ABSTRACT
BACKGROUND: Currently, there is a strong movement to implement mindfulness interventions with young people. The objective of this randomised clinical trial was to assess the potential effects of a mindfulness-based stress reduction (MBSR) programme for adolescent outpatients in mental health facilities in Cordoba, Spain. METHOD: A total of 101 adolescents aged 13-16 years old, receiving psychological or psychiatric treatment for various disorders, were eligible for the study. The participants' scores on mindfulness, self-esteem, perceived stress, state-trait anxiety and other psychological symptoms were examined at two time-points. Eighty adolescents completed the study (MBSR+TAU group = 41; TAU group = 39). RESULTS: The MBSR+TAU group showed a statistically significant decrease in anxiety state compared to the treatment-as-usual (TAU) group. No statistically significant differences were found between groups on the other scores, but the intervention was observed to have a greater impact on the MBSR+TAU group than in the TAU group, especially in reducing symptoms of depression, anxiety, paranoia and perceived stress. CONCLUSION: These results suggest that MBSR may be a useful adjunct treatment for adolescents in mental health facilities
ANTECEDENTES: actualmente, existe un fuerte movimiento respecto a la implantación de las intervenciones de mindfulness con adolescentes. El objetivo de este ensayo clínico fue evaluar el efecto potencial de un programa de reducción del estrés basado en la atención plena (MBSR) para pacientes ambulatorios adolescentes en los servicios de salud mental de Córdoba, España. MÉTODO: un total de 101 adolescentes (13-16 años) con trastornos heterogéneos que recibían tratamiento psicológico o psiquiátrico fueron seleccionados para participar en el estudio. Las puntuaciones de los participantes en mindfulness, autoestima, estrés percibido, ansiedad estado-rasgo y otros síntomas psicológicos fueron evaluados en dos momentos. Ochenta adolescentes completaron el estudio (grupo-MBSR+TAU = 41, grupo-TAU = 39). RESULTADOS: el grupo MBSR+TAU muestra una disminución estadísticamente significativa en ansiedad-estado comparado con el grupo de tratamiento habitual (grupo-TAU). No hay diferencias estadísticamente significativas entre los grupos en el resto de puntuaciones, pero hemos encontrado un mayor impacto de la intervención en el grupo MBSR+TAU que en el grupo TAU, especialmente en la reducción de los síntomas de depresión, ansiedad, paranoia y estrés percibido. CONCLUSIÓN: estos resultados sugieren que MBSR puede ser un tratamiento complementario útil para los adolescentes en los servicios de salud mental
Subject(s)
Humans , Female , Adolescent , Cognitive Behavioral Therapy/methods , Mental Disorders/therapy , Mindfulness , Psychology, Adolescent , Stress, Psychological/therapy , Anxiety Disorders/psychology , Anxiety Disorders/therapy , Depressive Disorder/psychology , Depressive Disorder/therapy , Mental Disorders/psychology , Paranoid Behavior/psychology , Paranoid Behavior/therapy , Self Concept , Surveys and Questionnaires , Stress, Psychological/prevention & controlABSTRACT
BACKGROUND: Many patients with psychotic disorders have persistent paranoid ideation and avoid social situations because of suspiciousness and anxiety. We investigated the effects of virtual-reality-based cognitive behavioural therapy (VR-CBT) on paranoid thoughts and social participation. METHODS: In this randomised controlled trial at seven Dutch mental health centres, outpatients aged 18-65 years with a DSM-IV-diagnosed psychotic disorder and paranoid ideation in the past month were randomly assigned (1:1) via block randomisation to VR-CBT (in addition to treatment as usual) or the waiting list control group (treatment as usual). VR-CBT consisted of 16 individual therapy sessions (each 1 h long). Assessments were done at baseline, after treatment (ie, 3 months from baseline), and at a 6 month follow-up visit. The primary outcome was social participation, which we operationalised as the amount of time spent with other people, momentary paranoia, perceived social threat, and momentary anxiety. Analysis was by intention to treat. This trial was retrospectively registered with ISRCTN, number 12929657. FINDINGS: Between April 1, 2014, and Dec 31, 2015, 116 patients with a psychotic disorder were randomly assigned, 58 to the VR-CBT group and 58 to the waiting list control group. Compared with the control, VR-CBT did not significantly increase the amount of time spent with other people at the post-treatment assessment. Momentary paranoid ideation (b=-0·331 [95% CI -0·432 to -0·230], p<0·0001; effect size -1·49) and momentary anxiety (-0·288 [-0·438 to -0·1394]; p=0·0002; -0·75) were significantly reduced in the VR-CBT group compared with the control group at the post-treatment assessment, and these improvements were maintained at the follow-up assessment. Safety behaviour and social cognition problems were mediators of change in paranoid ideation. No adverse events were reported relating to the therapy or assessments. INTERPRETATION: Our results suggest that the addition of VR-CBT to standard treatment can reduce paranoid ideation and momentary anxiety in patients with a psychotic disorder. FUNDING: Fonds NutsOhra, Stichting tot Steun VCVGZ.
Subject(s)
Cognitive Behavioral Therapy , Paranoid Behavior/therapy , Psychotic Disorders/therapy , Social Isolation , Virtual Reality , Adolescent , Adult , Aged , Cognitive Behavioral Therapy/methods , Female , Humans , Male , Middle Aged , Paranoid Behavior/psychology , Psychiatric Status Rating Scales , Single-Blind Method , Social Participation , Treatment Outcome , Young AdultABSTRACT
El síndrome de Sturge-Weber (SSW) es una anomalía congénita de origen desconocido caracterizada por angioma cutáneo, glaucoma congénito, calcificaciones intracraneales, crisis epilépticas, retraso intelectual y hemiparesia contralateral. Desde el punto de vista psiquiátrico el SSW se asocia típicamente a cuadros afectivos, trastornos adaptativos y alteraciones conductuales. Los síntomas psicóticos son poco frecuentes y suelen caracterizarse por la presencia de delirios de contenido paranoide. El presente artículo hace una pequeña revisión sobre las características clínicas y los criterios diagnósticos clásicos de este síndrome y presenta un caso clínico de una mujer de 48 años aquejada del SSW que muestra episodios psicóticos con delirios y alucinaciones auditivas y visuales que precisaron ingreso hospitalario. La paciente tenía una conciencia parcial de enfermedad y mejoró con el uso de un antipsicótico vía parenteral (palmitato de paliperidona). El presente caso tiene importancia clínica y puede servir para que otros profesionales sepan cómo diagnosticar y tratar dicho síndrome (AU)
Sturge-Weber syndrome (SWS) congenital anomaly of unknown origin, and is characterised by cutaneous angioma, congenital glaucoma, intracranial calcifications, epileptic seizures, intellectual retardation, and contralateral hemiparesis. From a psychiatric point of view, SWS is typically associated with affective symptoms, adaptive disorders, and behavioural changes. Psychotic symptoms are uncommon and are usually characterised by the presence of a paranoid-type delirium. This article presents a short review of the clinical characteristics and classic diagnostic criteria of this syndrome, as well as presenting a case of a 48 year-old women suffering from SWS who had psychotic episodes with delirium and auditory and visual hallucinations that required hospital admission. The patient was partially aware of the disease, and improved with the use of parenteral antipsychotics (paliperidone palmitate). The case presented is of clinical importance and may enable other professionals to know how to diagnose and treat this syndrome (AU)
Subject(s)
Humans , Female , Middle Aged , Sturge-Weber Syndrome/diagnosis , Sturge-Weber Syndrome/drug therapy , Sturge-Weber Syndrome/psychology , Delirium/complications , Delirium/therapy , Delusions/complications , Delusions/diagnosis , Diagnosis, Differential , Paranoid Behavior/physiopathology , Paranoid Behavior/therapy , Paranoid Disorders/complications , Paranoid Disorders/physiopathology , Paranoid Disorders/therapy , Paranoid Personality Disorder/complicationsABSTRACT
OBJECTIVES: Multiple complex developmental disorder (MCDD) is a little-known disorder characterized by disturbances in the regulation of emotions, social interactions and thought disorders. Neither the classification system of ICD-10 nor the DSM-IV lists MCDD as an independent disorder. METHODS: The study presents an overview on diagnostic criteria, current research and illustration by a case report of a 17-year-old adolescent. RESULTS: MCDD, autistic disorders and schizophrenic disorders partially overlap. A clear classification or differentiation is currently not clearly possible. CONCLUSIONS: Many open questions remain, and further research is needed.
