Disorders - Depressive Disorders
Cheng, F. K.
Childhood mental health problems not only incur a financial burden but more importantly damages individual and family well-being, which compels mental care practitioners to search for solutions, among which meditation is a more economical method. This integrative review investigates the effectiveness of meditation on psychological problems for adolescents under age of 20 through different types of meditation, though mainly mindfulness-based modes. The 36 reviewed publications include quantitative, qualitative and mixed methods research, conducted in North America, Europe, and the Asia Pacific region, related to developmental disabilities, emotional problems, and mental illnesses. Outcomes indicate a decrease in self-harm thoughts, disruptive behaviour, stress, anxiety, impulsivity, and psychological distress; and improvements in self-control, quality of sleep, emotional regulation, executive function, anger management, and social competence, resulting in better academic performance, quality of life, mental wellness, and child-parent relationships. This review suggests the integration of meditation into physical activities, and music and art therapies, as well as randomised controlled trials to examine such synthesis of these disciplines. In conclusion, meditation is a potential curative and preventive measure, both low cost and non-intrusive, for the promotion of adolescent mental wellness. This sheds light on nurses who look after children with mental health. Copyright © 2016 The Author.
International Journal of Africa Nursing Sciences, 4 : 7-19
- Year: 2016
- Problem: Anxiety Disorders (any), Depressive Disorders, Non-suicidal self-harm behaviours
, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: Universal prevention
, At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Psychological Interventions (any)
, Mindfulness based therapy, Meditation
Cipriani, A., Zhou, X., DelGiovane, C., Hetrick, S. E., Qin, B., Whittington, C., Coghill, D., Zhang, Y., Hazell, P., Leucht, S., Cuijpers, P., Pu, J., Cohen, D., Ravindran, A. V., Liu, Y., Michael, K. D., Yang, L., Liu, L., Xie, P.
BACKGROUND: Major depressive disorder is one of the most common mental disorders in children and adolescents. However, whether to use pharmacological interventions in this population and which drug should be preferred are still matters of controversy. Consequently, we aimed to compare and rank antidepressants and placebo for major depressive disorder in young people.
METHODS: We did a network meta-analysis to identify both direct and indirect evidence from relevant trials. We searched PubMed, the Cochrane Library, Web of Science, Embase, CINAHL, PsycINFO, LiLACS, regulatory agencies' websites, and international registers for published and unpublished, double-blind randomised controlled trials up to May 31, 2015, for the acute treatment of major depressive disorder in children and adolescents. We included trials of amitriptyline, citalopram, clomipramine, desipramine, duloxetine, escitalopram, fluoxetine, imipramine, mirtazapine, nefazodone, nortriptyline, paroxetine, sertraline, and venlafaxine. Trials recruiting participants with treatment-resistant depression, treatment duration of less than 4 weeks, or an overall sample size of less than ten patients were excluded. We extracted the relevant information from the published reports with a predefined data extraction sheet, and assessed the risk of bias with the Cochrane risk of bias tool. The primary outcomes were efficacy (change in depressive symptoms) and tolerability (discontinuations due to adverse events). We did pair-wise meta-analyses using the random-effects model and then did a random-effects network meta-analysis within a Bayesian framework. We assessed the quality of evidence contributing to each network estimate using the GRADE framework. This study is registered with PROSPERO, number CRD42015016023.
FINDINGS: We deemed 34 trials eligible, including 5260 participants and 14 antidepressant treatments. The quality of evidence was rated as very low in most comparisons. For efficacy, only fluoxetine was statistically significantly more effective than placebo (standardised mean difference -0.51, 95% credible interval [CrI] -0.99 to -0.03). In terms of tolerability, fluoxetine was also better than duloxetine (odds ratio [OR] 0.31, 95% CrI 0.13 to 0.95) and imipramine (0.23, 0.04 to 0.78). Patients given imipramine, venlafaxine, and duloxetine had more discontinuations due to adverse events than did those given placebo (5.49, 1.96 to 20.86; 3.19, 1.01 to 18.70; and 2.80, 1.20 to 9.42, respectively). In terms of heterogeneity, the global I(2) values were 33.21% for efficacy and 0% for tolerability.
INTERPRETATION: When considering the risk-benefit profile of antidepressants in the acute treatment of major depressive disorder, these drugs do not seem to offer a clear advantage for children and adolescents. Fluoxetine is probably the best option to consider when a pharmacological treatment is indicated.
FUNDING: National Basic Research Program of China (973 Program).
Copyright © 2016 Elsevier Ltd. All rights reserved.
Lancet, 388(10047) : 881-90
- Year: 2016
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Tricyclic antidepressants, Tetracyclic antidepressants (TECA/NSSAs), Serotonin-norepinephrine reuptake inhibitors (SNRIs), Antidepressants (any)
Eslami, A. A., Rabiei, L., Afzali, S. M., Hamidizadeh, S., Masoudi, R.
Background: Adolescence is a transition period from childhood to early adulthood. Because of the immense pressure imposed on adolescents due to the complications and ambiguities of this transition, their level of excitement increases and sometimes it appears in the form of sensitivity and intense excitement. Objectives: This study aimed at determining the effectiveness of assertiveness training on the levels of stress, anxiety, and depression of high school students. Materials and Methods: This quasi-experimental study was conducted on high school students of Isfahan in academic year 2012 -13. A total of 126 second grade high school students were collected according to simple random sampling method and divided into two groups: experimental with 63 participants and control with the same number. Data gathering instruments included a demographic questionnaire, Gambill-Richey assertiveness scale, and depression anxiety stress scales (DASS-21). Assertiveness training was carried out on the experimental group in 8 sessions; after 8 weeks, posttest was carried out on both groups. Statistical tests such as independent t test, repeated measures ANOVA, Chi-square test, and the Mann-Whitney test were used to interpret and analyze the data. Results: The Chi-square and Mann-Whitney tests did not show significant statistical differences between the two groups in terms of demographic variables (P = 0.05). Repeated measures ANOVA showed no significant difference between the mean scores for assertiveness before (100.23 ± 7.37), immediately after (101.57 ± 16.06), and 2 months after (100.77 ± 12.50) the intervention in the control group. However, the same test found a significant difference between the mean score for assertiveness in the experimental group before (101.6 ± 9.1), immediately after (96.47 ± 10.84), and 2 months after (95.41 ± 8.37) implementing the training program (P = 0.002). The independent t test showed no significant difference in the mean score for anxiety and stress between two groups before the assertiveness training program; however, 2 months after the intervention, the mean score for anxiety in the experimental group was found significantly lower than the control group. As for the mean score for depression, the independent t test showed no significant difference between two groups before training; however, despite the decrease in the mean scores for depression in the experimental group following the intervention, the difference was not significant (P = 0.09). Conclusions: The results of the current study show that conducting assertive training in high school students decreases their anxiety, stress, and depression. Given that high school years are among the most sensitive stages of one's life plus the fact that conducting such training programs besides their safe and low cost nature are effective and practical, it is highly recommended that such programs be carried out among high school adolescents.
Iranian Red Crescent Medical Journal, 18(1) : 1-10
- Year: 2016
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Controlled clinical trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Skills training
Clarke, G., DeBar, L. L., Pearson, J. A., Dickerson, J. F., Lynch, F. L., Gullion, C. M., Leo, M. C.
BACKGROUND AND OBJECTIVE: Health care providers have few alternatives for youth depression other than antidepressants. We examined whether brief cognitive behavioral therapy (CBT) is a viable alternative in primary care. METHODS: A total of 212 adolescents aged 12 to 18 with major depression who had recently declined or quickly discontinued new antidepressant treatment were randomized to selfselected treatment as usual (TAU) control condition or TAU plus brief individual CBT. Blinded evaluators followed youth for 2 years. The primary outcome was time to major depression diagnostic recovery. RESULTS: CBT was superior to the control condition on the primary outcome of time to diagnostic recovery from major depression, with number needed to treat from 4 to 10 across follow-up. A similar CBT advantage was found for time to depression diagnosis response, with number needed to treat of 5 to 50 across time points. We observed a significant advantage for CBT on many secondary outcomes over the first year of follow-up but not the second year. Cohen's d effect sizes for significant continuous measures ranged from 0.28 to 0.44, in the small to medium effect range. Most TAU health care services did not differ across conditions, except for psychiatric hospitalizations, which occurred at a significantly higher rate in the control condition through the first year of follow-up. CONCLUSIONS: Observed results were consistent with recent meta-analyses of CBT for youth depression. The initial year of CBT superiority imparted an important clinical benefit and may reduce the risk of future recurrent depression episodes.
Pediatrics, 137(5) :
- Year: 2016
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Collado, A., Calderon, M., MacPherson, L., Lejuez, C.
Objective: Major depressive disorder (MDD) is highly prevalent among U.S. Spanish-speaking Latinos, but the lack of empirically supported treatments precludes this population's access to quality mental health care. Method: Following the promising results of an open-label trial of the Behavioral Activation Treatment for Depression (BATD) among Spanish-speaking Latinos, the authors conducted a randomized control trial (RCT; N = 46) that compared BATD to supportive counseling. Study outcomes included depression, BATD proposed mechanisms of change, and nonspecific psychotherapy factors. Results: Relative to supportive counseling, BATD led to greater decreases in depressive symptoms over time (p =.04) and greater MDD remission at the end of treatment (p =.01). Activity level (p =.01) and environmental reward (p =.05) showed greater increases over time among those who received BATD compared to supportive counseling. Treatment adherence, therapeutic alliance, and treatment satisfaction did not differ between the groups over time (ps > 0.17). The 1-month follow-up suggested sustained clinical gains across therapies. Conclusions: The current study adds to a growing treatment literature and provides support that BATD is efficacious in reducing depression and increasing activity level and environmental reward in the largest, yet historically underserved U.S. ethnic minority population. This trial sets the stage for a larger RCT that evaluates the transportability and generalizability of BATD in an effectiveness trial. Copyright © 2016 American Psychological Association.
Journal of Consulting and Clinical Psychology, 84(7) : 651-657
- Year: 2016
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Supportive therapy
Conroy, D. A., Kiryakoza, L. C., Czopp, A. M., Huntley, E. D., Armitage, R.
Introduction: Depression during the adolescent years is common with 20% of adolescents experiencing a depressive episode by 18 years of age. Circadian and psychosocial factors can promote a preference to stay up later. These changes limit the developmentally appropriate total hours of sleep. Sleep deprivation has been shown to exacerbate depression. This study sought to evaluate the effectiveness of a time management program plus nightly evening exposure to light in the orange-red spectrum (above 600 nanometers) on mood, fatigue, and suicidality. Methods: Depressed teens (scoring > 33 on the CDRS) were randomized to waitlist control (WLC) for 1 week or an immediate start. Participants met with a psychologist and received psychoeducation about sleep requirements, biological rhythms, and the impact of light on rhythms. They received a personalized time management program to prioritize sleep. They received red goggles and a prescribed sleep schedule. Participants completed Quick Inventory of Depressive Symptomatology (QIDS), Suicide Inventory Questionnaire (SIQ), and Multidimensional Fatigue Inventory (MFI) at baseline, after 2 weeks (Posttx), and at a 3 month follow up. Sleep diaries were collected during WLC. Results: 25 participants (6 Males; 13 WLC) ages 14-19 years of age (M = 16.5, SD = 1.4) were studied. Paired t-tests of survey scores revealed improvement s in QIDS from baseline to post treatment (p < .001) and to 3 month follow up (p = .017). MFI decreased from baseline to post treatment (p = .035) and to follow up (p = .006). SIQ decreased from baseline to post treatment (p = .031) and to follow up (p = .012). Neither sleep schedules nor total sleep differed from baseline (23:528:22; 7hr 46 m) to post treatment (23:25-8:32; 7 hrs 47 m) or 3 month FU (23:34-6:50; 7 hrs 36 m) compared to WLC (23:42-8:14; 7 hrs 36m). Conclusion: Limiting evening light in the blue spectrum and prioritizing sufficient sleep in depressed adolescents was associated with improvements in mood, fatigue, and a reduction of suicidality over time. Larger trials focused on these interventions are needed in depressed adolescents.
Sleep, 39 : A297
- Year: 2016
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Psychological Interventions (any)
, Other Psychological Interventions, Bright light therapy
Darragh, M., Yow, B., Kieser, A., Booth, R. J., Kydd, R. R., Consedine, N. S.
Background: With a healthcare system burdened by symptomatic and mental-health related conditions, the placebo effect may represent a useful clinical tool. First, however, there is a need to broaden research attention and investigate placebo effects outside laboratories and beyond experimental pain. This study investigated the effectiveness of a take-home placebo treatment in the short-term alleviation of stress, anxiety and symptoms of depression in a non-patient population. Method: A sample of 77 participants was randomized to either the 'oxytocin' treatment group (n = 22), the 'serotonin' treatment group (n = 22) or the wait-list control group (n = 33). The two treatment groups were given an 'anti-stress treatment spray' (placebo) to self-administer for 3 days, and completed online measures of perceived stress (Perceived Stress Scale-10), anxiety (Cognitive Somatic Anxiety Questionnaire) and symptoms of depression (Centre for Epidemiological Studies-Depression) before and after the 3-day protocol. Results: Both the 'serotonin' and 'oxytocin' treatment sprays were effective in reducing symptoms of depression; however, only those in the 'oxytocin' group reported less stress and anxiety as compared with controls. Overall, the 'oxytocin' was perceived as more effective. Conclusion: Placebo effects can be translated to a real-life setting in the short-term reduction of stress, anxiety and symptoms of depression in a non-patient population. In treating psychological distress, placebos may be useful addition to the treatment repertoire. The information given with treatment may also be an important consideration for practitioners. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Australian and New Zealand Journal of Psychiatry, 50(9) : 858-865
- Year: 2016
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions (any)
, Other biological interventions, Psychological Interventions (any)
, Other Psychological Interventions
de-Voogd, E., Wiers, R., Prins, P., de-Jong, P., Boendermaker, W., Zwitser, R., Salemink, E.
Based on information processing models of anxiety and depression, we investigated the efficacy of multiple sessions of online attentional bias modification training to reduce attentional bias and symptoms of anxiety and depression, and to increase emotional resilience in youth. Unselected adolescents (N = 340, age: 11-18 years) were randomly allocated to eight sessions of a dot-probe, or a visual search-based attentional training, or one of two corresponding placebo control conditions. Cognitive and emotional measures were assessed pre- and post-training; emotional outcome measures also at three, six and twelve months follow-up. Only visual search training enhanced attention for positive information, and this effect was stronger for participants who completed more training sessions. Symptoms of anxiety and depression reduced, whereas emotional resilience improved. However, these effects were not especially pronounced in the active conditions. Thus, this large-scale randomized controlled study provided no support for the efficacy of the current online attentional bias modification training as a preventive intervention to reduce symptoms of anxiety or depression or to increase emotional resilience in unselected adolescents. However, the absence of biased attention related to symptomatology at baseline, and the large drop-out rates at follow-up preclude strong conclusions. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Behaviour Research and Therapy, 87 : 11-22
- Year: 2016
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Attention/cognitive bias modification
, Technology, interventions delivered using technology (e.g. online, SMS)
Deady, M., Mills, K. L., Teesson, M., Kay-Lambkin, F.
BACKGROUND: Depression and problematic alcohol use represent two of the major causes of disease burden in young adults. These conditions frequently co-occur and this is associated with increased harm and poorer outcomes than either disorder in isolation. Integrated treatments have been shown to be effective; however, there remains a significant gap between those in need of treatment and those receiving it. The increased availability of eHealth programs presents a unique opportunity to treat these conditions.
OBJECTIVE: This study aimed to evaluate the feasibility and preliminary efficacy of an automated Web-based self-help intervention (DEAL Project) in treating co-occurring depressive symptoms and problematic alcohol use in young people.
METHODS: Young people (aged 18 to 25 years) with moderate depression symptoms and drinking at hazardous levels (recruited largely via social media) were randomly allocated to the DEAL Project (n=60) or a Web-based attention-control condition (HealthWatch; n=44). The trial consisted of a 4-week intervention phase with follow-up assessment at posttreatment and at 3 and 6 months postbaseline. The primary outcomes were change in depression severity according to the Patient Health Questionnaire-9 as well as quantity and frequency of alcohol use (TOT-AL).
RESULTS: The DEAL Project was associated with statistically significant improvement in depression symptom severity (d=0.71) and reductions in alcohol use quantity (d=0.99) and frequency (d=0.76) in the short term compared to the control group. At 6-month follow-up, the improvements in the intervention group were maintained; however, the differences between the intervention and control groups were no longer statistically significant, such that between-group effects were in the small to moderate range at 6 months (depression symptoms: d=0.39; alcohol quantity: d=-0.09; alcohol frequency: d=0.24).
CONCLUSIONS: Overall, the DEAL Project was associated with more rapid improvement in both depression symptoms and alcohol use outcomes in young people with these co-occurring conditions relative to an attention-control condition. However, long-term outcomes are less clear.
TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12613000033741; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363461 (Archived by WebCite at http://www.webcitation.org/6fpsLEGOy).
Journal of Medical Internet Research, 18(3) : e71
- Year: 2016
- Problem: Depressive Disorders, Alcohol Use
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Other Psychological Interventions, Self-help
, Technology, interventions delivered using technology (e.g. online, SMS)
Dean, S., Britt, E., Bell, E., Stanley, J., Collings, S.
Background: The prevalence of anxiety and mood disorders in adolescents is a growing public health concern worldwide. Given the high rates of drop-out and limited resources available in psychiatric settings, the importance of engaging adolescents in evidence-based treatments cannot be understated. The aim of the study was to determine the efficacy of motivational interviewing (MI), as a brief pre-treatment intervention, to enhance treatment engagement in a standard therapy setting (group cognitive behavioral therapy; gCBT) for adolescents with anxiety and mood disorders. Method: Ninety-six adolescents (13-18 years) with a principal diagnosis of an anxiety or mood disorder participated in a trial conducted at two publicly funded outpatient services. Participants were randomly assigned to individual MI for treatment engagement prior to gCBT (MI + gCBT), or to an individually administered active control (befriending) prior to gCBT (befriending + gCBT). Eight pairs of gCBT were run in parallel. Outcome measures were the mean number of gCBT sessions attended, treatment initiation, and ratings of readiness for treatment. Results: Participants randomized to MI as a pretreatment intervention attended significantly more group therapy sessions compared to those in the active control condition. The MI group also demonstrated greater treatment initiation, and ratings of treatment readiness were significantly higher for those randomized to MI. Conclusions: MI, used as a pre-treatment intervention, enhanced group treatment engagement in adolescents diagnosed with anxiety and mood disorders compared to the active control condition. MI is a promising intervention to facilitate engagement in adolescent mental health settings. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Psychological Medicine, 46(9) : 1961-1969
- Year: 2016
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Motivational interviewing, includes Motivational Enhancing Therapy
Disner, S. G., Beevers, C. G., Gonzalez-Lima, F.
Background: Low-level light therapy (LLLT) with transcranial laser is a non-invasive form of neuroenhancement shown to regulate neuronal metabolism and cognition. Attention bias modification (ABM) is a cognitive intervention designed to improve depression by decreasing negative attentional bias, but to date its efficacy has been inconclusive. Adjunctive neuroenhancement to augment clinical effectiveness has shown promise, particularly for individuals who respond positively to the primary intervention. Objective/hypothesis: This randomized, sham-controlled proof-of-principle study is the first to test the hypothesis that augmentative LLLT will improve the effects of ABM among adults with elevated symptoms of depression. Methods: Fifty-one adult participants with elevated symptoms of depression received ABM before and after laser stimulation and were randomized to one of three conditions: right forehead, left forehead, or sham. Participants repeated LLLT two days later and were assessed for depression symptoms one and two weeks later. Results: A significant three-way interaction between LLLT condition, ABM response, and time indicated that right LLLT led to greater symptom improvement among participants whose attention was responsive to ABM (i.e., attention was directed away from negative stimuli). Minimal change in depression was observed in the left and sham LLLT. Conclusions: The beneficial effects of ABM on depression symptoms may be enhanced when paired with adjunctive interventions such as right prefrontal LLLT; however, cognitive response to ABM likely moderates the impact of neuroenhancement. The results suggest that larger clinical trials examining the efficacy of using photoneuromodulation to augment cognitive training are warranted.
Brain Stimulation, :
- Year: 2016
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions (any)
, Other biological interventions, Complementary & Alternative Interventions (CAM)
, Bright light therapy
Downey, D.
Intravenous infusion of lanicemine (formerly AZD6765), a low trapping non-selective N-methyl-. D-aspartate (NMDA) receptor antagonist, induces antidepressant effects with a similar time course to ketamine. We investigated whether a single dose lanicemine infusion would reproduce the previously reported decrease in subgenual anterior cingulate cortex (sgACC) activity evoked by ketamine, a potential mechanism of antidepressant efficacy. Sixty un-medicated adults meeting the criteria for major depressive disorder were randomly assigned to receive constant intravenous infusions of ketamine, lanicemine or saline during a 60 min pharmacological magnetic resonance imaging (phMRI) scan. Both ketamine and lanicemine gradually increased the blood oxygen level dependent signal in sgACC and rostral ACC as the primary outcome measure. No decreases in signal were seen in any region. Interviewer-rated psychotic and dissociative symptoms were minimal following administration of lanicemine. There was no significant antidepressant effect of either infusion compared to saline. The previously reported deactivation of sgACC after ketamine probably reflects the rapid and pronounced subjective effects evoked by the bolus-infusion method used in the previous study. Activation of the ACC was observed following two different NMDA compounds in both Manchester and Oxford using different 3 T MRI scanners, and this effect predicted improvement in mood 1 and 7 days post-infusion. These findings suggest that the initial site of antidepressant action for NMDA antagonists may be the ACC (NCT01046630. A Phase I, Multi-centre, Double-blind, Placebo-controlled Parallel Group Study to Assess the pharmacoMRI Effects of AZD6765 in Male and Female Subjects Fulfilling the Criteria for Major Depressive Disorder; http://clinicaltrials.gov/show/NCT01046630). Copyright © 2016 Elsevier B.V. and ECNP.
European Neuropsychopharmacology, 26(6) : 994-1003
- Year: 2016
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Other biological interventions