Dynamic interpersonal therapy for moderate to severe depression: A pilot randomized controlled and feasibility trial

Background: Improving Access to Psychological Therapies (IAPT) services treat most patients in England who present to primary care with major depression. Psychodynamic psychotherapy is one of the psychotherapies offered. Dynamic Interpersonal Therapy (DIT) is a psychodynamic and mentalization-based treatment for depression. 16 sessions are delivered over approximately 5 months. Neither DIT's effectiveness relative to low-intensity treatment (LIT), nor the feasibility of randomizing patients to psychodynamic or cognitive-behavioural treatments (CBT) in an IAPT setting has been demonstrated. Methods: 147 patients were randomized in a 3:2:1 ratio to DIT (n = 73), LIT (control intervention; n = 54) or CBT (n = 20) in four IAPT treatment services in a combined superiority and feasibility design. Patients meeting criteria for major depressive disorder were assessed at baseline, mid-treatment (3 months) and post-treatment (6 months) using the Hamilton Rating Scale for Depression (HRSD-17), Beck Depression Inventory-II (BDI-II) and other self-rated questionnaire measures. Patients receiving DIT were also followed up 6 months post-completion. Results: The DIT arm showed significantly lower HRSD-17 scores at the 6-month primary end-point compared with LIT (d = 0.70). Significantly more DIT patients (51%) showed clinically significant change on the HRSD-17 compared with LIT (9%). The DIT and CBT arms showed equivalence on most outcomes. Results were similar with the BDI-II. DIT showed benefit across a range of secondary outcomes.ConclusionsDIT delivered in a primary care setting is superior to LIT and can be appropriately compared with CBT in future RCTs

Does psychoanalysis have a valuable place in modern mental health services? Yes

Psychoanalysis is under greater attack than ever before. An unprecedented decommissioning of psychoanalytic services has taken place across the United Kingdom’s National Health Service (for example, Forest House NHS Psychotherapy Clinic), justified by cost savings. What are the reasons for this attack and what can be said in psychoanalysis’s defence? It has been claimed, perhaps fairly, that psychoanalysis and psychodynamic psychotherapies have failed to promote a culture of systematic evaluation and that the outcomes are difficult to measure and demonstrate. Relative to the number of studies on the effectiveness of cognitive behavioural therapy, few adequate studies are available of psychodynamic therapy outcomes. A growing body of studies, however, report that psychodynamic therapy is effective in the treatment of both mild and complex mental health problems

Feasibility Study of a Psychodynamic Online Group Intervention for Depression and Anxiety

Dynamic Interpersonal Therapy (DIT) was originally developed as a brief psychodynamic intervention for the treatment of depression and anxiety. More recently it has become the psychodynamic protocol for depression specifically within Improving Access to Psychological Therapies services across the U.K. The aim of the present study was to pilot and evaluate the feasibility of a group online version of DIT—Online Group Dynamic Interpersonal Therapy—and the perceived helpfulness of psychodynamically informed self-help materials. Twenty-four participants were randomly assigned to three groups. Participants in Condition A (n = 8) took part in an online DIT group, with self-help materials, facilitated by a therapist. Participants in Condition B (n = 8) were given access to a closed virtual group space where they could interact with each other and were supplied with the same self-help materials used by participants in Condition A, but without online therapist facilitation. Participants in Condition C (n = 8) received no instructions or facilitation, but had access to an online mental well-being site where they could meet virtually in a large, open, moderated virtual group space to discuss their psychological difficulties. This feasibility study was underpowered to detect significant differences in rates of change between facilitated and unfacilitated provision of material, but decline in symptoms appeared to be superior to control only for the facilitated group when the groups were considered separately. The response of the combined treated groups against control suggests that the DIT self-help materials may be helpful and appear to support the process of change. Further work is required

The ad-libitum alcohol 'taste test': secondary analyses of potential confounds and construct validity

RATIONALE: Motivation to drink alcohol can be measured in the laboratory using an ad-libitum 'taste test', in which participants rate the taste of alcoholic drinks whilst their intake is covertly monitored. Little is known about the construct validity of this paradigm. OBJECTIVE: The objective of this study was to investigate variables that may compromise the validity of this paradigm and its construct validity. METHODS: We re-analysed data from 12 studies from our laboratory that incorporated an ad-libitum taste test. We considered time of day and participants' awareness of the purpose of the taste test as potential confounding variables. We examined whether gender, typical alcohol consumption, subjective craving, scores on the Alcohol Use Disorders Identification Test and perceived pleasantness of the drinks predicted ad-libitum consumption (construct validity). RESULTS: We included 762 participants (462 female). Participant awareness and time of day were not related to ad-libitum alcohol consumption. Males drank significantly more alcohol than females (

Response of the Pacific Sector of the Southern Ocean to wind stress variability from 1995 to 2017

AbstractDrifter, satellite, expendable bathythermograph (XBT), and Argo float data are used to study the response of the Pacific Sector of the Southern Ocean (PSSO) to the wind stress field in the period 1995–2017, in terms of eddy field, water mass transport, and heat fluxes at large and regional scales. Increasing wind stress over the PSSO in those two decades led to a growth of the Eddy Kinetic Energy (EKE) in the region of the Antarctic Circumpolar Current (ACC). Increases of the EKE occur with delays of 1–4 years with respect to peaks in the zonal component of the wind stress. The persistent ACC meander located south of New Zealand (between 150°E and 180°W and 50°S to 66°S) responds to the interannual wind variations earlier than the entire ACC branch in the PSSO. In the same area, an estimate of the ACC transport based on in situ data shows interannual variability but no significant decadal trend over the study period. The effects of the EKE variability on the meridional eddy heat fluxes are significant on interannual scales. The strengthening of the EKE field leads to a local increase in the poleward meridional eddy heat fluxes in the PSSO, especially in the ACC band. The weakening of the EKE field defines an area of equatorward meridional eddy heat fluxes in the middle of the PSSO (south of 40°S, between 130°W and 160°W) and prevalent poleward fluxes in the further western and eastern regions

Wind direction data from a coastal HF radar system in the gulf of naples (central mediterranean sea)

Results on the accuracy of SeaSonde High Frequency (HF) radar wind direction measurements in the Gulf of Naples (Southern Tyrrhenian Sea, Central Mediterranean Sea) are here presented. The investigation was carried out for a winter period (2 February-6 March) and for one summer month (August) of the reference year 2009. HF radar measurements were compared with in situ recordings from a weather station and with model data, with the aim of resolving both small scale and large scale dynamics. The analysis of the overall performance of the HF radar system in the Gulf of Naples shows that the data are reliable when the wind speed exceeds a 5 m/s threshold. Despite such a limitation, this study confirms the potentialities of these systems as monitoring platforms in coastal areas and suggests further efforts towards their improvement

Visceral leishmaniasis patients display altered composition and maturity of neutrophils as well as impaired neutrophil effector functions

Immunologically, active visceral leishmaniasis (VL) is characterised by profound immunosuppression, severe systemic inflammatory responses and an impaired capacity to control parasite replication. Neutrophils are highly versatile cells, which play a crucial role in the induction as well as the resolution of inflammation, the control of pathogen replication and the regulation of immune responses. Neutrophil functions have been investigated in human cutaneous leishmaniasis, however, their role in human visceral leishmaniasis is poorly understood. In the present study we evaluated the activation status and effector functions of neutrophils in patients with active VL and after successful anti-leishmanial treatment. Our results show that neutrophils are highly activated and have degranulated; high levels of arginase, myeloperoxidase and elastase, all contained in neutrophils’ granules, were found in the plasma of VL patients. In addition, we show that a large proportion of these cells are immature. We also analysed effector functions of neutrophils that are essential for pathogen clearance and show that neutrophils have an impaired capacity to release neutrophil extracellular traps, produce reactive oxygen species and phagocytose bacterial particles, but not Leishmania parasites. Our results suggest that impaired effector functions, increased activation and immaturity of neutrophils play a key role in the pathogenesis of VL

Well-being in 15-year-old adolescents: a matter of relationship with school

Background Psychosomatic health complaints are significant indicators of adolescent well-being. The aim of this study is to describe the full set of interactions between health complaints and the presence of subjective resources, represented by the quality of relationships with parents and peers and by a positive school perception, in a population of 15-year-old adolescents. Smoking and alcohol consumption were also included in the analyses. Methods Bayesian networks were built for males and females separately, in order to understand the interactions among all considered variables in a representative sample of 16 018 Italian adolescents participating in the Health Behaviour in School-Aged Children survey 2009–10. Results The resulting networks show that school is the crucial node linking adolescents’ well-being with parents and peer relationships, as well as with smoking and alcohol consumption. Conclusions Adolescents' well-being, as well as the prevalence of typical risk behaviours, such as smoking and alcohol consumption, is mediated by the adolescents' academic stress. Therefore, public health interventions, to be effective, should consider addressing the school environment by making it a more inclusive environment promoting critical thinking and sense of belonging rather than just focusing on personal behaviours