Интересные новости для специалистов.

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20 March 2006

Depression appears to increase the risk of mild cognitive impairment (MCI) developing in elderly individuals, researchers report in the Archives or Neurology.

The association between depression and MCI appeared to be stronger in men than in women, although not significantly, but it was not influenced by the severity or duration of depression.

Yonas Geda (Mayo Clinic College of Medicine, Rochester, Minnesota, USA) and colleagues also found that there was a positive interaction between apolipoprotein E (APOE) genotype and depression, whereby people with depression and the APOE genotypes ε3/ε4 or ε4/ ε4 were more likely to develop MCI than people with either of these features alone.

The researchers explored whether depression increased the risk of developing incident MCI in 840 cognitively normal elderly individuals aged between 50 and 102 years.

All the participants were free of depression and cognitive impairment at the start of the study and were followed-up for a median of 3.5 years.

A total of 143 (17%) individuals developed depression during follow-up, with scores on the Geriatric Depression Scale (GDS) of 6 points in 47.6% of patients, 7 to 11 points in 50.4% of patients, and 12 to 15 points in 2.1% of patients.

Among the patients with depression, 13.3% developed MCI, compared with just 4.9% of those without the psychiatric disorder.

The hazard ratio for MCI for patients with depression, compared with those without depression, was 2.2, after taking into account age, education, and gender, and considering dementia as a competing outcome.

Patients with depression were also more likely than those without depression to develop the secondary outcome of incident MCI or dementia, with frequencies of 22.4% versus 7.2%.

The association between depression and MCI increased when APOE genotype was included in the model. Compared with controls, the hazard ratio for MCI among patients without depression who had the ε3/ ε4 or ε4/ ε4 genotypes was 1.6, while individuals with depression and either type of genotype had a hazard ratio for MCI of 5.1.

"Our study suggests that cognitively normal elderly individuals who develop depression are at increased risk of subsequent MCI," write Geda and team.

"In addition, there may be a synergistic interaction between APOE genotype and depression."



Source: Arch Neurol 2006; 63: 435–440

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15 March 2006

Researchers have successfully diagnosed schizophrenia in patients using a virtual reality environment that tests working memory, with an accuracy of 85%.

"The technology made it possible to collect multiple measurements during a complex behavior; including multimodal interactions that pose a high load on working memory," the team explains.

"In addition, the technology allowed us to conduct the experiment as a game and engage the patients in the task, which improved the subjects' concentration and motivation."

Currently, the diagnosis of schizophrenia involves psychiatric evaluation, which relies on symptoms, medical history, interview, and observation. Since each patient manifests different subsets of symptoms, this method is often unreliable.

Believing virtual reality technology to be suitable for studying schizophrenia, Anna Sorkin, from the Hebrew University of Jerusalem in Israel, and colleagues tested its use for measuring cognitive functions in 39 patients with schizophrenia and 21 mentally healthy controls.

The virtual environment was a maze consisting of multiple rooms. Each room had three doors displaying three features – color, shape, and sound. The correct combination of features unlocked the door. The participants therefore had to learn the correct combination and use it in order to enter the next room.

On completion of the task, a performance profile was assigned to each individual, based on various error scores, response time, navigation ability, and strategy.

The researchers found that using performance profiles consisting of four measures – distractor effect, error rate during use of the rule in training, consecutive error rate, and response time – they were able to correctly identify 33 (85%) of the 39 patients with schizophrenia and all of the controls.

"Viewing schizophrenia as a disturbance in integration creates a unified framework in which a unique disintegration profile can be created," say the investigators.

Soren told MedWire News: "We hope that future psychiatrists will describe his/her patients by their disintegration profiles, which will include objective measures of the patient's specific deficiencies, hopefully leading to better treatment and rehabilitation."

She added that integration of virtual reality technology into clinical practice could be a viable and cost-effective option, saying: "Virtual reality equipment is inexpensive in hospital terms, and the major part of the system would be computer software containing the tests and data analysis units."

The researchers note, however, that, as the current technology concentrated on working memory, a wider battery of integrative tests needs to be developed and validated.



Source: Am J Psychiatry 2006; 163: 512–520

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23 March 2006

Remission of maternal depression within the first 3 months of treatment appears to reduce the likelihood of children developing psychiatric disorders such as mood or disruptive behavior disorders during this time, study findings show.

"To our knowledge, this is the first published study to document prospectively the relation between remission of a mother's depression and her child's clinical state," say Myrna Weissman (Columbia University, New York, USA) and colleagues.

"These findings are intriguing because they suggest that an environmental influence (ie, the impact of maternal depression remission) had a measurable impact on the child's psychopathology."

The researchers explored the impact effective treatment of major depression in 151 mothers had on psychological symptoms and disorders in their children as part of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial.

Assessment of the children using the Kiddie Schedule for Affective Disorders and Schizophrenia showed that one third had a current psychiatric disorder including anxiety, depressive, or disruptive behavior disorders.

After 3 months of medication treatment, follow-up data available for 114 mothers showed that 28 (33%) met the remission criteria of a score of 7 or lower on the Hamilton Rating Scale for Depression.

Moreover, there was an 11% decrease in the rates of diagnoses in the children of these mothers, dropping from 35% to 24%. For children born to mothers whose depression continued, however, there was an 8% increase in diagnoses, from 35% to 43%.

Among the children who had psychiatric diagnoses at baseline, those whose mothers experienced remission of depression also showed remission of their own diagnoses, whereas only 12% of children born to mothers with continued depression achieved remission.

Children who had no psychiatric disorders at baseline all remained free of psychopathology at the 3-month follow-up if their mothers' depression remitted. This compared with just 17% of children whose mothers remained depressed or relapsed over this period.

"From a clinical vantage point, our findings suggest that vigorous treatment of depressed mothers to achieve remission is associated with positive outcomes in their children as well, whereas failure to treat depressed mothers may increase the burden of illness," says Weissman and team in the Journal of the American Medical Association.

"At a time when there are many questions about the appropriate and safe treatment of psychiatric disorders in children, these findings suggest that it is important to provide vigorous treatment to mothers if they are depressed."



Source: JAMA 2006; 295: 1389–1398

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31 March 2006

Study findings suggest that schizophrenia may be precipitated by substance use or that the early-onset of psychotic symptoms could be a risk factor for such use.

Thomas Barnes (Imperial College Faculty of Medicine, London, UK) and colleagues found an earlier age at onset of psychosis in patients who reported a lifetime history of comorbid substance use, highlighting the need for systematic assessment of substance use in people who have recently developed schizophrenia.

A total of 152 people participating in the West London First-Episode Schizophrenia Study provided information on their drug and alcohol use, as well as age at onset of psychosis. The patients' mental state, cognition, and social function were also assessed.

Among the participants, 60% were smokers, 27% reported a history of problems with alcohol use, 35% reported current substance use not including alcohol, and 68% reported lifetime substance use, with cannabis and psychostimulants those most commonly used.

Overall, patients with a history of substance use, compared with those without such a history, were significantly younger at the time of their first psychiatric contact, at an average of 24.4 years versus 27.8 years, and at the onset of their psychotic symptoms, at 23.3 years versus 26.1 years.

Analysis indicated that both cannabis use and gender had independent effects on age at onset of psychosis, after adjusting for alcohol misuse and use of other drugs.

The age at onset of psychosis was, on average, 4.2 years older for women than for men, after adjusting for substance use, while cannabis use, compared with no use, was significantly associated with a younger onset, by an average of 5 years.

Writing in the British Journal of Psychiatry, the researchers note that there was no difference between those with and without comorbid substance use with regard to IQ or cognition, and both groups had similar levels of social function.

"These results confirm the high prevalence of lifetime substance use in first-episode patients with schizophrenia," say Barnes and co-workers.

"From a clinical perspective, given that such substance use tends to predict a poorer initial outcome, our findings reinforce the need to routinely assess and consider appropriate treatment intervention for substance use in people with schizophrenia when they first present to psychiatric services."
Source: Br J Psychiatry 2006; 188: 237–242

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4 April 2006

Additional psychotherapy involving minimal contact with a therapist appears to reduce the incidence of depression compared with standard care by up to a third, study findings show.

"Not only is the intervention more effective, this economic evaluation indicates that choosing it over usual care alone is likely to be the best treatment option, because there is a 70% probability that the intervention is preferable to usual care when the costs of production losses are included in the analysis," Filip Smit (Free University, Amsterdam, The Netherlands) and colleagues report.

Noting that even under optimal care the burden of depression can only be averted in about a quarter of patients, the researchers looked at the cost-effectiveness of usual care plus minimal contact psychotherapy.

They randomly assigned primary care patients with subthreshold depression to receive minimal contact psychotherapy plus usual care from a general practitioner (n=107) or usual care alone (n=109).

The psychotherapy comprised a self-help manual with instructions on mood management. This was guided by six short telephone calls with a prevention worker.

After 1 year, 18% of patients receiving usual care alone had developed depressive disorders, compared with 12% of those receiving adjunctive psychotherapy.

Overall, the average annual per capita total cost for the usual care plus psychotherapy group was ?6766 (US$8161.07), which compared favorably with the ?8614 ($10,390.10) for the usual care group.

Economic evaluations that took into account the costs of all types of health services, as well as the costs that stem from production losses through absenteeism and reduced efficiency at work, showed a 70% probability that minimal contact psychotherapy in addition to usual care is more cost effective.

The investigators conclude that minimal contact psychotherapy can be used as a cost-effective adjunct to conventional primary care in order to reduce the incidence of depressive disorder.

"This choice is likely to result in health gains and economic benefits," they write in the British Journal of Psychiatry. "Therefore, its dissemination seems appropriate."

They add, however, that more research is needed into the cost-effectiveness of the therapy over the long term. The researchers also suggest that the therapy could be adapted for internet use in order to reduce provision costs, thereby promoting its use to a wider segment of the population.



Source: Br J Psychiatry 2006; 188: 330–336

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А по поводу этой новости попрошу высказаться коллег - эндокринологов.

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4 April 2006

Research findings reveal that the risk of Type 2 diabetes in patients with schizophrenia is similar for those taking typical and atypical antipsychotics, but the duration of exposure to such medications does not appear to be an influencing factor.

In their study of more than 200 patients with schizophrenia, D Cohen, from the Psychiatric Institute Rijngeest in Noordwijkerhout, The Netherlands, and colleagues found that the overall prevalence of Type 2 diabetes was 9%, which was significantly higher than the prevalence of 4.9% for the general population.

With regard to atypical or typical antipsychotics, they therefore suggest in the journal European Neuropsychopharmacology that, "whichever treatment is applied, the result in the long term is the same, namely an increase of risk of diabetes mellitus."

The researchers investigated the prevalence of diabetes in 266 patients with chronic schizophrenia or schizoaffective disorder and whether it was related to the duration of antipsychotic treatment.

Compared with estimates for the general population, patients with schizophrenia were found to be 1.89 times more likely to develop diabetes. There were no new cases of diabetes mellitus during the course of the study, however.

Cohen and co-workers note that the increased prevalence of diabetes was largely confined to patients aged between 30 and 39 years and those aged 40 to 49 years, with odds ratios of 13.29 and 6.74, respectively, compared with people of the same age from the general population.

The increased prevalence of diabetes appeared to be associated with being overweight and obese, but there was no significant correlation between diabetes and the duration of antipsychotic treatment.

Moreover, there was no relationship between diabetes and the prescribed antipsychotic drug or biochemical group of antipsychotic drugs.

"Irrespective of the pathophysiological mechanism involved, the results warrant modified indications for blood glucose control in long-term treated patients," the researchers say.

They note that the diabetes consensus document from the American Diabetes Association advises blood glucose control during treatment with atypical antipsychotics. But, based on the current findings, Cohen and team suggest that differentiation between typical and atypical antipsychotics is not needed. (выделение мое- И.Г.)

Moreover, no age limit is indicated in the current guidelines, whereas these results suggest that blood glucose control from the age of 30 onwards is needed in order to detect hyperglycemia or early cases of diabetes mellitus.



Source: Eur Neuropsychopharmacol 2006; 16: 187–194

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28 April 2006

The newer atypical antipsychotics appear to be effective for the treatment of acute bipolar mania, with only modest differences in acute efficacy seen among the drugs, study findings show.

Roy Perlis, from Massachusetts General Hospital in Boston, USA, and colleagues therefore suggest that "efficacy alone may not be a useful factor in selecting among the various acute treatment options available."

The researchers conducted a review of placebo-controlled studies of atypical antipsychotics, both as monotherapy and adjunctive therapy, for acute bipolar mania.

Data from 12 monotherapy and six adjunctive therapy trials involving a total of 4304 patients, including 1750 individuals taking placebo, were identified.

The effects of five atypical antipsychotics – aripiprazole, olanzapine, quetiapine, risperidone, and ziprasidone – were compared with that for placebo based on Young Mania Rating Scale (YMRS) scores.

All five antipsychotics proved to be superior to placebo as monotherapies. Overall, rates of response, defined as a 50% reduction in YMRS scores, were 53% for atypical antipsychotics and 30% for placebo.

The findings for the six add-on trials also indicated that atypical antipsychotics conferred an additional benefit over monotherapy with a traditional mood stabilizer.

"It therefore appears that recommendations for the use of combination therapy with a traditional mood stabilizer and an atypical antipsychotic in manic patients are warranted," say Perlis and team.

They add that there were only modest differences in efficacy across the five drugs, and acknowledge that comparisons were based upon their difference from placebo, rather than absolute change in mania rating scale score, in order to control for study differences.

"While studies are often compared in terms of effect size, this measure is somewhat more difficult to interpret in clinical terms," the investigators note.

They conclude: "Our results suggest broad similarity across the atypical antipsychotics in efficacy for treatment of bipolar mania, whether used in monotherapy or add-on therapy.

"In the face of substantial study heterogeneity, we cannot exclude modest differences. However, treatment selection among these agents may be better governed by factors other than short-term efficacy, such as maintenance efficacy, tolerability, safety, and cost."



Source: J Clin Psychiatry 2006; 67: 509–516

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2 May 2006

Study findings show a set of distinct, but overlapping, risk factors that may be linked to minor versus serious violent behavior in patients with schizophrenia.

"Serious violent behavior, although generally uncommon in people with mental disorder, carries a high human and social cost," note Jeffrey Swanson (Duke University Medical Center, Durham, North Carolina, USA) and colleagues.

"More informed and nuanced explanatory models, particularly in the clinical domain are needed to improve understanding of how and why violent behavior occurs in persons with schizophrenia with particular characteristics, under varying conditions of social life."

The researchers investigated the prevalence and correlates of violence in 1410 schizophrenia patients who were interviewed about such behavior in the past 6 months.

Violence was classified as minor violence, corresponding to simple assault without injury or weapon use; and serious violence, comprising assault resulting in injury or involving use of a lethal weapon, threat with a lethal weapon in hand, or sexual assault.

The 6-month prevalence of any violence was 19.1%, with 3.6% of participants reporting serious violent behavior.

"Positive" psychotic symptoms, such as persecutory ideation, increased the risk of both minor and serious violence, while "negative" psychotic symptoms, such as social withdrawal, lowered the risk of serious violence.

Serious violence was also associated with depressive symptoms, childhood conduct problems, and victimization.

Minor violence was linked to substance abuse, but in addition to clinical symptoms, Swanson et al also found a correlation between minor violence and interpersonal and social factors. These included being of female gender, residing in restrictive housing, residing with family or relatives, not feeling listened to by family members, and recent history of police contact, as well as functional impairment in the area of leisure activities and social interaction.

"To the extent that violence risk is significantly increased by positive psychotic symptoms, the crucial role of symptom management becomes clear (eg, through effective pharmacotherapy and patient adherence)," say the investigators.

"However, to the extent that risk of violence (particularly minor violence) is increased by other, nonclinical, variables… the clinical lesson is that violence risk management must include a focus on the whole person in the community environment."



Source: Arch Gen Psychiatry 2006; 63: 490–499

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3 May 2006

For young people with the early signs of schizophrenia, treatment with the antipsychotic olanzapine could lower or delay the rate of conversion to full-blown psychosis, researchers report.

They estimate that between four and five people meeting the criteria for prodromal symptoms would need to be treated in order to prevent one conversion to psychosis over a 1-year period.

Thomas McGlashan, from Yale University School of Medicine in New Haven, Connecticut, USA, and colleagues randomly assigned 60 patients showing prodromal signs of psychosis to receive either 5–15 mg/day of olanzapine or placebo for 1 year. The patients were participating in the Prevention Through Risk Identification, Management, and Education project.

During the year of treatment, 37.9% of patients taking placebo experienced a conversion to psychosis, compared with just 16.1% of those treated with olanzapine, reflecting a difference that was close to significance.

The hazard of conversion among placebo-treated patients was about 2.5 times that for patients given olanzapine.

In the follow-up year, after treatment was discontinued, only 17 patients remained in the trial. Among these, five patients converted to psychosis in the second year: three formerly treated with olanzapine and two treated with placebo.

If olanazapine truly prevents the transition to psychosis rather than just delaying it, the researchers would have expected there to be few, if any, conversions in the second year. However, due to the small number of patients, the study was underpowered to establish this.

While the overall difference in conversion to psychosis between the two groups did not reach statistical significance, McGlashan and team report in the American Journal of Psychiatry that the average score for prodromal positive symptoms improved more in the olanzapine-treated group.

However, the olanzapine-treated patients gained more weight than those taking placebo, at an average of 8.79 kg versus 0.30 kg. But there were no blood laboratory values suggestive of diabetes or cardiovascular disease.

The investigators conclude: "The nearly significant difference between treatment groups in the conversion rate points to the possibility that olanzapine might reduce the rate of conversion to psychosis and delay the onset of psychosis."

They add: "We feel that this clinical trial demonstrates that the benefits of pre-onset identification and treatment outweigh the risks to a degree sufficient to endorse future clinical trials… so that definitive recommendations on use of antipsychotics to treat the prodromal phase of schizophrenia can be made."



Source: Am J Psychiatry 2006; 163: 790–799

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3 May 2006

Maintenance antidepressant medication can prevent depression from recurring among patients with diabetes, study findings show.

Clinical depression is present in one of every four patients with Type 1 or Type 2 diabetes and can adversely affect medical prognosis and lessen the quality of life of affected patients, Patrick Lustman (Washington University School of Medicine, St Louis, Missouri, USA) and colleagues note in the Archives of General Psychiatry.

With sertraline maintenance treatment, however, they found that the time that elapsed before one third of patients experienced recurrence was almost four times longer than that for patients given placebo.

For their study, the researchers randomly assigned 152 patients aged an average of 52.8 years, who had recovered from depression using sertraline in an open-label trial, to either continue receiving sertraline or switch to placebo in a double-blind study.

During the 52-week trial, the patients visited a physician every month and were contacted by telephone every 2 weeks to screen for symptoms of depression. If symptoms were detected, they underwent a psychiatric interview. The patient's hemoglobin levels were also measured every 2 months to determine blood glucose control.

After 1 year, the proportion of patients who had not experienced a recurrence of their depression was 65.8% among patients taking sertraline, compared with 47.9% among placebo-treated individuals. This corresponds to six people needing to be treated with sertraline in order to prevent depression recurrence in one patient.

In one-third of patients, the time to recurrence increased from 57 days in patients given placebo to 226 days for patients treated with sertraline.

The researchers also note in the Archives of General Psychiatry that hemoglobin levels decreased in patients during the period of depression recovery and remained low during maintenance treatment as long as the patients were free of depression, with no significant difference between the two groups.

"Our study establishes a clear benefit of sertraline for prevention of depression recurrence in patients with diabetes," Lustman et al write.

"Sertraline lengthened the depression-free interval of maintenance and did not interfere with glycemic improvement achieved during the recovery phase."

They conclude: "Treatment with sertraline is relatively simple, safe, and widely available, and although it is not curative, it offers patients with diabetes a potentially viable method for ameliorating the suffering, incapacity, and burden associated with recurrent depression."



Source: Arch Gen Psychiatry 2006; 63: 521–529

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4 May 2006

Men and women born in the summer months appear to be more likely than those born in winter months to attempt suicide, with the risk higher for women than men, UK study findings show.

Assessing data on suicide for over 29,000 people, Emad Salib (Liverpool University) and Mario Cortina-Borja (University College London) found that being born in April, May, or June carries a 17% increased risk of committing suicide.

The investigators suggest that the trend is likely to be due to environmental exposure to adverse conditions in the womb as a fetus.

"Our results support the hypotheses that there is a seasonal effect in the monthly birth rates of people who kill themselves and that there is a disproportionate excess of such people born between late spring and midsummer compared with the other months," they say.

The finding correlates with previous research that linked being born in spring or early summer to affective disorders and alcohol dependence – conditions that contribute to around one in 10 deaths from suicide in England and Wales. However, it contrasts with findings that link birth in the winter months to increased risk of schizophrenia, a condition that accounts for around one in 20 cases of suicide.

Data collected between 1979 and 2001 for suicides and deaths for undetermined injury for people born between 1955 and 1966 were used for the study. Analysis showed that those born in the spring and early summer were 17% more likely to commit suicide than those born in autumn and early winter. When the data were considered for each gender, the team found the risk was greater among women than among men, at 29.6% and 13.7%, respectively.

In the British Journal of Psychiatry, Salib and Cortina-Borja suggest that the observed link between month of birth and risk of suicide may be due to in utero exposure to factors such as infections, maternal diet, and environmental toxins, which all show seasonal variation. Such exposures could potentially adversely affect tissue functions, predisposing individuals to neurological and psychiatric disorders in adulthood.

"This could act as a latent risk factor that might enhance other suicide risk factors in some predisposed individuals," explain the researchers.

They add: "This assumption gives us some hope that developmental approaches might improve our understanding of the psychopathology of depression and suicidal behavior and could offer new strategies for treatment and prevention."



Source: Br J Psychiatry 2006; 188: 416–422


В общем, коллеги! Надеюсь нашего сообщества это не касается. В самом крайнем случае наш департамент всегда готов помочь.

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10 May 2006

Depression in patients with congestive heart failure (CHF) is not always persistent, says a US researcher who found that minor depression tended to resolve soon after discharge, but that major depression is likely to require treatment.

"Because there are almost no data on the course of depression in inpatients with CHF, we do not know which of the many patients with depression during hospitalization need specific treatment or specialized psychiatric care," notes Harold Koenig, from Duke University Medical Center in Durham, North Carolina.

Over a 24-week period, he followed-up 473 inpatients aged over 50 years who had CHF and depression. Among the participants, 247 had minor depression and 157 had major depression.

In all, 64.0% of patients with minor depression went into remission after an average follow-up of 11.3 weeks, while 47.8% of patients with major depression achieved remission after a follow-up of 20.2 weeks.

Patients with minor depression were more likely to achieve remission sooner if they had less severe depressive symptoms and fewer comorbid medical illnesses, as measured on the Hamilton Depression Rating Scale and the Charlson Comorbidity Index.

Patients with minor depression who were younger, had better physical functioning, and those not treated with antidepressants also tended to go into remission faster.

Thus, remission for patients with CHF and minor depression appears to be related to both the degree of vulnerability and the degree of stress, says Koenig.

For major depression, however, the outcome appeared to be much more affected by intrinsic vulnerability.

Remission in these patients was predicted by less severe depression, being younger, male, and having no history of depression and fewer comorbid disorders. Stress from physical health problems appeared to have less impact on the course of major depression than on minor depression.

Koenig concludes in the Archives of Internal Medicine: "Clinicians should be aware that minor depression is related more to the patient's current medical condition and will resolve soon after discharge in two thirds of cases."

He adds: "For those with major depression, whose depression may be driven more by an inherent vulnerability and less likely to resolve soon after hospital discharge, consideration should be given to treatment.

"If patients are already receiving treatment and symptoms remain severe, then immediate psychiatric consultation is indicated."



Source: Arch Intern Med 2006; 166: 991-996

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17 May 2006

Body–oriented psychological therapy (BPT) may be effective for the treatment of persistent negative symptoms in patients with schizophrenia, exploratory trial data show.

"The approach of body-oriented interventions is based on phenomenological findings and the assumption that movement and emotional experiences are biologically and experientially associated," note Frank Röhricht (Newham Centre for Mental Health, London, UK) and Stefan Priebe (Barts and The London Queen Mary's School of Medicine and Dentistry, UK).

"This is supported by close anatomical and functional links between the limbic system, particularly the extended amygdala, and the basal ganglia."

The researchers investigated the potential for such therapy to reduce negative symptoms in 24 outpatients with schizophrenia. To control for the influence of non-specific attention and structured group activities, BPT was compared with supportive counseling, which was received by 21 schizophrenia patients.

The aims of BPT were to overcome communication barriers through non-verbal techniques; refocus cognitive and emotional awareness towards the body; stimulate activity and emotional responsiveness; promote exploration of self-potentials, focusing on body strength and capability; modify dysfunctional self-perception; and address common psychopathological features.

Each participant received 20 sessions of therapy in addition to treatment as usual.

Patients undergoing BPT attended more sessions than those assigned to supportive counseling, and had significantly lower negative symptoms scores on the Positive and Negative Symptom scale at the end of the trial.

Indeed, 50% of patients receiving BPT achieved a 20% or greater reduction in negative symptoms from baseline, compared with just 21% of those receiving supportive counseling.

"The findings did not suggest an influence of potentially confounding factors, ie, antipsychotic medication, extrapyramidal symptoms, improvement of positive symptoms, on the different treatment effect in the two groups," the investigators report in the journal Psychological Medicine.

Patients' assessment of treatment was broadly positive and their rating of the therapeutic relationship generally appreciative, with no significant differences between the two treatments.

"BPT was accepted by patients and associated with a favorable effect," Röhricht and co-workers comment. "The effect size was substantial and at least as high as those reported in the literature for antipsychotic medication and cognitive-behavioral therapy."

The team says further detailed studies to explore the therapeutic mechanisms involved in BPT are warranted.



Source: Psychol Med 2006; 36: 669–678

©2006 Current Medicine Group Ltd

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19 May 2006

Obese women with binge-eating disorder (BED) are already at increased risk of suffering from comorbid psychopathology, including anxiety and depression, but smoking could increase this risk further, US investigators report.

"These patients may have a deficit in coping strategies, making them more prone to using substances and/or food to regulate emotion," Marney White and Carlos Grilo, from Yale University School of Medicine in New Haven, Connecticut, comment.

The researchers explored whether obese women with BED who had smoked at some point in their lifetime differed from their nonsmoking counterparts in lifetime rates of comorbid psychopathology.

A total of 103 obese treatment-seeking women with a current DSM-IV diagnosis of BED participated in the study and were asked to complete diagnostic interviews to assess all Axis I psychiatric disorders.

Fifty-two of the women had never smoked, 45 were former smokers, and six were current smokers.

For the group as a whole, 68.9% met the criteria for at least one additional lifetime psychiatric disorder, of which mood disorders (53.4%), anxiety disorders (36.9%), and substance use disorders (13.6%) were the most common.

Comparing daily smokers with never smokers, the researchers found that the presence of any Axis I psychiatric disorder was more common in daily smokers, at 81.4%, compared with 57.7% for non-smokers.

Specifically, smokers were significantly more likely than non-smokers to meet the criteria for co-occurring diagnoses of major depressive disorder (62.8% vs 40.4%), panic disorder (27.9% vs 7.7%), post-traumatic stress disorder (11.6% vs 1.9%), and substance abuse or dependence (16.3% vs 1.9%).

Recognizing that the presence of substance use dependence may have confounded the results, the team compared the groups after removing individuals with lifetime substance use dependence from the analysis.

"Although attenuated, the results showed a pattern of increased lifetime risk of anxiety disorders among lifetime smokers," White and Grilo report in the Journal of Clinical Psychiatry.

They conclude: "The results of this study indicate that women with BED and a history of smoking may be especially distressed, with higher rates of comorbid lifetime psychiatric diagnosis."

The researchers add: "There is a great need for treatments to address multiple impulse control behaviors as clinicians and patients struggle with important unanswered questions around treatment formulation and planning."



Source: J Clin Psychiatry 2006; 67: 594–599

©2006 Current Medicine Group Ltd

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23 May 2006

Research presented at the 159th Annual Meeting of the American Psychiatric Association in Toronto, Canada, has revealed five predictors for bipolar disorder risk that could aid diagnosis of the condition.

The five factors were anxiety, feelings of people being unfriendly, family history of bipolar disorder, a recent diagnosis of depression, and legal problems.

In all, 43% of patients who reporting having any three of the risk factors also screened positive for bipolar disorder on the Mood disorder Questionnaire (MDQ).

"Bipolar disorder may be difficult for both patients and doctors to identify because the symptoms are often confused with major depression," said Joseph Calabrese, from Case Western Reserve University in Cleveland, Ohio, USA.

"Given the difficulty of diagnosing bipolar disorder, the five predictors identified in this study may help physicians better assess a patient's risk for bipolar disorder, which could lead to more effective treatment."

For the current study, the investigators selected patients attending community and private practice clinics who were unsuccessfully treated with antidepressants. Self-reported information was collected for the participants using the Epidemiologic Studies Depression (CES-D) scale and the patients were screened for bipolar disorder with the MDQ.

Among the 602 patients enrolled in the study, 18.6% screened positive for bipolar disorder on the MDQ. The researchers identified five key variables that they found were associated with bipolar risk: the CES-D item "people were unfriendly" (p<0.001), comorbid anxiety (p<0.002), depression diagnosis within 5 years (p<0.001), family history of bipolar disorder (p<0.010), and legal problems (p<0.026).

For the 41 patients with none of the five risk factors, 2.4% screened positive for bipolar disorder on the MDQ. Among the 103 patients reporting that "people were unfriendly," 31.1% screened positive for bipolar disorder.

The presence of this factor in addition to comorbid anxiety increased the rate of screening positive for bipolar disorder to 35.4%, with the addition of a recent diagnosis of depression onset increasing the likelihood of a positive screen for bipolar disorder to 41.2%. The combination of feeling people were unfriendly and a family history of bipolar disorder was associated with a 75% rate of screening positive for bipolar disorder on the MDQ.

All patients who reported the presence of all five factors screened positive for bipolar disorder on the MDQ, as did 43% of patients who had any three factors.

The researchers conclude that the five factors may prove useful indicators of bipolar disorder risk among patients with major depression from whom antidepressant treatment has failed.



Source: 159th Annual Meeting of the American Psychiatric Association; Toronto, Canada; 20–25 May 2006