The present study aimed to investigate the personal well‐being and family distress of Italian caregivers during the lockdown. Five hundred sixty‐five family caregivers and 638 age‐ and sex‐matched ...noncaregivers completed a web‐based survey. The following scales were administered to all participants: General Health Questionnaire‐12 items (GHQ‐12), Insomnia Severity Index (ISI), Brief Resilient Coping Scale (BRCS), and Family Distress Index (FDI). Caregivers were also asked to provide information about their family members with disabilities. Individual and family distress, as well as insomnia, were significantly higher in caregivers than controls. Contrariwise, caregivers reported lower resilience levels. Multiple linear regression showed that distress was higher in caregivers living in Central and Southern Italy. Individual well‐being was negatively predicted by low independence measured by the activities of daily living (ADL). Family distress was higher in households of psychiatric patients. Finally, low resilience levels appeared as the strongest predictors of both individual and family distress. The lockdown caused severe distress among caregivers and families of people with disabilities. Support networks for people with disabilities and their families are fundamental to prevent severe consequences from a psychological, social, and economical point of view.
Music therapy for depression Aalbers, Sonja; Fusar‐Poli, Laura; Freeman, Ruth E ...
Cochrane database of systematic reviews,
11/2017, Volume:
2017, Issue:
11
Journal Article
Peer reviewed
Open access
Background
Depression is a highly prevalent mood disorder that is characterised by persistent low mood, diminished interest, and loss of pleasure. Music therapy may be helpful in modulating moods and ...emotions. An update of the 2008 Cochrane review was needed to improve knowledge on effects of music therapy for depression.
Objectives
1. To assess effects of music therapy for depression in people of any age compared with treatment as usual (TAU) and psychological, pharmacological, and/or other therapies.
2. To compare effects of different forms of music therapy for people of any age with a diagnosis of depression.
Search methods
We searched the following databases: the Cochrane Common Mental Disorders Controlled Trials Register (CCMD‐CTR; from inception to 6 May 2016); the Cochrane Central Register of Controlled Trials (CENTRAL; to 17 June 2016); Thomson Reuters/Web of Science (to 21 June 2016); Ebsco/PsycInfo, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, and PubMed (to 5 July 2016); the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP), ClinicalTrials.gov, the National Guideline Clearing House, and OpenGrey (to 6 September 2016); and the Digital Access to Research Theses (DART)‐Europe E‐theses Portal, Open Access Theses and Dissertations, and ProQuest Dissertations and Theses Database (to 7 September 2016). We checked reference lists of retrieved articles and relevant systematic reviews and contacted trialists and subject experts for additional information when needed. We updated this search in August 2017 and placed potentially relevant studies in the "Awaiting classification" section; we will incorporate these into the next version of this review as appropriate.
Selection criteria
All randomised controlled trials (RCTs) and controlled clinical trials (CCTs) comparing music therapy versus treatment as usual (TAU), psychological therapies, pharmacological therapies, other therapies, or different forms of music therapy for reducing depression.
Data collection and analysis
Two review authors independently selected studies, assessed risk of bias, and extracted data from all included studies. We calculated standardised mean difference (SMD) for continuous data and odds ratio (OR) for dichotomous data with 95% confidence intervals (CIs). We assessed heterogeneity using the I2 statistic.
Main results
We included in this review nine studies involving a total of 421 participants, 411 of whom were included in the meta‐analysis examining short‐term effects of music therapy for depression. Concerning primary outcomes, we found moderate‐quality evidence of large effects favouring music therapy and TAU over TAU alone for both clinician‐rated depressive symptoms (SMD ‐0.98, 95% CI ‐1.69 to ‐0.27, 3 RCTs, 1 CCT, n = 219) and patient‐reported depressive symptoms (SMD ‐0.85, 95% CI ‐1.37 to ‐0.34, 3 RCTs, 1 CCT, n = 142). Music therapy was not associated with more or fewer adverse events than TAU. Regarding secondary outcomes, music therapy plus TAU was superior to TAU alone for anxiety and functioning. Music therapy and TAU was not more effective than TAU alone for improved quality of life (SMD 0.32, 95% CI ‐0.17 to 0.80, P = 0.20, n = 67, low‐quality evidence). We found no significant discrepancies in the numbers of participants who left the study early (OR 0.49, 95% CI 0.14 to 1.70, P = 0.26, 5 RCTs, 1 CCT, n = 293, moderate‐quality evidence). Findings of the present meta‐analysis indicate that music therapy added to TAU provides short‐term beneficial effects for people with depression if compared to TAU alone. Additionally, we are uncertain about the effects of music therapy versus psychological therapies on clinician‐rated depression (SMD ‐0.78, 95% CI ‐2.36 to 0.81, 1 RCT, n = 11, very low‐quality evidence), patient‐reported depressive symptoms (SMD ‐1.28, 95% CI ‐3.75 to 1.02, 4 RCTs, n = 131, low‐quality evidence), quality of life (SMD ‐1.31, 95% CI ‐ 0.36 to 2.99, 1 RCT, n = 11, very low‐quality evidence), and leaving the study early (OR 0.17, 95% CI 0.02 to 1.49, 4 RCTs, n = 157, moderate‐quality evidence). We found no eligible evidence addressing adverse events, functioning, and anxiety. We do not know whether one form of music therapy is better than another for clinician‐rated depressive symptoms (SMD ‐0.52, 95% CI ‐1.87 to 0.83, 1 RCT, n = 9, very low‐quality evidence), patient‐reported depressive symptoms (SMD ‐0.01, 95% CI ‐1.33 to 1.30, 1 RCT, n = 9, very low‐quality evidence), quality of life (SMD ‐0.24, 95% CI ‐1.57 to 1.08, 1 RCT, n = 9, very low‐quality evidence), or leaving the study early (OR 0.27, 95% CI 0.01 to 8.46, 1 RCT, n = 10). We found no eligible evidence addressing adverse events, functioning, or anxiety.
Authors' conclusions
Findings of the present meta‐analysis indicate that music therapy provides short‐term beneficial effects for people with depression. Music therapy added to treatment as usual (TAU) seems to improve depressive symptoms compared with TAU alone. Additionally, music therapy plus TAU is not associated with more or fewer adverse events than TAU alone. Music therapy also shows efficacy in decreasing anxiety levels and improving functioning of depressed individuals.
Future trials based on adequate design and larger samples of children and adolescents are needed to consolidate our findings. Researchers should consider investigating mechanisms of music therapy for depression. It is important to clearly describe music therapy, TAU, the comparator condition, and the profession of the person who delivers the intervention, for reproducibility and comparison purposes.
We provide here the first bottom‐up review of the lived experience of mental disorders in adolescents co‐designed, co‐conducted and co‐written by experts by experience and academics. We screened ...first‐person accounts within and outside the medical field, and discussed them in collaborative workshops involving numerous experts by experience – representing different genders, ethnic and cultural backgrounds, and continents – and their family members and carers. Subsequently, the material was enriched by phenomenologically informed perspectives and shared with all collaborators. The inner subjective experience of adolescents is described for mood disorders, psychotic disorders, attention‐deficit/hyperactivity disorder, autism spectrum disorders, anxiety disorders, eating disorders, externalizing disorders, and self‐harm behaviors. The recollection of individuals’ past histories also indexes the prodromal (often transdiagnostic) features predating the psychiatric diagnosis. The experience of adolescents with mental disorders in the wider society is described with respect to their family, their school and peers, and the social and cultural context. Furthermore, their lived experience of mental health care is described with respect to receiving a diagnosis of mental disorder, accessing mental health support, receiving psychopharmacological treatment, receiving psychotherapy, experiencing peer support and mental health activism, and achieving recovery. These findings can impact clinical practice, research, and the whole society. We hope that this co‐designed, co‐conducted and co‐written journey can help us maintain our commitment to protecting adolescents’ fragile mental health, and can help them develop into a healthy, fulfilling and contributing adult life.
Diagnosing autism spectrum disorder (ASD) in adulthood often represents a challenge in clinical practice. The aim of the present study was to evaluate the sensitivity and specificity of the ADOS and ...ADI-R in diagnosing ASD in adults. 113 subjects with an IQ of 70 or above were assessed through an extensive clinical evaluation. The ADOS-2 Module 4 and the ADI-R were separately administered by staff members blind to clinical judgment. Our results cautiously confirm the accuracy of ADOS-2 Module 4, while suggest that ADI-R might not be reliable in adults without intellectual disability. Clinicians’ training and experience remains of primary importance while assessing adults who could potentially belong to the autism spectrum.
Purpose
To explore Italian psychiatrists' attitudes toward the off‐label use of second generation antipsychotics (SGAs) in patients with substance use disorder and psychotic symptoms.
Design and ...Methods
A sample of 300 Italian psychiatrists associated with the Italian Society of Neuropsychopharmacology was randomly selected to complete a survey about the off‐label prescription of SGAs.
Findings
Oral aripiprazole (32.7%), olanzapine (30.2%), and quetiapine (25.2%) were considered “appropriate.” Long‐acting antipsychoticss were generally considered “inappropriate.”
Practice Implications
Our findings reflect a substantial level of uncertainty and a lack of coherent clinical guidance within the realm of dual diagnosis treatment. Therefore, they emphasize the need to develop specific guidelines to improve the management of pharmacotherapy among this population.
Several studies have demonstrated the neuromodulating function of oxytocin (OT) in response to anxiogenic stimuli as well as its potential role in the pathogenesis of depression. Consequently, ...intranasal OT (IN-OT) has been proposed as a potential treatment of anxiety and depressive disorders. The present systematic review aimed to summarize the randomized controlled trials (RCTs) evaluating the effect of IN-OT on anxiety and depressive symptoms. Overall, 15 studies were included, involving patients with social anxiety disorders (7 studies), arachnophobia (1), major depression (3) or post-natal depression (4), and mainly evaluating single-dose administrations of IN-OT. Results showed no significant effects on core symptomatology. Five crossover studies included functional magnetic resonance imaging investigation: one trial showed reduced amygdala hyper-reactivity after IN-OT in subjects with anxiety, while another one showed enhanced connectivity between amygdala and bilateral insula and middle cingulate gyrus after IN-OT in patients but not in healthy controls. More studies are needed to confirm these results. In conclusion, up to date, evidence regarding the potential utility of IN-OT in treating anxiety and depression is still inconclusive. Further RCTs with larger samples and long-term administration of IN-OT are needed to better elucidate its potential efficacy alone or in association with standard care.
Objectives
Working Alliance (WA) is important in the care of patients with Schizophrenia Spectrum Disorders (SSD). This study aims to determine which sociodemographic and clinical factors are ...associated with WA, as assessed by patients and staff members in Residential Facilities (RFs), and may predict WA dyads' discrepancies.
Methods
Three hundred and three SSD patients and 165 healthcare workers were recruited from 98 RFs and characterized for sociodemographic features. WA was rated by the Working Alliance Inventory (WAI) for patients (WAI‐P) and staff members (WAI‐T). SSD patients were assessed for the severity of psychopathology and psychosocial functioning.
Results
Pearson's correlation revealed a positive correlation (ρ = .314; p < .001) between WAI‐P and WAI‐T ratings. Linear regression showed that patients with higher education reported lower WAI‐P ratings (β = −.50, p = .044), while not being engaged in work or study was associated with lower WAI‐T scores (β = −4.17, p = .015). A shorter lifetime hospitalization was associated with higher WAI‐P ratings (β = 5.90, p = .008), while higher psychopathology severity negatively predicted WAI‐T (β = −.10, p = .002) and WAI‐P ratings (β = −.19, p < .001). Better functioning level positively foresaw WAI‐T (β = .14, p < .001) and WAI‐P ratings (β = .12, p < .001). Regarding discrepancies, staff members' age was associated with higher dyads discrepancy in Total scale and Agreement subscale scores, which were also associated with more severe negative symptoms, while patients' age was negatively correlated to Relationship subscale discrepancy.
Conclusions
This study provides insight into the factors that influence WA in SSD patients and health workers in RFs. The findings address interventions to improve WA and ultimately patient outcomes.
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