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BJPsych Open Mar 2016Light therapy is a known treatment for patients with seasonal affective disorder. However, the efficacy of light therapy in treating patients with non-seasonal... (Review)
Review
BACKGROUND
Light therapy is a known treatment for patients with seasonal affective disorder. However, the efficacy of light therapy in treating patients with non-seasonal depression remains inconclusive.
AIMS
To provide the current state of evidence for efficacy of light therapy in non-seasonal depressive disorders.
METHOD
Systematic review of randomised controlled trials (RCTs) was conducted by searching MEDLINE, EMBASE, PsycINFO, CINAHL, and CENTRAL from their inception to September 2015. Study selection, data abstraction and risk of bias assessment were independently conducted in duplicate. Meta-analyses were performed to provide a summary statistic for the included RCTs. The reporting of this systematic review follows the PRISMA guidelines.
RESULTS
A meta-analysis including 881 participants from 20 RCTs demonstrated a beneficial effect of light therapy in non-seasonal depression (standardised mean difference in depression score -0.41 (95% CI -0.64 to -0.18)). This estimate was associated with significant heterogeneity (=60%, =0.0003) that was not sufficiently explained by subgroup analyses. There was also high risk of bias in the included trials limiting the study interpretation.
CONCLUSIONS
The overall quality of evidence is poor due to high risk of bias and inconsistency. However, considering that light therapy has minimal side-effects and our meta-analysis demonstrated that a significant proportion of patients achieved a clinically significant response, light therapy may be effective for patients with non-seasonal depression and can be a helpful additional therapeutic intervention for depression.
DECLARATION OF INTEREST
None.
COPYRIGHT AND USAGE
© The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
PubMed: 27703764
DOI: 10.1192/bjpo.bp.115.001610 -
PloS One 2015Studies report contrasting results regarding the efficacy and safety of pharmacological, psychological, and combined interventions in psychosis and schizophrenia in... (Meta-Analysis)
Meta-Analysis Review
Efficacy and safety of pharmacological and psychological interventions for the treatment of psychosis and schizophrenia in children, adolescents and young adults: a systematic review and meta-analysis.
BACKGROUND
Studies report contrasting results regarding the efficacy and safety of pharmacological, psychological, and combined interventions in psychosis and schizophrenia in children, adolescents and young adults.
METHODS
Systematic review and meta-analysis. Embase, Medline, PreMedline, PsycINFO, and CENTRAL were searched to July 2013 without restriction to publication status. Randomised trials comparing any pharmacological, psychological, or combined intervention for psychosis and schizophrenia in children, adolescents and young adults were included. Studies were assessed for bias, and GRADE criteria were used to describe the quality of the results.
RESULTS
Twenty-seven trials including 3067 participants were identified. Meta-analyses were performed for 12 comparisons: symptoms, relapse, global state, psychosocial functioning, depression, weight and discontinuation. Low quality evidence demonstrated that antipsychotics have small beneficial effects on psychotic symptoms (SMD = -0.42, 95% CI -0.58 to -0.26), and a medium adverse effect on weight gain (WMD = 1.61, 95% CI 0.61 to 2.60) and discontinuation due to side effects (RR = 2.44, 95% CI, 1.12 to 5.31). There were no trials of psychological treatments in under-18 year olds. There was no evidence of an effect of psychological interventions on psychotic symptoms in an acute episode, or relapse rate, but low quality evidence of a large effect for family plus individual CBT on the number of days to relapse (WMD = 32.25, 95% CI -36.52 to -27.98).
CONCLUSIONS
For children, adolescents and young adults, the balance of risk and benefit of antipsychotics appears less favourable than in adults. Research is needed to establish the potential for psychological treatments, alone and in combination with antipsychotics, in this population.
Topics: Adolescent; Antipsychotic Agents; Child; Humans; Psychotherapy; Psychotic Disorders; Safety; Schizophrenia; Young Adult
PubMed: 25671707
DOI: 10.1371/journal.pone.0117166 -
The Cochrane Database of Systematic... Mar 2023This overview was originally published in 2017, and is being updated in 2022. Chronic pain is typically described as pain on most days for at least three months.... (Review)
Review
BACKGROUND
This overview was originally published in 2017, and is being updated in 2022. Chronic pain is typically described as pain on most days for at least three months. Chronic non-cancer pain (CNCP) is any chronic pain that is not due to a malignancy. Chronic non-cancer pain in adults is a common and complex clinical issue, for which opioids are prescribed by some physicians for pain management. There are concerns that the use of high doses of opioids for CNCP lacks evidence of effectiveness, and may increase the risk of adverse events.
OBJECTIVES
To describe the evidence from Cochrane Reviews and overviews regarding the efficacy and safety of high-dose opioids (defined as 200 mg morphine equivalent or more per day) for CNCP.
METHODS
We identified Cochrane Reviews and overviews by searching the Cochrane Database of Systematic Reviews in The Cochrane Library. The date of the last search was 21 July 2022. Two overview authors independently assessed the search results. We planned to analyse data on any opioid agent used at a high dose for two weeks or more for the treatment of CNCP in adults.
MAIN RESULTS
We did not identify any reviews or overviews that met the inclusion criteria. The excluded reviews largely reflected low doses or titrated doses, where all doses were analysed as a single group; we were unable to extract any data for high-dose use only.
AUTHORS' CONCLUSIONS
There is a critical lack of high-quality evidence, in the form of Cochrane Reviews, about how well high-dose opioids work for the management of CNCP in adults, and regarding the presence and severity of adverse events. No evidence-based argument can be made on the use of high-dose opioids, i.e. 200 mg morphine equivalent or more daily, in clinical practice. Considering that high-dose opioids have been, and are still being used in clinical practice to treat CNCP, knowing about the efficacy and safety of these higher doses is imperative.
Topics: Adult; Humans; Analgesics, Opioid; Chronic Pain; Systematic Reviews as Topic; Morphine; Pain Management
PubMed: 36961252
DOI: 10.1002/14651858.CD012299.pub3 -
The International Journal of Social... Dec 2023Psychosis is a mental disorder that, despite its low prevalence, causes high disease and economic burden. Inadequate knowledge, lack of confidence and stigmatising... (Review)
Review
BACKGROUND
Psychosis is a mental disorder that, despite its low prevalence, causes high disease and economic burden. Inadequate knowledge, lack of confidence and stigmatising attitudes of healthcare professionals (HCPs) may lead to suboptimal care.
AIM
To review the literature exploring HCPs' knowledge, confidence and attitudes in relation to psychosis care.
METHOD
A systematic search was undertaken across three databases (MEDLINE, Embase, PsycINFO) using a search strategy encompassing the concepts: 'healthcare professionals', 'knowledge, attitude, and confidence in care' and 'psychotic illnesses and symptoms' to identify relevant records published from 1st January 2002 to 18th March 2022. Results were screened against predetermined inclusion and exclusion criteria by title and abstract, followed by full text. Data were extracted into tables and synthesised narratively.
RESULTS
Initially, 7,397 studies were identified. Following two-stage screening, 24 studies were eligible for inclusion. Of these studies, 16 explored attitudes, four explored knowledge and attitudes, one explored knowledge, one explored confidence, one explored attitudes and confidence in care and one explored all three constructs. Most HCPs in the included studies demonstrated stigmatising attitudes towards people with psychosis. Furthermore, certain HCPs, including nurses and general practitioners, demonstrated low levels of knowledge, while psychiatrists, occupational therapists, psychologists and nurses had low levels of confidence in caring for people with psychosis. Conversely, positive attitudes were also observed in some HCPs resulting from having acquaintances with lived experience of psychosis. The need for additional education and training to improve HCPs' knowledge and confidence in relation to caring for people living with psychosis was identified.
CONCLUSIONS
Most attitudes identified were negative and stemmed from stigma, while some were positive due to HCPs' compassion and familiarity with psychosis. The level of knowledge and confidence identified were mostly suboptimal, and so further research is required to develop and evaluate tailored interventions to address this gap.
Topics: Humans; Health Personnel; Attitude of Health Personnel; Health Knowledge, Attitudes, Practice; Psychotic Disorders; Social Stigma; General Practitioners
PubMed: 37691420
DOI: 10.1177/00207640231194490 -
BMJ (Clinical Research Ed.) Jun 2003To ascertain patients' views on the benefits of and possible memory loss from electroconvulsive therapy. (Review)
Review
OBJECTIVE
To ascertain patients' views on the benefits of and possible memory loss from electroconvulsive therapy.
DESIGN
Descriptive systematic review.
DATA SOURCES
Psychinfo, Medline, Web of Science, and Social Science Citation Index databases, and bibliographies.
STUDY SELECTION
Articles with patients' views after treatment with electroconvulsive therapy.
DATA EXTRACTION
26 studies carried out by clinicians and nine reports of work undertaken by patients or with the collaboration of patients were identified; 16 studies investigated the perceived benefit of electroconvulsive therapy and seven met criteria for investigating memory loss.
DATA SYNTHESIS
The studies showed heterogeneity. The methods used were associated with levels of perceived benefit. At least one third of patients reported persistent memory loss.
CONCLUSIONS
The current statement for patients from the Royal College of Psychiatrists that over 80% of patients are satisfied with electroconvulsive therapy and that memory loss is not clinically important is unfounded.
Topics: Attitude to Health; Electroconvulsive Therapy; Humans; Memory Disorders; Patient Satisfaction
PubMed: 12816822
DOI: 10.1136/bmj.326.7403.1363 -
BJPsych Open Jan 2017There is limited empirical information on service-level outcome domains and indicators for the large number of people with intellectual disabilities being treated in... (Review)
Review
BACKGROUND
There is limited empirical information on service-level outcome domains and indicators for the large number of people with intellectual disabilities being treated in forensic psychiatric hospitals.
AIMS
This study identified and developed the domains that should be used to measure treatment outcomes for this population.
METHOD
A systematic review of the literature highlighted 60 studies which met eligibility criteria; they were synthesised using content analysis. The findings were refined within a consultation and consensus exercises with carers, patients and experts.
RESULTS
The final framework encompassed three superordinate domains: (a) effectiveness, (b) patient safety and (c) patient and carer experience. Within each of these, further sub-domains emerged from our systematic review and consultation exercises. These included severity of clinical symptoms, offending behaviours, reactive and restrictive interventions, quality of life and patient satisfaction.
CONCLUSIONS
To index recovery, services need to measure treatment outcomes using this framework.
DECLARATION OF INTEREST
None.
COPYRIGHT AND USAGE
© The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY) licence.
PubMed: 28243465
DOI: 10.1192/bjpo.bp.116.003616 -
MedEdPublish (2016) 2018This article was migrated. The article was marked as recommended. :The ability of physicians to practice appropriately is often evaluated by a fitness for duty exam....
This article was migrated. The article was marked as recommended. :The ability of physicians to practice appropriately is often evaluated by a fitness for duty exam. This report reviews the empirical literature on fitness for duty evaluations. : A literature review was performed on PubMed using the terms physician, impairment, burnout, fitness to practice and fitness for duty. At least one percent of physicians are referred each year for possibly serious difficulties. Surgery and its subspecialties and psychiatry may be at higher risk. Variables associated with fitness for duty evaluations include educational, personality, culture and emotional illness. : Risk factors appear to vary between modifiable (training, culture and treatable emotional illness), less modifiable (personality) and likely unmodifiable (specialty). Fitness for duty should be part of the training of all psychiatrists.
PubMed: 38089235
DOI: 10.15694/mep.2018.0000258.1 -
EClinicalMedicine Oct 2022Neuropsychiatric presentations of monkeypox (MPX) infection have not been well characterised, despite evidence of nervous system involvement associated with the related...
BACKGROUND
Neuropsychiatric presentations of monkeypox (MPX) infection have not been well characterised, despite evidence of nervous system involvement associated with the related smallpox infection.
METHODS
In this pre-registered (PROSPERO ID 336649) systematic review and meta-analysis, we searched MEDLINE, EMBASE, PsycINFO, AMED and the preprint server MedRxiv up to 31/05/2022. Any study design of humans infected with MPX that reported a neurological or psychiatric presentation was included. For eligible symptoms, we calculated a pooled prevalence using an inverse variance approach and corresponding 95% confidence intervals. The degree of variability that could be explained by between-study heterogeneity was assessed using the statistic. Risk of bias was assessed with the Newcastle Ottawa Scale and the Joanna Briggs Institute quality assessment tool.
FINDINGS
From 1705 unique studies, we extracted data on 19 eligible studies (1512 participants, 1031 with confirmed infection using CDC criteria or PCR testing) most of which were cohort studies and case series with no control groups. Study quality was generally moderate. Three clinical features were eligible for meta-analysis: seizure 2.7% (95% CI 0.7-10.2%, I 0%), confusion 2.4% (95% CI 1.1-5.2%, I 0%) and encephalitis 2.0% (95% 0.5-8.2%, I 55.8%). Other frequently reported symptoms included myalgia, headache and fatigue, where heterogeneity was too high for estimation of pooled prevalences, possibly as a result of differences in viral clades and study methodology.
INTERPRETATION
There is preliminary evidence for a range of neuropsychiatric presentations including severe neurological complications (encephalitis and seizure) and nonspecific neurological features (confusion, headache and myalgia). There is less evidence regarding the psychiatric presentations or sequelae of MPX. This may warrant surveillance within the current MPX outbreak, with prospective longitudinal studies evaluating the mid- to long-term sequelae of the virus. Robust methods to evaluate the potential causality of MPX with these clinical features are required. More evidence is necessary to explain heterogeneity in prevalence estimates.
FUNDING
UKRI/MRC (MR/V03605X/1), MRC-CSF (MR/V007181/1), MRC/AMED (MR/T028750/1) and the Wellcome Trust (102186/B/13/Z) and (102186/B/13/Z) and UCLH BRC.
PubMed: 36246957
DOI: 10.1016/j.eclinm.2022.101644 -
Canadian Journal of Psychiatry. Revue... Apr 2023Psychiatric disorders and their treatments have the potential to adversely impact driving skills. However, it is unclear to what extent this poses a public health risk... (Review)
Review
OBJECTIVE
Psychiatric disorders and their treatments have the potential to adversely impact driving skills. However, it is unclear to what extent this poses a public health risk by increasing the risk of motor vehicle crashes (MVCs). The aim of this systematic review was to synthesize and critically appraise evidence on the risk of MVC for drivers with psychiatric disorders.
METHOD
We conducted a systematic review of the MVC risk associated with psychiatric disorders using seven databases in November 2019. Two reviewers examined each study and extracted data. The National Heart, Lung, and Blood Institute Quality Assessment tools were used to assess each study's quality of evidence.
RESULTS
We identified 24 studies that met the inclusion criteria, including eight cohort, 10 case-control, and six cross-sectional designs. Quality assessment ratings were "Good" for four studies, "Fair" for 10, and "Poor" for 10. Self-report or questionnaires were used in place of objective measures of either MVC, psychiatric disorder, or both in 12 studies, and only seven adjusted for driving exposure. Fifteen studies reported an increased risk of MVC associated with psychiatric disorders, and nine did not. There was no category of disorder that was consistently associated with increased MVC risk.
CONCLUSION
The available evidence is mixed, not of high quality, and does not support a blanket restriction on drivers with psychiatric disorder. An individualized approach, as recommended by international guidelines, should continue. Further research should include objective assessments of psychiatric disorders and MVC risk and adjust for driving exposure.
Topics: Humans; Accidents, Traffic; Automobile Driving; Cross-Sectional Studies; Mental Disorders; Motor Vehicles; Cohort Studies; Case-Control Studies; Risk Assessment; Mood Disorders; Anxiety Disorders
PubMed: 36198019
DOI: 10.1177/07067437221128468 -
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