Pre-eclampsia and nasal CPAP: Part 2. Hypertension during pregnancy,chronic snoring,and early nasal CPAP intervention

ObjectivesTo evaluate the potential benefit of nasal continuous positive airway pressure (CPAP) administration in pregnant women recognized to have hypertension early in pregnancy.MethodsThis is a randomized study comparing the addition of nasal CPAP treatment to standard prenatal care to standard prenatal care alone in hypertensive women treated with alpha-methyl dopa during early pregnancy. Pregnant women with hypertension were recruited by their obstetricians and completed baseline sleep questionnaires and visual analogue scales on snoring and sleepiness. Subjects were then randomized to receive either CPAP with standard prenatal care (treatment group) or standard prenatal care alone (control group) with routine obstetric follow-up. Nocturnal polysomnography was performed in all patients randomized to the treatment group for initial CPAP titration. Periodic assessment of blood pressure control and CPAP compliance was performed by the same specialist at each scheduled follow-up visit.ResultsIn the control group (n = 9), a progressive rise in blood pressure with a corresponding increase in alpha-methyl dopa doses was observed, beginning at the sixth month of pregnancy. There was also an increase in the number of non-scheduled post-natal visits during the first postpartum month. Pre-eclampsia occurred in one subject; the remaining eight patients had normal pregnancies and infant deliveries. In the treatment group (n = 7), blood pressure was noted to decrease significantly as compared to the control group with associated decreases in doses of antihypertensive medications at six months of gestation. All treated patients experienced uncomplicated pregnancies and delivered infants with higher APGAR scores at one minute post-delivery compared to those of controls.ConclusionIn pregnant women with hypertension and chronic snoring, nasal CPAP use during the first eight weeks of pregnancy combined with standard prenatal care is associated with better blood pressure control and improved pregnancy outcomes.     

Stress in mothers of children with autism: Trait mindfulness as a protective factor

Mindfulness-based interventions may reduce parents’ stress and improve parent–child relationships. Given the chronic nature of autism spectrum disorder (ASD) and its influence on parents’ stress, interventions to promote mindfulness may be especially helpful for parents of children with ASD. Prior to undertaking intervention development, it is first necessary to establish the relationship between mindfulness and stress, as other factors like child behavioral difficulties may overshadow the mother's regulation strategies. In a sample of mothers of children with ASD (n = 67) and a comparison sample of mothers without ASD (n = 87), mindfulness was significantly associated with the level of maternal stress above and beyond child behavior problems (non-ASD: β = −.232; F(1, 64) = 15.749, p < .000; ASD: β = −.206; F(1, 84) = 15.576, p < .000). Results suggest that interventions to promote mindfulness may be helpful in reducing parenting stress among mothers of children with ASD, as well as mothers of typically developing children. Due to the chronic nature of ASD, such interventions may be particularly applicable.     

Cognitive treatment of post-traumatic stress disorder in the elderly. A longitudinal study

ObjectiveThis article aims to verify whether a cognitive treatment of post-traumatic stress disorder (PTSD) by cognitive behavioural therapy (CBT) adapted to elderly subjects can lead to long-term improvement in symptomatology and quality of life.MethodWe present a longitudinal study of 32 subjects over the age of 65 years, with no cognitive impairment or mild impairment, residing in two nursing homes. We compare a target group (n = 16) with PTSD treated with 20 CBT sessions and a control group (n = 16) with PTSD without symptom treatment. The two groups are compared in four stages: (T1) before treatment of the target group's PTSD, (T2) after treatment of PTSD, (T3) after six months of follow-up and (T4) after 18 months of follow-up. The absence of cognitive impairment is verified with the MMSE. The evolution of PTSD is monitored with the CAPS. The evolution of the quality of life of the subjects in the target group is verified with the ADRQL.ResultsIf both groups show elevated PTSD symptoms at the beginning of the study (T1), the signs of PTSD disappear for the target group at the end of treatment (T2) at the same time as quality of life improves (scores more than doubled). These improvements continue for more than 18 months (T4). Conversely, the control group retains high PTSD symptoms, without significant decrease over time.ConclusionThe treatment of PTSD by cognitive-behavioural therapy adapted to elderly people without cognitive impairment, or with mild cognitive or memory disorders, allows for a lasting disappearance of symptoms and an improvement in quality of life.     

Effectiveness of cognitive-behavioral group therapy for patients with hypochondriasis (health anxiety)

Cognitive behavioral therapy (CBT) has been shown to be highly effective in the treatment of health anxiety. However, little is known about the effectiveness of group CBT in the treatment of health anxiety. The current study is the largest study that has investigated the effectiveness of combined individual and group CBT for patients with the diagnosis of hypochondriasis (N = 80). Therapy outcomes were evaluated by several questionnaires. Patients showed a large improvement on these primary outcome measures both post-treatment (Cohen's d = 0.82–1.08) and at a 12-month follow-up (Cohen's d = 1.09–1.41). Measures of general psychopathology and somatic symptoms showed significant improvements, with small to medium effect sizes. Patients with more elevated hypochondriacal characteristics at therapy intake showed a larger therapy improvement, accounting for 7–8% of the variance in therapy outcome. CBT group therapy has therefore been shown to be an appropriate and cost-effective treatment for health anxiety.     

Epstein-Barr virus reactivation during pregnancy and postpartum: Effects of race and racial discrimination

ObjectiveAdverse pregnancy outcomes, including preterm birth, are markedly higher among African–Americans versus Whites. Stress-induced immune dysregulation may contribute to these effects. Epstein-Barr virus (EBV) reactivation provides a robust model for examining cellular immune competence. This study examined associations of EBV virus capsid antigen immunoglobulin G (VCA IgG) with gestational stage, race, and racial discrimination in women during pregnancy and postpartum.MethodsFifty-six women (38 African–American, 18 White) were included. African–Americans and Whites did not differ in age, education, income, parity, or body mass index (ps ? .51). During the 1st, 2nd, and 3rd trimester and ～5 weeks postpartum, women completed measures of racial discrimination, perceived stress, anxiety, depressive symptoms and health behaviors. EBV VCA IgG antibody titers were measured via ELISA in serum collected at each visit.ResultsIn the overall sample, EBV VCA IgG antibody titers were lower in the 3rd versus 1st trimester (p = .002). At every timepoint (1st, 2nd, 3rd trimester and postpartum), African–American women exhibited higher serum EBV VCA IgG antibody titers than Whites (ps < .001). This effect was most pronounced among African–Americans reporting greater racial discrimination [p = .03 (1st), .04 (2nd), .12 (3rd), .06 (postpartum)]. Associations of race and racial discrimination with EBV VCA IgG antibody titers were not accounted for by other measures of stress or health behaviors.ConclusionsCompared to Whites, African–American women showed higher EBV VCA IgG antibody titers, indicative of impaired cellular immune competence, across pregnancy and postpartum. This effect was particularly pronounced among African–American women reporting greater racial discrimination, supporting a role for chronic stress in this association. In women overall, EBV antibody titers declined during late as compared to early pregnancy. This may be due to pregnancy-related changes in cell-mediated immune function, humoral immune function, and/or antibody transfer to the fetus in late gestation. As a possible marker of stress-induced immune dysregulation during pregnancy, the role of EBV reactivation in racial disparities in perinatal health warrants further attention.     

Intervention effects on emotion regulation in preterm infants with very low birth weight: A randomize controlled trial

Preterm infants are at risk for emotional difficulties and behavioral problems. This study was aimed to investigate the effects of a clinic-based intervention program (CBIP) and a home-based intervention program (HBIP) compared with a usual care program (UCP) on emotion regulation to stress in preterm infants with very low birth weight (VLBW, birth weight <1500 g). A total of 178 VLBW preterm infants had been previously randomly assigned to receive one of three interventions (57 in CBIP, 63 in HBIP and 58 in UCP). The CBIP and HBIP contained identical child-, parent- and dyad-focused interventions that were provided to infants during hospitalization and were respectively delivered at clinics and at home at PMA 36–38 and 40 weeks, and 1, 2, 4, 6, 9, 12 months of corrected age. All infants were prospectively observed for behavioral reactivity and regulation in response to experimentally evoke stress evoked by a toy-behind-barrier procedure at 12, 18, and 24 months of corrected age. Their cognitive and language abilities, and mothers’ responsiveness were also assessed at 12 months as potential covariates. Compared to the UCP-group infants, the HBIP-group infants exhibited shorter durations of visual orientation to a toy (adjusted difference [95% CI] = −1.60 [−3.07 to −0.13], p = 0.03), and the CBIP-group infants exhibited shorter durations of avoidance (adjusted difference [95% CI] = −0.84 [−1.57 to −0.10], p = 0.03) from 12 to 24 months of corrected age. The CBIP and HBIP showed no difference in the stress reactivity from the UCP, however. These results suggest that comprehensive interventions incorporating child-, parent- and dyad-focused services enhanced VLBW preterm infants’ emotion regulation in response to stress at toddler age.     

Prediction of rhythmic and periodic EEG patterns and seizures on continuous EEG with early epileptiform discharges

BackgroundContinuous EEG (cEEG) is necessary to document nonconvulsive seizures (NCS), nonconvulsive status epilepticus (NCSE), as well as rhythmic and periodic EEG patterns of ‘ictal–interictal uncertainty’ (RPPIIU) including periodic discharges, rhythmic delta activity, and spike-and-wave complexes in neurological intensive care patients. However, cEEG is associated with significant recording and analysis efforts. Therefore, predictors from short-term routine EEG with a reasonably high yield are urgently needed in order to select patients for evaluation with cEEG.ObjectiveThe aim of this study was to assess the prognostic significance of early epileptiform discharges (i.e., within the first 30 min of EEG recording) on the following: (1) incidence of ictal EEG patterns and RPPIIU on subsequent cEEG, (2) occurrence of acute convulsive seizures during the ICU stay, and (3) functional outcome after 6 months of follow-up.MethodsWe conducted a separate analysis of the first 30 min and the remaining segments of prospective cEEG recordings according to the ACNS Standardized Critical Care EEG Terminology as well as NCS criteria and review of clinical data of 32 neurological critical care patients.ResultsIn 17 patients with epileptiform discharges within the first 30 min of EEG (group 1), electrographic seizures were observed in 23.5% (n = 4), rhythmic or periodic EEG patterns of ‘ictal–interictal uncertainty’ in 64.7% (n = 11), and neither electrographic seizures nor RPPIIU in 11.8% (n = 2). In 15 patients with no epileptiform discharges in the first 30 min of EEG (group 2), no electrographic seizures were recorded on subsequent cEEG, RPPIIU were seen in 26.7% (n = 4), and neither electrographic seizures nor RPPIIU in 73.3% (n = 11). The incidence of EEG patterns on cEEG was significantly different between the two groups (p = 0.008). Patients with early epileptiform discharges developed acute seizures more frequently than patients without early epileptiform discharges (p = 0.009). Finally, functional outcome six months after discharge was significantly worse in patients with early epileptiform discharges (p = 0.01).ConclusionsEpileptiform discharges within the first 30 min of EEG recording are predictive for the occurrence of ictal EEG patterns and for RPPIIU on subsequent cEEG, for acute convulsive seizures during the ICU stay, and for a worse functional outcome after 6 months of follow-up.This article is part of a Special Issue entitled Status Epilepticus.     

The effects of a parent-focused intervention for children with a recent diagnosis of autism spectrum disorder on parenting stress and competence

This paper reports on the effects of two types of parent-focused intervention, for parents of children with autism spectrum disorder (ASD) aged 2–4 years and within 6 months of diagnosis, on parent's perceptions of stress and competence. Interventions aimed to decrease parenting stress and increase parenting competence by embedding empirically supported parenting strategies within family routines. Families were assigned to a professionally supported intervention that included a workshop and 10 home-visits (n = 17) or to a self-directed video based intervention (n = 22). Development in social communication was greater for children of families receiving professional support as measured by a caregiver questionnaire but not on a clinically measured behavior sample. Improvements in adaptive behavior were greater for children in the professionally supported intervention when relatively low adaptive behavior scores had been demonstrated at pre-intervention. The professionally supported intervention resulted in reduced child-related parenting stress and increased parenting self-efficacy relative to the self-directed intervention. The findings support the importance of providing individualized information and professional support around the time of diagnosis for families who have a child with ASD.     

Association between morningness–eveningness and the severity of compulsive Internet use: the moderating role of gender and parenting style

BackgroundEveningness and Internet addiction are major concerns in adolescence and young adulthood. We investigated the relationship between morningness–eveningness and compulsive Internet use in young adults and explored the moderating effects of perceived parenting styles and family support on such relationships.MethodsThe participants consisted of 2731 incoming college students (men, 52.4%; mean age, 19.4 ± 3.6 years) from a National University in Taiwan. Each participant completed the questionnaires, which included the Morningness–Eveningness Scale (MES), the Yale-Brown Obsessive Compulsive Scale modified for Internet use (YBOCS-IU), the Parental Bonding Instrument for parenting style, the Family Adaptation, Partnership, Growth, Affection, and Resolve questionnaire (APGAR) for perceived family support, and the Adult Self-Report Inventory-4 (ASRI-4) for psychopathology. The morning (n = 459), intermediate (n = 1878), and evening (n = 394) groups were operationally defined by the MES t scores.ResultsThe results showed that eveningness was associated with greater weekend sleep compensation, increased compulsive Internet use, more anxiety, poorer parenting styles, and less family support; additionally, the most associated variables for increased compulsive Internet use were the tendency of eveningness, male gender, more anxiety symptoms, less maternal affection/care, and a lower level of perceived family support. The negative association between the morning type and compulsive Internet use severity escalated with increased maternal affection/care and decreased with increased perceived family support. The positive association between the evening type and compulsive Internet use severity declined with increased maternal protection. However, the father’s parenting style did not influence the relationship between morningness–eveningness and compulsive Internet use severity.ConclusionsOur findings imply that sleep schedule and the parental and family process should be part of specific measures for prevention and intervention of compulsive Internet use.     

Exploratory associations with Tumor Necrosis Factor-α, disinhibition and suicidal endorsement after traumatic brain injury

PurposeTo examine the relationship of Tumor Necrosis Factor (TNF)-α to disinhibition and suicidal endorsement after traumatic brain injury (TBI).ParticipantsAdults with moderate to severe TBI (acute serum levels: n = 48, n = 543 samples; acute CSF levels: n = 37, n = 389 samples; chronic serum levels: n = 48, n = 326 samples).Main measuresTNFα levels (CSF, Serum) from time of injury to 12 months post-injury; Frontal Systems Behavior Scale – Disinhibition Subscale at 6 and 12 months post-injury; Patient Health Questionnaire at 6 and 12 months post-injury.ResultsParticipants with TBI had significantly higher CSF and serum TNFα levels than healthy controls (p < 0.05). Acute and chronic serum TNFα was significantly associated with disinhibition at 6 months post-injury (p = 0.009, p = 0.029 respectively), and 6 month disinhibition was associated with suicidal endorsement at both 6 and 12 months (p = 0.045, p = 0.033 respectively) and disinhibition at 12 months post-injury (p < 0.001).ConclusionThese preliminary data suggest a biological to behavioral pathway of suicidality after TBI, from TNFα to disinhibition to suicidal endorsement. Future investigation is warranted to validate these findings and clarify what biological mechanisms might underlie these relationships.     

Évaluation du recours au programme de soins prévu par la loi du 5 juillet 2011

ObjectivesThe law of 5 July 2011 introduced the possibility of outpatient care without consent in the context of care programs (CP). Despite major ethical and legal issues and frequent recourse in France, few studies are available on the use of this mechanism. An in-depth review of practices involving a large sample of CP was essential. The main objective of this study was to look at their content, the clinical profile of the patients involved, and the progress of these CP.MethodsWe carried out a retrospective, observational study, including all the CP set up between January 1st, 2016 and December 31st, 2018 in the Sarthe department. Data strictly related to the CP (content, justification, duration, patient compliance, re-hospitalizations, etc.), and patient-related variables (socio-demographic characteristics, diagnosis, antecedents, etc.) were studied.ResultsWe studied 559 CP, 70 % of which (n = 391) in the context of “care by decision of the hospital director”, with a wide disparity of recourse by psychiatric sector. One third of the hospitalizations without consent ended with a CP. They involved men (68.5 %, n = 383), with a psychotic disorder (77.8 %, n = 435), with a history of hospitalization (90 %, n = 503), and with poor adherence to care (83.2 %, n = 465). Cannabis use accounted for 41.3 % (n = 231) of cases. Certificates initiating CP did not have a clear justification (34.6 %, n = 251) or state a goal of adherence to treatment (16.5 %, n = 120). The content of the different CP was homogeneous: 65.6% of medical consultations and 47.6 % with a nurse, 100 % mentioned treatment used. Their average duration was 3.4 months. Even though the CP were followed (69.9 %, n = 391), 52.8% (n = 295) ended with reintegration, mainly justified by symptomatic relapse (34.8 %, n = 147), and new CP were put in place almost systematically (90.6 %, n = 260). However, reintegrations were shorter than first-time admissions (26 vs. 95 days). When a decision was lifted (n = 174), it was based on the criteria of clinical stability (35.7 %, n = 120) and compliance with the CP (27.6 %, n = 93). Half of hospitalizations in “care at the decision of the State representative” ended with a CP. These CP were longer (4.5 months) and with a higher rate of reintegration (62.2 %) than for those in “care at the decision of the hospital director”. There was no significant difference of CP compliance according to the mode of psychiatric care.ConclusionsOur study allows a precise vision of patients concerned by CP: men with risk factors for psychiatric dangerousness, with a severe clinical profile. It also found a high rate of re-hospitalization despite good adherence with the CP which is in line with a device allowing the work of an alliance to care and interventions at the beginning of relapse. CP have poorly personalized content and are poorly justified by psychiatrists although it is a freedom-restricting measure, highlighting the need for increased awareness amongst psychiatrists of the legal framework of their practice regarding care without consent.     

Transitioning pediatric patients receiving ketogenic diets for epilepsy into adulthood

PurposeTo examine the process for transitioning adolescents on dietary management for intractable epilepsy to adult neurologic care.MethodsTen patients, ages 6–16 years when the ketogenic or modified Atkins diet was initiated, were identified; age at transition was 18–43 years. All patients were seen at Johns Hopkins Hospital, Baltimore, Maryland.ResultsSeven remain on diets (4 Ketogenic, 3 modified Atkins diet) at this time with mean diet duration of 15.5 years (range 4–32 years). Most patients had excellent but not complete seizure control and several had recurrence or worsening of seizures with attempts to wean dietary therapy, hence the need to continue. Three main transition options were utilized: (1) continue being followed in pediatric clinic (n = 2), (2) establish care with an adult neurologist (n = 2), or 3) receive care from the Adult Epilepsy Diet Center (n = 6). Those patients followed in the Adult Epilepsy Diet Center were slightly more likely to remain on dietary therapy following transition (5/6 vs. 1/4, p = 0.12).ConclusionIt is important for adolescents with epilepsy receiving ketogenic diets to have transition plans in place for when they become adults. Adult epilepsy diet centers are the ideal option when possible.     

IV t-PA therapy in acute stroke patients with atrial fibrillation

Background and purposeAtrial fibrillation (AF) is a predictor for severe stroke. Intravenous administration of tissue plasminogen activator (t-PA) can improve clinical outcomes in patients with acute ischemic stroke. We investigated clinical characteristics and patient outcome in patients with and without AF after t-PA therapy.MethodsConsecutive ischemic stroke patients treated with t-PA within 3 h of stroke onset were studied prospectively. MRI examinations, including diffusion weighted imaging and MRA, were performed before t-PA thrombolysis. NIHSS scores were obtained before and 7 days after t-PA infusion. The patients were divided into two groups (AF group and Non-AF group). Their clinical characteristics and outcome 7 days and 3 months after t-PA therapy were compared.Results85 patients (56 males, mean age, 73.4 ± 11.5 years) were enrolled in the present study. The AF-group had 44 patients, and the Non-AF group had 41 patients. Fewer patients with AF had dramatic improvement at 7 days and favorable outcome (mRS 0–1) at 3 months after t-PA therapy than patients without AF (31.8% vs. 61.0%, P = 0.007, and 15.9% vs. 46.3%, P = 0.002). On the other hand, worsening at 7 days and poor outcome (mRS > 3 and death) at 3 months after t-PA therapy were more frequently observed in AF group than Non-AF group (22.7% vs. 9.8%, P = 0.107, and 70.5% vs. 41.5%, P = 0.007). After adjusting age and gender, patients with AF more frequently had worsening and poor outcome than those without AF (adjusted OR; 4.54, 95% CI 1.04–19.75, P = 0.044, and adjusted OR; 2.8, 95% CI 1.10–7.28, P = 0.032).ConclusionThe present study found that acute ischemic stroke patients with AF more frequently had poor outcome after IV-t-PA therapy compared with those without AF.     

Prenatal maternal stress in relation to the effects of prenatal lead exposure on toddler cognitive development

ObjectiveTo evaluate the effects of maternal lead exposure during pregnancy on toddler cognitive development and the potential effect modification by maternal stress.MethodsWe conducted a prospective birth-cohort study in Shanghai from 2010 to 2012 and investigated 225 mother-infant pairs. The mothers were recruited in mid-to-late pregnancy and children were followed up until 24–36 months old. A self-administered Symptom Checklist-90-Revised Scale (SCL-90-R) was used to assess maternal emotional stress during pregnancy. Maternal whole blood lead levels were measured during gestational weeks 28–36. The toddlers’ cognitive levels were assessed using the Gesell Development Scale. Multiple linear regression models were established to explore the main effects of prenatal lead exposure on toddlers’ cognitive abilities and the modifying effects of maternal stress. Covariate information was collected through interviews, questionnaires and medical records.ResultsThe mean maternal blood lead concentration was 3.30 (95%CI: 3.05, 3.57) μg/dL. After adjusting for relevant confounders, no significant associations of maternal blood lead concentrations with toddlers' cognitive levels were observed in all five domains of the Gesell scale (P > 0.05). However, the interaction between prenatal maternal blood lead and stress was significant in the domains of adaptive behavior, language and social behavior. When stratified by maternal stress levels, compared with non-significant associations (P > 0.05) among low (P1-P75) prenatal stress group, adverse associations between maternal blood lead concentrations (log10-transformed) and toddlers’ cognitive levels were observed among high (P75-P100) prenatal stress group in the domains of language (β = −33.82, 95%CI: −60.04, −7.59), social behavior (β = −41.00, 95%CI: −63.11, −18.89) and adaptive behavior (β = −17.93, 95%CI: −35.83, −0.03).ConclusionPrenatal maternal stress may exacerbate the deleterious effects of prenatal exposure to lead on toddler cognitive development.     

The sleep macroarchitecture of children at risk for depression recruited in sleep centers

ObjectiveThe primary aim of this study was to compare the sleep macroarchitecture of children and adolescents whose mothers have a history of depression with children and adolescents whose mothers do not.MethodPolysomnography (PSG) and Holter electroencephalogram (EEG) were used to compare the sleep architecture of 35 children whose mothers had at least one previous depressive episode (19 boys, aged 4–18 years, “high-risk” group) and 25 controls (13 males, aged 4–18 years, “low-risk” group) whose mothers had never had a depressive episode. The total sleep time, wakefulness after sleep onset (WASO), sleep latency, sleep efficiency, number of awakenings per hour of sleep, percentages of time spent in each sleep stage, rapid eye movement (REM) latency and the depressive symptoms of participants were measured.ResultsIn children (4–12 years old), the high-risk group exhibited significantly more depressive symptoms than controls (P = 0.02). However, PSG parameters were not significantly different between high-risk children and controls. In adolescents (13–18 years old), the high-risk subjects presented with significantly more depressive symptoms (P = 0.003), a significant increase in WASO (P = 0.019) and a significant decrease in sleep efficiency compared to controls (P = 0.009).ConclusionThis study shows that children and adolescents born from mothers with a history of at least one depressive episode had significantly more depressive symptoms than controls. However, only high-risk adolescents presented with concurrent alterations of sleep macroarchitecture.     

Use of the distress thermometer to evaluate symptoms,outcome and satisfaction in a specialist psycho-oncology service

ObjectiveThe National Institute for Health and Care Excellence recommends the use of structured tools to improve holistic care for patients with cancer. The Distress Thermometer and Problem Checklist (DT) is commonly used for screening in physical health settings. However, it has not been integrated into the clinical pathway within specialist psycho-oncology services. We used the DT to examine the broad clinical effectiveness of psycho-oncology intervention and to ascertain factors from the DT linked to an improved outcome. We also evaluated patients' satisfaction with their care.MethodWe asked 111 adult outpatients referred to York Psycho-Oncology Service to complete the DT at their first appointment. Individuals offered a period of psycho-oncology care re-rated their emotional distress, problems and service satisfaction on the DT at discharge.ResultsMedian distress scores decreased significantly (from 6 to 4, Wilcoxon's z=−4.83, P< .001) indicating a large clinical effect size (Cohen's d= 1.22). Frequency of emotional problems (anxiety, depression and anger) fell significantly by 15–24% despite no significant change in patients' physical health or practical problems. Number of emotional problems was the best predictor of distress at discharge (beta=0.468, P= .002). Satisfaction was high and correlated with lower distress scores (r=−0.42, P= .005) and fewer emotional problems (r=−0.31, P= .04) at discharge but not with number of appointments attended. Qualitative thematic analysis showed patients particularly value supportive listening and advice on coping strategies from professionals independent of their physical care.ConclusionThe DT is an acceptable and useful tool for enhancing the delivery of structured psycho-oncology care. It may also provide evidence to support the effectiveness of specialist psycho-oncology interventions.     

Testing alternative factor models of PTSD and the robustness of the dysphoria factor

ObjectivesThis study first aimed to examine the structure of self-reported posttraumatic stress disorder (PTSD) symptoms using three different samples. The second aim of the paper was to test the robustness of the factor analytic model when depression scores were controlled for.DesignBased on previous factor analytic findings and the DSM-IV formulation, six confirmatory factor models were specified and estimated that reflected different symptom clusters. The best fitting model was subsequently re-fitted to the data after including a depression variable.MethodsThe analyses were based on responses from 973 participants across three samples. Sample 1 consisted of 633 parents who were members of ‘The National Association of Infant Death’ and who had lost a child. Sample 2 consisted of 227 victims of rape, who completed a questionnaire within 4 weeks of the rape. Each respondent had been in contact with the Centre for Rape Victims (CRV) at the Aarhus University Hospital, Denmark. Sample 3 consisted of 113 refugees resident in Denmark. All participants had been referred to a treatment centre which focused on rehabilitating refugees through treatment for psychosocial integration problems (RRCF: Rehabliterings og Revliderings Centre for Flygtninge). In total 500 participants received a diagnosis of PTSD/sub-clinical PTSD (Sample 1, N = 214; 2, N = 176; 3, N = 110).ResultsA correlated four-factor model with re-experiencing, avoidance, dysphoria, and arousal factors provided the best fit to the sample data. The average attenuation in the factor loadings was highest for the dysphoria factor (M = ?.26, SD = .11) compared to the re-experiencing (M = ?.14, SD = .18), avoidance (M = ?.10, SD = .21), and arousal (M = ?.09, SD = .13) factors.ConclusionsWith regards to the best fitting factor model these results concur with previous research findings using different trauma populations but do not reflect the current DSM-IV symptom groupings. The attenuation of dysphoria factor loadings suggests that dysphoria is a non-specific component of PTSD.     

Mindfulness-based stress reduction for healthy individuals: A meta-analysis

BackgroundAn increasing number of mindfulness-based stress reduction (MBSR) studies are being conducted with nonclinical populations, but very little is known about their effectiveness.ObjectiveTo evaluate the efficacy, mechanisms of actions, and moderators of MBSR for nonclinical populations.Data sourcesA systematic review of studies published in English journals in Medline, CINAHL or Alt HealthWatch from the first available date until September 19, 2014.Study selectionAny quantitative study that used MBSR as an intervention, that was conducted with healthy adults, and that investigated stress or anxiety.ResultsA total of 29 studies (n = 2668) were included. Effect-size estimates suggested that MBSR is moderately effective in pre–post analyses (n = 26; Hedge's g = .55; 95% CI [.44, .66], p < .00001) and in between group analyses (n = 18; Hedge's g = .53; 95% CI [.41, .64], p < .00001). The obtained results were maintained at an average of 19 weeks of follow-up. Results suggested large effects on stress, moderate effects on anxiety, depression, distress, and quality of life, and small effects on burnout. When combined, changes in mindfulness and compassion measures correlated with changes in clinical measures at post-treatment and at follow-up. However, heterogeneity was high, probably due to differences in the study design, the implemented protocol, and the assessed outcomes.ConclusionsMBSR is moderately effective in reducing stress, depression, anxiety and distress and in ameliorating the quality of life of healthy individuals; however, more research is warranted to identify the most effective elements of MBSR.     

The effect of antiepileptic drugs on thyroid function in children

BackgroundLimited and conflicting data exist for the influence of antiepileptic drugs on thyroid function in children.ObjectiveThe aim of this study was to investigate the effects of phenobarbital, valproate, carbamazepine, oxcarbazepine, and levetiracetam monotherapy on thyroid function in daily clinical practice during a 12-month treatment period.MethodA total of 223 children (103 females and 120 males) with new onset and controlled epilepsy treated with valproate (n = 129), phenobarbital (n = 33), carbamazepine (n = 36), oxcarbazepine (n = 14), levetiracetam (n = 11) were enrolled in the study. Serum free thyroxine (fT4) and thyroid-stimulating hormone (TSH) levels were measured before and at first, sixth and twelfth months of therapy.ResultsAt baseline, average fT4 and TSH concentrations were not different between the drug groups. Valproate-treated patients had decreased fT4 and increased TSH levels at months 1, 6, and 12. Carbamazepine-treated patients had decreased fT4 levels at months 1, 6, and 12 and increased TSH levels at months 1, and 6. Phenobarbital-treated patients had decreased fT4 levels at months 1, and 6, and increased TSH levels at months 6 and 12. Oxcarbazepine-treated patients had decreased fT4 levels at month 1. Levetiracetam-treated patients showed no significant change of fT4 and TSH at any times. The frequency of subclinical hypothyroidism at month 12 was 28% in valproate, 21.4% in oxcarbazepine, 18.2% in phenobarbital, 13.9% in carbamazepine, and 0% in levetiracetam groups.ConclusionOur data suggest that all antiepileptic drugs studied except levetiracetam had varying degrees of deleterious effects on thyroid function.