‘It will get even better’: preliminary findings from a trauma-focused psychotherapy effectiveness study reveal false positive patients’ long-term outcome expectations after the treatment

Background: There is considerable evidence that outcome expectations may predict psychotherapy outcomes. However, little is known about the long-term outcome expectations following the end of the treatment.

Aims: The aim of this study was to evaluate patients’ long-term outcome expectations after trauma-focused post-traumatic stress disorder (PTSD) psychotherapy in a single group effectiveness study.

Methods: Twenty participants with various traumatic experiences who completed the Brief Eclectic Psychotherapy for Post-Traumatic Stress Disorder (BEPP) and all the assessments were included into the study. Self-report measures were used to evaluate the therapeutic outcomes: Impact of Event Scale–Revised (IES-R), Clinical Outcomes in Routine Evaluation–Outcome Measure (CORE-OM) at pre-treatment, post-treatment, and 6-month follow-up. Subjective Units of Distress Scale was used to measure long-term outcome expectations at post-treatment, asking participants to measure the expected distress in 6 months following the treatment. Assessments at 6-month follow-up were used to estimate the accuracy of patients’ expectations of their distress at previous post-treatment assessment.

Results: Significant decline of PTSD symptoms at post-treatment with large effect sizes was observed. At post-treatment assessment participants expected significant improvement of their condition in 6 months after the treatment. However, therapeutic effects remained stable at the 6-month follow-up.

Conclusion: It is concluded that the PTSD patients, even after successful trauma-focused treatment, tend to expect further significant positive changes. However, therapeutic effects were stable half a year after the psychotherapy, and patients tend to have false expectations about further improvement of their condition.     

Treatment of hemorrhagic radiation-induced proctopathy with a 4% formalin application under perianal anesthetic infiltration

AIM:To evaluate the results of hemorrhagic radiation proctopathy treatment with a 4% formalin application.METHODS:A prospective study was performed.Over a three-year period,38 patients underwent 4% formalin application under perianal anesthetic infiltration for hemorrhagic radiation proctopathy.All patients included in the study were irradiated for prostate cancer.The patients ranged in age from 56-77 years(average 70 ± 5 years).All of the patients were referred for formalin therapy after noninvasive management had failed.Twenty-four(63.2%)patients underwent a single application,10(26.3%)patients underwent 2 applications,and 4(10.5%)patients underwent 3 applications.RESULTS:Two to 36 mo(average 12 ± 3 mo)following treatment,34 patients were interviewed(four were lost to follow-up).Twenty(58.8%)subjects reported complete cure,8(23.5%)subjects reported significant improvement,and 6(17.7%)subjects reported no change.One patient(who underwent a colostomy at a regional hospital with no specialized services available for previous bleeding episodes from radiation proctopathy)was cured,and the colostomy was closed.One patient(2.6%)developed rectal mucosal damage after the second application.CONCLUSION:A 4-min application of 4% formalin for hemorrhagic radiation-induced proctopathy under perianal anesthetic infiltration in patients who have received external radial radiation therapy for prostate cancer is simple,reasonably safe,inexpensive,generally well tolerated,and effective.     

Injection of methylene blue solution into the inferior mesenteric artery of resected rectal specimens for rectal cancer as a method for increasing the lymph node harvest

Background

The aim of the present study was to determine whether the injection of methylene blue solution into the inferior mesenteric artery could improve the lymph node harvest in rectal specimens of rectal cancer patients treated with rectal resection with total mesorectal excision.

Methods

The study group consisted of 20 randomly selected fresh rectal specimens from patients with stages I-III rectal cancer treated at the Surgery Clinic at the Institute of Oncology of Vilnius University during the period from February 2008 to December 2010, and 20 specimens were selected under the same conditions to serve as the control group. The patients underwent conventional rectal resection with total mesorectal excision and coloanal anastomosis for low rectal cancer performed by the same surgeon, did not receive preoperative radiotherapy and had no distant metastases. After the removal of the specimen, 30?ml of 0.5% methylene blue solution was injected into the inferior mesenteric artery of the specimens in the study group (methylene blue group). The specimens from both the methylene blue and control groups were examined using the standards established by the Lithuanian National Centre of Pathology. The pathologist was not required to make any special macroscopic preparations. A retrospective analysis of clinical and histopathological records was performed.

Results

Comparison of the mean lymph node harvest showed a significant difference between methylene blue and control groups with average lymph node numbers per specimen of 18?±?5 and 14?±?6, respectively (p?=?0.025). The specimens from 12 of the 20 patients in the methylene blue group and the specimens from 7 of the 20 patients from the control group had positive nodes.

Conclusions

Injecting methylene blue solution into the inferior mesenteric artery is an efficient and simple method for improving the lymph node harvest in the histopathological examination of rectal specimens of rectal cancer patients treated with rectal resection with total mesorectal excision.     

Fifteen years of treatment with intravenous immunoglobulin in central nervous system Langerhans cell histiocytosis

Aim: There is currently no well‐accepted therapy for central nervous system Langerhans cell histiocytosis (CNS‐LCH), a neuroinflammatory disease clinically characterized by often progressive, neurological symptoms including ataxia, dysarthria, dysphagia, hypertonicity, intellectual impairment and behavioural abnormalities. We applied immunomodulative/anti‐inflammatory treatment on a patient with progressive CNS‐LCH disease. Method: Intravenous immunoglobulin (IVIG) was administered monthly for 15 years to a patient with severe, image‐verified neurodegenerative CNS‐LCH. Results: During the IVIG treatment, the neurological deterioration initially appeared to be haltered, but over time there was still some deterioration. Conclusions: IVIG may be beneficial in partly haltering CNS‐LCH neurodegeneration, but further studies are needed.     

Association Between Resting-State Microstates and Ratings on the Amsterdam Resting-State Questionnaire

There is a gap in understanding on how physiologically observed activity is related to the subjective, internally oriented experience during resting state. Microstate analysis is a frequent approach to evaluate resting-state EEG. But the relationship of commonly observed resting-state microstates to psychological domains of resting is not clear. The Amsterdam Resting-State Questionnaire (ARSQ) was recently introduced, offering an effective way to quantify subjective states after a period of resting and associate these quantifiers to psychological and physiological variables. In a sample of 94 healthy volunteers who participated in closed-eyes 5 min resting session with concurrent EEG recording and subsequent filling of the ARSQ we evaluated parameters of microstate Classes A, B, C, D. We showed a moderate negative association between contribution (r = ?0.40) of Class C and experienced somatic awareness (SA). The negative correlation between Class C and SA seems reasonable as Class C becomes more dominant when connections to contextual information (and bodily sensations as assessed with SA) are loosened (in reduced attention states, during sleep, hypnosis, or psychosis). We suggest that the use of questionnaires such as the ARSQ is helpful in exploring the variation of resting-state EEG parameters and its relationship to variation in sensory and non-sensory experiences.