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International Journal of Environmental... Aug 2023A systematic review was conducted to assess and synthesize recent research on mental health professionals' attitudes towards trans people. The main objectives of our... (Review)
Review
A systematic review was conducted to assess and synthesize recent research on mental health professionals' attitudes towards trans people. The main objectives of our research were (a) to identify, synthesize, and analyze the scientific evidence available so far about the attitudes of mental health professionals towards the trans community, and (b) to determine the factors related to these professionals' attitudes, paying special attention to psychosocial and cultural aspects. A systematic search was carried out in the following electronic databases: Pubmed, Web of Science, PsycINFO, PsycARTICLES, Gender Studies Database, and Lilacs. A total of 32 articles of quantitative (n = 19), qualitative (n = 11), and mixed (n = 2) design, published up to March 2023, were included. Most studies used a cross-sectional or qualitative design, limiting the possibility of generalizing the results. The studies reviewed indicated mostly positive attitudes among the professionals, depending on their psychosocial characteristics. In line with the results of our review, we recommend that the training of professionals is important to improve their positive attitudes towards transgender and gender diverse people.
Topics: Humans; Mental Health; Cross-Sectional Studies; Health Personnel; Attitude of Health Personnel; Transgender Persons
PubMed: 37569035
DOI: 10.3390/ijerph20156495 -
Harvard Review of Psychiatry• Analyze and compare the different bipolar disorder (BD) types.• Identify markers that distinguish BD types and explain how the DSM-IV defines the disorder. (Meta-Analysis)
Meta-Analysis
LEARNING OBJECTIVES AFTER PARTICIPATING IN THIS CME ACTIVITY, THE PSYCHIATRIST SHOULD BE BETTER ABLE TO
• Analyze and compare the different bipolar disorder (BD) types.• Identify markers that distinguish BD types and explain how the DSM-IV defines the disorder.
ABSTRACT
Since the status of type II bipolar disorder (BD2) as a separate and distinct form of bipolar disorder (BD) remains controversial, we reviewed studies that directly compare BD2 to type I bipolar disorder (BD1). Systematic literature searching yielded 36 reports with head-to-head comparisons involving 52,631 BD1 and 37,363 BD2 patients (total N = 89,994) observed for 14.6 years, regarding 21 factors (with 12 reports/factor). BD2 subjects had significantly more additional psychiatric diagnoses, depressions/year, rapid cycling, family psychiatric history, female sex, and antidepressant treatment, but less treatment with lithium or antipsychotics, fewer hospitalizations or psychotic features, and lower unemployment rates than BD1 subjects. However, the diagnostic groups did not differ significantly in education, onset age, marital status, [hypo]manias/year, risk of suicide attempts, substance use disorders, medical comorbidities, or access to psychotherapy. Heterogeneity in reported comparisons of BD2 and BD1 limits the firmness of some observations, but study findings indicate that the BD types differ substantially by several descriptive and clinical measures and that BD2 remains diagnostically stable over many years. We conclude that BD2 requires better clinical recognition and significantly more research aimed at optimizing its treatment.
Topics: Humans; Female; Bipolar Disorder; Mania; Psychotherapy; Antipsychotic Agents; Diagnostic and Statistical Manual of Mental Disorders
PubMed: 37437249
DOI: 10.1097/HRP.0000000000000371 -
Journal of the Academy of... 2024Othello syndrome (OS) is a condition characterized by a delusion of jealousy that one's spouse is having extramarital affairs. As in the eponymous Shakespearean tragedy,... (Review)
Review
BACKGROUND
Othello syndrome (OS) is a condition characterized by a delusion of jealousy that one's spouse is having extramarital affairs. As in the eponymous Shakespearean tragedy, there is an unfortunate risk of violence. For patients with these symptoms, consultation-liaison psychiatrists may be asked to assist with evaluating the differential diagnosis, assessing safety, and developing treatment options.
OBJECTIVE
This study's objective was to solidify current knowledge of the clinical presentations and management of OS through a systematic review of the literature and description of 2 new cases.
METHODS
We conducted a literature search from the start of relevant databases through August 2023 to identify English language case reports of adults (≥18 years) with OS that described clinical evaluations, biological treatments, and outcomes. We extracted demographics, proposed etiologies, treatment choices and responses, duration of delusions, comorbid psychiatric symptoms, neuro-radiographic findings, and presence of physical violence. We reported clinical findings for 2 new cases.
RESULTS
Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we screened 705 abstracts and conducted full-text reviews of 118 articles to identify 73 cases published from 1983 to 2023 meeting inclusion criteria. The mean age was 58.2 years with male predominance (M:F = 1.88). Etiologies included primary psychiatric disorders (16, 22%), other medical conditions (38, 52%), and medications or other substances (19, 26%). Delusional disorder, cerebrovascular accident, and dopaminergic agonists were the most common etiologies, respectively, in these groups. Antipsychotics were the most common treatment (57, 78%). Symptom remission was reported in 51 (70%) cases. The average duration of OS was 39.5 months. Of 32 cases reporting brain imaging insults, 12 of 20 (60%) showed right-sided lesions, and 8 of 20 (40%) showed left-sided lesions, with 9 of 32 (28%) located in the frontal lobes. The most commonly co-existing psychiatric symptom was depression (14, 19%). Violence was reported in 25 cases (34%). Our 2 new cases were consistent with these findings.
CONCLUSIONS
OS may be a manifestation of several neuropsychiatric conditions, primarily delusional disorder, cerebrovascular accident, Alzheimer's dementia, and the use of dopaminergic agonists. One-third of cases include violent behaviors. It appears to respond to antipsychotic medications, but treatment is delayed more than 3 years on average. Available data have not localized OS to a specific brain region.
Topics: Adult; Humans; Male; Middle Aged; Female; Schizophrenia, Paranoid; Delusions; Dopamine Agonists; Antipsychotic Agents; Stroke
PubMed: 37832650
DOI: 10.1016/j.jaclp.2023.09.006 -
Journal of Affective Disorders Jul 2024Long-term antidepressant (AD) use, much longer than recommended, is very common and can lead to potential harms. (Review)
Review
INTRODUCTION
Long-term antidepressant (AD) use, much longer than recommended, is very common and can lead to potential harms.
OBJECTIVE
To investigate the existing literature on perspectives of health professionals (HPs) regarding long-term AD treatment, focusing on barriers and facilitators to discontinuation.
METHODS
A systematic review with thematic synthesis. Eight electronic databases were searched until August 2023 including MEDLINE, PubMed, Embase, PsycINFO, CINAHL, AMED, Health Management Information Consortium, and the Networked Digital Library of Theses and Dissertation.
RESULTS
Thirteen studies were included in the review. Of these, nine focused on general practitioner perspectives, one on psychiatrist perspectives, and three on a mix of HPs perspectives. Barriers and facilitators to discontinuing long-term ADs emerged within eight themes, ordered chronologically based on HP considerations during an AD review: perception of AD use, fears, HP role and responsibility, HPs' perception of AD discontinuation, HPs' confidence regarding their ability to manage discontinuation, perceived patient readiness to stop, support from patient's trusted people, and support from other HPs.
LIMITATIONS
Coding and development of subthemes and themes was performed by one researcher and further developed through discussion within the research team.
CONCLUSION
Deprescribing long-term ADs is a challenging concept for HPs. The review found evidence that the barriers far outweigh the facilitators with fear of relapse as a main barrier. HP education, reassurance and confidence-building is essential to increase the initiation of the discontinuation process. Further research into the perspectives of pharmacists and mental health workers is needed as well as exploring the role of trusted people.
Topics: Humans; Antidepressive Agents; Attitude of Health Personnel; Health Personnel
PubMed: 38640978
DOI: 10.1016/j.jad.2024.04.060 -
Asia-Pacific Psychiatry : Official... Jun 2021This review aimed to systematically investigate patients' and caregivers' knowledge and beliefs about mental illness in mainland China. A total of 48 eligible studies... (Review)
Review
This review aimed to systematically investigate patients' and caregivers' knowledge and beliefs about mental illness in mainland China. A total of 48 eligible studies (N = 11 895) were retrieved from eight electronic databases. Prevalence statistics were computed for themes (eg, stress) under each construct relating to knowledge or belief about mental illness (eg, beliefs about causes). Effect size r was calculated for each correlation with an identified construct. We found that only 27.8% of patients recognized the symptoms of schizophrenia. Although 65% of caregivers declared that they knew the names of the disorders that their ill relatives had, depression (43.6%), schizophrenia (28.5%) and anxiety disorders (18.1%) had low recognition rates. Both caregivers and patients preferred psychosocial explanations of mental illness. Pharmacological interventions (eg, antipsychotics), non-specific actives (eg, "getting out and learning more"), mental health professionals (eg, psychiatrists) and informal support (eg, family) were each considered helpful for different disorders by caregivers, whereas regular contact with mental health professionals was not highly rated as helpful by patients. Additionally, while more patients knew about the effects of the medications that they were taking, more caregivers emphasized the importance of medicine adherence. Psychosocial variables (eg, family burden) demonstrated significant effects on both groups' mental health literacy. The government should invest more in supporting caregivers of people with mental disorders and monitor the implementation of mental health policies.
Topics: Anxiety Disorders; Caregivers; China; Humans; Mental Disorders; Mental Health; Schizophrenia
PubMed: 32935477
DOI: 10.1111/appy.12423 -
The Lancet. Psychiatry Nov 2023Self-binding directives (SBDs) are an ethically controversial type of advance decision making involving advance requests for involuntary treatment. This study... (Review)
Review
Self-binding directives (SBDs) are an ethically controversial type of advance decision making involving advance requests for involuntary treatment. This study systematically reviewed the academic literature on psychiatric SBDs to elucidate reasons for and against their use in psychiatric practice. Full-text articles were thematically analysed within the international, interdisciplinary authorship team to produce a hierarchy of reasons. We found 50 eligible articles. Reasons for SBD use were promoting service user autonomy, promoting wellbeing and reducing harm, improving relationships, justifying coercion, stakeholder support, and reducing coercion. Reasons against SBD use were diminishing service user autonomy, unmanageable implementation problems, difficulties with assessing mental capacity, challenging personal identity, legislative issues, and causing harm. A secondary finding was a clarified concept of capacity-sensitive SBDs. Future pilot implementation projects that operationalise the clarified definition of capacity-sensitive SBDs with safeguards around informed consent, capacity assessment, support for drafting, and independent review are required.
PubMed: 37714174
DOI: 10.1016/S2215-0366(23)00221-3 -
Implementation Science : IS Jul 2022Many strategies aimed at deprescribing benzodiazepine receptor agonists (BZRA) in older adults have already been evaluated with various success rates. There is so far no... (Review)
Review
Barriers and enablers for deprescribing benzodiazepine receptor agonists in older adults: a systematic review of qualitative and quantitative studies using the theoretical domains framework.
BACKGROUND
Many strategies aimed at deprescribing benzodiazepine receptor agonists (BZRA) in older adults have already been evaluated with various success rates. There is so far no consensus on which strategy components increase deprescribing the most. Yet, despite an unfavourable benefit-to-risk ratio, BZRA use among older adults remains high. We systematically reviewed barriers and enablers for BZRA deprescribing in older adults.
METHODS
Two reviewers independently screened records identified from five electronic databases-Medline, Embase, PsycINFO, CINAHL and the Cochrane library-and published before October 2020. They searched for grey literature using Google Scholar. Qualitative and quantitative records reporting data on the attitudes of older adults, caregivers and healthcare providers towards BZRA deprescribing were included. Populations at the end of life or with specific psychiatric illness, except for dementia, were excluded. The two reviewers independently assessed the quality of the included studies using the mixed-methods appraisal tool. Barriers and enablers were identified and then coded into domains of the theoretical domains framework (TDF) using a combination of deductive and inductive qualitative analysis. The most relevant TDF domains for BZRA deprescribing were then identified.
RESULTS
Twenty-three studies were included 13 quantitative, 8 qualitative and 2 mixed-method studies. The points of view of older adults, general practitioners and nurses were reported in 19, 9 and 3 records, respectively. We identified barriers and enablers in the majority of TDF domains and in two additional themes: "patient characteristics" and "BZRA prescribing patterns". Overall, the most relevant TDF domains were "beliefs about capabilities", "beliefs about consequences", "environmental context and resources", "intention", "goals", "social influences", "memory, attention and decision processes". Perceived barriers and enablers within domains differed across settings and across stakeholders.
CONCLUSION
The relevant TDF domains we identified can now be linked to behavioural change techniques to help in the design of future strategies and health policies. Future studies should also assess barriers and enablers perceived by under-evaluated stakeholders (such as pharmacists, psychiatrists and health care professionals in the hospital setting).
TRIAL REGISTRATION
This work was registered on PROSPERO under the title "Barriers and enablers to benzodiazepine receptor agonists deprescribing".
REGISTRATION NUMBER
CRD42020213035.
Topics: Aged; Deprescriptions; General Practitioners; Humans; Intention; Pharmacists; Qualitative Research; Receptors, GABA-A
PubMed: 35804428
DOI: 10.1186/s13012-022-01206-7 -
Journal of Clinical PsychopharmacologyClozapine is a very effective therapeutic option for schizophrenic disorders that have been refractory to most other therapies. This extremely positive aspect clashes...
BACKGROUND
Clozapine is a very effective therapeutic option for schizophrenic disorders that have been refractory to most other therapies. This extremely positive aspect clashes easily with an adverse effect of the drug that is deemed to be a very dangerous one: agranulocytosis. We asked whether the mandatory strict hematological follow-up prescribed in the black box warning of clozapine's label is proportioned to the actual incidence of agranulocytosis, considering that is the main reason that such a drug is often used only late in the treatment course.
METHODS
We carried out a systematic review of reports examining clozapine administration and agranulocytosis incidence. We specifically selected those where mild and moderate neutropenia was not used as a trigger to stop administration of clozapine, to better estimate the sheer incidence of agranulocytosis when clozapine was continued even with mild hematological effect, where detected. We used PubMed, MEDLINE, EMBASE, Cochrane, and ScienceDirect databases to identify clinical studies conducted between January 1975 and April 2023.
RESULTS
We included 14 studies, mostly retrospective ones, that examined the incidence of hematological adverse effects in patients using clozapine. A total of 2354 subjects were included. The mean age of the subjects was 33.5 years. The mean duration of observation of subjects who took clozapine was 800 days, with a mean daily dose of 319.5 mg per day. Of the 2354 subjects examined, we found that 11 of them experienced agranulocytosis (0.47%).
CONCLUSIONS
These results suggest the evidence of a lower incidence of agranulocytosis than previously estimated and are in line with more recent meta-analyses. We may therefore think that clinical practice may demand a revision of the approach that both psychiatrists and supervising organizations often take when talking about clozapine.
Topics: Humans; Adult; Clozapine; Antipsychotic Agents; Retrospective Studies; Agranulocytosis; Neutropenia; Schizophrenia
PubMed: 37930206
DOI: 10.1097/JCP.0000000000001765 -
Journal of Traumatic Stress Oct 2022Previous research suggests that the effect of therapist factors on patient outcomes is significant. Yet, to date, no reviews have explored the potential effects of... (Meta-Analysis)
Meta-Analysis
Associations between therapist factors and treatment efficacy in randomized controlled trials of trauma-focused cognitive behavioral therapy for children and youth: A systematic review and meta-analysis.
Previous research suggests that the effect of therapist factors on patient outcomes is significant. Yet, to date, no reviews have explored the potential effects of therapist characteristics on treatment outcomes for children and youth with posttraumatic stress disorder (PTSD). This systematic review and meta-analysis aimed to summarize the professional characteristics of trial therapists delivering trauma-focused cognitive behavioral interventions (TF-CBT) for child PTSD in clinical trials and understand the association between treatment efficacy and therapist factors. Systematic searches for randomized controlled trials (RCTs) published through November 3, 2020, were conducted; 40 RCTs were included in the full review. PTSD treatment outcome data were extracted from each publication along with any available data regarding trial therapists. Subgroup analyses were conducted to compare the outcomes of interventions conducted by different types of therapists. All therapist groups yielded significant effects for TF-CBT relative to active and passive control conditions, with the largest effect size, Hedges' g = -1.11, for RCTs that used clinical psychologists and psychiatrists. A significant moderating effect was found when comparing the treatment outcomes of clinical psychologists and psychiatrists versus other professionals, p = .044; however, this effect was no longer apparent when only studies with an active control arm were included. Further moderator analyses demonstrated no significant differences regarding therapists' educational and professional backgrounds and PTSD treatment outcomes. The current RCT evidence for TF-CBT for children and youth with PTSD does not suggest that therapist educational or professional background influences treatment efficacy. Limitations and implications for future research are discussed.
Topics: Adolescent; Child; Cognitive Behavioral Therapy; Humans; Randomized Controlled Trials as Topic; Stress Disorders, Post-Traumatic; Treatment Outcome
PubMed: 35478465
DOI: 10.1002/jts.22840 -
Neuroscience and Biobehavioral Reviews Jan 2023Inborn errors of metabolism (IEMs) are characterized by deficits in metabolic enzymes as a result of an inherited disease, leading to the accumulation or decreased... (Review)
Review
Inborn errors of metabolism (IEMs) are characterized by deficits in metabolic enzymes as a result of an inherited disease, leading to the accumulation or decreased excretion of proteins, carbohydrates and lipids. Although IEMs are often diagnosed during childhood, adolescent and adult onset variants may be accompanied by less somatic and more psychiatric manifestations, which often hampers recognition by psychiatrists of the distinction between a primary and secondary psychiatric disorder. To help clinicians in the diagnostic process, we aimed to provide an overview of psychiatric manifestations in IEMs. Our literature search yielded 4380 records in total, of which 88 studies were included in the qualitative synthesis. Reported psychiatric disorders in adolescent and adult IEMs included depression, anxiety disorder, psychosis, attention deficit hyperactivity disorder, autism spectrum disorder, bipolar disorder and obsessive-compulsive disorder as assessed by semi-structured diagnostic interviews and validated questionnaires. A diagnostic screener and multidisciplinary IEM clinics are proposed to help clinicians during the diagnostic process, to prevent diagnostic delay and to raise awareness of the psychiatric manifestations among IEMs.
Topics: Adult; Adolescent; Humans; Metabolism, Inborn Errors; Autism Spectrum Disorder; Delayed Diagnosis; Psychotic Disorders; Bipolar Disorder
PubMed: 36436739
DOI: 10.1016/j.neubiorev.2022.104970