Significant Reduction In Symptom Severity Research Articles

A Pilot Study of a Trauma Resiliency Protocol for Law Enforcement Officers With Posttraumatic Stress Disorder Symptoms.

The aim of the study is to test the efficacy of the 22ZERO Trauma Resiliency Protocol (TR-P) on posttraumatic stress disorder (PTSD) symptom severity among current and former law enforcement officers. The study used a retrospective, pre/post intervention design to test the effects of the TR-P on measures of self-reported symptom severity. One hundred twenty-eight current and former law enforcement officers were exposed to the TR-P treatment. All participants were administered the PTSD Checklist for DSM-5 PTSD Checklist and other psychological assessments before and after exposure. Participants experienced a significant reduction in symptom severity, suggesting that exposure to the TR-P reduced the effects of PTSD in this sample of law enforcement officers. The 22ZERO TR-P may be an efficacious mechanism for reducing PTSD symptom severity among current and former law enforcement officers. It should be tested using a randomized trial and a longer follow-up period.

Does Reducing Alcohol Use Among People with HIV Alleviate Psychological Distress and Symptoms of Depression? A Randomized Controlled Trial in Tshwane, South Africa

Although alcohol use is associated with depression, it is unclear if brief alcohol reduction interventions can ameliorate depression and psychological distress among people with HIV (PWH). We use data from a two-arm randomised controlled trial to examine this question. PWH on antiretroviral treatment (ART) were randomly assigned to receive a brief intervention or treatment as usual (n = 622). Screening was done with the Alcohol Use Disorders Identification Test (AUDIT), AUDIT-C, Centre for Epidemiological Studies Depression inventory and Kessler Psychological Distress Scale, at baseline and at 3- and 6-months post-baseline. Changes in depression and psychological distress was assessed using analysis of covariance models with baseline measures of alcohol consumption, sex and age included as covariates and adjusting for baseline symptom severity. Changes in alcohol consumption between baseline and follow-up were included in the analysis to establish if this affected outcomes. For both the intervention and control groups, there were significant reductions in symptom severity at 3-months and 6-months for depression and psychological distress, but no significant between group differences were observed. Reductions in alcohol consumption were significantly associated with reductions in depression and psychological distress, supporting the hypothesis that alcohol use is linked to depression among PWH.Trial Registration Pan African Clinical Trials Register, PACTR201405000815100.nh

A study to assess the effectiveness of ginger tea on symptoms of dyspepsia among adults

Introduction: Dyspepsia is a common gastrointestinal (GI) condition around the world. Dyspepsia is a symptom complex that includes a variety of upper GI symptoms such as epigastric pain or burning, early satiety, and post-prandial fullness. Treatment with complementary and alternative medicines, particularly herbal remedies, is one option for treating dyspepsia symptoms. Objectives: The objectives of the study were to evaluate the effectiveness of ginger tea on symptoms of dyspepsia among adults Methods: A one-group pre-test and post-test research design with 30 samples who met the inclusion criteria was used. Demographic and clinical data were collected using a self-structured questionnaire. During the pre-test, a questionnaire (LDQ) was used to assess the severity of dyspepsia symptoms using an interview method. Following the pre-test, 100ml of freshly prepared ginger tea was given once a day, seven days a week, in the morning before meals. The same tool was used for the post-test after seven days of ginger tea administration. Data has been subjected to descriptive and inferential statistics Result: During the pre-test, 13(43.33 %) of the 30 samples had moderate dyspepsia, 9(30%) had severe dyspepsia, and 8(26.67%) had mild dyspepsia, whereas in the post-test, 14(46.67%) had moderate dyspepsia, 12(40%) had mild dyspepsia, and 4(13.33%) had severe dyspepsia. Ginger tea is effective when the pre-test and post-test values are compared. At the p<0.001 level, the calculated paired ‘t’ test value of t = 9.104 was found to be statistically highly significant. Demographic variables such as marital status and clinical variables such as dyspepsia duration and smoking history show a significant association with post-test dyspepsia level at p<0.05. Conclusion: According to the study findings, the overall pre-test symptom score was mild to moderate. The post-test symptom score of dyspepsia patients who were given ginger tea showed a significant reduction in symptom severity. It was concluded that ginger had a greater impact on symptom relief in dyspepsia patients than other foods.

A study to assess the effectiveness of ginger tea on symptoms of dyspepsia among adults

Introduction: Dyspepsia is a common gastrointestinal (GI) condition around the world. Dyspepsia is a symptom complex that includes a variety of upper GI symptoms such as epigastric pain or burning, early satiety, and post-prandial fullness. Treatment with complementary and alternative medicines, particularly herbal remedies, is one option for treating dyspepsia symptoms. Objectives: The objectives of the study were to evaluate the effectiveness of ginger tea on symptoms of dyspepsia among adults Methods: A one-group pre-test and post-test research design with 30 samples who met the inclusion criteria was used. Demographic and clinical data were collected using a self-structured questionnaire.During the pre-test, a questionnaire (LDQ) was used to assess the severity of dyspepsia symptoms using an interview method. Following the pre-test, 100ml of freshly prepared ginger tea was given once a day, seven days a week, in the morning before meals. The same tool was used for the post-test after seven days of ginger tea administration. Data has been subjected to descriptive and inferential statistics Result: During the pre-test, 13(43.33 %) of the 30 samples had moderate dyspepsia, 9(30%) had severe dyspepsia, and 8 (26.67 %) had mild dyspepsia, whereas in the post-test, 14(46.67%) had moderate dyspepsia, 12(40%) had mild dyspepsia, and 4(13.33%) had severe dyspepsia. Ginger tea is effective when the pre-test and post-test values are compared. At the p<0.001 level, the calculated paired ‘t’ test value of t = 9.104 was found to be statistically highly significant. Demographic variables such as marital status and clinical variables such as dyspepsia duration and smoking history show a significant association with post-test dyspepsia level at p<0.05. Conclusion: According to the study findings, the overall pre-test symptom score was mild to moderate. The post-test symptom score of dyspepsia patients who were given ginger tea showed a significant reduction in symptom severity. It was concluded that ginger had a greater impact on symptom relief in dyspepsia patients than other foods.

The Bergen 4-day treatment for panic disorder: replication and implementation in a new clinic

BackgroundBergen 4-day treatment (B4DT) is a concentrated exposure-based treatment (cET), where the patient receives concentrated, individually tailored cognitive behavioral therapy (CBT) during four consecutive days. Previous findings have indicated that B4DT could be a promising treatment for panic disorder (PD).AimThe aim of the present study was to evaluate the implementation of B4DT for panic disorder with- and without agoraphobia, at a new clinic. This is the first replication study for B4DT on panic disorder.MethodThirty consecutively recruited patients with PD were included in an open trial design. Assessment of symptoms of panic disorder were measured with Panic Disorder Severity Scale (PDSS), while symptoms of generalized anxiety were assessed by Generalized Anxiety Disorder-7 (GAD-7) and depressive symptoms by Patient Health Questionnaire (PHQ-9) pre-treatment, post-treatment and at 3-month follow-up. Treatment satisfaction was measured with Client Satisfaction Questionnaire (CSQ-8) post-treatment.ResultsThe results showed a significant reduction in symptom severity from pre-treatment to post-treatment (d = 4.32), and at 3-month follow-up (d = 4.91). The proportion of patients classified as fulfilling the criteria for remission was 80.0% at post-treatment and 86.7% at follow up. There was a significant reduction in symptoms of depression and generalized anxiety. Treatment satisfaction was high and none of the patients dropped out.ConclusionThe current study replicated the results from the original study and indicate that the treatment can be successfully implemented at new clinics. B4DT may be a promising treatment for panic disorder and comorbid symptoms of generalized anxiety and depression. Larger and more controlled studies are needed to establish the efficacy of B4DT for panic disorder.

The effects of mindfulness-based training in virtual reality on psychotic symptoms, mood and cognitive functioning - a pilot study.

Virtual reality (VR) is growing in popularity in treating various psychiatric disorders, including psychotic ones. However, no studies have been published on mindfulness interventions aided by virtual reality in psychotic patients to date. 25 patients with schizophrenia or schizoaffective disorder were assessed at three time points with 4-week intervals using the six-item Positive and Negative Syndrome Scale (PANSS-6), Quick Inventory of Depressive Symptomatology (QIDS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), State-Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS-10), and the Addenbrooke's Cognitive Examination III (ACE-III). Additionally, the intensity of seven emotions was rated using the Visual Analog Scale (VAS) before and after each training session. The subjects achieved a significant reduction in symptom severity after completing mindfulness training. This was reflected by the PANSS-6 total score, as well as by the subscales for negative and positive symptoms. A significant increase in cognitive functioning (ACE-III scores) was also found. No significant changes in these measures were observed when only the standard intervention was used. Our study indicates good feasibility of the developed mindfulness intervention in VR in schizophrenic patients. The results indicate potential benefits in terms of lessening of the symptoms and improvement in cognition.

Quality of life with relugolix combination therapy for uterine fibroids: LIBERTY randomized trials

Symptomatic uterine fibroids are burdensome to live with; they are associated with symptom-related distress, affect daily activities, and reduce health-related quality of life. The LIBERTY randomized clinical trials showed that oral relugolix combination therapy (40 mg relugolix, 1 mg estradiol, and 0.5 mg norethindrone acetate once daily) markedly improved fibroid-associated symptoms and conditions, including heavy menstrual bleeding, pain, and anemia, and was well-tolerated. This study aimed to evaluate the effect of relugolix combination therapy on the symptom burden and health-related quality of life among women with uterine fibroids. Two replicate, multinational, double-blind, 24-week, randomized, placebo-controlled, phase 3 studies, LIBERTY 1 and LIBERTY 2, were conducted in premenopausal women with uterine fibroid-associated heavy menstrual bleeding (≥80 mL per cycle for 2 cycles or ≥160 mL during 1 cycle). The symptom burden and health-related quality of life were secondary endpoints and were assessed using the validated Uterine Fibroid Symptom and Quality of Life questionnaire, which the participants completed at baseline and at week 12 and 24 of treatment. For this secondary analysis, the pooled LIBERTY 1 and LIBERTY 2 data set was used. The Uterine Fibroid Symptom and Quality of Life questionnaire is made up of a Symptom Severity scale and a Health-Related Quality of Life scale, the latter of which includes 6 subscales focusing on the following aspects of daily life: concern, activities, energy or mood, control, self-consciousness, and sexual function. The Revised Activities subscale of the Health-Related Quality of Life scale addresses the impact of uterine fibroids on physical and social activities. Symptom burden was also assessed via the Bleeding and Pelvic Discomfort subscale, a patient-reported outcome measure derived from the Uterine Fibroid Symptom Severity scale that focuses on distress from key uterine fibroid symptoms, which was a key secondary endpoint. Least squares mean changes from baseline to week 24 in the Symptom Severity scale, Bleeding and Pelvic Discomfort subscale, overall Health-Related Quality of Life scale, and the respective subscales were compared between the relugolix combination therapy and placebo groups. Responder analyses of the proportion of women who experienced a clinically meaningful change from baseline to week 24 were conducted for the Bleeding and Pelvic Discomfort and the activity subscales. A stratified Cochran-Mantel-Haenszel test, adjusted for stratification factors (region [North America vs rest of world] and baseline menstrual blood loss volume), was used for treatment comparisons. Across both trials, 509 women were randomized to the relugolix combination therapy or placebo groups (April 2017-December 2018). Participants on relugolix combination therapy showed a statistically significant reduction in symptom severity (-33.5 vs-12.1; nominal P<.0001) and the Bleeding and Pelvic Discomfort subscale from baseline to week 24 when compared with those on placebo treatment (-48.4 vs-17.4; nominal P<.0001). Overall, the total Health-Related Quality of Life scores improved significantly from baseline to week 24 in the relugolix combination therapy group when compared with the placebo (+37.6 vs+13.1; nominal P<.0001). Responder analyses demonstrated that more women treated with relugolix combination therapy reported a clinically meaningful reduction in the Bleeding and Pelvic Discomfort subscale and an improvement in physical and social activities when compared with those treated with the placebo (nominal P<.0001). After 24 weeks of treatment with relugolix combination therapy, women with symptomatic uterine fibroids experienced substantial improvements in health-related quality of life with all subscales showing improvement, including emotional well-being, physical and social activities, and sexual function. In addition, women reported substantial reductions in the overall symptom burden and distress caused by key fibroid-associated symptoms.

Biocontrol Potential of Endophytic Plant-Growth-Promoting Bacteria against Phytopathogenic Viruses: Molecular Interaction with the Host Plant and Comparison with Chitosan.

Endophytic plant-growth-promoting bacteria (ePGPB) are interesting tools for pest management strategies. However, the molecular interactions underlying specific biocontrol effects, particularly against phytopathogenic viruses, remain unexplored. Herein, we investigated the antiviral effects and triggers of induced systemic resistance mediated by four ePGPB (Paraburkholderia fungorum strain R8, Paenibacillus pasadenensis strain R16, Pantoea agglomerans strain 255-7, and Pseudomonas syringae strain 260-02) against four viruses (Cymbidium Ring Spot Virus—CymRSV; Cucumber Mosaic Virus—CMV; Potato Virus X—PVX; and Potato Virus Y—PVY) on Nicotiana benthamiana plants under controlled conditions and compared them with a chitosan-based resistance inducer product. Our studies indicated that ePGPB- and chitosan-treated plants presented well-defined biocontrol efficacy against CymRSV and CMV, unlike PVX and PVY. They exhibited significant reductions in symptom severity while promoting plant height compared to nontreated, virus-infected controls. However, these phenotypic traits showed no association with relative virus quantification. Moreover, the tested defense-related genes (Enhanced Disease Susceptibility-1 (EDS1), Non-expressor of Pathogenesis-related genes-1 (NPR1), and Pathogenesis-related protein-2B (PR2B)) implied the involvement of a salicylic-acid-related defense pathway triggered by EDS1 gene upregulation.

Efficacy, Effectiveness, and Quality of Resilience-Building Mobile Health Apps for Military, Veteran, and Public Safety Personnel Populations: Scoping Literature Review and App Evaluation.

BackgroundMilitary members (MMs) and public safety personnel (PSP) are vulnerable to occupational stress injuries because of their job demands. When MMs and PSP transition out of these professions, they may continue to experience mental health challenges. The development and implementation of resilience-building mobile health (mHealth) apps as an emergent mental health intervention platform has allowed for targeted, cost-effective, and easily accessible treatment when in-person therapy may be limited or unavailable. However, current mHealth app development is not regulated, and often lacks both clear evidence-based research and the input of health care professionals.ObjectiveThis study aims to evaluate the evidence-based quality, efficacy, and effectiveness of resilience-building mobile apps targeted toward the MMs, PSP, and veteran populations via a scoping literature review of the current evidence base regarding resilience apps for these populations and an evaluation of free resilience apps designed for use among these populations.MethodsThe studies were selected using a comprehensive search of MEDLINE, CINAHL Plus, PsycINFO, SocINDEX, Academic Search Complete, Embase, and Google and were guided by PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). A narrative synthesis of the resulting papers was performed. The Alberta Rating Index for Apps was used to conduct a review of each of the identified apps. The inclusion criteria consisted of apps that were free to download in either the Google Play Store or the Apple App Store; updated within the last 3 years; available in English and in Canada; and intended for use by MMs, veterans, and PSP.ResultsIn total, 22 apps met the inclusion criteria for evaluation. The resilience strategies offered by most apps included psychoeducation, mindfulness, cognitive behavioral therapy, and acceptance and commitment therapy. Overall, 50% (11/22) of apps had been tested in randomized controlled trials, 7 (32%) apps had been evaluated using other research methods, and 5 (23%) apps had not been studied. Using the Alberta Rating Index for Apps, the app scores ranged from 37 to 56 out of 72, with higher rated apps demonstrating increased usability and security features.ConclusionsThe mHealth apps reviewed are well-suited to providing resilience strategies for MMs, PSP, and veterans. They offer easy accessibility to evidence-based tools while working to encourage the use of emotional and professional support with safety in mind. Although not intended to function as a substitute for professional services, research has demonstrated that mHealth apps have the potential to foster a significant reduction in symptom severity for posttraumatic stress disorder, depression, anxiety, and other mental health conditions. In clinical practice, apps can be used to supplement treatment and provide clients with population-specific confidential tools to increase engagement in the treatment process.

Effectiveness of intranasal steroids on rhinitis symptoms, sleep quality, and quality of life in patients with perennial allergic rhinitis.

Evaluate the impact of perennial allergic rhinitis (PAR) on the health-related quality of life (HRQL) and measure performance issues that are of major concerns for PAR patients, as well as determining the effect of intra-nasal steroids (INS) on PAR and associated congestion, sleep complaints, and daytime sleepiness. This study was a cross-sectional study. A total of 78 PAR patients underwent otorhinolaryngological examination and skin test. All participants filled in the Nocturnal Rhinoconjunctivitis Quality of Life Questionnaire (NRQLQ), the Stanford Sleepiness Scale (SSS), and the Epworth Sleepiness Scale (ESS). Participants were asked to undergo treatment with Budesonide (BUD) topical aqueous nasal spray for eight weeks. After the treatment period, all participants were again asked to answer the three questionnaires. The results of this study found statistically significant improvements in the overall NRQLQ score (p < 0.001) and individual NRQLQ domain scores (p < 0.05) after INS treatment. A statistically significant reduction in symptom severity in the four NRQLQ domains before and after treatment was found (p < 0.05), except for restlessness, post-nasal drip, and avoiding symptom triggers (p = 0.575, 0.172, and 0.705, respectively). There was a statistically significant difference in ESS and SSS scores before and after treatment (p < 0.001). PAR has a significant impact on sleep quality and, as a result, a lower QOL. This study demonstrates that INS is an effective modality in the treatment of PAR and positively impacts patients' QOL by improving nasal symptoms, daytime fatigue, and somnolence, and sleep quality.

Influence of Bifidobacterium infantis 35624 on the clinical course of irritable bowel syndrome depending on the phenotype: results of a local non-interventional prospective epidemiological study IBS-Control

Objective — to evaluate the clinical efficacy of B. infantis 35624 on the course of IBS depending on the phenotype.Materials and methods. The clinical study involved 1870 patients. From them, 1260 patients with a verified diagnosis of IBS according to Rome IV criteria (2016) were included for further follow‑up. Patients were divided into three groups depending on the phenotype: diarrhea predominant IBS (IBS‑D) — 522 patients, constipation predominant IBS (IBS‑C) — 376 patients, mixed IBS (IBS‑M) — 362 patients. All patients were prescribed a dietary supplement «Alflorex», which contains the original strain of B. infantis 35624 in a dosage &gt; 109 bacteria, 1 capsule daily. The efficiency criteria included dynamic of bowel movement frequency, stool consistency according to the Bristol stool scale, an assessment of a pain syndrome and flatulence on a visual analog scale (VAS). Assessment of the symptoms severity in patients with IBS was performed by specialized questionnaire IBS‑SSI (Irritable Bowel Syndrome‑Symptom Severity Index).Results. After 8 weeks of treatment, absence of the pain was detected in 450 (86.2 %) patients with IBS‑D, in 296 (79.6 %) patients with IBS‑M and in 282 (75.0 %) patients with IBS‑C. The satisfaction of stool consistency and bowel movement was marked in 309 (59.2 %) patients with IBS‑D, in 166 (44.6 %) — patients with IBS‑M and in 93 (24.7 %) patients with IBS‑C after 4 weeks of the treatment. At the end of the 8th week, this index significantly improved in 420 (80.5 %) patients with IBS‑D, in 231 (62.1 %) patients with IBS‑M and in 184 (49.0 %) patients with IBS‑C. The greatest positive effect of B. infantis 35624 on the pain intensity was found in patients with IBS‑D after 8 weeks of treatment. It was confirmed by a reducing pain intensity in 2.4 times (p &lt; 0.02) and in 1.9 times (p &lt; 0.05) compared with patients with IBS‑C and IBS‑M, respectively. The patients with IBS‑D had a significant decrease in stool frequency in 1.4 times (p &lt; 0.05) after the first treatment week. Reduction in the IBS severity (according to the IBS‑SSI questionnaire) was found in all groups of patients who received B. infantis 35624. However, after 4th treatment weeks, the fastest positive dynamics was found in patients with IBS‑D. It was a significant reduction in symptom severity in 2.0 times (p &lt; 0.01) due to a decrease in bloating and heaviness in the abdomen, reduced pain intensity, days when the pain was appeared.Conclusions. The results of clinical study confirmed that during treatment with B. infantis 35624 the most positive dynamics of the IBS symptoms reduction was found in patients with IBS‑D. Based on patients’ evaluation, the normalization of the stool frequency and bowel movements with attenuation of pain intensity and flatulence took place regardless of IBS type.

Striatal Volume Increase After Six Weeks of Selective Dopamine D2/3 Receptor Blockade in First-Episode, Antipsychotic-Naïve Schizophrenia Patients

Patients with chronic schizophrenia often display enlarged striatal volumes, and antipsychotic drugs may contribute via the dopamine D2/3 receptor (D2/3R) blockade. Separating the effects of disease from medication is challenging due to the lack of a proper placebo-group. To address this, we conducted a longitudinal study of antipsychotic-naïve, first-episode schizophrenia patients to test the hypothesis that selective blockade of D2/3R would induce a dose-dependent striatal volume increase. Twenty-one patients underwent structural magnetic resonance imaging (sMRI), single-photon emission computed tomography (SPECT), and symptom severity ratings before and after six weeks of amisulpride treatment. Twenty-three matched healthy controls underwent sMRI and baseline SPECT. Data were analyzed using repeated measures and multiple regression analyses. Correlations between symptom severity decrease, volume changes, dose and receptor occupancy were explored. Striatal volumes did not differ between patients and controls at baseline or follow-up, but a significant group-by-time interaction was found (p = 0.01). This interaction was explained by a significant striatal volume increase of 2.1% in patients (Cohens d = 0.45). Striatal increase was predicted by amisulpride dose, but not by either D2/3R occupancy or baseline symptom severity. A significant reduction in symptom severity was observed at a mean dose of 233.3 (SD = 109.9) mg, corresponding to D2/3R occupancy of 44.65%. Reduction in positive symptoms correlated significantly with striatal volume increase, driven by reductions in hallucinations. Our data demonstrate a clear link between antipsychotic treatment and striatal volume increase in antipsychotic-naïve schizophrenia patients. Moreover, the treatment-induced striatal volume increase appears clinically relevant by correlating to reductions in core symptoms of schizophrenia.

Symptom improvement in children with autism spectrum disorder following bumetanide administration is associated with decreased GABA/glutamate ratios

Bumetanide has been reported to alter synaptic excitation–inhibition (E-I) balance by potentiating the action of γ-aminobutyric acid (GABA), thereby attenuating the severity of autism spectrum disorder (ASD) in animal models. However, clinical evidence of its efficacy in young patients with ASD is limited. This was investigated in the present clinical trial of 83 patients, randomised to the bumetanide group (bumetanide treatment, 0.5 mg twice daily) or the control group (no bumetanide treatment). Primary [Children Autism Rating Scale (CARS)], secondary [Clinical Global Impressions (CGI)], and exploratory [inhibitory (γ-aminobutyric acid, GABA) and excitatory (glutamate, Glx) neurotransmitter concentrations measured in the insular cortex (IC) and visual cortex (VC) by magnetic resonance spectroscopy (MRS)] outcome measures were evaluated at baseline and at the 3-month follow-up. Side effects were monitored throughout the treatment course. Compared with the control group, the bumetanide group showed significant reduction in symptom severity, as indicated by both total CARS score and number of items assigned a score ≥ 3. The improvement in clinical symptoms was confirmed by CGI. GABA/Glx ratio in both the IC and VC decreased more rapidly over the 3-month period in the bumetanide group than that in the control group. This decrease in the IC was associated with the symptom improvement in the bumetanide group. Our study confirmed the clinical efficacy of bumetanide on alleviating the core symptoms of ASD in young children and it is the first demonstration that the improvement is associated with reduction in GABA/Glx ratios. This study suggests that the GABA/Glx ratio measured by MRS may provide a neuroimaging biomarker for assessing treatment efficacy for bumetanide.

Evaluation of the impacts of a district-level mental health care plan on contact coverage, detection and individual outcomes in rural Uganda: a mixed methods approach

BackgroundThe burden of mental disorders in low- and middle-income countries is large. Yet there is a major treatment gap for these disorders which can be reduced by integrating the care of mental disorders in primary care.AimWe aimed to evaluate the impact of a district mental health care plan (MHCP) on contact coverage for and detection of mental disorders, as well as impact on mental health symptom severity and individual functioning in rural Uganda.ResultsFor adults who attended primary care facilities, there was an immediate positive effect of the MHCP on clinical detection at 3 months although this was not sustained at 12 months. Those who were treated in primary care experienced significant reductions in symptom severity and functional impairment over 12 months. There was negligible change in population-level contact coverage for depression and alcohol use disorder.ConclusionThe study found that it is possible to integrate mental health care into primary care in rural Uganda. Treatment by trained primary care workers improves clinical and functioning outcomes for depression, psychosis and epilepsy. Challenges remain in accessing the men for care, sustaining the improvement in detection over time, and creating demand for services among those with presumed need.

A dietitian-first gastroenterology clinic results in improved symptoms and quality of life in patients referred to a tertiary gastroenterology service

The Dietitian First Gastroenterology Clinic (DFGC) is an initiative that has been established in response to increased gastroenterology clinical demand resulting in increased number of patients waiting outside clinically recommended timeframes for specialist care. In this clinic, a dietitian is the primary contact for eligible patients referred to tertiary gastroenterology services and provides assessment and management strategies for patients under the clinical governance of a gastroenterology consultant. This service has previously been shown to reduce patient wait-times and induce excellent patient satisfaction. Evaluation of models of care need to consider patient health outcomes as a key indicator for overall health service effectiveness. The aim of this study was to determine the impact of DFGC on patient related health outcomes. This study utilised a pretest-posttest design of patients seen in the DFGC who met the diagnostic criteria for irritable bowel syndrome using the Rome IV criteria Consenting participants completed the validated symptom-severity (IBS-SSS) and health-related quality of life (IBSQoL) assessments. Paired sample t-tests were used to analyse differences pre- and post-management in the DFGC. Univariate mixed effects analyses were conducted to examine associations between IBS-SSS, IBSQoL and patient demographics. A total of 80 of 122 patients seen in the DFGC were recruited and completed baseline data, with 60 (75%) completing follow up assessments. The average participant age was 35.6 years (75% female), and IBS subtypes; IBS-C 15.0%, IBS-D 38.3%, IBS-M 26.7% and IBS-U 20.0%. Participants experienced significant reductions in symptom severity based on IBS-SSS (300.1 vs 151.7; p<0.001) independent of IBS subtype, age or gender, with 88% (53/60) experiencing a clinically significant improvement. Quality of life significantly improved for all IBS subtypes (p<0.001) across all subscales except food avoidance (p=0.11). There was a moderate negative correlation between the changes in symptom severity and quality of life (R=0.432, p=0.001). Management in the DFGC provided positive patient health outcomes demonstrated by improvements in symptom severity and QoL.

Evaluating a Web-Based Social Anxiety Intervention Among Community Users: Analysis of Real-World Data.

BackgroundSocial anxiety is both harmful and prevalent. It also currently remains among the most undertreated major mental disorders, due, in part, to socially anxious individuals’ concerns about the stigma and expense of seeking help. The privacy and affordability of computer-aided psychotherapy interventions may render them particularly helpful in addressing these concerns, and they are also highly scalable, but most tend to be only somewhat effective without therapist support. However, a recent evaluation of a new self-guided, 7-module internet-delivered cognitive behavioral therapy intervention called Overcome Social Anxiety found that it was highly effective.ObjectiveThe initial evaluation of Overcome Social Anxiety revealed that it led to significant reductions in symptom severity among university undergraduates. The aim of this study was to extend the results of the initial study and investigate their generalizability by directly evaluating the intervention’s effectiveness among a general community sample.MethodsWhile signing up for Overcome Social Anxiety, users consented to the usage of their anonymized outcome data for research purposes. Before and after completing the intervention, users completed the Fear of Negative Evaluation Scale (FNE), which we employed as the primary outcome measure. Secondary outcome measures included the Depression Anxiety Stress Scales (DASS) and 2 bespoke questionnaires measuring socially anxious thoughts (Thoughts Questionnaire) and avoidance behaviors (Avoidance Questionnaire).ResultsParticipants who completed the intervention (102/369, 27.7%) experienced significant reductions in the severity of their symptoms on all measures employed, including FNE (P<.001; Cohen d=1.76), the depression subscale of DASS (P<.001; Cohen d=0.70), the anxiety subscale of DASS (P<.001; Cohen d=0.74), the stress subscale of DASS (P<.001; Cohen d=0.80), the Thoughts Questionnaire (P<.001; Cohen d=1.46), and the Avoidance Questionnaire (P<.001; Cohen d=1.42).ConclusionsOur results provide further evidence that Overcome Social Anxiety reduces the severity of social anxiety symptoms among those who complete it and suggest that its effectiveness extends to the general community. The completion rate is the highest documented for a fully automated intervention for anxiety, depression, or low mood in a real community sample. In addition, our results indicate that Overcome Social Anxiety reduces the severity of symptoms of depression, physiological symptoms of anxiety, and stress in addition to symptoms of social anxiety.

Intestinal Microbiome in Irritable Bowel Syndrome before and after Gut-Directed Hypnotherapy.

Irritable bowel syndrome (IBS) is a disorder with brain-gut-microbiome alterations. Gut-directed hypnotherapy (GHT) has been shown to improve quality of life and symptoms in IBS. This therapy targets psychological coping, central nervous processing and brain-gut interaction. Studies have also demonstrated effects of hypnosis on intestinal transit and the mucosal immune system. So far, no study has examined the effect of GHT on the intestinal microbiome. This study aimed at examining microbial composition, IBS symptoms, and psychological distress before and after GHT. Methods: Fecal samples were collected from 38 IBS patients (Rome-III criteria, mean age 44 years, 27 female, 11 male, 22 diarrhea-dominant, 12 alternating-type and 4 constipation-dominant IBS) before and after 10 weekly group sessions of GHT. Assessments in psychological (perceived stress, PSQ; psychological distress, HADS-D; quality of life, visual analogue scales) and IBS symptom-related variables (IBS severity, IBS-SSS; single symptoms, visual analogue scales) were performed with validated questionnaires. Fecal samples underwent microbial 16S rRNA analyses (regions V1–2). Results: Microbial alpha diversity was stable before and after GHT (chao1 2591 ± 548 vs. 2581 ± 539, p = 0.92). No significant differences were found in relative bacterial abundances but trends of reduced abundance of Lachnospiraceae 32.18 (4.14–39.89) Median (Q1–Q3) vs. 28.11 (22.85; 35.55) and Firmicutes: Bacteroidetes ratio after GHT were observable. Significant reductions in symptom severity (323 (266–371) vs. 264 (191–331), p = 0.001) and psychological distress 17.0 (12.6–21.8) vs. 12.0 (8.3–18.0), p = 0.001, and increased well-being were found after GHT. Adequate relief after therapy was reported by 32 (84%) patients. Conclusion: Reductions in IBS symptoms and psychological burden were observed after gut-directed hypnotherapy, but only small changes were found in intestinal microbiota composition. The findings suggest that hypnosis may act by central nervous impact and other factors largely independent from microbiota composition modulating the brain-gut axis, possibly alterations in vagus nerve functioning and microbiota metabolism.

F60. INFLAMMATORY MARKERS AND COGNITIVE PERFORMANCE IN PATIENTS WITH SCHIZOPHRENIA TREATED WITH LURASIDONE

BackgroundRecent studies have linked inflammation, obesity, and lipid dysregulation with cognitive impairment, a core feature of schizophrenia. Elevated C-reactive protein concentration has been shown to be a reliable biomarker for inflammatory states. We conducted an exploratory analysis to investigate the potential influence of inflammation, obesity and lipid metabolism on changes in symptom severity and cognitive performance in patients with schizophrenia treated with lurasidone.MethodsPatients with acute exacerbation of schizophrenia were treated with one of two fixed doses of lurasidone (80 or 160 mg/day), placebo, or 600 mg/day quetiapine XR in a 6-week double-blind study. A wide-range CRP (wr-CRP) assay (equivalent to high sensitivity CRP assay) was used to assess levels of inflammation. CRP was evaluated as a logarithm transformed (log) continuous variable and as a categorical variable divided into low (≤ 2 mg/L), medium (> 2 mg/L and ≤ 5 mg/L) and high (> 5 mg/L) subgroups. Cognitive function was assessed with the CogState computerized cognitive battery at baseline and week 6 endpoint. Nonparametric bootstrap resampling method was applied to estimate the main and interactive effects of CRP on ranked cognitive scores.ResultsElevated level of wr-CRP (log) was associated with cognitive impairment at study baseline (P < 0.05), with significantly lower cognitive performance in the subgroup with high wr-CRP (> 5 mg/L) compared to those with low wr- CRP (< 2 mg/L) at study baseline (P < 0.05). Higher level of CRP (log) was also associated with significantly greater symptom severity as assessed by PANSS score, as well as higher BMI/body weight, and lower levels of high-density lipoprotein (HDL) and high hemoglobin A1c (HbA1c) at study baseline (P < 0.05). No significant associations were found for wr-CRP (log) with low-density lipoprotein (LDL) and total cholesterol at study baseline. High wr-CRP level (> 5 mg/L) at study baseline predicted less improvement of cognitive composite score at week 6 endpoint for all treatment groups, compared to those with low to medium wr-CRP levels (< 5 mg/L).The joint effect of wr-CRP (log) and HDL or HOMA-IR on moderating procognitive effects of lurasidone was significant (P<0.05), with greater lurasidone (vs. placebo) effect size in patients with either low wr-CRP and high HDL concentration or lower levels of both wr-CRP and HOMA-IR.Lurasidone treatment was associated with significant reduction in symptom severity as assessed by PANSS, CGI-S, and MADRS change scores from baseline to week 6, independent of wr-CRP, HDL and HOMA-IR levels at study baseline. Lurasidone had no significant effect on change in wr-CRP level from baseline to week 6 endpoint.DiscussionOur findings from this exploratory analysis of a placebo-controlled trial in patients with schizophrenia suggest that the joint effects of low wr-CRP level combined with either high HDL or low HOMA-IR can predict cognitive improvement in patients treated with lurasidone (vs. placebo). These findings suggest that inflammation and its interactive effects with insulin resistance and lipid parameters in patients with schizophrenia might impact cognition and response to treatment with antipsychotics.

A Randomized Clinical Trial of Caregiver-Delivered Reflexology for Symptom Management During Breast Cancer Treatment

PurposeThe objective of this study was to determine the effects of a home-based reflexology intervention delivered by a friend/family caregiver compared with attention control on health-related quality of life of women with advanced breast cancer undergoing chemotherapy, targeted and/or hormonal therapy. MethodsPatient-caregiver dyads (N = 256) were randomized to four weekly reflexology sessions or attention control. Caregivers in the intervention group were trained in a 30-minute protocol. During the four weeks, both groups had telephone symptom assessments, and intervention group had fidelity assessments. The intervention effects were assessed using linear mixed-effects models at weeks 5 and 11 for symptom severity and interference with daily activities, functioning, social support, quality of patient-caregiver relationship, and satisfaction with life. ResultsSignificant reductions in average symptom severity (P = 0.02) and interference (P < 0.01) over 11 weeks were found in the reflexology group compared with control, with no group differences in functioning, social support, quality of relationship, or satisfaction with life at weeks 5 and 11. Stronger quality of relationship was associated with lower symptom interference in the entire sample (P = 0.02), but controlling for it did not diminish the effect of intervention on symptoms. Significant reductions in symptom severity in the reflexology group compared with attention control were seen during weeks 2–5 but were reduced at Week 11. DiscussionEfficacy findings of caregiver-delivered reflexology with respect to symptom reduction open a new evidence-based avenue for home-based symptom management.

12 Self-help for medically unexplained symptoms: a systematic review and meta-analysis

Objective Medically unexplained symptoms (MUS), which are highly prevalent in all fields of medicine, are difficult to treat. Psychological treatments have shown modest effects, but these are costly, time consuming, and not easily accessible. Self-help interventions might overcome these barriers. The primary aim of this systematic review and meta-analysis was to assess the efficacy of self-help interventions for adults with MUS. Method Relevant studies were identified by searching electronic databases (PubMed, Embase, PsycINFO, and CINAHL from inception to May 2014) and scanning reference lists of included articles and related reviews. Two researchers independently selected randomised controlled trials comparing self-help to usual care or waiting list in adults with MUS. Data were extracted independently by two researchers using standardised forms. Standardised mean differences (Hedges’ g) were pooled using a random-effects model. Studies were critically appraised using the Cochrane ‘risk of bias assessment tool’. Outcomes were symptom severity and quality of life directly post-treatment and at follow-up. Results Out of 582 studies identified, 18 studies met all inclusion criteria. Studies were heterogeneous with regard to patient populations, intervention characteristics, and outcome measures. Compared to usual care or waiting list, self-help was associated with lower symptom severity (17 studies, n=1894, g=0.58, 95% CI 0.32–0.84, p Conclusion Self-help is associated with a significant reduction in symptom severity and improvement of QoL. Due to the suboptimal methodological quality of the majority of included studies, further research is needed to confirm the findings of this study. For future studies we recommend the use of uniform and validated measurement instruments, inclusion of follow-up assessments, and performance of intention-to-treat analyses.