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1.
J Consult Clin Psychol ; 86(2): 200-204, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-29265831

RESUMEN

OBJECTIVE: Both Mindfulness Based Cognitive Therapy (MBCT) and Cognitive Therapy (CT) enhance self-management of prodromal symptoms associated with depressive relapse, albeit through divergent therapeutic procedures. We evaluated rates of relapse in remitted depressed patients receiving MBCT and CT. Decentering and dysfunctional attitudes were assessed as treatment-specific process markers. METHOD: Participants in remission from Major Depressive Disorder (MDD; N = 166) were randomized to 8 weeks of either MBCT (N = 82) or CT (N = 84) and were followed for 24 months, with process markers measured every 3 months. Attendance in both treatments was high (6.3/8 session) and treatment fidelity and competence were evaluated. Relapse was defined as a return of symptoms meeting the criteria for major depression on Module A of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID). RESULTS: Intention-to-treat analyses indicated no differences between MBCT and CT in either rates of relapse to MDD or time to relapse across 24 months of follow up. Both groups experienced significant increases in decentering and participants in CT reported greater reductions in dysfunctional attitudes. Within both treatments, participants who relapsed evidenced lower decentering scores than those who stayed well over the follow up. CONCLUSIONS: This is the first study to directly compare relapse prophylaxis following MBCT and CT directly. The lack of group differences in time to relapse supports the view that both interventions are equally effective and that increases in decentering achieved via either treatment are associated with greater protection. These findings lend credence to Teasdale et al.'s (2002) contention that, even though they may be taught through dissimilar methods, CT and MBCT help participants develop similar metacognitive skills for the regulation of distressing thoughts and emotions. (PsycINFO Database Record


Asunto(s)
Terapia Cognitivo-Conductual/métodos , Trastorno Depresivo Mayor/terapia , Atención Plena/métodos , Evaluación de Resultado en la Atención de Salud , Prevención Secundaria/métodos , Adulto , Antidepresivos/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia
2.
Am J Addict ; 26(6): 602-609, 2017 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-28570773

RESUMEN

BACKGROUND: Major Depressive Disorder (MDD) and Alcohol Use Disorder (AUD) are highly prevalent, comorbid, and have significant impact on morbidity, mortality, and socioeconomic burden in Canada. Combined psycho- and pharmacotherapies for both conditions promise better outcomes than treatment as usual (TAU). At the Centre for Addiction and Mental Health, Toronto, Canada, we developed and implemented an Integrated Care Pathway (ICP) specifically for treatment of concurrent MDD and AUD. The goal of the study is to assess the clinical effectiveness of the ICP approach in comparison to TAU. MATERIALS AND METHODS: Non-randomized design, clinical chart review, Chi-square and t-tests, Cohen's d, Linear Mixed Effects Models, Kaplan-Meier, and log-rank analyses. RESULTS: Eighty-one ICP patients were included, matched to 81 controls by age, sex, severity of depressive symptoms, and patterns of drinking. ICP cohort had a significantly lower dropout rate (18.5% vs 69.1%, p < .001; at 16 weeks of treatment, respectively), both cohorts demonstrated significant reduction in the number of heavy drinking days (ß = .01, p < .001) and standard drinks per week (ß = .15, p < .001) with a significantly higher reduction of both indicators over time in the ICP cohort. Significant reduction in depressive symptoms severity (QIDS: 14.6 vs 10.0, p < .001; BDI: 26.3 vs 16.2, p < .001) was observed in ICP cohort (no data for TAU cohort). CONCLUSIONS: The ICP patients demonstrated improvements on several levels including depressive symptoms, and changes in alcohol drinking patterns. The study demonstrated the overall effectiveness of the ICP and apparent advantage over TAU, which must be corroborated through a randomized clinical trial. (Am J Addict 2017;26:602-609) SCIENTIFIC SIGNIFICANCE: This study is one of the first works showing the outcomes of an ICP developed in the mental health area and for co-occurring disorders. Despite the limitations, the relative advantage of the ICP methodology warrants future research in this area.


Asunto(s)
Consumo de Bebidas Alcohólicas/psicología , Alcoholismo , Prestación Integrada de Atención de Salud , Trastorno Depresivo Mayor , Servicios de Salud Mental/organización & administración , Manejo de Atención al Paciente/métodos , Adulto , Alcoholismo/epidemiología , Alcoholismo/psicología , Canadá/epidemiología , Estudios de Cohortes , Comorbilidad , Prestación Integrada de Atención de Salud/métodos , Prestación Integrada de Atención de Salud/organización & administración , Trastorno Depresivo Mayor/epidemiología , Trastorno Depresivo Mayor/psicología , Trastorno Depresivo Mayor/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Resultado del Tratamiento
3.
Psychiatr Serv ; 66(12): 1265-7, 2015 Dec 01.
Artículo en Inglés | MEDLINE | ID: mdl-26278235

RESUMEN

Integrated care pathways (ICPs) provide an approach for delivering evidence-based treatment in a hospital setting. This column describes the development and pilot implementation in a clinical setting of an ICP for patients with concurrent major depressive disorder and alcohol dependence at the Centre for Addiction and Mental Health (CAMH), an academic tertiary care hospital, in Toronto, Canada. The ICP methodology includes evidence reviews, knowledge translation, process reengineering, and change management. Pilot results indicate high patient satisfaction, evidence of symptom improvement, and excellent retention.


Asunto(s)
Alcoholismo/terapia , Atención Ambulatoria/métodos , Prestación Integrada de Atención de Salud , Trastorno Depresivo Mayor/terapia , Evaluación de Programas y Proyectos de Salud , Alcoholismo/complicaciones , Canadá , Servicios Comunitarios de Salud Mental , Trastorno Depresivo Mayor/complicaciones , Implementación de Plan de Salud , Humanos , Proyectos Piloto , Resultado del Tratamiento
4.
Sante Ment Que ; 38(2): 65-82, 2013.
Artículo en Francés | MEDLINE | ID: mdl-24719003

RESUMEN

Against the backdrop of dauntingly high prevalence rates of clinical depression and subsequent relapse, Segal, Teasdale and Williams (2002) sought to develop an intervention that would address the long-term sequence of depression. In the past decade, Mindfulness-Based Cognitive Therapy has been supported with a robust evidence base, highlighting its efficacy in the short, and long-term follow-up studies. Currently, novel adaptations of this intervention are being developed and piloted with a wide range of clinical issues that share amplified ruminative processes as a core feature of pathology. This review aims to summarize current and past research on MBCT, and to practically illuminate how this intervention can aid individuals in stepping out of the ruminative spirals that are part-and-parcel with major depressive episode.


Asunto(s)
Terapia Cognitivo-Conductual/métodos , Atención Plena , Investigación Biomédica , Terapia Cognitivo-Conductual/tendencias , Predicción , Humanos
5.
Mol Cancer Ther ; 10(9): 1542-52, 2011 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-21764904

RESUMEN

We describe here the identification and characterization of 2 novel inhibitors of the fibroblast growth factor receptor (FGFR) family of receptor tyrosine kinases. The compounds exhibit selective inhibition of FGFR over the closely related VEGFR2 receptor in cell lines and in vivo. The pharmacologic profile of these inhibitors was defined using a panel of human tumor cell lines characterized for specific mutations, amplifications, or translocations known to activate one of the four FGFR receptor isoforms. This pharmacology defines a profile for inhibitors that are likely to be of use in clinical settings in disease types where FGFR is shown to play an important role.


Asunto(s)
Antineoplásicos/farmacología , Factores de Crecimiento de Fibroblastos/metabolismo , Inhibidores de Proteínas Quinasas/farmacología , Receptores de Factores de Crecimiento de Fibroblastos/antagonistas & inhibidores , Animales , Antineoplásicos/química , Línea Celular Tumoral , Proliferación Celular/efectos de los fármacos , Supervivencia Celular/efectos de los fármacos , Diseño de Fármacos , Evaluación Preclínica de Medicamentos , Humanos , Ratones , Ratones Endogámicos BALB C , Ratones Desnudos , Modelos Moleculares , Neoplasias/tratamiento farmacológico , Neoplasias/metabolismo , Inhibidores de Proteínas Quinasas/química , Inhibidores de Proteínas Quinasas/uso terapéutico , Receptores de Factores de Crecimiento de Fibroblastos/genética , Transducción de Señal/efectos de los fármacos , Resultado del Tratamiento , Ensayos Antitumor por Modelo de Xenoinjerto
6.
Leuk Res ; 35(9): 1233-40, 2011 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-21316102

RESUMEN

BACKGROUND: Fibroblast growth factor receptor 3 (FGFR3) is up-regulated as a result of the t(4;14)(p16;q32) translocation that occurs in up to 20% of multiple myeloma (MM) patients. Recent studies have demonstrated that up-regulation of FGFR3 promotes cell survival, growth and drug resistance in malignant plasma cells, both in vitro and in vivo. Therefore, inhibition of FGFR3 signalling is potential target for the chemotherapeutic intervention in t(4;14) MM. METHODS: Small molecule receptor tyrosine kinase inhibitors (PD173074, sunitinib (SU-11248), vandetanib (ZD6474) and vatalanib (PTK-787)) with varying degrees of inhibitory activity and selectivity against FGFR, were assessed in Ba/f3 cells expressing ZNF198-FGFR1 and MM cell lines. Cell viability, FGFR3 and ZNF198-FGFR1 phosphorylation and apoptosis were evaluated by growth inhibition assays, immunoblotting and fluorescence-activated cell sorting analysis, respectively. An in vivo study was performed with sunitinib in t(4;14)-positive and t(4;14)-negative human MM tumour xenograft models. RESULTS: PD173074 and sunitinib differentially inhibited the growth of Ba/f3 cells expressing ZNF198-FGFR1 (GI(50)=10 nM and 730 nM, versus GI(50) >1 µM and 2.7 µM for parental cells; p<0.0001) and t(4;14) positive MM cell lines (GI(50)=4-10 µM and 1-3 µM, versus GI(50)=14-15 µM and 4-5 µM for t(4;14) negative MM cells; p≤0.002). In addition, both PD173074 and sunitinib inhibited the activation of FGFR3 in t(4;14)-positive MM cells. PD173074 and sunitinib induced an apoptotic response in a concentration and time-dependent manner in a t(4;14)-positive (PD174073 and sunitinib) but not a t(4;14)-negative MM cell line (sunitinib only); however, in in vivo tumours derived from the same cell lines, sunitinib was only active in the t(4;14)-negative model. CONCLUSIONS: These data demonstrate that PD173074 and sunitinib are inhibitors of FGFR3 in MM cell lines, and that sunitinib has in vivo activity in a human MM tumour xenograft model. However, caution should be exercised in using the t(4;14) translocation as a predictive biomarker for patient selection in clinical trials with sunitinib.


Asunto(s)
Mieloma Múltiple/tratamiento farmacológico , Inhibidores de Proteínas Quinasas/uso terapéutico , Proteínas Tirosina Quinasas Receptoras/antagonistas & inhibidores , Animales , Antineoplásicos/uso terapéutico , Línea Celular Tumoral , Evaluación Preclínica de Medicamentos , Humanos , Indoles/uso terapéutico , Ratones , Ratones Endogámicos BALB C , Ratones Desnudos , Mieloma Múltiple/genética , Mieloma Múltiple/patología , Ftalazinas/uso terapéutico , Piperidinas/uso terapéutico , Piridinas/uso terapéutico , Pirimidinas/uso terapéutico , Pirroles/uso terapéutico , Quinazolinas/uso terapéutico , Sunitinib , Ensayos Antitumor por Modelo de Xenoinjerto
7.
Complement Ther Clin Pract ; 15(2): 61-6, 2009 May.
Artículo en Inglés | MEDLINE | ID: mdl-19341981

RESUMEN

Demands faced by health care professionals include heavy caseloads, limited control over the work environment, long hours, as well as organizational structures and systems in transition. Such conditions have been directly linked to increased stress and symptoms of burnout, which in turn, have adverse consequences for clinicians and the quality of care that is provided to patients. Consequently, there exists an impetus for the development of curriculum aimed at fostering wellness and the necessary self-care skills for clinicians. This review will examine the potential benefits of mindfulness-based stress reduction (MBSR) programs aimed at enhancing well-being and coping with stress in this population. Empirical evidence indicates that participation in MBSR yields benefits for clinicians in the domains of physical and mental health. Conceptual and methodological limitations of the existing studies and suggestions for future research are discussed.


Asunto(s)
Personal de Salud , Meditación , Estrés Psicológico/prevención & control , Estrés Psicológico/terapia , Agotamiento Profesional/prevención & control , Agotamiento Profesional/terapia , Ensayos Clínicos como Asunto , Humanos
8.
CMAJ ; 169(2): 129-31, 2003 Jul 22.
Artículo en Inglés | MEDLINE | ID: mdl-12874162

RESUMEN

Zinc is a common supplement and is widely available as a standard component of many over-the-counter products. A number of reports have identified an association between excessive zinc intake and severe cytopenia. We report a case of zinc-induced copper deficiency in a young adult to illustrate this under-recognized cause of anemia and neutropenia.


Asunto(s)
Anemia Sideroblástica/inducido químicamente , Suplementos Dietéticos/efectos adversos , Neutropenia/inducido químicamente , Zinc/efectos adversos , Adulto , Femenino , Humanos , Medicamentos sin Prescripción , Neurodegeneración Asociada a Pantotenato Quinasa/tratamiento farmacológico
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