus nerve stimulation 0.88 per 1,000 person-years vs. 1.61 per 1,000 patient years for treatment as usual). Treatment with vagus nerve stimulation produced a statistically lower relative risk of suicidal ideation 0.80, 95% confidence interval (0.68,0.95). Further, patients that responded to either treatment saw a 51% reduction in relative risk of suicidal behavior; relative risk and 95% confidence interval of 0.49 (0.41,0.58). In summary, we find that treatment with adjunctive vagus nerve stimulation can potentially lower the risk of all-cause mortality, suicide and suicide attempts."

Abstract"Objective To evaluate whether a new computerised cognitive behavioural therapy intervention (SPARX, Smart, Positive, Active, Realistic, X-factor thoughts) could reduce depressive symptoms in help seeking adolescents as much or more than treatment as usual.Design Multicentre randomised controlled non-inferiority trial.Setting 24 primary healthcare sites in New Zealand (youth clinics, general practices, and school based counselling services).Participants 187 adolescents aged 12-19, seeking help for depressive symptoms, with no major risk of self harm and deemed in need of treatment by their primary healthcare clinicians: 94 were allocated to SPARX and 93 to treatment as usual.Interventions Computerised cognitive behavioural therapy (SPARX) comprising seven modules delivered over a period of between four and seven weeks, versus treatment as usual comprising primarily face to face counselling delivered by trained counsellors and clinical psychologists.Outcomes The primary outcome was the change in score on the children's depression rating scale-revised."

Among the research in collaborative care, the most comprehensive work has been done by Wayne Katon, MD, and Jürgen Unützer, MD, both of the University of Washington. Under the latter's collaborative care model, participants had fewer suicidal thoughts, higher recovery rates and improved function, and more depression-free days compared to typical primary care treatment. In addition, Unützer's research has shown potential overall health care savings of $3,300 per individual over a four-year period compared to individuals in usual primary care treatment.

Treatment is challenging both because interventions with clear empirical support have not been identified and because individuals affected by AN are typically reluctant to undergo weight restoration. Preliminary studies suggest that family-based treatment may be useful for younger patients with AN. Treatment development for adults with AN and pursuit of neurobiological correlates of AN remain high-priority research areas. (requires subscription or payment)

Profile of Marsha Linehan who developed Dialectical Behavioral Therapy (DBT) for the treatment of borderline personality disorder, revealing that she suffers from the disease herself.

"Difficulties resolving conflict between identity and depressive symptoms may account for significant delays in seeking help for depression. The results have implications for predicting health behaviour and improving treatment uptake for depression, and may inform existing help-seeking models. "

"The Child Mind Institute, dedicated to transforming mental health care for children everywhere, is waging war against the stigma, lack of awareness, and misinformation that cause so many children to miss out on treatments that can change their lives with its second annual national public education program, Speak Up for Kids. It will be held during National Children's Mental Health Awareness Week, May 6-12, 2012."

Offered at no cost to participants, the program has enhanced access to treatment, employment, and job training; reduced suicide and self-harm attempts, hospitalizations, emergency department visits, incarcerations, and homelessness; and significantly lowered health care and other mental illness-related costs.

"Family and friends are well placed to provide support which consumers perceive to be positive and which can assist them in obtaining formal mental health treatment. However, the input of some family members may be unhelpful or toxic. There may be benefits in undertaking community education and destigmatisation programs which target carers. "

The policies include mandatory screening for both disorders using validated tools, a learning collaborative and evaluations to promote quality improvement, and financial incentives to clinics achieving various service benchmarks. The department also offers training to help providers with various issues related to these policies.

From the abstract: "We conducted systematic literature searches in PubMed, PsycINFO, and Embase up to November 2012, and identified additional studies through earlier meta-analyses and the references of included studies. We identified 198 studies, including 15,118 adult patients with depression, and coded moderator variables. Each of the seven psychotherapeutic interventions was superior to a waitlist control condition with moderate to large effects (range d = −0.62 to d = −0.92). Relative effects of different psychotherapeutic interventions on depressive symptoms were absent to small (range d = 0.01 to d = −0.30). Interpersonal therapy was significantly more effective than supportive therapy (d = −0.30, 95% credibility interval [CrI] [−0.54 to −0.05]). Moderator analysis showed that patient characteristics had no influence on treatment effects, but identified aspects of study quality and sample size as effect modifiers. Smaller effects were found in studies of at least moderate (Δd = 0.29 [−0.01 to 0.58]; p = 0.063) and large size (Δd = 0.33 [0.08 to 0.61]; p = 0.012) and those that had adequate outcome assessment (Δd = 0.38 [−0.06 to 0.87]; p = 0.100). Stepwise restriction of analyses by sample size showed robust effects for cognitive-behavioural therapy, interpersonal therapy, and problem-solving therapy (all d>0.46) compared to waitlist. Empirical evidence from large studies was unavailable or limited for other psychotherapeutic interventions."

biological discoveries supporting possible new treatments (requires subscription or payment)

A guide prepared by the National Resource Center for Youth Development

from the introduction: "his progress report outlines advances made to date to expand the quality and availability of mental health care services for active military service members, veterans, and their families. Highlights of the report include: Increasing the capacity of the Veterans Crisis Line Building partnerships between the VA and community-based mental health providers Increasing the number of VA mental health providers and peer specialists Implementing a national suicide prevention campaign."

"MentalHealth.gov provides one-stop access to U.S. government mental health and mental health problems information."

Canadian university hosts "Stop Out Stigma" week of raising awareness of mental health issues

Reports on a review of research published in the October 5, 2012 issue of Science magazine

Criticisms from two authors and perspectives from trauma victims in Africa