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Paediatric migraine: evidence-based management and future directions.
Orr, SL, Kabbouche, MA, O'Brien, HL, Kacperski, J, Powers, SW, Hershey, AD
Nature reviews. Neurology. 2018;(9):515-527
Abstract
Migraine is prevalent in children and adolescents and constitutes an important cause of disability in this population. Early, effective treatment of paediatric migraine is likely to result in improved outcomes. Findings from the past few years suggest that a biopsychosocial approach that uses interdisciplinary multimodal care is most effective for treatment of migraine in the paediatric population. Key elements of this management include effective and timely acute pharmacological interventions (such as NSAIDs and/or triptans), education of patients regarding self-management techniques, and psychological interventions such as biofeedback, relaxation and cognitive-behavioural therapy. The efficacy of current pharmacological or nutraceutical interventions for migraine prevention in children and adolescents is unclear, although reported placebo response patterns suggest that the effect of pill-taking behaviour is positive. As such, clinicians can consider adding a preventive intervention that involves a daily pill-taking behaviour to evidence-based non-pharmacological first-line preventive interventions (such as cognitive-behavioural therapy). More rigorous research is needed to delineate the role of pharmacological and nutraceutical interventions, the mechanisms of the clinically relevant placebo response, and interventions that enhance this response for migraine prevention in this population. Given the prevalence of migraine, cost-effective and efficacious strategies are needed for the large-scale delivery of interdisciplinary multimodal paediatric migraine care.
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The effectiveness of ICT-based neurocognitive and psychosocial rehabilitation programmes in people with mild dementia and mild cognitive impairment using GRADIOR and ehcoBUTLER: study protocol for a randomised controlled trial.
Vanova, M, Irazoki, E, García-Casal, JA, Martínez-Abad, F, Botella, C, Shiells, KR, Franco-Martín, MA
Trials. 2018;(1):100
Abstract
BACKGROUND Cognitive rehabilitation is a highly individualised, non-pharmacological intervention for people with mild cognitive impairment (MCI) and dementia, which in recent years has also been developed for various IT platforms. METHODS In this study, we aim to evaluate the effectiveness of the cognitive rehabilitation software GRADIOR in a multi-centre, single-blinded randomised controlled trial with people with MCI and mild dementia. A total of 400 people with MCI and mild dementia will be randomly allocated to one of four groups. This trial will compare the cognitive rehabilitation treatment using the GRADIOR programme with a psychosocial stimulation intervention (PSS) using the ehcoBUTLER platform, with a combined treatment consisting of GRADIOR and ehcoBUTLER, and with a group receiving treatment as usual during a period of 1 year. DISCUSSION The outcomes of this clinical trial will be to determine any relevant changes in cognition, mood, quality of life, activities of daily living and quality of patient-carer relationship after 4 months and 1 year of intervention in a cross-sectional group comparison. Participants will be followed-up for 1 year to investigate potential long-term effects of the conducted treatments. TRIAL REGISTRATION Current Controlled Trials ISRCTN, ID: 15742788 . Registered on 12 June 2017.
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An online growth mindset intervention in a sample of rural adolescent girls.
Burnette, JL, Russell, MV, Hoyt, CL, Orvidas, K, Widman, L
The British journal of educational psychology. 2018;(3):428-445
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Abstract
BACKGROUND Students living in rural areas of the United States exhibit lower levels of educational attainment than their suburban counterparts. Innovative interventions are needed to close this educational achievement gap. AIMS We investigated whether an online growth mindset intervention could be leveraged to promote academic outcomes. SAMPLE We tested the mindset intervention in a sample of 222 10th-grade adolescent girls (M age = 15.2; 38% White, 25% Black, 29% Hispanic) from four rural, low-income high schools in the Southeastern United States. METHODS We conducted a randomized controlled trial to test the efficacy of the growth mindset intervention, relative to a sexual health programme. We used random sampling and allocation procedures to assign girls to either the mindset intervention (n = 115) or an attention-matched control programme (n = 107). We assessed participants at pre-test, immediate post-test, and 4-month follow-up. RESULTS Relative to the control condition, students assigned to the mindset intervention reported stronger growth mindsets at immediate post-test and 4-month follow-up. Although the intervention did not have a total effect on academic attitudes or grades, it indirectly increased motivation to learn, learning efficacy and grades via the shifts in growth mindsets. CONCLUSIONS Results indicate that this intervention is a promising method to encourage growth mindsets in rural adolescent girls.
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Exercise, diet and educational interventions for metabolic syndrome in persons with schizophrenia: A systematic review.
Gurusamy, J, Gandhi, S, Damodharan, D, Ganesan, V, Palaniappan, M
Asian journal of psychiatry. 2018;:73-85
Abstract
INTRODUCTION Individuals with major psychotic disorders such as schizophrenia are at increased risk for developing metabolic syndrome due to lifestyle- and treatment-related factors. Numerous interventions have been tested in inpatient and outpatient mental health settings to decrease risk factors. Diet and exercise represent the mainstay of weight loss treatment. With this background the review aimed to evaluate the effects of psychoeducation, diet and physical activity interventions on reduction of metabolic syndrome risk factors such as BMI, Body weight, biochemical profiles in schizophrenia. METHODS The authors conducted database searches of PsychINFO, MEDLINE, Pubmed, Proquest, EBSCO and the Cochrane Database of Systematic Reviews, and manual searches from 1968 to 2017. Search indentified 11 studies that met the inclusion criteria. Study quality was critically appraised by 2 reviewers using established criteria. The outcome measures were body mass index, body weight, waist circumference, lipid profile, fasting glucose. RESULTS Interventions led to significant weight reduction (8 studies), reduced body mass index (5 studies), decreased waist circumference (4 studies) and lower blood glucose levels (5 studies). Dietician and nurse led interventions (6 studies). The studies showed non pharmacological interventions were effective in reducing risk factors. CONCLUSION This review was able to demonstrate effectiveness of peychoeducation, diet and physical activity interventions were helpful to decrease and manage antipsychotic-induced weight gain. Results showed lifestyle interventions are safer and effective for promoting decrease or maintenance of weight and it can be delivered at low cost, safe and improves quality of life.
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Using dolls for therapeutic purposes: A study on nursing home residents with severe dementia.
Cantarella, A, Borella, E, Faggian, S, Navuzzi, A, De Beni, R
International journal of geriatric psychiatry. 2018;(7):915-925
Abstract
OBJECTIVES Among the psychosocial interventions intended to reduce the behavioral and psychological symptoms of dementia (BPSD), doll therapy (DT) is increasingly used in clinical practice. Few studies on DT have been based on empirical data obtained with an adequate procedure; however, none have assessed its efficacy using an active control group, and the scales used to assess changes in BPSD are usually unreliable. The aim of the present study was to measure the impact of DT on people with severe dementia with a reliable, commonly used scale for assessing their BPSD, and the related distress in formal caregivers. Effects of DT on the former's everyday abilities (ie, eating behavior) were also examined. METHOD Twenty-nine nursing home residents aged from 76 to 96 years old, with severe dementia (Alzheimer's or vascular dementia), took part in the experiment. They were randomly assigned to an experimental group that used dolls or an active control group that used hand warmers with sensory characteristics equivalent to the dolls. Benefits of DT on BPSD and related formal caregiver distress were examined with the Neuropsychiatric Inventory. The effects of DT on eating behavior were examined with the Eating Behavior Scale. RESULTS Only the DT group showed a reduction in BPSD scores and related caregiver distress. DT did not benefit eating behavior, however. CONCLUSIONS This study suggests that DT is a promising approach for reducing BPSD in people with dementia, supporting evidence emerging from previous anecdotal studies.
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Excess weight gain prevention in adolescents: Three-year outcome following a randomized controlled trial.
Tanofsky-Kraff, M, Shomaker, LB, Wilfley, DE, Young, JF, Sbrocco, T, Stephens, M, Brady, SM, Galescu, O, Demidowich, A, Olsen, CH, et al
Journal of consulting and clinical psychology. 2017;(3):218-227
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OBJECTIVE Interpersonal psychotherapy (IPT) prevents weight gain in adults with obesity and binge-eating-disorder, and is especially effective among those with increased psychosocial problems. However, IPT was not superior to health education (HE) to prevent excess weight gain at 1-year follow-up in 113 adolescent girls at high-risk for excess weight gain because of loss-of-control eating and high body mass index (BMI; kg/m2; Tanofsky-Kraff et al., 2014). METHOD Participants from the original trial were recontacted 3 years later for assessment. At baseline, adolescent- and parent-reported social-adjustment problems and trait anxiety were evaluated. At baseline and follow-ups, BMIz and adiposity by dual-energy x-ray absorptiometry were obtained. RESULTS Nearly 60% were reassessed at 3 years, with no group differences in participation (ps ≥ .70). Consistent with 1 year, there was no main effect of group on change in BMIz/adiposity (ps ≥ .18). In exploratory analyses, baseline social-adjustment problems and trait-anxiety moderated outcome (ps < .01). Among girls with high self-reported baseline social-adjustment problems or anxiety, IPT, compared to HE, was associated with the steepest declines in BMIz (p < .001). For adiposity, girls with high or low anxiety in HE and girls with low anxiety in IPT experienced gains (ps ≤ .03), while girls in IPT with high anxiety stabilized. Parent-reports yielded complementary findings. CONCLUSION In obesity-prone adolescent girls, IPT was not superior to HE in preventing excess weight gain at 3 years. Consistent with theory, exploratory analyses suggested that IPT was associated with improvements in BMIz over 3 years among youth with high social-adjustment problems or trait anxiety. Future studies should test the efficacy of IPT for obesity prevention among at-risk girls with social-adjustment problems and/or anxiety. (PsycINFO Database Record
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Fostering Self-Compassion and Loving-Kindness in Patients With Borderline Personality Disorder: A Randomized Pilot Study.
Feliu-Soler, A, Pascual, JC, Elices, M, Martín-Blanco, A, Carmona, C, Cebolla, A, Simón, V, Soler, J
Clinical psychology & psychotherapy. 2017;(1):278-286
Abstract
UNLABELLED The aim of this randomized pilot study is to investigate the effects of a short training programme in loving-kindness and compassion meditation (LKM/CM) in patients with borderline personality disorder. Patients were allocated to LKM/CM or mindfulness continuation training (control group). Patients in the LKM/CM group showed greater changes in Acceptance compared with the control group. Remarkable changes in borderline symptomatology, self-criticism and self-kindness were also observed in the LKM/CM group. Mechanistic explanations and therapeutic implications of the findings are discussed. HIGHLIGHTS Three weeks of loving-kindness and compassion meditations increased acceptance of the present-moment experience in patients with borderline personality disorder. Significant improvements in the severity of borderline symptoms, self-criticism, mindfulness, acceptance and self-kindness were observed after the LKM/CM intervention. LKM/CM is a promising complementary strategy for inclusion in mindfulness-based interventions and Dialectical Behavioural Therapy for treating core symptoms in borderline personality disorder. Copyright © 2016 John Wiley & Sons, Ltd.
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Legacy Interventions With Patients with Co-Occurring Disorders: Legacy Definitions, Life Satisfaction, and Self-Efficacy.
Franklin, FC, Cheung, M
Substance use & misuse. 2017;(14):1840-1849
Abstract
BACKGROUND Individuals with co-occurring disorders tend to avoid interaction with others. To instill hope, legacy intervention aims to highlight past experiences while managing life stressors for a positive outlook. Participants take part in legacy activities-crafting tangible projects and recording one's life events-in order to actualize a personal sense of legacy. OBJECTIVES This pre-posttest research tested whether legacy intervention in a partial hospital program (PHP) on reframing past experiences through creative activities could increase life satisfaction and self-efficacy among adults with co-occurring substance misuse and mental health symptoms. METHOD Eighty consented patients with co-occurring disorders were randomly assigned to two groups with 62 participants continuing: 37 in legacy intervention (LI) and 25 in partial hospital program only (PHP-only). LI participants were engaged in both PHP and legacy activities. Ten group sessions were held over the course of five weeks for cohorts of 10-15 adult patients in each intervention. Sense of legacy was measured to ensure that LI patients received the appropriate legacy dosage. RESULTS With RANOVA analyses between and among three time points, life satisfaction was significantly higher in the LI group with group interaction effect over time. In terms of self-efficacy, both groups showed positive changes but no significant difference could be found between the two groups over time and the interaction (time X group) effect was not significant. IMPORTANCE The legacy definitions gathered from the LI group were consistent with existing literature and showed three additional themes: children's involvement, concreteness, and life continuation after death.
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Heads Up: a pilot trial of a psychological intervention to improve nutrition in head and neck cancer patients undergoing radiotherapy.
Britton, B, Baker, A, Clover, K, McElduff, P, Wratten, C, Carter, G
European journal of cancer care. 2017;(4)
Abstract
Malnutrition in head and neck cancer (HNC) patients is common and associated with poorer radiotherapy outcomes including increased mortality. This pilot trial investigates the feasibility and effectiveness of a psychological intervention to improve nutritional status, depression and mortality in HNC patients undergoing radiotherapy. Fifty-nine intervention patients received motivational interviewing and cognitive behavioural therapy compared to 70 historical controls who received treatment as usual. Participants were assessed for nutrition, depression and mortality. There were no significant differences between groups in nutritional status, depression or mortality. Subgroup analyses among patients at greater nutritional risk (cancers of the oral cavity, pharynx, larynx) revealed a potentially clinically important reduction on the PG-SGA and lower mortality (31% of controls vs. 16% intervention; P = 0.03) in favour of the intervention condition. Potential benefits in nutritional status and in mortality in this pilot trial of a psychological intervention among HNC patients at high nutritional risk suggest that a larger randomised controlled trial is warranted.
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[Psychotherapy with Adjuvant use of Serotonergic Psychoactive Substances: Possibilities and Challenges].
Majić, T, Jungaberle, H, Schmidt, TT, Zeuch, A, Hermle, L, Gallinat, J
Fortschritte der Neurologie-Psychiatrie. 2017;(7):383-392
Abstract
Background Recently, scientific interest in the therapeutic potential of serotonergic and psilocybin hallucinogens (psychedelics) such as lysergic acid diethylamide (LSD) and entactogens like 3,4-methylendioxymethamphetamine (MDMA) within the framework of psychotherapy has resumed. The present article provides an overview on the current evidence on substance-assisted psychotherapy with these substances. Method A selective search was carried out in the PubMed and Cochrane Library including studies investigating the clinical use of serotonergic psychoactive substances since 2000. Results Studies were found investigating the following indications: alcohol (LSD and psilocybin) and tobacco addiction (psilocybin), anxiety and depression in patients suffering from life-threatening somatic illness (LSD and psilocybin), obsessive-compulsive disorder (OCD) (psilocybin), treatment-resistant major depression (psilocybin), and posttraumatic stress disorder (PTSD) (MDMA). Discussion Substance use disorders, PTSD and anxiety and depression in patients suffering from life-threatening somatic illness belong to the indications with the best evidence for substance-assisted psychotherapy with serotonergic psychoactive agents. To date, studies indicate efficacy and relatively good tolerability. Further studies are needed to determine whether these substances may represent suitable and effective treatment options for some treatment-resistant psychiatric disorders in the future.