Unlinking Negative Cognition and Symptoms of Depression: Evidence of a Specific Treatment Effect for Cognitive Therapy.

Ulcerative colitis (UC) is a subset disorder of inflammatory bowel disease (IBD) with chronic course and symptoms such as fatigue, gastrointestinal pain, fever, etc. IBD is associated with psychological manifestations including depression and anxiety. There is an increased number of studies trying to link these comorbidities. The gut-brain axis is regulated by intestinal microbiota and this bidirectional communication including immune, neural, endocrine and metabolic mechanisms may bring us closer to the answer. The following case concerns a 56-year-old patient with history of major depressive disorder who was in continuous psychiatric care and treated with antidepressants. Several years after the beginning of psychiatric treatment, he was hospitalized for diagnostic examination due to subfebrility of unknown etiology, but with no final somatic diagnosis. After two years he was referred to our department and at administration the patient showed symptoms of depression, anxiety, lack of motivation and suicidal thoughts and tendencies. Subfebrility was still present at that time. His psychopharmacotherapy was revised and there was a slight improvement in mood and behaviour. During outpatient follow-ups the symptoms of depression were still prominent and remission was not achieved even with modulation of antidepressant pharmacotherapy. The following year the patient was diagnosed with UC and started specific treatment after he presented with diarrhea in addition to subfebrility. Subsequently his mood improved, suicidal thoughts were diminished and ultimately remission was achieved. This case suggests that only after UC was being treated the psychiatric symptoms also withdrew which implicates that inflammatory mediators were involved in pathogenesis of depression.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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THE EFFECTIVENESS OF MINDFULNESS-BASED BEHAVIOR - COGNITIVE THERAPY IN REDUCING SYMPTOMS OF DEPRESSION IN PEOPLE WITH PERSISTENT DEPRESSION

The Turkish Online Journal of Design Art and Communication ◽

10.7456/1060jse/039 ◽

2016 ◽

Vol 6 (JLYSPCL) ◽

pp. 705-713

Author(s):

Nazli Rajabpouranvar ◽

Mohammad Hatami ◽

Hadi Hashemi Rezini

Keyword(s):

Cognitive Therapy ◽

Symptoms Of Depression ◽

Persistent Depression

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Treatment of pulmonary hypertension associated with chronic obstructive pulmonary disease: a systematic review

ERJ Open Research ◽

10.1183/23120541.00348-2021 ◽

2021 ◽

pp. 00348-2021

Author(s):

Ragdah Arif ◽

Arjun Pandey ◽

Ying Zhao ◽

Kyle Arsenault-Mehta ◽

Danya Khoujah ◽

...

Keyword(s):

Systematic Review ◽

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Hypertension ◽

Pulmonary Disease ◽

Treatment Effect ◽

Specific Treatment ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Phosphodiesterase Type 5 Inhibitors ◽

Clinical Benefits

Chronic obstructive pulmonary disease-associated pulmonary hypertension (COPD-PH) is an increasingly recognised condition which contributes to worsening dyspnea and poor survival in COPD. It is uncertain whether specific treatment of COPD-PH, including use of medications approved for pulmonary arterial hypertension (PAH), improves clinical outcomes. This systematic review and meta-analysis assesses potential benefits and risks of therapeutic options COPD-PH.We searched Medline and Embase for relevant publications until Sep 2020. Articles were screened for studies on treatment of COPD-PH for at least 4 weeks in 10 or more patients. Screening, data extraction, and risk of bias assessment were performed independently in duplicate. When possible, relevant results were pooled using the random effects model.Supplemental long-term O2 therapy (LTOT) mildly reduced mean pulmonary artery pressure (PAP), slowed progression of PH, and reduced mortality, but other clinical or functional benefits were not assessed. Phosphodiesterase type-5 inhibitors significantly improved systolic PAP (pooled treatment effect −5.9 mmHg; 95%CI −10.3, −1.6), but had inconsistent clinical benefits. Calcium-channel blockers and endothelin receptor antagonists had limited hemodynamic, clinical, or survival benefits. Statins had limited clinical benefits despite significantly lowering systolic PAP (pooled treatment effect −4.6 mmHg; 95% CI: −6.3, −2.9).This review supports guideline recommendations for LTOT in hypoxemic COPD-PH patients as well as recommendations against treatment with PAH-targeted medications, Effective treatment of COPD-PH depends upon research into the pathobiology, and future high-quality studies comprehensively assessing clinically relevant outcomes are needed.

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Predictors of treatment effect

Prognosis Research in Health Care ◽

10.1093/med/9780198796619.003.0009 ◽

2019 ◽

pp. 188-207

Author(s):

Richard D Riley ◽

Aroon Hingorani ◽

Karel GM Moons

Keyword(s):

Prognostic Factors ◽

Treatment Effect ◽

Interaction Effect ◽

Specific Treatment ◽

Health Condition ◽

Effect Modification ◽

Sign Test ◽

Stratified Care ◽

Multiple Trials ◽

Using Data

A predictor of treatment effect is any factor or combination of factors (such as a patient characteristic, symptom, sign, test, or biomarker result) associated with the effect (benefit or harm) of a specific treatment in persons with a particular disease or health condition. Various terms are used across disciplines to refer to prediction of treatment effect, including treatment-predictor (treatment-covariate) interaction, effect modification, predictive (as opposed to prognostic) factors (in oncology), or moderation analysis. This chapter reviews principles of the design of studies of treatment effect predictors, such as exploration of treatment-predictor interactions in randomized trials and the importance of replication of such estimates using data from multiple trials. The application of predictors of treatment effect in practice for matching individuals or subgroups to specific treatments is introduced as one type of stratified care, and the need for impact studies to investigate whether stratified care leads to better outcomes and improved efficiency of healthcare is highlighted.

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Two psychological treatments for hypochondriasis

The British Journal of Psychiatry ◽

10.1192/bjp.173.3.218 ◽

1998 ◽

Vol 173 (3) ◽

pp. 218-225 ◽

Cited By ~ 198

Author(s):

David M. Clark ◽

Paul M. Salkovskis ◽

Ann Hackmann ◽

Adrian Wells ◽

Melanie Fennell ◽

...

Keyword(s):

Stress Management ◽

Cognitive Therapy ◽

Specific Treatment ◽

Post Treatment ◽

Waiting List ◽

Control Group ◽

One Year ◽

Almost All ◽

Better Than

BackgroundHypochondriasis is generally considered difficult to manage. This study aimed to assess the effectiveness of cognitive therapy and to compare it with an equally credible, alternative treatment.MethodForty-eight patients with hypochondriasis were initially randomly assigned to either cognitive therapy, behavioural stress management or a no treatment waiting list control group. At the end of the waiting period, patients in the control group were randomly assigned to one of the two treatments. Assessments were at pre-, mid- and post-treatment or waiting list and at three-, six- and 12-month post-treatment follow-up.ResultsComparisons with the waiting list group showed both treatments were effective. Comparisons between the treatments showed that cognitive therapy was more effective than behavioural stress management on measures of hypochondriasis, but not general mood disturbance at mid-treatment and at post-treatment. One year after treatment patients who had received either treatment remained significantly better than before treatment, and on almost all measures the two therapies did not differ from each other.ConclusionsCognitive therapy is a specific treatment for hypochondriasis. Behavioural stress management is also effective but its specificity remains to be demonstrated.

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Internet-Based Cognitive Behavioral Therapy for Symptoms of Depression and Anxiety Among Patients With a Recent Myocardial Infarction: The U-CARE Heart Randomized Controlled Trial (Preprint)

10.2196/preprints.9710 ◽

2017 ◽

Author(s):

Fredrika Norlund ◽

Emma Wallin ◽

Erik Martin Gustaf Olsson ◽

John Wallert ◽

Gunilla Burell ◽

...

Keyword(s):

Myocardial Infarction ◽

Cognitive Behavioral Therapy ◽

Treatment Adherence ◽

Treatment Effect ◽

Behavioral Therapy ◽

Depression Scale ◽

Cognitive Behavioral ◽

Depression And Anxiety ◽

Sample Mean ◽

Symptoms Of Depression

BACKGROUND Symptoms of depression and anxiety are common after a myocardial infarction (MI). Internet-based cognitive behavioral therapy (iCBT) has shown good results in other patient groups. OBJECTIVE The aim of this study was to evaluate the effectiveness of an iCBT treatment to reduce self-reported symptoms of depression and anxiety among patients with a recent MI. METHODS In total, 3928 patients were screened for eligibility in 25 Swedish hospitals. Of these, 239 patients (33.5%, 80/239 women, mean age 60 years) with a recent MI and symptoms of depression or anxiety were randomly allocated to a therapist-guided, 14-week iCBT treatment (n=117), or treatment as usual (TAU; n=122). The iCBT treatment was designed for post-MI patients. The primary outcome was the total score of the Hospital Anxiety and Depression Scale (HADS) 14 weeks post baseline, assessed over the internet. Treatment effect was evaluated according to the intention-to-treat principle, with multiple imputations. For the main analysis, a pooled treatment effect was estimated, controlling for age, sex, and baseline HADS. RESULTS There was a reduction in HADS scores over time in the total study sample (mean delta=−5.1, P<.001) but no difference between the study groups at follow-up (beta=−0.47, 95% CI −1.95 to 1.00, P=.53). Treatment adherence was low. A total of 46.2% (54/117) of the iCBT group did not complete the introductory module. CONCLUSIONS iCBT treatment for an MI population did not result in lower levels of symptoms of depression or anxiety compared with TAU. Low treatment adherence might have influenced the result. CLINICALTRIAL ClinicalTrials.gov NCT01504191; https://clinicaltrials.gov/ct2/show/NCT01504191 (Archived at Webcite at http://www.webcitation.org/6xWWSEQ22)

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