Translating Cognitive Behavioral Therapy for Anxious Youth to Rural-Community Settings via Tele-Psychiatry.

This study aimed to determine the feasibility of translating cognitive behavioral therapy for anxious youth to rural-community settings via tele-psychiatry training. A 20-week group-supervision training program was delivered to ten different groups from different agencies within Northern Ontario. Each group consisted of four to nine clinicians with child therapy background not specific to CBT (n = 78, 51% social workers, 49% other mental health disciplines). Clinicians were each required to treat an anxious youth under supervision. Changes in clinician knowledge and youth internalizing symptoms were measured. Northern Ontario clinicians showed significant gains on a child CBT-related knowledge test (t (1, 52) = -4.6, p < .001). Although youth treated by these clinicians showed a significant decrease in anxiety symptoms, possible response bias and the lack of a comparison group mandate further studies before generalizing our findings. Nevertheless, training local therapists in anxiety-focused CBT for children via a group supervision based tele-psychiatry model appears to be a feasible and well-received approach to knowledge translation to rural settings.

Cognitive behavioral therapy age effects in child and adolescent anxiety: an individual patient data metaanalysis.

BACKGROUND: Investigations of age effects on youth anxiety outcomes in randomized trials (RCTs) of cognitive behavior therapy (CBT) have failed to yield a clear result due to inadequate statistical power and methodologic weaknesses. We conducted an individual patient data metaanalysis to address this gap. QUESTION: Does age moderate CBT effect size, measured by a clinically and statistically significant interaction between age and CBT exposure? METHODS: All English language RCTs of CBT for anxiety in 6-19 year olds were identified using systematic review methods. Investigators of eligible trials were invited to submit their individual patient data. The anxiety disorder interview schedule (ADIS) primary diagnosis severity score was the primary outcome. Age effects were investigated using multilevel modeling to account for study level data clustering and random effects. RESULTS: Data from 17 of 23 eligible trials were obtained (74%); 16 studies and 1,171 (78%) cases were available for the analysis. No interaction between age and CBT exposure was found in a model containing age, sex, ADIS baseline severity score, and comorbid depression diagnosis (power ≥ 80%). Sensitivity analyses, including modeling age as both a categorical and continuous variable, revealed this result was robust. CONCLUSIONS: Adolescents who receive CBT in efficacy research studies show benefits comparable to younger children. However, CBT protocol modifications routinely carried out by expert trial therapists may explain these findings. Adolescent CBT protocols are needed to facilitate the transportability of efficacy research effects to usual care settings where therapists may have less opportunity for CBT training and expertise development.

Self-perceptions in relation to self-reported depressive symptoms in boys and girls.

BACKGROUND: Low self-esteem is associated with depressive symptoms in children. However, the association between domains of self-esteem (e.g., self perceptions) and depressive symptoms may vary by gender. AIMS: This study evaluated self-perceptions in relation to self-reported depressive symptoms in boys and girls. METHODS: School children in grades 3 to 6 (n = 140; 54% boys; 46% girls) completed the Children's Depression Inventory (CDI) and The Self-Perception Profile for Children (SPPC) as part of a school-based intervention targeting anxious and depressive symptoms. The CDI was re-administered about 1 month later. Pearson correlations between the subscales of the SPPC and the average CDI T-scores were determined. Significant correlations were entered in stepwise regressions to predict depressive symptoms for the whole sample and then separately for boys and girls. RESULTS: Self-perceived scholastic competence, physical appearance, and behavioral conduct accounted for 19.8% of the variance in self-reported depressive symptoms overall. Behavioral conduct was a more salient predictor in boys (adjusted R(2) =0.146) whereas scholastic competence and physical appearance were more salient in girls (adjusted R(2) =0.203). CONCLUSION: Although replication is needed, boys and girls appear to have different self-perceptions in relation to depressive symptoms. Understanding these differences may help to inform clinical interventions.

The feelings club: randomized controlled evaluation of school-based CBT for anxious or depressive symptoms.

BACKGROUND: Children with anxious or depressive symptoms are at risk of developing internalizing disorders and their attendant morbidity. To prevent these outcomes, school-based cognitive-behavioral therapy (CBT) has been developed, but few studies include active control conditions. We evaluated a preventive CBT program targeting internalizing symptoms relative to an activity contrast condition post-intervention and at 1-year follow-up. METHODS: One thousand one hundred and thirty-nine children from Grades 3-6 from a diverse sample of schools, were screened with the Multidimensional Anxiety Scale for Children and Children's Depression Inventory. Those with t>60 on either measure were offered participation in a randomized 12-week trial, school-based group CBT versus a structured after-school activity group of equal duration. We explored several therapeutic elements as potential predictors of change. RESULTS: One hundred and forty-eight children participated (84 boys, 64 girls; 78 CBT, 70 contrast; 57% Caucasian) and 145 completed the program. Self-reported anxious and depressive symptoms decreased significantly over time (η(2)=.15 and .133, respectively), with no group by time interaction. There was a trend toward fewer children meeting diagnostic criteria for an anxiety disorder on the Anxiety Disorders Interview Schedule at 1-year post-CBT than post-contrast (6/76 versus 12/69). Positive reinforcement of child behavior was associated with change in anxiety symptoms; checking homework was understood with change in depressive symptoms. CONCLUSIONS: Findings suggest that children with internalizing symptoms may benefit from both school-based CBT and structured activity programs. Replication, longer follow-up, and further studies of therapeutic elements in child CBT are indicated. ISRCTN Registry identifier: ISRCTN88858028, url: http://www.controlled-trials.com/.

Cognitive behavioural therapy for depressed youth: predictors of attendance in a pilot study.

OBJECTIVE: Of the many forms of psychotherapy offered to treat depression in youth, Cognitive Behavioural Therapy (CBT) has been shown to be efficacious. Nonetheless, a high degree of apparent non-responsiveness, failure to remit post-treatment, and lack of long term benefit are all problematic. Given that regular participation is critical to treatment success, child and family predictors of attendance were researched. METHOD: Twenty-nine depressed Canadian youth (aged 10-17) participated in a youth only or youth plus parent CBT group. Child and parent predictors of attendance were examined. RESULTS: Youth who were younger, less anxious (by maternal report), and had more formally educated parents attended CBT more consistently. Further, mothers who perceived their children's depressive symptoms as more severe, whose children reported more depressive and anxious symptoms, and who reported more life stressors attended more parent sessions. CONCLUSIONS: This study identifies key factors influencing youth and parent attendance in group CBT for depressed youth. Addressing these factors at the outset of treatment may decrease attrition in this form of psychotherapy.

An increase in N-Ras expression is associated with development of hormone refractory prostate cancer in a subset of patients.

Protein expression of H, K and N-Ras was assessed in hormone sensitive and hormone refractory prostate tumour pairs from 61 patients by immunohistochemistry. Expression of H-Ras and K- Ras was not associated with any known clinical parameters. In contrast an increase in N-Ras membrane expression in the transition from hormone sensitive to hormone refractory prostate cancer was associated with shorter time to relapse (p=0.01) and shorter disease specific survival (p=0.008). In addition, patients with an increase in N-Ras membrane expression had lower levels of PSA at relapse (p=0.02) and expression correlated with phosphorylated MAP kinase (p=0.010) and proliferation index (Ki67, p=0.02). These results suggest that in a subgroup patients N-Ras expression is associated with development of hormone refractory prostate cancer via activation of the MAP kinase cascade.

Differential effects of an adult observer's presence on sex-typed play behavior: A comparison between gender-schematic and gender-aschematic preschool children.

The present study examined the differential effect of an adult observer's presence on the sex-typed play behavior of gender schematic and aschematic preschoolers. A total of 116 Israeli preschoolers (M age = 64.9 months) participated in the study. Children were classified as either gender schematic or aschematic based upon responses to a computerized measure of different sex stereotype components. Children's play behavior with gender typical and atypical, attractive and unattractive, toys was videotaped. An observer was present for half the children's play and absent for the other half's play. Observation status affected the aschematic, but not the schematic, children's play with gender typical toys. For example, observed aschematic boys spent a greater percent of time playing with the unattractive masculine toys compared to unobserved aschematic boys. This difference was not apparent for schematic boys. Additionally, a difference found for schematic boys was not apparent in schematic girls, i.e., when unobserved, schematic boys tended to spend a greater percent of time playing with the unattractive masculine toy than aschematic boys. Further, some differences were found for unattractive, and not attractive, toys. For instance, observed aschematic boys spent a greater percent of time playing with the unattractive masculine toy than did the unobserved aschematic boys. This gap was not found for the attractive masculine toy. Results are discussed with reference to the accessibility and complexity of gender schemas.

Bad expression influences time to androgen escape in prostate cancer.

OBJECTIVE: To assess the role of selected downstream Bcl-2 family members (Bad, Bax, Bcl-2 and Bcl-xL) in the development of androgen-independent prostate cancer (AIPC), as androgen-deprivation therapy is the treatment of choice in advanced prostate cancer, yet patients generally relapse and progress to an AI state within 18-24 months. PATIENTS, MATERIALS AND METHODS: The patient cohort was established by retrospectively selecting patients with prostate cancer who had an initial response to androgen-deprivation therapy, but subsequently relapsed with AIPC. In all, 58 patients with prostate cancer were included with matched androgen-dependent (AD) and AI prostate tumours available for immunohistochemical analysis; two independent observers using a weighted-histoscore method scored the staining. Changes in Bad, Bax, Bcl-2 and Bcl-xL expression during transition to AIPC were evaluated and then correlated to known clinical variables. RESULTS: High Bad expression in AD tumours was associated with an increased time to biochemical relapse (P = 0.007) and a trend towards improved overall survival (P = 0.053). There were also trends towards a decrease in Bad (P = 0.068) and Bax (P = 0.055) expression with progression to AIPC. There were no significant results for Bcl-2 or Bcl-xL. CONCLUSION: There is evidence to suggest that Bad expression levels at diagnosis influence time to biochemical relapse and overall survival, and that levels of pro-apoptotic proteins Bad and Bax fall during AIPC development. Bad might therefore represent a possible positive prognostic marker and potential therapeutic target for AIPC in the future.

The role of HER1-HER4 and EGFRvIII in hormone-refractory prostate cancer.

PURPOSE: The role of the type I receptor tyrosine kinase (HER) family in progression of prostate cancer is controversial. Breast cancer studies show that these receptors should be investigated as a family. The current study investigates expression of HER1-HER4 and EGFRvIII in matched hormone-sensitive and hormone-refractory prostate tumors. EXPERIMENTAL DESIGN: Immunohistochemical analysis was used to investigate protein expression of HER1-HER4, EGFRvIII, and phosphorylated Akt (pAkt) in matched hormone-sensitive and hormone-refractory prostate tumors. RESULTS: Surprisingly, high HER2 membrane expression in hormone-sensitive tumors was associated with an increased time to biochemical relapse (P = 0.0003), and this translated into longer overall survival (P = 0.0021). Consistent with other studies, HER4 membrane expression in hormone-sensitive tumors was associated with longer time to biochemical relapse (P = 0.042), and EGFRvIII membrane expression was associated with shorter time to biochemical relapse (P = 0.015). An increase in pAkt expression was associated with reduced survival (P = 0.0098). Multivariate analysis showed that HER2 was an independent positive predictive marker of time to relapse in hormone-sensitive prostate tumors (P = 0.014). In contrast, high HER2 expression in hormone-refractory tumors was associated with decreased time to death from biochemical relapse (P = 0.039), and EGFRvIII nuclear expression was associated with decreased time to death from biochemical relapse and decreased overall survival (P = 0.02 and P = 0.005). CONCLUSION: These results suggest that the HER family may have multiple roles in prostate cancer, and that expression of the proteins alone is insufficient to predict the biological response that they may elicit.