NRNP 665 Assignment: Patient Education for Children and Adolescents
Assignment: Patient Education for Children and Adolescents
Generalized anxiety disorder (GAD) is one of the anxiety disorders in children and adolescents. GAD is a constant state of increased anxiety and apprehension. Anxiety disorders in children and adolescents are characterized by worry, fear, or dread that significantly impair a person’s ability to function normally and are disproportionate to the situation (Iani et al., 2019). The following blog seeks to educate caregivers on GAD, including the signs and symptoms, pharmacological and non-pharmacological treatments, appropriate community resources, and referrals.
GAD Signs and Symptoms
The child with GAD will likely have multiple and diffuse worries aggravated by stress. If your child has GAD, you may notice that they have a shortened attention span and maybe hyperactive and restless, or keyed up. In addition, the child may have sleeping difficulties (difficulties initiating or maintaining sleep), sweat excessively, exhibit irritable behavior, and complain of constant fatigue (Bhatia & Goyal, 2018). GAD also presents with physical symptoms, and the child may report muscle aches, stomachaches, and headaches.
Pharmacological and Non-Pharmacological Treatments
Treatment of GAD in children and adolescents has two main approaches, pharmacological and non-pharmacological interventions. Pharmacological treatment is used for patients with severe GAD and those who fail to respond to psychotherapeutic interventions. Anxiolytic drugs include selective serotonin reuptake inhibitors (SSRIs), typically the drugs of choice in children and adolescents (Bushnell et al., 2018). Most children tolerate SSRIs without significant side effects. In addition, Benzodiazepines are prescribed for short-term treatment of anxiety but are not recommended for long-term treatment (Garakani et al., 2020).
Non-pharmacological treatment includes psychotherapy, the first-line treatment for mild to moderate GAD in children and adolescents. Psychotherapies used include behavioral therapy such as exposure-based cognitive-behavioral therapy (CBT). Exposure-based CBT involves systematically exposing the child to the anxiety-triggering situation, but in a graded fashion (Amray et al., 2019). The therapist helps the child remain in the anxiety-provoking situation, which makes them become desensitized and feel less anxious. In mild-moderate GAD cases, behavioral therapy alone is usually sufficient. Mindfulness-Based Psychotherapy is also a non-pharmacological approach used in GAD. It entails using regular mindfulness meditation practices to help the child develop mindfulness skills (Amray et al., 2019).
Community Resources and Referrals
Community resources available for children and adolescents with GAD include organizations such as the American Academy of Child & Adolescent Psychiatry, Child Mind Institute, and Anxiety and Depression Association of America – Anxiety and Depression in Children. The organizations provide information about the condition and how to help a child diagnosed with GAD. In addition, there are online communities where one can learn more about GAD, such as Parenting Anxious Kids, Turn around Anxiety Blog, and Anxiety-Free Child Blog. Children with GAD who do not improve with treatment disorder are referred to a child psychiatrist for more specialized treatment.
Conclusion
GAD in children and adolescents presents with excessive anxiety/worry and behavioral and physical symptoms. Treatment includes psychotherapy such as CBT and mindfulness-based therapy for mild to moderate exercises. Medications are prescribed for children with severe cases or those who do not respond adequately to psychotherapy.
References
Amray, A. N., Munir, K., Jahan, N., Motiwala, F. B., & Naveed, S. (2019). Psychopharmacology of Pediatric Anxiety Disorders: A Narrative Review. Cureus, 11(8), e5487. https://doi.org/10.7759/cureus.5487
Bhatia, M. S., & Goyal, A. (2018). Anxiety disorders in children and adolescents: Need for early detection. Journal of postgraduate medicine, 64(2), 75–76. https://doi.org/10.4103/jpgm.JPGM_65_18
Bushnell, G. A., Compton, S. N., Dusetzina, S. B., Gaynes, B. N., Brookhart, M. A., Walkup, J. T., Rynn, M. A., & Stürmer, T. (2018). Treating Pediatric Anxiety: Initial Use of SSRIs and Other Antianxiety Prescription Medications. The Journal of clinical psychiatry, 79(1), 16m11415. https://doi.org/10.4088/JCP.16m11415
Garakani, A., Murrough, J. W., Freire, R. C., Thom, R. P., Larkin, K., Buono, F. D., & Iosifescu, D. V. (2020). Pharmacotherapy of anxiety disorders: current and emerging treatment options. Frontiers in psychiatry, 1412. https://doi.org/10.3389/fpsyt.2020.595584
Iani, L., Quinto, R. M., Lauriola, M., Crosta, M. L., & Pozzi, G. (2019). Psychological well-being and distress in patients with generalized anxiety disorder: The roles of positive and negative functioning. PloS one, 14(11), e0225646. https://doi.org/10.1371/journal.pone.0225646
Introduction
Depression is a mental health disorder characterized by sadness, loss of interest in activities, and depressed or irritable mood severe enough to affect an individual’s ability to function effectively significantly. It is a common mental illness that can occur at any age and affects how individuals feel, thinks, and acts. It can result in emotional or physical problems that can interfere with the individual’s ability to function. There are several depressive disorders which include major depressive disorder, persistent depressive disorder (dysthymia), disruptive mood dysregulation disorder, premenstrual dysphoric disorder, substance/medication-induced depressive disorder, and unspecified depressive disorder (American Psychiatric Association, 2013). This paper aims to discuss persistent depressive disorder (dysthymia), its signs and symptoms, pharmacological and nonpharmacological interventions, and possible community referrals.
Persistent Depressive Disorder (Dysthymia)
Persistent depressive disorder, also called dysthymia, is a combination of chronic major depressive disorder and dysthymic disorder characterized by low mood for most of the day, occurring for at least two years for adults. It can be diagnosed in pediatric patients, either children or adolescents when the depressed or irritable mood is present for at least one year (American Psychiatric Association, 2013). During the 2 or 1 year period of the illness, two or more of the following symptoms such as poor appetite or overeating, insomnia or hypersomnia, low energy, fatigue, low self-esteem, poor concentration, and feelings of hopelessness, must also be present (American Psychiatric Association, 2013). Many factors can trigger the risk of persistent depressive disorder in children or adolescents, such as increased stress, physical or emotional trauma, abuse, neglect, loss of a parent, caregiver, or relationship, health-related problems, developmental or learning disabilities, and substance use.
Signs and Symptoms of Persistent Depressive Disorder
Depression can cause lower quality of life, higher risk of suicide, disability, and loss of productivity. Unfortunately, depression is often undiagnosed because of failure to recognize the symptoms and seek mental health care (Farid et al., 2020). Individuals with persistent depressive disorder have different symptoms, and they include sadness, low self-esteem, feelings of despair, helplessness or guilt, suicidal thoughts and attempts, sleep problems, problems with appetite, low energy, problems with focus and concentration, irritability, aggression, fatigue, loss of interest in usual activities, running away from home, and feelings of rejection. If your child experiences two of these symptoms, please notify the child’s health care provider, and provide details of the child’s clinical presentation. This disorder can be treated with medications and psychotherapy.
Pharmacological Treatment of Persistent Depressive Disorder (Dysthymia)
There are FDA-approved medications that can be used to treat depression in pediatric patients. They include Escitalopram (Lexapro) for individuals between 12 and 17 years and Fluoxetine (Prozac) for ages between 8 and 17 years.
Escitalopram (Lexapro) and Fluoxetine (Prozac) are antidepressants that belong to the class of medications called the Selective serotonin reuptake inhibitor (SSRIs), used primarily for the treatment of depression and anxiety. These medications work by increasing the chemical serotonin in the brain. Studies have shown that adolescents with persistent depressive disorder treated with these antidepressants showed significant improvement in symptoms, better response, and remission rates. They are generally well-tolerated, and few individuals experience adverse reactions, usually occurring within the first eight weeks (Findling et al., 2013).
Nonpharmacological Treatment of Persistent Depressive Disorder
Persistent depressive disorder can also be treated without the use of medications or by combining medications with therapies. Psychotherapies have been studied and proven to be effective in significantly reducing depressive symptoms and helping patients to develop coping skills to manage these symptoms effectively. The psychotherapies include Cognitive behavioral therapy (CBT), Interpersonal psychotherapy, and the cognitive-behavioral analysis system of psychotherapy.
- Cognitive Behavioral Therapy (CBT): Individuals suffering from depression are taught cognitive and behavioral skills to help them develop more positive beliefs about themselves, others, and the world. It helps them to learn to value their own feelings, replace behaviors that generate negative feelings with more appropriate behaviors, and modify distorted thoughts and inaccurate reasoning (Bernaras et al., 2019).
- Interpersonal Psychotherapy: It uses certain behavioral strategies such as problem- solving and social skills training and lasts between 12 and 16 sessions in the most severe cases and between 3 and 8 sessions in milder cases (Bernaras et al., 2019).
- Cognitive Behavioral Analysis System of Psychotherapy: This therapy combines components of cognitive, behavioral, interpersonal, and psychodynamic therapies. It is developed specifically to treat chronic depression. Patients undergoing this therapy generate more empathic behaviors and identify, change and heal interpersonal patterns related to depression (Bernaras et al., 2019).
Community Resources or Referrals
Several communities and online resources can help promote mental health awareness and provide support to achieve the treatment goals. Transitioning into full recovery without community support services can be overwhelming. The support services can help the individual to deal with the stressors and difficult situations and enhance the chances to function independently and effectively. Some of the community and online resources that can be utilized include the National Alliance on Mental Illness (NAMI), National Institute of Mental Health (NIH), Federation of Families for Children’s Mental Health NJ State Organization (NJ FFCMH), and other groups that can provide services and resources to caregivers parents and their children.
For safety, the patient is to call 911 or talk to someone anytime he experiences intrusive thoughts or unsafe thoughts to harm himself or others. The helplines that can be utilized are:
- National Alliance on Menatl Illness (NAMI) helpline – 1-800-950-NAMI or info@nami.org
- National Institute of Mental Health (NIH) helpline – 1-866-615-6464 or nimhinfo@nih.gov
- Federation of Families for Children’s Mental Health NJ State Organization (NJ FFCMH) helpline – 973-642-8100
References
American Psychiatric Association. (2013). Dianostic and statistical manual of mental disorders: DSM-5. (5th ed.). Washington, DC: American Psychiatric Association.
Bernaras, E., Jaureguizar, J., & Garaigordobil, M. (2019). Child and adolescent depression: A Review of theories, evaluation, instruments, prevention programs, and treatments. Frontiers in Psychology. Retrieved from https://www.frontiersin.org/articles/10.3389/fpsyg.2019.00543/full
Farid, D., Da Costa, D., Afif, W., & Szabo, J. (2020). Undiagnosed depression, persistent depressive symptoms and seeking mental health care: Analysis of immigrant and non-immigrant participants of the Canadian longitudinal study of aging. Epidemiology and Psychiatric Sciences, 29. Retrieved from https://www.proquest.com/nahs/docview/2433596660/9BF493EBA21D473APQ/5?accountid=14872
Findling, R.L., Robb, A., & Bose, A. (2013). Escitalopram in the treatment of adolescent depression: A Randomized, double-blind, placebo-controlled extension trial. Journal of Child and Adolescent Psychopharmacology, 23 (7), 468-480. Retrieved from https://www.proquest.com/nahs/docview/1432656831/A0B73C6D1BDA4825PQ/5?accountid=14872
Introduction
Disruptive mood dysregulation disorder (DMDD) involves persistent irritability and frequent episodes of behavior that is very out of control, with onset at age 6-10 years (Elia, 2021). In this paper, I will be educating about DMDD, which includes the sign and symptoms, pharmacological and nonpharmacological treatments, and community resources.
Sign and Symptoms
To diagnose, patient must not be before age 6 or after age 18 years (Elia, 2021). Sign and symptoms must be ongoing for more than 12 months, with on period more than 3 months without them (Elia, 2021). Sign and symptoms include:
- Severe recurrent temper outbursts that are grossly out of proportion to the situation and that occurs more than 3 times a week on average (Elia, 2021)
- Temper outburst that are inconsistent with developmental level (Elia, 2021)
- An irritable, angry mood present every day for most of the day and observed by others such as teachers, parents and peers (Elia, 2021)
Pharmacological Treatments
DMDD is a newly added diagnosis in DSM-5. Currently, there is not enough literature that reviews the possible treatment options for the cardinal symptoms of DMDD (Tourian et al, 2015). Due to this issue, there is no pharmacological treatment that is FDA approved for DMDD. However, clinicians can prescribe medication such as stimulants, antipsychotics and mood stabilizers that can handle symptoms such as irritability. According to Tapia & John (2018), these medications are used to manage the symptoms but not the condition.
Non-Pharmacological Treatments
According to Lovering (2021), there are three common nonpharmacological treatments used for DMDD and they are the following:
- Cognitive Behavioral Therapy (CBTP – can help children cope with their feelings. Can also help kids respond to frustration and anger with the goal to control or reduce the frequency of outburst
- Dialectical behavior therapy for children (DBT-C) – focuses on emotional and social aspects of living. Can also help them learn relationship strategies as well as personal strategies.
- Parent training – a technique where they learn to anticipate aggressive behavior and work to prevent it
Community Resources
According to Uran & Kilic (2020), families dealing with children with DMDD can get more information about the disorder, what it is and how to manage it, from organizations such as Mental Health America and National Alliance on Mental Illness. They (2021) also mentioned going to Substance Abuse and Mental Health Services Administration, who has a referral treatment helpline and get information on treatment services.
Conclusion
In conclusion, dealing with children diagnosed with DMDD can be challenging. It would help families to learn as much information about the disorder and how to manage it. It is good to know that there are resources available.
References
Elia, J. (2021, April). Depressive Disorders in Children and Adolescents. Merch Manual Professional Version. Retrieved April 1, 2022, from https://www.merckmanuals.com/professional/pediatrics/mental-disorders-in-children-and-adolescents/depressive-disorders-in-children-and-adolescents?query=disruptive%20mood%20dysregulation%20disorder
Lovering, C. (2021, September 27). Treating Disruptive Mood Dysregulation Disorder (DMDD). PsychCentral. Retrieved on April 1, 2022, from https://psychcentral.com/disorders/disruptive-mood-dysregulation-disorder-treatment
Tapia, V., & John, R. M. (2018). Disruptive Mood Dysregulation Disorder. The Journal of Nurse Practitioners, 14 (8), 573-578. https://doi.org//10.1016/j.nurpra.2018.07.007
Tourian, L., LeBoeuf, A., Breton, J. J., Cohen, D., Gignac, M., Labelle, R., Guile, J.M., & Renaud, J. (2015, March 4). Treatment Options for the Cardinal Symptoms of Disruptive Mood Dysregulation Disorder. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 24(1), 41-54.
Anxiety Disorder
At times life can be stressful and can make us anxious. These anxious feelings can come from a problem from work, a test in a class or just trying something new. But an anxiety disorder involves more than just temporary worry. An anxiety disorder is anxiety that does not go away and can worsen over time. It can impede day-to-day activities such as work performance, school performance and even relationships (National Institute of Mental Health, 2018). According to Vahratian, Blumberg, Terlizzi and Schiller, between August 2020 and February 2021, the rate of adults with new symptoms of an anxiety or a depressive disorder increased from 36.4% to 41.5%, and the percentage of those reporting an undiagnosed mental health care need increased from 9.2% to 11.7%. These percentages reported the largest among adults aged between 18 and 29 years of age and those with less than a high school education.
Signs and Symptoms and Types of Anxiety Disorders
There are many diverse types of anxiety disorders such as general anxiety disorder, selective mutism, social anxiety disorder, substance induced and panic disorder just to name a few. They all share some of the same symptoms with each other but have some characteristics unique to themselves. But the common signs and symptoms of anxiety disorder include feeling nervous, restlessness, tension, having a sense of impending doom, increased heart rate, hyperventilation, sweating, trembling, feeling weak, trouble concentrating or thinking about anything other than the present worry, insomnia, gastrointestinal problems, difficulty controlling worry and avoiding situations that triggers anxiety (Mayo Clinic, 2018). The causes of anxiety disorders are not fully understood. Events such as trauma can be a trigger, but genetics can also be a factor (Mayo Clinic, 2018). Medical problems such as cardiovascular, respiratory problems, drug and alcohol abuse, withdrawal, and pain can also trigger anxiety. Some of the risk factors are trauma, stress, and other mental health comorbidities such as depression.
Pharmacological Treatment
The first line of defense for anxiety disorders are selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) (Garakani et al, 2001). A meta-analysis stated that most SSRIs and SNRIs were more successful than placebo in generalized anxiety disorder, with escitalopram and duloxetine potentially having the largest effect sizes (Garakani et al, 2001). These medications are well-tolerated, with short-lived but manageable side effects like nausea, headache, dry mouth, diarrhea, or constipation. Sexual dysfunction is a more durable and problematic side effect of SSRIs and SNRIs, but these side effects can be controlled with adjunctive care. There is a possibility of patients developing jitteriness and anxiety, because of initial surge of serotonin. Although this anxiety can be controlled by slower adjustment rate or the supplemental use of benzodiazepines.
Non-Pharmacological Treatment
Some of the non-pharmacological treatments can include cognitive behavior therapy. According to Therapist Aid, “cognitive behavioral therapy (CBT) has become the leading treatment for anxiety.” Research indicates that CBT can be a successful treatment for anxiety after as few as eight sessions. It can have a successful rate with or without pharmacological intervention (Therapist Aid, 2016). Some other treatments can include dietary restrictions such as limiting caffeine, eating a balanced diet, avoiding foods high in sugar (including sodas that can be high in caffeine and sugar) and processed foods. Limiting alcohol and nicotine can be beneficial to managing anxiety as well (Therapist Aid, 2016). Drinking more water, getting adequate rest and exercise helps to manage anxiety, also meditation and relaxation techniques such as yoga are extremely beneficial to anxiety reduction.
Resources
There are many different resources that a person can use to get help, education, and inspiration for hope against debilitating anxiety. One of the resources called Sanity Break is a site where people share how they cope with anxiety. Organizations like The National Alliance on Mental Illness and The Centers of Disease Control and Prevention, The Division of Mental Health conducts studies and can offer insight on coping mechanisms. There are stigmas that impede therapy for Black American, Asian American, Pacific Islander, Hispanic or Latino, and Indigenous communities. There are organizations such as The Asian Mental Health Collective and The Black Mental Health Alliance. According to Bennington-Castro et al the Inclusive Therapists was created to “center the needs of Black, Indigenous, and People of Color (BIPOC) and the LGBTQIA2S+ community” while respecting the neurodiversity spectrum and advocating for mental health care accessibility for people with disabilities or disabled people.” The drugs to treat anxiety disorders may not be affordable to some patients so programs like Good Rx, Medical Assistance Tool, Needy Meds, Together Rx Access, and Social Security are viable options to help patients get the medications they need for successful treatment (Bennington-Castro et al, 2021).
References
Bennington-Castro, J., Vaughn, L., Pugle, M., Upham, B., Konkel, L., Bennington-Castro, J., Chant, I., & Fletcher, J. (2021, April 8). Anxiety resources. EverydayHealth.com. Retrieved April 3, 2022, from https://www.everydayhealth.com/anxiety/guide/resources/
Garakani, A., Murrough, J. W., Freire, R. C., Thom, R. P., Larkin, K., Buono, F. D., & Iosifescu, D. V. (1AD, January 1). Pharmacotherapy of anxiety disorders: Current and emerging treatment options. Frontiers. Retrieved April 3, 2022, from https://www.frontiersin.org/articles/10.3389/fpsyt.2020.595584/full
Mayo Foundation for Medical Education and Research. (2018, May 4). Anxiety disorders. Mayo Clinic. Retrieved April 3, 2022, from https://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961
Therapist Aid. (2016, April 29). Treating anxiety with CBT (guide). Therapist Aid. Retrieved April 3, 2022, from https://www.therapistaid.com/therapy-guide/cbt-for-anxiety
U.S. Department of Health and Human Services. (2022). Anxiety disorders. National Institute of Mental Health. Retrieved April 3, 2022, from https://www.nimh.nih.gov/health/topics/anxiety-disorders
Patient education is one of the safety measures that healthcare professionals have been applying to manage diseases. The process involves influencing patient behavior and producing changes in skills and attitudes required to maintain and improve health (Başer & Mollaoğlu, 2019). All physicians are responsible for teaching patients, their families, and the community. Consequently, teaching patients on effective management of Obsessive-compulsive disorder (OCD) is effective in heightening safety of patients. The purpose of this blog is to increase awareness on the effective of patient education in managing OCD disease.
Signs and Symptoms of Obsessive-Compulsive Disorder
People diagnosed with OCD may experience obsession or compulsion. These are the main symptoms that affect a child in adolescent life. For instance, it affects their relationship with others in the school. The obsessions faced by adolescents are repeated thoughts, urges, and mental images that result in anxiety. Common obsession symptoms include fear of germs or contamination, taboo thoughts involving sex, and aggressive thoughts (Martinotti et al., 2021). The adolescents may also experience compulsive behavior like excess cleanliness, compulsive counting, and repeated checking of things. These signs and symptoms make adolescents more preoccupied with tiny things that affect their social relationships with their peers.
Pharmacological Treatments
The clinical approach to these disorders has been gaining more attention recently. This is because of the positive impact that such treatments have on patients. An adolescent diagnosed with OCD needs Serotonin reuptake inhibitors (SRIs) which will include selective serotonin reuptake inhibitors (SSRIs) to aid in reducing the OCD signs and symptoms (Wu et al., 2021). The SRIs often require high daily doses to treat OCD than the dose taken to treat depression. These drugs take 8-12 weeks to start working. However, some patients may experience more and more rapid improvement.
Non-Pharmacological Treatments
Psychotherapy is one of the most effective treatments for OCD in children and adolescents. Cognitive behavior and interpersonal and psychodynamic therapies are non-pharmacological treatments applied to OCD patients. These therapies help one to develop self-awareness of what one feels and the reasons for feeling that way. Besides, they teach skills in dealing with negative thinking and changing behaviors and attitudes. Three majorly used therapies are always healthy, traditional, and easy to use among the many therapies available (Del Casale et al., 2019). Cognitive-behavioral therapy is physiotherapy that depicts irrational thinking patterns, emotional responses, and behavior thus replacing them with rational patterns. It has become a crucial part of psychology since its formation as a treatment for depression.
Community Resources
OCD in adolescents also affects their relationship with the surrounding community. Adolescents’ growth and development may be affected by age, gender, and culture. On the other hand, neurodevelopment among children is affected by the culture and the social practices adopted in the community (Gröndahl et al., 2019). Motor skills adopt a similar fashion of development in every culture. However, the development of social skills depends on cultural context and norms (Martinotti et al., 2021). A child might be born with an OCD condition, but the power and interaction they find in the community and their culture limit the condition from affecting their lives adversely.
Conclusion
OCD is considered a mental disorder, and its symptoms and severity vary considerably between individuals. Some individuals are severely impaired by their symptoms. For example, they may have special affinities for objects or activities others find unusual. Some individuals with OCD resist more socially appropriate play demonstrations, and it is difficult to engage in social activities. Fortunately, implementing pharmacological and non-pharmacological approaches results in effective outcomes.
References
Başer, E., & Mollaoğlu, M. (2019). The effect of a hemodialysis patient education program on fluid control and dietary compliance. Hemodialysis International, 23(3), 392-401.https://doi.org/10.1111/hdi.12744
Del Casale, A., Sorice, S., Padovano, A., Simmaco, M., Ferracuti, S., Lamis, D. A., … & Pompili, M. (2019). Psychopharmacological treatment of obsessive-compulsive disorder (OCD). Current Neuropharmacology, 17(8), 710-736.https://doi.org/10.2174/1570159X16666180813155017
Gröndahl, W., Muurinen, H., Katajisto, J., Suhonen, R., & Leino-Kilpi, H. (2019). Perceived quality of nursing care and patient education: a cross-sectional study of hospitalised surgical patients in Finland. BMJ Open, 9(4), e023108.http://dx.doi.org/10.1136/bmjopen-2018-023108
Martinotti, G., Chiappini, S., Pettorruso, M., Mosca, A., Miuli, A., Di Carlo, F., … & Di Giannantonio, M. (2021). Therapeutic potentials of ketamine and esketamine in Obsessive–Compulsive Disorder (OCD), Substance Use Disorders (sud) and Eating Disorders (ed): a review of the current literature. Brain Sciences, 11(7), 856.https://doi.org/10.3390/brainsci11070856
Wu, H., Hariz, M., Visser-Vandewalle, V., Zrinzo, L., Coenen, V. A., Sheth, S. A., … & Nuttin, B. (2021). Deep brain stimulation for refractory obsessive-compulsive disorder (OCD): emerging or established therapy?. Molecular Psychiatry, 26(1), 60-65.https://doi.org/10.1038/s41380-020-00933-x