Psychotherapy and (or) Medications for Depression in Youth? An Evidence-Based Review with Recommendations for Treatment

This article reviews existing research pertaining to antidepressant medications, psychotherapy, and their combined efficacy in the treatment of clinical depression in youth. Based on this review, we recommend that youth depression and its treatment can be readily understood from a social-psycho-bio model. We maintain that this model presents an alternative conceptualization to the dominant biopsychosocial model, which implies the primacy of biological contributors. Further, our review indicates that psychotherapy should be the frontline treatment for youth with depression and that little scientific evidence suggests that combined psychotherapy and medication treatment is more effective than psychotherapy alone. Due primarily to safety issues, selective serotonin reuptake inhibitors should be initiated only in conjunction with psychotherapy and/or supportive monitoring.     

Occupational Therapy in the Rehabilitation of the Patient with Anorexia Nervosa

The first part of this paper develops an ecological and rehabilitative stance for the occupational therapist in relation to the anorexic patient. Maximizing the individual's level of psychosocial functioning is regarded as the primary aim of treatment. A model for approaching the anorexic patient is described which examines environmental factors, and the importance of assessment and follow up. The cognitive behavioral approach is discussed and suggestions are made for adapting it to the occupational therapist's orientation towards practical activity. In the second part of the paper concrete suggestions for therapy are made.     

Improving adherence to medication regimens for children with asthma and its effect on clinical outcome.

We examined the effects of a combined education and token system intervention to improve adherence to inhaled corticosteroids for an 8-year-old girl and a 10-year-old boy with asthma. Adherence was measured by an electronic chronolog monitor, and disease outcome was assessed by repeated pulmonary function testing. A withdrawal design demonstrated improved adherence and, for 1 child, an associated improvement in pulmonary function occurred. Methodological and clinical implications are discussed, including variables other than adherence that may affect disease outcome.     

从2型糖尿病的发病机制谈糖尿病治疗的新策略

2型糖尿病的发病机制主要为胰岛素抵抗与胰岛β细胞分泌功能受损,二者相互依存、相互作用。2型糖尿病的治疗应以减轻胰岛素的抵抗和保护胰岛β细胞为主,以生活方式干预加二甲双胍作为基础治疗,根据不同个体在不同阶段所侧重的不同发病机制,采用联合、综合管理。     

Typologies of Alcohol Dependence. From Jellinek to Genetics and Beyond

The goal of typology research is to identify subtypes of alcohol dependent (AD) patients sharing fundamental characteristics and try to match each subtype, with the most precise treatment strategy. This review provides a comprehensive history of the literature on alcohol dependent subtypes starting from the earliest attempt made by Jellinek. The binary models identified most closely with Cloninger and Babor as well as the successively more complex classifications are discussed. Typology classification potentially useful in guiding the treatment of AD patients, especially in the case of the serotonergic medications. Contrasting data suggests that other factors could influence the response to a medication and/or that more complex typologies should be identified. In summary, typology models may assist in the ascertainment criteria for clinical trials performed in behavioral and pharmacotherapeutic interventions. Greater emphasis, however, must be made to more clearly delineate this field of research, while moving toward more standardized typologies.     

Recent Developments in the Treatment of Depression

The cognitive and behavioral interventions can be as efficacious as antidepressant medications and more enduring, but some patients will be more likely to respond to one than the other. Recent work has focused on developing sophisticated selection algorithms using machine-learning approaches that answer the question, “What works best for whom?” Moreover, the vast majority of people suffering from depression reside in low- and middle-income countries where access to either psychotherapy or medications is virtually nonexistent. Great strides have been made in training nonspecialist providers (known as task sharing) to overcome this gap. Finally, recent work growing out of evolutionary psychology suggests that antidepressant medications may suppress symptoms at the expense of prolonging the underlying episode so as to increase the risk of relapse whenever someone tries to stop. We address each of these developments and their cumulative implications.