Elements in Mental Health Interventions Associated with Effects on Emotion Regulation in Adolescents: A Meta-Analysis.

PURPOSE: Adolescence is a sensitive period for developing mental health problems. Interventions targeting emotion regulation have shown promising transdiagnostic effects for this group, but optimization efforts are called for. In the current study, we used an element-based approach to identify potentially active ingredients in interventions measuring emotion regulation, to guide further optimization. METHODS: We coded practice elements in 30 studies based on a systematic review of mental health interventions measuring emotion regulation in adolescents (N = 2,389 participants, mean age 13-17 years). Using a three-level modeling approach, we then investigated the difference in effect on emotion regulation between studies of interventions with and without these practice elements. RESULTS: We identified 75 practice elements and 15 element categories used in the included interventions. Results showed significantly stronger effects on emotion regulation when interventions included the practice elements Setting goals for treatment (difference in d = 0.40, 95% CI [0.09, 0.70], p = .012) and Psychoeducation about acceptance (difference in d = 0.58, 95% CI [0.09, 1.07], p = .021). Furthermore, a total of 11 elements and four overall categories were identified as potentially active ingredients, based on an effect size difference of > 0.20 between interventions with and without the elements. CONCLUSION: The results can direct experimental research into the selection of practices that are most likely key to mechanisms of change in interventions addressing emotion regulation for adolescents. The challenge of measuring emotion regulation is discussed.

Changes in the retinal veins in acute optic neuritis.

OBJECTIVE: To investigate patients with acute optic neuritis (ON) for changes of the retinal veins. MATERIAL AND METHODS: Seventy-six patients with acute ON were extensively neuro-ophthalmologically examined. RESULTS: Multiple sclerosis (MS) was found in 41 patients of whom 1 had periphlebitis retinae (PR) and 2 had venous sheathing (VS). Probable MS was found in 15 patients without prior symptoms of MS. One had PR and VS, and 2 had VS. Twenty patients had mono-symptomatic ON, none had retinal changes. CONCLUSION: Changes of the retinal veins should alert the clinician to a probable diagnosis of MS. ON appears frequently as the initial symptom of MS. Our observation of VS in these patients suggest that clinically silent retinal disease activity had occurred prior to the ON.

A clinical patho-anatomical study of clinically silent multiple sclerosis.

This is the first study on the frequency, size, number, and location of plaques in clinically silent MS. Among the present 18 patients in whom MS was unexpectedly diagnosed at autopsy, it had been clinically silent in 13. An estimate of the prevalence of silent MS is about 25% of that diagnosed in vivo. In the silent group, the MS plaques were located mainly in the periventricular areas, and this may explain the silent nature of the disease.

A clinico-pathoanatomical study of multiple sclerosis diagnosis.

The diagnosis of multiple sclerosis (MS) is clinical and verifiable at post mortem. Neuropathological examination of 518 consecutive patients with clinically definite MS revealed a correct diagnosis in 485 cases (94%). Clinical diagnosis had been established by a neurologist in all cases. Erroneous diagnosis included a variety of other neurological disorders. Also investigated was a randomly selected series of 33 patients with a clinical diagnosis of probable MS: post mortem confirmation of MS was obtained in circa 66%, for the remainder the error pattern was similar to the above. Clinical diagnosis of definite MS was correct in 94% cases. Laboratory tests and examinations have not radically improved diagnosis. Neuropathological examination may occasionally fail to demonstrate MS plaques if the optic nerves are not investigated.

Subclinical optic neuropathy in multiple sclerosis. A neuro-ophthalmological investigation by means of visually evoked response, Farnworth-Munsell 100 Hue test and Ishihara test and their diagnostic value.

Affection of the optic nerves play a central role in multiple sclerosis (MS) symptomatology. In reported autopsy series the prevalence of optic neuropathy has approached 100%. In the present study subclinical affection of the optic nerves was investigated by visual evoked response (VER), Farnworth-Munsell 100 Hue test (FM 100 Hue test) and Ishihara plates in 17 patients with normal visual acuity and without a history of acute optic neuritis. Optic neuropathy was demonstrated in 72% of the eyes. The occurrence of optic neuropathy was also investigated by the same methods in 16 patients with previous acute optic neuritis, which was bilateral in 5 patients. Affection of the optic nerves was demonstrated in 95% in this group. The affection of also the fellow eye in patients with previous monolateral optic neuritis is unexplained. It may be an analogue to the symmetry of plaques found in the brain and the spinal cord. The cause of this peculiar distribution of lesions is, like the ethiology of MS, unexplained at present. In comparing the different methods of demonstrating optic neuropathy, VER is recommended as the method of choice.

Breakdown of the blood-retinal barrier in multiple sclerosis measured by vitreous fluorophotometry.

Periphlebitis retinae in multiple sclerosis appears as transitory cellular infiltrations around veins in an otherwise normal retina. Similar cellular infiltrations have been found around veins in the central nervous system. In the present study the blood-retinal barrier has been investigated by vitreous fluorophotometry. Eight multiple sclerosis patients with actual periphlebitis retinae and 9 patients with previous but not active periphlebitis retinae were included in this study. Abnormal leakage of fluorescein was manifest in the group of multiple sclerosis patients with periphlebitis retinae. Permeability (1.8 +/- 0.2 X 10(-7) cm/sec; mean +/- SEM) but not in the control group as a whole permeability (1.3 +/- 0.1 X 10(-7) cm/sec; mean +/- SEM) compared to 17 normals (permeability 1.1 +/- 0.005). It is thus concluded that breakdown of the blood-retinal barrier may be transitory when connected with periphlebitis retinae in multiple sclerosis.

Neurological disease activity in multiple sclerosis patients with periphlebitis retinae.

Periphlebitis retinae (PR) in multiple sclerosis (MS) is seen as cuffs around veins in the otherwise normal retinae. The frequency of PR in MS varies considerably between different series, approximately from 5 to 25%. The aim of the present study was to investigate if PR, when present, is correlated to neurological disease activity. No similar study has been performed to the author's knowledge. The prevalence of PR in a hospital material of 135 MS patients was 15%, compared to the frequency of 5% found in 168 MS patients examined at a Rehabilitation Center. Thus a three times higher frequency was found in the hospital material which comprised more patients with active disease. The status of neurological disease activity was assessed in 27 patients at the occurrence of PR. One patient only had stationary disease. The frequency of malignant MS in the 27 PR patients was 26% versus 9%. The present study suggests a correlation between neurological disease activity and PR in MS patients.

Recurrence of periphlebitis retinae in multiple sclerosis.

Periphlebitis retinae (PR) in multiple sclerosis (MS) is defined as ophthalmoscopically visible cuffs around veins in the otherwise normal retina. PR in MS has been suggested to be of a recurring nature, but to the authors knowledge this is the first study in which PR in MS has been seen to recur. A recurrence of PR in MS reflects the neurological progress. The material is unique because of the span of years these patients have been followed. In the 4 patients here presented the interval between the two episodes of PR was 16, 13, 5 and 0.5 years, respectively.

Periphlebitis retinae in multiple sclerosis. A histopathological study of two cases.

The reported findings of periphlebitis retinae (PR) at autopsy, in which brain autopsy was also performed, in 2 patients with multiple sclerosis (MS) are, so far as the authors are aware, the first histological account of this manifestation of the disease. The similarity between the cellular accumulations around the veins of the central nervous system seen in multiple sclerosis and the periphlebitic cellular accumulations here described suggests that periphlebitis is an initial event in plaque formation.

Multiple sclerosis: periphlebitis retinalis et cerebro-spinalis. A correlation between periphlebitis retinalis and abnormal technetium brain scintigraphy.

Periphlebitis retinae (PR) in multiple sclerosis (MS) is seen as transitory infiltrations around veins in the otherwise normal retina. Cellular infiltrations have been found around veins in the central nervous system (CNS), where it has been suggested that they are the first event in plaque formation. Technetium brain scans are usually normal in MS patients, but transitory abnormal scans of the cerebrum have been found in MS patients during acute attack or exacerbation. In order to test the hypothesis that active PR is a sign of simultaneous disease activity in the CNS, 29 technetium brain scans were carried out on 14 MS patients with active PR and on 15 MS patients without any signs of PR. Significantly more of the patients with active PR, compared with MS patients with previous PR, displayed abnormal brain scans. This indicates that a disruption of the blood brain barrier (BBB) and active PR occur simultaneously in MS.

HLA and heterogeneity of multiple sclerosis.

Age at onset, debut symptoms, optic nerve signs, and severity of symptoms were evaluated from the medical records of 135 patients with MS. HLA-D/DR2 was significantly more frequent in rapidly progressive MS, and D/DR2 seemed to confer both susceptibility to the disease and to more rapid progression. However, D/DR3 seemed to protect against rapid progression.