Tamara Melnik

Psychogenic erectile dysfunction: comparative study of three therapeutic approaches.

We admistered the International Index of Erectile Function (IIEF; Rosen et al., 1997) questionnaire to 30 patients with psychogenic erectile dysfunction (ED) at baseline, immediately after treatment, and 3 months after treatment. We randomized patients into three groups: group I, who had weekly sessions of time-limited theme-based group psychotherapy for 6 months and 50 mg sildenafil citrate orally on demand; group II, who had an intake of 50 mg sildenafl citrate orally on demand for 6 months only; and group III, who had weekly sessions of time-limited theme-based group psychotherapy for 6 months. We analyzed data (15-item IIEF) for each group at three times during the study and compared by the data using analysis of variance (ANOVA), followed by the Bonferroni multiple comparison test. We used Cochrans Q-test for analysis between baseline and posttreatment stages of patients with remission of symptoms (EF equal to or higher than 26 points). Group III had a mean score higher than group II, with the difference being statistically significant (immediately after treatment, p = 0.033; at 3 months after treatment, p = 0.049; p < 0.05). All three therapeutic alternatives resulted in an improvement of erectile function domain score. However, significant differences from baseline were observed in groups I (p = 0.0009) and III (p = 0.0002) but not in group II (p = 0.135). The psychotherapy groups, I and III, had significantly higher scores compared with group II, in which patients were exclusively treated with sildenafil citrate. These findings suggest that time-limited theme-based group psychotherapy is an effective treatment for psychogenic ED.

Efficacy and safety of atypical antipsychotic drugs (quetiapine, risperidone, aripiprazole and paliperidone) compared with placebo or typical antipsychotic drugs for treating refractory schizophrenia: overview of systematic reviews

CONTEXT AND OBJECTIVE According to some cohort studies, the prevalence of refractory schizophrenia (RS) is 20-40%. Our aim was to evaluate the effectiveness and safety of aripiprazole, paliperidone, quetiapine and risperidone for treating RS. METHODS This was a critical appraisal of Cochrane reviews published in the Cochrane Library, supplemented with reference to more recent randomized controlled trials (RCTs) on RS. The following databases were searched: Medical Literature Analysis and Retrieval System Online (Medline) (1966-2009), Controlled Trials of the Cochrane Collaboration (2009, Issue 2), Embase (Excerpta Medica) (1980-2009), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) (1982-2009). There was no language restriction. Randomized controlled trials, systematic reviews and meta-analyses evaluating atypical antipsychotics for treating RS were included. RESULTS Seven Cochrane systematic reviews and 10 additional RCTs were included in this review. The data generally showed minor differences between the atypical antipsychotics evaluated and typical antipsychotics, regarding improvement in disease symptoms, despite better adherence to treatment with atypical antipsychotics. Risperidone was specifically evaluated in patients with RS in one of the systematic reviews included, with favorable outcomes, but without definitive superiority compared with other drugs of proven efficacy, like amisulpride, clozapine and olanzapine. CONCLUSIONS The findings underscore the difficulty in treating these patients, with high dropout rates and treatment patterns of modest improvement in assessments of effectiveness. Atypical antipsychotics have advantages over typical antipsychotics mainly through their better safety profile, which leads to better adherence to treatment. A combination of antipsychotics may also be an option for some refractory patients.

Psychological intervention for premature ejaculation

While psychological issues are present in most patients with premature ejaculation (PE), whether as a cause or a consequence of the disorder, the effectiveness of psychological intervention for PE is not clear. Searches of the MEDLINE, EMBASE, PsychINFO, LILACS and the Cochrane Library electronic databases find little high-quality evidence for the psychosexual and behavioral approaches to treatment of PE. Five randomized and four quasi-randomized trials were included in this Review. Little evidence was found that psychological interventions are effective in the treatment of PE. Three studies showed strong evidence in support of improved intravaginal ejaculatory latency times following psychosexual therapy combined with pharmacotherapy, compared with monotherapy. One study found that functional–sexological treatment markedly improved duration of intercourse, sexual satisfaction, and sexual function. Limitations of published studies include a lack of randomization, uncertain clinical significance of outcomes, absence of compelling follow-up data that show long-term response and lack of reproducibility. Randomized trials with large sample sizes are still needed to expand the currently available evidence on psychological intervention for treating PE. Besides examining the main effects of treatment, trials in this field should also address the complex interactions between patient characteristics, PE subtype and treatment approach.

Satisfaction with the treatment, confidence and 'naturalness' in engaging in sexual activity in men with psychogenic erectile dysfunction: preliminary results of a randomized controlled trial of three therapeutic approaches.

Study Type – Therapy (RCT)

Homicide in Chile: Trends 2000 – 2012

BackgroundHomicide, an external cause of morbidity and mortality, caused 473,000 deaths worldwide in 2012, a rate of 6.2 per 100,000 inhabitants. The aim of this study was to describe homicide mortality trends in Chile between 2000 and 2012 by year, gender, age group, geographic distribution (by zone and by region) and type of homicide.MethodsThis was a population-based study. Data for homicide mortality in Chile between 2000 and 2012 were used and they were provided by the Chilean Ministry of Health’s Department of Statistics and Health Information (DEIS) and PAHO/WHO. The homicide mortality rates were calculated per 100,000 inhabitants. The study variables were year, geographic distribution, gender, age group and type of homicide. The annual percentage change (APC) of the rates was analyzed, and a logarithm of the rates by year and region was fitted by applying linear regression models. In addition, relative risks (RR) were calculated. 95 % confidence intervals were considered in all the analyses.ResultsThe average yearly rate of homicide (HMR) in Chile (2000–2012) was 4.9. The rates were higher in men (8.7) than in women (1.1), with a RR of 8.2. The rates were higher in the country’s central zone (5.0), increasing in recent years in the southern zone, with a significant positive APC of 1.1 %. The Aisén Region had the highest rate (7.6), although Antofagasta was the region with the most significant APC (3.1 %). The highest rate (9.2) was verified in the 25 to 39 age group. The highest rate (5.5) was recorded in 2005. The most frequent type of homicide was assault with an object (44.8 %).ConclusionsAlthough the homicide rates are higher in the southern zone of the country, the northern zone is showing a tendency to increase, becoming an even more serious problem, which not only affects those directly involved, but society as a whole.

Sexual medicine: the psychological effects of recreational PDE5 inhibitor use.

The availability of PDE5 inhibitors has significantly altered the way in which erectile dysfunction (ED) is treated. Some major issues have emerged since the advent of PDE5 inhibitor use for ED, especially in relation to recreational use in young, healthy men and the role of confidence in erectile ability.

Effectiveness of psychosocial interventions in eating disorders: an overview of Cochrane systematic reviews

ABSTRACT Eating disorders are psychiatric conditions originated from and perpetuated by individual, family and sociocultural factors. The psychosocial approach to treatment and prevention of relapse is crucial. To present an overview of the scientific evidence on effectiveness of psychosocial interventions in treatment of eating disorders. All systematic reviews published by the Cochrane Database of Systematic Reviews - Cochrane Library on the topic were included. Afterwards, as from the least recent date of these reviews (2001), an additional search was conducted at PubMed with sensitive search strategy and with the same keywords used. A total of 101 primary studies and 30 systematic reviews (5 Cochrane systematic reviews), meta-analysis, guidelines or narrative reviews of literature were included. The main outcomes were: symptomatic remission, body image, cognitive distortion, psychiatric comorbidity, psychosocial functioning and patient satisfaction. The cognitive behavioral approach was the most effective treatment, especially for bulimia nervosa, binge eating disorder and the night eating syndrome. For anorexia nervosa, the family approach showed greater effectiveness. Other effective approaches were interpersonal psychotherapy, dialectic behavioral therapy, support therapy and self-help manuals. Moreover, there was an increasing number of preventive and promotional approaches that addressed individual, family and social risk factors, being promising for the development of positive self-image and self-efficacy. Further studies are required to evaluate the impact of multidisciplinary approaches on all eating disorders, as well as the cost-effectiveness of some effective modalities, such as the cognitive behavioral therapy.

Transport accident mortality in Chile: trends from 2000 to 2012

The aim of this study is to describe the trends of transport accident mortality in Chile from 2000 to 2012 by year, geographic distribution, gender, age group, and type of accident. Population-based study. Data for transport accident mortality in Chile between 2000 and 2012 were used. The crude and adjusted per region transport accident mortality rates were calculated per 100,000 inhabitants. The annual percentage change (APC) of the rates and relative risks (RR) were calculated. The average transport accident mortality rate (TAMR) in Chile (2000-2012) was 12.2. The rates were greater in men (19.7) than in women (4.8), with a RR of 4.1. The rates were higher in the countrys southern zone (15.9), increasing in recent years in the southern zone, with a significant positive APC in the northern and central zones. The Maule region had the highest rate (21.1), although Coquimbo was the region with the most significant APC (2.2%). The highest rate (20.3) was verified in the 25-40 age group. The highest rate (14.3) was recorded in 2008. The most frequent type of accident was pedestrian. In general the APC trends of the rates are increasing significantly. This, added to rapid annual automotive growth, will only exacerbate mortality due to transport accidents.

Evidence-based psychology.

1published results from a presidential task force under the title “Evidence-Based Clinical Practice in Psychology”, which emphasized the importance of scientific evidence in psychological practice, alongside clinical experience and patients’ individual preferences and characteristics. The APA pointed out that there was an urgent need to bring in scientific evidence within psychology: “Evidencebased practice in psychology is therefore consistent with the past twenty years of work in evidence-based medicine, which advocated for improved patient outcomes by informing clinical practice with relevant research. The use and misuse of evidence based principles in the practice of health care has affected the dissemination of health care funds, but not always to the benefit of the patient. Therefore, psychologists, whose training is grounded in empirical methods, have an important role to play in the continuing development of evidence based practice and its focus on improving patient care”. 1 The search for scientific evidence to underpin psychotherapeutic practice also involves prevention-related objectives, given that early treatment may often avoid or diminish the psychological distress that results from prolongation or worsening of psychological disorders. Evidence-based psychology: scientific proof of the effectiveness of psychotherapy (translation of the Portuguese title) 2 is a pioneering work written by several hands, which indubitably include the most renowned specialists in the field of mental health in Brazil. We had the privilege of counting on collaboration from researchers, clinicians and educators, and this diversity was the driving force towards enrichment of the work. The text places at healthcare pro fessionals’ disposal scientific information of high methodological quality that has already been evaluated through systematic reviews published by the Cochrane Collaboration. It also provides a succinct panorama of the current evidence relating to the effectiveness of psychotherapy for treating psychiatric disorders. Each chapter presents a systematic review on the subjects (published in the Cochrane Library), with comments by one or more specialists in the field. The work also discusses issues relating to prevention of these disorders, and covers systematic reviews of studies on preventive programs at different levels. In this respect, it includes chapters on studies conducted among children and adolescents that had the aim of identifying risk factors and ways of avoiding them and protection factors and ways of promoting them. Studies and research within the field of mental health involving children and adolescents are well-known to be very limited in numbers, despite recognition of their importance among professionals working in this field. This book also seeks to encourage evolution and expansion of this knowledge and makes suggestions for new studies. This work can be used by healthcare professionals as a reference source in making decisions about patient care and in drawing up research protocols, thereby opening up a range of topics for scientific research evaluated by researchers in this field and by society. This is a novel text that makes a valuable contribution towards presenting research results within psychotherapy and assessing the evidence available. Its objective and instructional format facilitate access to information.

Erratum to: Homicide in Chile: Trends 2000 – 2012

The online version of the original article can be found at http://​dx.​doi.​org/​10.​1186/​s12888-015-0632-5. After publication of this work [1], we noted that the given order of the authors was incorrect. The list of authors has now been corrected in the original article, and both the corrected and original lists are reported below. We apologize for any inconvenience this oversight may have caused. Original author list: Tamara Otzen1,2,3,4*, Antonio Sanhueza5,6, Carlos Manterola1,7, Tamara Melnik4 and Monica Hetz8 Corrected author list: Tamara Otzen1,2,3,4*, Antonio Sanhueza5,6, Carlos Manterola1,7, Monica Hetz8 and Tamara Melnik4 Language: en