1,721,141 research outputs found
Unraveling the role of eco-anxiety: from pro-environmental behaviors and orthorexia nervosa risk in the general population to mental health professional perspectives
Full text linkThe sequential model in the treatment of depression
No full textObject: Administration of treatments in a sequential order is a common practice in clinical medicine, but has received insufficient attention in psychiatry. The aim of this review was to consider the literature concerned with a sequential use of pharmacotherapy and psychotherapy in depression. Method: A review of the clinical trials where treatment components were used in a sequential order (pharmacotherapy followed by psychotherapy; psychotherapy followed by pharmacotherapy; one drug treatment following another; one psychotherapeutic technique following another) was performed. Results: In unipolar recurrent depression the sequential use of pharmacotherapy was found to improve relapse rate. Conclusions: The sequential treatment of depression does not fall within the realm of maintenance strategies. It is an intensive, two-stage approach, which is based on the fact that one course of treatment with a specific treatment (whether pharmacotherapy or psychotherapy) is unlikely to entail solution to the complex array of symptoms of patients with affective disorders. The sequential model introduces a conceptual shift in current assessment methods
An innovative approach for the assessment of mood disturbances in patients with eating disorders
Full text linkObjective. Assessment of mood in eating disorders (EDs) has important clinical implications, but the current standard psychiatric classification (DSM-5) has limitations. The aim of the current study is to broaden the evaluation of depressive symptomatology by providing a comprehensive and innovative assessment approach in EDs through instruments that capture clinical phenomena of demoralization, subclinical distress, and psychological well-being.Methods. Seventy-nine patients who met diagnostic criteria for EDs of the Diagnostic and Statistical Manual of Mental Disorders - Fifth edition (DSM-5) were evaluated for depressive symptoms through Paykel's Clinical Interview for Depression, the Structured Clinical Interview for DSM-5 for major depressive episode and persistent depressive disorder, and the Diagnostic Criteria for Psychosomatic Research (DCPR) interview for demoralization. Further, self-report inventories encompassing psychological well-being and distress were used.Results. Guilt, abnormal reactivity to social environment, and depressed mood were the most common depressive symptoms in the sample. DSM-defined depressive disorders were found in 55.7% of patients. The DCPR-demoralization criteria identified an additional 20.3% of the sample that would have been undetected with DSM criteria. Both DSM and DCPR diagnostic categories were associated with compromised psychological well-being and distress. Demoralization, unlike depression, was not associated with the severity of ED symptomatology.Conclusion. The findings indicate that a standard psychiatric approach, DSM-5-based, captures only a narrow part of the spectrum of mood disturbances affecting patients with EDs. A broadened clinimetric assessment unravels the presence of demoralization and yields clinical distinctions that may entail prognostic and therapeutic differences among patients who would be otherwise simply labeled as depressed
Clinimetrics: the science of clinical measurements.
No full text'Clinimetrics' is the term introduced by Alvan R. Feinstein in the early 1980s to indicate a domain concerned with indexes, rating scales and other expressions that are used to describe or measure symptoms, physical signs and other clinical phenomena. Clinimetrics has a set of rules that govern the structure of indexes, the choice of component variables, the evaluation of consistency, validity and responsiveness. This review illustrates how clinimetrics may help expanding the narrow range of information that is currently used in clinical science. It will focus on characteristics and types of clinimetric indexes and their current use. The clinimetric perspective provides an intellectual home for clinical judgment, whose implementation is likely to improve outcomes both in clinical research and practice
Mental pain in eating disorders: An exploratory controlled study
Full text linkMental pain (MP) is a transdiagnostic feature characterized by depression, suicidal ideation, emotion dysregulation, and associated with worse levels of distress. The study explores the presence and the discriminating role of MP in EDs in detecting patients with higher depressive and ED-related symptoms. Seventy-one ED patients and 90 matched controls completed a Clinical Assessment Scale for MP (CASMP) and the Mental Pain Questionnaire (MPQ). ED patients also completed the Beck Depression Inventory-II (BDI-II), Clinical Interview for Depression (CID-20), and Eating Attitudes Test (EAT-40). ED patients exhibited significantly greater severity and higher number of cases of MP than controls. Moreover, MP resulted the most important cluster predictor followed by BDI-II, CID-20, and EAT-40 in discriminating between patients with different ED and depression severity in a two-step cluster analysis encompassing 87.3% (n = 62) of the total ED sample. Significant positive associations have been found between MP and bulimic symptoms, cognitive and somaticaffective depressive symptoms, suicidal tendencies, and anxiety-related symptoms. In particular, those presenting MP reported significantly higher levels of depressive and anxiety-related symptoms than those without. MP represents a clinical aspect that can help to detect more severe cases of EDs and to better understand the complex interplay between ED and mood symptomatology
Clinical assessment of allostatic load and clinimetric criteria
No full textThe concept of allostasis emphasizes that healthy functioning requires continual adjustments to the internal physiological milieu. Allostatic load reflects the cumulative effects of stressful experiences in daily life. When the cost of chronic exposure to fluctuating or heightened neural or neuroendocrine responses exceeds the coping resources of an individual, allostatic overload ensues. So far these issues have been addressed only on pathophysiological terms that do not find application in clinical settings. However, several features that have been described in psychosomatic research may allow the assessment of allostatic load on clinical grounds. Clinimetric criteria for the determination of allostatic overload are suggested. They are based on: (a) the presence of a stressor exceeding individual coping skills, and (b) clinical manifestations of distress. They may provide specification to the fourth axis of DSM, may supplement the Diagnostic Criteria for Psychosomatic Research, and may help discriminate neuroendocrine patterns with important clinical and research implications. A state of allostatic overload is frequently associated with alterations in biological markers and calls for a close medical evaluation of the patient's condition. The ultimate goal is to be able to prevent or decrease the negative impact of excessive stress on health
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