ABSTRACT
BACKGROUND: The use of antidepressant therapy alone has a limited efficacy in patients with childhood trauma-associated major depressive disorder (MDD). However, the effectiveness of antidepressant treatment combined with psychodrama in these patients is unclear. AIM: To evaluate the effectiveness of antidepressant treatment combined with psychodrama. METHODS: Patients with childhood trauma-associated MDD treated with antidepressants were randomly assigned to either the psychodrama intervention (observation group) or the general health education intervention (control group) and received combination treatment for 6 mo. The observation group received general health education given by the investigator together with the "semi-structured group intervention model" of Yi Shu psychodrama. A total of 46 patients were recruited, including 29 cases in the observation group and 17 cases in the control group. Symptoms of depression and anxiety as well as coping style and resting-state functional magnetic resonance imaging were assessed before and after the intervention. RESULTS: Symptoms of depression and anxiety, measured by the Hamilton Depression Scale, Beck Depression Inventory, and Beck Anxiety Inventory, were reduced after the intervention in both groups of patients. The coping style of the observation group improved significantly in contrast to the control group, which did not. In addition, an interaction between treatment and time in the right superior parietal gyrus node was found. Furthermore, functional connectivity between the right superior parietal gyrus and left inferior frontal gyrus in the observation group increased after the intervention, while in the control group the connectivity decreased. CONCLUSION: This study supports the use of combined treatment with antidepressants and psychodrama to improve the coping style of patients with childhood trauma-associated MDD. Functional connectivity between the superior parietal gyrus and inferior frontal gyrus was increased after this combined treatment. We speculate that psychodrama enhances the internal connectivity of the cognitive control network and corrects the negative attention bias of patients with childhood trauma-associated MDD. Elucidating the neurobiological features of patients with childhood trauma-associated MDD is important for the development of methods that can assist in early diagnosis and intervention.
ABSTRACT
OBJECTIVE: To evaluate the effect of preoperative chemotherapy on bulky cervical cancer by internal iliac arterial infusion. METHODS: One hundred and eighty-six patients with bulky cervical cancer were randomly divided into two groups: chemotherapy + radiotherapy group (C + R group, n = 105) and radiotherapy group (R group, n = 81). Patients in C + R group underwent internal iliac arterial infusion chemotherapy by using Seldinger technique internal iliac arterial or epigastric arterial catheterization. Combined regimens were prescribed including cisplatin as the major drug. Meanwhile 192Ir high-dose-rate intracavitary radiotherapy was performed, with A point dose at 12 - 24 Gy/2-4 times (C + R group). Patients in R group were only given radiotherapy. Both groups of patients received radical hysterectomy two weeks after radiotherapy. RESULTS: The tumor regression rate of C + R group was 97.1%, significantly higher than 79.0% in R group (P < 0.01). The effective rate for clinical Ib stage cancer in C + R group was 100.0%, significantly higher than 78.3% in R group (P < 0.01), but for clinical IIa, IIb stage cancers, the effective rate between two groups had no obvious difference (P > 0.05). Postoperative pathologic examinations showed the percentage of cervical tumor residue, parauterine invasion, pelvic lymph node metastasis in C + R group was lower than those of R group (P < 0.01). The 2-year recurrent rate in R group (23.5%) was higher than that of C + R group (6.7%, P < 0.01), but 2-year survival rate between two groups had no obvious difference. CONCLUSIONS: Internal iliac arterial infusion chemotherapy can effectively reduce tumor volume, decrease lymph node and subclinical metastasis rates and postoperative recurrence rate; it can also improve radical resectability of patients with stage IIb cervical cancer. But the effect on long-term survival rate needs to be further evaluated through long-term follow-up of patients.
