EMDR therapy vs. supportive therapy as adjunctive treatment in trauma-exposed bipolar patients: A randomised controlled trial.

INTRODUCTION: Patients with bipolar disorder (BD) are frequently exposed to traumatic events which worsen disease course, but this study is the first multicentre randomised controlled trial to test the efficacy of a trauma-focused adjunctive psychotherapy in reducing BD affective relapse rates. MATERIALS AND METHODS: This multicentre randomised controlled trial included 77 patients with BD and current trauma-related symptoms. Participants were randomised to either 20 sessions of trauma-focused Eye Movement Desensitization and Reprocessing (EMDR) therapy for BD, or 20 sessions of supportive therapy (ST). The primary outcome was relapse rates over 24-months, and secondary outcomes were improvements in affective and trauma symptoms, general functioning, and cognitive impairment, assessed at baseline, post-treatment, and at 12- and 24-month follow-up. The trial was registered prior to starting enrolment in clinical trials (NCT02634372) and carried out in accordance with CONSORT guidelines. RESULTS: There was no significant difference between treatment conditions in terms of relapse rates either with or without hospitalisation. EMDR was significantly superior to ST at the 12-month follow up in terms of reducing depressive symptoms (p=0.0006, d=0.969), manic symptoms (p=0.027, d=0.513), and improving functioning (p=0.038, d=0.486). There was no significant difference in dropout between treatment arms. CONCLUSIONS: Although the primary efficacy criterion was not met in the current study, trauma-focused EMDR was superior to ST in reducing of affective symptoms and improvement of functioning, with benefits maintained at six months following the end of treatment. Both EMDR and ST reduced trauma symptoms as compared to baseline, possibly due to a shared benefit of psychotherapy. Importantly, focusing on traumatic events did not increase relapses or dropouts, suggesting psychological trauma can safely be addressed in a BD population using this protocol.

High incidence of PTSD diagnosis and trauma-related symptoms in a trauma exposed bipolar I and II sample.

Background: Post-traumatic stress disorder (PTSD) is an established comorbidity in Bipolar Disorder (BD), but little is known about the characteristics of psychological trauma beyond a PTSD diagnosis and differences in trauma symptoms between BD-I and BD-II. Objective: (1) To present characteristics of a trauma-exposed BD sample; (2) to investigate prevalence and trauma symptom profile across BD-I and BD-II; (3) to assess the impact of a lifetime PTSD diagnosis vs. a history of trauma on BD course; and (4) to research the impacts of sexual and physical abuse. Methods: This multi-center study comprised 79 adult participants with BD with a history of psychological trauma and reports baseline data from a trial registered in Clinical Trials (https://clinicaltrials.gov; ref: NCT02634372). Clinical variables were gathered through clinical interview, validated scales and a review of case notes. Results: The majority (80.8%) of our sample had experienced a relevant stressful life event prior to onset of BD, over half of our sample 51.9% had a lifetime diagnosis of PTSD according to the Clinician Administered PTSD scale. The mean Impact of Event Scale-Revised scores indicated high levels of trauma-related distress across the sample, including clinical symptoms in the PTSD group and subsyndromal symptoms in the non-PTSD group. Levels of dissociation were not higher than normative values for BD. A PTSD diagnosis (vs. a history of trauma) was associated with psychotic symptoms [2(1) = 5.404, p = 0.02] but not with other indicators of BD clinical severity. There was no significant difference between BD-I and BD-II in terms of lifetime PTSD diagnosis or trauma symptom profile. Sexual abuse significantly predicted rapid cycling [2(1) = 4.15, p = 0.042], while physical abuse was not significantly associated with any clinical indicator of severity. Conclusion: Trauma load in BD is marked with a lack of difference in trauma profile between BD-I and BD-II. Although PTSD and sexual abuse may have a negative impact on BD course, in many indicators of BD severity there is no significant difference between PTSD and subsyndromal trauma symptoms. Our results support further research to clarify the role of subsyndromic PTSD symptoms, and highlight the importance of screening for trauma in BD patients.

Mental disorders, psychopharmacological treatments, and mortality in 2150 COVID-19 Spanish inpatients.

OBJECTIVE: To determine how mental disorders and psychopharmacological treatments before and during COVID-19 hospital admissions are related to mortality. METHODS: Subjects included in the study were all adult patients with a diagnosis of COVID-19, confirmed clinically and by PCR, who were admitted to a tertiary university hospital in Badalona (Spain) between March 1 and November 17, 2020. Data were extracted anonymously from computerized clinical records. RESULTS: 2,150 subjects were included, 57% males, mean age 61 years. History of mental disorders was registered in 957 (45%). Throughout admission, de novo diagnosis of mood or anxiety, stress, or adjustment disorder was made in 12% of patients without previous history. Delirium was diagnosed in 10% of cases. 1011 patients (47%) received a psychotropic prescription during admission (36% benzodiazepines, 22% antidepressants, and 21% antipsychotics). Mortality rate was 17%. Delirium during admission and history of mood disorder were independently associated with higher mortality risk (hazard ratios, 1.39 and 1.52 respectively), while previous year's treatments with anxiolytics/hypnotics and antidepressants were independently associated with lower mortality risk (hazard ratios, 0.47 and 0.43, respectively). CONCLUSION: Mental symptoms are very common in patients hospitalized for COVID-19 infection. Detecting, diagnosing, and treating them is key to determining the prognosis of the disease and functional recovery.

Los soldados persas de las cortinas de foulkes, o la agresividad en terapia de grupo / No disponible

La agresividad ofrece un potencial creativo y de transformación al grupo, y la importancia de atender a la parte más oscura, disruptiva del ser humano permite que potenciemos el insight y la integración de nuevos puntos de vista. Atenderemos no sólo a las áreas en las que la psicoterapia de grupo ayuda al individuo, sino también a las dificultades que estar en un grupo de estas características genera. Tomando como guía el concepto de antigrupo redefinido por Nitsun en 2015, y las aportaciones de Bion y Foulkes a la hora de explicar los fenómenos grupales, describimos los procesos destructivos que tienen lugar, amenazan y potencian el funcionamiento de los grupos de psicoterapia para la deshabituación de sustancias psicoactivas. Más allá de los procesos intragrupales relacionados con la tarea, tales manifestaciones de agresividad pueden derivar de la actitud de los terapeutas: Su impacto en la capacidad para crear un ambiente sustentador, creativo y de transformación individual y grupal es fundamental

Aggressiveness offers a creative potential of transformation to the group. The importance of attending to the darkest, disruptive parts of the human beings, promotes insight and integration of new points of view. We will not just consider the areas in which the group psychotherapy helps the individual, but also the difficulties that being in a group of these characteristics generates. Taking as a guide the concept of anti-group revisited by Nitsun in 2015, and the contributions of both Bion and Foulkes explaining the group phenomena, we describe the destructive processes that take place, threaten and promote the functioning of the psychotherapy groups for patients with a drug addiction problem. Beyond the processes related to the task, such manifestations of aggressiveness can derive from the therapists' attitude to the work, which is key in creating a supportive environment of individual and group transformation

Cognitive impairment associated with cocaine use: The role of co-existent alcohol abuse/dependence.

BACKGROUND: Cocaine abuse has been reported as leading to impaired cognitive function. However, cocaine abusers commonly also abuse alcohol, which can itself produce cognitive impairment. This study, therefore, aimed to examine the potential confounding effect of alcohol abuse on neuropsychological test performance in cocaine and alcohol abusing individuals, comparing them with individuals who abused alcohol alone and non-abusing controls. METHODS: Nineteen cocaine abusers who also met DSM-IV criteria for alcohol abuse/dependence (14 m, 5f; mean age 38.65 ±â€¯3.83) and 20 matched individuals who met criteria for alcohol abuse/dependence alone (12 m, 8f; mean age 38.19 ±â€¯4.82) were administered a battery of neuropsychological tests covering executive function, memory, language and visual/visuospatial function after two to four weeks of abstinence. Nineteen matched healthy controls (8 m, 11f; mean age 37.01 ±â€¯5.98) were also tested. RESULTS: Both the cocaine + alcohol group and the alcohol group performed significantly more poorly than the healthy controls on the executive (ESs 2.13 and 2.57) and memory tests (ESs 0.58 and 1.06). The findings were similar for language (ESs 0.92 and 1.69), where the cocaine + alcohol abusers additionally performed significantly better than the alcohol abusers. Both patient groups were impaired on two of the five tests of visual/visuospatial function, with better performance by the cocaine + alcohol group on one of them. CONCLUSIONS: Chronic cocaine abuse does not appear from this study to be associated with cognitive impairment over and above that which can be attributed to co-existent alcohol abuse.

Psicoterapia grupal de seguimiento en adicciones: de la hospitalización al tratamiento ambulatorio / No disponible

El presente trabajo evalúa laefectividad de unapsicoterapia grupal de seguimiento para pacientes que tras un ingreso en una unidad hospitalaria para elmantenimiento de laabstinencia alargo plazo (AU)

The present study evaluatesthe effectiveness of group psychotherapy treatment for patients who, after hospitalization for detox andpsychiatric stabilization,return to outpatient treatment. The authors conducted a 30-month longitudinal study. The sample was obtained from those patients admitted to Benito Menni’s Dual Pathology Unit. All those patients were referred from Sant Boi’s CAS, Benito Menni CASM. The authors compared the results obtained in the experimental group (group psychotherapy) with those form the control group (usual treatment) in terms of relapse rate, insight into their illnesses, adherence to treatment, and maintenance of abstinence. The results show how specific group psychotherapy for patients who transit from outpatients to inpatients care can reinforcethemaintenance of long-termabstinence (AU)