Relapse prevention

预防复发
  • 文章类型: Journal Article
    羞耻是在物质使用治疗环境中成功恢复的主要障碍之一。这项次要分析研究检查了内部化羞耻量表(ISS)的测量不变性,并探讨了治疗过程中羞耻的变化。父母研究中的参与者(N=105)是从非营利性住宅治疗中心招募的涉及司法的女性,并随机接受基于正念的复发预防或复发预防治疗。在ISS的单因素测量模型中,使用了一系列验证性因子分析来评估测量不变性。潜在生长曲线模型用于检查耻辱随时间的变化。我们的发现支持跨多个时间点和跨治疗条件的测量不变性的假设,支持组间和随时间推移的污名评分比较。尽管我们观察到从治疗前到治疗后的耻辱显着减少,不同的治疗条件没有差异.需要额外的研究来确定不同的治疗成分如何与接受物质使用障碍治疗的个体的羞耻减少有关。
    Shame is one of the leading barriers to successful recovery in substance use treatment settings. This secondary analysis study examined measurement invariance of the Internalized Shame Scale (ISS) and explored changes in shame during treatment. Participants (N=105) in the parent study were recruited from a nonprofit residential treatment center for justice-involved women and were randomized to receive mindfulness-based relapse prevention or relapse prevention treatment. A series of confirmatory factor analyses were used to assess measurement invariance in a one-factor measurement model of the ISS. Latent growth curve modeling was used to examine change in shame over time. Our findings support the assumption of measurement invariance across multiple time points and across treatment conditions, supporting comparisons of stigma scores across groups and over time. Although we observed significant reductions in shame from pre- to post-treatment, there were no differences across treatment conditions. Additional research is needed to determine how distinct treatment components relate to reductions in shame among individuals receiving treatment for a substance use disorder.
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  • 文章类型: Journal Article
    背景:自助干预可能为传统护理提供可扩展的辅助手段,但是它们在预防复发方面的有效性还没有得到很好的证实。目的:本综述旨在评估其预防情绪障碍患者复发的有效性。
    方法:我们系统回顾了WebofScience的相关试验文献,EMBASE,PubMed,PsycINFO,和Cochrane数据库,直到2024年5月。包括随机对照试验,这些试验检查了被诊断为重度抑郁症(MDD)或双相情感障碍(BD)的个体中的自助干预措施。随机效应模型计算了复发的合并风险比,通过亚组分析和荟萃回归分析探索异质性来源。
    结果:15篇论文和16项随机试验的比较,涉及2735名情绪障碍患者,符合这项荟萃分析的条件。辅助自助干预对降低重度抑郁症的复发率有很小但显著的影响(合并风险比:0.78,95%置信区间(CI):0.66-0.92,P=0.0032,NNT=11),并且在双相情感障碍中略有好转(合并风险比:0.62,95%CI:0.40-0.97,P=.0344,NNT=12),与常规治疗(TAU)相比。根据干预成分没有发现亚组差异,设置,交货方式,或指导水平。自助干预措施的平均辍学率(18.9%)与TAU辍学率没有显着差异。治疗依从性的检查是高度可变的,排除明确的结论。
    结论:自助干预对情绪障碍的复发具有适度的预防作用,尽管确定性很低到很低。未来的研究对于确定自助干预措施的哪些要素最有效至关重要。
    BACKGROUND: Self-help interventions may offer a scalable adjunct to traditional care, but their effectiveness in relapse prevention is not well-established. Objectives: This review aimed to assess their effectiveness in preventing relapses among individuals with mood disorders.
    METHODS: We systematically reviewed the pertinent trial literature in Web of Science, EMBASE, PubMed, PsycINFO, and Cochrane databases until May 2024. Randomized controlled trials that examined the self-help interventions among individuals diagnosed with major depressive disorder (MDD) or bipolar disorder (BD) were included. The random-effects model computed the pooled risk ratios of relapse, with subgroup analyses and meta-regression analyses to explore heterogeneity sources.
    RESULTS: Fifteen papers and 16 comparisons of randomized trials involving 2735 patients with mood disorders were eligible for this meta-analysis. Adjunct self-help interventions had a small but significant effect on reducing the relapse rates of major depressive disorder (pooled risk ratio: 0.78, 95% confidence interval (CI): 0.66-0.92, P = 0.0032, NNT = 11), and were marginally better in bipolar disorder (pooled risk ratio: 0.62, 95% CI: 0.40-0.97, P = .0344, NNT = 12), as compared to treatment as usual (TAU). No subgroup difference was found based on intervention components, settings, delivery method, or guidance levels. The average dropout rate for self-help interventions (18.9%) did not significantly differ from TAU dropout rates. The examination of treatment adherence was highly variable, precluding definitive conclusions.
    CONCLUSIONS: Self-help interventions demonstrate a modest preventative effect on relapse in mood disorders, despite low to very low certainty. Future research is essential to identify which elements of self-help interventions are most effective.
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  • 文章类型: Journal Article
    这项回顾性研究分析了106例接受自体造血干细胞移植(ASCT)的急性髓系白血病(AML)患者,以评估多次小剂量输注粒细胞集落刺激因子(G-CSF)动员的单倍体相合淋巴细胞作为ASCT维持治疗后的影响。其中,50例患者接受淋巴细胞维持治疗,21人接受了替代维持治疗,35人没有接受维持治疗。接受淋巴细胞维持治疗的患者与未接受维持治疗的患者相比,总生存期(OS)和无病生存期(DFS)显着提高。4年OS和DFS率明显升高。虽然三组之间的复发率没有显着差异,淋巴细胞维持治疗显示了对中危AML患者的特殊益处,与替代维持治疗和无维持治疗相比,OS和DFS率显著较高,复发率显著较低.该研究表明,多次小剂量输注G-CSF动员的单倍体淋巴细胞可能为ASCT后的AML患者提供有希望的结果,特别是那些被归类为中等风险的人。这些发现强调了淋巴细胞维持治疗在该患者人群中减少疾病复发和改善长期预后的潜在功效。
    This retrospective study analysed 106 acute myeloid leukaemia (AML) patients undergoing autologous haematopoietic stem cell transplantation (ASCT) to assess the impact of multiple small-dose infusions of granulocyte-colony-stimulating factor (G-CSF)-mobilized haploidentical lymphocytes as post-ASCT maintenance therapy. Among them, 50 patients received lymphocyte maintenance therapy, 21 received alternative maintenance therapy, and 35 received no maintenance therapy. Patients receiving lymphocyte maintenance therapy demonstrated significantly higher overall survival (OS) and disease-free survival (DFS) compared to those without maintenance therapy, with 4-year OS and DFS rates notably elevated. While there were no significant differences in recurrence rates among the three groups, lymphocyte maintenance therapy showcased particular benefits for intermediate-risk AML patients, yielding significantly higher OS and DFS rates and lower relapse rates compared to alternative maintenance therapy and no maintenance therapy. The study suggests that multiple small-dose infusions of G-CSF-mobilized haploidentical lymphocytes may offer promising outcomes for AML patients after ASCT, particularly for those classified as intermediate-risk. These findings underscore the potential efficacy of lymphocyte maintenance therapy in reducing disease relapse and improving long-term prognosis in this patient population.
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  • 文章类型: Journal Article
    Objectives.基于认知行为的干预(CBI)是对酒精和其他药物(AOD)使用的循证治疗方法,具有按人群分组的潜在可变有效性。这项研究使用证据综合来检查在AOD的CBI临床试验中通过人口统计学和研究背景因素的治疗效果。方法。系统确定了研究,并对其特点和结果数据进行了提取和总结。计算了条件内和条件间对物质使用结果的影响的标准化平均差异。在数据采集过程中确定了人口统计和研究背景主持人,并进行了一些敏感性分析。结果。样本包括K=29项试验,共检查了15项研究水平的主持人。关于参与者年龄的信息,生物性别,至少有26项试验报道了种族,但是关于性别认同的信息,性取向,和种族不经常或以非包容性方式报告。平均条件间效应大小小且中等异质性(d=0.158,95%CI=0.079,0.238,I2=46%),平均条件内效应大小大且表现出高异质性(dz=1.147,95%CI=0.811,1.482,-I2=96%)。研究中针对的特定药物以及是否使用基于生物测定的结果来缓解病情间CBI疗效,并纳入共同发生的精神健康状况和研究发表日期来缓解病情内CBI效果。Conclusions.结果提供了与基于美国CBI的AOD临床试验中的效果估计相关的研究背景因素的初步数据。
    Objectives. Cognitive-Behaviorally Based Interventions (CBIs) are evidence-based treatments for alcohol and other drug (AOD) use with potential variable effectiveness by population sub-groups. This study used evidence synthesis to examine treatment effect by demographic and study context factors in clinical trials of CBI for AOD. Methods. Studies were systematically identified, and their characteristics and outcome data were extracted and summarized. Standardized mean differences were calculated for within- and between-condition effects on substance use outcomes. Demographic and study context moderators were identified during data acquisition and several sensitivity analyses were conducted. Results. The sample included K = 29 trials and a total of 15 study-level moderators were examined. Information on participants\' age, biological sex, and race were reported in at least 26 trials, but information on gender identity, sexual orientation, and ethnicity were reported infrequently or in non-inclusive ways. The mean between-condition effect size was small and moderately heterogenous (d = 0.158, 95% CI = 0.079, 0.238, I2 = 46%) and the mean within-condition effect size was large and showed high heterogeneity (dz = 1.147, 95% CI = 0.811, 1.482, - I2 = 96%). The specific drug targeted in the study and whether biological assay-based outcomes were used moderated between-condition CBI efficacy and the inclusion of co-occurring mental health conditions and study publication date moderated within-condition CBI effects. Conclusions. Results provide preliminary data on study context factors associated with effect estimates in United States based clinical trials of CBI for AOD.
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  • 文章类型: Journal Article
    目的:这项探索性研究分析了酗酒者匿名(AA)和复发预防(RP)在成瘾个人故事中的治疗哲学之间的相互作用。虽然AA和RP的基本思想在许多方面是兼容的,它们也有一些根本的差异。方法:数据包括对12名从物质使用问题中恢复的个体的访谈,谁有AA和RP的经验。分析借鉴了对话叙事的观点,复调概念被用来揭示个人复发故事中不同治疗理念之间的相互作用。研究结果:虽然有时会导致不一致,治疗哲学是独特地结合在一起的,以对参与者的自我形象和康复之旅似乎富有成效的方式。结论:AA和RP哲学在复发和康复叙事中的结合可能反映了一种新的治疗话语,其中个性化和责任化与集体主义和屈服于所谓的成瘾过程有着复杂的关系。
    Aim: This exploratory study analyses the interplay between the treatment philosophies of Alcoholics Anonymous (AA) and Relapse Prevention (RP) in personal stories of addiction. While the basic ideas of AA and RP are compatible in many ways, they also carry some fundamental differences. Methods: The data consisted of interviews with 12 individuals recovering from substance use problems, who had experience of both AA and RP. The analysis drew on a dialogical narrative perspective, and the concept polyphony was used to shed light on the interplay between different treatment philosophies in personal stories of relapse. Findings: Although sometimes resulting in incoherence, the treatment philosophies were combined idiosyncratically, in ways that appeared productive for the participants\' self-images and recovery journeys. Conclusion: The combination of AA and RP philosophies in narratives of relapse and recovery may reflect a new treatment discourse where individualisation and responsibilisation stand in a complicated relationship with collectivism and surrendering to so-called addicting processes.
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  • 文章类型: Journal Article
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  • 文章类型: Editorial
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  • 文章类型: Journal Article
    背景:由于患有酒精使用障碍(AUD)的个体在治疗和恢复过程中通常会恢复使用酒精,在这种严重的事件发生后,保持禁欲动机是很重要的。我们的研究旨在探讨在住院治疗后参与电话指导的基于应用程序的干预的AUD个体在恢复饮酒后如何感知他们的禁欲动机,他们的应用程序使用行为是否受到影响,并找出有助于保持禁欲动机的因素。
    方法:使用混合方法方法,来自随机对照试验SmartAssistEntz的干预组的10名参与者返回酒精使用并在应用程序Appstinence中记录了这一点,为AUD个人设计的带有电话教练的智能手机应用程序,采访了他们的经历。采访被记录下来,使用定性内容分析进行转录和编码。另外通过使用日志数据来检查应用使用行为。
    结果:在十个受访者中,七人报告说,在重新饮酒后,他们的禁欲动机增加了。原因包括提醒人们饮酒的负面后果,渴望重新控制自己的情况以及应用程序提供的感知支持。应用程序数据显示,在恢复使用酒精后,应用程序使用保持稳定,平均使用时间为58.70天(SD=25.96,Mdn=58.50,范围=24-96,IQR=44.25)。
    结论:该研究的结果初步表明,该应用程序可以在恢复饮酒后为个人提供支持,以维持和增加发病后的动机。未来的研究应(1)专注于加强对高风险情况的识别,并在此类关键事件中达到,(2)积极将回归酒精使用的经验整合到基于应用程序的干预措施中,以更好地支持个人实现其个人AUD行为改变目标,(3)调查退出研究和干预并完全停止使用应用程序的个人可能需要哪种类型的支持。
    背景:主要评估研究已在德国临床试验注册(DRKS,注册号DRKS00017700),并获得弗里德里希-亚历山大大学埃尔兰根-纽伦堡(193_19B)道德委员会的批准。
    As the return to alcohol use in individuals with alcohol use disorder (AUD) is common during treatment and recovery, it is important that abstinence motivation is maintained after such critical incidences. Our study aims to explore how individuals with AUD participating in an app-based intervention with telephone coaching after inpatient treatment perceived their abstinence motivation after the return to alcohol use, whether their app use behavior was affected and to identify helpful factors to maintain abstinence motivation.
    Using a mixed-methods approach, ten participants from the intervention group of the randomized controlled trial SmartAssistEntz who returned to alcohol use and recorded this in the app Appstinence, a smartphone application with telephone coaching designed for individuals with AUD, were interviewed about their experiences. The interviews were recorded, transcribed and coded using qualitative content analysis. App use behavior was additionally examined by using log data.
    Of the ten interviewees, seven reported their abstinence motivation increased after the return to alcohol use. Reasons included the reminder of negative consequences of drinking, the desire to regain control of their situation as well as the perceived support provided by the app. App data showed that app use remained stable after the return to alcohol use with an average of 58.70 days of active app use (SD = 25.96, Mdn = 58.50, range = 24-96, IQR = 44.25) after the return to alcohol use which was also indicated by the participants\' reported use behavior.
    The findings of the study tentatively suggest that the app can provide support to individuals after the return to alcohol use to maintain and increase motivation after the incidence. Future research should (1) focus on specifically enhancing identification of high risk situations and reach during such critical incidences, (2) actively integrate the experience of the return to alcohol use into app-based interventions to better support individuals in achieving their personal AUD behavior change goals, and (3) investigate what type of support individuals might need who drop out of the study and intervention and discontinue app use altogether.
    The primary evaluation study is registered in the German Clinical Trials Register (DRKS, registration number DRKS00017700) and received approval of the ethical committee of the Friedrich-Alexander University Erlangen-Nuremberg (193_19 B).
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  • 文章类型: Journal Article
    已经开发了各种心理社会和心理干预措施来减少精神分裂症复发的预防。更好地理解这些积极的干预措施对于临床实践和有意义的资源分配很重要。然而,尚未对该区域进行文献计量分析。研究是从WebofScience核心收藏数据库中检索的。通过Origin2021可视化了出版物的输出和机构的合作。使用ArcGISPro3.0可视化了全球合作。VOSviewer用于生成作者和关键字网络的可视化。在过去的20年中,年度出版物的数量总体上呈波动上升趋势。德国发表的相关文章最多(361篇,占26.76%)。慕尼黑工业大学是生产力最高的机构(70,9.86%)。LeuchtStefan发表的文章最多(46,6.48%),引用次数最多(4,375次引用)。精神分裂症研究发表的研究最多(39,5.49%)。关键词大致分为三类:认知行为疗法(CBT),家庭干预和家庭心理教育等相关因素的干预。研究结果从文献计量学的角度提供了预防精神分裂症复发的社会心理和心理干预的研究现状。最近的研究主要集中在CBT,家庭干预和家庭心理教育。
    Various psychosocial and psychological interventions have been developed to reduce schizophrenia relapse prevention. A better understanding of these active interventions is important for clinical practice and for meaningful allocation of resources. However, no bibliometric analysis of this area has been conducted. Studies were retrieved from the Web of Science Core Collection database. The publication outputs and cooperation of institutions were visualized with Origin 2021. Global cooperation was visualized using ArcGIS Pro3.0. VOSviewer was used to generate visualizations of network of authors and keywords. The number of annual publications generally showed a fluctuating upward trend over the past 20 years. Germany published the most relevant articles (361, 26.76%). The Technical University of Munich was the most productive institution (70, 9.86%). Leucht Stefan published the most articles (46, 6.48%) and had the highest number of citations (4,375 citations). Schizophrenia Research published the most studies (39, 5.49%). Keywords were roughly classified into three clusters: cognitive behavioral therapy (CBT), family interventions and family psychoeducation and other factors related to interventions. The findings provided the current status of research on psychosocial and psychological interventions for schizophrenia relapse prevention from a bibliometric perspective. Recent research has mainly focused on CBT, family interventions and family psychoeducation.
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  • 文章类型: Journal Article
    网络成瘾是一个普遍而复杂的问题,在数字时代得到了越来越多的关注。这篇全面的综述为管理网络成瘾的临床干预和模式提供了深入的探索。它首先检查用于识别网络成瘾的诊断标准和评估工具,突出了不同的亚型和不同程度的严重程度。随后,这篇综述深入研究了各种临床干预措施,包括认知行为疗法(CBT)等心理治疗方法,辩证行为疗法(DBT),和基于正念的干预措施。药物干预,基于技术的工具,并对综合方法进行了全面分析。该评论还概述了各种治疗设置和方式,例如住院治疗中心,门诊诊所,远程医疗,支持团体,学校和社区的预防计划。此外,它讨论了与管理网络成瘾相关的功效和挑战,强调需要有效的干预措施,预防复发,伦理考虑,解决污名化和准入障碍。总之,这篇综述为临床实践提供了实际意义.它强调了未来研究在完善诊断标准方面的重要性,探索新兴技术,并使干预措施适应不断发展的数字环境。这篇全面的综述对临床医生来说是一个宝贵的资源,研究人员,和政策制定者寻求了解和解决网络成瘾的复杂性。
    Internet addiction is a pervasive and complex issue that has gained increasing attention in the digital age. This comprehensive review provides an in-depth exploration of clinical interventions and modalities for managing internet addiction. It begins by examining the diagnostic criteria and assessment tools used to identify internet addiction, highlighting the diverse subtypes and varying degrees of severity. Subsequently, the review delves into various clinical interventions, including psychotherapeutic approaches like cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), and mindfulness-based interventions. Pharmacological interventions, technology-based tools, and integrative approaches are also thoroughly analyzed. The review also outlines various treatment settings and modalities such as inpatient treatment centers, outpatient clinics, telehealth, support groups, and prevention programs for schools and communities. Furthermore, it discusses the efficacy and challenges associated with managing internet addiction, emphasizing the need for effective interventions, relapse prevention, ethical considerations, and addressing stigma and access barriers. In conclusion, the review offers practical implications for clinical practice. It emphasizes future research\'s importance in refining diagnostic criteria, exploring emerging technologies, and adapting interventions to an ever-evolving digital landscape. This comprehensive review is a valuable resource for clinicians, researchers, and policymakers seeking to understand and address the complexities of internet addiction.
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