Improvements In General Psychopathology Research Articles

A pilot study to investigate the efficacy and tolerability of lesion network guided transcranial electrical stimulation in outpatients with psychosis spectrum illness

BackgroundTranscranial electrical stimulation (tES) may improve psychosis symptoms, but few investigations have targeted brain regions causally linked to psychosis symptoms. We implemented a novel montage targeting the extrastriate visual cortex (eVC) previously identified by lesion network mapping in the manifestation of visual hallucinations. ObjectiveTo determine if lesion network guided High Definition-tES (HD-tES) to the eVC is safe and efficacious in reducing symptoms related to psychosis. MethodsWe conducted a single-blind crossover pilot study (NCT04870710) in patients with psychosis spectrum disorders. Participants first received HD-tDCS (direct current), followed by 4 weeks of wash out, then 2 Hz HD-tACS (alternating current). Participants received 5 days of daily (2×20 min) stimulation bilaterally to the eVC. Primary outcomes included the Positive and Negative Syndrome Scale (PANSS), biological motion task, and Event Related Potentials (ERP) from a steady state visual evoked potential (SSVEP) paradigm. Secondary outcomes included the Montgomery-Asperg Depression Rating Scale, Global Assessment of Functioning (GAF), velocity discrimination and visual working memory task, and emotional ERP. ResultsHD-tDCS improved PANSS general psychopathology in the short-term (d=0.47; pfdr=0.03), with long-term improvements in general psychopathology (d=0.62; pfdr=0.05) and GAF (d=−0.56; pfdr=0.04) with HD-tACS. HD-tDCS reduced SSVEP P1 (d=0.25; pfdr=0.005), which correlated with general psychopathology (β = 0.274, t = 3.59, p = 0.04). No significant differences in safety or tolerability measures were identified. ConclusionLesion network guided HD-tES to the eVC is a safe, efficacious, and promising approach for reducing general psychopathology via changes in neuroplasticity. These results highlight the need for larger clinical trials implementing novel targeting methodologies for the treatments of psychosis.

Clinical Features Associated with Female Genital Mutilation/Cutting: A Pilot Longitudinal Study.

(1) Background: Female genital mutilation/cutting (FGM/C) is associated with physical and psychological complications. However, there is scarce literature on how women with FGM/C respond to treatment interventions. (2) Methods: In the present pilot longitudinal study, we assessed changes in general psychopathology (Symptom Check List-90-R), sexual functioning and distress (Female Sexual Function Index, Female Sexual Distress Scale-Revised, and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) female sexual dysfunction criteria), body image (Body Shape Questionnaire), and sexual body image (Female Genital Self-Image Scale) in a sample of n = 15 women with FGM/C before and after reconstructive surgery. (3) Results: Sexual distress was significantly improved following surgery. We also observed an improvement in general psychopathology and genital self-image. However, sexual function was not improved. (4) Conclusions: These results provide evidence for the benefits of reconstructive surgery on sexual distress in women with FGM/C. The impact of surgery on sexual function cannot be conclusively evaluated.

Toward precision therapeutics: general and specific factors differentiate symptom change in depressed adolescents

BackgroundThe longitudinal course of multiple symptom domains in adolescents treated for major depression is not known. Revealing the temporal course of general and specific psychopathology factors, including potential differences between psychotherapies, may aid therapeutic decision‐making.MethodsParticipants were adolescents with major depressive disorder (aged 11–17; 75% female; N = 465) who were part of the IMPACT trial, a randomized controlled trial comparing cognitive behavioral therapy, short‐term psychoanalytic psychotherapy, and brief psychosocial intervention. Self‐reported symptoms at baseline and 6, 12, 36, 52, and 86 weeks postrandomization were analyzed with bifactor modeling.ResultsGeneral psychopathology factor scores decreased across treatment and one‐year follow‐up. Specific melancholic features and depressive cognitions factors decreased from baseline to 6 weeks. Conduct problems decreased across treatment and follow‐up. Anxiety increased by 6 weeks and then reverted to baseline levels. Obsessions–compulsions did not change. Changes in general and specific factors were not significantly different between the three psychotherapies during treatment. During follow‐up, however, conduct problems decreased more in brief psychosocial intervention versus cognitive behavioral therapy (1.02, 95% Bayes credible interval 0.25, 1.96), but not versus short‐term psychoanalytic psychotherapy.ConclusionsThe clinical response signature in this trial is best revealed by rapid reductions in depression symptoms and general psychopathology. Protracted improvements in general psychopathology and conduct problems subsequently occur. Psychosocial treatments for adolescent depression have comparable effects on general and specific psychopathology, although a psychoeducational, goal‐focused approach may be indicated for youth with comorbid conduct problems.

A meta-analysis of treatment as usual for borderline personality disorder.

In the era of evidence-based medicine, "treatment as usual" (TAU) for borderline personality disorder (BPD) is often considered ineffective or even iatrogenic. To evaluate the effects of TAU, this meta-analysis examined published data from the TAU arms of randomized controlled trials of manualized psychotherapies for BPD. Studies were selected through a comprehensive bibliographic search. A total of 16 studies met inclusion criteria. Comprehensive Meta-analysis V3 software was used for computing and pooling effect sizes. For the primary outcome category of BPD symptoms, Hedges' g showed a small-to-moderate improvement for patients in TAU conditions (11 studies; g = 0.371; 95% confidence intervals [CI: 0.246, 0.495]). Secondary outcomes included general psychopathology, global functioning, and self-harm/suicidality. Hedges' g indicated small improvements in general psychopathology (14 studies; g = 0.119; 95% CI [0.025, 0.214]) and global functioning (10 studies; g = 0.254; 95% CI [0.123, 0.384]). No significant effect was found for changes in self-harm/suicidality (four studies; g = 0.003; 95% CI [-0.193, 0.199]). These findings question the notion that TAU for BPD is inherently iatrogenic. Thus, in the absence of specialized treatment for BPD, standard available care may be a practical option. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A randomised controlled pilot study of Experience Focused Counselling with voice hearers

Background: There is a need for improved psychosocial interventions for distressed voice hearers.Aims: To evaluate a novel approach to hearing voices: Experience Focused Counselling (EFC) aka Making Sense of Voices.Study design and methods: Twelve voice hearers were randomly assigned to a 44-week EFC or Treatment As Usual intervention as part of a pilot study design.Results: At the end of intervention, EFC showed clinically large treatment effect improvements on the Brief Psychiatric Rating Scale – Expanded Version psychotic symptoms (Cohen’s d=1.6) and overall psychopathology domains (d=1.3), and the Psychotic Symptom Rating Scales voices (d=1) and delusions (aka non-shared reality) (d=1) scales. EFC voice hearers also felt more able to do first trauma disclosures (n=4) than TAU group voice hearer (n=1).Discussion: EFC improvements may have been related to the focus on reducing voices-related distress. EFC holds some promise as a safe and effective intervention for voice hearers, with possible improvements in general psychopathology, psychosis, voices and non-shared reality (aka delusions)-related distress. This will need replicating in more powerful studies.

Changes in Psychological Health and Subjective Well-Being Among Incarcerated Individuals With Serious Mental Illness.

While improving the psychological health and well-being of individuals with serious mental illness can help reduce emotional distress and increase resilience, not enough is known about the well-being of incarcerated individuals with mental illness. Using the Schwartz Outcome Scale-10, the authors examined changes in subjective well-being and its association with other clinical symptoms and personality features in 43 mentally ill inmates in a large jail. All participants demonstrated significant improvement in general psychopathology and negative emotions. For well-being, however, different trajectories were associated with high versus low baseline ratings. Furthermore, those in the high well-being group were more likely to show features of aggression, dominance, hostility, mania, and more positive affect. These findings suggest that the level of well-being among inmates with serious mental illness may be an early indicator of personality features, clinical changes, and resilience, which is essential knowledge required when completing effective treatment planning.

A randomized controlled study of the efficacy of six-month supplementation with concentrated fish oil rich in omega-3 polyunsaturated fatty acids in first episode schizophrenia

Short-term clinical trials of omega-3 polyunsaturated fatty acids (n-3 PUFA) as add-on therapy in patients with schizophrenia revealed mixed results. The majority of these studies used an 8- to 12-week intervention based on ethyl-eicosapentaenoic acid. A randomized placebo-controlled trial was designed to compare the efficacy of 26-week intervention, composed of either 2.2 g/day of n-3 PUFA, or olive oil placebo, with regard to symptom severity in first-episode schizophrenia patients. Seventy-one patients (aged 16–35) were enrolled in the study and randomly assigned to the study arms. The primary outcome measure of the clinical evaluation was schizophrenia symptom severity change measured by the Positive and Negative Syndrome Scale (PANSS). Mixed models repeated measures analysis revealed significant differences between the study arms regarding total PANSS score change favouring n-3 PUFA (p = 0.016; effect size (ES) = 0.29). A fifty-percent improvement in symptom severity was achieved significantly more frequently in the n-3 PUFA group than in the placebo group (69.4 vs 40.0%; p = 0.017). N-3 PUFA intervention was also associated with an improvement in general psychopathology, measured by means of PANSS (p = 0.009; ES = 0.32), depressive symptoms (p = 0.006; ES = 0.34), the level of functioning (p = 0.01; ES = 0.31) and clinical global impression (p = 0.046; ES = 0.29). The findings suggest that 6-month intervention with n-3 PUFA may be a valuable add-on therapy able to decrease the intensity of symptoms and improve the level of functioning in first-episode schizophrenia patients.

Three‐week inpatient Cognitive Evolutionary Therapy (CET) for patients with personality disorders: Evidence of effectiveness in symptoms reduction and improved treatment adherence

The aim of this study was to evaluate the efficacy of Cognitive Evolutionary Therapy (CET) in an intensive short residential treatment of a wide range of severe personality disorders (PDs) that resulted in a reduction of social functioning and significant personal distress. Each patient was assessed at admission, discharge, and 3 months later in order to determine if there was a reduction in symptoms and an improved adherence to former outpatient programs and to check if patients were undergoing new treatment after discharge. Fifty-one patients participated in this study. The 20-hr weekly program consisted of two individual sessions and various group modules. Outcome measures included: self-reported measures of depression, anxiety, general symptoms, number and duration of inpatient admissions after the programme, and continuation in an outpatient treatment programme. The results show an overall improvement in general psychopathology after the release and in follow-up sessions, a decrease in the number of further hospital admissions, and an increased level of attendance of outpatient therapy. This study shows that intensive short residential treatment is an effective treatment for patients with a wide range of PDs.

Dissociation Predicts Poor Response to Dialectial Behavioral Therapy in Female Patients with Borderline Personality Disorder

A substantial proportion of Borderline Personality Disorder (BPD) patients respond by a marked decrease of psychopathology when treated with Dialectical Behavioral Therapy (DBT). To further enhance the rate of DBT-response, it is useful to identify characteristics related to unsatisfactory response. As DBT relies on emotional learning, we explored whether dissociation-which is known to interfere with learning- predicts poor response to DBT. Fifty-seven Borderline Personality Disorder (BPD) patients (DSM-IV) were prospectively observed during a three-month inpatient DBT program. Pre-post improvements in general psychopathology (SCL-90-R) were predicted from baseline scores of the Dissociative Experiences Scale (DES) by regression models accounting for baseline psychopathology. High DES-scores were related to poor pre-post improvement (β = -0.017 ± 0.006, p = 0.008). The data yielded no evidence that some facets of dissociation are more important in predicting DBT-response than others. The results suggest that dissociation in borderline-patients should be closely monitored and targeted during DBT. At this stage, research on treatment of dissociation (e.g., specific skills training) is warranted.