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Journal Cover Evidence-Based Mental Health
  [SJR: 0.217]   [H-I: 17]   [134 followers]  Follow
   Full-text available via subscription Subscription journal
   ISSN (Print) 1362-0347 - ISSN (Online) 1468-960X
   Published by BMJ Publishing Group Homepage  [57 journals]
  • Increased serotonin 1A receptor availability in the raphe nuclei predicts
           future suicidal behaviour
    • Authors: Frick A.
      Abstract: ABSTRACT FROM: Oquendo MA, Galfalvy H, Sullivan GM, et al. Positron emission tomographic imaging of the serotonergic system and prediction of risk and lethality of future suicidal behavior. JAMA Psychiatry 2016;73:1048–55. What is already known on this topic Each year, suicide ends an estimated 800 000 lives worldwide.1 Thus, identifying risk factors of future suicidal behaviour is of great importance. Accumulating evidence for the last 40 years have linked suicide to alterations in the central serotonergic system,2 but prospective studies predicting future suicidal behaviour from brain serotonin measures are lacking. Methods of the study Brain serotonin 1A (n=100) and serotonin transporter (n=50) binding potentials were investigated in vivo in patients with major depressive disorder using positron emission tomography (PET) with the radiotracers [11C]WAY100635 and [11C]DASB, respectively. The patients scored>15 on the Hamilton Depression Rating Scale (17-item), indicating at least moderate severity of depression. All the patients...
      PubDate: 2017-07-27T08:23:37-07:00
      DOI: 10.1136/eb-2017-102650
      Issue No: Vol. 20, No. 3 (2017)
  • Analysis of multisource data establishes wide-ranging antecedents of youth
           suicide in England
    • Authors: Horowitz, L; Bridge, J. A.
      Abstract: ABSTRACT FROM: Rodway C, Tham S, Ibrahim S, et al. Suicide in children and young people in England: a consecutive case series. Lancet Psychiatry 2016;3:751–59. What is already known on this topic Suicide is a leading cause of death among young people worldwide and an international public health concern.1 While research has established common risk factors that may serve as key components of suicide prevention strategies (eg, past suicidal behaviour, psychiatric disorders, substance abuse), little is known about specific antecedents of youth suicide. Knowing what factors precede youth suicide can help frame targets for intervention and identify promising sites for suicide prevention. Methods of the study The authors collected data from the Office for National Statistics about people aged 10–19 years who died by suicide in England or were a resident of England. The researchers took a novel approach in analyzing suicide deaths reported between 1 January...
      PubDate: 2017-07-27T08:23:37-07:00
      DOI: 10.1136/eb-2016-102565
      Issue No: Vol. 20, No. 3 (2017)
  • Childhood comorbidity and parental mental health problems appear to be
           associated with ADHD persistence
    • Authors: Agnew-Blais J.
      Abstract: ABSTRACT FROM: Roy A, Hechtman L, Arnold LE, et al. Childhood factors affecting persistence and desistence of attention-deficit/hyperactivity disorder symptoms in adulthood: results from the MTA. J Am Acad Child Adolesc Psychiatry 2016;55:937–44. What is already known on this topic While many children with attention-deficit hyperactivity disorder (ADHD) will experience remission of the disorder,1 a substantial proportion will continue to have ADHD and associated impairments into adolescence and adulthood.2 Those with persistent ADHD have poorer outcomes later in life in some domains, including more emotional and substance use problems, compared to those whose ADHD remits.3 Previous studies have identified factors such as childhood ADHD severity, comorbidities4 and IQ5 as associated with ADHD persistence. Methods of the study The Multimodal Treatment Study of Children with ADHD (MTA) is one of the largest ADHD treatment studies to date. The original trial assigned...
      PubDate: 2017-07-27T08:23:37-07:00
      DOI: 10.1136/eb-2017-102656
      Issue No: Vol. 20, No. 3 (2017)
  • Subthreshold hypomania affects half of patients with bipolar disorder
           presenting with depressive symptoms
    • Authors: McIntyre R. S.
      Abstract: ABSTRACT FROM: Miller S, Trisha S, Jim M, et al. Mixed depression in bipolar disorder: prevalence rate and clinical correlates during naturalistic follow-up in the stanley bipolar network. Am J Psychiat 2016;173:1015–23. What is already known on this topic It is well established that mixed features are a common presentation in bipolar disorder (BD).1 It is also previously reported that subthreshold depressive symptoms are common during hypomania and differentially affect female patients.2 Moreover, individuals with mixed features are more likely to present with greater illness complexity, higher rates of chronicity and non-recovery, as well as a less favourable course of illness.3 Methods of the study A total of 907 patients with bipolar disorder (BD I n=680, BD II n=187, BD not otherwise specified n=18 or schizoaffective disorder-bipolar type n=22) who were participants in the Stanley Bipolar Network Study were included. Patients were seen monthly...
      PubDate: 2017-07-27T08:23:37-07:00
      DOI: 10.1136/eb-2017-102627
      Issue No: Vol. 20, No. 3 (2017)
  • Structured group psychoeducation in patients with bipolar disorder delays
           time to mania and time to any episode compared with a peer support group
    • Authors: Watson, S; Dodd, A.
      Abstract: ABSTRACT FROM: Morriss R, Lobban F, Riste L, et al. Clinical effectiveness and acceptability of structured group psychoeducation versus optimised unstructured peer support for patients with remitted bipolar disorder (PARADES): a pragmatic, multicentre, observer-blind, randomised controlled superiority trial. Lancet Psychiatry 2016;3:1029–38. What is already known on this topic Based in part on the resource heavy group psychoeducation delivered in Barcelona, the National Institute for Health and Care Excellence (NICE) argue that psychological interventions specifically developed for adults with bipolar disorder improve outcome, and therefore have made a developmental quality standard that patients with bipolar disorder should be offered psychological interventions.1 However, trials of more accessible interventions, for example, with fewer sessions or delivered by psychiatric nurses, have not shown such clear benefit.2 This research aims to determine whether pragmatic group psychoeducation reduces relapse risk in NHS (National Health Service) patients. Methods of...
      PubDate: 2017-07-27T08:23:37-07:00
      DOI: 10.1136/eb-2017-102648
      Issue No: Vol. 20, No. 3 (2017)
  • Spoken language shows some improvement following intervention for children
           with autism: but for which children and why'
    • Authors: Hudry, K; Dimov, S.
      Abstract: ABSTRACT FROM: Hampton LH, Kaiser AP. Intervention effects on spoken-language outcomes for children with autism: a systematic review and meta-analysis. J Intellect Disabil Res 2016;60:444–63. What is already known on this topic Autism is a neurodevelopmental disorder of core social-communication impairment and behavioural inflexibility, often accompanied by delayed language development.1 A key research goal is to understand which interventions are effective, for whom and to what extent. Existing meta-analyses have considered whether particular approaches improve core symptoms, cognitive ability and adaptive behaviour in autism.2 Methods of the study This systematic review and meta-analysis investigated the effects of early behavioural interventions on language outcomes for young children with autism (
      PubDate: 2017-07-27T08:23:37-07:00
      DOI: 10.1136/eb-2016-102435
      Issue No: Vol. 20, No. 3 (2017)
  • Short-term efficacy of psychological and psychopharmacological
           interventions for panic disorder appears not to be different
    • Authors: Hoffart A.
      Abstract: ABSTRACT FROM: Imai H, Tajika A, Chen P, et al. Psychological therapies versus pharmacological interventions for panic disorder with or without agoraphobia in adults. Cochrane Database Syst Rev 2016;10:CD011170. What is already known on this topic The efficacy of psychological treatments for panic disorder — without or with agoraphobia — in comparison with waitlist, psychological placebo or pharmacological placebo controls is well established.1 Also pharmacotherapy has proved to be efficacious compared with placebo.2 However, meta-analyses directly comparing psychological and pharmacological treatments tend to be outdated.3 The aim of this paper was therefore to assess the relative efficacy and acceptability of psychological and pharmacological treatments for panic disorder in adults. Methods of the study The authors searched the Cochrane Common Mental Disorders Group Specialised Register on 11 September 2015. Among psychological treatments, the focus was on cognitive-behavioural, psychodynamic and supportive therapies. The main pharmacotherapies...
      PubDate: 2017-07-27T08:23:37-07:00
      DOI: 10.1136/eb-2017-102626
      Issue No: Vol. 20, No. 3 (2017)
  • No significant difference in long-term remission between psychological
           therapies and antidepressants in panic disorder
    • Authors: Imai, H; Furukawa, T. A.
      Abstract: Dear Editor, We thank Dr Hoffart for his commentary1 on our Cochrane review entitled ‘Psychological therapies versus pharmacological interventions for panic disorder with or without agoraphobia in adults’2 and for pointing out some factual errors of data extraction that we made. We are very happy to correct these errors in the Cochrane Library. Four studies reported long-term outcomes.3–5 There was no significant difference in long-term remission (risk ratio 1.30, 95% CI 0.95 to 1.80; four studies; 314 participants) between all psychological therapies and antidepressants.3–6 We will also correct the proportion of women in the study by Clark et al.7 We will update the review accordingly.Competing interestsNone declared.Provenance and peer reviewNot commissioned; internally peer reviewed.
      PubDate: 2017-07-27T08:23:37-07:00
      DOI: 10.1136/eb-2017-102738
      Issue No: Vol. 20, No. 3 (2017)
  • Social anxiety apps: a systematic review and assessment of app descriptors
           across mobile store platforms
    • Authors: Alyami, M; Giri, B, Alyami, H, Sundram, F.
      Pages: 65 - 70
      Abstract: QuestionThe aim of this systematic review is twofold: (1) to characterise the purpose and description of available social anxiety apps and (2) to review the evidence on the effectiveness of social anxiety apps.Study selection and analysisA search was conducted on three major mobile platforms: Apple iTunes, Google Play and Windows Store. Apps were included if they addressed social anxiety and used an English language interface. A systematic review of the literature from MEDLINE, EMBASE, PsycINFO, Cochrane, Scopus and Web of Science to identify evidence-based evaluations of social anxiety apps was also undertaken.FindingsOf the 1154 apps identified, 38 apps met the inclusion criteria: iTunes (n=18), Google Play (n=16) and Windows Store (n=4). Over 60% of apps were exclusively focused on social anxiety, while the remainder targeted social anxiety and related conditions. Most developers did not provide information on their organisational affiliations or their content source. Most apps used multimedia while 17 apps used text only. Finally, although the systematic review of the literature identified 94 articles, none of which met inclusion criteria.ConclusionsSocial anxiety apps have the potential to overcome barriers to accessing treatment; however, none of the apps identified have had studies on their effectiveness published. As the evidence base is lacking, it is therefore not currently possible to recommend their use.
      Keywords: Editor's choice
      PubDate: 2017-07-27T08:23:37-07:00
      DOI: 10.1136/eb-2017-102664
      Issue No: Vol. 20, No. 3 (2017)
  • Recent advances in understanding and managing body dysmorphic disorder
    • Authors: Krebs, G; Fernandez de la Cruz, L, Mataix-Cols, D.
      Pages: 71 - 75
      Abstract: Body dysmorphic disorder (BDD) is a relatively common and disabling psychiatric disorder characterised by excessive and persistent preoccupation with perceived defects or flaws in one's appearance, which are unnoticeable to others, and associated repetitive behaviours (eg, mirror checking). The disorder generally starts in adolescence, but often goes unnoticed and is severely underdiagnosed. Left untreated, BDD typically persists and causes marked functional impairment in multiple domains. This clinical review considers recent advances in the epidemiology and classification of BDD, including its reclassification in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders under the new ‘Obsessive–Compulsive and Related Disorders’ chapter. Key issues in assessment are outlined including the use of validated screening instruments to minimise misdiagnosis and the importance of risk assessment in this population given the high rates of suicidality and inappropriate use of cosmetic treatments. In addition, current knowledge regarding the causes and mechanisms underlying BDD are summarised. The recommended treatments for BDD are outlined, namely cognitive behavioural therapy (CBT) and antidepressants, such as selective serotonin reuptake inhibitors. Both CBT and pharmacotherapy have been shown to be efficacious treatments for BDD in adult populations, and evidence is emerging to support their use in young people. Although the majority of patients improve with existing evidence-based treatment, a large proportion are left with clinically significant residual symptoms. Priorities for future research are therefore discussed including the need to further refine and evaluate existing interventions with the goal of improving treatment outcomes and to increase their availability.
      Keywords: Open access
      PubDate: 2017-07-27T08:23:37-07:00
      DOI: 10.1136/eb-2017-102702
      Issue No: Vol. 20, No. 3 (2017)
  • Internet-based cognitive behavioural therapy for young people with
           suicide-related behaviour (Reframe-IT): a randomised controlled trial
    • Authors: Hetrick, S. E; Yuen, H. P, Bailey, E, Cox, G. R, Templer, K, Rice, S. M, Bendall, S, Robinson, J.
      Pages: 76 - 82
      Abstract: BackgroundSuicide-related behaviours are common in young people and associated with a range of negative outcomes. There are few evidence-based interventions; however, cognitive behavioural therapy (CBT) shows promise. Internet delivery of CBT is popular, with potential to increase reach and accessibility.ObjectiveTo test the effectiveness of an internet-based CBT program (Reframe-IT) in reducing suicide-related behaviours, depression, anxiety, hopelessness and improving problem solving and cognitive and behavioural skills in school students with suicide-related behaviours.MethodsA parallel randomised controlled trial testing the effectiveness of Reframe-IT plus treatment as usual (TAU) compared with TAU alone in reducing suicidal ideation, suicide attempts, depression, hopelessness, symptoms of anxiety, negative problem orientation and cognitive and behavioural skill acquisition was undertaken. We recruited students experiencing suicidal ideation from 18 schools in Melbourne, Australia, between August 2013 and December 2016. The intervention comprised eight modules of CBT delivered online over 10 weeks with assessments conducted at baseline, 10 weeks and 22 weeks.FindingsOnly 50 of the planned 169 participants were recruited. There were larger improvements in the Reframe-IT group compared with the TAU group for the primary outcome of suicidal ideation (intervention –61.6, SD 41.6; control –47.1, SD 42.3, from baseline to 22-week follow-up intervention); however, differences were non-significant (p=0.593). There were no increases in distress in the majority of participants (91.1%) after completion of each module. Changes in depression and hopelessness partly mediated the effect of acquisition of CBT skills on suicidal ideation.ConclusionsThe trial was underpowered due to difficulties recruiting participants as a result of the complex recruitment procedures that were used to ensure safety of participants. Although there were no significant differences between groups, young people were safely and generally well engaged in Reframe-IT and experienced decreases in suicidal ideation and other symptoms as well as improvements in CBT skills. The study is the first online intervention trial internationally to include young people demonstrating all levels of suicide risk.Clinical implicationsIntegration of internet-delivered interventions for young people with suicide-related behaviour may result in reductions in these behaviours. Further research is needed, but researchers should feel more confident about being able to safely undertake research with young people who experience these behaviours.Trial registration numberACTRN12613000864729.
      Keywords: Editor's choice
      PubDate: 2017-07-27T08:23:37-07:00
      DOI: 10.1136/eb-2017-102719
      Issue No: Vol. 20, No. 3 (2017)
  • Applying deep neural networks to unstructured text notes in electronic
           medical records for phenotyping youth depression
    • Authors: Geraci, J; Wilansky, P, de Luca, V, Roy, A, Kennedy, J. L, Strauss, J.
      Pages: 83 - 87
      Abstract: BackgroundWe report a study of machine learning applied to the phenotyping of psychiatric diagnosis for research recruitment in youth depression, conducted with 861 labelled electronic medical records (EMRs) documents. A model was built that could accurately identify individuals who were suitable candidates for a study on youth depression.ObjectiveOur objective was a model to identify individuals who meet inclusion criteria as well as unsuitable patients who would require exclusion.MethodsOur methods included applying a system that coded the EMR documents by removing personally identifying information, using two psychiatrists who labelled a set of EMR documents (from which the 861 came), using a brute force search and training a deep neural network for this task.FindingsAccording to a cross-validation evaluation, we describe a model that had a specificity of 97% and a sensitivity of 45% and a second model with a specificity of 53% and a sensitivity of 89%. We combined these two models into a third one (sensitivity 93.5%; specificity 68%; positive predictive value (precision) 77%) to generate a list of most suitable candidates in support of research recruitment.ConclusionOur efforts are meant to demonstrate the potential for this type of approach for patient recruitment purposes but it should be noted that a larger sample size is required to build a truly reliable recommendation system.Clinical implicationsFuture efforts will employ alternate neural network algorithms available and other machine learning methods.
      Keywords: Open access
      PubDate: 2017-07-27T08:23:37-07:00
      DOI: 10.1136/eb-2017-102688
      Issue No: Vol. 20, No. 3 (2017)
  • Common pitfalls and mistakes in the set-up, analysis and interpretation of
           results in network meta-analysis: what clinicians should look for in a
           published article
    • Authors: Chaimani, A; Salanti, G, Leucht, S, Geddes, J. R, Cipriani, A.
      Pages: 88 - 94
      Abstract: ObjectiveSeveral tools have been developed to evaluate the extent to which the findings from a network meta-analysis would be valid; however, applying these tools is a time-consuming task and often requires specific expertise. Clinicians have little time for critical appraisal, and they need to understand the key elements that help them select network meta-analyses that deserve further attention, optimising time and resources. This paper is aimed at providing a practical framework to assess the methodological robustness and reliability of results from network meta-analysis.MethodsAs a working example, we selected a network meta-analysis about drug treatments for generalised anxiety disorder, which was published in 2011 in the British Medical Journal. The same network meta-analysis was previously used to illustrate the potential of this methodology in a methodological paper published in JAMA.ResultsWe reanalysed the 27 studies included in this network following the methods reported in the original article and compared our findings with the published results. We showed how different methodological approaches and the presentation of results can affect conclusions from network meta-analysis. We divided our results into three sections, according to the specific issues that should always be addressed in network meta-analysis: (1) understanding the evidence base, (2) checking the statistical analysis and (3) checking the reporting of findings.ConclusionsThe validity of the results from network meta-analysis depends on the plausibility of the transitivity assumption. The risk of bias introduced by limitations of individual studies must be considered first and judgement should be used to infer about the plausibility of transitivity. Inconsistency exists when treatment effects from direct and indirect evidence are in disagreement. Unlike transitivity, inconsistency can be always evaluated statistically, and it should be specifically investigated and reported in the published paper. Network meta-analysis allows researchers to list treatments in preferential order; however, in this paper we demonstrated that rankings could be misleading if based on the probability of being the best. Clinicians should always be interested in the effect sizes rather than the naive rankings.
      Keywords: Editor's choice, EBMH Statistics in Practice
      PubDate: 2017-07-27T08:23:37-07:00
      DOI: 10.1136/eb-2017-102753
      Issue No: Vol. 20, No. 3 (2017)
  • HCR-20 shows poor field validity in clinical forensic psychiatry settings
    • Authors: Tully J.
      Pages: 95 - 96
      Abstract: ABSTRACT FROM: Jeandarme I, Pouls C, De Laender J, et al. Field validity of the HCR-20 in forensic medium security units in Flanders. Psychology, Crime & Law 2017;23:305–22. What is already known about this topic Assessment and prediction of violence risk is central to forensic psychiatry practice. From the 1970s, increasing awareness of the limitations of clinical judgement alone meant services began to employ actuarial risk assessment tools, which were shown to significantly improve predictive accuracy.1 However, these tools soon came under criticism for their own limitations, including focus on relatively static factors that are immutable and lack of applicability to specific real-world scenarios.1 This led to the development of structured professional judgement (SPJ) tools, which have largely replaced purely actuarial tools as the gold standard of risk assessment and management. Such instruments combine actuarial and dynamic components and are thought to be yet practically...
      Keywords: EBMH Forensic Psychiatry
      PubDate: 2017-07-27T08:23:37-07:00
      DOI: 10.1136/eb-2017-102745
      Issue No: Vol. 20, No. 3 (2017)
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
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Fax: +00 44 (0)131 4513327
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