Effectiveness of metacognitive interventions for mental disorders in adults—A systematic review and meta‐analysis (METACOG)

We evaluated the effectiveness and acceptability of metacognitive interventions for mental disorders. We searched electronic databases and included randomized and nonrandomized controlled trials comparing metacognitive interventions with other treatments in adults with mental disorders. Primary effectiveness and acceptability outcomes were symptom severity and dropout, respectively. We performed random‐effects meta‐analyses. We identified Metacognitive Training (MCTrain), Metacognitive Therapy (MCTherap), and Metacognition Reflection and Insight Therapy (MERIT). We included 49 trials with 2,609 patients. In patients with schizophrenia, MCTrain was more effective than a psychological treatment (cognitive remediation, SMD = ?0.39). It bordered significance when compared with standard or other psychological treatments. In a post hoc analysis, across all studies, the pooled effect was significant (SMD = ?0.31). MCTrain was more effective than standard treatment in patients with obsessive–compulsive disorder (SMD = ?0.40). MCTherap was more effective than a waitlist in patients with depression (SMD = ?2.80), posttraumatic stress disorder (SMD = ?2.36), and psychological treatments (cognitive–behavioural) in patients with anxiety (SMD = ?0.46). In patients with depression, MCTherap was not superior to psychological treatment (cognitive–behavioural). For MERIT, the database was too small to allow solid conclusions. Acceptability of metacognitive interventions among patients was high on average. Methodological quality was mostly unclear or moderate. Metacognitive interventions are likely to be effective in alleviating symptom severity in mental disorders. Although their add‐on value against existing psychological interventions awaits to be established, potential advantages are their low threshold and economy.     

Anterior segment parameters associated with extramuscular manifestations in polymyositis and dermatomyositis

AIM: To evaluate the efficacy and safety of high-dose ultrasound cyclo-plasty (UCP) for the treatment of refractory glaucoma in Chinese patients. METHODS: In this 6-month retrospective study, 37 eyes of 37 patients suffering from severe glaucoma with uncontrolled intraocular pressure (IOP) of ≥21 mm Hg underwent 8-s ultrasonic cyclocoagulation with ten active piezoelectric elements. A complete ophthalmic examination was performed before and at 1d, 1, 3, 6mo after UCP. Therapeutic success was defined as IOP reduction from baseline ≥20% and IOP > 5 mm Hg without adding new glaucoma medication compare to baseline at the 6-month follow-up visit. In addition to mean IOP at each follow-up visit, medications used and complications were also detected and compared to baseline. RESULTS: After UCP procedure, the mean IOP was significantly reduced (P<0.01) from the preoperative 44.1±11.9 mm Hg to postoperative 26.7±11.8 mm Hg at 3mo, and 30.4±14.5 mm Hg at 6mo. The overall mean IOP reductions achieved at 3 and 6mo were 39% and 31%. Sixty-one percent of patients responded well to UCP treatment with a mean IOP reduction of 48% at 3mo and 42% at 6mo. Ocular pain in most of patients were alleviated. No serious intraoperative or postoperative complications occurred. CONCLUSION: High-dose UCP treatment is an effective and safe procedure to reduce IOP in Chinese patients with severe glaucoma.     

Intact brown adipose tissue thermogenesis is required for restorative sleep responses after sleep loss

Metabolic signals related to feeding and body temperature regulation have profound effects on vigilance. Brown adipose tissue (BAT) is a key effector organ in the regulation of metabolism in several species, including rats and mice. Significant amounts of active BAT are also present throughout adulthood in humans. The metabolic activity of BAT is due to the tissue‐specific presence of the uncoupling protein‐1 (UCP‐1). To test the involvement of BAT thermogenesis in sleep regulation, we investigated the effects of two sleep‐promoting stimuli in UCP‐1‐deficient mice. Sleep deprivation by gentle handling increased UCP‐1 mRNA expression in BAT and elicited rebound increases in non‐rapid‐eye‐movement sleep and rapid‐eye‐movement sleep accompanied by elevated slow‐wave activity of the electroencephalogram. The rebound sleep increases were significantly attenuated, by ~ 35–45%, in UCP‐1‐knockout (KO) mice. Wild‐type (WT) mice with capsaicin‐induced sensory denervation of the interscapular BAT pads showed similar impairments in restorative sleep responses after sleep deprivation, suggesting a role of neuronal sleep‐promoting signaling from the BAT. Exposure of WT mice to 35 °C ambient temperature for 5 days led to increased sleep and body temperature and suppressed feeding and energy expenditure. Sleep increases in the warm environment were significantly suppressed, by ~ 50%, in UCP‐1‐KO animals while their food intake and energy expenditure did not differ from those of the WTs. These results suggest that the metabolic activity of the BAT plays a role in generating a metabolic environment that is permissive for optimal sleep. Impaired BAT function may be a common underlying cause of sleep insufficiency and metabolic disorders.     

The Vicious Cycle of Family Atmosphere,Interpersonal Self-concepts,and Paranoia in Schizophrenia—A Longitudinal Study

Recent cognitive models of paranoid delusions highlight the role of self-concepts in the development and maintenance of paranoia. Evidence is growing that especially interpersonal self-concepts are relevant in the genesis of paranoia. In addition, negative interpersonal life-experiences are supposed to influence the course of paranoia. As dysfunctional family atmosphere corresponds with multiple distressing dyadic experiences, it could be a risk factor for the development and maintenance of paranoia. A total of 160 patients with a diagnosis of schizophrenia were assessed twice within 12 months. Standardized questionnaires and symptom rating scales were used to measure interpersonal self-concepts, perceived family atmosphere, and paranoia. Data were analyzed using longitudinal cross-lagged structural equation models. Perceived negative family atmosphere was associated with the development of more pronounced negative interpersonal self-concepts 12 months later. Moreover, paranoia was related to negative family atmosphere after 12 months as well. As tests revealed that reversed associations were not able to explain the data, we found evidence for a vicious cycle between paranoia, family atmosphere, and interpersonal self-concepts as suggested by theoretical/cognitive model of paranoid delusions. Results suggest that broader interventions for patients and their caretakers that aim at improving family atmosphere might also be able to improve negative self-concepts and paranoia.Key words: self-schema, psychosis, structural equation modelling, relatives, social cognition     

Treatment of depressive symptoms and attitudes towards treatment options in a representative German general population sample

Objective. To estimate treatment rates, self-medication, and preferences for treatment options of depressive symptoms. Methods. A German nationwide representative sample (n=2224) was interviewed. Subjects were asked to fill in a depressive symptom checklist, as well as to answer questions about current treatments and treatment preferences. Results. A total of 16.7% was mildly, 7.5% moderately and 6.5% strongly affected by depressive symptoms; 22.7% of the total affected group were currently or previously being treated by a physician. Self-initiated treatments had been stated as effective in 54.2% of cases. The preference for phytotherapeutic treatment approaches was about 3–6-fold higher than for standard antidepressants and psychotherapies. Treatment preference and wish for treatment increased with increasing severity of symptoms with regard to treatments that had to be professionally initiated. Conclusion. Despite considerable educational efforts, the prevalence of untreated and undiagnosed depressive symptoms seems to be high. There is still little acceptance for the most efficacious therapies for depression. More efforts should be made to increase knowledge about self-administered phytotherapeutic drugs, which might play an important role in a stepped-care approach of future depression management.     

Prevalence of human papillomaviruses in the healthy oral mucosa of women with high‐grade squamous intra‐epithelial lesion and of their partners as compared to healthy controls

Oral human papillomavirus (HPV) carriage rates were investigated in relation to genital HPV carriage in women with HPV‐associated cervical lesions and male partner of such women, including several couples, in comparison with healthy individuals. Buccal and lingual mucosa of 60 males and 149 females with healthy oral mucosa and without known genital lesion, genital and oral mucosa of further 40 females with cervical high‐grade squamous intraepithelial lesion (HSIL) and 34 male sexual partners of women with HSIL (including 20 couples) were sampled. HPV DNA was detected using MY/GP PCR. Genotype was determined by sequencing or restriction fragment length polymorphism. Virus copy numbers were determined by real‐time PCR. Overall, oral HPV carriage rate was 5.7% (12/209) in healthy individuals; average copy number was 5.8 × 10² copies/1 μg DNA; male and female rates were comparable. Oral carriage in women with HSIL was significantly higher, 20.0% (8/40, P = 0.003); males with partners with HSIL showed a carriage rate of 17.6% (6/34), copy numbers were similar to the healthy controls. In contrast, genital carriage rate (52.9%, 18/34 vs. 82.5%, 33/40; P = 0.006) and average copy number were lower in males (5.0 × 10⁵ vs. 7.8 × 10⁵ copies/1 μg DNA; P = 0.01). Oral copy numbers in these groups and in healthy individuals were comparable. High‐risk genotypes were dominant; couples usually had the same genotype in the genital sample. In conclusion, genital HPV carriage is a risk factor of oral carriage for the individual or for the sexual partner, but alone is not sufficient to produce an oral HPV infection in most cases.