Changing negative core beliefs with trial-based thought record

Background Trial-based thought record (TBTR) is a technique used in trial-based cognitive therapy (TBCT), and simulates a court trial. It was designed to restructure unhelpful core beliefs (CBs) during psychotherapy. Objective To confirm previous findings on the efficacy of TBTR in decreasing patients’ adherence to self-critical and unhelpful CBs and corresponding emotions, as well as assessing the differential efficacy of the empty-chair approach relative to the static format of TBTR. Methods Thirty-nine outpatients were submitted to a 50-minute, one-session, application of the TBTR technique in the empty-chair (n = 18) or conventional (n = 21) formats. Patients’ adherence to unhelpful CBs and the intensity of corresponding emotions were assessed after each step of TBTR, and the results obtained in each format were compared. Results Significant reductions in percent values both in the credit given to CBs and in the intensity of corresponding emotions were observed at the end of the session (p < .001), relative to baseline values. ANCOVA also showed a significant difference in favor of the empty-chair format for both belief credit and emotion intensity (p = .04). Discussion TBTR may help patients reduce adherence to unhelpful CBs and corresponding emotions and the empty-chair format seems to be more efficacious than the conventional format

Comorbidade de sintomas ansiosos e depressivos em pacientes com dor crônica e o impacto sobre a qualidade de vida

BACKGROUND: Pain is an unpleasant sensory and emotional experience. Both chronic pain and depression result in substantial disability reduced HRQoL and increased health care costs and utilization. OBJECTIVES: To evaluate the strength of the association between depressive and anxiety symptoms and chronic pain, and to investigate the impact of these symptoms on health-related quality of life (HRQoL) in chronic pain individuals. METHODS: Pain was assessed by means of a Visual Analogue Scale (VAS). Depressive and anxiety symptoms were assessed by the Hospital Anxiety and Depression (HAD) scale. Quality of life was assessed by means of the SF-36. RESULTS: Four hundred patients were studied, mean age 45.6 ± 11.4 years and 82.8% female gender. According to HAD, 70% had anxiety and 60% depression symptoms. SF-36 showed mean scores < 50% for all the domains. Patients with severe pain/extreme (70.4%) had a higher frequency of anxiety than those with pain selvagem/moderada (59,5%). This was a statistically significant (p = 0.027). However, the frequency of depression did not reach statistical significance when both groups were compared p = 0.109). DISCUSSION: Depressive/anxiety symptoms and pain together have worse clinical outcomes than each condition alone.CONTEXTO: Dor é uma experiência emocional e sensorial desagradável. Tanto a dor crônica como a depressão reduzem de forma significativa a qualidade de vida, além de aumentar muito os custos dos cuidados com a saúde. OBJETIVOS: Analisar a associação entre sintomas depressivos e de ansiedade em relação à dor crônica e investigar o impacto desses sintomas na saúde e na qualidade de vida em indivíduos com dor crônica. MÉTODOS: A dor foi avaliada por meio de uma Escala Analógica Visual (VAS). Os sintomas depressivos e a ansiedade foram avaliados pela Escala Hospitalar de Ansiedade e Depressão (HAD). A qualidade de vida foi avaliada por meio do SF-36. RESULTADOS: Quatrocentos pacientes foram estudados, com idade média de 45,6 ± 11,4 anos e 82,8% são do sexo feminino. De acordo com a HAD, 70% tinham ansiedade e 60%, os sintomas de depressão. A SF-36 apresentou escores < 50% para todos os domínios. Os pacientes com dor intensa/ extrema apresentaram maior frequência (70,4%) de ansiedade do que aqueles com dor selvagem/moderada (59,5%). Essa foi uma associação estatisticamente significante (p = 0,027). No entanto, a frequência de depressão não atingiu significância estatística quando ambos os grupos foram comparados (p = 0,109). CONCLUSÃO: Os sintomas depressivos/ansiedade e dor, em conjunto, apresentaram piores desfechos clínicos de cada estado sozinho. É necessária mais investigação para determinar se o tratamento da dor ajuda os sintomas dos pacientes depressivos e se o alívio dos sintomas depressivos melhora a dor e sua morbidade

Can antidepressants prevent interferon-alpha-induced depression? A review of the literature

Objective: To review the literature about the efficacy of antidepressant prophylaxis during interferon-alpha (IFN-alpha) therapy.Method: We have performed a database search in PUBMED and ISI Web of Knowledge (1980-August 2009) for the available literature. the keywords prevention or prophylaxis, and depression, and interferon, and antidepressant or antidepressive agents were used.Results: the six eligible studies comprise three randomized controlled trials, two in hepatitis C virus (HCV) patients and one in individuals with melanoma, and three open-label studies with HCV patients. the results of the randomized controlled trials suggest that antidepressant prophylaxis may blunt the magnitude of depressive symptoms in HCV patients and raise the rates of treatment completion. in melanoma patients, this preventive strategy may reduce the incidence of depression during IFN-alpha treatment. in addition, the open-label studies with HCV patients suggest that this strategy may reduce the onset of major depression in specific samples (current psychiatric diagnosis, major depression in remission, past history of IFN-alpha-induced depression) on IFN-alpha (re-)treatment.Conclusions: in the face of so few trials about the usefulness of prophylaxis with antidepressants before IFN-alpha treatment, there is not enough information to sufficiently and widely support this strategy to prevent depression. However, this approach may, nonetheless, bring some beneficial outcomes, if applied to specific patient groups. (C) 2010 Elsevier Inc. All rights reserved.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Univ Fed Bahia, Teaching Hosp, Psychiat Serv, BR-40110909 Salvador, BA, BrazilUniversidade Federal de São Paulo, Dept Psychiat, BR-04026001 São Paulo, BrazilLab Interdisciplinar Neurociencias Clin LiNC, BR-04026001 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychobiol, BR-04023062 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychiat, BR-04026001 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychobiol, BR-04023062 São Paulo, BrazilCNPq: 142262/2008-0Web of Scienc

High frequency of unrecognized mental disorders in HCV-infected patients

Objective: This study indexed the frequency of psychiatric disorders among hepatitis C virus (HCV)-infected patients.Method: HCV-infected patients treated at a university hospital in the northeastern region of Brazil were evaluated in a cross-sectional study using the Mini International Neuropsychiatric Interview.Results: Ninety HCV-infected outpatients were included in the study and 44 (49%) had at least one psychiatric diagnosis. Among the 26 patients (59.1%) with a current psychiatric morbidity, 22 (84.6%) had gone undiagnosed.Conclusions: HCV-infected patients have a high frequency of unrecognized psychiatric comorbidity. (c) 2008 Elsevier Inc. All rights reserved.Univ Fed Bahia, Univ Hosp, Fac Med, BR-41170290 Salvador, BA, BrazilUniversidade Federal de São Paulo, LiNC, São Paulo, BrazilUniversidade Federal de São Paulo, LiNC, São Paulo, BrazilWeb of Scienc