Components of smartphone cognitive-behavioural therapy for subthreshold depression among 1093 university students: a factorial trial

BACKGROUND: Internet-based cognitive-behavioural therapy (iCBT) is effective for subthreshold depression. However, which skills provided in iCBT packages are more effective than others is unclear. Such knowledge can inform construction of more effective and efficient iCBT programmes. OBJECTIVE: To examine the efficacy of five components of iCBT for subthreshold depression. METHODS: We conducted an factorial trial using a smartphone app, randomly allocating presence or absence of five iCBT skills including self-monitoring, behavioural activation (BA), cognitive restructuring (CR), assertiveness training (AT) and problem-solving. Participants were university students with subthreshold depression. The primary outcome was the change on the Patient Health Questionnaire-9 (PHQ-9) from baseline to week 8. Secondary outcomes included changes in CBT skills. FINDINGS: We randomised a total of 1093 participants. In all groups, participants had a significant PHQ-9 reduction from baseline to week 8. Depression reduction was not significantly different between presence or absence of any component, with corresponding standardised mean differences (negative values indicate specific efficacy in favour of the component) ranging between -0.04 (95% CI -0.16 to 0.08) for BA and 0.06 (95% CI -0.06 to 0.18) for AT. Specific CBT skill improvements were noted for CR and AT but not for the others. CONCLUSIONS: There was significant reduction in depression for all participants regardless of the presence and absence of the examined iCBT components. CLINICAL IMPLICATION: We cannot yet make evidence-based recommendations for specific iCBT components. We suggest that future iCBT optimisation research should scrutinise the amount and structure of components to examine. TRIAL REGISTRATION NUMBER: UMINCTR-000031307

Naltrexone, but not atropine or yohimbine, antagonizes suppression of formalin-induced spinal sensitization by intrathecal nociceptin

We investigated the effects of spinal nociceptin on formalin-induced spinal sensitization and examined the role of the opioidergic, alpha 2-adrenergic and muscarinic cholinergic receptors in the nociceptin-produced suppression of spinal sensitization. The results demonstrated that spinal nociceptin suppressed the formalin-induced spinal sensitization in a dose-dependent manner (1, 5 and 10 nmol). The inhibitory effect of 10 nmol of nociceptin on spinal sensitization, was readily antagonized by naltrexone, but not by atropine or yohimbine. Each of the antagonists, naltrexone, atropine or yohimbine, alone had no effect on the formalin-induced spinal sensitization. Our results show that spinal nociceptin elicits dose-dependent, naltrexone-reversible suppression of spinal sensitization evoked by injection of formalin

Sevoflurane suppresses behavioral response in the rat formalin test: combination with intrathecal lidocaine produced profound suppression of the response

We investigated the effects of intrathecal (i.t.) lidocaine, inhalation sevoflurane, and a combination of i.t. lidocaine and sevoflurane on the formalin test in rats. Group 1 (control) received i.t. saline 10 μl. Groups 2 and 3 received i.t. lidocaine 200 μg and 400 μg, respectively. Groups 4–6 received 1.2%, 2.4% and 3.6% sevoflurane, respectively. Interaction of drugs was analyzed using a dose addition model. Group 7 received i.t. lidocaine 200 μg and 1.2% sevoflurane. The biphasic behavioral activity of the hindpaw of rats was observed. This study showed that i.t. lidocaine or inhalation sevoflurane before formalin injection, significantly suppressed the behavioral activity of the hindpaw of rats, and that this suppression was significantly potentiated by the co-administration of i.t. lidocaine and inhalation sevoflurane

三叉神経痛に対する葛根湯の投与経験

出版社

長時間手術症例における肝機能と麻酔薬の関連

出版社版麻酔時間が18時間以上の長時間に及んだ31症例を取り上げ,麻酔方法とMAC-hoursを指標として術前から術3週間後の肝機能の変化を比較検討した.GOT, GPT, LDHを肝機能の指標として検討したところ,全例で肝機能異常が指摘された.麻酔方法,MAC-hours,反復麻酔の有無と肝機能異常の程度に関連はなかった.麻酔薬が直接肝臓に障害を及ぼすよりも他の要素の方が影響が大きいと考え

Engelmann病の麻酔経験

18歳女で,下肢痛の原因検索の為に左脛骨骨髄圧測定,筋生検を予定した.前投薬にはアトロピンを用い,腰部硬膜外腔にカテーテルを挿入し,始めの骨穿刺,脛骨骨髄圧測定では穿刺部位への1%リドカインの局所注入で対処した.起立前後の筋肉内圧も測定した.1時間の測定後,硬膜外腔に2%メピバカイン10 mlを注入し,効果発現確認後,サイアミラル5 mg/kg,サクシニルコリン1 mg/kgを静注し,喉頭展開を行ったが,声門の確認は容易であった.ラリンゲルマスクを挿入し,自発呼吸下で酸素-笑気-エンフルレンで維持した.術中は血圧変動も少なく,覚醒,抜管も良好であった.術後は特に合併症もなく,現在歩行訓練中であ

意識障害時と全身麻酔下における瞳孔径の変化

出版社版エピネフリン点眼前後の瞳孔径を比較し,自律神経の活動性を類推できるか否かを検討した.意識障害患者82名で点眼前後に瞳孔径を測定した.Japan Coma Scaleの桁数で群分類を行った.コントロール群は30名とした.点眼前には1桁群と2桁群の間で差がみられた.点眼後ではコントロール群で大きさ,点眼前後の径差とも小さかった.次いで全身麻酔下患者20名で瞳孔径を測定した.患者を亜酸化窒素-酸素-エンフルラン(GOE)群,亜酸化窒素-酸素-エンフルラン-硬膜外(GOE-Epi)群,亜酸化窒素-酸素-NLA-硬膜外(GONLA-Epi)群に分類した.GOE群とGOE-Epi群では点眼直前と最大散瞳時で,またGONLA-Epi群では入室前と最大散瞳時で瞳孔径が異なってい

炭酸ガスボンベを利用した急速輸血時のバッグ加減圧装置

出版社

胆石症手術後に心内膜下虚血を呈した1症例

雑誌掲載