New, but improved? Comparison between first and revised version of the Helping Alliance questionnaire

There is a consensus in the psychotherapy research field to consider the therapeutic alliance, broadly defined as the mutual collaboration between the therapist and the patient, as a robust and consistent predictor of therapy outcome. There is little agreement, however, on the best way to operationalise and measure it. Several instruments are available, each of them displaying some unique features so that investigators have problems to choose among them on the basis of considerations other than ease of administration, continuity with previous research or availability. One of the early self-report measures and widely used instruments was the Helping Alliance questionnaire (HAq-I) (Alexander and Luborsky, 1986). In recent years, we have become aware that it was limited by the presence of items that were explicitly assessing early symptomatic improvement and by the fact that all the items were worded positively. A revised version (HAq-II) was developed (Luborsky et al., 1996), guided by two main goals: (1) to reduce the inclination of the scale toward measuring early symptomatic improvement and thus confusing these two dimensions, and (2) to better incorporate the various aspects of the alliance related to the collaborative effort of patient and therapist. The new instrument includes 5 from the 11 items of the HAq-I and 14 new items - 5 of them worded negatively. The aim of the study is twofold: to validate the French version of the new HAq-II and to investigate empirically to what extent the HAq-II has improved over the HAq-I. The sample included 60 self-referred outpatients assigned to a Brief Psychodynamic Investigation (BPI), a manual-based investigation procedure in four sessions guided by psychodynamic principles. We looked at the correlation between the two HAq (I and II) and the Working Alliance Inventory (WAI), patient pretreatment characteristics (SCL-90, HDRS, HAMA, IIP) and outcome (SCL-90, SAS and patient satisfaction). Results showed that the French version of the HAq-II has good psychometric properties. Estimates of internal consistency and test-retest reliability were fairly similar to the original English version. Indication of its validity included high correlation with other alliance measures and independence from patient pretreatment characteristics. Surprisingly, HAq-II score predicted patient's satisfaction with the treatment but not symptomatic improvement. Taken together, these first results are promising and indicate that the translated version of the HAq-II is a valid instrument for measuring the helping alliance. Concerning the comparison between the two versions of the HAq, HAq-II has proved to be an improvement compared to the original HAq-I scale: it better relates to the alliance construct and it is less influenced by the symptoms of the patient. Considering also its better construct validity (Luborsky et al., 1996), we definitely recommend the use of the revised HAq-II instead of the initial version of the scale. (PsycINFO Database Record (c) 2006 APA, all rights reserved

Swiss Psychiatrists Beliefs and Attitudes about Cannabis Risks in Psychiatric Patients: Ideologically Determined or Evidence-based?

The objective of this survey was to assess the beliefs of Swiss psychiatrists about the risks associated with cannabis, and to assess their prohibitive attitudes toward their patients. Eighty-two doctors agreed to fill-up the questionnaire. Cluster analysis retained a 3-cluster solution. Cluster 1: "Prohibitionists” believed that cannabis could induce and trigger all forms of psychiatric disorder, and showed a highly prohibitive attitude. Cluster 2: "Causalists” believed that schizophrenia, but not other psychiatric disorders, could be induced and triggered. Cluster 3: "Prudent liberals” did not believe that psychiatric disorders could be induced by cannabis, and were generally less prohibitiv

Simultaneous determination of melatonin and 6-hydroxymelatonin in human overnight urine by LC-MS/MS.

For the quantification of the pineal hormone melatonin and its metabolite, 6-hydroxymelatonin, in human overnight urine, a single accurate method by liquid chromatography-tandem mass spectrometry (LC-MS/MS) has been developed. Urine samples were deconjugated using β-glucuronidase/arylsulfatase from Helix pomatia before solid phase extraction (SPE) purification. Chromatographic separation was performed using a reverse phase C18 column with a 7-minute gradient elution. Water was used as matrix to prepare the calibration standards, and deuterated analogues of melatonin and 6-hydroxymelatonin were used as internal standards. This newly developed method was validated in terms of linearity, accuracy, repeatability, intermediate precision, recovery, matrix effect, and stability according to the guidelines of the European Medicines Agency. The method was successfully applied to the analysis of overnight urine samples from 12 healthy volunteers, showing significant correlations of urinary melatonin and 6-hydroxymelatonin excretion rates with age. The urinary 6-hydroxymelatonin to melatonin ratio was also established and will be assessed in further studies as a potential endogenous metric of CYP1A2 activity

Efficacy and tolerability of quetiapine in cluster B personality disorder: an open-label study

Objective. The aim of this open-label 8-week study was to assess the effectiveness of quetiapine on aggressive behaviour and social dysfunctions in patients suffering from a cluster B personality disorder (DSM-IV). Methods. The visits were performed at baseline and at days 14, 28 and 56. After a standard titration schedule, the patients received a dose augmented or reduced dose, within a range from 50 to 400 mg/day during the visits, depending on efficacy and tolerance. Assessment of efficacy was based on the French version of the Social Disability and Aggression Scale SDAS (SDAS-21). Response was defined as a decrease of 50% reduction of the total scores compared to baseline. Tolerability was assessed with the CGI, UKU, EPS-scales. Results and conclusion. Eight of the 12 patients included received 200 mg/day quetiapine after titration (all patients: 50-400 mg/day). At week 8, five out of 12 patients were responders based on the SDAS-21 scores for the average expression of the symptoms, and six out of 12 on the basis of SDAS-21 scores for the peak expression. There was a significant correlation between weight change and total SDAS variation (Kendall's b= -0.644; p=0.02). These findings should be reexamined in further studies

Nicotinic Acid Accelerates HDL Cholesteryl Ester Turnover in Obese Insulin-Resistant Dogs.

Nicotinic acid (NA) treatment decreases plasma triglycerides and increases HDL cholesterol, but the mechanisms involved in these change are not fully understood. A reduction in cholesteryl ester transfer protein (CETP) activity has been advanced to explain most lipid-modulating effects of NA. However, due to the central role of CETP in reverse cholesterol transport in humans, other effects of NA may have been hidden. As dogs have no CETP activity, we conducted this study to examine the specific effects of extended-release niacin (NA) on lipids and high-density lipoprotein (HDL) cholesteryl ester (CE) turnover in obese Insulin-Resistant dogs with increase plasma triglycerides.HDL kinetics were assessed in fasting dogs before and four weeks after NA treatment through endogenous labeling of cholesterol and apolipoprotein AI by simultaneous infusion of [1,2 13C2] acetate and [5,5,5 2H3] leucine for 8 h. Kinetic data were analyzed by compartmental modeling. In vitro cell cholesterol efflux of serum from NA-treated dogs was also measured.NA reduced plasma total cholesterol, low-density lipoprotein cholesterol, HDL cholesterol, triglycerides (TG), and very-low-density lipoprotein TG concentrations (p < 0.05). The kinetic study also showed a higher cholesterol esterification rate (p < 0.05). HDL-CE turnover was accelerated (p < 0.05) via HDL removal through endocytosis and selective CE uptake (p < 0.05). We measured an elevated in vitro cell cholesterol efflux (p < 0.05) with NA treatment in accordance with a higher cholesterol esterification.NA decreased HDL cholesterol but promoted cholesterol efflux and esterification, leading to improved reverse cholesterol transport. These results highlight the CETP-independent effects of NA in changes of plasma lipid profile

Swiss psychiatrists beliefs and attitudes about cannabis risks in psychiatric patients: ideologically determined or evidence-based?

The objective of this survey was to assess the beliefs of Swiss psychiatrists about the risks associated with cannabis, and to assess their prohibitive attitudes toward their patients. Eighty-two doctors agreed to fill-up the questionnaire. Cluster analysis retained a 3-cluster solution. Cluster 1: "Prohibitionists" believed that cannabis could induce and trigger all forms of psychiatric disorder, and showed a highly prohibitive attitude. Cluster 2: "Causalists" believed that schizophrenia, but not other psychiatric disorders, could be induced and triggered. Cluster 3: "Prudent liberals" did not believe that psychiatric disorders could be induced by cannabis, and were generally less prohibitive

Monocompartmental model used for the modeling of apolipoprotein AI (apoAI) (A) and HDL cholesteryl ester (B) turnover in dogs.

<p>UC, unesterified cholesterol; CE, cholesteryl ester; k₀₁, apoAI uptake; k_01’, CE selective uptake; k_LCAT, cholesterol esterification rate.</p

Kinetic parameters of HDL apolipoprotein AI and HDL-cholesteryl ester before (week 0) and after 4 weeks of NA treatment (week 4) identified using models of Fig 1.

<p>FCR, fractional catabolic rate; APR, absolute production rate; HDL-UC, HDL unesterified cholesterol concentration; HDL-CE, HDL cholesteryl ester concentration; K_LCAT, cholesterol esterification rate by LCAT. Data are expressed as median [minimum-maximum], n = 6.</p