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Psychiatry Research Aug 2011Although fairly frequent in psychiatric in-patient, episodes of aggression/violence are mainly limited to verbal aggression, but the level of general health is... (Review)
Review
Although fairly frequent in psychiatric in-patient, episodes of aggression/violence are mainly limited to verbal aggression, but the level of general health is significantly lower in nurses who report 'frequent' exposure to violent incidents, and there is disagreement between patients and staff concerning predictors of these episodes. We searched the Pubmed, Embase and PsychInfo databases for English, Italian, French or German language papers published between 1 January 1990 and 31 March 2010 using the key words "aggress*" (aggression or aggressive) "violen*" (violence or violent) and "in-patient" or "psychiatric wards", and the inclusion criterion of an adult population (excluding all studies of selected samples such as a specific psychiatric diagnosis other than psychosis, adolescents or the elderly, men/women only, personality disorders and mental retardation). The variables that were most frequently associated with aggression or violence in the 66 identified studies of unselected psychiatric populations were the existence of previous episodes, the presence of impulsiveness/hostility, a longer period of hospitalisation, non-voluntary admission, and aggressor and victim of the same gender; weaker evidence indicated alcohol/drug misuse, a diagnosis of psychosis, a younger age and the risk of suicide. Alcohol/drug misuse, hostility, paranoid thoughts and acute psychosis were the factors most frequently involved in 12 studies of psychotic patients. Harmony among staff (a good working climate) seems to be more useful in preventing aggression than some of the other strategies used in psychiatric wards, such as the presence of male nurses.
Topics: Aggression; Databases, Factual; Female; Hospitals, Psychiatric; Humans; Inpatients; Male; Mental Disorders
PubMed: 21236497
DOI: 10.1016/j.psychres.2010.12.024 -
JMIR Serious Games Nov 2018Although traditional forms of therapy for anxiety-related disorders (eg, cognitive behavioral therapy, CBT) have been effective, there have been long-standing issues... (Review)
Review
BACKGROUND
Although traditional forms of therapy for anxiety-related disorders (eg, cognitive behavioral therapy, CBT) have been effective, there have been long-standing issues with these therapies that largely center around the costs and risks associated with the components comprising the therapeutic process. To treat certain types of specific phobias, sessions may need to be held in public, therefore risking patient confidentiality and the occurrence of uncontrollable circumstances (eg, weather and bystander behavior) or additional expenses such as travel to reach a destination. To address these issues, past studies have implemented virtual reality (VR) technologies for virtual reality exposure therapy (VRET) to provide an immersive, interactive experience that can be conducted privately and inexpensively. The versatility of VR allows various environments and scenarios to be generated while giving therapists control over variables that would otherwise be impossible in a natural setting. Although the outcomes from these studies have been generally positive despite the limitations of legacy VR systems, it is necessary to review these studies to identify how modern VR systems can and should improve to treat disorders in which anxiety is a key symptom, including specific phobias, posttraumatic stress disorder and acute stress disorder, generalized anxiety disorder, and paranoid ideations.
OBJECTIVE
The aim of this review was to establish the efficacy of VR-based treatment for anxiety-related disorders as well as to outline how modern VR systems need to address the shortcomings of legacy VR systems.
METHODS
A systematic search was conducted for any VR-related, peer-reviewed articles focused on the treatment or assessment of anxiety-based disorders published before August 31, 2017, within the ProQuest Central, PsycINFO, and PsycARTICLES databases. References from these articles were also evaluated.
RESULTS
A total of 49 studies met the inclusion criteria from an initial pool of 2419 studies. These studies were a mix of case studies focused solely on VRET, experimental studies comparing the efficacy of VRET with various forms of CBT (eg, in vivo exposure, imaginal exposure, and exposure group therapy), and studies evaluating the usefulness of VR technology as a diagnostic tool for paranoid ideations. The majority of studies reported positive findings in favor of VRET despite the VR technology's limitations.
CONCLUSIONS
Although past studies have demonstrated promising and emerging efficacy for the use of VR as a treatment and diagnostic tool for anxiety-related disorders, it is clear that VR technology as a whole needs to improve to provide a completely immersive and interactive experience that is capable of blurring the lines between the real and virtual world.
PubMed: 30404770
DOI: 10.2196/10965 -
Neuroscience and Biobehavioral Reviews Apr 2020Clozapine (CLZ) is prescribed to (relatively) treatment-resistant patients with schizophrenia spectrum disorders. Currently, it is unknown what factors predict response... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Clozapine (CLZ) is prescribed to (relatively) treatment-resistant patients with schizophrenia spectrum disorders. Currently, it is unknown what factors predict response to CLZ. Therefore, we performed meta-analyses to identify predictors of CLZ response, hence aiming to facilitate timely and efficient prescribing of CLZ.
METHODS
A systematic search was performed in 'Pubmed' and 'Embase' until 1 January 2019. Articles were eligible if they provided data on predictors of CLZ response measured demographic and clinical factors at baseline or biochemical factors at follow-up in schizophrenia spectrum disorder patients.
RESULTS
A total of 34 articles, total number of participants = 9386; N unique = 2094, were eligible. Factors significantly associated with better CLZ response were: lower age, lower PANSS negative score and paranoid schizophrenia subtype.
CONCLUSION
The results of our meta-analyses suggest that three baseline demographic and clinical features are associated with better clozapine response, i.e. relatively young age, few negative symptoms and paranoid schizophrenia subtype. These variables may be taken into account by clinicians who consider treating a specific patient with CLZ.
Topics: Antipsychotic Agents; Clozapine; Humans; Outcome Assessment, Health Care; Schizophrenia
PubMed: 31982601
DOI: 10.1016/j.neubiorev.2020.01.017 -
Psychiatry Research Feb 2020Existing models of Borderline Personality Disorder (BPD) suggest that a combination of genetic vulnerability, childhood trauma, and disrupted attachment can lead to the... (Review)
Review
Existing models of Borderline Personality Disorder (BPD) suggest that a combination of genetic vulnerability, childhood trauma, and disrupted attachment can lead to the marked emotional lability, impulsivity and interpersonal difficulties observed clinically. Brain structural differences in frontal, limbic and hippocampal regions have been reported in BPD. Less clear is how specific psychological factors relate to these structural differences, and how consistently this is found across studies. This was the focus of the present review. Eighteen studies published between 2004 and 2018 met inclusion criteria encompassing 990 participants. Study quality was assessed using the Nottingham-Ottawa Scale. We also introduce a newly devised scale to assess MRI reporting quality. The most frequently investigated psychological variable were impulsivity (9 studies), depression (8), trauma (6), aggression (6), severity of symptoms (3), global functioning, abuse and dissociation (2). Study quality varied, however, a trend was observed where newer studies were higher in reporting quality. Impulsivity demonstrated greater association with frontal structures, trauma related to the hypothalamus and limbic systems, and aggression with hippocampal and frontal structures. The present review recommends greater exploration of neurocognitive and psychosis-related features such as delusions, paranoia and voice-hearing in future studies, and to investigate cortical changes in longitudinal designs.
PubMed: 32163818
DOI: 10.1016/j.psychres.2020.112864 -
International Journal of Mental Health... Aug 2022Previous research has demonstrated significant associations between adverse childhood experiences (ACEs) and risks of psychosis. Further research has examined underlying... (Review)
Review
Previous research has demonstrated significant associations between adverse childhood experiences (ACEs) and risks of psychosis. Further research has examined underlying mechanisms to understand the relationship between these variables. This review aimed to explore the associations between various ACEs and the development of different psychotic symptoms in adulthood. The Cochrane Library, Cinahl, PsychINFO, Medline, Embase, and Web of Science were searched from January 1980 to November 2021 to ensure a systematic review of relevant literature. Poverty, fostering, adoption, childhood emotional and physical neglect, and childhood physical (CPA), sexual (CSA), and emotional abuse (CEA) significantly correlated with delusions. Significant relationships were found between hallucinations and CSA and CPA. Paranoia correlated with violent adversities including CPA, assault, and witnessing killing. Limited associations were identified for thought disorder and negative symptoms. The findings of this review indicate that there may be a degree of specificity between various ACEs and psychotic symptoms, but these findings are subject to some limitations. The findings also demonstrate the importance of inquiring about and addressing ACE in clinical practice to develop formulations and treatment plans for individuals with psychosis.
Topics: Adult; Adverse Childhood Experiences; Child; Child Abuse; Hallucinations; Humans; Paranoid Disorders; Psychotic Disorders
PubMed: 35306711
DOI: 10.1111/inm.12992 -
The Cochrane Database of Systematic... Jul 2007The consumption of psychostimulants for non-medical reasons probably occurs because of their euphoriant and psychomotor-stimulating properties. Chronic consumption of... (Review)
Review
BACKGROUND
The consumption of psychostimulants for non-medical reasons probably occurs because of their euphoriant and psychomotor-stimulating properties. Chronic consumption of these agents results in development of stereotyped behaviour, paranoia, and possibly aggressive behaviour. Psychosocial treatments for psychostimulant use disorder are supposed to improve compliance, and to promote abstinence. Evidence from randomised controlled trials in this subject needs to be summarised.
OBJECTIVES
To conduct a systematic review of all RCTs on psychosocial interventions for treating psychostimulant use disorder.
SEARCH STRATEGY
Electronic searches of Cochrane Library, EMBASE, MEDLINE, and LILACS (to may 2006); reference searching; personal communication; conference abstracts; unpublished trials from pharmaceutical industry; book chapters on treatment of psychostimulants abuse/ dependence.
SELECTION CRITERIA
All randomised-controlled trials focusing on psychosocial interventions for treating psychostimulants abuse/ dependence.
DATA COLLECTION AND ANALYSIS
Three authors extracted the data independently and Relative Risks, weighted mean difference and number needed to treat were estimated, when possible. The reviewers assumed that people who died or dropped out had no improvement (intention to treat analysis) and tested the sensitivity of the final results to this assumption.
MAIN RESULTS
Twenty-seven randomised controlled studies (3663 participants) fulfilled inclusion criteria and had data that could be used for at least one of the main comparisons. There was a wide heterogeneity in the interventions evaluated: this did not allow to provide a summary estimate of effect and results cannot be summarised in a clear cut way. The comparisons between different type of Behavioural Interventions showed results in favour of treatments with some form of Contingency management in respect to both reducing drop outs and lowering cocaine use..
AUTHORS' CONCLUSIONS
Overall this review reports little significant behavioural changes with reductions in rates of drug consumption following an intervention. Moreover, with the evidence currently available, there are no data supporting a single treatment approach that is able to comprise the multidimensional facets of addiction patterns and to significantly yield better outcomes to resolve the chronic, relapsing nature of addiction, with all its correlates and consequences.
Topics: Adaptation, Psychological; Adult; Aged; Amphetamine-Related Disorders; Cocaine-Related Disorders; Cognitive Behavioral Therapy; Counseling; Female; Humans; Male; Middle Aged; Psychotherapy; Reinforcement, Psychology; Secondary Prevention; Treatment Outcome
PubMed: 17636713
DOI: 10.1002/14651858.CD003023.pub2 -
International Review of Psychiatry... 2020, also known as shared psychotic disorder, shows intrinsic differences when compared to other psychiatric disorders. Literature about this condition is scanty and...
, also known as shared psychotic disorder, shows intrinsic differences when compared to other psychiatric disorders. Literature about this condition is scanty and findings about its clinical correlates are not univocal. The present systematic review aimed at critically summarizing the existing evidence about , also focussing on psychopathological, diagnostic and treatment features. The electronic databases PUBMED, Web of Science and Scopus were systematically searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Articles reporting original data about socio-demographic, aetiological, clinical, diagnostic and treatment features of , providing information about both primaries and secondaries, were included. Risk of bias was evaluated using the Critical Appraisal Skills Programme (CASP) instruments. The initial search yielded 834 records. After the screening process only 9 papers were deemed eligible for inclusion in the review. emerged to be a heterogeneous condition with a complex etiopathogenesis. The clinical presentation of the disorder included a multi-facet aspect, going beyond the classical description mainly focussed on delusions and possibly explaining conflicting outcomes of different treatments. Diagnostic categories appear to be often reductive and the need for a dimensional approach capable of global reliability emerged.
Topics: Delusions; Humans; Reproducibility of Results; Shared Paranoid Disorder
PubMed: 32363956
DOI: 10.1080/09540261.2020.1756754 -
JNCI Cancer Spectrum Jan 2024How cannabis products are being used by cancer patients and survivors in the United States is poorly understood. This study reviewed observational data to understand the...
BACKGROUND
How cannabis products are being used by cancer patients and survivors in the United States is poorly understood. This study reviewed observational data to understand the modes, patterns, reasons, discontinuation, and adverse experiences of cannabis use.
METHODS
PubMed and PsycINFO database searches were conducted between May 2022 and November 2022. Of the 1162 studies identified, 27 studies met the inclusion criteria. The intercoder agreement was strong (0.81).
RESULTS
The majority (74%) of the studies were cross-sectional in design. Study samples were approximately equal proportions of men and women and majority White participants. The prevalence of cannabis use based on national samples ranged between 4.8% and 22%. The most common modes of cannabis intake were topical application (80%), smoking (73%), vaping (12%), and ingestion of edible products (10%). Younger age, male gender, being a current or former smoker, and higher socioeconomic status were associated with greater likelihood of cannabis use. The main motive for cannabis use was management of symptoms due to cancer or cancer treatment such as pain, nausea, lack of sleep, and anxiety. A majority of the participants across studies reported that cannabis helped reduce these symptoms. Lack of symptom improvement, side effects such as fatigue and paranoia, cost, and social stigma were identified as some of the reasons for discontinuing cannabis use.
CONCLUSIONS
It appears that cannabis may help cancer patients and survivors manage symptoms. However, more longitudinal studies are needed to determine whether positive experiences of cannabis use outweigh adverse experiences over time in this vulnerable population.
Topics: Humans; Male; Female; United States; Cannabis; Nausea; Neoplasms; Analgesics; Survivors; Observational Studies as Topic
PubMed: 38291891
DOI: 10.1093/jncics/pkae004 -
Memory (Hove, England) Mar 2000Patients, when admitted to an intensive care unit (ICU), have one thing in common: their illness is life-threatening. Patients may remain on ICU in a critical condition,... (Review)
Review
Patients, when admitted to an intensive care unit (ICU), have one thing in common: their illness is life-threatening. Patients may remain on ICU in a critical condition, needing support with their breathing, circulation, and/or kidneys for varying lengths of time, from days to weeks. During that time the patients will receive sedative and analgesic drugs to ensure compliance with artificial ventilation. Patients recovering from critical illness frequently have little or no recall of their period in ICU, or remember nightmare, hallucinations, or paranoid delusions. The nature, extent and reason for these difficulties, have been under-reported and consequently our purpose was to conduct a review of memory problems experienced by ICU patients. A systematic literature review of computer databases (Medline, PsycLit, and CINAHL) identified 25 relevant papers. In addition, other relevant articles were obtained, citation lists and associated articles retrieved. Due to lack of research on processes underlying memory problems in ICU patients all articles that introduced an insight into possible mechanisms were included in the review. There seem to be two possible processes contributing to memory problems in ICU patients. First the illness and treatment may have a general dampening effect on memory. Delirium and sleep disturbance are both common in ICU patients. Delirium can result in a profound amnesia for the period of confusion. Sleep deprivation exacerbates the confusional state. Slow wave sleep is important for the consolidation of episodic memories. Treatment administered to patients in ICU can have effects on memory. Opiates, benzodiazepines, sedative drugs such as propofol, adrenaline, and corticosteroids can all influence memory. In addition, the withdrawal of drugs, such as benzodiazepines, can cause profound withdrawal reactions, which may contribute to delirium. Second, we hypothesise that there is a process that affects memory negatively for external events but enhances memory for internal events. The physical constraints and social isolation experienced by ICU patients and the life-threatening nature of the illness may increase the experience of hypnagogic hallucinations. Attentional shift during hypnagogic images from external stimuli to internally generated images would explain why ICU patients have such poor recall of external ICU events, but can clearly remember hallucinations and nightmares. Patients describe these memories as being very vivid and this is explored in terms of flashbulb memory formation. The absence of memories for real events on ICU can result in ICU patients remembering paranoid delusions of staff trying to kill them, with little information to reject these vivid memories as unreal. This has implications for patients' future psychological health.
Topics: Critical Care; Critical Illness; Delirium; Hallucinations; Humans; Memory; Memory Disorders; Sleep Deprivation
PubMed: 10829125
DOI: 10.1080/096582100387632 -
Frontiers in Psychiatry 2022The hierarchy of evidence coming from evidence-based medicine favors meta-analyses and randomized controlled trials over observational studies and clinical cases....
BACKGROUND
The hierarchy of evidence coming from evidence-based medicine favors meta-analyses and randomized controlled trials over observational studies and clinical cases. Nonetheless, in the field of psychiatry, where conditions are much more complex, additional evidence coming from real-world clinical practice is necessary to complement data from these gold standards. Thus, in this systematic review, the aim is to summarize the evidence coming from clinical case reports regarding cariprazine, a third-generation antipsychotic drug that has been approved for the treatment of schizophrenia and bipolar I disorder with manic, depressive or mixed features in adults.
METHODS
A systematic review was performed using Embase and Pubmed databases searching for English-language cases published in peer-reviewed journals between 2000 January and 2021 September with the following search terms: (cariprazin OR "rgh-188" OR rgh188 OR vraylar OR reagila) AND ("case report" OR "case report"/de OR "case stud" OR "case study"/de OR "case seri").
RESULTS
After the removal of duplicates, 49 articles were retrieved via the search, from which 22 were suitable for this review. These 22 articles encompassed 38 cases from which 71% described patients with schizophrenia, 16% patients with psychotic disorders, 5% patients with mood disorder and 8% described patients with other disorders such as Wernicke-Korsakoff syndrome, borderline personality disorder and obsessive-compulsive disorder with paranoid schizophrenia. The median age of patients was 31, and half of them were female. The majority of patients (76%) started cariprazine with 1.5 mg/day, and the most common maintenance dose was 4.5 mg/day (34%) and 3.0 mg/day (29%).
CONCLUSION
Cariprazine was found to be safe and effective in a wide range of psychiatric conditions with different symptom profiles from acute psychotic symptoms through addiction to negative and cognitive symptoms. The results are in-line with the established evidence from clinical trials, however, they also show how cariprazine can be successfully utilized for treating certain symptoms irrespective of the indication.
PubMed: 35370825
DOI: 10.3389/fpsyt.2022.827744