Physical exercise augmented cognitive behaviour therapy for older adults with generalised anxiety disorder (PEXACOG): a feasibility study for a randomized controlled trial.

BACKGROUND: Generalised anxiety disorder (GAD) is a frequent and severe disorder among older adults. For older adults with GAD the effect of the recommended treatment, cognitive behaviour therapy (CBT), is reduced. Physical exercise (PE) may enhance the effect of CBT by improving cognitive function and increasing levels of brain-derived neurotrophic factor (BDNF), a predictor of the effect of CBT in patients with anxiety. The aim of the study was to assess the feasibility of a randomized controlled trial (RCT) investigating treatment effect of the combination of CBT and PE for GAD in a sample of older adults, including procedures for assessment and treatment. METHODS: Four participants aged 62-70 years (M = 65.5, SD = 3.2) with a primary diagnosis of GAD were included. Participants received 15 weeks of PE in combination with 10 weeks of CBT. Participants completed self-report measures, and clinical, biological, physiological and neuropsychological tests at pre-, interim- and post-treatment. RESULTS: Procedures, protocols, and results are presented. One participant dropped out during treatment. For the three participants completing, the total adherence to PE and CBT was 80% and 100%, respectively. An independent assessor concluded that the completers no longer fulfilled the criteria for GAD after treatment. Changes in self-report measures suggest symptom reduction related to anxiety and worry. The sample is considered representative for the target population. CONCLUSIONS: The results indicate that combining CBT and PE for older adults with GAD is feasible, and that the procedures and tests are suitable and manageable for the current sample. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02690441. Registered on 24 February 2016, https://clinicaltrials.gov/ct2/show/NCT02690441 .

Improved emotion regulation in depression following cognitive remediation: A randomized controlled trial.

OBJECTIVE: Executive functions (EFs) play a key role in emotion regulation and, related to this, depression. Cognitive remediation (CR) targeting EFs, such as Goal Management Training (GMT) and computerized cognitive training (CCT), may reduce maladaptive emotion regulation. However, the clinical potential of GMT in the context of depression and emotion regulation remains to be tested. Hence, the primary aim of the present study was to compare effects of GMT with CCT on symptoms of emotion dysregulation. METHOD: The paper reports the effects of a preregistered randomized controlled trial. Sixty-three participants (18-60yrs) with active or remitted depression and EF complaints were randomized to nine sessions of GMT (n = 35) or CCT (n = 28). All were assessed at baseline, post-intervention, and at 6-month follow-up. The Ruminative Response Scale and the Difficulties in Emotion Regulation Scale were employed to assess emotion regulation. RESULTS: Both groups improved following the intervention on emotion regulation domains after controlling for intention-to-treat, including brooding rumination and on items reflecting non-accepting reactions to distress. Relative to CCT, the GMT-group demonstrated increased clarity of emotional responses in the per protocol analysis. CONCLUSIONS: Our findings demonstrate the potential of GMT and CCT in reducing maladaptive emotion regulation in depression.

Electroconvulsive therapy in bipolar depression - effectiveness and prognostic factors.

OBJECTIVE: Electroconvulsive therapy (ECT) is used in patients with severe forms of bipolar depression. ECT is effective but not all patients respond. The aim of this study was to determine prognostic factors for response to ECT in patients hospitalized for bipolar depression. METHODS: Data were obtained from several national Swedish registers. All patients with bipolar depression treated with ECT in any hospital in Sweden between 2011 and 2016 for whom information about ECT response was available were included (n = 1251). Response was defined as a score on the Clinical Global Impression - Improvement scale of one or two. Univariate and multivariate logistic regression were conducted to investigate associations between socio-demographic and clinical factors and response. RESULTS: Response was achieved in 80.2% patients. Older age was associated with higher response rate to ECT. Patients with comorbid obsessive-compulsive disorder or personality disorder, and patients previously treated with lamotrigine had lower response rate. CONCLUSION: Electroconvulsive therapy for bipolar depression was associated with very high response rates. The strongest prognostic factors were higher age, absence of comorbid obsessive-compulsive disorder or personality disorder, and less prior pharmacologic treatment.

Low noise 874 GHz receivers for the International Submillimetre Airborne Radiometer (ISMAR).

We report on the development of two 874 GHz receiver channels with orthogonal polarizations for the International Submillimetre Airborne Radiometer. A spline horn antenna and dielectric lens, a Schottky diode mixer circuit, and an intermediate frequency (IF) low noise amplifier circuit were integrated in the same metallic split block housing. This resulted in a receiver mean double sideband (DSB) noise temperature of 3300 K (minimum 2770 K, maximum 3400 K), achieved at an operation temperature of 40 °C and across a 10 GHz wide IF band. A minimum DSB noise temperature of 2260 K at 20 °C was measured without the lens. Three different dielectric lens materials were tested and compared with respect to the radiation pattern and noise temperature. All three lenses were compliant in terms of radiation pattern, but one of the materials led to a reduction in noise temperature of approximately 200 K compared to the others. The loss in this lens was estimated to be 0.42 dB. The local oscillator chains have a power consumption of 24 W and consist of custom-designed Schottky diode quadruplers (5% power efficiency in operation, 8%-9% peak), commercial heterostructure barrier varactor (HBV) triplers, and power amplifiers that are pumped by using a common dielectric resonator oscillator at 36.43 GHz. Measurements of the radiation pattern showed a symmetric main beam lobe with full width half maximum <5° and side lobe levels below -20 dB. Return loss of a prototype of the spline horn and lens was measured using a network analyzer and frequency extenders to 750-1100 GHz. Time-domain analysis of the reflection coefficients shows that the reflections are below -25 dB and are dominated by the external waveguide interface.

The significance of personality in pain from gallbladder stones.

BACKGROUND: The aim of the study was to investigate the association between personality factors related to coping styles and reported pain due to gallstones. METHODS: Personality trait measures were completed by 28 consecutive gallstone patients to provide estimates of positive coping resources (Life Regard Index, Sense of Coherence Scale, Sense of Humor Questionnaire) and negative coping resources (Eysenck Personality Questionnaire on Neuroticism, Tension, and Effort Stress Inventory). An overall index of gallstone-related complaints (pain) over the past 7 days/6 months was also obtained. Ultrasonography confirmed the gallstone condition. Multiple regression analyses tested the hypothesis that pain would be moderated by positive coping resources and mediated by negative coping resources. RESULTS: Reported pain was less severe with positive coping resources (39% of pain variance explained) and more severe with negative coping resources (45% of pain variance explained). CONCLUSION: The results confirm that mental coping resources have a significant role in pain differences among gallstone patients.

Test-retest reliability for the consonant-vowel syllables dichotic listening paradigm.

The present study compared test-retest reliability for dichotic listening (DL) performance to consonant-vowel (CV) syllables under three different attentional instructions. Previous studies of reliability in dichotic listening have shown great variability which most likely reflects the large variations in stimuli, procedures, and techniques used in the different studies. Sixteen subjects were tested twice, 2 weeks apart, with the same dichotic listening procedure, including a divided attention condition and two focused attention conditions on each test occasion. The results showed test-retest correlations ranging from .61 to .86 for the three attentional conditions, with the smallest correlation coefficient for the divided attention condition.

Antibody response to a human diploid cell rabies vaccine.

An experimentally killed rabies virus vaccine prepared in a human diploid cell strain (WI-38)-Wyeth rabies vaccine (WRV)-was used by various injection schedules in two separate studies to define more closely in human volunteer subjects an effective vaccination schedule for pre- or postexposure immunization, particularly for donors of rabies-hyperimmune plasma. To permit valid comparisons between our results and those of other workers, antibody levels achieved were expressed in terms of international units (IU) per milliliter of serum. Antibody response of previously nonvaccinated persons were only modest after a single dose of WRV, never reaching a level higher than 0.80 IU/ml over a 56-day testing period. Moreover, antibody was not detected at 0.16 IU/ml before the 14th day, either after a single dose or after two doses given 3 days apart. The best response followed four doses of WRV given within 4 weeks. This schedule resulted in the highest rate of seroconversion to the >/=6 IU/ml antibody level required of potential rabies-immune plasma donors. Giving the first vaccine dose in aluminum hydroxide diluent did not enhance the antibody response. There was a definite suggestion in the various injection schedules that higher and more sustained antibody levels were reached when the interval between the first and second vaccine doses was longest. The greater immunogenicity of WRV as compared with duck embryo vaccine was best demonstrated by the fact that a single booster dose of duck embryo vaccine to previously vaccinated individuals resulted in only a sevenfold antibody rise during the following 56 days, whereas a booster dose of WRV elicited a 69-fold rise. Al(OH)(3) in the first dose of WRV had no effect, but the enhancing effect of a longer interval between vaccine doses was noted once again; 20 of 20 subjects who received three doses of WRV with 4 weeks between doses developed good levels of rabies antibody, and 19 exceeded 6 IU/ml.