Efectividad del tratamiento con neurofeedback en trastornos del estado del ánimo, ansiedad y fibromialgia: una revisión de literatura

El neurofeedback es una técnica no invasiva en la que se pretende corregir, mediante condicionamiento operante, ondas cerebrales que se encuentren alteradas en el electroencefalograma. Desde 1967, se han conducido numerosas investigaciones relacionadas con los efectos de la técnica en el tratamiento de alteraciones psicológicas. Sin embargo, a la fecha no existen revisiones sistemáticas que reúnan los temas que serán aquí tratados. El aporte de este trabajo es la revisión de 56 artículos, publicados entre los años 1995 y 2013 y la evaluación metodológica de 29 estudios incluidos en la revisión. La búsqueda fue acotada a la efectividad del neurofeedback en el tratamiento de depresión, ansiedad, trastorno obsesivo compulsivo (TOC), ira y fibromialgia. Los hallazgos demuestran que el neurofeedback ha tenido resultados positivos en el tratamiento de estos trastornos, sin embargo, es una técnica que aún está en desarrollo, con unas bases teóricas no muy bien establecidas y cuyos resultados necesitan de diseños metodológicamente más sólidos que ratifiquen su validez.

Enhancing recovery rates: lessons from year one of IAPT

BACKGROUND: The English Improving Access to Psychological Therapies (IAPT) initiative aims to make evidence-based psychological therapies for depression and anxiety disorder more widely available in the National Health Service (NHS). 32 IAPT services based on a stepped care model were established in the first year of the programme. We report on the reliable recovery rates achieved by patients treated in the services and identify predictors of recovery at patient level, service level, and as a function of compliance with National Institute of Health and Care Excellence (NICE) Treatment Guidelines. METHOD: Data from 19,395 patients who were clinical cases at intake, attended at least two sessions, had at least two outcomes scores and had completed their treatment during the period were analysed. Outcome was assessed with the patient health questionnaire depression scale (PHQ-9) and the anxiety scale (GAD-7). RESULTS: Data completeness was high for a routine cohort study. Over 91% of treated patients had paired (pre-post) outcome scores. Overall, 40.3% of patients were reliably recovered at post-treatment, 63.7% showed reliable improvement and 6.6% showed reliable deterioration. Most patients received treatments that were recommended by NICE. When a treatment not recommended by NICE was provided, recovery rates were reduced. Service characteristics that predicted higher reliable recovery rates were: high average number of therapy sessions; higher step-up rates among individuals who started with low intensity treatment; larger services; and a larger proportion of experienced staff. CONCLUSIONS: Compliance with the IAPT clinical model is associated with enhanced rates of reliable recovery.

Assessment of the effects of a parental intervention with mothers of children with internalizing problems

The present study assesses the effects of a semi-structured intervention held exclusively with mothers and its effects on internalizing problems, social skills of children, and positive and negative parenting practices. The single subject experimental design with three participants was adopted. The three mothers had, in baseline, children diagnosed with internalizing and externalizing problems. The instruments used were CBCL, RE-HSE-P, QRSH-Pais and PHQ-9, they were performed in baseline, pre-test, post-test, and follow-up assessments. The intervention held is characterized as semi-structured for it promotes the development of parental practices that are considered positive by the literature on behavior problems, however, contingently to the difficulties and demands of each case. The number of sessions performed for each case was 14, 15 and 17, which lasted about two hours each. The data were analyzed according to the instruments' norms and under the perspective of each singular case. The results found include remission of internalizing problems, increase in frequency of the children's social skills, increase in frequency of positive parental practices, and decrease in variability of negative parental practices. All the improvements were maintained on the six months follow-up, with the exception of variability on the negative parental practices of one client. Results are discussed in a context of mental health promotion and indicate the need for strategies to prevent internalizing problems in children.

ARE TWO ITEMS SUFFICIENT TO SCREEN FOR DEPRESSION WITHIN THE HOSPITAL CONTEXT?

Objective: to determine the ability of the reduced form of a screening instrument, the Patient Health Questionnaire-2 (PHQ-2), to assess the presence of depressive disorders in patients admitted to a general hospital. Method: A sample of 227 patients admitted to the clinical wards of a Brazilian general university hospital were assessed with Module A of the Diagnostic Structured Interview for the DSM-IV (SCID-IV) and filled out the PHQ-9 and PHQ-2. Results: The PHQ-2 demonstrated an area under the ROC curve of 0.89 (p < 0.0001), with a cutoff point of three or more being the one that best equilibrated the sensitivity (0.86) and specificity (0.75) values. The agreement index between the PHQ-2 and module A of SCID-W was 78.4% and the Kappa value was 0.51. Regarding reliability, the Cronbach alpha value obtained was 0.64 and the intraclass correlation coefficient was 0.52. Conclusion: PHQ-2 proved to be an instrument with good psychometric properties comparable to those of PHQ-9, being superior to the latter regarding the rate of false-positive results. In addition, it is a brief instrument that elicits little resistance on the part of the patient, being inexpensive and requiring little time, thus being of important help to the treatment teams for the detection of depressive disorder, being suitable for incorporation into hospital admission protocols and thus possibly favoring more immediate interventions. (Int'l J. Psychiatry in Medicine 2012;44:141-148)

[Implementation of a routine gradual psycho-diagnostic programme in somatic rehabilitation centres - results of a pilot study]

STUDY AIM: A pilot study was conducted to implement and evaluate a routine gradual psycho-diagnostic programme to improve diagnostics and treatment of mental disorders in somatic rehabilitation centres. First of all, implementation strategies were acquired in trainings together with psychologists and physicians. The psycho-diagnostic programme consists of a screening instrument (PHQ-9) designed to permit time-effective detection of comorbid mental disorders. Besides evaluation of the training, the aim of the study was to analyze the extent to which it is possible to implement the routine gradual psycho-diagnostic programme in practice. Additionally, it was intended to identify beneficial and obstructive conditions for implementation. METHODOLOGY: The pilot study was conducted in two orthopaedic and one cardiological rehabilitation centre. The training was evaluated directly after its completion using a questionnaire. Three months after its implementation, the introduction of the psycho-diagnostic programme was evaluated using interviews with n=11 physicians and psychologists. RESULTS: The training was rated positively by the participants . Implementation of the entire gradual psycho-diagnostic programme was possible in one centre and to some degree in the other two. Beneficial for implementation were a frank organisational climate, sufficient time resources, and physicians' biopsychosocial understanding of disease. A dismissive attitude towards psycho-diagnostics, little communication between staff members, little perceived advantage for one's own work and fear to stigmatise patients by psychiatric diagnoses were obstructive. CONCLUSION: Essential for a successful implementation are sufficient time and personal resources, a motivation for change in staff and centre management, and a positive attitude regarding psycho-diagnostics in clinic staff. Furthermore, flexibility in implementation strategies and the opportunity to participate in the implementation process are important.

The EVIDENT-trial: protocol and rationale of a multicenter randomized controlled trial testing the effectiveness of an online-based psychological intervention

BACKGROUND: Depressive disorders are among the leading causes of worldwide disability with mild to moderate forms of depression being particularly common. Low-intensity treatments such as online psychological treatments may be an effective way to treat mild to moderate depressive symptoms and prevent the emergence or relapse of major depression. METHODS/DESIGN: This study is a currently recruiting multicentre parallel-groups pragmatic randomized-controlled single-blind trial. A total of 1000 participants with mild to moderate symptoms of depression from various settings including in- and outpatient services will be randomized to an online psychological treatment or care as usual (CAU). We hypothesize that the intervention will be superior to CAU in reducing depressive symptoms assessed with the Personal Health Questionnaire (PHQ-9, primary outcome measure) following the intervention (12 wks) and at follow-up (24 and 48 wks). Further outcome parameters include quality of life, use of health care resources and attitude towards online psychological treatments. DISCUSSION: The study will yield meaningful answers to the question of whether online psychological treatment can contribute to the effective and efficient prevention and treatment of mild to moderate depression on a population level with a low barrier to entry. TRIAL REGISTRATION: Trial Registration Number: NCT01636752.

Depression in early adulthood: prevalence and psychosocial correlates among young Swiss men

QUESTION UNDER STUDY Depression in young adults is common, but data from Switzerland are scarce. Our study gives a point prevalence estimate of depression in young Swiss men, and describes the association between depression and education, material and social resources, and job/school satisfaction. METHODS We used data from the cross-sectional Swiss Federal Surveys of Adolescents (ch-x) from 2010 to 2011 comprising 9,066 males aged between 18 and 25 years. Depression was assessed by means of self-reports using the Patient Health Questionnaire (PHQ-9). Persons were categorised into three groups: depression, subthreshold depression, and no depression. We assessed the relationship between depression and education, material and social resources, and satisfaction with job/school. Differences according to depression status were tested with chi-square tests for categorical variables and one-way analyses of variance for continuous variables. RESULTS Point prevalence of depression (3.60%) and subthreshold depression (3.62%) was high. Poor mental health was associated with lower education in young adults (p <0.001), and with their parents' education (p = 0.024). Social resources in persons with depression and subthreshold depression were substantially reduced (i.e., social support and satisfaction with social relations; both p <0.001). Young men with depression and subthreshold depression also reported a current lack of satisfaction with job/school (p <0.001). CONCLUSIONS Prevalence of (subthreshold) depression is high in young Swiss men. Depression at this age might result in a bad long-term prognosis owing to its association with low satisfaction with job/school and low self-efficacy. Interventions should especially consider the lower social resources of young men with depression.

More adaptive versus less maladaptive coping: What is more predictive of symptom severity? Development of a new scale to investigate coping profiles across different psychopathological syndromes

BACKGROUND: Lack of adaptive and enhanced maladaptive coping with stress and negative emotions are implicated in many psychopathological disorders. We describe the development of a new scale to investigate the relative contribution of different coping styles to psychopathology in a large population sample. We hypothesized that the magnitude of the supposed positive correlation between maladaptive coping and psychopathology would be stronger than the supposed negative correlation between adaptive coping and psychopathology. We also examined whether distinct coping style patterns emerge for different psychopathological syndromes. METHODS: A total of 2200 individuals from the general population participated in an online survey. The Patient Health Questionnaire-9 (PHQ-9), the Obsessive-Compulsive Inventory revised (OCI-R) and the Paranoia Checklist were administered along with a novel instrument called Maladaptive and Adaptive Coping Styles (MAX) questionnaire. Participants were reassessed six months later. RESULTS: MAX consists of three dimensions representing adaptive coping, maladaptive coping and avoidance. Across all psychopathological syndromes, similar response patterns emerged. Maladaptive coping was more strongly related to psychopathology than adaptive coping both cross-sectionally and longitudinally. The overall number of coping styles adopted by an individual predicted greater psychopathology. Mediation analysis suggests that a mild positive relationship between adaptive and certain maladaptive styles (emotional suppression) partially accounts for the attenuated relationship between adaptive coping and depressive symptoms. LIMITATIONS: Results should be replicated in a clinical population. CONCLUSIONS: Results suggest that maladaptive and adaptive coping styles are not reciprocal. Reducing maladaptive coping seems to be more important for outcome than enhancing adaptive coping. The study supports transdiagnostic approaches advocating that maladaptive coping is a common factor across different psychopathologies.

The association of internet use and depression among spinal cord injury population

The purpose of this study was to exam the relationship between internet use and depression among a population of individuals who have sustained spinal cord injury. This was cross-sectional survey design conducted among spinal cord injury (SCI) patients in the Model Spinal Cord Injury System. We included a total of 1,011 SCI-patients who were interviewed face-to-face or by telephone interview over approximately a three year time period (2004–2006). All data were collected through a telephone survey which included the Patient Health Questionnaire-9 (PHQ-9) to assess depression. We examined various scales of this survey, included a reduced 3-item scale (items 1, 2 and 6) to avoid the presence of somatic symptoms among SCI patients from influencing classification of depression. The frequency of internet usage was grouped as daily/weekly/monthly/non user. Covariates examined as possible confounders included demographic characteristics, occupational status, educational level, injury type, daily function of living, pain level, self-perceived health status and satisfaction with life. We observed a negative association between the frequency of internet use and the level of depression. Daily use of internet was associated with lower PHQ-9 score and depression; however this association did not reach statistical significance after for the mentioned covariates. In conclusion, the factors related to lower depression in SCI patients who use the internet are complicated. Daily internet usage was associated with lower levels of depression. The accuracy of 3-item scale needs further validation and investigation. Further study of internet usage pattern in SCI patient is recommended. ^

A relevância das medidas individualizadas : ouvimos o paciente mas captamos a história?

Individualized measures are relevant for the assessment of therapeutic results and allow patients to identify the aspects that they value the most in assessing their clinical improvement. PSYCHLOPS, as an individualized measure, invite the patient to create their own items. The items created by the patients were compared with the contents of standardized measures. A sample composed by 107 patients admitted for psychological treatment in Hospital Espírito Santo (Évora), and three institutions for drug misuse fill in the PSYCHLOPS and two standardized measures presented in a random order: CORE-OM and PHQ-9. 279 items were created in PSYCHLOPS and later recoded, by thematic analysis, in 51 subthemes. Work-related problems was the most common subtheme identified by patients as relevant to the clinical improvement assessment. From the 51 subthemes, 17 (33.3%) were not represented in CORE-OM and 43 (84.3%) were not represented in PHQ-9. The majority of our sample indicated at least one subtheme that was not represented in CORE-OM and PHQ-9. These results show us the importance of individualized measures in identifying the patients’ most value concerns, which may have implications in the therapeutic process.

Modeling Depression Progression Dynamics from Electronic Health Record

Thesis (Master's)--University of Washington, 2016-06

Depression Management Using Electronic Health Record: Individual Progression Prediction

Thesis (Master's)--University of Washington, 2016-06

Developing and Validating a Perinatal Depression Screening Tool in Bungoma County, Kenya

Background: Depression-screening tools exist and are widely used in Western settings. There have been few studies done to explore whether or not existing tools are valid and effective to use in sub-Saharan Africa. Our study aimed to develop and validate a perinatal depression-screening tool in rural Kenya.

Methods: We utilized conducted free listing and card sorting exercises with a purposive sample of 12 women and 38 CHVs living in a rural community to explore the manifestations of perinatal depression in that setting. We used the information obtained to produce a locally relevant depression-screening tool that comprised of existing Western psychiatric concepts and locally derived items. Subsequently, we administered the novel depression-screening tool and two existing screening tools (the Edinburgh Postnatal Depression Scale and the Patient Health Questionnaire-9) to 193 women and compared the results of the screening tool with that of a gold standard structured clinical interview to determine validity.

Results: The free listing and card sorting exercise produced a set of 60 screening items. Of the items in this set, we identified the 10 items that most accurately classified cases and non-cases. This 10-item scale had a sensitivity of 100.0 and specificity of 81.2. This compared to 90.0, 31.5 and 90.0, 49.7 for the EPDS and the PHQ-9, respectively. Overall, we found a prevalence of depression of 5.2 percent.

Conclusions: The new scale does very well in terms of diagnostic validity, having the highest scores in this domain compared to the EPDS, EPDS-R and PHQ-9. The adapted scale does very well with regards to convergent validity-illustrating clear distinction between mean scores across the different categories. It does well with regards to discriminant validity, internal consistency reliability, and test-retest reliability- not securing top scores in those domains but still yielding satisfactory results.

Implicações Emocionais e Sócio-Cognitivas da Depressão Materna na Criança em Idade Escolar

A depressão materna tem sido associada a factores que em nada promovem o desenvolvimento infantil. O presente estudo tem como objectivo compreender implicações da depressão materna no desenvolvimento da criança em idade escolar A amostra foi composta por 24 mães e respectivos filhos de ambos os sexos, com idades compreendidas entre os 8 e os 15 anos, do 1º, 2º e 3º ciclo, pertencentes ao Agrupamento de Escolas da Batalha, encaminhados aos Serviços de Psicologia e Orientação. As crianças foram distribuídas em grupos distintos, G1, constituído por 12 crianças cujas mães sofreram depressão nos primeiros três anos de vida dos seus filhos, e G2, composto por 12 crianças cujas mães não sofreram depressão nem outros distúrbios psiquiátricos nos primeiros três anos de vida dos seus filhos. A identificação das mães com indicadores de depressão foi feita de forma retrospectiva, através do questionário sobre a saúde do paciente (PHQ-9) e a confirmação diagnóstica através da SCID. Os dados sociodemográficos das mães e crianças foram recolhidos em contexto de entrevista, em que se analisaram dados relativos à gravidez, ao desenvolvimento da criança e ao seu contexto escolar. As mães responderam igualmente ao questionário de capacidades e dificuldades (SDQ) relativo ao comportamento dos seus filhos. Para a análise do sucesso escolar, foi feito um levantamento das notas a Português e Matemática. Por fim, realizou-se a avaliação psicológica das crianças através da WISC-III. A partir da análise dos resultados obtidos, conclui-se a existência do impacto negativo da depressão materna no desenvolvimento da criança em idade escolar, observando-se que as crianças que conviveram com a depressão nos três primeiros anos de vida, apresentam piores notas nas áreas estruturantes do Português e da Matemática, e maiores problemas na adaptação escolar. Relativamente aos Q.I.’s, observam-se diferenças estatisticamente significativas em todos os domínios da escala, apresentando estas crianças um perfil de resultados mais baixo. De acordo com a avaliação feita pelas mães, estas crianças manifestam maiores dificuldades na regulação emocional e apresentam menores habilidades pró-sociais. / Maternal depression has been linked to factors that in no way promote child development. The present study aims to understand the implications of maternal depression on child development at school age. The sample consisted of 24 mothers and their children of both sexes, aged between 8 and 15, from 1st, 2nd and 3rd cycle, belonging to Agrupamento de Escolas da Batalha, referred to the Serviços de Psicologia e Orientação (Psychology and Guidance Services). The children were divided into distinct groups, G1, consisting of 12 children whose mothers suffered depression in the first three years of life of their children, and G2, composed of 12 children whose mothers did not suffer depression or other psychiatric disorders in the first three years of life of their children. The identification of mothers with indicators of depression was made retrospectively, by questionnaire on the patient's health (PHQ-9) and diagnosis confirmation by SCID. Socio-demographic data of mothers and children were gathered in the context of the interview, where data on pregnancy, child development and their school context were analysed. Mothers also responded to the strengths and difficulties questionnaire (SDQ) on the behavior of their children. For the analysis of academic success, a survey was made of the notes on Portuguese and Mathematics. Finally, there was a psychological assessment of children using the WISC-III. From the analysis of the results obtained, the existence of the negative impact of maternal depression on child development at school age is concluded, noting that children who lived with depression for the first three years of life, have worse grades in the structuring areas of Portuguese and Mathematics, and major problems in school adjustment. For IQs, there are significant statistical differences in all areas of the scale, presenting these children lower profile results. According to the assessment made by the mothers, these children have greater difficulty in emotional regulation and have lower pro-social skills.

Cultural influences on positive affect and reward processing in depressed youth

Thesis (Ph.D.)--University of Washington, 2016-07