Changes In Symptoms Research Articles

Should face-to-face in-person therapy be preserved for some clients with anxiety? Evaluation of Anxiety UK's psychological therapy services before and during the COVID-19 pandemic.

The COVID-19 pandemic initiated a mass switch to psychological therapy being delivered remotely, including at Anxiety UK, a national mental health charity. Understanding the impact of this forced switch could raise implications for the provision of psychological therapies going forwards. To understand whether the forced switch to remote therapy had any impact on outcomes, and if certain groups should continue to be routinely offered certain delivery modalities in future. Data were available for 2323 individuals who accessed Anxiety UK services between January 2019 and October 2021. Demographic data, baseline and discharge anxiety and depression symptoms, and mode of therapy delivery were available.Regression models were built to model (a) the mode of therapy delivery received pre-pandemic using logistic regression, and (b) outcomes pre- and post-pandemic onset within demographic groups. No statistically significant changes in baseline anxiety symptoms, demographics or outcomes were observed before and after the onset of the COVID-19 pandemic.Pre-pandemic, males were more likely to receive online video therapy than telephone therapy (Relative Risk Ratio (RRR) 1.42, [1.01, 1.99]), while older clients were less likely to receive online video therapy (RRR 0.98, [0.97, 0.99]). However, no differences in outcomes were observed post-pandemic onset within these groups, with only the number of sessions of therapy being a significant predictor of outcomes. Anxiety UK services remained effective throughout the pandemic. We observed no evidence that any demographic group had worse outcomes following the forced switch to remote therapy.

Increasing outcome measurement precision: Network analysis of items on the Outcome Questionnaire-45.

Psychotherapy outcome research mainly focuses on scale-level changes and constructs that were developed using cross-sectional statistical analysis, possibly concealing important findings on the level of single items, and limiting the clinical utility of outcome scales. Our goal was to explore changes in symptoms, interpersonal problems, and level of functioning in everyday life and to establish groups of items with similar rates of change that could be used to form more coherent targets for measuring different therapeutic outcomes. Triangulated maximally filtered graphs were used to model the network structure of the Outcome Questionnaire-45 in a data set of N = 12,075 university counseling center patients. Dynamic exploratory graph analysis was used to establish communities of items with similar rates of change. Five item communities (anxiety, hopelessness, interpersonal problems, well-being, and work impairment) were found. Compared to the original Outcome Questionnaire-45 subscales, they showed better fit to the data. The "hopelessness" community, which describes the extent of a patient's demoralization before the start of therapy, had a significantly higher rate of change compared to other communities. The discerned item communities provide clinicians with theoretically grounded, precise targets for outcome tracking, thereby enhancing the responsiveness and adaptability of treatment interventions to individual client trajectories. Such granularity enriches our understanding of therapeutic change, with direct implications for tailoring intervention strategies to maximize early therapeutic gains and sustain long-term recovery. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Clinical outcomes and outcome predictors of two-year assertive community treatment in Norway: an explorative prospective pre–post study

BackgroundAssertive Community Treatment (ACT) teams have become a part of mental health services for people with severe mental illness in many high-income countries. Studies in several countries have investigated the outcomes of ACT, and knowledge is also needed about outcomes of ACT teams in Norway. Our aims were to study clinical outcomes of ACT, how the outcomes were associated with characteristics of patients and treatment, and whether they differed across ACT teams.MethodsOur explorative, prospective, pre–post multicenter study involved 142 patients who received ACT for two years from the first 12 ACT teams established in urban and rural areas of Norway. There was no control group. The primary outcome was change in clinician-rated psychiatric symptoms. Secondary outcomes were clinician-rated change in functioning and engagement and change in community tenure compared with 2 years prior to ACT. We measured fidelity to the ACT model using the Tool for Measurement of Assertive Community Treatment. We performed linear mixed-effects modeling to analyze outcomes and their associations with characteristics of patients and treatment.ResultsAfter two years, psychiatric symptoms were significantly reduced with a small effect size. Negative symptoms, anxiety and depression, and agitation and mania had significant reductions, while positive symptoms had nonsignificant changes. Functioning, engagement, and community tenure all significantly increased with small effect sizes. Age, difficulty to engage, problematic use of alcohol, frequent previous use of inpatient services, total number of sessions, and team’s fidelity to the ACT model were associated with different groups of symptoms. Less improvement in functioning was associated with team fidelity and number of sessions. Change in engagement was not associated with any predictors. Increased community tenure was greater for younger patients and patients who were on community treatment orders at treatment start.ConclusionsACT for two years led to significant positive outcomes with small effect sizes for psychiatric symptoms, functioning, engagement, and community tenure. The outcomes were associated with some potential predictors, and some team-level variance emerged. Positive significant outcomes after two years indicate that larger improvements may be achieved from longer-term treatments by ACT teams.

Perceived Changes in Anxiety Symptom Burden During Treatment with Bryophyllum pinnatum: A Prospective, Single-Arm Study

Background/Objectives: Bryophyllum spp. preparations are widely used in Anthroposophic Medicine, most often for mental and behavioral disorders, including anxiety. Studies in animals revealed various anxiolytic and neurosedative effects for Bryophyllum pinnatum. We set out to investigate the effectiveness of Bryophyllum 50% chewable tablets, a product registered without indication by means of notification in Switzerland, in the treatment of anxiety symptoms in psychiatric and psychosomatic patients. Methods: A total of 99 patients with anxiety symptoms were recruited from the waiting list for an inpatient stay at the hospital “Klinik Arlesheim”, Department of Psychiatry and Psychosomatics; of these, 54 completed the study and returned fully completed questionnaires. Patients were treated with Bryophyllum 50% chewable tablets (350 mg tablets, made from leaf press juice, 3 × 2 per day; Weleda AG Arlesheim, Switzerland) and filled out questionnaires at baseline and after two and three weeks of tablet intake. The primary endpoint of the study was the change in anxiety symptoms measured with the Beck Anxiety Inventory (BAI). Results: A clinically relevant decrease in BAI score from baseline (27.4 ± 12.0) to after two (22.4 ± 12.1; p < 0.001) and three (20.6 ± 12.9; p < 0.001) weeks of treatment was observed. Additional improvements were observed in the secondary endpoints (including in depression, sleep quality, and stress); tolerability and compliance were very good. Conclusions: The results suggest that Bryophyllum 50% chewable tablets have beneficial effects on anxiety-related symptoms. Since the study design does not allow us to conclude causality between treatment and observed improvements, a randomized clinical trial is urgently needed.

Effectiveness of psychological therapies for depression and anxiety in atypical dementia.

People with dementia may benefit from psychological therapies for depression or anxiety, but evidence of their effectiveness in atypical dementia is limited. Using electronic health-care records of > 2 million people who attended psychological therapy services in England between 2012 and 2019, we examined pre-post therapy symptom changes and compared therapy outcomes among 523 people with atypical dementia, a matched cohort without dementia, and 1157 people with typical dementia. People with atypical dementia experienced reductions in depression (Cohen d=-0.92 [-1.05 to -0.79]) and anxiety (d=-0.85 [-0.98 to -0.73]) symptoms. They had similar odds of improvement than people with typical dementia (odds ratio [OR]=1.07, 95% confidence interval [CI]: 0.85 to 1.34), but lower odds than people living without dementia (OR=0.70, 95% CI: 0.53 to 0.91). Reasons for discharge were similar between all groups. People with atypical dementia may benefit from primary care psychological therapies, but further research is needed to explore necessary adaptations. Talking therapies for depression and anxiety may be beneficial for people with atypical dementia. Being younger and havinga lower socioeconomic background are associated with poorer outcomes. Receiving more treatment sessions and shorter waiting times are associated with better outcomes.

Depression symptoms, wellbeing, health-related quality of life, and diabetes-related distress in novel subtypes of recent-onset diabetes in Germany: a 5-year observational follow-up study.

The subjective experiences of individuals living with diabetes is commonly assessed with patient-reported outcomes (PROs; eg, depression symptoms, wellbeing, health-related quality of life [HRQOL], and diabetes-related distress). Cluster analyses have identified novel diabetes subtypes differing in phenotypic and metabolic characteristics. We aimed to investigate associations between these subtypes and PROs and whether subtype predicted PROs 5 years later. Baseline (<12 months after a diabetes diagnosis) and 5-year follow-up data were collected from German Diabetes Study (GDS) participants. Multiple regressions were applied to analyse associations between diabetes subtypes and depression symptoms (Center for Epidemiologic Studies Depression Scale), wellbeing (WHO-5), HRQOL (SF-36), and diabetes-related distress (Problem Areas in Diabetes Scale). Cluster analyses at baseline (n=1391) identified participants with severe autoimmune diabetes (SAID, 417 [30%]), severe insulin-deficient diabetes (SIDD, 33 [2%]), severe insulin-resistant diabetes (SIRD, 150 [11%]), mild obesity-related diabetes (MOD, 354 [25%]), and mild age-related diabetes (MARD, 437 [31%]). At baseline, multiple regression analyses showed that participants with SIRD had higher depression symptoms than participants with MARD and lower physical HRQOL than all other subtypes. Participants with SAID reported higher depression symptoms and lower mental HRQOL than participants with MARD, higher physical HRQOL than participants with MARD and MOD, and higher diabetes-related distress than most other subtypes. At the 5-year follow-up, clustering predicted no statistically significant changes in PROs after adjustment for multiple testing, whereas descriptive analyses demonstrated that individuals with SIRD were more likely to experience clinically relevant depression symptoms (16% vs 6%) and low wellbeing (31% vs 14%), respectively, than individuals with MARD. Diabetes subtypes already differ in PROs at diabetes diagnosis. Our analyses had limited predictive power during follow-up. However, our findings suggest that clustering could predict future changes in depression symptoms. The GDS was initiated and financed by the German Diabetes Center, which is funded by the German Federal Ministry of Health, the Ministry of Culture and Science of the state of North Rhine-Westphalia, and by the German Federal Ministry of Education and Research to the German Center for Diabetes Research. For the German translation of the abstract see Supplementary Materials section.

Investigating the effects of a daily multidisciplinary intensive outpatient rehabilitation program on innovative biomarkers in people with Parkinson's disease: Study protocol for a phase III randomized controlled clinical trial.

To date, there has been no medication that has prevented the progression of Parkinson's disease (PD). Many benefits of intensive and multidisciplinary rehabilitation program for PD are supported by clinical, epidemiological, and experimental data. The main question is whether high-intensity motor and cognitive exercises have an effect on the disease's biological mechanisms. This study protocol is a Randomized Controlled Trial (RCT) designed to determine the efficacy of an experimental, intensive, and multidisciplinary treatment in comparison to a home-based self-treatment in improving biomolecular and functional parameters in PD. A total of 72 participants will be randomly allocated to two different groups, experimental (n = 36) and control group (n = 36). The rehabilitation program will last 6 consecutive weeks and will involve the execution of a total of 30 sessions, one for each day of the week from Monday to Friday. Participants allocated to the control group will carry out a home-based self-treatment program that includes muscle-stretching and active mobilization exercises for 40'/day for 6 consecutive weeks. The primary outcome measure is the effects of both treatments on a new set of molecular biomarkers such as oligomeric alpha-synuclein and neurotrophic factors measured in peripheral neural derived extracellular vesicles (NDEVs). Secondary outcomes will include changes of motor and non-motor symptoms, balance and gait performance and cognitive functioning. This RCT has been registered as "Intensive Multidisciplinary Rehabilitation and Biomarkers in Parkinson's Disease" on 30 May, 2022 to ClinicalTrials.gov with the Study ID number: NCT05452655. This rehabilitation program is believed to be crucial in modifying biomolecular and functional parameters in people with PD. We expect that this study will provide additional evidence to understand the impact of an aerobic and intensive rehabilitation program on brain plasticity in patients with PD.

Efficacy and Safety of Sarpogrelate on Symptom Improvement in Patients with Peripheral Arterial Disease (PAD) and/or Being at Risk of PAD: A Single Arm, Multi-Centered, Open-Label Trial.

To assess the efficacy and safety of sarpogrelate (300 mg) for symptom improvement in patients having peripheral arterial disease (PAD) and/or being at risk of PAD in clinical practice using the Peripheral Artery Questionnaire (PAQ). Symptomatic changes with antiplatelets in patients with PAD are limited. To determine the effect and safety of sarpogrelate on the PAQ at 24 weeks from baseline. A total of 1003 patients having PAD and/or being at risk of PAD from 17 tertiary hospitals in South Korea who were treated with sarpogrelate, were enrolled in this study. PAQs were collected at baseline and at 12 and 24 weeks, together with physical examination and vital signs measurements. Lifestyle pattern was also investigated. The average PAQ Summary Score in the efficacy evaluation analysis group significantly improved from 62.9 ± 23.7 at baseline to 68.9 ± 21.7 at 24 weeks (P<0.0001). Physical limitation items significantly improved from 69.5 ± 30.0 at baseline to 72.9 ± 28.3 after 24 weeks (P=0.0011). Symptom stability also significantly improved from 52.1 ± 21.6 at baseline to 63.6 ± 22.9 after 24 weeks (P<0.0001). Symptoms, treatment satisfaction, quality of life, and social limitation domains all improved after treatment. A total of 201 patients reported adverse events (20.0%), not directly associated with treatment. Treatment with 300 mg (orally) of sarpogrelate demonstrated statistically significant improvements in all domains and for the summary score of the PAQ at 24 weeks, it gave good results in terms of safety. Sarpogrelate may be helpful in reducing symptoms related to PAD.

Omicron-COVID-19-Related Knowledge in Parkinson’s Disease Patients and Their Caregivers: A Cross-sectional Study

Introduction The Omicron variant of SARS-CoV-2 (COVID-19) became the global community’s third major cause of worry. In the current study, we deployed a self-reported survey questionnaire to investigate the degree of comprehension, awareness and perception of the Omicron variant of COVID-19 in patients with Parkinson’s disease (PD) and their respective caregivers (CGs). Materials and Methods Using a standardised questionnaire, we conducted a prospective study on PD patients attending the neurology outpatient department prior to and during the COVID-19 pandemic. The study period was between February and August of 2022. Results A total of 114 CGs and 134 disease-affected patients were evaluated. Approximately 1.8% of the CGs and 4.5% of the patients contracted the Omicron-COVID-19. Over half of the patients (77.6%) were aware of the Omicron variant, and approximately 40.3% of them were aware of its symptoms. After receiving the Covid immunisation, patients (94.02%) reported no change in symptoms. The percentage of patients and CGs who had no symptoms of the viral infection and were not even got tested ever was 95.5% and 98.2%, respectively. Further, patients (95.5%) opted for the ‘offline’ as a preferred mode of consultation, citing the precision of treatment being the main reason. Conclusion No definite correlation between the Omicron variant infection and symptoms of PD could be established. The awareness regarding Omicron variant was largely unknown. More patient-centred research on larger population groups, incorporating literate and urban groups would unravel the knowledge gaps.

A longitudinal study of adolescent pathways differentiating suicide ideation and attempt in early adulthood.

Suicide ideation and attempt are leading risk factors for mortality in young adults. However, the adolescent risk factors distinguishing suicide ideation from attempt in young adults remain unclear. The present study aimed to examine the extent to which within-person stability and change in depressive symptoms, school difficulties, and peer victimization from ages 12 to 17 were differentially associated with later suicide ideation and attempt from ages 20 to 23. The study included 1647 participants from the Quebec Longitudinal Study of Child Development (QLSCD; 52% female). Participants reported on their depressive symptoms, school difficulties, and peer victimization at ages 12, 13, 15, and 17, and on suicide ideation and attempt at ages 20 and 23. Data were collected in the Province of Quebec, Canada, between 2010 and 2021. Results indicated that 11% (N = 121) and 8% (N = 86) reported suicide ideation and attempt, respectively, between ages 20 and 23. A random-intercept cross-lagged panel model showed that within-person increases in depressive symptoms during adolescence were related to both suicide ideation and attempt, whereas within-person increases in school difficulties and peer victimization were for the most part related to suicide attempt only. Within-person stability in depressive symptoms from ages 12 to 17 years were also related to suicide attempt, and not ideation. However, this association was only marginally significant. Findings suggest that experiencing unusual rises in school difficulties and peer victimization during adolescence, as well as depressive symptoms persisting over time, may distinguish young adults who think about suicide from those who attempt suicide.

Changes in Pain and Mental Health Symptoms Associated with Prescribed Medicinal Cannabis Use: A One-Year Longitudinal Study.

Chronic pain and mental health issues like depression and anxiety significantly contribute to disease burden in Western countries. While cannabinoids are suggested to have analgesic, anxiolytic and antidepressant properties, evidence, especially for long-term use, is inconclusive. This 12-month observational study evaluated the effects of prescribed medicinal cannabis for 96 patients suffering from pain, as well as sleep disturbances, depression and anxiety. Treatment outcomes for pain, depression, anxiety and sleep problems were assessed at 3, 6, and 12 months using validated instruments. Significant reductions were observed in pain scores and the interference of pain on daily functions, alongside improvements in mental health and sleep. Many patients reported notable improvements in pain severity and reduced use of pain medications in the first 6 months, with a decline at 12 months. Additionally, sustained improvements in depression, anxiety, stress and sleep were observed, with about half reporting substantial improvement. Adverse effects were common but mostly mild or moderate, most commonly dry mouth and sleepiness. These results show that prescribed medicinal cannabis treatment is associated with improvements in chronic pain and mental health symptoms, such as depression, anxiety and stress. However, findings also suggest reduced effectiveness with longer-term use, emphasizing the need for additional research.

Evaluating Criteria for Symptoms Suggestive of Early Osteoarthritis Over Two Years Post-ACL Reconstruction: Data from the New Zealand ACL Registry.

The objectives were to determine the prevalence of meeting criteria for symptoms suggestive of early osteoarthritis (OA) following anterior cruciate ligament reconstruction (ACLR) and to characterize the longitudinal changes in these symptoms during the first two years post-ACLR. We analyzed data from 10231 patients aged 14-40 years in the New Zealand ACL Registry who completed the Knee injury and Osteoarthritis Outcome Score (KOOS) at 6, 12, and 24 months post-ACLR. Symptoms suggestive of early OA were defined as scoring ≤85% on at least 2 of 4 KOOS subscales. Longitudinal patterns of change were categorized as persistent, resolution, new, inconsistent, or no symptoms across the three visits. Prevalence and odds ratios (ORs) of symptoms were compared across visits, sex, and age groups using generalized estimating equations, and longitudinal patterns of symptom change were analyzed using multinomial logistic regression. Prevalence of meeting criteria of symptoms suggestive of early OA was 68% at 6 months, 54% at 12 months, and 46% at 24 months post-ACLR. Longitudinally, 33% had persistent symptoms, 23% had no symptoms, 29% showed symptom resolution, 6% developed new symptoms, and 9% had inconsistent symptoms. Females consistently showed higher odds of symptoms (OR range:1.17-1.52). Older age groups demonstrated higher odds of symptoms, particularly at 6 months (OR range:1.64-2.45). Symptoms suggestive of early OA are highly prevalent within two years post-ACLR, with one-third of patients experiencing persistent symptoms. These findings indicate that symptoms are more likely to persist rather than newly develop, emphasizing the importance of early identification and targeted interventions.

Heart Failure Symptoms Improve With More Intense Physical Activity.

Little is known about how changes in physical activity (PA) over time may influence symptoms in people with heart failure (HF). A secondary analysis was conducted with data from an RCT of an exercise intervention in patients with ICDs (implantable cardioverter defibrillator) and a HF diagnosis (n = 96). Data were collected at baseline and 2months of PA intervention. Physical activity (PA Steps = mean steps/day; PA Intensity = mean steps/min for most intense 30minutes/day) were measured over 5days at each timepoint. Physical symptoms were measured using the Patient Concerns Assessment, the SF-36 Vitality, and Bodily Pain subscales for fatigue and pain. Psychological symptoms were assessed using the Patient Health Questionnaire-9, and the State-Trait Anxiety Index. Associations between PA and physical and psychological symptoms were analyzed with multivariate regression. Patients (n = 96) were predominately male (83%) and Caucasian (79%), aged 55.8 ± 12.3years, BMI of 29.7 ± 5.1, with heart failure with reduced ejection fraction (HFrEF; 30.9 ± 9.9%). An increase in PA Steps was associated with improvement in anxiety (β = -1.178, p = .048). An increase in PA Intensity was associated with significant reductions in depression (β = -0.127, p = .021), anxiety (β = -0.234, p = .037), and fatigue (β = 0.528, p = .022). Decreases in PA Steps and PA Intensity were not associated with changes in any symptoms. For HF patients with an ICD, more intense PA over 2months was associated with improved psychological symptoms and reduced fatigue. Decreases in PA (total and intensity) were not associated with changes in symptoms. Interventions promoting increasing the intensity of PA over time may be an effective approach to reduce some HF symptoms.

Comparative efficacy of PsyPills and OCAT mobile psychological interventions in reducing depressive, anxiety and stress symptoms: A blinded randomized clinical trial

BackgroundDigital applications, such as in smartphone apps format, have shown high suggestive evidence for their efficacy in reducing general distress, but rigorous studies of their efficacy in symptom change and the mechanisms involved are still needed. MethodsIn the current multi-arm parallel-group randomized trial, participants aged 18–65 with smartphone access were recruited through social media. They were randomly assigned to two app interventions (PsyPills and OCAT) or an active placebo group (shamOCAT). The primary outcome was psychological distress measured up to one month. ResultsA total of 229 participants from diverse regional and demographic groups of the general population of Romania were randomly allocated into the three groups (PsyPills n = 80; OCAT n = 70; shamOCAT n = 79) and included in intention-to-treat analyses. Both the PsyPills (MD = −522; 95%CI = −10.00 to −0.44; d = 0.48) and OCAT (MD = −6.30; 95%CI = −11.39 to −1.21; d = 0.58) reduced significantly, with medium effect sizes, the psychological distress levels compared with the control group at follow-up. For the separate outcomes, only PsyPills showed significant medium reduction effects for anxiety symptoms (MD = −2.17; 95%CI = −3.83 to −0.50; d = −0.60), while OCAT showed reduction effects of small size for depression (MD = −1.50 (95%CI = −3.53 to 0.54, d = −0.34), that was however statistically nonsignificant. LimitationsWe registered high attrition and low adherence rates. Also, lower-than-planned effects might have been statistically underpowered to detect. ConclusionThe results support the high potential of both apps as scalable tools to provide low-intensity self-guided interventions for common psychological problems in the general population and expand opportunities for further research (e.g., confirm and capitulate on the differential effects).

Effects of 6-week olanzapine treatment on serum IL-2, IL-4, IL-8, IL-10, and TNF-α levels in drug-naive individuals with first-episode schizophrenia

BackgroundSchizophrenia is a complex neuropsychiatric disorder. Growing evidence indicates that the activation of the inflammatory response system with interleukin (IL)-2, IL-4, IL-8, IL-10, and tumor necrosis factor-alpha (TNF-α) plays an important role in the pathogenesis of schizophrenia,. However, clinical data on cytokine levels in patients with schizophrenia treated with antipsychotics are inconsistent or inconclusive. In this study, we have examined inflammatory factors’ alterations and their relationship to changes in clinical symptoms before and after olanzapine treatment of drug-naive patients with first-episode schizophrenia.MethodsWe recruited 142 hospitalized patients with first-episode schizophrenia as a study group; blood samples were collected, and the patients were assessed for clinical symptoms at baseline and after 6 weeks of olanzapine treatment. One hundred individuals with no history of mental illness were also recruited as healthy controls. Blood samples were collected, and the serum levels of IL-2, IL-4, IL-8, IL-10, and TNF-α were determined using an enzyme cycling assay. The severity of clinical symptoms was assessed according to the Positive and Negative Syndrome Scale (PANSS).ResultsIndividuals with schizophrenia had lower IL-8 levels and higher IL-10 levels than healthy controls (P < 0.001). Positive correlations were detected between serum IL-2 and IL-10 concentrations and each subscale of the PANSS (all P < 0.05). Moreover, a negative correlation existed between the serum IL-8 concentration and the PANSS negative score (r = − 0.172, P = 0.040). After 6 weeks of treatment, serum IL-8 levels in the patient group were lower than at baseline (P < 0.001), whereas serum IL-10 and TNF-α levels were higher than at baseline (all P < 0.05). Therefore, serum IL-10 can be determined as an independent risk factor for outcome in patients with first-episode schizophrenia (P = 0.02, OR = 2.327). Furthermore, serum IL-2, IL-10, and TNF-α levels were significantly lower, whereas the serum IL-8 level was significantly higher (P < 0.001) in the healthy control group than in the “response” and “no-response” treatment groups respectively.ConclusionsOur results indicate that serum IL-2, IL-8, IL-10, and TNF-α levels may be involved in the pathophysiological mechanisms of schizophrenia and correlate with the effects of olanzapine.

Insomnia as a predictor of treatment outcomes in adolescents receiving concentrated exposure treatment for OCD

BackgroundResearch suggests that individuals with obsessive-compulsive disorder (OCD) frequently experience insomnia. Some previous studies have suggested that insomnia may predict treatment outcomes, but the evidence is limited, especially for adolescents. This study examined the prevalence of insomnia in an adolescent OCD patient sample, explored the correlation between OCD and insomnia, and tested whether levels of insomnia at baseline predict outcomes for adolescent patients receiving the Bergen 4-Day Treatment (B4DT) for OCD.MethodsForty-three adolescent OCD patients who received B4DT were selected for this study. Treatment outcome was quantified as change in Children Yale-Brown Obsessive Compulsive Scale (CY-BOCS) scores across time from pre- to posttreatment and 3-month follow-up. Insomnia symptoms were measured by the Bergen Insomnia Scale (BIS). Linear mixed models were used to examine the relationship between the BIS and changes in CY-BOCS scores. We controlled for symptoms of general anxiety disorder measured by the GAD-7 and depression symptoms measured by the PHQ-9.ResultsIn this sample, 68.4% of the patients scored above the cutoff for insomnia on the BIS. There was a moderate correlation between baseline CY-BOCS and BIS that did not reach statistical significance (r = .32, p = .051). High BIS scores before treatment were significantly associated with poorer treatment outcomes, as measured by changes in CY-BOCS over time (p = .002). The association between baseline insomnia and change in OCD symptoms remained significant (p = .033) while controlling for GAD-7 and PHQ-9.ConclusionInsomnia is common among adolescents with OCD, and these data suggest that these patients may be at increased risk for poor treatment outcomes. Future research to explore mechanisms and adjunctive treatments is warranted.Trial registrationThe study was approved by the Regional Committee for Medical and Health Research Ethics of Northern Norway (REK Nord: 2023/606482).

Predictors of treatment outcome in higher levels of care among a large sample of adolescents with heterogeneous eating disorders

BackgroundDespite widespread use of higher levels of care in treating eating disorders in adolescents, research supporting the use of these treatments remains limited by small sample sizes and a predominant focus on anorexia nervosa. Further, existing data regarding predictors of outcome have yielded mixed findings. In the current study, we evaluated treatment outcomes and predictors of outcome among a large sample of adolescents with eating disorders presenting to inpatient, residential, partial hospitalization programs, and intensive outpatient programs across the United States.MethodsAdolescents (N = 1,971) completed self-report measures of eating disorder symptoms, depression, and anxiety at treatment admission, stepdown, and discharge. Using linear mixed effect models, we evaluated changes in symptoms over treatment separately among youth admitted to inpatient/residential treatment and those admitted to partial hospitalization/intensive outpatient programs, and used established metrics to gauge frequency of reliable (i.e., statistically reliable) and clinically significant change.ResultsResults suggested decreases in eating disorder symptoms, depression, and anxiety from intake to discharge. Around 50% of the sample reported reliable decreases in eating disorder symptoms at stepdown and discharge, with 30% of the sample reporting reliable reductions in depression and anxiety. Psychiatric comorbidity, primary diagnosis, age, and eating disorder symptoms at admission consistently predicted treatment-related change, although patterns in findings varied across symptoms.ConclusionsData from our sample are consistent with past work suggesting that adolescents enrolled in higher levels of care report clinical benefit; however, these effects are heterogenous, and a significant portion of individuals may not report reliable change in symptoms. Ultimately, ongoing work is required to better understand how and for whom higher levels of care may achieve their benefit and to identify the optimal approach for improving outcomes for adolescents with eating disorders.

Changes in core depressive symptoms over time in peripartum women: A network analysis

Perinatal depression (PND) is a prevalent mental health condition that affects women during pregnancy and after childbirth. Distinct clinical subtypes of PND exist, with the timing of symptom onset being a pivotal element in the classification of these subtypes. However, the specific manifestations of PND across the various stages of pregnancy and the postpartum period remain to be elucidated. This study aimed to explore the changes in depression symptoms with the stage of pregnancy. Women in their second (n = 161) and third trimesters (n = 248) of pregnancy as well as those in their first 6 weeks of the postpartum period (n = 110) were recruited. Each patient was evaluated using the Edinburgh Postnatal Depression Scale. A network analysis approach was used to explore the interconnections among depressive symptoms across the different time periods. Women in the postpartum period exhibited the most pronounced prevalence of PND and severity of depressive symptoms. In the second and third trimesters, &amp;ldquo;sadness and misery&amp;rdquo; was the most central symptom. However, its prominence diminished after childbirth. &amp;ldquo;Fear and panic&amp;rdquo; was the predominant symptom in the postpartum network. The structural integrity of PND symptom networks was maintained across all three periods, with consistent strength and closeness. This study demonstrates the temporal evolution of PND&amp;rsquo;s central symptoms in women during and after pregnancy, transitioning from depression-centric to anxiety-centric manifestations. These findings advocate for symptom-specific interventions to enhance the mental well-being of mothers and their offspring. Furthermore, this study offers clinical insights into the biological underpinnings of PND subtypes, facilitating precise diagnosis and targeted treatment strategies.

Detection, Patterns, and Outcomes of Recurrent HPV-Positive Oropharyngeal Squamous Cell Carcinoma

Recurrent human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) is a relatively rare but serious disease with little empirical data. Previous works have studied patterns of recurrence in HPV-positive OPSCC, but only one has studied truly recurrent disease as opposed to persistent disease, and no work systematically analyzed posttreatment surveillance imaging strategies and how recurrences were detected. To refine the understanding of HPV-positive OPSCC recurrence and inform optimal imaging surveillance strategies. This retrospective cohort study involved electronic medical record review at a tertiary care hospital. Patients treated for OPSCC from 2012 to 2019 were extracted, and patients diagnosed with HPV-positive OPSCC were identified. Data were analyzed from December 2022 to May 2023. Percentage of patients with a true recurrence, location of recurrence, time of recurrence detection, and method of recurrence detection. Recurrence was demonstrated with a scan after an imaging-established disease-free state 3 to 6 months posttreatment. Of the 367 patients with HPV-positive OPSCC (mean [SD] age, 60.6 [9.2] years; 310 [84.5%] male), 37 (10.1%) experienced true disease recurrence. Median (IQR) follow-up time of the cohort was 3.6 years (8.5-88 months), defined as time from diagnosis to death or last contact. Within the true recurrence cohort, 21 patients (56.8%) experienced local, regional, or local and regional recurrence (LRR); 15 (40.5%) experienced distant metastasis (DM); and 1 (2.7%) experienced both LRR and DM. The mean (SD) time for detecting LRR was 2.46 (1.94) years and was considerably longer compared to the 1.89 (0.87) years for detecting DM (difference, 0.57 [95% CI, -0.29 to 1.02] years). The majority of patients identified their recurrence through symptom changes (31 [81.1%]) rather than through surveillance imaging (3 [8.1%]). In this cohort study, 10.1% of patients experienced true HPV-positive OPSCC disease recurrence, with most incidences of DM occurring in the lung and brain. Disease recurrence was identified primarily through symptomatic change, suggesting that further research may be needed to understand the optimal surveillance strategies after definitive treatment.

Gastrointestinal, Behaviour and Anxiety Outcomes in Autistic Children Following an Open Label, Randomised Pilot Study of Synbiotics vs Synbiotics and Gut-Directed Hypnotherapy.

Alterations of the microbiome-gut-brain (MGB) axis have been associated with autism spectrum disorder (ASD) and disorders of gut-brain interaction (DGBI). DGBI are highly prevalent in autistic children and are associated with worsening behaviour and anxiety. Treatments such as probiotics, prebiotics and gut-directed hypnotherapy (GDH) have shown efficacy in improving gut symptoms in children. The primary objective of the study was to compare changes in gastrointestinal (GI) scores following a 12-week intervention of synbiotics (prebiotic + probiotic) +/- GDH with a follow-up at 24 weeks. Secondary objectives included changes in behavioural and anxiety symptoms, while changes in gut microbiome composition were assessed as an exploratory objective. Children diagnosed with ASD aged 5.00-10.99 years (n = 40) were recruited and randomised (1:1) to a 12-week intervention of either synbiotics (SYN group) or synbiotics + GDH (COM group). Both the SYN and COM group experienced significant reductions in total GI scores post-intervention and at follow-up (p < 0.001), with no superiority of the COM treatment over the SYN treatment. The COM group showed beneficial reductions in anxiety scores (p = 0.002) and irritability behaviours (p < 0.001) which were not present in the SYN group. At follow-up, only those in the COM group maintained significant reductions in GI pain scores (p < 0.001). There were significant changes in gut microbiota such as increases in Bifidobacterium animalis and Dialister in both groups over time. In conclusion,synbiotics with or without GDH may help support standard care for autistic children who suffer comorbid DGBI. The trial was prospectively registered at clinicialtrials.gov on 16 November 2020 (NCTO4639141).