Changes In Symptom Severity Research Articles

An examination of relationship satisfaction as a predictor of outcomes of brief couple therapy for posttraumatic stress disorder.

The pretreatment quality of intimate relationships can promote or interfere with couple therapy for posttraumatic stress disorder (PTSD) treatment response. We tested whether baseline relationship satisfaction predicted clinical and process outcomes in two dyadic treatments for PTSD. Using data from a randomized trial comparing brief cognitive behavioral conjoint therapy (bCBCT) for PTSD to PTSD family education (PFE) among 137 military veterans and their partners (N = 274, Mage = 42.3 years, 46.7% White, 81.0% male veteran partner), we examined whether baseline relationship satisfaction (Couples Satisfaction Index; CSI-32) predicted change in PTSD symptom severity (Clinician Administered PTSD Scale for DSM-5; CAPS-5), psychosocial functioning (Brief Inventory of Psychosocial Functioning; B-IPF), and relationship satisfaction at posttreatment and 6-month follow-up. We also explored associations with process outcomes (working alliance, treatment satisfaction, dropout). In both treatment conditions, neither partner's baseline CSI-32 score moderated change in veteran CAPS-5 or B-IPF score or any process variable. However, baseline CSI-32 scores moderated both partners' CSI-32 score change during bCBCT and PFE; participants who scored in the distressed range at baseline (n = 123) experienced significant improvements in relationship satisfaction, β = .199, whereas there was no change among those in the nondistressed range at baseline (n = 151), β = .025. Results suggest bCBCT and PFE are effective in improving PTSD symptoms and psychosocial functioning regardless of whether a couple is experiencing clinically significant relationship distress; further, these treatments improve relationship satisfaction for the most distressed individuals.

PEP-flute selfcare in epidemic respiratory infectious diseases – high societal impact at low cost?

Abstract Background The COVID-19 pandemic has led to worldwide increases in mortality and disrupted healthcare systems. The necessary countermeasures have adversely affected our lives, both mentally and economically. Home-based interventions to help individuals with early COVID-19 overcome the disease with fewer symptoms are needed. This study explored if self-care using positive expiratory pressure (PEP) as airway clearance is effective in reducing respiratory symptoms and, thus hypothetically prevent COVID-19 associated pneumonia. Methods This open-label, randomized trial (ClinicalTrials.gov:NCT04530435) recruited community dwelling adults from Capital Region and Region Zealand in Denmark from 6 Oct 2020 to 26 Feb 2021. Eligible participants (verified SARS-CoV-2 infection, COVID-19 symptoms, and able to perform self-care) were randomized to usual care or to PEP-flute self-care (PEP thrice daily) as an add-on to usual care. PEP-flutes were delivered by express mail and instructions given by video-links. The primary outcome was a change (analyzed by repeated measures mixed linear models) in self-reported symptom severity from baseline to day 30, as assessed by the COPD (chronic obstructive pulmonary disease) assessment test (CAT). Another outcome was the perceived effect of PEP-selfcare. Results The PEP self-care group (n = 190) had significantly lower symptom severity (group difference -1.2 points (95% confidence interval -2.1 to -0.2; p = 0.017)) at day 30 compared to the usual care group (n = 188). The PEP self-care group reported less chest tightness, less dyspnea, more vigor, and higher level of daily activity. When asked, “How do you describe the PEP-flute effect?”, 30% (n = 56) from the PEP group reported PEP-use to provoke coughing of phlegm. No serious adverse events were reported. Conclusions In early COVID-19, PEP-flute self-care was effective in reducing respiratory symptom severity among community dwelling adults and may have a future societal impact at a low cost. Key messages • We advocate for more research in self-care interventions to confirm if campaigns and handouts of PEP-flutes to mobilize the citizens’ selfcare are suitable public health responses to the next pandemic. • More research is needed to establish efficacy of non-drug interventions like PEP-selfcare for airway clearance to prevent pneumonia.

Evaluation of a Low-Intensity Online Intervention (LiON) for Reducing Distress and Mental Health Symptoms in Young People

PurposeEnhancing young people’s mental health is crucial given that most adult mental disorders develop before age 24 years. However, it is unclear whether low-intensity interventions delivered online can be effective. This study aimed to provide preliminary evidence on whether a low-intensity online intervention (LiON) can effectively lower young people’s distress levels and mental health symptoms. MethodsWe compared the preintervention and postintervention changes in distress level and severity of depression and anxiety symptoms in 137 young people aged 15–24 years who used the LiON service with the three-month changes in a 1:1 propensity score–matched control group of community young people who did not use the service. They participated in one of the following modules for the first time: (1) sleep and relaxation, (2) stress-coping, and (3) problem-solving. ResultsParticipants who received LiON intervention (mean age 22.88 [standard deviation 3.67] years, 65.7% female) showed significantly greater reductions in distress level (Cohen’s f2: 0.079), as well as the severity of depressive symptoms (Cohen’s f2: 0.056) and anxiety symptoms (Cohen’s f2: 0.044) compared to the control group. DiscussionThe findings suggest that the LiON intervention has the potential to effectively reduce distress and mental health symptoms in young people. Future research should aim to confirm these findings through randomized controlled trials and explore the cost-effectiveness of the intervention.

Treatment of dyspeptic symptoms with YamatoGast. A non-interventional study of a registered traditional herbal Rikkunshito extract product from Japanese Kampo Medicine in routine practice in Germany.

Dyspeptic symptoms belong to the most frequent reasons to seek medical advice and are a burden both for the individual affected and the healthcare system. In Japan, the traditional herbal Kampo prescription rikkunshito has proven benefit for this indication. In a prospective, multicentre, non-interventional study (NIS), the effectiveness, safety, and tolerability of a two-week treatment with the registered rikkunshito extract product YamatoGast was assessed in German patients with an acute episode of dyspeptic symptoms of functional origin under real-world conditions. The primary endpoint was the responsiveness to treatment assessed by the overall treatment effect (OTE) score. Secondary endpoints were the change in severity of dyspeptic symptoms and the change in quality of life (QoL). Safety evaluation was based on reported adverse drug reactions, drug compliance, and ratings of tolerability by physicians and patients. Sixty-six patients were enrolled (mean age 48.9 years, 74% females). The treatment was well tolerated and highly beneficial, as expressed by pronounced responder rates of 78.9% for the primary endpoint OTE. All secondary endpoints were also met. The severity of dyspeptic symptoms significantly improved by 62-77% compared to baseline, confirmed by a remarkable improvement of QoL. Significant symptom relief started from the third day of treatment onwards. In this non-interventional study, two-week treatment with YamatoGast resulted in a significant improvement of dyspeptic symptoms and was associated with high patient response and satisfaction. YamatoGast was confirmed as a safe and clinically relevant therapeutic option for patients suffering upper gastrointestinal complaints in routine practice.

GPi-DBS-induced brain metabolic activation in cervical dystonia

BackgroundDeep brain stimulation (DBS) of the globus pallidus interna (GPi) is a highly efficacious treatment for cervical dystonia, but its mechanism of action is not fully understood. Here, we investigate...

Improved Symptom Change Enhances Quality of Dying in Patients With Advanced Cancer: An East Asian Cross-Cultural Study.

Symptom burdens tend to increase for patients with cancer and their families over the disease trajectory. There is still a lack of evidence on the associations between symptom changes and the quality of dying and death. In this context, this research investigated how symptom changes influence the quality of dying and death. This international prospective cohort study (the East Asian Collaborative Cross-Cultural Study to Elucidate the Dying Process (EASED), 2017-2019) included 22, 11, and 4 palliative care units across Japan, South Korea, and Taiwan. Eligible participants were adults (Japan and Korea, ≥18 years; Taiwan, ≥20 years) with locally advanced or metastatic cancer. Physical and psychological symptoms were assessed by physicians upon admission and within 3 days before death. Death quality was assessed using the Good Death Scale (GDS), developed in Taiwan. Univariate and multivariate regression analyses were used to identify correlations between symptom severity changes and GDS scores. Among 998 patients (542 [54.3%] men and 456 [45.7%] women; mean [SD] age = 70.1 [± 12.5] years), persistent dyspnea was associated with lower GDS scores when compared to stable dyspnea (β = -0.427, 95% CI = -0.783 to -0.071). Worsened (-1.381, -1.932 to -0.831) and persistent (-1.680, -2.701 to -0.659) delirium were also significantly associated with lower GDS scores. Better quality of dying and death was associated with improved symptom control, especially for dyspnea and delirium. Integrating an outcome measurement for the quality of dying and death is important in the management of symptoms across the disease trajectory in a goal-concordant manner.

Changes in posttraumatic stress disorder symptom severity during the COVID-19 pandemic: Ten-wave findings from a longitudinal observational cohort study of community adults

Few studies have examined changes in posttraumatic-stress disorder (PTSD) symptomatology across an extended time period during the COVID-19 pandemic. This study used a longitudinal cohort design to examine: (1) changes in overall PTSD symptoms and symptom clusters; (2) moderators of change; (3) the clinical significance of observed changes; and (4) correlates of clinically meaningful changes. Community adults (N = 1412) were assessed using the PTSD Checklist for DSM-5 (PCL-5) at 10 timepoints (October 2018 - April 2022). Changes in overall PCL-5 score and symptom clusters were substantially moderated by pre-pandemic clinical severity (i.e., above/below PCL-5 cut-off). Pre-pandemic non-clinical participants exhibited increases in overall scores, Cluster D (negative cognitions), and Cluster E (arousal), while clinically elevated participants exhibited decreases overall and in all clusters. Regarding clinical significance, 12% of pre-pandemic non-clinical participants exhibited clinically meaningful increases, and 4% exhibited decreases. Conversely, 42% of the pre-pandemic elevated group exhibited clinically meaningful decreases, while 6% exhibited increases. Pandemic impacts in numerous psychosocial domains were associated with clinically meaningful change. Collectively, these findings reveal substantively divergent trajectories by pre-pandemic severity and PTSD symptom cluster. The large proportion of pre-pandemic high-severity participants exhibiting sizable decreases was an unexpected notable observation.

Association between longitudinal changes in striatal dopamine transporter uptake and clinical features of dementia with Lewy bodies.

It is widely known that there is low striatal 123 I-2β-Carbomethoxy-3β-(4-iodophenyl)-N-(3- fluoropropyl) nortropane (123 I-FP-CIT) dopamine transporter single photon emission tomography (DaT-SPECT) uptake in patients with dementia with Lewy bodies (DLB). No studies to date have analyzed the association between longitudinal changes of clinical features and DaT uptake in patients with Parkinson syndrome, particularly those with DLB. The aim of this study was to investigate the association between the longitudinal changes in DaT uptake and the severity of parkinsonism and cognitive function in DLB patients. A total of 35 outpatients with probable DLB who underwent DaT-SPECT twice (at the initial examination and the follow-up period) in the Memory Disorder Clinic at the Department of Geriatric Medicine, Tokyo Medical University, were enrolled in this study between April 2014 and September 2020. The correlation between annual changes in DaT uptake and clinical features (cognitive function decline and parkinsonism) of the patients was analyzed. A significant correlation was detected between annual changes in parkinsonism symptom severity and DaT uptake in the left posterior putamen (r = -0.39, P = 0.03), and between Mini-Mental State Examination scores and DaT uptake in all regions except the right posterior putamen (P < 0.05) in patients with DLB. Our results suggested that the pathway from the ventrolateral tier of the substantia nigra to the putamen might be more crucial for motor function than other pathways, not only in Parkinson's disease but also in DLB.

Brief cognitive-behavioral treatment for avoidant/restrictive food intake disorder in the context of functional dyspepsia: Study protocol for a feasibility randomized controlled trial

BackgroundAvoidant/restrictive food intake disorder (ARFID) symptoms are common (up to 40%) among adults with functional dyspepsia (FD), a disorder of gut-brain interaction characterized by early satiation, post-prandial fullness, epigastric pain, and/or epigastric burning. Using an 8-session exposure-based cognitive-behavioral treatment (CBT) for adults with FD + ARFID compared to usual care (UC) alone, we aim to: (1) determine feasibility, (2) evaluate change in clinical outcomes in, and (3) explore possible mechanisms of action. MethodsWe will randomize adults with FD who meet criteria for ARFID with ≥5% weight loss (N = 50) in a 1:1 ratio to CBT (with continued UC) or to UC alone. A priori primary benchmarks will be: ≥75% eligible participants enroll; ≥75% participants complete assessments; ≥70% participants attend 6/8 sessions; ≥70% of sessions have all content delivered; ≥70% participants rate Client Satisfaction Questionnaire scores above scale midpoint. We will also examine the size of changes in FD symptom severity and related quality of life within and between groups, and explore possible mechanisms of action. ConclusionsFindings from this trial will inform next steps with treatment development or evaluation—either for further refinement or for next-step efficacy testing with a fully-powered clinical trial.

Treatment motivation in child anxiety treatment – Factor structure and associations with outcomes

Motivation is associated with cognitive behavioral treatment (CBT) outcomes. We examined the factor structure of a motivation measure, and if motivation factors were differentially associated with CBT outcomes for children with anxiety. The sample comprised 179 children aged 8–15 years (M age = 11.5 years, SD = 2.1; 53.0% girls) with anxiety disorders who received CBT in a randomized controlled community clinic trial. Participants completed the Nijmegen Motivation List – child version (NML-C) at treatment onset. Outcomes were diagnostic recovery, anxiety/depression symptom and clinical severity change from pre-treatment to post-treatment, one-, and 3.9-years follow-up, and treatment dropout. Principal component analysis showed that the NML-C comprised two factors, preparedness (beliefs that CBT is useful and willingness to engage in treatment; 36.4% explained variance) and distress (discomfort from symptoms and perceived urgency to be helped; 12.7% explained variance). Higher preparedness predicted larger clinical severity reduction at post-treatment, alongside pre-treatment clinical severity. Higher distress predicted larger depression reduction at one-year follow-up, alongside pre-treatment depression. Higher preparedness predicted lower dropout. In conclusion, the NML-C comprises two factors that are differentially associated with CBT outcomes, but not above the effects of pre-treatment symptoms. Clinicians' focus on children's distress and preparedness could enhance CBT outcomes and reduce dropout.

Changes in Symptom Severity and Sleeping Habits After Earthquake in Children and Adolescents with Autism Spectrum Disorder: The Case of the Kahramanmaras Earthquake in 2023, Turkey

Changes in Symptom Severity and Sleeping Habits After Earthquake in Children and Adolescents with Autism Spectrum Disorder: The Case of the Kahramanmaras Earthquake in 2023, Turkey

Abstract P339: Association Between Self-monitored Blood Pressure, Heart Rate, And Anxiety Symptoms In A Digital Heart Health Self-management Program

Introduction: Anxiety is a risk factor for hypertension and other cardiovascular (CV) diseases, and this relationship may be mediated by direct biological effects and/or indirectly via behaviors. We aimed to study the association between change in blood pressure (BP), heart rate (HR), and anxiety symptom severity among participants enrolled in a smartphone-based CV risk self-management program. Methods: We retrospectively studied participants with hypertension engaging with digital coaching focused on non-pharmacological lifestyle interventions, and who completed at least two generalized anxiety disorder (GAD-7) questionnaires between April 2020 and March 2023. Change in GAD-7 score was correlated with change in systolic BP, diastolic BP, and HR, controlling for age, gender, number of GAD-7 self-assessments, and initial GAD-7 score. Median BP and HR for the week of each GAD-7 self-assessment was used, and all change scores were converted to rate of change per day to control for variable time between scores. Results: A total of 5079 (age 58 ± 0.15y, 58% female) participants were included. Median days between GAD-7 scores was 148 (IQR 47-330). At baseline, mean GAD-7 was 7 (± 0.001), mean BP was 135/83 (± 0.28/0.18) mm Hg, and mean HR was 75 (± 0.22) bpm. Severe anxiety (GAD-7 &gt; 14) was reported in 605 (12%) participants, and 34.3% were stage 2 hypertensive. By follow up, most of those with severe anxiety at baseline (430, 71%) showed reduced GAD-7 score (mean change = -4.5 ± 0.23). Both SBP (β = 0.03 ± 0.008, t = 3.6) and HR (β = 0.02 ± 0.009, t = 2.3) rate of change were associated with GAD-7 change such that the more participants reduced SBP or HR, the greater the reduction in anxiety symptoms. Initial GAD-7 scores were negatively associated with GAD change (β = -0.2 ± 0.016, t = -12.3). No other variable was statistically significant (all ps &gt; 0.15). Conclusion: In a smartphone-based CV risk self-management program, reduction in systolic BP and HR is associated with improvement in anxiety symptoms, suggesting that digital coaching targeting CV risk factors has the potential to also improve mental health.

Are informants required to obtain valid ratings on the Positive and Negative Syndrome Scale (PANSS)?

Ratings on the Positive and Negative Syndrome Scale (PANSS) are ideally based on both a patient interview and an informant questionnaire. In research and clinical settings, however, the informant questionnaire is often omitted. This study investigated the consequences of omitting informant information by comparing PANSS ratings of patients with schizophrenia (n = 49 patients, 77 ratings) conducted with and without informant information, respectively. Additionally, changes in symptom severity over time based on ratings with and without informant information were also compared for the full PANSS and the six-item version of the PANSS (PANSS-6). PANSS ratings including informant information were higher than those without, both at the total score and individual item level. Additionally, the full PANSS appeared less “responsive” to baseline-to-endpoint changes for ratings without informant information compared to ratings including informant information, while no differences were found for the PANSS-6.

The Effect of Coenzyme Q10 as a Prophylactic Treatment in Episodic Migraine

Aim: Migraine is a neurological disorder characterized by recurring and often severe headaches. The aim of this study was to evaluate the effectiveness of coenzyme Q10 (CoQ10) in episodic migraine prophylaxis. Material and Methods: In a prospective follow-up study, 80 patients with episodic migraine were enrolled according to the International Classification of Headache Disorders 3rd edition and divided into two groups. One group consisted of 40 patients who received CoQ10 oral 200 mg twice daily as monotherapy for three months, while the other group consisted of 40 patients who received CoQ10 as an adjunct therapy in combination with other prophylactic antimigraine drugs. The Migraine Disability Assessment (MIDAS) questionnaire was administered to both groups before and after three months of therapy. Throughout the three-month therapy period, patients recorded daily symptoms, allowing for observation of changes in symptom severity, number, and duration of attacks from baseline. Results: Both groups that received CoQ10 supplementation exhibited positive responses. The group receiving adjunct therapy showed a statistically more significant reduction in the MIDAS (p&amp;lt;0.001), duration (p&amp;lt;0.001), and frequency (p&amp;lt;0.001) of attacks compared to the monotherapy group. Vomiting (p&amp;lt;0.001) in the adjunct therapy group completely disappeared and sound sensitivity (p=0.002) showed a dramatic response to treatment. Conclusion: CoQ10 appears to have more beneficial effects as an adjunct than monotherapy in reducing the duration, frequency, and presenting symptoms such as nausea, vomiting, and light sensitivity, in addition to sound sensitivity that responded only to adjunct therapy than monotherapy among Iraqi patients with episodic migraine.

Written Exposure Therapy vs Prolonged Exposure Therapy in the Treatment of Posttraumatic Stress Disorder

Evidence-based treatments for posttraumatic stress disorder (PTSD) exist, but all require 8 to 15 sessions and thus are less likely to be completed than brief treatments. Written exposure therapy (WET) is a brief and efficacious treatment that has not been directly compared with prolonged exposure therapy (PE), a more time-intensive, exposure-based treatment. To determine whether WET is noninferior to PE in treating PTSD among veterans. A randomized noninferiority clinical trial was conducted between September 9, 2019, and April 30, 2022. Participants were 178 veterans with PTSD presenting to 1 of 3 Veterans Affairs medical centers. Inclusion criteria consisted of a primary diagnosis of PTSD and stable medication. Exclusion criteria included current psychotherapy for PTSD, high suicide risk, active psychosis, unstable bipolar disorder, and severe cognitive impairment. Independent evaluations were conducted at baseline and 10, 20, and 30 weeks after the first treatment session. Data were analyzed from January 1 to March 31, 2023. Participants assigned to WET (n = 88) received five to seven 45- to 60-minute sessions. Participants assigned to PE (n = 90) received eight to fifteen 90-minute sessions. The WET sessions included 30 minutes of writing-based imaginal exposure conducted in session, whereas PE sessions included 40 minutes of in-session imaginal exposure and between-session in vivo exposures. The primary outcome was change in PTSD symptom severity measured with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) from baseline to the 20-week assessment; noninferiority was defined as a less than 10-point difference between the 2 treatment groups. Difference in treatment dropout was also examined. Of the 178 participants, 134 (75.3%) were men, and the mean (SD) age was 44.97 (13.66) years. In terms of race, 37 participants (20.8%) were Black, 112 (62.9%) were White, 11 (6.2%) were more than 1 race, and 18 (10.1%) were of other race (including American Indian or Alaska Native, Asian, and Native Hawaiian or Other Pacific Islander [some participants did not specify their race when selecting the category "other"]); in terms of ethnicity, 19 participants (10.7%) were Hispanic. Changes in PTSD symptom severity from baseline to all subsequent assessments among individuals randomized to WET were noninferior relative to individuals randomized to PE. The largest difference between treatments was observed at 10 weeks and was in favor of WET (mean difference, 2.42 [95% CI, 0.35-1.46] points). Participants were significantly less likely to drop out of WET compared with PE (11 [12.5%] vs 32 [35.6%]; χ2 = 12.91; Cramer V = 0.27). In this study, WET was noninferior to PE in PTSD symptom change and was associated with significantly less attrition. Findings suggest that WET may transcend previously observed barriers to PTSD treatment for both patients and clinicians. ClinicalTrials.gov Identifier: NCT03962504.

Multilingual markers of depression in remotely collected speech samples: A preliminary analysis

BackgroundSpeech contains neuromuscular, physiological and cognitive components, and so is a potential biomarker of mental disorders. Previous studies indicate that speaking rate and pausing are associated with major depressive disorder (MDD). However, results are inconclusive as many studies are small and underpowered and do not include clinical samples. These studies have also been unilingual and use speech collected in controlled settings. If speech markers are to help understand the onset and progress of MDD, we need to uncover markers that are robust to language and establish the strength of associations in real-world data. MethodsWe collected speech data in 585 participants with a history of MDD in the United Kingdom, Spain, and Netherlands as part of the RADAR-MDD study. Participants recorded their speech via smartphones every two weeks for 18 months. Linear mixed models were used to estimate the strength of specific markers of depression from a set of 28 speech features. ResultsIncreased depressive symptoms were associated with speech rate, articulation rate and intensity of speech elicited from a scripted task. These features had consistently stronger effect sizes than pauses. LimitationsOur findings are derived at the cohort level so may have limited impact on identifying intra-individual speech changes associated with changes in symptom severity. The analysis of features averaged over the entire recording may have underestimated the importance of some features. ConclusionsParticipants with more severe depressive symptoms spoke more slowly and quietly. Our findings are from a real-world, multilingual, clinical dataset so represent a step-change in the usefulness of speech as a digital phenotype of MDD.

Examining trauma cognition change trajectories among initial PTSD treatment non-optimal responders: a potential avenue to guide subsequent treatment selection

ABSTRACT Background: Despite their general effectiveness, 14-50% of individuals do not fully respond to evidence-based treatments for posttraumatic stress disorder (PTSD). Although changes in negative posttrauma cognitions (NPCs) are considered a likely PTSD treatment mechanism, less is known about how NPCs change among individuals who continue to be symptomatic following treatment (non-optimal responders). Objective: The objective of this study was to examine NPC change trajectories among individuals who were determined to be non-optimally responsive to intensive PTSD treatment. Method: Using a 3-week Cognitive Processing Therapy-based intensive PTSD treatment sample (ITP; N = 243), the present study examined the number of distinct NPC change trajectories among non-optimal responders via Group Based Trajectory Modeling and assessed predictors of non-optimal responders’ NPC change trajectory membership. Analyses were replicated in a separate 2-week ITP sample (N = 215). Results: In both non-optimal responder samples, two trajectories emerged; a no NPC change group which represented those with an overall lack of NPC change throughout treatment and an NPC change group which represented those with an overall reduction of NPCs occurring primarily later in treatment. Changes in PTSD symptom severity during treatment was the only consistent predictor of NPC change trajectory group membership among treatment non-optimal responders across ITPs. Conclusions: Findings suggest NPC change among non-optimal responders is nuanced and may inform subsequent intervention selection, resulting in testable hypotheses for future research.

Family Accommodation in Intensive/Residential Treatment for Adults With OCD: A Cross-Lagged Panel Analysis

Many adults with OCD experience residual symptoms following CBT, with or without medication. A potential target for enhancing treatment effectiveness is family accommodation (FA). This study examined (1) possible sociodemographic and clinical correlates of FA in adults presenting for intensive/residential treatment, and (2) temporal relationships between FA and OCD symptom severity during acute treatment and follow-up phases. Adult patients (N = 315) completed baseline measures of FA and OCD symptom severity at admission to IRT. Follow-up data were collected from a subset of participants (n = 111) at discharge, 1-month, and 6-month follow-up. Cross-lagged panel analysis showed that changes in OCD symptom severity from admission to discharge predicted changes in FA from discharge to 1-month follow-up. Increases in FA from discharge to 1-month follow-up predicted increases in OCD symptom severity from 1-month to 6-month follow-up. Female patients reported greater baseline FA from their family members than did males, and there were no significant differences in FA by relationship type or marital status. Contamination, Responsibility for Harm, and Symmetry/Incompleteness symptoms were each found to uniquely predict FA at admission. Results from this study provide support for the temporal precedence of FA reduction in OCD symptom improvement as adults transition home following residential treatment.

The Efficacy and Safety of Single-Strain Probiotic Formulations Containing Bifidobacterium lactis or Bacillus coagulans in Adult Patients with Irritable Bowel Syndrome-A Randomized Double-Blind Placebo-Controlled Three-Arm Interventional Trial.

Probiotics offer a potential new therapeutic approach for irritable bowel syndrome (IBS), but current results are still controversial. The aim of this study was to assess the efficacy and safety of single-strain probiotic formulations in adult IBS patients and to compare the effects of Bifidobacterium lactis NORDBIOTIC™ BI040 (DSM 33812/34614) and Bacillus coagulans NORDBIOTIC™ BC300 (DSM 33836) in a prospective three-arm interventional randomized double-blind placebo-controlled clinical trial. The study included 123 IBS subjects diagnosed according to the Rome IV criteria. The primary outcomes were changes in symptom severity and symptom improvement as assessed using the IBS Severity Scoring System (IBS-SSS) after 4, 8, and 12 weeks of intervention and after 4 weeks of follow-up. Secondary outcomes included the assessment of individual IBS symptoms and the occurrence of adverse events. During the 12-week intervention, IBS-SSS scores significantly decreased (p-values < 0.001) in the study groups but differences between the interventional and placebo groups did not reach statistical significance. However, at the 16th week of follow-up, a significant improvement in the total IBS-SSS score in comparison to the placebo group (20.5%) was found in 43.8% and 52.9% of the Bifidobacterium lactis (p = 0.038, OR 3.0, [95% CI 1.1-8.6]) and the Bacillus coagulans (p = 0.005, OR 4.6 [95% CI 1.5-12.2]) groups, respectively. Bifidobacterium lactis had a beneficial effect on the intensity and frequency of pain, whereas Bacillus coagulans decreased the bowel dissatisfaction. Both strains increased the percentage of patients with normal stool consistency, but only Bifidobacterium lactis induced a decrease in the number of patients with constipation after 6 weeks of supplementation. Both probiotic strains were well tolerated, without differences in the occurrence of adverse events between groups. In conclusion, single-strain supplementation was safe and efficient in IBS patients but showed a different range of effects. Bifidobacterium lactis BI040 primarily reduced the frequency and intensity of pain, while Bacillus coagulans BC300 increased bowel satisfaction [ClinicalTrials.gov NCT05064930].

Changes in cardiac output, rhythm regularity, and symptom severity after electrical cardioversion of atrial fibrillation

Objectives Symptoms in atrial fibrillation (AF) range from none to disabling. The physiological correlates of AF symptoms are not well characterized. This study investigated the association between physiological parameters and symptom severity before and after electrical cardioversion (EC) of AF. Design We studied 44 patients with persistent AF (age 66.2 ± 7.9 years, 16% females) 4 ± 2 days before and 5 ± 2 days after EC. Physiological parameters included cardiac output (CO; non-invasive inert gas rebreathing), heart rate (HR), RR variability and resting and ambulatory blood pressure (BP). Symptoms and quality of life (QoL) were assessed by the modified European Heart Rhythm Association score (mEHRA), the Atrial Fibrillation Effect on Quality of Life (AFEQT) and the Symptom Checklist for frequency and severity of symptoms (SCL). Results 28 of 44 patients were still in sinus rhythm (SR) at post EC evaluation. Those in SR had a decreased HR (-15.4 ± 13.1 bpm, p < 0.001), and an increased CO (+0.8 ± 0.7 L/min, p < 0.001) as compared to those with recurrent AF. Changes in CO after EC correlated with symptom improvement as scored by AFEQT (r = 0.36; p < 0.05), AFEQT symptoms subscore (r = 0.46; p < 0.01), SCL for frequency (r = 0.62; p < 0.01) and severity (r = 0.33; p < 0.05) of symptoms, and the mEHRA score (r = 0.50; p < 0.01). A decrease in RR variability showed similar correlations with these measures of symptom improvement. Conclusions Improvements in symptoms and quality of life experienced by patients after electrical conversion of atrial fibrillation are correlated with an increase in CO and a decreased RR variability.