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Background: Depression and anxiety are the most prevalent mental health difficulties in the workplace, costing the global economy $1 trillion each year. Evidence indicates that symptoms may be reduced by interventions in the workplace. This paper is the first to systematically review psychosocial interventions for depression, anxiety, and suicidal ideation and behaviours in small-to medium-size enterprises (SMEs). Methods: A systematic search following PRISMA guidelines, registered in PROSPERO (CRD42020156275), was conducted for psychosocial interventions targeting depression, anxiety, and suicidal ideation/behaviour in SMEs. The PubMed, PsycINFO, Scopus, and two specific occupational health databases were searched, as well as four databases for grey literature, without time limit until 2nd December 2019. Results: In total, 1283 records were identified, 70 were retained for full-text screening, and seven met the inclusion criteria: three randomised controlled trials (RCTs), three before and after designs and one non-randomised trial, comprising 5111 participants. Study quality was low to moderate according to the Quality Assessment Tool for Quantitative Studies. Five studies showed a reduction in depression and anxiety symptoms using techniques based on cognitive behavioural therapy (CBT), two reported no significant change. Limitations: Low number and high heterogeneity of interventions and outcomes, high attrition and lack of rigorous RCTs. Conclusions: Preliminary evidence indicates CBT-based interventions can be effective in targeting symptoms of depression and anxiety in SME employees. There may be unique challenges to implementing programmes in SMEs. Further research is needed in this important area.

Psychological trauma has been identified in substance use disorders (SUD) as a major etiological risk factor. However, detailed and systematic data about the prevalence and types of psychological trauma in dual disorders have been scarce to date. In this study, 150 inpatients were recruited and cross-sectionally screened on their substance use severity, psychological trauma symptoms, comorbidities, and clinical severity. One hundred patients fulfilled criteria for a dual disorder, while 50 patients were diagnosed with only SUD. Ninety-four percent of the whole sample suffered from at least one lifetime traumatic event. The prevalence rates of Posttraumatic Stress Disorder diagnosis for dual disorder and only SUD was around 20% in both groups; however, patients with dual disorder presented more adverse events, more childhood trauma, more dissociative symptoms, and a more severe clinical profile than patients with only SUD. Childhood maltreatment can also serve as a predictor for developing a dual disorder diagnosis and as a risk factor for developing a more complex and severe clinical profile. These data challenge our current clinical practice in the treatment of patients suffering from dual disorder or only SUD diagnosis and favor the incorporation of an additional trauma-focused therapy in this population. This may improve the prognosis and the course of the illness in these patients.

The default-mode network (DMN) comprises a set of brain regions that show deactivations during performance of attentionally demanding tasks, but also activation during certain processes including recall of autobiographical memories and processing information about oneself, among others. However, the DMN is not activated in a homogeneous manner during performance of such tasks, so it is not clear to what extent its activation patterns correspond to deactivation patterns seen during attention-demanding tasks. In this fMRI study we compared patterns of activation in response to an autobiographical memory task to those observed in a self/other-reflection task, and compared both to deactivations observed during the n-back working memory task. Autobiographical recall and self-reflection activated several common DMN areas, which were also deactivated below baseline levels by the n-back task. Activation in the medial temporal lobe was seen during autobiographical recall but not the self/other task, and right angular gyrus activity was specifically linked to other-reflection. ROI analysis showed that most, but not all DMN regions were activated above baseline levels during the autobiographical memory and self-reflection tasks. Our results provide evidence for the usefulness of the autobiographical memory task to study DMN activity and support the notion of interacting subsystems within this network.

SPIRIT flow diagram. (PDF 83 kb)

SPIRIT Checklist. (DOC 122 kb)

El Trastorno por Déficit de Atención con Hiperactividad (TDAH) es uno de los trastornos del neurodesarrollo más comunes que se inicia en la edad temprana y que se caracteriza por presentar un cuadro clínico de inatención, hiperactividad e impulsividad. Desde un punto de vista farmacológico, el metilfenidato (MFD) es el fármaco de primera elección para tratar el TDAH debido a la alta eficacia que presenta a la hora de mejorar los síntomas, no obstante, se ha estimado que un 30% de estos pacientes no responden de manera adecuada. Actualmente no se disponen de marcadores clínicos, genéticos o neurobiológicos que permitan identificar a los pacientes susceptibles de presentar una buena o mala respuesta al MFD. El objetivo del presente estudio ha sido identificar a través de técnicas de resonancia magnética (RM) y variables clínicas y neuropsicológicas si existen diferencias cerebrales y/o clínico-cognitivas entre los pacientes que presentan una respuesta favorable o desfavorable al MFD. Para ello, se ha utilizado un diseño ex post facto de casos y controles para estudiar una muestra de 27 pacientes TDAH (de entre 6 y 15 años de edad) naïve al tratamiento con MFD. La evaluación clínica de los pacientes al mes de iniciar el tratamiento farmacológico ha indicado que 16 sujetos han presentado una respuesta favorable y 11 desfavorable. Los resultados de RM han mostrado que los pacientes con una buena respuesta al MFD tienen una mayor concentración de sustancia gris en la cabeza de ambos núcleos caudados y en el núcleo accumbens derecho respecto a los pacientes que no responden de manera adecuada. En relación a las variables clínicas y neuropsicológicas, no se han encontrado diferencias entre los dos grupos antes de iniciar el tratamiento farmacológico, sin embargo sí se han hallado en la evaluación post-tratamiento en el cuestionario de Conners para padres y el test Continuous Performance Test. Asimismo, se ha encontrado una relación entre estas dos medidas y los volúmenes del núcleo caudado y accumbens de manera bilateral. Estos resultados no sólo apoyan la hipótesis sobre la implicación de estas estructuras en la fisiopatología del TDAH, sino que también ponen de manifiesto su implicación en la respuesta al tratamiento farmacológico y su relación con los síntomas tanto cognitivos como conductuales que se manifiestan en los pacientes con TDAH. Los resultados derivados de este trabajo podrían ser de gran utilidad para determinar un fenotipo neuroanatómico que permita diferenciar a los pacientes que presentarán una respuesta favorable o desfavorable al MFD en el momento del diagnóstico y predecir su grado de mejoría a nivel clínico y neuropsicológico, Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders occurring in childhood. The main symptoms are developmentally excessive levels of inattention, impulsivity and hyperactivity. Methylphenidate (MPH) is the drug of first choice for treating ADHD because of its high efficacy to reduce the symptoms. It has been estimated that 30% of patients with ADHD do not respond adequately to MPH. Presently, there are no clinical or biological markers distinguishing good and bad responders. The aim of this study was to evaluate whether anatomical and/or clinical/cognitive differences exist between these two types of patients (good and bad responders) by applying magnetic resonance (MR) procedures and clinical and neuropsychological assessments. A case-control study was implemented to analyze a sample of twenty-seven treatment-naïve patients with ADHD (between six and fifteen years old). MPH administration started one day after the MR acquisition. After a month, psychiatrists established the good or poor response to MPH according to clinical criteria. Sixteen patients showed good response to the MPH and eleven did a poor one. The results has showed the good responders had a higher concentration of gray matter in the both Caudate nucleus head and the right Accumbens nucleus than the bad responders. Before MPH treatment it has no found differences between groups regarding clinical and neuropsychological measures. However, statistical differences has found in the Conners' Parent Rating Scales (CPRS) and Continuous Performance Test (CPT) after treatment. Furthermore, a significant correlation has found between Caudate and Accumbens nuclei volume (bilaterally) and the CPRS and CPT improvement. These results support the hypothesis of the involvement of the Caudate and Accumbens nuclei in MPH response and in physiopathology of ADHD. Also, such findings could also be useful to determinate a neuroanatomical phenotype as an eventual sign that helps in characterizing, at the time of diagnosis, patients with good and bad response to MPH and predicting the clinical and neuropsychological improvement level.

An expert survey was designed to support the development of a workplace-based multi-country intervention tackling depression, anxiety, and mental illness-related stigma in small- and medium-sized enterprises (SMEs). Academic experts and representatives of SME organisations, specific sector organisations, labour or advocacy groups, and occupational health organisations, were contacted across eight European countries and Australia. The survey comprised closed and open text questions to assess expert opinion about interventions for employees with mental health difficulties, interventions supporting their managers, and anti-stigma interventions. The survey was available in six languages. The online platform Qualtrics was used for data collection. Quantitative data was analysed through descriptive statistics and qualitative data was analysed through thematic analysis. Sixty-five of 146 experts responded, representing a 42% response rate. Results showed only 26.2% of experts agreed that employees could speak openly about mental health issues, and 81.5% of experts indicated a large or medium unmet need for support for employees with mental health issues. Psychoeducational materials, face-to-face workshops and interventions based on cognitive behavioural therapy were ranked most likely to be taken up by employees. Experts rated as most useful for managers' guidelines on how to act if an employee has mental health issues (67.7%). The greatest number of experts indicated workshops of people with lived experience of mental illness (80.0%) and awareness campaigns (78.5%) were most required to tackle stigma. Responses were consistent between experts from different countries and areas of expertise. Experts in this multinational survey assessed that interventions supporting mental health in the workplace and tackling stigma are greatly needed. A multicomponent intervention with a wide range of materials and tools is supported. ispartof: EUROPEAN ARCHIVES OF PSYCHIATRY AND CLINICAL NEUROSCIENCE vol:273 issue:3 ispartof: location:Germany status: Published online

Structural imaging studies of cannabis users have found evidence of both cortical and subcortical volume reductions, especially in cannabinoid receptor-rich regions such as the hippocampus and amygdala. However, the findings have not been consistent. In the present study, we examined a sample of adult heavy cannabis users without other substance abuse to determine whether long-term use is associated with brain structural changes, especially in the subcortical regions. Method: We compared the gray matter volume of 14 long-term, heavy cannabis users with non-using controls. To provide robust findings, we conducted two separate studies using two different MRI techniques. Each study used the same sample of cannabis users and a different control group, respectively. Both control groups were independent of each other. First, whole-brain voxel-based morphometry (VBM) was used to compare the cannabis users against 28 matched controls (HC1 group). Second, a volumetric analysis of subcortical regions was performed to assess differences between the cannabis users and a sample of 100 matched controls (HC2 group) obtained from a local database of healthy volunteers. Results: The VBM study revealed that, compared to the control group HC1, the cannabis users did not show cortical differences nor smaller volume in any subcortical structure but showed a cluster (p < 0.001) of larger GM volume in the basal ganglia, involving the caudate, putamen, pallidum, and nucleus accumbens, bilaterally. The subcortical volumetric analysis revealed that, compared to the control group HC2, the cannabis users showed significantly larger volumes in the putamen (p = 0.001) and pallidum (p = 0.0015). Subtle trends, only significant at the uncorrected level, were also found in the caudate (p = 0.05) and nucleus accumbens (p = 0.047). Conclusions: This study does not support previous findings of hippocampal and/or amygdala structural changes in long-term, heavy cannabis users. It does, however, provide evidence of basal ganglia volume increases.