Fra angstneurose til panikangst – fra psykoanalyse til emotionsregulering

I artiklen gennemgås historiske faser og ideologier i behandling af angsttilstande. Der tages udgangspunkt i oprettelsen af den første neuroseklinik i dansk psykiatri i 1961 og dermed den psykoanalytiske neuroselære. Herefter gennemgås centrale aspekter af indlæringsteoriens forståelse og behandling af angstneurosen, der aldrig slog igennem i Danmark. 1980’erne kaldes en intermediær fase, og dens revolutioner på angstområdet gennemgås med hovedvægt på navneskiftet fra angstneurose til panikangst og den øgede empiriske forskning. Faserne herefter er domineret af to kognitivt adfærdsterapeutiske retninger, der er stærkt nytænkende og principielt evidensbaserede. Disse leder frem til de nyeste faser, henholdsvis emotionsreguleringsforskningen og neurobiologisk funderet forståelse af angsttilstandene. Artiklen slutter i den Klinik for angstlidelser i dagens psykiatri, hvor forfatteren er leder, og udstikker nogle retningslinier for arbejdet her under forudsætning af ønsket om at bevare kliniker forsker-konceptet og levere evidensbaseret behandling

Systematisk selektivisme eller kritisk eklekticisme i angstbehandling

It is suggested that systematic selectivism should found the basis of treatment of anxiety-disorder patients. From classical psychiatry, cognitive theory, learning theory together with psychoanalysis relevant techniques can be chosen and combined. Copingtechniques developed within learning and cognitive theories are presented and discussed as well as parts of psychoanalytic theory (the deficit-theory) and psychodynamically oriented supportive therapy (POST).Der argumenteres for systematisk selektivisme som grundlag for behandling af angsttilstande.Den klassiske psykiatri, kognitivteori og indlæringspsykologi samt psykoanalyse er de teorier, det hovedsageligt anbefales at vælge terapeutiske teknikker fra.En række coping-teknikker udviklet indenfor rammerne af indlæringspsykologien og kognitiv teori gennemgås, ligesom psykoanalytisk funderet terapi med udgangspunkt i deficit-teori og psykodynamisk orienteret støttende terapi (POST) omtales

Decadal Climate Information Needs of Stakeholders for Decision Support in Water and Agriculture Production Sectors: A Case Study in the Missouri River Basin

Many decadal climate prediction efforts have been initiated under phase 5 of the World Climate Research Programme Coupled Model Intercomparison Project. There is considerable ongoing discussion about model deficiencies, initialization techniques, and data requirements, but not much attention is being given to decadal climate information (DCI) needs of stakeholders for decision support. Here, the authors report the results of exploratory activities undertaken to assess DCI needs in water resources and agriculture sectors, using the Missouri River basin as a case study. This assessment was achieved through discussions with 120 stakeholders. Stakeholders’ awareness of decadal dry and wet spells and their societal impacts in the basin are described, and stakeholders’ DCI needs and potential barriers to their use of DCI are enumerated. The authors find that impacts, including economic impacts, of decadal climate variability (DCV) on water and agricultural production in the basin are distinctly identifiable and characterizable. Stakeholders have clear notions about their needs for DCI and have offered specific suggestions as to how these might be met. However, while stakeholders are eager to have climate information, including decadal climate outlooks (DCOs), there are many barriers to the use of such information. The first and foremost barrier is that the credibility ofDCOs is yet to be established. Second, the nature of institutional rules and regulations, laws, and legal precedents that pose obstacles to the use of DCOs must be better understood and means to modify these, where possible, must be sought. For the benefit of climate scientists, these and other stakeholder needs are also articulated in this paper

Transdiagnostic group CBT vs. standard group CBT for depression, social anxiety disorder and agoraphobia/panic disorder:Study protocol for a pragmatic, multicenter non-inferiority randomized controlled trial

Abstract Background Transdiagnostic Cognitive Behavior Therapy (TCBT) manuals delivered in individual format have been reported to be just as effective as traditional diagnosis specific CBT manuals. We have translated and modified the \u201cThe Unified Protocol for Transdiagnostic Treatment of Emotional Disorders\u201d (UP-CBT) for group delivery in Mental Health Service (MHS), and shown effects comparable to traditional CBT in a naturalistic study. As the use of one manual instead of several diagnosis-specific manuals could simplify logistics, reduce waiting time, and increase therapist expertise compared to diagnosis specific CBT, we aim to test the relative efficacy of group UP-CBT and diagnosis specific group CBT. Methods/design The study is a partially blinded, pragmatic, non-inferiority, parallel, multi-center randomized controlled trial (RCT) of UP-CBT vs diagnosis specific CBT for Unipolar Depression, Social Anxiety Disorder and Agoraphobia/Panic Disorder. In total, 248 patients are recruited from three regional MHS centers across Denmark and included in two intervention arms. The primary outcome is patient-ratings of well-being (WHO Well-being Index, WHO-5), secondary outcomes include level of depressive and anxious symptoms, personality variables, emotion regulation, reflective functioning, and social adjustment. Assessments are conducted before and after therapy and at 6\ua0months follow-up. Weekly patient-rated outcomes and group evaluations are collected for every session. Outcome assessors, blind to treatment allocation, will perform the observer-based symptom ratings, and fidelity assessors will monitor manual adherence. Discussion The current study will be the first RCT investigating the dissemination of the UP in a MHS setting, the UP delivered in groups, and with depressive patients included. Hence the results are expected to add substantially to the evidence base for rational group psychotherapy in MHS. The planned moderator and mediator analyses could spur new hypotheses about mechanisms of change in psychotherapy and the association between patient characteristics and treatment effect. Trial registration Clinicaltrials.gov NCT02954731 . Registered 25 October 201

Decadal Climate Information Needs of Stakeholders for Decision Support in Water and Agriculture Production Sectors: A Case Study in the Missouri River Basin

Many decadal climate prediction efforts have been initiated under phase 5 of the World Climate Research Programme Coupled Model Intercomparison Project. There is considerable ongoing discussion about model deficiencies, initialization techniques, and data requirements, but not much attention is being given to decadal climate information (DCI) needs of stakeholders for decision support. Here, the authors report the results of exploratory activities undertaken to assess DCI needs in water resources and agriculture sectors, using the Missouri River basin as a case study. This assessment was achieved through discussions with 120 stakeholders. Stakeholders’ awareness of decadal dry and wet spells and their societal impacts in the basin are described, and stakeholders’ DCI needs and potential barriers to their use of DCI are enumerated. The authors find that impacts, including economic impacts, of decadal climate variability (DCV) on water and agricultural production in the basin are distinctly identifiable and characterizable. Stakeholders have clear notions about their needs for DCI and have offered specific suggestions as to how these might be met. However, while stakeholders are eager to have climate information, including decadal climate outlooks (DCOs), there are many barriers to the use of such information. The first and foremost barrier is that the credibility ofDCOs is yet to be established. Second, the nature of institutional rules and regulations, laws, and legal precedents that pose obstacles to the use of DCOs must be better understood and means to modify these, where possible, must be sought. For the benefit of climate scientists, these and other stakeholder needs are also articulated in this paper

Early-life viral infection and allergen exposure interact to induce an asthmatic phenotype in mice

<p>Abstract</p> <p>Background</p> <p>Early-life respiratory viral infections, notably with respiratory syncytial virus (RSV), increase the risk of subsequent development of childhood asthma. The purpose of this study was to assess whether early-life infection with a species-specific model of RSV and subsequent allergen exposure predisposed to the development of features of asthma.</p> <p>Methods</p> <p>We employed a unique combination of animal models in which BALB/c mice were neonatally infected with pneumonia virus of mice (PVM, which replicates severe RSV disease in human infants) and following recovery, were intranasally sensitised with ovalbumin. Animals received low-level challenge with aerosolised antigen for 4 weeks to elicit changes of chronic asthma, followed by a single moderate-level challenge to induce an exacerbation of inflammation. We then assessed airway inflammation, epithelial changes characteristic of remodelling, airway hyperresponsiveness (AHR) and host immunological responses.</p> <p>Results</p> <p>Allergic airway inflammation, including recruitment of eosinophils, was prominent only in animals that had recovered from neonatal infection with PVM and then been sensitised and chronically challenged with antigen. Furthermore, only these mice exhibited an augmented Th2-biased immune response, including elevated serum levels of anti-ovalbumin IgE and IgG₁as well as increased relative expression of Th2-associated cytokines IL-4, IL-5 and IL-13. By comparison, development of AHR and mucous cell change were associated with recovery from PVM infection, regardless of subsequent allergen challenge. Increased expression of IL-25, which could contribute to induction of a Th2 response, was demonstrable in the lung following PVM infection. Signalling via the IL-4 receptor α chain was crucial to the development of allergic inflammation, mucous cell change and AHR, because all of these were absent in receptor-deficient mice. In contrast, changes of remodelling were evident in mice that received chronic allergen challenge, regardless of neonatal PVM infection, and were not dependent on signalling via the IL-4 receptor.</p> <p>Conclusion</p> <p>In this mouse model, interaction between early-life viral infection and allergen sensitisation/challenge is essential for development of the characteristic features of childhood asthma, including allergic inflammation and a Th2-biased immune response.</p

Rumination-focused cognitive behaviour therapy vs. cognitive behaviour therapy for depression:Study protocol for a randomised controlled superiority trial

BACKGROUND: Cognitive behavioural therapy is an effective treatment for depression. However, one third of the patients do not respond satisfactorily, and relapse rates of around 30 % within the first post-treatment year were reported in a recent meta-analysis. In total, 30–50 % of remitted patients present with residual symptoms by the end of treatment. A common residual symptom is rumination, a process of recurrent negative thinking and dwelling on negative affect. Rumination has been demonstrated as a major factor in vulnerability to depression, predicting the onset, severity, and duration of future depression. Rumination-focused cognitive behavioural therapy is a psychotherapeutic treatment targeting rumination. Because rumination plays a major role in the initiation and maintenance of depression, targeting rumination with rumination-focused cognitive behavioural therapy may be more effective in treating depression and reducing relapse than standard cognitive behavioural therapy. METHOD/DESIGN: This study is a two-arm pragmatic randomised controlled superiority trial comparing the effectiveness of group-based rumination-focused cognitive behaviour therapy with the effectiveness of group-based cognitive behavioural therapy for treatment of depression. One hundred twenty-eight patients with depression will be recruited from and given treatment in an outpatient service at a psychiatric hospital in Denmark. Our primary outcome will be severity of depressive symptoms (Hamilton Rating Scale for Depression) at completion of treatment. Secondary outcomes will be level of rumination, worry, anxiety, quality of life, behavioural activation, experimental measures of cognitive flexibility, and emotional attentional bias. A 6-month follow-up is planned and will include the primary outcome measure and assessment of relapse. DISCUSSION: The clinical outcome of this trial may guide clinicians to decide on the merits of including rumination-focused cognitive behavioural therapy in the treatment of depression in outpatient services. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02278224, registered 28 Oct. 2014

HLA Alleles Associated with Delayed Progression to AIDS Contribute Strongly to the Initial CD8+ T Cell Response against HIV-1

Background: Very little is known about the immunodominance patterns of HIV-1-specific T cell responses during primary HIV-1 infection and the reasons for human lymphocyte antigen (HLA) modulation of disease progression. Methods and Findings: In a cohort of 104 individuals with primary HIV-1 infection, we demonstrate that a subset of CD8+ T cell epitopes within HIV-1 are consistently targeted early after infection, while other epitopes subsequently targeted through the same HLA class I alleles are rarely recognized. Certain HLA alleles consistently contributed more than others to the total virus-specific CD8+ T cell response during primary infection, and also reduced the absolute magnitude of responses restricted by other alleles if coexpressed in the same individual, consistent with immunodomination. Furthermore, individual HLA class I alleles that have been associated with slower HIV-1 disease progression contributed strongly to the total HIV-1-specific CD8+ T cell response during primary infection. Conclusions: These data demonstrate consistent immunodominance patterns of HIV-1-specific CD8+ T cell responses during primary infection and provide a mechanistic explanation for the protective effect of specific HLA class I alleles on HIV-1 disease progression

Discovery of Novel Biomarker Candidates for Liver Fibrosis in Hepatitis C Patients: A Preliminary Study

Background: Liver biopsy is the reference standard for assessing liver fibrosis and no reliable non-invasive diagnostic approach is available to discriminate between the intermediate stages of fibrosis. Therefore suitable serological biomarkers of liver fibrosis are urgently needed. We used proteomics to identify novel fibrosis biomarkers in hepatitis C patients with different degrees of liver fibrosis.Methodology/Principal Findings: Proteins in plasma samples from healthy control individuals and patients with hepatitis C virus (HCV) induced cirrhosis were analysed using a proteomics technique: two dimensional gel electrophoresis (2-DE). This technique separated the proteins in plasma samples of control and cirrhotic patients and by visualizing the separated proteins we were able to identify proteins which were increasing or decreasing in hepatic cirrhosis. Identified markers were validated across all Ishak fibrosis stages and compared to the markers used in FibroTest, Enhanced Liver Fibrosis (ELF) test, Hepascore and FIBROSpect by Western blotting. Forty four candidate biomarkers for hepatic fibrosis were identified of which 20 were novel biomarkers of liver fibrosis. Western blot validation of all candidate markers using plasma samples from patients across all Ishak fibrosis scores showed that the markers which changed with increasing fibrosis most consistently included lipid transfer inhibitor protein, complement C3d, corticosteroid-binding globulin, apolipoprotein J and apolipoprotein L1. These five novel fibrosis markers which are secreted in blood showed a promising consistent change with increasing fibrosis stage when compared to the markers used for the FibroTest, ELF test, Hepascore and FIBROSpect. These markers will be further validated using a large clinical cohort.Conclusions/Significance: This study identifies 20 novel fibrosis biomarker candidates. The proteins identified may help to assess hepatic fibrosis and eliminate the need for invasive liver biopsies.</br