Meta-analysis of cognitive behaviour therapy and selective serotonin reuptake inhibitors for the treatment of hypochondriasis: Implications for trial design

Background: Classification of hypochondriasis as an obsessive-compulsive and related disorder in the International Classification of Diseases 11th Revision (ICD-11) has generated new heuristics for treatment of this common, chronic and disabling disorder. Standard treatment involves cognitive behaviour therapy (CBT) or selective serotonin reuptake inhibitors (SSRIs), but no meta-analysis has so far considered hypochondriasis as a structured diagnosis or assessed the role of medication. A clearer understanding of the relative effectiveness of these interventions and identification of clinically relevant factors moderating the treatment response is needed for clinical guideline development. Methods: The current systematic review and meta-analysis of interventions for hypochondriasis was preregistered on PROSPERO (CRD42020185768) and follows PRISMA guidelines. We searched MEDLINE, PsycINFO, and Cochrane Library databases until July 2021 for randomized controlled trials (RCTs) of interventions for patients diagnosed with hypochondriasis (or historical diagnostic equivalents). We assessed aspects of study quality using: the CONSORT Checklist for evaluation of RCTs, the Cochrane Risk of Bias 2 tool, researcher allegiance and treatment fidelity. The primary outcome was improvement in hypochondriasis symptoms, comparing intervention and control groups at trial endpoint. Moderator variables were assessed using subgroup and meta-regression analyses. Results: Searches identified 13 randomised controlled trials (RCTs) (N = 1405); 12 included CBT (N = 1212) and three included SSRI (N = 193) arms as the experimental intervention. Random effects meta-analysis yielded a moderate-to-large effect size for CBT versus all controls (g = −0.70 [95% CI -0.99 to −0.41], k = 18, I2 = 81.1%). Funnel plot asymmetry indicated possible publication bias and two potentially missing trials, reducing the effect size (g = −0.60 [95% CI -0.88 to −0.32]). Subgroup analysis showed that choice of control significantly moderated effect size, with those in CBT vs. wait-list (g = −1.32 [95% CI -1.75 to −0.90], k = 7, I2 = 0%) being double those of CBT vs. psychological or pharmacological placebo controls (g = −0.58 [95% CI -0.95 to −0.22], k = 7, I2 = 82%). Analysis of studies directly comparing CBT and SSRIs found a numerical, but not statistical advantage for SSRIs (g = 0.21 [95% CI -0.46 to 0.87], k = 2, I2 = 58.34%) and a modest effect size emerged for SSRIs vs. pill placebo (g = −0.29 [95% CI -0.57 to −0.01], k = 3, I2 = 0%). Most studies (11/13) were rated as high on potential researcher allegiance bias in favour of CBT. Meta-regressions revealed that effect sizes were larger in younger participants, and smaller in better quality and more recent RCTs and those with greater CBT fidelity. Conclusion: CBT and SSRIs are effective in the acute treatment of hypochondriasis, with some indication that intervention at a younger age produces better outcomes for CBT. In the case of CBT, effect sizes appear to have been significantly inflated by the use of wait list controls, and researcher allegiance bias. We recommend that a definitive, adequately controlled trial, designed with respect to the methodological issues raised in this meta-analysis, is needed to determine the magnitude effects for CBT and SSRIs with confidence and the long-term effect of treatments, to inform mental health service provision for this overlooked patient group

Assessing suicide risk in patients with obsessive-compulsive disorder: a dimensional approach

Objectives: Although an association has been found recently between obsessive-compulsive disorder and an increased risk of suicide, the prevalence of both suicidal ideation and attempts vary considerably and are generally assessed categorically. Our aims were to evaluate the prevalence of suicidal ideation and behaviors using a dimensional approach. Methods: The sample included 129 patients with obsessive-compulsive disorder. Suicidality was assessed by administering the Columbia-Suicide Severity Rating Scale. Logistic and linear regres-sions were used to examine predictors of suicidal ideation, severe suicidal ideation, and suicidal behavior. Results: The lifetime prevalence of suicidal ideation and behaviors were 64.3% and 16.3%, respectively. Lifetime suicidal ideation was associated with the number of stressful life events, duration of illness, Hamilton Rating Scale for Depression scores, and family history of mood disorders. A family history of obsessive-compulsive disorder was associated with a lower probability of lifetime suicidal ideation. Severe suicidal ideation was related to greater severity of the most stressful life event, Hamilton Rating Scale for Depression scores, and longer duration of untreated illness. The probability of lifetime suicidal behavior was related to Hamilton Rating Scale for Anxiety scores, symmetry obsessions, and washing and checking compulsions. The probability of lifetime non-suicidal self-injurious behaviors was related to Hamilton Rating Scale for Anxiety scores. Conclusions: Recognizing predictors of suicidal ideation/behavior is crucial to identifying patients at greater risk

Real-space anisotropy of the superconducting gap in the charge-density wave material 2H-NbSe2

We present a scanning tunneling microscopy (STM) and ab-initio study of the anisotropic superconductivity of 2H-NbSe2 in the charge-density-wave (CDW) phase. Differential-conductance spectra show a clear double-peak structure, which is well reproduced by density functional theory simulations enabling full k- and real-space resolution of the superconducting gap. The hollow-centered (HC) and chalcogen-centered (CC) CDW patterns observed in the experiment are mapped onto separate van der Waals layers with different electronic properties. We identify the CC layer as the high-gap region responsible for the main STM peak. Remarkably, this region belongs to the same Fermi surface sheet that is broken by the CDW gap opening. Simulations reveal a highly anisotropic distribution of the superconducting gap within single Fermi sheets, setting aside the proposed scenario of a two-gap superconductivity. Our results point to a spatially localized competition between superconductivity and CDW involving the HC regions of the crystal

Repetitive transcranial magnetic stimulation (r-TMS) and selective serotonin reuptake inhibitor-resistance in obsessive-compulsive disorder: A meta-analysis and clinical implications

Introduction: Despite promising results from several randomized controlled trials (RCTs) and meta-analyses, the efficacy of r-TMS as a treatment for OCD remains controversial, at least in part owing to inconsistency in the trial methodologies and heterogeneity in the trial outcomes. This meta-analysis attempts to explain some of this heterogeneity by comparing the efficacy of r-TMS in patients with or without resistance to treatment with selective serotonin reuptake inhibitors (SSRI), defined using standardized criteria. Methods: We conducted a pre-registered (PROSPERO ID: 241381) systematic review and meta-analysis. English language articles reporting blinded RCTs were retrieved from searches using MEDLINE, PsycINFO, and Cochrane Library databases. Studies were subjected to subgroup analysis based on four stages of treatment resistance, defined using an adaptation of published criteria (1 = not treatment resistant, 2 = one SSRI trial failed, 3 = two SSRI trials failed, 4 = two SSRI trials failed plus one or more CBT trial failed). Meta-regression analyses investigated patient and methodological factors (age, duration of OCD, illness severity, stage of treatment-resistance, or researcher allegiance) as possible moderators of effect size. Results: Twenty-five independent comparisons (23 studies) were included. Overall, r-TMS showed a medium-sized reduction of Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores (Hedge's g: -0.47; 95%CI: - 0.67 to −0.27) with moderate heterogeneity (I2 = 39.8%). Assessment of publication bias using Trim and Fill analysis suggested a reduced effect size that remained significant (g: -0.29; 95%CI: −0.51 to −0.07). Subgroup analysis found that those studies including patients non-resistant to SSRI (stage 1) (g: -0.65; 95%CI: −1.05 to −0.25, k = 7) or with low SSRI-resistance (stage 2) (g:-0.47; 95%CI: −0.86 to −0.09, k = 6) produced statistically significant results with low heterogeneity, while studies including more highly resistant patients at stage 3 (g: −0.39; 95%CI: −0.90 to 0.11, k = 4) and stage 4 (g: -0.36; 95%CI: −0.75 to 0.03, k = 8) did not. Intriguingly, the only significant moderator of the effect size found by meta-regression was the severity of baseline depressive symptoms. All trials showed evidence of researcher allegiance in favour of the intervention and therefore caution is required in interpreting the reported effect sizes. Conclusion: This meta-analysis shows that r-TMS is an effective treatment for OCD, but largely for those not resistant to SSRI or failing to respond to only one SSRI trial. As a consequence, r-TMS may be best implemented earlier in the care pathway. These findings would have major implications for clinical service development, but further well-powered RCTs, which eliminate bias from researcher allegiance, are needed before definitive conclusions can be drawn

Technical note: First spectral measurement of the Earth's upwelling emission using an uncooled wideband Fourier transform spectrometer

The first spectral measurement of Earth's emitted radiation to space in the wideband range from 100 to 1400 cm^−1 with 0.5 cm^−1 spectral resolution is presented. The measurement was performed from a stratospheric balloon in tropical region using a Fourier transform spectrometer, during a field campaign held in Brazil in June 2005. The instrument, which has uncooled components including the detector module, is a prototype developed as part of the study for the REFIR (Radiation Explorer in the Far InfraRed) space mission. This paper shows the results of the field campaign with particular attention to the measurement capabilities of the prototype. The results are compared with measurements taken by IASI-balloon (Infrared Atmospheric Sounding Interferometer – Balloon version), aboard the same platform, and with forward model estimations. The infrared signature of clouds is observed in the measurements

First spectral measurement of the Earth's upwelling emission using an uncooled wideband Fourier transform spectrometer

International audienceThe first spectral measurement of Earth's emitted radiation to space in the wideband range from 100 to 1400 cm-1 with 0.5 cm-1 spectral resolution is presented. The measurement was performed from a stratospheric balloon in tropical region using a Fourier transform spectrometer, during a field campaign held in Brazil in June 2005. The instrument, which has uncooled components including the detector module, is a prototype developed as part of the study for the REFIR (Radiation Explorer in the Far InfraRed) space mission. This paper shows the results of the field campaign with particular attention to the measurement capabilities of the prototype. The results are compared with measurements taken by IASI-balloon (Infrared Atmospheric Sounding Interferometer – Balloon version), aboard the same platform, and with forward model estimations. The infrared signature of clouds is observed in the measurements

Technical note: First spectral measurement of the Earth's upwelling emission using an uncooled wideband Fourier transform spectrometer

International audienceThe first spectral measurement of Earth's emitted radiation to space in the wideband range from 100 to 1400 cm-1 with 0.5 cm-1 spectral resolution is presented. The measurement was performed from a stratospheric balloon in tropical region using a Fourier transform spectrometer, during a field campaign held in Brazil in June 2005. The instrument, which has uncooled components including the detector module, is a prototype developed as part of the study for the REFIR (Radiation Explorer in the Far InfraRed) space mission. This paper shows the results of the field campaign with particular attention to the measurement capabilities of the prototype. The results are compared with measurements taken by IASI-balloon (Infrared Atmospheric Sounding Interferometer – Balloon version), aboard the same platform, and with forward model estimations. The infrared signature of clouds is observed in the measurements

Fast and Furious: Shock Heated Gas as the Origin of Spatially Resolved Hard X-ray Emission in the Central 5 kpc of the Galaxy Merger NGC 6240

We have obtained a deep, sub-arcsecond resolution X-ray image of the nuclear region of the luminous galaxy merger NGC 6240 with Chandra, which resolves the X-ray emission from the pair of active nuclei and the diffuse hot gas in great detail. We detect extended hard X-ray emission from kT~6 keV (~70 million K) hot gas over a spatial scale of 5 kpc, indicating the presence of fast shocks with velocity of ~2200 km/s. For the first time we obtain the spatial distribution of this highly ionized gas emitting FeXXV, which shows a remarkable correspondence to the large scale morphology of H_2(1-0) S(1) line emission and H\alpha filaments. Propagation of fast shocks originated in the starburst driven wind into the ambient dense gas can account for this morphological correspondence. With an observed L(0.5-8 keV)=5.3E+41 erg/s, the diffuse hard X-ray emission is 100 times more luminous than that observed in the classic starburst galaxy M82. Assuming a filling factor of 1% for the 70 MK temperature gas, we estimate its total mass (M_{hot}=1.8E+8 Msun) and thermal energy (E_{th}=6.5E+57 ergs). The total iron mass in the highly ionized plasma is M_{Fe}=4.6E+5 Msun. Both the energetics and the iron mass in the hot gas are consistent with the expected injection from the supernovae explosion during the starburst that is commensurate with its high star formation rate. No evidence for fluorescent Fe I emission is found in the CO filament connecting the two nuclei.Comment: Accepted to ApJ. 37 pages, 13 figures. Figures 5 and 6 are rotated for better visualization in prin