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Schizophrenia Research Jun 2022For people with a psychotic disorder lack of insight can be detrimental on their condition and recovery. For this reason, insight has been considered as a target for... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
For people with a psychotic disorder lack of insight can be detrimental on their condition and recovery. For this reason, insight has been considered as a target for therapy. We conducted a systematic review of the literature on pharmacological, psychological and other treatments to test the hypothesis that these interventions could improve insight.
METHODS
We performed a literature search (1970-2020) across the following databases: PubMed, EMBASE, PsychINFO, Medline and Web of Science. Within each database the following search terms and the associated Boolean operatives were used: "Insight AND (treatment OR therapy) AND (psychosis OR schizophrenia) AND (awareness or denial)". Further filters were applied to identify peer reviewed controlled trials on adults. Following assessment for bias and inclusion criteria, we calculated the effect size (Cohen's d) for each study and overall, using a random effects model with 95% confidence intervals.
RESULTS
Of 94 articles found in the initial literature search, 30 studies that examined the treatment of insight in psychosis met the initial selection criteria and were assessed for bias. A total of 21 studies were included in the final meta-analysis. The overall calculated mean effect size for all interventions was 0.441 (95% CI, 0.23-0.66), representing a medium effect size. The effect of psychoeducation studies alone was medium (0.613, 95% CI, -0.35-2.06), but not significant. The effect of CBT studies was small (0.235, 95% CI, 0.01-0.46), and significant. The effect of combined antipsychotic medication and psychosocial intervention was of medium size and significant (0.683, 95% CI = 0.54-0.83). Finally, tDCS over the left fronto-temporal cortex, produced a very large and significant improvement of insight 1.153 (95% CI = 0.61-1.70), which was present for at least a month after the intervention.
CONCLUSIONS
Despite the variation and small number and size of trials into possible interventions, the hypothesis that insight could be improved was confirmed. Whilst most research focuses on psychotherapies, there is scope and potential for pharmacological, as well as other interventions (e.g. physical exercise, self-video observation, Direct Current Stimulation) to improve insight over and above treatment as usual. Given the association of insight with illness severity and treatment adherence, it is important to direct efforts in therapies that target insight improvement in psychosis.
Topics: Adult; Antipsychotic Agents; Humans; Psychotherapy; Psychotic Disorders; Schizophrenia
PubMed: 35661550
DOI: 10.1016/j.schres.2022.05.023 -
The International Journal of Eating... Jan 2017To systematically review the literature on perceived barriers and facilitators of help-seeking for eating disorders. (Review)
Review
OBJECTIVE
To systematically review the literature on perceived barriers and facilitators of help-seeking for eating disorders.
METHOD
Three databases (PubMed, PsychInfo, Cochrane) were searched using keywords and Medical Subject Headings (MeSH) terms. Retrieved abstracts (N = 3493) were double screened and relevant papers (n = 13) were double coded. Qualitative and quantitative studies were included if they reported perceived barriers and facilitators towards seeking help for eating disorders. Barriers and facilitators were extracted from the included papers and coded under themes. The most prominent barriers and facilitators were determined by the number of studies reporting each theme.
RESULTS
Eight qualitative, three quantitative, and two mixed-methods studies met the inclusion criteria for the current review. The most prominent perceived barriers to help-seeking were stigma and shame, denial of and failure to perceive the severity of the illness, practical barriers (e.g., cost of treatment), low motivation to change, negative attitudes towards seeking help, lack of encouragement from others to seek help and lack of knowledge about help resources. Facilitators of help-seeking were reported in six studies, with the most prominent themes identified as the presence of other mental health problems or emotional distress, and concerns about health.
DISCUSSION
Programs targeting prevention and early intervention for eating disorders should focus on reducing stigma and shame, educating individuals about the severity of eating disorders, and increasing knowledge around help-seeking pathways for eating disorders. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2017; 50:9-21).
Topics: Denial, Psychological; Feeding and Eating Disorders; Female; Health Education; Humans; Patient Acceptance of Health Care; Shame; Social Stigma
PubMed: 27526643
DOI: 10.1002/eat.22598 -
American Journal of Kidney Diseases :... Mar 2016Kidney transplantation offers better outcomes compared to dialysis, but requires patients to adhere to an ongoing and complex self-management regimen. Medication... (Review)
Review
BACKGROUND
Kidney transplantation offers better outcomes compared to dialysis, but requires patients to adhere to an ongoing and complex self-management regimen. Medication nonadherence remains a leading cause of transplant loss, and inadequate self-management undermines transplantation and other health outcomes. We aimed to describe kidney transplant recipients' motivations, challenges, and attitudes toward self-management.
STUDY DESIGN
Systematic review and thematic synthesis of qualitative studies.
SETTING & POPULATION
Kidney transplant recipients.
SEARCH STRATEGY & SOURCES
MEDLINE, EMBASE, PsycINFO, and CINAHL were searched to October 2014.
ANALYTICAL APPROACH
Thematic synthesis.
RESULTS
50 studies involving 1,238 recipients aged 18 to 82 years across 19 countries were included. We identified 5 themes: empowerment through autonomy (achieving mastery, tracking against tangible targets, developing bodily intuition, routinizing and problem solving, and adaptive coping), prevailing fear of consequences (inescapable rejection anxiety, aversion to dialysis, minimizing future morbidity, trivialization and denial, and defining acceptable risks), burdensome treatment and responsibilities (frustrating ambiguities, inadvertent forgetfulness, intrusive side effects, reversing ingrained behaviors, and financial hardship), overmedicalizing life (dominating focus, evading patienthood, and succumbing to burnout), and social accountability and motivation (demonstrating gratitude toward medical team, indebtedness to donor, and peer learning).
LIMITATIONS
Non-English articles were excluded.
CONCLUSIONS
Self-efficacy and social accountability are motivators for self-management, although adherence can be mentally and physically taxing. Multicomponent interventions incorporating personalized care planning, education, psychosocial support, decision aids, and self-monitoring tools may foster self-management capacity and improve transplantation outcomes.
Topics: Adaptation, Psychological; Attitude to Health; Graft Rejection; Graft Survival; Humans; Kidney Failure, Chronic; Kidney Transplantation; Medication Adherence; Motivation; Qualitative Research; Self Care
PubMed: 26372087
DOI: 10.1053/j.ajkd.2015.07.030 -
Journal of Clinical Nursing May 2023Inflammatory Bowel Disease (IBD) affects patients and their family members, but most reviews have focused only on patients themselves. This review synthesises evidence... (Review)
Review
BACKGROUND AND AIMS
Inflammatory Bowel Disease (IBD) affects patients and their family members, but most reviews have focused only on patients themselves. This review synthesises evidence on the impact of IBD on family members.
METHODS
A systematic review was undertaken, searching six bibliographic databases, focusing on the impact of IBD on family members, coping strategies, and interventions. A narrative synthesis was conducted. This review was reported following the Preferred Reporting Items for Systematic Reviews (PRISMA).
RESULTS
3258 records were identified; 33 papers (2748 participants) were included. Three themes were identified: impact of IBD on family members; coping strategies for family members to overcome the impact of IBD; and the support needed by family members. IBD affects family members' well-being in many ways, including their emotional well-being, relationship with the patient, social life, work and finances, and leisure time and travel. Family members use adaptive coping patterns such as acceptance, developing resilience, and emotional support from others. Maladaptive coping patterns such as denial of diagnosis, self-distraction, and self-blame were also evident. Family members reported that they needed better information about IBD, support groups, and better access to a counsellor or psychologist. No studies assessed interventions to relieve family members' burden.
CONCLUSIONS
Family members of IBD patients require psychosocial support to facilitate better family function, cohesion, and enhanced coping strategies. Healthcare services should adopt a multidisciplinary care model with a bio-psycho-social approach including an IBD nurse, family therapist, and psychologist, to improve quality of life for patients and their families.
Topics: Humans; Quality of Life; Inflammatory Bowel Diseases; Family; Adaptation, Psychological; Emotions
PubMed: 35908208
DOI: 10.1111/jocn.16446 -
Drug and Alcohol Dependence Mar 2023The prevalence of drug use in Muslim communities is difficult to estimate due to religious, social, and cultural prohibition toward drug use. With Islam affecting all... (Review)
Review
Barriers and facilitators to accessing inpatient and community substance use treatment and harm reduction services for people who use drugs in the Muslim communities: A systematic narrative review of studies on the experiences of people who receive services and service providers.
BACKGROUND
The prevalence of drug use in Muslim communities is difficult to estimate due to religious, social, and cultural prohibition toward drug use. With Islam affecting all aspects of life in the Muslim world, people who use drugs do it clandestinely to avoid stigma and exclusion from the community, leading to a low number of them seeking treatment for their drug use. This review explored the barriers and facilitators to accessing inpatient and community substance use treatment and harm reduction services for people who use drugs in Muslim communities.
METHODS
This review was in accordance with PRISMA. Seven databases were systematically searched for qualitative, quantitative, and mixed methods studies conducted in countries where at least 70% of the population were Muslim or where data were presented separately for Muslim communities in other countries. Eligible articles were reviewed, and key qualitative themes were abstracted and compared across studies and settings.
RESULTS
Twenty-four studies were included from Iran, Bangladesh, Afghanistan, Tajikistan, Kazakhstan, Kyrgyzstan, Egypt, Lebanon, and UAE. Two themes were identified: a psychosocial theme included denial of the problem severity, lack of trust in the treatment system, fear of breach in confidentiality and privacy, the need for community support, religion and women who use drugs. Additionally, an organizational theme included affordability, treatment Service characteristics, lack of Awareness, service providers' Attitudes, drug use registration and fear of legal consequences of drug use. Stigma was also identified as an over-arching theme. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of the included studies with where 12 of the studies met all 5 the quality criteria. No studies were excluded for having lower quality scores.
CONCLUSION
This review reflected how diverse the Muslim world is in drug use. It is important to use mosques to raise awareness on people who use drugs and reduce stigma. Providing holistic services for people who use drugs specially women will improve their access to treatment and harm reduction services in the Muslim world.
Topics: Humans; Female; Islam; Harm Reduction; Inpatients; Substance-Related Disorders; Social Stigma; Qualitative Research
PubMed: 36805826
DOI: 10.1016/j.drugalcdep.2023.109790 -
BMJ Open Dec 2023Patients with breast cancer and endocrine therapy-related symptoms often experience pain, self-denial, anxiety, fear of recurrence and despair, which can be extremely...
INTRODUCTION
Patients with breast cancer and endocrine therapy-related symptoms often experience pain, self-denial, anxiety, fear of recurrence and despair, which can be extremely physically and psychologically traumatising for the patients. Failure to receive effective support and management reduces adherence to medications, leading to a higher risk of relapse and mortality. Clearly, it is paramount to identify what support these patients may need and how to meet their symptom management needs. This paper outlines a protocol to synthesise qualitative evidence on endocrine therapy symptom experiences, management expectations and preferences of patients with breast cancer.
METHODS AND ANALYSIS
The following databases were searched in November 2023 with no date restriction applied: The Cochrane Library, PubMed, Embase, Web of Science, Scopus, CINAHL and OpenGrey. Published studies on qualitative or mixed-method on symptom experiences and management needs during endocrine therapy in patients with breast cancer will be retrieved. We will also search for reference lists and perform a forward citation search. Before inclusion in this review, two reviewers will independently apply the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research to ensure methodological validity. Any disagreements regarding the evaluation of the articles will be resolved through discussion with or by a third reviewer. Data will be extracted using the standardised data extraction tool EndNote20 for unified management, assessment, and review of information. The common sense model of self-regulation will guide data extraction and synthesis. The final synthesised findings will be graded according to the GRADE-CERQual approach to establish confidence.
ETHICS AND DISSEMINATION
This systematic review addressed previously published studies without personally identifiable participant information. Ethical approval from the research committee was not required. The findings of this systematic review will be disseminated to various key stakeholders and published in peer-reviewed journals.
PROSPERO REGISTRATION NUMBER
CRD42023406987.
Topics: Female; Humans; Breast Neoplasms; Mental Processes; Neoplasm Recurrence, Local; Palliative Care; Qualitative Research
PubMed: 38149416
DOI: 10.1136/bmjopen-2023-073915 -
Journal of Gambling Studies Mar 2020Although well-recognized and clinically relevant, impaired awareness of problem and pathological gambling (IAPPG) is a poorly understood phenomenon that contributes to...
Although well-recognized and clinically relevant, impaired awareness of problem and pathological gambling (IAPPG) is a poorly understood phenomenon that contributes to treatment denial and negative clinical and social outcomes. In this study, we aimed to conduct a systematic review of the measures available to assess problem gambling awareness, evaluate their psychometric properties, and determine the extent to which they cover the core domains of illness awareness: General Disorder Awareness, Symptom Attribution, Awareness of Need for Treatment, and Awareness of Negative Consequences. A systematic search using OVID database (Medline, PsycINFO, and Embase) was performed to identify English language papers describing gambling awareness measures. We identified only 8 measures partially assessing IAPPG. Measures differed in their effectiveness and comprehensiveness in evaluating IAPPG. Most measures were principally developed to evaluate barriers or motivators to treatment-seeking among gamblers and were not specific to IAPPG. Two were psychometrically validated, but the items were not specific to the evaluation of subjective awareness of the disorder and they only covered up to two domains of IAPPG. With the development and psychometric validation of an easy-to-use, comprehensive measure of subjective IAPPG, future studies will be able to investigate the role of IAPPG in help-seeking behavior, treatment adherence, and clinical and social outcomes.
Topics: Adult; Behavior, Addictive; Female; Gambling; Humans; Internal-External Control; Male; Middle Aged; Motivation; Psychometrics; Self Care; Self Efficacy
PubMed: 31863419
DOI: 10.1007/s10899-019-09926-0 -
Obesity Reviews : An Official Journal... Feb 2017The success of childhood weight management programmes relies on family engagement. While attendance offers many benefits including the support to make positive lifestyle... (Review)
Review
Barriers and facilitators to initial and continued attendance at community-based lifestyle programmes among families of overweight and obese children: a systematic review.
The success of childhood weight management programmes relies on family engagement. While attendance offers many benefits including the support to make positive lifestyle changes, the majority of families referred to treatment decline. Moreover, for those who do attend, benefits are often compromised by high programme attrition. This systematic review investigated factors influencing attendance at community-based lifestyle programmes among families of overweight or obese children. A narrative synthesis approach was used to allow for the inclusion of quantitative, qualitative and mixed-method study designs. Thirteen studies met the inclusion criteria. Results suggest that parents provided the impetus for programme initiation, and this was driven largely by a concern for their child's psychological health and wellbeing. More often than not, children went along without any real reason or interest in attending. Over the course of the programme, however, children's positive social experiences such as having fun and making friends fostered the desire to continue. The stigma surrounding excess weight and the denial of the issue amongst some parents presented barriers to enrolment and warrant further study. This study provides practical recommendations to guide future policy makers, programme delivery teams and researchers in developing strategies to boost recruitment and minimise attrition.
Topics: Adolescent; Child; Humans; Life Style; Overweight; Patient Compliance; Patient Dropouts; Pediatric Obesity
PubMed: 27862851
DOI: 10.1111/obr.12478 -
Trauma, Violence & Abuse Jul 2024Intimate partner abuse (IPA) is widespread, and denial, minimization, justifying, and blaming (DMJB) are common among people who have committed IPA. Views on the... (Review)
Review
Intimate partner abuse (IPA) is widespread, and denial, minimization, justifying, and blaming (DMJB) are common among people who have committed IPA. Views on the function of DMJB in IPA are mixed, often based on the theoretical standpoint of the authors. This systematic review brings together the knowledge of how distorted accounts operate in IPA committed by men. A systematic review of primary research related to DMJB in heterosexual men who have committed to IPA was conducted. In all, 31 papers were found to meet the inclusion criteria (adult, male-to-female abuse, in western culture, peer reviewed and published in English) and were quality appraised. Data were extracted and analyzed using narrative synthesis. The findings indicate the way DMJB operates in this group is complex. It can represent facilitators of abusive behavior, a way to protect the individual's identity and self-esteem, and a tool men use instrumentally to achieve goals. Themes were present within and between studies highlighting the complex function of DMJB. A model representing the hypothesized intertwined function of DMJB for IPA is proposed. The limitations of the review are discussed and implications and recommendations for policy, practice, and future research are proposed.
Topics: Humans; Male; Intimate Partner Violence; Denial, Psychological; Female; Self Concept; Adult; Interpersonal Relations
PubMed: 37702188
DOI: 10.1177/15248380231196108 -
Clinical Psychology & Psychotherapy Nov 2016Posttraumatic growth (PTG) and Posttraumatic Stress Disorder (PTSD) are possible consequences of trauma. PTG is supposed to emerge from cognitive processes and can have... (Review)
Review
UNLABELLED
Posttraumatic growth (PTG) and Posttraumatic Stress Disorder (PTSD) are possible consequences of trauma. PTG is supposed to emerge from cognitive processes and can have functional and dysfunctional aspects. This systematic review aims to identify and evaluate publications assessing PTG in adults diagnosed with PTSD in order to analyse the relationship between both constructs, how PTG is related to specific psychological variables and if there are biological variables linked to PTG. This extended review evaluates the quality of measures applied and is the first to study PTG only in populations meeting full PTSD criteria. In addition, the relationship between PTG and other relevant constructs, such as openness, optimism and social support, is explored. Our systematic literature search identified 140 studies of which 19 fulfilled our inclusion criteria; most of them used the Post-Traumatic Growth Inventory. Results indicate that trauma survivors with PTSD exhibit more PTG than those without PTSD and that PTG can be intensified during the therapeutic process whereat it is unclear whether PTG is a desirable outcome of PTSD therapy. Positive correlations between PTG and PTSD are reported. For diagnosed populations, we could not find strong evidence of a quadratic relationship between PTG and PTSD, although some studies support this hypothesis. Findings regarding the association of PTG with psychological variables are heterogeneous. Only one study focused on PTG as well as on biological variables (salivary cortisol) but did not discuss possible links between these two so far unconnected research fields in PTSD. Copyright © 2015 John Wiley & Sons, Ltd.
KEY PRACTITIONER MESSAGE
Trauma survivors with PTSD develop more PTG than those without PTSD, it remains unclear whether PTSD and PTG are curvilinearly related. PTG can be enhanced through PTSD therapy, nevertheless one must not assume that PTG is a favorable treatment outcome since we do not know if the development of PTG during therapy promotes the reduction of PTSD symptoms. It is unclear whether PTG in PTSD sufferers is a constructive outcome of cognitive processes or a positive illusion in favor of avoidance and denial. Results regarding the association of personality factors, social support and PTG are inconsistent, studies on biological aspects of PTG are lacking.
Topics: Adaptation, Psychological; Adult; Humans; Psychotherapy; Social Support; Stress Disorders, Post-Traumatic; Survivors
PubMed: 26514236
DOI: 10.1002/cpp.1985