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Disorders - Suicide or self-harm with comorbid mental disorder
Eskin, M., Ertekin, K., Demir, H.
Short-term and structured
cognitive behavioral problem-solving therapy (PST) is a developmentally relevant mode of action for the treatment of emotional problems in young
people. This study aimed at testing the efficacy of a problem-solving therapy in treating depression and suicide potential in adolescents and young
adults. A total of 46 self-referred high school and university students who were randomly assigned to a problem-solving therapy (n = 27) and a
waiting list control (n = 19) conditions completed a controlled cognitive behavioral problem-solving treatment trial. Participants were administered
the measures of depression, suicide potential, problem solving, self-esteem and assertiveness. Twenty-two of the 27 participants from the PST
condition could be reached after 12-months for follow-up. Participants completed depression and problem-solving measures at follow-up. Results showed
that post-treatment depression and suicide risk scores of participants within the PST condition decreased significantly compared to the pre-treatment
scores but post-waiting and pre-waiting depression and suicide risk scores of participants within the WLC condition were unchanged. Likewise, post-
treatment self-esteem and assertiveness scores of participants within the PST condition increased significantly compared to the pre-treatment scores
while post-waiting and pre-waiting self-esteem and assertiveness scores of participants within the WLC condition were unchanged. At post-treatment,
77.8% of the participants in the PST but only 15.8% of those in the WLC condition achieved full or partial recovery according to BDI scores.
Similarly, 96.3% of participants in the PST but only 21.1% of those in the WLC condition achieved full or partial recovery according to HDRS scores.
The improvements were maintained at 12-months follow-up. Therefore, it is concluded that problem-solving therapy should be considered as a viable
option for the treatment of depression and suicide potential in adolescents and young adults. copyright 2007 Springer Science+Business Media,
LLC.
Cognitive Therapy & Research., 32(2) : 227-245
- Year: 2008
- Problem: Depressive Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm), Suicide or self-harm with comorbid mental disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder), At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Problem solving therapy (PST)
Chanen, AM, McCutcheon, LK, Jovev, M, Jackson,
HJ, McGorry, PD
No accepted intervention exists for borderline personality\rdisorder presenting
in adolescence.\rAims\rTo compare the effectiveness of up to 24 sessions of\rcognitive analytic therapy (CAT) or manualised good clinical\rcare (GCC)
in addition to a comprehensive service model of\rcare.\rMethod\rIn a randomised controlled trial, CAT and GCC were\rcompared in out-patients aged 15
- 18 years who fulfilled two\rto nine of the DSM - IV criteria for borderline personality\rdisorder. We predicted that, compared with the GCC group,
\rthe CAT group would show greater reductions in\rpsychopathology and parasuicidal behaviour and greater\rimprovement in global functioning over 24
months. Results\rEighty-six patients were randomised and 78 (CAT n=41;\rGCC n=37) provided follow-up data. There was no significant\rdifference
between the outcomes of the treatment groups\rat 24 months on the pre-chosen measures but there was\rsome evidence that patients allocated to CAT
improved\rmore rapidly. No adverse effect was shown with either\rtreatment.\rConclusions\rBoth CAT and GCC are effective in reducing externalising
\rpsychopathology in teenagers with sub-syndromal or fullsyndrome\rbipolar personality disorder. Larger studies are\rrequired to determine the
specific value of CAT in this\rpopulation.
British Journal of Psychiatry, 193 : 477-
484
- Year: 2008
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm), Suicide or self-harm with comorbid mental disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive analytic therapy (CAT)
March, John S., Silva, Susan, Petrycki, Stephen, Curry, John, Wells, Karen, Fairbank, John, Burns, Barbara, Domino,
Marisa, McNulty, Steven, Vitiello, Benedetto, Severe, Joanne
CONTEXT: The Treatment
for Adolescents With Depression Study evaluates the effectiveness of fluoxetine hydrochloride therapy, cognitive behavior therapy (CBT), and their
combination in adolescents with major depressive disorder. OBJECTIVE: To report effectiveness outcomes across 36 weeks of randomized treatment.
DESIGN AND SETTING: Randomized, controlled trial conducted in 13 academic and community sites in the United States. Cognitive behavior and
combination therapies were not masked, whereas administration of placebo and fluoxetine was double-blind through 12 weeks, after which treatments
were unblinded. Patients assigned to placebo were treated openly after week 12, and the placebo group is not included in these analyses by design.
PARTICIPANTS: Three hundred twenty-seven patients aged 12 to 17 years with a primary DSM-IV diagnosis of major depressive disorder. INTERVENTIONS:
All treatments were administered per protocol. MAIN OUTCOME MEASURES: The primary dependent measures rated blind to treatment status by an
independent evaluator were the Children's Depression Rating Scale-Revised total score and the response rate, defined as a Clinical Global
Impressions-Improvement score of much or very much improved. RESULTS: Intention-to-treat analyses on the Children's Depression Rating Scale-Revised
identified a significant time x treatment interaction (P < .001). Rates of response were 73% for combination therapy, 62% for fluoxetine therapy, and
48% for CBT at week 12; 85% for combination therapy, 69% for fluoxetine therapy, and 65% for CBT at week 18; and 86% for combination therapy, 81% for
fluoxetine therapy, and 81% for CBT at week 36. Suicidal ideation decreased with treatment, but less so with fluoxetine therapy than with combination
therapy or CBT. Suicidal events were more common in patients receiving fluoxetine therapy (14.7%) than combination therapy (8.4%) or CBT (6.3%).
CONCLUSIONS: In adolescents with moderate to severe depression, treatment with fluoxetine alone or in combination with CBT accelerates the response.
Adding CBT to medication enhances the safety of medication. Taking benefits and harms into account, combined treatment appears superior to either
monotherapy as a treatment for major depression in adolescents.
Archives of
General Psychiatry, 64(10) : 1132-43
- Year: 2007
- Problem: Depressive Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm), Suicide or self-harm with comorbid mental disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Kaminer, Y., Burleson, J. A., Goldston, D. B., Burke, R. H.
The objectives of this study are to assess the magnitude and course of suicidal ideation during outpatient treatment and aftercare for
adolescents with alcohol use disorders (AUD). One hundred seventy-seven adolescents meeting eligibility criteria, including no past 30-day suicidal
behavior, participated in 9 weeks of outpatient cognitive-behavioral group therapy. Treatment completers were randomized into: (1) No-Active, (2)
In-Person, or (3) Telephone aftercare conditions for a period of 12 weeks. No specific intervention for suicidal behavior was provided during the
study. The Suicide Ideation Questionnaire (SIQ-JR, Reynolds, 1988) was administered at baseline, end of treatment, and end of aftercare. The results
are as follows, a higher baseline suicidal ideation was associated with higher retention at the end of treatment and through aftercare. The In-Person
Aftercare condition showed a significant decrease in suicidal ideation, relative to the No-Active Aftercare condition. There was a trend for
similarly reduced severity of suicidal ideation in the Telephone Aftercare condition. In conclusion, the type of aftercare and resulting decrease in
AUD may play a role in the reduction in suicidal ideation. The mechanism of change by which suicidal ideation is reduced in adolescents in treatment
for AUD needs to be further explored. Copyright copyright American Academy of Addiction Psychiatry.
American Journal on Addictions., 15(SUPPL. 1) : 43-
49
- Year: 2006
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm), Suicide or self-harm with comorbid mental disorder, Alcohol
Use
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement
interventions
March,
John, Silva, Susan, Petrycki, Stephen, Curry, John, Wells, Karen, Fairbank, John, Burns, Barbara, Domino, Marisa, McNulty, Steven, Vitiello, Benedetto, Severe, Joanne, TADSTeam
CONTEXT: Initial treatment of major depressive disorder in adolescents may include
cognitive-behavioral therapy (CBT) or a selective serotonin reuptake inhibitor (SSRI). However, little is known about their relative or combined
effectiveness. OBJECTIVE: To evaluate the effectiveness of 4 treatments among adolescents with major depressive disorder. DESIGN, SETTING, AND
PARTICIPANTS: Randomized controlled trial of a volunteer sample of 439 patients between the ages of 12 to 17 years with a primary Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition, diagnosis of major depressive disorder. The trial was conducted at 13 US academic and
community clinics between spring 2000 and summer 2003. INTERVENTIONS: Twelve weeks of (1) fluoxetine alone (10 to 40 mg/d), (2) CBT alone, (3) CBT
with fluoxetine (10 to 40 mg/d), or (4) placebo (equivalent to 10 to 40 mg/d). Placebo and fluoxetine alone were administered double-blind; CBT alone
and CBT with fluoxetine were administered unblinded. MAIN OUTCOME MEASURES: Children's Depression Rating Scale-Revised total score and, for
responder analysis, a (dichotomized) Clinical Global Impressions improvement score. RESULTS: Compared with placebo, the combination of fluoxetine
with CBT was statistically significant (P =.001) on the Children's Depression Rating Scale-Revised. Compared with fluoxetine alone (P =.02) and CBT
alone (P =.01), treatment of fluoxetine with CBT was superior. Fluoxetine alone is a superior treatment to CBT alone (P =.01). Rates of response for
fluoxetine with CBT were 71.0% (95% confidence interval [CI], 62%-80%); fluoxetine alone, 60.6% (95% CI, 51%-70%); CBT alone, 43.2% (95% CI, 34%-
52%); and placebo, 34.8% (95% CI, 26%-44%). On the Clinical Global Impressions improvement responder analysis, the 2 fluoxetine-containing conditions
were statistically superior to CBT and to placebo. Clinically significant suicidal thinking, which was present in 29% of the sample at baseline,
improved significantly in all 4 treatment groups. Fluoxetine with CBT showed the greatest reduction (P =.02). Seven (1.6%) of 439 patients attempted
suicide; there were no completed suicides. CONCLUSION: The combination of fluoxetine with CBT offered the most favorable tradeoff between benefit and
risk for adolescents with major depressive disorder.
JAMA, 292(7) : 807-
20
- Year: 2004
- Problem: Depressive Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm), Suicide or self-harm with comorbid mental disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Joiner-Jr, Thomas E., Voelz, Zachary R., Rudd, M.
Practicing psychologists face
many complexities and challenges in caring for suicidal patients who have comorbid mood and anxiety disorders. Not only must suicidal crises be
addressed, but co-occurring depressive and anxiety symptoms compete for attention as well and are associated with relatively poor clinical prognosis
in usual treatments. The current study compared problem-solving treatment to treatment as usual among depression-anxiety comorbid versus noncomorbid
clinically suicidal young adults. Suicidal patients with mood and anxiety disorders were randomized to the 2 treatments and followed over time.
Comorbid suicidal patients, in particular, experienced notable symptom improvements from the problem-solving treatment. Features of the problem-
solving treatment are described for use in clinical practice. (PsycINFO Database Record (c) 2008 APA, all rights reserved).
Professional Psychology: Research & Practice, 32(3) : 278-
282
- Year: 2001
- Problem: Anxiety Disorders (any), Depressive Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm), Suicide or self-harm with comorbid mental disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Problem solving therapy (PST)