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In this groundbreaking book, psychiatrist and ethicist Mona Gupta analyzes the basic assumptions of Evidence-based medicine (EBM), and critically examines their applicability to psychiatry. Highlighting ethical tensions between psychiatry and EBM, she asks the controversial question - should psychiatrists practice evidence-based medicine at all?.

Abstract Background Evidence for the management of inadequate clinical response to clozapine in treatment-resistant schizophrenia is sparse. Accordingly, an international initiative was undertaken with the aim of developing consensus recommendations for treatment strategies for clozapine-refractory patients with schizophrenia. Methods We conducted an online survey among members of the Treatment Response and Resistance in Psychosis (TRRIP) working group. An agreement threshold of ≥75% (responses “agree” + “strongly agree”) was set to define a first-round consensus. Questions achieving agreement or disagreement proportions of >50% in the first round, were re-presented to develop second-round final consensus recommendations. Results Forty-four (first round) and 49 (second round) of 63 TRRIP members participated. Expert recommendations at ≥75% agreement included raising clozapine plasma levels to ≥350 ng/ml for refractory positive, negative, and mixed symptoms. Where plasma level-guided dose escalation was ineffective for persistent positive symptoms, waiting for a delayed response was recommended. For clozapine-refractory positive symptoms, combination with a second antipsychotic (amisulpride and oral aripiprazole) and augmentation with ECT achieved consensus. For negative symptoms, waiting for a delayed response was recommended, and as an intervention for clozapine-refractory negative symptoms, clozapine augmentation with an antidepressant reached consensus. For clozapine-refractory suicidality, augmentation with antidepressants or mood-stabilizers, and ECT met consensus criteria. For clozapine-refractory aggression, augmentation with a mood-stabilizer or antipsychotic medication achieved consensus. Generally, cognitive-behavioral therapy and psychosocial interventions reached consensus. Conclusions Given the limited evidence from randomized trials of treatment strategies for clozapine-resistant schizophrenia (CRS), this consensus-based series of recommendations provides a framework for decision making to manage this challenging clinical situation.

Among all diseases globally, mental illnesses are one of the major causes of burden. As many people are resistant to conventional evidence-based treatments, there is an unmet need for the implementation of novel mental health treatments. Efforts to increase the effectiveness and benefits of evidence-based psychotherapy in psychiatry have led to the emergence of virtual reality (VR)-based interventions. These interventions have shown a wide range of advantages over conventional psychotherapies. Currently, VR-based interventions have been developed mainly for anxiety-related disorders; however, they are also used for developmental disorders, severe mental disorders, and neurocognitive disorders. This meta-review aims to summarize the current state of evidence on the efficacy of VR-based interventions for various psychiatric disorders by evaluating the quality of evidence provided by meta-analytical studies. A systematic search was performed using the following electronic databases: PubMed, PsycINFO, Web of Science, and Google Scholar (any time until February 2020). Meta-analyses were included as long as they quantitatively examined the efficacy of VR-based interventions for symptoms of a psychiatric disorder. To avoid overlap among meta-analyses, for each subanalysis included within this meta-review, only one analysis provided from one meta-analysis was selected based on the best quality of evidence. The search retrieved 11 eligible meta-analyses. The quality of evidence varied from very low to moderate quality. Several reasons account for the lower quality evidence, such as a limited number of randomized controlled trials, lack of follow-up analysis or control group, and the presence of heterogeneity and publication bias. Nonetheless, evidence has shown that VR-based interventions for anxiety-related disorders display overall medium-to-large effects when compared with inactive controls but no significant difference when compared with standard evidence-based approaches. Preliminary data have highlighted that such effects appear to be sustained in time, and subjects may fare better than active controls. Neurocognitive disorders also appear to improve with VR-based approaches, with small effects being found for various clinical outcomes (eg, cognition, emotion). Finally, there are insufficient data to classify VR-based interventions as an evidence-based practice for social skills training in neurodevelopmental disorders and compliance among patients with schizophrenia. VR provides unlimited opportunities by tailoring approaches to specific complex problems and individualizing the intervention. However, VR-based interventions have not shown superiority compared with usual evidence-based treatments. Future VR-based interventions should focus on developing innovative approaches for complex and treatment-resistant symptoms that are difficult to address with traditional treatments. Future research should also aim to gain a better understanding of the potential factors that may mediate VR outcomes to improve treatment.

The author, a professional social worker and professor at the Arizona State University West Department of Social Work, expresses his concern for the increasing number of children being diagnosed and treated for emotional problems. \"The unsettling thought of misdiagnosing children who need help but are not being served because of racial and gender issues, and treatment of large number of children who are, in reality, responding in normal ways to maturational and social changes has begun to capture a great deal of attention in the popular and professional literature.\" -- p. [3]. He proposes an evidence-based practice approach regarding assessment, diagnosis and treatment of children and adolescents with social and emotional problems \"including, but not limited to: ADHD; Bi-Polar Disorder; anxiety and depression; eating disorders; Autism; Asperger's Syndrome; lonelines and social isolation; school related problems; gender issues and prolonged grief. The psychosocial interventions discussed in the book provide practitioners and educators with a range of effective treatments that serve as an alternative to the use of unproven medications with unknown but potentially harmful side effects.\" -- Back cover.

In Neuropsychological Aspects of Substance Use Disorders, internationally recognized experts provide clinicians with a translational overview of basic research and treatment findings regarding addictions, neuropsychological and neurological sequalae of the most common substances of abuse, and consideration of special issues that might confound interpretation of neuropsychological test results.

The Second Edition of the Handbook of Adolescent Behavioral Problems clarifies the current state of treatment and prevention through comprehensive examinations of mental disorders and dysfunctional behaviors as well as the varied forces affecting their development. New or revised chapters offer a basic framework for approaching mental health concerns in youth and provide the latest information on how conditions (e.g., bipolar disorder, suicidality, and OCD) and behaviors (e.g., sex offenses, gang activities, dating violence, and self-harm) manifest in adolescents. Each chapter offers diagnostic guidance, up-to-date findings on prevalence, biological/genetic aspects, risk and resilience factors, and a practical review of prevention and treatment methods. Best-practice recommendations clearly differentiate among what works, what might work, what doesn't work, and what needs further research across modalities, including pharmacotherapy. Key topics addressed include: Families and adolescent development. Adolescent mental health and the DSM-5. Oppositional Defiant Disorder and Conduct Disorder. Autism spectrum disorder. Media and technology addiction. School failure versus school success. Bullying and cyberbullying. The Second Edition of the Handbook of Adolescent Behavior Problems is a must-have reference for researchers, clinicians, allied practitioners and professionals, and graduate students in school and clinical child psychology, education, pediatrics, psychiatry, social work, school counseling, and public health.

For the past quarter of a century, Frank et al.'s (1991) consensus-based definitions of major depressive disorder (MDD) episode, remission, recovery, relapse and recurrence have been the paramount driving forces for consistency in MDD research as well as in clinical practice. This study aims to review the evidence for the empirical validation of Frank et al.'s proposed concept definitions and to discuss evidence-based modifications. A literature search of Web of Science and PubMed from 1/1/1991 to 08/30/2017 identified all publications which referenced Frank et al.'s request for definition validation. Publications with data relevant for validation were included and checked for referencing other studies providing such data. A total of 56 studies involving 39 315 subjects were included, mainly presenting data to validate the severity and duration thresholds for defining remission and recovery. Most studies indicated that the severity threshold for defining remission should decrease. Additionally, specific duration thresholds to separate remission from recovery did not add any predictive value to the notion that increased remission duration alleviates the risk of reoccurrence of depressive symptoms. Only limited data were available to validate the severity and duration criteria for defining a depressive episode. Remission can best be defined as a less symptomatic state than previously assumed (Hamilton Rating Scale for Depression, 17-item version (HAMD-17) ⩽4 instead of ⩽7), without applying a duration criterion. Duration thresholds to separate remission from recovery are not meaningful. The minimal duration of depressive symptoms to define a depressive episode should be longer than 2 weeks, although further studies are required to recommend an exact duration threshold. These results are relevant for researchers and clinicians aiming to use evidence-based depression outcomes.