Maintenance cognitive-behavioral therapy and manualized psychoeducation in the treatment of recurrent depression: a multicenter prospective randomized controlled trial.

OBJECTIVE: This multicenter study compared the relapse and recurrence outcomes of two active treatments, maintenance cognitive-behavioral therapy (CBT) and manualized psychoeducation, both in addition to treatment as usual, in patients in remission from depression. METHOD: This was a multicenter prospective randomized observer-blinded study with two parallel groups. The authors assessed 180 patients with three or more previous major depressive episodes who met remission criteria over a 2-month baseline period and who were randomly assigned to 16 sessions of either maintenance CBT or manualized psychoeducation over 8 months and then followed up for 12 months. The main outcome measure was time to first relapse or recurrence of a major depression, based on DSM-IV criteria, as assessed by blinded observers with the Longitudinal Interval Follow-Up Evaluation. RESULTS: Cox regression analysis showed that time to relapse or recurrence of major depression did not differ significantly between treatment conditions, but a significant interaction was observed between treatment condition and number of previous episodes (<5 or ≥5). Within the subsample of patients with five or more previous episodes, maintenance CBT was significantly superior to manualized psychoeducation, whereas for patients with fewer than five previous episodes, no significant treatment differences were observed in time to relapse or recurrence. CONCLUSIONS: The results indicate that maintenance CBT has significant effects on the prevention of relapse or recurrence only in patients with a high risk of depression recurrence. For patients with a moderate risk of recurrence, nonspecific effects and structured patient education may be equally effective.

Cerebral correlates of selective attention in schizophrenic patients with formal thought disorder: a controlled H2 15O-PET study.

There is a widespread belief that formal thought disorders may be associated with disturbed selective attention in schizophrenia. Two hypotheses are derived: (1) patients with slightly pronounced formal thought disorders should differ from those with severely expressed formal thought disorders in terms of selective attention; and (2) the cerebral correlates of selective attention should be organised differently in mildly versus severely thought-disordered patients. We compared 20 female schizophrenic patients, one-half with mild, one-half with obvious formal thought disorders, and 10 control subjects on a neuropsychological battery and a cognitive activation task for selective attention (Go/NoGo) for the assessment of rCBF using H2 15O-PET. While the first hypothesis has not been confirmed, we found that the cerebral regions activated by selective attention in the two patient groups showed completely differing organisations. Low degrees of formal thought disorders were associated with significant activations in frontal superior gyrus and ventral anterior thalamic nucleus whereas high degrees of formal thought disorders were accompanied by significant activations in fusiform gyrus and precuneus. We suggest that differing task-solving strategies are applied by both clinical subgroups to achieve comparable results on the selective attention paradigm.