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PURPOSE: To review the evidence on screening benefits and harms of screening, accuracy of screening, benefits and harms of treatment for suicide risk, anxiety, and depression in children and adolescents in settings relevant to primary care in the United States for the U.S. Preventive Services Task Force. DATA SOURCES: PubMed, the Cochrane Library, PsycINFO, CINAHL and trial registries through July 19, 2021; bibliographies from retrieved articles, outside experts, and surveillance of the literature through June 1, 2022. STUDY SELECTION: Two investigators independently selected English-language studies using a priori defined criteria. We included trials that evaluated the benefits or harms of screening for suicide risk, anxiety, or depression compared with no screening or usual care. We included studies of screening with instruments feasible in primary care settings. For treatment benefits and harms, we included drugs approved for pediatric use by the Food and Drug Administration. For suicide and depression treatment studies, we included any eligible psychotherapy or collaborative care interventions. For anxiety, we restricted nonpharmacological interventions to cognitive behavioral therapy CBT. Eligible outcomes included test accuracy, symptoms, response, remission, loss of diagnosis, all-cause mortality, functioning, suicide-related symptoms or events, withdrawal due to adverse events, serious adverse events, and harms from screening. We also included systematic reviews reporting on harms of treatment. We excluded studies with poor methodological quality. DATA EXTRACTION AND ANALYSIS: One investigator extracted data and a second checked accuracy. Two reviewers independently rated methodological quality for all included studies. When at least three similar studies were available, we conducted meta-analyses. DATA SYNTHESIS: We included 80 studies in 106 publications. No studies evaluated the direct benefits of screening compared with no screening or usual care. Seventeen studies reported on accuracy of screening instruments for one or more conditions; of these, one reported on suicide N=580, 10 on anxiety N=3,260, seven on depression N=3,316, and two on anxiety or depression N=695. Studies reported a wide range for sensitivity and specificity across a variety of instruments, with no more than one or two studies on each instrument. For suicide, sensitivity ranged from 0.87 to 0.91, and specificity was 0.60. For anxiety, sensitivity generally ranged from 0.34 to 1.00, and specificity from 0.47 to 0.98. For depression, sensitivity ranged from 0.59 to 0.94, and specificity from 0.38 to 0.96. Two RCTs N=2,675 compared short-term distress from screening for suicide risk and reported no significant differences between those screened and those who were not screened. Sixty randomized, controlled trials RCTs addressed benefits of treatment; of these, 16 reported on suicide risk interventions N=3,034, 29 on anxiety treatment N=2,970, 13 on depression treatment N=2,156, and two on depression or anxiety treatment N=236. Interventions addressing suicide risk or self-harm reported lower scores for the Beck Hopelessness Scale pooled mean difference: −2.35 95% confidence interval CI, −4.06 to −0.65; N=644; k=4 for intervention arms when compared with control arms. Findings for other measures were mixed or not statistically significantly different. Of the 29 RCTs on anxiety treatment, 22 were on CBT; six were on pharmacotherapy; and one had multiple arms evaluating CBT, sertraline, and CBT plus sertraline. The evidence suggests CBT was associated with gains on several pooled measures of symptom improvement magnitude of change varies by outcome measure, response pooled relative risk RR: 1.89 95% CI, 1.17 to 3.05; N=606; k=6; I2=64%, remission RR: 2.68 95% CI, 1.48 to 4.88; N=321; k=4, and loss of diagnosis RRs range from 3.02 to 3.09, when compared with usual care or wait-list. The evidence on functioning for CBT was mixed. The evidence suggests pharmacotherapy, when compared with placebo, was associated with gains on two pooled measures of symptom improvement mean difference Pediatric Anxiety Rating Scale: −4.0 95% CI, −5.5 to −2.5, N=726, k=5 and mean difference Clinical Global Impressions-Severity: −0.84 95% CI, −1.13 to −0.55; N=550, k=4 and response RR: 2.11 95% CI, 1.58 to 2.98; N=370; k=5 but was mixed on measures of functioning. Of the 13 RCTs on depression treatment, eight were on psychotherapy; two on pharmacotherapy; one on CBT, fluoxetine, and their combination; and one on collaborative care. Results for psychotherapy varied by measure. Two pooled estimates suggested that psychotherapy is associated with improved symptoms Beck Depression Inventory BDI or BDI-II standardized mean difference: −0.58 95% CI, −0.83 to −0.34; N=471; k=4 and Hamilton Depression Scale mean difference: −2.25 95% CI,−4.09 to −0.41; N=262; k=3, clinical response 3 studies with statistically significant results using varying thresholds, and loss of diagnosis RR: 1.73 95% CI, 1.00 to 3.00; N=395; k=4 but no statistically significant differences for other measures. The evidence suggested statistically pharmacotherapy was associated with improvement for one measure of symptoms Children's Depression Rating Scale-Revised CDRS-R mean difference −3.76 95% CI, −5.95 to −1.57, N=793; k=3, and pharmacotherapy was associated with improvement for remission, but the pooled differences were not statistically significant. The single collaborative care trial N=101 found that collaborative care was associated with improved symptoms at 6 months CDRS-R change: 8.5 95% CI, 13.4 to −3.6, response by 12 months odds ratio OR for ≥50% reduction in CDRS-R score: 3.3 95% CI, 1.4 to 8.2, and remission OR for Patient Health Questionnaire-9 <5 at 6 months: 5.2 95% CI, 1.6 to 17.3. The study reported no statistically significant benefits on measures of functioning. Twenty studies 19 randomized controlled trials and 1 meta-analysis addressed harms. Of these, two reported on suicide risk interventions N=885, 11 on anxiety treatment N=1,293, and seven on depression treatment N=1,352. Two RCTs of interventions to reduce suicide risk or self-harm reported no statistically significant differences in adverse events. Of the 11 RCTs reporting harms of anxiety treatments, four evaluated CBT; six evaluated pharmacotherapy; and one evaluated CBT, sertraline, and their combination. The evidence from CBT studies yielded inconsistent results on suicide-related events; these studies also suggested lower rates of withdrawal due to adverse events and serious adverse events in the CBT arms. Suicide-related events and withdrawals due to adverse events in pharmacotherapy studies were rare and not statistically significant; however, they were more commonly reported in pharmacotherapy arms when compared with placebo arms. Of the seven studies reporting harms of depression treatment, three evaluated pharmacotherapy; two evaluated psychotherapy; one evaluated CBT, fluoxetine, and their combination; and one evaluated collaborative care 1,276 from trials. Suicide-related outcomes, withdrawal as a result of adverse events, and serious adverse events were not statistically significant between study arms but were more frequent for pharmacotherapy when compared with placebo; inconsistencies in the evidence further reduced certainty. The evidence from the collaborative care study was inconsistent. LIMITATIONS: No studies were available that reported benefits of screening compared with no screening. Limited evidence was available on harms of screening, long-term outcomes, test accuracy, and suicide risk and depression treatment in children. Treatment-as-usual comparators for suicide risk interventions included active treatments. The review was limited to drugs approved for pediatric use by the Food and Drug Administration FDA. For anxiety, psychotherapy was limited to CBT. CONCLUSIONS: We found no eligible studies that reported on benefits directly arising from screening when compared with usual care or no screening. Limited direct evidence suggests no short-term harms from screening for suicide risk. The evidence for screening for suicide risk, anxiety, and depression in children and adolescents relied on indirect evidence on the accuracy of screening and the benefits and harms of treatment. The evidence suggests that some screening instruments are reasonably accurate for anxiety and depression, but the evidence is limited for suicide risk screening instruments. Both pharmacotherapy and psychotherapy treatments have some benefit for some depression and anxiety outcomes (specifically, CBT for anxiety alone was reviewed); the evidence is limited for suicide risk interventions. Harms are rare in treatment studies but more frequent in pharmacotherapy arms when compared with placebo. Evidence gaps persist in children younger than age 11 years for test accuracy; depression and suicide risk interventions; and screening and treatment differences by sex, race/ethnicity, sexual orientation, and gender identity.

Anxiety disorders.

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This book aims to synthesize recent theoretical and experimental findings from psychology, neuroscience, epigenetics and genetics to understand anxiety disorders and their etiology and treatments. Each anxiety disorder is discussed from cognitive, behavioral and biological perspectives. The book evaluates talk therapies, mindfulness-based interventions, brain stimulation, biofeedback and neurofeedback treatments. Chapters consider a biologically-informed framework for the understanding of anxiety disorders. In line with current thinking, the book integrates many levels of information (from genomics and circuits to behavior and self-report) to understand normal and abnormal human behaviors. Synthesizing recent research on anxiety disorders according to their categorization in the DSM5, this book will bring psychology students, researchers, psychiatrists and psychologists up to date. Synthesizes recent research on anxiety disorders according to categorization in the DSM5 A useful, up-to-date reference for psychology students, researchers, psychiatrists, and psychologists Discusses each anxiety disorder from cognitive, behavioral and biological perspectives.

Law --- Psychiatry --- psychotherapie --- counseling --- klinische psychologie --- Anxiety disorders.. --- Ansietat

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Nous avons tous peur de manquer : peur de perdre ceux que j'aime, peur d'un manque matériel... Comment penser cette angoisse que nous cherchons toujours à combler ? Nous sommes tous porteurs de l'angoisse du manque, de la perte, qui nous habite dès notre naissance. Manque de ce que j'aime, de ceux que j'aime. Tristesse de manquer un jour de tout ce que l'on a laissé derrière soi. Peur aussi d'avoir manqué l'essentiel. Elle peut engendrer tantôt une désespérance, tantôt une consommation à outrance de biens matériels, quête illusoire de comblement du vide. Mais il est d'autres modes de remplissage : objets conservés ou encore hyperactivité, travail trépidant et loisir non moins trépidant. Rempart élevé contre la conscience de l'absence absolue, contre notre finitude et notre disparition. Partie de l'expérience du trop et du trop-plein, Nicole Fabre nous mène dans un passionnant cheminement, jalonné des récits de ses patients et de son expérience de clinicienne. Elle nous conduit à un questionnement existentiel, une quête menée par chacun de nous et nous aide à penser ce manque fondamental que nous cherchons toujours à combler.

Névroses d'angoisse. --- Névroses d'angoisse --- Anxiety --- Loss (Psychology) --- Anxiety disorders.

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Introduction. The present study was designed to assess the efficacy of an intervention (i.e., initially VRET) on the clinical symptomatology of patients suffering from anxiety disorders. Unfortunately, the patient only carried out a single VRET exercise, which did not cause her anxiety. Therefore, the intervention was modified to fit the patient’s prevailing needs. Moreover, we aimed to explore the presence of SGs. This research also had the specific intention to implement an EBP approach in the care of the patient. &#13;Methods. This case study consisted of a multiple baseline design. Our sample consisted of one patient with GAD and agoraphobia. The present study incorporates the data collected during the first eight sessions of the therapeutic intervention. In each session, we investigated the evolution of several anxiety-related variables such as the intensity of the anxiety, anxiety-related physical symptoms, the frequency of the avoidance, the anticipation of the feared stimuli, and the sense of self-efficacy in regard to facing the feared stimuli. The effect size of the treatment was measured by the method of Percentage of Nonoverlapping Data (PND). Moreover, the presence of SGs was determined in accordance with the criteria established by Tang and DeRubeis (1999).&#13;Hypotheses. We hypothesized that there would be a decrease in participants’ anxiety during the psychological intervention compared to their pre-treatment anxiety. More specifically, the intensity of the anxiety, the anxiety-related physical symptoms, the frequency of the avoidance, and the anticipation of the feared stimuli would lessen and the sense of self-efficacy in regard to facing the feared stimuli would increase. Furthermore, we expected to detect SGs in the evolution of clinical symptomatology.&#13;Results. The intervention led to a decrease in the patient’s avoidance behaviors and the anxiety-related physical symptom dizziness intensity. Moreover, there was an SG between sessions four and five in the intensity of dizziness felt by the patient.&#13;Conclusion. These results suggest that the first sessions of therapeutic intervention can lead to an amelioration of the patient’s symptomatology, in this case, a decrease in avoidance behaviors and dizziness intensity. It also confirmed the presence of SGs in psychological intervention for anxiety disorders. It would be interesting to analyze the data again once the intervention is completed, with the hope to find further amelioration of the clinical symptomatology and/or other SGs. More research on VRET, SGs, and the implementation of EBP in clinical practice is necessary.

Virtual Reality Exposure Therapy --- Anxiety disorders --- Sudden gains --- Evidence-based practice --- Sciences sociales & comportementales, psychologie > Traitement & psychologie clinique

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A treatment manual for delivering culturally adapted Cognitive Behavioural Therapy (CBT) for patients with PTSD and related disorders. Offering scripted text for sessions, and covering areas such as breathing techniques, muscle relaxation, stretching, anger, worry, and sleep. An accessible book for a wide-range of mental health practitioners.

Post-traumatic stress disorder. --- Anxiety disorders --- Stress (Psychology) --- Traumatic neuroses --- Intrusive thoughts --- Posttraumatic stress disorder --- PTSD (Psychiatry) --- Stress disorder, Post-traumatic --- Traumatic stress syndrome