Group-Based Relaxation Response Skills Training for Pharmacologically-Resistant Depressed and Anxious Patients.

BACKGROUND: Drug-resistance for depression and anxiety is a major limitation in the treatment of these common disorders, and adjunct support interventions may be beneficial in the treatment of these patients. AIMS: The purpose of this study was to evaluate the effects of a short-term (8 session) Relaxation Response Skills Training (RRST) programme for a population of psychiatric outpatients with anxiety and mood disorders who were unresponsive to drug treatment, and to test the feasibility of this intervention as complementary treatment for a psychiatric setting. METHOD: Forty patients were measured for overall psychopathological symptoms, depression, and anxiety, and were then given an 8-week course of RRST, while continuing their pharmacological treatment. Following the RRST intervention, participants were again assessed. RESULTS: The results demonstrated reductions in overall symptoms (large effect size and reasonable clinically significant change), and also in depression and anxiety (medium effect sizes and clinically significant change). CONCLUSIONS: These results suggest that this short-term RRT offers a simple and cost-effective way to augment drug management for participants with common psychiatric disorders who are less responsive to the drug treatment.

Unrevealed Depression Involves Dysfunctional Coping Strategies in Crohn's Disease Patients in Clinical Remission.

Background and Aims. This study investigated the proportion of CD patients in clinical remission with clinical depression, and coping strategies in those with severe depressive disorders. Materials and Methods. One hundred consecutive CD patients in clinical remission were screened for anxiety and depression by using Hospital Anxiety and Depression Scale and patients with depressive symptoms were further investigated by means of Cognitive Behavioural Assessment 2.0 and Beck Depression Inventory (BDI). Afterwards the coping strategies were assessed through the Brief-COPE questionnaire. Results. Twenty-one patients had anxious symptoms and 16 had depressive symptoms with or without anxiety. Seven of these patients (43.8%) showed significant depressive symptoms. Compared to patients without psychiatric disorders, these patients showed significant lower score in "positive reframing" (p: 0.017) and in "planning" (p: 0.046) and higher score in "use of instrumental social support" (p < 0.001), in "denial" scale (p: 0.001), and in "use of emotional social support" (p: 0.003). Conclusions. Depressed CD patients in clinical remission may have dysfunctional coping strategies, meaning that they may not be able to implement functional strategies to manage at best stress related with their disease.

Is it possible to assess subjective well-being among bipolar inpatients? An 18-week follow-up study.

OBJECTIVE: The study evaluates the association between subjective well-being and psychopathology in bipolar inpatients at the time of hospitalization and during a follow-up period. METHOD: One hundred twenty consecutive inpatients with a diagnosis of bipolar affective disorder were studied on admission (T0), at discharge (T1) and every 6 weeks for 18 weeks after hospitalization. The Young's Mania Rating Scale (YMRS) and the Hamilton Rating Scale for Depression (HAM-D) were used to determine affective symptoms, while subjective well-being was assessed by subjective well-being under neuroleptic (SWN). Associations between SWN and HAM-D or YMRS scores and between their changes were analyzed across the different time points by using Pearson correlation coefficients. Linear regression models were constructed using SWN as the dependent variable and demographic and clinical characteristics as possible predictors. RESULTS: At baseline, depression explained 24% and mania explained an additional 16% of baseline SWN variance. Changes in SWN and HAM-D total score displayed an inverse correlation during hospitalization and follow-up. End point severity of depression was associated with the end point SWN total score explaining additional 26% of SWN total score variance, whereas severity of mania was inversely associated with SWN total score. CONCLUSION: Data of this study provide further support for the need to consider the subjective well-being as a personal variable associated to psychopathological state in bipolar patients. However, results seem to be in line with authors who suggest to use other subjective quality of life scales in acute mania.

Short-term psychodynamic psychotherapy versus treatment as usual for depressive and anxiety disorders: a randomized clinical trial of efficacy.

This randomized clinical trial aimed to evaluate the clinical efficacy of short-term psychodynamic psychotherapy (STPP) in the treatment of patients suffering from anxiety or depressive disorders, as compared with a control case sample composed of patients undergoing treatment as usual (TAU). Sixty patients with depressive or anxiety disorders according to DSM IV-TR were randomly assigned in a 1:1 ratio to an intervention group (STPP) or control group for 12 months (T1). Primary outcome measures were the Symptom Checklist 90-Revised (SCL-90-R), the Inventory of Interpersonal Problems (IIP), and the Clinical Global Impression Improvement Scale. Intention to treat analysis revealed that patients who received STPP showed significantly more improvements in comparison with those who were in the TAU group on Clinical Global Impression Improvement Scale and IIP measures. This study offers evidence that STPP is an effective treatment for patients with anxiety or depressive disorders, and it could be more effective than TAU in improving interpersonal problems as measured by IIP.

Expressed emotion in wives of myocardial infarction patients: an exploratory feasibility study.

INTRODUCTION: We assessed the emotional components expressed by the spouses of patients at the first episode of acute myocardial infarction (AMI) and considered potential underlying links among these components and the course of the cardiac symptoms over time. This was an exploratory prospective cohort study. METHODS: A sample of 50 consecutive male inpatients with a diagnosis of AMI and their wives was studied. At baseline spouses were assessed with the Camberwell Family Interview and ratings of Expressed Emotion were made. Patients completed the State-Trait Anxiety Inventory (STAI XI-X2) and the Beck's Depression Inventory (BDI). After 12 months (T1), during appropriate treatment by a cardiologist blinded to the Expressed Emotion ratings, the existence or absence of serious adverse events (death or hospitalizations because of cardiac causes) were determined as an all-or-none phenomenon. Stepwise logistic regression analysis was performed to estimate associations among illness course and Expressed Emotion subscales, STAI X1-X2, BDI scores and clinical variables. RESULTS: High family Emotional Overinvolvement (EOI) scores were associated with higher study entry levels of depression (P = 0.003) among the patients and high Warmth was related to higher score on state anxiety scale (P = 0.000). Poor illness course at T1 was associated with high EOI [P = 0.005, exp(B) = 0.502, 95% confidence interval 0.308-0.818]. CONCLUSION: The association among wives' emotional profile, patients' psychological variables and illness course suggested the importance of a family assessment and of interventions directed towards changing emotional behaviours which could threaten the patient's psychological adjustment and the clinical course following a heart attack.