A randomized trial on the efficacy of group psychoeducation in the prophylaxis of recurrences in bipolar patients whose disease is in remission. Is the Comparison between Exercise and Pharmacologic Treatment of Depression in the Clinical Practice Guideline of the American College of Physicians Evidence-Based? Psychoeducation efficacy in bipolar disorders: beyond compliance enhancement. The Bipolar Interactive Psychoeducation (BIPED) study: trial design and protocol Psychoeducational treatment for school-aged children with bipolar disorder. The expert consensus guideline series. Pharmacotherapy of depressive disorders in older patients. Family-focused treatment for adolescents with bipolar disorder. Bupropion in tricyclic antidepressant nonresponders with unipolar major depressive disorder. World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Unipolar Depressive Disorders, Part 1: Update 2013 on the acute and continuation treatment of unipolar depressive disorders Self-help interventions for depressive disorders and depressive symptoms: a systematic review The expert consensus guideline series. Optimizing pharmacologic treatment of psychotic disorders. Introduction: methods, commentary, and summary. GET.ON Mood Enhancer: efficacy of Internet-based guided self-help compared to psychoeducation for depression: an investigator-blinded randomised controlled trial Efficacy of a dilemma-focused intervention for unipolar depression: study protocol for a multicenter randomized controlled trial European clinical guidelines for Tourette Syndrome and other tic disorders. Part III: behavioural and psychosocial interventions A psychoeducational approach to the treatment of depression: comparison of group, individual, and minimal contact procedures. [The effectiveness of psychoeducation in schizophrenic and depressive patients--preliminary report]. The influence of psychoeducation on regulating biological rhythm in a sample of patients with bipolar II disorder: a randomized clinical trial Impact of caregiver group psychoeducation on the course and outcome of bipolar patients in remission: a randomized controlled trial. Number needed to treat analyses of drugs used for maintenance treatment of bipolar disorder Cardiovascular Health in Anxiety or Mood Problems Study (CHAMPS): study protocol for a randomized controlled trial TREAD: TReatment with Exercise Augmentation for Depression: study rationale and design Placebo response and antidepressant response. The impact of staging bipolar disorder on treatment outcome of family psychoeducation.
BACKGROUND Studies on individual psychotherapy indicate that some interventions may reduce the number of recurrences in bipolar patients . However , there has been a lack of structured , well- design ed , blinded , controlled studies demonstrating the efficacy of group psychoeducation to prevent recurrences in patients with bipolar I and II disorder . METHODS One hundred twenty bipolar I and II out patients in remission ( Young Mania Rating Scale score < 6 , Hamilton Depression Rating Scale-17 score < 8) for at least 6 months prior to inclusion in the study , who were receiving st and ard pharmacologic treatment , were included in a controlled trial . Subjects were matched for age and sex and r and omized to receive , in addition to st and ard psychiatric care , 21 sessions of group psychoeducation or 21 sessions of nonstructured group meetings . Subjects were assessed monthly during the 21-week treatment period and throughout the 2-year follow-up . RESULTS Group psychoeducation significantly reduced the number of relapsed patients and the number of recurrences per patient , and increased the time to depressive , manic , hypomanic , and mixed recurrences . The number and length of hospitalizations per patient were also lower in patients who received psychoeducation . CONCLUSION Group psychoeducation is an efficacious intervention to prevent recurrence in pharmacologically treated patients with bipolar I and II disorder Major depression disorder is most commonly treated with antidepressants . However , due to their side effects clinicians seek non-pharmacologic options , and one of these is exercise . The literature on the benefits of exercise for depression is extensive . Nevertheless , two recent review s focusing on antidepressants vs. other therapies as a basis for clinical practice guidelines recommended mainly antidepressants , excluding exercise as a viable choice for treatment of depression . The aim of this perspective is to analyze the literature exploring the reasons for this discrepancy . Two categories of publications were examined : r and omized controlled trials ( RCTs ) and meta-analyses or systematic review s. Based on this re assessment , RCTs comparing exercise to antidepressants reported that exercise and antidepressants were equally effective . RCTs comparing exercise combined with antidepressants to antidepressants only reported a significant improvement in depression following exercise as an adjunctive treatment . Almost all the review s examining exercise vs. other treatments of depression , including antidepressants , support the use of exercise in the treatment of depression , at least as an adjunctive therapy . The two review s examining pharmacologic vs. non-pharmacologic therapies as a basis for clinical practice guidelines examined limited evidence on exercise vs. antidepressants . In addition , it is possible that academics and health care practitioners are skeptical of viewing exercise as medicine . Maybe , there is a reluctance to accept that changes in lifestyle as opposed to pharmacological treatment can alter biological mechanisms . Longitudinal studies are needed for assessing the effectiveness of exercise in real clinical setting s , as well as studies exploring dose-response relationship between exercise and depression BACKGROUND Several previous studies have established that low treatment adherence is common among bipolar patients and may explain high rates of recurrence . On the other h and , some patients keep relapsing even when they strictly follow their prescribed somatic treatments . Psychological interventions such as psychoeducation may foster early recognition of prodromal symptoms and minimize the risk of relapse . To date , studies assessing the usefulness of psychoeducation in fully compliant patients are lacking . METHOD This was a single-blind , r and omized , prospect i ve clinical trial on the efficacy of group psychoeducation in remitted fully compliant DSM-IV bipolar I patients ( N = 25 ) who were compared with a group with similar characteristics ( N = 25 ) who did not receive psychoeducation .  All patients received naturalistic pharmacologic treatment . Recruitment began in 1997 and follow-up was completed in January 2002 . The follow-up phase comprised 2 years during which all patients continued receiving naturalistic treatment without psychological intervention and were assessed monthly on several outcome measures . RESULTS At the end of the 2-year follow-up , 23 subjects ( 92 % ) in the control group fulfilled criteria for recurrence versus 15 patients ( 60 % ) in the psychoeducation group ( p < .01 ) . The number of total recurrences and the number of depressive episodes were significantly lower in psychoeducated patients . CONCLUSION Although the present study has the limitation of small sample size , psychoeducation showed its efficacy in preventing relapses in bipolar I patients who were adherent to drug treatment . The action of psychoeducation seems to go beyond compliance enhancement and may support a tripod model composed by lifestyle regularity and healthy habits , early detection of prodromal signs followed by prompt drug intervention , and finally treatment compliance Background Bipolar disorders affect between 3–5 % of the population and are associated with considerable lifelong impairment . Since much of the morbidity associated with bipolar disorder is caused by recurrent depressive symptoms , which are often only poorly responsive to antidepressants , there is a need to develop alternative , non-pharmacological interventions . Psychoeducational interventions have emerged as promising long-term therapeutic options for bipolar disorder . Methods / design The study is an exploratory , individually r and omised controlled trial . The intervention known as ' Beating Bipolar ' is a psychoeducational programme which is delivered via a novel web-based system . We will recruit 100 patients with a diagnosis of DSM-IV bipolar disorder ( including type I and type II ) currently in clinical remission . The primary outcome is quality of life . This will be compared for those patients who have participated in the psychoeducational programme with those who received treatment as usual . Quality of life will be assessed immediately following the intervention as well as 10 months after r and omisation . Secondary outcomes include current depressive and manic symptoms , number of episodes of depression and mania/hypomania experienced during the follow-up period , global functioning , functional impairment and insight . An assessment of costs and a process evaluation will also be conducted which will explore the feasibility and acceptability of the intervention as well as potential barriers to effectiveness . Discussion Bipolar disorder is common , under-recognised and often poorly managed . It is a chronic , life-long , relapsing condition which has an enormous impact on the individual and the economy . This trial will be the first to explore the effectiveness of a novel web-based psychoeducational intervention for patients with bipolar disorder which has potential to be easily rolled out to patients .Trial registration Current Controlled Trials IS RCT Bipolar disorder ( BPD ) has received increasing attention from public and professional sources . Although pharmacologic treatments are considered the sine qua non in the treatment of youth with BPD , psychosocial interventions are critical to assist the child and family cope with symptoms that carry with them significant morbidity and mortality . Treatments developed to date are few in number ; all are psychoeducationally based , using cognitive-behavioral and family systems interventions within a biopsychosocial framework . This paper review s possible mediators of outcome , including caregiver concordance , children 's social skills , hopelessness , and family stress . The author has developed two family-based psychoeducational interventions for the treatment of youth with BPD : multifamily psychoeducation groups ( MFPG ) and individual family psychoeducation ( IFP ) . These treatments are both described and the results from a previously published r and omized clinical trial ( RCT ) of MFPG are summarized . Then , new findings from an RCT of IFP are presented , along with preliminary pilot data from an exp and ed version of IFP . The paper concludes with recommendations for future research OBJECTIVES Depression in older patients contributes to personal suffering and family disruption and increases disability , medical morbidity , mortality , suicide risk , and healthcare utilization . The majority of clinical trials of antidepressant treatments are conducted in younger patients . For this reason , clinicians often have to extrapolate from studies in population s that do not present the same problems as older patients . For example , older patients often have serious coexisting medical conditions that may contribute to the depression and complicate the choice of treatment . Older patients as a rule need to be on many medications , some of which may contribute to depression and /or interact with antidepressants . Finally , older adults metabolize medications slowly and are more sensitive to side effects than younger patients . Because of these complexities , we conducted a consensus survey of expert opinion on the pharmacotherapy of depressive disorders in older patients to address clinical questions not definitively answered in the research literature . METHOD After review ing the literature and convening a work group of experts , we prepared a written survey with 64 questions that asked about 857 options . 618 of the options were scored using a modified version of the R AND 9-point scale for rating appropriateness of medical decisions . For the other options , the experts were asked to write in answers ( e.g. , average doses ) or to check a box to indicate their preferred answer . We sent the survey to 50 national experts on geriatric depression , all of whom completed it . Consensus on each option was defined as a nonr and om distribution of scores by chi-square " goodness-of-fit " test . We assigned a categorical rank ( first line/preferred choice , second line/alternate choice , third line/usually inappropriate ) to each option based on the 95 % confidence interval around the mean rating . Guideline tables indicating preferred treatment strategies were then developed for key clinical situations . RESULTS The expert panel reached consensus on 89 % of the options rated on the 9-point scale . The experts stress the importance of identifying coexisting medical conditions that may be contributing to the depression or complicate treatment . For unipolar nonpsychotic major depression , the preferred strategy is an antidepressant ( selective serotonin reuptake inhibitor [ SSRI ] or venlafaxine XR preferred ) plus psychotherapy . For unipolar psychotic major depression , the treatment of choice is an antidepressant ( SSRI or venlafaxine XR ) plus one of the newer atypical antipsychotics . Electroconvulsive therapy is also first line . For dysthymic disorder or persistent milder depression , the experts recommend combining an antidepressant ( SSRIs preferred ) and psychotherapy . If the patient has a comorbid medical condition ( e.g. , hypothyroidism ) that is contributing to the depression , the experts recommend treating both the depression and the medical condition from the outset . The SSRIs were the top-rated antidepressants for all types of depression . Among them , the experts gave the highest ratings for efficacy and tolerability to citalopram and sertraline . Paroxetine was another first-line option , and fluoxetine was rated high second line . The preferred psychotherapy techniques for treating depression in older patients are cognitive-behavioral therapy , supportive psychotherapy , problem-solving psychotherapy , and interpersonal psychotherapy . The experts also give strong support to including appropriate psychosocial interventions ( e.g. , psychoeducation , family counseling , visiting nurse services ) in the treatment program . The majority of experts would continue treatment with antidepressant medication for at least 1 year if a patient has had a single episode of severe unipolar major depression , for 1 - 3 years for a patient who has had 2 such episodes , and for longer than 3 years if there is a history of 3 or more episodes . CONCLUSIONS The experts reached a high level of consensus on the appropriateness of including both antidepressant medication , specifically SSRIs , and nonpharmacological modalities in treatment plans for severe depression . Within the limits of expert opinion and with the expectation that future research data will take precedence , these guidelines provide direction for addressing common clinical dilemmas in older individuals . They can be used to inform clinicians and educate patients regarding the relative merits of a variety of interventions . Nonetheless , the guidelines can not address the complexities involved in the care of each individual patient and can be most helpful in the h and s of experienced clinicians BACKGROUND Research has begun to eluci date the optimal pharmacological treatments for pediatric-onset bipolar patients , but few studies have examined the role of psychosocial interventions as adjuncts to pharmacotherapy in maintenance treatment . This article describes an adjunctive family-focused psychoeducational treatment for bipolar adolescents ( FFT-A ) . The adult version of FFT has been shown to be effective in forestalling relapses in two r and omized clinical trials involving bipolar adults . METHODS FFT-A is administered to adolescents who have had an exacerbation of manic , depressed , or mixed symptoms within the last 3 months . It is given in 21 outpatient sessions of psychoeducation , communication enhancement training , and problem solving skills training . We describe modifications to the adult FFT model to address the developmental issues and unique clinical presentations of pediatric-onset patients . RESULTS An open treatment trial involving 20 bipolar adolescents ( 11 boys , 9 girls ; mean age 14.8+/-1.6 ) found that the combination of FFT-A and mood stabilizing medications was associated with improvements in depression symptoms , mania symptoms , and behavior problems over 1 year . LIMITATIONS These early results are based on a small-scale open trial . CONCLUSIONS Results from an ongoing r and omized controlled trial will clarify whether combining FFT-A with pharmacotherapy improves the 2-year course of adolescent bipolar disorder . If the results are positive , then a structured manual-based psychosocial approach will be available for clinicians who treat adolescent bipolar patients in the community Tricyclic antidepressant ( TCA ) medications are among the most widely used pharmacologic treatments for depression . However , a substantial number of patients fail to respond to these agents . Few st and ardized trials of pharmacologic treatments for TCA nonresponders are available . Bupropion has an apparently different mechanism of action than TCAs and represents a possible treatment for the TCA nonresponder . Based on positive results from pilot studies , a st and ardized study evaluating bupropion in TCA nonresponders was conducted . Forty-one depressed out patients who had failed to respond to adequate documented TCA treatment , defined by specific criteria of dosage , duration , and plasma concentrations , entered a 1-week single-blind placebo phase , followed by an open 8-week bupropion treatment phase utilizing doses of up to the maximum daily dose of 450 mg . Response was measured by change on the Hamilton Depression Rating Scale ( HAM-D ) , Clinical Global Impressions-Severity ( CGI-S ) and Improvement ( CGI-I ) Scales , and the Hamilton Anxiety Rating Scale ( HAM-A ) .  Bupropion treatment result ed in an improvement in depression on all outcome measures . Forty-nine percent were considered " responders , " in that they achieved > or = 50 % improvement on the 28-item HAM-D. Fifty-four percent were classified as responders based on a CGI-I rating of much or very much improved . Statistically significant improvement in depressive symptoms , measured by mean scores for the HAM-D , CGI-S , and HAM-A , was achieved at the end of the study ( as compared to baseline ) . Twelve patients ( 32 % ) had a HAM-D score of < or = 10 at termination . ( ABSTRACT TRUNCATED AT 250 WORDS Abstract Objectives . This 2013 up date of the practice guidelines for the biological treatment of unipolar depressive disorders was developed by an international Task Force of the World Federation of Societies of Biological Psychiatry ( WFSBP ) . The goal has been to systematic ally review all available evidence pertaining to the treatment of unipolar depressive disorders , and to produce a series of practice recommendations that are clinical ly and scientifically meaningful based on the available evidence . The guidelines are intended for use by all physicians seeing and treating patients with these conditions . Methods . The 2013 up date was conducted by a systematic up date literature search and appraisal . All recommendations were approved by the Guidelines Task Force . Results . This first part of the guidelines ( Part 1 ) covers disease definition , classification , epidemiology , and course of unipolar depressive disorders , as well as the management of the acute and continuation phase treatment . It is primarily concerned with the biological treatment ( including antidepressants , other psychopharmacological medications , electroconvulsive therapy , light therapy , adjunctive and novel therapeutic strategies ) of adults . Conclusions . To date , there is a variety of evidence -based antidepressant treatment options available . Nevertheless there is still a substantial proportion of patients not achieving full remission . In addition , somatic and psychiatric comorbidities and other special circumstances need to be more thoroughly investigated . Therefore , further high- quality informative r and omized controlled trials are urgently needed Background Research suggests that depressive disorders exist on a continuum , with subthreshold symptoms causing considerable population burden and increasing individual risk of developing major depressive disorder . An alternative strategy to professional treatment of subthreshold depression is population promotion of effective self-help interventions that can be easily applied by an individual without professional guidance . The evidence for self-help interventions for depressive symptoms is review ed in the present work , with the aim of identifying promising interventions that could inform future health promotion campaigns or stimulate further research . Methods A literature search for r and omised controlled trials investigating self-help interventions for depressive disorders or depressive symptoms was performed using PubMed , PsycINFO and the Cochrane Data base of Systematic Review s. Reference lists and citations of included studies were also checked . Studies were grouped into those involving participants with depressive disorders or a high level of depressive symptoms , or non- clinical ly depressed participants not selected for depression . A number of exclusion criteria were applied , including trials with small sample sizes and where the intervention was adjunctive to antidepressants or psychotherapy . Results The majority of interventions search ed had no relevant evidence to review . Of the 38 interventions review ed , the ones with the best evidence of efficacy in depressive disorders were S-adenosylmethionine , St John 's wort , bibliotherapy , computerised interventions , distraction , relaxation training , exercise , pleasant activities , sleep deprivation , and light therapy . A number of other interventions showed promise but had received less research attention . Research in non- clinical sample s indicated immediate beneficial effects on depressed mood for distraction , exercise , humour , music , negative air ionisation , and singing ; while potential for helpful longer-term effects was found for autogenic training , light therapy , omega 3 fatty acids , pets , and prayer . Many of the trials were poor quality and may not generalise to self-help without professional guidance . Conclusion A number of self-help interventions have promising evidence for reducing subthreshold depressive symptoms . Other forms of evidence such as expert consensus may be more appropriate for interventions that are not feasible to evaluate in r and omised controlled trials . There needs to be evaluation of whether promotion to the public of effective self-help strategies for subthreshold depressive symptoms could delay or prevent onset of depressive illness , reduce functional impairment , and prevent progression to other undesirable outcomes such as harmful use of substances OBJECTIVES A growing number of atypical antipsychotics are available for clinicians to choose from in the treatment of psychotic disorders . However , a number of important questions concerning medication selection , dosing and dose equivalence , and the management of inadequate response , compliance problems , and relapse have not been adequately addressed by clinical trials . To aid clinical decision-making , a consensus survey of expert opinion on the pharmacologic treatment of psychotic disorders was undertaken to address questions not definitively answered in the research literature . METHOD Based on a literature review , a written survey was developed with 60 questions and 994 options . Approximately half of the options were scored using a modified version of the R AND 9-point scale for rating the appropriateness of medical decisions . For the other options , the experts were asked to write in answers ( e.g. , average doses ) or check a box to indicate their preferred answer . The survey was sent to 50 national experts on the pharmacologic treatment of psychotic disorders , 47 ( 94 % ) of whom completed it . In analyzing the responses to items rated on the 9-point scale , consensus on each option was defined as a non r and om distribution of scores by chi-square " goodness-of-fit"test . We assigned a categorical rank ( first line/preferred choice , second line/alternate choice , third line/usually inappropriate ) to each option based on the 95 % confidence interval around the mean rating . Guideline tables indicating preferred treatment strategies were then developed for key clinical situations . RESULTS The expert panel reached consensus on 88 % of the options rated on the 9-point scale . The experts overwhelmingly endorsed the atypical antipsychotics for the treatment of psychotic disorders . Risperidone was the top choice for first-episode and multi-episode patients , with the other newer atypicals rated first line or high second line depending on the clinical situation . Clozapine and a long-acting injectable atypical ( when available)were other high second line options for multi-episode patients . The expert 's dosing recommendations agreed closely with the package inserts for the drugs , and their estimates of dose equivalence among the antipsychotics followed a linear pattern . The experts considered 3 - 6 weeks an adequate antipsychotic trial , but would wait a little longer ( 4 - 10 weeks ) before making a major change in treatment regimen if there is a partial response . The experts recommended trying to improve response by increasing the dose of atypical and depot antipsychotics before switching to a different agent ; there was less agreement about increasing the dose of conventional antipsychotics before switching , probably because of concern about side effects at higher doses . If it is decided to switch because of inadequate response , risperidone was the expert 's first choice to switch to , no matter what drug was initially tried . Although there was some disparity in the expert 's recommendations concerning how many agents to try before switching to clozapine , the expert 's responses suggest that switching to clozapine should be Clozapine was also the antipsychotic of choice for patients with suicidal behavior . When switching oral antipsychotics , the experts considered cross-titration the preferred strategy . When switching to an injectable antipsychotic , the experts stressed the importance of continuing the oral antipsychotic until therapeutic levels of the injectable agent are achieved . The experts considered psychosocial interventions the first choice strategy for partially compliant patients , with pharmacologic interventions the first choice for patients with clear evidence of noncompliance . However , because it can be difficult to distinguish partially compliant from noncompliant patients , the editors recommended combining psychosocial and pharmacologic interventions to improve compliance whenever possible . When patients relapse because of compliance problems or if there is any doubt about compliance , the experts recommended the use of a long-acting injectable antipsychotic and would select an injectable atypical when this option becomes available . The experts would also consider using an injectable atypical antipsychotic ( when available ) in many clinical situations that do not involve compliance problems . The experts stressed the importance of monitoring for health problems-especially obesity , diabetes , cardiovascular problems , HIV risk behaviors , medical complications of substance abuse , heavy smoking and its effects , hypertension , and amenorrhea-in patients being treated with antipsychotics . Although many patients are prescribed adjunctive treatments , multiple antipsychotics , and combinations of different classes of drugs ( e.g. , antipsychotics plus mood stabilizers or antidepressants ) in an effort to enhance response , the experts gave little support to any of these strategies , with the exception of antidepressants for patients with  dysphoria/depression  , antidepressants or ECT for patients with suicidal behavior , and mood stabilizers for patients with aggression/violence . When asked about indicators of remission and recovery , the experts considered acute improvement in psychotic symptoms the most important indicator of remission , whereas they considered more sustained improvement in multiple outcome domains ( e.g. , occupational/educational functioning , peer relationships , independent living ) important in assessing recovery . CONCLUSIONS The experts reached a high level of consensus on many of the key treatment questions in the survey . Within the limits of expert opinion and with the expectation that future research data will take precedence , these guidelines provide direction for addressing common clinical dilemmas that arise in the pharmacologic treatment of psychotic disorders . They can be used to inform clinicians and educate patients regarding the relative merits of a variety of interventions . Clinicians should keep in mind that no guidelines can address the complexities involved in the care of each individual patient and that sound clinical judgment based on clinical experience should be used in applying these recommendations Background Major depressive disorder ( MDD ) imposes a considerable disease burden on individuals and societies . A large number of r and omised controlled trials ( RCTs ) have shown the efficacy of Internet-based guided self-help interventions in reducing symptoms of depression . However , study quality varies considerably . The aim of this study is to evaluate the efficacy of a new Internet-based guided self-help intervention ( GET.ON Mood Enhancer ) compared to online-based psychoeducation in an investigator-blinded RCT . Methods / design A RCT will be conducted to compare the efficacy of GET.ON Mood Enhancer with an active control condition receiving online psychoeducation on depression ( OPD ) . Both treatment groups will have full access to treatment as usual . Adults with MDD ( n = 128 ) will be recruited and r and omised to one of the two conditions . Primary outcome will be observer-rated depressive symptoms ( HRSD-24 ) by independent assessors blind to treatment conditions . Secondary outcomes include changes in self-reported depressive symptom severity , anxiety and quality of life . Additionally , potential negative effects of the treatments will systematic ally be evaluated on several dimensions ( for example , symptom deteriorations , attitudes toward seeking psychological help , relationships and stigmatisation ) . Assessment s will take place at baseline , 6 and 12 weeks after r and omisation . Discussion This study evaluates a new Internet-based guided self-help intervention for depression using an active control condition ( psychoeducation-control ) and an independent , blinded outcome evaluation . This study will further enhance the evidence for Internet-based guided self-help interventions for MDD.Trial registration German Clinical Trial Registration ( DRKS ) : Background Depression is one of the more severe and serious health problems because of its morbidity , disabling effects and for its societal and economic burden . Despite the variety of existing pharmacological and psychological treatments , most of the cases evolve with only partial remission , relapse and recurrence . Cognitive models have contributed significantly to the underst and ing of unipolar depression and its psychological treatment . However , success is only partial and many authors affirm the need to improve those models and also the treatment programs derived from them . One of the issues that requires further elaboration is the difficulty these patients experience in responding to treatment and in maintaining therapeutic gains across time without relapse or recurrence . Our research group has been working on the notion of cognitive conflict viewed as personal dilemmas according to personal construct theory . We use a novel method for identifying those conflicts using the repertory grid technique ( RGT ) . Preliminary results with depressive patients show that about 90 % of them have one or more of those conflicts . This fact might explain the blockage and the difficult progress of these patients , especially the more severe and /or chronic . These results justify the need for specific interventions focused on the resolution of these internal conflicts . This study aims to empirically test the hypothesis that an intervention focused on the dilemma(s ) specifically detected for each patient will enhance the efficacy of cognitive behavioral therapy ( CBT ) for depression . Design A therapy manual for a dilemma-focused intervention will be tested using a r and omized clinical trial by comparing the outcome of two treatment conditions : combined group CBT ( eight , 2-hour weekly sessions ) plus individual dilemma-focused therapy ( eight , 1-hour weekly sessions ) and CBT alone ( eight , 2-hour group weekly sessions plus eight , 1-hour individual weekly sessions ) . Method Participants are patients aged over 18 years meeting diagnostic criteria for major depressive disorder or dysthymic disorder , with a score of 19 or above on the Beck depression inventory , second edition ( BDI-II ) and presenting at least one cognitive conflict ( implicative dilemma or dilemmatic construct ) as assessed using the RGT . The BDI-II is the primary outcome measure , collected at baseline , at the end of therapy , and at 3- and 12-month follow-up ; other secondary measures are also used . Discussion We expect that adding a dilemma-focused intervention to CBT will increase the efficacy of one of the more prestigious therapies for depression , thus result ing in a significant contribution to the psychological treatment of depression . Trial registration IS RCT N92443999 ; Clinical Trials.gov Identifier : NCT01542957 This clinical guideline provides recommendations for the behavioural and psychosocial interventions ( BPI ) of children and adolescents with tic disorders prepared by a working group of the European Society for the Study of Tourette Syndrome ( ESSTS ) . A systematic literature search was conducted to obtain an up date on the efficacy of BPI for tics . Relevant studies were identified using computerised search es of the Medline and PsycINFO data bases and the Cochrane Library for the years 1950–2010 . The search identified no meta-analyses , yet twelve ( systematic ) review s and eight r and omised controlled trials provided evidence for the current review . Most evidence was found for habit reversal training ( HRT ) and the available but smaller evidence also supports the efficacy of exposure with response prevention ( ERP ) . Both interventions are considered first line behavioural treatments for tics for both children and adults and should be offered to a patient , taking into account his preference . Treatments that are considered second line or add-on behavioural treatments are  contingency management , function based interventions and relaxation training . Neurofeedback is still experimental . Almost no research was identified that examined the efficacy of psychosocial interventions , e.g. , psychoeducation and group work . Based on clinical practice , this guideline recommends behavioural treatment as first line offer to patients in most cases . It should be embedded within a psychoeducational and supportive context and can be combined with drug treatment This study examined the efficacy of a psychoeducational approach in treating unipolar depression . The vehicle of treatment was a course in " Coping with Depression . " An explicit educational experience , the course addressed several specific target behaviors ( social skills , thinking , pleasant activities , and relaxation ) as well as more general components hypothesized to be critical to successful cognitive-behavioral therapy for depression . Sixty-three individuals who met Research Diagnostic Criteria ( RDC ) for unipolar depression were r and omly assigned to one of four conditions : class , individual tutoring , minimal contact , or delayed treatment control . Participants in the immediate treatment conditions were assessed pre- and posttreatment and at 1- and 6-month follow-up sessions ; the delayed treatment group was assessed prior to and following an 8-week waiting period . Results indicated clinical improvement by all of the active treatment conditions compared to the delayed treatment condition . Differences between active treatment conditions were small , and some differences between high and low responders to treatment were found . Results are discussed in terms of their implication s for future clinical use of this approach . Stimulated by recent theoretical developments , there has been an impressive proliferation of interventions and approaches for the psychological treatment of unipolar depression . Treatments derived from cognitive positions have been aim ed at depressive thought processes ( e.g. , Beck , Rush , Shaw , & Emery , 1979 ; Fuchs & Rehm , 1977 ) , whereas those derived from behavioral positions have been aim ed at the improvement of social skills ( Hersen , Bellack , & Himmelhoch , 1980 ; Sanchez , Lewinsohn , & Larson , 1980 ; Zeiss , 1977 ) , at increasing pleasant activities and time management relaxation skills ( Lewinsohn , 1977 ) , and at more general problemsolving skills ( McLean & Hakstian , 1979 ) . UNLABELLED Earlier studies suggest that psychoeducation as a form of psychosocial care is of value in improving the patient 's attitude towards mental illness as well as in reducing and delaying the relapse rates of both -- psychotic and depressive disorders . AIM The aim of this study was the evaluation of influence of psychoeducation on clinical symptoms , quality of life and drug attitude in schizophrenic and depressive patients . METHOD 52 patients , aged 18 - 50 years , hospitalized in the Department of Psychiatry of Medical Academy in Białystok , were involved in the study . They were r and omly assigned into 2 groups : on medication without psychoeducation ( 12 schizophrenics , 12 depressive patients ) and on medication and psychoeducation ( 16 schizophrenics and 12 depressive patients ) . The patients were assessed by means of BPRS , BNS , IMHC 2000 , Raskin/Covi Scale , DAI-10 . The assessment was performed twice -- shortly after admission and before discharge from the hospital . RESULTS The patients in both groups showed improvement in symptoms and in quality of life . Patients on psychoeducation changed their drug attitude positively significantly more often . CONCLUSION Knowledge about the positive influence of medication on psychiatric symptoms helps to improve compliance and improves the course of disease Introduction Changes in biological rhythm are among the various characteristics of bipolar disorder , and have long been associated with the functional impairment of the disease . There are only a few viable options of psychosocial interventions that deal with this specific topic ; one of them is psychoeducation , a model that , although it has been used by practitioners for some time , only recently have studies shown its efficacy in clinical practice . Aim To assess if patients undergoing psychosocial intervention in addition to a pharmacological treatment have better regulation of their biological rhythm than those only using medication . Method This study is a r and omized clinical trial that compares a st and ard medication intervention to an intervention combined with drugs and psychoeducation . The evaluation of the biological rhythm was made using the Biological Rhythm Interview of Assessment in Neuropsychiatry , an 18-item scale divided in four areas ( sleep , activity , social rhythm , and eating pattern ) . The combined intervention consisted of medication and a short-term psychoeducation model summarized in a protocol of six individual sessions of 1 hour each . Results The sample consisted of 61 patients with bipolar II disorder , but during the study , there were 14 losses to follow-up . Therefore , the final sample consisted of 45 individuals ( 26 for st and ard intervention and 19 for combined ) . The results showed that , in this sample and time period evaluated , the combined treatment of medication and psychoeducation had no statistically significant impact on the regulation of biological rhythm when compared to st and ard pharmacological treatment . Conclusion Although the changes in biological rhythm were not statistically significant during the time period evaluated in this study , it is noteworthy that the trajectory of the score showed a trend towards improvement , which may indicate a positive impact on treatment , though it may take a longer time than expected OBJECTIVE Although there are some r and omized controlled trials that highlight the positive role of family-focused treatment added to pharmacotherapy in bipolar disorder , no trials using contemporary method ologies have analyzed the specific effect of working with caregiver-only groups . The aim of this study was to assess the efficacy of a psychoeducational group intervention focused on caregivers of euthymic bipolar patients . METHOD A total of 113 medicated euthymic bipolar out patients who lived with their caregivers were r and omized into an experimental and a control group . Caregivers in the experimental group received twelve 90-min group psychoeducation sessions focused on knowledge of bipolar disorder and training in coping skills . The patients did not attend the groups . Caregivers assigned to the control group did not receive any specific intervention . Patients were assessed monthly during both the intervention and the 12 months of follow-up . The primary outcome was time to any mood recurrence . RESULTS Psychoeducation group intervention focused on the caregivers of bipolar patients carried a reduction of the percentage of patients with any mood recurrence ( chi2 = 6.53 ; p = 0.011 ) and longer relapse-free intervals ( log-rank chi(2 ) = 4.04 ; p = 0.044 ) . When different types of episodes were analyzed separately , the effect was significant for both the number of patients who experienced a hypomanic/manic recurrence ( chi2 = 5.65 ; p = 0.017 ) and the time to such an episode ( log-rank chi2 = 5.84 ; p = 0.015 ) . The differences in preventing depressive and mixed episodes were not significant . CONCLUSIONS A psychoeducation group intervention for the caregivers of bipolar patients is a useful adjunct to usual treatment for the patients in reducing the risk of recurrences , particularly mania and hypomania , in bipolar disorder Rationale Due to the episodic and chronic nature of bipolar disorder ( BD ) , maintenance therapy represents a critical part of treatment ; however , there is a paucity of studies comparing effectiveness of available long-term treatments . Objective The aim of this study is to determine and compare the efficacy of pharmacological treatments for maintenance treatment of BD by means of the number needed to treat ( NNT ) . Methods The efficacy of drugs used for maintenance treatment of BD , as emerging from the results of r and omized controlled trials , was assessed using the size effect measure of NNT . PubMed search es were conducted on English- language articles published until May 2010 using the search terms “ bipolar disorder , ” “ mania , ” “ mixed episode , ” or “ bipolar depression , ” cross-referenced with trial characteristic search phrases and generic names of medications . The search was supplemented by manually review ing reference lists from identified publications . Results In 15 studies , aripiprazole , olanzapine , quetiapine , risperidone long-acting injection , lithium , lamotrigine , and divalproex proved effectiveness in terms of NNTs ( ≥10 % advantage over placebo ) for prevention of relapse into any mood episode . Quetiapine , lithium , risperidone long-acting injection , aripiprazole , and olanzapine are effective in manic recurrence prevention .  Lamotrigine , quetiapine , and lithium present significant NNTs for prevention of depressive relapses . Conclusions All of the pharmacological agents assessed were effective in the prevention of any kind of mood episode ; however , different efficacy profiles were found for prevention of manic and /or depressive relapses . The comparison of NNT values of the available agents may represent a useful tool in clinical setting s , in order to facilitate implementation of long-term pharmacological interventions in patients with BD Background Previous psychological and pharmacological interventions have primarily focused on depression disorders in population s with cardiovascular diseases ( CVDs ) and the efficacy of anxiety disorder interventions is only more recently being explored . Transdiagnostic interventions address common emotional processes and the full range of anxiety and depression disorders often observed in population s with CVDs . The aim of CHAMPS is to evaluate the feasibility of a unified protocol ( UP ) for the transdiagnostic treatment of emotional disorders intervention in patients recently hospitalized for CVDs . The current study reports the protocol of a feasibility r and omized controlled trial to inform a future trial . Methods / Design This is a feasibility r and omized , controlled trial with a single-center design . A total of 50 participants will be block-r and omized to either a UP intervention or  enhanced usual care . Both groups will receive st and ard CVD care . The UP intervention consists of 1 ) enhancing motivation , readiness for change , and treatment engagement ; ( 2 ) psychoeducation about emotions ; ( 3 ) increasing present focused emotion awareness ; ( 4 ) increasing cognitive flexibility ; ( 5 ) identifying and preventing patterns of emotion avoidance and maladaptive emotion-driven behaviors ( EDBs , including tobacco smoking , and alcohol use ) ; ( 6 ) increasing tolerance of emotion-related physical sensations ; ( 7 ) interoceptive and situation-based emotion-focused exposure ; and ( 8) relapse prevention strategies . Treatment duration is 12 to 18 weeks . Relevant outcomes include the st and ard deviation of self-rated anxiety , depression and quality of life symptoms . Other outcomes include intervention acceptability , satisfaction with care , rates of EDBs , patient adherence , physical activity , cardiac and psychiatric readmissions . Parallel to the main trial , a nonr and omized comparator cohort will be recruited comprising 150 persons scoring below the predetermined depression and anxiety severity thresholds . Discussion CHAMPS is design ed to evaluate the UP for the transdiagnostic treatment of emotional disorders targeting emotional disorder processes in a CVD population . The design will provide preliminary evidence of feasibility , attrition , and satisfaction with treatment to design a definitive trial . If the trial is feasible , it opens up the possibility for interventions to target broader emotional processes in the precarious population with CVD and emotional distress . Trial registration ACTRN12615000555550 , registered on Background Despite recent advancements in the pharmacological treatment of major depressive disorder ( MDD ) , over half of patients who receive treatment with antidepressant medication do not achieve full remission of symptoms . There is evidence that exercise can reduce depressive symptomatology when used as a treatment for MDD . However , no r and omized controlled trials have evaluated exercise as an augmentation strategy for patients with carefully diagnosed MDD who remain symptomatic following an adequate acute phase trial of antidepressant therapy . Purpose TReatment with Exercise Augmentation for Depression  ( TREAD ) is an NIMH-funded , r and omized , controlled trial design ed to assess the relative efficacy of two doses of aerobic exercise to augment selective serotonin reuptake inhibitor ( SSRI ) treatment of MDD . Methods The TREAD study includes 12 weeks of acute phase treatment with a 12-week post-treatment follow-up . In addition to looking at change in depressive symptoms as a primary outcome , it also includes comprehensive assessment of psychosocial function and treatment adherence . Results This paper review s the rationale and design of TREAD and illustrates how we address several key issues in contemporary patient-oriented research on MDD : 1 ) the use of augmentation strategies in the treatment of depressive disorders in general , 2 ) the use of non-pharmacological strategies in the treatment of depressive disorders , 3 ) the considerations of design ing a well-controlled trial using two active treatment groups , and 4 ) the implementation of an adherence program for the use of exercise as a treatment strategy . Conclusions The TREAD study is uniquely design ed to overcome sources of potential bias and threats to internal and external validity that have limited prior research on the mental health effects of exercise . The study is facilitated by the development of a multidisciplinary research team that includes experts in both depression treatment and exercise physiology , as well as other related fields OBJECTIVE Much of the response to an antidepressant is the result of placebo response . The placebo response embedded in drug response confounds studies seeking to identify brain mechanisms essential for pharmacologic response . Exclusion of patients who fail to meet entry criteria at the end of a placebo lead-in phase has been inadequate to reduce the effect of placebo during pharmacologic trials . This study focused on the placebo lead-in phase and examines whether change in severity of depression during placebo lead-in predicts change in depressive symptoms during antidepressant treatment . METHOD The subjects were patients aged 60 - 85 years with nonpsychotic unipolar major depression not attributed to dementing disorders , medical illnesses , or drugs causing depression and had a 24-item Hamilton Depression Rating Scale score of 18 or greater . After a two-week placebo lead-in , subjects with Hamilton Depression Rating Scale score of 18 or greater received 10 mg escitalopram for 12 weeks . RESULTS Worsening or limited change in depression during placebo treatment predicted improvement in depressive symptoms during escitalopram treatment . Limited change in anxiety , melancholia , helplessness , and paranoia during placebo treatment were the strongest predictors of improvement in depression while on escitalopram . CONCLUSIONS These findings , if replicated , may be used to characterize depressed older patients likely to respond to the pharmacologic action of antidepressants rather than the placebo response embedded in drug trials and thus improve the methodology of biomarker studies of antidepressant response . On a clinical level , depressed older patients who improve during a prolonged evaluation may be c and i date s for nonpharmacologic treatments because their drug response may be limited BACKGROUND Psychological interventions on top of pharmacological treatment can improve the outcome of bipolar disorder . However , there is a paucity of data on the aspects that may influence the effectiveness of psychological approaches to bipolar disorders . The staging models suggest a progression from prodromal to more severe and treatment-resistant presentations . The aim of this study was to assess whether a staging model in bipolar disorder was related to patients ' response to psychoeducation delivered to caregivers . METHODS Post-hoc analysis from a 15-month r and omized controlled trial showing the efficacy of group psychoeducation for caregivers in the prophylaxis of recurrences . The sample was composed of 113 medicated euthymic bipolar out patients who lived with their caregivers . For the purpose of this study the patients were subdivided into two groups according to staging . The prophylactic efficacy of  caregiver psychoeducation  was studied based on staging . RESULTS Patients on Stage I benefited from  caregiver psychoeducation  by having longer time to recurrence ( Log-rank chi-square : 6.26 ; p=0.012 ) . No significant benefits from  caregiver psychoeducation  were found in patients on advanced stages . LIMITATIONS The present post-hoc analysis was not properly powered to compare each one of the four stages with each other , instead staging was divided into Stage I and advanced stages ( II , III or IV ) . CONCLUSIONS Psychoeducation for caregivers of bipolar patients on Stage I may improve long-term outcome in terms of time to recurrence . This study highlights the need to introduce psychological interventions early in the course of the illness as some treatments may be more useful in patients at earlier stages of bipolar disorder
Conclusions : Psychoeducation is a psychosocial treatment that has been well documented as an adjunct to pharmacological therapy .
However , there are only a few studies regarding its effectiveness on adult patients with major depressive disorder .
Although the publications in this area are still very limited , the articles selected in this review suggest that psychoeducation is effective in improving the clinical course , treatment adherence , and psychosocial functioning of depressive patients
Objective : Pharmacological treatment is considered indispensable to major depressive disorder .
In spite of this , a significant number of patients do not respond adequately to treatment based only on medication , presenting high relapse and recurrence rates .
Therefore , psychosocial interventions , such as psychoeducation , have been increasingly recognized as an essential component in the treatment of depression , associated with pharmacological strategies .
Thus , the aim of the present systematic review was to evaluate the effectiveness of psychoeducation  for patients with unipolar depression , analyzing the evidence from the literature .