Changes In Symptom Severity Research Articles

Overnight Abstinence Is Associated With Smaller Secondary Somatosensory Cortical Volumes and Higher Somatosensory-Motor Cortical Functional Connectivity in Cigarette Smokers.

Abstinence symptoms present challenges to successful cessation of cigarette smoking. Chronic exposure to nicotine and long-term nicotine abstinence are associated with alterations in cortical and subcortical gray matter volumes (GMVs). We aimed at examining changes in regional GMVs following overnight abstinence and how these regional functions relate to abstinence symptoms. Here, in a sample of 31 regular smokers scanned both in a satiety state and after overnight abstinence, we employed voxel-wise morphometry and resting-state functional connectivity (rsFC) to investigate these issues. We processed imaging data with published routines and evaluated the results with a corrected threshold. Smokers showed smaller GMVs of the left ventral hippocampus and right secondary somatosensory cortex (SII) after overnight abstinence as compared to satiety. The GMV alterations in right SII were positively correlated with changes in withdrawal symptom severity between states. Furthermore, right SII rsFC with the precentral gyrus was stronger in abstinence as compared to satiety. The inter-regional rsFC was positively correlated with motor impulsivity and withdrawal symptom severity during abstinence and negatively with craving to smoke during satiety. These findings highlight for the first time the effects of overnight abstinence on cerebral volumetrics and changes in functional connectivity of a higher-order sensory cortex. These changes may dispose smokers to impulsive behaviors and aggravate the urge to smoke at the earliest stage of withdrawal from nicotine. Overnight abstinence leads to changes in gray matter volumes and functional connectivity of the second somatosensory cortex in cigarette smokers. Higher somatosensory and motor cortical connectivity in abstinence is significantly correlated with trait motor impulsivity and withdrawal symptom severity. The findings add to the literature of neural markers of nicotine addiction.

Trends of Prevalence Estimates and Risk Factors of Depressive Symptoms among Healthcare Workers Over one Year of the COVID-19 Pandemic.

COVID-19 pandemic has an overwhelming psychologic burden on healthcare workers (HCWs). This study aims to investigate the changes in the prevalence, estimates, severity, and risk factors of depressive symptoms among HCWs within the first year of the COVID-19 pandemic. An observational e-survey collected data on HCWs' socio-demographic characteristics, occupational situation, and depressive symptoms as measured by Patient Health Questionnaire-9 (PHQ-9). The e-survey was distributed one month after the onset of the COVID-19 pandemic (onset group) and again after one year (one-year group). A total of 422 HCWs were included (Mean (SD) age, 35.3 (9.9) years; 71.3% males), with 211 (50%) participants in each group. In the total cohort, the mean PHQ-9 score was 8.5, and 36.7% reported clinically significant levels of depressive symptoms with a PHQ-9 score of ≥10. Compared to the onset group, the one-year group reported a higher risk of major depressive disorder (41.7% vs. 31.8%; OR 1.538; 95%CI 1.032-2.291; p=0.034), a higher mean PHQ-9 score (9.5 (6.8) vs. 7.4 (5.3), p<0.001), and more severe depressive symptoms (p<0.005). Participants who were younger, unmarried, underwent testing for COVID-19, reported lower monthly income, did not receive special COVID-19 education, or had lower satisfaction with institutional preparedness had significantly higher depression scores and symptoms in both onset and one-year groups (p<0.05 for each category). Female gender and direct contact with COVID-19 patients or samples were significant risk factors within the onset group. Occupation as a physician, history of COVID-19 testing or infection, and perception of significant changes in work schedule or intensity were significantly associated with higher depression scores and symptoms among the one-year group. This study sheds light on an unspoken but significant rise in prevalence estimates and severity of depressive symptoms among HCWs over a year of the COVID-19 pandemic and shows the vulnerable subgroups for whom a psychological intervention might be warranted.

A systematic review of the use of atomoxetine for management of comorbid anxiety disorders in children and adolescents with attention-deficit hyperactivity disorder

BackgroundAnxiety disorders are among the most common comorbid mental disorders in children and adolescents with attention-deficit hyperactivity disorder (ADHD). While the role of atomoxetine, a non-stimulant medication, is well-established in the management of ADHD symptoms since two decades, there is a dearth of evidence regarding its efficacy in the management of anxiety disorders in children and adolescents with ADHD. AimsWe aimed to provide insights into (1) the comparative efficacy of atomoxetine in children and adolescents with comorbid ADHD and anxiety disorders, (2) change in severity of anxiety symptoms based on patients’, parents’, and clinicians’ ratings, (3) tolerability and side effects. MethodsWe searched PubMed, EMBASE, and PsycINFO for clinical trials that addressed the efficacy of atomoxetine for anxiety symptoms in children and adolescents with ADHD. All published literature was systematically reviewed. ResultsWe included four studies, out of which two specifically addressed comorbid ADHD and anxiety disorder. The studies suggested that atomoxetine did not exacerbate and in fact reduced anxiety symptoms in young patients with comorbid ADHD. Conclusions and implicationsOverall, atomoxetine demonstrates good efficacy in improving anxiety symptoms in children and adolescents with ADHD. Further studies are needed to shed light on atomoxetine’s efficacy for anxiety subtypes in ADHD.

Early response to cognitive behavioral therapy for body dysmorphic disorder as a predictor of outcomes

Individuals with body dysmorphic disorder (BDD) suffer from distressing or impairing preoccupations with perceived imperfections in their appearance. This often-chronic condition is associated with significant functional impairment and elevated rates of psychiatric comorbidity and morbidity, including depression, substance use disorders, and suicidality. Cognitive behavioral therapy (CBT) for BDD has been shown to be efficacious. However, this intervention is long (up to 24 weeks) relative to many manualized approaches for other related conditions, there is a significant shortage of clinicians trained in CBT for BDD, and some patients drop out of treatment and/or do not respond. Thus, there is great interest in understanding and predicting who is most likely to respond, to better allocate clinical resources. This secondary data analysis of participants enrolled in prior uncontrolled and controlled studies of CBT for BDD explored whether early response to CBT, operationalized as percentage change in symptom severity within the first four weeks and the first 12 weeks of this 24-week treatment, predicts clinical outcomes for patients with BDD (n = 90). The findings indicated that minimal early symptom change was not indicative of eventual non-response. This suggests that patients and clinicians should not be discouraged by limited early improvement but should instead continue with a full course of treatment before reevaluating progress and alternative interventions. Overall, the results support the view that treatment success is more likely if a longer CBT protocol is followed. More work is needed to understand mechanisms of change and thus match optimal interventions to patient characteristics.

Within and between associations of clinical microskills and correct application of techniques/strategies: A longitudinal multilevel approach.

The therapist effect has been demonstrated in various studies. However, studies on putative therapist characteristics show heterogeneous results. Although the majority of studies have solely examined effects between therapists, a growing interest in effects within therapists has emerged. However, it remains unclear whether therapist characteristics are rather a state-like than a trait-like phenomenon. The main aim of the present study is to test whether clinical microskills as well as correct application of techniques and strategies (both between and within therapists) predict across-session change of symptom severity in a large naturalistic data set. The results are based on 398 patients and 48 therapists who treated 5-17 patients each. Clinical microskills and correct application of techniques/strategies were rated using the Inventory of Therapeutic Interventions and Skills, and symptom severity was assessed with the Hopkins Symptom Checklist-11. Results demonstrated significant within- and between-therapist variability in clinical microskills and correct application of techniques/strategies, and no change over the course of treatment in both variables. Moreover, correct application of techniques/strategies was significantly associated with symptom improvement within, but not between therapists. In addition, higher treatment difficulty as well as an interaction between treatment difficulty and correct application of techniques/strategies were significantly associated with symptom improvement. Clinical microskills were neither predictive of symptom improvement within nor between therapists. These results provide initial evidence that not the therapist's average correct application of techniques/strategies is important, but rather how correctly they use a technique with a specific patient. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

0550 Health-Economic Implications of Defined Improvements in Restless Leg Syndrome Severity: A Model-Based Exploratory Analysis based on Prior Publication Data

Abstract Introduction Restless leg syndrome (RLS) is a debilitating condition associated with reduced health-related quality of life (HRQoL) and increased resource utilization. Our objective was to provide model-based estimates of quality-adjusted life year (QALY) gain and reduction in healthcare utilization that might be expected for changes in symptom severity. Methods We identified two health-economic studies which reported severity-specific quality-of-life and resource utilization. Happe et al. 2009 reported HRQoL using EQ-5D measurements stratified by International Restless Legs Scale (IRLS) severity (n=519, 63.6% female, 64.2 years) and Durgin et al. 2015 reported healthcare utilization stratified by RLS severity (no/mild/moderate/severe RLS) (n=2,392, 56.9% female, 56.0 years). We fitted regression models to support IRLS-specific estimates of EQ-5D and healthcare resource utilization. These models (polynomial for EQ-5D, linear for resource utilization) were applied to calculate QALY gain, and events avoided for ER visits, hospitalizations, and healthcare provider (HCP) visits over 5 years for IRLS improvement of 1-10 points, from a baseline of 30, 25, and 20. Results At five years, a 1, 3, 5, 7, and 10-point IRLS reduction corresponded to a QALY gain of 0.09, 0.25, 0.40, 0.52, and 0.69 for a baseline of 30, 0.07, 0.19, 0.29, 0.37, and 0.47 for a baseline of 25, and 0.04, 0.12, 0.18, 0.22, and 0.26 for a baseline of 20. The events avoided over 5 years with an IRLS reduction of 1, 3, 5, 7, and 10 points respectively were 1.12, 3.37, 5.62, 7.87, and 11.25 HCP visits, 0.09, 0.26, 0.43, 0.61, and 0.87 ER visits, and 0.04, 0.11, 0.18, 0.26, and 0.36 hospitalizations. Conclusion This exploratory analysis based on two health-economic studies confirms the substantial quality-of-life and healthcare cost burden associated with RLS. The data provide guidance on the magnitude of potential quality-of-life improvement and cost reduction that might be associated with defined improvement in RLS severity. Further investigation may be warranted for the factors that link change in IRLS and healthcare resource utilization, such as sleep deficits or cardiovascular risks. Support (If Any) Funding was provided by Noctrix Health

Acquisition, extinction, and return of fear in veterans in intensive outpatient prolonged exposure therapy: A fear-potentiated startle study

Prolonged exposure (PE) therapy is a first-line treatment for posttraumatic stress disorder (PTSD) and involves repeated presentation of trauma-related cues without aversive outcomes. A primary learning mechanism of PE is fear extinction (new learning that a dangerous cue is now safe) and its retention (maintaining this new learning over time). Extant research suggests extinction is impaired in PTSD patients. In this study, we employed an established fear-potentiated startle-based paradigm to examine fear acquisition, extinction learning and retention before and after completion of intensive outpatient treatment. First, PTSD patients undergoing PE (n = 55) were compared to trauma-exposed patients without PTSD (n = 57). We identified excessive fear in PTSD patients during acquisition and extinction before treatment compared to non-PTSD patients. At post-treatment, we examined the return of fear after extinction in PTSD patients showing high or low treatment response to PE (≥50% change in PTSD symptom severity vs. < 50%). High PE responders maintained fear extinction learning whereas low PE responders showed significant return of fear at post-treatment. These results replicate and extend previous findings of impaired extinction in PTSD and provide support for the proposed theoretical link between fear extinction and PE response.

Do positive memory characteristics influence daily-level trajectories of posttraumatic stress disorder symptoms? an exploratory daily diary study

ABSTRACT Background and Objectives Evidence links posttraumatic stress disorder (PTSD) with positive memory characteristics. To extend this research, we utilized daily diary data to examine (1) concurrent/lagged associations between daily PTSD symptom severity and positive memory vividness/accessibility; and (2) associations between baseline-assessed positive memory characteristics and changes in PTSD symptom severity over time. Design and Methods A sample of 238 trauma-exposed participants (M age = 21.19 years; 86% women) completed baseline and 10 daily measures of PTSD symptoms and positive memory characteristics. Multilevel models covaried for gender, number of trauma types, and number of completed surveys. Results Days with greater PTSD symptom severity than an individual’s average associated with less vividness (b = −0.02, p < .001) and accessibility (b = −0.02, p < .001) of the positive memory on the same day. Days with greater positive memory vividness (b = −1.06, p < .001) and accessibility (b = −0.93, p < .001) than an individual’s average associated with less PTSD symptom severity on the same day. There were no significant lagged associations between these constructs. There were significant interactions between baseline-assessed psychological distance and time (b = −0.04, p = .042) and between baseline-assessed visual perspective and time (b = 0.05, p = .023) on PTSD symptom severity across days. Conclusions Findings inform positive memory intervention targets for PTSD and provide impetus for longitudinal investigations on their inter-relations.

Early Warning Signals in Phase Space: Geometric Resilience Loss Indicators From Multiplex Cumulative Recurrence Networks.

The detection of Early Warning Signals (EWS) of imminent phase transitions, such as sudden changes in symptom severity could be an important innovation in the treatment or prevention of disease or psychopathology. Recurrence-based analyses are known for their ability to detect differences in behavioral modes and order transitions in extremely noisy data. As a proof of principle, the present paper provides an example of a recurrence network based analysis strategy which can be implemented in a clinical setting in which data from an individual is continuously monitored for the purpose of making decisions about diagnosis and intervention. Specifically, it is demonstrated that measures based on the geometry of the phase space can serve as Early Warning Signals of imminent phase transitions. A publicly available multivariate time series is analyzed using so-called cumulative Recurrence Networks (cRN), which are recurrence networks with edges weighted by recurrence time and directed towards previously observed data points. The results are compared to previous analyses of the same data set, benefits, limitations and future directions of the analysis approach are discussed.

MO861: Symptom Improvement With Standard Care in People Receiving Haemodialysis Across a Range of Symptoms in the POS-S Renal: Consideration for Clinical Practice and Trial Design

Abstract BACKGROUND AND AIMS Although the high prevalence of symptoms experienced by haemodialysis patients is recognized, how these symptoms change over time is poorly understood, and could have implications for clinical practice and research. This study investigates the change in symptom burden over time with standard care using the POS-S renal questionnaire. METHOD Three times a week haemodialysis patients participating in a stepped wedge cluster randomized trial (SHAREHD) reported the severity of the 17 POS-S Renal symptoms (none, mild, moderate, severe and overwhelming) at baseline, 6, 12 and 18 months. Patients reporting moderate or worse for each of these symptoms at baseline were identified. Symptoms were categorized by the absolute change in population prevalence of individuals in the ‘severe’ group, estimated using multi-level mixed effects ordered probit regression adjusting for age, sex, time on HD and Charlson Comorbidity Score. To assess change within individuals, the proportion of patients changing their symptom score every 6 months was estimated, with &amp;gt;35% of patients remaining in the ‘severe’ category used to class a symptom as more stable. RESULTS 552 patients completed 1724 questionnaires across the four timepoints. Across all 17 symptoms with moderate or worse symptom severity at baseline, the majority of the change in population symptom prevalence occurred in the ‘severe’ category with moderate category remaining stable and mild/none prevalence increasing. The change in prevalence of the ‘severe’ category was 10%–20% &amp;gt;18 months in difficult sleeping, weakness, anxious, depression, shortness of breath, poor mobility, skin changes, drowsiness, pain, poor appetite, restless leg experienced an absolute improvement. Meanwhile greater absolute improvements in prevalence of 21–40% were observed in constipation, diarrhoea, sore mouth, pruritus, vomiting and nausea. Most of the symptoms with larger changes in population prevalence of the ‘severe’ category were associated with only 22–28% of patients remaining in the severe category at any one time. But larger prevalence change was driven by 9–18% difference between the proportion of patients moving out of severe compared with those moving into this category. Despite less change (10%–20%) in population prevalence of the ‘severe’ category in other symptoms, there was still a large degree of within patient movement that was relatively balanced in and out of the severe category. Examples include depression, skin changes and drowsiness, which had 75–80% movement both in and out of severe category each 6 months period, but maintained relatively static prevalence over time. All symptoms had &amp;gt;50% of patients in the severe group change their severity &amp;gt;6 months. CONCLUSION In response to standard care, the prevalence and movement in and out of the severe category can help characterize the longitudinal behavior of symptoms. More dramatic changes at the population and patient level in some symptoms could have a significant impact for clinical trial design as improvements are observed with standard care, which could be interpreted as a placebo effect. Symptom severity changes in more than 50% of patients within 6 months, arguing for routine measurement of symptom-based PROMS in haemodialysis population to identify individuals requiring intervention. Funded by VIFOR Pharma.

Randomised clinical trial: individual versus group hypnotherapy for irritable bowel syndrome.

SummaryBackgroundGut‐directed hypnotherapy improves symptoms for patients with irritable bowel syndrome (IBS). Group hypnotherapy, as well as hypnotherapy administered by nurses, can increase treatment availability, but there are few comparisons between individual and group‐based hypnotherapy.AimWe aimed to evaluate and compare the effectiveness of nurse‐administered hypnotherapy for IBS delivered individually or in groups.MethodsIBS patients were randomised to individual or group hypnotherapy (8 sessions, 12 weeks). The primary endpoint was changes in severity of IBS symptoms. A responder was defined as reduction of IBS severity scoring system (IBS‐SSS) ≥50 points at the end of treatment compared to baseline. The effects on extracolonic and psychological symptoms, and quality of life were also assessed. Symptoms were also followed up 6 months after treatment start.ResultsA total of 119 patients were randomised (61 individual, 58 group hypnotherapy). Patients reported improvements in IBS symptoms (IBS‐SSS) (individual: 332 (273–401) (median, IQR), versus 216 (140–308), (p < 0.0001), group: 315 (239–382), versus 217 (149–314), (p < 0.0001)), with no differences between the groups (p = 0.16). Extracolonic symptoms, psychological symptoms and quality of life also improved, without clear differences between the groups. Sixty‐nine percent of the individual hypnotherapy patients were responders after treatment versus 57% of the group hypnotherapy patients (p = 0.25). Symptom improvements were also seen at follow‐up.ConclusionsNurse‐administered gut‐directed hypnotherapy, delivered individually or in groups, relieves IBS symptoms, improves psychological symptoms and quality of life. Group hypnotherapy can be an efficacious alternative, enabling more patients to benefit from the treatment (ClinicalTrials.gov ID no of study: NCT03432078).

P218. The Impact of Risk Group on the Relationship Between Functional Connectivity and Longitudinal Symptom Severity in Anhedonia and Depression

Anhedonia is a common symptom of major depressive disorder that often precedes illness onset and develops during adolescence. To understand and treat anhedonia and depression, it is important to characterize the neural signatures that are associated with changes in symptom severity, and assess the impact of risk group.

Longitudinal PTSD symptom trajectories: Relative contributions of state anxiety, depression, and emotion dysregulation

BackgroundProspective research on the development and trajectory of PTSD symptoms after a traumatic event is crucial for assessment and early intervention. Further, examining predictors of PTSD pathology provides a better conceptualization of the temporal course of PTSD in trauma victims. MethodsThe present study examined PTSD symptom severity in individuals presenting to the emergency department (ED) following a traumatic event. Participants (N = 147) were assessed at four timepoints: 2-weeks, 3-months, between 6 and 9 months, and 12-months after ED admission. Growth curve modeling was conducted to examine changes in PTSD symptom severity over time. Age, sex, state anxiety, trait anxiety, emotion dysregulation, depression, and trauma type (motor vehicle accident [MVA] and assault), and PTSD diagnosis were included as covariates in the model. ResultsResults demonstrated that baseline PTSD symptom severity was positively associated with severity of depression and state (but not trait) anxiety, emotion dysregulation, and PTSD diagnosis. Results also revealed significant associations with PTSD symptom changes over time; greater state anxiety and depression symptoms at baseline were associated with steeper declines in PTSD symptoms over time. LimitationsData were collected at only four timepoints over the course of 12-months. Results may be different with more measurement points over longer periods and inclusion of pre-, peri- and post-trauma risk factors. ConclusionsResults illustrate the relevance of assessing state anxiety, depression, and emotion dysregulation in following trauma victims for trauma-related psychopathology over the course of time to alleviate the negative impact of the same.

A novel management strategy for treatment of pelvic venous disorders utilizing a clinical screening score and non-invasive imaging.

Background: Treatment of pelvic venous disorders (PVD) including pelvic congestion syndrome (PCS) are often delayed due to its varying clinical manifestations. Patients and methods: Patient referral was based on a literature- and personal experience-derived clinical "PCS screening score" (higher score points indicate greater likelihood with a maximum score of 10 points). We studied consecutive women who were (i) referred for vascular assessment and treatment to the University Hospital Zurich (2017-2021), (ii) had a PCS score ≥3 points, (iii) had evidence of obstructive or non-obstructive PVD by duplex sonography or cross-sectional imaging, and (iv) underwent endovascular therapy. The primary outcome was change in symptom severity after endovascular therapy: (i) freedom from symptoms, (ii) improvement with residual symptoms, (iii) no improvement. Results: We included 43 women (mean age 36 years): 81% had previous pregnancy, 19% endometriosis. The median PCS score was 7 (IQR 5-9) points. Chronic lower-abdominal pain was the leading symptom in 86% patients, followed by recurrent leg (9%) and vulvar (5%) varicosities. The main PVD pathologies were ovarian vein insufficiency (61%), internal iliac vein insufficiency (9%), or a combination of both (30%), whereas 42% had a deep venous obstruction of the inferior vena cava, common iliac or left renal veins. Endovascular therapy included ovarian vein embolization (86%), internal iliac vein embolization (9%), and venous stent placement (35%). After a median of 4 (IQR 1-8) months from endovascular treatment, 40 (93%) patients reported improvement of the leading symptom, and 14 (33%) were symptom-free. Complications included re-intervention for stent stenosis (13%, all post-thrombotic), coil-migration into the left renal vein (7%, all retrieved), and transient pelvic sclerotherapy-induced thrombophlebitis (2%). Conclusions: Endovascular therapy following a diagnostic approach, which included a PCS screening tool and non-invasive imaging, appeared to be highly effective and was associated with a low rate of complications.

P 50 The safety and feasibility of deep transcranial magnetic stimulation in patients with Parkinson syndromes and medical refractory symptoms: a retrospective analysis

Introduction: Deep transcranial magnetic stimulation (dTMS) is a relatively novel, non-invasive therapeutic tool whereby magnetic fields are utilized to assert neuromodulatory effects in targeted brain area. The aim of the current study was to investigate the safety and feasibility of dTMS as an add-on treatment for patients with Parkinson syndromes in a retrospective manner. Hypotheses included if the application is safe and not associated with severe adverse reactions; if dTMS can successfully be applied to patients regardless of their diagnosis, age, impairment profile and symptom severity; and to assess the potential short- term effects of this application on patients‘ self- related symptom severity as well as on motor and cognitive and emotional functions. Patients and Methods: Multifaceted patient data of patients with different parkinson syndroms (PD, atypical) (N = 21) were analyzed to examine adverse effects (AEs) as well as short-term effects of the dTMS treatment on patients‘ self-rated symptom severity and on motor, cognitive, and emotional functions obtained in neuropsychological tests and questionnaires. Results: We found dTMS to be safe and generally well tolerated with headache as the most common AE. A large variation was apparent in the rate (50%) and severity ratings ( M = 5.4, SD = 2.6) of the reported AEs, which was not related to the examined patient characteristics nor stimulation parameters. The explorative analysis of the short-term effects revealed a significant decrease in the self-rated main motor symptom severity that were recorded at each stimulation session ( t (18) = -2.06, p = .027), which was more pronounced in PD patients. There were no correlations between the changes in main symptom severity and different stimulation parameters in our sample. Interestingly, older patients reported larger decreases in symptom severity. No significant effect of dTMS could be found on cognition. Depression scores improved, but failed significance. Conclusion: DTMS can be safely administered to patients with Parkinson syndromes with medical refractory symptoms. Moreover, treatment with dTMS can lead to a subjective decrease in the self-rated main symptom severity especially in PD patients.

Brief behavioral treatment for insomnia decreases trauma-related nightmare frequency in veterans.

Trauma-related nightmares are highly prevalent among veterans and are associated with higher-severity insomnia and posttraumatic stress disorder. Cognitive behavioral therapy for insomnia (typically 6-8 sessions) has been shown to reduce trauma-related nightmares. Brief behavioral treatment for insomnia (BBTI, 4 sessions) has been found to be comparable to CBT-I in decreasing insomnia severity; however, the effects of BBTI on nightmares have not been investigated. The current study tested the effects of BBTI on both trauma-related nightmares and nontrauma-related bad dreams using an active control group treated using progressive muscle relaxation therapy. In addition, we tested whether baseline trauma-related nightmare frequency and baseline nontrauma-related bad dream frequency moderated changes in insomnia severity. Participants were 91 military veterans with insomnia disorder randomized to BBTI or progressive muscle relaxation therapy. Participants reported insomnia severity on the Insomnia Severity Index and reported trauma-related nightmare frequency and nontrauma-related bad dream frequency on the Pittsburgh Sleep Quality Index-PTSD Addendum. We found that BBTI significantly reduced trauma-related nightmares from baseline to posttreatment, whereas progressive muscle relaxation therapy did not. However, reductions in trauma-related nightmares were not maintained at the 6-month follow up. Neither BBTI nor progressive muscle relaxation therapy reduced nontrauma-related bad dreams from baseline to posttreatment. We also found that neither baseline trauma-related nightmare frequency nor baseline nontrauma-related bad dream frequency moderated changes in insomnia symptom severity. Findings from the current study suggest that BBTI may help reduce trauma-related nightmares. Further research is needed to better understand the potential mechanisms underlying how improved sleep may reduce trauma-related nightmares. Registry: ClinicalTrials.gov; Name: Brief Behavioral Insomnia Treatment Study (BBTI); URL: https://clinicaltrials.gov/ct2/show/NCT02571452; Identifier: NCT02571452. Ranney RM, Gloria R, Metzler TJ, Huggins J, Neylan TC, Maguen S. Brief behavioral treatment for insomnia decreases trauma-related nightmare frequency in veterans. J Clin Sleep Med. 2022:18(7):1831-1839.

A digital therapeutic for management of psychosocial aspects of psoriasis: A pre-post proof of concept study.

BackgroundDespite the psychosocial challenges of living with psoriasis many patients may not be able to access appropriate services to manage these challenges. Mobile health interventions may be helpful as a means to support patients in managing the impact of their condition.ObjectiveTo conduct a preliminary examination of the feasibility and acceptability of a bespoke psoriasis‐specific digital therapeutic solution (hereafter termed Allay), and to provide initial data on psychological changes pre‐post.MethodsPhase one proof of concept pre‐post study. Eligible patients were provided with Allay on their smartphone and assessed at baseline and at 12 weeks on a range of indices of well‐being. Participants experiences on usability were collected by telephone interview at 4 weeks, 8 and 12 weeks.ResultsOut of 66 participants recruited, 59 persisted in using Allay after the familiarisation phase, and 34 participants completed the 12 weeks programme. Participants showed a statistically significant improvement between induction and the end of the 12 weeks programme on Quality of life, Resilience, Perceptions of ‘Overall impact’ of psoriasis, and ‘Emotional impact’. There was a significant change over the course of using Allay for symptoms of depression but not anxiety. While there was an interaction effect of changes in severity of psoriasis symptoms over the course of the study for dermatology‐specific measures, there was no interaction between such changes in psoriasis symptoms and changes in depression, resilience or beliefs in emotional impact.ConclusionsStudy results suggest that the use of Allay as an adjunct to medical management of psoriasis may help patients improve resilience, mood, beliefs about their condition and enhance their quality of life. Given that this is a phase one proof of concept study, and our rates of attrition further research is necessary to examine comparative effectiveness and stability of these findings.

Trajectories of Uremic Symptom Severity and Kidney Function in Patients with Chronic Kidney Disease.

Uremic symptoms, including fatigue, anorexia, pruritus, nausea, paresthesia, and pain, are attributed to the accumulation of organic waste products normally cleared by the kidneys, but whether kidney function is the primary driver of changes in symptom severity over time is not known. The goal of our study was to evaluate the association between eGFR and uremic symptom severity score in patients with CKD. We identified 3685 participants with CKD not on dialysis in the prospective, observational Chronic Renal Insufficiency Cohort (CRIC) Study with baseline assessment of eGFR and uremic symptom severity. Symptoms were assessed by separate questions on the Kidney Disease Quality of Life-36 instrument (zero- to 100-point scale). The longitudinal association between eGFR and uremic symptom severity score was examined with multivariable adjusted linear mixed-effects models with random intercepts and random slopes. The mean±SD eGFR at baseline was 44±15 ml/min per 1.73 m2, and participants had a median of six (interquartile range 3-11) simultaneous assessments of eGFR and uremic symptoms over the duration of follow-up. The most prevalent symptoms at baseline were pain (57%), fatigue (52%), paresthesia (45%), and pruritus (42%). In adjusted models, a decrease in eGFR of 5 ml/min per 1.73 m2 was associated with a worsening of the symptom severity score by two points or less for each uremic symptom (P<0.01; zero- to 100-point scale). The association between eGFR and uremic symptom severity score was nonlinear. When starting from a lower initial eGFR, a 5 ml/min per 1.73 m2 decrease in eGFR was associated with a greater magnitude of uremic symptom worsening. The prevalence of uremic symptoms in CKD is high, with significant variability in patient symptom change over time. Declines in eGFR were associated with worsening of uremic symptom severity, but the magnitude of these changes is small and of uncertain clinical significance.

Best Practices for the Management of Chronic Idiopathic Constipation and Irritable Bowel Syndrome With Constipation: A Roundtable Discussion and Review.

Chronic idiopathic constipation (CIC) and irritable bowel syndrome with constipation (IBS-C) are highly prevalent conditions that affect a significant proportion of the US population. Pathogenic, diagnostic, and treatment paradigms for patients with constipation have changed considerably over time. A clinical roundtable consisting of experts from across the United States was convened (virtually) to discuss the burden of constipation and current evidence-based diagnostic and management tools at a mechanistic level, with a primary goal of determining realistic clinical strategies to improve outcomes in patients with CIC or IBS-C. This 4-part supplement provides a critical review and discussion of the burden of illness and strategies for the diagnosis and management of CIC and IBS-C. These common and bothersome disorders of gut–brain interaction present a spectrum of stool-related symptoms such as infrequent bowel movements, hard stools, excessive straining, and an overall sensation of incomplete evacuation or obstruction. In addition, patients commonly report a variety of non‒stool-related abdominal symptoms that are often directly related to the patients' severity of CIC or IBS-C. The overlapping symptomatology of CIC and IBS-C have a significant impact on health-related quality of life, with individuals reporting frustration, shame, and embarrassment, along with an overall sense of helplessness. Many patients cycle through multiple treatment options in an attempt to manage their abdominal symptoms and to regulate bowel frequency and stool consistency. For healthcare providers, central to the management of patients with CIC or IBS-C is the utilization of a patient-centered communication approach that ensures understanding of symptom type and intensity, accurate symptom reporting, and compliance to treatment. Although treatment strategies for patients with CIC and IBS-C can often be challenging—with many patients unaware of available treatment options and instead choosing to self-medicate with diet or over-the-counter strategies—it is vital that patients are educated about symptomatology and available treatments, actively monitored for changes in symptom severity and response to treatment, and appropriately managed to maximize clinical outcomes such as patient adherence and cost benefit. My colleagues and I hope that this supplement provides practitioners, such as gastroenterologists, and the medical community at-large with a better understanding of the burden and unmet needs of patients with CIC or IBS-C. With this recognition, we hope to improve management outcomes. CONFLICTS OF INTEREST Guarantor of the article: Darren M. Brenner, MD. Specific author contributions: Darren M. Brenner moderated and participated in the advisory board discussions, contributed to the drafting of the manuscript, provided critical revision of all manuscript drafts for important intellectual content, and approved the final version for publication. Financial support: This supplement was funded by Salix Pharmaceuticals, Inc. Potential competing interests: D.M.B. is a consultant, advisor, and/or speaker for Salix, AbbVie (Allergan), Ironwood, Takeda, RedHill, Alnylam, AlphaSigma, Bayer, Arena Pharmaceuticals, GI Health Foundation, IFFGD, and the Rome Foundation. His research is sponsored by an unrestricted grant from the Irene D. Pritzker Foundation.

Digital Therapeutics Care Utilizing Genetic and Gut Microbiome Signals for the Management of Functional Gastrointestinal Disorders: Results From a Preliminary Retrospective Study.

Diet and lifestyle-related illnesses including functional gastrointestinal disorders (FGIDs) and obesity are rapidly emerging health issues worldwide. Research has focused on addressing FGIDs via in-person cognitive-behavioral therapies, diet modulation and pharmaceutical intervention. Yet, there is paucity of research reporting on digital therapeutics care delivering weight loss and reduction of FGID symptom severity, and on modeling FGID status and symptom severity reduction including personalized genomic SNPs and gut microbiome signals. Our aim for this study was to assess how effective a digital therapeutics intervention personalized on genomic SNPs and gut microbiome signals was at reducing symptomatology of FGIDs on individuals that successfully lost body weight. We also aimed at modeling FGID status and FGID symptom severity reduction using demographics, genomic SNPs, and gut microbiome variables. This study sought to train a logistic regression model to differentiate the FGID status of subjects enrolled in a digital therapeutics care program using demographic, genetic, and baseline microbiome data. We also trained linear regression models to ascertain changes in FGID symptom severity of subjects at the time of achieving 5% or more of body weight loss compared to baseline. For this we utilized a cohort of 177 adults who reached 5% or more weight loss on the Digbi Health personalized digital care program, who were retrospectively surveyed about changes in symptom severity of their FGIDs and other comorbidities before and after the program. Gut microbiome taxa and demographics were the strongest predictors of FGID status. The digital therapeutics program implemented, reduced the summative severity of symptoms for 89.42% (93/104) of users who reported FGIDs. Reduction in summative FGID symptom severity and IBS symptom severity were best modeled by a mixture of genomic and microbiome predictors, whereas reduction in diarrhea and constipation symptom severity were best modeled by microbiome predictors only. This preliminary retrospective study generated diagnostic models for FGID status as well as therapeutic models for reduction of FGID symptom severity. Moreover, these therapeutic models generate testable hypotheses for associations of a number of biomarkers in the prognosis of FGIDs symptomatology.