- Abstract: This article discusses the use of combined treatments for patients with chronic mood disorders. Although very little research concerning the efficacy of combined treatments for patients with chronic depression exists, clinical experience and limited available research suggest that combined treatment may be the most effective treatment option available for this population. The use of combination treatment involving pharmacotherapy, individual psychotherapy, and marital/family therapy is... Show More
Article: Dr. Keitner and Colleagues Reply
- Abstract: The objective of the current study was to better understand the nature of prodromal and residual symptoms of mania and depression, as reported by patients with bipolar I disorder and their family members. Prodromal and residual symptoms of mania and depression were elicited from 74 patients with bipolar I disorder. In 45 cases, an adult family member provided similar information. Three clinicians classified the symptoms into six broad categories: behavioral, cognitive, mood, neurovegetative,... Show More
- Abstract: Developing competence within families where mothers had diagnosed psychopathology was examined in 123 14-month-old children. Categorical diagnosis, depression symptom severity, functional impairment, and multiple contextual risks were measured. These multiple risks included family functioning and composition, home environment, social status indicators, maternal illness, and adverse events. Overall social competence measured during two laboratory visits was best predicted by multiple... Show More
- Abstract: This pilot study compared the efficacy of lithium plus divalproex sodium with the efficacy of lithium alone for the continuation and maintenance treatment of patients with bipolar I disorder. Twelve patients with bipolar I disorder as defined by the DSM-III-R were recruited and followed prospectively for up to 1 year. Each subject received lithium at serum levels of 0.8 to 1.0 mmol/L and a management/education session weekly or every 2 weeks. By random assignment, subjects received either... Show More
- Abstract: Fifty-nine subjects participated in a telephone follow-up interview 6 years after being hospitalized with a severe major depressive episode and 5 years after completing a 12 month follow-up study. Patient information was used to provide a rating of symptom-free (n = 19), episodic (n = 30), or chronic (n = 10) that described each patient's long-term course of illness. Few variables from the acute stage were related to long-term course of illness; however, early patterns of global and family... Show More
- Abstract: The authors of the current study examined the impact of severe negative life events on time to recovery from episodes of bipolar disorder. Although negative life events have been shown to influence relapse in bipolar disorder, research has not focused on life events and recovery in bipolar disorder. The authors recruited 67 individuals with bipolar disorder during hospitalization and conducted monthly assessments for at least 1 year. Individuals with severe negative life events took more... Show More
- Abstract: Alcoholics with depressive symptoms score > or = 10 on the Beck Depression Inventory (A.T. Beck, C. H. Ward, M. Mendelson, J. Mock, & J. Erbaugh, 1961) received 8 individual sessions of cognitive-behavioral treatment for depression (CBT-D, n = 19) or a relaxation training control (RTC; n = 16) plus standard alcohol treatment. CBT-D patients had greater reductions in somatic depressive symptoms and depressed and anxious mood than RTC patients during treatment. Patients receiving CBT-D had a... Show More
- Abstract: The primary objective of the present investigation was to examine adaptive functioning in the families of patients with a wide range of psychiatric disorders. Seven dimensions of family functioning, as measured by the Family Assessment Device (FAD), were compared across families of patients with a schizophrenia spectrum disorder (n = 61), bipolar disorder (n = 60), major depression (n = 111), anxiety disorder (n = 15), eating disorder (n = 26), substance abuse disorder (n = 48), and... Show More
- Abstract: The association of maternal and contextual risk factors with whole-family, marital, and parent–child levels of family functioning was examined. Maternal mental illness and multiple contextual risk best predicted whole-family functioning, but each was related to marital and parent–child levels as well. Nonspecific indicators of maternal illness, rather than diagnostic category, were the better predictors of family functioning. The multiple contextual risk index was the variable most... Show More
- Abstract: Families are complicated systems to assess and quantify, requiring that decisions be made regarding where to focus research. The authors examined 3 levels of family interaction: marital, parent-child, and whole family. Instruments included the McMaster Structured Interview of Family Functioning, the Family Assessment Device, the Mealtime Interaction Coding System, the Dyadic Adjustment Scale, and the Parent/Caregiver Involvement Scale. Results suggest that each measure, representing a unique... Show More
- Abstract: Families are complicated systems to assess and quantify, requiring that decisions be made regarding where to focus research. The authors examined 3 levels of family interaction: marital, parent–child, and whole family. Instruments included the McMaster Structured Interview of Family Functioning, the Family Assessment Device, the Mealtime Interaction Coding System, the Dyadic Adjustment Scale, and the Parent/Caregiver Involvement Scale. Results suggest that each measure, representing a unique... Show More
- Abstract: Standard pharmacotherapy for the maintenance treatment of patients with bipolar I disorder consists of lithium, valproate, or carbamazepine. However, many patients fail to respond to monotherapy with any of these agents, and as a result, psychiatrists often resort to polypharmacy. Findings from some open-label trials and retrospective chart reviews suggest this approach may be useful, but in the few controlled trials that have been conducted, the results have been negative. One drug... Show More
- Abstract: Smokers with past major depressive disorder participating in a smoking cessation treatment study were interviewed at 6, 26, and 29 weeks postquit to retrospectively assess their smoking behavior using the timeline follow-back (TLFB) method. Participants also completed calendars by self-monitoring the number of cigarettes smoked each day for two 4-week periods over the 26-week follow-up. The 3- and 20-week test-retest reliabilities of the smoking TLFB interview were high. Agreement between... Show More
- Abstract: Evaluated the psychosocial functioning of 635 outpatients with chronic depression (depression and dysthymia or chronic major depression) before, during, and after acute treatment with either sertraline or imipramine. Chronically depressed patients manifested severe impairments in psychosocial functioning at baseline. After treatment with sertraline or imipramine, psychosocial functioning improved significantly. Significant improvements appeared relatively early in treatment (Week 4). Despite... Show More
- Abstract: Previous research has suggested that depressed patients, and particularly chronically depressed patients, have significant impairments in many areas of their lives. While previous studies suggested that these "psychosocial" impairments improve following pharmacologic treatment, no large scale definitive study using multiple measures of psychosocial functioning has been reported. We assessed multiple domains of psychosocial functioning using interviewer-rated and self-report measures within... Show More
- Abstract: The literature on predictors of response to treatment of nonchronic major depression has identified shorter duration of illness, acute onset, and less severity of illness as positive predictors. Unfortunately, there are almost no data on predictors of response to treatment for chronic depression. This study examined predictors of response to pharmacotherapy (sertraline or imipramine) in the treatment of outpatients who had DSM-III-R-defined chronic major or double depression. The acute phase... Show More
- Abstract: Background: Previous research has suggested that depressed patients, and particularly chronically depressed patients, have significant impairments in many areas of their lives. While previous studies suggested that these "psychosocial" impairments improve following pharmacologic treatment, no large scale definitive study using multiple measures of psychosocial functioning has been reported. Method: We assessed multiple domains of psychosocial functioning using interviewer-rated and... Show More
- Abstract: Patients with double depression (major depression + dysthymia) have a particularly chronic course of illness, yet few studies have investigated treatments for these patients. 26 inpatients with double depression were assigned to two types of treatment: (1) pharmacotherapy and (2) combined treatment (pharmacotherapy + cognitive-behavioral psychotherapy). Treatment began while the patients were in the hospital and continued for 20 weeks after discharge. Comprehensive assessments were conducted... Show More
Publications citing this author (11781)
[Show abstract] [Hide abstract] ABSTRACT: Background Over 1100 Veterans work in the Veterans Health Administration (VHA) as peer specialists (PSs). PSs are Veterans with formal training who provide support to other Veterans with similar diagnoses, primarily in mental health settings. A White House Executive Action mandated the pilot reassignment of VHA PSs from mental health to 25 primary care Patient Aligned Care Teams (PACT) in order to broaden the provision of wellness services that can address many chronic illnesses. An evaluation of this initiative was undertaken to assess the impact of outside assistance on the deployment of PS in PACT, as implementation support is often needed to prevent challenges commonly experienced when first deploying PSs in VHA settings. We present the protocol for this cluster-randomized hybrid type II trial to test the impact of standard implementation (receive minimal assistance) vs. facilitated implementation (receive outside assistance) on the deployment of VHA PSs in PACT. MethodsA VHA Office of Mental Health Services work group is recruiting 25 Veterans Affairs Medical Centers to reassign a mental health PSs to provide wellness-oriented care in PACT. Sites in three successive cohorts (n = 8, 8, 9) beginning over 6-month blocks will be matched and randomized to either standard or facilitated implementation. In facilitated implementation, an outside expert works with site stakeholders through a site visit, regular calls, and performance data to guide the planning and address challenges. Standard implementation sites will receive a webinar and access the Office of Mental Health Services work group. The two conditions will be compared on PS workload data, fidelity to the PS model of service delivery, team functioning, and Veteran measures of activation, satisfaction, and functioning. Qualitative interviews will collect information on implementation barriers and facilitators. DiscussionThis evaluation will provide critical data to guide administrators and VHA policy makers on future deployment of PSs, as their role has been expanding beyond mental health. In addition, development of novel implementation strategies (facilitation tailored to PSs) and the use of new tools (peer fidelity) can be models for monitoring and supporting deployment of PSs throughout VHA. Trial registrationClinicalTrials.gov, NCT02732600 (URL:https://clinicaltrials.gov/ct2/show/NCT02732600)
- Persons with mental illness, particularly Veterans, have higher rates of common diseases, e.g., cardiovascular, lung, and digestive, and worse health outcomes associated with those conditions compared to the general population. Those with mental illness have higher risk for certain lifestyle choices (e.g., obesity, physical inactivity, smoking, and drug use) that contribute to chronic medical illness, and have a higher mortality rate than the general population as a result[2,3,13,14,19]. These poor outcomes increase healthcare spending, as 75% of the Veterans Health Administration (VHA) healthcare dollars are spent on these chronic diseases.
[Show abstract] [Hide abstract] ABSTRACT: The aim of this paper is to review the effects of negative childhood experiences on the development and course of bipolar disorder (BD) and to discuss the involved mechanisms. The negative childhood experiences that may play a role in BD are critical or traumatic events including all kinds of abuse, loss of a parent or parents resulting from death, suicide, separation, divorce or prolonged separation. Previous studies indicate that in BD patients negative childhood events are more frequent than in control group. In BD patients these events are associated with an earlier onset and more severe course of the illness, including more frequent relapses, suicidal behavior, substance abuse and somatic diseases. This paper presents the possibility of the specific impact of individual events on the clinical outcome of BD. Mechanisms explaining the impact of negative childhood events on the development and course of BD include the interaction between biological predisposition and stress factors, the concept of kindling and activation of negative cognitive schemas. Early negative experiences cause a modification of the expression of the mediators of stress and neurotransmitters in certain areas of the brain. The interaction of these mediators with the development of neural networks may lead to longlasting structural and functional changes. Molecular genetic studies indicate the possibility of interactions between environmental factors (stress) and the polymorphisms of serotonin transporter, brain-derived neurotrophic factor (BDNF) and toll-like receptor (TLR2). It has also been hypothesized that childhood experiences affect DNA methylation, acting as a form of molecular memory and modifying brain activity over the next decade.
- zdarzenia ?yciowe zaostrzaj? objawy afektywne  . Wydarzenia krytyczne uaktywniaj?
[Show abstract] [Hide abstract] ABSTRACT: Background Infant mental health is a significant public health issue as early adversity and exposure to early childhood stress are significant risk factors that may have detrimental long-term developmental consequences for the affected children. Negative outcomes are seen on a range of areas such as physical and mental health, educational and labor market success, social network and establishing of family. Secure attachment is associated with optimal outcomes in all developmental domains in childhood, and both insecure and disorganized attachment are associated with a range of later problems and psychopathologies. In disadvantaged populations insecure and disorganized attachment are common, which points to the need of identifying early risk and effective methods of addressing such problems. This protocol describes an experimental evaluation of an indicated group-based parental educational program, Circle of Security–Parenting (COS-P), currently being conducted in Denmark. Methods/design In a parallel randomized controlled trial of two intervention groups this study tests the efficacy of COS-P compared to Care as Usual (CAU) in enhancing maternal sensitivity and child attachment in a community sample in the City of Copenhagen, Denmark. During the project a general population of an estimated 17.600 families with an infant aged 2–12 months are screened for two known infant mental health risks, maternal postnatal depression and infant social withdrawal. Eligible families (N = 314), who agree to participate, will be randomly allocated with a ratio of 2:1 into the COS-P intervention arm and into CAU. Data will be obtained at inclusion (baseline) and at follow-up when the child is 12–16 months. The primary outcome is maternal sensitivity. Secondary outcomes include quality of infant attachment, language, cognitive and socioemotional development, family functioning, parental stress, parental mentalizing and maternal mental wellbeing. Discussion The potential implications of the experimental evaluation of an indicated brief group-based parenting educational program to enhance parental sensitivity and attachment are discussed. Trial registration ClinicalTrials.govID: NCT02497677. Registered July 15 2015
- Higher scores indicate greater family dysfunction. FAD has been reported to have good psychometric properties, and to be a reliable and valid assessment of both clinical and non-clinical families . State-Trait Anxiety Questionnaire (STAI)  will be used to assess maternal and partner's level of anxiety at T0 and T1.
[Show abstract] [Hide abstract] ABSTRACT: Background Major depressive disorder has been shown to affect many domains of family life including family functioning. Conversely, the influence of the family on the course of the depression, including the risk of relapse, is one reason for targeting the family in interventions. The few studies conducted within this area indicate that family psychoeducation as a supplement to traditional treatment can effectively reduce the risk of relapse in patients with major depression as well as being beneficial for the relatives involved. However, the evidence is currently limited. This study will investigate the effect of family psychoeducation compared to social support on the course of the illness in patients with major depressive disorder. Method/designThe study is designed as a dual center, two-armed, observer-blinded, randomized controlled trial. Relatives are randomized to participate in one of two conditions: either four sessions of manualized family psychoeducation or four sessions in a social support group led by a health care professional. Patients will not participate in the groups and will continue their treatment as usual. A total of 100 patients, each accompanied by one relative, will be recruited primarily from two outpatient clinics in the Capital Region of Denmark.The primary outcome is the occurrence of depressive relapse at 9-month follow-up defined as a score ≥7 on the Hamilton six-item subscale. Secondary outcomes will include time to relapse. DiscussionIt is hoped that the results from this study will help to clarify the mechanisms behind any beneficial changes due to family psychoeducation and provide information on the long-term effect of this intervention for both patient and relatives. If the results are positive, the family psychoeducation program may be suitable for implementation within a clinical setting. Trial registrationClinicalTrials.gov Identifier: NCT02348827, registered 5 January 2015.
- Conversely, depression affects the function of the family , as well as impacting on the life of the relatives. Viewing the family as whole, families of patients suffering from depression are characterized by reduced family functioning compared to both nonclinical families and families of patients with schizophrenia or bipolar dis- order . Furthermore, relatives of depressed patients report significantly lower levels of quality of life in terms of " psychological wellbeing " compared to the general population .
[Show abstract] [Hide abstract] ABSTRACT: A large body of research, documenting the impact of a family's functioning on health outcomes, highlights the importance of introducing the evaluation of patients' family dynamics into clinical judgment. The Family Assessment Device (FAD) is a self-report questionnaire designed to assess specific dimensions of family functioning. This qualitative systematic review, which follows PRISMA guidelines, aimed to identify the FAD's clinimetric properties and to report the incremental utility of its inclusion in clinical settings. A thorough literature search was performed, using both computerized and manual searches, yielding a total of 148 studies that were included in this review. The FAD has been extensively used in a variety of research contexts. In the majority of studies it was able to discriminate between clinical populations and controls and among groups of patients with different illnesses. The FAD also showed good test-retest and concurrent reliability, and modest sensitivity to change after treatment. FAD-dysfunctional family functioning was related to several patient clinical outcomes, including lower recovery rates and adherence to treatment, longer recovery time, poorer quality of life, and increased risk of relapse and drop-out. The present review demonstrates that the FAD is a suitable instrument for the evaluation of family functioning both in clinical and research settings.
- Finally, in a study without a control group, patients with substance addiction showed similar FAD-GF scores to those of normal nonclinical families reported by Epstein and Bishop (1983; Cleveland, Harris, Baker, Herbert, & Dean, 2007). Among the 17 studies reporting FAD's discriminant validity between families of psychiatric patients and those of controls, in six studies the questionnaire has been administered only to patients (Bell et al., 2004; Black et al., 1998; Cleveland et al., 2007; Hossein et al., 2004; Steiger et al., 1991; Waller et al., 1989) and in 11 studies to both patients and at least one family member (Davidson & Mellor, 2001; Dickstein et al., 1998; Du Rocher Schudlich et al., 2008; Eakin et al., 2004; Friedmann et al., 1997; Keitner et al., 1987a Keitner et al., ,b, 1990 Keitner et al., 1991; McDermut et al., 2001; Waller et al., 1990).
- It describes the structural and organizational properties of the family group and the patterns of transactions among family members which have been found to distinguish between healthy and unhealthy families. Many studies have examined family functioning of patients with psychiatric disorders, including depression, adjustment disorders, anxiety disorder, etc. (Friedmann, McDermut, Solomon, Ryan, keitner, & Miller, 1997; Keitner, Miller, & Ryan, 1993; Miller, Keitner, whisman, Ryan, Epstein, & Bishop, 1992).
[Show abstract] [Hide abstract] ABSTRACT: Suicide is a major cause of death worldwide, responsible for 1.5% of all mortality. The causes of suicidal behavior are not fully understood. Dysregulated hypothalamic-pituitary-adrenal (HPA) axis activity, as measured by cortisol levels, is one potential risk factor. This meta-analytic review aimed (i) to estimate the strength and variability of the association between naturally fluctuating cortisol levels and suicidal behavior and (ii) to identify moderators of this relationship. A systematic literature search identified 27 studies (N=2226; 779 suicide attempters and 1447 non-attempters) that met the study eligibility criteria from a total of 417 unique records initially examined. Estimates of effect sizes (r) obtained from these studies were analysed using Comprehensive Meta-Analysis. In these analyses, we compared participants identified as having a past history of suicide attempt(s) to those with no such history. Study quality, mean age of sample and percentage of male participants were examined as potential moderators. Overall, there was no significant effect of suicide group on cortisol. However, significant associations between cortisol and suicide attempts were observed as a function of age. In studies where the mean age of the sample was below 40 years the association was positive (i.e., higher cortisol was associated with suicide attempts; r=.234, p<.001), and where the mean age was 40 or above the association was negative (i.e., lower cortisol was associated with suicide attempts; r=-.129, p<.001). These findings confirm that HPA axis activity, as indicated by age-dependent variations in cortisol levels, is associated with suicidal behavior. The challenge for theory and clinical practice is to explain the complete reversal of the association with age and to identify its clinical implications.
- The Dexamethasone Suppression Test (DST; Carroll et al., 1968) has been commonly employed to assess HPA axis dysregulation by measuring cortisol inhibition after the administration of the synthetic glucocorticoid dexamethasone. Failure to suppress cortisol is evidence for HPA-axis hyperactivity and has consistently been found to predict completed suicide in patients with mood disorder for example (Coryell and Schlesser, 1981; Coryell et al., 2006; Nordstrom, 2008, 2009; Norman et al., 1990). However, while DST research has contributed enormously to knowledge regarding HPA axis dysregulation and suicide vulnerability, findings remain inconsistent and contradictory (McGirr et al., 2011).
[Show abstract] [Hide abstract] ABSTRACT: The objectives of the study were to examine family functioning and relatives' emotional state after traumatic brain injury (TBI), and to test a model of the relationship between neurobehavioural status, family functioning and relatives' emotional status at two and five years post-injury. The relatives of 98 adult individuals who had sustained severe TBI were followed up 2 and 5 years post-injury and completed the Family Assessment Device, the Hospital Anxiety and Depression Scale, and rated the neurobehavioural status (cognitive, behavioural, emotional, social) of their injured relative, using the Structured Outcomes Questionnaire. A structural equation model, based on existing research, was developed and tested on 66 of the participants. The level of family functioning and the rates of clinically relevant levels of anxiety and depression did not change over time (p > .05). The starting path model was revised. The final model had an excellent fit, χ(2)(16) = 15.20, p = .51; CFI = 1.00, RMSEA < .001, p for test of close fit = .66. In this model, poor family functioning and symptoms of anxiety and depression in the relatives were predicted by behavioural and mood changes in the injured individual. The relationship between family functioning and relatives' mood was reciprocal. The findings suggest the need for timely investigation and institution of interventions. Support is needed both for individual family members in dealing with their emotional distress as well as for the family as a whole, with the aim of maximising quality of life for those with TBI and their relatives.
- Miller et al. (1985) reported that 22% of non-clinical families had such a score (mean General Functioning scale score ¼ 1.7, SD ¼ 0.5), and Kabacoff et al. (1990) a mean General Functioning scale score of 1.84 (SD ¼ 0 .43). The FAD has been shown to have good psychometric properties (Bishop & Miller, 1988; Epstein et al., 1983; Miller et al., 1985; Perlesz, Kinsella, & Crowe, 1999), with a Cronbach's alpha for the General Functioning scale of .90. The FAD has been the measure most frequently used to study responses of family members across different disability groups, including those with TBI.
[Show abstract] [Hide abstract] ABSTRACT: Background Evidence suggests that alcohol use and smoking are negatively associated with mood in bipolar disorders (BD). It is unknown if this relationship is moderated by the number of previous mood episodes. Therefore, this paper aims to examine whether the number of previous mood episodes moderates the relationship between alcohol use and smoking, and mood. Method This study assessed the outcomes of 108 outpatients with BD I and II in a prospective observational cohort study. For 1 year, subjects daily registered mood symptoms and substance use with the prospective Life Chart Method. The relationship between the average daily consumption of alcohol and tobacco units in the whole year and mood were examined by multiple linear regression analyses. Number of previous mood episodes, grouped into its quartiles, was added as effect moderator. Outcome was the number of depressive, hypomanic and manic days in that year. Results The number of depressive days in a year increased by 4% (adjusted β per unit tobacco = 1.040; 95% CI 1.003–1.079; p = 0.033) per unit increase in average daily tobacco consumption in that same year. Interaction analyses showed that in those subjects with less than 7 previous mood episodes, the number of manic and hypomanic days increased by 100.3% per unit increase in alcohol consumption (adjusted β per unit alcohol = 2.003; 95% CI 1.225–3.274; p = 0.006). In those with 7 to 13 previous mood episodes, the number of manic and hypomanic days decreased by 28.7% per unit increase in alcohol consumption (adjusted β per unit alcohol = 0.713; 95% CI 0.539–0.944; p = 0.019); and in subjects with 14 to 44 previous mood episodes, the number of manic and hypomanic days decreased by 7.2% per unit increase in tobacco consumption (adjusted β per unit tobacco = 0.928; 95% CI 0.871–0.989; p = 0.021). Conclusions The number of previous mood episodes moderates the relationship between alcohol use and smoking and mood; and smoking is adversely associated with the number of depressive days.
- On average, patients spend more time in depressive than in manic or hypomanic episodes. Even when patients receive adequate treatment, the naturalistic course of BD is characterized by recurrences of manic, hypomanic and depressive episodes, that occur in up to 50% of BD patients within one year after recovery from a mood episode and in up to 90% of BD patients during their lifetime. Therefore, it is relevant to identify those factors that impact on mood, as these factors may be a target for intervention.
- The first of these, utilizing a depressed outpatient sample (n = 531), found these symptoms to display poor internal consistency (Haslam & Beck, 1994 ). The second taxometric analysis , utilizing a depressed adolescent inpatient sample (n = 160), found these symptoms to exhibit a continuous rather than categorical latent structure, but also reported low internal consistency (Whisman & Pinto, 1997). A limitation acknowledged in this study is that, generally, a sample size of at least 300 participants is recommended for conducting taxometric analysis (Meehl & Yonce, 1994), the smaller sample size in the current study possibly preventing the detecting of a hopelessness depression taxon if it occurs at a low base rate.
[Show abstract] [Hide abstract] ABSTRACT: En este capítulo se aborda el problema de la conducta suicida y el gran reto que implica para la atención psicoterapéutica de los consultantes, por estar asociada con un gran número de factores de riesgo. Se propone la terapia dialéctica comportamental como un modelo psicoterapéutico interdisciplinario para la atención de consultantes con trastorno límite de la personalidad y múltiples intentos de suicidio, debido a que este modelo y tratamiento cuentan con diversas dimensiones y elementos biológicos, psicológicos y sociales que hacen posible una mirada más amplia del comportamiento suicida. Este tipo de tratamiento incorpora en el contexto del trabajo psicoterapéutico, además, elementos de la filosofía hegeliana y Zen, técnicas psicoterapéuticas cognitivas, conductuales, humanistas, y de mindfulness de manera comprehensiva y articulada para la atención del consultante con las características referidas.
- La calidad de las relaciones familiares también es un factor de riesgo. Los problemas familiares, aunados a la poca cohesión y adaptabilidad (Campo et al., 2003; Lee, Wong & Chow, 2006; Wagner, Silverman & Martin, 2003), las discusiones y los conflictos entre padres y sus hijos con poca cercanía emocional entre ambos (Fergusson et al., 2000; Lai & McBride–Chang, 2001; Ruangkanchanasetr et al., 2005; Wagner, Cole & Schwartzman, 1995; Wagner, 1997; Wagner, Silverman & Martin, 2003), o el acercamiento inseguro de los hijos hacia los padres (Wagner, Silverman & Martin, 2003); los problemas en la comunicación entre padres e hijos (Lai & McBride–Chang, 2001; Larraguibel, González, Martínez & Valenzuela, 2000; Wagner, 1997), el poco acercamiento emocional con disciplina familiar estricta (Kashani, Suarez, Luchen & Reid, 1998; Larraguibel et al., 2000; Wagner y Cohen, 1994); la confusión en los roles o la trasgresión de límites establecidos en la familia (Kashani et al., 1998), percepción de la familia como disfuncional (McDermut, Miller, Solomon, Ryan & Keitner, 2001; Spirito, Brown, Overholser & Fritz, 1989), son los factores de riesgo identificados. Las relaciones familiares son en particular importantes en la cultura mexicana.
[Show abstract] [Hide abstract] ABSTRACT: Bupropion has been used as an antidepressant for over 20 years, though its licence for such use varies and it is typically a third- or fourth-line agent. It has a unique pharmacology, inhibiting the reuptake of noradrenaline and dopamine, potentially providing pharmacological augmentation to more common antidepressants such as selective serotonergic reuptake inhibitors (SSRIs). This systematic review and meta-analysis identified 51 studies, dividing into four categories: bupropion as a sole antidepressant, bupropion coprescribed with another antidepressant, bupropion in ‘other’ populations (e.g. bipolar depression, elderly populations) and primary evaluation of side effects.
- Post hoc analysis showed a trend towards response in those diagnosed with severe MDD. The study had notably stringent inclusion criteria to reduce the potential enrolment of patients with mild depression, a factor reported to impact placebo response rates in clinical trials [Posternak et al. 2002]. However, mean MADRS baseline scores (31.8–32.1)
- Extensive research supports the psychometric properties of the FAD or its General Functioning scale as measures of family functioning for use with nonclinical , psychiatric, and medical samples of adolescents, youths, and adults (Boterhoven de Haan et al., 2015; Juliusdottir & Olafssdottir, 2015; Kabacoff et al., 1990; Keitner et al., 1991; Miller et al., 2000; Morris, 1990; Roncone et al., 1998; Sawyer et al., 1988; Staccini et al., 2015; Walrath et al., 2004). Since their inception in the USA, both versions of the FAD have been translated into several languages and tested with various ethnic groups, with quite strong empirical evidence of their utility in different cultures and segments of the population (Juliusdottir & Olafssdottir, 2015; Kazarian, 2010; Keitner et al., 1991; Morris, 1990; Roncone et al., 1998; Shek, 2002; Walrath et al., 2004; Wenninger, Hageman & Arrindell, 1993).
[Show abstract] [Hide abstract] ABSTRACT: Abstract Self-defeating behaviours have been defined as behaviours leading to lower cost - reward ratio than is available to the person through alternative behaviours (Curtis, 1989). The concept is in not a novel one in the field of Psychology. The discussions about the philosophy of freedom of choice to defeat/destruct oneself and the development of the concept of death instinct, all denotes the antiquity of the concept. The concept has important implications in understanding various clinical manifestations and probably great utility in the treatment of the same. However, the discussions about and research on the construct has been confined to the realm of social psychology. Such research has helped us understand the concept, its development, its various dimensions and difficulties in dealing with/modifying such behaviour patterns. However, an active effort to integrate the concept to clinical psychology would help clinicians in understanding and using the concept better. Key Words: Self-defeating behaviours, self-defeating personality disorder, masochism, belief-perseverance.
- A particular problem in life event and suicide research lies in ascertaining the extent to which life events that precede suicidal behaviour are independent of or caused by antecedent factors, including socio-demographic factors, personality factors, social support, coping styles and psychiatric disorders. Lack of social support may be stressful independently or may indicate a lack of a buffer against psychosocial stress originating from life events (Overholser et al, 1990). Rudd (1990) has noted a significant relationship between social support and both life stress and suicidal ideation.
- Department of Psychiatry and Human Behavior
University of Texas at Austin
Texas City, TX, United States
- Department of Psychology
Clark UniversityWorcester, Massachusetts, United States
????????, New York, United States
- Department of Psychiatry
Lewis & Clark College
Portland, Oregon, United States
- Department of Psychology
Filadelfia, Pennsylvania, United States
- Department of Psychology
Columbia UniversityNew York, New York, United States