World Psychiatry最新文献_第6页

Toward a personalized approach to psychotherapy outcome and the study of therapeutic change. 对心理治疗结果的个性化方法和治疗变化的研究。

IF 73.3 1区医学

World Psychiatry Pub Date : 2019-10-01 DOI: 10.1002/wps.20666

Jacques P Barber, Nili Solomonov

{"title":"Toward a personalized approach to psychotherapy outcome and the study of therapeutic change.","authors":"Jacques P Barber, Nili Solomonov","doi":"10.1002/wps.20666","DOIUrl":"https://doi.org/10.1002/wps.20666","url":null,"abstract":"Cuijpers highlights that, in spite of major progress in mental health research, there are still many important unanswered questions regarding psychotherapies. He emphasizes the significance of looking beyond symptomatic reduction and studying a range of treatment outcomes. He suggests (and we agree) that symptom reduction does not necessarily reflect many crucial and sustainable aspects of therapeutic change. One of the reasons why change in symptoms is the most widely studied outcome is that researchers conducting rando mized controlled trials (RCTs) are required to define their primary outcome a priori. Defining multiple primary outcomes results in an increase of the number of individuals to be included in a study to satisfy statistical power requirements. Thus, selecting a broader more representative range of outcomes becomes expensive, impractical and strategically problematic within the current major funding mechanisms. Additionally, reports of con flicting findings when similar research questions are examined using different measures make it difficult to determine which measures are to be prioritized conceptually and psychometrically. It is indeed crucial to conceptualize and measure outcomes from the patient’s perspective. Even patients who experience reductions in symptoms and meet remission criteria may still struggle in major domains such as navigating relationships, regulating emotions, maintaining consistent employment, and coping with stress. Other aspects of outcome, such as patients’ capacity to cope with stressors and to use strategies learned in therapy in the face of adversity, should also be evaluated. Another understudied outcome is patients’ gained subjective sense of freedom – one’s ability to confront and resolve conflicting demands that arise from perceptions of the outer and inner worlds and make “choices” that are not determined by unconscious forces. A patient-centered approach suggests that the treatment course should be guided by patients’ specific needs, preferences, and perspectives on their own therapeutic change. Many medical specialties are now shifting towards a “precision medicine” model – tailoring treatment to the individual patient. In psychotherapy, this model requires a comprehensive assessment of the individual patient’s functioning across multiple domains in order to develop a personalized treatment plan. Some progress has been made in the development of computerized algorithms, with preliminary evidence for efficacy of matching patients with the optimal treatment package. However, implementing these algorithms requires the availability of skilled therapists who can deliver the selected “optimal” complex treatment modality. Treatment packages involve extensive clinical training and supervision, which limits their feasibility and applicability, especially for large populations of patients who reside in areas with limited access to experienced mental health professionals. Thus, in addition to focusing on m","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":"18 3","pages":"291-292"},"PeriodicalIF":73.3,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20666","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41217725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 16

Evidence and perspectives in eating disorders: a paradigm for a multidisciplinary approach. 饮食失调的证据和观点：多学科方法的范例。

IF 73.3 1区医学

World Psychiatry Pub Date : 2019-10-01 DOI: 10.1002/wps.20687

Alessio M Monteleone, Fernando Fernandez-Aranda, Ulrich Voderholzer

{"title":"Evidence and perspectives in eating disorders: a paradigm for a multidisciplinary approach.","authors":"Alessio M Monteleone, Fernando Fernandez-Aranda, Ulrich Voderholzer","doi":"10.1002/wps.20687","DOIUrl":"https://doi.org/10.1002/wps.20687","url":null,"abstract":"369 leadership for a significant improvement in practice on the subject; b) through supporting and building a network of practitioners and those with lived experience of mental ill health and their supporters, in effect a movement for better practice to minimize coercion; c) by developing new materials, testing them and learning from their use in a way that strengthens knowledge on human rights and mental health more broadly, of which minimizing coercion is a central element. Ultimately, the impact we seek is that an understanding of ways to minimize coercion is developed by mental health professionals internationally, in collaboration with civil society, and that better practices are adopted. As a result, the dangers of coercive practices will also be minimized, and the supports available to people experiencing mental health problems and their families will increase significantly over time. There are people and groups across countries working actively to promote these and other initiatives that contribute to the common goal of the advancement of psychiatry and mental health for all people. All of us in the WPA leadership welcome comments and engage ment from readers and colleagues. Helen Herrman President, World Psychiatric Association","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":"18 3","pages":"369-370"},"PeriodicalIF":73.3,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20687","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41217716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 17

Transdiagnostic psychiatry goes above and beyond classification 跨诊断精神病学超越了分类范畴

IF 73.3 1区医学

World Psychiatry Pub Date : 2019-10-01 DOI: 10.1002/wps.20680

W. Mansell

引用次数: 18

Reimagining outcomes requires reimagining mental health conditions. 重塑结果需要重塑心理健康状况。

IF 73.3 1区医学

World Psychiatry Pub Date : 2019-10-01 DOI: 10.1002/wps.20662

Vikram Patel

引用次数: 5

What is "evidence" in psychotherapies? 什么是心理治疗师的“证据”？

IF 60.5 1区医学

World Psychiatry Pub Date : 2019-10-01 DOI: 10.1002/wps.20654

Scott O Lilienfeld

引用次数: 0

iSupport: a WHO global online intervention for informal caregivers of people with dementia. issupport:世卫组织针对痴呆症患者非正式照护者的全球在线干预措施

IF 60.5 1区医学

World Psychiatry Pub Date : 2019-10-01 DOI: 10.1002/wps.20684

Anne Margriet Pot, Dolores Gallagher-Thompson, Lily D Xiao, Bernadette M Willemse, Iris Rosier, Kala M Mehta, Diana Zandi, Tarun Dua

引用次数: 0

Outcomes help map out evidence in an uncertain terrain, but they are relative. 结果有助于在不确定的地形中绘制证据，但它们是相对的。

IF 60.5 1区医学

World Psychiatry Pub Date : 2019-10-01 DOI: 10.1002/wps.20668

Tim Kendall

引用次数: 0

Cognitive remediation for severe mental illness: state of the field and future directions 严重精神疾病的认知修复：研究现状和未来方向

IF 73.3 1区医学

World Psychiatry Pub Date : 2019-10-01 DOI: 10.1002/wps.20660

C. Bowie

引用次数: 27

Post‐traumatic stress disorder: a state‐of‐the‐art review of evidence and challenges 创伤后应激障碍:证据和挑战的最新回顾

IF 73.3 1区医学

World Psychiatry Pub Date : 2019-10-01 DOI: 10.1002/wps.20656

R. Bryant

{"title":"Post‐traumatic stress disorder: a state‐of‐the‐art review of evidence and challenges","authors":"R. Bryant","doi":"10.1002/wps.20656","DOIUrl":"https://doi.org/10.1002/wps.20656","url":null,"abstract":"Post‐traumatic stress disorder (PTSD) is arguably the most common psychiatric disorder to arise after exposure to a traumatic event. Since its formal introduction in the DSM‐III in 1980, knowledge has grown significantly regarding its causes, maintaining mechanisms and treatments. Despite this increased understanding, however, the actual definition of the disorder remains controversial. The DSM‐5 and ICD‐11 define the disorder differently, reflecting disagreements in the field about whether the construct of PTSD should encompass a broad array of psychological manifestations that arise after trauma or should be focused more specifically on trauma memory phenomena. This controversy over clarifying the phenotype of PTSD has limited the capacity to identify biomarkers and specific mechanisms of traumatic stress. This review provides an up‐to‐date outline of the current definitions of PTSD, its known prevalence and risk factors, the main models to explain the disorder, and evidence‐supported treatments. A major conclusion is that, although trauma‐focused cognitive behavior therapy is the best‐validated treatment for PTSD, it has stagnated over recent decades, and only two‐thirds of PTSD patients respond adequately to this intervention. Moreover, most people with PTSD do not access evidence‐based treatment, and this situation is much worse in low‐ and middle‐income countries. Identifying processes that can overcome these major barriers to better management of people with PTSD remains an outstanding challenge.","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20656","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43152609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 224

Mental illness among relatives of successful academics: implications for psychopathology‐creativity research 成功学者亲属的精神疾病：对精神病理学创造性研究的启示

IF 73.3 1区医学

World Psychiatry Pub Date : 2019-10-01 DOI: 10.1002/wps.20682

J. Parnas, Karl Erik Sandsten, C. Vestergaard, J. Nordgaard

{"title":"Mental illness among relatives of successful academics: implications for psychopathology‐creativity research","authors":"J. Parnas, Karl Erik Sandsten, C. Vestergaard, J. Nordgaard","doi":"10.1002/wps.20682","DOIUrl":"https://doi.org/10.1002/wps.20682","url":null,"abstract":"World Psychiatry 18:3 October 2019 Another illustrative example is the fact that authors themselves disagree on the ultimate aim of transdiagnostic research. Some of them claim that transdiagnostic research is a fundamental pathway to clinical utility for improving psychiatric classification and diagnosis, while others argue that the transdiagnostic approach does not primarily target the improvement of psychiatric classifi cation and diagnosis, but rather tests a general theory of psycho pathology. A further example is the fact that, until the publication of this systematic review, the empirical limitations and reporting quality of transdiagnostic research remained unaddressed: appraising and acknowledging the specific limitations of a certain domain of knowledge is equally, if not more, important as celebrating its successes. It may well be that some versions of a transdiagnostic approach are going to be necessary to improve psychiatric classification and care. What is certain is that, until studies continue to loosely and incoherently self-proclaim transdiagnostic without acknowledging any diagnostic information, it is unlikely that transdiagnostic research will bear any real-world meaning for clinicians, patients, and medical practice. Similarly, poor reporting on the number and type of (trans)diagnostic spectra prevents the appraisal, refinement, and eventual integration of categorical and dimensional approaches in psychiatric classification. The systematic review acknowledged that transdiagnostic categorical approaches that respect dimensionality are possible in organic medicine as well as in psychiatry, but this requires transparent reporting of the results. For example, the largest transdiagnostic study published to date demonstrated that it is possible to report the diagnostic information for almost all ICD-10 mental disorders. Furthermore, while it is possible that transdiagnostic interventions may display superior efficiency, cost-effectiveness, accessibility, and patient-reported satisfaction compared to specific-diagnostic interventions, demonstrating this would require robust comparative analyses specifically conducted to test the non-inferiority or superiority of the transdiagnostic approach. These analyses are infrequent in the current literature. The systematic review leveraged these caveats to put forward six empirical transdiagnostic research recommendations: TRANSD. The TRANSD recommendations are pragmatic and focus on improving the quality of appraising and reporting transdiagnostic constructs. Importantly, they do not provide any a priori restrictive definition of the transdiagnostic schemata; as such, they can be applied to different topics and stimulate critical research in the field. The first recommendation is to have a transparent definition of the gold standard (ICD, DSM, other), including specific diagnostic types, official codes, primary vs. secondary diagnoses, and diagnostic assessment interviews. Second, the primar","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20682","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47429363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 6