Current Issue : October - December Volume : 2016 Issue Number : 4 Articles : 5 Articles
Background: Cognitive models of obsessive-compulsive disorder suggest that changes in obsessive beliefs are a\nkey mechanism of treatments for obsessive-compulsive disorder. Thus, in the present process-outcome study, we\ntested whether changes in obsessive beliefs during a primarily cognitive behavioral inpatient treatment predicted\ntreatment outcome and whether these changes mediated symptom changes over the course of treatment.\nMethods: Seventy-one consecutively admitted inpatients with obsessive-compulsive disorder were assessed with\nthe Yale-Brown Obsessive-Compulsive Scale and the Obsessive Beliefs Questionnaire at treatment intake, after six\nweeks of treatment and at discharge, and with the Beck-Depression-Inventory-II at intake and discharge.\nResults: Changes in obsessive beliefs during the first six weeks of treatment predicted obsessive-compulsive\nsymptoms at discharge when controlling for obsessive-compulsive and depressive symptoms at intake in a\nhierarchical regression analysis. Multilevel mediation analyses showed that reductions in obsessive beliefs\npartially mediated improvements in obsessive-compulsive symptoms over time.\nConclusions: Our findings indicate that decreasing obsessive beliefs in inpatient cognitive behavioral therapy\nfor obsessive-compulsive disorder might be a promising treatment approach....
Background: The neurological correlates of Generalised Anxiety Disorder (GAD) are not well known, however there\nis evidence of cortical dysregulation in patients with GAD. The aim of the study was to examine cortical functional\nactivity in different cerebral regions in patients with GAD using electroencephalogram (EEG) nonlinear analysis to\nevaluate its contribution of anxiety severity.\nMethods: The cohorts consisted of 64 patients diagnosed with GAD as classified by the Structured Clinical\nInterview for the Diagnostic and Statistical Manual of the American Psychiatric Association-IV-TR. Anxiety severity was\nassessed using the Hamilton Rating Scale for Anxiety (HAMA) severity score, with 7 � scores � 17 indicating\nmild anxiety as A group (n = 31) and 18 and above indicating moderate-severe anxiety as B group (n = 33).\nParticipants with clinical levels of depression symptoms were excluded. A healthy control group comprising\n30 participants was matched for age and gender. Closed eyes EEGs were conducted, and between-group\ndifferences on non-linear parameter Correlation Dimension (D2) were analyzed. The association of D2 value\nwith HAMA scores was analyzed using multiple linear stepwise regression.\nResults: Compared with the control group, D2 values were increased in anxiety groups (P < .05). For those\nwith mild anxiety, this difference occurred in the left prefrontal regions (P < .05). For those with moderate-severe\nanxiety, significantly greater D2 values were observed in all of the cerebral regions, especially in the left cerebral\nregions and right temporal lobe (P < .01). When compared with those with mild anxiety, D2 values were significantly\ngreater for those with moderate-severe anxiety in the right temporal lobe and all left cerebral regions except\nfor left occipital lobe (P < .05). A positive correlation was observed between D2 values and moderate-severe\nanxiety HAMA scores.\nConclusions: The increased D2 values were found in the majority of cerebral regions in GAD patients, especially in\nthe left cerebral regions and the right temporal lobe. The increased GAD severity positively correlates to the D2 values\nin a larger number of cerebral regions. This analysis method can potentially be used as a complementary tool\nto examine dysfunctional cortical activity in GAD....
Background: This multicenter, double-blind, placebo-controlled study assessed the efficacy of rotigotine\ntransdermal patch on apathy and motor symptoms in patients with Parkinsonââ?¬â?¢s disease (PD).\nMethods: Patients with PD-associated apathy (Unified Parkinson's Disease Rating Scale [UPDRS] I item 4\n[motivation] ââ?°Â¥2 and patient-rated Apathy Scale [AS] ââ?°Â¥14) were randomized 1:1:1 to ââ?¬Å?low-doseââ?¬Â rotigotine\n(ââ?°Â¤6 mg/24 h for early PD [those not receiving levodopa] or ââ?°Â¤8 mg/24 h for advanced PD [those receiving\nlevodopa]), ââ?¬Å?high-doseââ?¬Â rotigotine (ââ?°Â¤8 mg/24 h for early PD or ââ?°Â¤16 mg/24 h for advanced PD), or placebo, and\nmaintained at optimal/maximal dose for 12 weeks. Coprimary efficacy variables were: change from baseline to End\nof Maintenance in patient-rated AS and UPDRS II + III total score. Recruitment was stopped after an interim futility\nanalysis; therefore, all p values are exploratory.\nResults: Of 122 patients randomized, 81.1 % completed the study (placebo, n = 32/40 [80.0 %]; low-dose rotigotine,\nn = 30/41 [73.2 %]; high-dose rotigotine, n = 37/41 [90.2 %]). No treatment difference was observed in the change\nin patient-rated AS (least squares mean [95 % confidence interval (CI)] difference: low-dose, 0.04 [âË?â??2.42, 2.50],\np =0.977; high-dose, âË?â??0.22 [âË?â??2.61, 2.18], p = 0.859). Rotigotine improved UPDRS II + III total scores versus placebo\n(least squares mean [95 % CI] treatment difference: low-dose, âË?â??7.29 [âË?â??12.30, âË?â??2.28], p = 0.005; high-dose, âË?â??6.06 [âË?â??10.\n90, âË?â??1.21], p = 0.015), and the ââ?¬Å?mood/apathyââ?¬Â domain of the Non-Motor Symptom Scale as rated by the investigator\n(secondary outcome). The most frequent adverse events in rotigotine-treated patients were application site\nreactions, somnolence, and nausea.\nConclusions: Rotigotine did not improve PD-associated apathy as rated by the patient but provided clinically\nrelevant improvement in motor control and activities of daily living....
Background: Around two thirds stroke patients may suffer from vascular cognitive impairment (VCI). Our previous\nstudy has validated the NINDS-CSN harmonization standard for VCI diagnosis in Chinese. In this study, we aimed to\ninvestigate the predictors for VCI in Chinese post-stroke patients.\nMethods: We compared epidemiological, clinical, and neuroimaging data (number, size and location of acute\ninfarcts and lacunes, severities of white matter hyperintensities and brain atrophy) between stroke patients with\nand without VCI. Univariate and logistic regression analyses were utilized to determine VCI predictors.\nResults: Fifty-six consecutive patients (age, 63.8 Ã?± 8.3 years; female, 37.5 %) were recruited at a mean interval of 7.\n1 months after stroke onset, and 31 (55.4 %) patients were diagnosed with VCI based on a validated 60-min\nneuropsychological battery. VCI patients were older (p = 0.023), less educated (p = 0.001), more likely to be female\n(p < 0.001), had a recurrent stroke (p = 0.028), and described higher apathy (p = 0.022) and worse pre-stroke\ncognition (p = 0.048) than cognitively normal patients. Lower educational level (adjusted odds ratio [OR] 0.750,\n95 % confidence interval [CI], 0.573ââ?¬â??0.981; p = 0.035), female sex (adjusted OR 8.288, 95 % CI, 1.522ââ?¬â??45.113; p = 0.\n014), recurrent stroke (adjusted OR 11.327, 95 % CI, 1.335ââ?¬â??96.130, p = 0.026), and global cortical atrophy (adjusted\nOR 5.730, 95 % CI, 1.128ââ?¬â??29.101, p = 0.035) were independently associated with VCI in post-stroke patients.\nConclusions: Lower education, female sex, recurrent stroke and global cortical atrophy were associated with VCI in\nChinese stroke patients....
Background: Phase 3 trials supporting dextromethorphan/quinidine (DM/Q) use as a treatment for pseudobulbar\naffect (PBA) were conducted in patients with amyotrophic lateral sclerosis (ALS) or multiple sclerosis (MS). The PRISM II\nstudy provides additional DM/Q experience with PBA secondary to dementia, stroke, or traumatic brain injury (TBI).\nMethods: Participants in this open-label, multicenter, 90-day trial received DM/Q 20/10 mg twice daily. The primary\noutcome was the Center for Neurologic Study-Lability Scale (CNS-LS), assessing change in PBA episode frequency and\nseverity. The CNS-LS final visit score was compared to baseline (primary analysis) and to the response in a previously\nconducted placebo-controlled trial with DM/Q in patients with ALS or MS. Secondary outcomes included change in\nPBA episode count and Clinical Global Impression of Change with respect to PBA as rated by a clinician (CGI-C) and by\nthe patient or caregiver (PGI-C).\nResults: The study enrolled 367 participants with PBA secondary to dementia, stroke, or TBI. Mean (standard deviation\n[SD]) CNS-LS score improved significantly from 20.4 (4.4) at baseline to 12.8 (5.0) at Day 90/Final Visit (change, âË?â??7.7 [6.1]; P\n< .001, 95 % CI: âË?â??8.4, âË?â??7.0). This magnitude of improvement was consistent with DM/Q improvement in the earlier\nphase-3, placebo-controlled trial (mean [95 % CI] change from baseline, âË?â??8.2 [âË?â??9.4, âË?â??7.0]) and numerically exceeds the\nimprovement seen with placebo in that study (âË?â??5.7 [âË?â??6.8, âË?â??4.7]). Reduction in PBA episode count was 72.3 % at Day\n90/Final Visit compared with baseline (P < .001). Scores on CGI-C and PGI-C showed that 76.6 and 72.4 % of participants,\nrespectively, were ââ?¬Å?muchââ?¬Â or ââ?¬Âvery muchââ?¬Â improved with respect to PBA. The most frequently occurring adverse events\n(AEs) were diarrhea (5.4 %), headache (4.1 %), urinary tract infection (2.7 %), and dizziness (2.5 %); 9.8 % had AEs that led to\ndiscontinuation. Serious AEs were reported in 6.3 %; however, none were considered treatment related.\nConclusions: DM/Q was shown to be an effective and well-tolerated treatment for PBA secondary to dementia, stroke, or\nTBI. The magnitude of PBA improvement was similar to that reported in patients with PBA secondary to ALS or MS, and\nthe adverse event profile was consistent with the known safety profile of DM/Q....
Loading....