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

The validity of the DSM-IV diagnostic classification system of non-affective psychoses

Objective: The schizophrenia and other non-affective disorders categories listed in the DSM-IV, are currently under revision for the development of the fifth edition. The aim of the present study is to demonstrate the validity of these categories by investigating possible differences between diagnostic patient subgroups on various measures. Methods: 1064 patients with a diagnosis of non-affective psychosis (schizophrenia N = 731 (paranoid type 82%), schizoaffective N = 63, schizophreniform N = 120, psychosis not otherwise specified/brief psychotic disorder N = 150) participated in this study. Dependent variables were demographic and clinical characteristics, severity of psychopathology, premorbid and current functioning, and indicators of quality of life. Results: Within the diagnostic group of schizophrenia, no significant differences were observed between paranoid schizophrenia, disorganized, and undifferentiated schizophrenia. Patients with schizophrenia experienced more severe psychopathology and had poorer levels of current functioning compared to patients with psychosis not otherwise specified or brief psychotic disorder. Differences between schizophrenia and schizoaffective disorder were less clear. Conclusion: Our results do not support the validity of schizophrenia subtypes. Schizophrenia can be distinguished from brief psychotic disorder and psychotic disorder not otherwise specified. These findings may fuel the actual DSM-V discussion