COVID-19 infection in 50 patients receiving lithium

Objectives. The aim of the study was a naturalistic observation of the occurrence and course of COVID-19 infection in fifty patients treated with lithium from March 2020 to March 2021 and not receiving the vaccination against COVID-19 during this period. Materials and methods. The study group included 23 men and 27 women aged 23–71 (mean 45) receiving lithium for 1–45 (mean 7) years. Bipolar disorder (BD) was diagnosed in 46 patients, including BD type 1 in 19 patients and BD type 2 in 26 patients, and recurrent depression in one patient. The patients were treated with lithium to prevent manic and depressive recurrences, of which six underwent lithium monotherapy. Four patients with schizophrenia receiving clozapine were administered with lithium to treat and prevent neutropenia. Results. In the study group, 37 patients (74%), including five patients receiving lithium monotherapy, did not develop the infection. The infection was mild in 8 patients and moderately severe in two. Two patients developed lithium intoxication. One patient died of COVID-19 related pneumonia. Conclusions. The observations made on the study group show that COVID-19 infection occurred in one-fourth of lithium-treated patients. In the majority of the subjects, the infection was benign. The results also suggest that COVID-19 infection and related circumstances may be a risk factor for lithium intoxication.

Mindfulness-based cognitive therapy for depression in people with dementia: A qualitative study on participant, carer and facilitator experiences

Background Depression in dementia is common and associated with negative health outcomes. Mindfulness-based cognitive therapy is a recommended treatment of choice for recurrent depression, but its use for depression in dementia is yet to be assessed. Objective This study aimed to investigate the experiences of people with depression and dementia who participated in the mindfulness-based cognitive therapy intervention and those of their carers and facilitators. Methods This qualitative study was nested within a randomised controlled feasibility study. Semi-structured interviews were conducted with 18 people (eight people with dementia and depression, six carers and four course facilitators). Thematic analysis was used to analyse the data. Findings Several beneficial effects of mindfulness-based cognitive therapy were described. These were a sense of shared suffering among the group, greater present moment focus and awareness, various positive emotional changes, including greater self-compassion, and benefits for carers, such as the reduction of anxiety. Specific aspects of the programme were identified as particularly useful, including facilitator characteristics and certain mindfulness practices. Carer involvement, cognitive difficulties and barriers to home practice influenced engagement with the course. Facilitators described adaptations made to mindfulness-based cognitive therapy and suggested additional modifications for future groups. Conclusion Results of this process evaluation suggest that mindfulness-based cognitive therapy is a potentially useful intervention for people with depression in dementia, but that further adaptation of the intervention is required to make the programme suitable for this clinical population.

A feasibility study of a novel work-focused relational group CBT treatment programme for moderate to severe recurrent depression

Purpose No current psychotherapeutic intervention is designed to enhance job retention in employees with moderate–severe recurrent depression. The aim of this study is to test the feasibility of a new, interdisciplinary work-focused relational group cognitive behavioural therapy (CBT) treatment programme for moderate–severe depression. Design/methodology/approach The programme was based on a theoretical integration of occupational stress, psychological, social/interpersonal and bio-medical theories. It consisted of up to four 1:1 psychotherapy sessions; 12 work-focused, full-day, weekly CBT sessions facilitated by a cognitive behavioural therapist and occupational therapist; and up to four optional 1:1 sessions with an occupational therapist. Depression severity (primary outcome) and a range of secondary outcomes were assessed before (first CBT session) and after (twelfth CBT session) therapy using validated instruments. Findings Eight women (26–49 years) with moderate–severe depression participated. Five were on antidepressant medication. While there was no statistically significant change in Hamilton Depression Rating Scale depression scores after therapy (n = 5; p = 0.313), Beck Depression Inventory-II depression scores significantly decreased after therapy (n = 8; –20.0 median change, p = 0.016; 6/8 responses, 7/8 minimal clinically important differences, two remissions). There were significant improvements in the secondary outcomes of overall psychological distress, coping self-efficacy, health-related quality of life and interpersonal difficulties after therapy. All clients in work at the start of therapy remained in work at the end of therapy. The intervention was safe and had 100% retention. Research limitations/implications A major limitation was recruitment shortfall, resulting in a small sample of middle-aged women, which reduces representativeness and increases the possibility of methodological weaknesses in terms of the statistical analysis. A definitive trial would need much larger samples to improve statistical power and increase confidence in the findings. Another major limitation was that two of the authors were involved in delivering the intervention such that its generalisability is uncertain. Practical implications This novel programme was evaluated and implemented in the real world of clinical practice. It showed promising immediate positive outcomes in terms of depressive symptoms, interpersonal difficulties and job retention that warrant further exploration in a longer-term definitive study. Social implications Empirical studies focused on enhancing job retention in employees with moderate–severe recurrent depression are lacking, so this study was highly relevant to a potentially marginalised community. Originality/value While limited by a recruitment shortfall, missing data and client heterogeneity, this study showed promising immediate positive outcomes for the new programme in terms of depressive symptoms, interpersonal difficulties and job retention that warrant exploration in a definitive study.