共查询到20条相似文献,搜索用时 390 毫秒
1.
Renee J. Thompson Aleksandr Spectre Philip S. Insel Douglas Mennin Ian H. Gotlib June Gruber 《Cognitive therapy and research》2017,41(5):673-685
Although emotional disturbances characterize mood disorders, little is known about the affective forecasts of these individuals. We examined forecasted intensity and accuracy for negative affect (NA) and positive affect (PA) among two remitted clinical groups: individuals with Bipolar I (BD; n?=?31) and Major Depressive Disorder (MDD; n?=?21), and healthy controls (CTL; n?=?32). We also examined whether each group’s forecasting accuracy varied by valence. At the lab, participants forecasted their short-term (next day) and long-term (next week) NA and PA; then they completed a week of experience sampling. The MDD group forecasted lower PA and higher NA than the CTL group; the BD group’s forecasts varied across time frames. There were no group differences in forecasting accuracies. Regarding within group forecasting accuracy, the CTL group was more accurate in PA than NA; the BD group was similarly accurate across valence, and the MDD group’s accuracy varied based on the time frame. 相似文献
2.
We examined whether major depressive disorder (MDD) is associated with a tendency to recall more remote, specific autobiographical memories, particularly in the context of positive memories. To this end, individuals with MDD (n?=?26) and healthy controls (n?=?54) completed the Autobiographical Memory Test. Consistent with the hypothesis, remoteness of specific memories in the MDD group, but not the control group, depended on valence. Compared to the control group, the MDD group recalled more remote positive events. Additionally, the MDD group’s positive specific memories were significantly more remote than their negative specific memories. Retrieving remote positive memories might impair mood regulation and maintain an individual’s negative mood and perpetuate depression. 相似文献
3.
Investigating differences in the ways that people react to mood-evoking stimuli and regulate subsequent emotions may help to elucidate important mechanisms underlying depressed or hypomanic mood states. Euthymic young adults with bipolar disorder (n = 23) or depression (n = 21) were recruited for a study of emotion and mood. Two mood inductions assessed for differences in mood reactivity. Participants completed measures of current symptoms and emotion regulation strategies. Maladaptive (B = 0.42, p = .021) and adaptive (B = ?0.26, p = .011) emotion regulation strategies were significantly associated with depressive symptoms. Bipolar diagnosis (B = 5.51, p = .035), and threat mood reactivity (B = ?0.26, p = .015) were associated with hypomanic symptoms. Interaction terms for mood reactivity and emotion regulation were not significant in either model, although net regression indicated significant differences in two trends. Depressed moods, associated with MDD or BD, may be initiated and maintained primarily due to poor choice of emotion regulation strategies. Elevated mood states are more specific to bipolar disorder, and may be triggered by mood reactivity, rather than regulation. 相似文献
4.
5.
Laura Mandelli Sheng-Min Wang Changsu Han Soo-Jung Lee Ashwin A. Patkar Prakash S. Masand Chi-Un Pae Alessandro Serretti 《Advances in therapy》2017,34(3):713-724
Introduction
Ample evidence suggested a role of sigma-1 receptor in affective disorders since the interaction of numerous antidepressants with sigma receptors was discovered. A recent study on Japanese subjects found a genetic variant within the encoding gene SIGMAR1 (rs1800866A>C) associated with major depressive disorder (MDD). We aimed to evaluate the same polymorphism in both MDD and bipolar disorder (BD) as well as its relationship to response to treatment with antidepressants and mood stabilizers.Methods
A total of 238 MDD patients treated for an acute episode of depression, 132 BD patients in treatment with mood stabilizers for a manic or mixed episode, and 324 controls were genotyped for rs1800866. At discharge, response to treatments was evaluated in MDD and BD patients by the Hamilton Rating Scale for Depression (HRSD) and the Young Mania Rating Score (YMRS), respectively.Results
In our Korean sample, allele frequencies were different from those reported in other Asian and non-Asian populations. The CC genotype was associated with BD and, as a trend, with MDD. No significant effect was observed on response to antidepressants in MDD or mood stabilizers in BD, although the CC genotype was more frequent among BD patients experiencing a mixed episode.Conclusion
The present findings are the first to propose the putative role of genetic variants within SIGMAR1 and sigma-1 receptor in BD. Sigma-1 receptor can modulate a number of central neurotransmitter systems as well as some other signaling pathways (e.g., neurotrophin and growth factor signaling) which are seemingly involved in BD and other mood disorders.6.
Sunny J. Dutra Greg J. Siegle Elizabeth J. Reeves Iris B. Mauss June Gruber 《Cognitive therapy and research》2016,40(2):139-149
Elevated anger and impairments in executive functioning are prominent features of bipolar disorder (BD). Given that anger has been found to interfere with some aspects of cognition in healthy individuals, it is possible that heightened anger could compromise cognitive processing even more substantially among individuals with BD. Despite the important clinical and psychosocial implications of such an effect, the precise consequences of anger for cognition in BD are not well understood. To address this, the present study employed a validated anger provocation task and examined its impact on performance of an arithmetic task, assessing both accuracy (number of correct responses) and task engagement (number of responses made) among adults with remitted bipolar I disorder (BD; n = 27), healthy non-psychiatric controls (CTL; n = 29), and a clinical control group of adults with remitted depression (MDD; n = 29). Results revealed that individuals with BD uniquely declined in the number of responses made across the task. In addition, self-reported anger was predictive of reduced task performance among individuals with BD. These results suggest that elevated anger may add to existing executive impairments in BD, compromising these individuals’ ability to remain engaged in cognitively demanding tasks in the context of anger. 相似文献
7.
Kajal Gokal Deborah Wallis Samreen Ahmed Ion Boiangiu Kiran Kancherla Fehmidah Munir 《Supportive care in cancer》2016,24(3):1139-1166
Purpose
This study evaluated the effectiveness of a self-managed home-based moderate intensity walking intervention on psychosocial health outcomes among breast cancer patients undergoing chemotherapy.Methods
The randomised controlled trial compared a self-managed, home-based walking intervention to usual care alone among breast cancer patients receiving chemotherapy. Outcome measures included changes in self-report measures of anxiety, depression, fatigue, self-esteem, mood and physical activity. Fifty participants were randomised to either the intervention group (n?=?25), who received 12 weeks of moderate intensity walking, or the control group (n?=?25) mid-way through chemotherapy. Participants in the intervention group were provided with a pedometer and were asked to set goals and keep weekly diaries outlining the duration, intensity and exertion of their walking. Levels of psychosocial functioning and physical activity were assessed pre- and post-intervention in both groups.Results
The intervention had positive effects on fatigue (F?=?5.77, p?=?0.02), self-esteem (F?=?8.93, p?≤?0.001), mood (F?=?4.73, p?=?0.03) and levels of physical activity (x 2?=?17.15, p?=?0.0011) but not anxiety (F?=?0.90, p?=?0.35) and depression (F?=?0.26, p?=?0.60) as assessed using the HADS. We found an 80 % adherence rate to completing the 12-week intervention and recording weekly logs.Conclusion
This self-managed, home-based intervention was beneficial for improving psychosocial well-being and levels of physical activity among breast cancer patients treated with chemotherapy.Trial registration
Current Controlled Trials ISRCTN50709297.8.
Emma C. Woodward Andres G. Viana Elizabeth M. Raines Abigail E. Hanna Michael J. Zvolensky 《Cognitive therapy and research》2018,42(6):823-831
The present investigation examined the underlying role of anxiety sensitivity and its facets in the association between emotion dysregulation and three of the most prevalent and debilitating symptom classes among trauma-exposed psychiatric inpatient youth: posttraumatic stress disorder (PTSD), anxiety, and depression symptoms. Participants (N?=?50; 52.0% female; Mage?=?15.1 years, SD?=?.51, range 12–17 years) completed an assessment battery that included measures of emotion dysregulation anxiety sensitivity, PTSD, anxiety, and depression symptoms. Consistent with hypotheses, the global construct of anxiety sensitivity, as well as its mental incapacitation concerns and disease concerns facets, explained, in part, associations between emotion dysregulation and the three symptom classes. The study results provide novel and clinically meaningful findings regarding the potential mechanistic role of anxiety sensitivity in the relation of emotion dysregulation to PTSD and internalizing symptoms among trauma-exposed inpatient adolescents. As such, findings underscore the potential value of targeting anxiety sensitivity in general, and mental incapacitation and disease concerns specifically, as a means of reducing risk for internalizing psychopathology among trauma-exposed inpatient youth. 相似文献
9.
Nikolaos Kazantzis Hoang Kim Luong Alexsandra S. Usatoff Tara Impala Rui Ying Yew Stefan G. Hofmann 《Cognitive therapy and research》2018,42(4):349-357
Cognitive Behavioral Therapy (CBT) refers to a treatment approach with strong empirical support for its efficacy for various disorders and populations. The goal of the present review was to provide a comprehensive survey of meta-analyses examining the processes of CBT, namely: treatment processes (cognitive reappraisal, behavioral strategies, emotional regulation, motivation strategies, and psychoeducation) and in-session processes (alliance, goal consensus and collaboration, feedback, group cohesion, and homework). We identified 558 meta-analyses of CBT, and 30 meta-analyses met our inclusion criteria as reviews of process-outcome relations. For treatment processes, the strongest support currently exists for cognitive (n?=?8 meta-analyses) and behavioral strategies (n?=?3 meta-analyses) as change processes in CBT for anxiety disorders and depression. For in-session processes, the strongest support currently exists for the role of the alliance (n?=?8 meta-analyses) and homework assignments (n?=?6 meta-analyses) as predictors of outcome. Overall, the evidence base for process-outcome relations in CBT is just emerging. Additional research is needed to examine the range of treatment processes in various clinical contexts. Moreover, except for a meta-analysis on collaboration, no meta-analytic studies have been reported on CBT-specific elements of the therapeutic relationship, such as collaborative empiricism and Socratic dialogue. 相似文献
10.
Jessica Leen Joanna K. Soczynska Laura Ashley Gallaugher Hanna O. Woldeyohannes Mohammad T. Alsuwaidan Danielle S. Cha Roman M. Dale David J. Muzina Sidney H. Kennedy Roger S. McIntyre 《Advances in therapy》2013,30(7):671-683
Introduction
Functional impairment associated with mood disorders may be related to a characteristic “profile” of normative personality dimensions.Methods
Individuals (age ≥ 18 years) with MDD (n = 400) or BD (n = 317), as defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR), were enrolled in the IMDCP. Personality was evaluated with the Neuroticism–Extraversion–Openness Five-Factor Inventory (NEO-FFI), and functionality with the Sheehan Disability Scale and Endicott Work Productivity Scale. Path analysis using linear multiple regressions was performed to identify direct and indirect effects of personality on functional impairment.Results
Lower conscientiousness exerted a significant direct effect on global (p = 0.017) and family life dysfunction in individuals with MDD (p = 0.002), as well as lower work productivity in both MDD (p = 0.020) and BD (p = 0.018). Lower extraversion exerted a significant direct effect on social impairment in individuals with BD (p = 0.017). Higher neuroticism and agreeableness as well as lower extraversion exerted indirect effects on global and social dysfunction in individuals with MDD via their effects on depression severity. In BD, higher neuroticism and openness indirectly affected global dysfunction. Family dysfunction was indirectly affected by higher neuroticism and openness as well as lower extraversion in MDD and BD.Conclusion
The results suggest that discrete personality dimensions may exert direct and indirect effects on functional outcomes in individuals with mood disorders. Personalizing disease management approaches in mood disorders with emphasis on vocational rehabilitation may benefit from measurement and intervention targeting personality. 相似文献11.
Matilda E. Nowakowski Karen Rowa Martin M. Antony Randi McCabe 《Cognitive therapy and research》2016,40(4):468-478
The current study examined changes in anxiety sensitivity following cognitive behavior therapy as a predictor of treatment outcome in patients with social anxiety disorder (SAD) and patients with panic disorder (PD). One-hundred ninety-seven patients with a principal diagnosis of SAD (n = 108) or PD (n = 89) completed the Anxiety Sensitivity Index (ASI; Reiss et al in Behav Res Ther 24:1–8, 1986), Depression Anxiety Stress Scales (DASS-21; Lovibond and Lovibond in Behav Res Ther 33:335–343, 1995), Social Phobia Inventory (SPIN; Connor et al in Br J Psychiatry 176:379–386, 2000) and Panic Disorder Severity Scale-Self Report (PDSS-SR; Houck et al in Depress Anxiety 15:183–185, 2002; Shear et al in Am J Psychiatry 154:1571–1575, 1997) pre and post disorder specific treatment. For the SAD group, changes on ASI Physical and ASI Social subscales made significant contributions to the prediction of posttreatment social anxiety symptoms over and above pretreatment social anxiety symptoms and changes in depression scores. For the PD group, changes on the ASI Physical subscale made a significant contribution to the prediction of posttreatment panic symptoms over and above pretreatment panic symptoms and changes in depression scores. The present study provides further support that, while the global construct of anxiety sensitivity is a transdiagnostic factor across the anxiety disorders, the lower-order dimensions of anxiety sensitivity have specificity for particular anxiety disorders. 相似文献
12.
Background
Nurses often have difficulties with using interdisciplinary stroke guidelines for patients with stroke as they do not focus sufficiently on nursing. Therefore, the Stroke Nursing Guideline (SNG) was developed and implemented. The aim of this study was to determine the implementation and feasibility of the SNG in terms of changes in documentation and use of the guideline in the care of stroke patients on Neurological and Rehabilitation wards, barriers and facilitators, and nurses’ and auxiliary nurses’ view of the implementation.Methods
A sequential explorative mixed method design was used including pre-test post-test measures and post intervention focus groups interviews. For the quantitative part retrospective electronic record data of nursing care was collected from 78 patients and prospective measures with Barriers and Facilitators Assessment Instrument (BFAI) and Quality Indicator Tool (QIT) from 33 nursing staff including nurses and auxiliary nurses. In the qualitative part focus groups interviews were conducted with nursing staff on usefulness of the SNG and experiences with implementation.Results
Improved nursing documentation was found for 23 items (N?=?37), which was significant for nine items focusing mobility (p?=?0.002, p?=?0.024, p?=?0.012), pain (p?=?0.012), patient teaching (p?=?0.001, p?=?0.000) and discharge planning (p?=?0.000, p?=?0.002, p?=?0.004). Improved guideline use was found for 20 QIT-items (N?=?30), with significant improvement on six items focusing on mobility (p?=?0.023), depression (p?=?0.033, p?=?0.025, p?=?0.046, p?=?0.046), discharge planning (p?=?0.012). Facilitating characteristics for change were significantly less for two of four BFAI-subscales, namely Innovation (p?=?0.019) and Context (p?=?0.001), whereas no change was found for Professional and Patient subscales. The findings of the focus group interviews showed the SNG to be useful, improving and providing consistency in care. The implementation process was found to be successful as essential components of nursing rehabilitation were defined and integrated into daily care.Conclusion
Nursing staff found the SNG feasible and implementation successful. The SNG improved nursing care, with increased consistency and more rigorous functional exercises than before. The SNG provides nurses and auxiliary nurses with an important means for evidence based care for patients with stroke. Several challenges of implementing this complex nursing intervention surfaced which mandates ongoing attention.13.
Luis Montesinos Rossana Castaldo Leandro Pecchia 《Journal of neuroengineering and rehabilitation》2018,15(1):116
Background
Approximate entropy (ApEn) and sample entropy (SampEn) have been previously used to quantify the regularity in centre of pressure (COP) time-series in different experimental groups and/or conditions. ApEn and SampEn are very sensitive to their input parameters: m (subseries length), r (tolerance) and N (data length). Yet, the effects of changing those parameters have been scarcely investigated in the analysis of COP time-series. This study aimed to investigate the effects of changing parameters m, r and N on ApEn and SampEn values in COP time-series, as well as the ability of these entropy measures to discriminate between groups.Methods
A public dataset of COP time-series was used. ApEn and SampEn were calculated for m?=?{2, 3, 4, 5}, r?=?{0.1, 0.15, 0.2, 0.25, 0.3, 0.35, 0.4, 0.45, 0.5} and N?=?{600, 1200} (30 and 60?s, respectively). Subjects were stratified in young adults (age?<?60, n?=?85), and older adults (age?≥?60) with (n?=?18) and without (n?=?56) falls in the last year. The effects of changing parameters m, r and N on ApEn and SampEn were investigated with a three-way ANOVA. The ability of ApEn and SampEn to discriminate between groups was investigated with a mixed ANOVA (within-subject factors: m, r and N; between-subject factor: group). Specific combinations of m, r and N producing significant differences between groups were identified using the Tukey’s honest significant difference procedure.Results
A significant three-way interaction between m, r and N confirmed the sensitivity of ApEn and SampEn to the input parameters. SampEn showed a higher consistency and ability to discriminate between groups than ApEn. Significant differences between groups were mostly observed in longer (N?=?1200) COP time-series in the anterior-posterior direction. Those differences were observed for specific combinations of m and r, highlighting the importance of an adequate selection of input parameters.Conclusions
Future studies should favour SampEn over ApEn and longer time-series (≥ 60?s) over shorter ones (e.g. 30?s). The use of parameter combinations such as SampEn (m?=?{4, 5}, r?=?{0.25, 0.3, 0.35}) is recommended.14.
Eva Naumann Brunna Tuschen-Caffier Ulrich Voderholzer Jennifer Svaldi 《Cognitive therapy and research》2016,40(3):304-313
The aim of the current study was to examine the usage of spontaneous emotion regulation in eating disorders (ED). After watching a sad film clip, women with anorexia nervosa (n = 42), bulimia nervosa (n = 40), and a non-ED control group (n = 41) indicated on visual analogue scales to what extent they had used emotional acceptance, reappraisal, rumination and suppression to cope with their emotions during the film clip. Results revealed no differences between the groups with regard to levels of reappraisal. However, both ED groups used rumination and suppression to a greater extent, and acceptance to a lesser extent, than the non-ED control group. ED severity was predicted by spontaneous rumination and suppression. Results suggest that—when not instructed—individuals with anorexia and bulimia nervosa have a greater tendency to engage in maladaptive emotion regulation. In particular, spontaneous rumination and suppression seem to be closely related to ED pathology. 相似文献
15.
Yidan Li Yidan Wang Xiangli Meng Weiwei Zhu Xiuzhang Lu 《The international journal of cardiovascular imaging》2017,33(11):1737-1748
The right ventricular longitudinal strain (RVLS) of pulmonary hypertension (PH) patients and its relationship with RV function parameters measured by echocardiography and hemodynamic parameters measured by right heart catheterization was investigated. According to the WHO functional class (FC), 66 PH patients were divided into FC I/II (group 1) and III/IV (group 2). RV function parameters were measured by echocardiographic examinations. Hemodynamic parameters were obtained by right heart catheterization. Patients in group 2 had higher systolic pulmonary artery pressure (sPAP; P?<?0.05) than patients in group (1) significant between-group differences were observed in global RVLS (RVLSglobal), free wall RVLS (RVLSFW; P?<?0.01), and RV conventional function parameters (all P?<?0.05). Moreover, mPAP and PVR increased remarkably and CI decreased significantly in group (2) RVLSglobal had a positive correlation with 6-min walking distance (6MWD; r?=?0.492, P?<?0.001) and N-terminal pro-brain natriuretic peptide (NT-proBNP; r?=?0.632, P?<?0.001), while RVLSFW had a positive correlation with 6MWD (r?=?0.483, P?<?0.001) and NT-proBNP (r?=?0.627, P?<?0.001). Hemodynamics analysis revealed that RVLSglobal had a positive correlation with mPAP (r?=?0.594, P?<?0.001), PVR (r?=?0.573, P?<?0.001) and CI (r?=?0.366, P?=?0.003), while RVLSFW had a positive correlation with mPAP (r?=?0.597, P?<?0.001), PVR (r?=?0.577, P?<?0.001) and CI (r?=?0.369, P?=?0.002). According to receiver operating characteristic curves, the optimal cut-off values of RVLSglobal (–15.0%) and RVLSFW (–15.3%) for prognosis detection with good sensitivity and specificity. Evidence has shown that RVLS measurement can provide the much-needed and reliable information on RV function and hemodynamics. Therefore, this qualifies as a patient-friendly approach for the clinical management of PH patients. 相似文献
16.
U. Nowak S. Eisenacher H. Braun F. Rausch S. Muszinski J. Thiem A. Becker S. Englisch P. Kirsch A. Meyer-Lindenberg M. Zink 《Cognitive therapy and research》2018,42(5):699-710
Several attributional biases have been discussed as putative causal factors in psychosis formation and maintenance. The monocausality bias in particular describes the excessive tendency to disregard multifactorial explanations and to instead attribute events to a single cause. To elucidate the role of monocausality in psychosis development, this study compared patients with an at-risk mental state of psychosis (ARMS, n?=?49), first-episode patients (FEP, n?=?35), chronic schizophrenia patients (SZ, n?=?32) and healthy controls (HC, n?=?39) on the Internal Personal and Situational Attributions Questionnaire—Revised. FEP patients made significantly more monocausal attributions than HC to the external-personal locus for positive events. Moreover, monocausality was linked with psychotic as well as depressive symptoms and tentatively also with a hasty data gathering style. Future studies should explore associations with other metacognitive deficits and the potential to prevent or correct the monocausality bias through psychological interventions. 相似文献
17.
Gerald J. Haeffel Rachel Hershenberg Jason T. Goodson Sascha Hein Amanda Square Elena L. Grigorenko John Chapman 《Cognitive therapy and research》2017,41(4):543-555
To date, “basic” research has dominated the empirical literature on hopelessness theory. The next logical step in this area of research is to determine if the theory can be used to help people. We conducted three studies to determine if the cognitive vulnerability factor featured in hopelessness theory could be reliably measured in diverse samples in a treatment context and if it could predict depressive therapeutic outcomes. Study 1 used a sample of male juvenile detainees (n?=?296; 70% from underrepresented groups) and found that cognitive vulnerability moderated the effectiveness of a social problem solving training intervention. Study 2 used a clinical sample of U.S. Veterans (n?=?16; 56% from underrepresented groups) enrolled in a cognitive behavioral therapy group for depression and found that cognitive vulnerability predicted post-therapy depressive outcomes. In both Study 1 and Study 2, higher levels of cognitive vulnerability resulted in poorer treatment outcomes (i.e., greater post-treatment levels of depressive symptoms). Study 3 used a clinical sample of U.S. Veterans (n?=?76; 67% from underrepresented groups) enrolled in a behavior activation group and found no effect of cognitive vulnerability on post-therapy depressive outcomes. The results of the three studies indicate that hopelessness theory’s cognitive vulnerability construct can be reliably measured in diverse samples in real world clinical contexts and that it has the potential to be a useful predictor of clinical outcomes in the context of cognitively focused treatments. 相似文献
18.
Rainbow T. H. Ho Ted C. T. Fong Phyllis H. Y. Lo Samuel M. Y. Ho Peter W. H. Lee Pamela P. Y. Leung David Spiegel Cecilia L. W. Chan 《Supportive care in cancer》2016,24(12):4929-4937
Purpose
This study aimed to evaluate the efficacy of supportive-expressive group (SEG) therapy and body-mind-spirit (BMS) intervention on emotional suppression and psychological distress in Chinese breast cancer patients.Methods
This three-arm randomized controlled trial assigned 157 non-metastatic breast cancer patients to BMS, SEG, or social support control group. SEG focused on emotional expression and group support, whereas BMS emphasized relaxation and self-care. All groups received 2-h weekly sessions for 8 weeks. The participants completed measurements on emotional suppression, perceived stress, anxiety, and depression at baseline and three follow-up assessments in 1 year.Results
Using latent growth modeling, overall group difference was found for emotional suppression (χ 2(2)?=?8.88, p?=?0.012), marginally for perceived stress (χ 2(2)?=?5.70, p?=?0.058), but not for anxiety and depression (χ 2(2)?=?0.19–0.94, p?>?0.05). Post-hoc analyses revealed a significant and moderate reduction (Cohen d?=?0.55, p?=?0.007) in emotional suppression in SEG compared to control group, whereas BMS resulted in a marginally significant and moderate fall (d?=?0.46, p?=?0.024) in perceived stress. Neither SEG nor BMS significantly improved anxiety and depression (d?<?0.20, p?>?0.05).Conclusions
The present results did not demonstrate overall effectiveness for either BMS or SEG therapy in the present sample of Chinese non-metastatic breast cancer patients. The participants appear to derive only modest benefits in terms of their psychological well-being from either intervention.19.
Natalie Bennett Lokho John Nishkarsh Likhar Rumjhum Agrawal Winfried M. Amoaku 《Advances in therapy》2018,35(5):591-603
Introduction
The aim of this systematic literature review was to evaluate the efficacy and safety of interventions for the treatment of choroidal neovascularization (CNV) secondary to etiologies other than age-related macular degeneration and pathologic myopia.Methods
Relevant randomized controlled trials (RCTs) and prospective observational studies were identified by searching MEDLINE, MEDLINE In-Process, EMBASE, and CENTRAL.Results
The search identified 5 RCTs; no relevant observational studies were identified. The studies differed in terms of underlying cause of CNV, patient numbers (n?=?9–178), follow-up time (2–36 months) and quality assessment. In the largest RCT (n?=?178 across a range of rare CNV etiologies), intravitreal ranibizumab showed superior efficacy versus sham from baseline to month 2 [mean best-corrected visual acuity (BCVA): +?9.5 vs. ??0.4 letters; p?<?0.001]; the gain was maintained up to month 12. In the treatment of CNV secondary to presumed ocular histoplasmosis syndrome (POHS), both intravitreal ranibizumab and photodynamic therapy (PDT) showed significant improvement from baseline BCVA over the 12-month period (n?=?9); however, all patients in the PDT group required rescue ranibizumab therapy. Unlicensed intravitreal bevacizumab was associated with a statistically significant improvement in BCVA compared to PDT at 12 months (p?<?0.001) in patients with CNV secondary to multifocal choroiditis (n?=?27). The use of steroids before PDT showed better BCVA outcomes than PDT alone (p?<?0.05) in patients with idiopathic CNV (n?=?20). Argon green laser therapy showed limited efficacy in patients with CNV secondary to OHS (n?=?134).Conclusion
There is evidence from a relatively large, good-quality study to support the use of intravitreal ranibizumab for the treatment of CNV secondary to rare diseases. However, the limited number of RCTs for this indication and differences in study characteristics between RCTs mean that there is uncertainty regarding comparative clinical effectiveness of interventions. RCTs with an active comparator are required to fully establish the comparative effectiveness of treatments for CNV secondary to rare diseases.Funding
Novartis Pharmaceuticals UK Ltd, Surrey, UK.20.
Alfonso Gil-Martínez Mónica Grande-Alonso Ibai López-de-Uralde-Villanueva Almudena López-López Josué Fernández-Carnero 《The journal of headache and pain》2015,17(1):103