Relationship between patients' in-process evaluations of therapy and psychotherapy outcome

Investigated relationship between patients' session-by-session evaluations of brief psychotherapy and outcome. Twenty-eight patients were seen by six therapists for a mean of 10 sessions in a university health service setting. In addition to the session evaluations, which were administered at the conclusion of the second session and each session thereafter, a variety of dependent measures were administered pre and post. Factor analysis of these dependent measures yielded three factors, which were correlated with session evaluation scores. Results indicated that patients' in-process evaluations were correlated significantly and positively with some positive treatment outcome measures, especially achievement of patients' specified treatment goals, but only during initial and final phases of therapy. Results were interpreted as supportive of Mann's model of brief psychotherapy.     

Sleep architecture based on sleep depth and propensity: patterns in different demographics and sleep disorders and association with health outcomes

Study ObjectivesConventional metrics of sleep quantity/depth have serious shortcomings. Odds-Ratio-Product (ORP) is a continuous metric of sleep depth ranging from 0 (very deep sleep) to 2.5 (full-wakefulness). We describe an ORP-based approach that provides information on sleep disorders not apparent from traditional metrics.MethodsWe analyzed records from the Sleep-Heart-Health-Study and a study of performance deficit following sleep deprivation. ORP of all 30-second epochs in each PSG and percent of epochs in each decile of ORPs range were calculated. Percentage of epochs in deep sleep (ORP < 0.50) and in full-wakefulness (ORP > 2.25) were each assigned a rank, 1–3, representing first and second digits, respectively, of nine distinct types (“1,1”, “1,2” … ”3,3”). Prevalence of each type in clinical groups and their associations with demographics, sleepiness (Epworth-Sleepiness-Scale, ESS) and quality of life (QOL; Short-Form-Health-Survey-36) were determined.ResultsThree types (“1,1”, “1,2”, “1,3”) were prevalent in OSA and were associated with reduced QOL. Two (“1,3” and “2,3”) were prevalent in insomnia with short-sleep-duration (insomnia-SSD), but only “1,3” was associated with poor sleep depth and reduced QOL, suggesting two phenotypes in insomnia-SSD. ESS was high in types “1,1” and “1,2”, and low in “1,3” and “2,3”. Prevalence of some types increased with age while in others it decreased. Other types were either rare (“1,1” and “3,3”) or high (“2,2”) at all ages.ConclusionsThe proposed ORP histogram offers specific and unique information on the underlying neurophysiological characteristics of sleep disorders not captured by routine metrics, with potential of advancing diagnosis and management of these disorders.     

Rheumatoid-like nodules presenting as “pump bumps” in a patient without rheumatoid arthritis

Bilateral “pump bumps” removed from the heels of a 23-year-old woman had the histologic appearance of rheumatoid nodules. The patient had no symptoms, physical signs or laboratory evidence of rheumatoid arthritis.     

Complex Partial Seizure Provocation by Vasovagal Syncope: Video-EEG and Intracranial Electrode Documentation

Summary: Vasovagal syncope precipitating an epileptic seizure has only rarely been described. A patient with known intractable complex partial seizures being evaluated for a left anterior temporal lobectomy experienced a typical seizure with mesial temporal onset precipitated by an observed vasovagal episode. This is the first report of a partial epileptic seizure precipitated by vasovagal syncope and the first example of an epileptic seizure induced by syncope in an adult. Video and intracranial depth electrode and subdural grid recordings documented the event.     

The effects of intrahypothalamic injections of norepinephrine upon affective defense behavior in the cat

The effects of norepinephrine microinjected into the anterior hypothalamus were examined in feline affective defense behavior elicited by electrical stimulation of the region of the ventromedial nucleus. Anterior hypothalamic sites from which affective defense behavior could also be elicited by electrical stimulation and which are known to receive inputs from both the ventromedial nucleus and brainstem noradrenergic neurons were selected for pharmacological analysis. Intracerebral injections of 250 ng (1 nM) and 500 ng (2 nM) quantities of norepinephrine placed into the anterior hypothalamus resulted in a significant lowering of the attack thresholds. These reductions in response thresholds which were reversed by either pre- or post-treatment with yohimbine, indicate that the noradrenergic system may play an important role in the regulation of affective defense behavior.     

Neural membrane glycoproteins associated with chicken Thy-1: an anti-idiotypic antibody study

In order to investigate the possible binding of Thy-1 to other neuronal cell surface proteins, anti-idiotypic antibodies were raised using a panel of anti-Thy-1 monoclonal antibodies. Anti-idiotypic antibodies were selected for their ability to bind to day-old chick brain membrane components in enzyme-linked immunosorbent assays (ELISA), and to bind to membrane glycoproteins as determined by Western transfer immunoblotting assays. The 5 monoclonal anti-idiotypic antibodies bind to a membrane glycoprotein component of 70 kDa, and one of the antibodies also binds to 3 higher molecular weight components of 160 kDa, 120 kDa and 90 kDa. These antibodies bind to areas of the chicken cerebellum known to be rich in Thy-1. It is postulated that these molecules are associated with Thy-1, and that the role of Thy-1 on the neuronal cell surface, may be to form complexes with, and/or to stabilise these higher molecular weight glycoproteins during synaptic development.     

Use of computed tomography in appendicitis: technique, findings, and pitfalls

Twelve patients with acute appendicitis were studied by computed tomography. Our technique of conducting the examination, the computed tomography signs, and the pitfalls encountered in studying these patients are presented. Use of computed tomography should be considered whenever the clinical presentation is atypical or confirmation of the clinical diagnosis is necessary.     

Nucleic Acid Preservation Card Surveillance Is Effective for Monitoring Arbovirus Transmission on Crocodile Farms and Provides a One Health Benefit to Northern Australia

The Kunjin strain of West Nile virus (WNV_KUN) is a mosquito-transmitted flavivirus that can infect farmed saltwater crocodiles in Australia and cause skin lesions that devalue the hides of harvested animals. We implemented a surveillance system using honey-baited nucleic acid preservation cards to monitor WNV_KUN and another endemic flavivirus pathogen, Murray Valley encephalitis virus (MVEV), on crocodile farms in northern Australia. The traps were set between February 2018 and July 2020 on three crocodile farms in Darwin (Northern Territory) and one in Cairns (North Queensland) at fortnightly intervals with reduced trapping during the winter months. WNV_KUN RNA was detected on all three crocodile farms near Darwin, predominantly between March and May of each year. Two of the NT crocodile farms also yielded the detection of MVE viral RNA sporadically spread between April and November in 2018 and 2020. In contrast, no viral RNA was detected on crocodile farms in Cairns during the entire trapping period. The detection of WNV_KUN and MVEV transmission by FTA^TM cards on farms in the Northern Territory generally correlated with the detection of their transmission to sentinel chicken flocks in nearby localities around Darwin as part of a separate public health surveillance program. While no isolates of WNV_KUN or MVEV were obtained from mosquitoes collected on Darwin crocodile farms immediately following the FTA^TM card detections, we did isolate another flavivirus, Kokobera virus (KOKV), from Culex annulirostris mosquitoes. Our studies support the use of the FTA^TM card system as a sensitive and accurate method to monitor the transmission of WNV_KUN and other arboviruses on crocodile farms to enable the timely implementation of mosquito control measures. Our detection of MVEV transmission and isolation of KOKV from mosquitoes also warrants further investigation of their potential role in causing diseases in crocodiles and highlights a “One Health” issue concerning arbovirus transmission to crocodile farm workers. In this context, the introduction of FTA^TM cards onto crocodile farms appears to provide an additional surveillance tool to detect arbovirus transmission in the Darwin region, allowing for a more timely intervention of vector control by relevant authorities.     

Sex Differences in Responses to Antidepressant Augmentations in Treatment-Resistant Depression

BackgroundWomen are nearly twice as likely as men to suffer from major depressive disorder. Yet, there is a dearth of studies comparing the clinical outcomes of women and men with treatment-resistant depression (TRD) treated with similar augmentation strategies. We aimed to evaluate the effects of the augmentation strategies in women and men at the McGill University Health Center.MethodsWe reviewed health records of 76 patients (42 women, 34 men) with TRD, treated with augmentation strategies including antidepressants (AD) with mood stabilizers (AD+MS), antipsychotics (AD+AP), or in combination (AD+AP+MS). Clinical outcomes were determined by comparing changes on the 17-item Hamilton Depression Rating Scale (HAMD-17), Montgomery-Åsberg Depression Rating Scale (MADRS), Quick Inventory of Depressive Symptomatology (QIDS-C16), and Clinical Global Impression rating scale (CGI-S) at the beginning and after 3 months of an unchanged treatment. Changes in individual items of the HAMD-17 were also compared between the groups.ResultsWomen and men improved from beginning to 3 months on all scales (P < .001, η _p² ≥ 0.68). There was also a significant sex × time interaction for all scales (P < .05, η _p² ≥ 0.06), reflecting a greater improvement in women compared with men. Specifically, women exhibited greater improvement in early (P = .03, η _p^2 =0.08) and middle-of-the-night insomnia (P = .01, η _p^2 =0.09) as well as psychomotor retardation (P < .001 η _p^2 =0.16) and psychic (P = .02, η _p^2 =0.07) and somatic anxiety (P = .01, η _p^2 =0.10).ConclusionsThe combination of AD+AP/MS generates a significantly greater clinical response in women compared with men with TRD, supporting the existence of distinct pharmacological profiles between sexes in our sample. Moreover, they emphasize the benefit of augmentation strategies in women, underscoring the benefit of addressing symptoms such as insomnia and anxiety with AP and MS.     

Adjuvant treatment of hepatocellular carcinoma after resection

Hepatocellular carcinoma (HCC) is the most frequent primary liver cancer, and surgical resection offers an opportunity for cure in patients fortunate enough to ...