A cognitive behavioural group therapy for bipolar disorder using daily mood monitoring.

BACKGROUND AND AIM: This study investigated the effects of group cognitive behavioural therapy (CBT) for patients with bipolar disorder. The development of CBT for this disorder is relatively under-explored. METHOD: Participants with bipolar I or II disorder were treated with group CBT in addition to treatment as usual. The effectiveness of the protocol was explored through sequence analysis of daily mood monitoring prior to, during and after the intervention. Also, a repeated measures design was used assessing symptomatology, dysfunctional attitudes, sense of mastery, psychosocial functioning, and quality of life at start and end of intervention, and at follow-up 2 and 12 months later. RESULTS: The results indicate that variation in mood states diminished over the course of the intervention. Also, there was a change from depressive states to more euthymic states. Greater number of reported lifetime depressive episodes was associated with greater diversity of mood states. There was an increase in overall psychosocial functioning and self-reported psychological health following the intervention. Improvement continued after treatment ended until follow-up at 2 months, and measured 1 year later, for outcomes representing depression, general psychosocial functioning and self-reported psychological health. Due to small sample size and the lack of a control group the results are preliminary. CONCLUSIONS: The results of this pilot study suggest that both offering CBT in group interventions and sequence analysis of time series data are helpful routes to further explore when improving standard CBT interventions for patients suffering from bipolar disorder.

[The use of HoNOS in the treatment of patients]. / Gebruik van de HoNOS bij de behandeling van patiënten.

BACKGROUND: In order to use outcome scores for making decisions about treatment, practitioners need to know the course of scores of several groups of patients. AIM: To test the applicability of methods for computing cut-off scores and individual changes. METHOD: Using Health of the Nation Outcome Scales (HoNOS), we analysed repeated assessments of 699 adults and 414 elderly patients in different treatment settings. RESULTS: Mean HoNOS scores and cut-off scores differentiated between patient groups reasonably well. Scores and threshold values for elderly patients were relatively high. The reliable change index showed few individual changes even for groups where change was expected. The effect size and the standard error of measurement were found to be more sensitive to change. CONCLUSION: More research is needed before the findings can be generalised.

[ROM in adult psychiatry: an evaluation of measurement instruments]. / ROM in de volwassenenpsychiatrie: een evaluatie van meetinstrumenten.

BACKGROUND: An evaluation of the most commonly used ROM measures in Dutch psychiatry is lacking, both for severe mental illnesses and for common psychiatric disorders. AIM: To provide an overview of the characteristics and quality of outcome measures. METHOD: A literature study yielded six outcome measures. The psychometrical, clinical and practical aspects of these scales are described. RESULTS: The measures are suitable and are of adequate quality. DISCUSSION: It remains to be seen if any of the outcome measures are suitable for both serious and less serious mental illnesses. The use of a combination of a self-rating scale and an observerrating scale that measure symptoms and domains of functioning may be the most promising choice.

[Validation of two measuring instruments for routine outcome monitoring in psychiatry: the HORVAN study]. / Validering van twee meetinstrumenten voor routine outcome monitoring in de psychiatrie: de HORVAN-studie.

BACKGROUND: Transparency in psychiatry can be increased by the use of routine outcome monitoring (rom) instruments. Instruments should be easy to use and take very little time to complete; they also need to have psychometric qualities, be sensitive to change, and provide information about patients' symptoms, and about interpersonal and social functioning. AIM: To investigate to what extent the combination of Health of the Nation Outcome Scales (HoNOS) and the Outcome Questionnaire (OQ) in the Dutch situation meets the above-mentioned quality criteria and to examine how the combination relates to the Symptom CheckList (SCL-­90). METHOD: Data for 148 patients collected at three measurement moments were available for analysis. The psychometric qualities of the instruments and their sensitivity to change were checked carefully. RESULTS: The three scales showed high values for internal consistency (Cronbach's alpha). The HoNOS total score and the subscales of the OQ correlated reasonably well with the SCL­-90 total score (convergence validity). At the first measurements, patients with a comorbid diagnosis had the lowest scores (discrimination validity). The clinically significant change between T1 and T2 and between T2 and T3 was sufficiently high for all three measuring instruments. CONCLUSION: The combination of the HoNOS rating scale and the self­-report list OQ seems to be suitable for ROM in psychiatry.

Variation in the composition of corals, fishes, sponges, echinoderms, ascidians, molluscs, foraminifera and macroalgae across a pronounced in-to-offshore environmental gradient in the Jakarta Bay-Thousand Islands coral reef complex.

Substrate cover, water quality parameters and assemblages of corals, fishes, sponges, echinoderms, ascidians, molluscs, benthic foraminifera and macroalgae were sampled across a pronounced environmental gradient in the Jakarta Bay-Thousand Islands reef complex. Inshore sites mainly consisted of sand, rubble and turf algae with elevated temperature, dissolved oxygen, pH and chlorophyll concentrations and depauperate assemblages of all taxa. Live coral cover was very low inshore and mainly consisted of sparse massive coral heads and a few encrusting species. Faunal assemblages were more speciose and compositionally distinct mid- and offshore compared to inshore. There were, however, small-scale differences among taxa. Certain midshore sites, for example, housed assemblages resembling those typical of the inshore environment but this differed depending on the taxon. Substrate, water quality and spatial variables together explained from 31% (molluscs) to 72% (foraminifera) of the variation in composition. In general, satellite-derived parameters outperformed locally measured parameters.

The effect of moderate and excessive alcohol use on the course and outcome of patients with bipolar disorders: a prospective cohort study.

OBJECTIVE: Comorbid alcohol use disorders (AUDs) are frequently associated with negative effects on course and outcome of bipolar disorder. This prospective cohort study assessed the effect of actual alcohol use (no, moderate, and excessive) on the course and outcome of patients with bipolar disorders. METHOD: Between June 2003 and November 2005, 137 outpatients (aged 23-68 years) with DSM-IV-diagnosed bipolar I (66%) or II (34%) disorder rated their mood and the number of alcohol units consumed daily for a period up to 52 weeks with the National Institute of Mental Health Self-Rating Prospective Life-Chart Method (LCM). At baseline, the Structured Clinical Interview for DSM-IV was administrated, and demographic, social, and clinical characteristics were obtained. At monthly visits, the Clinical Global Impressions Scale-Bipolar Version (CGI-BP), the Global Assessment of Functioning (GAF) scale, and the Medical Outcomes Study 36-Item Short-Form Health Survey (MOS-SF-36) were rated. Based on the alcohol use in the first 4 weeks of follow-up, patients were assigned to 1 of 3 groups: no/incidental, moderate, or excessive alcohol use. RESULTS: None of the sociodemographic and clinical characteristics at baseline were significantly different between the 3 drinking groups, with the exception of-and as a consequence of the group assignment-the prevalence of lifetime and current diagnosis of AUD. Also, no differences between the 3 drinking groups were found on any of the clinical outcome variables, ie, number of days ill (depressed, hypomanic/manic, and total); severity of depression, mania, and overall bipolar illness (LCM); GAF score; CGI-BP (depression, mania, and overall); and all the subscales of the MOS-SF-36. Also, the number of episodes according to DSM-IV and the Leapfrog method showed no significant differences between the drinking groups. CONCLUSIONS: In this sample of patients and with the sensitive measurement of mood and drinking status over a full year, we could not confirm the findings of other studies indicating a negative effect of excessive alcohol use on the course of bipolar illness. This study found that neither moderate nor excessive use of alcohol has a negative effect on the course and outcome of bipolar illness. Possible explanations for these findings are discussed.

A phylogenetic study of Boletus section Boletus in Europe.

A phylogenetic study of the species in Boletus sect. Boletus was undertaken using the molecular markers ITS1-5.8S-ITS2 and GAPDH. Four well-supported lineages, one comprising Boletus edulis s.l., the others referring to B. aereus, B. reticulatus and B. pinophilus have been distinguished. The ML and MP trees of ITS showed remarkably low resolution within the B. edulis clade, and confirmed earlier published results, despite the use of samples from a wider geographical area and different hosts. The results of GAPDH demonstrate clearly that this low resolution must be ascribed to a low genetic variability with the B. edulis clade, and make clear that morphological and ecological characters have been overestimated within this species complex. Boletus edulis is therefore defined as a variable species with a wide morphological, ecological and geographic range, and includes several specific and subspecific taxa described in the literature (e.g. B. betulicola, B. persoonii, B. quercicola and B. venturii). Three other European species (B. aereus, B. pinophilus and B. reticulatus) are well delimited species based on morphology and our genetic data.