The temporal relation of adherence and alliance to symptom change in cognitive therapy for depression.

This study attempted to replicate an earlier study (R. J. DeRubeis & M. Feeley, 1990) of the prediction of symptom change from process variables in cognitive therapy for depressed outpatients. Measures of in-session therapist behavior and therapist-patient interactions were correlated with prior and subsequent symptom change. One of the positive findings was confirmed, but the other received only marginal support. A "concrete" subset of theory-specified therapist actions, measured early in treatment, predicted subsequent change in depression. The therapeutic alliance was predicted by prior symptom change in 1 of the 2 later assessments, but only at a trend level. Several negative findings were similar to those obtained in the earlier study. Specifically, the alliance, an "abstract" subset of theory-specified therapist actions, and facilitative conditions did not predict subsequent change. Implications for causal inferences in psychotherapy process research are discussed.

Medications versus cognitive behavior therapy for severely depressed outpatients: mega-analysis of four randomized comparisons.

OBJECTIVE: The purpose of this study was to compare the acute outcomes of antidepressant medication and cognitive behavior therapy in the severely depressed outpatient subgroups of four major randomized trials. A secondary objective was to compare the results obtained in the National Institute of Mental Health Treatment of Depression Collaborative Research Program, upon which treatment guidelines have been based, with those obtained in the other three studies. METHOD: Outcomes of antidepressant medication and cognitive behavior therapy were compared within each of the four studies separately and for patients aggregated across the four studies. In addition, the outcomes in the antidepressant medication and cognitive behavior therapy conditions of the Treatment of Depression Collaborative Research Program were compared with those obtained in the other three studies. RESULTS: The overall effect sizes comparing antidepressant medication to cognitive behavior therapy favored cognitive behavior therapy, but tests comparing the two modalities did not reveal a significant advantage for either modality overall. CONCLUSIONS: Cognitive behavior therapy has fared as well as antidepressant medication with severely depressed outpatients in four major comparisons. Until findings emerge from current or future comparative trials, antidepressant medication should not be considered, on the basis of empirical evidence, to be superior to cognitive behavior therapy for the acute treatment of severely depressed outpatients.

The Alcohol Clinical Index in lower socioeconomic alcohol-dependent men.

The Alcohol Clinical Index, consisting of a 17-item Clinical Signs checklist and a 13-item Medical History questionnaire, was designed to provide an economic screening instrument for alcoholism not subject to self-report biases. There has been little validation work with this instrument. We therefore administered the Alcohol Clinical Index to a group of 40 alcohol-dependent men undergoing treatment at a VA Medical Center and a group of 17 nonalcoholic men being treated at an outpatient medical clinic at the same facility. The Clinical Signs checklist had high sensitivity, but poor specificity. Overall accuracy was 70% for a threshold score from 1 to 5. The Medical History questionnaire had more moderate sensitivity, but 100% specificity for a cutoff score of 2 or more. At a cutoff of 2, it had an overall accuracy of 84%. The high specificity of the Medical History questionnaire suggests that it could be used to help discriminate between alcoholics and nonalcoholics. Further study of these measures and individual items within the measures is recommended with different groups of alcohol users and nonusers.

Mechanism of in vivo iron chelation by pyridoxal isonicotinoyl hydrazone and other imino derivatives of pyridoxal.

The source of iron chelated in vivo by the new iron-chelating agent PIH and its mechanism of excretion have been studied in normal and hypertransfused rats. PIH is able to chelate iron from both parenchymal and RE iron stores. Unlike DF, which promotes both urinary and fecal iron excretion, in this model PIH-induced iron excretion is limited almost entirely to the gut. Response to PIH is directly related to dosage, and oral doses ranging from 125 to 500 mg/kg/day are well tolerated. Six additional imino derivatives of pyridoxal have been studied, but none of these new compounds was as effective as PIH. Our study indicates that oral PIH is comparable in efficiency with parenteral DF and is of potential usefulness in the management of iron overload.

Relationship between ADH activity and behavioral response to environmental alcohol in Drosophila.

Three alcohol dehydrogenase genotypes, homozygous for either the electrophoretically fast, slow, or null allele at the Adh locus in D. melanogaster, were tested for relative larval alcohol preference behavior (APB) over a range of ethanol concentrations. Differences in behavior between genotypes were not significant at concentrations below 10%. At concentrations greater than 10%, avoidance behavior was negatively correlated with the relative ADH activity levels of the genotypes tested. A model based on the differential buildup of toxic acetaldehyde is proposed to explain the avoidance response.