Latent classes of nonresponders, rapid responders, and gradual responders in depressed outpatients receiving antidepressant medication and psychotherapy

BackgroundWe used growth mixture modeling (GMM) to identify subsets of patients with qualitatively distinct symptom trajectories resulting from treatment. Existing studies have focused on 12-week antidepressant trials. We used data from a concurrent antidepressant and psychotherapy trial over a 6-month period. MethodEight hundred twenty-one patients were randomized to receive either fluoxetine or tianepine and received cognitive-behavioral therapy, supportive therapy, or psychodynamic therapy. Patients completed the Montgomery-angstrom sberg depression rating scale (MADRS) at the 0, 1, 3, and 6-month periods. Patients also completed measures of dysfunctional attitudes, functioning, and personality. GMM was conducted using MADRS scores and the number of growth classes to be retained was based on the Bayesian information criterion. ResultsCriteria supported the presence of four distinct latent growth classes representing gradual responders of high severity (42% of sample), gradual responders of moderate severity (31%), nonresponders (15%), and rapid responders (11%). Initial severity, greater use of emotional coping strategies, less use of avoidance coping strategies, introversion, and less emotional stability predicted nonresponder status. Growth classes were not associated with different treatments or with proportion of dropouts. ConclusionsThe longer time period used in this study highlights potential overestimates of nonresponders in previous research and the need for continued assessments. Our findings demonstrate distinct growth trajectories that are independent of treatment modality and generalizable to most psychotherapy patients. The correlates of class membership provide directions for future studies, which can refine methods to predict likely nonresponders as a means to facilitate personalized treatments

The outlier paradox: The role of iterative ensemble coding in discounting outliers

Ensemble perception—the encoding of objects by their group properties—is known to be resistant to outlier noise. However, this resistance is somewhat paradoxical: how can the visual system determine which stimuli are outliers without already having derived statistical properties of the ensemble? A simple solution would be that ensemble perception is not a simple, one-step process; instead, outliers are detected through iterative computations that identify items with high deviance from the mean and reduce their weight in the representation over time. Here we tested this hypothesis. In Experiment 1, we found evidence that outliers are discounted from mean orientation judgments, extending previous results from ensemble face perception. In Experiment 2, we tested the timing of outlier rejection by having participants perform speeded judgments of sets with or without outliers. We observed significant increases in reaction time (RT) when outliers were present, but a decrease compared to no-outlier sets of matched range suggesting that range alone did not drive RTs. In Experiment 3 we tested the timing by which outlier noise reduces over time. We presented sets for variable exposure durations and found that noise decreases linearly over time. Altogether these results suggest that ensemble representations are optimized through iterative computations aimed at reducing noise. The finding that ensemble perception is an iterative process provides a useful framework for understanding contextual effects on ensemble perception

Cognitive Structure and Processing During Cognitive Behavioral Therapy vs. Pharmacotherapy for Depression

Background: Evidence has converged to suggest that cognitive processing and content covary with depression severity, whereas indices of cognitive structure exhibit greater stability and promise as markers of vulnerability for depression. The objective of the current study was to investigate the temporal dynamics and causal role of cognitive structure and processing in treatment for depression. Method: A total of 104 patients with major depressive disorder were randomized to receive cognitive behavioral therapy (CBT; n = 54) or pharmacotherapy (n = 50). Patients completed the Hamilton Depression Rating Scale (HAM-D), Beck Depression Inventory-II (BDI-II), Psychological Distance Scaling Task (PDST), Redundancy Card-Sorting Task (RCST), and Self-Referent Encoding Task (SRET) before, during, and after treatment. Results: Most cognitive indices exhibited change over treatment to a similar degree across both treatments. Evidence for the mediating role of cognition was limited, and not specific to CBT. Discussion: Results suggest that both cognitive structure and processing may be amenable to change, by both CBT and pharmacotherapy. The role of cognitive structure in the course of depression may require qualification

Cognitive change in cognitive-behavioural therapy

BACKGROUND: Although cognitive-behavioural therapy (CBT) is a well-established treatment for adult depression, its efficacy and efficiency may be enhanced by better understanding its mechanism(s) of action. According to the theoretical model of CBT, symptom improvement occurs via reductions in maladaptive cognition. However, previous research has not established clear evidence for this cognitive mediation model. METHODS: The present study investigated the cognitive mediation model of CBT in the context of a randomized controlled trial of CBT v. antidepressant medication (ADM) for adult depression. Participants with major depressive disorder were randomized to receive 16 weeks of CBT (n = 54) or ADM (n = 50). Depression symptoms and three candidate cognitive mediators (dysfunctional attitudes, cognitive distortions and negative automatic thoughts) were assessed at week 0 (pre-treatment), week 4, week 8 and week 16 (post-treatment). Longitudinal associations between cognition and depression symptoms, and mediation of treatment outcome, were evaluated in structural equation models. RESULTS: Both CBT and ADM produced significant reductions in maladaptive cognition and depression symptoms. Cognitive content and depression symptoms were moderately correlated within measurement waves, but cross-lagged associations between the variables and indirect (i.e. mediated) treatment effects were non-significant. CONCLUSIONS: The results provide support for concurrent relationships between cognitive and symptom change, but not the longitudinal relationships hypothesized by the cognitive mediation model. Results may be indicative of an incongruence between the timing of measurement and the dynamics of cognitive and symptom change

The role of outcome expectancy in therapeutic change across psychotherapy versus pharmacotherapy for depression.

BACKGROUND: Patient outcome expectancy - the belief that treatment will lead to an improvement in symptoms - is linked to favourable therapeutic outcomes in major depressive disorder (MDD). The present study extends this literature by investigating the temporal dynamics of expectancy, and by exploring whether expectancy during treatment is linked to differential outcomes across treatment modalities, for both optimistic versus pessimistic expectancy. METHODS: A total of 104 patients with MDD were randomized to receive either cognitive behavioral therapy (CBT) or pharmacotherapy for 16 weeks. Outcome expectancy was measured throughout treatment using the Depression Change Expectancy Scale (DCES). Depression severity was measured using both the Hamilton Depression Rating Scale and Beck Depression Inventory-II. RESULTS: Latent growth curve models supported improvement in expectancy across both treatments. Cross-lagged panel models revealed that both higher optimistic and lower pessimistic expectancy at mid-treatment predicted greater treatment response in pharmacotherapy. For CBT, the associative patterns between expectancy and depression differed as a function of expectancy type; higher optimistic expectancy at pre-treatment and lower pessimistic expectancy at mid-treatment predicted greater treatment response. LIMITATIONS: The sample size limited statistical power and the complexity of models that could be explored. CONCLUSIONS: Results suggest that outcome expectancy improved during treatment for depression. Whether outcome expectancy represents a specific mechanism for the reduction of depression warrants further investigation

Antimicrobial Properties of Vertically Aligned Nano-Tubular Copper

In this work, the antimicrobial properties of vertically aligned nano-tubular Cu arrays (NT-Cu) fabricated via a template-based electrodeposition approach were investigated. The NT-Cu display good bactericidal activity against S.aureus and bacteriostatic properties against E.coli, S.sonnei, S.enterica and C.albicans. In contrast, Cu-foil electrodeposited from the same solution shows low biological activity against the same microorganisms. The antimicrobial activity of NT-Cu depends on both the type of microorganism and exposure time. After 6 hours of exposure, over 99.99% (log red = 4.43) of S.aureus population was inactivated, whereas, for E.coli, S.sonnei, S.enterica and C.albicans it was 97.8, 94.2, 89.9, and 90.3%, respectively

On the Convergence Between PSY-5 Domains and PID-5 Domains and Facets: Implications for Assessment of DSM-5 Personality Traits

The DSM-5 Personality and Personality Disorders workgroup and their consultants have developed the 220-item, self-report Personality Inventory for the DSM-5 (PID-5) for direct assessment of the proposed personality trait system for DSM-5; however, most p

Timing and Nature of the Deepening of the Tasmanian Gateway

Tectonic changes that produced a deep Tasmanian Gateway between Australia and Antarctica are widely invoked as the major mechanism for Antarctic cryosphere growth and Antarctic Circumpolar Current (ACC) development during the Eocene/Oligocene (E/O) transition (∼34–33 Ma). Ocean Drilling Program (ODP) Leg 189 recovered near-continuous marine sedimentary records across the E/O transition interval at four sites around Tasmania. These records are largely barren of calcareous microfossils but contain a rich record of siliceous- and organic-walled marine microfossils. In this study we integrate micropaleontological, sedimentological, geochemical, and paleomagnetic data from Site 1172 (East Tasman Plateau) to identify four distinct phases (A–D) in the E/O Tasmanian Gateway deepening that are correlative among ODP Leg 189 sites. Phase A, prior to ∼35.5 Ma: minor initial deepening characterized by a shallow marine prodeltaic setting with initial condensation episodes. Phase B, ∼35.5–33.5 Ma: increased deepening marked by the onset of major glauconitic deposition and inception of energetic bottom-water currents. Phase C, ∼33.5–30.2 Ma: further deepening to bathyal depths, with episodic erosion by increasingly energetic bottom-water currents. Phase D, \u3c30.2 Ma: establishment of stable, open-ocean, warm-temperate, oligotrophic settings characterized by siliceous-carbonate ooze deposition. Our combined evidence indicates that this early Oligocene Tasmanian Gateway deepening initially produced an eastward flow of relatively warm surface waters from the Australo-Antarctic Gulf into the southwestern Pacific Ocean. This “proto-Leeuwin” current fundamentally differs from previous regional reconstructions of eastward flowing cool water (e.g., a “proto-ACC”) during the early Oligocene and thereby represents an important new constraint for reconstructing regional- to global-scale dynamics for this major global change event

A Randomized Trial of a Brace for Patellofemoral Osteoarthritis Targeting Knee Pain and Bone Marrow Lesions.

Objective Braces used to treat (PF) osteoarthritis (OA) may reduce contact stress across the PF joint. We hypothesised that in PF OA, braces would decrease knee pain and shrink PF bone marrow lesions (BMLs). Methods Eligible subjects had painful PF OA. Subjects were randomly allocated to brace or no brace for 6 weeks. Knee MRIs were acquired at baseline and 6 weeks. We measured BMLs on post-contrast fat suppressed sagittal and proton density weighted axial images. The primary symptom outcome was change in pain at 6 weeks during a preselected painful activity, and the primary structural outcome was BML volume change in the PF joint. Analyses used multiple linear regression. Results We randomised 126 subjects aged 40–70 years (mean age 55.5  years; 72 females (57.1%)). Mean nominated visual analogue scale (0–10 cm) pain score at baseline was 6.5 cm. 94 knees (75%) had PF BMLs at baseline. Subjects wore the brace for a mean of 7.4 h/day. 6 subjects withdrew during the trial. After accounting for baseline values, the brace group had lower knee pain than the control group at 6 weeks (difference between groups −1.3 cm, 95% CI −2.0 to −0.7; p<0.001) and reduced PF BML volume (difference −490.6 mm3, 95% CI −929.5 to −51.7; p=0.03) but not tibiofemoral volume (difference −53.9 mm3, 95% CI −625.9 to 518.2; p=0.85). Conclusions A PF brace reduces BML volume in the targeted compartment of the knee, and relieves knee pain