ABSTRACT
This is a longitudinal randomized control trial on the impact of adding a parent psychoeducation intervention (TEPSI) as part of cognitive-behavioral therapy (CBT) for adolescents with Major Depressive Disorder (MDD) in a Puerto Rican sample. We tested the efficacy of adding 8 group sessions of TEPSI to 12 sessions of individual CBT on reducing depressive symptoms, MDD diagnosis, and improving family functioning. Participants (n = 121) were randomized to individual CBT with or without TEPSI. No main group effects were found for most patient domains including depression symptoms, as well as presence of adolescent's MDD diagnosis at posttreatment. Results did show a main effect of CBT over time for depression symptoms, suicide ideation, family criticism, and the presence of MDD diagnosis decreasing from pre- to postintervention. A year post treatment, almost 70% of adolescents in both conditions (CBT and CBT + TEPSI) remained in remission. A main effect was obtained for treatment in the adolescent's perception of familism and family emotional involvement. The primary hypothesis that family psychoeducation would optimize CBT for depression in adolescents was not supported. Both conditions yielded similar clinical end points. The culturally adapted CBT was found effective with Latino/a adolescents showing clinically significant improvements from pretreatment to posttreatment and remained stable at a 1-year follow-up. Regarding family outcomes, adolescents in CBT + TEPSI remained stable from pretreatment to posttreatment on family emotional involvement, while adolescents in CBT-alone showed an increase. The implication of these findings is discussed.
Este es un ensayo clínico longitudinal aleatorizado y controlado sobre el efecto de agregar una intervención psicoeducativa para los padres (TEPSI, en inglés) como parte de la terapia cognitivo-conductual (TCC) para adolescentes con trastorno depresivo mayor (TDM) en una muestra puertorriqueña. Evaluamos la eficacia de agregar 8 sesiones grupales de TEPSI a 12 sesiones de TCC individual en la reducción de síntomas depresivos, en el diagnóstico de TDM y en la mejora del funcionamiento familiar. Los participantes (n = 121) fueron distribuidos al azar a la TCC individual con o sin TEPSI. No se encontraron efectos grupales principales en la mayoría de las áreas de los pacientes, como en los síntomas de depresión ni en la presencia de un diagnóstico de TDM en los adolescentes después del tratamiento. Los resultados sí demostraron un efecto principal de la TCC con el tiempo para los síntomas de depresión, las ideas suicidas, la crítica familiar y la presencia de un diagnóstico de TDM que disminuye desde antes hasta después de la intervención. Un año después del final del tratamiento, casi el 70 % de los adolescentes en ambas condiciones (TCC y TCC + TEPSI) se mantuvo en remisión. Se obtuvo un efecto principal del tratamiento en la percepción de los adolescentes del familismo y la implicación emocional familiar. No se respaldó la hipótesis principal de que la psicoeducación familiar optimizaría la TCC para la depresión en los adolescentes. Ambas condiciones dieron variables clínicas similares. Se descubrió que la TCC culturalmente adaptada fue eficaz con los adolescentes latinos, ya que demostró mejoras clínicas considerables desde antes del tratamiento hasta después del tratamiento y permaneció estable un año después al momento del seguimiento. Con respecto a los resultados familiares, los adolescentes de la TCC + TEPSI se mantuvieron estables desde antes del tratamiento hasta después del tratamiento en la implicación emocional familiar, mientras que los adolescentes de la TCC sola demostraron un aumento. Se debaten las implicancias de estos resultados.
Subject(s)
Cognitive Behavioral Therapy/methods , Depressive Disorder, Major/therapy , Family Therapy/methods , Parents/education , Patient Education as Topic/methods , Adolescent , Adult , Depressive Disorder, Major/psychology , Female , Humans , Male , Middle Aged , Parents/psychology , Puerto Rico , Treatment OutcomeABSTRACT
Video games have become a popular entertainment among adolescents. Although some video games are educational, there are others with high content of violence and the potential for other harmful effects. Lack of appropriate supervision of video games use during adolescence, a crucial stage of development, may lead to serious behavioral consequences in some adolescents. There is also concern about time spent playing video games and the subsequent neglect of more developmentally appropriate activities, such as completing academic tasks. Self-administered questionnaires were used to assess video game use patterns and parental supervision among 55 adolescent patients 13-17 years old (mean age 14.4 years; 56.4% males) and their parents. Parental supervision /monitoring of the adolescents video games use was not consistent and gender related differences were found regarding their video game use. Close to one third (32%) of the participants reported video game playing had interfered with their academic performance. Parents who understood video games rating system were more likely to prohibit their use due to rating. These findings underscore the need for clear and consistently enforced rules and monitoring of video games use by adolescents. Parents need to be educated about the relevance of their supervision, video games content and rating system; so they will decrease time playing and exposure to potentially harmful video games. It also supports the relevance of addressing supervision, gender-based parental supervisory styles, and patterns of video games use in the evaluation and treatment of adolescents.
Subject(s)
Hispanic or Latino , Parenting , Video Games/statistics & numerical data , Adolescent , Female , Humans , Male , Surveys and QuestionnairesABSTRACT
The Department of Psychiatry of the University of Puerto Rico was established 50 years ago. We describe its mission and accomplishments in Education, Clinical Services and Research. We are proud of our achievements in preparing 243 General Psychiatrists and 65 Child/Adolescent Psychiatrists as well as participating in the education to medical students and other health related disciplines. There have being other excellent contributions in Clinical Services and Research. The Department will continue it's commitment with the education of Residents and students and offering high quality clinical services based on up-to date research. An example of that is the establishment of the CEMPAS, an anxiety specialty center with special interest in psychosomatic medicine.
Subject(s)
Psychiatry/history , Schools, Medical/history , Universities/history , History, 20th Century , History, 21st Century , Puerto RicoABSTRACT
Attention deficit and hyperactivity disorders are among the most common psychiatric disorder in children. In a great number of cases, its presentation is manifested throughout the life cycle. There are serious consequences when this disorder is not detected early or effectively treated, including substance abuse, delinquent behavior, and poor interpersonal relationships among many others. This article reviews clinical data from scientific studies among our population and compares findings with national data, including prevalence, clinical differences by genre, clinical correlations and its implications, as well as evidence in treatment options. General findings are alarming as there is poor detection and less than optimal treatment offered to our population.
