A new scale for assessing the quality of randomized clinical trials of psychotherapy

Context

In 2004, the American Psychiatric Association's Committee on Research on Psychiatric Treatments appointed a subcommittee to investigate the status of empirical evidence with regard to psychodynamic psychotherapy.

Objective

As a part of this effort, the committee developed a rating scale designed to assess the quality of randomized controlled trials (RCTs) of psychotherapy.

Data Sources

A 25-item RCT of Psychotherapy Quality Rating Scale was generated by expert consensus. Interrater reliability, internal consistency, and validity testing were undertaken using 7 trained raters.

Study Selection

A PubMed search was conducted to locate all RCTs of psychotherapies identified by their authors as being “psychodynamic” or “psychoanalytic” in origin and implementation.

Data Extraction

A total of 69 RCTs were independently rated by 2 raters.

Data Synthesis

The scale was found to have good interrater reliability (total score intraclass correlation = 0.76), internal consistency (Cronbach α = .87), and external validity.

Conclusions

This scale establishes a new standard for the design and execution of psychotherapy RCTs and provides a systematic empirical method for evaluating the quality of published RCTs.     

Attention to the body in nonclinical somatoform dissociation depends on emotional state

Objective

Unexplained neurological symptoms (“somatoform dissociation”) are common in health care settings and associated with disproportionately high levels of distress, disability, and resource utilization. Theory suggests that somatoform dissociation is associated with disturbed attentional processing, but there is a paucity of research in this area and the available evidence is contradictory.

Methods

We compared undergraduate participants (n=124) with high and low scores on the Somatoform Dissociation Questionnaire (SDQ-20) on a tactile cueing paradigm measuring the time course of attention to touch, following either a neutral film or a film designed to simulate the emotional effects of trauma exposure.

Results

Following the neutral film, high SDQ-20 participants exhibited delayed disengagement from tactile cue stimuli compared to the low SDQ-20 group. Following the “trauma” film, however, the high SDQ-20 group showed attentional effects suggesting avoidance of the tactile stimuli in this condition. Early attention to tactile cues following the trauma film predicted film-related intrusive thoughts after the experiment.

Conclusion

These findings suggest that both body vigilance and body avoidance may be involved in the expression of somatoform dissociation.     

Construct validity of the Chinese version of the Chalder Fatigue Scale in a Chinese community sample

Objective

This paper aims to evaluate the factorial validity of the Chinese version of the Chalder Fatigue Scale (ChCFS) using a Chinese community sample.

Methods

A total of 201 Chinese adults completed the ChCFS, the 12-item Short-Form Health Survey (SF12), and the Hospital Anxiety and Depression Scale (HADS). Confirmatory factor analysis was conducted to assess the fit of a one-factor model, a two-factor correlated model, and a three-factor hierarchical model in both the 14-item and 11-item versions of ChCFS to the current data.

Results

ChCFS successfully replicated the original two-factor structure in the current Chinese community sample, and the 11-item version demonstrated better data-model fit than the 14-item version. The instrument possessed good internal consistency (Cronbach's α=.863). The convergent validity with HADS and divergent validity with SF12 were also evident.

Conclusions

ChCFS is valid and reliable among Chinese adults in the general population.     

Évaluation d’un programme de psychoéducation individuel chez des patients hospitalisés pour un trouble bipolaire

Objective

To assess the effectiveness of an individual program of psychoeducation in inpatients hospitalized for the first time with bipolar disorder, by comparing the acquired knowledge of patients who have received the program and that of patients who did not.

Methods

Patients who followed psychoeducation program were hospitalized in a bipolar disorder unit and control patients were hospitalized in other units of the same psychiatric department. At the end of hospitalization, personal questionnaires assessed knowledge with respect to bipolar disorder and its treatment; allowing us to calculate a “knowledge score”.

Results

The psychoeducation group had a better knowledge of bipolar disorder and of its treatment than that of the control group [39.3 (ET 3) versus 29.8 (ET 6,8); p < 0.0001], independently of other demographic and clinical characteristics.

Discussion

Structured and formalized psychoeducation appeared useful in inpatients in order to familiarize them with their disorder and their treatment.     

Depression in Down syndrome: a review of the literature

Background

Depression has been frequently reported in individuals with Down Syndrome (DS). The aim of this article is to provide a comprehensive, critical review of the clinically relevant literature concerning depression in DS, with a focus on epidemiology, potential risk factors, diagnosis, course characteristics and treatment.

Methods

We searched the PUBMED database (January 2011) using the keywords (“Depressive Disorder [MESH]” OR “Depression [MESH]” OR “depress* [All Fields]”) AND (“Down Syndrome [MESH]” OR “Down syndrome [All Fields]” OR “Down's syndrome [All Fields]”). Review articles not adding new information, single case reports and papers focusing on subjects other than depression in DS were excluded.

Results

The PUBMED search resulted in 390 articles, of which 30 articles were finally included. Recent information does not support earlier suggestions of an increased prevalence of depression in DS compared to other causes of Intellectual Disability (ID). However, individuals with DS show many vulnerabilities and are exposed to high levels of stressors that could confer an increased risk for the development of depression. Apart from general risk factors, several potential risk factors are more specific for DS, including smaller hippocampal volumes, certain changes in neurotransmitter systems, deficits in language and working memory, attachment behaviours and frequently occurring somatic disorders. Protective factors might play a role in reducing the vulnerability to depression. The diagnosis of depression in DS is mainly based upon observable characteristics, and therefore, the use of modified diagnostic criteria is advised.Although several common treatments, including antidepressants, electroconvulsive therapy and psychotherapy seem effective, there is evidence of undertreatment of depression in DS.

Conclusions

There are important limitations to our current clinical knowledge of depression in DS. Future studies should include systematic evaluations of pharmacotherapeutic and psychotherapeutic interventions.     

Effect of median-nerve electrical stimulation on BOLD activity in acute ischemic stroke patients

Objective

To investigate blood oxygenation level-dependent (BOLD) activation during somatosensory electrical stimulation of the median nerve in acute stroke patients and to determine its correlation with ischemic damage and clinical recovery over time.

Methods

Fourteen acute stroke patients underwent functional magnetic resonance imaging (fMRI) during contralesional median-nerve electrical stimulation 12-48 h after stroke. Findings were then validated by diffusion tensor imaging (DTI) and motor evoked potential by transcranial magnetic stimulation (TMS).

Results

Poor clinical recovery at three months was noted in four patients with no activation in the early days after stroke, whereas good clinical recovery was observed in eight patients with a normal activation pattern in the primary sensory motor area in the acute phase. In two patients BOLD activation correlated weakly with clinical recovery. Findings from TMS and DTI partially correlated with clinical recovery and functional scores.

Conclusions

Clinically relevant insights into the “functional reserve” of stroke patients gained with peripheral nerve stimulation during fMRI may carry prognostic value already in the acute period of a cerebrovascular accident.

Significance

BOLD activation maps could provide insights into the functional organization of the residual systems and could contribute to medical decision making in neurological and rehabilitative treatment.     

Application of the Type D Scale (DS14) in Chinese coronary heart disease patients and healthy controls

Objective

To examine the psychometric properties of the Type D Scale (DS14) in mainland China.

Methods

One hundred and seventy-eight coronary heart disease (CHD) patients and 376 healthy controls were recruited. They completed the Chinese version of the DS14, the Zung Self-Rating Depression Scale, the Positive Affect and Negative Affect Scale, the Perceived Social Support Scale, and the Social Avoidance and Distress Scale. Thirty-five of the patients were also rated by their family members on the DS14.

Results

The two-factor structure of the DS14 was replicated. The Cronbach's α coefficients for the negative affectivity (NA) and social inhibition (SI) subscales were 0.90 and 0.85, respectively, for the CHD patients and 0.87 and 0.69, respectively, for the healthy subjects. The correlations between the self-reports and the observer ratings (r_NA=0.56, r_SI=0.69) supported satisfactory consensual validity. Good convergent validity was shown by the expected correlations and the scale-level factor analyses of NA with depression and negative affect, and SI with perceived social support and social avoidance and distress. With the standardized cut-off of NA ≥10 and SI ≥10, 31.4% of the CHD patients and 31.9% of the healthy controls in China were defined as having a Type D personality.

Conclusions

The results indicate that the Type D construct is valid and reliable in Chinese populations. The Chinese version of the DS14 shows good psychometric properties. The prevalence of Type D personality in China falls within the range of what has been found in Western countries, at least for CHD patients. This study indicates that it is possible to use the DS14 among Chinese populations in future cross-cultural studies.     

Expansion of the phenotypic spectrum of SPG6 caused by mutation in NIPA1

Background

Hereditary spastic paraplegia type 6 (SPG6) is caused by mutations in the NIPA1 gene, this is a rare cause of HSP, until now, all the affected individuals reported displayed “pure” spastic paraplegia.

Objectives

To analyze the genotype/phenotype correlation of mutations so far described in NIPA1.

Methods

Eighty-six Chinese Han HSP patients were investigated for SPG6 mutations by direct sequencing of the NIPA1 gene.

Results

One heterozygous missense mutation c.316G > C/p.G106R was identified in a complicated form of ADHSP family with peripheral nerves disease, and SPG6 mutation in our sample accounted for 3.6% (1/28) of ADHSP families and 1.1% (1/86) of non-ARHSP patients who were negative for SPG4, SPG3A and SPG31 mutations.

Conclusions

We report the first complicated case of SPG6 in the world by the presence of peripheral neuropathy, which extends the phenotype initially described.     

The MMSE is not an adequate screening cognitive instrument in studies of late-life depression

Background

The Mini Mental State Examination (MMSE) is frequently used to assess cognition in studies of late-life depression (LLD). However, its sensitivity and specificity in this population are largely unknown. We undertook an analysis of subjects with LLD and hypothesized that: (1) at the traditional cutoff of 24, the MMSE would have low sensitivity in the detection of cognitive impairment; (2) increasing the cutoff score would improve this sensitivity at the expense of a minimal reduction in specificity.

Methods

We analyzed the MMSE scores of 447 non-demented subjects with LLD using the Dementia Rating Scale (DRS) as the gold standard for cognitive function.

Results

Using the DRS raw total cutoff of 132 as the “gold standard”, the MMSE at a cutoff of 24 has a sensitivity of 8.0% and a specificity of 99.4% in detecting “cognitively impaired” depressed elders. A receiver operating characteristic curve demonstrates that with an MMSE cutoff of 27 instead of 24, its sensitivity more than quadruples and increases to 37.5% while its specificity decreases minimally from 99.4% to 91.3%.

Conclusions

In our sample almost all of those classified as cognitively impaired by the DRS are mislabelled as “cognitively intact” by the MMSE. By using a higher cutoff score, the sensitivity can be increased with a minimal reduction in specificity. Our findings have significant implications for those who study or treat persons with LLD or other neuropsychiatric disorders.     

Tryptophan-hydroxylase 2 haplotype association with borderline personality disorder and aggression in a sample of patients with personality disorders and healthy controls

Background

There is a decreased serotonergic function in impulsive aggression and borderline personality disorder (BPD), and genetic association studies suggest a role of serotonergic genes in impulsive aggression and BPD. Only one study has analyzed the association between the tryptophan-hydroxylase 2 (TPH2) gene and BPD. A TPH2 “risk” haplotype has been described that is associated with anxiety, depression and suicidal behavior.

Methods

We assessed the relationship between the previously identified “risk” haplotype at the TPH2 locus and BPD diagnosis, impulsive aggression, affective lability, and suicidal/parasuicidal behaviors, in a well-characterized clinical sample of 103 healthy controls (HCs) and 251 patients with personality disorders (109 with BPD). A logistic regression including measures of depression, affective lability and aggression scores in predicting “risk” haplotype was conducted.

Results

The prevalence of the “risk” haplotype was significantly higher in patients with BPD compared to HCs. Those with the “risk” haplotype have higher aggression and affect lability scores and more suicidal/parasuicidal behaviors than those without it. In the logistic regression model, affect lability was the only significant predictor and it correctly classified 83.1% of the subjects as “risk” or “non-risk” haplotype carriers.

Conclusions

We found an association between the previously described TPH2 “risk” haplotype and BPD diagnosis, affective lability, suicidal/parasuicidal behavior, and aggression scores.