1
|
Balasanova AA, Ruble A, Nakamura A, Mitra S, Frank A. Effective but Undertaught: Training Psychiatrists in Psychotherapy for Substance Use Disorders. Am J Psychother 2024:appipsychotherapy20240001. [PMID: 39267481 DOI: 10.1176/appi.psychotherapy.20240001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2024]
Abstract
Considering the escalating gap between the population-level need for substance use services and the availability of board-certified addiction specialty physicians, all psychiatrists must be equipped to treat substance use disorders. Residency training programs must therefore ensure that graduates are equipped with a sufficient knowledge base and skill set to treat substance use disorders, including an understanding of medications for addiction treatment and appropriate selection and utilization of psychotherapy for substance use disorders. Resources for teaching psychiatric residents about psychotherapeutic approaches to substance use disorders are often limited, and many programs may struggle to include this content in their curricula. The authors highlight the core evidence-based psychotherapeutic approaches relevant to the care of patients with substance use disorders and identify supervised experiential learning opportunities for psychiatric residents to practice psychotherapy for substance use disorders during existing clinical rotations within their general psychiatry residency programs.
Collapse
Affiliation(s)
- Alëna A Balasanova
- Department of Psychiatry, University of Nebraska Medical Center, Omaha (Balasanova); Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medicine, Baltimore (Ruble); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Nakamura); Department of Psychiatry, Grossman School of Medicine, New York University, New York City (Mitra); Department of Psychiatry, Cambridge Health Alliance/Harvard Medical School, Cambridge, Massachusetts (Frank)
| | - Anne Ruble
- Department of Psychiatry, University of Nebraska Medical Center, Omaha (Balasanova); Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medicine, Baltimore (Ruble); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Nakamura); Department of Psychiatry, Grossman School of Medicine, New York University, New York City (Mitra); Department of Psychiatry, Cambridge Health Alliance/Harvard Medical School, Cambridge, Massachusetts (Frank)
| | - Alyson Nakamura
- Department of Psychiatry, University of Nebraska Medical Center, Omaha (Balasanova); Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medicine, Baltimore (Ruble); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Nakamura); Department of Psychiatry, Grossman School of Medicine, New York University, New York City (Mitra); Department of Psychiatry, Cambridge Health Alliance/Harvard Medical School, Cambridge, Massachusetts (Frank)
| | - Souparno Mitra
- Department of Psychiatry, University of Nebraska Medical Center, Omaha (Balasanova); Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medicine, Baltimore (Ruble); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Nakamura); Department of Psychiatry, Grossman School of Medicine, New York University, New York City (Mitra); Department of Psychiatry, Cambridge Health Alliance/Harvard Medical School, Cambridge, Massachusetts (Frank)
| | - Amber Frank
- Department of Psychiatry, University of Nebraska Medical Center, Omaha (Balasanova); Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medicine, Baltimore (Ruble); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Nakamura); Department of Psychiatry, Grossman School of Medicine, New York University, New York City (Mitra); Department of Psychiatry, Cambridge Health Alliance/Harvard Medical School, Cambridge, Massachusetts (Frank)
| |
Collapse
|
2
|
McQuaid JR, Buelt A, Capaldi V, Fuller M, Issa F, Lang AE, Hoge C, Oslin DW, Sall J, Wiechers IR, Williams S. The Management of Major Depressive Disorder: Synopsis of the 2022 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline. Ann Intern Med 2022; 175:1440-1451. [PMID: 36122380 DOI: 10.7326/m22-1603] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
DESCRIPTION In February 2022, the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) approved a joint clinical practice guideline (CPG) for the management of major depressive disorder (MDD). This synopsis summarizes key recommendations. METHODS Senior leaders within the VA and the DoD assembled a team to update the 2016 CPG for the management of MDD that included clinical stakeholders and conformed to the National Academy of Medicine's tenets for trustworthy CPGs. The guideline panel developed key questions, systematically searched and evaluated the literature, created two 1-page algorithms, and distilled 36 recommendations for care using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. Select recommendations that were identified by the authors to represent key changes from the prior CPG are presented in this synopsis. RECOMMENDATIONS The scope of the CPG is diverse; however, this synopsis focuses on key recommendations that the authors identified as important new evidence and changes to prior recommendations on pharmacologic management, pharmacogenomics, psychotherapy, complementary and alternative therapies, and the use of telemedicine.
Collapse
Affiliation(s)
- John R McQuaid
- San Francisco VA Health Care System, and Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California (J.R.M.)
| | - Andrew Buelt
- C.W. Bill Young Veterans Administration Medical Center, Bay Pines, Florida (A.B.)
| | - Vincent Capaldi
- Uniformed Services University of the Health Sciences, Bethesda, Maryland (V.C.)
| | - Matthew Fuller
- VHA Pharmacy Benefits Management Services, U.S. Department of Veterans Affairs, Mentor, Ohio, and Case Western Reserve University, Cleveland, Ohio (M.F.)
| | - Fuad Issa
- Defense Health Agency, Silver Spring, Maryland (F.I.)
| | - Adam Edward Lang
- Department of Primary Care, McDonald Army Health Center, Fort Eustis, Virginia, and Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, Richmond, Virginia (A.E.L.)
| | - Charles Hoge
- Walter Reed Army Institute of Research, Silver Spring, Maryland (C.H.)
| | - David W Oslin
- Corporal Michael J. Crescenz VA Medical Center, and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania (D.W.O.)
| | - James Sall
- Veterans Administration Central Office, Washington, DC (J.S.)
| | - Ilse R Wiechers
- Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, and Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California (I.R.W.)
| | - Scott Williams
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, and School of Medicine, Case Western Reserve University, Cleveland, Ohio (S.W.)
| |
Collapse
|
3
|
Bozzatello P, Giordano B, Montemagni C, Rocca P, Bellino S. Real-World Functioning in Psychiatric Outpatients: Predictive Factors. J Clin Med 2022; 11:4400. [PMID: 35956015 PMCID: PMC9369214 DOI: 10.3390/jcm11154400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 06/17/2022] [Accepted: 07/27/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Investigations on predictors of real-world functioning were mainly performed in patients with schizophrenia, while fewer studies have been conducted in other psychiatric disorders. OBJECTIVE Our objective was to identify clinical, socio-demographic, and illness-related predictors of real-world functioning during 12 months of standard treatments in outpatients with different diagnoses. METHODS Outpatients (n = 1019) with schizophrenia (SZ), major depressive disorder (MDD), bipolar disorder (BD), and borderline personality disorder (BPD) were evaluated with the following tools: SCID-5-CV and SCID-5-PD, CGI-S, SAT-P, DAI-10, and PSP. Change of PSP (ΔPSP) between baseline and 12 months was used as the dependent variable in multiple regression analysis. RESULTS Higher PSP score at baseline and the achievement of main milestones predicted better functioning after follow-up in all subgroups of patients, with the exception of BD. In the total sample, ΔPSP was related to age of onset, treatments, and quality of life, and inversely related to psychiatric anamnesis, antidepressants, and global symptoms. In SZ, ΔPSP was related to adherence and quality of life. In MDD, ΔPSP was related to psychotherapy and quality of life, and inversely related to antidepressants and global symptoms. In BD, ΔPSP was related to age of onset, antipsychotics, and quality of life, while it was inversely related to psychiatric anamnesis. In BPD, antipsychotics, mood stabilizers, psychotherapy, and quality of life were directly related to ΔPSP, while suicidal attempts and global symptoms had an inverse relation. Conclusions: Several socio-demographic and illness-related variables predicted improvement of real-world functioning, besides psychopathology and severity of the disease.
Collapse
Affiliation(s)
- Paola Bozzatello
- Department of Neuroscience, University of Turin, 10126 Turin, Italy; (B.G.); (C.M.); (P.R.); (S.B.)
| | | | | | | | | |
Collapse
|
4
|
A piece of the puzzle: Does bipolarity partly explain the high prevalence of treatment resistance in depression? Psychiatry Res 2022; 307:114275. [PMID: 34847512 DOI: 10.1016/j.psychres.2021.114275] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 11/01/2021] [Accepted: 11/06/2021] [Indexed: 12/28/2022]
Abstract
In this cross-sectional study we examined whether the prevalence of treatment resistant depression (TRD) can be partly attributed to level of bipolarity. We included data of 201 patients with either episodic depression or TRD, who received treatment for their depression at either an outpatient or 2nd opinion/daytime setting, within a specialised mental healthcare department in the Netherlands. Whether level of TRD, assessed by the 'Dutch Measure for quantification of Treatment Resistance in Depression', can be partly explained by level of bipolarity, assessed by 'the Bipolarity Index', was examined using linear regression. We found no direct association between level of TRD and level of bipolarity, nor did comorbid anxiety disorders obscure an existing association. In this study we found no evidence for overlooked bipolarity contributing to the high prevalence of TRD. If replicated, we could state that additional screening on bipolarity with an instrument such as the 'Bipolarity Index' in the specialised mental health care is unnecessary.
Collapse
|
5
|
Wienicke FJ, Driessen E. Short-Term Psychodynamic Psychotherapy for Depression: For Whom Does It Work? A Research Perspective. Psychodyn Psychiatry 2021; 49:370-374. [PMID: 34478326 DOI: 10.1521/pdps.2021.49.3.370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Short-term psychodynamic psychotherapy (STPP) is an empirically supported treatment for depression that is frequently applied in clinical practice. However, it remains largely unclear which patients can benefit specifically from STPP for depression, because studies often have small sample sizes and, therefore, lack statistical power to examine patient characteristics associated with differential treatment efficacy. Individual participant data (IPD) meta-analyses, which combine patient-level data from multiple studies, can help overcome this obstacle. Currently, the first IPD meta-analysis project regarding STPP for depression is being conducted. We describe this project, its progress, and first findings.
Collapse
Affiliation(s)
- Frederik J Wienicke
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ellen Driessen
- Department of Clinical Psychology, Behavioural Science Institute, Radboud University, and Depression Expertise Centre, Pro Persona Mental Health Care, Nijmegen, Netherlands
| |
Collapse
|
6
|
Pater ME. Cycling Without a Bike. PHYSICIAN ASSISTANT CLINICS 2021. [DOI: 10.1016/j.cpha.2021.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
7
|
Shang P, Cao X, You S, Feng X, Li N, Jia Y. Problem-solving therapy for major depressive disorders in older adults: an updated systematic review and meta-analysis of randomized controlled trials. Aging Clin Exp Res 2021; 33:1465-1475. [PMID: 32767273 DOI: 10.1007/s40520-020-01672-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/09/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Major depressive disorder is a global public health problem among older adults. Many studies show that problem-solving therapy (PST) is a cognitive behavioral approach that can effectively treat late-life depression. AIM To summarize and assess the effects of PST on major depressive disorders in older adults. METHODS We searched the PubMed, Web of Science, Cochrane Library, EMBASE, MEDLINE, UpToDate, and PsycINFO databases and three Chinese databases (CNKI, CBM, and Wan Fang Data) to identify articles written in English or Chinese that were published until Feb 1, 2020. Randomized controlled trials were included if they evaluated the impact of PST on major depression disorder (MDD) in older adults. Two authors of this review independently selected the studies, assessed the risk of bias, and extracted the data from all the included studies. We calculated the standard mean differences (SMDs) with 95% confidence intervals (CIs) for continuous data. We assessed heterogeneity using the I2 statistic. RESULTS Ten studies with a total of 892 participants met the inclusion criteria. Subgroup analyses and quality ratings were performed. After problem-solving therapy, the depression scores in the intervention group were significantly lower than those in the control group (SMD = - 1.06, 95% CI - 1.52 to - 0.61, p < 0.05; I2 = 88.4%). DISCUSSION Compared with waitlist (WL), PST has a significant effect on elderly patients with depression, but we cannot rank the therapeutic effects of all the treatment methods used for MDD. CONCLUSIONS Our meta-analysis and systematic review suggest that problem-solving therapy may be an effective approach to improve major depressive disorders in older adults.
Collapse
Affiliation(s)
- Pingping Shang
- Senior Officials Inpatient Ward, First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, 130021, Jilin, China
| | - Xuelian Cao
- School of Nursing, Jilin University, No. 965 XinJiang Road, Changchun, 130021, Jilin, China
| | - Simiao You
- Department of Nursing Welfare, College of Humanities and Sciences of Northeast, College of Health and Welfare, Normal University, Changchun, 130117, China
| | - Xuezhu Feng
- School of Nursing, Jilin University, No. 965 XinJiang Road, Changchun, 130021, Jilin, China
| | - Na Li
- Laboratory of Molecular Pharmacology, Jilin Provincial Key Laboratory of BioMacromolecules of Chinese Medicine, Jilin Ginseng Academy, Changchun University of Chinese Medicine, Changchun, 130117, Jilin, China.
| | - Yong Jia
- School of Nursing, Jilin University, No. 965 XinJiang Road, Changchun, 130021, Jilin, China.
| |
Collapse
|
8
|
Malhi GS, Bell E, Bassett D, Boyce P, Bryant R, Hazell P, Hopwood M, Lyndon B, Mulder R, Porter R, Singh AB, Murray G. The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry 2021; 55:7-117. [PMID: 33353391 DOI: 10.1177/0004867420979353] [Citation(s) in RCA: 246] [Impact Index Per Article: 82.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To provide advice and guidance regarding the management of mood disorders, derived from scientific evidence and supplemented by expert clinical consensus to formulate s that maximise clinical utility. METHODS Articles and information sourced from search engines including PubMed, EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (e.g. books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Relevant information was appraised and discussed in detail by members of the mood disorders committee, with a view to formulating and developing consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous consultation and external review involving: expert and clinical advisors, key stakeholders, professional bodies and specialist groups with interest in mood disorders. RESULTS The Royal Australian and New Zealand College of Psychiatrists mood disorders clinical practice guidelines 2020 (MDcpg2020) provide up-to-date guidance regarding the management of mood disorders that is informed by evidence and clinical experience. The guideline is intended for clinical use by psychiatrists, psychologists, primary care physicians and others with an interest in mental health care. CONCLUSION The MDcpg2020 builds on the previous 2015 guidelines and maintains its joint focus on both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. MOOD DISORDERS COMMITTEE Gin S Malhi (Chair), Erica Bell, Darryl Bassett, Philip Boyce, Richard Bryant, Philip Hazell, Malcolm Hopwood, Bill Lyndon, Roger Mulder, Richard Porter, Ajeet B Singh and Greg Murray.
Collapse
Affiliation(s)
- Gin S Malhi
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Erica Bell
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | | | - Philip Boyce
- Department of Psychiatry, Westmead Hospital and the Westmead Clinical School, Wentworthville, NSW, Australia.,Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Philip Hazell
- Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne and Professorial Psychiatry Unit, Albert Road Clinic, Melbourne, VIC, Australia
| | - Bill Lyndon
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Ajeet B Singh
- The Geelong Clinic Healthscope, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
| |
Collapse
|
9
|
Zajenkowska A, Rajchert J, Macianowicz O, Holas P, Murawic S. Cognitive-Behavioral (CBT) and Psychodynamic (PDT) Group Psychotherapy and Their Impact on Depressive Symptoms and Hostile Attributions. Int J Group Psychother 2019; 69:383-407. [PMID: 38449151 DOI: 10.1080/00207284.2019.1653189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This article examined how intensive group cognitive-behavioral therapy (GCBT) and group psychodynamic psychotherapy (GPDT) modified depressive symptoms and processing of social information (hostility attributions in a variety of ambiguous situations). The sample (N = 37) comprised individuals who were attending psychotherapy due to psychological distress (GCBT or GPDT). The study examined how group psychotherapy influences depression symptoms and social cognition. There was a decrease in depressive symptoms after three months of intensive CBGT, but PDGT did not significantly improve symptoms of depression. Moreover, in both psychotherapies, the authors noted a significant decrease in hostile attributions, mainly in situations involving people with whom one does not have a close relationship.
Collapse
|
10
|
Rottenberg J, Devendorf AR, Kashdan TB, Disabato DJ. The Curious Neglect of High Functioning After Psychopathology: The Case of Depression. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2019; 13:549-566. [PMID: 30213257 DOI: 10.1177/1745691618769868] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We address a key issue at the intersection of emotion, psychopathology, and public health-the startling lack of attention to people who experience benign outcomes, and even flourish, after recovering from depression. A rereading of the epidemiological literature suggests that the orthodox view of depression as chronic, recurrent, and lifelong is overstated. A significant subset of people recover and thrive after depression, yet research on such individuals has been rare. To facilitate work on this topic, we present a generative research framework. This framework includes (a) a proposed definition of healthy end-state functioning that goes beyond a reduction in clinical symptoms, (b) recommendations for specific measures to assess high functioning, and (c) a road map for a research agenda aimed at discovering how and why people flourish after emotional disturbance. Given that depression remains the most burdensome health condition worldwide, focus on what makes these excellent outcomes possible has enormous significance for the public health.
Collapse
|
11
|
Cohen ZD, Kim TT, Van HL, Dekker JJM, Driessen E. A demonstration of a multi-method variable selection approach for treatment selection: Recommending cognitive–behavioral versus psychodynamic therapy for mild to moderate adult depression. Psychother Res 2019; 30:137-150. [DOI: 10.1080/10503307.2018.1563312] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Zachary D. Cohen
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Thomas T. Kim
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Jack J. M. Dekker
- Arkin Mental Health Care, Amsterdam, The Netherlands
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Ellen Driessen
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit, Amsterdam, The Netherlands
| |
Collapse
|