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Anorexia nervosa is a potentially deadly psychiatric illness that develops predominantly in females around puberty but is increasingly being recognized as also affecting boys and men and women across the lifespan. The aim of this environmental scan is to provide an overview of best practices in anorexia nervosa treatment across the age spectrum. A triangulation approach was used. First, a detailed review of randomized controlled trials (RCTs) for anorexia nervosa published between 1980 and 2011 was conducted; second, clinical practice guidelines were consulted and reviewed; third, information about RCTs currently underway was sourced. This approach facilitated a comprehensive overview, which addressed the extant evidence base, recent advances in evidence and improvements in treatment, and future directions. The evidence base for the treatment of anorexia nervosa is advancing, albeit unevenly. Evidence points to the benefit of family-based treatment for youth. For adults no specific approach has shown superiority and, presently, a combination of renourishment and psychotherapy such as specialist supportive clinical management, cognitive behavioral therapy, or interpersonal psychotherapy is recommended. RCTs have neither sufficiently addressed the more complex treatment approaches seen in routine practice settings, such as multidisciplinary treatment or level of care, nor specifically investigated treatment in ethnically diverse populations. Methodological challenges that hinder progress in controlled research for anorexia nervosa are explained. The review highlights evidence-based and promising treatment modalities for anorexia nervosa and presents a triangulated analysis including controlled research, practice guidelines, and emerging treatments to inform and support clinical decision making.

ABSTRACTBackgroundPharmacotherapy is a key component of comprehensive obesity management, alongside behavioural therapy and metabolic and bariatric surgery. In this guideline, we update the pharmacotherapy recommendations in the 2020 Canadian clinical practice guideline on obesity in adults and in the 2022 pharmacotherapy for obesity management revision to provide current recommendations for clinicians on the efficacy, safety, and appropriate use of pharmacotherapy in the management of obesity in adults. MethodsThis guideline update follows the same methodology as the 2020 Canadian guideline on obesity in adults, adhering to the Appraisal of Guidelines for Research and Evaluation instrument and using the Shekelle framework to assess and grade evidence and to formulate recommendations. Building on the search conducted for the 2022 pharmacotherapy revision, we conducted a systematic literature review (search dates January 2022 to July 2024), supplemented by relevant trials published through May 2025, to identify studies assessing the efficacy of pharmacotherapy for weight management. We also conducted 13 targeted searches on the management of weight-related complications in 13 subpopulations with important adiposity-related health issues. We engaged primary care physicians, obesity medicine specialists, and people with lived experience of obesity to provide feedback on the recommendations. RecommendationsThis update includes 6 new and 7 revised recommendations since the 2022 pharmacotherapy guideline revision (all 2020 pharmacotherapy recommendations are updated). Measures of central adiposity, in addition to ethnicity-specific body mass index and adiposity-related complications, should be used to guide the decision to initiate pharmacotherapy. Obesity pharmacotherapy should be used in conjunction with health behaviour changes and individualized based on a person’s specific health needs and in keeping with their values and preferences. Recommendations support long-term use of obesity pharmacotherapy for sustained weight loss and maintenance of weight loss. We provide recommendations for use of specific obesity pharmacotherapies with proven benefit in specific subpopulations — atherosclerotic cardiovascular disease, heart failure with preserved ejection fraction, metabolic dysfunction–associated steatohepatitis, prediabetes, type 2 diabetes, obstructive sleep apnea, osteoarthritis — and for those with certain specific monogenic causes of obesity. We recommend against the use of compounded medications or medications other than those approved for weight loss in people with excess adiposity. InterpretationPharmacotherapy in obesity facilitates clinically meaningful weight loss and important improvements in obesity-related health complications. Clinicians who treat people with obesity with or without obesity-related health complications should appropriately use pharmacotherapy as an integral part of their treatment paradigm.

Part II of the European clinical guidelines for Tourette syndrome and other tic disorders (ECAP journal, 2011) provides updated information and recommendations for psychological interventions for individuals with tic disorders, created by a working group of the European Society for the Study of Tourette Syndrome (ESSTS). A systematic literature search was conducted to obtain original studies of psychological interventions for tic disorders, published since the initial European clinical guidelines were issued. Relevant studies were identified using computerized searches of the MEDLINE and PsycINFO databases for the years 2011–2019 and a manual search for the years 2019–2021. Based on clinical consensus, psychoeducation is recommended as an initial intervention regardless of symptom severity. According to a systematic literature search, most evidence was found for Habit Reversal Training (HRT), primarily the expanded package Comprehensive Behavioral Intervention for Tics (CBIT). Evidence was also found for Exposure and Response Prevention (ERP), but to a lesser degree of certainty than HRT/CBIT due to fewer studies. Currently, cognitive interventions and third-wave interventions are not recommended as stand-alone treatments for tic disorders. Several novel treatment delivery formats are currently being evaluated, of which videoconference delivery of HRT/CBIT has the most evidence to date. To summarize, when psychoeducation alone is insufficient, both HRT/CBIT and ERP are recommended as first-line interventions for tic disorders. As part of the development of the clinical guidelines, a survey is reported from ESSTS members and other tic disorder experts on preference, use and availability of psychological interventions for tic disorders.

There is a current escalating need for telehealth (TH) options in family mental health services. In the absence of replicated evidence, TH guidelines from peak bodies are largely based on assumptions of the effectiveness of TH methods. New investments in TH would optimally be based in evidence of clinical efficacy. To this end, we conducted three studies in which we (1) systematically reviewed eight professional guidelines for TH family therapy, (2) examined replicated evidence for the efficacy of TH family therapy through systematic review of 20 studies and meta-analyses of 13 effects, and (3) synthesised clinical accommodations to TH methodology from a study of 12 experienced TH family therapists. The studies found (1) a predominant focus in existing TH guidelines on operational matters pertaining to TH and relative neglect of therapeutic process; (2) meta-analyses of efficacy for child behavioural problems (k = 8) and parental depression (k = 5) showed equivalent outcomes in TH and face-to-face therapy and enhanced outcomes in TH relative to treatment as usual, resource provision (i.e. written materials), or wait-list control. Narrative review of 20 studies for a range of relational and mental health outcomes aligned with these findings; and (3) therapists defined clear conditions for enhanced engagement and therapeutic process via TH and reflected on cautions and accommodations for purposes of rapport building and mitigating risk. Given moderate-strong evidence for the efficacy of TH methods of family therapy for a range of conditions, we offer recommendations for future implementation of TH for family therapy.

The first contact for patients with obesity for any medical treatment or other issues is generally with General Practitioners (GPs). Therefore, given the complexity of the disease, continuing GPs’ education on obesity management is essential. This article aims to provide obesity management guidelines specifically tailored to GPs, favouring a practical patient-centred approach. The focus is on GP communication and motivational interviewing as well as on therapeutic patient education. The new guidelines highlight the importance of avoiding stigmatization, something frequently seen in different health care settings. In addition, managing the psychological aspects of the disease, such as improving self-esteem, body image and quality of life must not be neglected. Finally, the report considers that achieving maximum weight loss in the shortest possible time is not the key to successful treatment. It suggests that 5–10% weight loss is sufficient to obtain substantial health benefits from decreasing comorbidities. Reducing waist circumference should be considered even more important than weight loss per se, as it is linked to a decrease in visceral fat and associated cardiometabolic risks. Finally, preventing weight regain is the cornerstone of lifelong treatment, for any weight loss techniques used (behavioural or pharmaceutical treatments or bariatric surgery).

Eight members of the International Parkinson's Disease and Movement Disorders Society Tic and Tourette Syndrome Study Group formed a subcommittee to discuss further barriers to practice guideline implementation. Based on expert opinion and literature review, the consensus was that practice variations continue to be quite broad and that many barriers in different clinical settings might negatively influence the adoption of the American Academy of Neurology and the European Society for the Study of Tourette Syndrome published guidelines. 1) To identify how clinical practices diverge from the existing American Academy of Neurology and European Society for the Study of Tourette Syndrome guidelines, and 2) to identify categories of barriers leading to these clinical care gaps. This article presents the methodology of a planned cross-sectional survey amongst healthcare professionals routinely involved in the clinical care of patients with persistent tic disorders, aimed at 1) identifying how practices diverge from the published guidelines; and 2) identifying categories of barriers leading to these clinical care gaps. Purposeful sampling methods are used to identify and recruit critical persistent tic disorders stakeholders. The analysis will use descriptive statistics.

Background Post-traumatic stress disorder (PTSD) is strongly associated with sleep disorders, and current clinical guidelines for PTSD differ in recommending treatment for patients with PTSD associated with sleep disorders. This meta-analysis evaluates the acceptability and efficacy of psychotherapy, pharmacotherapy, and other complementary/alternative therapies, to help clinicians make decisions about treatment regimens for individuals with PTSD and sleep disorders. Method We systematically searched PubMed, EMBASE, the Cochrane Library, and American Psychological Association PsyNet for randomized controlled trials (RCTs) related to placebo-controlled and active intervention trials for PTSD with sleep disorders up to February 2, 2023. Results Active intervention significantly improved PTSD (standardized mean difference (SMD) = 0.86, 95% confidence interval (CI): 1.21, 0.50), sleep disorders (SMD = 1.06, 95%CI: 1.50, 0.63), and depression (SMD = 0.58, 95%CI: -0.96, -0.19). Regarding compliance, the active intervention group did not show lower acceptability ((Risk ratios (RR) = 1.08, 95%CI: 0.92, 1.26). Compared to placebo or supportive groups, the active intervention did not exhibit statistically significant improvements in total sleep time (SMD = 0.87, 95%CI: -0.27, 1.47) and overall psychological symptoms (SMD = 0.13, 95%CI: -0.12, 0.37). Details results of the subgroup analyses were provided in the text. Bias may be present in total PTSD symptoms, change of total sleep symptoms and change of depression symptoms, and no significant bias was observed in acceptability. Conclusion Active intervention effectively reduces the main symptoms of PTSD in patients with sleep disorders. Consideration of pharmacotherapy (hydroxyzine) is recommended over prazosin, as suggested by the WFSBP clinical guidelines, especially when patients are insensitive to psychotherapy or have urgent symptoms. Psychological interventions, particularly IRT or IRT plus CBT-I, are recommended. Stratified by population, psychotherapy is more advisable for veterans and those with involuntary sexual experiences, while pharmacotherapy is more suitable for military staff. For patients with only nightmare symptoms, both psychotherapy and pharmacotherapy could be considered. When patients have insomnia symptoms, psychotherapy is preferable. The effect of psychotherapy is particularly recommended for females, while the effect of pharmacotherapy is emphasized for males.

Background Clinical practice guidelines are intended to improve the process and outcomes of patient care. However, their implementation remains a challenge. We designed an implementation strategy, based on peer assessment (PA) focusing on barriers to change in physical therapy care. A previously published randomized controlled trial showed that PA was more effective than the usual strategy “case discussion” in improving adherence to a low back pain guideline. Peer assessment aims to enhance knowledge, communication, and hands-on clinical skills consistent with guideline recommendations. Participants observed and evaluated clinical performance on the spot in a role-play simulating clinical practice. Participants performed three roles: physical therapist, assessor, and patient. This study explored the critical features of the PA program that contributed to improved guideline adherence in the perception of participants. Methods Dutch physical therapists working in primary care ( n  = 49) organized in communities of practice ( n  = 6) participated in the PA program. By unpacking the program we identified three main tasks and eleven subtasks. After the program was finished, a questionnaire was administered in which participants were asked to rank the program tasks from high to low learning value and to describe their impact on performance improvement. Overall ranking results were calculated. Additional semi-structured interviews were conducted to elaborate on the questionnaires results and were transcribed verbatim. Questionnaires comments and interview transcripts were analyzed using template analysis. Results Program tasks related to performance in the therapist role were perceived to have the highest impact on learning, although task perceptions varied from challenging to threatening. Perceptions were affected by the role-play format and the time schedule. Learning outcomes were awareness of performance, improved attitudes towards the guideline, and increased self-efficacy beliefs in managing patients with low back pain. Learning was facilitated by psychological safety and the quality of feedback. Conclusion The effectiveness of PA can be attributed to the structured and performance-based design of the program. Participants showed a strong cognitive and emotional commitment to performing the physical therapist role. That might have contributed to an increased awareness of strength and weakness in clinical performance and a motivation to change routine practice.

Primary health professionals are well positioned to support the delivery of patient self-management in an evidence-based, structured capacity. A need exists to better understand the active components required for effective self-management support, how these might be delivered within primary care, and the training and system changes that would subsequently be needed. (1) To examine self-management support interventions in primary care on health outcomes for a wide range of diseases compared to usual standard of care; and (2) To identify the effective strategies that facilitate positive clinical and humanistic outcomes in this setting. A systematic review of randomized controlled trials evaluating self-management support interventions was conducted following the Cochrane handbook & PRISMA guidelines. Published literature was systematically searched from inception to June 2019 in PubMed, Scopus and Web of Science. Eligible studies assessed the effectiveness of individualized interventions with follow-up, delivered face-to-face to adult patients with any condition in primary care, compared with usual standard of care. Matrices were developed that mapped the evidence and components for each intervention. The methodological quality of included studies were appraised. 6,510 records were retrieved. 58 studies were included in the final qualitative synthesis. Findings reveal a structured patient-provider exchange is required in primary care (including a one-on-one patient-provider consultation, ongoing follow up and provision of self-help materials). Interventions should be tailored to patient needs and may include combinations of strategies to improve a patient's disease or treatment knowledge; independent monitoring of symptoms, encouraging self-treatment through a personalized action plan in response worsening symptoms or exacerbations, psychological coping and stress management strategies, and enhancing responsibility in medication adherence and lifestyle choices. Follow-up may include tailored feedback, monitoring of progress with respect to patient set healthcare goals, or honing problem-solving and decision-making skills. Theoretical models provided a strong base for effective SMS interventions. Positive outcomes for effective SMS included improvements in clinical indicators, health-related quality of life, self-efficacy (confidence to self-manage), disease knowledge or control. An SMS model has been developed which sets the foundation for the design and evaluation of practical strategies for the construct of self-management support interventions in primary healthcare practice. These findings provide primary care professionals with evidence-based strategies and structure to deliver SMS in practice. For this collaborative partnership approach to be more widely applied, future research should build on these findings for optimal SMS service design and upskilling healthcare providers to effectively support patients in this collaborative process.