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L'Encephale Mar 2024Dissociation is a psychological process in reaction to threat which can be found in many psychiatric conditions. Dissociative symptoms can become very disabling, whether...
INTRODUCTION
Dissociation is a psychological process in reaction to threat which can be found in many psychiatric conditions. Dissociative symptoms can become very disabling, whether in daily life or in care. Nevertheless, few studies seem to have examined the efficacy of psychotherapy on the latter and its relevance as a therapeutic target.
METHOD
A systematic review of the literature (PRISMA) on the efficacy of psychotherapy on dissociative symptoms in adults with mental disorders was conducted. Effectiveness was considered in terms of reduction in dissociative symptomatology. The search was conducted on Scopus, PubMed and PsycInfo. Overall, 50 full-text articles were evaluated.
RESULTS
Fourteen studies were included in the review. In all, 711 adult subjects with post-traumatic stress disorder, borderline personality disorder or dissociative disorder were included. Overall, this systematic review reports a reduction in dissociative symptoms associated with a variety of psychotherapeutic interventions, without allowing any conclusions to be drawn on the superiority of one psychotherapy over another.
DISCUSSION
The conclusions of this work highlight three possible therapeutic orientations for reducing dissociative symptoms: (i) by reintegrating the dynamic subsystems, (ii) by treating the cognitive processes underlying dissociation, and (iii) by acting on the processes identified as common to the effectiveness of psychotherapy.
PubMed: 38523025
DOI: 10.1016/j.encep.2024.01.001 -
Behavioural Brain Research Aug 2020Esketamine was recently licensed by the US Food and Drug Administration (FDA) and European Drug Agency (EDA) for use in treatment resistant depression (TRD), and further...
Esketamine was recently licensed by the US Food and Drug Administration (FDA) and European Drug Agency (EDA) for use in treatment resistant depression (TRD), and further research indicates ketamine as a possible treatment in other mental health conditions. While the underlying mechanisms remain unclear, it has been hypothesised that ketamine's acute psychoactive effects may be associated with psychiatric treatment efficacy. We systematically reviewed the evidence for this association. The databases Medline, Embase and PsychInfo were searched up to June 2019. Studies were included if they enrolled adults with a psychiatric diagnosis, assessed acute psychoactive effects using a quantitative measure, and reported on the relationship between acute effects and treatment outcome. We included 21 studies, involving 891 patients. Seventeen studies assessed patients with depression (TRD [k = 14]), three assessed substance use disorders, and one assessed social anxiety disorder. Overall, 41 associations were assessed, of which 26 % were significant. The studies reviewed displayed great variability in terms of methodology and quality of reporting. The most commonly assessed effect was dissociation, measured by the CADSS. Our results suggest that the CADSS total is not consistently associated with antidepressant outcomes. Apart from this, the current literature is too limited to draw definite conclusions on the presence of an association between acute psychoactive effects and mental health outcomes. The field would benefit from consistently employing a priori hypotheses, more transparent reporting and sufficiently powered statistical analyses. Furthermore, the use of a broader range of assessments tools of acute psychoactive effects during ketamine administration would be beneficial.
Topics: Adult; Antidepressive Agents; Depressive Disorder, Major; Depressive Disorder, Treatment-Resistant; Female; Humans; Ketamine; Male; Mental Disorders; Mental Health; Middle Aged; Psychotropic Drugs; Substance-Related Disorders; Treatment Outcome
PubMed: 32485203
DOI: 10.1016/j.bbr.2020.112629 -
Seizure Jul 2024Psychological interventions are the most recommended treatment for functional/dissociative seizures (FDS); however, there is ongoing uncertainty about their... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Psychological interventions are the most recommended treatment for functional/dissociative seizures (FDS); however, there is ongoing uncertainty about their effectiveness on seizure outcomes.
METHODS
This systematic review and meta-analysis synthesises the available data. In February 2023, we completed a systematic search of four electronic databases. We described the range of seizure-related outcomes captured, used meta-analytic methods to analyse data collected during treatment and follow-up; and explored sources of heterogeneity between outcomes.
RESULTS
Overall, 44 relevant studies were identified involving 1,300 patients. Most were categorised as being at high (39.5 %) or medium (41.9 %) risk of bias. Seizure frequency was examined in all but one study; seizure intensity, severity or bothersomeness in ten; and seizure duration and cluster in one study each. Meta-analyses could be performed on seizure freedom and seizure reduction. A pooled estimate for seizure freedom at the end of treatment was 40 %, while for follow-up it was 36 %. Pooled rates for ≥50 % improvement in seizure frequency were 66 % and 75 %. None of the included moderator variables for seizure freedom were significant. At the group level, seizure frequency improved during the treatment phase with a moderate pooled effect size (d = 0.53). FDS frequency reduced by a median of 6.5 seizures per month. There was also evidence of improvement of the other (non-frequency) seizure-related measures with psychological therapy, but data were insufficient for meta-analysis.
CONCLUSIONS
The findings of this study complement a previous meta-analysis describing psychological treatment-associated improvements in non-seizure-related outcomes. Further research on the most appropriate FDS-severity measure is needed.
Topics: Adult; Humans; Dissociative Disorders; Psychotherapy; Seizures; Treatment Outcome
PubMed: 38824867
DOI: 10.1016/j.seizure.2024.05.016 -
The Journal of Nervous and Mental... Feb 2024Traffic accidents put tremendous burdens on the psychosocial aspects of communities. Post-traumatic stress disorder (PTSD), after an accident, is one of the most...
Traffic accidents put tremendous burdens on the psychosocial aspects of communities. Post-traumatic stress disorder (PTSD), after an accident, is one of the most prevalent and incapacitating psychiatric conditions worldwide. In this systematic review, we aimed to investigate the predictors of PTSD in traffic accident victims. Primary search was conducted in November 2021 and updated in 2023. Studies were excluded if they used any analysis except regression for predictors. Cumulatively, primary and update searches retrieved 10,392 articles from databases, and of these, 87 studies were systematically reviewed. The predictors were categorized into sociodemographics, pretrauma, peritrauma, and post-trauma factors. The PTSD assessment time varied between 2 weeks and 3 years. Being a woman, having depression and having a history of road traffic accidents pretraumatically, peritraumatic dissociative experiences, acute stress disorder diagnosis, rumination, higher injury severity, and involvement in litigation or compensation after the trauma were significant predictors of PTSD.
Topics: Female; Humans; Stress Disorders, Post-Traumatic; Accidents, Traffic; Stress Disorders, Traumatic, Acute; Survivors; Dissociative Disorders
PubMed: 38290103
DOI: 10.1097/NMD.0000000000001739 -
Medicina (Kaunas, Lithuania) Feb 2020The current psychopharmacological treatment approaches for major depression focus on monoaminergic interventions, which are ineffective in a large proportion of... (Meta-Analysis)
Meta-Analysis
Safety and Tolerability of Ketamine Use in Treatment-Resistant Bipolar Depression Patients with Regard to Central Nervous System Symptomatology: Literature Review and Analysis.
The current psychopharmacological treatment approaches for major depression focus on monoaminergic interventions, which are ineffective in a large proportion of patients. Globally, treatment-resistant bipolar depression (TRBD) affects up to 33% of depressive patients receiving treatment. Certain needs are still unmet and require new approaches. Many studies are in favor of treatments with ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, even in single use, whose effects emerge in minutes to hours post administration. However, little data are available on ketamine performance in TRBD patients with somatic comorbidities, including highly prevalent ones, i.e., cardiovascular disease (heart failure, hypertension, post-myocardial infarct, arrhythmias, etc.) diabetes, and obesity, and depression-associated comorbidities such as stroke, epilepsy, as well as in the elderly population. The literature shows that treatment with ketamine is efficacious and safe, and the majority of adverse drug reactions are mild and tend to mostly disappear within 30 min to 2 h of ketamine administration.
Topics: Administration, Intravenous; Administration, Oral; Antidepressive Agents; Bipolar Disorder; Comorbidity; Depressive Disorder, Major; Depressive Disorder, Treatment-Resistant; Dissociative Disorders; Humans; Ketamine
PubMed: 32050466
DOI: 10.3390/medicina56020067