Suicidal, abused African American women's response to a culturally informed intervention.

Objective: This study examined (a) the efficacy of a manualized, culturally informed, empowerment-focused psychoeducational group intervention (Nia) designed in accord with the theory of triadic influence or treatment as usual (TAU) for reducing psychological symptomatology (suicidal ideation, depressive symptoms, posttraumatic stress symptoms, general psychological distress), and (b) the effect of Nia versus TAU on the relation between exposure to intimate partner violence (IPV) and psychological symptomatology in these women. Method: Two hundred eight low-socioeconomic-status African American women with a recent history of IPV and a suicide attempt were randomized to Nia or TAU and assessed at baseline, postintervention, and 6- and 12-month follow-up. They were assessed on their levels of IPV (Index of Spouse Abuse), suicidal ideation (Beck Scale for Suicidal Ideation), depressive symptoms (Beck Depression Inventory–II), posttraumatic stress symptoms, and general psychological distress (Brief Symptom Inventory). Results:Hierarchical linear modeling found that women receiving the culturally informed Nia intervention showed more rapid reductions in depressive symptoms and general distress initially, and the between-group difference in depressive symptoms persisted at follow-up. Following intervention, compared with women randomized to TAU, women in Nia exhibited less severe suicidal ideation when exposed to physical and nonphysical IPV. Conclusions:Findings highlight the value of incorporating Nia as an adjunctive intervention for abused, suicidal, low-income women. They underscore the ways the intervention needs to be bolstered to address more directly more mediating and moderating constructs, as well as the need to target more effectively the key outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cost-effectiveness of guided self-help treatment for recurrent binge eating.

Objective: Adoption of effective treatments for recurrent binge-eating disorders depends on the balance of costs and benefits. Using data from a recent randomized controlled trial, we conducted an incremental cost-effectiveness analysis (CEA) of a cognitive–behavioral therapy guided self-help intervention (CBT–GSH) to treat recurrent binge eating compared to treatment as usual (TAU). Method: Participants were 123 adult members of an HMO (mean age = 37.2 years, 91.9% female, 96.7% non-Hispanic White) who met criteria for eating disorders involving binge eating as measured by the Eating Disorder Examination (C. G. Fairburn & Z. Cooper, 1993). Participants were randomized either to treatment as usual (TAU) or to TAU plus CBT–GSH. The clinical outcomes were binge-free days and quality-adjusted life years (QALYs); total societal cost was estimated using costs to patients and the health plan and related costs. Results: Compared to those receiving TAU only, those who received TAU plus CBT–GSH experienced 25.2 more binge-free days and had lower total societal costs of $427 over 12 months following the intervention (incremental CEA ratio of ?$20.23 per binge-free day or ?$26,847 per QALY). Lower costs in the TAU plus CBT–GSH group were due to reduced use of TAU services in that group, resulting in lower net costs for the TAU plus CBT group despite the additional cost of CBT–GSH. Conclusions: Findings support CBT–GSH dissemination for recurrent binge-eating treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of perceived interpersonal functioning on treatment for adolescent depression: IPT-A versus treatment as usual in school-based health clinics.

Objective: Aspects of depressed adolescents’ perceived interpersonal functioning were examined as moderators of response to treatment among adolescents treated with interpersonal psychotherapy for depressed adolescents (IPT-A; Mufson, Dorta, Moreau, & Weissman, 2004) or treatment as usual (TAU) in school-based health clinics. Method: Sixty-three adolescents (12–18 years of age) participated in a clinical trial examining the effectiveness of IPT-A (Mufson, Dorta, Wickramaratne, et al., 2004). The sample was 84.1% female and 15.9% male (mean age = 14.67 years). Adolescents were 74.6% Latino, 14.3% African American, 1.6% Asian American, and 9.5% other. They came primarily from low-income families. Adolescents were randomly assigned to receive IPT-A or TAU delivered by school-based mental health clinicians. Assessments, completed at baseline and at Weeks 4, 8, and 12 (or at early termination), included the Hamilton Rating Scale for Depression (Hamilton, 1967), the Conflict Behavior Questionnaire (Robin & Foster, 1989), and the Social Adjustment Scale–Self-Report (Weissman & Bothwell, 1976). Results: Multilevel modeling indicated that treatment condition interacted with adolescents’ baseline reports of conflict with their mothers and social dysfunction with friends to predict the trajectory of adolescents’ depressive symptoms over the course of treatment, controlling for baseline levels of depression. The benefits of IPT-A over TAU were particularly strong for the adolescents who reported high levels of conflict with their mothers and social dysfunction with friends. Conclusions: Replication with larger samples would suggest that IPT-A may be particularly helpful for depressed adolescents who are reporting high levels of conflict with their mothers or interpersonal difficulties with friends. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The comparative effectiveness of cognitive processing therapy for male veterans treated in a VHA posttraumatic stress disorder residential rehabilitation program.

Objective: To examine the effectiveness of group cognitive processing therapy (CPT) relative to trauma-focused group treatment as usual (TAU) in the context of a Veterans Health Administration (VHA) posttraumatic stress disorder (PTSD) residential rehabilitation program. Method: Participants were 2 cohorts of male patients in the same program treated with either CPT (n = 104) or TAU (n = 93; prior to the implementation of CPT). Cohorts were compared on changes from pre- to posttreatment using the PTSD Checklist (PCL; Weathers, Litz, Herman, Huska, & Keane, 1993) and other measures of symptoms and functioning. Minorities represented 41% of the sample, and the mean age was 52 years (SD = 9.22). The CPT group was significantly younger and less likely to receive disability benefits for PTSD; however, these variables were not related to outcome. Results: Analyses of covariance controlling for intake symptom levels and cohort differences revealed that CPT participants evidenced more symptom improvement at discharge than TAU participants on the PCL, F(3, 193) = 15.32, p     

Effectiveness of Cognitive-Behavioral Treatment for Panic Disorder Versus Treatment as Usual in a Managed Care Setting.

Eighty clients enrolled in a managed care health plan who identified panic disorder as their primary presenting problem were randomly assigned to treatment by a therapist recently trained in a manual-based empirically supported psychotherapy (M. G. Craske, E. Meadows, & D. H. Barlow, 1994) or a therapist conducting treatment as usual (TAU). Participants in both conditions showed significant change from pre- to posttreatment on a number of measures. Those receiving panic control therapy (PCT) showed greater levels of change than those receiving TAU. Among treatment completers, an average of 42.9% of those in PCT and 18.8% in TAU achieved clinically significant change across measures. The results are discussed with reference to the dissemination of PCT and other evidence-based psychotherapies to clinical practice settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized trial of telephone psychotherapy and pharmacotherapy for depression: Continuation and durability of effects.

Randomized trial evidence and expert guidelines are mixed regarding the value of combined pharmacotherapy and psychotherapy as initial treatment for depression. This study describes long-term results of a randomized trial (N = 393) evaluating telephone-based cognitive-behavioral therapy (CBT) plus care management for primary care patients beginning antidepressant treatment versus usual care. In a repeated measures linear model with adjustment for baseline scores, the phone therapy group showed significantly lower mean Hopkins Symptom Checklist (HSCL) Depression Scale scores (L. Derogatis, K. Rickels, E. Uhlenhuth, & L. Covi, 1974) from 6 months to 18 months versus usual care, F(1, 336) = 11.28, p = .001. Average HSCL depression scores over the period from 6 months to 18 months were 0.68 (SD = 0.55) in the telephone therapy group and 0.85 (SD = 0.65) in the usual-care comparison group. Addition of a brief, structured CBT program can significantly improve clinical outcomes for the large number of patients beginning antidepressant treatment in primary care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of amlodipine on 24-hour ambulatory blood pressure profiles, electrocardiographic monitoring, and left ventricular mass and function in black patients with very severe hypertension

In a 3-month, open-label study, 54 consecutive black patients with very severe hypertension were treated with amlodipine. Very severe hypertension was defined as an average sitting diastolic blood pressure (BP) > or = 115 mmHg and < or = 140 mmHg as a mean of 10 readings over a 30-minute period using an automatic BP measuring device and a mean 24-hour diastolic ambulatory blood pressure (ABP) > or = 110 mmHg and < or = 140 mmHg). Serial changes in 24-hour ABP and electrocardiographic monitoring, left ventricular (LV) mass index, and LV systolic function were evaluated. Mean 24-hour ABP was reduced from 181 +/- 14/119 +/- 6 to 140 +/- 15/92 +/- 9 mmHg at 3 months (P < 0.0001). Target BP (mean 24-hour diastolic ABP < 90 mmHg) was achieved in 35% of the patients. The reduction in BP was sustained for 24 hours after drug administration. Simultaneous BP measurements using the automatic BP measuring device were significantly different from the ABP measurements before and after treatment, suggesting a marked "white coat" pressor effect. At baseline, frequent or complex ventricular arrhythmias (> 30 ventricular extrasystoles per hour, ventricular couplets) were present in 2 (4%) patients, with no significant change after treatment. Left ventricular mass index regressed from 140 +/- 50 to 111 +/- 30 g/m2 at 3 months (P < 0.03); LV performance was not adversely affected. Adverse effects were few and tended to disappear during the treatment period. All of the clinical laboratory parameters tested remained unchanged. In this group of patients, treatment with amlodipine showed a marked and sustained antihypertensive action as demonstrated by 24-hour ABP monitoring, and was well tolerated and associated with LV mass regression without adverse effect on systolic cardiac function. Further, a low rate of complex ventricular arrhythmias was documented.     

The usefulness of the timeliness of endoscopic sphincterotomy in severe acute pancreatitis of biliary origin

There are evidence indicating that endoscopic retrograde cholangiopancreatography with sphincterotomy (ERCP+S) reduces the rate of complications in patients with severe acute biliary pancreatitis (ABP). The aim of this study was to analyze our experience in the treatment of severe ABP with ERCP+S and compare the evolution of the patients treated early (3 days or less following admission) with those treated late (after the 3rd day). A retrospective review of the clinical histories of the 16 patients with severe ABP treated with ERCP+S over the last two years is presented, analyzing their clinical features on admission and evolution. Biliary stones or biliary sludge was observed in 11 cases (69%). Nine patients had undergone early, and 7 late, ERCP+S. The patients of the latter group presented a greater number of complications during evolution than the former group (43% vs 0%; p = 0.025). The mortality of the patients of the late ERCP+S was also greater although without statistical significance (28.6% vs 0%; p = 0.15). No complication secondary to ERCP+S was detected. These findings confirm the fact that ERCP+S performed early in severe ABP significantly reduces the number of complications and is associated with a lower mortality.     

A controlled trial of psychodynamic psychotherapy for co-occurring borderline personality disorder and alcohol use disorder.

A randomized controlled trial was conducted to determine whether a manual-based psychodynamic treatment, labeled dynamic deconstructive psychotherapy (DDP), would be feasible and effective for individuals with co-occurring borderline personality disorder (BPD) and alcohol use disorder. Thirty participants were assessed every 3 months during a year of treatment with either DDP or treatment as usual (TAU) in the community. DDP participants showed statistically significant improvement in parasuicide behavior, alcohol misuse, institutional care, depression, dissociation, and core symptoms of BPD, and treatment retention was 67% to 73%. Although TAU participants received higher average treatment intensity, they showed only limited change during the same period. The results support the feasibility, tolerability, and efficacy of DDP for the co-occurring subgroup and highlight the need for further research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of cognitive-behavioral treatment for panic disorder versus treatment as usual in a managed care setting: 2-year follow-up.

Eighty clients meeting criteria for panic disorder and receiving either panic control therapy (PCT; M. G. Craske, E. Meadows, & D. H. Barlow, 1994) or treatment as usual (TAU) in a managed care setting were assessed 1 and 2 years following acute treatment. PCT was provided by therapists with little or no previous exposure to cognitive-behavioral therapies. Analyses of the full intent-to-treat sample revealed no significant differences between the treatments across the follow-up period. However, when treatment completer status was added as a moderator, those receiving PCT showed lower levels of panic severity and phobic avoidance and a greater likelihood of achieving and maintaining clinically significant change. Benzodiazepine use during follow-up was associated with greater panic severity for those clients who received PCT, but no such relationship was found for TAU clients. Results are discussed in relation to the dissemination and effectiveness of PCT as well as evidence-based psychotherapies more generally. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

AIDS risk behavior in opioid dependent patients treated with community reinforcement approach and relationships with psychiatric disorders

This study examined the Community Reinforcement Approach's (CRA) effect on AIDS risk behaviors and the relationship between comorbid psychiatric disorders and the risk for AIDS behavior in opioid dependent patients entering methadone maintenance treatment. Additionally, we looked at AIDS risk behaviors as they related to the Addition Severity Index (ASI), Beck Depression Inventory, Symptom Checklist-90-Revised (SCL-90-R), and the Social Adjustment Scale-Self Report (SAS-SR). Subjects (N = 227) were drawn from a large clinical trial that examined the effectiveness of a Community Reinforcement Approach for treatment of opioid dependence. Both CRA and standard treatment demonstrated a significant effect on reduction of AIDS risk behaviors. There was no relationship found regarding comorbid psychiatric disorders with the risk for AIDS behavior. However, there were correlations with other psychiatric, social, and substance abuse variables. Multivariate analyses indicated that increased drug and legal ASI composite scores were the primary predictors of increased AIDS risk behavior.     

HPLC fractionated soluble egg antigen from Schistosoma mansoni elicits a heterogeneous human immune response

Antihypertensive effects of beni-koji were studied using 29 outpatients with mild hypertension in a placebo-controlled double-blind comparative fashion. After a 4-week vehicle (apple juice) run-in period, 13 patients were assigned to receive beni-koji aqueous extracts containing juice once daily (27 g of beni-koji eq. per day) for 8 weeks and 16 were assigned to vehicle. Two patients assigned to the vehicle group did not complete the study. In addition to casual blood pressure, 24-hr non-invasive ambulatory blood pressure (ABP) was monitored in 6 patients given the beni-koji drink and 5 patients given the vehicle. 1) In the beni-koji group, both casual systolic and diastolic pressure decreased significantly during the treatment period (from 150 +/- 10/96 +/- 6 mmHg to 140 +/- 10/89 +/- 10 mmHg, p < 0.01). The averages of the 24-hr blood pressure recorded in ABP (24-BP) also significantly decreased (from 141 +/- 17/95 +/- 13 mmHg to 132 +/- 21/86 +/- 10 mmHg, p < 0.05) when compared with those of the control period. Casual pressure normalized (less than 140/90 mmHg) in 4 patients who received beni-koji. Circadian variation of the blood pressure by ABP showed a significant decrease during the daytime. 2) In the vehicle group, casual systolic pressure did not change significantly (from 155 +/- 8 mmHg to 151 +/- 12 mmHg), but diastolic pressure decreased significantly (98 +/- 7 mmHg to 93 +/- 6 mmHg). Casual blood pressure did not normalize in any of the patients and 24-BP did not change significantly. 3) Summative evaluation of safety showed that no problems appeared in the beni-koji group. In conclusion, beni-koji appears to be an effective and safe food material for mild essential hypertension. The mechanism of the antihypertensive effect of beni-koji still remains to be investigated.     

Competitive memory training (COMET) for treating low self-esteem in patients with eating disorders: A randomized clinical trial.

This study evaluates a short stepwise cognitive–behavioral intervention for the treatment of low self-esteem in patients with eating disorders. Competitive memory training (COMET) for low self-esteem is based on insights and findings from experimental psychology. A total of 52 patients with eating disorders and low self-esteem were treated with COMET in a routine mental health center in addition to their regular treatment. These patients were randomized to receive 8 weeks of COMET + therapy as usual (TAU) or to receive TAU only. Differential effects in favor of COMET + TAU were found for 2 indexes of self-esteem and for 1 index of depressive mood. Shortcomings of this study and possible clinical implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Training and dissemination of cognitive behavior therapy for depression in adults: A preliminary examination of therapist competence and client outcomes.

Objective: In this study, the authors examined the feasibility and effectiveness of training community therapists to deliver cognitive behavior therapy (CBT) for depression. Method: Participants were therapists (n = 12) and clients (n = 116; mean age = 41 years, 63% women) presenting for treatment of depression at a not-for-profit and designated community mental health center for St. Joseph County, Indiana. The training model included a 2-day workshop followed by 1 year of phone consultations. CBT competence ratings from the Cognitive Therapy Scale were obtained prior to training and at 6 and 12 months posttraining. Two different groups of clients, a treatment-as-usual (TAU) group (n = 74) and a CBT group (n = 42), were compared with respect to decrease in symptoms of depression (assessed with the Beck Depression Inventory) and anxiety (assessed with the Beck Anxiety Inventory). Results: Therapists showed significant increases in total scores from pretraining to 6 months posttraining, increases that were maintained at 12 months. The increase in the total score reflected gains on items that specifically measure CBT skills and structure. Although both TAU and CBT resulted in a significant decrease in depressive symptoms, the CBT clients showed significantly greater change than the TAU clients, F(2, 113) = 53.40, p     

Mental health and support of women treated for breast cancer

This article presents the results of a pilot-study conducted on a small sample of women with breast cancer and the members of their social support system. The purpose was to determine the potential link between the mental health of the breast cancer patient and their support system. Mental health was assessed with the SCL-90-R (Derogatis, 1977), a self-report scale composed of 90 items divided into nine categories, offering three global indicators of distress: the Global Severity Index (GSI); the Positive Symptom Distress Index (PSDI), and the Positive Symptom Total (PST). The SCL-90-R was distributed to a sample of 14 subjects: seven women treated for breast cancer and seven significant others (social support). The results led to the definition of symptoms such as hostility, phobic anxiety and psychosis specific to either the woman or the support system.     

Drug abuse day treatment: a randomized clinical trial comparing day and residential treatment programs

Clients entering a therapeutic community (TC)-oriented drug treatment program were randomly assigned to day or residential conditions and interviewed at 2 weeks and 6 months after admission. Outcomes included Addiction Severity Index composite scores and summary scores for the Beck Depression Inventory, Symptom Checklist-90-R, and a social support scale. Only clients who remained in treatment for at least 2 weeks were included. The mean age of the sample (N = 261) was 32.9 (SD = 6.7 years) and the mean education level was 12.1 years (SD = 1.9 years); 30% were women. Comparison of outcome scores at 6 months between groups, while controlling for baseline values, indicated greater improvement for residential clients on social problems and psychiatric symptoms. The groups were similar on the 8 remaining outcomes, including measures of alcohol and drug problems. Overall, the level of improvement among day treatment clients was not significantly different from that of residential clients.     

Mindfulness-Based Cognitive Therapy for Depression: Replication and Exploration of Differential Relapse Prevention Effects.

Recovered recurrently depressed patients were randomized to treatment as usual (TAU) or TAU plus mindfulness-based cognitive therapy (MBCT). Replicating previous findings, MBCT reduced relapse from 78% to 36% in 55 patients with 3 or more previous episodes; but in 18 patients with only 2 (recent) episodes corresponding figures were 20% and 50%. MBCT was most effective in preventing relapses not preceded by life events. Relapses were more often associated with significant life events in the 2-episode group. This group also reported less childhood adversity and later first depression onset than the 3-or-more-episode group, suggesting that these groups represented distinct populations. MBCT is an effective and efficient way to prevent relapse/recurrence in recovered depressed patients with 3 or more previous episodes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pretreatment and process predictors of outcome in interpersonal and cognitive behavioral psychotherapy for binge eating disorder.

The present study examined pretreatment and process predictors of individual nonresponse to psychological group treatment of binge eating disorder (BED). In a randomized trial, 162 overweight patients with BED were treated with either group cognitive-behavioral therapy or group interpersonal psychotherapy. Treatment nonresponse, which was defined as nonabstinence from binge eating, was assessed at posttreatment and at 1 year following treatment completion. Using 4 signal detection analyses, greater extent of interpersonal problems prior to treatment or at midtreatment were identified as predictors of nonresponse, both at posttreatment and at 1-year follow-up. Greater pretreatment and midtreatment concerns about shape and weight, among those patients with low interpersonal problems, were predictive of posttreatment nonresponse. Lower group cohesion during the early treatment phase predicted nonresponse at 1-year follow-up. Attention to specific pre- or intreatment predictors could allow for targeted selection into differential or augmented care and could thus improve response to group psychotherapy for BED. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adhesion of staphylococci to polyurethane and hydrogel-coated polyurethane catheters assayed by an improved radiolabelling technique

Glutamate decarboxylase autoantibodies (GAD65Ab) and beta-cell function were evaluated at and 3 years after diabetes onset in consecutive subjects over 15 years of age. At onset, 21/32 (66%) insulin-treated patients (mean age 43, range 16-79 years) had GAD65Ab; all GAD65Ab persisted 3 years later. At onset, 20/82 (24%) non-insulin-treated patients (mean age 56, range 20-79 years) had GAD65Ab. Of those with persistent GAD65Ab, 8 non-insulin-treated and 11 insulin-treated patients consented to follow-up glucose and glucagon stimulation tests. For non-insulin-treated patients, quantitative GAD65Ab index at onset correlated inversely with 1 + 3 min C-peptide response to glucose (r = -0.68, P < 0.05) and to glucagon (r = -0.79, P < 0.05) 3 years later. Those with high (> 0.50) initial GAD65Ab index had lower C-peptide (fasting, 1 + 3 min after glucose and after glucagon) 3 years later, versus those with low (< 0.50) initial GAD65Ab index (P < 0.05). In conclusion, not only did GAD65Ab presence predict future insulin dependence, but higher GAD65Ab levels may mark more rapid decline in beta-cell function in apparent non-insulin-dependent diabetes.