A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression

Background Patients with chronic forms of major depression are difficult to treat, and the relative efficacy of medications and psychotherapy is uncertain. Methods We randomly assigned 681 adults with a chronic nonpsychotic major depressive disorder to 12 weeks of outpatient treatment with nefazodone (maximal dose, 600 mg per day), the cognitive behavioral-analysis system of psychotherapy (16 to 20 sessions), or both. At base line, all patients had scores of at least 20 on the 24-item Hamilton Rating Scale for Depression (indicating clinically significant depression). Remission was defined as a score of 8 or less at weeks 10 and 12. For patients who did not have remission, a satisfactory response was defined as a reduction in the score by at least 50 percent from base line and a score of 15 or less. Raters were unaware of the patients’ treatment assignments. Results Of the 681 patients, 662 attended at least one treatment session and were included in the analysis of response. The overall rate of response (both remission and satisfactory response) was 48 percent in both the nefazodone group and the psychotherapy group, as compared with 73 percent in the combined-treatment group (P Conclusions Although about half of patients with chronic forms of major depression have a response to short-term treatment with either nefazodone or a cognitive behavioral-analysis system of psychotherapy, the combination of the two is significantly more efficacious than either treatment alone

A review of the changing culture and social context relating to forensic facial depiction of the dead

The recognition of a decedent by a family member is commonplace in forensic investigation and is often employed as identity confirmation. However, it is recognised that misidentification from facial recognition is also common and faces of the dead may be extremely difficult to recognise due to decomposition or external damage, and even immediate post-mortem changes may be significant enough to confuse an observer. The depiction of faces of the dead can be a useful tool for promoting recognition leading to identification and post-mortem facial depiction is described as the interpretation of human remains in order to suggest the living appearance of an individual. This paper provides an historical context relating to the changing view of society to the presentation and publication of post-mortem facial depictions and discusses the current ethical, practical and academic challenges associated with these images

Meta-cognitive beliefs about worry and pain catastrophising as mediators between neuroticism and pain behaviour

© 2015 The Australian Psychological SocietyBackground: The present study explored the relationship between neuroticism, meta-cognitive beliefs about worry, pain catastrophising, and pain behaviour. Methods: A non-clinical convenience sample of 308 participants completed the following four measures in this cross-sectional study: Neo Five-Factor Inventory, Meta-Cognitions Questionnaire 30, Pain Catastrophising Scale, and the Pain Behaviour Checklist. Results: A multiple-step multiple mediator analysis was employed to test a model in which (1) positive meta-cognitive beliefs about worry would mediate the relationship between neuroticism and pain catastrophising and (2) negative meta-cognitive beliefs about worry would mediate the relationship between pain catastrophising and self-reported pain behaviour. We also hypothesised that the combined effects of meta-cognitive beliefs about worry and pain catastrophising on self-reported pain behaviour would be independent of neuroticism. Results supported the proposed structure with pain catastrophising and meta-cognitive beliefs about worry mediating fully the effect of neuroticism on self-reported pain behaviour. Conclusions: These findings identify, for the first time in the literature, a link between meta-cognitive beliefs about worry and both self-reported pain behaviour and pain catastrophising. The implications of these findings are discussed. This is an electronic version of an article published in Spada, MM and Gay, H and Nikčevic, AV and Fernie, BA and Caselli, G (2016) Meta-cognitive beliefs about worry and pain catastrophising as mediators between neuroticism and pain behaviour. Clinical Psychologist, 20 (3). pp. 138-146. DOI 10.1111/cp.1208

Using fMRI connectivity to define a treatment-resistant form of post-traumatic stress disorder.

A mechanistic understanding of the pathology of psychiatric disorders has been hampered by extensive heterogeneity in biology, symptoms, and behavior within diagnostic categories that are defined subjectively. We investigated whether leveraging individual differences in information-processing impairments in patients with post-traumatic stress disorder (PTSD) could reveal phenotypes within the disorder. We found that a subgroup of patients with PTSD from two independent cohorts displayed both aberrant functional connectivity within the ventral attention network (VAN) as revealed by functional magnetic resonance imaging (fMRI) neuroimaging and impaired verbal memory on a word list learning task. This combined phenotype was not associated with differences in symptoms or comorbidities, but nonetheless could be used to predict a poor response to psychotherapy, the best-validated treatment for PTSD. Using concurrent focal noninvasive transcranial magnetic stimulation and electroencephalography, we then identified alterations in neural signal flow in the VAN that were evoked by direct stimulation of that network. These alterations were associated with individual differences in functional fMRI connectivity within the VAN. Our findings define specific neurobiological mechanisms in a subgroup of patients with PTSD that could contribute to the poor response to psychotherapy.PEV was supported by the Medical Research Council (grant no. MR/K020706/1) and is a Fellow of MQ: Transforming Mental Health (MQF17_24)

Binge eating among the obese: A descriptive study

Nineteen obese females applying for treatment for binge eating were administered a semistructured interview assessing the presence or absence of food restrictions, thoughts, feelings and physical sensations associated with binges, typical precipitants to binges, and factors identified as useful in avoiding binge eating. Both negative mood and abstinence violations emerged as important precipitants. The results also suggested that these precipitants constitute separate, independent pathways to binge eating. Implications of these findings with respect to restraint theory are discussed

The emotional eating scale: The development of a measure to assess coping with negative affect by eating

The development of the Emotional Eating Scale (EES) is described. The factor solution replicated the scale's construction, revealing Anger/Frustration, Anxiety, and Depression subscales. All three subscales correlated highly with measures of binge eating, providing evidence of construct validity. None of the EES subscales correlated significantly with general measures of psychopathology. With few exceptions, changes in EES subscales correlated with treatment‐related changes in binge eating. In support of the measure's discriminant efficiency, when compared with obese binge eaters, subscale scores of a sample of anxiety‐disordered patients were significantly lower. Lack of correlation between a measure of cognitive restraint and EES subscales suggests that emotional eating may precipitate binge episodes among the obese independent of the level of restraint. The 25‐item scale is presented in an Appendix (Arnow, B., Kenardy, J., & Agras, W.S.: International Journal of Eating Disorders, 17, 00‐00, 1995). © 1995 by John Wiley & Sons, Inc

The aversiveness of specific emotional states associated with binge-eating in obese subjects

Objective: The aim of this study was to examine the hypothesis that non-purge-related binge-eating in obesity is maintained by a 'trade-off' in which a highly aversive emotional state is exchanged for a less aversive state. Method: Ninety-eight obese binge-eaters meeting the DSM-IV criteria for binge-eating disorder [1] were contrasted with 65 non-binge-eating controls on their perceived distress associated with negative mood states usually experienced before and after binges. Results: Binge-eaters reported significantly greater distress and lower tolerance of negative mood compared to controls. Furthermore, when compared with controls, binge-eaters reported that emotions typically reported before binges (e.g. anger) were more aversive than those reported after (e.g. guilt). Conclusions: These results were interpreted as supporting the 'trade-off' theory and have implications for the treatment of binge-eating disorder