New therapy may help people with unexplained symptoms of pain, weakness and fatigue

ScienceDaily (July 28, 2011) — A new type of therapy may help people with symptoms such as pain, weakness, or dizziness that can't be explained by an underlying disease, according to a study published in the July 27, 2011, online issue of Neurology®, the medical journal of the American Academy of Neurology. These symptoms, which can also include fatigue, tingling and numbness, are also known as functional or psychogenic symptoms.

"People with these symptoms make up one-third of all clinic visits, but the outcomes are poor," said study author Michael Sharpe, MD, of the University of Edinburgh in Scotland.

Previous studies have shown that intense cognitive behavioral therapy can reduce the symptoms, distress and disability in people with these symptoms, but there are obstacles to providing this therapy. Many people do not feel psychological treatment is appropriate and resist referrals to mental health services, and therapists trained in cognitive behavioral therapy are not available in all communities.

Cognitive behavioral therapy aims to improve people's physical symptoms, emotional state and functioning by helping them to understand, and where necessary change, how they think about and respond to their symptoms and life situation.

For the study, the researchers developed a self-help workbook especially for patients with physical symptoms that was based on the therapy. A total of 62 people were given the workbook and over three months had up to four half-hour hour sessions guiding them in the use of the book with a nurse at their neurologist's office in addition to their usual medical care. They were compared to 63 people who received only their usual medical care. Most of the participants also had psychiatric diagnoses, such as panic disorder, anxiety disorder and depression.

After three months, the people who received the extra therapy were approximately twice as likely to report improvements in their overall health as those who did not receive the extra therapy. A total of 13 percent more people who received the extra therapy reported that their health was "better" or "much better" than those who received only their usual care.

After six months, there was no longer a significant difference in improvements in overall health between the two groups. However, those receiving the extra therapy continued to have greater improvement in their symptoms than those who received the usual care and also in their physical functioning. They were also more satisfied with their treatment.

"This study suggests that cognitive behavioral therapy-based guided self-help may be a new and potentially useful first step in improving the management of these challenging symptoms," Sharpe said. "This approach needs further evaluation but can be a potentially effective and cost-effective first step toward providing more help for these often neglected patients."

The study was supported by the United Kingdom Medical Research Council.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by American Academy of Neurology.

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

View the original article here

New therapy may help people with unexplained symptoms of pain, weakness and fatigue

ScienceDaily (July 28, 2011) — A new type of therapy may help people with symptoms such as pain, weakness, or dizziness that can't be explained by an underlying disease, according to a study published in the July 27, 2011, online issue of Neurology®, the medical journal of the American Academy of Neurology. These symptoms, which can also include fatigue, tingling and numbness, are also known as functional or psychogenic symptoms.

"People with these symptoms make up one-third of all clinic visits, but the outcomes are poor," said study author Michael Sharpe, MD, of the University of Edinburgh in Scotland.

Previous studies have shown that intense cognitive behavioral therapy can reduce the symptoms, distress and disability in people with these symptoms, but there are obstacles to providing this therapy. Many people do not feel psychological treatment is appropriate and resist referrals to mental health services, and therapists trained in cognitive behavioral therapy are not available in all communities.

Cognitive behavioral therapy aims to improve people's physical symptoms, emotional state and functioning by helping them to understand, and where necessary change, how they think about and respond to their symptoms and life situation.

For the study, the researchers developed a self-help workbook especially for patients with physical symptoms that was based on the therapy. A total of 62 people were given the workbook and over three months had up to four half-hour hour sessions guiding them in the use of the book with a nurse at their neurologist's office in addition to their usual medical care. They were compared to 63 people who received only their usual medical care. Most of the participants also had psychiatric diagnoses, such as panic disorder, anxiety disorder and depression.

After three months, the people who received the extra therapy were approximately twice as likely to report improvements in their overall health as those who did not receive the extra therapy. A total of 13 percent more people who received the extra therapy reported that their health was "better" or "much better" than those who received only their usual care.

After six months, there was no longer a significant difference in improvements in overall health between the two groups. However, those receiving the extra therapy continued to have greater improvement in their symptoms than those who received the usual care and also in their physical functioning. They were also more satisfied with their treatment.

"This study suggests that cognitive behavioral therapy-based guided self-help may be a new and potentially useful first step in improving the management of these challenging symptoms," Sharpe said. "This approach needs further evaluation but can be a potentially effective and cost-effective first step toward providing more help for these often neglected patients."

The study was supported by the United Kingdom Medical Research Council.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by American Academy of Neurology.

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

View the original article here

Group therapy helps multiple sclerosis patients cope with depression, study finds

ScienceDaily (June 13, 2011) — Offering Multiple Sclerosis sufferers emotional support through group therapy sessions could improve their quality of life and save the NHS almost £500 per patient, a study at The University of Nottingham has discovered.

Researchers are now planning a larger multi-centre study into the issue to establish whether psychological therapy should be incorporated into the MS services currently provided by the NHS.

The study, funded by the MS Society, was led by Professor Nadina Lincoln, of the University's Institute of Work, Health and Organisations. She said: "These are very encouraging findings as many people with MS have problems with depression and anxiety and there are few treatments provided in NHS clinical services to address these. It is important that the psychological effects of MS are fully recognised as they can have a devastating effect on people's lives."

Depression and anxiety are common among sufferers of MS, a disabling neurological condition that affects around 100,000 people in the UK.

Previous studies have suggested that depression in MS can lead to patients failing to take their medication and a reduced quality of life. National Institute for Health and Clinical Excellence (NICE) guidelines also recognise that many people with both MS and depression or anxiety would prefer not to take antidepressants and recommends that psychological therapies should be offered as an alternative.

For the Nottingham study researchers recruited MS patients currently attending clinics run by Nottingham University Hospitals NHS Trust, as well as inviting referrals from specialist MS nurses and placing adverts in publications produced by the MS Society.

The volunteers were asked to complete questionnaires about how MS affects their daily lives and the extent to which they felt in control.

The patients were then randomly divided into two groups of just over 70 people. One group received all the usual care offered to MS and were put on a waiting list to receive group therapy at the end of the study.

The other group were invited to attend a course of six two-hour sessions of group therapy attended by up to eight participants at a time. Each session was led by a research psychologist, supervised by a qualified clinical psychologist with experience of working with people with MS.

Each session focussed on a topic, such as worry, gloom and relationships and was followed by practical exercises in strategies to cope with emotional problems and group discussion. They finished with relaxation exercises and group members were given tasks centred on practising coping strategies between sessions.

To assess the effectiveness of the sessions, questionnaires were sent to the participants at both four and eight months later and the results of those who received treatment were compared to those on the waiting list only.

The researchers found that those MS sufferers who attended the group sessions had fewer problems with anxiety and depression, the impact of the disease on their daily lives was reduced and their quality of life improved.

In terms of potential savings to the NHS, the researchers have also collected information on cost, which will be submitted for a future publication. They found that costs were reduced by £470 per patient for those who attended the therapy sessions compared with usual care. It was shown to almost halve the cost of visits to the GP, falling from £11,340 at the start of the study to just £5,832 at the eight month follow up. The costs of outpatient hospital visits were also slashed from £32,592 at the beginning of the study to £21,534 at the eight-month follow-up.

The next stage of the research will be to assess whether the group therapy approach works equally well in other centres through a larger study with the hope that the treatment could potentially be provided through NHS services for those with MS.

Dr Susan Kohlhass from the MS Society said: "Knowing group-based sessions can reduce anxiety and depression is a strong development towards improving the quality of peoples' lives with MS. We are committed to funding work that will imminently benefit people with the condition and this is a great example. The next stage will be to find if this approach is as effective in other areas of the country."

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of Nottingham.

Journal Reference:

N. B. Lincoln, F. Yuill, J. Holmes, A. E. Drummond, C. S. Constantinescu, S. Armstrong, C. Phillips. Evaluation of an adjustment group for people with multiple sclerosis and low mood: a randomized controlled trial. Multiple Sclerosis Journal, 2011; DOI: 10.1177/1352458511408753

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

View the original article here

Cognitive behavioral therapy may benefit patients in residential substance abuse treatment programs

ScienceDaily (June 6, 2011) — Patients in residential treatment programs for drug and alcohol abuse may benefit from cognitive behavioral therapy for depressive symptoms, according to a report in the June issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

The article notes, as background information, that depression and substance abuse often co-occur, but that individuals with both disorders are not always treated for both. "The consequences of this unmet need are great," report the authors. "The interactive nature of the two disorders leads to poorer depression and substance abuse treatment outcomes compared with the outcomes when only one disorder is treated."

Katherine E. Watkins, M.D., M.S.H.S., from RAND Corporation, Santa Monica, Calif., and colleagues conducted the study at four Behavioral Health Services facilities in Los Angeles County, Calif. Between August 2006 and January 2009, the sites alternated every four months between usual care for substance abuse and usual care plus cognitive behavioral therapy as modeled in the Building Recovery by Improving Goals, Habits, and Thoughts (BRIGHT) study. The intervention comprised 16 two-hour BRIGHT sessions over the course of eight weeks.

Initially, 1,262 patients were screened for participation in the study. The researchers enrolled 140 patients in the intervention group and 159 patients in the control group. On average, participants scored in the clinically severe range on a scale of depression symptoms and nearly half (45.8%) had a past 12-month depressive disorder.

On the depression-symptom instrument used in the study, at three months patients receiving the intervention generally had mild symptoms and patients receiving usual care alone generally had moderate symptoms. At three months, 55.8 percent of patients in the BRIGHT group had minimal symptoms, compared with 33.6 percent in the control group; at six months, these numbers increased to 63.9 percent and 43.8 percent, respectively. Among patients no longer living in a treatment center at the six-month mark, those in the intervention group had fewer days of problem substance abuse and fewer drinking days than did those in the usual care group.

With the study, the authors hope to address a gap in the substance abuse treatment system, particularly in the public sector. They note that the BRIGHT intervention involved substance abuse counselors, as opposed to other mental health professionals and resources that some substance abuse programs cannot access. "The study demonstrates that it is possible to develop the capacity of substance abuse programs to deliver evidence-based mental health care by enhancing the skills and expanding the clinical roles of substance abuse counselors," the researchers state. This is important, they add, because "Lack of access to efficacious depression treatment for substance abusers is an important public health problem."

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by JAMA and Archives Journals.

Journal Reference:

K. E. Watkins, S. B. Hunter, K. A. Hepner, S. M. Paddock, E. de la Cruz, A. J. Zhou, J. Gilmore. An Effectiveness Trial of Group Cognitive Behavioral Therapy for Patients With Persistent Depressive Symptoms in Substance Abuse Treatment. Archives of General Psychiatry, 2011; 68 (6): 577 DOI: 10.1001/archgenpsychiatry.2011.53

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

View the original article here

Cognitive behavioral therapy may benefit patients in residential substance abuse treatment programs

ScienceDaily (June 6, 2011) — Patients in residential treatment programs for drug and alcohol abuse may benefit from cognitive behavioral therapy for depressive symptoms, according to a report in the June issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

The article notes, as background information, that depression and substance abuse often co-occur, but that individuals with both disorders are not always treated for both. "The consequences of this unmet need are great," report the authors. "The interactive nature of the two disorders leads to poorer depression and substance abuse treatment outcomes compared with the outcomes when only one disorder is treated."

Katherine E. Watkins, M.D., M.S.H.S., from RAND Corporation, Santa Monica, Calif., and colleagues conducted the study at four Behavioral Health Services facilities in Los Angeles County, Calif. Between August 2006 and January 2009, the sites alternated every four months between usual care for substance abuse and usual care plus cognitive behavioral therapy as modeled in the Building Recovery by Improving Goals, Habits, and Thoughts (BRIGHT) study. The intervention comprised 16 two-hour BRIGHT sessions over the course of eight weeks.

Initially, 1,262 patients were screened for participation in the study. The researchers enrolled 140 patients in the intervention group and 159 patients in the control group. On average, participants scored in the clinically severe range on a scale of depression symptoms and nearly half (45.8%) had a past 12-month depressive disorder.

On the depression-symptom instrument used in the study, at three months patients receiving the intervention generally had mild symptoms and patients receiving usual care alone generally had moderate symptoms. At three months, 55.8 percent of patients in the BRIGHT group had minimal symptoms, compared with 33.6 percent in the control group; at six months, these numbers increased to 63.9 percent and 43.8 percent, respectively. Among patients no longer living in a treatment center at the six-month mark, those in the intervention group had fewer days of problem substance abuse and fewer drinking days than did those in the usual care group.

With the study, the authors hope to address a gap in the substance abuse treatment system, particularly in the public sector. They note that the BRIGHT intervention involved substance abuse counselors, as opposed to other mental health professionals and resources that some substance abuse programs cannot access. "The study demonstrates that it is possible to develop the capacity of substance abuse programs to deliver evidence-based mental health care by enhancing the skills and expanding the clinical roles of substance abuse counselors," the researchers state. This is important, they add, because "Lack of access to efficacious depression treatment for substance abusers is an important public health problem."

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by JAMA and Archives Journals.

Journal Reference:

K. E. Watkins, S. B. Hunter, K. A. Hepner, S. M. Paddock, E. de la Cruz, A. J. Zhou, J. Gilmore. An Effectiveness Trial of Group Cognitive Behavioral Therapy for Patients With Persistent Depressive Symptoms in Substance Abuse Treatment. Archives of General Psychiatry, 2011; 68 (6): 577 DOI: 10.1001/archgenpsychiatry.2011.53

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

View the original article here

Limitations of evidence base for prescribing aripiprazole in maintenance therapy of bipolar disorder

ScienceDaily (May 3, 2011) — The evidence base for the prescribing of aripiprazole in maintenance treatment of bipolar disorder is limited to a single trial, sponsored by the manufacturer of aripiprazole, according to a rigorous appraisal of the evidence for its use led jointly by Alexander Tsai of Harvard University, Boston USA, and Nicholas Rosenlicht of the University of California San Francisco, USA. In the paper, published in PLoS Medicine, the authors describe key limitations of the trial, which were not identified in most subsequent review articles and guidelines for the treatment of bipolar disorder in which the trial was cited.

Bipolar disorder (also known as manic depression) is a common and serious psychiatric illness. Individuals with bipolar disorder experience mood swings with manic episodes (where they may feel euphoric, restless, and behave impulsively), along with depressive episodes where they may feel low, worthless, and suicidal. Aripiprazole is a second-generation antipsychotic medication and the newest of such drugs to have received approval by the US Food and Drug Administration (FDA) for use both in treatment of acute episodes and, more recently, for maintenance therapy.

Drs. Tsai and Rosenlicht and their colleagues conducted a systematic search to find all published and unpublished studies relating to use of aripiprazole for maintenance therapy of bipolar disorder, including a request to the FDA under Freedom of Information Act legislation. They critically appraised this evidence and then used citation searches to examine how the primary evidence was subsequently referenced in the medical literature. The authors found only a single trial describing the use of aripiprazole during the maintenance phase of bipolar disorder. Further, they found significant limitations of this trial that constrain its interpretation as supporting the use of aripiprazole for this indication. First, the trial duration was too short to show that the drug was truly helpful in maintaining initial benefit or preventing mood swings over the long term. Second, very few participants in the trial completed the entire study. Third, the trial was based on a select minority of subjects who had shown an initial response to the drug, making it difficult to extrapolate these findings to patients with bipolar disorder more widely. Fourth, the trial had a design whereby patients assigned to placebo were abruptly taken off aripiprazole treatment given to them during a previous "run-in" phase and reassigned to placebo; differences in risk of relapse seen between trial arms may thus also reflect the potentially harmful effects of rapid drug withdrawal in patients given placebo.

Despite these shortcomings, the authors found that this single trial was subsequently cited by 104 review articles and treatment guidelines, with very few mentioning the study's limitations.

The authors comment that "…alternative modifications or study designs may improve the probability of generating more useful data from studies in this vulnerable patient population to inform the treatment of similar patients in the future."

Patients (or their family members) who may learn of this study's findings are urged to contact their physician if concerned about what these findings may mean for their treatment. Specifically, the findings do not mean patients should cease their medication; despite the limitations of the evidence described here, this drug may be helpful to them. In addition, the study did not assess the evidence for the use of aripiprazole in acute treatment of bipolar disorder.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Public Library of Science, via EurekAlert!, a service of AAAS.

Journal Reference:

Alexander C. Tsai, Nicholas Z. Rosenlicht, Jon N. Jureidini, Peter I. Parry, Glen I. Spielmans, David Healy. Aripiprazole in the Maintenance Treatment of Bipolar Disorder: A Critical Review of the Evidence and Its Dissemination into the Scientific Literature. PLoS Medicine, 2011; 8 (5): e1000434 DOI: 10.1371/journal.pmed.1000434

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

View the original article here