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Evidence-based Psychiatry

Lisa Hochstrasser, Alexander Voulgaris, Julian Möller, Tatjana Zimmermann, Regine Steinauer, Stefan Borgwardt, Undine E Lang, Christian G Huber
Background: Implementing an open door policy is a complex intervention comprising changes in therapeutic stance, team processes, and a change from locked to open doors. Recent studies show that it can lead to a reduction of seclusion and forced medication, but the role of the physical change of door status is still unclear. Aims: The aims of this study is to examine the transition from closed to predominantly open doors on a psychiatric intensive care unit (PICU) and its associations with the frequency of seclusion and forced medication...
2018: Frontiers in Psychiatry
Timothy C Bates, Brion S Maher, Sarah E Medland, Kerrie McAloney, Margaret J Wright, Narelle K Hansell, Kenneth S Kendler, Nicholas G Martin, Nathan A Gillespie
Research on environmental and genetic pathways to complex traits such as educational attainment (EA) is confounded by uncertainty over whether correlations reflect effects of transmitted parental genes, causal family environments, or some, possibly interactive, mixture of both. Thus, an aggregate of thousands of alleles associated with EA (a polygenic risk score; PRS) may tap parental behaviors and home environments promoting EA in the offspring. New methods for unpicking and determining these causal pathways are required...
March 13, 2018: Twin Research and Human Genetics: the Official Journal of the International Society for Twin Studies
J Steiner, H Prüß, S Köhler, A Hasan, P Falkai
Despite intensive research, a precise cause of schizophrenic and schizoaffective disorders has not yet been identified. Therefore, psychiatric diagnoses are still made based on clinical ICD-10/DSM‑5 criteria and not on any objective markers; however, various causes or pathophysiological processes may ultimately lead to similar symptoms. An important task for the future of psychiatry is to identify disease subtypes with a distinct pathophysiology to develop more specific and causally acting therapies. A new diagnostic entity has become established in clinical neurology and psychiatry in recent years: autoimmune encephalitis with psychotic symptoms caused by specific antineuronal antibodies has been identified as a rare but potentially treatable cause of psychotic disorders; however, these inflammatory brain diseases are not reliably detected by routine psychiatric diagnostics...
March 9, 2018: Der Nervenarzt
F Mathy, A Malchair
In line with Evidence-based medicine and more recently with the emergence of Evidence-based practice in psychology, what are the current trends in medical prescriptions in child psychiatry? The use of psychotropic drugs for children and adolescents is constantly increasing, although most pharmacological prescriptions in child psychiatry result in off-label drug use. This article aims at understanding the legal and scientific framework that regulates the prescription of psychopharmacological treatments for children and adolescents...
February 2018: Revue Médicale de Liège
R Mezzina
AIM: Italy pioneered deinstitutionalisation over the past 60 years and enforced a famous mental health (MH) reform law in 1978. Deinstitutionalisation has been completed with the very closure of all psychiatric hospitals over two decades. METHODS: After 40 years of implementation, this article presents the main achievements and challenges of the Italian MH reform law, including its long-term effect and impact in Italy and abroad. RESULTS: The Legislation of 1978 was based on the discovery of rights as a key tool in mental healthcare...
March 6, 2018: Epidemiology and Psychiatric Sciences
Anne-Laure Lemaitre, Gilles Lafargue, Hugues Duffau, Guillaume Herbet
A growing body of evidence suggests that individuals with pronounced schizotypal traits also display particular neurophysiological and morphological features - notably with regard to left frontotemporal connectivity. However, the studies published to date have focused on subclinical subjects and psychiatric patients, rather than brain-damaged patients. Here, we used the French version of the Schizotypal Personality Questionnaire to assess schizotypal traits in a sample of 97 patients having undergone surgical resection of a diffuse low-grade glioma...
February 27, 2018: Schizophrenia Research
Mohammed D Saleem
Rosacea is one of the most common and misunderstood dermatologic conditions. Currently, rosacea criteria are based on expert opinion; the definition of rosacea is primarily a reflection of opinion that is prone to bias. It has been more than a decade since the initial criteria were created by the National Rosacea Society. Revisiting the criteria and incorporating evidence-based techniques used by rheumatology and psychiatry can improve the validity and reliability of rosacea criteria. Literature from other specialties is reviewed and a method proposed for developing valid criteria...
April 2018: Dermatologic Clinics
Adriani Nikolakopoulou, Dimitris Mavridis, Toshi A Furukawa, Andrea Cipriani, Andrea C Tricco, Sharon E Straus, George C M Siontis, Matthias Egger, Georgia Salanti
OBJECTIVE: To examine whether the continuous updating of networks of prospectively planned randomised controlled trials (RCTs) ("living" network meta-analysis) provides strong evidence against the null hypothesis in comparative effectiveness of medical interventions earlier than the updating of conventional, pairwise meta-analysis. DESIGN: Empirical study of the accumulating evidence about the comparative effectiveness of clinical interventions. DATA SOURCES: Database of network meta-analyses of RCTs identified through searches of Medline, Embase, and the Cochrane Database of Systematic Reviews until 14 April 2015...
February 28, 2018: BMJ: British Medical Journal
Danilo Bzdok, Andreas Meyer-Lindenberg
The nature of mental illness remains a conundrum. Traditional disease categories are increasingly suspected to misrepresent the causes underlying mental disturbance. Yet psychiatrists and investigators now have an unprecedented opportunity to benefit from complex patterns in brain, behavior, and genes using methods from machine learning (e.g., support vector machines, modern neural-network algorithms, cross-validation procedures). Combining these analysis techniques with a wealth of data from consortia and repositories has the potential to advance a biologically grounded redefinition of major psychiatric disorders...
March 2018: Biological Psychiatry: Cognitive Neuroscience and Neuroimaging
Joanne L Gusella, Anna G Campbell, Kristin Lalji
Family-based treatment (FBT) has emerged as a promising approach for medically stable youth with anorexia nervosa (AN). While there is evidence that therapists embrace the core principles of FBT, most face barriers in implementing the model with fidelity. Little research has been conducted to determine whether adhering to the core methods of placing parents in charge are sufficient in restoring weight in youth with AN. This study involved a chart review of youth under 16 years of age, treated by a Canadian tertiary care health centre-based eating disorders team (EDT)...
August 2017: Paediatrics & Child Health
Ali Anwar, Michael D Yingling, Alicia Zhang, Ujjwal Ramtekkar, Ginger E Nicol
As part of a university-based quality improvement project, we aimed to evaluate child psychiatrists' knowledge, skills, attitudes, and practices regarding assessment and treatment of pediatric sleep problems. We developed a nine-question survey of knowledge, skills, attitudes, and practices regarding assessing for and treating sleep complaints in pediatric patients, and administered this survey to child psychiatrists in training and in practice in the state of Missouri. Respondents reported sleep hygiene as the first-line treatment strategy, followed by the use of supplements or over-the-counter remedies...
February 23, 2018: Medical Sciences: Open Access Journal
Gillian Scott, David M Semple
OBJECTIVES: The objective of the survey was to assess confidence in electroconvulsive therapy (ECT) in core psychiatry trainees across Scotland, looking at both theoretical and practical aspects of ECT. METHODS: A link to a 14-item electronic questionnaire was distributed to core trainees via deanery administrators. Most questions were based on the Royal College of Psychiatry's ECT guidelines. RESULTS: A total of 85 responses were analyzed from trainees at all 3 levels of core training and from all health boards across Scotland...
February 7, 2018: Journal of ECT
Shane P Gill, Charles H Kellner
OBJECTIVES: Continuation or maintenance electroconvulsive therapy (ECT) is often provided as a strategy for post-ECT relapse prevention. However, the evidence has been insufficient until recently to produce clear consensus on what best practice maintenance ECT (mECT) should be like in a real world ECT clinical service. The aims of this article are to help fill this gap and to provide a comprehensive set of practical, clinically-based recommendations for ECT clinicians and services. METHODS: A workshop was held at the Royal Australian and New Zealand College of Psychiatry Congress in Adelaide on April 30, 2017...
February 7, 2018: Journal of ECT
Paul Barrett
The European Federation of Psychologists' Associations (EFPA) has issued sets of test standards and guidelines for psychometric test reviews without any attempt to address the critical content of many substantive publications by measurement experts such as Joel Michell. For example, he has argued that the psychometric test-theory which underpins classical and modern IRT psychometrics is "pathological", with the entire profession of psychometricians suffering from a methodological thought disorder. With the advent of new kinds of assessment now being created by the "Next Generation" of psychologists which no longer conform to the item-based, statistical test theory generated last century, a new framework is set out for constructing evidence-bases suitable for these "Next Generation" of assessments, which avoids the illusory beliefs of equal-interval or quantitatively structured psychological attributes...
January 2018: Behavioral Sciences
Alessandro Serretti
Precision medicine is a concept which is recently gaining momentum in all branches of medicine. In particular in psychiatry it is greatly needed given the huge societal costs of psychiatric disorders and given the long time needed to observe benefit from treatments and the response variability. The future will be based on biological determinants, however until such an interesting but still futuristic aim will be reached, at present we may only rely on clinical features to guide our individualized prescription which is currently still frequently based on personal opinion and subjective previous experiences...
February 28, 2018: Clinical Psychopharmacology and Neuroscience: the Official Scientific Journal of the Korean College of Neuropsychopharmacology
Yasmin Busch, Andreas Menke
Major depressive disorder is a common, serious and in some cases, life-threatening condition and affects approximately 350 million people globally. Although there is effective treatment available for it, more than 50% of the patients fail to respond to the first antidepressant they receive. The selection of a distinct treatment is still exclusively based on clinical judgment without incorporating lab-derived objective measures. However, there is growing evidence of biomarkers that it helps to improve diagnostic processes and treatment algorithms...
January 27, 2018: Journal of Neural Transmission
Zahra Fatahi, Zahra Reisi, Gregor Rainer, Abbas Haghparast, Abbas Khani
Despite evidence from psychiatry and psychology clinics pointing to altered cognition and decision making following the consumption of cannabis, the effects of cannabis derivatives are still under dispute and the mechanisms of cannabinoid effects on cognition are not known. In this study, we used effort-based and delay-based decision tasks and showed that ACEA, a potent cannabinoid agonist induced apathetic and impulsive patterns of choice in rats in a dose-dependent manner when locally injected into the anterior cingulate cortex (ACC) and orbitofrontal cortex (OFC), respectively...
January 17, 2018: Neuropharmacology
K W Miskowiak, K E Burdick, A Martinez-Aran, C M Bonnin, C R Bowie, A F Carvalho, P Gallagher, B Lafer, C López-Jaramillo, T Sumiyoshi, R S McIntyre, A Schaffer, R J Porter, S Purdon, I J Torres, L N Yatham, A H Young, L V Kessing, E Vieta
OBJECTIVES: Cognition is a new treatment target to aid functional recovery and enhance quality of life for patients with bipolar disorder. The International Society for Bipolar Disorders (ISBD) Targeting Cognition Task Force aimed to develop consensus-based clinical recommendations on whether, when and how to assess and address cognitive impairment. METHODS: The task force, consisting of 19 international experts from nine countries, discussed the challenges and recommendations in a face-to-face meeting, telephone conference call and email exchanges...
January 18, 2018: Bipolar Disorders
Anna M Wehry, Laura Ramsey, Shane E Dulemba, Sarah A Mossman, Jeffrey R Strawn
Significant advances have been made in the application of pharmacogenomic testing for the treatment of patients with psychiatric disorders. Over the past decade, a number of studies have evaluated the utility of pharmacogenomic testing in pediatric patients with psychiatric disorders. The evidence base for pharmacogenomic testing in youth with depressive and anxiety disorders as well as attention/deficit hyperactivity disorder (ADHD) is reviewed in this article. General pharmacogenomic principles are summarized and functional polymorphisms in P450 enzymes (and associated metabolizer phenotypes), the serotonin transporter promoter polymorphisms, serotonin 2 A receptor genes (e...
January 8, 2018: Current Problems in Pediatric and Adolescent Health Care
Peter Henningsen, Stephan Zipfel, Heribert Sattel, Francis Creed
Functional somatic syndromes (FSS), like irritable bowel syndrome or fibromyalgia and other symptoms reflecting bodily distress, are common in practically all areas of medicine worldwide. Diagnostic and therapeutic approaches to these symptoms and syndromes vary substantially across and within medical specialties from biomedicine to psychiatry. Patients may become frustrated with the lack of effective treatment, doctors may experience these disorders as difficult to treat, and this type of health problem forms an important component of the global burden of disease...
January 6, 2018: Psychotherapy and Psychosomatics
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