scholarly journals The Gut Microbiome and Mental Health: What Should We Tell Our Patients?: Le microbiote Intestinal et la Santé Mentale : que Devrions-Nous dire à nos Patients?

2019 ◽  
Vol 64 (11) ◽  
pp. 747-760 ◽  
Author(s):  
Mary I. Butler ◽  
Sabrina Mörkl ◽  
Kiran V. Sandhu ◽  
John F. Cryan ◽  
Timothy G. Dinan
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Psychiatric Disorders ◽  
Gut Microbiome ◽  
Treatment Strategies ◽  
Health Benefit ◽  
Evidence Base ◽  
Autism Spectrum ◽  
Current Evidence ◽  
Current Evidence Base

The gut microbiome as a potential therapeutic target for mental illness is a hot topic in psychiatry. Trillions of bacteria reside in the human gut and have been shown to play a crucial role in gut–brain communication through an influence on neural, immune, and endocrine pathways. Patients with various psychiatric disorders including depression, bipolar disorder, schizophrenia, and autism spectrum disorder have been shown to have significant differences in the composition of their gut microbiome. Enhancing beneficial bacteria in the gut, for example, through the use of probiotics, prebiotics, or dietary change, has the potential to improve mood and reduce anxiety in both healthy people and patient groups. Much attention is being given to this subject in the general media, and patients are becoming increasingly interested in the potential to treat mental illness with microbiome-based therapies. It is imperative that those working with people with mental illness are aware of the rationale and current evidence base for such treatment strategies. In this review, we provide an overview of the gut microbiome, what it is, and what it does in relation to gut–brain communication and psychological function. We describe the fundamental principles and basic techniques used in microbiome–gut–brain axis research in an accessible way for a clinician audience. We summarize the current evidence in relation to microbiome-based strategies for various psychiatric disorders and provide some practical advice that can be given to patients seeking to try a probiotic for mental health benefit.

Short report: A quantitative methodological review of participant characteristics in the literature testing mental health interventions for youth with autism spectrum disorder

Autism ◽  
2021 ◽  
pp. 136236132110564
Author(s):  
Kelsey S Dickson ◽  
Megan Ledoux Galligan ◽  
Ho Lok
Keyword(s):  
Mental Health ◽  
Mental Health Treatment ◽  
Evidence Base ◽  
Autism Spectrum ◽  
Health Interventions ◽  
Current Evidence ◽  
Health Treatment ◽  
Current Evidence Base ◽  
Mental Health Interventions ◽  
Treatment Research

There have been significant efforts to develop, adapt, and test interventions targeting the co-occurring mental health conditions common among autistic youth, with several extant narrative and systematic reviews demonstrating the efficacy of these interventions. Yet, a methodological analysis of the literature testing these interventions, particularly the characteristics of the participant samples comprising this evidence base, is needed to contextualize our current understanding of treatment effects and highlight current gaps in the current evidence base to inform future research. This systematic quantitative methodology review characterized participants included in the mental health treatment research for autistic youth. One hundred and thirty-one articles testing mental health interventions for autism spectrum disorder were coded for youth, caregiver, and provider participant demographics. Findings indicated limited representation of females, transition age youth, racial/ethnic minority groups, and youth diverse in cognitive functioning and co-occurring mental health symptoms or conditions. Limited inclusion of providers’ representative of the clinical workforce was also noted. These results illuminate several critical gaps in the current evidence base for mental health interventions for autistic youth and provide recommendations for future research directions. Lay abstract Previous research has highlighted the importance of mental health treatment for autistic youth. In that research base, most studies focus on demonstrating the efficacy of a particular intervention with a sample of autistic youth. However, understanding the characteristics of samples used within these studies (i.e. demographics) is an important avenue for expanding this research to a more diverse, representative sample of autistic youth in community settings. As such, the current review examined and characterized participants included within mental health treatment research. We coded studies for various demographics among the youth sample, caregivers, and providers participants. Results indicated that while efforts have been made to increase diversity in research, very few studies including transition-aged youth, those identifying as female, and/or those identifying as non-Caucasian. Clinically, a few studies included youth with lower cognitive abilities and/or those with specific mental health problems (e.g. trauma and depression) or more than one co-occurring mental health conditions. Overall, our results highlight several critical gaps in our current evidence base regarding mental health treatment for autistic youth, including the limited clinical representativeness of both provider and child participants.

scholarly journals Toward the diagnosis of rare childhood genetic diseases: what do parents value most?

2021 ◽  
Author(s):  
Samantha Pollard ◽  
Deirdre Weymann ◽  
Jessica Dunne ◽  
Fatemeh Mayanloo ◽  
John Buckell ◽  
...  
Keyword(s):  
Focus Groups ◽  
Genetic Disease ◽  
Diagnostic Yield ◽  
Management Strategies ◽  
Health Benefit ◽  
Sampling Technique ◽  
Evidence Base ◽  
Current Evidence ◽  
Genomic Testing ◽  
Current Evidence Base

AbstractGenomic testing is becoming routine for diagnosing rare childhood genetic disease. Evidence underlying sustainable implementation is limited, focusing on short-term endpoints such as diagnostic yield, unable to fully characterize patient and family valued outcomes. Although genomic testing is becoming widely available, evidentiary and outcomes uncertainty persist as key challenges for implementation. We examine whether the current evidence base reflects public tolerance for uncertainty for genomics to diagnose rare childhood genetic disease. We conducted focus groups with general population parents in Vancouver, Canada, and Oxford, United Kingdom, to discuss expectations and concerns related to genomic testing to diagnose rare childhood genetic disease. Applying a purposive sampling technique, recruitment continued until thematic saturation was reached. Transcripts were analysed using thematic analysis. Thirty-three parents participated across four focus groups. Participants valued causal diagnoses alongside management strategies to improve patient health and wellbeing. Further, participants valued expanding the evidence base to reduce evidentiary uncertainty while ensuring security of information. Willingness to pay out of pocket for testing reflected perceived familial health benefit. Diagnostic yield fails to fully capture valued outcomes, and efforts to resolve uncertainty better reflect public priorities. Evaluations of genomic testing that fully integrate valued endpoints are necessary to ensure consistency with best practices and public willingness to accept the uncertain familial benefit.

scholarly journals Encouraging the implementation of clinical standards into practice

2000 ◽  
Vol 24 (3) ◽  
pp. 90-93 ◽  
Author(s):  
Claire Palmer ◽  
Paul Lelliott
Keyword(s):  
Mental Health ◽  
Evidence Base ◽  
Current Evidence ◽  
Routine Practice ◽  
Clinical Standards ◽  
Current Evidence Base

The articles by Geddes & Wessely (2000, this issue) and Lelliott (2000, this issue) describe the current evidence base and guidelines from which clinical standards can be developed in mental health. They highlight some of the issues and complexity surrounding the development of standards. It could be argued, however, that an even greater challenge lies in getting clinical standards used in routine practice.

An update on the growing evidence base for peer support

2017 ◽  
Vol 21 (3) ◽  
pp. 161-167 ◽  
Author(s):  
Chyrell Bellamy ◽  
Timothy Schmutte ◽  
Larry Davidson
Keyword(s):  
Mental Health ◽  
Physical Health ◽  
Clinical Outcomes ◽  
Peer Support ◽  
Support Services ◽  
Evidence Base ◽  
Current Evidence ◽  
Content Type ◽  
Current Evidence Base ◽  
Peer Support Services

Purpose As peer support services have become increasingly used in mental health settings as a recovery-oriented practice, so has the body of published research on this approach to care. The purpose of this paper is to provide an update on the current evidence base for peer support for adults with mental illness in two domains: mental health and recovery, and physical health and wellness. Design/methodology/approach To provide a robust, non-redundant, and up-to-date review, first the authors searched for meta-analyses and systematic reviews. Second, the authors found individual studies not included in any of the reviews. Findings Peer services are generally equally effective to services provided by non-peer paraprofessionals on traditional clinical outcomes. Although some studies found peer services to be effective at reducing hospitalization rates and symptom severity, as a whole, the current evidence base is confounded by heterogeneity in programmatic characteristics and methodological shortcomings. On the other hand, the evidence is stronger for peer support services having more of a positive impact on levels of hope, empowerment, and quality of life. Research limitations/implications In addition to the need for further high-quality research on peer support in mental and physical health domains, the authors also question whether measures of hope, empowerment, and integration into the community are more relevant to recovery than traditional clinical outcomes. Originality/value This paper provides an original, robust, and up-to-date review of the evidence for peer services.

Autism, Attention Deficit Hyperactivity Disorder, and Cognitive Enhancement

2017 ◽  
Author(s):  
Iulia Dud ◽  
Louise Brennan ◽  
Dene Robertson
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Executive Functions ◽  
Attention Deficit ◽  
Behavioral Interventions ◽  
Psychosocial Interventions ◽  
Evidence Base ◽  
Autism Spectrum ◽  
Current Evidence ◽  
Hyperactivity Disorder ◽  
Current Evidence Base

Attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are common neurodevelopmental disorders. Impairments in attention and executive functions are core characteristics of ADHD. ASD is primarily characterized by severe deficits in social communication, but cognitive impairments are common, including in attention and executive functions. Currently, there is only limited evidence for efficacy of either pharmacological or behavioral interventions for the treatment of the cognitive deficits associated with the disorders. This chapter presents the current evidence base for cognitive enhancements for ADHD and ASD. It summarizes evidence from available and experimental pharmacological interventions, as well as behavioral, cognitive, and psychosocial interventions. The chapter also discusses the limitations of current tools and future directions.

Matching clients to CBT self-help resources

2010 ◽  
pp. 113-120 ◽  
Author(s):  
Rebeca Martinez ◽  
Chris Williams
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Research And Development ◽  
Evidence Base ◽  
Current Evidence ◽  
Shared Decision ◽  
Mental Health Difficulty ◽  
Self Help ◽  
Current Thinking ◽  
Current Evidence Base

Chapter 9 addresses the range of factors that may inform shared decision making following assessment. Several of these draw upon the current evidence base surrounding the type of mental health difficulty for which self-help CBT is effective, and echo conclusions reached within other chapters in this title and, at times, challenge current thinking concerning LI working. This highlights how there is still much to learn regarding the application of the LI approach, which will hopefully stimulate further research and development in this area.

scholarly journals Psychological interventions for depression in children and young people with an intellectual disability and/or autism: systematic review

2020 ◽  
pp. 1-10
Author(s):  
Lauren A. Cameron ◽  
Katelyn Phillips ◽  
Glenn A. Melvin ◽  
Richard P. Hastings ◽  
Kylie M. Gray
Keyword(s):  
Intellectual Disability ◽  
Young People ◽  
Psychological Treatment ◽  
Evidence Base ◽  
Autism Spectrum ◽  
Risk Of Bias ◽  
Current Evidence ◽  
Psychological Interventions ◽  
Children And Young People ◽  
Current Evidence Base

Background Children and young people with intellectual disability and/or Autism Spectrum Disorder (autism) experience higher rates of mental health problems, including depression, than their typically developing peers. Although international guidelines suggest psychological therapies as first-line intervention for children and young people, there is limited evidence for psychological therapy for depression in children and young people with intellectual disability and/or autism. Aims To evaluate the current evidence base for psychological interventions for depression in children and young people with intellectual disability and/or autism, and examine the experiences of children and young people with intellectual disability and/or autism, their families and therapists, in receiving and delivering psychological treatment for depression. Method Databases were searched up to 30 April 2020 using pre-defined search terms and criteria. Articles were independently screened and assessed for risk of bias. Data were synthesised and reported in a narrative review format. Results A total of 10 studies met the inclusion criteria. Four identified studies were clinical case reports and six were quasi-experimental or experimental studies. All studies were assessed as being of moderate or high risk of bias. Participants with intellectual disability were included in four studies. There was limited data on the experiences of young people, their families or therapists in receiving or delivering psychological treatment for depression. Conclusions Well-designed, randomised controlled trials are critical to develop an evidence base for psychological treatment for young people with intellectual disability and/or autism with depression. Future research should evaluate the treatment experiences of young people, their families and therapists.

scholarly journals Evidence base for psychological treatment of personality disorder – a narrative review

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S278-S278
Author(s):  
Caoimhe Ni Shuilleabhain
Keyword(s):  
Personality Disorder ◽  
Psychological Treatment ◽  
Clinical Care ◽  
Treatment Strategies ◽  
Empirical Support ◽  
Evidence Base ◽  
Treatment Modalities ◽  
Current Evidence ◽  
Specific Patient ◽  
Current Evidence Base

AimsThis review critically appraises the up-to-date evidence base for psychological treatment of PD.BackgroundThe prevalence rate of any personality disorder (PD) in the general population has been estimated to be as high as 12% rising to over 70% in prison settings. PD is known to carry significant psychosocial and health burdens with increased mortality, increased suicide, increased substance misuse, increased crime, reduced capacity to work, poorer outcomes for comorbid mental disorders, dysfunctional engagement with services, and high economic costs through a high utilisation of healthcare systems. In the 1990s several manualised treatment strategies emerged, specifically for borderline PD. These include dialectical behaviour therapy, cognitive therapy, cognitive analytic therapy, mentalization-based therapy, transference-focused psychotherapy, and schema-focussed therapy.MethodUsing relevant search criteria, literature was identified through a search of the following databases: PubMed, EMBASE, and PsycINFO. Data were appraised and synthesised to provide a comprehensive overview of the current evidence base for psychological treatment of PD.ResultThe DSM-V defined Cluster B borderline PD has received the majority of attention. Increasing attention has been paid in recent years to the Cluster B antisocial PD. Cluster A (Paranoid, Schizoid, Schizotypal) and Cluster C PDs (Avoidant, Dependent, Obsessive Compulsive) have received relatively little attention with few studies to draw upon regarding the effectiveness of therapy. The remaining Cluster B personality disorders (Narcissistic and Histrionic) have been criticised as having poor construct validity, with a lack of rigorously designed treatment trials.A number of treatment protocols have gained empirical support. However, of those that have empirical support, there appears to be little demonstrable evidence to suggest superiority of any one of the evidence-based interventions over another. While specialised therapies are more efficacious than “treatment as usual” or treatment delivered by expert clinicians, when specialised therapies are compared with well-specified manualised general psychiatric care tailored to personality disorder, the results are different, with little consistent evidence demonstrating the superiority of specialised therapies.ConclusionCurrent evidence suggests that individual therapies do not differ substantially from each other or from structured clinical care that relies on generic change factors. This is in keeping with established psychotherapy outcome literature. Current evidence would indicate that common features across the proven treatment strategies should be emphasised and implemented well. There may be justification for added interventions from specific treatment modalities targeted to specific patient problems.

scholarly journals What outcomes should be measured to evaluate the benefits of exercise for maternal mental health?

2019 ◽  
Vol 7 (9) ◽  
pp. 442-454
Author(s):  
Dawn Brenchley ◽  
Gilly Mancz
Keyword(s):  
Mental Health ◽  
Postnatal Depression ◽  
Maternal Mental Health ◽  
Methodological Approach ◽  
Evidence Base ◽  
Primary Outcome Measure ◽  
Depression Score ◽  
Current Evidence ◽  
Physical And Mental Health ◽  
Current Evidence Base

The physical and mental health of women antenatally and postnatally has been described as fundamentally important to the development of children and the family. Exercise was proposed as a strategy to support maternal mental health, such as postnatal depression with an emphasis on structured and supervised activities. However, a recent systematic review by Saligheh et al (2017) revealed inconsistencies in the evidence base and could not confirm that exercise reduced symptoms of postnatal depression. This study aims to analyse the current evidence base to determine what outcomes should be measured to evaluate the benefits of exercise to maternal mental health. The research concludes that using a quantitative methodological approach, predominantly using the Edinburgh Postnatal Depression Score as a primary outcome measure, does not appear to capture the effects of exercise on postnatal depression and anxiety. Further research using a qualitative approach is recommended to identify outcomes that should be measured to demonstrate the benefits of exercise to maternal mental health.

Update on the effectiveness of psychotherapy for anxiety disorders in children and adolescents with ASD

2019 ◽  
Vol 83 (3) ◽  
pp. 326-352 ◽  
Author(s):  
Michelle C. Hunsche ◽  
Connor M. Kerns
Keyword(s):  
Anxiety Disorders ◽  
Behavioral Therapy ◽  
Evidence Base ◽  
Autism Spectrum ◽  
Current Evidence ◽  
Future Research ◽  
Current Evidence Base ◽  
Research Findings ◽  
Individual Program ◽  
Spectrum Disorders

A growing body of research has examined the efficacy of varying formats (individual, group, linear, modular) of cognitive-behavioral therapy (CBT) as a treatment for anxiety disorders in children and youth with autism spectrum disorders (ASD). The present review utilized Chambless and Hollon's (1998) criteria for efficacious treatments to: (1) critically review the current evidence base for the efficacy of CBT for anxiety disorders in ASD; and (2) provide recommendations for future research. Findings identify two probably efficacious CBT programs (one group and one individual program) and five possibly efficacious programs, but no well-established programs. Similarities and differences in the components of these programs, which range from unmodified to specifically developed for ASD populations, are highlighted. In addition, the steps required to demonstrate well-established efficacy, and ultimately effectiveness, are discussed alongside other recommendations for refined future research.

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