Differential Responses to Cognitive Behavioral Therapy and Pharmacotherapy Versus Combined Therapy in Young Adolescents with Depression

Psychotic disorders occupy an essential place in the structure of general morbidity of the population, affect quality and life expectancy, reduce working capacity and often cause disability. Psychotic symptoms cause significant distress in patients and lead to alterations in important spheres of life, such as social functioning, and could be the cause of suicidal or socially dangerous behavior. According to the World Health Organization, schizophrenia affects about 21 million people, worldwide. The onset of the disease occurs in adolescents and early adulthood, with a range of 15-29 years. The present paper aims to investigate the features of the use of cognitive-behavioral therapy techniques and their effectiveness in the treatment of early stages of psychosis. This study presents already existing systemic literature reviews and meta-analyses on the topic of cognitive-behavioral therapy (CBT) of psychotic disorders, namely devoted to CBT of the first psychotic episode. Besides, it examines the effectiveness of the use of CBT not only in the prodromal stage of psychosis and during its manifestation, as well as in the remission period as a method for preventing recurrence. According to the data, CBT is a useful and scientifically based method in the combined therapy of patients in the early stages of the course of psychotic illness. CBT early interventions reduce positive and negative symptoms severity, improve access to engagement with treatment, which also reduces hospital admission and relapse rates.

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Differential Treatment Response Between Hypochondriasis With and Without Prominent Somatic Symptoms

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.691703 ◽

2021 ◽

Vol 12 ◽

Author(s):

Brian A. Fallon ◽

Cale Basaraba ◽

Martina Pavlicova ◽

David K. Ahern ◽

Arthur J. Barsky

Keyword(s):

Cognitive Behavioral Therapy ◽

Treatment Response ◽

Behavioral Therapy ◽

Combined Therapy ◽

Health Anxiety ◽

Somatic Symptoms ◽

Symptom Burden ◽

Cognitive Behavioral ◽

Study Objective ◽

The Impact

Background: Health anxiety may exist with or without prominent somatic symptoms, but the impact of somatic symptoms on treatment response is unclear. The study objective was to examine this question further as symptom burden may impact choice of type of treatment.Methods: This exploratory study used a unique database from a prior trial of 193 individuals with DSM-IV hypochondriasis who had been randomly assigned to either cognitive behavioral therapy, fluoxetine, combined therapy, or placebo. Two subgroups were newly defined—no/low somatic burden (n = 42) and prominent somatic burden (n = 151). Response was defined by ≥30% improvement in hypochondriasis.Results: Among high somatic hypochondriacal participants, compared to placebo, the odds of being a responder were significantly greater among those who received fluoxetine, either alone (OR = 4.46; 95% CI: 1.38, 14.41) or with cognitive behavioral therapy (OR = 3.56; 95% CI: 1.19, 10.68); the estimated odds were not significantly different for those receiving cognitive behavioral therapy alone (OR = 1.81; 95% CI: 0.59, 5.54). In contrast, among low somatic hypochondriacal participants, compared to placebo, the observed odds of being a responder were similar in magnitude and direction for those who received cognitive behavioral therapy, either alone (OR = 3.00; 95% CI: 0.38, 23.68) or in combination with fluoxetine (OR = 3.60; 95% CI: 0.62, 21.03), compared to the odds for those receiving fluoxetine alone (OR = 0.90; 95% CI: 0.14, 5.65). High somatic hypochondriacal individuals assigned to any fluoxetine group had significantly greater odds of being a responder than those who had not received fluoxetine (OR = 2.70; 95% CI: 1.33, 5.48). Low somatic hypochondriacal individuals assigned to any cognitive behavioral therapy group had significantly greater odds of being a responder than those who had not received cognitive behavioral therapy (OR = 8.03; 95% CI: 1.41, 45.67).Conclusion: These findings indicate that somatic symptom burden may be important in guiding treatment selection among individuals with marked health anxiety, as hypochondriacal individuals with high somatic burden responded more often to fluoxetine while those with low somatic burden responded more often to cognitive behavioral therapy. Systematic replication with larger studies is needed.

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