Patients' attitudes to discontinuing not-indicated long-term antidepressant use:Barriers and facilitators

Contains fulltext : 208034.pdf (publisher's version ) (Open Access

The Feasibility, Effectiveness, and Process of Change of Mindfulness-Based Cognitive Therapy for Adults With ADHD:A Mixed-Method Pilot Study

Objective: Mindfulness-Based Cognitive Therapy (MBCT) is a promising psychosocial intervention for adult ADHD. The feasibility and effectiveness of an adapted MBCT program is explored, together with the possible process of change. Method: Mixed-method study with 31 ADHD patients participating in an adapted MBCT program. Self-report questionnaires on ADHD symptoms, executive functioning, mindfulness skills, self-compassion, patient functioning, and health status were administered before and after MBCT. Semi-structured interviews were conducted with 24 patients. Results: A modest drop-out of n = 5 (16%) was found. MBCT resulted in a significant reduction of ADHD symptoms and improvements of executive functioning, self-compassion, and mental health. Qualitative analysis provided insight in facilitators and barriers participants experienced, and their process of change. Conclusion: The adapted MBCT program seemed to be feasible for adults with ADHD and preliminary evidence for the effectiveness is shown. An adequately powered Randomized Controlled Trial (RCT) is needed to further examine the effectiveness of MBCT for ADHD

Table of Contents

Table of contents for Volume 10, Issue 3 of the Linfield Magazin

How medical specialists experience the effects of a mindful leadership course on their leadership capabilities: a qualitative interview study in the Netherlands

OBJECTIVES: Medical leaders are facing leadership challenges that ask for a leadership style that takes care of both themselves and their coworkers. Mindfulness may support this leadership style. We explored how a 'Mindful leadership for medical specialists' course affected medical specialists' leadership. DESIGN: We conducted a qualitative study based on in-depth interviews. The grounded theory method was used to analyse the data. SETTING: A university medical centre in the Netherlands. PARTICIPANTS: Seventeen medical specialists (six male) with an average age of 51 years (ranging from 40 to 66 years). INTERVENTIONS: The mindful leadership course consisted of 10-weekly 5-hour sessions that focused on cultivating mindfulness and compassion. In addition, sessions included didactic and interactional teaching about leadership theories. RESULTS: Four categories emerged from the data: (A) Self - Attitude: psychological attitude towards self, (B) Self - Behaviour: behaviour towards self, (C) Other - Attitude: psychological attitude towards others, and (D) Other - Behaviour: behaviour towards others. Themes were defined within these categories: awareness of self, open mind, insight and appreciation of self (A), emotional and cognitive self-regulation, letting go of unhelpful behaviour and developing helpful behaviour (B), differences in attitude to others such as awareness of (impact on) others, keeping an open mind about others, allowing difficult emotions associated with others, appreciating of others (C), and communicating more effectively, providing direction, empowering and caring for others (D). CONCLUSIONS: The results help us understand the core elements of mindful leadership, both with respect to one's psychological attitude and behaviour towards oneself and others. More research on mindful leadership and the effects on self and others is needed. Mindful leadership courses could be a valuable part of clinical training and might contribute to more sustainable healthcare organisations

Mindfulness-based stress reduction for elementary school teachers:a randomized controlled trial

Educators frequently grapple with elevated levels of job-related stress, heightening the risk of mental health issues. Although Mindfulness-Based Stress Reduction (MBSR) has demonstrated effectiveness in reducing stress among the general populace, its implementation among educators, especially in non-United States settings, has received limited exploration. This pre-registered randomized-controlled trial investigates the effectiveness of the standard MBSR in reducing perceived stress among Dutch elementary school teachers. Additionally, it examines the impact of MBSR on mindfulness skills, emotion regulation, and self-compassion as secondary proximal outcomes, along with exploring its influence on teacher self-efficacy, perceived pupil-teacher relationships, and classroom climate quality as secondary distal outcomes. Involving 146 teachers randomly assigned to either the intervention (n = 72) or waitlist-control condition (n = 74), assessments were conducted pre- and post-intervention or control period, with a 3-month follow-up. Participants in the intervention reported significantly lower perceived stress compared to the control group, demonstrating a substantial effect size at post-treatment (d = −0.84) and a moderate effect at follow-up (d = −0.69). MBSR not only yielded improvements in personal well-being but also positively impacted teacher self-efficacy and classroom climate quality at both post-treatment and follow-up. These positive outcomes aligned with enhancements in mindfulness skills, emotion regulation, and self-compassion. However, no significant effects were observed on the pupil-teacher relationship. Exploratory analyses revealed no moderation effects based on past or present psychological problems, school weight/pupil population, years of experience, or age on perceived stress at post-measurement. Furthermore, the study examined the potential influence of COVID-19 on the results, concluding that the pandemic had no discernible impact. These findings advocate for the widespread adoption of the standard MBSR program as a means of enhancing the well-being of elementary school teachers.</p

A cross-sectional examination of psychological distress, positive mental health and their predictors in medical students in their clinical clerkships

Background Medical students can experience the transition from theory to clinical clerkships as stressful. Scientific literature on the mental health of clinical clerkship students is scarce and mental health is usually defined as absence of psychological distress without assessing psychological, emotional and social wellbeing, together called ‘positive mental health’. This cross-sectional study examines the prevalence of psychological distress and positive mental health and explores possible predictors in a Dutch sample of clinical clerkship students. Methods Fourth-year medical students in their first year of clinical clerkships were invited to complete an online questionnaire assessing demographics, psychological distress (Brief Symptom Inventory), positive mental health (Mental Health Continuum- SF), dysfunctional cognitions (Irrational Beliefs Inventory) and dispositional mindfulness skills (Five Facet Mindfulness Questionnaire). Multiple linear regression analysis was used to explore relationships between psychological distress, positive mental health (dependent variables) and demographics, dysfunctional cognitions and dispositional mindfulness skills (predictors). Results Of 454 eligible students, 406 (89%) completed the assessment of whom 21% scored in the clinical range of psychological distress and 41% reported a flourishing mental health. These proportions partially overlap each other. Female students reported a significantly higher mean level of psychological distress than males. In the regression analysis the strongest predictors of psychological distress were ‘acting with awareness’ (negative) and ‘worrying’ (positive). Strongest predictors of positive mental health were ‘problem avoidance’ (negative) and ‘emotional irresponsibility’ (negative). Conclusions The prevalence of psychopathology in our sample of Dutch clinical clerkship students is slightly higher than in the general population. Our results support conclusions of previous research that psychological distress and positive mental health are not two ends of one continuum but partially overlap. Although no conclusion on causality can be drawn, this study supports the idea that self-awareness and active, nonavoidant coping strategies are related to lower distress and higher positive mental health.This study was financed by the Department of Psychiatry and Department of Primary and Community Care of the Radboudumc and by a grant of the department of Evaluation, Quality and Development of Education of the Radboudum

Withdrawal of unnecessary antidepressant medication:a randomised controlled trial in primary care

Background: Antidepressant use has increased exponentially in recent decades, mostly due to long continuation.Aim: To assess the effectiveness of a tailored recommendation to withdraw antidepressant treatment.Design &amp; setting: Randomised controlled trial in primary care (PANDA study) in the Netherlands.Method: Long-term antidepressant users (≥9 months) were selected from GPs prescription databases. Patients were diagnosed with the Composite International Diagnostic Interview (CIDI). Long-term users without indication for maintenance treatment (overtreatment) were selected. The intervention consisted of disclosure of the current psychiatric diagnosis combined with a tailored treatment recommendation. Patients were followed for 12 months.Results: The study included 146 participants from 45 family practices. Of the 70 patients in the intervention group, 34 (49%) did not comply with the advice to stop their antidepressant medication. Of the 36 (51%) patients who agreed to try, only 4 (6%) succeeded. These figures were consistent with the control group, where 6 (8%) of the 76 patients discontinued antidepressant use successfully. Patients who were recommended to discontinue their antidepressant medication reported a higher relapse rate than the control group (26% versus 13%, P = 0.05).Conclusion: Changing inappropriate long-term antidepressant use is difficult.</p

Exploring Fear of Cancer Recurrence in a sample of heterogeneous distressed cancer patients with and without a psychiatric disorder

Fear of Cancer Recurrence (FCR) is a concern among cancer patients. Recent insights suggest that FCR should be viewed as a distinct syndrome. However, few studies have explored its overlap with psychiatric morbidity. We examined this overlap in a sample of distressed cancer patients. Self-referred patients (n = 245) were assessed with the Structured Clinical Interview for DSM-IV-TR Axis-I disorders and the Fear of Cancer Recurrence Inventory-Short Form. Proportions of patients with and without a psychiatric disorder meeting validated cut-offs for screening and clinically relevant FCR were compared. The prevalence of psychiatric disorders was 36%. Clinically relevant FCR was found in 198 patients (81%). Patients with a current psychiatric disorder reported clinically relevant FCR more frequently (89%) compared to those with no disorder (77%). Of patients reporting clinically relevant FCR, the majority (61%) did not additionally meet the criteria for a psychiatric disorder. These findings suggest that there should be particular attention for patients with elevated levels of FCR, warranting FCR-specific treatment. Trial registry number Clinicaltrials.gov NCT0213851

A multi-method assessment of attentional processes in chronic, treatment-resistant depression

Contains fulltext : 233751.pdf (Publisher’s version ) (Open Access)Attentional deficits as well as attentional biases towards negative material are related to major depression and might maintain chronicity. However, studies investigating attentional deficits and attentional biases in chronic, treatment-resistant depressed are lacking. The aim of the current study was to compare measures of attentional deficits and attentional bias between chronic, treatment-resistant depressed outpatients and never-depressed control participants. Attentional deficits were assessed with the attentional control scale (ACS) and the Stroop Color naming task. Attentional bias was measured with the exogenous cueing task (ECT) and an emotional Stroop task. Chronic, treatment-resistant depressed patients (n=80) showed significantly more attentional deficits than never-depressed controls (n=113) on the ACS and Stroop color-naming task. However, in contrast with hypotheses, no differences were found between chronic, treatment-resistant depressed patients and never-depressed individuals on the ECT or emotional Stroop task. The current findings indicate that chronic, treatment-resistant depressed patients present attentional deficits. The results however question whether this patient group shows attentional biases for negative material. Future research should include comparisons of chronic, treatment-resistant and non-chronically depressed patients. If replicated, these current results might indicate that focusing on improving attentional deficits could be a more promising target for treatment than addressing attentional biases.9 p

Putting mindfulness-based cognitive therapy to the test in routine clinical practice:A transdiagnostic panacea or a disorder specific intervention?

BACKGROUND: Over the past two decades there has been a growing number of randomized clinical trials supporting the efficacy of mindfulness-based cognitive therapy (MBCT) in the treatment of several psychiatric disorders. Since evidence for its effectiveness in routine clinical practice is lagging behind, we aimed to examine adherence, outcome and predictors of MBCT in a well-characterized, heterogeneous outpatient population in routine clinical practice. METHODS: Data were collected from a naturalistic uncontrolled cohort of 998 patients formally diagnosed with mainly depression, anxiety disorders, personality disorders, somatoform disorders and/or ADHD. Patients received protocolized MBCT and completed self-report questionnaires pre- and post-treatment on overall functioning (Outcome Questionnaire, primary outcome), depressive symptoms, worry, mindfulness skills and self-compassion. Pre-to post-treatment changes were analysed for the overall sample and each diagnostic category separately with paired sample t-tests, reliable change indices (only overall sample) and repeated measures ANOVA for groups with and without comorbidity. Multiple linear regression was carried out to assess possible predictors of adherence and change in overall functioning. RESULTS: Adherence was high (94%) but negatively affected by lower levels of education, more comorbidity and presence of ADHD. Outcome in terms of improvement in overall functioning was good in the overall sample (Cohen's d = 0.50, 30% showed reliable improvement vs. 3.5% reliable deterioration) and within each diagnostic category (Cohen's d range = 0.37-0.61). Worse overall functioning at baseline was the only predictor for a larger treatment effect. CONCLUSIONS: After MBCT, overall functioning improved in a large heterogeneous psychiatric outpatient population independent of diagnosis or comorbidity