强迫症团体认知行为治疗与药物治疗的随机对照研究

目的分析团体认知行为治疗(group cognitive-behavioral therapy,GCBT)对强迫症患者的疗效。方法本研究采用随机对照试验设计,与常规抗强迫药物治疗做对照。将符合入组标准的94例未用药强迫症患者,采用Excel软件中的RAND函数产生随机数字表形成随机分组序列的简单随机分组法,随机分为GCBT组(47例)和药物治疗组(47例)。经12周的结构化GCBT治疗和常规抗强迫药物治疗,采用t检验、卡方检验和方差分析比较2组间Y-BOCS、HAMA14和HAMD24平均减分率和减分值的差异。结果(1)2组基线Y-BOCS及HAMA14评分差异无统计学意义(t=0.281,P=0.779;t=0.795,P=0.429),但GCBT组HAMD24评分显著低于药物治疗组(t=2.316,P<0.05)。2组各有16例患者退出治疗,总脱落率为34%(32/94)。(2)12周治疗结束时,2组患者的Y-BOCS评分较基线显著降低,GCBT组和药物治疗组治疗前后Y-BOCS平均减分率[(37.0±27.4)%比(45.5±22.9)%]和平均减分值[(9.0±6.3)分比(11.0±5.8)分]比较差异无统计学意义[F(1,62)=0.069,P=0.794;F(1,62)=0.001,P=0.975]。GCBT组和药物治疗组的有效率和治愈率差异无统计学意义(χ^2=1.653,P=0.199;χ^2=0.088,P=0.767)。(3)GCBT组HAMA14减分率和减分值与药物治疗组治疗前后比较差异无统计学意义(t=-0.922,P=0.362;t=1.082,P=0.286)。(4)GCBT组HAMD24减分率与药物治疗组治疗前后比较差异无统计学意义,但药物治疗组HAMD24减分值显著高于GCBT组(t=2.239,P=0.029)。结论GCBT与常规抗强迫药物治疗强迫症患者的强迫和焦虑症状的疗效相当,常规药物治疗对抑郁症状的疗效优于GCBT。     

轻症抑郁患者在团体认知行为治疗后特质应对方式的变化

目的 探讨轻症抑郁患者在团体认知行为治疗后特质应对方式的改善及特质应对方式对团体认知行为治疗的影响.方法 采用前瞻性自身对照设计,对轻症抑郁患者在治疗前后,以及随访期的抑郁症状、焦虑症状和特质应对方式进行比较.结果 共纳入102例患者.与基线时比较,患者的抑郁症状、焦虑症状和特质应对方式在团体认知行为治疗结束后及随访的各个时期均有显著改善(P<0.05).Logistic回归分析显示,基线焦虑症状、消极应对方式及出勤率进入回归方程.结论 团体认知行为治疗能够改善轻症抑郁患者的抑郁焦虑症状及特质应对方式,且能够维持相对较长的时间.基线焦虑症状、消极应对方式及出勤率对团体认知行为治疗有显著影响.     

Death and suicide among former child and adolescent psychiatric patients

Background

Postnatal depression has received considerable research and clinical attention, however anxiety and stress in the postpartum has been relatively ignored. Along with the widespread use of the Edinburgh Postnatal Depression Scale (EPDS), depression has become the marker for postnatal maladjustment. Symptoms of anxiety tend to be subsumed within diagnoses of depression, which can result in anxiety being minimized or overlooked in the absence of depression. Some researchers have identified the need to distinguish between postnatal depression and anxiety, and to discern cases where depression and anxiety co-exist. The aim of this study was to assess the prevalence of postnatal distress using the EPDS and the Depression Anxiety Stress Scales (DASS-21).

Method

As part of a larger cross-sectional study, the EPDS and DASS-21 were administered to a convenience sample of 325 primiparous mothers, who ranged in age from 18 to 44 years (M = 32 years). Recruited through mother's groups and health centres in Melbourne Australia, inclusion was limited to mothers whose babies were aged between 6 weeks and 6 months. Analyses included comparisons between the classifications of women according to the EPDS and the DASS-21, and an exploration of the extent to which the EPDS identified anxious-depressed women.

Results

The EPDS identified 80 women (25%) as possibly depressed (using a cut-off of over 9), of which the DASS-21 corroborated 58%. In the total sample, 61 women (19%) were classified by the DASS-21 to be depressed. Using broader criteria for distress, it was revealed by the DASS-21 that a further 33 women (10%) showed symptoms of anxiety and stress without depression. A total of 41 women (13%) had symptoms of anxiety either in isolation or in combination with depression. The DASS-21 identified 7% of the sample as being both anxious and depressed. This at-risk sub-group had higher mean EPDS and DASS-depression scores than their depressed-only counterparts.

Conclusion

The prevalence of anxiety and stress in the present study points to the importance of assessing postnatal women for broader indicators of psychological morbidity than that of depression alone. The DASS-21 appears to be a useful instrument for this purpose.     

Worried no more: The effects of medication status on treatment response to a CBT group for children with anxiety in a community setting

The present study compared preexisting groups of medicated and non-medicated children aged 8-13 years, with a primary diagnosis of an anxiety disorder, participating in a 12-session, manualized cognitive-behavior therapy group (GCBT). Of the 42 children, 13 (31%) were concurrently treated with Selective Serotonin Reuptake Inhibitors (SSRIs) for anxiety while they attended group treatment. Treatment outcomes for these medicated children were compared to those of children who were not on any medications for anxiety. Results suggested that both groups showed a significant decrease in their anxiety symptoms from pre- to post-treatment and from pre-treatment to 4-month follow-up, based on both child- and parent-report. No significant differences in anxiety symptoms were found between the medicated and non-medicated groups at pre-, post-, or 4-month follow-up, suggesting that the two groups benefited similarly from GCBT.     

Treatment of childhood anxiety disorders: a preliminary comparison between cognitive-behavioral group therapy and a psychological placebo intervention

The present study examined the efficacy of group cognitive-behavioral therapy (CBT) in the treatment of childhood anxiety disorders. Thirty high-anxious children (aged 9-12 years) were assigned to either (a) group CBT (n = 10), (b) a psychological placebo intervention (i.e., emotional disclosure [ED]; n = 10), or (c) a no-treatment control condition (n = 10). Therapy outcome measures (i.e., children's self-report of anxiety disorders symptoms, depression, and trait anxiety) were obtained three months before treatment, at pretreatment, and at posttreatment. Results showed that levels of psychopathological symptoms remained relatively stable during the three months preceding treatment. Most importantly, pretreatment-posttreatment comparisons indicated that CBT was superior to ED and the no-treatment control condition. That is, only in the CBT condition significant reductions of anxiety disorders symptoms, trait anxiety, and depression were observed. These findings can be taken as further evidence for the efficacy of CBT in the treatment of childhood anxiety disorders.     

线上结构式团体认知行为治疗对轻症抑郁患者的有效性和可行性探索

目的探讨线上结构式团体认知行为治疗(internet-based structured group cognitive behavior therapy,I-GCBT)对轻症抑郁患者的有效性和可行性。方法使用SPSS20.0软件生成随机表,将96例轻症抑郁患者分配到线上视频团体干预组(线上组,n=64)与面对面干预组(线下组,n=32),使用HAMD17、HAMA、功能大体评定量表(Global Assessment of Functioning Scale,GAF)以及抑郁症状快速检查-自我报告评分16项(16 Items Quick Inventory of Depressive Symptomatology-Self Report,QIDS-SR16)分别在基线、4周末、8周末和12周末评估患者抑郁、焦虑及整体功能水平。采用重复测量方差分析比较两组治疗效果差异,采用卡方检验比较两组脱落率、治愈率、治疗接受度差异。结果(1)2组患者基线HAMA评分差异有统计学意义(t=-2.08,P=0.04),其他基线数据差异无统计学意义。(2)对患者在组别和时间的交互作用分析显示,HAMD17、HAMA和QIDS-SR16的时间与组别交互作用均不显著(F=0.69,P>0.05;F=0.95,P>0.05;F=0.64,P>0.05),GAF的时间与组别交互作用显著(F=4.09,P<0.01),2组患者在各量表上时间主效应均显著(HAMD17:F=32.81,P<0.01;HAMA:F=20.86,P<0.01;GAF:F=105.98;P<0.01;QIDS-SR16:F=25.27,P<0.01)。12周末临床治愈率达62%(43/69),线上组57%(25/44),线下组72%(18/25),差异无统计学意义(χ^2=1.57,P=0.21)。(3)治疗期间总体脱落率为26%(21/81),线上组29%(15/51),线下组20%(6/30),2组比较差异无统计学意义(χ^2=0.87,P=0.35),患者对方案的接受程度达97%(58/60),线上组97%(35/36),线下组96%(23/24),2组比较差异无统计学意义(χ^2=0.09,P=0.78)。结论线上结构式团体认知行为治疗对轻症抑郁患者的疗效与面对面干预组相当,患者依从性较好。     

The prevalence and socio-demographic correlations of depression,anxiety and stress among a group of university students

BACKGROUND: The mental health of university students is an area of increasing concern worldwide. The objective of this study is to examine the prevalence of depression, anxiety and stress among a group of Turkish university students. METHODS: Depression Anxiety and Stress Scale (DASS-42) completed anonymously in the students' respective classrooms by 1,617 students. RESULTS: Depression, anxiety and stress levels of moderate severity or above were found in 27.1, 47.1 and 27% of our respondents, respectively. Anxiety and stress scores were higher among female students. First- and second-year students had higher depression, anxiety and stress scores than the others. Students who were satisfied with their education had lower depression, anxiety and stress scores than those who were not satisfied. CONCLUSIONS: The high prevalence of depression, anxiety and stress symptoms among university students is alarming. This shows the need for primary and secondary prevention measures, with the development of adequate and appropriate support services for this group.     

Change in attachment anxiety is associated with improved depression among women with binge eating disorder

The study examined if the relationship between change in attachment insecurity and target symptom outcomes was moderated by treatment type. Women (N = 66) with binge eating disorder (BED) were randomly assigned to two treatment types: group cognitive-behavioral therapy (GCBT) or group psychodynamic-interpersonal psychotherapy (GPIP). Results indicated significant positive pre- to posttreatment changes in all attachment insecurity scales, but no difference between GCBT and GPIP on these changes. Change in attachment anxiety was related to improved depression for women completing GPIP, but not for women completing GCBT. This indicated a moderating effect of treatment type in explaining the relationship between change in attachment anxiety and improved depression. Changes in attachment anxiety may be important for symptom outcomes related to psychodynamic-interpersonal therapies. (PsycINFO Database Record (c) 2010 APA, all rights reserved).     

Structured group therapy for posttraumatic stress disorder in incarcerated male juveniles

This is the first study to evaluate the efficacy of a structured group therapy for posttraumatic stress disorder (PTSD) in incarcerated male juveniles. Ten groups of juveniles (n = 45) completed a 12-session intervention with pre- and postassessments composed of the Post Traumatic Stress Disorder Reaction Index (C. Frederick, 1985) and supplementary measures of anxiety, anger, and depression. Overall, group participants experienced significant reductions in self-reported PTSD symptoms. Supplemental analyses suggest that this treatment was most beneficial for youth with trauma related to gang and community violence.     

The Italian version of the Depression Anxiety Stress Scales-21: Factor structure and psychometric properties on community and clinical samples

ObjectiveThe Depression Anxiety Stress Scales-21 (DASS-21) is the short version of a self-report measure that was originally developed to provide maximum differentiation between depressive and anxious symptoms. Despite encouraging evidence, the factor structure and other features of the DASS-21 are yet to be firmly established.MethodA community sample of 417 participants and two clinical groups (32 depressive patients and 25 anxious patients) completed the Italian version of the DASS-21 along with several measures of psychopathology.ResultsConfirmatory factor analyses suggested that the DASS-21 is a measure of general distress plus three additional orthogonal dimensions (anxiety, depression, and stress). The internal consistency and temporal stability of the measure were good; each DASS-21 scale correlated more strongly with a measure of a similar construct, demonstrating good convergent and divergent validity. Lastly, the DASS-21 demonstrated good criterion-oriented validity.ConclusionThe validity of the Italian DASS-21 and its utility, both for community and clinical individuals, are supported.     

早年情感创伤对轻症抑郁患者团体认知行为治疗效果的影响

目的 探讨早年情感创伤经历在轻症抑郁患者接受团体认知行为治疗时对疗效的影响.方法 纳入102例轻症抑郁患者,在常规治疗基础上,按照统一的结构式团体认知行为治疗手册进行治疗,使用早年创伤问卷简表评估早年创伤情况,用汉密尔顿抑郁量表(HAMD-17)得分作为主要疗效指标,分别在基线,治疗4周、8周、12周,随访24周、36周、48周进行评估.根据情感创伤中位数将情感创伤分为高情感创伤组和低情感创伤组,对两组患者的治疗效果进行比较.结果 12周治疗结束时,高情感创伤组和低情感创伤组的轻症抑郁患者抑郁症状均达到临床治愈标准,且治疗效果一直持续到随访48周末.早年情感创伤组间效应不显著(F=1.36,P=0.247),交互效应显著(F=3.72,P<0.05).简单效应分析显示,两组患者接受团体认知行为治疗后,抑郁均改善明显(高情感创伤组:F=77.98,P<0.01;低情感创伤组:F=22.45,P<0.01).两组患者改善速度差异无统计学意义(t=1.19,P=0.237),但是4周末时,低情感创伤组患者抑郁得分下降更快,与高情感创伤组比较差异有统计学意义(t=-2.54,P=0.013).结论 无论情感创伤的程度如何,轻症抑郁患者接受团体认知行为治疗之后,抑郁症状显著改善且效果较持久.但在症状改善初期,高情感创伤组的改善速度较慢.     

Individual versus group family-focused cognitive-behaviour therapy for childhood anxiety: pilot randomized controlled trial

OBJECTIVE: The aim of the present study was to compare the relative effectiveness of group and individual formats of a family-focused cognitive-behavioural intervention, for the treatment of childhood anxiety disorders. METHOD: Twenty-nine clinically anxious children aged between 7 and 12 years were randomly allocated to either individual cognitive-behaviour therapy (ICBT) or group cognitive-behaviour therapy (GCBT). RESULTS: At post-treatment assessment 57% of children in the ICBT condition no longer met criteria for any anxiety disorder, compared to 47% of children in the GCBT condition. At 3 month follow up these improvements were retained with some weakening. By the 6 month follow up 50% of children in the ICBT compared to 53% of children in the GCBT condition were anxiety diagnosis free. In terms of questionnaire data, no significant differences were detected between the ICBT and GCBT conditions at any of the follow-up points. However, a significant treatment effect for time was found, with both self-reports and parent reports indicating a significant reduction over time in anxiety symptoms. CONCLUSION: Overall, results suggest that children with anxiety disorders appear to improve following a family-focused cognitive behavioural intervention, regardless of individual or group administration. The interpretation and potential clinical implications of these findings are discussed, together with the limitations of this study and suggestions for future research.     

A Quantitative Analysis of Mental Health Among Sexual and Gender Minority Groups in ASD

There is increased mental-health adversity among individuals with autism spectrum disorder. At the same time, sexual and gender minority groups experience poorer mental-health when compared to heteronormative populations. Recent research suggests that autistic individuals report increased non-heterosexuality and gender-dysphoric traits. The current study aimed to investigate whether as membership of minority grouping becomes increasingly narrowed, mental health worsened. The present study compared the rates of depression, anxiety, and stress using the DASS-21 and Personal Well-Being using the personal well-being index between 261 typically-developing individuals and 309 autistic individuals. As membership to a minority group became more restrictive, mental health symptoms worsened (p?<?.01), suggesting stressors added. Specialized care is recommended for this vulnerable cohort.     

Do psychiatric patients experience more psychiatric symptoms during COVID-19 pandemic and lockdown? A case-control study with service and research implications for immunopsychiatry

This study aimed to assess and compare the immediate stress and psychological impact experienced by people with and without psychiatric illnesses during the peak of 2019 coronavirus disease (COVID-19) epidemic with strict lockdown measures. Seventy-six psychiatric patients and 109 healthy control subjects were recruited from Chongqing, China and completed a survey on demographic data, physical symptoms during the past 14 days and a range of psychiatric symptoms using the Impact of Event Scale-Revised (IES-R), Depression, Anxiety and Stress Scale (DASS-21) and Insomnia Severity Index (ISI). IES-R measures PTSD symptoms in survivorship after an event. DASS-21 is based on tripartite model of psychopathology that comprise a general distress construct with distinct characteristics. The mean IES-R, DASS-21 anxiety, depression and stress subscale and ISI scores were higher in psychiatric patients than healthy controls (p < 0.001). Serious worries about their physical health, anger and impulsivity and intense suicidal ideation were significantly higher in psychiatric patients than healthy controls (p < 0.05). More than one-third of psychiatric patients might fulfil the diagnostic criteria post-traumatic stress disorder (PTSD). More than one-quarter of psychiatric patients suffered from moderately severe to severe insomnia. Respondents who reported no change, poor or worse physical health status and had a psychiatric illness were significantly more likely to have higher mean IES-R, DASS depression, anxiety and stress subscale scores and ISI scores (p < 0.05). This study confirms the severity of negative psychological impact on psychiatric patients during the COVID-19 epidemic with strict lockdown measures. Understanding the psychological impact on psychiatric patients during the COVID-19 pandemic has the potential to provide insight into how to develop a new immunopsychiatry service. Further research is required to compare pro-inflammatory cytokines between psychiatric patients and healthy controls during the pandemic.     

Body Dysmorphic Disorder and Other Clinically Significant Body Image Concerns in Adolescent Psychiatric Inpatients: Prevalence and Clinical Characteristics

Background  This study assessed prevalence and clinical correlates of body dysmorphic disorder (BDD), eating disorders (ED), and other clinically significant body image concerns in 208 consecutively admitted adolescent inpatients. It was hypothesized that adolescents with BDD would have higher levels of depression, anxiety, and suicidality. Adolescents with eating disorders were expected to have higher levels of depression, anxiety, and trauma-related symptoms. Trauma-related symptoms were also examined in relation to BDD, in the absence of specific hypotheses. Method  Participants completed the Body Dysmorphic Disorder Questionnaire (BDDQ) and reliable and valid self-report measures of suicidality, depression, anxiety, post-traumatic stress disorder (PTSD), dissociation, and sexual preoccupation/distress. Prevalence of BDD, eating disorders, and other clinically significant body image concerns was determined, and clinical correlates were examined. Results  6.7% (n=14) of participants met DSM-IV criteria for definite (n=10) or probable (n=4) DSM-IV BDD, 3.8% (n=8) met criteria for an eating disorder, and 22.1% (n=46) had clinically significant shape/weight concerns (SWC) that did not clearly meet criteria for BDD or an eating disorder. Both the BDD and SWC groups scored significantly higher than the group with no significant body image concerns (no BDD/ED/SWC group) on measures of anxiety and suicidality. The BDD, SWC, and ED groups all had significantly higher levels of depression than the no BDD/ED/SWC group. Only the SWC group scored significantly higher than the no BDD/ED/SWC group on measures of PTSD, dissociation, and sexual preoccupation/distress. Conclusions  A high proportion of participants had clinically significant body image concerns or a body image disorder. These concerns/disorders were associated with higher levels of depression, anxiety, and suicidality. In addition, the group concerned with body shape or weight had significantly greater symptoms of PTSD, dissociation, and sexual preoccupation/distress. These relatively common body image concerns and disorders deserve further study in adolescents.This research was supported by the Bradley Hospital Adolescent Unit and a Mid-Career Investigator Award in Patient-Oriented Research (1 K24 MH63975) from the National Institute of Mental Health to Dr. Phillips     

Verbal memory functions in unipolar major depression with and without co-morbid anxiety

The aim of this study was to examine both executive control of verbal working memory and verbal learning as well as long-term storage function in outpatients with major depressive disorder (n = 61) compared to healthy controls (n = 92). A total of 37 patients had no co-morbid anxiety disorder, whereas 24 had a co-morbid anxiety disorder. Both patient groups showed impaired working memory test performance compared to healthy controls. Patients with co-morbid depression and anxiety disorder performed significantly below the depression group. Only patients with depression and co-morbid anxiety displayed deficient long-term memory function compared to healthy controls. The present results show impairments in various memory functions in patients presenting depression and depression with co-morbid anxiety disorder.     

Group cognitive and behavioral treatment for compulsive hoarding: a preliminary trial

Background: Time‐limited group cognitive behavioral treatments (GCBT) for obsessive–compulsive disorder have demonstrated improvement in target symptoms. One small sample study of GCBT specifically for hoarding problems also showed benefit. This study examines the efficacy of a specialized GCBT for compulsive hoarding on a larger sample. Methods: Thirty‐two clients diagnosed with hoarding participated in five groups. Four groups met once weekly for 2 hour over 16 weeks (n=27) and one group met for 20 weeks (n=5). All participants had two individual 90‐min home sessions. Self‐report assessments were completed at baseline, mid‐treatment, and post‐treatment about hoarding behavior and related symptoms (e.g., depression). The sample was predominantly female, White, highly educated, unemployed, and not partnered/married; mean age was 53. A majority was diagnosed with major depressive disorder and obsessive–compulsive personality disorder. Results: Participants showed significant improvement from pre‐ to post‐treatment on the Saving Inventory Revised, Saving Cognitions Inventory, Clutter Image Rating, and Clinical Global Severity. The most recent group (n=8) that used a more formalized treatment and research protocol improved significantly more than did earlier members. Conclusion: This study demonstrates the feasibility and modest success of GCBT methods in improving hoarding symptoms. Group treatment may be especially valuable because of its cost‐effectiveness, greater client access to trained clinicians, and reduction in social isolation and stigma linked to this problem. Further research is needed to improve the efficacy of GCBT methods for hoarding and to examine durability of change, predictors of outcomes, and processes that influence change. Depression and Anxiety, 2009. © 2009 Wiley‐Liss, Inc.     

Immediate and sustained psychological impact of an emerging infectious disease outbreak on health care workers.

OBJECTIVE: To assess the immediate and sustained psychological health of health care workers who were at high risk of exposure during the severe acute respiratory syndrome (SARS) outbreak. METHODS: At the peak of the 2003 SARS outbreak, we assessed health care workers in 2 acute care Hong Kong general hospitals with the Perceived Stress Scale (PSS-10). One year later, we reassessed these health care workers with the PSS-10, the 21-Item Depression and Anxiety Scale (DASS-21), and the Impact of Events Scale-Revised (IES-R). We recruited high-risk health care workers who practised respiratory medicine and compared them with nonrespiratory medicine workers, who formed the low-risk health care worker control group. RESULTS: In 2003, high-risk health care workers had elevated stress levels (PSS-10 score = 17.0) that were not significantly different from levels in low-risk health care worker control subjects (PSS-10 score = 15.9). More high-risk health care workers reported fatigue, poor sleep, worry about health, and fear of social contact, despite their confidence in infection-control measures. By 2004, however, stress levels in the high-risk group were not only higher (PSS-10 score = 18.6) but also significantly higher than scores among low-risk health care worker control subjects (PSS-10 score = 14.8, P < 0.05). In 2004, the perceived stress levels in the high-risk group were associated with higher depression, anxiety, and posttraumatic stress scores (P < 0.001). Posttraumatic stress scores were a partial mediator of the relation between the high risk of exposure to SARS and higher perceived stress. CONCLUSIONS: Health care workers who were at high risk of contracting SARS appear not only to have chronic stress but also higher levels of depression and anxiety. Front-line staff could benefit from stress management as part of preparation for future outbreaks.     

Psychological health of men with partners who have post-partum depression

OBJECTIVE: To compare the psychological health of men with partners who have post-partum depression (PPD; index group) with that of men with partners without PPD (comparison group). METHOD: Using a cross-sectional survey, psychological symptoms and disturbances of index group men (n = 58) and comparison group men (n = 116) were compared. Validated self-report measures were used to assess five key areas of mental health: depression, anxiety, non-specific psychological impairment, aggression and alcohol use. RESULTS: Index group men had more symptoms of depression, aggression and non-specific psychological impairment, and had higher rates of depressive disorder, non-specific psychological problems and problem fatigue than comparison group men. Index group men were also more likely to have three or more comorbid psychological disturbances. There was no difference between the groups on measures of anxiety and alcohol use. CONCLUSIONS: Although many men in the postnatal period experience a variety of mental health problems, those who have a partner with PPD are themselves at increased risk for experiencing psychological symptoms and disturbances. Differentiation of psychological syndromes is important; higher rates of depressive disorder, non-specific psychological problems and problem fatigue were found, but rates of anxiety disorder and hazardous alcohol use did not differ between the groups. More attention from health professionals to men's mental health in the postnatal period may be beneficial to the entire family system.