Search Results (22)

Background: Depression that is resistant to two or more adequate treatment trials—treatment-resistant depression (TRD)—is a prevalent clinical challenge. Although psychotherapies have been recommended by clinical guidelines as an alternative or adjunctive treatment strategy, the effectiveness of psychotherapy in individuals with TRD has not yet been evaluated through meta-analytic methods, primarily due to a limited number of trials. This highlights the necessity of personalized research targeting this specific population. This systematic review and meta-analysis aimed to summarize the evidence on psychotherapy in treating TRD. Methods: A systematic search was conducted following the Guidelines from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Articles were included if they quantitatively examined the efficacy of psychotherapy on depression symptoms in individuals diagnosed with depression who had not responded to at least two prior treatments (i.e., pharmacotherapy and/or psychotherapy). Results: A total of 12 studies were included. The quality of evidence was evaluated as being globally moderate. When pooling all psychotherapies, a small-to-moderate, but significant, effect on depressive symptoms was observed compared to the control group (SMD = −0.49, CI = −0.63; −0.34). The observed effect remained unchanged after removing the outlier (SMD = −0.47, CI = −0.62; −0.32). When examining depressive symptoms by type of psychotherapy, Mindfulness-Based Cognitive Therapy (SMD = −0.51, CI = −0.76; −0.25), Cognitive Behavioral Therapy (SMD = −0.53, CI = −0.92; −0.14), and Cognitive Therapy (SMD = −0.51, CI = −1.01; −0.01) showed a moderately significant effect on depressive symptoms compared to the control group. Conclusions: Although this potentially represents the first meta-analysis in this area, the number of studies specifically addressing this complex population remains limited, and the existing literature is still in its early stages. Research focusing on TRD is notably sparse compared to the broader body of work on depression without treatment resistance. Consequently, it was not possible to conduct meta-analyses by type of psychotherapy across all treatment modalities and by type of control group. Due to several study limitations, there is currently limited evidence available about the effectiveness of psychotherapy for TRD, and further trials are needed. Beyond the treatments usually offered for depression, it is possible that TRD requires a personalized medicine approach. Full article

Road traffic accidents (RTAs) are a leading cause of physical injury worldwide, but they also frequently result in post-traumatic stress disorder (PTSD). This systematic review examines the prevalence, predictors, comorbidity, and treatment of PTSD among RTA survivors. Four electronic databases (PubMed, Scopus, EBSCO, and ProQuest) were searched following PRISMA 2020 guidelines. Articles were included if reporting on the presence of post-traumatic stress disorder as a result of a road traffic accident in adults aged 18 years and older. Including peer-reviewed journal articles and awarded doctoral theses across all publication years, and written in English, Macedonian, Serbian, Bosnian, Croatian, and Bulgarian, identified 259 articles, and using Literature Evaluation and Grading of Evidence (LEGEND) assessment of evidence 96 were included in the final review, involving 50,275 participants. Due to the heterogeneity of findings, quantitative data were synthesized thematically rather than through meta-analytic techniques. Findings are reported from Random Control Trial (RCT) and non-RCT studies. PTSD prevalence following RTAs ranged widely across studies, from 20% (using Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, DSM-5 criteria) to over 45% (using International Classification of Diseases, 10th Revision, ICD-10 criteria) within six weeks post-accident (non-RCT). One-year prevalence rates ranged from 17.9% to 29.8%, with persistence of PTSD symptoms found in more than half of those initially diagnosed up to three years post-RTA (non-RCTs). Mild or severe PTSD symptoms were reported by 40% of survivors one month after the event, and comorbid depression and anxiety were also frequently observed (non-RCTs). The review found that nearly half of RTA survivors experience PTSD within six weeks, with recovery occurring over 1 to 3 years (non-RCTs). Even minor traffic accidents lead to significant psychological impacts, with 25% of survivors avoiding vehicle use for up to four months (non-RCT). Evidence-supported treatments identified include Cognitive Behavioural Therapy (CBT) (RCTs and non-RCTs), Virtual Reality (VR) treatment (RCTs and non-RCTs), and Memory Flexibility training (Mem-Flex) (pilot RCT), all of which demonstrated statistically significant reductions in PTSD symptoms across validated scales. There is evidence for policy actions including mandatory and regular psychological screening post RTAs using improved assessment tools, sharing health data to better align early and ongoing treatment with additional funding and access, and support and interventions for the family for RTA comorbidities. The findings underscore the importance of prioritizing research on the psychological impacts of RTAs, particularly in regions with high incident rates, to understand better and address the global burden of post-accident trauma. Full article

Effective postoperative pain management remains a major clinical challenge in spinal surgery, with poorly controlled pain affecting up to 50% of patients and contributing to delayed mobilization, prolonged hospitalization, and risk of chronic postsurgical pain. This review synthesizes current and emerging strategies in postoperative spinal pain management, tracing the evolution from opioid-centric paradigms to individualized, multimodal approaches. Multimodal analgesia (MMA) has become the cornerstone of contemporary care, combining pharmacologic agents, such as non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and gabapentinoids, with regional anesthesia techniques, including erector spinae plane blocks and liposomal bupivacaine. Adjunctive nonpharmacologic modalities like early mobilization, cognitive behavioral therapy, and mindfulness-based interventions further optimize recovery and address the biopsychosocial dimensions of pain. For patients with refractory pain, neuromodulation techniques such as spinal cord and peripheral nerve stimulation offer promising results. Advances in artificial intelligence (AI), biomarker discovery, and nanotechnology are poised to enhance personalized pain protocols through predictive modeling and targeted drug delivery. Enhanced recovery after surgery protocols, which integrate many of these strategies, have been shown to reduce opioid use, hospital length of stay, and complication rates. Nevertheless, variability in implementation and the need for individualized protocols remain key challenges. Future directions include AI-guided analytics, regenerative therapies, and expanded research on long-term functional outcomes. This review provides an evidence-based framework for pain control following spinal surgery, emphasizing integration of multimodal and innovative approaches tailored to diverse patient populations. Full article

Background and Objectives: Psychological distress is a pervasive yet often undertreated aspect of the cancer experience, contributing to reduced quality of life, poorer treatment adherence, and worse health outcomes. This systematic review and meta-analysis evaluated the efficacy of non-pharmacological, evidence-based psychological interventions on distress, depression, anxiety, coping capacity, and quality of life in adult cancer patients. Interventions were grouped into three domains: structured psychotherapeutic therapies (e.g., Cognitive Behavioral Therapy [CBT], Acceptance and Commitment Therapy [ACT], Meaning-Centered Psychotherapy [MCP]); mindfulness and stress reduction programs (e.g., Mindfulness-Based Stress Reduction [MBSR], Mindfulness-Based Cognitive Therapy [MBCT]); and coping and resilience-enhancing modalities (e.g., Promoting Resilience in Stress Management [PRISM], expressive writing). Materials and Methods: Following PRISMA guidelines, 42 randomized controlled trials published between 2015 and 2025 were included. A stratified meta-analytic approach calculated pooled standardized mean differences for each intervention class and outcome. Heterogeneity, subgroup, and moderator analyses explored drivers of effect variability. Results: Structured psychotherapeutic interventions yielded the largest effects, especially for depression. Mindfulness-based interventions produced moderate but significant improvements in distress and emotional regulation. Coping and resilience programs provided smaller yet statistically significant gains in adaptive coping. Between-study heterogeneity was moderate, partly explained by intervention type, delivery modality, and cancer subtype. Conclusions: These findings support integrating psychosocial care into standard oncology protocols and endorse its routine implementation as a core component of comprehensive cancer treatment. Full article

Background and clinical significance: Functional/dissociative seizures (FDSs) in adolescents are paroxysmal events which superficially resemble epileptic seizures or syncope. This study evaluated the effectiveness of brief cognitive analytic therapy (CAT). Case presentation: The patient was a 17-year-old white cisgender male with a diagnosis of non-epileptic attack disorder. The functional/dissociative seizures were treated with 8-session CAT, with follow-up at 5 weeks. Two target problems (TPs) and associated target problem procedures (TPPs) were rated for recognition and revision at each session and at follow-up. An A-B-C-FU single-case experimental evaluation of the TP/TPPs was conducted. Nomothetic outcome measures (DES-2 and RCADS) were administered at session 1, session 8, and at follow-up, and the YP-CORE and the Session Rating Scale were completed at each session. The patient was independently interviewed using the Change Interview 13 weeks after completing therapy. The results show that CAT effectively increased the recognition and revision of TPs/TPPs, four specific changes occurred (including cessation of functional seizures). There were pre–post reliable and clinically significant improvements to psychological wellbeing, but these were not maintained at follow-up. Conclusions: This study indicates that CAT was a partially effective intervention. The use of CAT as a treatment for FND in adolescents holds promise, but more research is needed. Full article

Deep learning (DL) approaches to natural language processing (NLP) offer powerful tools for creating digital twins (DTs) of patients in psychiatry and neurological rehabilitation by processing unstructured textual data such as clinical notes, therapy transcripts, and patient-reported outcomes. Techniques such as transformer models (e.g., BERT, GPT) enable the analysis of nuanced language patterns to assess mental health, cognitive impairment, and emotional states. These models can capture subtle linguistic features that correlate with symptoms of degenerative disorders (e.g., aMCI) and mental disorders such as depression or anxiety, providing valuable insights for personalized treatment. In neurological rehabilitation, NLP models help track progress by analyzing a patient’s language during therapy, such as recovery from aphasia or cognitive decline caused by neurological deficits. DL methods integrate multimodal data by combining NLP with speech, gesture, and sensor data to create holistic DTs that simulate patient behavior and health trajectories. Recurrent neural networks (RNNs) and attention mechanisms are commonly used to analyze time-series conversational data, enabling long-term tracking of a patient’s mental health. These approaches support predictive analytics and early diagnosis by predicting potential relapses or adverse events by identifying patterns in patient communication over time. However, it is important to note that ethical considerations such as ensuring data privacy, avoiding bias, and ensuring explainability are crucial when implementing NLP models in clinical settings to ensure patient trust and safety. NLP-based DTs can facilitate collaborative care by summarizing patient insights and providing actionable recommendations to medical staff in real time. By leveraging DL, these DTs offer scalable, data-driven solutions to promote personalized care and improve outcomes in psychiatry and neurological rehabilitation. Full article

Occupational therapy (OT) is vital in improving functional outcomes and aiding recovery for individuals with long-term disabilities, particularly those resulting from neurological diseases. Traditional assessment methods often rely on clinical judgment and individualized evaluations, which may overlook broader, data-driven insights. The integration of artificial intelligence (AI) presents a transformative opportunity to enhance assessment precision and personalize therapeutic interventions. Additionally, advancements in human–computer interaction (HCI) enable more intuitive and adaptive AI-driven assessment tools, improving user engagement and accessibility in OT. This scoping review investigates current applications of AI in OT, particularly regarding the evaluation of functional outcomes and support for clinical decision-making. The literature search was conducted using the PubMed and Scopus databases. Studies were included if they focused on AI applications in evaluating functional outcomes within OT assessment tools. Out of an initial pool of 85 articles, 13 met the inclusion criteria, highlighting diverse AI methodologies such as support vector machines, deep neural networks, and natural language processing. These were primarily applied in domains including motor recovery, pediatric developmental assessments, and cognitive engagement evaluations. Findings suggest that AI can significantly improve evaluation processes by systematically integrating diverse data sources (e.g., sensor measurements, clinical histories, and behavioral analytics), generating precise predictive insights that facilitate tailored therapeutic interventions and comprehensive assessments of both pre- and post-treatment strategies. This scoping review also identifies existing gaps and proposes future research directions to optimize AI-driven assessment tools in OT. Full article

Background and Clinical Significance: Evaluations of interventions for sexual orientation obsessive–compulsive disorder (SO-OCD) are rare. This study therefore evaluated the effectiveness of cognitive analytic therapy (CAT). Case Presentation: A 28-year-old heterosexual male presented with SO-OCD in the form of obsessions concerning his sexual identity and associated avoidance and reassurance-seeking compulsions. The evaluation was a quasi-experiential A/B single-case experimental design (SCED) with follow-up of the eight-session CAT intervention. The SCED had three phases: baseline ‘A’ (two sessions; 21 days), active treatment ‘B’ (six sessions; 56 days) and follow-up (one session; 44 days). There were seven daily rated idiographic outcome measures (intrusion count as the control, a compulsion count and then intensity measures of checking, worrying, generating evidence, shame and anxiety). Four nomothetic outcome measures (including a primary outcome measure of SO-OCD) were collected at assessment, end of treatment and follow-up. Generalised logistical models were fitted to the idiographic outcomes. Six of the seven idiographic measures responded to treatment, indicating an effective intervention. Idiographic change was non-linear and synchronised with specific psychotherapeutic actions and there was no evidence of relapse. There was a clinically significant and reliable pre–post reduction in SO-OCD with progress sustained over the follow-up period. Conclusions: Overall, the study indicates that CAT was an effective intervention for the SO-OCD. The study methodology is critiqued and guidance on SO-OCD treatment is provided. Full article

This systematic review explores the integration of machine learning (ML) with augmented reality (AR) and virtual reality (VR) technologies in cognitive therapies for mental health disorders. Analyzing 141 studies following PRISMA guidelines, the findings reveal that ML-driven AR/VR therapies offer significant advancements in personalization, real-time adaptation, and treatment efficacy. VR-based interventions demonstrate strong effectiveness in reducing symptoms of PTSD, anxiety disorders, and phobias, with ML algorithms—such as neural networks (NNs), supervised learning, and reinforcement learning (RL)—further optimizing therapy through predictive analytics and dynamic adjustments. These technologies enhance patient engagement, improve treatment adherence, and sustain therapeutic benefits for up to six months. This review highlights the transformative impact of ML-enhanced AR/VR therapies in delivering immersive, scalable, and highly personalized interventions, redefining the future of mental health treatment. As AI-powered therapeutic frameworks are poised to evolve further, such advancements have enormous potential to revolutionize cognitive therapies, enhancing their accessibility and optimizing patient outcomes worldwide. Full article

Background: Although digital cognitive behavioral therapy (dCBT) is considered effective for anxiety disorders, there is considerable heterogeneity in its efficacy across studies, and its varied treatment content and clinical components may explain such heterogeneity. Objective: This review aimed to identify the efficacy of digital cognitive behavioral therapy for panic disorder and agoraphobia, and examine whether applying relevant clinical components of interoceptive exposure, inhibitory-learning-based exposure, and personalization of treatment enhances its efficacy. Methods: Randomized controlled trials of dCBT for panic disorder and agoraphobia with passive or active controls were identified from OVID Medline, Embase, Cochrane Library, and PsycINFO. The overall effect sizes for dCBT groups (interventions through digital platforms based on the internet, mobile, computers, VR, etc.) were aggregated against passive control (placebo/sham) and active control (traditional CBT) groups. For subgroup analysis, key intervention components such as interoceptive exposure, inhibitory learning, and personalization were assessed dichotomously (0 or 1) along with other study characteristics. The stepwise meta-regression models were applied with traditional and Bayesian statistical testing. The risk of bias and publication bias of included studies were assessed. Results: Among the 31 selected studies, dCBT had an overall effect size of g = 0.70 against passive control and g = −0.05 against active control. In subgroup analysis, interoceptive exposure improved the clinical effects for both controls, and inhibitory learning and personalization increased the clinical effects for passive control along with therapist guide/support and the length of sessions. Many studies were vulnerable to therapist bias and attrition bias. No publication bias was detected. Conclusions: The heterogeneity in clinical effects of dCBT for panic and agoraphobia can be explained by the different intervention factors they include. For effective dCBT, therapists should consider the clinical components relevant to the treatment. Full article

Background: The integration of digital health technologies has transformed mental healthcare, particularly for young adults with First-Episode Psychosis (FEP). Digital interventions, such as telepsychiatry and mobile applications, address barriers like social stigma, restricted access to services, and the urgency of timely care. Methods: A systematic literature review was conducted using PubMed and APA PsycINFO. Included studies focused on randomized controlled trials, cohort studies, and open studies of digital interventions for FEP rehabilitation. Exclusion criteria included meta-analyses, reviews, and irrelevant studies. Results: Smartphone applications like Horyzons-Canada facilitated peer support and symptom management, while tools such as My Journey 3 emphasized the need for better user engagement. Digital innovations, including Cognitive Behavioral Therapy for insomnia (CBT-I) and telepsychiatry, demonstrated improvements in recovery and treatment adherence. Discussion: Digital interventions significantly enhance the accessibility and quality of FEP care, supporting functional recovery and patient engagement. Future research should prioritize longitudinal studies, user engagement strategies, and advanced analytics to develop personalized, scalable solutions. Full article

Objective: The objective of this study was to assess clinical decision-making associated with the use of a multi-analyte blood biomarker (BBM) test among patients presenting with signs or symptoms of mild cognitive impairment or dementia. Methods: The Quality Improvement PrecivityAD2 (QUIP II) Clinician Survey (NCT06025877) study evaluated the clinical utility of the PrecivityAD2™ blood test in a prospective, single cohort of 203 patients presenting with symptoms of Alzheimer’s disease (AD) or other causes of cognitive decline across 12 memory specialists. The PrecivityAD2 blood test (C2N Diagnostics, St. Louis, MO) combines the plasma Aβ42/Aβ40 ratio and the p-tau217/np-tau217 ratio (%p-tau217) measurements in a statistical algorithm to yield an Amyloid Probability Score 2 (APS2) that informs on the likelihood of brain amyloid plaques. After receiving the BBM test results, clinicians completed surveys on management strategies for each patient. Results: Patients had a median age of 74, 53% were female, and 28% were traditionally under-represented in Black, Hispanic, and Asian groups. The composite primary endpoint, defined as a change in AD diagnostic certainty, drug therapy, or additional brain amyloid evaluation pre- and post-BBM testing, was 75% (p < 0.0001 versus the pre-specified threshold of 20% clinically meaningful change). Anti-AD medication orders decreased among negative APS2 patients and increased among positive APS2 patients (p < 0.0001). Additional brain amyloid testing decreased among negative APS2 patients (p < 0.0001). Conclusions: This blood biomarker test can help memory specialists guide patients to anti-AD therapies as well as rule out AD to allow for other diagnostic considerations. Full article

Objective: Noninvasive brain stimulation (NIBS) is a promising complementary treatment for attention-deficit/hyperactivity disorder (ADHD). However, its efficacy varies due to diverse participant profiles and methodologies. This meta-analysis, registered with PROSPERO (CRD42023457269), seeks to assess NIBS efficacy in improving cognitive deficits and clinical symptoms in individuals with ADHD. Methods: We systematically searched five databases (October 2024) for randomized controlled trials focusing on cognitive functions and clinical symptoms in individuals meeting the DSM/ICD criteria for ADHD. A meta-analytical synthesis was conducted using RevMan 5.4.1. Results: Meta-analyses found significant improvement in inhibitory control, working memory, and inattention in active transcranial direct current stimulation (tDCS) groups compared with sham groups. Conversely, repetitive transcranial magnetic stimulation (rTMS) did not demonstrate significant therapeutic benefits for ADHD symptoms. Additionally, four transcranial random noise stimulation (tRNS) and three transcranial alternating current stimulation (tACS) studies demonstrated promising improvements in executive functions and the alleviation of ADHD symptoms. Conclusions: The findings from this meta-analysis highlight NIBS as a promising adjunctive therapy for managing ADHD, advancing both theoretical knowledge and practical treatment options in this field. Full article

Schizophrenia is a serious mental disorder that significantly affects the social and professional life of patients, causing distortion of reality and loss of identity and cognitive abilities. Psychopharmacological treatment is an integral part of modern psychiatry, and the introduction of new “atypical” antipsychotic drugs has brought significant progress in the treatment of this disorder. One of these drugs is olanzapine, which has an effective effect on the productive symptoms of schizophrenia while having an almost minimal potential to cause extrapyramidal syndrome. However, its effectiveness is confronted with frequent side effects, referred to as “metabolic disorders”. Therefore, to ensure the effectiveness of treatment and to minimize the side effects caused by olanzapine, it is recommended to monitor the drug level during therapy. This article reviews the bioanalytical methodologies that enable efficient extraction and sensitive analysis of olanzapine. We considered the advantages and disadvantages of different sample pretreatment methods, including traditional and novel strategies. The analytical conditions required for the separation and detection of olanzapine and its metabolites were analyzed using chromatographic methods combined with various detectors. Full article

Self-harm is becoming increasingly common in student populations. Brief psychological therapies might be helpful for those who have recently self-harmed. The current paper reports on an evaluation of a brief psychotherapy service delivered via remote means, namely University–Community Outpatient Psychotherapy Engagement (U-COPE). The service combines elements of psychodynamic interpersonal and cognitive analytic therapy to help students who present with self-harm related difficulties. The primary aim was to understand students’ and practitioners’ experiences of a remote psychotherapy service. Semi-structured interviews were conducted with a total of nine participants (seven students and two practitioners). Interview data were analysed using thematic analysis. Analyses of the interviews across the stakeholders revealed three overarching themes: ‘Accessibility’; ‘Therapeutic experiences’; and ‘Spaces and places of therapy’. Students appreciated the rapid access to intervention, especially as student services are typically characterised by long waiting lists. Despite the brief nature of the intervention, many students reported feeling a sense of control over the direction and pace of the therapeutic sessions, which is an important consideration for those who self-harm. The findings suggest that U-COPE may be helpful to students with difficulties related to self-harm. Further investigation of this brief intervention is warranted in order to ascertain whether U-COPE has a long-term impact on difficulties and distress-related behaviours. Full article