Background Auditory hallucinations in patients with psychotic disorders may be very distressing. Unfortunately, a large proportion of individuals are resistant to pharmacological interventions and the gold-standard cognitive-behavioral therapy for psychosis offers at best modest effects. To improve therapeutic outcomes, several therapies have been created to establish a relationship between voice-hearers and their voices. With increasing literature, we conducted a systematic review of dialogical therapies and examined the evidence behind their efficacy. Methods A systematic search was performed in PubMed, PsycINFO, Web of Science, and Google Scholar. Articles were included if they discussed the effects of dialogical interventions for patients with psychotic disorders. Results A total of 17 studies were included within this systematic review. Cumulative evidence from various therapies has shown that entering in a dialog with voices is beneficial to patients, even those who are resistant to current pharmacological treatments. Heightened benefits have been mainly observed with Relating Therapy and Avatar Therapy/Virtual Reality assisted Therapy, with evidence generally of moderate quality. Both these interventions have shown large to very large effects on voices and voice-related distress as well as moderate to large magnitude improvements on affective symptoms. Though, cognitive-behavioral therapy for command hallucinations and making sense of voices noted no improvements on voices. Conclusions Literature on relational-based interventions with a strong emphasis on the relational aspects of voice hearing has shown positive effects. Results suggest that these dialogical therapies might surpass the efficacy of current gold-standard approaches.
Objectives. The COVID-19 pandemic has had many public health impacts, especially on vulnerable individuals including adults with neurocognitive disorders (NCD). With increasing literature, this systematic literature review aimed to address the mental health effects of COVID-19 on people with NCD in addition to examine the impact of the pandemic on treatments/resources for NCD. Methods. A literature search was conducted in the electronic databases of PubMed, PsycINFO, Web of Science and Google Scholar. Studies were included so long as they assessed the mental health or therapeutic effects of COVID-19 on NCD. Results. Among the retrieved articles, 59 met eligibility criteria. First, the pandemic and resulting self-isolation led to many detrimental effects on psychological well-being. Exacerbation and relapses of neurocognitive and behavioral symptoms were observed, as well as emergences of new psychological symptoms (i.e., depression, anxiety). Second, therapeutic and community services for individuals suffering from NCD, such as social support services and outpatient clinics, were disrupted or reduced leading to postponed appointments and evaluations, as well as reduced access to medications. These issues were somewhat palliated with the growth of telemedicine. Conclusion. This systematic review highlights the extent of the effects of the pandemic, and the topics addressed should be taken into consideration by healthcare practitioners, institutions, and policymakers to ensure that proper measures are employed to protect this population from additional harm.
Introduction: This systematic review sought to describe the prognostic implications of SES on clinical outcomes in patients undergoing vascular interventions for claudication and critical limb threatening ischemia (CLTI). Hypothesis: Methods: Studies were systematically searched across 5 databases from inception to June 2021. Studies focused on patients with claudication or CLTI undergoing open, endovascular, or hybrid procedures. Studies were included if SES was documented and associated with a clinical outcome. Two independent reviewers selected studies for inclusion, extracted data, and assessed risk of bias using ROBINS-I and Newcastle-Ottawa scales. Extracted data included study and clinical characteristics, demographics, interventions, outcome measured, and association of SES with the clinical outcomes. Results: Thirty four studies met our inclusion criteria and addressed the impact of SES in patients undergoing interventions for PAD, with 8 articles including only claudication patients, 2 including only CLTI patients, and 24 including a combination of both groups. The way SES was defined varied across studies, with some describing it in relation to insurance status (n=14), household income (n=13), income in area of living (n=8), income in the hospital’s area (n=1) and employment status (n=1). Low SES was associated with higher rates of amputation as a primary intervention, higher rates of above the knee amputation compared to below the knee amputation, higher 30 day postoperative death, longer lengths of stay, higher surgical sites infections, amputations following primary interventions, in-hospital complications, long term major adverse limb events and long term amputation rates. Given the amount of heterogeneity that was present in the designs, populations, and comparators among the included studies, we were unable to statistically pool data across trials. Conclusions: Our qualitative findings suggest that low SES is associated with significant adverse outcomes in patients with PAD including higher rates of primary amputation, post-operative mortality, length of stay, among others. Reasons for these disparities should be explored to identify solutions for decreasing and eliminating these health inequities.
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