No abstract

A rather large body of literature now exists on the use of telemental health services in the diagnosis and management of various psychiatric conditions. This review aims to provide an up-to-date assessment of telemental health, focusing on four main areas: computerized CBT (cCBT), Internet-based CBT (iCBT), virtual reality exposure therapy (VRET), and mobile therapy (mTherapy). Four scientific databases were searched and, where possible, larger, better-designed meta-analyses and controlled trials were highlighted. Taken together, published studies support an expanded role for telepsychiatry tools, with advantages that include increased care access, enhanced efficiency, reduced stigma associated with visiting mental health clinics, and the ability to bypass diagnosis-specific obstacles to treatment, such as when social anxiety prevents a patient from leaving the house. Of technology-mediated therapies, cCBT and iCBT possess the most efficacy evidence, with VRET and mTherapy representing promising but less researched options that have grown in parallel with virtual reality and mobile technology advances. Nonetheless, telepsychiatry remains challenging because of the need for specific computer skills, the difficulty in providing patients with a deep understanding or support, concerns about the "therapeutic alliance", privacy fears, and the well documented problem of patient attrition. Future studies should further test the efficacy, advantages and limitations of technology-enabled CBT, as well as explore the online delivery of other psychotherapeutic and psychopharmacological modalities.

Addiction is a major public health problem with few efficacious and safe treatments. The goal of this review is to provide an evidence-based assessment of the therapeutic role of the opioid antagonist naltrexone across the addiction spectrum-substance-based and behavioral. The PubMed database was searched for randomized, placebo-controlled clinical trials that investigated the oral or intramuscular long-acting formulation of naltrexone in substance use disorders or behavioral addictions such as pathological gambling, kleptomania, and trichotillomania. Thirty-nine efficacy studies were retrieved, covering alcohol use disorder (n = 22), opioid use disorder (n = 6), nicotine use disorder (n = 5), stimulant use disorder (n = 2), gambling disorder (n = 2), trichotillomania (n = 1), and kleptomania (n = 1). Despite the very different presentations within and between both addiction categories, the data, as a whole, show consistency in favor of naltrexone's relative efficacy and safety. Given the potential benefit and good tolerability revealed in the studies, the high morbidity associated with addiction, and the dearth of alternate treatments, naltrexone would seem like an underutilized treatment option. Further, naltrexone's seemingly broad anti-addiction efficacy supports a shared role for brain opioid pathways in the pathophysiology of addiction, broadly defined. More studies investigating the efficacy and tolerability of naltrexone and other opioid modulators are warranted. Studies should also further examine the effect of combining psychotherapy with naltrexone, as well as the potential role of naltrexone in treating comorbid addictions.

Purpose To assess the relationship between xenophobia and the coping strategies and evaluate factors associated with xenophobia in Lebanon. Design/Methods This cross‐sectional study, conducted between March and July 2017, enrolled 433 participants. Results Severe xenophobia (β = 1.46) and female sex (β = 1.45) were associated with higher problem‐focused engagement scores. Participants with a low income had lower problem‐focused disengagement score compared to those without income. Moderate (β = 0.80) and intense xenophobia (β = 1.38) were significantly associated with higher emotion‐focused engagement, whereas female sex was significantly associated with lower emotion‐focused engagement (β = −0.71) and disengagement (β = −0.83). Being divorced compared to single (β = 2.32) and female sex (β = 2.04) were associated with higher xenophobia. Practice implications Our study supports the prevalence of xenophobia amongst Lebanese but requires a broader assessment of that trend.

No abstract

T elepsychiatry can be defined as the use of computer, Internet, and mobile technologies for the remote delivery of mental health services. Compared with traditional treatments, it may reduce costs through reduced reliance on office infrastructure, 1 save time by eliminating the need to commute, 2 reduce the stigma of visiting mental health clinics, and counter disorder-specific obstacles that complicate leaving the house to see a provider (eg, social anxiety disorder). 3 A particular advantage in the pediatric population may be to address the severe shortage of mental health specialists in underserved communities. 3-5 Our aim is to describe the diverse applications of pediatric telepsychiatry by highlighting research from its main categories to offer evidence-based guidance for current practice and to offer suggestions for future investigation.

Psychosis can be considered a severity index in bipolar disorder, with decreased severity and overall clinical improvement and remission taking place in response to pharmacotherapy.

No abstract