Internet Cognitive Behavioural Therapy for Mixed Anxiety and Depression: A Randomized Controlled Trial and Evidence of Effectiveness in Primary Care.

Internet cognitive behavioural therapy for mixed anxiety and depression: a randomized controlled trial and evidence of effectiveness in primary care.

Filed under: Depression Treatment

Psychol Med. 2013 Feb 18; 1-14
Newby JM, Mackenzie A, Williams AD, McIntyre K, Watts S, Wong N, Andrews G

BACKGROUND: Major depressive disorder (MDD) and generalized anxiety disorder (GAD) have the highest co-morbidity rates within the internalizing disorders cluster, yet no Internet-based cognitive behavioural therapy (iCBT) programme exists for their combined treatment. Method We designed a six-lesson therapist-assisted iCBT programme for mixed anxiety and depression. Study 1 was a randomized controlled trial (RCT) comparing the iCBT programme (n = 46) versus wait-list control (WLC; n = 53) for patients diagnosed by structured clinical interview with MDD, GAD or co-morbid GAD/MDD. Primary outcome measures were the Patient Health Questionnaire nine-item scale (depression), Generalized Anxiety Disorder seven-item scale (generalized anxiety), Kessler 10-item Psychological Distress scale (distress) and 12-item World Health Organization Disability Assessment Schedule II (disability). The iCBT group was followed up at 3 months post-treatment. In study 2, we investigated the adherence to, and efficacy of the same programme in a primary care setting, where patients (n = 136) completed the programme under the supervision of primary care clinicians. RESULTS: The RCT showed that the iCBT programme was more effective than WLC, with large within- and between-groups effect sizes found (>0.8). Adherence was also high (89%), and gains were maintained at 3-month follow-up. In study 2 in primary care, adherence to the iCBT programme was low (41%), yet effect sizes were large (>0.8). Of the non-completers, 30% experienced benefit. CONCLUSIONS: Together, the results show that iCBT is effective and adherence is high in research settings, but there is a problem of adherence when translated into the ‘real world’. Future efforts need to be placed on developing improved adherence to iCBT in primary care settings.
HubMed – depression


Structural Changes in Hippocampal Subfields in Major Depressive Disorder: A High-Field Magnetic Resonance Imaging Study.

Filed under: Depression Treatment

Biol Psychiatry. 2013 Feb 15;
Huang Y, Coupland NJ, Lebel RM, Carter R, Seres P, Wilman AH, Malykhin NV

BACKGROUND: Magnetic resonance imaging (MRI) has shown lower hippocampal volume in major depressive disorder (MDD). Preclinical and postmortem studies show that chronic stress and MDD may affect hippocampal subfields differently, but MRI spatial resolution has previously been insufficient to measure subfield volumes. METHODS: Twenty MDD participants (9 unmedicated and 11 medicated, both>6 months) and 27 healthy control subjects were studied. We used T2-weighted two-dimensional fast spin echo and T1-weighted three-dimensional magnetization prepared rapid acquisition gradient-echo sequences at 4.7 T to compare hippocampal subfield volumes at .09 ?L voxel volume. RESULTS: Unmedicated MDD participants had a lower dentate gyrus volume than control subjects or medicated MDD participants and a lower cornu ammonis (CA1-3) volume in the hippocampal body subregion than control subjects. CONCLUSIONS: Hippocampal volumes in unmedicated MDD showed evidence of localization to specific subfields and subregions, findings that appear, on the surface, consistent with preclinical evidence for localized mechanisms of hippocampal neuroplasticity. Strengths include in vivo measurement of entire hippocampal subfields and separation between unmedicated and medicated MDD. Limitations include power to control for multiple comparisons and that MRI landmarks approximate the subfields defined by cellular microstructure.
HubMed – depression


Clinical outcomes and inflammatory biomarkers in current smokers and exsmokers with severe asthma.

Filed under: Depression Treatment

J Allergy Clin Immunol. 2013 Feb 15;
Thomson NC, Chaudhuri R, Heaney LG, Bucknall C, Niven RM, Brightling CE, Menzies-Gow AN, Mansur AH, McSharry C

BACKGROUND: Clinical outcomes are worse in current smokers and exsmokers with mild-to-moderate asthma compared with never smokers, but little is known about the influence of smoking status in patients with severe asthma. OBJECTIVES: We sought to examine the association of current or previous cigarette smoking with clinical and inflammatory variables in patients with severe asthma. METHODS: We compared patients’ demographics, disease characteristics, and biomarkers of inflammation in current smokers (n = 69 [9%]), exsmokers (n = 210 [28%]), and never smokers (n = 461 [62%]) with severe asthma (n = 760) recruited to the British Thoracic Society Severe Asthma Registry. RESULTS: Current smokers had poorer asthma control, more unscheduled health care visits, more rescue courses of oral steroids, and higher anxiety and depression scale scores than exsmokers or never smokers. Current smokers had a reduced proportion of sputum eosinophils compared with never smokers (1% and 4%, respectively) and lower fraction of expired nitric oxide (50 mL/s; 14 ppb and 35 ppb, respectively). Exsmokers compared with never smokers had an increased proportion of sputum neutrophils (59% and 43%, respectively) but a similar proportion of sputum eosinophils (3%) and fraction of expired nitric oxide (50 mL/s; 35 ppb). Both current smokers and exsmokers had reduced serum specific IgE levels to several common environmental allergens. CONCLUSION: Current smokers with severe asthma exhibit worse clinical and health care outcomes compared with exsmokers and never smokers with severe asthma. Their inflammatory profiles in sputum and blood differ.
HubMed – depression



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