https://www.um.edu.mt/library/oar/handle/123456789/28028 2026-04-12T17:21:06Z https://www.um.edu.mt/library/oar/handle/123456789/28370 Title: Managing insomnia : pharmacotherapy versus cognitive behavioural therapy Abstract: Treatment modalities to treat and manage insomnia include pharmacotherapy, cognitive behavioural therapy (CBT) or a combination of both treatments. The primary aim in the management of insomnia is to provide adequate sleep thus improve quality of life. The research question reads: Is pharmacotherapy more effective than Cognitive behavioural therapy in the management of insomnia? The PICO framework guided this dissertation and included, Adults suffering from Insomnia as the population, Pharmacotherapy as the intervention, Cognitive Behavioural Therapy (CBT) as the comparison and Better quality of life as the outcome. Inclusion criteria consisted of studies with participants’ aged 18 years or older suffering from insomnia, published in English within the last 15 years including any type of pharmacotherapy. Studies had to be peer-reviewed, included symptoms of insomnia, diagnosed either per the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International classification of sleep disorder (ICSD) guidelines. The Exclusion criteria limited studies published prior to 2001, not in English, with participants less than 18 years of age. The literature search yielded 9 relevant articles. The Oxford Appraisal Skills Programme (CASP, 2014) tools were used to evaluate and critique the various study designs identified, namely Meta-analysis, Randomised Controlled Trials, Systematic Reviews and Clinical Case Series. Results show that CBT and Cognitive Behavioural Therapy for Insomnia (CBT-I) seem to be the most effective long-term treatment for insomnia, providing the least burden for patients, thus improving their quality of life. Although new data is still emerging, there is a strong need to understand how best to integrate both behavioural and pharmaceutical approaches to maximize the effectiveness of treatment and ultimately ameliorate the quality of life of insomnia sufferers. Description: B.SC.(HONS)MENTAL HEALTH NURSING 2017-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/28089 Title: Treating negative symptoms of schizophrenia : antipsychotics vs. antidepressants and antipsychotics Abstract: Negative symptoms are a clinical manifestation of schizophrenia characterized by anhedonia, avolition, alogia, anergia, poor co-ordination and self-care (Rhoads & Murphy, 2015). The severity of this symptom domain is associated with low quality of life and a decline in cognitive function (Fusar-Poli et al., 2014; Kishi & Iwata, 2014). The persistent nature of negative symptoms led researchers to introduce the use of augmentation therapy with antidepressants to antipsychotics (Singh, Singh, Kar & Chan, 2010). For this reason the following PICO question was set: In adults with schizophrenia, how do antipsychotics combined with antidepressants compared to antipsychotics alone, affect the treatment of negative symptoms? Population chosen were adults with schizophrenia, whilst augmentation with antidepressants to antipsychotics was the intervention. The intervention was compared to using antipsychotic mono-therapy, while the expected outcome was the treatment of the negative symptom domain in schizophrenia. The literature search was performed through HyDi, Google Scholar and ResearchGate. Inclusion criteria consisted of peer reviewed studies in English, published during the last 10 years. Included studies focused on augmentation therapy to antipsychotics in the adult population with negative symptoms of schizophrenia. Studies focusing on depressive and cognitive symptoms were excluded. Finally, nine studies were chosen and critically appraised using the Critical Appraisal Skills Programme (CASP) and the Centre for Evidence-Based Management (CEBM). Not all results demonstrated statistically significant data in favour of augmentation therapy with antidepressants. However, all the selected studies reported an improvement in negative symptoms. In conclusion, individuals with negative symptoms of schizophrenia seem to benefit from this treatment strategy where even a minor improvement in this symptom domain may lead to better quality of life (Fusar-Poli et al., 2014). Recommendations for practice, education, research and management were addressed. This included the introduction of scales to identify individuals experiencing negative symptoms and allocating time and resources to educate health-care professionals and care-givers alike regarding this symptom domain. Description: B.SC.(HONS)MENTAL HEALTH NURSING 2017-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/28088 Title: Comparing effectiveness of cognitive behavioural therapy in adults with depression using group cognitive behavioural therapy versus individual cognitive behavioural therapy Abstract: Depression is a major health challenge commonly diagnosed in adults; effective intervention will aid in reducing its symptoms. Curran, Machin & Gournay (2006) acknowledged that Cognitive Behavioural Therapy (CBT) is effective in treating depression. Despite its availability, some people could not afford this treatment. CBT has particular benefits delivered in distinct formats which aim to facilitate access to the treatment. Evidence-based research is in favour of an individual format in contrast to group format (Gudmond et al., 2014.) The aim of this critical appraisal was to compare the effectiveness of the CBT using individual and group formats on depressive adults. The following question was formulated: “In adults with depression, is Group Cognitive Behavioural Therapy (GCBT) more effective than Individual Cognitive Behavioural Therapy (ICBT) in symptom reduction?” Adults with depression were the targeted population. GCBT was the intervention. ICBT was the comparison while the expected outcome was a reduction in depressive symptoms. Reputable databases available online at the university of Malta library such as Academic-Search Complete, CINAHL Plus, Google Scholar and PubMed were used to carry out the research. To identify new studies, PICO framework and different keywords were used. The selected studies were assessed against inclusion and exclusion criteria. Critical appraisal tools CASP (CASP Team, 2006) were used to appraise the twelve English published, full-texts identified between 2004 and 2016. The results clearly indicated significant similarities between GCBT and ICBT; however, the PICO question was not completely answered since both formats were found to considerably reduce depressive symptoms. This study recommended several developments with regards to management, education, research, practice and policy. The importance of educating the general public and staff members was highlighted and was followed by suggestions for the implementation of the recommended strategies. Description: B.SC.(HONS)MENTAL HEALTH NURSING 2017-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/28081 Title: Relapse prevention in depression : psychotherapy combined with antidepressants vs antidepressants alone Abstract: There are different treatment modalities that are prescribed to individuals with depression. These include psychotherapy, anti-depressants or a combined therapy of both methods. The main aim in the management of depression is to regain stabilization of the symptoms and additionally prevent relapse in the future. The research question reads: Is psychotherapy combined with antidepressants more effective than antidepressants alone in relapse prevention amongst adults with depression? The PICO elements consists of: Adults with depression as the population, the intervention consists of Psychotherapy combined with antidepressants, comparison is Antidepressants alone and the outcome is the prevention of relapse. Inclusion criteria consisted of Adults, Relapse Prevention, Combined therapy, Antidepressants and Psychotherapy. Exclusion criteria consisted of Studies not in English language and not available in full text, not peer reviewed studies, studies published later than ten years, older adults, children and adolescents, articles which included comorbidities. The outcome of the search was intended to identify which treatment modality is the most efficacious in preventing relapse amongst individuals with depression. The two treatment modalities consisted of combined therapy of antidepressants and psychotherapy and the monotherapy of antidepressants alone. The CASP was used as the critical appraisal tools to evaluate both RCTs and Meta-analysis. Two versions, one for the RCTs and one for the Metaanalysis were used accordingly. The main results in view of different treatment modalities in preventing relapse in depression favoured combination therapy of antidepressants and psychotherapy over antidepressants alone. It is evident that the follow up care in the studies need to be longer. Another important aspect is that studies need to include individuals that have severe depression as well. There is the need of more research in the local scenario as this is strongly lacking. Description: B.SC.(HONS)MENTAL HEALTH NURSING 2017-01-01T00:00:00Z