psychotherapy

心理治疗
  • 文章类型: Journal Article
    本次范围审查的目的是综合与COVID-19感染相关的心理健康问题的心理干预措施的已发表研究和正在进行的临床试验。该研究方案是根据系统评价和荟萃分析(PRISMA)扩展范围评价的首选报告项目制定的。我们使用八个科学数据库和临床试验注册中心,对2020年1月至2022年10月之间发表或注册的研究进行了系统搜索。确定了40项完整的已发表研究和53项正在进行的临床试验。我们发现,大多数研究是随机对照试验(74%),而其余的研究设计的方法学质量较低。大多数研究调查了急性COVID-19患者的干预措施(74%),其他研究探讨了COVID后状况(PCC)或康复患者。认知和行为疗法是主要的干预方法(31%),其次是多学科计划(21%)和正念(17%)。最常评估的结果是焦虑(33%),抑郁症(26%),生活质量(13%),失眠(10%)。没有关于年轻人的研究,老年人,或边缘化社区被发现。这些发现总结了对感染COVID-19的个体进行一系列心理干预的新兴研究。然而,该领域尚处于起步阶段,需要进一步研究以开发有针对性护理的证据基础。目前研究中发现的差距也凸显了对青少年进行更多研究的必要性,老年人,和边缘化社区的成员,PCC患者。重要的是要确定干预措施和交付策略,不仅有效且负担得起,而且还允许高可扩展性和可访问性。
    The aim of this scoping review was to synthesize published studies and ongoing clinical trials of psychological interventions for mental health problems associated with COVID-19 infection. The study protocol was developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews. We conducted systematic searches for studies published or registered between January 2020 and October 2022 using eight scientific databases and clinical trial registries, which identified 40 complete published studies and 53 ongoing clinical trials. We found that most studies were randomized controlled trials (74%) while the remaining used study designs of lower methodological quality. Most studies investigated interventions for acute COVID-19 patients (74%) and others explored post-COVID conditions (PCC) or recovered patients. Cognitive and behavioral therapies were the main intervention approaches (31%), followed by multidisciplinary programs (21%) and mindfulness (17%). The most frequently evaluated outcomes were anxiety (33%), depression (26%), quality of life (13%), and insomnia (10%). No studies on youths, older people, or marginalized communities were found. These findings summarize the burgeoning research on a range of psychological interventions for individuals infected with COVID-19. However, the field is in its infancy and further research to develop an evidence base for targeted care is necessary. The gaps identified in the current study also highlight the need for more research on youths, older people, and members of marginalized communities, and PCC patients. It is important to ascertain interventions and delivery strategies that are not only effective and affordable but also allow high scalability and accessibility.
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  • 文章类型: Journal Article
    背景:近年来,越来越多的证据表明,非药物干预治疗精神分裂症谱系障碍(SSD)的疗效,包括幻听(AH)等阳性症状.然而,临床试验主要检查阳性症状的一般治疗效果.因此,先前的研究缺乏有关主要针对治疗AH的心理和心理社会方法的全面和明确的证据。为了克服当前文献中的这种知识差距,我们将进行系统评价和荟萃分析,以评估明确针对性的心理和社会心理干预对SSD患者AH的疗效.
    方法:本研究方案是根据系统评价和荟萃分析方案的首选报告项目指南制定的。我们将包括所有随机对照试验,分析针对性的心理和心理社会干预措施的疗效,特别是旨在治疗SSD中的AH。我们将包括对经历AH的SSD成年患者的研究。主要结果将是测量AH的已发布评级量表的变化。次要结果将是妄想,总体症状,阴性症状,抑郁症,社会功能,生活质量,和可接受性(辍学)。我们将搜索相关数据库和所包含文献的参考列表。研究选择过程将由两名独立评审员进行。我们将进行随机效应荟萃分析,以考虑不同研究的异质性。将通过R中的软件包进行分析。将使用Cochrane偏差风险工具评估每个研究中的偏差风险。将进行异质性评估和敏感性分析。
    结论:拟议的研究将通过概述有效的治疗方法及其在SSD中治疗AH的总体疗效来增强现有证据。这些发现将通过解决治疗AH的有效策略来补充可能影响临床实践中未来治疗实施的现有证据,从而改善所处理人群的结果。
    背景:没有道德问题可以预见。我们将在同行评审的期刊和相关的科学会议上发表这项研究的结果。
    背景:PROSPERO注册号:CRD42023475704。
    BACKGROUND: In recent years, a growing body of evidence has demonstrated the efficacy of non-pharmacological interventions for schizophrenia spectrum disorders (SSD) including positive symptoms such as auditory hallucinations (AH). However, clinical trials predominantly examine general treatment effects for positive symptoms. Therefore, previous research is lacking in comprehensive and clear evidence about psychological and psychosocial approaches that are primarily tailored to treat AH. To overcome this knowledge gap in the current literature, we will conduct a systematic review and meta-analysis to assess the efficacy of clearly targeted psychological and psychosocial interventions for AH in persons with SSD.
    METHODS: This study protocol has been developed according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. We will include all randomized controlled trials analyzing the efficacy of targeted psychological and psychosocial interventions especially aimed at treating AH in SSD. We will include studies on adult patients with SSD experiencing AH. The primary outcome will be the change on a published rating scale measuring AH. Secondary outcomes will be delusions, overall symptoms, negative symptoms, depression, social functioning, quality of life, and acceptability (drop-out). We will search relevant databases and the reference lists of included literature. The study selection process will be conducted by two independent reviewers. We will conduct a random-effect meta-analysis to consider heterogeneity across studies. Analyses will be carried out by software packages in R. The risk of bias in each study will be evaluated using the Cochrane Risk of Bias tool. Assessment of heterogeneity and sensitivity analysis will be conducted.
    CONCLUSIONS: The proposed study will augment the existing evidence by providing an overview of effective treatment approaches and their overall efficacy at treating AH in SSD. These findings will complement existing evidence that may impact future treatment implementations in clinical practice by addressing effective strategies to treat AH and therefore improve outcomes for the addressed population.
    BACKGROUND: No ethical issues are foreseen. We will publish the results from this study in peer-reviewed journals and at relevant scientific conferences.
    BACKGROUND: PROSPERO registration number: CRD42023475704.
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  • 文章类型: Journal Article
    这篇综述评估了干预成人状态焦虑(牙科治疗期间的恐惧和情绪困扰)的随机对照试验(RCT),慢性牙科(特质焦虑)或牙科恐惧症(不成比例的高特质焦虑;符合特定恐惧症的诊断标准)。系统检索了7个在线数据库。173项RCT符合纳入标准,其中67人符合14项汇总分析的资格。为了减轻口腔手术期间的状态焦虑,中度确定性证据支持使用催眠(SMD=-0.31,95CI[-0.56,-0.05]),低确定性证据支持使用苯二氮卓类药物(SMD=-0.43,[-0.74,-0.12])。关于心理治疗,减少状态焦虑的证据尚无定论,并且不支持虚拟现实暴露疗法(VRET),虚拟现实分心,音乐,芳香疗法,视频信息和针灸。为了减少特质焦虑,中度确定性证据支持使用认知行为疗法(CBT;SMD=-0.65,[-1.06,-0.24])。关于牙科恐惧症,具有低到中等确定性的证据支持采用心理治疗(SMD=-0.48,[-0.72,-0.24]),特别是CBT(SMD=-0.43,[-0.68,-0.17]),但不是VRET。这些结果表明牙齿焦虑是可控制和可治疗的。临床医生应确保干预措施符合他们在治疗期间管理急性情绪的目的,或缓解慢性焦虑和回避倾向。现有的研究差距强调了未来试验最小化偏倚和遵循CONSORT报告指南的必要性。
    This review evaluates randomized controlled trials (RCTs) intervening on adult state anxiety (fear and emotional distress during dental treatment), chronic dental (trait) anxiety or dental phobia (disproportionately high trait anxiety; meeting diagnostic criteria for specific phobia). Seven online databases were systematically searched. 173 RCTs met inclusion criteria, of which 67 qualified for 14 pooled analyses. To alleviate state anxiety during oral surgery, moderate-certainty evidence supports employing hypnosis (SMD=-0.31, 95 %CI[-0.56,-0.05]), and low-certainty evidence supports prescribing benzodiazepines (SMD=-0.43, [-0.74,-0.12]). Evidence for reducing state anxiety is inconclusive regarding psychotherapy, and does not support virtual reality exposure therapy (VRET), virtual reality distraction, music, aromatherapy, video information and acupuncture. To reduce trait anxiety, moderate-certainty evidence supports using Cognitive Behavioral Therapy (CBT; SMD=-0.65, [-1.06, -0.24]). Regarding dental phobia, evidence with low-to-moderate certainty supports employing psychotherapy (SMD=-0.48, [-0.72,-0.24]), and CBT specifically (SMD=-0.43, [-0.68,-0.17]), but not VRET. These results show that dental anxieties are manageable and treatable. Clinicians should ensure that interventions match their purpose-managing acute emotions during treatment, or alleviating chronic anxiety and avoidance tendencies. Existing research gaps underscore the necessity for future trials to minimize bias and follow CONSORT reporting guidelines.
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  • 文章类型: Journal Article
    目的:本研究旨在探讨产后妇女妊娠相关并发症与创伤后应激障碍(PTSD)之间的关系。然后总结妊娠相关PTSD或亚PTSD的有效心理干预措施。
    方法:在PubMed,Embase,科克伦,ISIWebofScience,中国国家知识基础设施(CNKI),和万方数据库使用“应激障碍”的主题词,创伤后\",\"孕妇\",和“心理治疗”。为了确保尽可能多的相关研究被纳入,免费条款,如产前,产后,围产期和妊娠期也被使用。7月1日发表的干预研究和相关案例,2023年,也进行了搜索。
    结果:本综述包括21篇文章(包括3,901名母亲)。证据表明,典型的心理干预措施表现出巨大的效果,和家庭支持计划,同行支持,在线瑜伽,和音乐疗法在降低风险和改善被研究人群的心理健康方面也是有效的。
    结论:胎儿异常,流产,早产,低出生体重婴儿,高血压,先兆子痫,HELLP综合征,妊娠剧吐与PTSD的风险增加有关。此外,高危孕妇可从认知行为疗法(CBT)等心理干预中获益.对于音乐疗法和暴露疗法来说,减轻母亲PTSD的强度也可能是可行且广为接受的。
    OBJECTIVE: This scoping review sought to investigate the association between pregnancy-related complications and post-traumatic stress disorder (PTSD) among postpartum women, then summarize effective psychological interventions for pregnancy-related PTSD or sub-PTSD.
    METHODS: Publications in English and Chinese were searched in PubMed, Embase, Cochrane, ISI Web of Science, China National Knowledge Infrastructure (CNKI), and WanFang databases using the subject headings of \"Stress Disorders, Post-Traumatic\", \"Pregnant Women\", and \"psychotherapy\". To ensure that as many relevant studies are incorporated as possible, free terms such as prenatal, postnatal, perinatal and gestation were also used. Intervention studies and related cases published by July 1st, 2023, were also searched.
    RESULTS: Twenty-one articles (including 3,901 mothers) were included in this review. Evidence showed that typical psychological interventions exhibited great effect, and family support programs, peer support, online yoga, and music therapy were also effective in reducing risk and improving the psychological well-being of the studied population.
    CONCLUSIONS: Fetal abnormalities, miscarriage, premature birth, infants with low birth weights, hypertension, pre-eclampsia, HELLP syndrome, and hyperemesis gravidarum are associated with an increased risk of PTSD. Moreover, high-risk pregnant women may benefit from psychological interventions such as cognitive behavioral therapy (CBT). It may also be feasible and well-accepted for music therapy and exposure therapy to lessen the intensity of PTSD in mothers.
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  • 文章类型: Journal Article
    目前强迫症的心理治疗方法,虽然有效,有复杂的结果和混合的疗效。先前的研究已经观察到强迫症患者的基线脑激活模式,阐明这种疾病的一些含义。观察基于证据的精神疗法对强迫症脑激活的影响(通过MRI)可以提供更全面的病理学概述。这项系统评价和荟萃分析评估了认知行为疗法(CBT)与暴露反应预防(ERP)对强迫症患者脑激活的影响。系统地搜索了学术数据库,评估的结局包括基线和治疗后大脑激活和症状严重程度的变化.患者(n=193)已确认OCD诊断,并接受了由训练有素的治疗师提供的ERP计划的原型CBT。CBT与ERP计划的参与者表现出症状严重程度的显着改善(Cohen'sd=-1.91)。总的来说,CBT与ERP导致额叶治疗后活化降低(Cohen'sd=0.40),顶叶(科恩的d=0.79),时间(科恩的d=1.02),和枕叶(科恩的d=0.76),和小脑(科恩的d=-0.78)。研究结果支持CBT与ERP改善OCD患者脑激活异常的能力。通过识别提高激活水平的区域,心理治疗计划可能受益于功能特异性功能的增加,这些功能特异性功能可以改善治疗结果.
    Current psychotherapeutic treatments for OCD, while effective, have complex outcomes with mixed efficacy. Previous research has observed baseline brain activation patterns in OCD patients, elucidating some of the implications of this disorder. Observing the effects of evidence-based psychotherapeutics for OCD on brain activation (through MRI) may provide a more comprehensive outline of pathology. This systematic review and meta-analysis evaluated the effects of cognitive behavioural therapy (CBT) with exposure-response prevention (ERP) on brain activation in OCD patients. Academic databases were systematically searched, and the outcomes evaluated included changes in brain activation and symptom severity between baseline and post-treatment. Patients (n = 193) had confirmed OCD diagnosis and underwent protocolized CBT with ERP programs delivered by trained therapists. Participants in the CBT with ERP programs demonstrated significant improvements in symptom severity (Cohen\'s d = - 1.91). In general, CBT with ERP resulted in decreased activation post-treatment in the frontal (Cohen\'s d = 0.40), parietal (Cohen\'s d = 0.79), temporal (Cohen\'s d = 1.02), and occipital lobe (Cohen\'s d = 0.76), and cerebellum (Cohen\'s d = - 0.78). The findings support CBT with ERP\'s ability to improve brain activation abnormalities in OCD patients. By identifying regions that improved activation levels, psychotherapy programs may benefit from the addition of function-specific features that could improve treatment outcomes.
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  • 文章类型: Systematic Review
    全球范围内,大约有13亿香烟消费者,表明它是早期死亡和发病的第二高危险因素。同时,心理治疗提供基于其不同模式和技术的工具,这有助于戒烟。在这种情况下,这项研究收集了科学证据,以确定可用于减少香烟消费的心理治疗方法。对对照临床研究进行了系统评价,实施PRISMA方法。使用从MESH(医学主题词)和DECS(健康科学中的描述符)提取的术语进行搜索查询。随后,搜索在Medline/PubMed的科学数据库中进行了查询,科克伦,Scopus,科学直接,ProQuest,和PsycNet,随后使用乔安娜·布里格斯研究所的检查表验证方法学质量。选定的文件显示,认知行为疗法因其在七份出版物中的使用和有效性而盛行(25%)。正念疗法的认知方法见于4份出版物(14%),动机疗法的跨理论模型发表在4篇出版物中(14%),简短的心理治疗在3出版物(10%),其余10份文件(37%)与其他文件对应。干预研究认为认知行为疗法是减少香烟消费最常用的方法;在禁欲持续时间方面,科学证据显示短期减少的有益效果。
    Globally, there are around 1.3 billion cigarette consumers, indicating it to be the second highest risk factor for early death and morbidity. Meanwhile, psychological therapy offers tools based on its different models and techniques, which can contribute to smoking cessation. In this context, this study gathers scientific evidence to identify psychological therapies that can be used to reduce cigarette consumption. A systematic review of controlled clinical studies was conducted, implementing the PRISMA methodology. Search queries were performed with terms extracted from MESH (Medical Subject Headings) and DECS (Descriptors in Health Sciences). Subsequently, the search was queried in the scientific databases of Medline/PubMed, Cochrane, Scopus, Science Direct, ProQuest, and PsycNet, with subsequent verification of methodological quality using the Joanna Briggs Institute checklists. The selected documents revealed that cognitive behavioral therapy prevails due to its use and effectiveness in seven publications (25%). The cognitive approach with mindfulness therapy is found in 4 publications (14%), the transtheoretical model with motivational therapy in 4 publications (14%), brief psychological therapy in 3 publications (10%), and the remaining 10 documents (37%) correspond with others. Intervention studies refer to cognitive behavioral therapy as the most used in reducing cigarette consumption; in terms of the duration of abstinence, scientific evidence shows beneficial effects with short-term reduction.
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  • 文章类型: Journal Article
    精神病患者的心理治疗是一种有效的治疗方法,可以通过各种方式促进康复。虽然各种模式都有强有力的定量证据,从病人的角度来看,人们知道的较少。有许多不同形式的心理治疗,获得患者的观点可以提高对心理治疗显著要素的理解,增加参与度,最终提高回收率。这篇综述的目的是识别和整合已发表的关于精神病心理治疗患者观点的研究数据,以了解各种方法的基本要素,方法之间的差异,以及心理治疗如何影响康复。我们的目的是进一步了解:从精神病患者的角度来看,对个人心理治疗的看法是什么?本研究是使用PRISMA研究指南的系统评价,包括对参与心理治疗的有精神病经历的人进行定性访谈。所有三位作者都使用Pubmed参与了文献检索,APAPsycInfo,和精神病学在线。我们确定N=33项研究。研究包括认知疗法,接受和正念方法,创伤治疗,元认知治疗,和音乐疗法。所有研究都报告参与者对治疗关系的感知益处尤其显著。与会者描述了客观的不同方面(例如,症状,功能)和主观(例如,自我体验或生活质量)恢复改善,随着感知的变化机制,音乐疗法有一些独特的好处。与会者还报告了挑战和改进建议。研究结果强调了患者确定的心理治疗的突出方面,这些方面可能有助于治疗师在与经历精神病的个体一起工作时个性化和改进心理治疗方法。总的来说,研究结果支持综合心理治疗方法实现最大程度个性化治疗的潜力.
    Psychotherapy for individuals with psychosis is an effective treatment that promotes recovery in various ways. While there is strong quantitative evidence across modalities, less is known from the patient\'s perspective. There are many varied forms of psychotherapy, and gaining the patient\'s perspective can improve understanding of salient elements of psychotherapy and increase engagement, ultimately improving recovery rates. The purpose of this review is to identify and integrate data from published studies of patient perspectives of psychotherapy for psychosis to understand essential elements across approaches, differences between approaches, and how psychotherapy impacts recovery. We aimed to understand further: what are the perceptions about individual psychotherapy from the perspective of individuals with psychosis? The current study was a systematic review using PRISMA guidelines of studies that included qualitative interviews with persons with experiences of psychosis who participated in psychotherapy. All three authors participated in the literature search using Pubmed, APA PsycInfo, and Psychiatry Online. We identified N = 33 studies. Studies included cognitive therapies, acceptance and mindfulness approaches, trauma therapies, metacognitive therapy, and music therapy. All studies reported participants\' perceived benefit with the therapeutic relationship as especially salient. Participants described diverse aspects of objective (e.g., symptoms, functioning) and subjective (e.g., self-experience or quality of life) recovery improvements, with perceived mechanisms of change, and with music therapy having some unique benefits. Participants also reported challenges and suggestions for improvement. Study findings highlight the salient aspects of psychotherapy identified by patients that may help therapists to individualize and improve approaches to psychotherapy when working with individuals experiencing psychosis. Overall, findings support the potential for integrative psychotherapy approaches for maximal treatment personalization.
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  • 文章类型: Journal Article
    目的:创建配方是临床心理学家的关键能力之一,并且被认为对于指导治疗输入和理解客户困扰很重要。然而,客户对配方的体验可能会有所不同,有一些报道,这是无益和痛苦的。这篇新颖的评论探讨了临床医生和客户在创建配方时的经验,特别是合作制定的障碍和促进者。这最终旨在改善客户体验和参与制定。
    方法:对PubMed的系统搜索,WebofScience,使用PRISMA指南进行PsycINFO和EMBASE。该协议已在PROSPERO上注册。此搜索是使用与\'心理公式\'和\'经验\'相关的术语进行的。19篇定性论文符合纳入标准,并使用关键评估技能计划进行了评估。与制剂相关的发现是按主题合成的。
    结果:确定了三个分析主题:对配方过程的容忍-“必要的邪恶”,这突出了配方对客户的潜在情感影响,并表明了应对客户准备和配方期望的重要性;治疗关系的发展-它就像一个双向的事情,不是吗?这表明客户授权,适应客户需求和临床医生创造一个安全和包容的环境促进了制定过程;系统性因素-“走钢丝”,这突出了治疗师参与协作配方的能力中资源和团队动态的限制。
    结论:协作配方的促进者包括:简单配方,全面评估和制定准备,\'用\'活动,如时间表和图表和工作环境,包括支持同事和反思和培训的时间。
    OBJECTIVE: Creating a formulation is one of the key competencies of a clinical psychologist and is understood to be important for guiding therapeutic input and understanding client distress. However, client experience of formulations can vary, with some reporting it is unhelpful and distressing. This novel review explores the experiences of clinicians and clients when creating a formulation, specifically the barriers and facilitators to collaborating on a formulation. This ultimately aims to improve client experience and engagement in formulation.
    METHODS: A systematic search of PubMed, Web of Science, PsycINFO and EMBASE was conducted using PRISMA guidelines. The protocol was registered on PROSPERO. This search was conducted using terms related to \'psychological formulation\' and \'experience\'. Nineteen qualitative papers met inclusion criteria and were appraised using the Critical Appraisal Skills Programme. Findings that pertained to formulation were thematically synthesised.
    RESULTS: Three analytical themes were identified: toleration of the formulation process-\'a necessary evil\', which highlights the potential emotional impact of formulation on the client and indicates the importance of responding to client readiness and expectations of formulation; development of the therapeutic relationship-\'it\'s like a two way thing, isn\'t it?\', which suggests that client empowerment, adapting to client needs and clinicians creating a safe and containing environment facilitated the formulation process; systemic factors-\'walking a tightrope\', which highlights the constraints of resources and team dynamics in therapists\' ability to engage in collaborative formulation.
    CONCLUSIONS: Facilitators to a collaborative formulation include the following: simple formulations, thorough assessment and preparation for formulation, \'doing with\' activities such as timelines and diagrams and working environments that include supportive colleagues and time for reflection and training.
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  • 文章类型: Journal Article
    强迫症(OCD)是一种普遍且使人衰弱的心理健康状况。这篇文献综述探讨了管理和治疗强迫症的最新策略,强调心理治疗,药理干预,和神经外科的选择。利用PubMed进行全面的文献检索,谷歌学者,ClinicalKey,并进行了Embase数据库。利用选择的关键字,根据纳入和排除标准对所得文章进行筛选.纳入的文章用于讨论有关强迫症治疗和管理的当前研究。研究结果揭示了认知行为疗法等治疗方法的功效和障碍,选择性5-羟色胺再摄取抑制剂(SSRIs),5-羟色胺-去甲肾上腺素再摄取抑制剂(SNRIs),和循证神经外科方法,为强迫症管理提供了广阔的视角。我们讨论了这些既定治疗方法的局限性,并研究了神经外科治疗强迫症患者的创新反应。这篇综述强调了个性化治疗计划和未来研究领域的重要性。
    Obsessive-compulsive disorder (OCD) is a prevalent and debilitating mental health condition. This literature review examines the latest strategies in managing and treating OCD, with an emphasis on psychotherapy, pharmacological interventions, and neurosurgical options. A comprehensive literature search utilizing PubMed, Google Scholar, ClinicalKey, and Embase databases was conducted. Utilizing chosen keywords, the resulting articles were filtered based on inclusion and exclusion criteria. Included articles were used to discuss current research regarding OCD treatment and management. Findings reveal the efficacy and obstacles of treatments such as cognitive-behavioral therapy, selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and evidence-based neurosurgical methods, offering a broad perspective on OCD management. We discuss the limitations of these established treatments and examine the innovative response of neurosurgery in treating patients with OCD. This review highlights the importance of individualized treatment plans and areas for future research.
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  • 文章类型: Journal Article
    背景:许多精神分裂症患者的症状对抗精神病药无效。这种情况被称为难治性精神分裂症,与一般精神分裂症相比,没有受到特别关注。心理和心理社会干预作为药物治疗的附加治疗可能是有用的,但在这一人群中,它们之间的作用和相对疗效以及对标准治疗的疗效尚不清楚。我们调查了疗效,可接受性,以及对难治性精神分裂症患者的心理和社会心理干预的耐受性。
    方法:在本系统综述和网络荟萃分析(NMA)中,我们通过系统的数据库搜索BIOSIS,搜索已发表和未发表的随机对照试验(RCT),CINAHL,Embase,LILACS,MEDLINE,PsychInfo,ClinicalTrials.gov,和世卫组织国际临床试验注册平台的文章从开始到2020年1月31日。我们还搜索了Cochrane精神分裂症组注册表中从开始到2022年3月31日发表的研究,以及PubMed和CochraneCENTRAL中从开始到2023年7月31日发表的研究。我们纳入了RCTs,其中包括难治性精神分裂症患者。主要结果是总体症状。我们进行了随机效应成对荟萃分析和NMA,以95%CIs计算标准化平均差(SMD)或风险比。在整个研究过程中,没有有生活经验的人参与其中。研究方案在PROSPERO注册,CRD4202238696。
    结果:我们确定了30326条记录,不包括24526按标题和摘要筛选。5762篇全文进行了资格评估,其中5540人因不符合资格标准而被排除在外,与60项研究对应的222份报告被纳入定性综合.其中,52个RCT与5034名参与者(1654[33·2%]女性和3325[66·8%]男性性别)比较了20个心理和社会心理干预措施,为NMA提供了数据。参与者的平均年龄为38·05岁(范围23·10-48·50)。我们的目标是收集种族数据,但他们几乎没有报道。根据证据的质量,精神病的认知行为疗法(CBTp;SMD-0·22,95%CI-0·35至-0·09,35项试验),虚拟现实干预(SMD-0·41,-0·79至-0·02,四项试验),综合干预(SMD-0·70,-1·18至-0·22,三项试验),和音乐疗法(SMD-1·27,-1·83至-0·70,一项研究)在减轻总体症状方面比标准治疗更有效。没有发现发表偏倚的迹象。
    结论:我们提供了有力的发现,即CBTp可以减轻难治性精神分裂症患者的总体症状,因此,临床医生可以在临床实践中优先考虑这种干预措施。其他心理和社会心理干预显示出可喜的结果,但需要进一步调查。
    背景:DAAD-ASFE。
    BACKGROUND: Many patients with schizophrenia have symptoms that do not respond to antipsychotics. This condition is called treatment-resistant schizophrenia and has not received specific attention as opposed to general schizophrenia. Psychological and psychosocial interventions as an add-on treatment to pharmacotherapy could be useful, but their role and comparative efficacy to each other and to standard care in this population are not known. We investigated the efficacy, acceptability, and tolerability of psychological and psychosocial interventions for patients with treatment-resistant schizophrenia.
    METHODS: In this systematic review and network meta-analysis (NMA), we searched for published and unpublished randomised controlled trials (RCTs) through a systematic database search in BIOSIS, CINAHL, Embase, LILACS, MEDLINE, PsychInfo, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform for articles published from inception up to Jan 31, 2020. We also searched the Cochrane Schizophrenia Group registry for studies published from inception up to March 31, 2022, and PubMed and Cochrane CENTRAL for studies published from inception up to July 31, 2023. We included RCTs that included patients with treatment-resistant schizophrenia. The primary outcome was overall symptoms. We did random-effects pairwise meta-analyses and NMAs to calculate standardised mean differences (SMDs) or risk ratios with 95% CIs. No people with lived experience were involved throughout the research process. The study protocol was registered in PROSPERO, CRD42022358696.
    RESULTS: We identified 30 326 records, excluding 24 526 by title and abstract screening. 5762 full-text articles were assessed for eligibility, of which 5540 were excluded for not meeting the eligibility criteria, and 222 reports corresponding to 60 studies were included in the qualitative synthesis. Of these, 52 RCTs with 5034 participants (1654 [33·2%] females and 3325 [66·8%] males with sex indicated) comparing 20 psychological and psychosocial interventions provided data for the NMA. Mean age of participants was 38·05 years (range 23·10-48·50). We aimed to collect ethnicity data, but they were scarcely reported. According to the quality of evidence, cognitive behavioural therapy for psychosis (CBTp; SMD -0·22, 95% CI -0·35 to -0·09, 35 trials), virtual reality intervention (SMD -0·41, -0·79 to -0·02, four trials), integrated intervention (SMD -0·70, -1·18 to -0·22, three trials), and music therapy (SMD -1·27, -1·83 to -0·70, one study) were more efficacious than standard care in reducing overall symptoms. No indication of publication bias was identified.
    CONCLUSIONS: We provide robust findings that CBTp can reduce the overall symptoms of patients with treatment-resistant schizophrenia, and therefore clinicians can prioritise this intervention in their clinical practice. Other psychological and psychosocial interventions showed promising results but need further investigation.
    BACKGROUND: DAAD-ASFE.
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