THE MORE IT IS NEEDED,THE LESS IT IS WANTED: ATTITUDES TOWARD FACE‐TO‐FACE INTERVENTION AMONG DEPRESSED PATIENTS UNDERGOING ONLINE TREATMENT

Many individuals suffering from depression do not actively seek treatment. Self‐help strategies represent low‐threshold treatment options that are particularly relevant for milder cases. The present study addressed two important issues: (1) we examined depressed individuals’ motives and attitudes that may represent barriers to face‐to‐face treatment; (2) we examined if the participation in an online treatment program facilitates or compromises their willingness to undergo face‐to‐face treatment. We recruited 210 participants with depression for a trial on the efficacy of an online treatment program for depression. Participants were randomly allocated either to a self‐help treatment (Deprexis) or to a wait‐list control group. All participants filled out a newly developed 42‐item questionnaire called Psychotherapy Expectations, Concerns, and Hopes Inventory (PECHI). The scale measures attitudes toward face‐to‐face treatment and was administered at baseline and 8 weeks later. Principal component analysis of the PECHI revealed five dimensions: hope for symptomatic improvement, fear of poor alliance with the therapist, skill acquisition, skepticism and resentment of psychotherapy, and self‐stigma. Attitudes toward treatment were stable over time and neither modulated by group status nor by self‐reported or objective symptom decline. Correlation analyses revealed that current levels of depression and well‐being were potent predictors of attitudes toward treatment, suggesting that when the patient feels more depressed, doubts about the effectiveness of therapy emerge more strongly. To conclude, results suggest that Deprexis neither promotes nor reduces negative attitudes toward psychotherapy, nor does it increase barriers to enter face‐to‐face treatments. An alarming paradox emerged: when a depressed person is in greatest need of help, motivation to seek face‐to‐face treatment is lowest. Depression and Anxiety 00:1‐11, 2012. © 2012 Wiley Periodicals, Inc.     

WT1 and interferon‐β–vitamin D association in MS: a longitudinal study

The above article from Acta Neurologica Scandinavica, published online on 7 April 2005 in Wiley Online Library (wileyonlinelibrary.com) and in Volume 111, pp. 329‐332, has been retracted by agreement between the journal Editor in Chief, Professor Elinor Ben‐Menachem, and John Wiley & Sons Ltd. The article has been retracted because a similar article had previously been published in the Jugoslovenska medicinska biohemija in 2003. The authors presumed that since the journal was no longer existing, they felt the need to re‐publish their work in Acta Neuorologica Scandinavica. However, in the consideration of the Journal, this constitutes dual publication. References Selakovi?VM, Jovanovi?MD, Mihajlovi?R, Radenovi?LLJ. Cytochrome c oxidase in patients with acute ischaemic brain disease. Jugoslovenska medicinska biohemija. 2003;22:329–334. Selakovi?VM, Jovanovi?MD, Mihajlovi?RR, Radenovi?LLJ. Dynamics of cytochrome c oxidase activity in acute ischemic stroke. Acta Neurol Scand. 2005;111:329–332.     

Hospital and outpatient care for psychotic patients during the last three decades SUBSEQUENT HOSPITAL AND OUTPATIENT TREATMENT OF PSYCHOTIC PATIENTS HOSPITALIZED FOR THE FIRST TIME IN 1949–50, 1959–60 OR 1969–70

The study deals with the development in the extent of hospital treatment and trends concerning outpatient visits for psychotics in Turku hospitalized for the first time in 1949-50 (period of shock therapy), 1959–60 (period of neuroleptics) or 1969–70 (period of intensified outpatient treatment). The bed capacity for psychiatric patients increased in Turku in the 1950's, but has declined slowly since then. The number of hospitalized cases nevertheless continued to rise up to the 1970's. The number of caretaking personnel in the outpatient sector has increased five-fold and the extent of outpatient visits 20-fold over the 25 years covered by the study. After the introduction of neuroleptics, first hospitalizations became shorter, as fewer and fewer patients remained in long-term hospital treatment. At the same time the annual extent of hospital treatment declined, whereas rehospitalizations became more frequent. Along with intensified outpatient treatment first hospitalizations became still shorter, but the total need for hospital treatment was not reduced. During intensified outpatient treatment, rehospitalization was rapid and, at first, frequent; subsequently rehospitalizations became less frequent compared to the period of neuroleptics. In the 1970's, intensive outpatient treatment provided immediately after the first hospital stay appears to be most clearly associated with a reduction in the number of hospital treatment days of schizophrenics. In the case of psychoses of old age an increased extent of outpatient treatment did not lead to a decline in the need for hospital treatment.     

Polymyositis – treatment and prognosis

One hundred and seven patients with polymyositis or dermatomyositis were followed for an average of 5 years. In 100 patients it was possible to evaluate the effect of treatment with steroids or a combination of steroids and immunosuppressive drugs. Fifty patients improved, 50 did not. Compared with the treatment-resistant group the treatment-responsive patients were of younger age, did not have an associated malignancy or cardiac disease and began treatment within 24 months after the onset of muscular weakness. In the treatment-responsive group the degree of improvement was correlated to the mean dose of steroids given during the first 3 months of treatment. Eighty-seven per cent of surviving responsive patients had no or slight disability at the end of the investigation. The mortality rate was 23% and was highest in the treatment-resistant group. Comparison between different treatment programs was possible and based on the results, a treatment schedule could be recommended. The principles of this schedule are: During the first month high doses of prednisone or prednisolone should be given daily. From the second month, an alternate-day administration can be employed. Tapering to maintenance dose should be gradual and slow. The treatment period should be long. The mean duration in the present series was 27 months.     

Evidence from regression‐discontinuity analyses for beneficial effects of a criterion‐based increase in alcohol treatment

Brief interventions effectively reduce alcohol problems; however, it is controversial whether longer interventions result in greater improvement. This study aims to determine whether an increase in treatment for people with more severe problems resulted in better outcome. We employed regression‐discontinuity analyses to determine if drinking driver clients (n = 22,277) in Ontario benefited when they were assigned to a longer treatment program (8‐hour versus 16‐hour) based on assessed addiction severity criteria. Assignment to the longer16‐hour program was based on two addiction severity measures derived from the Research Institute on Addictions Self‐inventory (RIASI) (meeting criteria for assignment based on either the total RIASI score or the score on the recidivism subscale). The main outcome measure was self‐reported number of days of alcohol use during the 90 days preceding the six month follow‐up interview. We found significant reductions of one or two self‐reported drinking days at the point of assignment, depending on the severity criterion used. These data suggest that more intensive treatment for alcohol problems may improve results for individuals with more severe problems. Copyright © 2012 John Wiley & Sons, Ltd.     

Non‐adherence to interferon‐beta therapy in Swedish patients with multiple sclerosis

Cunningham A, Gottberg K, von Koch L, Hillert J. Non‐adherence to interferon‐beta therapy in Swedish patients with multiple sclerosis.
Acta Neurol Scand: 2010: 121: 154–160.
© 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard. Objectives – To explore the occurrence and reasons for stopping, switching or continuing first prescribed interferon‐beta therapy in patients with multiple sclerosis in Sweden, with respect to demographic, clinical and/or therapy‐related factors. Materials and methods – A retrospective study reviewing the medical charts of 259 patients with multiple sclerosis, comparing patients continuing therapy for at least 3 years with those switching or stopping therapy. Results – Sixty 9% stopped (15%), or switched (54%), interferon‐beta therapy within 3 years. Stoppers had longer disease duration before starting therapy (P = 0.002), less frequently relapsing‐remitting multiple sclerosis (P = 0.046), and more often Expanded Disability Status Scale scores 6–9.5 (P = 0.045) compared to Switchers. The most common reasons for switching/stopping therapy were perceived lack of effect and side‐effects. Conclusions – Adherence to initial immune‐modulating therapy is low; identification of patients at higher risk of stopping therapy and provision of adequate support are essential.     

Obstructive sleep apnea – management update

Obstructive sleep apnea (OSA) is a highly significant condition based both on the high prevalence in community and significant consequences. Obstructive sleep apnea syndrome (OSAS), OSA together with hypersomnolence, is seen in 4% of middle-aged men and 2% of middle-aged women. OSA is associated with impaired quality of life and increased risks of motor vehicle accidents, cardiovascular disease (including hypertension and coronary artery disease), and metabolic syndrome. There is some evidence for the use of conservative interventions such as weight loss and position modification. CPAP remains the mainstay of treatment in this condition with high-level evidence supporting its efficacy. Continuous positive airway pressure (CPAP) is an intrusive therapy, with long-term adherence rates of less than 70%. Dental appliances have been shown to be effective therapy in some subjects but are limited by the inability to predict treatment responders. Alternative treatments are discussed but there is little role for upper airway surgery (except in a select few experienced institutions) or pharmacological treatment. The current levels of evidence for the different treatment regimens are reviewed.     

Health‐related quality‐of‐life and treatment targets in myasthenia gravis

Introduction: The aim of this study was to determine factors affecting health‐related quality of life (HRQOL) and to propose appropriate treatment targets for patients with myasthenia gravis (MG). Methods: We evaluated 640 consecutive patients with MG seen at 11 neurological centers. Two‐year follow‐up data were obtained for 282 patients. Correlations between detailed clinical factors and the Japanese version of the 15‐item MG‐specific QOL scale score were analyzed. Results: In a cross‐sectional analysis of 640 MG patients, multivariate regression revealed that disease severity, as evaluated by the MG Composite (P < 0.0001), total dose of oral prednisolone during the last year (P = 0.002), and Cushingoid appearance index (P = 0.0004), showed significant negative effects on HRQOL, but the quantitative MG score and current prednisolone dose did not. Conclusions: Achieving minimal manifestations (MM) status or better with prednisolone ≤5 mg/day was found to exert a major positive impact on HRQOL in both the cross‐sectional and 2‐year follow‐up patient samples and can be recommended as a treatment target. Muscle Nerve 50: 493–500, 2014     

Barriers to treatment and service utilization in an internet sample of individuals with obsessive–compulsive symptoms

Background: Despite the increasing dissemination of treatment for Obsessive–Compulsive Disorder (OCD) in the past decade, the majority of individuals with OCD are not receiving appropriate treatment. This study examined rates of treatment utilization and barriers to treatment in an internet sample of individuals with self‐reported OCD. Methods: One hundred and seventy‐five participants completed an online survey examining OCD symptoms, psychosocial measures, barriers to treatment, and treatment utilization. Results: Sixty percent of the sample reported receiving treatment for their OCD symptoms. The majority of participants who sought pharmacotherapy received SSRIs, whereas the majority who sought psychotherapeutic treatment received “talk therapy.” The cost of treatment, lack of insurance coverage, shame, and doubt that treatment would be effective were the most commonly endorsed barriers to treatment among the sample. Conclusions: Findings demonstrated relatively low treatment utilization rates among the sample, with many participants receiving treatments other than the gold‐standard medication and psychotherapy treatments (i.e. SSRIs and cognitive behavioral therapy, respectively). Furthermore, a large portion of the sample endorsed many barriers to treatment seeking, such as logistic and financial barriers; stigma, shame, and discrimination barriers; and treatment perception and satisfaction barriers. This study highlights the need for more effective treatment dissemination in OCD. Depression and Anxiety, 2010. © 2010 Wiley‐Liss, Inc.