scholarly journals Managing a patient with globus pharyngeus

2017 ◽  
Vol 9 (3) ◽  
pp. 208.1-212 ◽  
Author(s):  
Philip R Harvey ◽  
Byron T Theron ◽  
Nigel J Trudgill
Keyword(s):  
Speech Therapy ◽  
Final Diagnosis ◽  
Behavioural Therapy ◽  
Upper Gastrointestinal Endoscopy ◽  
Cognitive Behavioural ◽  
Benign Nature ◽  
Unusual Stress ◽  
Upper Gastrointestinal ◽  
Nose And Throat

A woman aged 47 years reported the feeling of a lump in her throat for the past year. The sensation was present intermittently and usually improved when she ate. She noted it was worse with dry swallows when she felt like a tablet was stuck in her throat. The sensation had become more persistent in recent weeks leading her to worry that she had cancer. She had no cough, sore throat or hoarseness. There were no precipitating factors and no symptoms of weight loss, dysphagia, odynophagia or change in her voice. She had smoked previously and rarely had heartburn. She had no other anxieties and was not under any unusual stress. She was initially assessed by an ear, nose and throat surgeon, who found no abnormalities on examination of her neck, throat and oral cavity. Nasolaryngoscopy was normal. An upper gastrointestinal endoscopy was organised and reported a hiatus hernia, but a 3-month trial of a proton pump inhibitor did not have any impact on her symptoms. The benign nature of her symptoms was discussed at her gastroenterology follow-up appointment. She was discharged back to primary care with a final diagnosis of ’globus'. A trial of speech therapy, cognitive behavioural therapy or amitriptyline would be recommended if her symptoms became more troublesome in future.

scholarly journals Computerised cognitive–behavioural therapy for adults with intellectual disability: randomised controlled trial

2017 ◽  
Vol 211 (2) ◽  
pp. 95-102 ◽  
Author(s):  
Patricia Cooney ◽  
Catherine Jackman ◽  
David Coyle ◽  
Gary O'Reilly
Keyword(s):  
Intellectual Disability ◽  
Randomised Controlled Trial ◽  
Primary Outcome ◽  
Outcome Measure ◽  
Controlled Trial ◽  
Behavioural Therapy ◽  
Primary Outcome Measure ◽  
Cognitive Behavioural ◽  
Randomised Controlled

BackgroundDespite the evidence base for computer-assisted cognitive–behavioural therapy (CBT) in the general population, it has not yet been adapted for use with adults who have an intellectual disability.AimsTo evaluate the utility of a CBT computer game for adults who have an intellectual disability.MethodA 2 × 3 (group × time) randomised controlled trial design was used. Fifty-two adults with mild to moderate intellectual disability and anxiety or depression were randomly allocated to two groups: computerised CBT (cCBT) or psychiatric treatment as usual (TAU), and assessed at pre-treatment, post-treatment and 3-month follow-up. Forty-nine participants were included in the final analysis.ResultsA significant group x time interaction was observed on the primary outcome measure of anxiety (Glasgow Anxiety Scale for people with an Intellectual Disability), favouring cCBT over TAU, but not on the primary outcome measure of depression (Glasgow Depression Scale for people with a Learning Disability). A medium effect size for anxiety symptoms was observed at post-treatment and a large effect size was observed after follow-up. Reliability of Change Indices indicated that the intervention produced clinically significant change in the cCBT group in comparison with TAU.ConclusionsAs the first application of cCBT for adults with intellectual disability, this intervention appears to be a useful treatment option to reduce anxiety symptoms in this population.

scholarly journals Cognitive–behavioural therapy combined with music therapy for chronic fatigue following Epstein-Barr virus infection in adolescents: a feasibility study

2020 ◽  
Vol 4 (1) ◽  
pp. e000620 ◽  
Author(s):  
Sadaf Malik ◽  
Tarjei Tørre Asprusten ◽  
Maria Pedersen ◽  
Julie Mangersnes ◽  
Gro Trondalen ◽  
...  
Keyword(s):  
Music Therapy ◽  
Intervention Group ◽  
Chronic Fatigue ◽  
Behavioural Therapy ◽  
Control Group ◽  
Barr Virus ◽  
Cognitive Behavioural ◽  
Epstein Barr ◽  
Harmful Effects

​BackgroundCognitive–behavioural therapy (CBT) is effective in chronic fatigue syndrome. However, CBT has not been investigated in postinfectious chronic fatigue (CF), nor is it known whether addition of therapeutic elements from other disciplines might be feasible. We studied the feasibility of a combined CBT and music therapy intervention for CF following Epstein-Barr virus (EBV) infection in adolescents.​MethodsAdolescents (12–20 years old) participating in a postinfectious cohort study who developed CF 6 months after an acute EBV infection were eligible for the present feasibility study. A combined CBT and music therapy programme (10 therapy sessions and related homework) was compared with care as usual in a randomised controlled design. Therapists and participants were blinded to outcome evaluation. Endpoints included physical activity (steps/day), symptom scores, recovery rate and possible harmful effects, but the study was underpowered regarding efficacy. Total follow-up time was 15 months.​ResultsA total of 43 individuals with postinfectious CF were included (21 intervention group, 22 control group). Seven individuals left the study during the first 3 months, leaving 15 in the intervention group and 21 in the control group at 3 months’ follow-up. No harmful effects were recorded, and compliance with appointment was high. In intention-to-treat analyses, number of steps/day tended to decrease (difference=−1158, 95% CI −2642 to 325), whereas postexertional malaise tended to improve (difference=−0.4, 95% CI −0.9 to 0.1) in the intervention group at 3 months. At 15 months’ follow-up, there was a trend towards higher recovery rate in the intervention group (62% vs 37%).​ConclusionAn intervention study of combined CBT and music therapy in postinfectious CF is feasible, and appears acceptable to the participants. The tendencies towards positive effects on patients’ symptoms and recovery might justify a full-scale clinical trial.​Trial registration numberNCT02499302.

scholarly journals Cognitive–behavioural therapy for refractory psychotic symptoms of schizophrenia resistant to atypical antipsychotic medication

2005 ◽  
Vol 186 (4) ◽  
pp. 324-330 ◽  
Author(s):  
Lucia R. Valmaggia ◽  
Mark van der Gaag ◽  
Nicholas Tarrier ◽  
Marieke Pijnenborg ◽  
Cees J. Slooff
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Rating Scale ◽  
Behavioural Therapy ◽  
Controlled Study ◽  
Psychotic Symptoms ◽  
Positive Symptoms ◽  
Cognitive Behavioural ◽  
Supportive Counselling ◽  
Treatment Refractory

BackgroundThere is increasing evidence that cognitive–behavioural therapy can be an effective intervention for patients experiencing drug-refractory positive symptoms of schizophrenia.AimsTo investigate the effects of cognitive–behavioural therapy on in-patients with treatment-refractory psychotic symptoms.MethodManualised therapy was compared with supportive counselling in a randomised controlled study. Both interventions were delivered by experienced psychologists over 16 sessions of treatment. Therapy fidelity was assessed by two independent raters. Participants underwent masked assessment at baseline, after treatment and at 6 months' follow-up. Main outcome measures were the Positive and Negative Syndrome Scale and the Psychotic Symptoms Rating Scale. The analysis was by intention to treat.ResultsParticipants receiving cognitive–behavioural therapy had improved with regard to auditory hallucinations and illness insight at the post-treatment assessment, but these findings were not maintained at follow-up.ConclusionsCognitive–behavioural therapy showed modest short-term benefits over supportive counselling for treatment-refractory positive symptoms of schizophrenia.

scholarly journals Dual-focus magnification, high-definition endoscopy improves pathology detection in direct-to-test diagnostic upper gastrointestinal endoscopy

2019 ◽  
Vol 26 (1) ◽  
Author(s):  
Ashley Bond ◽  
Michael D Burkitt ◽  
Trevor Cox ◽  
Howard L. Smart ◽  
Chris Probert ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Care Physician ◽  
Upper Gastrointestinal Endoscopy ◽  
High Definition ◽  
Substantial Impact ◽  
Significant Pathology ◽  
The Uk ◽  
Upper Gastrointestinal

Background: In the UK, the majority of diagnostic upper gastrointestinal (UGI) endoscopies are a result of direct-to-test referral from the primary care physician. The diagnostic yield of these tests is relatively low, and the burden high on endoscopy services. Dual-focus magnification, high-definition endoscopy is expected to improve detection and classification of UGI mucosal lesions and also help minimize biopsies by allowing better targeting.Methods: This is a retrospective study of patients attending for direct-to-test UGI endoscopy from January 2015 to June 2015. The primary outcome of interest was the identification of significant pathology. Detection of significant pathology was modelled using logistic regression.Results: 500 procedures were included. The mean age of patients was 61.5 (±15.6) years; 60.8% of patients were female. Ninety-four gastroscopies were performed using dual-focus magnification high-definition endoscopy. Increasing age, male gender, type of endoscope, and type of operator were all identified as significant factors influencing the odds of detecting significant mucosal pathology. Use of dual-focus magnification, high-definition endoscopy was associated with an odds ratio of 1.87 (95%CI 1.11-3.12) favouring the detection of significant pathology. Subsequent analysis suggested that the increased detection of pathology during dual-focus magnification, high-definition endoscopy also influenced patient follow-up and led to a 3.0 fold (p=0.04) increase in the proportion of patients entered into an UGI endoscopic surveillance program.Conclusion: Dual-focus magnification, high-definition endoscopy improved the diagnostic yield for significant mucosal pathology in patients referred for direct-to-test endoscopy. If this finding is recapitulated elsewhere it will have substantial impact on the provision of UGI endoscopic services.

Long-term Effects of Cognitive-Behavioural Therapy and Lithium Therapy on Depression in the Elderly

1995 ◽  
Vol 167 (5) ◽  
pp. 653-658 ◽  
Author(s):  
K. C. M. Wilson ◽  
M. Scott ◽  
M. Abou-Saleh ◽  
R. Burns ◽  
J. R. M. Copeland
Keyword(s):  
Maintenance Therapy ◽  
Cognitive Behavioural Therapy ◽  
Rating Scale ◽  
Behavioural Therapy ◽  
Lithium Therapy ◽  
Controlled Study ◽  
Depression Severity ◽  
Cognitive Behavioural

BackgroundWe examine the effects of cognitive-behavioural therapy (CBT) as an adjuvant to acute physical treatment and lithium maintenance therapy in reducing depression severity over a follow-up year in elderly depressed patients.MethodThe study consists of three phases. During the acute treatment and continuation phase, 17 of 31 patients received CBT as an adjuvant to treatment as usual. During the maintenance phase of 1 year, subjects were entered into a double-blind, placebo-controlled study of low-dose lithium therapy.ResultsReceiving adjuvant CBT significantly reduced patients' scores on the Hamilton Rating Scale for Depression during the follow-up year (repeated measures analyses of variance; P = 0.007). No significant differences were found between lithium and placebo maintenance therapy.ConclusionsCBT can be adapted as an adjuvant therapy in the treatment of severely depressed elderly patients and reduces depression severity during follow-up. The prophylactic failure of long-term lithium therapy may be explained through poor compliance.

Feasibility trial of virtual reality exposure therapy for selective mutism

2021 ◽  
pp. 135910452110569
Author(s):  
Yi Ren Tan ◽  
Yoon Phaik Ooi ◽  
Rebecca P Ang ◽  
Dion H Goh ◽  
Clare Kwan ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Exposure Therapy ◽  
Selective Mutism ◽  
Behavioural Therapy ◽  
Feasibility Trial ◽  
Virtual Reality Exposure Therapy ◽  
Cognitive Behavioural ◽  
Evidence Based Care ◽  
Virtual Reality Exposure

Virtual reality exposure therapy (VRET) has been commonly utilised as an extension of cognitive behavioural therapy (CBT). However, most studies examined its effectiveness among adults, with no study focusing on children with selective mutism (SM). We aimed to examine its feasibility and acceptability among children with SM. Twenty children aged 6–12 with SM diagnosis were recruited and completed six therapist-guided VRET sessions. Parents and clinicians completed measures at pre-VRET, post-VRET, 1-month and 3-month follow-up visits. At post-VRET, parent and child participants completed the acceptability questionnaires. Findings suggested the feasibility of VRET as all participants completed the programme with no attrition. Parents and child participants also reported VRET to be an acceptable and effective treatment for SM. Significant improvement in overall functioning were found at post-treatment and follow-up measures, but there were no significant changes in parent-rated speech frequency and anxiety measures. These support the acceptability of VRET as an adjunct modality (and not substitute) of CBT in SM treatment. Future studies, with more robust experimental designs and larger sample sizes, can be conducted to confirm its efficacy. As technology becomes more sophisticated, tools such as virtual environments can be explored to enhance evidence-based care for children and their families.

Importance of knowledge in the behavioural treatment of panic disorder

2019 ◽  
Vol 47 (5) ◽  
pp. 611-615
Author(s):  
Kathleen M. Grubbs ◽  
James D. Broussard ◽  
Emily L. Hiatt ◽  
Melissa A. Beason-Smith ◽  
Ellen J. Teng
Keyword(s):  
Panic Disorder ◽  
Intensive Therapy ◽  
Behavioural Therapy ◽  
Behavioural Treatment ◽  
Knowledge Domains ◽  
Cognitive Behavioural ◽  
Severity Scores ◽  
Good Internal Consistency ◽  
Knowledge Scale

AbstractBackground:Cognitive behavioural therapy (CBT) for panic disorder encourages patients to learn about and make changes to thoughts and behaviour patterns that maintain symptoms of the disorder. Instruments to assess whether or not patients understand therapy content do not currently exist.Aims:The aim of this study was to examine if increases within specific knowledge domains of panic disorder were related to improvement in panic symptoms following an intensive 2-day panic treatment.Method:Thirty-nine Veterans enrolled in an intensive weekend panic disorder treatment completed knowledge measures immediately before the first session of therapy and at the end of the last day of therapy. Four panic disorder experts evaluated items and reached consensus on subscales. Subscales were reduced further to create psychometrically sound subscales of catastrophic misinterpretation (CM), behaviours (BE), and self-efficacy (SE). A simple regression analysis was conducted to determine whether increased knowledge predicted symptom change at a 3-month follow-up assessment.Results:The overall knowledge scale was reduced to three subscales BE (n = 7), CM (n = 13) and SE (n = 8) with good internal consistency. Veterans’ knowledge of panic disorder improved from pre- to post-treatment. Greater increase in scores on the knowledge assessment predicted lower panic severity scores at a 3-month follow-up. A follow-up analysis using the three subscales as predictors showed that only changes in CM significantly contributed to the prediction.Conclusions:In an intensive therapy format, reduction in panic severity was related to improved knowledge overall, but particularly as a result of fewer catastrophic misinterpretations.

scholarly journals Outcome of Esophageal Variceal Ligation in Cirrhotic Patients: Experience in a Tertiary Care Hospital in Dhaka

2019 ◽  
Vol 9 (1) ◽  
pp. 63-69
Author(s):  
Shireen Ahmed ◽  
Md Nazmul Hoque ◽  
Tareq Mahmud Bhuiyan
Keyword(s):  
Adverse Events ◽  
Esophageal Varices ◽  
Gastrointestinal Endoscopy ◽  
Upper Gastrointestinal Endoscopy ◽  
Care Hospital ◽  
Esophageal Variceal ◽  
Band Ligation ◽  
Esophageal Variceal Ligation ◽  
Upper Gastrointestinal

Background: Bleeding from esophageal varices in cirrhosis is an emergency condition. Esophageal varices band ligation has shown better results in terms of variceal obliteration as well as having fewer side effects like ulceration, perforation and stricture formation. Methods: This observational study was conducted at the gastroenterology department of BIRDEM general hospital, from September 2014 to March 2015. Subjects were eligible if they had a diagnosis of cirrhosis based on history, physical examination, biochemical parameters and presence of esophageal varices in upper gastrointestinal endoscopy. All patients were tested to determine the cause of liver cirrhosis. All patients under-went upper gastrointestinal endoscopy after consent. Esophageal variceal ligation was done at appropriate situation and patients were followed up later on. SPSS 23 was used for statistical analysis. Results: The sample size was 69. The cumulative mean age was 55.58±14.462 years (range: 20-90), with gender-based mean age of 54.76±15.704 years for males and 57.22±11.739 years for female. Mild portal hypertensive gastropathy (PHG) was found 31 (44.9%) patient and severe PHG 36 (52.2%). Patients were followed up for mean period of 8.52±3.6 months. Variceal obliteration was achieved in 25 (36.2%) patients, while 06 (8.7%) cases developed re-bleeding during the study period and this type of patients were managed by other modalities or combination therapies. Recurrence of varices occurred in 13 (18.8%). 25 (36.2%) patients reduction of varix size occured after esophageal variceal ligation (EVL), 32 (46.4%) required second session and 12 (17.4%) required more than second session (Table-2). Thirty nine (56.5%) patients experienced minor adverse events like GI discomfort (retrosternal pain or dysphagia), while severe adverse events were noticed in 13 (18.8%) patients. Fundal varix was found among 8 (11.6%) patient on follow up endoscopy and GAVE found in 6 (8.69%) patients. All patient developed PHG during follow up endoscopy. Conclusion: Band ligation eradicates esophageal varices with less complications and a lower re-bleeding rate, but at the same time eradication is associated with more frequent development of PHG and fundal varices. Birdem Med J 2019; 9(1): 63-69

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