Comorbid Depressive Symptoms Research Articles

Interpretation biases and depressive symptoms among anxiety-disordered children: The role of individual differences in respiratory sinus arrhythmia.

Individual differences in interpretation biases-the tendency to interpret ambiguous stimuli as threatening-partially explain the presence of comorbid depressive symptoms among anxious youth. Increasing efforts have examined physiological processes that influence the association between interpretation biases and depressive symptoms in this population, and potential gender differences in this relationship. This study examined the moderating role of respiratory sinus arrhythmia (RSA) suppression (i.e., decrease from baseline)-an index of parasympathetic nervous system reactivity-in the association between interpretation biases and depressive symptoms in clinically anxious youth. One-hundred-and-five clinically anxious children (Mage =10.09years, SD=1.22; 56.7% female; 61.9% racial/ethnic minority) completed measures of self-reported and behaviorally indexed interpretation biases, reported anxiety/depression symptom severity, and participated in a speech task. RSA suppression during the task moderated the association between interpretation biases and depressive symptom severity in the total sample. Separate exploratory moderation analyses were conducted among girls and boys. Among girls, RSA suppression moderated the association between behaviorally indexed interpretation biases and depressive symptoms, and marginally moderated (p=.067) the association between self-reported interpretation biases and depressive symptoms. Among boys, RSA suppression was not a significant moderator. These findings may help identify clinically anxious youth most at-risk for comorbid depressive symptoms.

Development of Disordered Eating Behaviors and Comorbid Depressive Symptoms in Adolescence: Neural and Psychopathological Predictors

BackgroundEating disorders are common in adolescence and are devastating and strongly comorbid with other psychiatric disorders. Yet little is known about their etiology, knowing which would aid in developing effective preventive measures. MethodsLongitudinal assessments of disordered eating behaviors (DEBs)—binge-eating, purging, and dieting—and comorbid psychopathology were measured in 1386 adolescents from the IMAGEN study. Development of DEBs and associated mental health problems was investigated by comparing participants who reported symptoms at ages 16 or 19 years, but not at age 14 years, with asymptomatic control participants. Voxel-based morphometry and psychopathological differences at age 14 were investigated to identify risk factors for the development of DEBs and associated mental health problems. ResultsDEBs and depressive symptoms developed together. Emotional and behavioral problems, including symptoms of attention-deficit/hyperactivity disorder and conduct disorder, predated their development. Alterations in frontostriatal brain areas also predated the development of DEBs and depressive symptoms. Specifically, development of binge-eating was predicted by higher gray matter volumes in the right putamen/globus pallidus at age 14. Conversely, development of purging and depressive symptoms was predicted by lower volumes in the medial orbitofrontal, dorsomedial, and dorsolateral prefrontal cortices. Lower gray matter volumes in the orbitofrontal and anterior cingulate cortices mediated the relationship between attention-deficit/hyperactivity disorder and conduct disorder symptoms and future purging and depressive symptoms. ConclusionsThese findings suggest that alterations in frontal brain circuits are part of the shared etiology among eating disorders, attention-deficit/hyperactivity disorder, conduct disorder, and depression and highlight the importance of a transdiagnostic approach to treating these conditions.

Prevalence, Demographic, and Clinical Correlates of Comorbid Depressive Symptoms in Chinese Psychiatric Patients With Alcohol Dependence.

BackgroundDepressive symptoms are common among psychiatric patients with alcohol dependence (AD). However, the prevalence and clinical correlates of comorbid depressive symptoms are less well studied in Chinese Han patients.MethodsIn this hospital-based survey, we recruited 378 psychiatric patients diagnosed with AD according to the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV). All patients completed the Beck Depression Inventory (BDI) to evaluate depressive symptoms and the Alcohol Use Disorders Identification Test (AUDIT) to assess the severity of drinking.ResultsCompared to patients without depressive symptoms, 48.9% (185/378) of the patients with comorbid depressive symptoms were younger, had a more unstable marital status, had a higher AUDIT total score, and had a higher adverse consequences subscore (all P < 0.05). Further logistic regression analysis showed that unstable marital status (Odds ratios [OR] = 2.20, 95% confidence interval [CI] 1.21–3.99) and AUDIT total score (OR=1.07, 95% CI 1.03–1.11) were significantly associated with depressive symptoms.ConclusionsOur findings indicate high comorbidity between AD and depressive symptoms in Chinese psychiatric patients. Moreover, some variables are correlates of comorbid depressive symptoms. Particular attention should be paid to the early detection and intervention for this comorbid condition and its risk factors.

Metacognition in Cardiac Patients With Anxiety and Depression: Psychometric Performance of the Metacognitions Questionnaire 30 (MCQ-30).

The evaluation of effective psychological therapies for anxiety and depression in cardiac patients is a priority, and progress in this area depends on the suitability and validity of measures. Metacognitive Therapy is a treatment with established efficacy in mental health settings. It postulates that anxiety and depression are caused by dysfunctional metacognitions, such as those assessed with the Metacognitions Questionnaire 30 (MCQ-30), which impair effective regulation of repetitive negative thinking patterns. The aim of this study was to examine the psychometric properties of the MCQ-30 in a cardiac sample. A sample of 440 cardiac patients with co-morbid anxiety and/or depression symptoms completed the MCQ-30 and the Hospital Anxiety and Depression Scale. Confirmatory factor analysis (CFA) was used to test established factor structures of the MCQ-30: a correlated five-factor model and a bi-factor model. The five-factor model just failed to meet our minimum criteria for an acceptable fit on Comparative Fit Index (CFI) = 0.892 vs. criterion of ≥ 0.9; but was acceptable on the Root Mean Square Error of Approximation (RMSEA) = 0.061 vs. ≤ 0.08; whereas the bi-factor model just met those criteria (CFI = 0.913; RMSEA = 0.056). These findings suggest that the bi-factor solution may carry additional information beyond the five subscale scores alone. However, such a model needs to be evaluated further before widespread adoption could be recommended. Meantime we recommend cautious continued use of the five-factor model. Structural issues aside, all five subscales demonstrated good internal consistency (Cronbach alphas > 0.7) and similar relationships to HADS scores as in other patient populations. The MCQ-30 accounted for additional variance in anxiety and depression after controlling for age and gender.

Do adolescents with chronic fatigue syndrome (CFS/ME) and co-morbid anxiety and/or depressive symptoms think differently to those who do not have co-morbid psychopathology?

BackgroundCo-morbid anxiety and/or depression is common in adolescents with Chronic Fatigue Syndrome (CFS/ME). Adolescents with psychopathology typically endorse more negative cognitive errors. We do not know whether they make negative cognitive errors in response to fatigue. We examined the thinking patterns of adolescents with CFS/ME and co-morbid psychopathology compared to those without this co-morbidity. MethodsThis cross-sectional study recruited 205 adolescents (age 11–18) with CFS/ME, who completed measures of anxiety and depression, information processing biases and responses to fatigue. We grouped participants as having co-morbid psychopathology (or not) by applying a threshold score. We compared groups’ thinking pattern subscale scores using independent samples T tests. We examined the association between psychopathology and general negative thinking and specific responses to fatigue symptoms. ResultsAdolescents with CFS/ME with co-morbid psychopathology more strongly endorsed general negative cognitive errors (d = 0.61–1.31). They also more strongly endorsed damage beliefs (d = 0.49), embarrassment avoidance (d = 1.05), catastrophising (d = 0.97) and symptom focusing (d = 0.75) in response to fatigue but did not differ significantly on fear avoidance from those without co-morbid psychopathology. Both negative cognitive errors and unhelpful responses to symptoms explained 43% of the variance in psychopathology. ConclusionsAdolescents with CFS/ME with co-morbid psychopathology tend to be negatively biased in their thinking, both generally and about their symptoms of fatigue specifically. This may have implications for the sequencing of cognitive and behavioural strategies to address both fatigue and psychopathology.

Serotonergically dependent antihyperalgesic and antiallodynic effects of isoliquiritin in a mouse model of neuropathic pain

Chronic neuropathic pain poses a significant health problem worldwide, for which effective treatment is lacking. The current work aimed to investigate the potential analgesic effect of isoliquiritin, a flavonoid from Glycyrrhiza uralensis, against neuropathic pain and elucidate mechanisms. Male C57BL/6J mice were subjected to chronic constriction injury (CCI) by loose ligation of their sciatic nerves. Following CCI surgery, the neuropathic mice developed pain-like behaviors, as shown by thermal (heat) hyperalgesia in the Hargreaves test and tactile allodynia in the von Frey test. Repetitive treatment of CCI mice with isoliquiritin (p.o., twice per day for two weeks) ameliorated behavioral hyperalgesia to thermal (heat) stimuli and allodynia to tactile stimuli in a dose-dependent fashion (5, 15 and 45 mg/kg). The isoliquiritin-triggered analgesia seems serotonergically dependent, since its antihyperalgesic and antiallodynic actions were totally abolished by chemical depletion of spinal serotonin by p-chlorophenylalanine, whereas potentiated by 5-HTP (a precursor of 5-HT). Consistently, isoliquiritin-treated neuropathic mice showed escalated levels of spinal monoamines especially 5-HT, with depressed monoamine oxidase activity. Moreover, isoliquiritin-evoked antihyperalgesia and antiallodynia were preferentially counteracted by the 5-HT1A receptor antagonist WAY-100635 delivered systematically or spinally. Of notable benefit, isoliquiritin was able to correct co-morbid behavioral symptoms of depression and anxiety evoked by neuropathic pain. Collectively, these findings demonstrate, for the first time, the therapeutic efficacy of isoliquiritin on neuropathic hypersensitivity, and this effect is dependent on the spinal serotonergic system and 5-HT1A receptors.

Length Polymorphisms in the Angiotensin I-Converting Enzyme Gene and the Serotonin-Transporter-Linked Polymorphic Region Constitute a Risk Haplotype for Depression in Patients with Coronary Artery Disease

Genetic variations affecting the course of depressive symptoms in patients with coronary artery disease (CAD) have not yet been well studied. Therefore, we set out to investigate whether distinct haplotypes of the two insertion/deletion polymorphisms in the serotonin-transporter-linked polymorphic region (5-HTTLPR) and the angiotensin I-converting enzyme (ACE) gene located on chromosome 17 can be identified as risk factors for trajectories of depression. Clinical and genotyping data were derived from 507 depressed CAD patients participating in the randomized, controlled, multicenter Stepwise Psychotherapy Intervention for Reducing Risk in Coronary Artery Disease (SPIRR-CAD) trial, of whom the majority had an acute cardiac event before study inclusion. Depression scores on the Hospital Anxiety and Depression Scale (HADS) were assessed at baseline and at five follow-up time points up to 2 years after study entrance. At baseline, depression scores did not significantly differ between patients carrying the risk haplotype ACE D/D, 5-HTTLPR I/I (n = 46) and the non-risk haplotypes (n = 461, 10.9 ± 2.7 versus 10.4 ± 2.5, p = 0.254). HADS-depression scores declined from study inclusion during the first year irrespective of the genotype. At each follow-up time point, HADS-depression scores were significantly higher in ACE D/D, 5-HTTLPR I/I carriers than in their counterparts. Two years after study inclusion, the mean HADS depression score remained 1.8 points higher in patients with the risk haplotype as compared to subjects not carrying this haplotype (9.9 ± 4.2 versus 8.1 ± 4.0, p = 0.009). In summary, the presence of the ACE D/D, 5-HTTLPR I/I haplotype may be a vulnerability factor for comorbid depressive symptoms in CAD patients.

Co-Morbid Depressive Symptoms are Associated With Reduced Functional Brain Responses Within the Insula and Visual Cortex in Response to Masked Happy Faces in Individuals With PTSD

Elevated depressive symptoms are common in individuals with Post Traumatic Stress Disorder (PTSD), but it is unclear how this co-morbidity may influence the processing of positive emotional stimuli. The aim of this study was to investigate the influence of depressive symptoms on functional brain responses to subliminal presentation of happy faces in individuals with PTSD. We hypothesized that higher depressive symptoms would be associated with reduced activation within the insular cortex, in response to masked happy faces.

Symptom structure of PTSD and co-morbid depressive symptoms - a network analysis of combat veteran patients - CORRIGENDUM.

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Do anxiety, depression, and intolerance of uncertainty contribute to social problem solving in adult women with anorexia nervosa?

IntroductionInefficient problem solving in the social domain may be one of the difficulties underlying the interpersonal challenges thought to maintain anorexia nervosa (AN). However, past studies have neglected to control for depression, anxiety, and intolerance of uncertainty (IU), which are known to contribute to social problem solving.MethodsThis study aimed to investigate whether adults with AN would show differences in social problem solving on an experimental task (Means‐End Problem Solving; MEPS) and report differences in their attitudes (positive, negative) toward social problem solving and their use of social problem‐solving styles (rational, impulsive–careless, avoidant) on the Social Problem‐Solving Inventory Revised (SPSRI) compared to a non‐AN control group.ResultsSeventy‐four adult women took part (30 with AN and 44 non‐AN controls), and data show that those with AN generated significantly less effective solutions on the MEPS (d = 1.96) reported overall poorer social problem solving on the SPSRI (d = 0.58), reporting more negative and less positive attitudes toward social problem solving, and less impulsive and more avoidant social problem‐solving styles. However, those with AN did not differ from controls in being able to rationalize social problems. Once depression (Beck Depression Inventory: BDI), state anxiety (State‐Trait Anxiety Inventory: STAI), and IU (Intolerance of Uncertainty Scale‐12; IUS‐12) were included as covariates, these differences were no longer significant, suggesting that comorbid depression, anxiety, and IU symptoms may contribute to social problem solving in AN.ConclusionsThere was no specific effect of depression. Treating anxiety and IU might help to improve social problem solving and enable people with AN to be able to better access social support to aid their recovery.

IMPACT OF PAIN INTERFERENCE ON TREATMENT OUTCOMES AMONG OLDER ADULTS WITH DEPRESSIVE AND ANXIETY SYMPTOMS RECEIVING COLLABORATIVE MENTAL HEALTH CARE

Introduction Depression, anxiety and chronic pain are highly comorbid in the elderly population. These symptoms can interfere with daily activities and adversely affect quality of life. The mechanisms underlying the associations among pain and mental health symptoms are complex and likely bidirectional in nature. This interrelatedness between pain, depression and anxiety symptoms can often lead to diagnostic uncertainty and polypharmacy. Moreover, the literature points to less favorable outcomes among those receiving treatment for depression and anxiety who report comorbid pain. However, less is known about whether pain moderates outcomes among community-dwelling older adults engaged in care for more moderate symptomatology. The primary aim of the study was to examine if baseline pain interference with daily activities had an impact on treatment outcomes in elderly patients with depressive and anxiety symptoms at 3 months and 6 months. The sample consisted of low income, community-dwelling older adults with comorbid pain, depression and anxiety symptoms who were enrolled in a telephone-based collaborative care management program. Methods The sample included 519 older adults newly prescribed an antidepressant or benzodiazepine by a primary care provider and enrolled in the SUpporting Seniors Receiving Treatment And INtervention (SUSTAIN) program. The SUSTAIN program provides behavioral health services by telephone to enrollees in the Pennsylvania Department of Aging's pharmaceutical assistance program (PACE/PACENET). The PACE/PACENET program serves low and moderately low-income seniors. Patients who agree to participate in SUSTAIN complete comprehensive assessments of mental health symptoms, cognition, sleep, pain, and functional status by a health technician. The current study included those patients meeting criteria for clinically significant baseline mental health symptoms who agreed to engage in care management services delivered by a clinician (LSW or RN). Over the course of care management, patients received symptom and medication monitoring, brief behavioral therapy, and psychosocial support, and were connected to needed community resources. Summary reports were also sent to patients’ prescribers with recommendations for treatment planning (where indicated). Baseline clinical program data extracted for the current analyses included self-reported socio-demographics (age, financial status, gender), clinical symptoms (depressive [PHQ-9] and anxiety [GAD-7] symptoms), overall mental functioning (Veterans RAND 12-Item Health Survey [VR12]), and self-reported pain over the past 24?hours and 3 months. Pain interference was rated on a scale of 0 (no interference) to 10 (complete interference). Data on depression, anxiety, and overall mental health outcomes were also collected at 3 and 6-month follow-up. Bivariate analyses were run to examine associations among pain and various clinical and sociodemographic variables at baseline. Longitudinal, mixed effects models were run to examine the extent to which baseline pain moderated changes in depressive symptoms, anxiety symptoms, and overall mental functioning over time. Results Patients were on average 77.7 (SD 6.8) years old. The majority were female (86.7%), non-Hispanic white (92.9%), and reported having enough finances to “get along” (83.4%). Antidepressant or benzodiazepine was reported as the index medication for 59.3% and 40.7% of the patients, respectively. 51.4% reported pain interference with activities. Patients had a mean baseline score of 8.81 (SD 4.6) on the PHQ-9 (range=0-24), 4.74 (SD 4.4) on the GAD-7 (range=0-21), and 47.4 (SD 11.1) on overall mental functioning (range=4.85-72.85). Bivariate results revealed that greater baseline pain was significantly associated with lower financial status (p Conclusions The data suggest that in this sample of community-dwelling older adults enrolled in a state-sponsored pharmacy benefit and treatment support program, baseline pain interference did not impact treatment outcomes of depressive and anxiety symptoms over a period of 6 months. The findings suggest that a collaborative care program for depression and anxiety may be effective in reducing mental health symptoms even in the presence of self-reported pain interference with activities. This research was funded by: Commonwealth of Pennsylvania, Department of Aging, PACE Program, PACE/PACENET.

ECT FOR THE TREATMENT OF SOMATIC SYMPTOM DISORDER AND UNINTENTIONAL WEIGHT LOSS IN OLDER ADULTS: 2 CASE REPORTS

Introduction Somatoform disorders occur in up to 13% of those over age 65 and symptoms often cause significant impairment and disability (Hilderink et al. 2013; Leong et al. 2015). Unintentional weight loss in the elderly is also common and associated with increased morbidity and mortality (Hajek et al. 2017; McMinn et al. 2011). Studies show that depression is often comorbid with both somatoform disorders and unintentional weight loss in the elderly (Leong et al. 2015; Thompson and Morris 1991). Electroconvulsive therapy (ECT) is an effective treatment for severe depression, especially in older adults. However, there is limited of evidence regarding the use of ECT in elderly patients for the treatment of somatic symptom disorders (with predominant GI symptoms) or unintentional weight loss. Three case reports have been documented of women in their seventh decade of life with functional GI symptoms that responded to ECT (Cooper 2016; Cybulska 1997; Dols et al. 2012). Leong et?al reported a case series of 28 patients with somatic symptoms disorder who were successfully treated with ECT, examining the primary endpoint of improvement in somatic symptoms. However, only 2 of these cases included functional GI symptoms, and neither of the patients were over the age of 50 (Leong et al. 2015). Methods We report 2 cases of patients over age 65 who were psychiatrically hospitalized for co-morbid depressive symptoms, somatic symptom disorder (with predominant GI symptoms), and unintentional weight loss. Due to inability to tolerate medications and severity of depressive and somatic symptoms, both received an acute course of ECT. Results Both patients had gastrointestinal medical history (dumping syndrome, gastroparesis, irritable bowel syndrome), but extensive medical workup did not account for the severity of somatic symptoms, most notably nausea, or weight loss at the time of psychiatric admission. Both patients had diagnoses of major depressive episodes with PHQ-9 scores in the moderate range on admission (14 and 15). Both patients completed a full acute course of bitemporal ECT and reported subjective improvement in their somatic symptoms, appetite, and depressive symptoms (PQH-9 scores 0 and 1 respectively) following the course of ECT. Both also objectively gained a weight from time of admission to long-term follow-up without subsequent ECT treatment. Patient A's BMI on admission was 17.1 and increased to 23.81 at 8 month follow-up. Patient B's BMI on admission was 25.6 and increased to 29.17 at 7 month follow-up. In these two cases, ECT was well tolerated with reported side effects of mild headache, body aches, and mild to moderate memory loss. Of note, both patients had a rapid and robust response to ECT with remission of depressive symptoms and significant improvement in gastrointestinal symptoms after 5 bitemporal treatments. Conclusions Due to the higher rate of co-morbid medical conditions that could potentially contribute to somatic symptoms, it can be more challenging to diagnose somatic symptoms disorder in older adults (Wijeratne et al. 2003). When older adults present with somatic symptoms that are not fully explained by medical pathology, somatic symptom disorder should be considered and appropriate treatment initiated. Given the adverse outcomes and higher mortality in elderly individuals with unexplained weight loss, timely treatment is imperative. This case report suggests that ECT may be a well-tolerated and highly effective treatment for elderly patients with medically unexplained gastrointestinal disorders/somatic symptom disorder and significant weight loss with comorbid depression. This research was funded by: Not Applicable

Effectiveness and cost-effectiveness of guided Internet- and mobile-based CBT for adolescents and young adults with chronic somatic conditions and comorbid depression and anxiety symptoms (youthCOACHCD): study protocol for a multicentre randomized controlled trial

BackgroundAdolescents and young adults (AYA) with chronic somatic conditions have an increased risk of comorbid depression and anxiety symptoms. Internet- and mobile-based cognitive behavioural therapy (iCBT) might be one possibility to extend the access to evidence-based treatments. Studies suggest that guided iCBT can reduce anxiety and depression symptoms in AYA. However, little is known about the effectiveness of iCBT for AYA with chronic somatic conditions and comorbid symptoms of anxiety and/or depression in routine care. Evidence on the (cost-)effectiveness of iCBT is essential for its implementation in health care.Objectives and methodsThis multicentre two-armed randomized controlled trial (RCT) aims to evaluate the (cost-) effectiveness of guided iCBT (youthCOACHCD) in addition to treatment as usual (TAU) compared to enhanced treatment as usual (TAU+) in AYA aged 12–21 years with one of three chronic somatic conditions (type 1 diabetes, cystic fibrosis, or juvenile idiopathic arthritis). AYA with one of the chronic somatic conditions and elevated symptoms of anxiety or depression (Patient Health Questionnaire [PHQ-9] and/or Generalized Anxiety Disorder [GAD-7] Screener score ≥ 7) will be eligible for inclusion. We will recruit 212 patients (2 × n = 106) in routine care through three German patient registries. Assessments will take place at baseline and at 6 weeks, 3 months, 6 months, and 12 months post-randomization. The primary outcome will be combined depression and anxiety symptom severity as measured with the PHQ Anxiety and Depression Scale. Secondary outcomes will include health-related quality of life, coping strategies, self-efficacy, stress-related personal growth, social support, behavioural activation, adjustment and trauma-related symptoms, automatic thoughts, intervention satisfaction, working alliance, and Internet usage. The cost-effectiveness will be determined, and potential moderators and mediators of intervention effects will be explored.DiscussioniCBT might implicate novel ways to increase the access to evidence-based interventions in this specific population. The distinct focus on effectiveness and cost-effectiveness of youthCOACHCD in patients with chronic somatic conditions, as well as intervention safety, will most likely provide important new insights in the field of paediatric e-mental health. A particular strength of the present study is its implementation directly into routine collaborative health care. As such, this study will provide important insights for health care policy and stakeholders and indicate how iCBT can be integrated into existing health care systems.Trial registrationGerman Clinical Trials Register (DRKS), DRKS00017161. Registered on 17 September 2019.

The role of posttraumatic stress and depression symptoms in mother-infant bonding

BackgroundThere is some evidence posttraumatic stress disorder (PTSD) following childbirth may impact on the mother-infant bond. However, the evidence is inconsistent over whether PTSD or co-morbid depressive symptoms are primarily related to impaired bonding. This study therefore aimed to examine the relationship between PTSD symptoms, depressive symptoms and mother-infant bonding. MethodsA cross-sectional online study included 603 mothers of infants aged 1–12 months. Measures were taken of PTSD (City Birth Trauma Scale, Ayers et al., 2018) which has two subscales of birth-related PTSD symptoms and general PTSD symptoms; depression (Edinburgh Postnatal Depression Scale, Cox et al., 1987) and mother-infant bonding (Postpartum Bonding Questionnaire, Brockington et al., 2001). ResultsImpaired bonding was related to both dimensions of PTSD symptoms and depressive symptoms in bivariate analysis. Path analysis testing the model of whether depressive symptoms mediated the effect of PTSD symptoms on mother-infant bonding found a differential role of birth-related and general PTSD symptoms. Birth-related PTSD symptoms did not have any effect on bonding or depressive symptoms. In contrast, general PTSD symptoms had a direct effect on bonding and an indirect effect on bonding via depressive symptoms. LimitationsSelf-report measures of PTSD and depression symptoms were used. ConclusionsFurther research regarding different aspects of postpartum PTSD, depression and other disorders in the context of mother-infant bonding are needed. Future preventive programs should focus on diminishing symptoms of postpartum PTSD and depression so that the mother-infant bonding remains optimal.

Treatment outcomes in group-based cognitive behavioural therapy for chronic pain: An examination of PTSD symptoms.

The relevance of post-traumatic stress disorder (PTSD) symptoms to outcomes of cognitive behavioural therapy (CBT) for chronic pain is unclear. This study examines whether (a) traumatic exposure or the severity of PTSD symptoms at pre-treatment predicts the outcomes (pain intensity/interference), (b) participation in this treatment is associated with reduced PTSD symptoms and (c) any observed changes in PTSD symptoms are mediated by changes in psychological mechanisms that have been shown to be of importance to PTSD and chronic pain. Participants were 159 chronic pain patients who were consecutively admitted for a multidisciplinary, group-based CBT program at the Pain Rehabilitation Unit at Skåne University Hospital. A self-report measure of traumatic exposure and PTSD symptoms was administered before and after treatment, and at a 12-month follow-up, along with measures of depression, anxiety, pain intensity, pain interference, psychological inflexibility, life control and kinesiophobia. Traumatic exposure and PTSD symptom severity did not predict pain intensity or interference at 12-month follow-up. There were no overall significant changes in PTSD symptom severity at post-treatment or follow-up, but 24.6% of the participants showed potential clinically significant change at follow-up. Psychological inflexibility mediated the changes that occurred in PTSD symptoms during treatment. Neither traumatic exposure nor baseline symptoms of PTSD predicted the treatment outcomes examined here. Despite improvements in both comorbid depression and anxiety, participation in this pain-focused CBT program was not associated with improvements in comorbid PTSD. To the extent that changes in PTSD symptoms did occur, these were mediated by changes in psychological inflexibility during treatment. Pain-focused CBT programs yield clinically meaningful improvements in pain and comorbid symptoms of depression and anxiety, but may have little effect on comorbid PTSD. This raises the issue of whether current pain-focused CBT programs can be modified to improve outcomes for comorbid conditions, perhaps by better targeting of psychological flexibility, and/or whether separate treatment of PTSD may be associated with improved pain outcomes.

A randomized controlled trial examining the impact of individual trauma-focused therapy for individuals receiving group treatment for depression.

Adverse life events are associated with increased likelihood of depression and poorer prognosis. Trauma-focused treatments (TFT) appear to be effective in decreasing comorbid depressive symptoms. Accordingly, the aim of this study was to evaluate the effectiveness of a TFT on the memories of aversive events for individuals with a primary diagnosis of depression. A randomized controlled trial was conducted with 49 participants recruited from a 10-day outpatient group programme. All participants showed symptoms of depression with a subgroup (80%) meeting the DSM-5 criteria for a major depressive episode. Participants received treatment as usual (TAU); three additional individual trauma-focused sessions; or three additional individual assertiveness training sessions. Participants were assessed with regards to depression diagnosis and related symptoms. For participants with a major depressive episode, the addition of trauma-focused sessions significantly increased the likelihood of remission when compared to TAU, or additional assertiveness training. While no significant treatment difference was noted in depressive symptom change post-treatment, six weeks after treatment those who received an adjunct treatment were more likely to maintain treatment gains than those who received TAU. Furthermore, at 12-week follow-up, participants who received a TFT reported significantly fewer depressive symptoms than those who received assertiveness training. While differences in outcomes were minimal immediately post-treatment, differences among treatment groups increased over time. Thus, as few as three additional TFT sessions may impact positively on symptom change for people completing a group programme for the treatment of depression. Depression is the greatest cause of disability worldwide. Adverse experiences are linked with an increased likelihood of depression, more severe symptoms and poor treatment outcomes following evidence-based interventions. As few as three trauma-focused sessions can improve treatment outcomes in terms of depression diagnosis and related symptoms for individuals receiving group cognitive behavioural therapy.

Reciprocal links between anxiety sensitivity and obsessive-compulsive symptoms in youth: a longitudinal twin study.

BackgroundAnxiety sensitivity, the tendency to fear the symptoms of anxiety, is a key risk factor for the development anxiety disorders. Although obsessive–compulsive disorder was previously classified as an anxiety disorder, the prospective relationship between anxiety sensitivity and obsessive–compulsive symptoms (OCS) has been largely overlooked. Furthermore, a lack of genetically informative studies means the aetiology of the link between anxiety sensitivity and OCS remains unclear.MethodsAdolescent twins and siblings (N = 1,579) from the G1219 study completed self‐report questionnaires two years apart assessing anxiety sensitivity, OCS, anxiety and depression. Linear regression models tested prospective associations between anxiety sensitivity and OCS, with and without adjustment for anxiety and depressive symptoms. A phenotypic cross‐lagged model assessed bidirectional influences between anxiety sensitivity and OCS over time, and a genetic version of this model examined the aetiology of these associations.ResultsAnxiety sensitivity was prospectively associated with changes in OCS, even after controlling for comorbid anxiety and depressive symptoms. The longitudinal relationship between anxiety sensitivity and OCS was bidirectional, and these associations were predominantly accounted for by nonshared environmental influences.ConclusionsOur findings are consistent with the notion that anxiety sensitivity is a risk factor for OCS during adolescence, but also suggest that experiencing OCS confers risk for heightened anxiety sensitivity. The reciprocal links between OCS and anxiety sensitivity over time are likely to be largely mediated by nonshared environmental experiences, as opposed to common genes. Our findings raise the possibility that interventions aimed at ameliorating anxiety sensitivity could reduce risk for OCS, and vice versa.

Asceticism, perfectionism and overcontrol in youth with eating disorders

Personality traits such as perfectionism and asceticism, and combinations of these traits (i.e., overcontrol) have been related to eating disorder (ED) diagnosis, symptoms, and chronicity in adult patients with EDs. However, as limited evidence exists in adolescents, the aim of the present study was to examine these links in a clinical sample of adolescents with EDs. A retrospective chart review was conducted on 178 adolescents (91% females; Mage = 15.73years, SD = 1.31) receiving services at a tertiary care pediatric ED program. An examination of variability in mean levels of perfectionism, asceticism, and overcontrol across ED symptom groups (restrictive and binge/purge ED subtypes) was conducted to learn of diagnostic differences, while correlations were used to explore the association of these personality traits with comorbid anxiety and depressive symptoms. Hierarchical linear regression was used to assess whether overcontrol was related to length of stay (LOS) in an inpatient program. Results indicated that adolescents with binge-purge symptoms had higher levels of perfectionism, asceticism and overcontrol compared to those with restrictive symptoms, and that greater levels of perfectionism, asceticism and overcontrol were associated with elevated depression and anxiety symptoms. Additionally, overcontrol predicted greater LOS in the inpatient ED program. Results suggest the importance of assessing, monitoring and targeting overcontrol in treatment for adolescents with EDs given its impact on comorbid symptoms and LOS. Level III, evidence obtained from case-control analytic studies.

Study protocol for a randomized control trial to investigate the effectiveness of an 8-week mindfulness-integrated cognitive behavior therapy (MiCBT) transdiagnostic group intervention for primary care patients

BackgroundEffective transdiagnostic treatments for patients presenting with principal or comorbid symptoms of anxiety and depression enable more efficient provision of mental health care and may be particularly suitable for the varied population seen in primary healthcare settings. Mindfulness-integrated cognitive behavior therapy (MiCBT) is a transdiagnostic intervention that integrates aspects of CBT, including exposure skills targeting avoidance, with training in mindfulness meditation skills adopted from the Vipassana or insight tradition taught by the Burmese teachers U Ba Khin and Goenka. MiCBT is distinguished from both cognitive therapy and mindfulness-based cognitive therapy by the use of a theoretical framework which proposes that the locus of reinforcement of behavior is the interoceptive experience (body sensations) that co-arises with self-referential thinking. Consequently, MiCBT has a strong focus on body scanning to develop interoceptive awareness and equanimity. Designed for clinical purposes, the four-stage systemic approach of MiCBT, comprising intra-personal (Stage 1) exposure (Stage 2), interpersonal (Stage 3), and empathic (Stage 4) skillsets, is a distinguishing feature among other mindfulness-based interventions (MBIs). The aim of this study is to investigate whether and how group MiCBT decreases depression and anxiety symptoms for patients with a range of common mental health conditions.MethodsParticipants (n = 120) recruited via medical practitioner referral will be randomized to MiCBT or a wait-list control. Inclusion criteria are age 18–75; fluent in English and having a Kessler Psychological Distress Scale (K10) score of 20 or more. The MiCBT treatment group receive an 8-week MiCBT intervention delivered in a private psychology practice. Participants complete a suite of online self-report measures and record the amount of meditation practice undertaken each week. The control group receive usual treatment and complete the measures at the same time points. Primary outcome measures are the Depression Anxiety Stress Scale-21 (DASS-21) and K10. Analysis will use mixed-model repeated measures.DiscussionThe potential ability of MiCBT to provide a comprehensive therapeutic system that is applicable across diagnostic groups would make it an attractive addition to the available MBIs.Trial registrationThis trial is registered with the Australia and New Zealand Clinical Trials Registry: ACTRN12617000061336; Date of registration: 11th January 2017.

Role of comorbid depressive symptoms on the cognitive deficits in obsessive compulsive disorder.

Background:Obsessive compulsive disorder (OCD) is a chronic distressing condition that is marked with impairment in daily functioning including social, family, and occupational areas of life. Depression is the most common comorbidity among patients with OCD. The presence of co-occurring depressive symptoms adds to the burden of the OCD. Previous studies with neuropsychological testing reveals a pattern of cognitive deficits among patients with OCD. Few studies have also shown that the cognitive deficits in OCD are mediated by comorbid depressive symptoms.Objective:The objective of this study was to assess whether the comorbid depressive symptoms have any role on the cognitive deficits in OCD.Methodology:Forty patients diagnosed with OCD with an elevated rating in Beck Depression Inventory (BDI) and 20 normal controls were chosen for the study. The forty patients were split according to the severity scores of BDI as per one group consisting of patients with only mild depression and other group consisting of patients with moderate and severe depression. Yale–Brown Obsessive Compulsive Scale has been administered to assess the severity and symptoms of the disorder. Digit Vigilance Test and Triads Test have been administered to assess attention; Comprehensive Trial Making Test (CTMT) and Rey Complex Figure Test have been administered to assess attention, executive function, and memory.Results:OCD patients have significantly performed poor than the normal controls. On further analysis, OCD patients with moderate and severe depressive features have performed poor than the patients with mild depressive features on the tests administered for attention, executive function, and memory. On assessing the role of comorbid depressive features on cognitive deficits, having mild depressive features were not found to be significantly correlated to the cognitive deficits, whereas patients having moderate and severe depressive features were found to be significantly correlated to the cognitive deficits among OCD patients.Conclusion:The findings suggest that the higher level of depressive symptoms is associated with cognitive deficits in OCD patients. It can be suggested that the comorbid moderate-to-severe depressive symptoms play an important role in the cognitive deficits found among the OCD patients.