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Anxiety Disorders: HELP
Articles from Karolinska Institute
Based on 281 articles published since 2009
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These are the 281 published articles about Anxiety Disorders that originated from Karolinska Institute during 2009-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9 · 10 · 11 · 12
1 Review Psychological treatments for adults and children with epilepsy: Evidence-based recommendations by the International League Against Epilepsy Psychology Task Force. 2018

Michaelis, Rosa / Tang, Venus / Goldstein, Laura H / Reuber, Markus / LaFrance, William Curt / Lundgren, Tobias / Modi, Avani C / Wagner, Janelle L. ·Department of Neurology, Herdecke Community Hospital, University of Witten/Herdecke, Herdecke, Germany. · Integrated Curriculum for Anthroposophical Medicine (ICURAM), Witten/Herdecke University, Herdecke, Germany. · Department of Neurology, Center for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria. · Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong. · Department of Clinical Psychology, Prince of Wales Hospital, Shatin, Hong Kong. · Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK. · Academic Neurology Unit, Royal Hallamshire Hospital, University of Sheffield, Sheffield, UK. · Departments of Psychiatry and Neurology, Rhode Island Hospital, Brown University, Providence, RI, USA. · Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institute, Stockholm, Sweden. · Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA. · College of Nursing and Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA. ·Epilepsia · Pubmed #29917225.

ABSTRACT: Given the significant impact that psychosocial factors and epilepsy treatments can have on the health-related quality of life (HRQOL) of individuals with epilepsy and their families, there is great clinical interest in the role of psychological evaluation and treatments to improve HRQOL and comorbidities. Therefore, the International League Against Epilepsy (ILAE) charged the Psychology Task Force with the development of recommendations for clinical care based on evaluation of the evidence from their recent Cochrane review of psychological treatments in individuals with epilepsy. The literature search for a recent Cochrane review of randomized controlled trials investigating psychological treatments for individuals with epilepsy constitutes the key source of evidence for this article. To provide practical guidance to service providers, we provide ratings on study research designs based on (1) the American Academy of Neurology's Level of Evidence system and (2) the Grading of Recommendations, Assessment, Development, and Evaluation system. This paper is the culmination of an international collaboration process involving pediatric and adult psychologists, neurologists, psychiatrists, and neuropsychiatrists. The process and conclusions were reviewed and approved by the ILAE Executive Committee. The strongest evidence for psychological interventions was identified for the most common mental health problems, including depression, neurocognitive disturbances, and medication adherence. Psychological interventions targeting the enhancement of HRQOL and adherence and a decrease in comorbidity symptoms (anxiety, depression) should be incorporated into comprehensive epilepsy care. There is a range of psychological strategies (ie, cognitive behavioral therapy and mindfulness-based therapies) that show promise for improving the lives of persons with epilepsy, and clinical recommendations are provided to assist epilepsy health care providers in treating the comorbidities and challenges associated with epilepsy and its treatments.

2 Review The 5-HT 2018

Tiger, Mikael / Varnäs, Katarina / Okubo, Yoshiro / Lundberg, Johan. ·Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet and Stockholm County Council, Centrum för psykiatriforskning, R5:0, Karolinska Universitetssjukhuset i Solna, -171 76, Stockholm, SE, Sweden. mikael.tiger@ki.se. · Department of Neuropsychiatry, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan. mikael.tiger@ki.se. · Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet and Stockholm County Council, Centrum för psykiatriforskning, R5:0, Karolinska Universitetssjukhuset i Solna, -171 76, Stockholm, SE, Sweden. · Department of Neuropsychiatry, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan. ·Psychopharmacology (Berl) · Pubmed #29546551.

ABSTRACT: Major depressive disorder (MDD) is the leading cause of disability worldwide. The serotonin hypothesis may be the model of MDD pathophysiology with the most support. The majority of antidepressants enhance synaptic serotonin levels quickly, while it usually takes weeks to discern MDD treatment effect. It has been hypothesized that the time lag between serotonin increase and reduction of MDD symptoms is due to downregulation of inhibitory receptors such as the serotonin 1B receptor (5-HT1BR). The research on 5-HT1BR has previously been hampered by a lack of selective ligands for the receptor. The last extensive review of 5-HT1BR in the pathophysiology of depression was published 2009, and based mainly on findings from animal studies. Since then, selective radioligands for in vivo quantification of brain 5-HT1BR binding with positron emission tomography has been developed, providing new knowledge on the role of 5-HT1BR in MDD and its treatment. The main focus of this review is the role of 5-HT1BR in relation to MDD and its treatment, although studies of 5-HT1BR in obsessive-compulsive disorder, alcohol dependence, and cocaine dependence are also reviewed. The evidence outlined range from animal models of disease, effects of 5-HT1B receptor agonists and antagonists, case-control studies of 5-HT1B receptor binding postmortem and in vivo, with positron emission tomography, to clinical studies of 5-HT1B receptor effects of established treatments for MDD. Low 5-HT1BR binding in limbic regions has been found in MDD patients. When 5-HT1BR ligands are administered to animals, 5-HT1BR agonists most consistently display antidepressant-like properties, though it is not yet clear how 5-HT1BR is best approached for optimal MDD treatment.

3 Review Fear extinction in the human brain: A meta-analysis of fMRI studies in healthy participants. 2018

Fullana, Miquel A / Albajes-Eizagirre, Anton / Soriano-Mas, Carles / Vervliet, Bram / Cardoner, Narcís / Benet, Olívia / Radua, Joaquim / Harrison, Ben J. ·FIDMAG Germanes Hospitalàries, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain; Department of Psychiatry, Universitat Autònoma de Barcelona, Barcelona, Spain. Electronic address: mafullana@clinic.cat. · FIDMAG Germanes Hospitalàries, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain. · Department of Psychiatry, Bellvitge University Hospital-IDIBELL, CIBERSAM, Barcelona, Spain; Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Spain. · Center for Excellence on Generalization in Health and Psychopathology, University of KU Leuven, Leuven, Belgium; Department of Psychiatry, Harvard Medical School, Boston, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, USA. · Department of Psychiatry, Universitat Autònoma de Barcelona, Barcelona, Spain; Depression and Anxiety Unit, Mental Health Department, CIBERSAM, Parc Taulí Sabadell University Hospital, Barcelona, Spain. · Autonomous University of Barcelona, Spain. · FIDMAG Germanes Hospitalàries, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain; Institute of Psychiatry, King's College London, De Crespigny Park, London, UK; Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. · Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Level 3, 161 Barry Street, Melbourne, Victoria, Australia. Electronic address: habj@unimelb.edu.au. ·Neurosci Biobehav Rev · Pubmed #29530516.

ABSTRACT: The study of fear extinction represents an important example of translational neuroscience in psychiatry and promises to improve the understanding and treatment of anxiety and fear-related disorders. We present the results of a set of meta-analyses of human fear extinction studies in healthy participants, conducted with functional magnetic resonance imaging (fMRI) and reporting whole-brain results. Meta-analyses of fear extinction learning primarily implicate consistent activation of brain regions linked to threat appraisal and experience, including the dorsal anterior cingulate and anterior insular cortices. An overlapping anatomical result was obtained from the meta-analysis of extinction recall studies, except when studies directly compared an extinguished threat stimulus to an unextinguished threat stimulus (instead of a safety stimulus). In this latter instance, more consistent activation was observed in dorsolateral and ventromedial prefrontal cortex regions, together with other areas including the hippocampus. While our results partially support the notion of a shared neuroanatomy between human and rodent models of extinction processes, they also encourage an expanded account of the neural basis of human fear extinction.

4 Review Long-term effects of internet-supported cognitive behaviour therapy. 2018

Andersson, Gerhard / Rozental, Alexander / Shafran, Roz / Carlbring, Per. ·a Department of Behavioural Sciences and Learning , Linköping University , Linköping , Sweden. · b Department of Clinical Neuroscience, Psychiatry Section , Karolinska Institutet , Stockholm , Sweden. · c Department of Clinical Psychology , Stockholm University , Stockholm , Sweden. · d UCL Institute of Child Health , University College London , London , England. ·Expert Rev Neurother · Pubmed #29094622.

ABSTRACT: INTRODUCTION: Internet-supported and therapist-guided cognitive behaviour therapy (ICBT) is effective for a range of problems in the short run, but less is known about the long-term effects with follow-ups of two years or longer. Areas covered: This paper reviews studies in which the long-term effects of guided ICBT were investigated. Following literature searches in PubMed and other sources meta-analytic statistics were calculated for 14 studies involving a total of 902 participants, and an average follow-up period of three years. Studies were from Sweden (n = 11) or the Netherlands (n = 3). Long-term outcome studies were found for panic disorder, social anxiety disorder, generalized anxiety disorder, depression, mixed anxiety and depression, obsessive-compulsive disorder, pathological gambling, stress and chronic fatigue. The duration of the treatments was usually short (8-15 weeks). The pre-to follow-up effect size was Hedge's g = 1.52, but with a significant heterogeneity. The average symptom improvement across studies was 50%. Treatment seeking in the follow-up period was not documented and few studies mentioned negative effects. Expert commentary: While effects may be overestimated, it is likely that therapist-supported ICBT can have enduring effects. Long-term follow-up data should be collected for more conditions and new technologies like smartphone-delivered treatments.

5 Review Internet-Assisted Cognitive Behavioral Therapy. 2017

Andersson, Gerhard / Carlbring, Per. ·Department of Behavioural Sciences and Learning, Linköping University, Campus Valla, SE-581 83, Linköping SE-581 83, Sweden; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden. Electronic address: gerhard.andersson@liu.se. · Department of Psychology, Stockholm University, Stockholm SE-106 91, Sweden. ·Psychiatr Clin North Am · Pubmed #29080594.

ABSTRACT: Internet-assisted cognitive-behavioral therapy (ICBT) is a way to deliver cognitive-behavioral therapy (CBT) that has been found to generate similar effects as face-to-face CBT in some studies. Results have been replicated by different research groups. This article presents the treatment format and reviews evidence for mood and anxiety disorders. Future developments are discussed, including the lack of theories specific for the treatment format and ways to handle comorbidity. Although some programs have been implemented there is a need for further studies in clinical settings. Overall, clinician-assisted ICBT is becoming one of the most evidence-based forms of psychological treatment.

6 Review Brief, intensive and concentrated cognitive behavioral treatments for anxiety disorders in children: A systematic review and meta-analysis. 2017

Öst, Lars-Göran / Ollendick, Thomas H. ·Department of Psychology, Stockholm University, Sweden; Department of Clinical Neuroscience, Psychology Section, Karolinska Institutet, Sweden. Electronic address: ost@psychology.su.se. · Child Study Center, Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA. ·Behav Res Ther · Pubmed #28772195.

ABSTRACT: Anxiety disorders are among the most common disorders affecting youths in the general population, with up to 10% of children and 20% of adolescents meeting criteria for an anxiety disorder at any one point in time. Cognitive-behavior therapies (CBT), varying between 9 and 18 weeks of treatment, are considered evidence-based for the treatment of anxiety disorders in youth. During the last two decades treatments that are brief, intensive, or concentrated (BIC) have been developed and this meta-analysis includes 23 RCTs of these new approaches across the anxiety disorders. BIC yielded a lower attrition (2.3%) than standard CBT (6.5%). The effect sizes (ES) for comparison of BIC with waiting-list (1.47) and placebo (0.91) were significant, whereas that with standard CBT (0.01) was not. Regarding remission at post/recovery at follow-up BIC (54%/64%) and standard CBT (57%/63%) were comparable and both were significantly higher than placebo (26%/35%), which was higher than WLC (7%/9%). Within-group ES at post and follow-up were 1.50 and 1.53 for BIC, and 0.98 and 1.05 for standard CBT, indicating maintenance of the effects up to 12 months after therapy. Advantages and disadvantages of BIC are discussed and we suggest that BIC-interventions represent a paradigm shift in the delivery of services for youth with anxiety disorders.

7 Review Emotion regulation in mood and anxiety disorders: A meta-analysis of fMRI cognitive reappraisal studies. 2017

Picó-Pérez, Maria / Radua, Joaquim / Steward, Trevor / Menchón, José M / Soriano-Mas, Carles. ·Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain. · FIDMAG Germanes Hospitalàries, Barcelona, Spain; Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK; CIBER Salud Mental (CIBERSam), Instituto Salud Carlos III (ISCIII), Barcelona, Spain. · Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III (ISCIII), Barcelona, Spain. · Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain; CIBER Salud Mental (CIBERSam), Instituto Salud Carlos III (ISCIII), Barcelona, Spain. · Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain; CIBER Salud Mental (CIBERSam), Instituto Salud Carlos III (ISCIII), Barcelona, Spain; Department of Psychobiology and Methodology in Health Sciences, Universitat Autònoma de Barcelona, Barcelona, Spain. Electronic address: csoriano@idibell.cat. ·Prog Neuropsychopharmacol Biol Psychiatry · Pubmed #28579400.

ABSTRACT: Emotion regulation by means of cognitive reappraisal has been widely studied with functional magnetic resonance imaging (fMRI). To date, several meta-analyses of studies using cognitive reappraisal tasks in healthy volunteers have been carried out, but no meta-analyses have yet been performed on the fMRI data of clinical populations with identified alterations in emotion regulation capacity. We provide a comprehensive meta-analysis of cognitive reappraisal fMRI studies in populations of patients with mood or anxiety disorders, yielding a pooled sample of 247 patients and 262 controls from thirteen independent studies. As a distinguishing feature of this meta-analysis, original statistical brain maps were obtained from six of these studies. Our primary results demonstrated that patients with mood and anxiety disorders recruited the regulatory fronto-parietal network involved in cognitive reappraisal to a lesser extent in comparison to healthy controls. Conversely, they presented increased activation in regions that may be associated with the emotional experience (i.e., insula, cerebellum, precentral and inferior occipital gyri) and in regions whose activation may be the consequence of compensatory mechanisms (i.e., supramarginal gyri and superior parietal lobule). Moreover, activations in the left ventrolateral prefrontal cortex and the left superior temporal gyrus were associated with reinterpretation emotion regulation strategies, whereas medial frontal and parietal activations were associated with the deployment of distancing strategies. The regions revealed by this meta-analysis conform to a pattern of dysfunctional brain activation during cognitive reappraisal common to mood and anxiety disorders. As such, this neural pattern may reflect a transdiagnostic feature of these disorders.

8 Review A systematic review and quality assessment of psychological, pharmacological, and family-based interventions for hoarding disorder. 2017

Thompson, Claire / Fernández de la Cruz, Lorena / Mataix-Cols, David / Onwumere, Juliana. ·Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England, UK. Electronic address: Claire.c.thompson@kcl.ac.uk. · Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. · Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden. · Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England, UK. ·Asian J Psychiatr · Pubmed #28558897.

ABSTRACT: INTRODUCTION: Hoarding disorder (HD) affects at least 1.5% of the population and is considered to be hard to treat. The current study aimed to systematically review the treatments designed to improve HD symptoms and family impact. METHOD: Searches of PsycINFO, MEDLINE, EMBASE, and Web of Science were undertaken. Studies were included if: (i) the study evaluated an intervention for hoarding problems; (ii) outcome measures were reported; and (iii) study results were published in an indexed journal or were a published abstract from a professional/research conference. The quality of the studies was assessed using the Clinical Trials Assessment Measure (CTAM). RESULTS: Twenty studies, comprising 492 participants with clinically significant hoarding symptoms or HD and 21 relatives of individuals with HD, met inclusion criteria. Treatments reviewed included cognitive-behavior therapy, medication, cognitive remediation, and multi-component interventions for relatives. Most studies yielded statistically significant improvements in hoarding symptoms, although reductions were generally modest and many participants remained in the clinical range after treatment. According to the CTAM, most studies were judged to be of low methodological quality. CONCLUSIONS: HD is a chronic and highly burdensome condition for which efficacious treatments are needed. The current evidence base is somewhat limited and of low quality. Further research is needed to improve treatments, identify mechanisms of change, and increase the availability of evidence-based interventions for this group.

9 Review Social Fear Learning: from Animal Models to Human Function. 2017

Debiec, Jacek / Olsson, Andreas. ·Molecular & Behavioral Neuroscience Institute and Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA. Electronic address: jdebiec@umich.edu. · Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. Electronic address: andreas.olsson@ki.se. ·Trends Cogn Sci · Pubmed #28545935.

ABSTRACT: Learning about potential threats is critical for survival. Learned fear responses are acquired either through direct experiences or indirectly through social transmission. Social fear learning (SFL), also known as vicarious fear learning, is a paradigm successfully used for studying the transmission of threat information between individuals. Animal and human studies have begun to elucidate the behavioral, neural and molecular mechanisms of SFL. Recent research suggests that social learning mechanisms underlie a wide range of adaptive and maladaptive phenomena, from supporting flexible avoidance in dynamic environments to intergenerational transmission of trauma and anxiety disorders. This review discusses recent advances in SFL studies and their implications for basic, social and clinical sciences.

10 Review The relationship of specific items on the Neuropsychiatric Inventory to caregiver burden in dementia: a systematic review. 2017

Terum, Toril Marie / Andersen, John Roger / Rongve, Arvid / Aarsland, Dag / Svendsboe, Ellen J / Testad, Ingelin. ·Westeren Norway University of Applied Science, Førde, Norway. · Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway. · Department of Clinical Medicine, University of Bergen, Bergen, Norway. · Center of Health Research, Førde Hospital Trust, Førde, Norway. · Department of Research and Innovation, Helse Fonna, Haugesund, Norway. · Wolfson Centre for Age-Related Diseases, King's College London, London, UK. · Department of Nursing, Westeren Norway University of Applied Science, Stord, Norway. · Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Sweden. ·Int J Geriatr Psychiatry · Pubmed #28317166.

ABSTRACT: OBJECTIVE: Neuropsychiatric symptoms (NPSs) are common in dementia, and they have been identified as important care-recipient variables in terms of their impact on caregiver burden. The aim of this review was to describe how individual NPSs in dementia, assessed using the Neuropsychiatric Inventory, are associated with caregiver burden. METHODS: We performed a systematic review of English language, peer-reviewed articles retrieved from MEDLINE, PSYCINFO, and EMBASE. RESULTS: A total of 13 studies met the inclusion criteria. Four studies examined the association between individual NPSs and caregiver burden using the Spearman rank correlation test, while three used Pearson's correlation test. Of the remaining studies, five used multiple regression analyses and one the chi-squared test. The majority of included studies did not differentiate between dementia subtypes in the analysis or mainly included only caregivers of people with Alzheimer's disease. The Clinical Dementia Rating score and mean Mini-Mental State Examination score indicate mild to moderate dementia. The majority of caregivers were women, most of whom were children (53.8%) or spouses (36%). The data indicated that irritability, followed by agitation, sleep disturbances, anxiety, apathy, and delusion seem to impact caregiver burden the most. CONCLUSION: Our principal finding is that irritability, agitation, sleep disturbances, anxiety, apathy, and delusion seem to exert the most impact on caregiver burden. Heterogeneity in the measures and statistical analyses used, however, makes it difficult to make conclusive interpretations. Future research in this field would benefit from standardization of the scientific methodology in use. Copyright © 2017 John Wiley & Sons, Ltd.

11 Review Creating state of the art, next-generation Virtual Reality exposure therapies for anxiety disorders using consumer hardware platforms: design considerations and future directions. 2017

Lindner, Philip / Miloff, Alexander / Hamilton, William / Reuterskiöld, Lena / Andersson, Gerhard / Powers, Mark B / Carlbring, Per. ·a Department of Psychology , Stockholm University , Stockholm , Sweden. · b Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden. · c Mimerse , Stockholm , Sweden. · d Department of Behavioral Sciences and Learning , Linköping University , Linköping , Sweden. · e Department of Psychology , University of Texas , Austin , TX , USA. · f Baylor University Medical Center , Dallas , TX , USA. ·Cogn Behav Ther · Pubmed #28270059.

ABSTRACT: Decades of research and more than 20 randomized controlled trials show that Virtual Reality exposure therapy (VRET) is effective in reducing fear and anxiety. Unfortunately, few providers or patients have had access to the costly and technical equipment previously required. Recent technological advances in the form of consumer Virtual Reality (VR) systems (e.g. Oculus Rift and Samsung Gear), however, now make widespread use of VRET in clinical settings and as self-help applications possible. In this literature review, we detail the current state of VR technology and discuss important therapeutic considerations in designing self-help and clinician-led VRETs, such as platform choice, exposure progression design, inhibitory learning strategies, stimuli tailoring, gamification, virtual social learning and more. We illustrate how these therapeutic components can be incorporated and utilized in VRET applications, taking full advantage of the unique capabilities of virtual environments, and showcase some of these features by describing the development of a consumer-ready, gamified self-help VRET application for low-cost commercially available VR hardware. We also raise and discuss challenges in the planning, development, evaluation, and dissemination of VRET applications, including the need for more high-quality research. We conclude by discussing how new technology (e.g. eye-tracking) can be incorporated into future VRETs and how widespread use of VRET self-help applications will enable collection of naturalistic "Big Data" that promises to inform learning theory and behavioral therapy in general.

12 Review D-Cycloserine Augmentation of Exposure-Based Cognitive Behavior Therapy for Anxiety, Obsessive-Compulsive, and Posttraumatic Stress Disorders: A Systematic Review and Meta-analysis of Individual Participant Data. 2017

Mataix-Cols, David / Fernández de la Cruz, Lorena / Monzani, Benedetta / Rosenfield, David / Andersson, Erik / Pérez-Vigil, Ana / Frumento, Paolo / de Kleine, Rianne A / Difede, JoAnn / Dunlop, Boadie W / Farrell, Lara J / Geller, Daniel / Gerardi, Maryrose / Guastella, Adam J / Hofmann, Stefan G / Hendriks, Gert-Jan / Kushner, Matt G / Lee, Francis S / Lenze, Eric J / Levinson, Cheri A / McConnell, Harry / Otto, Michael W / Plag, Jens / Pollack, Mark H / Ressler, Kerry J / Rodebaugh, Thomas L / Rothbaum, Barbara O / Scheeringa, Michael S / Siewert-Siegmund, Anja / Smits, Jasper A J / Storch, Eric A / Ströhle, Andreas / Tart, Candyce D / Tolin, David F / van Minnen, Agnes / Waters, Allison M / Weems, Carl F / Wilhelm, Sabine / Wyka, Katarzyna / Davis, Michael / Rück, Christian / Anonymous171083 / Altemus, Margaret / Anderson, Page / Cukor, Judith / Finck, Claudia / Geffken, Gary R / Golfels, Fabian / Goodman, Wayne K / Gutner, Cassidy / Heyman, Isobel / Jovanovic, Tanja / Lewin, Adam B / McNamara, Joseph P / Murphy, Tanya K / Norrholm, Seth / Thuras, Paul. ·Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden2Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden. · Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. · Institute of Psychiatry, Psychology, and Neuroscience, Department of Psychology, King's College London, London, United Kingdom. · Department of Psychology, Southern Methodist University, Dallas, Texas. · Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. · Center for Anxiety Disorders Overwaal, Institution for Integrated Mental Health Care Pro Persona, Nijmegen, the Netherlands7Behavioral Science Institute, NijCare, Radboud University Nijmegen, Nijmegen, the Netherlands. · Department of Psychiatry, Weill Cornell Medical College, New York, New York. · Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia. · School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia11Menzies Health Institute of Queensland, Brisbane, Queensland, Australia. · Department of Psychiatry, Massachusetts General Hospital, Boston13Harvard Medical School, Boston, Massachusetts. · Brain and Mind Research Institute, Central Clinical School, University of Sydney, Sydney, New South Wales, Australia. · Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts. · Department of Psychiatry, University of Minnesota, Minneapolis. · Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri. · University of Louisville, Louisville, Kentucky. · Menzies Health Institute of Queensland, Brisbane, Queensland, Australia19School of Medicine, Griffith University, Brisbane, Queensland, Australia. · Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - University Medicine Berlin, Berlin, Germany. · Department of Psychiatry, Rush University Medical Center, Chicago, Illinois. · Harvard Medical School, Boston, Massachusetts22McLean Hospital, Belmont, Massachusetts. · Department of Psychological and Brain Sciences, Washington University School of Medicine, St Louis, Missouri. · Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, Louisiana. · School of Medicine, Griffith University, Brisbane, Queensland, Australia. · Institute for Mental Health Research, Department of Psychology, The University of Texas, Austin. · Department of Pediatrics, University of South Florida, Tampa27Rogers Behavioral Health, Tampa, Florida. · New Mexico Veterans Affairs Health Care System, Albuquerque, New Mexico. · The Institute of Living, Hartford, Connecticut30Yale University School of Medicine, New Haven, Massachusetts. · Department of Human Development and Family Studies, Iowa State University, Ames. · Department of Psychiatry, Weill Cornell Medical College, New York, New York32Cuny School of Public Health, City University of New York Graduate School of Public Health and Health Policy, New York. · Department of Psychology, Georgia State University, Atlanta. · Department of Psychiatry, University of Florida, Gainesville. · Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York. · Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts. · Great Ormond Street Hospital for Children, University College London, London, United Kingdom. · Department of Pediatrics, University of South Florida, Tampa. · Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota. ·JAMA Psychiatry · Pubmed #28122091.

ABSTRACT: Importance: Whether and under which conditions D-cycloserine (DCS) augments the effects of exposure-based cognitive behavior therapy for anxiety, obsessive-compulsive, and posttraumatic stress disorders is unclear. Objective: To clarify whether DCS is superior to placebo in augmenting the effects of cognitive behavior therapy for anxiety, obsessive-compulsive, and posttraumatic stress disorders and to evaluate whether antidepressants interact with DCS and the effect of potential moderating variables. Data Sources: PubMed, EMBASE, and PsycINFO were searched from inception to February 10, 2016. Reference lists of previous reviews and meta-analyses and reports of randomized clinical trials were also checked. Study Selection: Studies were eligible for inclusion if they were (1) double-blind randomized clinical trials of DCS as an augmentation strategy for exposure-based cognitive behavior therapy and (2) conducted in humans diagnosed as having specific phobia, social anxiety disorder, panic disorder with or without agoraphobia, obsessive-compulsive disorder, or posttraumatic stress disorder. Data Extraction and Synthesis: Raw data were obtained from the authors and quality controlled. Data were ranked to ensure a consistent metric across studies (score range, 0-100). We used a 3-level multilevel model nesting repeated measures of outcomes within participants, who were nested within studies. Results: Individual participant data were obtained for 21 of 22 eligible trials, representing 1047 of 1073 eligible participants. When controlling for antidepressant use, participants receiving DCS showed greater improvement from pretreatment to posttreatment (mean difference, -3.62; 95% CI, -0.81 to -6.43; P = .01; d = -0.25) but not from pretreatment to midtreatment (mean difference, -1.66; 95% CI, -4.92 to 1.60; P = .32; d = -0.14) or from pretreatment to follow-up (mean difference, -2.98, 95% CI, -5.99 to 0.03; P = .05; d = -0.19). Additional analyses showed that participants assigned to DCS were associated with lower symptom severity than those assigned to placebo at posttreatment and at follow-up. Antidepressants did not moderate the effects of DCS. None of the prespecified patient-level or study-level moderators was associated with outcomes. Conclusions and Relevance: D-cycloserine is associated with a small augmentation effect on exposure-based therapy. This effect is not moderated by the concurrent use of antidepressants. Further research is needed to identify patient and/or therapy characteristics associated with DCS response.

13 Review Internet-delivered transdiagnostic and tailored cognitive behavioral therapy for anxiety and depression: a systematic review and meta-analysis of randomized controlled trials. 2017

Păsărelu, Costina Ruxandra / Andersson, Gerhard / Bergman Nordgren, Lise / Dobrean, Anca. ·a Doctoral School Evidence-Based Assessment and Psychological Interventions , Babeș-Bolyai University , Cluj-Napoca , Romania. · b Department of Behavioural Sciences and Learning , Linköping University , Linkoping , Sweden. · c Psychiatry Section, Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden. · d Department of Clinical Psychology and Psychotherapy , Babeș-Bolyai University , Cluj-Napoca , Romania. ·Cogn Behav Ther · Pubmed #27712544.

ABSTRACT: Anxiety and depressive disorders are often comorbid. Transdiagnostic and tailored treatments seem to be promising approaches in dealing with comorbidity. Although several primary studies have examined the effects of Internet-delivered cognitive behavior therapy (iCBT) for anxiety and depression, no meta-analysis including different types of iCBT that address comorbidity has been conducted so far. We conducted systematic searches in databases up to 1 July 2016. Only randomized trials comparing transdiagnostic/tailored iCBT for adult anxiety and/or depression with control groups were included. Nineteen randomized trials with a total of 2952 participants that met inclusion criteria were analyzed. The quality of the studies was high, however the blinding criteria were not fulfilled. The uncontrolled effect size (Hedges' g) of transdiagnostic/tailored iCBT on anxiety and depression outcomes was large and medium for quality of life. The controlled effect size for iCBT on anxiety and depression outcomes was medium to large (anxiety: g = .82, 95% CI: .58-1.05, depression: g = .79, 95% CI: .59-1.00) and medium on quality of life (g = .56, 95% CI: .37-.73). Heterogeneity was small (quality of life) to moderate (anxiety, depression). There was a large effect on generic outcome measures and a moderate effect on comorbidities. When compared to disorder-specific treatments there were no differences on anxiety and quality of life outcomes, however there were differences in depression outcomes. Transdiagnostic and tailored iCBT are effective interventions for anxiety disorders and depression. Future studies should investigate mechanisms of change and develop outcome measures for these interventions.

14 Review The link between autoimmune diseases and obsessive-compulsive and tic disorders: A systematic review. 2016

Pérez-Vigil, Ana / Fernández de la Cruz, Lorena / Brander, Gustaf / Isomura, Kayoko / Gromark, Caroline / Mataix-Cols, David. ·Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. Electronic address: ana.perez.vigil@ki.se. · Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. · Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden. · Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden. ·Neurosci Biobehav Rev · Pubmed #27687817.

ABSTRACT: Immunological factors are increasingly recognized as being important in a range of neuropsychiatric disorders. We aimed to summarize the disperse and often conflicting literature on the potential association between autoimmune diseases (ADs) and obsessive-compulsive disorder (OCD) and tic disorders. We searched PubMed, EMBASE, and PsycINFO for original studies evaluating the relationship between ADs and OCD/tic disorders until July, 13th 2016. Seventy-four studies met inclusion criteria. Overall, the studies were of limited methodological quality. Rates of OCD were higher in rheumatic fever patients who were also affected by its neurological manifestation, Sydenham's chorea. The literature on other ADs was scarce and the findings inconclusive. Few studies examined the association between ADs and tic disorders. A handful of family studies reported elevated rates of ADs in first-degree relatives of individuals with OCD/tic disorders, and vice versa, potentially suggesting shared genetic and/or environmental mechanisms. In conclusion, at present, there is modest evidence for a possible association and familial co-aggregation between ADs and OCD/tic disorders. We offer some suggestions for future research.

15 Review Internet-delivered cognitive behavior therapy for children and adolescents: A systematic review and meta-analysis. 2016

Vigerland, Sarah / Lenhard, Fabian / Bonnert, Marianne / Lalouni, Maria / Hedman, Erik / Ahlen, Johan / Olén, Ola / Serlachius, Eva / Ljótsson, Brjánn. ·Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm County Council, Sweden. Electronic address: sarah.vigerland@ki.se. · Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm County Council, Sweden. · Stockholm Health Care Services, Stockholm County Council, Sweden; Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. · Stockholm Health Care Services, Stockholm County Council, Sweden; Department of Psychology, Uppsala University, Uppsala, Sweden. · Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Osher center for integrative medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. · Department of Psychology, Uppsala University, Uppsala, Sweden. · Department of Medicine, Karolinska Institutet, Stockholm, Sweden. · Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. ·Clin Psychol Rev · Pubmed #27668988.

ABSTRACT: Internet-delivered cognitive behavior therapy (ICBT) is a relatively novel treatment format with the potential to increase accessibility of evidence-based care. However, little is known about the feasibility and efficacy of ICBT in children and adolescents. We conducted a comprehensive systematic review and meta-analysis of ICBT for children and adolescents to provide an overview of the field and assess the efficacy of these interventions. A systematic literature search of six electronic databases was performed to identify ICBT intervention studies for children with a psychiatric condition, such as social anxiety disorder, or a somatic condition, such as chronic pain. Two reviewers independently rated study quality. Twenty-five studies, targeting 11 different disorders, were included in the review. Study quality and presentation of treatment variables, such as therapist time and treatment adherence, varied largely. Twenty-four studies (N=1882) were included in the meta-analysis and ICBT yielded moderate between-group effect sizes when compared with waitlist, g=0.62, 95% CI [0.41, 0.84]. The results suggest that CBT for psychiatric and somatic conditions in children and adolescents can be successfully adapted to an internet-delivered format.

16 Review Cognitive behavioral and pharmacological treatments of OCD in children: A systematic review and meta-analysis. 2016

Öst, Lars-Göran / Riise, Eili N / Wergeland, Gro Janne / Hansen, Bjarne / Kvale, Gerd. ·Department of Clinical Neuroscience, The Karolinska Institute, Stockholm, Sweden; Department of Psychology, Stockholm University, Sweden; Department of Clinical Psychology, University of Bergen, Norway. Electronic address: ost@psychology.su.se. · Department of Clinical Psychology, University of Bergen, Norway; Haukeland University Hospital, OCD-team, 5021 Bergen, Norway. · Department of Child and Adolescent Psychiatry, Haukeland University Hospital, Bergen, Norway. ·J Anxiety Disord · Pubmed #27632568.

ABSTRACT: Obsessive-compulsive disorder (OCD) is ranked by the World Health Organization (WHO) among the 10 most debilitating disorders. The treatments which have been found effective are cognitive behavior therapy (CBT) and serotonin reuptake inhibitors (SRI). This meta-analysis includes all RCTs of CBT (25) and SRI (9) for OCD in youth using the Children's Yale-Brown Obsessive Compulsive Scale (C-YBOCS). CBT yielded significantly lower attrition (12.7%) than SRI (23.5%) and placebo (24.7%). The effect sizes for comparisons of CBT with waiting-list (1.53), placebo (0.93), and SRI with placebo (0.51) were significant, whereas CBT vs. SRI (0.22) and Combo (CBT+SRI) vs. CBT (0.14) were not. Regarding response rate CBT (70%) and Combo (66%) were significantly higher than SRI (49%), which was higher than placebo (29%) and WLC (13%). As for remission CBT (53%) and Combo (49%) were significantly higher than SRI (24%), placebo (15%), and WLC (10%), which did not differ from each other. Combo was not more effective than CBT alone irrespective of initial severity of the samples. The randomized controlled trials (RCTs) have a number of methodological problems and recommendations for improving research methodology are discussed as well as clinical implications of the findings.

17 Review [Deep brain stimulation can break vicious circle in obsessive-compulsive disorder]. 2016

Chen, Long Long / Schechtmann, Gaston / Ring, Patrik / Djurfeldt, Diana. ·Stockholms läns - Psykiatri Nordväst Solna, Sweden Stockholms läns - Psykiatri Nordväst Solna, Sweden. · Neurokirurgiska kliniken, Karolinska sjukhuset - Department of Clinical Neuroscience (CNS), K8 Stockholm, Sweden Neurokirurgiska kliniken, Karolinska sjukhuset - Department of Clinical Neuroscience (CNS), K8 Stockholm, Sweden. · Neuroradiologiska kliniken - Department of Clinical Neuroscience (CNS), K8 Stockholm, Sweden Neuroradiologiska kliniken - Department of Clinical Neuroscience (CNS), K8 Stockholm, Sweden. · Psykiatri Sydväst - Stockholms läns landsting Stockholm, Sweden Psykiatri Sydväst - Stockholms läns landsting Stockholm, Sweden. ·Lakartidningen · Pubmed #27219079.

ABSTRACT: Obsessive-compulsive disorder (OCD), characterized by repetitive intrusive thoughts and ritualized behaviors, is a highly debilitating disorder with an estimated lifetime prevalence of about 2 %. Approximately 10 % of these patients have severe symptoms despite having received all available treatments, thus considered treatment refractory. Deep brain stimulation (DBS), a reversible, safe and adaptive method widely used for movement disorders, enables specific targeting of deep brain structures of relevance in OCD. About 60% of the patients with treatment refractory OCD show ameliorated symptoms and improved quality of life with DBS. Taking ethical aspects into consideration DBS is a viable option for patients with treatment refractory OCD though further studies are needed to fully understand and individualize this treatment.

18 Review Systematic review of environmental risk factors for Obsessive-Compulsive Disorder: A proposed roadmap from association to causation. 2016

Brander, Gustaf / Pérez-Vigil, Ana / Larsson, Henrik / Mataix-Cols, David. ·Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. Electronic address: gustaf.brander@ki.se. · Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. · Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. · Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden. ·Neurosci Biobehav Rev · Pubmed #27013116.

ABSTRACT: OBJECTIVE: To synthesize the current knowledge on possible environmental risk factors for Obsessive-Compulsive Disorder (OCD). METHOD: We conducted a systematic review following PRISMA guidelines. The Embase, PubMed and Scopus databases were searched up until October 6, 2015, employing relevant keywords and MeSH terms. RESULTS: 128 studies met inclusion criteria. Potential environmental risk factors for OCD have been identified in the broad areas of perinatal complications, reproductive cycle, and stressful life events. There is limited evidence regarding other potential risk factors, such as parental age, season of birth, socioeconomic status, parental rearing practices, infections, traumatic brain injury, substance use or vitamin deficiency. In general, studies were of limited methodological quality. CONCLUSIONS: At present, no environmental risk factors have convincingly been associated with OCD. We propose a roadmap for future studies, consisting of longitudinal, population-based research, employing quasi-experimental family and twin designs to identify risk factors that are not only associated with the disorder but also contribute to its causation either directly or moderating the effect of genes.

19 Review Universal Prevention for Anxiety and Depressive Symptoms in Children: A Meta-analysis of Randomized and Cluster-Randomized Trials. 2015

Ahlen, Johan / Lenhard, Fabian / Ghaderi, Ata. ·Department of Psychology, Uppsala University, Box 1225, 751 42, Uppsala, Sweden. johan.ahlen@psyk.uu.se. · Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden. ·J Prim Prev · Pubmed #26502085.

ABSTRACT: Although under-diagnosed, anxiety and depression are among the most prevalent psychiatric disorders in children and adolescents, leading to severe impairment, increased risk of future psychiatric problems, and a high economic burden to society. Universal prevention may be a potent way to address these widespread problems. There are several benefits to universal relative to targeted interventions because there is limited knowledge as to how to screen for anxiety and depression in the general population. Earlier meta-analyses of the prevention of depression and anxiety symptoms among children suffer from methodological inadequacies such as combining universal, selective, and indicated interventions in the same analyses, and comparing cluster-randomized trials with randomized trials without any correction for clustering effects. The present meta-analysis attempted to determine the effectiveness of universal interventions to prevent anxiety and depressive symptoms after correcting for clustering effects. A systematic search of randomized studies in PsychINFO, Cochrane Library, and Google Scholar resulted in 30 eligible studies meeting inclusion criteria, namely peer-reviewed, randomized or cluster-randomized trials of universal interventions for anxiety and depressive symptoms in school-aged children. Sixty-three percent of the studies reported outcome data regarding anxiety and 87 % reported outcome data regarding depression. Seventy percent of the studies used randomization at the cluster level. There were small but significant effects regarding anxiety (.13) and depressive (.11) symptoms as measured at immediate posttest. At follow-up, which ranged from 3 to 48 months, effects were significantly larger than zero regarding depressive (.07) but not anxiety (.11) symptoms. There was no significant moderation effect of the following pre-selected variables: the primary aim of the intervention (anxiety or depression), deliverer of the intervention, gender distribution, children's age, and length of the intervention. Despite small effects, we argue for the possible clinical and practical significance of these programs. Future evaluations should carefully investigate the moderators and mediators of program effects to identify active program components.

20 Review Economic evaluations of Internet interventions for mental health: a systematic review. 2015

Donker, T / Blankers, M / Hedman, E / Ljótsson, B / Petrie, K / Christensen, H. ·Department of Clinical Psychology,VU University,Amsterdam,The Netherlands. · Trimbos Institute,Netherlands Institute of Mental Health and Addiction,Utrecht,The Netherlands. · Department of Clinical Neuroscience,Osher Center for Integrative Medicine,Karolinska Institutet,Stockholm,Sweden. · Department of Clinical Neuroscience, Division of Psychology,Karolinska Institutet,Stockholm,Sweden. · The Black Dog Institute,University of New South Wales,Sydney,NSW,Australia. ·Psychol Med · Pubmed #26235445.

ABSTRACT: BACKGROUND: Internet interventions are assumed to be cost-effective. However, it is unclear how strong this evidence is, and what the quality of this evidence is. METHOD: A comprehensive literature search (1990-2014) in Medline, EMBASE, the Cochrane Central Register of Controlled Trials, NHS Economic Evaluations Database, NHS Health Technology Assessment Database, Office of Health Economics Evaluations Database, Compendex and Inspec was conducted. We included economic evaluations alongside randomized controlled trials of Internet interventions for a range of mental health symptoms compared to a control group, consisting of a psychological or pharmaceutical intervention, treatment-as-usual (TAU), wait-list or an attention control group. RESULTS: Of the 6587 abstracts identified, 16 papers met the inclusion criteria. Nine studies featured a societal perspective. Results demonstrated that guided Internet interventions for depression, anxiety, smoking cessation and alcohol consumption had favourable probabilities of being more cost-effective when compared to wait-list, TAU, group cognitive behaviour therapy (CBGT), attention control, telephone counselling or unguided Internet CBT. Unguided Internet interventions for suicide prevention, depression and smoking cessation demonstrated cost-effectiveness compared to TAU or attention control. In general, results from cost-utility analyses using more generic health outcomes (quality of life) were less favourable for unguided Internet interventions. Most studies adhered reasonably to economic guidelines. CONCLUSIONS: Results of guided Internet interventions being cost-effective are promising with most studies adhering to publication standards, but more economic evaluations are needed in order to determine cost-effectiveness of Internet interventions compared to the most cost-effective treatment currently available.

21 Review Cognitive behavioral treatments of obsessive-compulsive disorder. A systematic review and meta-analysis of studies published 1993-2014. 2015

Öst, Lars-Göran / Havnen, Audun / Hansen, Bjarne / Kvale, Gerd. ·Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Psychology, Stockholm University, Sweden; Department of Clinical Psychology, University of Bergen, Norway; Haukeland University Hospital, OCD-team, 5021 Bergen, Norway. Electronic address: ost@psychology.su.se. · Department of Clinical Psychology, University of Bergen, Norway; Haukeland University Hospital, OCD-team, 5021 Bergen, Norway. ·Clin Psychol Rev · Pubmed #26117062.

ABSTRACT: Obsessive-compulsive disorder is ranked by the WHO as among the 10 most debilitating disorders and tends to be chronic without adequate treatment. The only psychological treatment that has been found effective is cognitive behavior therapy (CBT). This meta-analysis includes all RCTs (N=37) of CBT for OCD using the interview-based Yale-Brown Obsessive Compulsive Scale, published 1993 to 2014. The effect sizes for comparisons of CBT with waiting-list (1.31), and placebo conditions (1.33) were very large, whereas those for comparisons between individual and group treatment (0.17), and exposure and response prevention vs. cognitive therapy (0.07) were small and non-significant. CBT was significantly better than antidepressant medication (0.55), but the combination of CBT and medication was not significantly better than CBT plus placebo (0.25). The RCTs have a number of methodological problems and recommendations for improving the methodological rigor are discussed as well as clinical implications of the findings.

22 Review Psychological therapy for anxiety in bipolar spectrum disorders: a systematic review. 2015

Stratford, Hannah J / Cooper, Myra J / Di Simplicio, Martina / Blackwell, Simon E / Holmes, Emily A. ·Oxford Institute of Clinical Psychology Training, University of Oxford, Oxford, UK; Highfield Unit Oxford, Oxford Health NHS Foundation Trust, Oxford, UK. Electronic address: emily.holmes@mrc-cbu.cam.ac.uk. · Oxford Institute of Clinical Psychology Training, University of Oxford, Oxford, UK. · MRC Cognition and Brain Sciences Unit, Cambridge, UK. · MRC Cognition and Brain Sciences Unit, Cambridge, UK; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. Electronic address: emily.holmes@mrc-cbu.cam.ac.uk. ·Clin Psychol Rev · Pubmed #25462111.

ABSTRACT: Comorbid anxiety is common in bipolar spectrum disorders [BPSD], and is associated with poor outcomes. Its clinical relevance is highlighted by the "anxious distress specifier" in the revised criteria for Bipolar Disorders in the Diagnostic and Statistical Manual 5th Edition [DSM-5]. This article reviews evidence for the effectiveness of psychological therapy for anxiety in adults with BPSD (bipolar I, II, not otherwise specified, cyclothymia, and rapid cycling disorders). A systematic search yielded 22 treatment studies that included an anxiety-related outcome measure. Cognitive behavioural therapy [CBT] for BPSD incorporating an anxiety component reduces anxiety symptoms in cyclothymia, "refractory" and rapid cycling BPSD, whereas standard bipolar treatments have only a modest effect on anxiety. Preliminary evidence is promising for CBT for post-traumatic stress disorder and generalised anxiety disorder in BPSD. Psychoeducation alone does not appear to reduce anxiety, and data for mindfulness-based cognitive therapy [MBCT] appear equivocal. CBT during euthymic phases has the greatest weight of evidence. Where reported, psychological therapy appears acceptable and safe, but more systematic collection and reporting of safety and acceptability information is needed. Development of psychological models and treatment protocols for anxiety in BPSD may help improve outcomes.

23 Review Internet-delivered psychological treatments for mood and anxiety disorders: a systematic review of their efficacy, safety, and cost-effectiveness. 2014

Arnberg, Filip K / Linton, Steven J / Hultcrantz, Monica / Heintz, Emelie / Jonsson, Ulf. ·Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden. · Center for Health and Medical Psychology, Department of Law, Psychology, and Social Work, Örebro University, Örebro, Sweden. · Swedish Council on Health Technology Assessment, Stockholm, Sweden. · Swedish Council on Health Technology Assessment, Stockholm, Sweden; Center for Medical Technology Assessment (CMT), Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. · Swedish Council on Health Technology Assessment, Stockholm, Sweden; Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. ·PLoS One · Pubmed #24844847.

ABSTRACT: BACKGROUND: Greater access to evidence-based psychological treatments is needed. This review aimed to evaluate whether internet-delivered psychological treatments for mood and anxiety disorders are efficacious, noninferior to established treatments, safe, and cost-effective for children, adolescents and adults. METHODS: We searched the literature for studies published until March 2013. Randomized controlled trials (RCTs) were considered for the assessment of short-term efficacy and safety and were pooled in meta-analyses. Other designs were also considered for long-term effect and cost-effectiveness. Comparisons against established treatments were evaluated for noninferiority. Two reviewers independently assessed the relevant studies for risk of bias. The quality of the evidence was graded using an international grading system. RESULTS: A total of 52 relevant RCTs were identified whereof 12 were excluded due to high risk of bias. Five cost-effectiveness studies were identified and three were excluded due to high risk of bias. The included trials mainly evaluated internet-delivered cognitive behavioral therapy (I-CBT) against a waiting list in adult volunteers and 88% were conducted in Sweden or Australia. One trial involved children. For adults, the quality of evidence was graded as moderate for the short-term efficacy of I-CBT vs. waiting list for mild/moderate depression (d = 0.83; 95% CI 0.59, 1.07) and social phobia (d = 0.85; 95% CI 0.66, 1.05), and moderate for no efficacy of internet-delivered attention bias modification vs. sham treatment for social phobia (d =  -0.04; 95% CI -0.24, 0.35). The quality of evidence was graded as low/very low for other disorders, interventions, children/adolescents, noninferiority, adverse events, and cost-effectiveness. CONCLUSIONS: I-CBT is a viable treatment option for adults with depression and some anxiety disorders who request this treatment modality. Important questions remain before broad implementation can be supported. Future research would benefit from prioritizing adapting treatments to children/adolescents and using noninferiority designs with established forms of treatment.

24 Review Pharmacotherapy of generalized anxiety disorder. 2013

Allgulander, Christer / Baldwin, David S. ·Section of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. ·Mod Trends Pharmacopsychiatry · Pubmed #25225022.

ABSTRACT: Generalized anxiety disorder (GAD) is chiefly characterized by a cognitive focus on threats and risks towards the individual and/or the immediate family. It is accompanied by a sense of tension, worry, muscle pain, disturbed sleep and irritability. The condition impairs work capacity, relations, and leisure activities, and aggravates concurrent somatic diseases. Due to its chronic course, GAD increases costs for the individual, the family, and health care services, and reduces work and educational performance. In cardiovascular or cerebrovascular disease, pulmonary disease, diabetes and neurological diseases, GAD is a risk factor for somatic complications and for lowered adherence to somatic treatments. There is evidence that GAD can be treated with cognitive behavioural therapy (CBT), and/or with medications. First-line pharmacotherapies are selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs) and pregabalin. If such therapies fail, one may reconsider the diagnosis, question adherence with the prescribed schedule, and determine the adverse influence of comorbidity (such as depression, substance use, and physical ill-health) as well as the influence of social stressors. Second-line pharmacotherapies are largely not supported by controlled trials, and so leave much to clinical judgment and careful monitoring. One may attempt treatments with benzodiazepine anxiolytics, with quetiapine, or with pregabalin as an adjunct therapy in patients with partial response to SSRI or SNRI treatment. CBT is a valid alternative to pharmacotherapy, depending on patient preference.

25 Review [Pathological collecting is a new diagnosis in DSM-5. Condition with high somatic and psychiatric comorbidity that is difficult to treat]. 2013

Ivanov, Volen Z / Rück, Christian. ·Psykiatri Nordväst. volen.ivanov@ki.se ·Lakartidningen · Pubmed #24044181.

ABSTRACT: -- No abstract --

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