Movement Disorder Profile and Treatment Outcomes in a One-Year Study of Patients With Schizophrenia.

Movement disorder profile and treatment outcomes in a one-year study of patients with schizophrenia.

Neuropsychiatr Dis Treat. 2013; 9: 815-822
Chen L, Ascher-Svanum H, Lawson A, Stauffer VL, Nyhuis A, Haynes V, Schuh K, Kinon BJ

This study identified subgroups of patients with schizophrenia who differed on their movement disorder profile and compared their treatment outcomes.Data from a randomized, open-label, one-year study of patients with schizophrenia who were treated with antipsychotics in usual clinical care settings were analyzed (n = 640). Five measures of movement disorder were incorporated into a single Movement Disorder Index (MDI). Subgroups that differed in their movement disorder profile over the one-year study period were compared on clinical and functional outcomes.THREE SUBGROUPS WERE IDENTIFIED: a worsening of MDI in 15% of patients, an improvement in 33%, and no change in 53%. Compared with the other two subgroups, the MDI-worsened subgroup had poorer symptom improvement measured by the Positive and Negative Syndrome Scale (PANSS) total score (mean changes of -11.0, -18.4, and -16.8 for the patients who had a worsening of MDI, no change, and an improvement, respectively), poorer symptom improvement on the PANSS positive and anxiety/depression subscale scores, worsening on the 36-Item Short Form Health Survey (SF-36) physical component summary score, and a higher rate of hospitalization (P < 0.05).Patients with schizophrenia who experience worsening of their MDI score appear to have poorer clinical and functional outcomes, suggesting that such worsening may be a marker of poorer prognosis. HubMed – depression treatment


A Service-Based Evaluation of a Therapist-Supported Online Cognitive Behavioral Therapy Program for Depression.

J Med Internet Res. 2013; 15(6): e121
Sharry J, Davidson R, McLoughlin O, Doherty G

Evidence suggests that Internet-delivered cognitive behavioral therapy (CBT) may be as effective as face-to-face delivery for depression, but attrition and engagement rates remain a challenge.This service-based study aimed to evaluate an online, therapist-supported, CBT-based program for depression. The program was specifically designed to address engagement issues, most notably by integrating online therapist support and communication within the platform.Participants were 80 adults who were registered university students. Participants used the modular online program over 8 weeks, supported by a therapist. Engagement information was gathered automatically by the online system, and analyzed for all participants. Severity of participants’ self-reported symptoms of depression were assessed preintervention and postintervention using the Beck Depression Inventory-II (BDI-II). Postintervention measures were completed by 53 participants.A high level of engagement was observed compared to a previous study within the same service, along with extensive use of a range of program features. A statistically significant (P<.001) decrease in self-reported depressive symptomatology from preintervention (mean BDI-II 25.47) to postintervention (mean BDI-II 15.53) with a large effect size (d=1.17) was also observed.The results indicate the potential of unintrusive and easily provided online support to enhance engagement with online interventions. The system described in the paper also illustrates how such online support can be tightly integrated with interactive online programs by using a range of design strategies intended to improve the user experience. HubMed – depression treatment


Cognitive emotion regulation strategies contributing to resilience in patients with depression and/or anxiety disorders.

Compr Psychiatry. 2013 Jun 24;
Min JA, Yu JJ, Lee CU, Chae JH

Research suggests that resilience is associated with favorable treatment outcome in patients with depression and/or anxiety disorders. In this regard, the identification of specific characteristics related to resilience that could provide targets for resilience-enhancement interventions is needed. Since the type of cognitive coping strategies is a possible marker of resilience, we investigated adaptive and maladaptive cognitive emotion regulation strategies contributing to resilience in patients with depression and/or anxiety disorders.A total of 230 outpatients with depression and anxiety disorders were consecutively recruited and completed the Cognitive Emotion Regulation Questionnaire, the Connor-Davidson Resilience Scale, the Beck Depression Inventory, and the State Anxiety Inventory. A linear regression model was used to determine which cognitive emotion regulation strategies predicted resilience after controlling for relevant covariates. Additionally, this model of resilience was compared with those of depression and anxiety symptoms.Adaptive strategies were more strongly correlated with resilience than maladaptive strategies. In the regression model, more use of refocus on planning and positive reappraisal as well as less use of rumination predicted high resilience after controlling for age, gender, marital status, depression, and anxiety. Among these strategies, refocus on planning was the common strategy contributing to resilience and depression.These results suggested that the cognitive emotion regulation strategies of refocus on planning, positive reappraisal, and less rumination contribute to resilience in patients with depression and anxiety disorders. It might provide potential targets for psychotherapeutic intervention to improve resilience in these patients. HubMed – depression treatment


Relapses in recurrent depression 1 year after maintenance cognitive-behavioral therapy: The role of therapist adherence, competence, and the therapeutic alliance.

Psychiatry Res. 2013 Jun 24;
Weck F, Rudari V, Hilling C, Hautzinger M, Heidenreich T, Schermelleh-Engel K, Stangier U

The prevention of relapse in recurrent depression is considered a central aim in cognitive-behavioral therapy, given the high risk of relapse. In this study, patients with recurrent major depressive disorder (currently remitted) received 16 sessions of Maintenance Cognitive-Behavioral Therapy (M-CBT) over a period of 8 months, in order to prevent relapse. Therapist adherence and competence, as well as the therapeutic alliance, were investigated as predictors for reducing the risk of recurrence in depression. Videotapes of 80 participants were analyzed in order to evaluate therapist adherence and competence. Additionally, the therapeutic alliance was assessed by questionnaire. No associations were found between therapist adherence or competence, and the risk of relapse 1 year after treatment. By contrast, the therapeutic alliance was a significant predictor of the time to relapse. Moreover, we found that the number of previous depressive episodes (?5 vs. ?4) was a significant moderator variable. This indicates that the alliance-outcome relationship was particularly important when patients with five or more previous depressive episodes were taken into account, in comparison to patients with four or fewer episodes. For the psychotherapeutic treatment of recurrent depression and the prevention of relapse, sufficient attention should be paid to the therapeutic alliance. HubMed – depression treatment