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Evidence-Based Mental Health
Journal Prestige (SJR): 0.839
Citation Impact (citeScore): 1
Number of Followers: 186  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1362-0347 - ISSN (Online) 1468-960X
Published by BMJ Publishing Group Homepage  [68 journals]
  • There has been very little progress in treating or preventing
           antipsychotic-induced tardive dyskinesia
    • Authors: van Harten; P.
      Abstract: Commentary on: Bergman H, Walker DM, Nikolakopoulou A, et al. Systematic review of interventions for treating or preventing antipsychotic-induced tardive dyskinesia. Health Technol Assess 2017;21:1-218. What is already known on this topic Tardive dyskinesia (TD) is a relatively frequent side effect of long-term use of antipsychotics and there is conflicting evidence if the incidence of TD is lower with second-generation antipsychotics (excluding clozapine), compared with first-generation antipsychotics. Until now there is no evidence-based algorithm to prevent or to treat TD. Methods of the study This systematic review1 evaluated any intervention for treating or preventing deterioration of symptoms of antipsychotic-induced TD in adult patients. Included were all relevant studies, regardless of language, about adults who had used antipsychotic drugs for ≥3 months and in whom the antipsychotic doses had been stable for at least 1 month. The authors included 112 randomised trials and eight prospective cohort studies. Seventy-nine separate...
      PubDate: 2018-07-30T05:57:24-07:00
      DOI: 10.1136/ebmental-2018-300006
      Issue No: Vol. 21, No. 3 (2018)
  • Clozapine and long-acting injectable antipsychotics reduce hospitalisation
           and treatment failure risk in patients with schizophrenia
    • Authors: Rubio, J. M; Correll, C. U.
      Abstract: Commentary on: Tiihonen J, Mittendorfer-Rutz E, Majak M, et al. Real-world effectiveness of antipsychotic treatments in a nationwide cohort of 29 823 patients with schizophrenia. JAMA Psychiatry 2017;74:686–693. What is already known on this topic It is essential to identify differences in efficacy and effectiveness between antipsychotic options to inform treatment decisions in schizophrenia. Presence or absence of superiority has recently been particularly controversial for clozapine and long-acting injectable antipsychotics (LAIs), triggered by contrasting positive, negative and inconsistent meta-analyses of randomised controlled trials (RCTs).1–4 These inconsistencies may have been largely the result of selection bias since patients enrolled in RCTs may have a less severe illness, more insight, greater adherence and an overall better prognosis.4 This selection bias may be particularly important for clozapine and LAIs, which may be most effective in treatment-resistant patients and those with greater likelihood of...
      PubDate: 2018-07-30T05:57:24-07:00
      DOI: 10.1136/ebmental-2018-300003
      Issue No: Vol. 21, No. 3 (2018)
  • Vesicular monoamine transporter type 2 inhibition can lead to effective
           and tolerable management of tardive dyskinesia
    • Authors: Citrome; L.
      Abstract: Commentary on: Anderson KE, Stamler D, Davis MD, et al. Deutetrabenazine for treatment of involuntary movements in patients with tardive dyskinesia (AIM-TD): a double-blind, randomised, placebo-controlled, phase 3 trial. Lancet Psychiatry. 2017 Aug;4(8):595–604. What is already known on this topic   Tardive dyskinesia (TD), characterised by involuntary movements of the tongue, lips, face, trunk and extremities, is thought to be a generally irreversible consequence of the use of dopamine receptor blocking agents and is not rare. The introduction of second-generation antipsychotics has not  eliminated TD. Vesicular monoamine transporter type 2 (VMAT2) inhibition has been known to reduce TD, as observed with tetrabenazine, but tetrabenazine has been relatively complex to use because of its short half-life and sensitivity to CYP2D6 metabolism.1 Deutetrabenazine is related to tetrabenazine in that deuterium is substituted for hydrogen at the key sites of primary metabolism, altering the pharmacokinetics of drug metabolism by slowing it...
      PubDate: 2018-07-30T05:57:24-07:00
      DOI: 10.1136/eb-2017-102825
      Issue No: Vol. 21, No. 3 (2018)
  • Women with schizophrenia are at increased risk of breast cancer
    • Authors: Yung, A. R; Firth, J.
      Abstract: Commentary on: Chou AIW, Wang Y-C, Lin C-L, et al. Female schizophrenia patients and risk of breast cancer: a population-based cohort study. Schizophrenia Research 2017;188:165–171. What is already known on this topic Research into rates of breast cancer in women with schizophrenia shows conflicting results, with reports of increased, decreased and the same risk as the general population. This is despite women with schizophrenia possibly being at increased risk of breast cancer through use of antipsychotic medications, many of which increase prolactin, a hormone involved in cellular differentiation of the mammary glands. This study1 investigated rates of breast cancer in individuals with schizophrenia compared with the general population. Methods of the study The authors used large databases of routinely collected health data to compare rates of breast cancer in women with schizophrenia receiving antipsychotics (n=10 727) with rates in women without schizophrenia nor receiving antipsychotic...
      PubDate: 2018-07-30T05:57:24-07:00
      DOI: 10.1136/ebmental-2018-300019
      Issue No: Vol. 21, No. 3 (2018)
  • Women with a history of postpartum affective disorder at increased risk of
           recurrence in future pregnancies
    • Authors: Gordon, H; Wilson, C.
      Abstract: Commentary on: Rasmussen M-LH, Strøm M, Wohlfahrt J et al. Risk, treatment duration, and recurrence risk of postpartum affective disorder in women with no prior psychiatric history: a population-based cohort study. PLoS Med. 2017;14(9): e1002392. What is already known on this topic Postpartum depression (PPD) has an estimated prevalence of 10%–15%1 with associated negative maternal and child sequelae if left untreated. Following an episode of PPD, women are more likely to experience recurrent postpartum and non-postpartum depressive episodes, regardless of whether this was a first or subsequent depressive episode.2 PPD prevalence estimates typically include women with and without pre-existing psychiatric diagnoses. Thus, there is a poor understanding of potential differences in recurrence risk and treatment duration between these two groups. Methods of the study Data were linked from Danish national registers to follow 457 317 primiparous women without previous psychiatric diagnoses delivering between 1996 and 2013.
      PubDate: 2018-07-30T05:57:24-07:00
      DOI: 10.1136/ebmental-2018-300009
      Issue No: Vol. 21, No. 3 (2018)
  • The times they are a-changin
    • Authors: Tomlinson, A; Cipriani, A.
      Pages: 81 - 81
      Abstract: The first issue of Evidence-Based Mental Health (EBMH) is celebrating the 20th anniversary. Readers were welcomed to EBMH in 1998, which was designed to assist ‘mental health clinicians stay up to date with the best available evidence as it is published’.1 EBMH has remained committed to this aim, building on the changes and developments in the field, helping clinicians via numerous resources use the strategies of evidence-based practice: ‘working every day to stimulate a critical approach to evidence-based practice’.2 EBMH has evolved to include important editorial members with expertise in adult, old age and child and adolescent mental health, and in forensic psychiatry and statistical methodology, and we have now a new section editor for health economics, Judit Simon, who is Professor of Health Economics and Head of Department at the Medical University of Vienna. We also plan to develop ways to harness the expertise from junior members...
      PubDate: 2018-07-30T05:57:24-07:00
      DOI: 10.1136/ebmental-2018-300035
      Issue No: Vol. 21, No. 3 (2018)
  • Evaluation of the minimum age for consent to mental health treatment with
           the minimum age of criminal responsibility in children and adolescents: a
           global comparison
    • Authors: Noroozi, M; Singh, I, Fazel, M.
      Pages: 82 - 86
      Abstract: BackgroundIn many countries, a young person who seeks medical care is not authorised to consent to their own assessment and treatment, yet the same child can be tried for a criminal offence. The absence of child and adolescent mental health legislation in most countries exacerbates the issues young people face in independently accessing mental healthcare. Countries with existing legislation rarely define a minimum age for mental health consent (MAMHC). In stark contrast, nearly all 196 nations studied maintain legislation defining a minimum age of criminal responsibility (MACR).ObjectiveThis review highlights inconsistent developmental and legal perspectives in defined markers of competency across medical and judicial systems.MethodsA review of the MAMHC was performed and compared with MACR for the 52 countries for which policy data could be identified through publicly available sources.FindingsOnly 18% of countries maintain identifiable mental health policies specific to children’s mental health needs. Of those reviewed, only 11 nations maintained a defined MAMHC, with 7 of 11 having a MAMHC 2 years higher than the country’s legislated MACR.ConclusionsWith increasing scientific understanding of the influences on child and adolescent decision making, some investment in the evidence-base and reconciliation of the very different approaches to child and adolescent consent is needed.Clinical implicationsA more coherent approach to child and adolescent consent across disciplines could help improve the accessibility of services for young people and facilitate mental health professionals and services as well as criminal justice systems deliver optimal care.
      Keywords: Editor's choice
      PubDate: 2018-07-30T05:57:24-07:00
      DOI: 10.1136/ebmental-2018-300032
      Issue No: Vol. 21, No. 3 (2018)
  • Meditation-based therapies for attention-deficit/hyperactivity disorder in
           children, adolescents and adults: a systematic review and meta-analysis
    • Authors: Zhang, J; Diaz-Roman, A, Cortese, S.
      Pages: 87 - 94
      Abstract: BackgroundThe efficacy of meditation-based therapies for attention deficit/hyperactivity disorder (ADHD) across the lifespan remains uncertain.ObjectiveTo conduct a systematic review and meta-analysis of randomised controlled trials (RCTs) assessing the efficacy of meditation-based therapies for ADHD core symptoms and associated neuropsychological dysfunctions in children/adolescents or adults with ADHD.MethodsWe searched Pubmed, PsycInfo, Embase+Embase Classic, Ovid Medline and Web of Knowledge with no language, date or type of document restriction, up to 5 May 2018. Random-effects model was used. Heterogeneity was assessed with Cochran’s Q and I2 statistics. Publication (small studies) bias was assessed with funnel plots and the Egger’s test. Studies were evaluated with the Cochrane risk of bias (RoB) tool. Analyses were conducted using Comprehensive Meta-Analysis.Findings13 RCTs (seven in children/adolescents, n=270 and six in adults, n=339) were retained. Only one RCT was double-blind.Meditation-based therapies were significantly more efficacious than the control conditions in decreasing the severity of ADHD core symptoms (inattention+hyperactivity/impulsivity: children/adolescents: Hedge’s g=-0.44, 95% CI –0.69 to –0.19, I20%; adults: Hedge’s g=–0.66, 95% CI –1.21 to –0.11, I281.81%). No significant effects were found on neuropsychological measures of inattention and inhibition in children/adolescents. In adults, significant effects were detected on working memory and inhibition, although these results were based on a small number of studies (n=3). 57% and 43% of the studies in children/adolescents were rated at overall unclear and high risk of bias, respectively. In adults, 33% and 67% of the studies were deemed at overall unclear and high risk of bias, respectively. No evidence of publication bias was found.ConclusionsDespite statistically significant effects on ADHD combined core symptoms, due to paucity of RCTs, heterogeneity across studies and lack of studies at low risk of bias, there is insufficient methodologically sound evidence to support meditation-based therapies for ADHD.Trial registration numberPROSPERO 2018 [CRD42018096156].
      PubDate: 2018-07-30T05:57:24-07:00
      DOI: 10.1136/ebmental-2018-300015
      Issue No: Vol. 21, No. 3 (2018)
  • Ten simple rules for conducting umbrella reviews
    • Authors: Fusar-Poli, P; Radua, J.
      Pages: 95 - 100
      Abstract: ObjectiveEvidence syntheses such as systematic reviews and meta-analyses provide a rigorous and transparent knowledge base for translating clinical research into decisions, and thus they represent the basic unit of knowledge in medicine. Umbrella reviews are reviews of previously published systematic reviews or meta-analyses. Therefore, they represent one of the highest levels of evidence synthesis currently available, and are becoming increasingly influential in biomedical literature. However, practical guidance on how to conduct umbrella reviews is relatively limited.MethodsWe present a critical educational review of published umbrella reviews, focusing on the essential practical steps required to produce robust umbrella reviews in the medical field.ResultsThe current manuscript discusses 10 key points to consider for conducting robust umbrella reviews. The points are: ensure that the umbrella review is really needed, prespecify the protocol, clearly define the variables of interest, estimate a common effect size, report the heterogeneity and potential biases, perform a stratification of the evidence, conduct sensitivity analyses, report transparent results, use appropriate software and acknowledge the limitations. We illustrate these points through recent examples from umbrella reviews and suggest specific practical recommendations.ConclusionsThe current manuscript provides a practical guidance for conducting umbrella reviews in medical areas. Researchers, clinicians and policy makers might use the key points illustrated here to inform the planning, conduction and reporting of umbrella reviews in medicine.
      Keywords: Editor's choice, EBMH Statistics in Practice
      PubDate: 2018-07-30T05:57:24-07:00
      DOI: 10.1136/ebmental-2018-300014
      Issue No: Vol. 21, No. 3 (2018)
  • Recent developments in the treatment of major depressive disorder in
           children and adolescents
    • Authors: Hussain, H; Dubicka, B, Wilkinson, P.
      Pages: 101 - 106
      Abstract: Major depressive disorder in adolescents is an important public health concern. It is common, a risk factor for suicide and is associated with adverse psychosocial consequences. The UK National Institute for Health and Care Excellence guidelines recommend that children and young people with moderate-to-severe depression should be seen within Child and Adolescent Mental Health Services and receive specific psychological interventions, possibly in combination with antidepressant medication. Cognitive behavioural therapy (in some studies) and interpersonal psychotherapy have been demonstrated to be more effective than active control treatments for depressed adolescents. For children with depression, there is some evidence that family focused approaches are more effective than individual therapy. Fluoxetine is the antidepressant with the greatest evidence for effectiveness compared with placebo. Treatment with antidepressants and/or psychological therapy is likely to reduce suicidality, although in some young people, selective serotonin reuptake inhibitors lead to increased suicidality. There is limited evidence that combination of specific psychological therapy and antidepressant medication is better than treatment with monotherapy. There are methodological limitations in the published literature that make it difficult to relate study findings to the more severely ill clinical population in Child and Adolescent Mental Health Services. Young people should have access to both evidence-based psychological interventions and antidepressants for paediatric depression. Collaborative decisions on treatment should be made jointly by young people, their carers and clinicians, taking into account individual circumstances and potential benefits, risks and availability of treatment.
      PubDate: 2018-07-30T05:57:24-07:00
      DOI: 10.1136/eb-2018-102937
      Issue No: Vol. 21, No. 3 (2018)
  • Challenges in end-of-life dementia care
    • Authors: Fetherston, A. A; Rowley, G, Allan, C. L.
      Pages: 107 - 111
      Abstract: Dementia is a chronic, progressive disease that is now much more widely recognised and treated. Patients with dementia may require palliative care when they reach the end stage of their illness, or they may have mild–moderate cognitive symptoms comorbid with a life-limiting illness. The variety of presentations necessitates a highly individual approach to care planning, and patients should be encouraged to set their own goals and contribute to advanced care planning where possible. Assessment and management of distressing symptoms at the end of life can be greatly helped by a detailed knowledge of the individuals’ prior wishes, interdisciplinary communication and recognition of changes in presentation that may result from new symptoms, for example, onset of pain, nutritional deficits and infection. To navigate complexity at the end of life, open communication that involves patients and families in decisions, and is responsive to their needs is vital and can vastly improve subjective experiences. Complex ethical dilemmas may pervade both the illness of dementia and provision of palliative care; we consider how ethical issues (eg, providing care under restraint) influence complex decisions relating to resuscitation, artificial nutrition and treatment refusal in order to optimise quality of life.
      PubDate: 2018-07-30T05:57:24-07:00
      DOI: 10.1136/eb-2018-102889
      Issue No: Vol. 21, No. 3 (2018)
  • Innovations in the psychosocial treatment of youth with anxiety disorders:
           implications for a stepped care approach
    • Authors: Ollendick, T. H; Öst, L.-G, Farrell, L. J.
      Pages: 112 - 115
      Abstract: Anxiety disorders are highly prevalent among children and adolescents and frequently result in impairments across multiple domains of life. While psychosocial interventions, namely cognitive-behavioural therapy (CBT), have been found to be highly effective in treating these conditions, significant numbers of youth simply do not have access to these evidence-based interventions, and of those who do, a substantial proportion (up to 40%) fail to achieve remission. Thus, there is a pressing need for innovation in both the delivery of evidence-based treatments and efforts to enhance treatment outcomes for those who do not respond to standard care. This paper reviews current innovations attempting to address these issues, including evidence for brief, low-intensity approaches to treatment; internet delivered CBT and brief, high-intensity CBT. Moreover, we propose a model of stepped care delivery of evidence-based mental health interventions for children and youth with anxiety. In general, a stepped care approach begins with a lower intensity, evidence-based treatment that entails minimal therapist involvement (ie, brief, low-intensity self-help or internet delivered CBT) and then proceeds to more intensive treatments with greater therapist involvement (ie, brief high-intensity CBT), but only for those individuals who show a poor response at each step along the way. Future research is needed in order to evaluate such a model, and importantly, to identify predictors and moderators of response at each step, in order to inform an evidence-based, fully-integrated stepped care approach to service delivery.
      PubDate: 2018-07-30T05:57:24-07:00
      DOI: 10.1136/eb-2018-102892
      Issue No: Vol. 21, No. 3 (2018)
  • Clinical review of user engagement with mental health smartphone apps:
           evidence, theory and improvements
    • Authors: Torous, J; Nicholas, J, Larsen, M. E, Firth, J, Christensen, H.
      Pages: 116 - 119
      Abstract: The potential of smartphone apps to improve quality and increase access to mental health care is increasingly clear. Yet even in the current global mental health crisis, real-world uptake of smartphone apps by clinics or consumers remains low. To understand this dichotomy, this paper reviews current challenges surrounding user engagement with mental health smartphone apps. While smartphone engagement metrics and reporting remains heterogeneous in the literature, focusing on themes offers a framework to identify underlying trends. These themes suggest that apps are not designed with service users in mind, do not solve problems users care most about, do not respect privacy, are not seen as trustworthy and are unhelpful in emergencies. Respecting these current issues surrounding mental health app engagement, we propose several solutions and highlight successful examples of mental health apps with high engagement. Further research is necessary to better characterise engagement with mental health apps and identify best practices for design, testing and implementation.
      PubDate: 2018-07-30T05:57:24-07:00
      DOI: 10.1136/eb-2018-102891
      Issue No: Vol. 21, No. 3 (2018)
  • Increased attention should be paid to perinatal mental health and to the
           need of dedicated services
    • Authors: Tomelleri, L; Pariante, C. M.
      Pages: 120 - 122
      Abstract: BackgroundSetting the scene Among pregnant women, up to 23% experience a depressive disorder, and up to 10% a generalised anxiety disorder.1 As reported by several studies, untreated depression (severe depression in particular) in pregnant women is associated with adverse birth outcomes, such as low birth weight, preterm delivery and developmental problems. Moreover, women with pre-existing psychiatric condition have high risk of relapse or worsening of symptoms during pregnancy.2 Similarly, anxiety disorders have been linked to the risk of preterm birth and delivery by caesarean section,3 but yet much remains to be understood about the effects of specific anxiety disorders, and the severity of their symptoms, on birth outcomes. Antidepressants, such as selective serotonin reuptake inhibitors (SSRI), are prescribed to an increasing number of pregnant women (approximately 2%–8%) to treat depression and anxiety disorders.1 Although in the scientific literature SSRIs are...
      PubDate: 2018-07-30T05:57:24-07:00
      DOI: 10.1136/ebmental-2018-300008
      Issue No: Vol. 21, No. 3 (2018)
  • Missing outcome data in meta-analysis
    • Authors: Mavridis, D; Chaimani, A, Efthimiou, O, Salanti, G.
      Pages: 123 - 123
      Abstract: Missing outcome data is a common problem in mental health trials compromising the validity of results and leading to the loss of precision. The problem is accumulated in a meta-analysis of clinical trials with missing outcome data.
      PubDate: 2018-07-30T05:57:24-07:00
      DOI: 10.1136/eb-2014-101899
      Issue No: Vol. 21, No. 3 (2018)
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
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