Putting a Hold on the Downward Spiral of Paranoia in the Social World: A Randomized Controlled Trial of Mindfulness-Based Cognitive Therapy in Individuals With a History of Depression.

Putting a Hold on the Downward Spiral of Paranoia in the Social World: A Randomized Controlled Trial of Mindfulness-Based Cognitive Therapy in Individuals with a History of Depression.

PLoS One. 2013; 8(6): e66747
Collip D, Geschwind N, Peeters F, Myin-Germeys I, van Os J, Wichers M

Paranoia embodies altered representation of the social environment, fuelling altered feelings of social acceptance leading to further mistrust. Mindfulness-based cognitive therapy (MBCT) may relieve paranoia and reduce its impact on social acceptance.To determine whether MBCT alters momentary feeling of paranoia and social acceptance in daily life.Randomized controlled trial of daily-life repeated measures (up to 120 per participant) before and after allocation to MBCT or waiting list control.Volunteer sample of 130 eligible men and women with residual affective dysregulation after at least one episode of major depressive disorder.Eight weeks of MBCT in groups of 10-15 participants in addition to participants’ usual treatment.Daily-life ratings of paranoia and social acceptance. This manuscript concerns additional analyses of the original trial; hypotheses were developed after data collection (focus initially on depressive symptoms) but before data analysis.Sixty-six participants were assigned to the waiting list control group and 64 to the MBCT intervention group, of whom 66 and 61 respectively were included in the per-protocol analyses. Intention-to-treat analyses revealed a significant group by time interaction in the model of momentary paranoia (b?=?-.18, p<0.001, d?=?-0.35) and social acceptance (b?=?.26, p<0.001, d?=?0.41). Paranoia levels in the intervention group were significantly reduced (b?=?-.11, p<0.001) and feelings of social acceptance significantly increased (b?=?.18, p<0.001), whereas in the Control condition a significant increase in paranoia (b?=?.07, p?=?0.008) and a decrease in social acceptance was apparent (b?=?-.09, p?=?0.013). The detrimental effect of paranoia on social acceptance was significantly reduced in the MBCT, but not the control group (group by time interaction: b?=?.12, p?=?0.022).MBCT confers a substantial benefit on subclinical paranoia and may interrupt the social processes that maintain and foster paranoia in individuals with residual affective dysregulation.Netherlands Trial Register NTR1084. HubMed – depression

Relative Impact of Multimorbid Chronic Conditions on Health-Related Quality of Life – Results from the MultiCare Cohort Study.

PLoS One. 2013; 8(6): e66742
Brettschneider C, Leicht H, Bickel H, Dahlhaus A, Fuchs A, Gensichen J, Maier W, Riedel-Heller S, Schäfer I, Schön G, Weyerer S, Wiese B, van den Bussche H, Scherer M, König HH, , Altiner A, Bickel H, Blank W, Brettschneider C, Bullinger M, van den Bussche H, Dahlhaus A, Ehreke L, Freitag M, Fuchs A, Gensichen J, Gerlach F, Hansen H, Heinrich S, Höfels S, von dem Knesebeck O, König HH, Krause N, Leicht H, Luppa M, Maier W, Mayer M, Mellert C, Nützel A, Paschke T, Petersen J, Prokein J, Riedel-Heller S, Romberg HP, Schäfer I, Scherer M, Schön G, Steinmann S, Schulz S, Wegscheider K, Weckbecker K, Werle J, Weyerer S, Wiese B, Zieger M

Multimorbidity has a negative impact on health-related quality of life (HRQL). Previous studies included only a limited number of conditions. In this study, we analyse the impact of a large number of conditions on HRQL in multimorbid patients without preselecting particular diseases. We also explore the effects of these conditions on the specific dimensions of HRQL.This analysis is based on a multicenter, prospective cohort study of 3189 multimorbid primary care patients aged 65 to 85. The impact of 45 conditions on HRQL was analysed. The severity of the conditions was rated. The EQ-5D, consisting of 5 dimensions and a visual-analogue-scale (EQ VAS), was employed. Data were analysed using multiple ordinary least squares and multiple logistic regressions. Multimorbidity measured by a weighted count score was significantly associated with lower overall HRQL (EQ VAS), b?=?-1.02 (SE: 0.06). Parkinson’s disease had the most pronounced negative effect on overall HRQL (EQ VAS), b?=?-12.29 (SE: 2.18), followed by rheumatism, depression, and obesity. With regard to the individual EQ-5D dimensions, depression (OR?=?1.39 to 3.3) and obesity (OR?=?1.44 to 1.95) affected all five dimensions of the EQ-5D negatively except for the dimension anxiety/depression. Obesity had a positive effect on this dimension, OR?=?0.78 (SE: 0.07). The dimensions “self-care”, OR?=?4.52 (SE: 1.37) and “usual activities”, OR?=?3.59 (SE: 1.0), were most strongly affected by Parkinson’s disease. As a limitation our sample may only represent patients with at most moderate disease severity.The overall HRQL of multimorbid patients decreases with an increasing count and severity of conditions. Parkinson’s disease, depression and obesity have the strongest impact on HRQL. Further studies should address the impact of disease combinations which require very large sample sizes as well as advanced statistical methods. HubMed – depression

Economic and humanistic burden of post-trauma and post-surgical neuropathic pain among adults in the United States.

J Pain Res. 2013; 6: 459-69
Parsons B, Schaefer C, Mann R, Sadosky A, Daniel S, Nalamachu S, Stacey BR, Nieshoff EC, Tuchman M, Anschel A

Neuropathic pain (NeP) can be chronic, debilitating, and can interfere with sleep, functioning, and emotional well being. While there are multiple causes of NeP, few studies have examined the disease burden and treatment patterns associated with post-traumatic/post-surgical (PTPS) NeP.To characterize pain, health status, function, health care resource utilization, lost productivity, and costs among subjects with PTPS NeP in the United States.This observational study enrolled 100 PTPS NeP subjects recruited during routine visits from general practitioner and specialist sites. Subjects completed a one-time questionnaire with validated measures of pain severity and pain interference, health status, sleep, anxiety and depression, productivity, and study-specific items on demographics, employment status, and out-of-pocket expenses. Investigators completed a case report form based on a 6-month retrospective chart review, recording subjects’ clinical characteristics as well as current and previous medications/treatments for NeP. Subjects were stratified into mild, moderate, and severe pain groups.Subjects’ demographic characteristics were: mean age of 54.9 years, 53% female, and 22% employed for pay. Mean pain severity score was 5.6 (0-10 scale), with 48% and 35% classified as having moderate and severe pain, respectively. The mean number of comorbidities increased with greater pain severity (P = 0.0009). Patient-reported outcomes were worse among PTPS NeP subjects with more severe pain, including pain interference with function, health state utility, sleep, and depression (P < 0.0001). Eighty-two percent of subjects were prescribed two or more NeP medications. The total mean annualized adjusted direct and indirect costs per subject were $ 11,846 and $ 29,617, respectively. Across pain severity levels, differences in annualized adjusted direct and indirect costs were significant (P < 0.0001).PTPS NeP subjects reported high pain scores, which were associated with poor health utility, sleep, mood, and function, as well as high health care resource utilization and costs. The quality of life impact and costs attributable to PTPS NeP suggest an unmet need for effective and comprehensive management. HubMed – depression

Exercise electrocardiogram testing in two brothers with different outcome – a case study exercise testing in master cyclists.

Int J Gen Med. 2013; 6: 495-501
Rüst CA, Knechtle B, Rosemann T

The cases of two brothers training and competing as master cyclists and both preparing for a cycling tour are presented. The older brother aged 66 years went first to the primary care physician and presented with an asymptomatic depression in the exercise stress test of the ST segment in V5 and V6 during recovery after complete exhaustion. Coronary angiography revealed a multi vessel coronary artery disease and he underwent bypass surgery. One year later, he successfully completed his planned cycling tour of ~600 km in seven stages and covering ~12,000 m of total ascent. The younger brother aged 59 years went a few months later to the primary care physician and also performed asymptomatic exercise stress testing without changes in the ST segments. Unfortunately, 2 months later he suffered a cardiac arrest during his cycling tour and survived following immediate successful cardiopulmonary resuscitation on the road by his cycling colleagues. Immediate invasive coronary arteriography showed a complete stenosis of the trunk of arteria coronaria sinistra (left coronary artery), a 40%-50% stenosis of ramus circumflexus, and a 20% stenosis of arteria coronaria dextra (right coronary artery). The left coronary artery was dilated and he continued cycling 2 months later. In both brothers, familial hypercholesterolemia was the main cardiovascular risk factor for the multi vessel coronary artery disease. A negative exercise electrocardiogram in siblings with an increased risk for coronary artery disease seemed not to exclude an advanced multi vessel coronary artery disease. In master athletes with asymptomatic exercise electrocardiogram but a positive family history, further examinations should be performed in order to detect relevant stenosis in coronary arteries. HubMed – depression

Depression Treatment: Self-Help – Self-help for depression is an important depression treatment. HealthyPlace.com Medical Director, Dr. Harry Croft, says some depression self-help treatments …