Comparative efficacy of the Cognitive Behavioral Analysis System of Psychotherapy versus Supportive Psychotherapy for early onset chronic depression: design and rationale of a multisite randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Effective treatment strategies for chronic depression are urgently needed since it is not only a common and particularly disabling disorder, but is also considered treatment resistant by most clinicians. There are only a few studies on chronic depression indicating that traditional psycho- and pharmacological interventions are not as effective as in acute, episodic depression. Current medications are no more effective than those introduced 50 years ago whereas the only psychotherapy developed specifically for the subgroup of chronic depression, the Cognitive Behavioral Analysis System of Psychotherapy (CBASP), faired well in one large trial. However, CBASP has never been directly compared to a non-specific control treatment.</p> <p>Methods/Design</p> <p>The present article describes the study protocol of a multisite parallel-group randomized controlled trial in Germany. The purpose of the study is to estimate the efficacy of CBASP compared to supportive psychotherapy in 268 non-medicated early-onset chronically depressed outpatients. The intervention includes 20 weeks of acute treatment with 24 individual sessions followed by 28 weeks of continuation treatment with another 8 sessions. Depressive symptoms are evaluated 20 weeks after randomisation by means of the 24-item Hamilton Rating Scale of Depression (HRSD). Secondary endpoints are depressive symptoms after 12 and 48 weeks, and remission after 12, 20, and 48 weeks. Primary outcome will be analysed using analysis of covariance (ANCOVA) controlled for pre-treatment scores and site. Analyses of continuous secondary variables will be performed using linear mixed models. For remission rates, chi-squared tests and logistic regression will be applied.</p> <p>Discussion</p> <p>The study evaluates the comparative effects of a disorder-specific psychotherapy and a well designed non-specific psychological approach in the acute and continuation treatment phase in a large sample of early-onset chronically depressed patients.</p> <p>Trial registration</p> <p>ClinicalTrials.gov (<a href="http://www.clinicaltrials.gov/ct2/show/NCT00970437">NCT00970437</a>).</p

The reference frame for encoding and retention of motion depends on stimulus set size

YesThe goal of this study was to investigate the reference frames used in perceptual encoding and storage of visual motion information. In our experiments, observers viewed multiple moving objects and reported the direction of motion of a randomly selected item. Using a vector-decomposition technique, we computed performance during smooth pursuit with respect to a spatiotopic (nonretinotopic) and to a retinotopic component and compared them with performance during fixation, which served as the baseline. For the stimulus encoding stage, which precedes memory, we found that the reference frame depends on the stimulus set size. For a single moving target, the spatiotopic reference frame had the most significant contribution with some additional contribution from the retinotopic reference frame. When the number of items increased (Set Sizes 3 to 7), the spatiotopic reference frame was able to account for the performance. Finally, when the number of items became larger than 7, the distinction between reference frames vanished. We interpret this finding as a switch to a more abstract nonmetric encoding of motion direction. We found that the retinotopic reference frame was not used in memory. Taken together with other studies, our results suggest that, whereas a retinotopic reference frame may be employed for controlling eye movements, perception and memory use primarily nonretinotopic reference frames. Furthermore, the use of nonretinotopic reference frames appears to be capacity limited. In the case of complex stimuli, the visual system may use perceptual grouping in order to simplify the complexity of stimuli or resort to a nonmetric abstract coding of motion information

Bases biológicas do transtorno de estresse pós-traumático Biological basis of posttraumatic stress disorder

A pesquisa neuroendocrinológica dos sistemas fisiológicos envolvidos no estresse evidencia hiper função do eixo simpato-adrenal em conjunto com uma redução da atividade do eixo hipotálamo-hipófise-adrenal (HHA) em pacientes com estresse pós-traumático (TEPT). Uma resposta prejudicada do cortisol aos estressores parece estar associada com um aumento da vulnerabilidade ao desenvolvimento do TEPT. O excesso de catecolaminas, sem o pareamento do aumento dos corticóides promoveria uma consolidação excessiva das memórias traumáticas e a indevida generalização para outras situações estressantes. Sintomas como o entorpecimento e flashbacks têm sido relacionados com o aumento de opióides endógenos. Estudos de neuroimagem evidenciam uma redução do volume hipocampal no TEPT, que tem sido relacionada a alterações cognitivas e anormalidades do eixo HHA encontrados no TEPT.<br>Neuroendocrinological research on the physiological systems involved in stress evidenced hyper functioning of the sympatho-adrenal axis together with reduced activity of the hypothalamic-pituitary-adrenal axis in patients with posttraumatic stress disorder (PTSD). An impaired corticoid response to stressors seems to be associated with enhanced vulnerability to PTSD. Excess catecholamines, unchecked by corticoids would promote over consolidation of traumatic memories and undue generalization to other stressful situations. Symptoms such as numbing and flashbacks have been related to endogenous opioids. Neuroimaging studies evidenced a reduction of hippocampal volume in PTSD patients, which has been related to both cognitive changes and abnormalities of the HPA axis that are found in PTSD