Combined cognitive and motor training improves the outcome in the early phase after stroke and prevents a decline of executive functions: A pilot study.

BACKGROUND: The negative impact of cognitive dysfunction on motor rehabilitation as a relearning-process is well known in stroke patients. However, evidence for combined cognitive and motor training (CMT) is lacking. OBJECTIVE: To evaluate the effects of combined CMT in early stroke rehabilitation. METHODS: In a controlled pilot study, 29 moderately affected stroke patients with low-level motor performance and cognitive impairment received motor therapy plus either cognitive (experimental group, EG) or low-frequency ergometer training (control group, CG) for eight days. RESULTS: Both groups improved their motor functioning significantly. After training, between-group comparison revealed significant differences for cognitive flexibility and trends for set-shifting, working memory, and reaction control in favor of the EG. Within-group effects showed improvement across all cognitive domains in the EG, which correlated with gains in bed-mobility, while the CG showed no significant improvement in cognition. Rather, a trend towards reaction control decline was observed, which correlated with less functional progression and recovery. Furthermore, a decline in cognitive flexibility, set-shifting, and working memory was descriptively observed. CONCLUSIONS: Combined CMT may enhance cognition and motor relearning early after stroke and is superior to single motor training. Further studies are needed to replicate these results and investigate long-term benefits.

The effectiveness of adjunct music therapy for patients with schizophrenia: A meta-analysis.

To evaluate the efficacy of adjunct music therapy on patients with schizophrenia, we conducted a meta-analysis of currently available randomized controlled trials and controlled clinical trials. Eight electronic databases (CNKI, PubMed, EMBASE, Cochrane Library, PsycINFO, Web of Science, Psychology and behavioural Sciences Collection, and Medline) were systematically searched from inception to January 2020. Standard mean difference (SMD) with 95% confidence interval (CI) values were used to evaluate the effects of music therapy. Finally, we selected eighteen studies comprising 1,212 participants comparing with control conditions. The meta-analysis demonstrated that adjunct music therapy significantly improved total symptoms (SMD = -0.48, 95%CI: -0.74 to -0.22), negative symptoms (SMD=-0.56, 95%CI: -0.72 to -0.40), depression symptoms (SMD = -0.35, 95% CI: -0.54 to -0.17), and quality of life (SMD = 0.35, 95%CI: 0.07 to 0.62) in people with schizophrenia compared with the control group. In addition, the meta-analysis indicated no publication bias for total symptoms, negative symptoms, and positive symptoms. The sensitivity analysis showed that the result was reliable. But the quality of evidence is still low, more well-designed studies with larger sample size and high quality are needed to confirm the efficiency of adjunct music therapy in treating schizophrenia.

To make a run for IT - A feasibility study of ICBT combined with physical exercise for patients with panic disorder.

BACKGROUND: Guided Internet-based cognitive behavioural therapy (ICBT) is a recommended treatment for panic disorder promising to increase treatment availability, but there are some concerns regarding adherence, including adherence to the in vivo exposure given as home assignments. The aim of this study was to assess the feasibility of combining ICBT with physical exercise with the aim of improving adherence and treatment response to ICBT. METHOD: 12 participants were included via routine clinical practice to an open pre- post trial of feasibility using ICBT and an aerobe exercise protocol. We used a mixed model design investigating multiple areas of adherence, participants' experience and clinical outcome. RESULTS: 90.9% of the participants was considered completers in the ICBT program and the average adherence to the physical exercise was 93.1%. The experience of participating was summarized as "Hard work but worth it". Clinical outcomes effect sizes (d) ranged from 2.79 (panic severity) to .64 (Beck's anxiety index). CONCLUSION: The sum results on adherence, qualitative and quantitative data all suggest that augmenting ICBT with an aerobic exercise protocol is feasible. We conclude that further research is warranted.

Meta-Analysis of Memory-Focused Training and Multidomain Interventions in Mild Cognitive Impairment.

BACKGROUND: Meta-analysis examining the efficacy of cognitive interventions on neuropsychological outcomes have suggested interventions that focus on memory may actually provide greater benefit against the cognitive declines associated with mild cognitive impairment (MCI). However, it remains unclear if memory-based training would be more effective at addressing the cognitive deficits associated with MCI than multidomain forms of intervention. OBJECTIVE: A meta-analytic review and subgroup analysis was conducted to examine the effects of cognitive training in individuals diagnosed with MCI and to compare the efficacy of memory-based training with multidomain interventions. METHODS: A total of 32 randomized controlled trials met inclusion criteria for the meta-analysis, which included 9 studies on memory-focused training and 17 studies on multidomain interventions. RESULTS: We found significant, large effects for memory-focused training (Hedges' g observed = 0.947; 95% CI [-1.668, 3.562]; Z = 2.517; p = 0.012) and significant, moderate effects for multidomain interventions (Hedges' g observed = 0.420; 95% CI [-0.4491, 1.2891]; Z = 3.525; p < 0.001). A subgroup analysis found significant point estimates for memory-based forms of training and multidomain interventions, with memory-based forms of content yielding significantly greater summary effects than multidomain interventions (SMD Z = 2.162; p = 0.031, two-tailed; all outcomes). There was no difference between effect sizes when comparing outcomes limited to its respective domain. CONCLUSION: Overall, these findings suggest that, while both interventions were beneficial, treatment interventions that were strictly memory-based were more effective at improving cognition in individuals diagnosed with MCI than interventions that targeted multiple cognitive domains.

Effect of a Multimodal Lifestyle Intervention on Sleep and Cognitive Function in Older Adults with Probable Mild Cognitive Impairment and Poor Sleep: A Randomized Clinical Trial.

BACKGROUND: Poor sleep is common among older adults with mild cognitive impairment (MCI) and may contribute to further cognitive decline. Whether multimodal lifestyle intervention that combines bright light therapy (BLT), physical activity (PA), and good sleep hygiene can improve sleep in older adults with MCI and poor sleep is unknown. OBJECTIVE: To assess the effect of a multimodal lifestyle intervention on sleep in older adults with probable MCI and poor sleep. METHODS: This was a 24-week proof-of-concept randomized trial of 96 community-dwelling older adults aged 65-85 years with probable MCI (<26/30 on the Montreal Cognitive Assessment) and poor sleep (>5 on the Pittsburgh Sleep Quality Index [PSQI]). Participants were allocated to either a multimodal lifestyle intervention (INT); or 2) education + attentional control (CON). INT participants received four once-weekly general sleep hygiene education classes, followed by 20-weeks of: 1) individually-timed BLT; and 2) individually-tailored PA promotion. Our primary outcome was sleep efficiency measured using the MotionWatch8© (MW8). Secondary outcomes were MW8-measured sleep duration, fragmentation index, wake-after-sleep-onset, latency, and PSQI-measured subjective sleep quality. RESULTS: There were no significant between-group differences in MW8 measured sleep efficiency at 24-weeks (estimated mean difference [INT -CON]: 1.18%; 95% CI [-0.99, 3.34]), or any other objective-estimate of sleep. However, INT participants reported significantly better subjective sleep quality at 24-weeks (estimated mean difference: -1.39; 95% CI [-2.72, -0.06]) compared to CON. CONCLUSION: Among individuals with probable MCI and poor sleep, a multimodal lifestyle intervention improves subjective sleep quality, but not objectively estimated sleep.

Randomized Controlled Trial of a Smartphone Application as an Adjunct to Acceptance and Commitment Therapy for Smoking Cessation.

There is a major public health need for innovative and efficacious behavioral and cognitive interventions for smoking cessation. This randomized controlled trial evaluated the efficacy of an acceptance and commitment therapy (ACT) smartphone application in augmenting ACT group treatment for smoking cessation. One hundred fifty adults smoking 10 or more cigarettes per day were randomly assigned to 6 weekly group sessions of behavioral support, ACT, or ACT combined with the smartphone application. Access to the app was provided from the start of the in-person treatment until the 6-month follow-up assessment. Participants were encouraged to make their quit attempts after the third session, and the posttreatment assessment occurred 3 weeks later. Measures of smoking status and ACT processes were obtained at baseline, posttreatment, and 6-month follow-up. Biochemically verified quit rates in the combined, ACT, and behavioral support groups were 36% (p = .079 relative to ACT; p = .193 relative to behavioral support), 20% (p = .630 relative to behavioral support) and 24% at posttreatment, as compared with 24% (p = .630 relative to behavioral support), 24% (p = .630 relative to behavioral support) and 20% at follow-up. There was no significant difference (p = > .999) in the primary outcome of biochemically verified 7-day point-prevalence abstinence at 6-month follow-up between the combined and ACT groups. The combined group reported significantly greater smoking reduction, acceptance and present-moment awareness than the behavioral support group at posttreatment, but not at follow-up. There were no significant differences between the groups in positive mental health. Contrary to hypotheses, the ACT group did not display significant improvements in positive mental health or ACT processes relative to the behavioral support group at posttreatment or follow-up. Implications and directions for future research are discussed.

Breast cancer patients' experiences of adherence and persistence to oral endocrine therapy: A qualitative evidence synthesis.

PURPOSE: Adjuvant endocrine therapy (AET) significantly reduces the risk of breast cancer recurrence and mortality in women with hormone receptor (HR+) breast cancer. Despite the documented survival benefits with AET, non-adherence and non-persistence remains a significant problem. This systematic review of qualitative research aimed to synthesise breast cancer patients' experiences of adherence and persistence to oral endocrine therapy. METHODS: The ENTREQ guidelines were followed. A systematic search strategy was performed across eleven electronic databases (Embase, Cinahl, Pubmed, Psychinfo, Proquest, Lenus, Scopus, Web of Science, Rian.ie, EThOS e-theses online, DART Europe). Thomas and Harden's three-stage approach to thematic analysis was undertaken on the findings of all included studies. Confidence in the findings were reviewed using GRADE-CERQual. RESULTS: Twenty-four qualitative studies were included in the synthesis. Three analytic themes were identified (We don't have an option; the side effects are worse than the disease; help us with information and support). Adherence was often driven by women feeling they had no option and a fear of cancer recurrence. Persistence was helped with support and information. Non-adherence and non-persistence were associated with debilitating side effects, inadequate information and lack of support. CONCLUSIONS: Adherence and persistence to AET was often suboptimal among breast cancer patients. Women commonly felt isolated and neglected as a result of insufficient information and support from healthcare professionals. If women are to persist with AET, primary care providers should be aware of the facilitators and barriers to adherence, and they should be knowledgeable in symptom management strategies.

Effect of Surgeon Factors on Long-Term Patient-Reported Outcomes After Breast-Conserving Therapy in Older Breast Cancer Survivors.

BACKGROUND: The effect of surgeon factors on patient-reported quality-of-life outcomes after breast-conserving therapy (BCT) is unknown and may help patients make informed care decisions. METHODS: We performed a survey study of women aged ≥ 67 years with non-metastatic breast cancer diagnosed in 2009 and treated with guideline-concordant BCT, to determine the association of surgeon factors with patient-reported outcomes. The treating surgeon was identified using Medicare claims, and surgeon factors were identified via the American Medical Association Physician Masterfile. The primary outcome was patient-reported cosmetic satisfaction measured by the Cancer Surveillance and Outcomes Research Team (CanSORT) Satisfaction with Breast Cosmetic Outcome instrument, while secondary outcomes included BREAST-Q subdomains. All patient, treatment, and surgeon covariables were included in a saturated multivariable linear regression model with backward elimination applied until remaining variables were p < 0.1. RESULTS: Of 1650 women randomly selected to receive the questionnaire, 489 responded, of whom 289 underwent BCT. Median age at diagnosis was 72 years and the time from diagnosis to survey was 6 years. The mean adjusted CanSORT score was higher for patients treated by surgical oncologists than patients treated by non-surgical oncologists (4.01 [95% confidence interval [CI] 3.65-4.38] vs. 3.53 [95% CI 3.28-3.77], p = 0.006). Similarly, mean adjusted BREAST-Q Physical Well-Being (91.97 [95% CI 86.13-97.80] vs. 83.04 [95% CI 80.85-85.22], p = 0.006) and Adverse Radiation Effects (95.28 [95% CI 91.25-99.31] vs. 88.90 [95% CI 86.23-91.57], p = 0.004) scores were better among patients treated by surgical oncologists. CONCLUSIONS: Specialized surgical oncology training is associated with improved long-term patient-reported outcomes. These findings underscore the value of specialized training and may be useful to patients choosing their care team.

Efficacy and Safety of ECT for Behavioral and Psychological Symptoms of Dementia (BPSD): A Retrospective Chart Review.

OBJECTIVE: Much of the functional disturbance in patients with dementia reflects the presence of noncognitive behavioral and psychological symptoms of dementia (BPSD). Agitation is among the most distressing symptoms for patients, clinicians, and caregivers. Currently no pharmacotherapy has clearly been shown to be of value for this condition. This study used a chart review method to examine the safety and efficacy of electroconvulsive therapy (ECT) for patients with dementia receiving ECT for agitation. METHODS: A retrospective chart review was conducted of patients with dementia presenting with symptoms of aggression or agitation and who received ECT treatments. Aggression and agitation were measured by pre- and post-ECT Pittsburg Agitation Scale (PAS) scores. Detailed history of the use of psychotropic medications as well as other clinically relevant variables was analyzed. FINDINGS: Sixty elderly patients (45 women and 15 men, 75% female, mean age 77.5 ± 8.0 years) were included in the analysis. Most patients were treatment resistant to multiple psychotropic medications prior to ECT (mean number 6.1±1.5). The baseline PAS total was 9.3 ± 3.7 and it decreased significantly after three (2.5±2.8) and six (1.5±2.3) ECT treatments. No significant ECT-related medical complications were observed except transient confusion. A decrease in the number of psychotropics prescribed along with an increase in the GAF score was observed after the ECT treatment course. CONCLUSION: ECT was safe in this sample of patients who had co-morbid medical conditions. ECT was associated with the following observations: 1) a reduction in agitation; 2) a reduction in psychotropic polypharmacy; and 3) an improvement in global functioning level. Further research evaluating the effects of ECT in the setting of dementia is warranted.

Examining race as a predictor and moderator of treatment outcomes for binge-eating disorder: Analysis of aggregated randomized controlled trials.

OBJECTIVE: To examine whether race predicted or moderated response to treatments for binge-eating disorder (BED). METHOD: Participants were 592 adults (n = 113 Black; n = 479 White) with DSM-IV-defined BED who participated in randomized controlled trials (RCTs) at 1 medical center. Data were aggregated from RCTs for BED testing cognitive-behavioral therapy, behavioral weight loss, multimodal treatment, and/or control conditions. Participants had weight and height measured and were assessed using established interviews and self-report measures at baseline, throughout treatment, and post treatment. RESULTS: Race did not significantly moderate treatment outcomes. Mixed models revealed a main effect of race: Black participants had fewer binge-eating episodes and lower depression than White participants across time points. Race also had a main effect in generalized estimating equations with a significantly greater proportion of Black participants achieving binge-eating remission than White participants. Race did not predict percent weight loss, but a significantly lower proportion of Black participants attained 5% weight loss than White participants. Race did not significantly predict global eating-disorder severity. CONCLUSION: Despite disparities in treatment-seeking reported in epidemiological and RCT studies, Black individuals appear to have comparable or better treatment outcomes in BED treatment research compared with White individuals, except they were less likely to attain 5% weight loss at post treatment. This suggests that disseminating evidence-based treatments for BED among diverse populations holds promise and treatments may not require further adaptation prior to dissemination. Implementation research is needed to test treatment effectiveness across diverse providers, settings, and patient groups to improve understanding of potential predictors and moderators. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Halalopathy: A science of trust in medicine.

The human body is well organized, regulated and connected. One of the greatest scientific challenges today is to integrate mind, behaviour and health. Enormous advances in health care have been achieved. However, diseases like cancer still require treatment options beyond therapeutic drugs, namely surgery and radiation. Human being is not only made of cells, tissues and organs, but also feelings and sensations. Linking mental state with physical health is essential to include all elements of disease. For this purpose, halalopathy has been introduced as a new model to integrate mind, behaviour and health, where psychology, spirituality and rationality can be integrated together to generate a well-organized, regulated and connected health system. Halalopathic approaches are based on mind-trust-drug and mind-trust-belief. If the drug and human's belief are compatible, trust in the rationally designed drug will be synergized and placebo effects will be activated to initiate the healing process. Such an organized health system will lower the body's entropy and increase potential energy, which is an important aspect to promote the healing process, with a therapeutic drug toward complete recovery. This study enlightens laws of compatibility to initiate a domino chain effect to activate placebo effects and lower the body's entropy. The healing power of each effect will contribute to the healing process and enhance the total drug effects.

Local Therapy Decisional Regret in Older Women With Breast Cancer: A Population-Based Study.

PURPOSE: Older women with nonmetastatic breast cancer can often choose from several surgery and radiation treatment options. Little is known regarding how these choices contribute to decisional regret, which is a negative emotion reflecting the idea that another surgery or radiation decision might have been preferable. We sought to characterize the burden of and examine potential risk factors for local therapy decisional regret among a population-based cohort of older breast cancer survivors. METHODS AND MATERIALS: National Medicare claims for age ≥67 female breast cancer incident in 2009 identified patients treated with lumpectomy plus whole-breast irradiation, brachytherapy, or endocrine therapy or mastectomy with or without radiation. We sampled 330 patients per treatment group (N = 1650), of whom 1253 agreed to receive a paper survey including the Decisional Regret Scale and EQ-5D-3L Health-Utility Scale. Local therapy regret was defined as neutral or worse response to questions regarding surgery- or radiation-related decisional regret. Local therapy regret risk factors were evaluated using a multivariable generalized linear model. Association of local therapy regret with health utility was modeled using multivariable linear regression. RESULTS: The response rate was 30.2% (n = 498 of 1650); 421 surveys were included in this analysis. Median diagnosis age was 72 years, and surveys were completed 6 years after diagnosis. Overall, 23.8% of respondents (n = 100) reported experiencing local therapy decisional regret. Type of local therapy was not associated with local therapy regret. Predictors of increased regret included black race (risk ratio [RR], 2.09; 95% confidence interval [CI], 1.33-3.29), high school education or less (RR, 1.87; 95% CI, 1.27-2.75), and axillary nodal dissection (RR, 2.13; 95% CI, 1.33-3.41). Local therapy regret was not associated with health utility (P = .37). CONCLUSIONS: Local therapy regret afflicts nearly one quarter of our cohort of older breast cancer survivors, and it is associated with black race, less education, and more extensive nodal dissection, but not breast surgery. Regret is distinct from health utility, suggesting that it is a unique psychosocial construct that merits further study and mitigation strategies.

A randomized controlled trial protocol to test the efficacy of a dual-task multicomponent exercise program in the attenuation of frailty in long-term nursing home residents: Aging-ONDUAL-TASK study.

BACKGROUND: The purpose of the Aging-ONDUAL-TASK study is to determine if a supervised dual-task program carried out in long-term nursing homes is able to attenuate frailty in a greater extent than the same multicomponent exercise program alone. METHODS: This multicenter randomized controlled trial will include 188 participants who will be randomly allocated to either a multicomponent exercise program or to the same multicomponent program with simultaneous cognitive training (dual-task training). Inclusion criteria are as follows: ≥ 70 years, ≥ 50 on the Barthel Index, ≥ 20 on the Mini Examen Cognoscitivo (MEC-35) who are able to stand up and walk independently for 10 m. Subjects in the multicomponent group will attend a twice-a-week multicomponent exercise program of 1-h duration per session, consisting of strength and balance exercises. Participants in the dual-task group will perform the same multicomponent exercise program with concurrent individually tailored cognitive tasks. Study assessments will be conducted at baseline and at 3 months. The primary outcome measure will be gait speed under dual-task conditions and secondary outcomes will include physical fitness measurements, gait spatiotemporal parameters, cognition and emotional assessments, several frailty scales and objectively measured physical activity. DISCUSSION: The present research will add valuable information to the knowledge around the effects of the dual-task program in long-term nursing home residents, taking altogether physical, cognitive and emotional variables linked to frailty. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry (ANZCTR) with the identifier: ACTRN12618000536268 . Registration date: 11/04/2018.

Nodal metastasis of cervix carcinoma- As a probable cause of bone erosion.

INTRODUCTION: Carcinoma of cervix is a common gynaecological malignancy and remains the third most common cancer in developing countries. While nodal metastases are common in cervical cancer, major sites of the less common haematogenous metastases include lung, liver and bones. Bone involvement in cases of carcinoma of cervix is low and the estimates range from 0.8-16 % according to various series.Several patterns of bone involvement are observed in cases of carcinoma of cervix including, (1) direct extension into bone, either from the parametrial extensions of the primary or recurrent pelvic tumor, (2) direct extension into adjacent bone from the pelvic or distant lymph node metastasis (3) regional or systemic haematogenous metastasis to bones. AIMS: To evaluate the pattern of metastases in patients of carcinoma of uterine cervix, with particular emphasis on the pattern of bone involvement on contrast enhanced CT. SETTINGS AND DESIGN: Retrospective study. MATERIALS AND METHODS: This was a retrospective study, where we reviewed the hospital records and data of patients of cervical cancer who underwent contrast enhanced CT (CECT) of the chest and abdomen over a period of one year between January and December 2016. A total of 100 patients of carcinoma cervix were included. CT images were reviewed by two experienced radiologists. The bony erosion due to pelvic mass or lymphadenopathy was classified as subtle or gross. RESULTS: Bone involvement was seen in 11 out of 100 cases (11% cases). Among 13 cases direct bone involvement by the pelvic mass/recurrence and metastatic lymph nodes (8/11; 72.7%) was slightly more common than thehematogenous bone metastasis (5/11; 45.4% cases). Among the direct bone involvement direct erosion of the underlying bone by the nodal metastasis (6/8; 75%) was twice more common than the direct bone involvement by the pelvic mass/recurrence(2/8; 25%). CONCLUSIONS: Direct bone involvement by erosion of adjacent bone by nodal metastasis is the most common mechanism of bone involvement in cases of carcinoma of cervix signifying the high propensity of lymph nodal deposits to erode the underlying bone. This finding of direct bone erosion is not seen in any other gynaecological malignancy and should be promptly looked for in all cases of carcinoma of cervix.

[Questionnaire on the Experience of the Art Therapy Group in Psychosomatics from Patient View (FEKTP) - Construction and Validation of a Measuring Instrument]. / Fragebogen zum Erleben der Kunsttherapiegruppe in der Psychosomatik aus Patientensicht (FEKTP).

Art therapy is a clinically accepted method of therapy, but there are still very few studies that deal with the efficacy, change factors or mode of action of art therapy. In particular, there is a dearth of research instruments and psychometrically verified research tools specially fitted for art therapy which measures the experience dimensions of the art therapy group from the patient's point of view. Hence, it provides evidence of its effectiveness, better understands the art therapy group processes and serves quality assurance. The aim of the present study was to develop and validate the questionnaire on the experience of the art therapy group from patient view (FEKTP). This questionnaire is based on Grawe's and Yalom's conceptions of change factors in group therapy. 133 patients participated in the study and completed the FEKTP directly after the 6th art therapy session. Patients additionally received established questionnaires concerning clinical symptoms and experience processes at the beginning and end of treatment. Factor analysis demonstrated a clear factor structure of the FEKTP, which corresponded to the theoretically predicted subscales to the greatest extent. The test psychometric main quality criteria of the FEKTP (reliability, validity and objectivity) can be classified as acceptable to good range. The criterion validity appear to be given, but should be examined more exactly in future studies. Thus, a valid instrument for the systemic detection of general change factors for art therapy is now available. The questionnaire can be recommended for research as well as clinical contexts.

Predictive utility of childhood diagnosis of ICD-10 hyperkinetic disorder: adult outcomes in the MTA and effect of comorbidity.

Diagnostic guidelines differ between DSM attention-deficit/hyperactivity disorder (ADHD) and ICD hyperkinetic disorder (HKD). Only 145 of 579 children age 7-9 in the Multimodal Treatment Study of ADHD (the MTA) with combined-type DSM-IV ADHD met criteria for ICD-10 HKD, because major internalizing comorbidities and more stringent symptom count/pervasiveness requirements excluded most. The 145 HKD had significantly better 14-month medication response than the rest. We explored whether HKD had greater adult symptom persistence and/or impairment than other ADHD. Multi-informant assessments were done for 16 years. We used the 12/14/16-year assessments, in young adulthood. The post-attrition 109 with baseline HKD had no greater adult persistence of ADHD symptoms/impairment than 367 without HKD, but had more cumulative stimulant use, more job losses, lower emotional lability, and fewer car crashes. However, those excluded for internalizing comorbidity but otherwise meeting HKD criteria had significantly more persistence. Only 6 of the 109 (5.5%) with baseline HKD met ICD-10 criteria for HKD in adulthood, compared to 25 of 367 (6.8%) without a childhood HKD diagnosis. Despite greater initial symptom severity, HKD had no worse 16-year young adult outcome than others, except for job losses, balanced by less emotional lability and fewer crashes. Comorbid internalizing disorder seems to have worse prognosis than initial severity/pervasiveness of ADHD symptoms.

Cancer survivors' needs during various treatment phases after multimodal treatment for colon cancer - is there a role for eHealth?

BACKGROUND: More colon cancer patients are expected to fully recover after treatment due to earlier detection of cancer and improvements in general health- and cancer care. The objective of this study was to gather participants' experiences with full recovery in the different treatment phases of multimodal treatment and to identify their needs during these phases. The second aim was to propose and evaluate possible solutions for unmet needs by the introduction of eHealth. METHODS: A qualitative study based on two focus group discussions with 22 participants was performed. The validated Supportive Care Needs Survey and the Cancer Treatment Survey were used to form the topic list. The verbatim transcripts were analyzed with Atlas.ti. 7th version comprising open, axial and selective coding. The guidelines of the consolidated criteria for reporting qualitative research (COREQ) were used. RESULTS: Experiences with the treatment for colon cancer were in general positive. Most important unmet needs were 'receiving information about the total duration of side effects', 'receiving information about the minimum amount of chemo needed to overall survival' and 'receiving a longer aftercare period (with additional attention for psychological guidance)'. More provision of information online, a chat function with the oncological nurse specialist via a website, and access to scientific articles regarding the optimal dose of chemotherapy were often mentioned as worthwhile additions to the current health care for colon cancer. CONCLUSIONS: Many of the unmet needs of colon cancer survivors occur during the adjuvant treatment phase and thereafter. To further optimize recovery and cancer care, it is necessary to have more focus on these unmet needs. More attention for identifying patients' problems and side-effects during chemotherapy; and identifying patients' supportive care needs after finishing chemotherapy are necessary. For some of these needs, eHealth in the form of blended care will be a possible solution.

Meaning and medication: a thematic analysis of depressed adolescents' views and experiences of SSRI antidepressants alongside psychological therapies.

BACKGROUND: Adolescence is a key period of risk for the emergence of Major Depressive Disorder (MDD). The prescription of selective serotonin re-uptake inhibitors (SSRIs) for the treatment of depression in adolescents is an issue of worldwide controversy, and evidence regarding their safety and efficacy is inconclusive. In the UK, NICE guidelines have recently recommended offering SSRIs to adolescents alongside psychological therapy or on their own if therapy is refused. Thus, SSRIs are increasingly becoming a major component of treatment for adolescents. This study qualitatively explored adolescents' views and experiences of SSRIs within their accounts of engaging in a psychological therapy for depression, particularly focusing on meanings they attached to medication-use. METHODS: The qualitative study reports data from semi-structured interviews conducted 12-months post-treatment with 12 adolescents who were clinically referred and treated for depression as part of the IMPACT trial. The interviews were analysed using Thematic Analysis. RESULTS: Four themes were identified: 'a perceived threat to autonomy', 'a sign of severity', 'a support, not a solution', and 'an ongoing process of trial and error'. CONCLUSIONS: This study highlights the value of bringing adolescents' voices into the broader debate on the use of antidepressants in their age group and in the development of future guidelines. Future implications for research and clinical practice are discussed.

Beyond Traditional Treatment: The Importance of Psychosocial Therapy in Vitiligo.

Vitiligo is an acquired depigmentation disorder of the skin. Patients with vitiligo often face a challenging disease course, having to cope with a condition that is known to be physically disfiguring, psychologically devastating, and socially stigmatizing. Although an extensive amount of research has been directed towards the dermatologic treatment of vitiligo, an overall lack of data exists investigating treatment of the psychological and emotional burden of patients with vitiligo. This paper reviews the literature for treatment options in patients with vitiligo that specifically target the psychosocial domain. Despite being limited in quantity, several studies have proven the benefits of adjuvant care in the form of group therapy, cognitive behavioral therapy, and self-help programs. Although preliminary evidence is promising, larger prospective studies are needed to further define the role of these psychosocial interventions before integrating them in a more official capacity into the standard of care for patients with vitiligo. Because of the considerable impact of vitiligo beyond its physical symptoms, dermatologists ought to consider the utility of adjuvant therapies to adequately address impairments in self-esteem, body image, and quality of life in patients with vitiligo. J Drugs Dermatol. 2018;17(6):688-691.