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Are you a picky eater? Do you worry that food will make you vomit or choke? Do you find eating to be a chore? If yes, this book is for you! Your struggles could be caused by Avoidant Restrictive Food Intake Disorder (ARFID); a disorder characterized by eating a limited variety or volume of food. You may have been told that you eat like a child, but ARFID affects people right across the lifespan, and this book is the first specifically written to support adults. Join Drs. Jennifer Thomas, Kendra Becker, and Kamryn Eddy - three ARFID experts at Harvard Medical School - to learn how to beat your ARFID at home and unlock a healthier relationship with food. Real-life examples show that you are not alone, while practical tips, quizzes, worksheets, and structured activities, take you step-by-step through the latest evidence-based treatment techniques to support your recovery.
The quality of mental health services is crucial for the effectiveness and efficiency of mental healthcare systems, symptom reduction, and quality of life improvements in persons with mental illness. In recent years, particularly care coordination (i.e., the integration of care across different providers and treatment settings) has received increased attention and has been put into practice. Thus, we focused on care coordination in this update of a previous European Psychiatric Association (EPA) guidance on the quality of mental health services.
Methods.
We conducted a systematic meta-review of systematic reviews, meta-analyses, and evidence-based clinical guidelines focusing on care coordination for persons with mental illness in three literature databases.
Results.
We identified 23 relevant documents covering the following topics: case management, integrated care, home treatment, crisis intervention services, transition from inpatient to outpatient care and vice versa, integrating general and mental healthcare, technology in care coordination and self-management, quality indicators, and economic evaluation. Based on the available evidence, we developed 15 recommendations for care coordination in European mental healthcare.
Conclusions.
Although evidence is limited, some concepts of care coordination seem to improve the effectiveness and efficiency of mental health services and outcomes on patient level. Further evidence is needed to better understand the advantages and disadvantages of different care coordination models.
Massive, early-type stars have been detected as radio sources for many decades. Their thermal winds radiate free–free continuum and in binary systems hosting a colliding-wind region, non-thermal emission has also been detected. To date, the most abundant data have been collected from frequencies higher than 1 GHz. We present here the results obtained from observations at 325 and 610 MHz, carried out with the Giant Metrewave Radio Telescope, of all known Wolf-Rayet and O-type stars encompassed in area of
$\sim$
15 sq degrees centred on the Cygnus region. We report on the detection of 11 massive stars, including both Wolf-Rayet and O-type systems. The measured flux densities at decimeter wavelengths allowed us to study the radio spectrum of the binary systems and to propose a consistent interpretation in terms of physical processes affecting the wide-band radio emission from these objects. WR 140 was detected at 610 MHz, but not at 325 MHz, very likely because of the strong impact of free–free absorption (FFA). We also report—for the first time—on the detection of a colliding-wind binary system down to 150 MHz, pertaining to the system of WR 146, making use of complementary information extracted from the Tata Institute of Fundamental Research GMRT Sky Survey. Its spectral energy distribution clearly shows the turnover at a frequency of about 600 MHz, that we interpret to be due to FFA. Finally, we report on the identification of two additional particle-accelerating colliding-wind binaries, namely Cyg OB2 12 and ALS 15108 AB.
Little is known about the physical co-morbidity in mentally ill living in psychiatric and social health care facilities with regard to variation, causes, risk factors and prevention strategies. Aim of this study was to determine patients’ and professionals’ perceptions, attitudes and thoughts of
(i) co-morbid physical health problems and illness,
(ii) risk factors and causes of somatic problems and
(iii) prevention measures across Europe.
Methods
A total of 52 focus groups in 14 European countries were conducted. Participants were recruited from psychiatric and social health care facilities. Data were content analyzed deductively and inductively.
Results
The physical health problems that were often mentioned were weight problems, diabetes, cardiovascular and gastrointestinal problems, problems of the circulatory system, and general aches and pains. Regarding the causes of somatic problems and illnesses, focus groups repeatedly emphasized side-effects from medications. Besides treatment-related factors, country-specific aspects also were mentioned, mainly in the field of the living environment. Findings concerning “prevention” demonstrated the greatest distinctions between the participant groups, particularly with regard to the implementation and realization of health promotion interventions. Discussions revealed that patients preferred active learning (hands-on experiences) coupled with group classes for education and social support.
Conclusions
Focus groups identified behavioural, environmental and iatrogenic health risks. Efforts need to be directed toward interventions for physical illness prevention and health promotion on the background of the heterogeneity of mental disorders and the multitude of physical problems, and need to be based on an understanding of residents’ cultural beliefs and life situations.
We will present results of a systematic review of the effectiveness of methylphenidate in the treatment of adult ADHD. Furthermore, we will discuss the influence of methods on the results of meta analyses.
Methods
We searched Medline, PsycINFO and CCTR to identify randomised controlled clinical trials comparing methylphenidate with placebo in the treatment of adult ADHD. Studies were summarized with meta-analytic methods. Subgroup analyses were conducted with respect to parallel group vs. cross-over trials and self vs. observer ratings. The relationship between dosage and effect size was explored by weighted regression analysis. The results were tested for publication bias, and several sensitivity analyses were conducted.
Results
Nineteen studies met the inclusion criteria of which 17 were included in the meta-analysis. The overall effect size was significant at d=0.42 different from zero, but this was only half the size expected on the basis of a previous meta-analysis. No significant differences could be observed in the subgroup analyses. The regression analysis showed no significant influence of mean daily dose on effect size.
Conclusions
These results contradict findings of a previous meta-analysis and challenge guideline recommendations. Differences between populations of children and adults and methodological issues in meta-analyses are discussed.
Chinese trials were rarely included in western meta-analyses. This systematic review investigates the efficacy of venlafaxine in the treatment of major depression (MDD) in Chinese populations.
Methods
Chinese databases (VIP and CNKI) were searched for blinded randomised clinical trials (RCTs) comparing venlafaxine with any other pharmacotherapy and/or placebo. Quality of included studies was assessed with the Jadad scale. Furthermore, fulfilment of the CONSORT items was recorded. Final mean HAM-D scores and response rates were extracted and combined using a fixed-effects model. Subgroup analyses by drug class were performed to assess further differences.
Results
23 blinded RCTs were included in the analyses. Six compared venlafaxine with selective serotonin reuptake inhibitors (SSRIs), 15 with tricyclic antidepressants (TCAs) and two with tetracyclic antidepressants. The average Jadad score was 2.7 and on average 55% of all CONSORT items were reported. On average, 36 patients were randomised per group. Only three trials included more than 80 patients per group.
Mean final HAMD scores were significantly lower in the venlafaxine groups compared to TCA (Hedges’ g 0.14, 95%-CI, 0.01-0.26), but not in comparison to SSRI treated groups (Hedges’ g 0.05, 95%-CI, -0.12-0.21). These findings were confirmed by analyses of response rates. (MH RR Ven vs. TCA: 1.11, 95%-CI, 1.04-1.18, Ven vs. SSRI: 1.01, 95%-CI, 0.93-1.11).
Conclusions
These results suggest that venlafaxine is significantly more effective than TCAs, but not than SSRIs in depressive Chinese populations. However, large high quality trials are needed to verify these findings.
We investigated whether the type of antipsychotic treatment has an impact on patients’ subjective quality of life (QoL).
In a prospective naturalistic long-term study, 374 patients meeting ICD-10 criteria for schizophrenia or schizoaffective disorder were examined biannually over a two-year period with regards to QoL, psychopathology, social functioning, use of medical and psychosocial services, compliance, side effects and current neuroleptic treatment. QoL was assessed by the Berliner Lebensqualitätsprofil (BeLP), an adaption of the Lancashire Quality of Life Profile. First examination took place two weeks around discharge from a psychiatric clinic. At study entry, all participants were receiving neuroleptic medication of either quetiapine, risperidone or olanzapine. Mixed regression analysis taking into account the unbalanced panel structure of the data and adjusted for selection bias by means of propensity scores were used for data analysis.
Overall quality of life improved continuously during the two years observed period regardless of the type of neuroleptic. A small, but significant difference emerged when comparing quetiapine monotherapy treatment with olanzapine monotherapy or with a combination treatment of conventional and atypical antipsychotics. QoL of patients treated with olanzapine was generally worse than that of patients treated with quetiapine but improved slightly more over the course of time. In total time and type of medication explained only small proportions of variance in QoL.
Type of neuroleptic had only marginal impact on the subjective QoL of our sample. In order to explain changes in quality of life, research on social and individual factors seems to be more promising.
Little is known about the physical co-morbidity in mentally ill living in psychiatric and social health care facilities with regard to variation, causes, risk factors and prevention strategies. Aim of this study was to determine patients’ and professionals’ perceptions, attitudes and thoughts of (i) co-morbid physical health problems and illness, (ii) risk factors and causes of somatic problems and (iii) prevention measures across Europe.
Methods
A total of 52 focus groups in 14 European countries were conducted. Participants were recruited from psychiatric and social health care facilities. Data were content analyzed deductively and inductively.
Results
The physical health problems that were often mentioned were weight problems, diabetes, cardiovascular and gastrointestinal problems, problems of the circulatory system, and general aches and pains. Regarding the causes of somatic problems and illnesses, focus groups repeatedly emphasized side-effects from medications. Besides treatment-related factors, country-specific aspects also were mentioned, mainly in the field of the living environment. Findings concerning “prevention” demonstrated the greatest distinctions between the participant groups, particularly with regard to the implementation and realization of health promotion interventions. Discussions revealed that patients preferred active learning (hands-on experiences) coupled with group classes for education and social support.
Conclusions
Focus groups identified behavioural, environmental and iatrogenic health risks. Efforts need to be directed toward interventions for physical illness prevention and health promotion on the background of the heterogeneity of mental disorders and the multitude of physical problems, and need to be based on an understanding of residents’ cultural beliefs and life situations.
Collecting prospective data on medication adherence, course of illness, course of treatment, cost effectiveness and quality of life among patients with schizophrenia under the German health system.
Methods
The ELAN study was conducted as a multi-centre, non-interventional observation study. 374 patients with a diagnosis of schizophrenia or schizoaffective disorder (ICD-10 F2) who had been discharged with a medication of quetiapine (N=183), olanzapine (N=91) or risperidone (N=100) were included. Follow-up interviews were conducted after 6,12,18 and 24 months. Applied instruments comprised PANSS, MARS-S, EPS-M, AIMS-S, GAF, ZST and a questionnaire for quality of life.
Results
For each follow-up, at least 80% of the original sample could be included. After two years, between 39% and 43% of patients continued to take the drug prescribed at discharge. Only between 4% and 7% of patients received no neuroleptic treatment in the last 6 months, respectively. The variety of drugs used increased during the course. Only small differences could be found regarding the defined outcome measures (PANSS, GAF, rehospitalisation rate) and side effects. Changes in medication were mostly due to insufficient efficacy or side effects. Doctor's recommendations had an important influence on patients’ decisions.
Conclusions
Under conditions of routine treatment, medication adherence was much greater and differences between drugs were smaller than reported in randomised controlled clinical trials. Taking into account the low sample selection bias and the small percentage of lost-to-follow-up subjects, this study provides some new insight into routine clinical treatment and outcomes in patients with schizophrenia.
Stigma against mental illness and the mentally ill is well known. However, stigma against psychiatrists and mental health professionals is known but not discussed widely. Public attitudes and also those of other professionals affect recruitment into psychiatry and mental health services. The reasons for this discriminatory attitude are many and often not dissimilar to those held against mentally ill individuals. In this Guidance paper we present some of the factors affecting the image of psychiatry and psychiatrists which is perceived by the public at large. We look at the portrayal of psychiatry, psychiatrists in the media and literature which may affect attitudes. We also explore potential causes and explanations and propose some strategies in dealing with negative attitudes. Reduction in negative attitudes will improve recruitment and retention in psychiatry. We recommend that national psychiatric societies and other stakeholders, including patients, their families and carers, have a major and significant role to play in dealing with stigma, discrimination and prejudice against psychiatry and psychiatrists.
Schizoaffective disorder is a common diagnosis in mental health services. The present article aims to provide an overview of diagnostic reliability, symptomatology, outcome, neurobiology and treatment of schizoaffective disorder.
Method
Literature was identified by searches in “Medline” and “Cochrane Library”.
Results
The diagnosis of schizoaffective disorder has a low reliability. There are marked differences between the current diagnostic systems. With respect to psychopathological symptoms, no clear boundaries were found between schizophrenia, schizoaffective disorder and affective disorders. Common neurobiological factors were found across the traditional diagnostic categories. Schizoaffective disorder according to ICD-10 criteria, but not to DSM-IV criteria, shows a more favorable outcome than schizophrenia. With regard to treatment, only a small and heterogeneous database exists.
Conclusion
Due to the low reliability and questionable validity there is a substantial need for revision and unification of the current diagnostic concepts of schizoaffective disorder. If future diagnostic systems return to Kraepelin's dichotomous classification of non-organic psychosis or adopt a dimensional diagnostic approach, schizoaffective disorder will disappear from the psychiatric nomenclature. A nosological model with multiple diagnostic entities, however, would be compatible with retaining the diagnostic category of schizoaffective disorder.
Forty-three patients with schizophrenia were investigated with a short neurocognitive screening battery focussing on working memory and executive functions. As compared to healthy controls, patients showed impairments in the modified card sorting test, in verbal fluency and all span tasks with exception of digit span forward. Patients who were treated with atypicals showed better performance in the digit ordering test (manipulation task) when compared to a group of patients who received conventional antipsychotics; this difference was not due to disease severity, age or education. Manipulation tasks might be useful for neurocognitive follow-up and intervention studies.
Attempts to reduce high utilisation of psychiatric inpatient care by targeting the critical time of hospital discharge have been rare. In Germany, until now no such intervention has been implemented, let alone subjected to a clinical trial.
Method
“Effectiveness and Cost-Effectiveness of Needs-Oriented Discharge Planning and Monitoring for High Utilisers of Psychiatric Services” (NODPAM) is a multicentre RCT conducted in five psychiatric hospitals in Germany (Günzburg, Düsseldorf, Regensburg, Greifswald, and Ravensburg). Subjects asked to provide informed consent to participate have to be of adult age with a primary diagnosis of schizophrenia or affective disorder, and a defined high utilisation of psychiatric care during two years prior to the current admission. Subjects are asked to provide detailed outcome data at four measurement points during a period of 18 months. Recruitment (which started in April 06) is still ongoing. Thus, baseline data of about 350 participants will be presented.
Results
Recruitment has been quite successful and the study has been generally well accepted by participating patients and their clinicians in in- and outpatient treatment settings. Subjects showed substantial initial impairment on outcome measures (e.g. needs, psychopathology, quality of life, and level of functioning) and high utilisation of mental health care. Further results on conduct and feasibility of the trial will be presented.
Conclusions
The first phase of this mulicentre trial was promising. The potential of this study to strengthen the integration of mental health care provision in Germany will be discussed.
Aim of this contribution is to describe the intervention used in the study “Effectiveness and Cost-Effectiveness of Needs-Oriented Discharge Planning and Monitoring for High Utilisers of Psychiatric Services” (NODPAM). This intervention applies principles of needs-led care and focusses on the inpatient-outpatient transition. The NODPAM intervention manual includes a range of predefined standardised options based on number and type of needs.
Method
For the intervention group, a trained intervention worker provides a coherent package of needs-oriented discharge planning and monitoring focussing on the care process. He or she emphasises continuity of the care process vis-à-vis both patient and clinician (and carers if possible) via providing two manualised intervention sessions): (a) A discharge planning session takes place just before discharge with the patient and responsible clinician at the inpatient service; (b) A monitoring session takes place three months after discharge with the patient and outpatient clinician (office-based or public outpatient mental health service-based). A written treatment plan is signed by and forwarded to all participants after each session.
Results
Acceptance of the intervention by patients and clinicians has been high so far. Further results on duration, participant characteristics, and participants' appraisal of the NODPAM intervention will be presented.
Conclusion
These first results indicate that the NODPAM intervention is feasible in inpatient mental health services in Germany. Discussion will focus on its applicability in other service systems.
CT findings in 17 patients and MRI in one patient with post partum psychiatric disorder (PPPD; psychosis: n = 17, depressive neurosis: n = 1) were compared with randomly selected CT scans in non-PPPD patients matched for age and sex. In the PPPD group, 13 examinations (controls: 8) revealed one or several abnormal findings such as sulcal widening, ventricular enlargement and asymmetry. There was a higher prevalence of abnormal CT/MRI findings in the PPPD group (trend, P < 0.1).
Despite considerable advances in the evidence-based treatments, the long-term management of depressive disorders remains a challenge. Many depressive disorders follow a chronic or recurrent course. Substantial proportions of patients end treatment, especially those with residual symptoms, leave treatment with considerable risk for relapses and/or persistent psychosocial impairment. Long-term strategies are needed that can effectively help patients minimize the negative consequences of their illness without imposing a too much of an extra burden. We present the protocol of a multi-center RCT on the efficacy of an Internet based disease management strategy for the specific health conditions in recurrent depression. 234 patients who are treated for their minimum third episode of a major depression (MD) in one of the six participating centers will participate post-treatment in one of two internet delivered interventions or usual care alone. The interventions continue over 12 months and consist of supportive monitoring, an online forum for peer support, and individual crisis management either with or without personal clinical support. Primary outcome of the trial is the ratio of “well” to “unwell weeks” over a 24-month observation period after index treatment assessed with the Longitudinal Interval Follow-Up Evaluation. We would like to discuss the new options that information and communication technology offers for long-term disease management strategies for patients with recurrent depression and invite for a discussion about strategies for other chronic mental disorders.