Relapse Prevention: Overview of Research Findings in the Treatment of Problem Drinking,Smoking, Obesity and Depression

The aim of this paper is to provide an overview of developments in the area of relapse prevention for selected psychological disorders: problem drinking; smoking; obesity; and depression. Relapse prevention methods, including booster sessions, have been associated with mixed outcomes, although there are some encouraging findings, particularly in the treatment of obesity and alcohol problems. A number of recommendations are made for research and/or clinical practice. In the treatment of alcohol problems it is recommended that more attention be paid to reducing co-existent marital problems and mood disorders. In obesity, there is a need for evaluations of intensive, long-term therapist contact with the severely obese, particularly those with serious medical problems. Studies of the complete relapse prevention approach advocated by Marlatt and Gordon (1985) are needed in the evaluation of smoking cessation programmes. It is concluded that maintenance of gains in smoking, obesity and problem drinking comes at a considerable cost in time and therapist contact. To date, there has been little application of relapse prevention methods to depression, and further empirical work is needed to identify the determinants of relapse and the efficacy of specific maintenance-enhancement strategies. Consistent themes in the prediction of relapse are identified, including low social support, ongoing interpersonal difficulties, and low self-efficacy.     

An evaluation of the effects of susceptibility changes on the water chemical shift method of temperature measurement in human peripheral muscle

Divergencies between chemical shift measurements of temperature and directly measured values using optical sensors have been studied in vivo in human peripheral muscle with the assistance of a variety of experimental and theoretical techniques. These include the modeling of both thermal and susceptibility changes using two- and three-dimensional finite element methods, as well as the use of multi-wavelength near infrared observations. The conclusion of these studies is that a simple temperature calibration is not accessible, with results affected by the complex response of the tissue itself.     

The effect of growth hormone administration in growth hormone deficient adults on bone, protein, carbohydrate and lipid homeostasis, as well as on body composition

OBJECTIVE: The effect on bone, protein, carbohydrate and lipid homeostasis as well as body composition of the administration of growth hormone to adult patients with growth hormone deficiency was studied. DESIGN: Growth hormone was administered at a dose of 25 micrograms/kg/day with a maximum of 1.48 mg (4 IU) a day, for 6 months in eight adults. Studies were done before the start and at 1, 3 and 6 months during therapy, as well as 3 months after treatment had been stopped. RESULTS: Subjective well-being as assessed by a short psychological tests showed an improvement in six and no change in two patients. Body composition, as assessed by body impedance assessment and D2O dilution, both showed an increase in lean body mass of 4 kg (5% of body weight), accompanied by a decrease in mean fat mass of 3 kg. Nitrogen turnover studies showed a transient increase in fed state nitrogen balance due to an increase in the rate of protein synthesis, which exceeded a smaller increase in the protein degradation rate. Growth hormone treatment did not affect the circulating levels of 25(OH)-vitD or PTH 1-84, while 1,25(OH)2-vitD had significantly increased after 6 months, as well as 3 months after treatment ended. Osteocalcin, procollagen I levels, as well as 24-hour urinary excretion of hydroxyproline and calcium rose during growth hormone administration but subsequently decreased rapidly after administration had been stopped, while the increase in alkaline phosphatase persisted. This increase in markers of both bone resorption and bone formation indicates an activation of bone remodelling, but this was not reflected by an increase in bone density. Glucose levels, measured before and during a normal breakfast, increased during growth hormone treatment, but serum insulin levels did not. Total cholesterol levels decreased by 0.5 mmol/l. Levels of T4 and free T4 as well as rT3 decreased, while T3 increased during growth hormone treatment. CONCLUSION: Therapy with growth hormone for 6 months in a dose varying between 6 and 25 micrograms/kg/day increased lean body mass and decreased fat mass. The sense of general well-being improved in most patients. Furthermore, growth hormone treatment increased bone turnover without a measurable increase in bone density, caused some minor changes in lipid and carbohydrate metabolism, and increased the metabolism of thyroxine to T3.     

Corneal Opacity: Cell Biological Determinants of the Transition From Transparency to Transient Haze to Scarring Fibrosis,and Resolution,After Injury

PurposeTo highlight the cellular, matrix, and hydration changes associated with opacity that occurs in the corneal stroma after injury.MethodsReview of the literature.ResultsThe regulated transition of keratocytes to corneal fibroblasts and myofibroblasts, and of bone marrow-derived fibrocytes to myofibroblasts, is in large part modulated by transforming growth factor beta (TGFβ) entry into the stroma after injury to the epithelial basement membrane (EBM) and/or Descemet''s membrane. The composition, stoichiometry, and organization of the stromal extracellular matrix components and water is altered by corneal fibroblast and myofibroblast production of large amounts of collagen type I and other extracellular matrix components—resulting in varying levels of stromal opacity, depending on the intensity of the healing response. Regeneration of EBM and/or Descemet''s membrane, and stromal cell production of non-EBM collagen type IV, reestablishes control of TGFβ entry and activity, and triggers TGFβ-dependent myofibroblast apoptosis. Eventually, corneal fibroblasts also disappear, and repopulating keratocytes reorganize the disordered extracellular matrix to reestablish transparency.ConclusionsInjuries to the cornea produce varying amounts of corneal opacity depending on the magnitude of cellular and molecular responses to injury. The EBM and Descemet''s membrane are key regulators of stromal cellularity through their modulation of TGFβ. After injury to the cornea, depending on the severity of the insult, and possibly genetic factors, trace opacity to severe scarring fibrosis develops. Stromal cellularity, and the functions of different cell types, are the major determinants of the level of the stromal opacity.     

Quetiapine augmentation of prolonged exposure therapy in veterans with PTSD and a history of mild traumatic brain injury:design and methodology of a pilot study

Background:Selective serotonergic reuptake inhibitors(SSRIs)are first-line pharmacologic treatments for patients with posttraumatic stress disorder(PTSD),but must be given over extended period of time before the onset of action.The use of SSRIs in PTSD patients with mild traumatic brain injury(mTBI)is problematic since SSRIs could exacerbate post-concussion syndrome(PCS)symptoms.VA/DOD guidelines identify trauma-focused psychotherapy as the best evidence-based treatment for PTSD,but overall effectiveness is limited by reduced levels of patient engagement and retention.A previous study from this research group suggested that quetiapine monotherapy,but not risperidone or valproate,could increase engagement in trauma-focused psychotherapy.Methods:We report the study protocol of a pilot study funded under the South-Central Mental Illness Research,Education,and Clinical Center pilot study program from the U.S.Department of Veterans Affairs.This randomized,open-label study was designed to evaluate the feasibility of completing a randomized trial of quetiapine vs.treatment as usual to promote patient engagement in PTSD patients with a history of mTBI.Discussion:We expect that the success of this ongoing study should provide us with the preliminary data necessary to design a full-scale randomized trial.Positive efficacy results in a full-scale trial should inform new VA guidelines for clinical practice by showing that quetiapine-related improvements in patient engagement and retention may be the most effective approach to assure that VA resources achieve the best possible outcome for veterans.     

Frequency of binge eating in bulimic patients: Diagnostic validity

One of the DSM-III-R criteria for bulimia nervosa is a minimum binge frequency of twice a week for 3 months. We classified eating disorder patients according to different binge eating and purging frequencies and examined their concurrent and predictive validity. Frequency of purging, but not binge eating, was related to general measures of psychopathology. Neither was related to posttreatment outcome. High SCL-90 scores at pretreatment were associated with poor outcome.     

Risk Factors for Development of Rectal Neuroendocrine Tumors Longer Than 9 mm: Retrospective Cohort

BackgroundRectal neuroendocrine tumors (R-NET) represent the most frequent of gastroenteropancreatic neuroendocrine neoplasms (NEN-GEP) according to the United States Surveillance, Epidemiology, and End Results database. With an annual percentage of occurrence increasing to 8.2% of all rectal neoplasms, R-NET affect less than 2% and are reported in only 0.05% to 0.07% of patients undergoing colorectal cancer (CRC) screening. The primary objective of this study was to assess the risk factors associated with R-NET greater than 10 mm. As a secondary objective, it was also aimed to evaluate the response to endoscopic treatment.Methods: This was a retrospective study, using data collected through the analysis of medical records of colonoscopies performed from January 2008 to December 2014. Records of polypectomies were identified, and the results were searched for pathological findings of R-NET. We also gathered epidemiological data and outcomes as risk factors for lesions greater than or equal to 10 mm, with local and distant recurrence.Results: During the study period, 18 218 colonoscopies were performed and 10 865 polypoid lesions were detected and removed, 20 with R-NET anatomopathology. The detection rate was 0.1%. The risk factors associated with major lesions were Japanese ethnicity, the lack of previous cancer diagnosis, and a Ki67 index > 2%. The mean follow-up was 56.6 months, and there was no local lymph node recurrence or distant relapse.ConclusionThis study concludes that endoscopic resection is a good and effective method for treatment of Grade 1 rectal NET smaller than 11 mm, with high cure rates and low rates of local or distant relapse.     

Laser for vascular anomalies: successful outcomes in children

Vascular anomalies can cause both emotional and physical distress to patients, particularly children. The paediatric laser service at Great Ormond Street Hospital (GOSH) treats a range of dermatological conditions including a variety of vascular anomalies, excess hair growth and disfiguring scars. The laser team at GOSH has 25 years of experience in treating a wide variety of paediatric dermatological conditions using various laser therapies. With over 600 new referrals for laser therapy and over 1000 laser procedures each year the GOSH laser team has vast amounts of experience with both common and rare conditions. Excellent clinical outcomes continue to be delivered, and new treatment therapies are constantly being developed to treat more recalcitrant lesions. The adverse effect rates experienced by the GOSH laser patients have been decreasing over the past two decades, reaching the low rate of 0.8% per treated patients per year. This remarkable achievement has been continuously improved by integrating specific and standardized laser protocols for each patient treated, to ensure efficacious and safe laser treatment delivery. Treating vascular anomalies with laser therapy creates significant positive results among the paediatric population, thus laser therapy at GOSH makes a significant impact upon children’s lives with both rare and common vascular anomalies.     

Joint analysis of frontal theta synchrony and white matter following mild traumatic brain injury

Brain Imaging and Behavior - Some of the most disabling aspects of mild traumatic brain injury (mTBI) include lingering deficits in executive functioning. It is known that mTBI can damage white...