The edition · Psychiatry
Therapy that plans the return to work was linked to fuller return to work
Work-focused CBT was associated with fuller return to work after sickness absence; remote therapy for women showed moderate effects on depression; and cognitive gaps in early-onset psychosis looked larger with age.
The edition in brief
A meta-analysis of 24 studies (3279 adults on sickness absence for common mental disorders) found cognitive behavioural therapy with return-to-work planning built in was associated with a higher likelihood of full return than control; 56% were back at work at the end of treatment and 87% at follow-up. Between-group symptom effects were small, and the way trials analysed return to work was often statistically unsound. A meta-analysis of telehealth interventions for women found moderate reductions in depression (Hedges g −0.56) and smaller reductions in anxiety (−0.45) and stress (−0.25), with prediction intervals wide enough to include no benefit in some settings. A cross-sectional study of 1004 young people with early-onset psychosis in Mexico found cognitive impairment was larger in older participants, most in non-affective psychosis, and that siblings showed a gap only in adulthood. A post hoc analysis of the Mirai trial found the prescription app Rejoyn, added to an antidepressant, gave 24–47% higher odds of a meaningful MADRS improvement than a sham app. Today's pearl covers the ordinary drugs that push lithium levels up.
Remote therapy for women reduced depressive symptoms moderately, but results varied widely
Offer structured remote therapy to women who cannot reach in-person care, and measure whether it is working at 4–6 weeks.
Cognitive deficits in early-onset psychosis appeared larger in older patients
Assess and periodically re-assess cognition in young people with psychosis, and build school and work plans around it.
A prescription app added to an antidepressant gave modestly higher odds of meaningful improvement
Use an 8–10 point MADRS change, the threshold derived in this trial, as a benchmark for meaningful improvement; treat this app evidence as supportive, not decisive.
Three common prescriptions raise lithium levels
Check a lithium level within a week of starting an NSAID, ACE inhibitor, ARB or thiazide, and prefer paracetamol for pain.
CBT with return-to-work planning built in was linked to fuller return after sickness absence
Build return-to-work planning into therapy from the first session for patients off work with depression or anxiety.
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