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Improving mood with psychoanalytic and cognitive therapies (IMPACT): a pragmatic effectiveness superiority trial to investigate whether specialised psychological treatment reduces the risk for relapse in adolescents with moderate to severe unipolar depression: study protocol for a randomised controlled trial
Ian M Goodyer, Sonya Tsancheva, Sarah Byford, Bernadka Dubicka, Jonathan Hill, Raphael Kelvin, Shirley Reynolds, Christopher Roberts, Robert Senior, John Suckling, Paul Wilkinson, Mary Target, Peter Fonagy
Trials , 2011, DOI: 10.1186/1745-6215-12-175
Abstract: Improving Mood with Psychoanalytic and Cognitive Therapies, the IMPACT Study, will determine whether Cognitive Behavioural Therapy or Short Term Psychoanalytic Therapy is superior in reducing relapse compared with Specialist Clinical Care. The study is a multicentre pragmatic effectiveness superiority randomised clinical trial: Cognitive Behavioural Therapy consists of 20 sessions over 30 weeks, Short Term Psychoanalytic Psychotherapy 30 sessions over 30 weeks and Specialist Clinical Care 12 sessions over 20 weeks. We will recruit 540 patients with 180 randomised to each arm. Patients will be reassessed at 6, 12, 36, 52 and 86 weeks. Methodological aspects of the study are systematic recruitment, explicit inclusion criteria, reliability checks of assessments with control for rater shift, research assessors independent of treatment team and blind to randomization, analysis by intention to treat, data management using remote data entry, measures of quality assurance, advanced statistical analysis, manualised treatment protocols, checks of adherence and competence of therapists and assessment of cost-effectiveness. We will also determine whether time to recovery and/or relapse are moderated by variations in brain structure and function and selected genetic and hormone biomarkers taken at entry.The objective of this clinical trial is to determine whether there are specific effects of specialist psychotherapy that reduce relapse in unipolar major depression in adolescents and thereby costs of treatment to society. We also anticipate being able to utilise psychotherapy experience, neuroimaging, genetic and hormone measures to reveal what techniques and their protocols may work best for which patients.Current Controlled Trials ISRCTN83033550First depressive episodes tend to arise in vulnerable individuals exposed to current chronic psychosocial adversities and acute adverse life events [1-3]. Later episodes of recurrent disorder are however associated with fewer external s
DIAGNOSIS AND TREATMENT OF DEPRESSION IN PERSONS WITH INTELLECTUAL DISABILITY  [PDF]
Katarina Tomi?1,,Goran Mihajlovi?2,,Natalija Jovanovi? Mihajlovi?3,Slavica ?uki? Dejanovi?2, and
Acta Medica Medianae , 2011,
Abstract: This paper considers, from the theoretical point of view, the problem of diagnosing and treatment of depressive disorders in people with intellectual disability (ID), relying primarily on the results of previous researches, which stress the etiological, symptomatic, diagnostic and therapeutic specifics when it comes to depression and its correlates in this population. The interest in mental health and psychopathology of people with ID intensified during the seventh decade of the previous century, when it became clear that some cognitive and behavioral symptoms are not, as hitherto thought, only a part or a consequence of the syndrome of intellectual disability, but a sign of ongoing mental disorder. So, the idea of ''dual diagnosis'' was born, and now it provides guidelines for the growing number of studies which theoretically and empirically review different issues of mental health problems in people with ID. Likewise, the observation of syndrome groups of genetic disorders resulting in intellectual disability has led to the narrowing of the circle of genetic syndromes that carry increased risk for the onset of depression and its correlates, such as: Down syndrome, Fragile X syndrome and Prader-Willi syndrome. Potential diagnostic problem in people with ID, when it comes to depression, may arise from ''diagnostic overshadowing’’ of depression symptoms, which often remain hidden under abnormal behavior and adjustment disorders, especially in patients with severe forms of ID. As a possible way to overcome these problems some authors have proposed the concept of ''behavioral equivalents of depression'' or behavioral disorders that evidently can be associated with depression, such as social withdrawal, aggression, hostility, irritability, psychomotor agitation or retardation. Intensification of these forms of behavior may be a sign of developing depression, and in that sense, this view represents a useful starting point. When it comes to therapeutic approaches, there is a general tendency in favour of psycho pharmacotherapy in the treatment of depression, although there is a growing number of researches that prove the favourable effects of cognitive-behavioral and psychoanalytic psychotherapy.
Managing depression: analytic, antidepressants or both?
Lucas, Richard;
Revista de Psiquiatria do Rio Grande do Sul , 2003, DOI: 10.1590/S0101-81082003000200004
Abstract: patients with depression cover the spectrum, in terms of severity of psychopathology, between those receptive to analytic psychotherapy and those that require treatment with medication. in this paper, the author demonstrates how a psychoanalytic framework of understanding has a place in the latter group, and can aid general psychiatrists in relating to their depressed patients. the notion of a pathological ego-destructive superego taking over control in depression is explored, with the need to unseat it and replace it with a more mature superego providing an overall framework of approach to treatment.
Managing depression: analytic, antidepressants or both?  [cached]
Lucas Richard
Revista de Psiquiatria do Rio Grande do Sul , 2003,
Abstract: Patients with depression cover the spectrum, in terms of severity of psychopathology, between those receptive to analytic psychotherapy and those that require treatment with medication. In this paper, the author demonstrates how a psychoanalytic framework of understanding has a place in the latter group, and can aid general psychiatrists in relating to their depressed patients. The notion of a pathological ego-destructive superego taking over control in depression is explored, with the need to unseat it and replace it with a more mature superego providing an overall framework of approach to treatment.
Bridging Music and Psychoanalytic Therapy
Deborah Salmon
Voices: A World Forum for Music Therapy , 2008,
Abstract: The author draws upon theory, training and clinical experience in palliative care music therapy and verbal psychoanalytic therapy. Elements common to both music and psychoanalytic therapy are explored; the centrality of listening, the boundaries and fluidity of time, the importance of containment and expression of affect, the capacity to facilitate mourning, and the inherent creativity of each. Contributions from analytic music therapy are considered. Two case vignettes are presented; the first integrates psychoanalytic thinking into music therapy work with a dying woman; the second, from verbal psychotherapy practise, illustrates mourning being facilitated by the spontaneous use of a song., The question of training music therapists to do depth work using psychoanalytic concepts is raised, particularly in respect to the use of words and recognition of transference and countertransference phenomena. Finally, the author reflects on her experience of music therapy and psychotherapy work each enriching and deepening the other.
Psychoanalytic and cognitive-behavior therapy of chronic depression: study protocol for a randomized controlled trial
Beutel Manfred E,Leuzinger-Bohleber Marianne,Rüger Bernhard,Bahrke Ulrich
Trials , 2012, DOI: 10.1186/1745-6215-13-117
Abstract: Background Despite limited effectiveness of short-term psychotherapy for chronic depression, there is a lack of trials of long-term psychotherapy. Our study is the first to determine the effectiveness of controlled long-term psychodynamic and cognitive-behavioral (CBT) treatments and to assess the effects of preferential vs. randomized assessment. Methods/design Patients are assigned to treatment according to their preference or randomized (if they have no clear preference). Up to 80 sessions of psychodynamic or psychoanalytically oriented treatments (PAT) or up to 60 sessions of CBT are offered during the first year in the study. After the first year, PAT can be continued according to the ‘naturalistic’ usual method of treating such patients within the system of German health care (normally from 240 up to 300 sessions over two to three years). CBT therapists may extend their treatment up to 80 sessions, but focus mainly maintenance and relapse prevention. We plan to recruit a total of 240 patients (60 per arm). A total of 11 assessments are conducted throughout treatment and up to three years after initiation of treatment. The primary outcome measures are the Quick Inventory of Depressive Symptoms (QIDS, independent clinician rating) and the Beck Depression Inventory (BDI) after the first year. Discussion We combine a naturalistic approach with randomized controlled trials(RCTs)to investigate how effectively chronic depression can be treated on an outpatient basis by the two forms of treatment reimbursed in the German healthcare system and we will determine the effects of treatment preference vs. randomization. Trial registration http://www.controlled-trials.com/ISRCTN91956346
Exercise for the Treatment of Depression
J. Knapen, D. Vancampfort, B. Schoubs, M. Probst, P. Sienaert, P. Haake, J. Peuskens,G. Pieters
The Open Complementary Medicine Journal , 2009, DOI: 10.2174/1876391X00901010078]
Abstract: Depression is a common mental disorder that presents with depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep and/or appetite, low energy, and poor concentration. Depression is a widespread and often chronic condition. Lifetime prevalence estimates for major depressive disorder are approximately 15% to 20%; 1-year prevalence estimates are 5% to 10%. Moreover, depression is characterized by high rates of relapse: 22% to 50% of patients suffer recurrent episodes within 6 months after recovery. Depression is associated with a high incidence of co-morbid somatic illness. Individuals suffering from major depression run a higher relative risk of coronary heart disease, type 2 diabetes and osteoporosis compared with the general population. In general, depressed individuals exhibit a less active life-style and have a reduced cardio-respiratory fitness in comparison with the general population. Strong evidence demonstrates that lack of physical activity is associated with an unhealthier body mass and composition, and a biomarker risk profile for cardiovascular disease, type 2 diabetes, and osteoporosis. A growing body of evidence suggests that exercise is an effective treatment for depression. For mild to moderate depression the effect of exercise may be comparable to antidepressant medication and psychotherapy; for severe depression exercise seems to be a valuable complementary therapy to the traditional treatments. Exercise training not only improves depression, but also produces ‘positive side effects’ on depression associated physical diseases and cognitive decline.
Interpersonal Psychotherapy in the Treatment of Perinatal Depression  [PDF]
Gamze Ergil Altin
Psikiyatride Guncel Yaklasimlar , 2012,
Abstract: Perinatal depression is a psychiatric disorder that is not sufficiently diagnosed and directed to treatment. Its acute and chronic outcomes influence not only the mother but also the infant and the relationship between them. Both pregnancy and the postpartum periods are the times of significant physiological and emotional changes which also influence interpersonal relationships. Interpersonal risk factors like insufficient social support and increased social conflict can have an important impact on the women’s mental and physiological health during this period. Studies have shown that women prefer psychological and social management over drugs during this period. Interpersonal psychotherapy is a time-limited treatment approach, especially focusing on interpersonal difficulties with the goal of reducing depressive symptoms and improving interpersonal functioning. Such distressing factors which can occur during pregnancy and delivery are compatible with the four main problem areas that interpersonal psychotherapy addresses so that the therapist can easily use interpersonal psychotherapy in order to solve such difficulties.
A Review on Assessment and Treatment for Depression in Malaysia  [PDF]
Firdaus Mukhtar,Tian P. S. Oei
Depression Research and Treatment , 2011, DOI: 10.1155/2011/123642
Abstract: This paper aimed to review the literature on depression that focused on its assessment and treatment in Malaysia. PsycINFO, Medline, local journals were searched, and 18 published articles were included in this paper. Results indicate that research on depression in Malaysia, particularly validation studies and psychotherapy research, was weak and fragmented, with minimal empirical evidence available. Pharmacotherapy still dominated the treatment for depression, and, in terms of psychotherapy, Cognitive Behavioural Therapy (CBT) was recently practiced, but only a few studies have reported on the treatment efficacy of CBT. Major limitations of studies were noted, and, consequently, the problems that are associated with the implementation and future direction of clinical and research on depression in Malaysia were discussed. In short, the contribution of empirical research on the assessment and treatment for depression remained inconsistent and fragmented and urgently in need of further empirical investigation. 1. Introduction It is projected that depression, an affective disturbance, will be among the leading causes of worldwide disability, by the year 2020 [1]. Across the Asia-Pacific region, rates of current or 1-month major depression ranged from 1.3 to 5.5% and rates of major depression in the previous year ranged from 1.7 to 6.7% [2]. Malaysia is no exception; in fact, depression is the most commonly reported mental illness in Malaysia. Depression is by far the most important and treatable condition and is projected to affect approximately 2.3 million Malaysians at some point in their lives [3]; yet depression remains underdetected and undertreated [4]. Theories of psychological disorders (particularly depression) are both clear and abundantly found in the literature. These theories can be broadly classified into either biological or psychosocial. Pharmacological theories of depression, such as amine dysregulations, are well established [5, 6] and thus provide a strong foundation for the pharmacological treatment of depression. It is clear that the efficacy of antidepressants, such as Selective Serotonin Reuptake Inhibitors (SSRI) and tricyclics, are well documented [7, 8]. Similarly, psychological theories such as Beck’s cognitive theories are well articulated and generally accepted in the West [9–11]. It is also generally accepted in the literature that Cognitive Behaviour Therapy (CBT) is an effective way of treating depression [12–15]. In Malaysia, biological theories, and, thus, the pharmacological treatment of depression, are commonly used in
Psicoterapia psicoanalítica del adolescente deprimido: principios técnicos Psychoanalytic Psychotherapy of the Depressed Adolescent: Technical Principles  [cached]
Alejandro Rojas-Urrego
Revista Colombiana de Psiquiatría , 2008,
Abstract: Introducción: Mientras la adolescencia significa, en esencia, "crecimiento", la depresión, en cambio, sería lo contrario: la tendencia al desfallecimiento, abatimiento, inhibición, inmovilidad, postración y, en ocasiones, incluso la nada. Desarrollo: A partir de un intento de articulación entre estos dos conceptos y las nociones de historia, estructura y coyuntura, el autor se propone subrayar la importancia del adecuado manejo psicoterapéutico de la depresión en la adolescencia. Considera, para comenzar, la multideterminación de este trastorno y, por consiguiente, los vértices de intervención posibles. Se centra en la psicoterapia psicoanalítica, apenas una de las modalidades psicoterapéuticas posibles en este contexto. Aborda algunas generalidades sobre la psicoterapia psicoanalítica y pasa enseguida a tratar tres temas no suficientemente estudiados en la literatura médica: las entrevistas iniciales, las indicaciones y, finalmente, la denominada terapia bifocal. Conclusión: En su conclusión, invita al lector a reflexionar sobre la importancia del encuentro terapéutico con el adolescente deprimido y sobre la trascendencia de analizar y de dar sentido a su depresión. Introduction: While adolescence in essence means growth, depression on the other hand would by definition be the opposing "movement": a tendency towards languor, abatement, inhibition, immobility, prostration, zero, sometimes even towards nothing. Development: In an attempt to articulate these two concepts and the notions of history, structure, and juncture, the author underscores the importance of an appropriate psychotherapeutic management of adolescent depression. To begin, he takes into account the fact that this disorder is multidetermined and in consequence, the existence of various vertexes of possible interventions. This paper focuses on psychoanalytic psychotherapy, one of several possible psychotherapeutic modalities available in this context. He discusses some of the generalities of psychoanalytic psychotherapy and then goes on to examine three themes not sufficiently explored in the literature: the initial interviews, the indications, and finally, what is known as bifocal therapy. Conclusion: To conclude, he invites the reader to ponder on the importance of the therapeutic encounter with the depressed adolescent and on the transcendence of analyzing and giving meaning to her depression
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