[CBASP as an Inpatient Concept for Treatment-Resistant Chronic Depression: A Pilot Study of the Relationship between Adverse Effects and Treatment Outcome]. / CBASP als stationäres Behandlungskonzept der therapieresistenten chronischen Depression: Eine Pilotstudie zum Zusammenhang von Nebenwirkungen und Therapieerfolg.

BACKGROUND: Inpatient psychotherapy might trigger adverse effects among others due to short but intensive treatment. Thus, in this pilot study, certain adverse effects of the multidisciplinary inpatient Cognitive Behavioral Analysis System of Psychotherapy (CBASP) for treatment-resistant chronically depressed patients as well as their relationship to treatment outcome (response-, remission-, and relapse-rates) are examined. MATERIAL AND METHODS: 50 patients with treatment-resistant and chronic depression completed the structured 12-weeks inpatient treatment program. Adverse effects were assessed by 1) deterioration of depressive symptoms (measured by the Hamilton Depression Rating Scale, HDRS) at discharge and 2) a self-report questionnaire measuring Adverse Effects of Inpatient Psychotherapy (ADEFIP), which were filled out 6 to 12 months after discharge by the patients. RESULTS: After 12 weeks of treatment, 84% could be classified as responder, of whom 44% fulfilled the remission criterion. 16% were Non-Responder. According to HDRS, none of the patients showed objective deterioration of the depressive symptoms. Six months after discharge, 40% of the responders suffered from relapse. Concerning the ADEFIP, 66% of the patients reported transient deterioration of symptoms. These patients were less likely to achieve remission. Over 50% reported interpersonal conflicts with treatment team members or other patients without any relation to outcome. Finally, more than half of the patients reported significant changes in social relationships after discharge. These patients were less likely to relapse. Overall, 94% of the patients reported at least one of the in this study assessed adverse effects. CONCLUSIONS: Despite some limitations, this pilot study suggests that the CBASP inpatient program could indeed cause adverse effects. However, only subjective transient deterioration appeared to have a negative impact on the individual treatment outcome in the short-term. Results encourage further research concerning adverse treatment effects in the context of short- and long-term treatment outcome investigating how relevant adverse effects are.

Autistic traits and empathy in chronic vs. episodic depression.

OBJECTIVES: Difficulties in social interaction are characteristic for depressive disorders and one of the cardinal symptoms of Autism Spectrum Disorders (ASD). It has been proposed that chronically depressed persons have profoundly impaired empathic abilities in comparison to episodically depressed persons, and that specifically they exhibit a deficit in cognitive empathy, but not in affective empathy, a pattern also reported in ASD. This study aimed to explore autistic traits and empathy deficits in chronic depression, and identify specific differences to episodic depression. METHOD: Autistic traits and multimodal empathy were assessed in chronically depressed patients (n=59), episodically depressed patients (n=40), and a healthy control group (n=55) using standardized questionnaires. RESULTS: Regardless of the disorder's chronicity, depressed patients exhibited higher levels of autistic traits and lower levels of perspective-taking than healthy controls. Chronically depressed patients reported significantly higher impairment in social skills and higher levels of personal distress in social interactions than episodic patients. DISCUSSION: Our results suggest that patients with chronic depression share two distinct characteristics, namely lower levels of social skills and higher levels of distress in tense social situations than patients with episodic depression. Future studies will need to determine whether the elevated autistic traits in chronic depression are specific to chronic depression, or represent the general tendency to withdraw from social situations. We conclude that chronically depressed patients are not specifically impaired in understanding another person's state of mind, but are unable to deal with another person's suffering or negative affective state.

Increased hippocampal volumes in adults with high functioning autism spectrum disorder and an IQ>100: A manual morphometric study.

Previous studies concerning the volumes of the amygdala and the hippocampus in autism spectrum disorders (ASD) show inconsistent results. We acquired magnetic resonance images of 30 individuals with ASD and individually matched controls. All participants had an IQ>100 to increase the likelihood of including non-syndromal forms of ASD. Manually defined amygdala volumes showed no significant group difference, while hippocampi were significantly enlarged in ASD. This finding is discussed with regard to the 'intense world hypothesis'.

Overcoming treatment resistance in chronic depression: a pilot study on outcome and feasibility of the cognitive behavioral analysis system of psychotherapy as an inpatient treatment program.

BACKGROUND: The Cognitive Behavioral Analysis System of Psychotherapy (CBASP), initially developed as an outpatient treatment for chronic depression (CD), has been adapted as a multidisciplinary 12-week inpatient program for CD. METHODS: Seventy inpatients with CD and treatment resistance were included in a noncontrolled trial. The Hamilton Depression Rating Scale served as the primary outcome measure. Prospective naturalistic follow-up assessments were conducted 6 and 12 months after discharge. RESULTS: Dropout rate was 7.1%; 90.4% perceived the program as helpful. Pre-post comparisons yielded strong effect sizes; 75.7% of the intention-to-treat sample responded, and 40.0% remitted. Nonremission was associated with experiencing temporary deterioration of symptoms during treatment. After 6 months 75.0% and after 12 months 48.0% of patients sustained response. CONCLUSIONS: The CBASP program appears as a feasible acute treatment for treatment-resistant CD inpatients with promising outcome. However, the continuation of treatment after discharge should be optimized especially for patients with subjective deterioration during treatment.

Evaluation of a new ELISA for the detection of specific IgG to the Epstein-Barr nuclear antigen 1 (EBNA-1).

Diagnosis of acute primary Epstein-Barr Virus (EBV) infection is predominantly performed by serology. Detection of specific antibodies to defined EBV antigens is considered state of the art. Antibodies to EBNA-1 are not produced early in primary infection and a positive EBNA-1 serology is a sign of past infection. Therefore EBNA-1 serology plays a crucial role for EBV routine diagnosis. In the present study the quantitative EBV EBNA-1-IgG-ELISA PKS medac was evaluated regarding its suitability for routine diagnosis. Using clinically and diagnostically defined serum samples (141 from seronegative, 111 from acute infected, and 52 from individuals with past infection) as well as 100 sera from healthy blood donors the diagnostic performance of the assay was investigated. Furthermore, precision, performance of the single-point quantitation (SPQ), and suitability of the assay for automation were evaluated. Compared to the pre-definition of the serum panel a sensitivity of 100% and a specificity of 99.6% was found. The measurement of the blood donor sera resulted in an anti-EBNA-1 IgG prevalence of 93% and an agreement of 99% with the results of a commercial ELISA used as reference. Regarding intra-assay variation, interassay variation (performed manually and automatically), and person-to-person variation a coefficient of variation < 10% was found with reactive samples. A good dilution linearity (r2 = 0.961), an excellent correlation of SPQ vs. the calibration curve (r2 = 0.997), and between the results of manually vs. automatically performed test runs (r2 > 0.995) was found. The evaluation has shown that the assay meets the demands of routine diagnosis very well.