Psychological and Brain Connectivity Changes Following Trauma-Focused CBT and EMDR Treatment in Single-Episode PTSD Patients

Among the different therapeutic alternatives for post-traumatic stress disorder (PTSD), Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) and Eye Movement Desensitization and Reprocessing (EMDR) Therapy have shown promising results in helping patients cope with PTSD symptoms. However, given the different theoretical and methodological substrate of TF-CBT and EMDR, a potentially different impact on the brain for the two interventions could be hypothesized, as well as an interaction between trauma-specific PTSD symptomatology and response to a given psychotherapy. In this study, we monitored psychological and spontaneous functional connectivity fMRI patterns in two groups of PTSD patients who suffered by the same traumatic event (i.e., natural disaster), before and after a cycle of psychotherapy sessions based on TF-CBT and EMDR. Thirty-seven (37) PTSD patients were enrolled from a larger sample of people exposed to a single, acute psychological stress (i.e., 2002 earthquake in San Giuliano di Puglia, Italy). Patients were randomly assigned to TF-CBT (n = 14) or EMDR (n = 17) psychotherapy. Clinical assessment was performed using the Clinician-Administered PTSD Scale (CAPS), the Davidson Trauma Scale (DTS) and the Work and Social Adjustment Scale (WSAS), both at baseline and after treatment. All patients underwent a fMRI data acquisition session before and after treatment, aimed at characterizing their functional connectivity (FC) profile at rest, as well as potential connectivity changes associated with the clinical impact of psychotherapy. Both EMDR and TF-CBT induced statistically significant changes in clinical scores, with no difference in the clinical impact of the two treatments. Specific changes in FC correlated with the improvement at the different clinical scores, and differently for EMDR and TF-CBT. However, a similarity in the connectivity changes associated with changes in CAPS in both groups was also observed. Specifically, changes at CAPS in the entire sample correlated with an (i) increase in connectivity between the bilateral superior medial frontal gyrus and right temporal pole, and a (ii) decrease in connectivity between left cuneus and left temporal pole. Results point to a similar, beneficial psychological impact of EMDR and TF-CBT for treatment of natural-disaster PTSD patients. Neuroimaging data suggest a similar neurophysiological substrate for clinical improvement following EMDR and TF-CBT, involving changes affecting bilateral temporal pole connectivity

Light therapy as a treatment for sexual dysfunctions -beyond a pilot study

Summary Aim. Seasonal trends were demonstrated in reproduction and sexual activity. Through the secretion of melatonin the pineal gland plays an important role, in the neuroendocrine control of sexual function and reproductive physiology. We hypothesized that inhibition of the pineal gland activity through a light treatment may favorably affect sexual function. Method. We recruited 24 subjects with a diagnosis of hypoactive sexual desire disorder and / or primary sexual arousal disorder. The subjects were randomly assigned to either active light treatment (ALT) or placebo light treatment (L-PBO). Participants were assessed during the first evaluation and after 2 weeks of treatment, using the Structured Clinical Interview for Sexual Disorders DSM-IV (SCID-S) and a self-administered rating scale of the level of sexual satisfaction (1 to 10). Repeated measures ANOVA were performed to compare the two groups of patients. Post-hoc analysis was performed by Holm-Sidak test for repeated comparisons. Results. At baseline the two groups were comparable. After 2 weeks the group treated with Light Therapy showed a significant improvement in sexual satisfaction, about 3 times higher than the group that received placebo, while no significant improvement was observed in the group L-PBO. Conclusions. Our results confirm a potentially beneficial effect of Light Therapy on primary sexual dysfunction. In the future, we propose to correlate clinical findings with testosterone levels pre / post treatment

International multi-site survey on the use of online support groups in bipolar disorder

Background: Peer support is an established component of recovery from bipolar disorder, and online support groups may offer opportunities to expand the use of peer support at the patient’s convenience. Prior research in bipolar disorder has reported value from online support groups. Aims: To understand the use of online support groups by patients with bipolar disorder as part of a larger project about information seeking. Methods: The results are based on a one-time, paper-based anonymous survey about information seeking by patients with bipolar disorder, which was translated into 12 languages. The survey was completed between March 2014 and January 2016 and included questions on the use of online support groups. All patients were diagnosed by a psychiatrist. Analysis included descriptive statistics and general estimating equations to account for correlated data. Results and conclusions: The survey was completed by 1222 patients in 17 countries. The patients used the Internet at a percentage similar to the general public. Of the Internet users who looked online for information about bipolar disorder, only 21.0% read or participated in support groups, chats, or forums for bipolar disorder (12.8% of the total sample). Given the benefits reported in prior research, clarification of the role of online support groups in bipolar disorder is needed. With only a minority of patients using online support groups, there are analytical challenges for future studies

Internet use by patients with bipolar disorder:results from an international multisite survey

There is considerable international interest in online education of patients with bipolar disorder, yet little understanding of how patients use the Internet and other sources to seek information. 1171 patients with bipolar disorder diagnosis in 17 countries completed a paper-based, anonymous survey. 81% of the patients used the Internet, a percentage similar to the general public. Older age, less education, and challenges in country telecommunications infrastructure and demographics decreased the odds of using the Internet. About 78% of the Internet users looked online for information on bipolar disorder or 63% of the total sample. More years of education in relation to the country mean, and feeling very confident about managing life decreased the odds of seeking information on bipolar disorder online, while having attended support groups increased the odds. Patients who looked online for information on bipolar disorder consulted medical professionals plus a mean of 2.3 other information sources such as books, physician handouts, and others with bipolar disorder. Patients not using the Internet consulted medical professionals plus a mean of 1.6 other information sources. The percentage of patients with bipolar disorder who use the Internet is about the same as the general public. Other information sources remain important

La depressione unipolare e il suo trattamento. Alla ricerca di una remissione completa [Treating major depressive disorder to remission. Looking for a complete remission]

Objectives: This paper reports the epidemiological and clinical characteristics of depression and evaluates the differences among the various available treatments, pointing to the need to achieve a complete remission. Methods: We reviewed the literature about epidemiology, impact and treatment of depression, as well as about the prevention of residual symptoms. Results: Conventional meta-analyses have shown inconsistent results in terms of efficacy and tolerability differences among antidepressants and this makes it difficult to inform treatment choice. Nonetheless it seems clear that the likelihood to respond to a given medication is influenced by the specific symptoms that each patient presents with. For instance, antidepressants that enhance noradrenergic and dopaminergic activity may afford a therapeutic advantage over serotonergic antidepressants in the treatment of symptoms associated with a reduction in positive affect, such as loss of pleasure, loss of interest, fatigue and loss of energy. Conclusions: There are not univocal criteria to inform the clinician on which specific treatment should be prescribed to a specific patient and clinical remission. There are, however preliminary indications that may help with our treatment choice, based on the close observation of all the symptoms contributing to the heterogeneous depressive picture that each patient presents with, with the ultimate goal to achieve a complete remission

Utilizzi clinici delle benzodiazepine Focus on: Benzodiazepine e disturbi d'ansia [Clinical uses of benzodiazepines. Focus on: benzodiazepines and anxiety disorders]

Benzodiazepines (BDZs) are usually safe and well-tolerated medications, which may be effectively prescribed in Anxiety Disorders and several other conditions requiring an anxiolytic and hypnotic therapeutic effect. Most often, BDZs should be considered as a complementary, rather than alternative, treatment to antidepressants such as SSRIs and SNRIs or to psychotherapies. Nonetheless, BDZs my be very useful tools both in the acute treatment phase, due to their ability to control anxious symptoms before the antidepressants start working, and in the continuation-maintenance treatment phase, as augmenting agents. BDZ have proven very effective in panic disorder, generalized anxiety and, even if to a lower degree, in social phobia. BDZ role in obsessive compulsive disorder and post traumatic stress disorder is not as strong but these medications may be useful for several patients with those diseases. BDZ are not devoid of side effects and risks such as tolerance and dependence. However, those risks may be reduced when BDZ are not used at high doses for long periods of time, when the choice of the specific compound is driven by an accurate evaluation of the specific pharmacokinetic properties and when patients at high risk of dependence are not prescribed these compounds, especially at high doses and for long periods of time. Copyright © 2013 by Pacini Editore S.p.A