Relapse Prevention Research Articles

Inhibition of ERK1/2 or CRMP2 Disrupts Alcohol Memory Reconsolidation and Prevents Relapse in Rats.

Relapse to alcohol abuse, often caused by cue-induced alcohol craving, is a major challenge in alcohol addiction treatment. Therefore, disrupting the cue-alcohol memories can suppress relapse. Upon retrieval, memories transiently destabilize before they reconsolidate in a process that requires protein synthesis. Evidence suggests that the mammalian target of rapamycin complex 1 (mTORC1), governing the translation of a subset of dendritic proteins, is crucial for memory reconsolidation. Here, we explored the involvement of two regulatory pathways of mTORC1, phosphoinositide 3-kinase (PI3K)-AKT and extracellular regulated kinase 1/2 (ERK1/2), in the reconsolidation process in a rat (Wistar) model of alcohol self-administration. We found that retrieval of alcohol memories using an odor-taste cue increased ERK1/2 activation in the amygdala, while the PI3K-AKT pathway remained unaffected. Importantly, ERK1/2 inhibition after alcohol memory retrieval impaired alcohol-memory reconsolidation and led to long-lasting relapse suppression. Attenuation of relapse was also induced by post-retrieval administration of lacosamide, an inhibitor of collapsin response mediator protein-2 (CRMP2)-a translational product of mTORC1. Together, our findings indicate the crucial role of ERK1/2 and CRMP2 in the reconsolidation of alcohol memories, with their inhibition as potential treatment targets for relapse prevention.

Correction: Digital Interventions for Relapse Prevention, Illness Self‑Management, and Health Promotion In Schizophrenia: Recent Advances, Continued Challenges, and Future Opportunities

Correction: Digital Interventions for Relapse Prevention, Illness Self‑Management, and Health Promotion In Schizophrenia: Recent Advances, Continued Challenges, and Future Opportunities

Clinical considerations and pitfalls in the use of depot antipsychotics

Long-acting injectable antipsychotics (LAI) is a frequently used treatment modality which has advantages over oral antipsychotics regarding hospitalization or relapse prevention. However, the pharmacokinetic properties of LAI greatly differ from oral antipsychotics. This necessitates an increased knowledge about LAI among clinicians, especially when commencing treatment, changing doses and discontinuing treatment. In this review, we summarize an array of clinically important characteristics of LAI and give a conceptual framework for understanding the pharmacokinetics of LAI.

EFFECTIVENESS OF CBT BASED RELAPSE PREVENTION THERAPY IN REDUCING RELAPSE RISK AND CRAVING AMONG INDIVIDUALS WITH SUBSTANCE USE DISORDER

Present study explored the effectiveness of Cognitive Behavioral Therapy with Relapse Prevention Techniques (CBT-BRPT) in reducing relapse risk and craving among individuals with substance use disorder (SUD). Drawing from a comprehensive literature review, the study addressed the pressing need for evidence-based interventions to combat SUD and its associated challenges. Present study employed a Pre-Experimental Research Design with a one-group pretest-posttest approach, utilized the purposive sampling to recruit a sample of 50 male participants seeking treatment for SUD. The instruments utilized include the Stimulant Relapse Risk Scale (SRRS), the Brief Substance Craving Scale (BSCS), and a Demographic Information Form. Results demonstrated significant reductions in both craving and relapse risk among participants who received CBT-BRPT intervention. These findings underscore the importance of CBT-BRPT as a viable treatment option for individuals with SUD, offering promising implications for clinical practice and substance abuse treatment programs. Despite limitations such as sample size and absence of a control group, the study's findings advocate for the integration of CBT approaches into existing treatment modalities and call for further research to validate the efficacy of CBT interventions in addressing substance use disorders comprehensively.

Relapse Prevention in Acute Myeloid Leukemia: The Role of Immunotherapy with Histamine Dihydrochloride and Low-Dose Interleukin-2.

The treatment and management of acute myeloid leukemia (AML) has improved in recent decennia by targeted therapy for subgroups of patients, expanded indications for allogeneic stem cell transplantation (allo-SCT) and surveillance of residual or arising leukemia. However, hematological relapse among patients who have attained complete remission (CR) after the initial courses of chemotherapy remains a significant cause of morbidity and mortality. Here, we review an immunotherapeutic option using histamine dihydrochloride and low-dose interleukin-2 (HDC/LD-IL-2) for remission maintenance in AML. The treatment is approved in Europe in the post-consolidation phase to avoid relapse among patients in CR who are not candidates for upfront allo-SCT. We present aspects of the purported anti-leukemic mechanism of this regimen, including translation of preclinical results into the clinical setting, along with relapse prevention in subgroups of patients. We consider that HDC/LD-IL-2 is a conceivable option for younger adults, in particular patients with AML of normal karyotype and those with favorable responses to the initial chemotherapy. HDC/LD-IL-2 may form an emerging landscape of remission maintenance in AML.

Emotion-Induced Frontal Alpha Asymmetry as a Candidate Predictor of Relapse After Discontinuation of Antidepressant Medication

BackgroundOne in 3 patients relapse after antidepressant discontinuation. Thus, the prevention of relapse after achieving remission is an important component in the long-term management of major depressive disorder. However, no clinical or other predictors are established. Frontal reactivity to sad mood as measured by functional magnetic resonance imaging has been reported to relate to relapse independently of antidepressant discontinuation and is an interesting candidate predictor. MethodsPatients (n = 56) who had remitted from a depressive episode while taking antidepressants underwent electroencephalography (EEG) recording during a sad mood induction procedure prior to gradually discontinuing their medication. Relapse was assessed over a 6-month follow-up period. Thirty five healthy control participants were also tested. Current source density of the EEG power in the alpha band (8–13 Hz) was extracted and alpha asymmetry was computed by comparing the power across 2 hemispheres at frontal electrodes (F5 and F6). ResultsSad mood induction was robust across all groups. Reactivity of alpha asymmetry to sad mood did not distinguish healthy control participants from patients with remitted major depressive disorder on medication. However, the 14 (25%) patients who relapsed during the follow-up period after discontinuing medication showed significantly reduced reactivity in alpha asymmetry compared with patients who remained well. This EEG signal provided predictive power (69% out-of-sample balanced accuracy and a positive predictive value of 0.75). ConclusionsA simple EEG-based measure of emotional reactivity may have potential to contribute to clinical prediction models of antidepressant discontinuation. Given the very small sample size, this finding must be interpreted with caution and requires replication in a larger study.

Frequency, characteristics, predictors and treatment of relapsing myelin oligodendrocyte glycoprotein antibody–associated disease (MOGAD)

BackgroundMyelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) may have a monophasic or relapsing disease course. To date, factors that may predict a relapsing disease course remain largely unknown and only limited data exist regarding the efficacy of different utilized immunotherapy regimens at preventing or reducing relapses. ObjectivesTo assess the characteristics, predictors, and immunotherapy of relapsing MOGAD. MethodsThis multicenter retrospective analysis included all MOGAD cases at the University of Florida, Baylor College of Medicine and the University of California San Diego with minimum follow-up time of 6 months. Cox proportional hazards regression analyses, corrected for age and sex, were performed to evaluate hazard ratios (HR) of predictors of a relapsing disease course and to compare relapse hazards for utilized immunotherapies. ResultsThe majority of included participants (51/79 [64.6 %]) had a relapsing course, and of these individuals, 68.6 % (35/51) experienced their first relapse within the first year. However, 10/51 (19.6 %) participants experienced their first relapse ≥5 years (5–15 years) after the initial presentation. Predictors of a relapsing course were CSF pleocytosis (>150 cells/mm3; HR 3.3 [1.18 – 9.24]; p = 0.023), a pediatric disease onset at age < 9 years (HR 2.69 [1.07–6.75]; p = 0.035), and an initial presentation with the clinical syndrome of meningoencephalitis (HR 3.42 [1.28 – 9.17]; p = 0.015),. In participants with a relapsing course, 13/24 (54.2 %) patients remained relapse-free on rituximab, 4/8 (50 %) on mycophenolate mofetil, and 11/14 (78.6 %) on scheduled immunoglobulins. Patients treated with immunoglobulins had significantly fewer relapses compared to patients treated with other immunotherapies (HR: 0.1 [0.2 – 0.63]; p = 0.014). ConclusionsIn our cohort, the majority of MOGAD patients relapsed. The initial relapse occurred most frequently within the first year, but first relapses also took place over a decade after the initial presentation. Prepubertal onset, severe CSF pleocytosis, and the clinical syndrome of meningoencephalitis may be predictors of a relapsing course. Of the currently available off-label steroid-sparing treatments, scheduled immunoglobulins may be the most effective in relapse prevention.

Reflections on Recidivism and Relapse Prevention among Italian Justice-Involved Juveniles: A General Overview

Research interprets antisocial and illegal behavior among juveniles as an expression of needs, as a conscious action, or as an adherence to family, cultural, and social contexts. Professionals and researchers interested in the topic could benefit from reflections and insights on relapse prevention among justice-involved juveniles (JIJs). In light of these considerations, we investigated the criminal conduct of JIJs, identifying their background, individual characteristics, and the educational and rehabilitative programs of the 17 Italian youth detention centers from a sample of 234 JIJs (214 males and 20 females, 14–25 years old). The sample completed the following questionnaires: the high-risk situation checklist, deviant behavior questionnaire (DBQ), and the neighborhood perception questionnaire (NPQ). The study aims to provide a general overview of the justice-involved adolescents and young adults in Italian youth detention centers, focusing on perpetrator profiles, family systems and the quality of life in the Italian youth detention centers. To achieve our goals, we investigated their occupations and education, the perceived quality of life in their neighborhoods, the use of drugs, and the tendency to commit illegal or antisocial behaviors before incarceration. The study also explored the awareness related to the personal perception of the risk factors in relapse, with the aim of stimulating reflections on behavior and crime-related cognitions to promote relapse prevention. We discuss the main findings and future implications.

Implementation of a crisis resolution team service improvement programme: a qualitative study of the critical ingredients for success

BackgroundCrisis Resolution Teams (CRTs) offer home-based care for people in mental health crisis, as an alternative to hospital admission. The success of CRTs in England has been variable. In response to this, the CRT Optimization and RElapse prevention (CORE) study developed and trialled a 12-month Service Improvement Programme (SIP) based on a fidelity model. This paper describes a qualitative evaluation of the perspectives of CRT staff, managers, and programme facilitators. We identify barriers and facilitators to implementation, and mechanisms by which service improvements took place.MethodsManagers and staff from six purposively sampled CRTs were interviewed, as well as six facilitators who were employed to support the implementation of service improvement plans. Semi-structured focus groups and individual interviews were conducted and analysed using thematic analysis.FindingsA majority of participants viewed all components of the SIP as helpful in improving practice, although online resources were under-used. Perceived barriers to implementation centred principally around lack of staff time and ownership. Support from both senior staff and facilitators was essential in enabling teams to undertake the work associated with the SIP. All participating stakeholder groups reported that using the fidelity model to benchmark their CRT work to best practice and feel part of a ‘bigger whole’ was valuable.ConclusionCRT staff, managers and programme facilitators thought that a structured service improvement programme helped to increase fidelity to a best practice model. Flexibility (from all stakeholders) was key to enable service improvement actions to be manageable within time- and resource-poor teams.

Identification of relapse predictors of IgG&lt;sub&gt;4&lt;/sub&gt;-related sclerosing cholangitis

Introduction. Relapses occur in 30–50% of patients IgG4-related sclerosing cholangitis. Relapses may act an independent risk factor for malignancy development and the need in maintenance therapy for relapse prevention is still uncertain. Thus, studying relapse predictors and developing reliable preventive approaches is an important area of research for this condition.Aim. To determine relapse predictors of IgG4-related sclerosing cholangitis.Materials and methods. A single- center dynamic bidirectional observational study was conducted in patients aged 18 years and older with verified IgG4-related sclerosing cholangitis (n = 32). We searched for possible factors influencing the relapse of IgG4- related sclerosing cholangitis. The development of a prognostic model for the relapse probability was carried out using logistic regression. ROC analysis was used to assess the diagnostic performance of quantitative variables in predicting of relapse.Results. The median follow-up period was 33 (16–60) months. The majority of patients with IgG4-related sclerosing cholan- gitis were male (71.9%), median age was 59 ± 13 years. In most patients, delayed diagnosis (median 10.5 [4.8; 22.5] months) was associated with overdiagnosis of primary sclerosing cholangitis (41.2%) or bile duct malignancy (43.8%). Surgical interventions were performed in 50% of patients. Median serum IgG4 level was 2.70 g/L [1.92; 6.48], and 21.9% of patients had normal serum IgG4 level. Disease relapse developed in 34.4% (n = 11) of patients. Serum IgG4 level before glucocorticosteroid therapy ≥ 2.24 g/L and a delay in diagnosis by ≥ 17 months were associated with the relapse (p = 0.040 and p = 0.049 respectively). Multi-organ involvement, and extrahepatic localization of biliary strictures in the patients with the history of surgical interventions increased the risk of relapse 85 (p = 0.001) and 12 (p = 0.047) fold, respectively. The presence of biliary strictures below the confluence reduced the risk of relapse 7.5 fold (p = 0.032).Conclusions. Possible predictors of IgG4-related sclerosing cholangitis relapse may include multi- organ involvement, intrahepatic and proximal extrahepatic strictures, prior surgical interventions in patients with extrahepatic strictures, high serum IgG4 level, and delayed diagnosis.

Enhancing Relapse Prevention: Examining the Impact of Experiential Avoidance, Integrative Self-Knowledge, and Basic Psychological Needs in Substance Use Treatment.

The harmful effects of drug relapse have always been one of the major challenges in addiction treatment. The present study aimed to predict drug relapse in addicted men under treatment based on experiential avoidance, integrative self-knowledge, and basic psychological needs. The present study was a correlational one. The statistical population included all addicted men in Choubindar prison in Qazvin in 2021, among whom 200 individuals were selected randomly. Then, the participants filled out the Relapse Prediction Scale (RPS), Multidimensional Experiential Avoidance Questionnaire (MEAQ), Integrative Self-Knowledge Scale (ISK), and Basic Psychological Needs Scale (BPNS). Data were analyzed using stepwise regression via SPSS software (version 25). The results of the study demonstrated that some of the components of experiential avoidance including distraction, distress endurance, behavioral avoidance, and distress aversion could account for 14.0% of the variance of the relapse in the addicts (P<0.05). Moreover, the obtained results considering the reflective self-knowledge component and the overall score of integrative self-knowledge could explain 15.0% of the variance in relapse in the addicts. Among the basic psychological needs, communication could predict 3.8% of the variance in relapse. Based on the results of the present study, it is suggested that through addiction treatment and prevention of relapse programs, psychologists reduce drug relapse in addicts by decreasing distractions and behavioral avoidance, increasing distress endurance, enhancing self-knowledge, and improving efficient relationships.

INTEGRATING PSYCHOEDUCATION INTO MOTIVATIONAL THERAPY: A PROTOCOL FOR POSITIVE CHANGE IN DEPRESSIVE SUBJECTS

The combination of psychoeducation and motivational therapy is proved to be a powerful approach to help individuals making positive changes in their lives.(Miller &amp; Rollnick, 2013) This scientific paper provides practitioners with information on a draft protocol for psychoeducation in motivational therapy,which is combining the two approaches to optimize the change process. This protocol emphasizes the importance of tailoring treatment to the patient's individual needs, and reinforcing the motivation induced to promote lasting change. The protocol begins with the establishment of a trusting relationship between therapist and patient, followed by in-depth information on the problem to be treated. Next, sessions are organized to explore motivation, identify the advantages and disadvantages of change, set goals for change and, finally, reinforce the skills needed to achieve these goals. In addition, relapse prevention strategies are discussed with the patient, and a long-term support plan is drawn up involving his collaboration. This protocol offers a holistic and personalized approach to guide practitioners in the application of psychoeducation in motivational therapy, promoting positive and lasting results for people seeking change. The scientific paper concludes by highlighting the interest of this integrated approach for a variety of issues in Depressive Subjects, while emphasizing the need for follow-up sessions to maintain progress and ongoing support

An Interdisciplinary Multimodal Integrative Healthcare Program for Chronic Spinal Pain and Comorbid Mental Disorders.

Previous studies evaluating interdisciplinary multimodal interventions for chronic spinal pain often excluded patients with comorbid mental disorders. This study aims to assess the effectiveness of an outpatient secondary care interdisciplinary multimodal integrative healthcare program for individuals experiencing co-occurring chronic spinal pain and mental disorders. Participants were 944 patients with chronic spinal pain and comorbid mental disorders. Primary outcomes were health-related quality of life, assessed using the Research and Development-36 (RAND-36), and pain-related disability, assessed using the Quebec Back Pain Disability Scale (QBPDS). Secondary outcomes included pain intensity, pain catastrophizing, kinesiophobia, fatigue, lumbar mobility, and isometric strength. Data were collected during the healthcare program at four time points: pretreatment (T0), midway through 20-week treatment (T1), end of 20-week treatment (T2), and at completion of 12-month relapse prevention program (T3). Multilevel regression analyses were conducted to examine the effects of the healthcare program on primary outcomes over time. The 20-week treatment period yielded significant improvements in both mental ( B = 0.44, t (943) = 19.42, p < .001) and physical component summary scores ( B = 0.45, t (943) = 18.24, p < .001) of the RAND-36, as well as in QBPDS total score ( B = -0.77, t (943) = -26.16 p < .001). Pretreatment scores indicated the presence of problematic fatigue, kinesiophobia, and clinical levels of pain catastrophizing, all of which resolved by the end of the 12-month relapse prevention program. An interdisciplinary multimodal integrative healthcare program seems effective for patients with chronic spinal pain and comorbid mental disorders.

A Review of Mobile App-Based Psychosocial Intervention for Personal and Clinical Recovery for People With Psychosis

Objectives: The social and economic costs of severe mental illness, including psychosis, are increasing, and methods to reduce costs such as a mobile app-based approach have been tried more than ever. This study aims to explore and analyze the methods that have been used in previous studies for mobile app-based psychosocial interventions for personal and clinical recovery of psychosis.Methods: To identify mobile apps associated with psychosis, psychotic disorder, and other related terms, we searched for literature published from 2017 to 2023 (n=21). After classifying them into personal and clinical recovery, we qualitatively analyzed each study’s topics, objectives, measurement tools, results, and other aspects.Results: For personal recovery, the focus was mainly on improving daily living, self-management, and cognitive and social function improvement, and for clinical recovery, the focus was mainly on preventing symptom recurrence and managing symptoms. Mobile apps for improving daily living functions, cognitive functions, and relapse prevention have significant effects. While mobile apps for improving social function and symptom management mainly reported smaller effects.Conclusion: The results of this study suggest that mobile app-based psychosocial interventions for personal and clinical recovery of psychosis are likely to be utilized. Finally, the significance and limitations of the studies were discussed.

Model of negative affect induced by withdrawal from acute and chronic morphine administration in male mice

Opioid use disorder (OUD) is a chronic relapsing disorder that is a major burden for the lives of affected individuals, and society as a whole. Opioid withdrawal is characterized by strong physical symptoms, along with signs of negative affect. Negative affect due to opioid withdrawal is a major obstacle to recovery and relapse prevention. The mechanisms behind negative affect due to either spontaneous or antagonist-precipitated opioid withdrawal are not well known, and more animal models need be developed. Here, we present behavioral models of negative affect upon naloxone-precipitated morphine withdrawal in adult male mice. Social, anxiety, and despair-like deficits were investigated following naloxone administration in mice receiving morphine under three dosing regimens; acute, chronic constant dose and chronic escalating doses. Social behaviour in the three-chamber social preference test was decreased following withdrawal from chronic and escalating but not acute morphine. Anxiety-like behaviour in the open field was increased for all three treatments. Despair-like behaviour was increased following withdrawal from chronic and escalating but not acute morphine. Altogether, these animal models will contribute to study behavioural and neuronal circuitries involved in the several negative affective signs characterizing OUD.

Effects of the mindfulness program for male substance abusers in Thailand on stress, deliberate self-harm, and drug abstinence intention: A repeated-measure design.

Substance abuse is prevalent among males, and mindfulness could serve as a means of helping individuals suffering from the adverse effects of substance abuse find relief. This study employed a one-group repeated-measure design and aimed to evaluate the effects of the mindfulness program on stress, deliberate self-harm, and drug abstinence intention among male substance abusers. The mindfulness program was implemented for Thai males with a history of narcotic drug use. Five participants were recruited from a rehabilitation institute in Thailand using convenience sampling. The program consisted of eight sessions over four weeks. The study outcomes were measured at three time points: pre-intervention (Time 1, Week 1), post-intervention (Time 2, Week 4), and follow-up (Time 3, Week 6). Research instruments included the Deliberate Self-Harm Inventory, the Perceived Stress Scale, and the Drug Abstinence Intention Questionnaire, all of which had Cronbach's alpha values above 0.80. Data analysis was carried out using the Friedman test and Dunn-Bonferroni post-hoc test. The eight-session program was implemented as intended, with a retention rate of 100%. The mean scores of deliberate self-harm and drug abstinence intention were significantly different across the three time points (χ2 = 10.000 and χ2 = 9.579, p <0.01, respectively). After conducting pairwise comparisons, the mean scores of deliberate self-harm at Time 2 and Time 3 were significantly lower than those at Time 1. Additionally, the mean scores of drug abstinence intention at Time 2 and Time 3 were higher than those at Time 1. However, the mean score of stress did not have a significant difference. This program was both acceptable and effective in reducing deliberate self-harm and improving drug abstinence intention. These findings suggest that nurses and healthcare teams involved in caring for individuals with substance abuse issues could utilize this intervention alongside other therapies or hospital treatments. Consequently, relapse prevention among substance abusers could be achieved.Thai Clinical Trials Registry Number: TCTR20230404001.

Application of mindfulness-based interventions – MBCT and MBSR – in depression treatment and relapse prevention

Introduction: Depression stands as a primary contributor to disability, prompting extensive exploration of treatment and prevention strategies. Recognizing the limitations of conventional approaches, the significance of effective non-pharmacological therapies, like psychotherapy, in managing mental health disorders is increasingly acknowledged. There's a growing interest in mindfulness-based interventions such as Mindfulness-Based Cognitive Therapy (MBCT) and Mindfulness-Based Stress Reduction (MBSR). These interventions, which prioritize present-moment awareness and acceptance, target depression's mechanisms, such as rumination, while cultivating coping strategies and resilience. Mindfulness, with its comprehensive approach and capacity for self-regulation, emerges as pivotal in addressing psychiatric conditions. This paper aims to provide a comprehensive evaluation of MBCT and MBSR's effectiveness in treating depression and preventing relapses. Description of the state of knowledge: MBCT and MBSR exhibit promising potential in effectively managing and preventing depression. Moreover, they alleviate anxiety, emotional exhaustion, stress and psychological distress, while fostering improved coping with rumination, memory disturbances and emotional regulation. Summary: Research indicates that incorporating MBCT and MBSR could offer a hopeful avenue for managing and alleviating the symptoms of depression and mental disorders, by addressing underlying factors which play a pivotal role in their development. To corroborate these encouraging results, additional randomized, large-scale, placebo-controlled trials are essential.

Application of mindfulness-based interventions – MBCT and MBSR – in depression treatment and relapse prevention

Introduction: Depression stands as a primary contributor to disability, prompting extensive exploration of treatment and prevention strategies. Recognizing the limitations of conventional approaches, the significance of effective non-pharmacological therapies, like psychotherapy, in managing mental health disorders is increasingly acknowledged. There's a growing interest in mindfulness-based interventions such as Mindfulness-Based Cognitive Therapy (MBCT) and Mindfulness-Based Stress Reduction (MBSR). These interventions, which prioritize present-moment awareness and acceptance, target depression's mechanisms, such as rumination, while cultivating coping strategies and resilience. Mindfulness, with its comprehensive approach and capacity for self-regulation, emerges as pivotal in addressing psychiatric conditions. This paper aims to provide a comprehensive evaluation of MBCT and MBSR's effectiveness in treating depression and preventing relapses. Description of the state of knowledge: MBCT and MBSR exhibit promising potential in effectively managing and preventing depression. Moreover, they alleviate anxiety, emotional exhaustion, stress and psychological distress, while fostering improved coping with rumination, memory disturbances and emotional regulation. Summary: Research indicates that incorporating MBCT and MBSR could offer a hopeful avenue for managing and alleviating the symptoms of depression and mental disorders, by addressing underlying factors which play a pivotal role in their development. To corroborate these encouraging results, additional randomized, large-scale, placebo-controlled trials are essential.

The effectiveness of using cognitive behavioral therapy and internet-based cognitive behavioral therapy interventions on relapse prevention and severity of symptoms among patients diagnosed with major depressive disorder: a systematic review of randomized controlled trials

Purpose This study aims to evaluate and summarize the effectiveness of cognitive behavioral therapy (CBT) and internet-based CBT (ICBT) interventions on relapse prevention and severity of symptoms among individuals with major depressive disorder (MDD). CBT is one of the most used and suggested interventions to manage MDD, whereas ICBT is a novel effective proposed approach. Design/methodology/approach The review was conducted following the preferred reporting items for systematic review and meta-analysis protocol. A comprehensive and extensive search was performed to identify and evaluate the relevant studies about the effectiveness of CBT and ICBT on relapse prevention and severity of symptoms among patients with MDD. Findings A total of eight research studies met the inclusion criteria and were included in this systematic review. RCT studies were conducted to assess and evaluate the effectiveness of CBT and ICBT on relapse prevention and severity of symptoms among patients with MDD. It has been found that CBT is a well-supported and evidently based effective psychotherapy for managing depressive symptoms and reducing the relapse and readmission rate among patients diagnosed with MDD. The ICBT demonstrated greater improvements in depressive symptoms during major depressive episodes among patients with MDDS. The ICBT program had good acceptability and satisfaction among participants in different countries. Research limitations/implications Despite the significant findings from this systematic review, certain limitations should be acknowledged. First, it is important to note that all the studies included in this review were exclusively conducted in the English language, potentially limiting the generalizability of the findings to non-English speaking populations. Second, the number of research studies incorporated in this systematic review was relatively limited, which may have resulted in a narrower scope of analysis. Finally, a few studies within the selected research had small sample sizes, which could potentially impact the precision and reliability of the overall conclusions drawn from this review. The authors recommend that nurses working in psychiatric units should use CBT interventions with patients with MDD. Practical implications This paper, a review of the literature gives an overview of CBT and ICBT interventions to reduce the severity of depressive symptoms and prevent patients’ relapse and rehospitalization and shows that CBT interventions are effective on relapse prevention among patients with MDD. In addition, there is still no standardized protocol to apply the CBT intervention in the scope of reducing the severity of depressive symptoms and preventing depression relapse among patients with major depressive disorder. Further research is needed to confirm the findings of this review. Future research is also needed to find out the most effective form and contents of CBT and ICBT interventions for MDD. Social implications CBT is a psychological intervention that has been recommended by the literature for the treatment of major depressive disorder (MDD). It is a widely recognized and accepted approach that combines cognitive and behavioral techniques to assist individuals overcome their depressive symptoms and improve their overall mental well-being. This would speculate that effectiveness associated with several aspects and combinations of different approaches in CBT interventions and the impact of different delivery models are essential for clinical practice and appropriate selection of the interventional combinations. Originality/value This systematic review focuses on the various studies that explore the effectiveness of face-to-face CBT and ICBT in reducing depressive symptoms among patients with major depressive disorder. These studies were conducted in different countries such as Iran, Australia, Pennsylvania and the USA.

A review on the pharmacology of cariprazine and its role in the treatment of negative symptoms of schizophrenia.

Management of negative symptoms is one of the most challenging and important unmet needs of schizophrenia treatment. Negative symptoms together with positive symptoms result in significant psychosocial impairment and poor quality of life. Existing studies on atypical antipsychotics reported limited treatment adherence due to higher prevalence of treatment-emergent adverse events, such as diabetes, weight gain, hyperlipidemia, hyperprolactinemia and hypertension. A compound with greater affinity for dopamine D2/D3 receptors may improve negative symptoms, mood, and cognitive impairment associated with schizophrenia. In 2015, the US FDA has approved cariprazine, a partial D2/D3 agonist for treatment of schizophrenia, mania or mixed episodes. Midlands and Lancashire Commissioning Support Unit, UK (2019) has particularly suggested cariprazine for the treatment of predominant negative symptoms of schizophrenia. India's Central Drugs Standard Control Organization (CDSCO) has approved cariprazine in 2021 for the treatment of schizophrenia, manic or mixed episodes associated with bipolar I disorder. A ten-fold greater affinity for D3 receptors and partial agonism to serotonin receptors, along with longer half-life make cariprazine distinct when compared with other atypical antipsychotics. Cariprazine is also reported to have fewer incidents of metabolic and hormonal adverse events, and has been shown to provide better relapse prevention. Recent evidence indicates promising effect of cariprazine in ameliorating negative symptoms as well as psychotic symptoms in patients with schizophrenia. In addition, improved adherence to treatment (adjunctive/monotherapy) with cariprazine in patients having inadequate response to an ongoing antipsychotic treatment has also been clinically established. This review presents the evidence-based safety and efficacy of cariprazine for treatment of predominant negative symptoms of schizophrenia.