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The article examines whether activity in the subgenual anterior cingulate cortex (sgACC) is a reliable outcome market of cognitive therapy for unmedicated depressed patients. Functional magnetic resonance imaging is presented to have been used to assess pretreatment sgACC activity in inception cohorts in response to negative words. Cognitive therapy is cited to have resulted in the most improvement in participants with the lowest pretreatment sustained sgACC reactivity.

The article discusses a research study on comparing early and delayed interventions for posttraumatic stress disorder (PTSD) with exposure-based and pharmacological measures. Study participants including traumatic events survivors were assessed through structured telephone interviews and given weekly sessions on cognitive therapy (CT), prolonged exposure (PE) and escitalopram or placebo tablets. Results showed that CT, prolonged exposure and delayed PE can prevent chronic PTSD effectively.

The article discusses a research study on determining the efficacy of 18-month cognitive therapy (CT) program for improving negative symptoms and psychosocial functioning among low-functioning schizophrenia patients. Study subjects include 60 schizophrenia patients with average age of 38.4 years and interventions used include cognitive therapy with standard treatment or standard treatment only. Conclusions indicated clinical improvements with cognitive therapy in patients with schizophrenia.

The article presents a study which investigated longitudinal trends in health service utilization, spending, and quality of care for patients with depression. Despite a decline in inpatient spending, mental health spending rose from a mean of 2,802 U.S. dollars to 3,610 U.S. dollars from July 1996 to June 2006. Antidepressant use climbed from 80.6 percent to 86.8 percent. Psychotherapy usage fluctuated and follow-up visits fell during the period.

The article focuses on the connection between predeployment psychiatric status and the development of posttraumatic stress disorder (PTSD). The Millennium Cohort Study was conducted to the members of U.S. military service who were asked to complete a baseline questionnaire to provide their self-reported health information. It has been found out that self-reported preinjury status is related to PTSD regardless of injury severity.

The article discusses research on whether problem-solving therapy (PST) can help reduce disability more than supportive therapy (ST) in old patients with depression. A randomized controlled trial was conducted on adults, 59 years old and above, with executive dysfunction and depression and quantified disability with the use of the 12-item World Health Organization Disability Assessment Schedule II. Results indicated that in reducing disability in older patients with depression and executive dysfunction, PST is more effective than ST.

The article discusses a research study on the outpatient treatment of depression based on the national trends from 1998 to 2007. Researchers analyzed the service utilization data for U.S. household population survey in 1998 and the Medical Expenditure Panel Surveys in 2007 and compared the data of patients receiving treatment, those using antidepressant medication and psychotherapy. Results showed the increase in the outpatient treatment for depression rate to 2.88 per 100 persons in 2007 from the 1998 rate of 2.37 per 100 persons.

The article presents a study on the sufficiency and prevalence of depression care in different ethnic group in the U.S. The study examined depression pharmacotherapy and psychotherapy outcome measures. Results show that Mexican American and African American individuals which consistently meet depression criteria had lesser chance of using any depression therapy. It states that few Americans with major depression use such therapies, but African and Mexican Americans use depression care the least.

The article presents a study designed to determine the effectiveness of an indicated stepped-care prevention program for depression and anxiety disorders for the old adults. It states that such study is essential in the development of effective strategies in preventing the said disorders. A total of 170 elderly volunteers were selected, through randomized controlled trial, as the subjects of the study in 33 primary care practices in the Netherlands. It mentions that the preventive stepped-care program involves bibliotherapy and problem-solving treatment. Results show that the prevention program is effective in reducing the risk of depression and anxiety disorders among the elderly and is seen as a valuable therapy from the views of the public health.

The article presents a study on national trends in psychotherapy rendered by office-based psychiatrists.The study's participants consisted of patients with psychiatric diagnoses who visit outpatient psychiatrists in the United States. Psychotherapy was given in 5597 of 14 108 visits sampled within a 10-year period. Analysis showed that percentage of visits declined from 44.4 to 28.9 due to change in reimbursement, increases in managed, care, and growth in the prescription of medications. The study ended that there has been a decrease in the provision of psychotherapy by psychiatrists in the United States.

The article focuses on a study of the treatment of acute stress disorder. The study was conducted to compare exposure therapy techniques for the treatment of acute stress disorder (ASD) on recent trauma survivors. The study observed outpatient individuals who have experienced trauma, and are qualified for the ASD between March 1, 2002, and June 30, 2006. Patients were randomly selected, and were given with either imaginal, and cognitive restructuring, from which results showed that exposure-based therapy lessens the posttraumatic stress disorder in patients with ASD.

The article offers information on the connection between posttraumatic stress disorder (PSTD) by young adults and Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) drug dependence and abuse. A multiwave longitudal study was conducted to determine the risk for DSM-IV drug use disorders among young adults in the United States. The result of the study shows that PSTD is a possible cause of drug use disorder. It is inferred that DSM-IV drug use disorder is a possible effect of self-medicate troubling trauma-associated memories.

The article discusses the Treatment for Adolescents With Depression Study which evaluates the effectiveness of flouxetine hydrochloride therapy, cognitive behavior therapy (CBT) and their combination in adolescents with major depressive disorder. The authors used a randomized controlled trial with 327 patients aged 12 to 17 years in 13 academic and community sites in the United States. They found out that adolescents with moderate to severe depression who went through fluoxetine treatment or in combination with CBT accelerated the response and adding CBT to medication can heighten the safety of medication.

The article reports on a randomized controlled comparison of family-based treatment (FBT) and supportive psychotherapy (SPT) for adolescent bulimia nervosa (BN). This study aims to evaluate the relative efficiency of FBT and SPT for adolescents with BN. Eighty patients, aged 12 to 19 years, with DSM-IV diagnosis of BN were taken as subjects of the study. It was identified that FBT manifested a clinical and statistical advantage over SPT at posttreatment and at 6-month follow-up. Randomized controlled trial is employed in the study.

The article presents a clinical trial to prevent depression in macular degeneration due to age. The author and his colleagues conducted a randomized controlled clinical trials to test the efficacy of problem solving therapy (PST) to prevent depression to older patients suffering from age-related macular degeneration. The study revealed that PST reduced depression incidence rate after two months by 50%. It is suggested that PST is an effective short-term treatment for the prevention of depression but needs rescue treatments to sustain its effect.

The article explores the benefits of four disorder-specific psychotherapies in conjunction with pharmacotherapy on time to recovery and the likelihood of remaining well after an episode of bipolar depression. Psychosocial treatments include collaborative care, cognitive behavior therapy, interpersonal and social rhythm therapy, and family-focused therapy. Results reveal that intensive psychosocial treatment as an adjunct pharmacotherapy was more beneficial than short treatment.

The article discusses a study to determine the amount of evidence-based therapy taught in accredited training programs in psychiatry, psychology, and social work and to observe whether the training was elective or required and presented as a didactic or clinical supervision. The study included a cross-sectional survey of a probability sample of all accredited training programs. Findings states that there is a considerable gap between research evidence for psychotherapy and clinical training.

The article evaluates the hypothesis that unique aspects of dialectical behavior therapy (DBT) are more efficacious compared with treatment offered by non-behavioral psychotherapy experts. DBT is a treatment for suicidal behavior and borderline personality disorder. DBT may be effective in reducing suicide attempts.

The article presents a study that compares the effectiveness of schema-focused therapy (SFT) and psychodynamically based transference-focused psychotherapy (TFP) in patients with personality disorder. Patients with borderline personality disorder severity index score were used as subjects. The results show that by using an intention-to-treat approach, significant improvements were found for both SFT and TFP treatments on all measures after a 3-year treatment period.

Context Contingency management interventions that provide tangible incentives based on objective indicators of drug abstinence are efficacious in improving outcomes in substance abusers, but these treatments have rarely been implemented in community-based settings. Objective To evaluate the efficacy of an abstinence-based contingency management intervention as an addition to usual care in community treatment settings. Design Random assignment to usual care or usual care plus abstinence-based incentives for 12 weeks. Setting Eight community-based outpatient psychosocial drug abuse treatment programs. Participants A total of 415 cocaine or methamphetamine users beginning outpatient substance abuse treatment. Intervention All participants received standard care, and those assigned to the abstinence-based incentive condition also earned chances to win prizes for submitting substance-free urine samples; the chances of winning prizes increased with continuous time abstinent. Main Outcome Measures Retention, counseling attendance, total number of substance-free samples provided, percentage of stimulant- and alcohol-free samples submitted, and longest duration of confirmed stimulant abstinence. Results Participants assigned to the abstinence-based incentive condition remained in treatment for a mean ± SD of 8.0 ± 4.2 weeks and attended a mean ± SD of 19.2 ± 16.8 counseling sessions compared with 6.9 ± 4.4 weeks and 15.7 ± 14.4 sessions for those assigned to the usual care condition (P<.02 for all). Participants in the abstinence-based incentive condition also submitted significantly more stimulant- and alcohol-free samples (P<.001). The abstinence-based incentive group was significantly more likely to achieve 4, 8, and 12 weeks of continuous abstinence than the control group, with odds ratios of 2.5, 2.7, and 4.5, respectively. However, the percentage of positive samples submitted was low overall and did not differ between conditions. Conclusion The abstinence-based incentive procedure, which provided a mean of $203 in prizes per participant, was efficacious in improving retention and associated abstinence outcomes. [ABSTRACT FROM AUTHOR]

Background Several studies have shown that telephone-administered cognitive-behavioral therapy (T-CBT) is superior to forms of no treatment controls. No study has examined if the skills-training component to T-CBT provides any benefit beyond that provided by nonspecific factors. Objective To test the efficacy of a 16-week T-CBT against a strong control for attention and nonspecific therapy effects. Design Randomized controlled trial including 12-month follow-up. Setting Telephone administration of psychotherapy with patients in their homes. Participants Participants had depression and functional impairments due to multiple sclerosis. Interventions A 16-week T-CBT program was compared with 16 weeks of telephone-administered supportive emotion-focused therapy. Main Outcome Measures Hamilton Depression Rating Scale score, Structured Clinical Interview for DSM-IV diagnosis of major depressive disorder, Beck Depression Inventory score, and Positive Affect scale score of the Positive and Negative Affect Scale. Results Of the 127 participants randomized, 7 (5.5%) dropped out of treatment. There were significant improvement during treatment on all outcome measures (P<.01 for all) and an increase in Positive Affect Scale score. Improvements over 16 weeks of treatment were significantly greater for T-CBT, compared with telephone-administered supportive emotion-focused therapy, for major depressive disorder frequency (P = .02), Hamilton Depression Rating Scale score (P = .02), and Positive Affect Scale score (P = .008), but not for the Beck Depression Inventory score (P = .29). Treatment gains were maintained during 12-month follow-up; however, differences across treatments were no longer evident (P > .16 for all). Conclusions Patients showed significant improvements in depression and positive affect during the 16 weeks of telephone-administered treatment. The specific cognitive-behavioral components of T-CBT produced improvements above and beyond the nonspecific effects of telephone-administered supportive emotion-focused therapy on evaluator-rated measures of depression and self-reported positive affect. Attrition was low. [ABSTRACT FROM AUTHOR]

The basic framework of the cognitive theory of psychopathology and cognitive therapy of specific psychiatric disorders was developed more than 40 years ago. Since that time, there has been continuing progress in the development of cognitive theory and therapy and in the empirical testing of both. A substantial body of research supports the cognitive model of depression and, to a somewhat lesser extent, the various anxiety disorders. Cognitive therapy (CT), often labeled as the generic term cognitive behavior therapy, has been shown to be effective in reducing symptoms and relapse rates, with or without medication, in a wide variety of psychiatric disorders. Suggestions for future research and applications are presented. [ABSTRACT FROM AUTHOR]

Context Numerous studies have pointed to the failure of prophylaxis with pharmacotherapy alone in the treat ment of bipolar I disorder. Recent investigations have demonstrated benefits from the addition of psychoeducation or psychotherapy to pharmacotherapy in this population. Objective To compare 2 psychosocial interventions: interpersonal and social rhythm therapy (IPSRT) and an intensive clinical management (ICM) approach in the treatment of bipolar I disorder. Design Randomized controlled trial involving 4 treatment strategies: acute and maintenance IPSRT (IPSRT/IPSRT), acute and maintenance ICM (ICM/ICM), acute IPSRT followed by maintenance ICM (IPSRT/ICM), or acute ICM followed by maintenance IPSRT (ICM/IPSRT). The preventive maintenance phase lasted 2 years. Setting Research clinic in a university medical center. Participants One hundred seventy-five acutely ill individuals with bipolar I disorder recruited from inpatient and outpatient settings, clinical referral, public presentations about bipolar disorder, and other public information activities. Interventions Interpersonal and social rhythm therapy, an adaptation of Klerman and Weissman’s interpersonal psychotherapy to which a social rhythm regulation component has been added, and ICM. Main Outcome Measures Time to stabilization in the acute phase and time to recurrence in the maintenance phase. Results We observed no difference between the treatment strategies in time to stabilization. After controlling for covariates of survival time, we found that participants assigned to IPSRT in the acute treatment phase survived longer without a new affective episode (P = .01), irrespective of maintenance treatment assignment. Participants in the IPSRT group had higher regularity of social rhythms at the end of acute treatment (P<.001). Ability to increase regularity of social rhythms during acute treatment was associated with reduced likelihood of recurrence during the maintenance phase (P = .05). Conclusion Interpersonal and social rhythm therapy appears to add to the clinical armamentarium for the management of bipolar I disorder, particularly with respect to prophylaxis of new episodes. [ABSTRACT FROM AUTHOR]

Context Psychopaths belong to a larger group of persons with antisocial personality disorder and are characterized by an inability to have emotional involvement and by the repeated violation of the rights of others. It was hypothesized that this behavior might be the consequence of deficient fear conditioning. Objective To study the cerebral, peripheral, and subjective correlates of fear conditioning in criminal psychopaths and healthy control subjects. Design An aversive differential pavlovian delay conditioning paradigm with slides of neutral faces serving as conditioned and painful pressure as unconditioned stimuli. Setting The Department of Medical Psychology at the University of Tübingen, Tübingen, Germany. Participants Ten male psychopaths as defined by the Hare Psychopathy Checklist–Revised and 10 age- and education-matched healthy male controls. The psychopaths were criminal offenders on bail and waiting for their trial or were on parole. The healthy controls were recruited from the community. Main Outcome Measures Brain activation based on functional magnetic resonance imaging, electrodermal responses, emotional valence, arousal, and contingency ratings. Results The healthy controls showed enhanced differential activation in the limbic-prefrontal circuit (amygdala, orbitofrontal cortex, insula, and anterior cingulate) during the acquisition of fear and successful verbal and autonomic conditioning. The psychopaths displayed no significant activity in this circuit and failed to show conditioned skin conductance and emotional valence ratings, although contingency and arousal ratings were normal. Conclusion This dissociation of emotional and cognitive processing may be the neural basis of the lack of anticipation of aversive events in criminal psychopaths. [ABSTRACT FROM AUTHOR]

Context There have been very few randomized controlled treatment studies of anorexia nervosa. Objective To evaluate factors leading to nonacceptance and noncompletion of treatment for 2 specific therapies and their combination in the treatment of anorexia nervosa. Design Randomized prospective study. Setting Weill-Cornell Medical Center, White Plains, NY; University of Minnesota, Minneapolis; and Stanford University, Stanford, Calif. Patients One hundred twenty-two patients meeting DSM-IV criteria for anorexia nervosa. Interventions Treatment with cognitive-behavioral therapy, fluoxetine hydrochloride, or their combination for 1 year. Main Outcome Measures Dropout rate and acceptance of treatment (defined as staying in treatment at least 5 weeks). Results Of the 122 randomized cases, 21 (17%) were withdrawn; the overall dropout rate was 46% (56/122) in the remaining patients. Treatment acceptance occurred in 89 (73%) of the 122 randomized cases. Of the 41 assigned to medication alone, acceptance occurred in 23 (56%). In the other 2 groups, acceptance rate was differentiated by high and low obsessive preoccupation scores (rates of 91% and 60%, respectively). The only predictor of treatment completion was high self-esteem, which was associated with a 51% rate of treatment acceptance. Conclusion Acceptance of treatment and relatively high dropout rates pose a major problem for research in the treatment of anorexia nervosa. Differing characteristics predict dropout rates and acceptance, which need to be carefully studied before comparative treatment trials are conducted. [ABSTRACT FROM AUTHOR]

Context Although various strategies are available to manage nonresponders to an initial treatment for depression, no controlled trials address the utility of switching from an antidepressant medication to psychotherapy or vice versa. Objective To compare the responses of chronically depressed nonresponders to 12 weeks of treatment with either nefazodone or cognitive behavioral analysis system of psychotherapy (CBASP) who were crossed over to the alternate treatment (nefazodone, n = 79; CBASP, n = 61). Design Crossover trial. Setting Twelve academic outpatient psychiatric centers. Patients There were 140 outpatients with chronic major depressive disorder; 92 (65.7%) were female, 126 (90.0%) were white, and the mean age was 43.1 years. Thirty participants dropped out of the study prematurely, 22 in the nefazodone group and 8 in the CBASP group. Interventions Treatment lasted 12 weeks. The dosage of nefazodone was 100 to 600 mg/d; CBASP was provided twice weekly during weeks 1 through 4 and weekly thereafter. Main Outcome Measures The 24-item Hamilton Rating Scale for Depression, administered by raters blinded to treatment, the Clinician Global Impressions–Severity scale, and the 30-item Inventory for Depressive Symptomatology–Self-Report. Results Analysis of the intent-to-treat sample revealed that both the switch from nefazodone to CBASP and the switch from from CBASP to nefazodone resulted in clinically and statistically significant improvements in symptoms. Neither the rates of response nor the rates of remission were significantly different when the groups of completers were compared. However, the switch to CBASP following nefazodone therapy was associated with significantly less attrition due to adverse events, which may explain the higher intent-to-treat response rate among those crossed over to CBASP (57% vs 42%). Conclusions Among chronically depressed individuals, CBASP appears to be efficacious for nonresponders to nefazodone, and nefazodone appears to be effective for CBASP nonresponders. A switch from an antidepressant medication to psychotherapy or vice versa appears to be useful for nonresponders to the initial treatment. [ABSTRACT FROM AUTHOR]

Background There is substantial evidence that antidepressant medications treat moderate to severe depression effectively, but there is less data on cognitive therapy’s effects in this population. Objective To compare the efficacy in moderate to severe depression of antidepressant medications with cognitive therapy in a placebo-controlled trial. Design Random assignment to one of the following: 16 weeks of medications (n = 120), 16 weeks of cognitive therapy (n = 60), or 8 weeks of pill placebo (n = 60). Setting Research clinics at the University of Pennsylvania, Philadelphia, and Vanderbilt University, Nashville, Tenn. Patients Two hundred forty outpatients, aged 18 to 70 years, with moderate to severe major depressive disorder. Interventions Some study subjects received paroxetine, up to 50 mg daily, augmented by lithium carbonate or desipramine hydrochloride if necessary; others received individual cognitive therapy. Main Outcome Measure The Hamilton Depression Rating Scale provided continuous severity scores and allowed for designations of response and remission. Results At 8 weeks, response rates in medications (50%) and cognitive therapy (43%) groups were both superior to the placebo (25%) group. Analyses based on continuous scores at 8 weeks indicated an advantage for each of the active treatments over placebo, each with a medium effect size. The advantage was significant for medication relative to placebo, and at the level of a nonsignificant trend for cognitive therapy relative to placebo. At 16 weeks, response rates were 58% in each of the active conditions; remission rates were 46% for medication, 40% for cognitive therapy. Follow-up tests of a site × treatment interaction indicated a significant difference only at Vanderbilt University, where medications were superior to cognitive therapy. Site differences in patient characteristics and in the relative experience levels of the cognitive therapists each appear to have contributed to this interaction. Conclusion Cognitive therapy can be as effective as medications for the initial treatment of moderate to severe major depression, but this degree of effectiveness may depend on a high level of therapist experience or expertise. [ABSTRACT FROM AUTHOR]

Background Antidepressant medication prevents the return of depressive symptoms, but only as long as treatment is continued. Objectives To determine whether cognitive therapy (CT) has an enduring effect and to compare this effect against the effect produced by continued antidepressant medication. Design Patients who responded to CT in a randomized controlled trial were withdrawn from treatment and compared during a 12-month period with medication responders who had been randomly assigned to either continuation medication or placebo withdrawal. Patients who survived the continuation phase without relapse were withdrawn from all treatment and observed across a subsequent 12-month naturalistic follow-up. Setting Outpatient clinics at the University of Pennsylvania and Vanderbilt University. Patients A total of 104 patients responded to treatment (57.8% of those initially assigned) and were enrolled in the subsequent continuation phase; patients were initially selected to represent those with moderate to severe depression. Interventions Patients withdrawn from CT were allowed no more than 3 booster sessions during continuation; patients assigned to continuation medication were kept at full dosage levels. Main Outcome Measures Relapse was defined as a return, for at least 2 weeks, of symptoms sufficient to meet the criteria for major depression or Hamilton Depression Rating Scale scores of 14 or higher during the continuation phase. Recurrence was defined in a comparable fashion during the subsequent naturalistic follow-up. Results Patients withdrawn from CT were significantly less likely to relapse during continuation than patients withdrawn from medications (30.8% vs 76.2%; P = .004), and no more likely to relapse than patients who kept taking continuation medication (30.8% vs 47.2%; P = .20). There were also indications that the effect of CT extends to the prevention of recurrence. Conclusions Cognitive therapy has an enduring effect that extends beyond the end of treatment. It seems to be as effective as keeping patients on medication. [ABSTRACT FROM AUTHOR]

Background The American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP) estimated the mental health burden and associated help-seeking in select American Indian reservation communities. Objective To determine the lifetime and 12-month prevalence of common DSM-IV disorders, their demographic correlates, and patterns of help-seeking in 2 culturally distinct American Indian reservation communities in the Southwest and Northern Plains. Design Completed between 1997 and 2000, a cross-sectional probability sample survey. Setting General community. Participants Three thousand eighty-four (Southwest = 1446 and Northern Plains = 1638) members, aged 15-54 years, of 2 tribal groups living on or near their home reservations were randomly sampled from the tribal rolls. Response rates were 73.7% and 76.8% for the Southwest and Northern Plains tribes, respectively. Main Outcomes Measures The AI-SUPERPFP Composite International Diagnostic Interview, a culturally adapted version of the University of Michigan version of the Composite International Diagnostic Interview, to assess DSM-IV diagnoses and help-seeking. Results Overall lifetime prevalence of AI-SUPERPFP DSM-IV disorders ranged from 35.7% for Southwest women to near 50% for both groups of men. Alcohol abuse and dependence were the most common disorders for men, with posttraumatic stress disorder most prevalent for women. Many of those with lifetime alcohol problems or posttraumatic stress disorder no longer met criteria for 12-month diagnoses. Significant levels of comorbidity were found between those with depressive and/or anxiety and substance disorders. Demographic correlates other than tribe, sex, and age were generally unrelated to disorder status. A majority of participants with lifetime disorders had sought help from mental health professionals, other medical personnel, or culturally traditional sources. Conclusions Alcohol disorders and posttraumatic stress disorder were more common in these American Indian populations than in other populations using comparable methods. Substantial comorbidity between depressive and/or anxiety and substance disorders suggests the need for greater coordination of treatment for comorbid disorders. [ABSTRACT FROM AUTHOR]

Background The efficacy of psychodynamic therapy is controversial. Previous meta-analyses have reported discrepant results. Objective To test the efficacy of short-term psychodynamic psychotherapy (STPP) in specific psychiatric disorders by performing a meta-analysis of more recent studies. We assessed outcomes in target problems, general psychiatric symptoms, and social functioning. Design We identified studies of STPP published between January 1, 1970, and September 30, 2004, by means of a computerized search using MEDLINE, PsycINFO, and Current Contents. Rigorous inclusion criteria, included randomized controlled trials, use of treatment manuals and ensurance of treatment integrity, therapists experienced or specifically trained in STPP, treatment of patients with specific psychiatric disorders, reliable and valid diagnostic measures, and data necessary to calculate effect sizes. Studies of interpersonal therapy were excluded. Seventeen studies fulfilled the inclusion criteria. The information was extracted by 3 raters. Effect sizes were calculated for target problems, general psychiatric symptoms, and social functioning using the data published in the original studies. To examine the stability of outcome, we assessed effect sizes separately for end of therapy and follow-up assessment. The effect sizes of STPP were compared with those of waiting-list control patients, treatments as usual, and other forms of psychotherapy. Results Short-term psychodynamic psychotherapy yielded significant and large pretreatment-posttreatment effect sizes for target problems (1.39), general psychiatric symptoms (0.90), and social functioning (0.80). These effect sizes were stable and tended to increase at follow-up (1.57, 0.95, and 1.19, respectively). The effect sizes of STPP significantly exceeded those of waiting-list controls and treatments as usual. No differences were found between STPP and other forms of psychotherapy. Conclusions Short-term psychodynamic psychotherapy proved to be an effective treatment in psychiatric disorders. However, further research of STPP in specific psychiatric disorders is needed, including a study of the active ingredients of STPP. Effectiveness studies should be included. [ABSTRACT FROM AUTHOR]

Background Traditional pharmacological approaches to treating psychiatric disorders focus on correcting presumed biochemical abnormalities. However, some disorders, particularly the anxiety-related disorders exemplified by specific phobia, have an emotional learning component to them that can be facilitated with psychotherapy. Objective To determine whether D-cycloserine (DCS), a partial agonist at the N-methyl-D-aspartate receptor that has previously been shown to improve extinction of fear in rodents, will also improve extinction of fear in human phobic patients undergoing behavioral exposure therapy. Design Randomized, double-blind, placebo-controlled trial examining DCS vs placebo treatment in combination with a precisely controlled exposure paradigm. Setting Participants were recruited from the general community to a research clinic. Participants Twenty-eight subjects with acrophobia diagnosed by the Structured Clinical Interview for DSM-IV were enrolled. Interventions After we obtained pretreatment measures of fear, subjects were treated with 2 sessions of behavioral exposure therapy using virtual reality exposure to heights within a virtual glass elevator. Single doses of placebo or DCS were taken prior to each of the 2 sessions of virtual reality exposure therapy. Subjects, therapists, and assessors were blind to the treatment condition. Subjects returned at 1 week and 3 months posttreatment for measures to determine the presence and severity of acrophobia symptoms. Main Outcome Measures Included were measures of acrophobia within the virtual environment, measures of acrophobia in the real world, and general measures of overall improvement. An objective measure of fear, electrodermal skin fluctuation, was also included during the virtual exposure to heights. Symptoms were assessed by self-report and by independent assessors at approximately 1 week and 3 months posttreatment. Results Exposure therapy combined with DCS resulted in significantly larger reductions of acrophobia symptoms on all main outcome measures. Subjects receiving DCS had significantly more improvement compared with subjects receiving placebo within the virtual environment (1 week after treatment, P≤.001; 3 months later, P≤.05). Subjects receiving DCS also showed significantly greater decreases in posttreatment skin conductance fluctuations during the virtual exposure (P≤.05). Additionally, subjects receiving DCS had significantly greater improvement compared with subjects receiving placebo on general measures of real-world acrophobia symptoms (acrophobia avoidance [P≤.02], acrophobia anxiety [P≤.01], attitudes toward heights [P≤.04], clinical global improvement [P≤.01], and number of self-exposures to real-world heights [P≤.01]); the improvement was evident early in treatment and was maintained at 3 months. Conclusion These pilot data provide initial support for the use of acute dosing of DCS as an adjunct to exposure-based psychotherapy to accelerate the associative learning processes that contribute to correcting psychopathology. [ABSTRACT FROM AUTHOR]

Background Adherence to antidepressant medication use is a problem in clinical practice. Some authors have posited that combined psychological treatment facilitates adherence to pharmacotherapy. Objectives To study the relationship between adherence to use of and efficacy of antidepressant drugs plus psychological treatment vs drug treatment alone in depressive disorders. Data Sources MEDLINE, Current Contents, PsychInfo, Cochrane Library, and reference lists were searched, from January 1980 to November 2002. Study Selection Randomized clinical trials comparing antidepressant treatment alone with antidepressant treatment in combination with a psychological intervention in depressive disorders were considered. The decision to include studies in the meta-analysis was performed by 2 reviewers. Data Extraction Three independent reviewers extracted the data, using a precoded form. Methodological quality of the studies was evaluated in terms of allocation concealment and independence of evaluators. Data Synthesis Sixteen trials met the inclusion criteria, with 932 patients randomized to pharmacotherapy alone and 910 to combined treatment. Overall, patients receiving combined treatment improved significantly compared with those receiving drug treatment alone (odds ratio [OR], 1.86; 95% confidence interval [CI], 1.38-2.52), but dropouts and nonresponders did not differ in distribution between the 2 treatment modalities (OR, 0.86; 95% CI, 0.60-1.24). Studies longer than 12 weeks showed a significant advantage of combined treatment over drug treatment alone (OR, 2.21; 95% CI, 1.22-4.03), with a significant reduction in dropouts compared with nonresponders (OR, 0.59; 95% CI, 0.39-0.88). These estimates were not affected by study quality. Conclusions Psychological treatment combined with antidepressant therapy is associated with a higher improvement rate than drug treatment alone. In longer therapies, the addition of psychotherapy helps to keep patients in treatment. Further studies are needed to investigate whether the improvement in response attributable to the combination of drug treatment and psychotherapy can be achieved by a combination of pharmacotherapy and a compliance-enhancing intervention. [ABSTRACT FROM AUTHOR]

Context Adolescent depression is highly prevalent and has substantial morbidity, including suicide attempts, school dropout, and substance abuse, but many depressed adolescents are untreated. The school-based health clinic offers the potential for accessible and efficient treatment, although it is unknown whether school-based clinicians can be trained to implement evidence-based psychotherapies for depression in routine care. Objective To assess the effectiveness of interpersonal psychotherapy modified for depressed adolescents (IPT-A) compared with treatment as usual (TAU) in school-based mental health clinics. Design A 16-week randomized clinical trial was conducted from April 1, 1999, through July 31, 2002. Setting Five school-based mental health clinics in New York City, NY. Patients Sixty-three adolescents referred for a mental health intake visit who met eligibility criteria. Eligible patients had a mean Hamilton Depression Rating Scale score of 18.6 (SD, 5.5) and a mean Children's Global Assessment Scale score of 52.6 (SD, 5.5) and met DSM-IV criteria for major depressive disorder, dysthymia, depression disorder not otherwise specified, or adjustment disorder with depressed mood. Mean age was 15.1 years (SD, 1.9 years). The sample was predominantly female (n = 53 [84%]), Hispanic (n = 45 [71%]), and of low socioeconomic status. Intervention Patients were randomly assigned to receive IPT-A (n = 34) or TAU (n = 29) from school-based health clinic clinicians. Main Outcome Measures The Hamilton Depression Rating Scale, Beck Depression Inventory, Children's Global Assessment Scale, Clinical Global Impressions scale, and the Social Adjustment Scale–Self-Report. Results Adolescents treated with IPT-A compared with TAU showed greater symptom reduction and improvement in overall functioning. Analysis of covariance showed that compared with the TAU group, the IPT-A group showed significantly fewer clinician-reported depression symptoms on the Hamilton Depression Rating Scale (P = .04), significantly better functioning on the Children's Global Assessment Scale (P = .04), significantly better overall social functioning on the Social Adjustment Scale–Self-Report (P = .01), significantly greater clinical improvement (P = .03), and significantly greater decrease in clinical severity (P = .03) on the Clinical Global Impressions scale. Conclusions Interpersonal psychotherapy delivered in school-based health clinics is an effective therapy for adolescent depression. This effort is a significant step toward closing the gap between treatment conducted in the laboratory and community clinic. [ABSTRACT FROM AUTHOR]

Context: Disulfiram has emerged as a promising treatment for cocaine dependence, but it has not yet been evaluated in general populations of cocaine users. Objectives: To compare the effectiveness of disulfiram therapy with that of a placebo condition in reducing cocaine use and to compare the effectiveness of 2 active behavioral therapies—cognitive behavior therapy (CBT) and interpersonal psychotherapy (IPT)—in reducing cocaine use. Design: Randomized, placebo-controlled, double-masked (for medication condition), factorial (2 × 2) trial with 4 treatment conditions: disulfiram plus CBT, disulfiram plus IPT, placebo plus CBT, and placebo plus IPT. Setting: A community-based outpatient substance abuse treatment program. Patients: A total of 121 individuals meeting the criteria for current cocaine dependence. Interventions: Patients received either disulfiram (250 mg/d) or placebo in identical capsules. Medication compliance was monitored using a riboflavin marker procedure. Both behavioral therapies (CBT and IPT) were manual guided and were delivered in individual sessions for 12 weeks. Main Outcome Measures: Random regression analyses of self-reported frequency of cocaine use and results of urine toxicology screens. Results: Participants assigned to disulfiram reduced their cocaine use significantly more than those assigned to placebo, and those assigned to CBT reduced their cocaine use significantly more than those assigned to IPT (P<.01 for both). Findings were consistent across all study samples (eg, intention to treat, treatment initiators, and treatment completers). Benefits of disulfiram use and CBT were most pronounced for participants who were not alcohol dependent at baseline or who fully abstained from drinking alcohol during treatment. Adverse effects experienced by participants who received disulfiram were mild and were not considerably different from those experienced by participants who received placebo. Conclusions: Disulfiram and CBT are effective therapies for general populations of cocaine-dependent individuals. Disulfiram seems to exert a direct effect on cocaine use rather than through reducing concurrent alcohol use. [ABSTRACT FROM AUTHOR]

Context: Depressive disorders are common among opiate abusers and are associated with detrimental behavioral effects. However, there is little precedent for offering active drug users complex treatments for depression. Objective: To determine whether combined psychotherapy and pharmacotherapy treatment reduces reported depressive symptoms compared with an assessment-only condition among out-of-treatment drug injectors. Design: Randomized controlled trial. Setting: Research office located at an academic medical center. Patients: Active injection drug users with a DSM-IV diagnosis of major depression, dysthymia, substance-induced mood disorder with symptoms persisting for at least 3 months, or major depression plus dysthymia, and a Modified Hamilton Rating Scale for Depression (HAM-D) score greater than 13. Intervention: Combined psychotherapy (8 sessions of cognitive behavior therapy) plus pharmacotherapy (citalopram). Main Outcome Measures: Modified HAM-D scale scores at the end of 3 months of combined treatment. Results: The 109 study subjects were 64% male and had a mean age of 36.7 years and a mean baseline HAM-D score of 20.7. Depression subtypes included major depression only (63%), substance-induced depression (17%), and major depression plus dysthymia (17%). In the intent-to-treat analysis, participants in treatment averaged 2.11 HAM-D points greater improvement than control subjects (P = .08), and 26.1% of combined treatment patients (n = 53) compared with 12.5% of control patients (n = 56) were in remission (P = .047). Nearly 40% of fully adherent subjects (receiving >75% of either psychotherapy or pharmacotherapy) were in remission at follow-up (odds ratio, 3.6; P = .04). Conclusions: Combined treatment for depression is significantly superior to a control condition (assessment only) in proportion of patients in remission, but not in HAM-D improvement among drug injectors. Full adherence to treatment is associated with the largest treatment effects. Our findings demonstrate that active drug users with dual diagnoses are able to participate in conventional treatment. [ABSTRACT FROM AUTHOR]

Background: Bipolar patients are at risk for relapses of their illness even when undergoing optimal pharmacotherapy. This study was performed to determine whether combining family-focused therapy (FFT) with pharmacotherapy during a postepisode interval enhances patients' mood stability during maintenance treatment. Methods: In a randomized controlled trial, 101 bipolar patients were assigned to FFT and pharmacotherapy or a less intensive crisis management (CM) intervention and pharmacotherapy. Outcome assessments were conducted every 3 to 6 months for 2 years. Participants (mean ± SD age, 35.6 ± 10.2 years) were referred from inpatient or outpatient clinics after onset of a manic, mixed, or depressed episode. FFT consisted of 21 sessions of psychoeducation, communication training, and problem-solving skills training. Crisis management consisted of 2 sessions of family education plus crisis intervention sessions as needed. Both protocols lasted 9 months. Patients received pharmacotherapy for 2 study years. Main outcome measures included time to relapse, depressive and manic symptoms, and medication adherence. Results: Rates of study completion did not differ across the FFT (22/31, 71%) and CM groups (43/70, 61%). Patients undergoing FFT had fewer relapses (11/31, 35%) and longer survival intervals (mean ± SD, 73.5 ± 28.8 weeks) than patients undergoing CM (38/70, 54%; mean ± SD, 53.2 ± 39.6 weeks; hazard ratio, 0.38; 95% confidence interval, 0.20-0.75; P = .003; intent to treat). Patients undergoing FFT showed greater reductions in mood disorder symptoms and better medication adherence during the 2 years than patients undergoing CM. Conclusion: Combining family psychoeducation with pharmacotherapy enhances the postepisode symptomatic adjustment and drug adherence of bipolar patients. [ABSTRACT FROM AUTHOR]

Background: Elderly persons (≥ 65 years) have the highest rate of suicide; still, little is known about the occurrence, course, and responsivity of suicidal ideation during treatment of depression in late life and how suicidality affects treatment response. Methods: This study was undertaken to determine (1) how suicidal ideation changes during short-term depression treatment and (2) whether treatment response differs among 3 groups of patients based on their levels of suicidality at baseline and during treatment (those with a recent suicide attempt or current suicidal ideation [high-risk group; n = 46], those with recurrent thoughts of death [moderate-risk group; n = 143], or those with no suicide attempt, suicidal ideation, or thoughts of death [low-risk group; n = 206]). This is a secondary analysis of pooled data from 3 treatment studies of late-life major depression. Participants were 395 elderly persons with a current major depressive episode, treated as inpatients or outpatients under protocolized conditions with paroxetine hydrochloride or nortriptyline hydrochloride, with or without interpersonal psychotherapy. Changes in suicidal ideation over time, rate of responses, and time to response in each group were compared. Results: Suicidal ideation decreased rapidly early in the course of treatment, with more gradual change thereafter. At the beginning of treatment, 77.5% of the patients reported suicidal ideation, thoughts of death, or feelings that life is empty. After 12 weeks of treatment, suicidal ideation had resolved in all treated patients; 4.6% still reported thoughts of death. However, 6-week (P = .001) and 12-week (P = .02) rates of response were significantly lower in high-risk patients than in low- and moderate-risk patients. High- and moderate-risk patients needed a significantly (P < .001) longer time to respond than low-risk patients (median time to response, 6 and 5 vs 3 weeks). Conclusions: While suicidal ideation resolves rapidly,... [ABSTRACT FROM AUTHOR]

Background: Studies on individual psychotherapy indicate that some interventions may reduce the number of recurrences in bipolar patients. However, there has been a lack of structured, well-designed, blinded, controlled studies demonstrating the efficacy of group psychoeducation to prevent recurrences in patients with bipolar I and II disorder. Methods: One hundred twenty bipolar I and II outpatients in remission (Young Mania Rating Scale score <6, Hamilton Depression Rating Scale–17 score <8) for at least 6 months prior to inclusion in the study, who were receiving standard pharmacologic treatment, were included in a controlled trial. Subjects were matched for age and sex and randomized to receive, in addition to standard psychiatric care, 21 sessions of group psychoeducation or 21 sessions of nonstructured group meetings. Subjects were assessed monthly during the 21-week treatment period and throughout the 2-year follow-up. Results: Group psychoeducation significantly reduced the number of relapsed patients and the number of recurrences per patient, and increased the time to depressive, manic, hypomanic, and mixed recurrences. The number and length of hospitalizations per patient were also lower in patients who received psychoeducation. Conclusion: Group psychoeducation is an efficacious intervention to prevent recurrence in pharmacologically treated patients with bipolar I and II disorder. [ABSTRACT FROM AUTHOR]

Background: Sustained-release bupropion hydrochloride and nortriptyline hydrochloride have been shown to be efficacious in the treatment of cigarette smoking. It is not known whether psychological intervention increases the efficacy of these antidepressants. This study compared both drugs with placebo. It also examined the efficacy of these 2 drugs and placebo with and without psychological intervention. Methods: This was a 2 (medical management vs psychological intervention) x 3 (bupropion vs nortriptyline vs placebo) randomized trial. Participants were 220 cigarette smokers. Outcome measures were biologically verified abstinence from cigarettes at weeks 12, 24, 36, and 52. Results: Psychological intervention produced higher 7-day point-prevalence rates of biochemically verified abstinence than did medical management alone. With the use of point-prevalence abstinence, both nortriptyline and bupropion were more efficacious than placebo. On rates of 1-year continuous abstinence, the 2 drugs did not differ from each other or from placebo. Psychological intervention did not differ from medical management alone on rates of 1-year continuous abstinence. Conclusions: Both nortriptyline and bupropion are efficacious in producing abstinence in cigarette smokers. Similarly, psychological intervention produces better abstinence rates than simple medical management. Both drugs, and psychological intervention, have limited efficacy in producing sustained abstinence. The data also suggest that combined psychological intervention and antidepressant drug treatment may not be more effective than antidepressant drug treatment alone. [ABSTRACT FROM AUTHOR]

Background: Postpartum depression causes women great suffering and has negative consequences for their social relationships and for the development of their infants. Research is needed to evaluate the efficacy of psychotherapy for postpartum depression. Methods: A total of 120 postpartum women meeting DSM-IV criteria for major depression were recruited from the community and randomly assigned to 12 weeks of interpersonal psychotherapy (IPT) or to a waiting list condition (WLC) control group. Subjects completed interview and self-report assessments of depressive symptoms and social adjustment every 4 weeks. Results: Ninety-nine of the 120 patients completed the protocol. Hamilton Rating Scale for Depression (HRSD) scores of women receiving IPT declined from 19.4 to 8.3, a significantly greater decrease than occurred in the WLC group (19.8 to 16.8). The Beck Depression Inventory (BDI) scores of women who received IPT declined from 23.6 to 10.6 over 12 weeks, a significantly greater decrease than occurred in the WLC group (23.0 to 19.2). A significantly greater proportion of women who received IPT recovered from their depressive episode based on HRSD scores of 6 or lower (37.5%) and BDI scores of 9 or lower (43.8%) compared with women in the WLC group (13.7% and 13.7%, respectively). Women receiving IPT also had significant improvement on the Postpartum Adjustment Questionnaire and the Social Adjustment Scale–Self-Report relative to women in the WLC group. Conclusions: These findings suggest that IPT is an efficacious treatment for postpartum depression. Interpersonal psychotherapy reduced depressive symptoms and improved social adjustment, and represents an alternative to pharmacotherapy, particularly for women who are breastfeeding. [ABSTRACT FROM AUTHOR]

Background: To our knowledge, this study provides the first national estimates for use of practitioner-based complementary treatments by US residents reporting mental conditions. Methods: A total of 16,038 respondents to the 1996 Medical Expenditure Panel Survey were asked about visits for 12 complementary medical services (eg, chiropractic services and herbal remedies). Bivariate and multiple regression models examined use of these therapies in individuals reporting a mental condition (n=1803), fair or poor mental health status (n=992), and 1 of 4 chronic medical conditions (n=3262) and in the remainder of the sample (n=10,793). Results: A total of 9.8% of those reporting a mental condition made a complementary visit, and about half of these (4.5%) made a visit to treat the mental condition. Persons reporting transient stress or adjustment disorders were most likely (odds ratio, 9.1%; 95% confidence interval, 5.5%-12.7%), and those with psychotic (odds ratio, 1.5%; 95% confidence interval, 0.0%-4.2%) and affective (odds ratio, 2.6%; 95% confidence interval, 1.5%-3.8%) conditions least likely, to use complementary therapies to treat their mental condition. In multivariate models controlling for medical comorbidity, fair or poor mental health status, and demographic factors, report of a mental condition predicted a 1.27-fold increase in the odds of a complementary visit (95% confidence interval, 1.04-1.54). Conclusions: Self-reported mental conditions were associated with increased use of complementary treatments, although use of these treatments was concentrated in respondents with transient distress rather than chronic and serious conditions. More research using structured diagnostic interviews is needed to examine the prevalence, patterns, and clinical implications of use of these treatments by individuals with mental conditions in "real world" community settings. [ABSTRACT FROM AUTHOR]

Background: Cognitive behavioral therapy has been shown to be more efficacious than alternative psychosocial interventions for the acute treatment of adolescents with major depressive disorder. However, the long-term impact of brief psychosocial interventions on the course of adolescent depression is not well established. Methods: One hundred seven adolescents with major depressive disorder randomly assigned to 12 to 16 weeks of cognitive behavioral therapy, systemic behavioral family therapy, or nondirective supportive therapy were evaluated for 2 years after the psychotherapy trial to document the subsequent course and predictors of major depressive disorder. Results: There were no long-term differential effects of the 3 psychotherapies. Most participants (80%) recovered (median time, 8.2 months from baseline), and 30% had a recurrence (median time, 4.2 months from recovery). Twenty-one percent were depressed during at least 80% of the follow-up period. Severity of depression (at baseline) and presence of self-reported parent-child conflict (at baseline and during the follow-up period) predicted lack of recovery, chronicity, and recurrence. Despite the similarity to clinically referred patients at baseline, patients recruited via advertisement were less likely to experience a recurrence. Conclusions: There were no significant differences in long-term outcome among cognitive behavioral therapy, systematic behavioral family therapy, and nondirective supportive therapy. While most participants in this study eventually recovered, those with severe depression and self-perceived parent-child conflict are at greater risk for chronic depression and recurrences. [ABSTRACT FROM AUTHOR]

Background: This was a multicenter investigation examining the efficacy of 4 psychosocial treatments for cocaine-dependent patients. Methods: Four hundred eighty-seven patients were randomly assigned to 1 of 4 manual-guided treatments: individual drug counseling plus group drug counseling (GDC), cognitive therapy plus GDC, supportive-expressive therapy plus GDC, or GDC alone. Treatment was intensive, including 36 possible individual sessions and 24 group sessions for 6 months. Patients were assessed monthly during active treatment and at 9 and 12 months after baseline. Primary outcome measures were the Addiction Severity Index–Drug Use Composite score and the number of days of cocaine use in the past month. Results: Compared with the 2 psychotherapies and with GDC alone, individual drug counseling plus GDC showed the greatest improvement on the Addiction Severity Index–Drug Use Composite score. Individual group counseling plus GDC was also superior to the 2 psychotherapies on the number of days of cocaine use in the past month. Hypotheses regarding the superiority of psychotherapy to GDC for patients with greater psychiatric severity and the superiority of cognitive therapy plus GDC compared with supportive-expressive therapy plus GDC for patients with antisocial personality traits or external coping style were not confirmed. Conclusion: Compared with professional psychotherapy, a manual-guided combination of intensive individual drug counseling and GDC has promise for the treatment of cocaine dependence. [ABSTRACT FROM AUTHOR]

Addresses issues in neurosciences and psychiatry. Influence of life experience in altering gene expression; Neurobiological effects of psychotherapy; Relation between various physical illnesses and mood and anxiety regulation.