Enduring effects of Preventive Cognitive Therapy in adults remitted from recurrent depression:A 10 year follow-up of a randomized controlled trial

BACKGROUND: Prevention of recurrence is a challenge in the management of major depressive disorder (MDD). The long-term effects of Preventive Cognitive Therapy (PCT) in preventing recurrence in MDD are not known.METHODS: A RCT comparing the addition of PCT to Treatment As Usual (TAU), versus TAU including patients with recurrent depression who were in remission at entry (N=172). PCT consisted of eight weekly group sessions. TAU involved standard treatment. Primary outcome is time to first recurrence of a depressive episode as assessed by blinded interviewers over 10 years based on DSM-IV-TR criteria.RESULTS: Also over 10 years, the protective effect of PCT was dependent on the number of previous episodes a patient experienced. The protective effect intensified with the number of previous depressive episodes (Cox regression; p=.004, Hazard ratio=.576, 95% CI=.396-.837) and is mainly established within the first half of the 10 year follow-up period. For patients with more than three previous episodes (52% of the sample), PCT significantly increased the median survival time (713.0 days) versus patients that received TAU (205.0 days). No enduring effects were found on secondary outcomes.LIMITATIONS: Dropout rates were relatively high for secondary outcomes, but relatively low for the primary outcome. Results were comparable after multiple imputation.CONCLUSIONS: PCT in remitted patients with multiple prior episodes has long-term preventive effects on time to recurrence. To reduce recurrence rates, booster sessions might be necessary. A personalized medicine approach might be necessary to reduce recurrence rates even further.</p

Cognitive functioning in euthymic recurrently depressed patients : Relationship with future relapses and prior course of disease

Background: Cognitive impairment seems to persist during the euthymic phase of recurrent depression but its relationship with future relapses as with prior course of the disease has to be elucidated. The purpose of this study is to investigate the presence and prognostic value of cognitive dysfunctions for relapse in high risk euthymic patients and to identify relevant associations between cognitive functioning and prior course of illness. Methods: Standardized neuropsychological tests of mental speed, memory and executive functioning were assessed in 137 remitted patients and compared with clinically used published normative data. Previous episodes and relapses within 24 months were measured using the Structured Clinical Interview for DSM-IV. Results: Cognitive performance was significantly impaired on 12 of the 14 variables indicating deficits in the domain of speed of information processing and memory. With Cox regression no significant neuropsychological predictors for relapse or recurrence were identified. Furthermore, Pearson correlations between neuropsychological test scores and number of previous episodes, residual depressive symptoms and duration of remission were non-significant. Later age of onset was correlated with a slower speed of information processing and lower verbal memory performance. Limitations: Published test reference data were used but no healthy control group. Conclusion: Presence of mild cognitive impairment in remitted patients was demonstrated but did not predict future relapses nor was it related with prior course of disease except for age of onset. Though, mild cognitive impairment after remission might have an impact on the quality of life, adding techniques from cognitive rehabilitation might prove to be a treatment option. (C) 2012 Elsevier B.V. All rights reserve

The use and helpfulness of self-management strategies for depression: The experiences of patients

Contains fulltext : 197726.pdf (publisher's version ) (Open Access

Alcohol-dependent patients with comorbid phobic disorders: A comparison between comorbid patients, pure alcohol-dependent and pure phobic patients

Background: Patients with a double diagnosis of alcohol dependence and phobic disorders are a common phenomenon in both alcohol and anxiety disorder clinics. If we are to provide optimum treatment we need to know more about the clinical characteristics of this group of comorbid patients. Objective: To answer the following questions. (1) What are the clinical characteristics of treatment-seeking alcohol-dependent patients with a comorbid phobic disorder? (2) Are alcohol dependence and other clinical characteristics of comorbid patients different from those of 'pure' alcohol-dependent patients? (3) Are the anxiety symptoms and other clinical characteristics of comorbid patients different from those of 'pure' phobic patients? Method: Three groups of treatment-seeking patients were compared on demographic and clinical characteristics: alcohol dependent patients with a comorbid phobic disorder (n = 110), alcohol-dependent patients (n = 148) and patients with social phobia or agoraphobia (n = 106). In order to diagnose the comorbid disorders validly, the assessment took place at least 6 weeks after detoxification. Results: Comorbid patients have high scores on depressive symptoms and general psychopathology: 25% of patients have a current and 52% a lifetime depressive disorder. The majority have no partner and are unemployed, they have a high incidence of other substance use (benzodiazepine, cocaine, cannabis) and a substantial proportion of comorbid patients have been emotionally, physically and sexually abused. They do not have a more severe, or different type of alcohol dependence or anxiety disorder than 'pure' alcohol-dependent patients and phobic patients respectively. Conclusion: Comorbid patients constitute a complex part of the treatment-seeking population in alcohol clinics and psychiatric hospitals. These findings should be taken into account when diagnosing and treating alcohol-dependent patients with a comorbid phobic disorder

Anxiety disorders: Treatable regardless of the severity of comorbid alcohol dependence

Aims: Clinical and epidemiological research has shown that comorbidity is the rule rather than exception in the case of psychiatric disorders. Cognitive behavioral therapy (CBT) has been clearly demonstrated to be effective in treating anxiety and avoidance symptoms in patient samples of social phobia and agoraphobia without comorbid alcohol use disorders. It has recently been shown that treatment of comorbid anxiety disorders in alcohol-dependent patients can also be very successful. The purpose of the present study was to find predictors of treatment success for comorbid anxiety disorders in alcohol-dependent patients. Methods: The study was conducted in a sample of 34 completers with a double diagnosis of alcohol dependence and agoraphobia or social phobia who received CBT for their comorbid anxiety disorder in a 32-week randomized controlled trial comparing alcohol and CBT anxiety disorder treatment with alcohol treatment alone. In the current report, treatment success was defined as a clinically significant change (recovery) on the anxiety discomfort scale. Results: The severity of comorbid alcohol dependence did not influence the beneficial effect of CBT on the anxiety disorder. Psychological distress (SCL-90), neuroticism (NEO N), conscientiousness (NEO C), gender, employment and age of onset of alcohol dependence showed some predictive value. Conclusions: Alcohol-dependent males with a comorbid anxiety disorder seem to benefit most from CBT if their alcohol dependence started after age 25, if they are employed and if their general psychopathology is less severe. The most important conclusion, however, is that even severely alcohol-dependent patients with an anxiety disorder can benefit from psychotherapy for their anxiety disorder

Nursing Staff Factors Contributing to Seclusion in Acute Mental Health Care–An Explorative Cohort Study

Background: Seclusion is a controversial intervention. Efficacy with regard to aggressive behaviour has not been demonstrated, and seclusion is only justified for preventing safety hazards. Previous studies indicate that nursing staff factors may be predictors for seclusion, although methodological issues may have led to equivocal results. Objective: To perform a prospective cohort study to determine whether nursing staff characteristics are associated with seclusion of adult inpatients admitted to a closed psychiatric ward. Method: We studied the association between nurses' demographics and incidence of seclusion during every shift. Data were collected during five months in 2013. Multiple logistic regression was used for analysis. Results: In univariable analysis, we found a non-significant association between seclusion and female gender, odds ratio (OR) = 5.27 (0.98–28.49) and a significant association between seclusion and nurses' large physical stature, OR = 0.21 (0.06–0.72). We found that physical stature is the most substantial factor, although not significant: ORadjusted = 0.27 (0.07–1.04). Conclusion: Nurses' gender may be a predictor for seclusion, but it seems to be mediated by the effect of physical stature. We used a rigorous, census-based, prospective design to collect data on a highly detailed level and found a large effect of physical stature of nurses on seclusion. We found nurses' physical stature to be the most substantial predictor for seclusion. These and other factors need to be explored in further research with larger sample size