Does the addition of integrated cognitive behaviour therapy and motivational interviewing improve the outcomes of standard care for young people with comorbid depression and substance misuse?

Background: The high rates of comorbid depression and substance use in young people have been associated with a range of adverse outcomes. Yet, few treatment studies have been conducted with this population. Objective: To determine if the addition of Motivational Interviewing and Cognitive Behaviour Therapy (MI/CBT) to standard alcohol and other drug (AOD) care improves the outcomes of young people with comorbid depression and substance use. Participants and Setting: Participants comprised 88 young people with comorbid depression (Kessler 10 score of > 17) and substance use (mainly alcohol/cannabis) seeking treatment at two youth AOD services in Melbourne, Australia. Sixty young people received MI/CBT in addition to standard care (SC) and 28 received SC alone. Outcomes Measures: Primary outcome measures were depressive symptoms and drug and alcohol use in the past month. Assessments were conducted at baseline, 3 and 6 months follow up. Results and Conclusions: The addition of MI/CBT to SC was associated with a significantly greater rate of change in depression, cannabis use, motivation to change substance use and social contact in the first 3 months. However, those who received SC had achieved similar improvements on these variables by 6 months follow up. All young people achieved significant improvements in functioning and quality of life variables over time, regardless of the treatment group. No changes in alcohol or other drug use were found in either group. The delivery of MI/CBT in addition to standard AOD care may offer accelerated treatment gains in the short-term

Outcomes of an integrated cognitive behaviour therapy (CBT) treatment program for co-occurring depression and substance misuse in young people

Background: There are high rates of co-occurring depression among young people with substance use disorders. While there is preliminary evidence for the effectiveness of integrated cognitive behaviour therapy (CBT) in combination with antidepressants among alcohol and substance dependent adolescents and adults with co-existing depression, no studies have examined the effectiveness of integrated CBT interventions in the absence of pharmacotherapy. The aim of the current study was to determine the outcomes of an integrated CBT intervention for co-occurring depression and substance misuse in young people presenting to a mental health setting. Methods: Sixty young people (aged 15 to 25), with a DSM-IV diagnosis of Major Depressive Disorder and concurrent substance misuse (at least weekly use in the past month) or disorder were recruited from a public youth mental health service in Melbourne, Australia. Participants received 10 sessions of individual integrated CBT treatment delivered with case management over a 20-week period. Results: The intervention was associated with significant improvements in depression, anxiety, substance use, coping skills, depressive and substance use cognitions and functioning at mid- (10\ua0weeks) and post- (20\ua0weeks) treatment. These changes were maintained at 6\ua0months follow-up (44\ua0weeks). Conclusions: These results provide preliminary evidence for the effectiveness of the integrated CBT intervention in young people with co-occurring depression and substance misuse. Further studies using randomised controlled designs are required to determine its efficacy

Analgesia post-operatoria nell'osteosintesi di femore: utilità della somministrazione preparatoria di morfina orale a pronto rilascio

abbiamo valutato l'efficacia e l'utilità della somministrazione di morfina per via orale a pronto rilascio nella fase preparatoria della grande chirurgia ortopedica

Analgosedazione con remifentanil nelle ablazioni transcatetere

viene descritta la tecnica di sedazione ed analgesia durante le ablazioni transcatetere per aritmie cardiache in situazioni cliniche di rispetto del ritmo spontaneo evitando d'indurre fenomeni intrinsecamente aritmogeni legati ai farmaci

Implementing mental health screening within a youth alcohol and other drugs service

Background: While clinical studies consistently demonstrate high rates of co-occurring mental health problems among young people with substance use disorders, mental health assessments are not routinely conducted within Alcohol and Other Drug (AOD) settings. Aims: To describe the implementation of a universal mental health screening program within a youth AOD service. We report on the adoption of screening by AOD staff over the subsequent 30 months, as well as rates of identified psychological problems. Method: Examination of service data that were collected following implementation of the screening program. Results: Between August 2005 and December 2007, AOD workers completed 383 screens (87.4%) from a total of 438 eligible young people. Two hundred and sixty-eight (70.0%) scored 17 or above on the K10, with the mean score of the sample being 23.4 (SD9.6). Twenty-seven per cent reported moderate to severe suicide risk, with 9.9% reporting self-harm in the past month. Conclusion: With appropriate levels of training and support, mental health screening can be readily implemented within routine AOD practice. However, such initiatives require screening to be identified as a core service issue. Given the high rates of psychological issues identified within the sample, we recommend that mental health screening should be integral to treatment planning within youth AOD settings