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.

Perianal disease is associated with psychiatric co-morbidity in Crohn's disease in remission.

BACKGROUND AND AIM: Crohn's disease is a life-long inflammatory disease which can impair quality of life, in particular in patients with psychiatric co-morbidities such as depression and anxiety. The aim of this prospective cohort study was to assess the prevalence of depression and anxiety and related risk factors in patients with quiescent Crohn's disease. METHODS: A consecutive series of adult patients with confirmed diagnosis of Crohn's disease, in clinical remission, were included and investigated during ambulatory visits using a standard questionnaire assessing demographic and clinical features of the disease. Within 1 month after the ambulatory visit, all patients were interviewed by phone to assess the presence of psychiatric disorders using standardized questionnaires. The questionnaire assessed the development of psychiatric disorders after the diagnosis of Crohn's disease, the use of antidepressant or antianxiety therapy and current anxiety or depression by means of the Hospital Anxiety and Depression Scale. RESULTS: One hundred and ninety-five patients were included. Seventy-two (36.9 %) patients showed anxiety and/or depression symptoms, 46 (23.6 %) patients showed anxiety symptoms, 6 (3.1 %) patients showed depression symptoms and 20 (10.3 %) patients showed both symptoms. Forty-eight of these patients (58 %) were without any antidepressive or antianxiety treatment. Anxiety with or without depression was significantly correlated with female sex (p = 0.017), history of perianal disease (p = 0.003) and perianal surgery (p = 0.042). CONCLUSION: Anxiety is a frequent, often untreated, condition in patient affected by Crohn's disease in clinical remission. Female sex, history of perianal disease and perianal surgery are major risk factors for anxiety.

Quality of experience during psychosocial rehabilitation: a real-time investigation with experience sampling method.

OBJECTIVE: This study aimed to identify contextual and clinical factors contributing to the quality of experience of people participating in psychosocial rehabilitation activities (RA) and to investigate the association of RA with optimal experience or flow, a state characterized by the perception of high challenges and high skills, deep concentration, positive affect, clear goals, control and autonomous motivation, which contributes to individuals' well-being. METHOD: Twenty-seven people at an Italian psychiatric rehabilitation center provided real-time information on daily activities and associated experience through experience sampling method. Multilevel models were calculated to assess the factors contributing to participants' quality of experience. RESULTS: Analyses showed that situation-contingent factors-type of activity and relationship between perceived challenges and skills-predicted participants' quality of experience over and above the clinical factors taken into account in this study: level of global functioning (GAF), rehabilitation duration, and type of setting (residential vs. semi-residential). In addition, RA were prominently associated with optimal experience. CONCLUSION AND IMPLICATIONS FOR PRACTICE: Results suggest the importance for people involved in rehabilitation programs to engage in challenging tasks, favoring both the onset of positive and complex experiences and skill development. Findings further show the usefulness of real-time assessment methods in monitoring the rehabilitation process.

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.