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The Cochrane Database of Systematic... Mar 2018Attention deficit hyperactivity disorder (ADHD) is a developmental condition characterised by symptoms of inattention, hyperactivity and impulsivity, along with deficits... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Attention deficit hyperactivity disorder (ADHD) is a developmental condition characterised by symptoms of inattention, hyperactivity and impulsivity, along with deficits in executive function, emotional regulation and motivation. The persistence of ADHD in adulthood is a serious clinical problem.ADHD significantly affects social interactions, study and employment performance.Previous studies suggest that cognitive-behavioural therapy (CBT) could be effective in treating adults with ADHD, especially when combined with pharmacological treatment. CBT aims to change the thoughts and behaviours that reinforce harmful effects of the disorder by teaching people techniques to control the core symptoms. CBT also aims to help people cope with emotions, such as anxiety and depression, and to improve self-esteem.
OBJECTIVES
To assess the effects of cognitive-behavioural-based therapy for ADHD in adults.
SEARCH METHODS
In June 2017, we searched CENTRAL, MEDLINE, Embase, seven other databases and three trials registries. We also checked reference lists, handsearched congress abstracts, and contacted experts and researchers in the field.
SELECTION CRITERIA
Randomised controlled trials (RCTs) evaluating any form of CBT for adults with ADHD, either as a monotherapy or in conjunction with another treatment, versus one of the following: unspecific control conditions (comprising supportive psychotherapies, no treatment or waiting list) or other specific interventions.
DATA COLLECTION AND ANALYSIS
We used the standard methodological procedures suggested by Cochrane.
MAIN RESULTS
We included 14 RCTs (700 participants), 13 of which were conducted in the northern hemisphere and 1 in Australia.Primary outcomes: ADHD symptomsCBT versus unspecific control conditions (supportive psychotherapies, waiting list or no treatment)- CBT versus supportive psychotherapies: CBT was more effective than supportive therapy for improving clinician-reported ADHD symptoms (1 study, 81 participants; low-quality evidence) but not for self-reported ADHD symptoms (SMD -0.16, 95% CI -0.52 to 0.19; 2 studies, 122 participants; low-quality evidence; small effect size).- CBT versus waiting list: CBT led to a larger benefit in clinician-reported ADHD symptoms (SMD -1.22, 95% CI -2.03 to -0.41; 2 studies, 126 participants; very low-quality evidence; large effect size). We also found significant differences in favour of CBT for self-reported ADHD symptoms (SMD -0.84, 95% CI -1.18 to -0.50; 5 studies, 251 participants; moderate-quality evidence; large effect size).CBT plus pharmacotherapy versus pharmacotherapy alone: CBT with pharmacotherapy was more effective than pharmacotherapy alone for clinician-reported core symptoms (SMD -0.80, 95% CI -1.31 to -0.30; 2 studies, 65 participants; very low-quality evidence; large effect size), self-reported core symptoms (MD -7.42 points, 95% CI -11.63 points to -3.22 points; 2 studies, 66 participants low-quality evidence) and self-reported inattention (1 study, 35 participants).CBT versus other interventions that included therapeutic ingredients specifically targeted to ADHD: we found a significant difference in favour of CBT for clinician-reported ADHD symptoms (SMD -0.58, 95% CI -0.98 to -0.17; 2 studies, 97 participants; low-quality evidence; moderate effect size) and for self-reported ADHD symptom severity (SMD -0.44, 95% CI -0.88 to -0.01; 4 studies, 156 participants; low-quality evidence; small effect size).Secondary outcomesCBT versus unspecific control conditions: we found differences in favour of CBT compared with waiting-list control for self-reported depression (SMD -0.36, 95% CI -0.60 to -0.11; 5 studies, 258 participants; small effect size) and for self-reported anxiety (SMD -0.45, 95% CI -0.71 to -0.19; 4 studies, 239 participants; small effect size). We also observed differences in favour of CBT for self-reported state anger (1 study, 43 participants) and self-reported self-esteem (1 study 43 participants) compared to waiting list. We found no differences between CBT and supportive therapy (1 study, 81 participants) for self-rated depression, clinician-rated anxiety or self-rated self-esteem. Additionally, there were no differences between CBT and the waiting list for self-reported trait anger (1 study, 43 participants) or self-reported quality of life (SMD 0.21, 95% CI -0.29 to 0.71; 2 studies, 64 participants; small effect size).CBT plus pharmacotherapy versus pharmacotherapy alone: we found differences in favour of CBT plus pharmacotherapy for the Clinical Global Impression score (MD -0.75 points, 95% CI -1.21 points to -0.30 points; 2 studies, 65 participants), self-reported depression (MD -6.09 points, 95% CI -9.55 points to -2.63 points; 2 studies, 66 participants) and self-reported anxiety (SMD -0.58, 95% CI -1.08 to -0.08; 2 studies, 66 participants; moderate effect size). We also observed differences favouring CBT plus pharmacotherapy (1 study, 31 participants) for clinician-reported depression and clinician-reported anxiety.CBT versus other specific interventions: we found no differences for any of the secondary outcomes, such as self-reported depression and anxiety, and findings on self-reported quality of life varied across different studies.
AUTHORS' CONCLUSIONS
There is low-quality evidence that cognitive-behavioural-based treatments may be beneficial for treating adults with ADHD in the short term. Reductions in core symptoms of ADHD were fairly consistent across the different comparisons: in CBT plus pharmacotherapy versus pharmacotherapy alone and in CBT versus waiting list. There is low-quality evidence that CBT may also improve common secondary disturbances in adults with ADHD, such as depression and anxiety. However, the paucity of long-term follow-up data, the heterogeneous nature of the measured outcomes, and the limited geographical location (northern hemisphere and Australia) limit the generalisability of the results. None of the included studies reported severe adverse events, but five participants receiving different modalities of CBT described some type of adverse event, such as distress and anxiety.
Topics: Adult; Anxiety Disorders; Attention Deficit Disorder with Hyperactivity; Cognitive Behavioral Therapy; Depression; Diagnostic Self Evaluation; Humans; Randomized Controlled Trials as Topic; Waiting Lists
PubMed: 29566425
DOI: 10.1002/14651858.CD010840.pub2 -
Frontiers in Psychiatry 2020Climate change is one of the great challenges of our time. The consequences of climate change on exposed biological subjects, as well as on vulnerable societies, are a...
BACKGROUND
Climate change is one of the great challenges of our time. The consequences of climate change on exposed biological subjects, as well as on vulnerable societies, are a concern for the entire scientific community. Rising temperatures, heat waves, floods, tornadoes, hurricanes, droughts, fires, loss of forest, and glaciers, along with disappearance of rivers and desertification, can directly and indirectly cause human pathologies that are physical and mental. However, there is a clear lack in psychiatric studies on mental disorders linked to climate change.
METHODS
Literature available on PubMed, EMBASE, and Cochrane library until end of June 2019 were reviewed. The total number of articles and association reports was 445. From these, 163 were selected. We looked for the association between classical psychiatric disorders such as anxiety schizophrenia, mood disorder and depression, suicide, aggressive behaviors, despair for the loss of usual landscape, and phenomena related to climate change and extreme weather. Review of literature was then divided into specific areas: the course of change in mental health, temperature, water, air pollution, drought, as well as the exposure of certain groups and critical psychological adaptations.
RESULTS
Climate change has an impact on a large part of the population, in different geographical areas and with different types of threats to public health. However, the delay in studies on climate change and mental health consequences is an important aspect. Lack of literature is perhaps due to the complexity and novelty of this issue. It has been shown that climate change acts on mental health with different timing. The phenomenology of the effects of climate change differs greatly-some mental disorders are common and others more specific in relation to atypical climatic conditions. Moreover, climate change also affects different population groups who are directly exposed and more vulnerable in their geographical conditions, as well as a lack of access to resources, information, and protection. Perhaps it is also worth underlining that in some papers the connection between climatic events and mental disorders was described through the introduction of new terms, coined only recently: ecoanxiety, ecoguilt, ecopsychology, ecological grief, solastalgia, biospheric concern, etc.
CONCLUSIONS
The effects of climate change can be direct or indirect, short-term or long-term. Acute events can act through mechanisms similar to that of traumatic stress, leading to well-understood psychopathological patterns. In addition, the consequences of exposure to extreme or prolonged weather-related events can also be delayed, encompassing disorders such as posttraumatic stress, or even transmitted to later generations.
PubMed: 32210846
DOI: 10.3389/fpsyt.2020.00074 -
Schizophrenia Bulletin Nov 2023Impaired social functioning is a major, but under-elucidated area of schizophrenia. It's typically understood as consequential to, eg, negative symptoms, but... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Impaired social functioning is a major, but under-elucidated area of schizophrenia. It's typically understood as consequential to, eg, negative symptoms, but meta-analyses on the subject have not examined psychopathology in a broader perspective and there's severe heterogeneity in outcome measures. To enhance functional recovery from schizophrenia, a more comprehensive understanding of the nature of social functioning in schizophrenia is needed.
STUDY DESIGN
In this systematic review and meta-analysis, we searched PubMed, PsycInfo, and Ovid Embase for studies providing an association between psychopathology and social functioning. Meta-analyses of the regression and correlation coefficients were performed to explore associations between social functioning and psychopathology, as well as associations between their subdomains.
STUDY RESULTS
Thirty-six studies with a total of 4742 patients were included. Overall social functioning was associated with overall psychopathology (95% CI [-0.63; -0.37]), positive symptoms (95% CI [-0.39; -0.25]), negative symptoms (95% CI [-0.61; -0.42]), disorganized symptoms (95% CI [-0.54; -0.14]), depressive symptoms (95% CI [-0.33; -0.11]), and general psychopathology (95% CI [-0.60; -0.43]). There was significant heterogeneity in the results, with I2 ranging from 52% to 92%.
CONCLUSIONS
This is the first systematic review and meta-analysis to comprehensively examine associations between psychopathology and social functioning. The finding that all psychopathological subdomains seem to correlate with social functioning challenges the view that impaired social functioning in schizophrenia is mainly a result of negative symptoms. In line with classical psychopathological literature on schizophrenia, it may be more appropriate to consider impaired social functioning as a manifestation of the disorder itself.
Topics: Humans; Schizophrenia; Social Interaction; Social Adjustment; Psychopathology; Outcome Assessment, Health Care
PubMed: 37260350
DOI: 10.1093/schbul/sbad075 -
European Psychiatry : the Journal of... Apr 2023Psychopathology and side effects of antipsychotic drugs contribute to worsening physical health and long-term disability, and increasing the risk of mortality in these... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Psychopathology and side effects of antipsychotic drugs contribute to worsening physical health and long-term disability, and increasing the risk of mortality in these patients. The efficacy of exercise on these factors is not fully understood, and this lack of knowledge may hamper the routine application of physical activity as part of the clinical care of schizophrenia.
AIMS
To determine the effect of exercise on psychopathology and other clinical markers in patients with schizophrenia. We also looked at several moderators.
METHOD
MEDLINE, Web of Science, Scopus, CINAHL, SPORTDiscus, PsycINFO, and Cochrane Library databases were systematically searched from inception to October 2022. Randomized controlled trials of exercise interventions in patients 18-65 years old diagnosed with schizophrenia disorder were included. A multilevel random-effects meta-analysis was conducted to pool the data. Heterogeneity at each level of the meta-analysis was estimated via Cochran's , , and .
RESULTS
Pooled effect estimates from 28 included studies (1,460 patients) showed that exercise is effective to improve schizophrenia psychopathology (Hedges' = 0.28, [95% CI 0.14, 0.42]). Exercise presented stronger effects in outpatients than inpatients. We also found exercise is effective to improve muscle strength and self-reported disability.
CONCLUSIONS
Our meta-analysis demonstrated that exercise could be an important part in the management and treatment of schizophrenia. Considering the current evidence, aerobic and high-intensity interval training exercises may provide superior benefits over other modalities. However, more studies are warranted to determine the optimal type and dose of exercise to improve clinical outcomes in people with schizophrenia.
Topics: Humans; Adolescent; Young Adult; Adult; Middle Aged; Aged; Schizophrenia; Depression; Exercise; Exercise Therapy; Psychopathology
PubMed: 37096668
DOI: 10.1192/j.eurpsy.2023.24 -
The International Journal of Social... Sep 2023Homeless people present high rates of psychopathology, including personality disorders. Given the link between personality disorders and attachment, and the potential... (Review)
Review
BACKGROUND
Homeless people present high rates of psychopathology, including personality disorders. Given the link between personality disorders and attachment, and the potential importance of these two traits for understanding homeless populations.
AIMS
Our aim was to review all studies focusing on attachment and on the full assessment of personality disorders in the homeless.
METHOD
Overall, 213 studies were screened through title and abstract. Of these, 63 articles were chosen for full-text assessment.
RESULTS
A total of 14 articles met eligibility criteria and were included in the present review. Six studies evaluated personality disorders and eight studies assessed attachment in the homeless. In general, reports suggested that personality disorders are highly common in the homeless, with frequencies ranging between 64% and 79% for any personality disorder. The most common personality diagnoses were paranoid (14%-74%), borderline (6%-62%), avoidant (14%-63%), and antisocial (4%-57%) personality disorders. Attachment reports differed in the methods used and presented diverse results and correlates. Even so, insecure types of attachment dominated in the homeless, accounting for 62% to 100% of the samples.
CONCLUSIONS
The high prevalence of personality disorders and insecure types of attachment in the homeless may impact intervention strategies for these people. The available literature evaluating attachment and the full assessment of personality disorders in the homeless is scarce, which supports the need for more research on these two topics.
Topics: Humans; Personality Disorders; Psychopathology; Ill-Housed Persons; Prevalence; Personality; Borderline Personality Disorder
PubMed: 36951386
DOI: 10.1177/00207640231161201 -
Research Square Jan 2024Sub-optimal response in schizophrenia is frequent, warranting augmentation strategies over treatment-as-usual (TAU).
BACKGROUND
Sub-optimal response in schizophrenia is frequent, warranting augmentation strategies over treatment-as-usual (TAU).
METHODS
We assessed nutraceuticals/phytoceutical augmentation strategies via network meta-analysis. Randomized controlled trials in schizophrenia/schizoaffective disorder were identified via the following databases: PubMed, MEDLINE, EMBASE, Scopus, PsycINFO, CENTRAL, and ClinicalTrials.gov. Change (Standardized Mean Difference=SMD) in total symptomatology and acceptability (Risk Ratio=RR) were co-primary outcomes. Secondary outcomes were positive, negative, cognitive, and depressive symptom changes, general psychopathology, tolerability, and response rates. We conducted subset analyses by disease phase and sensitivity analyses by risk of bias and assessed global/local inconsistency, publication bias, risk of bias, and confidence in the evidence.
RESULTS
The systematic review included 49 records documenting 50 studies (n=2,384) documenting 22 interventions. Citicoline (SMD=-1.05,95%CI=-1.85; -.24), L-lysine (SMD=-1.04,95%CI=-1.84;-.25), N-acetylcysteine (SMD=-.87,95%CI=-1.27;-.47) and sarcosine (SMD=-.5,95%CI=-.87-.13) outperformed placebo for total symptomatology. High heterogeneity (tau=.10, I=55.9%) and global inconsistency (Q=40.79, df=18, p=.002) emerged without publication bias (Egger's test, p=.42). Sarcosine improved negative symptoms (SMD=-.65, 95%CI=-1.10; -.19). N-acetylcysteine improved negative symptoms (SMD=-.90, 95%CI=-1.42; -.39)/general psychopathology (SMD=-.76, 95%CI=-1.39; -.13). No compound improved total symptomatology within acute phase studies (k=7, n=422). Sarcosine (SMD=-1.26,95%CI=-1.91; -.60), citicoline (SMD=-1.05,95%CI=-1.65;-.44), and N-acetylcysteine (SMD=-.55,95%CI=-.92,-.19) outperformed placebo augmentation in clinically stable participants. Sensitivity analyses removing high-risk-of-bias studies confirmed overall findings in all phases and clinically stable samples. In contrast, the acute phase analysis restricted to low risk-of-bias studies showed a superior effect vs. placebo for N-acetylcysteine (SMD=-1.10,95%CI=-1.75,-.45), L-lysine (SMD=-1.05,95%CI=-1.55,-.19), omega-3 fatty acids (SMD=-.83,95%CI=-1.31,-.34) and withania somnifera (SMD=-.71,95%CI=-1.21,-.22). Citicoline (SMD=-1.05,95%CI=-1.86,-.23), L-lysine (SMD=-1.04,95%CI=-1.84,-.24), N-acetylcysteine (SMD=-.89,95%CI=-1.35,-.43) and sarcosine (SMD=-.61,95%CI=-1.02,-.21) outperformed placebo augmentation of TAU ("any phase"). Drop-out due to any cause or adverse events did not differ between nutraceutical/phytoceutical vs. placebo+TAU.
CONCLUSIONS
Sarcosine, citicoline, and N-acetylcysteine are promising augmentation interventions in stable patients with schizophrenia, yet the quality of evidence is low to very low. Further high-quality trials in acute phases/specific outcomes/difficult-to-treat schizophrenia are warranted.
PubMed: 38260297
DOI: 10.21203/rs.3.rs-3787917/v1 -
Biological Psychiatry Global Open... Jul 2022Greenspace exposure is associated with psychological benefits. In this systematic review, we summarized and critically evaluated the literature on the relationship... (Review)
Review
Greenspace exposure is associated with psychological benefits. In this systematic review, we summarized and critically evaluated the literature on the relationship between greenspace exposure (i.e., objective and subjective assessments of interactions with nature) and psychopathology incidence and symptom severity in those with and without a clinical diagnosis. A secondary aim of our review was to examine potential interactions between greenspace exposure and urban environmental features (e.g., pollution, population density) associated with poorer mental health. We identified 40 studies published between January 1, 1981, and July 31, 2020, from PubMed and PsycINFO electronic database search. Although heterogeneous in assessments of greenspace exposure and psychopathology symptom domain, the majority of cross-sectional and longitudinal evidence found that objectively assessed greenspace exposure (e.g., satellite measures of greenery) was related to less severe symptoms and lower incidence of psychopathology in children (e.g., attention-deficit/hyperactivity disorder symptoms) and adults (e.g., depression symptoms). In addition, five studies that assessed urban environmental features suggest that greenspace exposure may show a net positive relationship with psychopathology over and above the absence of urban features. We discuss limitations of the literature and future directions, including more mechanistic work to delineate the potential cognitive, affective, and behavioral factors that may contribute to the beneficial relationship between greenspace exposure and psychological health.
PubMed: 36325036
DOI: 10.1016/j.bpsgos.2022.01.004 -
Children (Basel, Switzerland) Dec 2023This study aimed to determine, through a systematic review, the relationship between Reactive Attachment Disorder (RAD) and the presence of psychopathology in children... (Review)
Review
This study aimed to determine, through a systematic review, the relationship between Reactive Attachment Disorder (RAD) and the presence of psychopathology in children and adolescents, and to determine the existence of differences in terms of internalising and externalising psychological problems between the RAD group and groups with other disorders or with typical development. Following the PRISMA methodology, a search was carried out in the Web of Science, PubMed and Scopus databases. The search yielded 770 results, of which only 25 met the inclusion criteria. The results indicate a relationship between the presence of RAD and/or disinhibited social engagement disorder (DSED), with the presence of internalising and externalising problems. These difficulties are more present in children with RAD compared to children without personal difficulties, or children with DSED, children with autism, children with intellectual disabilities or children with hyperactivity. It can be concluded that the presence of RAD has negative consequences on the mental health of children and adolescents, with these being greater in the inhibited group than in the disinhibited group, and with respect to children with autism or hyperactivity.
PubMed: 38136094
DOI: 10.3390/children10121892 -
Frontiers in Psychiatry 2023Terrorism and violent extremism are major social threats worldwide and are committed not only by men but also by women. Previous research has shown indications of...
INTRODUCTION
Terrorism and violent extremism are major social threats worldwide and are committed not only by men but also by women. Previous research has shown indications of psychopathology, among other personal and contextual factors, as a potential risk factor for perpetrating terrorist and violent extremist crimes. Despite the fact that women have engaged in acts of terrorism and violent extremism throughout history, the vast majority of literature on psychopathology so far has been mainly focused on men with terrorist and violent extremist behavior. As women's engagement in terrorism and violent extremism is increasing, and gender differences in psychopathology in offenders of terrorism or violent extremism may exist based on empirical evidence for such differences in offenders of violence, gender-informed research into psychopathology as a potential risk factor for offending is of pivotal importance for improving the effectiveness of counter-terrorism interventions. The present systematic review was designed to examine what empirical knowledge exists on the presence and potential contributing role of psychopathology in female perpetrators of terrorism or violent extremism.
METHODS
A literature search was conducted to identify primary source studies in PsycINFO, PubMed, Embase, Web of Science, and Sociological Abstracts. ASReview as an artificial intelligence software was used to screen references.
RESULTS
In total, eight studies were included, of which only two studies distinguished prevalence rates and types of psychopathology separately for women, indicating personality disorder as most common. All four out of the eight studies that reported on the relationship between psychopathology and terrorism and violent extremism assumed psychopathology to be a contributing factor in engaging in terrorist or violent extremist acts. However, none of these four studies reported on potentially present female-specific mechanisms of the role of psychopathology in offenses.
DISCUSSION
The present systematic review draws the striking conclusion that there is a lack of clearly described empirical studies on psychopathology in female perpetrators of terrorism and violent extremism and emphasizes the importance of more future empirically based inquiries on this topic by the forensic psychiatric field.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=275354, identifier: CRD42021275354.
PubMed: 37441140
DOI: 10.3389/fpsyt.2023.1123243 -
Journal of Anxiety Disorders Mar 2021This systematic review and meta-analysis aimed to clarify the association between social anxiety and affective (AE) and cognitive empathy (CE). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This systematic review and meta-analysis aimed to clarify the association between social anxiety and affective (AE) and cognitive empathy (CE).
METHODS
1442 studies from PsycINFO, Medline, and EMBASE (inception-January 2020) were systematically reviewed. Included studies (N = 48) either predicted variance in empathy using social anxiety scores or compared empathy scores between socially anxious individuals and a control group.
RESULTS
Social anxiety and AE were statistically significantly positively associated, k = 14, r = .103 (95%CI [.003, .203]), z = 2.03, p = .043. Sex (Q (2) = 18.79, p < .0001), and type of measures (Q (1 = 7.34, p = .007) moderated the association. Correlations were significant for male samples (r = .316, (95%CI [.200, .432])) and studies using self-report measures (r = .162 (95%CI [.070, .254])). Overall, social anxiety and CE were not significantly associated, k = 52, r =-.021 (95%CI [-.075, .034]), z= -0.74, p = .459. Sample type moderated the association (Q (1) = 5.03, p < .0001). For clinical samples the association was negative (r= -.112, (95%CI [-.201, -.017]).
CONCLUSION
There was evidence for a positive association between social anxiety and AE, but future studies are needed to verify the moderating roles of sex and type of measure. Besides, low CE might only hold for patients with SAD.
Topics: Anxiety; Empathy; Fear; Humans; Male; Self Report
PubMed: 33588287
DOI: 10.1016/j.janxdis.2021.102357