Body, Mind & Spirit Articles and Latest News

Psychological risk factors for graft rejection among liver transplant recipients.

Transplant Proc. 2011 May;43(4):1123-7

Authors: Calia R, Lai C, Aceto P, Luciani M, Saraceni C, Avolio AW, Agnes S

The purpose of this prospective study was to find psychological risk factors predicting acute, chronic, and psychological rejection in patients undergoing liver transplantation using Cognitive Behavioural Assessment (CBA-2.0). The primary scale included an assessment of fears, personality, obsessive-compulsive symptoms, state and trait anxiety, psychological reactions, and depression. We prospectively recruited 44 patients undergoing orthotopic liver transplantation (OLT). Exclusion criteria were: education level below secondary school, unstable clinical situation in an out-patient setting, fulminant hepatitis, psychotic disorders, neurocognitive deficits, dementia, serious mental retardation, current alcohol or drug abuse, recent ideation of or attempted suicide, and non-adherence to therapy. CBA-2.0 primary scale series of questionnaires were handed out to patients immediately after the medical examination, which had been performed to ascertain eligibility for OLT. Rejection (acute and/or chronic) was diagnosed according to clinical and histopathological criteria. Psychological rejection was diagnosed when patients declared, after transplantation, a refusal of the new organ which caused psychiatric symptoms requiring medical treatment and/or psychotherapy. Analysis of variance and logistic regression of psychological variables was performed to detect possible risk factors for each type of rejection. A greater fear of repulsive animals was able a predictor for an acute rejection episode (odds ratio = 1.1; P < .05). No other psychological pretransplant predictor was noted for chronic or psychological rejection. In patients undergoing OLT, preoperative emotions of fear could predict an acute graft rejection episode. These findings imply that pre-OLT screening should include psychological factors in addition to traditional medical criteria with intervention in selected cases.

PMID: 21620068 [PubMed - in process]

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How negative affect influences neural control processes underlying the resolution of cognitive interference: An event-related fMRI study.

Neurosci Res. 2011 May 23;

Authors: Melcher T, Born C, Gruber O

In this event-related fMRI study, we sought to investigate the influence of negative affect on the processing of two kinds of cognitive interference: Stroop-interference and oddball interference. For our purpose, we adopted an oddball variant of the Stroop task in which Stroop-interference and oddball interference conditions were created by presenting incongruent and rarely occurring word meanings, respectively. Immediately preceding the target stimuli, we presented pictures of the International Affective Picture System which were either emotionally negative and arousing or emotionally neutral, providing two affective conditions under which the cognitive task was administered. Both the behavioral and the neuroimaging data exhibited an interaction effect between emotional and cognitive condition. First, the emotion induction selectively impaired behavioral performance on interference trials while behavioral measures on non-interference trials were roughly identical in both emotional conditions. Second, in the negative emotional condition there was incremental interference-related activation in control-related regions (fronto-parietal cortices). Taken together, findings suggest that negative affect specifically disturbs the neural control processes that in a neutral affective state allow to select task-relevant information and to shield its processing from task-irrelevant distraction. Accordingly, agents in a negative affective state have to exert enhanced control efforts to resolve cognitive interference. Additional connectivity analyses revealed that a negative coupling between lateral PFC on the one hand and amygdala and OFC on the other is related to enhanced interference resolution which can be tentatively interpreted as evidence that emotional regulation is an integrated part of an agent’s efforts to preserve cognitive performance in affective situations.

PMID: 21620907 [PubMed - as supplied by publisher]

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Orexin A expression and promoter methylation in patients with alcohol dependence comparing acute and protracted withdrawal.

Alcohol. 2011 May 26;

Authors: Bayerlein K, Kraus T, Leinonen I, Pilniok D, Rotter A, Hofner B, Schwitulla J, Sperling W, Kornhuber J, Biermann T

The orexins (hypocretins) are neuropeptides deriving from the lateral hypothalamus and may be of importance within the context of drug craving, withdrawal, and relapse. Therefore, the orexin A expression and promoter methylation in peripheral blood cells of 68 patients (41 male and 27 female patients at three different time points during withdrawal and 27 patients during stationary dehabituation therapy) suffering from alcohol dependence were assessed by quantitative reverse transcription-polymerase chain reaction and bisulfite sequencing. There was a statistically significant difference of orexin A expression between the three time points of withdrawal and long-term (LT) abstinence (F=4.16, P=.011). This difference was most prominent in comparison with LT abstinence (t=-3.08, P=.0032). Expression was significantly associated with the severity of withdrawal symptoms measured with the Withdrawal Syndrome Scale for Alcohol and Related Psychoactive Drugs (WSA) (t=2.17, P=.0356). The stronger the withdrawal symptoms, the lower the orexin A expression (F=4.69, P=.036). Body mass index (t=2.15, P=.041), the severity of withdrawal measured with the WSA (t=2.595, P=.0133), craving measured either by the Obsessive Compulsive Drinking Scale (t=2.77, P=.0085) or the Lübecker Craving Questionnaire (t=-2.23, P=.0314) had a significant influence on orexin A expression taking into account mean methylation of the CpG island of the orexin A promoter during withdrawal. Orexin A may be a possible candidate to further elucidate mechanisms of alcohol withdrawal taking into account energy homoeostasis in the circuit of reward and motivation.

PMID: 21621370 [PubMed - as supplied by publisher]

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The effects of combined acamprosate and integrative behaviour therapy in the outpatient treatment of alcohol dependence: A randomized controlled trial.

Drug Alcohol Depend. 2011 May 27;

Authors: Wölwer W, Frommann N, Jänner M, Franke PE, Scherbaum N, Lieb B, Falkai P, Wobrock T, Kuhlmann T, Radermacher M, Maier W, Schütz C, Ohmann C, Burtscheidt W, Gaebel W

AIMS: The aim of this randomized, controlled, multisite trial was to evaluate the efficacy of combined treatment with integrative behaviour therapy (IBT) and acamprosate on drinking behaviour in detoxified alcohol-dependent patients. METHODS: A total of 371 patients were randomized to one of the three treatment conditions: IBT plus acamprosate, IBT plus placebo, or supportive counselling (’treatment as usual’, TAU) plus acamprosate. The main outcome was success rate, i.e., rate of abstinence plus improvement according to the criteria of Feuerlein and Küfner (1989), at the end of the six-month treatment phase and at the subsequent six-month follow-up. Drinking status was validated by blood parameters (CDT, GGT, and MCV). Data were analyzed by an intent-to-treat model and missing data were classified as relapse. RESULTS: The success rates at the end of treatment under both TAU plus acamprosate (37.7%) and IBT plus placebo (48%) almost reached the levels derived from the literature. However, adding acamprosate to IBT did not result in the expected increase in success rate (IBT plus acamprosate: 47.6%), and success rates did not differ significantly between groups. Similarly, there was no significant difference between treatment success rates at follow-up. CONCLUSION: The results suggest that the combination of acamprosate and IBT is not more effective than treatment with either IBT or acamprosate alone. However, the two acamprosate conditions differed in success rate by about 10%, which might constitute a clinically relevant though statistically non-significant effect.

PMID: 21621929 [PubMed - as supplied by publisher]

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Changes in self and object representations following psychotherapy measured by a theory-free, computational, semantic space method.

Psychother Res. 2011 May 27;:1-17

Authors: Arvidsson D, Sikstrom S, Werbart A

We propose a theory-neutral, computational and data-driven method for assessing changes in semantic content of object representations following long-term psychodynamic psychotherapy. Young adults in psychotherapy are compared with an age-matched, non-clinical sample at three time points. Verbatim transcripts of descriptions of the self and parents were quantified in a semantic space constructed by Latent Semantic Analysis. In the psychotherapy group, all representations changed from baseline to follow-up, whereas no comparable changes could be observed in the comparison group. The semantic space method supports the hypothesis that long-term psychodynamic psychotherapy contributes to sustained change of affective-cognitive schemas of self and others.

PMID: 21623547 [PubMed - as supplied by publisher]

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Therapist effectiveness: Implications for accountability and patient care.

Psychother Res. 2011 May;21(3):267-76

Authors: Kraus DR, Castonguay L, Boswell JF, Nordberg SS, Hayes JA

Significant therapist variability has been demonstrated in both psychotherapy outcomes and process (e.g., the working alliance). In an attempt to provide prevalence estimates of “effective” and “harmful” therapists, the outcomes of 6960 patients seen by 696 therapists in the context of naturalistic treatment were analyzed across multiple symptom and functioning domains. Therapists were defined based on whether their average client reliably improved, worsened, or neither improved nor worsened. Results varied by domain with the widespread pervasiveness of unclassifiable/ineffective and harmful therapists ranging from 33 to 65%. Harmful therapists demonstrated large, negative treatment effect sizes (d=-0.91 to -1.49) while effective therapists demonstrated large, positive treatment effect sizes (d=1.00 to 1.52). Therapist domain-specific effectiveness correlated poorly across domains, suggesting that therapist competencies may be domain or disorder specific, rather than reflecting a core attribute or underlying therapeutic skill construct. Public policy and clinical implications of these findings are discussed, including the importance of integrating benchmarked outcome measurement into both routine care and training.

PMID: 21623550 [PubMed - in process]

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Therapeutic work with the present moment: A comparative conversation analysis of existential and cognitive therapies.

Psychother Res. 2011 May;21(3):316-30

Authors: Kondratyuk N, Perakyla A

Therapeutic work with the client’s present moment experience in existential therapy was studied by means of conversation analysis. Using publicly available video recordings of therapy sessions as data, an existential therapist’s practice of guiding a client into immediacy, or refocusing the talk on a client’s immediate experience, was described and compared with a therapist’s corresponding action in cognitive therapy. The study contributes to the description of interactional practice of existential therapy, and involves the first application of conversation analysis to a comparative study of psychotherapy process. The potential utility of this approach and the clinical and empirical implications of the present findings are discussed.

PMID: 21623551 [PubMed - in process]

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The vaginal ring (NuvaRing®) for contraception in adolescent women.

Gynecol Endocrinol. 2011 May 26;

Authors: Bitzer J

Adolescence is a phase of life of utmost importance for the present and future physical, psychological, and social health of individuals of both genders. Contraception as a preventive measure and behavior has to be integrated into this developmental context. The aim hereby is not only the prevention of unwanted pregnancies, but also the maintenance and promotion of reproductive and sexual health in a broader sense. This includes protection against sexually transmitted diseases (STI), preservation of fertility, promotion of a self-determined and satisfying sexual life, diminution of general health risks and prevention of diseases which may occur later in life. The vaginal contraceptive ring seems to respond to most of these needs except for protection against STI. In conclusion, the vaginal ring is for these reasons an important option in the contraceptive care of adolescents.

PMID: 21615237 [PubMed - as supplied by publisher]

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Association between the prevalence of depression and age in a large representative German sample of people aged 53 to 80 years.

Int J Geriatr Psychiatry. 2011 May 25;

Authors: Wild B, Herzog W, Schellberg D, Lechner S, Niehoff D, Brenner H, Rothenbacher D, Stegmaier C, Raum E

OBJECTIVE: The aim of the study was to determine the association between the prevalence of clinically significant depression and age in a large representative sample of elderly German people. METHODS: In the second follow-up (2005-2007) of the ESTHER cohort study, the 15-item geriatric depression scale (GDS-15) as well as a sociodemographic and clinical questionnaire were administered to a representative sample of 8270 people of ages 53 to 80 years. The prevalence of clinically significant depression was estimated using a GDS cut-off score of 5/6. Prevalence rates were estimated for the different age categories. Association between depression and age was analyzed using logistic regression, adjusted for gender, co-morbid medical disorders, education, marital status, physical activity, smoking, self-perceived cognitive impairment, and anti-depressive medication. RESULTS: Of the participants, 7878 (95.3%) completed more than twelve GDS items and were included in the study. The prevalence of clinically significant depression was 16.0% (95%CI = [15.2; 16.6]). The function of depression prevalence dependent on age group showed a U-shaped pattern (53-59: 21.0%, CI = [18.9; 23.3]; 60-64: 17.7%, CI = [15.7; 19.7]; 65-69: 12.6%, CI = [11.2; 14.0]; 70-74: 14.4%, CI = [12.6; 16.0]; 75-80: 17.1%, CI = [14.9; 19.4]). Adjusted odds ratios showed that the chances of being depressive decrease with the age category but remain relatively stable for people aged 65 and over. CONCLUSIONS: The prevalence of depression in the elderly seems to be associated with the age category. Adjusted odds ratios showed that people aged 60 and older had lower chances of being depressive than people aged 53 to 59 years. Copyright © 2011 John Wiley & Sons, Ltd.

PMID: 21618284 [PubMed - as supplied by publisher]

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Life events and dementia: What is the nature of their relationship?

Psychiatry Res. 2011 May 28;

Authors: Fountoulakis KN, Pavlidis I, Tsolaki M

The current study analyzed the life events reported by 1271 demented patients vs. 140 cognitively healthy elderly subjects. The Life Change Unit (LCU) method was used to quantify the results. When all the events were included in the analysis, the two groups had similar LCU scores (61.26 vs. 63.42). However, when events causally related to dementia (e.g. stroke) are excluded, demented patients were found to experience half of the LCU load in comparison to controls (30.70 vs. 63.42). In both groups the level of LCU load is far below 100 which is the threshold suggested for the induction of psychosomatic disorders. Conclusively, the current study suggests that there is no causal role for life events in the etiopathogenesis of dementia. On the contrary, demented patients even the last few months before the clinical onset of dementia experience low life-events-related stress, possibly because of subclinical impairment which is already present.

PMID: 21621852 [PubMed - as supplied by publisher]

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