氟伏沙明联合认知行为疗法治疗儿童青少年强迫症对照研究

目的 探讨氟伏沙明联合认知行为疗法治疗儿童青少年强迫症的临床疗效和安全性.方法 将60例儿童青少年强迫症患者随机分为两组,每组30例,两组均口服氟伏沙明治疗,研究组在此基础上联合认知行为治疗,观察12周.于治疗前及治疗2周、4周、8周、12周末采用Yale-Brown强迫量表评定临床疗效,儿童大体评定量表评定儿童精神障...     

Normalization of the auditory startle reflex after symptom reduction in children with anxiety disorders

Background

In an earlier study the Auditory Startle Response (ASR) of anxiety disordered (AD) children proved to be enlarged. This study examines in a controlled design to what extent this increase is responsive to symptom reduction during Cognitive Behavioral Therapy (CBT)

Methods

The activity of 6 muscles following 104 dB tones in 20 patients (M = 12,7 years; SD = 2.5) and 25 matched controls was measured with an electromyogram (EMG). In addition, the sympathetic skin response was investigated. Response to treatment was investigated with the Anxiety Disorder Interview Schedule for Children (ADIS-C) and the Spence Children’s Anxiety Scale (SCAS).

Results

Treatment responders (n = 12) showed a significant ASR decrease over time, whereas non-responders (n = 8) showed a significant ASR increase or no significant ASR difference. In controls, the ASR was not significantly different at follow up compared to baseline. The sympathetic skin response was stable in controls and treatment responders but significantly increased over time in treatment non-responders. Linear regression suggested that one of the ASR pre-treatment parameters (multiple muscle EMG magnitude) predicts treatment response.

Conclusions

The ASR decreases in AD children when anxiety symptoms diminish. In addition, the ASR may be useful in predicting response to CBT in AD children.     

Late-Onset Fatal Epstein-Barr Virus—Associated Hemophagocytic Syndrome Following Cord Blood Cell Transplantation for Adult Acute Lymphoblastic Leukemia

A 43-year-old Japanese woman underwent unrelated cord blood transplantation (CBT) during remission for acute lymphoblastic leukemia with t(4; 11)(q21;q23). Tacrolimus was given for prophylaxis of graft-versus-host disease. The posttransplantation clinical course was mostly uneventful, and the leukemia remained in remission. Fourteen months after CBT, the patient developed pancytopenia and hepatic dysfunction with persistent high-grade fever. The bone marrow was hypocellular with increased numbers of macrophages and hemophagocytes. The numbers of Epstein-Barr virus (EBV) copies in peripheral blood samples were remarkably high. Although the patient showed complete donor-type hematopoiesis, the titer of viral capsid antigen immunoglobulin G was low, and the results of a test for EBV nuclear antigen were negative. There was no clinical response to the reduction of immunosuppressive therapy or to the administration of high-dose methylprednisolone, human immunoglobulin, or acyclovir. The patient died 466 days after CBT of massive gastrointestinal hemorrhage due to bone marrow and hepatic failures. This case demonstrates that fatal EBV-associated hemophagocytic syndrome (HPS) can occur more than 1 year after CBT. This report is the first of a case of late-onset EBV-associated HPS following CBT.     

Long-term efficacy of cognitive-behavioral therapy by general practitioners for fatigue: a 4-year follow-up study

OBJECTIVE: In an earlier study, we found that cognitive-behavioral therapy (CBT) delivered by general practitioners (GPs) for fatigue among employees on sick leave was not effective after 12 months. In this study we aim to assess the long-term efficacy of CBT by GPs for fatigue. It was hypothesized that the intervention could prevent deterioration as well as relapse of fatigue complaints and relapse into absenteeism in the long term. METHODS: Patients who participated in the original randomized controlled trial were followed up 4 years later. Fatigue and absenteeism were the main outcomes. RESULTS: Fatigue and absenteeism were high in the intervention and control groups at the 4-year follow-up. There was no significant difference between the intervention group and the control group on fatigue and absenteeism. The intervention group however tended toward less-favorable outcomes as compared with the control group. CONCLUSIONS: Like that of chronic fatigue syndrome, the prognosis of less-advanced fatigue is rather poor. CBT delivered by GPs is not effective in the long term.     

Moving Empirically Supported Practices to Addiction Treatment Programs: Recruiting Supervisors to Help in Technology Transfer

Federal and state funding agencies are encouraging or mandating the use of empirically supported treatments in addiction programs, yet many programs have not moved in this direction (Forman, Bovasso, and Woody, ; Roman and Johnson, ; Willenbring et al., ). To improve the skills of counselors in community addiction programs, the authors developed an innovative Web-based course on Cognitive Behavioral Therapy (CBT), a widely accepted empirically-supported practice (ESP) for addiction. Federal funding supports this Web course and a randomized controlled trial to evaluate its effectiveness. Since supervisors often play a pivotal role in helping clinicians transfer learned skills from training courses to the workplace, the authors recruited supervisor-counselor teams, engaging 54 supervisors and 120 counselors. Lessons learned focus on supervisor recruitment and involvement, supervisors’ perceptions of CBT, their own CBT skills and their roles in the study, and implications for technology transfer for the addiction field as a whole. Recruiting supervisors proved difficult because programs lacked clinical supervisors. Recruiting counselors was also difficult because programs were concerned about loss of third-party reimbursement. Across the addiction field, technology transfer will be severely hampered unless such infrastructure problems can be solved. Areas for further investigation are identified.     

认知行为疗法对乳腺癌患者生活质量的影响

目的：探讨认知行为治疗对乳腺癌患者生活质量的影响。方法将110例乳腺癌患者随机分为两组,每组55例,两组均予以常规治疗及护理,研究组在此基础上联合认知行为治疗。观察5周。于治疗前后采用乳腺癌患者生命质量测定量表评价治疗效果。结果治疗前两组乳腺癌患者生命质量测定量表评分比较差异无显著性（P＞0．05）,治疗5周末研究组乳腺癌患者生命质量测定量表总分及各领域得分均显著高于对照组（P＜0．01）。结论认知行为治疗能显著改善乳腺癌患者的情绪状况,提高心理健康水平与生活质量。     

The current status and future direction of self-help treatments for problem gamblers

The self-help treatment (SHT) studies for other psychological problems significantly outweigh those for problem gambling. Currently, very little is published about the application and efficacy of various forms of SHTs for problem gambling. Thus, this paper reviews the self-help literature (using the PsycINFO database--all years up to April 2008) to stimulate further research in this area for problem gambling. The findings show that SHTs in problem gambling are still in their infancy. Although the problem gambling literature has mainly reported on two forms of SHTs with problem gamblers (i.e. use of self-help manuals and audiotapes), the review discuss utilizing a wide range of SHTs with problem gamblers. These include written materials (e.g. self-help books and treatment manuals), audiotapes, videotapes, computer-based SHTs implemented on palmtop computers, desktop computers, via telephone (Interactive Voice Response systems--IVR) or via the Internet and virtual reality applications. These SHTs would suit those problem gamblers who are not accessing professional treatment due to shame, guilt, fear of stigma, privacy concerns or financial difficulties, as well as those living in rural areas or with less severe gambling problems. The review also suggest future protocols for conducting further research in this area with problem gamblers, highlighting a need for a cohesive theory to guide research.     

Shared decision making in the recovery of people with schizophrenia: The role of metacognitive capacities in insight and pragmatic language use

In the development of consumer-centered care for mental health consumers with schizophrenia, one key ingredient is consumer participation in health care decisions together with their healthcare providers, termed "shared decision making" (SDM). SDM requires consumers to form a number of complex ideas about themselves and their providers then use that knowledge to make sense of the illness and reach medical and psychosocial decisions. However, metacognitive deficits widely observed in schizophrenia might lead to poor insight and pragmatic language deficits in some consumers, disrupting the whole process by which a personal and consensually valid narrative account of psychiatric challenges is synthesized and flexibly evolved. Given the current understanding that it is possible to improve metacognition, in this article we summarize how Metacognitive Training (MCT) and individual psychotherapy could potentially be tailored, or modified, to help consumers to develop metacognitive capacities with an end goal of facilitating the SDM process. Consistent with the principles of consumer-defined recovery, we also suggest a strategy for engaging consumers in SDM dialogue based on "where the consumers are at". Providers are advised to be cognizant of their medically driven perspective and attempt to work with the consumers in the perspective of the consumers' own recovery goals.