Disorders - Depressive Disorders
McNamara, R. K., Strimpfel, J., Jandacek, R., Rider, T., Tso, P., Welge, J. A., Strawn, J. R., DelBello, M. P.
Residual depressive symptoms are commonly observed in adolescents with major depressive disorder (MDD) following treatment with selective serotonin reuptake inhibitors (SSRIs). This study combined a case-control analysis and an open-label fish oil (FO) trial to investigate the relationship between long-chain omega-3 (LC. n-3) fatty acid status and residual depressive symptoms in SSRI-resistant adolescent MDD patients. Baseline erythrocyte docosahexaenoic acid (DHA) (-28%, p=0.0003), but not eicosapentaenoic acid (EPA) (-18%, p=0.2), was significantly lower in patients ( n=20) compared with healthy controls ( n=20). Patients receiving 10-week low-dose (2.4g/day, n=7) and high-dose (16.2g/day, n=7) FO exhibited significant increases in erythrocyte EPA and DHA composition. In the intent-to-treat sample, depressive symptoms decreased significantly in the high-dose group ( n=7, -40%, p<0.0001), and there was a trend in the low-dose group ( n=10, -20%, p=0.06). Symptom remission was observed in 40% of patients in the low-dose group and 100% of patients in the high-dose group. There were no significant changes in vital signs and adverse events were rated as mild or moderate in severity. These preliminary findings demonstrate that adolescents with SSRI-resistant depression exhibit robust DHA deficits, and suggest that adjunctive FO supplementation is well-tolerated and effective for increasing LC. n-3 fatty acid status and augmenting SSRI antidepressant effects. (copyright) 2014 Elsevier B.V.
PharmaNutrition, 2(2) : 38-46
- Year: 2014
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Treatment resistant/treatment refractory
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Fish oil (Omega-3 fatty acids)
, Omega 3 fatty acids (e.g. fish oil, flax oil)
McNamara, R., Strawn, J., Stahl, L., Weber, W., Welge, J., Patino, R., Strakowski, S., DelBello, M.
Background: When offspring of parents with bipolar disorder develop major depressive disorder they are at increased risk for developing mania (and by definition bipolar I disorder). Antidepressant medications that are commonly used to treat depressive symptoms may further increase risk of developing manic symptoms. Therefore, treatments for mood symptoms in ultra-high risk youth are urgently needed to establish early intervention and ultimately prevention strategies. Long-chain omega-3 (LCn-3) fatty acids are anti-inflammatory and have neurotrophic and neuroprotective properties, and increasing LCn-3 fatty acid status with fish oil (FO) has antidepressant actions. However, the central mechanisms mediating this effect remain poorly understood. This study investigated the effects of increasing LCn-3 fatty acid status on corticolimbic activation patterns elicited by emotional images in depressed adolescent bipolar offspring by functional magnetic resonance imaging (fMRI). Methods: Sixty medication-free youth (ages 9-20 years) with a current diagnosis of MDD or Depressive Disorder NOS and a biological parent with bipolar I disorder were randomized to 12 week treatment with FO supplements (2,100 mg/d) or placebo (olive oil). At baseline and endpoint, fMRI scans were obtained while performing a continuous performance task with emotional and neutral distractors (CPT-END). Standard event-related voxel-wise fMRI analysis was performed. Symptom ratings were performed weekly using the Children's Depression Rating Scale-Revised CDRS-R, Young Mania Rating Scale (YMRS), Clinical Global Impression-Severity Scale (CGI-S), and CGIImprovement Scale (CGI-I). Erythrocyte fatty acid levels were obtained at baseline and endpoint. Results: Baseline-endpoint RBC LCn-3 fatty acid (EPA+ DHA) levels increased, and the ratio of arachidonic acid to EPA+DHA (AA/EPA+DHA) decreased, significantly following FO supplementation but not placebo. Both treatment groups demonstrated significant reductions over time in symptoms of depression (p<0.0001) and mania (p<0.0001). Response rates (mean CDRS % improvement) were 61% (FO) and 55% (Placebo) (p=0.39), and remission (CDRS< 28) rates were 46% (FO) and 54% (Placebo)(p=0.1). The rates of CGI-I response (defined as ≤ 2, i.e., very much improved or much improved) were significantly greater in the FO group than placebo group (64% vs. 36%, p=0.04). The FO group had a significantly greater CGI-S reduction than the placebo group (-1.8 vs. -1.0, p<0.01). Baseline-endpoint activation in the left parahippocampal gyrus and fusiform gyrus in response to emotional images decreased, and activation in bilateral cerebellar tonsils increased, following FO supplementation but not placebo. Conclusions: Increases in LCn-3 fatty acid status and reductions in depressive symptoms in bipolar offspring following FO supplementation are associated with reduced activation of limbic structures in response to emotional stimuli.
Neuropsychopharmacology, 39 : S228
- Year: 2014
- Problem: Bipolar Disorders, Depressive Disorders
- Type: Randomised controlled trials
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Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
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Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Fish oil (Omega-3 fatty acids)
, Omega 3 fatty acids (e.g. fish oil, flax oil)
McKee, L. G., Parent, J., Forehand, R., Rakow, A., Watson, K. H., Dunbar, J. P., Reising, M. M., Hardcastle, E., Compas, B. E.
This study utilized structural equation modeling to examine the associations among parental guilt induction (a form of psychological control), youth cognitive style, and youth internalizing symptoms, with parents and youth participating in a randomized controlled trial of a family-based group cognitive-behavioral preventive intervention targeting families with a history of caregiver depression. The authors present separate models utilizing parent report and youth report of internalizing symptoms. Findings suggest that families in the active condition (family-based group cognitive-behavioral group) relative to the comparison condition showed a significant decline in parent use of guilt induction at the conclusion of the intervention (6 months postbaseline). Furthermore, reductions in parental guilt induction at 6 months were associated with significantly lower levels of youth negative cognitive style at 12 months. Finally, reductions in parental use of guilt induction were associated with lower youth internalizing symptoms 1 year following the conclusion of the intervention (18 months postbaseline).;
Development & Psychopathology, 26(2) : 319-332
- Year: 2014
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
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Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Micco, J. A., Henin, A., Hirshfeld-Becker, D. R.
This study evaluated the efficacy of a four-session Cognitive Bias Modification-Interpretation program for 45 depressed adolescents and young adults (14-21 years old; 12 males, 33 females; Beck Depressive Inventory, Second Edition (greater-than or equal to)14) randomized to an active intervention condition (repeated exposure to positive outcomes of depression-relevant ambiguous scenarios; n = 23) or a control condition (n = 22). Both conditions experienced reductions on a Test of Interpretation Bias at post-treatment, with no significant between-group differences. When limited to those with negative bias at baseline, the intervention group showed greater improvement in interpretation bias at mid- and post-treatment. In addition, the intervention group overall had greater improvements in self-reported negative cognitions than the control group at post-intervention and two-week follow-up. However, there were no differences between groups in depression or anxiety symptom change. Potential factors contributing to mixed findings are discussed. (copyright) 2013 Springer Science+Business Media.
Cognitive Therapy & Research, 38(2) : 89-102
- Year: 2014
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Randomised controlled trials
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Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Attention/cognitive bias modification
Langford, R., Bonell, CP., Jones, HE., Pouliou, T., Murphy, SM., Waters, E., Komro, KA., Gibbs LF., Magnus, D., Campbell, R.
Background: The World Health Organization's (WHO's) Health Promoting Schools (HPS) framework is an holistic, settings-based approach to promoting health and educational attainment in school. The effectiveness of this approach has not been previously rigorously reviewed.Objectives: To assess the effectiveness of the Health Promoting Schools (HPS) framework in improving the health and well-being of students and their academic achievement.Search methods: We searched the following electronic databases in January 2011 and again in March and April 2013: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, CINAHL, Campbell Library, ASSIA, BiblioMap, CAB Abstracts, IBSS, Social Science Citation Index, Sociological Abstracts, TRoPHI, Global Health Database, SIGLE, Australian Education Index, British Education Index, Education Resources Information Centre, Database of Education Research, Dissertation Express, Index to Theses in Great Britain and Ireland, ClinicalTrials.gov, Current controlled trials, and WHO International Clinical Trials Registry Platform. We also searched relevant websites, handsearched reference lists, and used citation tracking to identify other relevant articles.Selection criteria: We included cluster-randomised controlled trials where randomisation took place at the level of school, district or other geographical area. Participants were children and young people aged four to 18 years, attending schools or colleges. In this review, we define HPS interventions as comprising the following three elements: input to the curriculum; changes to the school's ethos or environment or both; and engagement with families or communities, or both. We compared this intervention against schools that implemented either no intervention or continued with their usual practice, or any programme that included just one or two of the above mentioned HPS elements.Data collection and analysis: At least two review authors identified relevant trials, extracted data, and assessed risk of bias in the trials. We grouped different types of interventions according to the health topic targeted or the approach used, or both. Where data permitted, we performed random-effects meta-analyses to provide a summary of results across studies.Main results: We included 67 eligible cluster trials, randomising 1443 schools or districts. This is made up of 1345 schools and 98 districts. The studies tackled a range of health issues: physical activity (4), nutrition (12), physical activity and nutrition combined (18), bullying (7), tobacco (5), alcohol (2), sexual health (2), violence (2), mental health (2), hand-washing (2), multiple risk behaviours (7), cycle-helmet use (1), eating disorders (1), sun protection (1), and oral health (1). The quality of evidence overall was low to moderate as determined by the GRADE approach. 'Risk of bias' assessments identified methodological limitations, including heavy reliance on self-reported data and high attrition rates for some studies. In addition, there was a lack of long-term follow-up data for most studies.We found positive effects for some interventions for: body mass index (BMI), physical activity, physical fitness, fruit and vegetable intake, tobacco use, and being bullied. Intervention effects were generally small but have the potential to produce public health benefits at the population level. We found little evidence of effectiveness for standardised body mass index (zBMI) and no evidence of effectiveness for fat intake, alcohol use, drug use, mental health, violence and bullying others; however, only a small number of studies focused on these latter outcomes. It was not possible to meta-analyse data on other health outcomes due to lack of data. Few studies provided details on adverse events or outcomes related to the interventions. In addition, few studies included any academic, attendance or school-related outcomes. We therefore cannot draw any clear conclusions as to the effectiveness of this approach for improving academic achievement.Authors' conclusions: The resu ts of this review provide evidence for the effectiveness of some interventions based on the HPS framework for improving certain health outcomes but not others. More well-designed research is required to establish the effectiveness of this approach for other health topics and academic achievement.
Cochrane Database of Systematic Reviews, (4) : CD008959
- Year: 2014
- Problem: Anxiety Disorders (any), Depressive Disorders, Eating Disorders (any), Substance Use Disorders (any)
- Type: Systematic reviews
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Stage: Universal prevention
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Treatment and intervention: Service Delivery & Improvement
Lampe, L., Coulston, C. M., Berk, L.
Objective: To be used in conjunction with 'Pharmacological management of unipolar depression' [Malhi et al. Acta Psychiatr Scand 2013;127(Suppl. 443):6-23] and 'Lifestyle management of unipolar depression' [Berk et al. Acta Psychiatr Scand 2013;127(Suppl. 443):38-54]. To provide clinically relevant recommendations for the use of psychological treatments in depression derived from a literature review. Method: Medical databases including MEDLINE and PubMed were searched for pertinent literature, with an emphasis on recent publications. Results: Structured psychological treatments such as cognitive behaviour therapy and interpersonal therapy (IPT) have a robust evidence base for efficacy in treating depression, even in severe cases of depression. However, they may not offer benefit as quickly as antidepressants, and maximal efficacy requires well-trained and experienced therapists. These therapies are effective across the lifespan and may be preferred where it is desired to avoid pharmacotherapy. In some instances, combination with pharmacotherapy may enhance outcome. Psychological therapy may have more enduring protective effects than medication and be effective in relapse prevention. Newer structured psychological therapies such as mindfulness-based cognitive therapy and acceptance and commitment therapy lack an extensive outcome literature, but the few published studies yielding positive outcomes suggest they should be considered options for treatment. Conclusion: Cognitive behaviour therapy and IPT can be effective in alleviating acute depression for all levels of severity and in maintaining improvement. Psychological treatments for depression have demonstrated efficacy across the lifespan and may present a preferred treatment option in some groups, for example, children and adolescents and women who are pregnant or postnatal. (copyright) 2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.
Acta Psychiatrica Scandinavica, 127(SUPPL. 443) : 24-37
- Year: 2013
- Problem: Depressive Disorders
- Type: Systematic reviews
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Psychological Interventions (any)
McCarty, C. A., Violette, H. D., Duong, M. T., Cruz, R. A., McCauley, E.
This study was conducted to compare the outcomes of a group-based cognitive-behavioral preventive intervention (Positive Thoughts and Actions [PTA]) tailored to youth in middle school with a brief, individually administered supportive intervention (Individual Support Program [ISP]). A randomized, controlled trial was conducted with 120 early adolescents (72 girls, 48 boys; age = 11-15 years) who had elevated depressive symptoms and were selected from a school-based population. Measures of internalizing problems, externalizing problems, personal adjustment, school problems, and interpersonal relations were obtained from parents, youth, and/or teachers at preintervention (Time 1) and postintervention (Time 2, 5-7 months after preintervention). General linear model repeated measures analyses yielded a significant Group null Time interaction on youth-reported, but not parent-reported, depressive symptoms and internalizing symptoms. Youth in the PTA group showed greater decreases following intervention compared to youth who received ISP, yielding effect sizes (Cohen's d) of 0.36 for depressive symptoms, 95% CI [-.02,.73], and 0.44, 95% CI [.05,.82], for internalizing symptoms. PTA youth also showed improvements in their personal adjustment (sense of inadequacy, self-esteem), and parent-reported social skills, but no differences emerged between groups for externalizing symptoms, school problems, or interpersonal relationships. Cognitive-behavioral preventive interventions in which youth engage in personal goal-setting and practice social-emotional skills, such as PTA, may be beneficial for the reduction of depressive symptoms over and above general support and empathy. (copyright) 2013 Copyright Taylor and Francis Group, LLC.
Journal of Clinical Child & Adolescent Psychology, 42(4) : 554-563
- Year: 2013
- Problem: Depressive Disorders
- Type: Randomised controlled trials
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Stage: At risk (indicated or selected prevention)
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Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Supportive therapy
Melnyk, B. M., Jacobson, D., Kelly, S., Belyea, M., Shaibi, G., Small, L., O'Haver, J., Marsiglia, F. F.
Background: Although obesity and mental health disorders are two major public health problems in adolescents that affect academic performance, few rigorously designed experimental studies have been conducted in high schools. Purpose: The goal of the study was to test the efficacy of the COPE (Creating Opportunities for Personal Empowerment) Healthy Lifestyles TEEN (Thinking, Emotions, Exercise, Nutrition) Program, versus an attention control program (Healthy Teens) on: healthy lifestyle behaviors, BMI, mental health, social skills, and academic performance of high school adolescents immediately after and at 6 months post-intervention. Design: A cluster RCT was conducted. Data were collected from January 2010 to May of 2012 and analyzed in 2012-2013. Setting/participants: A total of 779 culturally diverse adolescents in the U.S. Southwest participated in the trial. Intervention: COPE was a cognitive-behavioral skills-building intervention with 20 minutes of physical activity integrated into a health course, taught by teachers once a week for 15 weeks. The attention control program was a 15-session, 15-week program that covered common health topics. Main outcome measures: Primary outcomes assessed immediately after and 6 months post-intervention were healthy lifestyle behaviors and BMI. Secondary outcomes included mental health, alcohol and drug use, social skills, and academic performance. Results: Post-intervention, COPE teens had a greater number of steps per day (p=0.03) and a lower BMI (p=0.01) than did those in Healthy Teens, and higher average scores on all Social Skills Rating System subscales (p-values <0.05). Teens in the COPE group with extremely elevated depression scores at pre-intervention had significantly lower depression scores than the Healthy Teens group (p=0.02). Alcohol use was 12.96% in the COPE group and 19.94% in the Healthy Teens group (p=0.04). COPE teens had higher health course grades than did control teens. At 6 months post-intervention, COPE teens had a lower mean BMI than teens in Healthy Teens (COPE=24.72, Healthy Teens=25.05, adjusted M=-0.34, 95% CI=-0.56, -0.11). The proportion of those overweight was significantly different from pre-intervention to 6-month follow-up (chi-square=4.69, p=0.03), with COPE decreasing the proportion of overweight teens, versus an increase in overweight in control adolescents. There also was a trend for COPE Teens to report less alcohol use at 6 months (p=0.06). Conclusions: COPE can improve short- and more long-term outcomes in high school teens. (copyright) 2013 American Journal of Preventive Medicine.
American Journal of Preventive Medicine, 45(4) : 407-415
- Year: 2013
- Problem: Anxiety Disorders (any), Depressive Disorders, Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Physical activity, exercise
Muriungi, S. K., Ndetei, D. M.
Objective. To determine the effectiveness of psycho-education on symptom severity in depression, hopelessness, suicidality, anxiety and risk of substance abuse among para-medical students at Kenya Medical Training College (KMTC). Methodology. A clinical trial drew experimental (N=1 181) and control (N=1 926) groups from different KMTC campuses. Self-administered questionnaires were used to collect data: the researcher-designed social demographic questionnaire was used at baseline only, while Beck's Depression Inventory, Beck's Hopelessness Scale, Beck's Suicide Ideation Scale, Beck's Anxiety Inventory and World Health Organization alcohol, smoking and substance involvement screening test (ASSIST) (for drug abuse) were used for baseline, mid-point and end-point assessments at 3-month intervals. The experimental group received a total of 16 hours of structured psycho-education. All study participants gave informed consent. Results. Overall, there was no significant reduction in symptom severity between the experimental and control groups at 3 months (p>0.05) but there was a significant difference at 6 months (p<0.05). Conclusion. Psycho-education was effective in reducing the severity of symptoms of depression, hopelessness, suicidality, anxiety and risk of substance abuse at 6 months.
South African Journal of Psychiatry, 19(2) : 41-50
- Year: 2013
- Problem: Anxiety Disorders (any), Depressive Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
, Substance Use Disorders (any)
- Type: Controlled clinical trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Psychoeducation
Lewandowski, R. E., Acri, M.C., Hoagwood, K. E., Olfson, M., Clarke, G., Gardner, W., Scholle, S. H., Byron, S., Kelleher, K., Pincus, H. A., Frank, S., Horwitz, S. M.,
Adolescent depression is a prevalent and disabling condition resulting in emotional suffering and social and educational dysfunction. Care for adolescent depression is suboptimal and could be improved through the development and use of quality indicators (QIs). This article reports on the development of a care pathway and QIs for the primary and specialty care management of adolescent depression from case identification through symptom remission. It presents evidence from a review of adolescent clinical practice guidelines and research literature to support QIs at critical nodes in the pathway, and describes implications for practice based on existing evidence. Barriers to measure development are identified, including gaps in empirical evidence, and a research agenda is suggested. (PsycINFO Database Record (c) 2014 APA, all rights reserved) (journal abstract)
Pediatrics, 132(4) : e996-e1009
- Year: 2013
- Problem: Depressive Disorders
- Type: Systematic reviews
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Service Delivery & Improvement
Lewis, K. M., Dubois, D. L., Bavarian, N., Acock, A., Silverthorn, N., Day, J., Ji, P., Vuchinich, S., Flay, B. R.
Purpose We examined the effects of Positive Action (PA), a school-based social-emotional learning and health promotion program, on the emotional health of predominately low-income and ethnic minority urban youth. Methods The study was a matched-pair, cluster-randomized controlled trial involving 14 Chicago public schools. Outcomes were assessed over a 6-year period of program implementation for a cohort of youth in each school, followed from grades 3 to 8. Youth reported on their emotional health (positive affect, life satisfaction, depression, anxiety) and social-emotional and character development. Growth-curve and structural-equation modeling analyses assessed overall program effects on the emotional health outcomes as well as mediation of these effects via the program's impact on youths' social-emotional and character development. Results Students in PA schools, compared with those in control schools, had more favorable change over the course of the study in positive affect (standardized mean difference effect size [ES] =.17) and life satisfaction (ES =.13) as well as significantly lower depression (ES = -.14) and anxiety (ES = -.26) at study end point. Program effects for positive affect, depression, and anxiety were mediated by more favorable change over time in social-emotional and character development for students in PA schools. Conclusions Results suggest that universal, school-based programs can benefit the emotional health of youth in low-income, urban settings. The modest magnitude of effects over an extended period of program implementation, however, reflects the challenges of both mounting interventions and offsetting formidable risks for mental health problems in such environments. (copyright) 2013 Society for Adolescent Health and Medicine. All rights reserved.
Journal of Adolescent Health, 53(6) : 706-711
- Year: 2013
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Lee, R. S. C., Redoblado-Hodge, M. A., Naismith, S. L., Hermens, D. F., Porter, M. A., Hickie, I. B.
Background: Cognitive remediation (CR) is an effective treatment for several psychiatric disorders. To date, there have been no published studies examining solely first-episode psychiatric cohorts, despite the merits demonstrated by early intervention CR studies. The current study aimed to assess the effectiveness of CR in patients with a first-episode of either major depression or psychosis. Method: Fifty-five patients (mean age=22.8 years, S.D.=4.3) were randomly assigned to either CR (n = 28) or treatment as usual (TAU; n = 27). CR involved once-weekly 2-h sessions for a total of 10 weeks. Patients were comprehensively assessed before and after treatment. Thirty-six patients completed the study, and analyses were conducted using an intent-to-treat (ITT) approach with all available data. Results: In comparison to TAU, CR was associated with improved immediate learning and memory controlling for diagnosis and baseline differences. Similarly, CR patients demonstrated greater improvements than TAU patients in psychosocial functioning irrespective of diagnosis. Delayed learning and memory improvements mediated the effect of treatment on psychosocial functioning at a marginal level. Conclusions: CR improves memory and psychosocial outcome in first-episode psychiatric out-patients for both depression and psychosis. Memory potentially mediated the functional gains observed. Future studies need to build on the current findings in larger samples using blinded allocation and should incorporate longitudinal follow-up and assessment of potential moderators (e.g. social cognition, self-efficacy) to examine sustainability and the precise mechanisms of CR effects respectively. (PsycINFO Database Record (c) 2013 APA, all rights reserved) (journal abstract)
Psychological Medicine, 43(6) : 1161-1173
- Year: 2013
- Problem: Depressive Disorders, Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
, First episode (psychosis only)
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Treatment and intervention: Psychological Interventions (any)
, Cognitive remediation therapy