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Evidence-Based Mental Health
Journal Prestige (SJR): 0.839
Citation Impact (citeScore): 1
Number of Followers: 136  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1362-0347 - ISSN (Online) 1468-960X
Published by BMJ Publishing Group Homepage  [57 journals]
  • Suicide, substance use and natural causes are respectively the most
           important causes of mortality in the first year post discharge from
           psychiatric hospitals
    • Authors: Large, M; Swaraj, S.
      Abstract: COMMENTARY ON: Walter F, Carr MJ, Mok PLH, et al. Premature mortality among patients recently discharged from their first inpatient psychiatric treatment. JAMA Psychiatry 2017;74:485–92. What is already known on this topic People with mental health conditions such as schizophrenia and mood or anxiety disorders have an elevated all-cause mortality.1 Those who have been admitted to psychiatric hospitals are at particular risk.2 Some of this increased mortality can be explained by suicides,3 but it is generally believed that the majority of the premature deaths of mentally ill people are from natural causes.1 However, suicide rates are alarmingly high in the year after discharge from psychiatric hospitals,4 but the relative contribution of suicide and natural death to premature mortality in this period is under-researched. Methods of the study The present study examined the relationship between the independent variable of psychiatric...
      PubDate: 2018-05-02T08:40:16-07:00
      DOI: 10.1136/eb-2017-102811
      Issue No: Vol. 21, No. 2 (2018)
       
  • Brief guided parent-delivered CBT is both efficacious andcost-effective
           for childhood anxiety disorders
    • Authors: Monga S.
      Abstract: COMMENTARY ON: Creswell C, Violato M, Fairbanks H, et al. Clinical outcomes and cost-effectiveness of brief guided parent-delivered cognitive behavioural therapy and solution-focused brief therapy for treatment of childhood anxiety disorders: a randomised controlled trial. Lancet Psychiatry 2017;4:529–39. What is already known on this topic Anxiety disorders are highly prevalent disorders in children and adolescents with half of all lifetime cases emerging before age 12.1 Solid evidence supports the use of cognitive–behavioural therapy (CBT) in the treatment of childhood anxiety disorders with recovery rates of approximately 60% seen in various studies. To date, however, little research has assessed the efficacy of shorter forms of CBT nor has there been much exploration of the cost-effectiveness of treatments for anxiety disorders in children and adolescents. This randomised controlled trial2 compared two brief treatments on efficacy and cost-effectiveness in the treatment of childhood anxiety disorders.
      Keywords: Clinical trials (epidemiology)
      PubDate: 2018-05-02T08:40:16-07:00
      DOI: 10.1136/eb-2017-102826
      Issue No: Vol. 21, No. 2 (2018)
       
  • Selecting a risk assessment tool to use in practice:a 10-point guide
    • Authors: Fazel, S; Wolf, A.
      Pages: 41 - 43
      Abstract: With the increase in the number of risk assessment tools and clinical algorithms in many areas of science and medicine, this Perspective article provides an overview of research findings that can assist in informing the choice of an instrument for practical use. We take the example of violence risk assessment tools in criminal justice and forensic psychiatry, where there are more than 200 such instruments and their use is typically mandated. We outline 10 key questions that researchers, clinicians and other professionals should ask when deciding what tool to use, which are also relevant for public policy and commissioners of services. These questions are based on two elements: research underpinning the external validation, and derivation or development of a particular instrument. We also recommend some guidelines for reporting drawn from consensus guidelines for research in prognostic models.
      Keywords: Open access
      PubDate: 2018-05-02T08:40:16-07:00
      DOI: 10.1136/eb-2017-102861
      Issue No: Vol. 21, No. 2 (2018)
       
  • Fifty years of preventing and treating childhood behaviour disorders: a
           systematic review to inform policy and practice
    • Authors: Waddell, C; Schwartz, C, Andres, C, Barican, J. L, Yung, D.
      Pages: 45 - 52
      Abstract: QuestionOppositional defiant and conduct disorders (ODD and CD) start early and persist, incurring high individual and collective costs. To inform policy and practice, we therefore asked: What is the best available research evidence on preventing and treating these disorders' Study selection and analysis We sought randomised controlled trials (RCTs) evaluating interventions addressing the prevention or treatment of behaviour problems in individuals aged 18 years or younger. Our criteria were tailored to identify higher-quality RCTs that were also relevant to policy and practice. We searched the CINAHL, ERIC, MEDLINE, PsycINFO and Web of Science databases, updating our initial searches in May 2017. Thirty-seven RCTs met inclusion criteria—evaluating 15 prevention programmes, 8 psychosocial treatments and 5 medications. We then conducted narrative synthesis.FindingsFor prevention, 3 notable programmes reduced behavioural diagnoses: Classroom-Centered Intervention; Good Behavior Game; and Fast Track. Five other programmes reduced serious behaviour symptoms such as criminal activity. Prevention benefits were long term, up to 35 years. For psychosocial treatment, Incredible Years reduced behavioural diagnoses. Three other interventions reduced criminal activity. Psychosocial treatment benefits lasted from 1 to 8 years. While 4 medications reduced post-test symptoms, all caused important adverse events.ConclusionsConsiderable RCT evidence favours prevention.Clinical implicationsEffective prevention programmes should therefore be made widely available. Effective psychosocial treatments should also be provided for all children with ODD/CD. But medications should be a last resort given associated adverse events and given only short-term evidence of benefits. Policymakers and practitioners can help children and populations by acting on these findings.
      Keywords: Public health, Open access
      PubDate: 2018-05-02T08:40:16-07:00
      DOI: 10.1136/eb-2017-102862
      Issue No: Vol. 21, No. 2 (2018)
       
  • Prevalence and treatment of panic disorder in bipolar disorder: systematic
           review and meta-analysis
    • Authors: Preti, A; Vrublevska, J, Veroniki, A. A, Huedo-Medina, T. B, Kyriazis, O, Fountoulakis, K. N.
      Pages: 53 - 60
      Abstract: QuestionRecent data suggest that anxiety disorders are as often comorbid with bipolar disorder (BD) as with unipolar depression. The literature on panic disorder (PD) comorbid with BD has been systematically reviewed and subject to meta-analysis.Study selection and analysisThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were thoroughly followed for literature search, selection and reporting of available evidence. The variance-stabilising Freeman-Tukey double arcsine transformation was used in the meta-analysis of prevalence estimates. Both fixed-effect and random-effects models with inverse variance method were applied to estimate summary effects for all combined studies. Heterogeneity was assessed and measured with Cochran’s Q and I2 statistics.FindingsOverall, 15 studies (n=3391) on cross-sectional prevalence and 25 independent lifetime studies (n=8226) were used to calculate pooled estimates. The overall random-effects point prevalence of PD in patients with BD, after exclusion of one potential outlier study, was 13.0% (95% CI 7.0% to 20.3%), and the overall random-effects lifetime estimate, after exclusion of one potential outlier study, was 15.5% (95% CI 11.6% to 19.9%). There were no differences in rates between BD-I and BD-II. Significant heterogeneity (I2 >95%) was found in both estimates.ConclusionsEstimates that can be drawn from published studies indicate that the prevalence of PD in patients with BD is higher than the prevalence in the general population. Comorbid PD is reportedly associated with increased risk of suicidal acts and a more severe course. There is no clear indication on how to treat comorbid PD in BD. Findings from the current meta-analysis confirm the highly prevalent comorbidity of PD with BD, implicating that in patients with BD, PD might run a more chronic course.
      PubDate: 2018-05-02T08:40:16-07:00
      DOI: 10.1136/eb-2017-102858
      Issue No: Vol. 21, No. 2 (2018)
       
  • Clinical imaging in dementia with Lewy bodies
    • Authors: Surendranathan, A; OBrien, J. T.
      Pages: 61 - 65
      Abstract: Dementia with Lewy bodies (DLB) is a common neurodegenerative dementia in older people; however, the clinical features, particularly cognitive fluctuations and rapid eye movement sleep disorder, are often hard to elicit, leading to difficulty in making the diagnosis clinically. Here we examine the literature for the evidence behind imaging modalities that could assist in making the diagnosis. Dopamine transporter (DAT) imaging remains the best modality for differentiation from dementia of Alzheimer’s type with high sensitivity and specificity reported based on pathological diagnoses. 123Iodine-metaiodobenzylguanidine myocardial scintigraphy (MIBG) however is rapidly becoming an alternative imaging modality for the diagnosis of DLB, though studies assessing its accuracy with postmortem verification are still awaited. However, there are suggestions that MIBG may be better in the differentiation of vascular parkinsonism from DLB than DAT scans but may have lower sensitivity for detecting DLB compared with the 80% sensitivity seen in DAT imaging. Structural MRI scans have long been used for the diagnosis of dementia; however, their utility in DLB is limited to revealing the presence of coexisting Alzheimer’s disease. Fluorodeoxyglucose (FDG) PET is an alternative biomarker that can also differentiate Alzheimer’s disease and DLB but lacks the evidence base of both DAT and MIBG scans.
      Keywords: Editor's choice
      PubDate: 2018-05-02T08:40:16-07:00
      DOI: 10.1136/eb-2017-102848
      Issue No: Vol. 21, No. 2 (2018)
       
  • Digital technologies for the assessment of cognition: a clinical review
    • Authors: Chinner, A; Blane, J, Lancaster, C, Hinds, C, Koychev, I.
      Pages: 67 - 71
      Abstract: Dementia is the most widespread form of neurodegenerative disorder and is associated with an immense societal and personal cost. Prevalence of this disorder is projected to triple worldwide by 2050 leading to an urgent need to make advances in the efficiency of both its care and therapy research. Digital technologies are a rapidly advancing field that provide a previously unavailable opportunity to alleviate challenges faced by clinicians and researchers working in this area. This clinical review aimed to summarise currently available evidence on digital technologies that can be used to monitor cognition. We identified a range of pervasive digital systems, such as smartphones, smartwatches and smart homes, to assess and assist elderly demented, prodromal and preclinical populations. Generally, the studies reported good level of agreement between the digital measures and the constructs they aimed to measure. However, most of the systems are still only in the initial stages of development with limited data on acceptability in patients. Although it is clear that the use of digital technology to monitor and support the cognitive domains affected by dementia is a promising area of development, additional research validating the efficacy, utility and cost-effectiveness of these systems in patient populations is needed.
      PubDate: 2018-05-02T08:40:16-07:00
      DOI: 10.1136/eb-2018-102890
      Issue No: Vol. 21, No. 2 (2018)
       
  • Practical guide to the meta-analysis of rare events
    • Authors: Efthimiou O.
      Pages: 72 - 76
      Abstract: ObjectiveMeta-analysing studies with low event rates is challenging as some of the standard methods for meta-analysis are not well suited to handle rare outcomes. This is more evident when some studies have zero events in one or both treatment groups. In this article, we discuss why rare events require special attention in meta-analysis, we present an overview of some approaches suitable for meta-analysing rare events and we provide practical recommendations for their use.MethodsWe go through several models suggested in the literature for performing a rare events meta-analysis, highlighting their respective advantages and limitations. We illustrate these models using a published example from mental health. We provide the software code needed to perform all analyses in the appendix.ResultsDifferent methods may give different results, and using a suboptimal approach may lead to erroneous conclusions. When data are very sparse, the choice between the available methods may have a large impact on the results. Methods that use the so-called continuity correction (eg, adding 0.5 to the number of events and non-events in studies with zero events in one treatment group) may lead to biased estimates.ConclusionsResearchers should define the primary analysis a priori, in order to avoid selective reporting. A sensitivity analysis using a range of methods should be used to assess the robustness of results. Suboptimal methods such as using a continuity correction should be avoided.
      Keywords: EBMH Statistics in Practice
      PubDate: 2018-05-02T08:40:16-07:00
      DOI: 10.1136/eb-2018-102911
      Issue No: Vol. 21, No. 2 (2018)
       
  • Correction: Acceptability of the Fitbit in behavioural activation therapy
           for depression: a qualitative study
    • Pages: 76 - 76
      Abstract: Chum J, Kim MS, Zielinski L, et al. Acceptability of the Fitbit in behavioural activation therapy for depression: a qualitative study. Evid Based Mental Health 2017;20:128–33. 10.1136/ebmental-2017-102763.A statement indicating that authors Jenny Chum and Min Suk Kim are co-first authors should have been included in this manuscript.
      Keywords: Open access
      PubDate: 2018-05-02T08:40:16-07:00
      DOI: 10.1136/ebmental-2017-102763corr1
      Issue No: Vol. 21, No. 2 (2018)
       
  • Choosing the optimum strategy for rTMS
    • Authors: Furukawa T. A.
      Pages: 77 - 78
      Abstract: Clinical casePatient A 45-year-old man. Present illness Mr A had been living a relatively eventless and successful life: after graduating from college, he found a post in the local government, got married with one of the colleagues at the office; the couple had two kids, and the patient was promoted to the section head at the age of 35 years, which is neither early nor late as a typical government employee. However, this section was in charge of the refurbishing of the old city centre, for which Mr A had to negotiate with all sorts of interested parties. The negotiation was endless while the deadline for the project was mandated by the mayor. His first major depressive episode set in, due to which he took a sickness leave for 6 months. After return to the office, he was transferred to a new section where he was exempted from...
      Keywords: EBMH Evidence-Based Case Conference
      PubDate: 2018-05-02T08:40:16-07:00
      DOI: 10.1136/eb-2017-102828
      Issue No: Vol. 21, No. 2 (2018)
       
  • Pharmacological treatment reduces the risk of motor vehicle crashes among
           men and women with ADHD
    • Authors: Bikic, A; Dalsgaard, S.
      Pages: 79 - 79
      Abstract: COMMENTARY ON: Chang Z, Quinn PD, Hur K, Gibbons RD, Sjölander A, Larsson H & D’Onofrio. Association between medication use for attention-deficit/hyperactivity disorder and risk of motor vehicle crashes. JAMA Psychiatry 2017;74(6):597–603. What is already known on this topic Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder with core symptoms of inattention, hyperactivity and impulsivity,; traits that may increase the risk of injuries and motor vehicle crashes (MVCs). Injuries in early childhood predict later ADHD,1 a diagnosis that is associated with a twofold increased risk of premature death, with accidents being the most common cause of death.2 ADHD is commonly treated with pharmacotherapy that successfully targets most of the impairing core symptoms.3 In children with ADHD, pharmacological treatment also reduces the risk of injuries by up to 43%.4 Similarly, a Swedish study of adults with ADHD suggests that pharmacotherapy may reduce the...
      Keywords: Epidemiology
      PubDate: 2018-05-02T08:40:16-07:00
      DOI: 10.1136/eb-2017-102816
      Issue No: Vol. 21, No. 2 (2018)
       
  • FRAX tool underestimates the risk of osteoporotic fractures in mental
           disorders
    • Authors: Aparasu, R. R; Rege, S.
      Pages: 80 - 80
      Abstract: COMMENTARY ON: Bolton JM, Morin SN, Majumdar SR, et al. Association of mental disorders and related medication use with risk for major osteoporotic fractures. JAMA Psychiatry 2017;74:641–8. What is already known on this topic Selected mental disorders and specific psychotropic medications are associated with increased risk of fracture and osteoporosis and adversely impact bone mineral density (BMD).1 2 Fractures are associated with high mortality and morbidity rates and increased disability burden and socioeconomic costs.3 FRAX, a fracture risk assessment tool, assesses the 10-year probability of major osteoporotic fractures (MOF) based on eight clinical risk factors and BMD.4 5 It was developed and calibrated based on population-based cohorts in several regions throughout the world. Although FRAX is included in numerous osteoporosis guidelines, there is a need to strengthen the tool by incorporating additional clinical risk factors and evaluating its...
      Keywords: Geriatric medicine
      PubDate: 2018-05-02T08:40:16-07:00
      DOI: 10.1136/eb-2017-102815
      Issue No: Vol. 21, No. 2 (2018)
       
 
 
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