Psychotherapeutic Interventions for Adolescents With Mental Disorders : Effectiveness and Predictors of Treatment Outcome

The prevalence of mental disorders increases significantly in adolescence. Half of the lifetime mental disorders start by the age of 14 years, with the proportion increasing to 75% by the age of 24 years. Psychotherapeutic interventions have proven effective in treating adolescents in randomized controlled trials, but the outcomes are typically measured with instruments designed for use in adults, and the evidence in naturalistic settings is limited. In addition, an understanding of the factors associated with successful treatment is needed to be able to make more individualized treatment recommendations. The aim of this study was to investigate the effectiveness of psychotherapeutic interventions for adolescents, to identify sociodemographic, clinical, and treatment-related variables related to treatment outcome and premature termination of treatment, and to examine the relation between patients’ own expectations and therapeutic alliance and treatment outcome. In addition, the study evaluated the psychometric properties and acceptability of the YP-CORE measure, designed to assess change and treatment outcomes in psychotherapeutic interventions among adolescents. The study was conducted in the Adolescent Psychiatry Unit of the Department of Psychiatry, Helsinki University Hospital. In the effectiveness studies (Studies I-III), 58 adolescents (mean age 14.2 years) referred to psychotherapeutic interventions completed self-assessments of psychological well-being and functioning (BDI-21, CORE-OM, SDQ) at baseline prior to starting the psychotherapeutic intervention and after three, six, and 12 months of treatment. In addition, patients filled in an assessment of control expectations (TBK) and therapeutic alliance (WAI-P). Therapists also assessed the alliance (WAI-T). In the study of psychometric properties of YP-CORE (Study IV), 104 adolescents (mean age 15.0 years) filled in self-assessments of YP-CORE, BDI-21, and BAI at the beginning of treatment in the psychiatric outpatient clinic and again after receiving three months of treatment. Psychotherapeutic interventions were effective in reducing symptoms and improving functioning in clinically referred adolescents with mental disorders. The largest change occurred during the first six months of treatment. The frequency of the intervention was the strongest predictor of good treatment outcome. Type of treatment was not related to outcome. Adolescents’ and therapists’ assessments of the alliance remained stable throughout treatment but were not related to each other. Strong alliance predicted better outcome, especially when assessed at baseline by the adolescent and when congruent with the therapist's assessment. Adolescents with externalizing symptoms and low expectations of their own role in treatment were at higher risk for premature termination of treatment, as were adolescents reporting weak or weakening alliance during treatment. The Finnish version of YP-CORE showed good psychometric properties and is suitable for use in measuring treatment outcomes of psychotherapeutic interventions in adolescents. Providing psychotherapeutic interventions intensively for at least six months would be important for reducing psychological symptoms and improving functioning of adolescents with mental disorders. Therapists should be aware of patients’ externalizing symptoms and focus on strengthening adolescents’ active role during treatment to increase their commitment to the process, and thus benefit more from treatment. Age-specific validated measures should be used in assessment of treatment outcomes. As the therapeutic alliance measured by patients but not by therapists was related to more successful treatment, measures on therapeutic alliance should be routinely used when implementing psychotherapeutic interventions in practice.Nuoruusiässä mielenterveyden häiriöiden yleisyys kasvaa merkittävästi. Diagnosoiduista häiriöistä 50% ilmenee 14 ikävuoteen mennessä, ja peräti 75% 24 vuoteen mennessä. Psykoterapeuttiset interventiot ovat satunnaistetuissa kontrolloiduissa tutkimuksissa osoittautuneet tehokkaiksi nuoruusikäisten mielenterveyden häiriöiden hoidossa, mutta vaikuttavuutta mitataan usein aikuisille kehitetyillä menetelmillä, eikä psykoterapeuttisten interventioiden vaikuttavuudesta naturalistisissa asetelmissa ole vielä riittävästi tutkimusnäyttöä. Lisäksi tarvitaan ymmärrystä siitä, mitkä tekijät ovat yhteydessä hoidon vaikuttavuuteen, jotta on mahdollista laatia yksilöllisempiä hoitosuosituksia. Tämän tutkimuksen tavoitteena oli tutkia psykoterapeuttisten interventioiden vaikuttavuutta nuoruusikäisillä psykiatrisilla avohoidon potilailla sekä selvittää vaikuttavuuteen ja hoidon keskeyttämiseen yhteydessä olevia sosiodemografisia, kliinisiä ja hoitoon liittyviä muuttujia, sekä tutkia potilaan omien odotusten ja potilaan ja terapeutin välisen yhteistyösuhteen merkitystä hoitotulosta ennustavina tekijöinä. Lisäksi tutkimuksessa arvioitiin hoidon vaikuttavuuden seurantaan nuorille suunnatun YP-CORE itsearviointimittarin suomenkielisen version psykometrisia ominaisuuksia ja käytettävyyttä. Tutkimus toteutettiin Helsingin ja Uudenmaan sairaanhoitopiirin (HUS) Psykiatrian tulosyksikön Nuorisopsykiatrian linjassa. Vaikuttavuustutkimuksen (osatutkimukset I-III) tutkimusaineisto koostui 58 nuoresta (ka. 14.2 vuotta), jotka oli ohjattu ostopalveluna toteutettaviin psykoterapeuttisiin interventioihin (keskusteluun pohjaavat sekä toiminnallisia elementtejä sisältävät terapiat). Potilaiden psyykkisiä oireita ja toimintakykyä kartoitettiin BDI-21, SDQ ja CORE-OM itsearviointimittareiden avulla ennen psykoterapeuttisen intervention alkua sekä kolme-, kuusi- ja 12-kuukautta hoidon alkamisen jälkeen. Potilaat täyttivät myös kontrolliodotuksia kartoittavan (TBK) ja terapeuttista yhteistyösuhdetta arvioivan (WAI-P) itsearviointilomakkeen. Lisäksi terapeutit täyttivät arvion yhteistyösuhteesta (WAI-T). YP-CORE menetelmän psykometrisia ominaisuuksia koskevan tutkimuksen (osatutkimus IV) aineisto koostui 104 nuoresta (ka. 15.0 vuotta), jotka aloittivat hoidon nuorisopsykiatrian poliklinikalla. Potilaat täyttivät YP-CORE, BDI-21 ja BAI itsearviointilomakkeet hoidon alkaessa sekä kolme kuukautta myöhemmin. Psykoterapeuttiset interventiot osoittautuivat vaikuttaviksi mielenterveyden häiriöistä kärsivien nuorten hoidossa vähentäen psyykkisiä oireita ja parantaen toimintakykyä. Suurin muutos ilmeni ensimmäisen kuuden kuukauden hoidon aikana. Intervention tiiviys oli keskeisin hoidon vaikuttavuuteen yhteydessä oleva tekijä, mutta hoitomuoto ei ollut yhteydessä parempaan hoitotulokseen. Nuorten ja terapeuttien arviot yhteistyösuhteesta säilyivät vakaina läpi hoidon, mutta ne eivät olleet yhteydessä toisiinsa. Hyvä yhteistyösuhde ennusti parempaa hoitotulosta etenkin hoidon alussa nuoren arvioimana, ja ollessaan yhtenevä terapeutin arvion kanssa. Nuoret, joilla oli eksternalisoivia oireita ja vähäinen odotus oman roolinsa aktiivisuudesta terapiassa olivat korkeammassa riskissä keskeyttää hoito samoin kuin nuoret, jotka kokivat yhteistyösuhteen heikoksi tai se heikkeni hoidon edetessä. Lisäksi YP-CORE arviointimenetelmän suomenkielisen version psykometriset ominaisuudet olivat hyvät ja se soveltuu käytettäväksi psykoterapeuttisten interventioiden vaikuttavuuden seurantaan nuoruusikäisillä. Psykoterapeuttisten interventioiden tarjoaminen tiiviisti vähintään puolen vuoden ajan olisi keskeistä nuorten psyykkisen oireilun vähentämiseksi ja toimintakyvyn parantamiseksi. Terapeuttien on tärkeä olla tietoisia siitä, jos nuorella on eksternalisoivia oireita, ja fokusoida nuoren oman aktiivisen roolin vahvistamiseen terapian aikana lisätäkseen nuoren sitoutumista ja sitä kautta hyötymistä psykoterapiasta. Psykoterapeuttisten interventioiden vaikuttavuuden seurannassa tulisi käyttää nuoruusikäisille suunnattuja validoituja menetelmiä. Koska arvio terapeuttisen yhteistyösuhteen laadusta potilaan arvioimana, mutta ei terapeutin arvioimana, on yhteydessä parempaan hoitotulokseen, tulisi psykoterapeuttisten interventioiden toteutuksessa hyödyntää säännönmukaisesti vaikuttavuuden arviointiin tarkoitettujen menetelmien lisäksi myös yhteistyösuhdetta kartoittavia arviointimenetelmiä

Sentimentality and Nostalgia in Elderly People: Psychometric Properties of a New Questionnaire

A new questionnaire measuring sentimentality and nostalgia in elderly people was developed based on the scale Sentimentality from HEXACO Personality Inventory – Revised (Lee & Ashton, 2013), the scale Sentimentality from Psychological Inventory of Criminal-Thinking Styles (PICTS) (Walters, 2002; Walters & Geyer, 2005); the subscale Sentimentality from Temperament and Character Inventory-Revised (TCI-R) (Cloninger, Svrakic, & Przybeck, 1993). A sample of 121 Bulgarian elderly people was studied. The results revealed the importance of the past for the elderly people. The questionnaire had good psychometric properties. Four factors were extracted - Past emotions continue in the present; Nostalgia of the Past; Sentimental compensation; and One’s past perceived by the others. Comparison of the average values on the factors divided into the number of the items in the factor indicated that nostalgia of the past was the most strongly expressed among the elderly people, followed by the experiences related to one’s past perceived by the other people, past emotions continuing in the present, and the attempts for sentimental compensation of some past bad deeds

Ageism and Negative Mental Tendencies in the Third Age

Ageism is one of the global problems of contemporary world. This article is an attempt to look at it from a point of view of mentality. A few of the main manifestations of ageism including prejudice and openly demonstrated discrimination against seniors are discussed. On the basis of a survey, some conclusions are made about the negative consequences from ageism for the mentality of older people. The survey was conducted among 27 people between the ages of 20 - 35 and 36 people between the ages of 65 - 80 (mean age of 73.5 years). Language: Englis

Library search-based drug analysis in forensic toxicology by liquid chromatography-mass spectrometry

Liquid chromatography–mass spectrometry (LC–MS) with electrospray (ES) ionization in the positive ion mode was applied to drug analysis in forensic toxicology. Several types of screening and confirmation strategies were developed, based essentially on searching of comprehensive MS libraries and databases that were created in-house for the purpose. Two spectral libraries, both containing spectra for approximately 400 drugs, were created. Spectra for the LC–MS/in-source collision-induced dissociation (CID) library were acquired by continuously switching between low (25 V) and high (90 V) orifice voltages during the run, and the summed mass spectra were added to the library. A library for liquid chromatography–triple quadrupole mass spectrometry (LC–MS/MS) was created by obtaining product ion spectra at a collision energy of 35 eV, and additionally at 20 eV or 50 eV, if the latter were more informative. The product ion spectra were reproducible in the long-term, based on a four-year experiment. Comparison of two libraries, independently created with similar instruments in different laboratories, showed that the libraries were fully compatible. Comparison of spectra obtained with different manufacturers' instruments suggested that after standardization of collision energy and gas pressure, LC–MS/MS spectral libraries are suitable for interlaboratory use. The libraries were utilized in two fully automated methods for selected drug groups, comprising screening and confirmation. Analysis of 16 β-blocking drugs in urine involved two-step MS analysis, including a screening step based on monitoring of protonated molecules and a confirmation step based on LC–MS/MS product ion spectra. A method for simultaneous screening and quantitation of 18 antihistamine drugs in blood involved multiple-reaction monitoring (MRM) for screening and quantitation and product ion spectra for confirmation of the drugs. The antihistamines were identified and quantified at concentrations ranging from subtherapeutic to toxic in blood. A data-dependent experiment (DDE) was utilized for automation of both procedures, from starting the sample batch to printing of the library search results. Two different approaches for comprehensive screening of drugs were developed. A method for simultaneous screening of 238 drugs in blood was developed using LC–MS/MS with multiple-reaction monitoring. Identification was based on RT and the presence of protonated molecule and one representative fragment ion. The method was shown to be sufficiently selective and sensitive to allow the majority of the drugs to be detected at therapeutic concentrations. Another approach was based on accurate mass determination with liquid chromatography–time-of-flight mass spectrometry (LC–MS/TOF), using a target database of monoisotopic masses for 433 drugs. The method was tentatively suitable for rapid screening of drugs in urine even without referral to primary reference standards.reviewe

Nostalgia and Sentimentality Among Minority Elderly People (Bulgarian Roma People and Hungarians Living in Romania)

Nostalgia and sentimentality are very typical for the old age. There are some characteristics that are perceived as typical for the elderly people in the different cultures, such as being dependent, and needing long-term care. There are also some similarities between the population tendencies in Bulgaria and Romania. The simultaneously acceptance in European Union of both countries also suggests the existence of some similar attitudes towards the past among elderly minority people in both countries. The hypothesis of the study was that together with some similarities, the elderly people from both ethnic minorities in the two countries would differ cross-culturally in their sentimentality and nostalgia related to the past. Sentimentality and nostalgia in elderly minority people (26 Roma people in Bulgaria and 21 Hungarians in Romania) were measured by means of a questionnaire created by Gergov & Stoyanova (2013). The results indicated that the Hungarian minority in Romania was more sentimental and nostalgic than the Roma minority in Bulgaria. More thoughts about the past reported the minority young elders than the minority oldest old. The females from the minority groups were more sentimental than the males from the minority groups. Higher sentimentality and nostalgia among elderly Hungarians could be explained by their higher conservatism and more satisfaction with the hystorical past than Roma people. Roma people living in institutions felt a sense of stability in their present and they shared some positive expectations for the future

Predictors of outcome after a time-limited psychosocial intervention for adolescent depression

Research on the predictors of outcome for early, community-based, and time-limited interventions targeted for clinical depression in adolescents is still scarce. We examined the role of demographic, psychosocial, and clinical variables as predictors of outcome in a trial conducted in Finnish school health and welfare services to identify factors associating to symptom reduction and remission after a brief depression treatment. A total of 55 12-16-year-olds with mild to moderate depression received six sessions of either interpersonal counseling for adolescents (IPC-A) or brief psychosocial support (BPS). Both interventions resulted in clinical improvement at end of treatment and 3- and 6-month follow-ups. Main outcome measures were self-rated BDI-21 and clinician-rated Adolescent Depression Rating Scale (ADRSc). Latent change score (LCS) models were used to identify predictors of change in depressive symptom scores and clinical remission at end of treatment and 3- and 6-month follow-ups over the combined brief intervention group. Symptom improvement was predicted by younger age and having a close relationship with parents. Both symptom improvement and clinical remission were predicted by male gender, not having comorbid anxiety disorder, and not having sleep difficulties. Our results add to knowledge on factors associating with good treatment outcome after a brief community intervention for adolescent depression. Brief depression interventions may be useful and feasible especially for treatment of mild and moderate depression among younger adolescents and boys, on the other hand clinicians may need to cautiously examine sleep problems and anxiety comorbidity as markers of the need for longer treatment.Peer reviewe

Psychological Interventions for Young People With Psychotic Disorders : A Systematic Review

Publisher Copyright: Copyright © 2022 Gergov, Milic, Löffler-Stastka, Ulberg, Vousoura and Poulsen.Background: Psychotic disorders are commonly accompanied by intense psychological burden, and psychological interventions are usually needed in order to reduce the symptoms and help in maintaining or improving the level of psychological and social functioning after the onset of psychosis. The evidence-base for treating young people at risk for psychosis and adults with psychotic disorders is accumulating. Yet, pervasive systematic literature reviews that would include patients from the full age range being the most essential period for the risk of developing a psychotic disorder, a wide range of psychological interventions, and various types of clinical trials, have been lacking. The aim of this systematic review is to fill the gap by presenting the current research evidence from clinical trials on the effectiveness of psychological interventions for treating young people (12–30) with psychotic disorders. Methods: A systematic search was conducted in PubMed and PsycINFO followed by a 3-step screening process based on the PICOS strategy. Risk of bias of the included studies was assessed by the Mixed Methods Appraisal Tool (MMAT). Extracted data from the included studies is reported using a narrative synthesis. Results: Of the 1,449 publications screened, 40 from 25 studies were included in the review. Of these, 10 studies reported results from cognitive or behavioral therapy, nine from cognitive remediation therapy (CRT), and six from other types of therapies (i.e., integrative interventions combining psychoeducation and family/group interventions). All but one study found the target interventions to be effective, but the results mostly did not differ significantly from the control conditions in reducing symptoms and improving functioning, preventing relapses and hospitalization, or improving psychological or family variables. The most consistent findings were from CRT, showing more improvement in cognitive functioning compared to control conditions while not being superior in reducing symptom severity. Integrative interventions might be effective in treating young people suffering from psychotic disorders. Conclusion: There is some evidence that psychological interventions are effective for young people with psychotic disorders. However, with regard to symptom severity, psychotherapy does not outperform control conditions, and the results do not strongly favor any specific type of treatment. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020166756], identifier [CRD42020166756].Peer reviewe

Nuorten itsetuhoisuuden ja epävakaiden piirteiden psykoterapeuttisten hoitomuotojen vaikuttavuus : Systemaattiseen hakuun perustuva kirjallisuuskatsaus

• Itsetuhoisten nuorten hoidossa suositellaan ensisijaisesti psykososiaalisia hoitoja. Myös tavanomainen hoito on tutkimuksissa vähentänyt itsetuhoisuutta, mutta ajankohtaisesti itsetuhoisille nuorille se ei yleensä ole riittävä. • Epävakaista piirteistä ja itsetuhoisuudesta kärsivät nuoret hyötyvät erityisesti dialektisesta käyttäytymis­terapiasta. Myös mentalisaatioon perustuvan terapian ja kognitiivis­analyyttisen psykoterapian vaikuttavuudesta on alustavaa tutkimusnäyttöä. • Nuorten itsetuhoisuuden ja myös epävakaiden piirteiden hoitomuodoissa perheterapeuttisten elementtien yhdistäminen psykoterapiaan on hyödyllistä. • Hoitosuositusten antamiseksi tarvitaan lisätutkimusta eri psykoterapiamuotojen vaikuttavuudesta.Peer reviewe

Nuorten depression psykoterapeuttisten hoitomuotojen vaikuttavuus : systemaattiseen hakuun perustuva kirjallisuuskatsaus

•Kognitiivinen käyttäytymisterapia ja interpersonaalinen psykoterapia ovat vaikuttavia hoitoja nuorten depressioissa. •Perheterapia soveltunee nuorten depressioiden hoitoon etenkin silloin, kun perheeseen liittyvät tekijät selvästi kuormittavat nuorta. •Muiden psykoterapiamuotojen vaikuttavuutta nuorten depressioissa ei ole toistaiseksi tutkittu riittävästi. •Vaikuttavuustutkimuksen perusteella nuorten depressioiden ensisijaisina psykoterapeuttisina hoitoina voidaan pitää kognitiivista käyttäytymisterapiaa ja interpersonaalista psykoterapiaa.Peer reviewe

Advanced spectrophotometric chemometric methods for resolving the binary mixture of doxylamine succinate and pyridoxine hydrochloride

The prediction power of partial least squares (PLS) and multivariate curve resolution-alternating least squares (MCR-ALS) methods have been studied for simultaneous quantitative analysis of the binary drug combination – doxylamine succinate and pyridoxine hydrochloride. Analysis of first-order UV overlapped spectra was performed using different PLS models – classical PLS1 and PLS2 as well as partial robust M-regression (PRM). These linear models were compared to MCR-ALS with equality and correlation constraints (MCR-ALS-CC). All techniques operated within the full spectral region and extracted maximum information for the drugs analysed. The developed chemometric methods were validated on external sample sets and were applied to the analyses of pharmaceutical formulations. The obtained statistical parameters were satisfactory for calibration and validation sets. All developed methods can be successfully applied for simultaneous spectrophotometric determination of doxylamine and pyridoxine both in laboratory-prepared mixtures and commercial dosage forms