Guidelines and practice of breastfeeding in women living with HIV-Results from the European INSURE survey.

INTRODUCTION: Antiretroviral therapy (ART) is integral to HIV prevention, including averting vertical transmission. The World Health Organization (WHO) recommends ART and breastfeeding for all women living with HIV for at least 12 months post-partum [1, 2]. Much of the data on HIV transmission through breastfeeding comes from low-resource settings, with a paucity of data on breastfeeding-related HIV transmission in women living with HIV in other settings. Women Against Viruses in Europe (WAVE), part of the European AIDS Clinical Society (EACS), aims to improve the standard of care for women living with HIV and sought to gain an understanding of breastfeeding guidelines and practice in women living with HIV across Europe. METHODS: A steering group convened by WAVE developed a survey to collate information on breastfeeding trends, practice, and guideline recommendations for women living with HIV in Europe and to establish interest in becoming involved in a collaborative breastfeeding network. The survey was disseminated to 31 countries in March 2022. RESULTS: In total, 25 eligible responses were received: 23/25 (92%) countries have HIV and pregnancy guidelines; 23/23 (100%) guidelines refer specifically to breastfeeding; 12/23 (52%) recommend against breastfeeding; 11/23 (48%) offer an option if certain criteria are met; 12/25 (48%) reported that the number of women living with HIV who breastfeed is increasing; 24/25 (96%) respondents were interested in joining a network on breastfeeding in women living with HIV. CONCLUSIONS: Recommendations vary, and nearly half of the guidelines recommend against breastfeeding. Many countries report an increase in breastfeeding. WAVE will establish a collaborative network to bridge data gaps, conduct research, and improve support for women living with HIV who choose to breastfeed.

Physical fitness, bone mineral density and associations with physical activity in females with longstanding eating disorders and non-clinical controls.

AIM: To examine (i) aerobic fitness, muscular strength, and bone mineral density (BMD) in female inpatients with longstanding eating disorders and non-clinical controls, and (ii) associated and explanatory factors for BMD among the inpatients. METHODS: Adult females with DSM-IV anorexia nervosa (AN), bulimia nervosa (BN) or eating disorders not otherwise specified (EDNOS) (n=59, mean(SD) age 30.1(8.5) yrs and ED duration 14.3 yrs) and non-clinical age-matched controls (n=53, mean(SD) age 31.3(8.3) yrs) accepted participation in this cross-sectional study. Measurements included accelerometer assessed and self reported amount of different types of physical activities, VO2max on treadmill, 1RM in leg and chest press, and BMD in lumbar spine (L2-L4), femur neck and total body analyzed by DXA. RESULTS: Muscular strength and BMD were lower in patients with AN, not in patients with BN or EDNOS, compared to controls. Aerobic fitness did not differ between patients and controls. BMD in the patients was positively associated with body weight, muscular strength and self reported high impact PA (min.w-1), not self reported general weight-bearing PA (min.w-1) or accelerometer assessed PA (counts.min). History of AN (28%) and muscular strength (9%) contributed significantly to explain the variance in total body BMD. CONCLUSION: Muscular strength and only high impact PA are associated with BMD in patients with longstanding ED. An implication of this is the need for more specific guidelines regarding types of PA recommended for this patient population. Special considerations should be made for severely malnourished patients, and for patients with osteoporosis.

Short-term follow-up of adults with long standing anorexia nervosa or non-specified eating disorder after inpatient treatment.

OBJECTIVE: There are few follow-up studies on outcome for patients with long standing anorexia nervosa (AN) or non-specified eating disorder with several comorbid psychiatric disorders. Inpatient treatment is one option for these patients. The aim of this prospective study was to report one-year follow-up for a consecutive sample of these patients after an inpatient treatment program. METHOD: All 24 patients with a mean age of 28 years and mean duration of an eating disorder of 11 years were treated in a 23-week inpatient group treatment program for AN. Patients were assessed using Eating Disorder Examination interview (EDE), Eating Disorder Inventory (EDI) and Symptom Check List (SCL-90-R) at pre-treatment, post-treatment and at one year after start of treatment. At the follow-up 24 patients were personally interviewed. On admission 12 (50%) had AN, 8 (33%) non-specified eating disorder (EDNOS) and 4 (17%) bulimia nervosa (BN). All had previously suffered from AN and were clinically evaluated to have mostly anorectic psychopathology. RESULTS: Ten (42%) patients had improved at follow-up and 14 (58%) had a poor outcome. There was a moderate but significant improvement on the EDE, EDI and GSI from pre-treatment to follow-up. The improvement occurred during inpatient treatment, and no significant differences from post-treatment to follow-up were found. Patients with low weight on admission showed a significant mean weight increase of about 4 kg at the follow-up. CONCLUSIONS: At one-year follow-up there was a moderate reduction of eating disorder symptoms and general psychiatric symptoms for patients with long standing anorexic symptoms. The improvement occurred during inpatient treatment. Inpatient treatment may be a treatment option in long-time rehabilitation for some of these patients.

A comparison of cognitive therapy, applied relaxation, and nitrous oxide sedation in the treatment of dental fear.

The aim of this study was to investigate the short-term efficacy of cognitive therapy and applied relaxation in dental fear treatment and to compare these methods with conventional pharmacological sedation (nitrous oxide sedation). Patients (n = 65) with severe dental fear were randomly assigned to the different treatment methods and received 10 weekly sessions of individual therapy. Dropout rates were low, and all patients who completed the therapy sessions were able to receive dental treatment. Scores on dental fear tests were significantly reduced compared with pretreatment level for all treatment groups. There were no major differences between treatment methods in this short-term perspective.

One-year follow-up of patients treated for dental fear: effects of cognitive therapy, applied relaxation, and nitrous oxide sedation.

The effects of dental fear treatments were assessed in a 1-year follow-up study. Sixty-two patients had finished a controlled study in which they were randomly allocated to nitrous oxide sedation (NO), cognitive therapy (CT), or applied relaxation (AR). During the trial highly significant reductions in dental fear and general distress were observed. One year later a majority (95%) of the participants had attended dental treatment in general practice. On the whole, continued favorable effects with regard to dental fear and general distress were observed. Patients in the applied relaxation group evidenced the largest reductions on the dental fear measures. All patients judged the dental fear treatment to have been beneficial, and 80% judged the treatment given in the year after the dental fear treatment successful. All three treatment groups scored in the normative range for general distress both at the end of treatment and at follow-up.

Schemas, affect consciousness, and cluster C personality pathology: a prospective one-year follow-up study of patients in a schema-focused short-term treatment program.

In this prospective study the aim was to investigate the relationship between affect consciousness and Cluster C personality pathology (DSM-IV, Axis-II). Forty-four patients with panic disorder and/or agoraphobia and Cluster C personality traits were treated in a schema-focused program comprising a first panic/agoraphobia-focused phase and a second personality-focused phase, being finally assessed at a one-year follow-up. According to the treatment strategy, affect consciousness was expected to change during the second phase, independent of change in agoraphobic avoidance being focused in the first phase. Pretreatment level of affect consciousness during treatment was related to a reduction in avoidant personality pathology (not dependent or obsessive-compulsive) from pretreatment to follow-up, while increase in affect consciousness did not contribute in the same way. These results indicate that affect consciousness is important as a selection criterion, as a parameter in treatment with focus on schemas and schema-avoidance, and as a predictor for outcome in agoraphobic patients with avoidant personality pathology.

The relationship between cognitions and panic attack intensity.

OBJECTIVE: To investigate the relationship between panic attack intensity, catastrophic belief and cognitions. METHOD: Data from 540 panic diaries were collected from 42 patients with panic disorder with agoraphobia. RESULTS: When we controlled for individual variation, effects of treatment and number of symptoms, catastrophic belief contributed significantly to more intense panic attacks (r2 change = 0.10, P<0.0001). There were no significant differences in panic attack intensity between primary and secondary cognitions. CONCLUSION: Our results indicate that catastrophic belief is a reliable predictor of panic attack intensity.

Effects of dental fear treatment on general distress. The role of personality variables and treatment method.

This study aimed to clarify the effects of applied relaxation, cognitive therapy, and nitrous oxide sedation on dental fear and general emotional distress symptoms. Relationships among outcome measures and the Big Five personality dimensions (i.e., Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness) were also investigated. After treatment, a highly significant decline in a broad range of emotional distress symptoms as well as dental fear was found. No main treatment method effect or treatment x phase interaction effect with regard to dental fear or distress symptoms was found. Thus, the three treatment methods had highly similar effects, at least on a short-term basis. Significant correlations between neuroticism, extraversion, and agreeableness on one hand, and emotional distress symptoms on the other, were demonstrated. However, when initial symptom level was controlled for in multiple regression analysis, the statistical effects of personality variables generally disappeared.

Therapists' emotional reactions to anxious inpatients during integrated behavioral-psychodynamic treatment: a psychometric evaluation of a feeling word checklist.

The purpose of this study was to examine the factor structure of a feeling checklist purported to measure therapists' emotional reactions to their patients, and to evaluate psychometrically the factor-based scales. Therapists completed the checklist after both a behavioral and a psychodynamic phase of a treatment program for inpatients with panic disorder, agoraphobia, and other phobic disorders. The results of factor analysis revealed three distinct dimensions: interest-boredom, insecurity-security, and anger. The corresponding three subscales proved to have a satisfactory internal consistency, and they correlated strongly with their respective factors. The criterion-oriented validity of the insecurity and anger subscales was supported by their ability to differentiate between completers and noncompleters of the program. The three subscales correlated poorly with DSM-III-R personality disorder indices. More subjectively experienced interest and less subjectively experienced anger on the part of the therapists toward patients were related to a stronger reduction in the patients' avoidance behavior in the one-year follow-up period.

Tolerance to intensive exercise and high levels of lactate in panic disorder.

We wanted to test the tolerance of intensive exercise and corresponding high levels of lactate in patients with panic disorder. Thirty-five consecutive patients with DSM-III-R panic disorder completed submaximal tests, and 24 completed additional supramaximal exercise tests. All experienced high values of lactate during the supramaximal test (M = 10.7 mmol/L, SD = 2.9), but only 1 patient experienced a panic attack. The blood lactate values in the present study were higher than the usually achieved values of 5 to 6 mmol/L during infusion. In general, 67% of patients panic during infusion, compared to 4% in the present study. This discrepancy in frequency of panic following exposure to endogenous and exogenous lactate is discussed on the basis of various hypotheses of panic disorder, with an emphasis on cognitive theory of panic. The study indicates that patients with panic disorder can safely undergo vigorous exercise of such intensity to result in significant lactate production, with the chances of panic being small.

Interpersonal problems among patients suffering from panic disorder with agoraphobia before and after treatment.

The aim of this study was to examine interpersonal problems among panic disorder with agoraphobia patients before and after treatment. Patients (N = 46) suffering from panic disorder with moderate or severe agoraphobia and considering agoraphobia as their main problem were randomly assigned to receive either cognitive therapy or guided mastery therapy in a six-week in-patient group programme. The Inventory of Interpersonal Problems (IIP) and various symptom measures were administered at pretreatment and at one-year follow-up. Two IIP subscales were derived from factor analysis of the present data: affiliation problems and power problems. The overall pattern of results supported a state model of interpersonal problems. At pre-treatment, the scores on the affiliation problems subscale were clearly related to non-specific state characteristics, that is, to depression and general anxiety. From pre-treatment to follow-up, levels of interpersonal problems decreased significantly. Pre-treatment depression was a powerful predictor of change in interpersonal problems from pre-treatment to one-year follow-up. On the other hand, interpersonal problems at pre-treatment failed to predict the change in levels on various symptom scales.

Personality traits among panic disorder with agoraphobia patients before and after symptom-focused treatment.

The first aim of this study was to examine the relationship between change of the agoraphobic state during treatment and personality change. The second aim was to examine the potential effect of PD traits on symptom change during and after treatment. Patients (N = 46) suffering from panic disorder with moderate or severe agoraphobia and considering agoraphobia as their main problem were randomly assigned to receive either cognitive therapy or guided mastery therapy in a 6-week inpatient group program. From before to 1 year after the end of treatment, the number of avoidant and dependent traits decreased significantly. Among changes during treatment on various symptom and cognitive variables, only change in catastrophic beliefs was significantly related to reduction in avoidant and dependent traits. Number of dependent traits at pretreatment was related to less improvement from pretreatment to 1-year follow-up on the symptom and cognitive scales.

Cognitive mediators of situational fear in agoraphobia.

The aim of this study was to examine cognitive mediators of situational fear in agoraphobia. Patients suffering from panic disorder with moderate or severe agoraphobia were randomly assigned to receive either cognitive therapy or guided mastery therapy in a 6-week inpatient group program. The results were consistent with a self-efficacy model of agoraphobia. Across test occasions, and when the other cognitive variables were controlled for, self-efficacy made a significant contribution to the prediction of situational fear or changes in situational fear in 5 out of 5 cases. Catastrophic beliefs were related to situational fear in 1 of the 5 cases.

Assessment of depression: comparison between Beck Depression Inventory and subscales of Comprehensive Psychopathological Rating Scale.

The purpose of this study was to investigate the relationship between self-rating and therapist rating in nonpsychotic patients with unipolar depressive disorders. We also wanted to find out whether the presence of personality disorders would influence the results. At admission and discharge 117 patients filled in the Beck Depression Inventory (BDI) and were rated by a therapist on the Comprehensive Psychopathological Rating Scale (CPRS). Based on the CPRS-scores, two indices of depression were calculated: CPRS-dep and Montgomery Asberg Depression Rating Scale (MADRS). Sixty-three patients had DSM-III-R major depression, 30 had dysthymic disorder, while 24 had no depressive disorder. Eighty suffered from one or more personality disorders, mostly within cluster C. The self rating (BDI) and therapist ratings (CPRS-dep and MADRS) were strongly intercorrelated, with a nonsignificant tendency for weaker correlations in patients with personality disorders. All scales were useful to separate depressed from non-depressed, and to discriminate between major depression and dysthymic disorder, with a tendency in favour of BDI. As cut-off scores for major depression we recommend the sum score of 23 on the BDI, and mean scores of 1 on CPRS-dep and 1.1 on MADRS on a 0-3 scale. When these values are used, 70-79% of patients are correctly classified.

A comparison of cognitive and guided mastery therapy of agoraphobia.

The aim of this study was to compare the efficacy of cognitive and performance-based therapy of agoraphobia. Fifty-two patients suffering from panic disorder with moderate or severe agoraphobia and considering agoraphobia as their main problem were randomly assigned to receive either cognitive therapy or guided mastery therapy in a six-week inpatient group program. Significantly more of the cognitive therapy patients attained high endstate functioning, whereas the proportion of responders in the two groups did not differ. An overall test revealed no differences between the two treatment groups on the continuous outcome measures at posttreatment. As predicted from the cognitive model of panic with agoraphobia, self-efficacy scores increased with the reduction of catastrophic belief scores in the cognitive therapy group. Inconsistent with the self-efficacy model, catastrophic belief scores did not change with the increase of self-efficacy scores in the guided mastery group. Overall, the superiority of one of the treatment methods over the other was not clearly demonstrated.

Psychoanalytical personality types and agoraphobia.

The aim of this study was to examine the relationship between psychoanalytical personality types and agoraphobia. Thirty-two panic disorder with agoraphobia patients and 18 agoraphobia without panic disorder patients attending an inpatient 11-week behavioral-psychodynamic treatment program were assessed repeatedly from pretreatment to 2 years after the end of treatment. On personality scales measuring oral, obsessive, hysterical, and reality-weak traits, there were no differences between agoraphobic patients with and without panic disorder. The examined traits correlated across the period from pretreatment to 2-year follow-up, although the potential influence of symptoms were controlled for. Higher scores on the oral scale predicted poorer course of symptoms in the year immediately after treatment. Scores on the oral scale decreased with the improvements of agoraphobic and general symptoms, but did not attain a normal level. The results supported a combined predisposition-state model for the relationship between oral traits and agoraphobia.

DSM-III-R Axis I and II disorders in agoraphobic inpatients with and without panic disorder before and after psychosocial treatment.

Panic disorder patients with agoraphobia (n = 32) and agoraphobic patients without panic disorder (n = 18) who were participants in an inpatient behavioral-psychodynamic treatment program were assessed repeatedly from pretreatment to 2-year posttreatment follow-up. At pretreatment, there were statistical trends for more of the panic with agoraphobia patients to have obsessive-compulsive disorder and alcohol abuse/dependence, and for more of the agoraphobia without panic patients to have generalized anxiety disorder and avoidant personality disorder. There was also a trend for more of the panic with agoraphobia patients to have met criteria for major depression during the 2-year follow-up period.

DSM-III-R Axis I and II disorders in agoraphobic patients with and without panic disorder.

Patients attending an inpatient phobia treatment program were diagnosed for DSM-III-R Axis I and II disorders, using the Structured Clinical Interview for DSM-III-R Disorders, and completed a set of self-report instruments. They were divided into 3 groups: (a) those who met the criteria for panic disorder with agoraphobia (n = 57), (b) those who met the criteria for agoraphobia without a history of panic disorder (n = 21), and (c) those who met criteria for other anxiety disorders, but not for panic/agoraphobia (n = 14). On Axis I, more of the panic with agoraphobia than of the agoraphobia without panic patients had obsessive-compulsive disorder. On Axis II, no significant differences between the agoraphobic patients with and without panic occurred. However, the number of hysterical traits was related to the presence of panic disorder among the agoraphobic patients. Avoidant and dependent traits were related to symptom severity.