Resumen de evidencia para políticas: intervenciones no farmacológicas para abordar las necesidades de adolescentes con Transtorno del Espectro Autista (TEA) / Summary of evidence for policies: non-pharmacological interventions to address the needs of adolescents with Autism Spectrum Disorder (ASD)

INTRODUCCIÓN: El Departamento de Salud Mental de la División de Prevención y Control de Enfermedades de la Subsecretaría de Salud Pública solicitó a la Unidad de Política de Salud Informadas por Evidencia del Departamento de Evaluaciones de Tecnología Sanitarias y Salud Basada en Evidencia de la División de Planificación Sanitaria el desarrollo de un Resumen de Evidencia para Políticas sobre el problema intervenciones no farmacológicas para abordar las necesidades de adolescentes con Trastorno del Espectro Autista (TEA). Para la elaboración de este informe, el equipo elaborador definió el método con el que se iba a identificar y seleccionar las potenciales opciones de solución. Una vez realizada la selección de las seis opciones, se realizó una búsqueda sistemática y síntesis de evidencia del efecto sobre los desenlaces de interés de cada una, utilizando la metodología GRADE. Luego, se hizo una búsqueda no sistemática de evidencia o antecedentes para analizar las consideraciones implementabilidad de cada opción. OPCIÓN 1: Terapia cognitivo conductual - Con moderada certeza de la evidencia, se observa que la terapia cognitivo conductual en adolescentes con TEA mejora levemente las habilidades de la vida diaria en comparación con no realizar la intervención. Con baja certeza de la evidencia, se observa que la terapia cognitivo conductual mejora levemente el funcionamiento social en adolescentes con TEA, en comparación con no recibir la intervención. Con muy baja certeza de la evidencia, se observa que la terapia cognitiva conductual en adolescentes con TEA podría mejorar la calidad de vida y el bienestar, y mejorar levemente la regulación emocional, síntomas depresivos, síntomas ansiosos, y la auto-determinación. La evidencia es limitada y se requieren más estudios para confirmar este resultado. Las distintas formas de terapia cognitivo conductual suelen ser manualizadas y requieren formación del profesional y logística en escuelas, centros de salud o donde se aplique. Existen además otras consideraciones de implementabilidad que se deben ajustar al contexto local. OPCIÓN 2: Musicoterapia: Con baja certeza de la evidencia, se observa que la musicoterapia en adolescentes con TEA mejora levemente la calidad de vida y regulación emocional, en comparación con no recibir la intervención. Con muy baja certeza de la evidencia, se observa que la musicoterapia en adolescentes con TEA podría mejorar síntomas depresivos y podría mejorar levemente la funcionalidad social, y habilidades de la vida diaria. La evidencia es limitada y se requieren más estudios para confirmar este resultado. OPCIÓN 3: Videomodelamiento No es posible establecer el efecto del videomodelamiento en adolescentes con TEA sobre la regulación emocional, funcionamiento social, habilidades de la vida diaria, y auto-determinación en comparación con no realizar la intervención. No se encontraron estudios que evaluaran los desenlaces de regulación emocional, síntomas depresivos, síntomas ansiosos, y calidad de vida y bienestar. Para esta intervención, los modelos podían ser pares, adultos o los mismos participantes, los facilitadores de la intervención fueron profesores, prestadores de salud o padres/cuidadores. Además, existen otras consideraciones de implementabilidad que se deben ajustar al contexto local. OPCIÓN 4: Terapia basada en mindfulness Con muy baja certeza de la evidencia, se observa que la terapia basada en mindfulness en adolescentes con TEA comparación con control podría mejorar levemente la regulación emocional, los síntomas depresivos, síntomas ansiosos, funcionamiento social, calidad de vida y bienestar, habilidades de la vida diaria y auto-determinación. La evidencia es limitada y se requieren más estudios para confirmar este resultado. Su aplicabilidad depende de la guía por parte de profesionales de salud formados en mindfulness o instructores (no profesionales de salud); en setting ambulatorio o colegios. La mayoría se implementó en formato grupal y ninguna incluía a cuidadores o familiares. Además, existen otras consideraciones de implementabilidad que se deben ajustar al contexto local. OPCIÓN 5: Terapia mediada por pares: Con baja certeza de la evidencia, se observa que el uso de intervención mediada por pares en adolescentes con TEA podría mejorar levemente la regulación emocional, y los síntomas ansiosos en comparación con no realizar la intervención. No es posible establecer el efecto de la intervención mediada por pares en adolescentes con TEA sobre el funcionamiento social y auto-determinación, en comparación con no realizar la intervención. No se encontraron estudios que evaluaran síntomas depresivos, calidad de vida y bienestar, y habilidades de la vida diaria. La evidencia que sintetizamos incluyó a las intervenciones mediadas por pares considerando PEERS, PRT, entre otros modelos estructurados o manualizados de marca registrada, cuya aplicabilidad depende de que sean supervisadas por profesores o facilitadores entrenados. Además, existen otras consideraciones de implementabilidad que se deben ajustar al contexto local. OPCIÓN 6: Terapia de integración sensorial: Con certeza baja de la evidencia, se observa que la terapia de integración sensorial comparada en adolescentes con TEA no tiene un efecto sobre regulación emocional, funcionamiento social, y calidad de vida y bienestar. No es posible establecer el efecto de la terapia de integración sensorial en adolescentes con TEA sobre habilidades de la vida diaria y auto-determinación en comparación con control por falta de información en los estudios. No se encontraron estudios que evaluaran síntomas depresivos y síntomas ansiosos. La evidencia que sintetizamos incluyó entre las terapias de integración sensorial los modelos de Ayres, entre otros modelos estructurados o manualizados. La intervención fue aplicada por profesionales de salud entrenados, en sesiones periódicas y en setting escolar, clínico-hospitalario o clínico ambulatorio. Además, existen otras consideraciones de implementabilidad que se deben ajustar al contexto local.

Ateneo General de la Residencia de Psicopedagogía: Abordaje psicopedagógico en pacientes con perfil externalizante / General Athenaeum of the Psychopedagogical Residence: Psychopedagogical approach in patients with externalizing profile

Ateneo centrado en la intervención psicopedagógica en niños y niñas con conductas externalizantes, En una pirmera parte, se desarrollan algunos conceptos que forman parte del marco teórico del equipo, y más adelante, los referidos a la Terapia Cognitivo Conductual. Se define la conducta y sus funciones, diferenciando conductas internalizantes y externalizantes. Luego se ejemplifican las estrategias de la Terapia Cognitivo Conductual utilizadas en cada uno de los tres subsistemas (familia, escuela y niño/a) a partir de diferentes casos clínicos. Por último, se reflexiona invitando a seguir repensando las intervenciones y prácticas clínicas con pacientes con estas características.

Effects of Cognitive Behavioral Therapy on Pain and Sleep in Adults with Traumatic Brain Injury: A Systematic Review and Meta-Analysis.

The objective of this study was to systematically review the literature on the effects of cognitive behavioral therapy (CBT) on insomnia and pain in patients with traumatic brain injury (TBI). PubMed, Embase, the Cochrane Library, Cumulative Index to Nursing and Allied Health, and Web of Science databases were searched. Outcomes, including pain, sleep quality, and adverse events, were investigated. Differences were expressed using mean differences (MDs) with 95% confidence intervals (CIs). The statistical analysis was performed using STATA 16.0. Twelve trials with 476 TBI patients were included. The included studies did not indicate a positive effect of CBT on pain. Significant improvements were shown for self-reported sleep quality, reported with the Pittsburgh Self-Reported Sleep Quality Index (MD, -2.30; 95% CI, -3.45 to -1.15; P < 0.001) and Insomnia Severity Index (MD, -5.12; 95% CI, -9.69 to -0.55; P = 0.028). No major adverse events related to CBT were reported. The underpowered evidence suggested that CBT is effective in the management of sleep quality and pain in TBI adults. Future studies with larger samples are recommended to determine significance. This trial is registered with PROSPERO registration number CRD42019147266.

Who gets evidence-based therapy for psychosis following a psychiatric hospital admission? Follow-up data from an inpatient randomised controlled trial.

A major barrier to clinicians referring service users with psychosis for psychological therapies is the belief that they will not engage. We investigated therapy receipt after discharge, in a sample of service users who had already demonstrated willingness to engage in psychological therapy during an inpatient admission. Only one-third of service users (33%; 16/48) received at least 1 session of evidence-based therapy at 6-month follow-up after discharge. Therapy receipt was more common for service users with (i) lower delusional distress at discharge, (ii) Black and Minority Ethnic (BME) background, and (iii) discharged to an Early Intervention (EI) service.

Biological rhythms and chronotherapeutics in depression.

Depressive syndromes are frequent and heterogeneous brain conditions with more than 90% of patients suffering from sleep complaints. Better characterizing this "sleep" domain may allow to both better treat acute episodes with existing chronotherapeutics, but also to prevent the manifestation or recurrences of mood disorders. This work aims to i) review theoretical and fundamental data of chronotherapeutics, and ii) provide practical recommendations. Light therapy (LT) can be used as a first-line monotherapy of moderate to severe depression of all subtypes. LT can be also used as a combination with antidepressant to maximize patients' response rates, which has a clear superiority to antidepressant alone. Sleep deprivation (SD) is a rapid and powerful chronotherapeutic with antidepressant responses within hours in 45-60% of patients with unipolar or bipolar depression. Different strategies should be combined to stabilize the SD antidepressant effect, including concomitant medications, repeated SD, combination with sleep phase advance and/or LT (triple chronotherapy). Melatonin treatment is of interest in remitted patients with mood disorder to prevent relapses or recurrences, if a complaint of insomnia, poor sleep quality or phase delay syndrome is associated. During the acute phase, melatonin could be used as an adjuvant treatment for symptoms of insomnia associated with depression. The cognitive behavioral therapy for insomnia (CBT-I) can be recommend to treat insomnia during euthymic phases. The Interpersonal and social rhythm therapy (IPSRT) is indicated for the acute treatment of bipolar depression and for the prevention of mood episodes. Chronotherapeutics should always be associated with behavioral measures for healthy sleep.

Apps para dejar de fumar mediante Terapia Cognitivo Conductual. Una revisión sistemática / Apps for smoking cessation through Cognitive Behavioural Therapy. A review

El tabaquismo constituye un problema sanitario y económico de difícil erradicación. Las personas más dependientes a la nicotina suelen presentar, además, problemas psicopatológicos como depresión yansiedad. Según las Guías de Práctica Clínica (GPC), el tratamientorecomendado para abandonar el hábito es la Terapia Cognitivo Conductual (TCC), sola o combinada con medicación. Actualmente, lasaplicaciones móviles (App) en salud (mHealth) permiten un accesomasivo y económico a este tratamiento. El objetivo de este trabajo consiste en llevar a cabo una revisión bibliográfica de las Apps para dejarde fumar que apliquen TCC y describir las técnicas implementadas.En el marco del protocolo PRISMA, la búsqueda se ciñó al periodo2010-19 y se realizó en las bases de datos: EBSCOhost, Cochrane, Webof Science y Scopus. Se hallaron un total de 415 trabajos, de los cuales,tras aplicar los criterios de inclusión/exclusión, solo 5 artículos fueron objeto de revisión. Únicamente se identificaron 3 Apps (en inglés)que incluyeran TCC y, las técnicas más utilizadas fueron: el registrode cigarrillos, la visualización del progreso mediante gráficas, videospsicoeducativos, la motivación, el apoyo social mediante redes socialesy elementos de gamificación para reforzar la adherencia y la conductade abstinencia. Los resultados sugieren incluir en este tipo de Apps elanálisis de la conducta de fumar, ya que no todas lo hacen, así comouna interfaz que comunique el personal sanitario con el usuario ypueda proporcionar un tratamiento personalizado. (AU)

Smoking is a health and economic problem that is difficult to eradicate.Nicotine addicts also often suffer from psychological problems suchas depression and anxiety. The recommended treatment according toclinical practice guidelines (CPG) is Cognitive Behavioural therapy(CBT), alone or combined with medication. Currently, health-relatedapps (m Health) enable wider availability and access to this treatment.The objectives of this study are to carry out a review of the smokingcessation apps that apply CBT and to describe the techniques used bythem. Following the PRISMA framework, the databases EBSCOhost,Cochrane, Web of Science and Scopus were searched for publicationsbetween 2010-2019. Four hundred fifteen studies were found and,after applying the inclusion and exclusion criteria, only five articleswere eligible for systematic review. Only three apps were identifiedas using CBT, and the techniques most commonly used were therecording of smoking history, progress visualised through graphics,psycho-educational videos, motivation, social support through socialmedia, and elements of gamification to reinforce adherence and abstinence behaviour. The results recommend the inclusion of smokingbehaviour analysis in these types of apps, as not all of them do so, aswell as an interface between the health professionals and the users toprovide a personalised treatment. (AU)

The effectiveness of cognitive behaviour therapy for reducing anxiety symptoms following traumatic brain injury: A meta-analysis and systematic review.

BACKGROUND: Anxiety is a common neuropsychological sequela following traumatic brain injury (TBI). Cognitive Behaviour Therapy (CBT) is a recommended, first-line intervention for anxiety disorders in the non-TBI clinical population, however its effectiveness after TBI remains unclear and findings are inconsistent. OBJECTIVE: There are no current meta-analyses exploring the efficacy of CBT as an intervention for anxiety symptoms following TBI, using controlled trials. The aim of the current study, therefore, was to systematically review and synthesize the evidence from controlled trials for the effectiveness of CBT for anxiety, specifically within the TBI population. METHOD: Three electronic databases (Web of Science, PubMed and PsycInfo) were searched and a systematic review of intervention studies utilising CBT and anxiety related outcome measures in a TBI population was performed through searching three electronic databases. Studies were further evaluated for quality of evidence based on Reichow's (2011) quality appraisal tool. Baseline and outcome data were extracted from the 10 controlled trials that met the inclusion criteria, and effect sizes were calculated. RESULTS: A random effects meta-analysis identified a small overall effect size (Cohen's d) of d = -0.26 (95%CI -0.41 to -0.11) of CBT interventions reducing anxiety symptoms following TBI. CONCLUSIONS: This meta-analysis tentatively supports the view that CBT interventions may be effective in reducing anxiety symptoms in some patients following TBI, however the effect sizes are smaller than those reported for non-TBI clinical populations. Clinical implications and limitations of the current meta-analysis are discussed.

Neuropsychological consequences of childhood medulloblastoma and possible interventions: A review.

BACKGROUND: Children who have been treated for a medulloblastoma often suffer long-term cognitive impairments that often negatively affect their academic performance and quality of life. In this article, we will review the neuropsychological consequences of childhood medulloblastoma and discuss the risk factors known to influence the presence and severity of these cognitive impairments and possible interventions to improve their quality of life. METHODS: This narrative review was based on electronic searches of PubMed to identify all relevant studies. RESULTS: Although many types of cognitive impairments often emerge during a child's subsequent development, the core cognitive domains that are most often affected in children treated for a medulloblastoma are processing speed, attention and working memory. The emergence and magnitude of these deficits varies greatly among patients. They are influenced by demographic (age at diagnosis, parental education), medical and treatment-related factors (perioperative complications, including posterior fossa syndrome, radiation therapy dose, etc.), and the quality of interventions such as school adaptations provided to the child or rehabilitation programs that focus on cognitive skills, behavior and psychosocial functioning. CONCLUSION: These patients require specialized and coordinated multidisciplinary rehabilitation follow-up that provides timely and adapted assessments and culminates in personalized intervention goals being set with the patient and the family. Follow-up should be continued until referral to adult services.

Clinical considerations in designing brief exposure interventions for primary care behavioral health settings.

INTRODUCTION: Prevalence rates of anxiety disorders and symptoms in primary care (PC) settings are very high. Behavioral health consultants in primary care behavioral health (PCBH) settings enable increased access to evidence-based anxiety treatment. Despite strong extant support for exposure-based therapy for anxiety disorders, the use of exposure to treat anxiety in PC settings is low. Although barriers to exposure therapy (ET) may be exacerbated in PC settings, many anxiety presentations in PC warrant an exposure-based approach to treatment. Thus, exploration of feasibility and efficacy of ET in PC represents a critical area for advancing evidence-based treatment of anxiety symptoms. METHODS: The current article addresses this gap through the presentation of two case examples of ET conducted in PCBH. Theoretical and practical information regarding the implementation of exposure using a brief (≤ 30 min), time-limited (4-6 visit) approached are presented. RESULTS: Results from the case examples demonstrate feasibility of conducting exposure in a brief format consistent with a PCBH approach. Additionally, patient outcomes presented suggest that ET conducted in PCBH reduces anxiety symptoms and may facilitate referral to specialty care settings. DISCUSSION: Exposure may offer promise in improving the quality of anxiety treatment in PC. Future work documenting both effectiveness and implementation outcomes of exposure in PC in clinical work and research trials is needed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Using Machine Learning to Predict Suicide Attempts in Military Personnel.

Identifying predictors of suicide attempts is critical in intervention and prevention efforts, yet finding predictors has proven difficult due to the low base rate and underpowered statistical approaches. The objective of the current study was to use machine learning to examine predictors of suicidal behaviors among high-risk suicidal Soldiers who received outpatient mental health services in a randomized controlled trial of Brief Cognitive Behavioral Therapy for Suicide Prevention (BCBT) compared to treatment as usual (TAU). Self-report measures of clinical and demographic variables, administered prior to the start of outpatient treatment to 152 participants with recent suicidal thoughts and/or behaviors were analyzed using machine learning software to identify the best combination of variables for predicting suicide attempts during or after treatment. Worst-point suicidal ideation, history of multiple suicide attempts, treatment group (i.e., BCBT or TAU), suicidogenic cognitions, and male sex were found, in combination, correctly classified 30.8% of patients who attempted suicide during the two-year follow-up period. This combination has higher sensitivity than many models that have previously been used to predict suicidal behavior. Overall, this study provides a combination of variables that can be assessed clinical to help identify high-risk suicidal individuals.

A multidimensional investigation of anxiety sensitivity and depression outcomes in cognitive-behavioral group therapy.

We examined how anxiety sensitivity - the fear of symptoms of anxiety due to their perceived harmful effects - and gender are associated with treatment trajectory and outcomes in a large outpatient sample (N = 278) who received 14-weeks of cognitive-behavioral group therapy (CBGT) for depression. Three dimensions of anxiety sensitivity (cognitive, physical, and social concerns) and depression were assessed at pre-treatment, and the latter was assessed weekly during treatment. Latent growth curve models supported a link between cognitive concerns (fears of losing control over thoughts) and greater improvement in depression near the end of treatment (i.e., weeks 10-14); gender did not moderate trajectory. Gender (i.e., identifying as a woman) and greater physical concerns (fears of physical consequences of arousal symptoms) were associated with completion of < 8 sessions. Results suggest that those with more cognitive concerns might require greater time in treatment and/or benefit most from the focus on maladaptive assumptions and core beliefs in later CBGT sessions. Future research, including investigation of intervening variables, may elucidate the mechanisms through which greater physical concerns and gender are associated with treatment non-completion. Results supported differential associations of anxiety sensitivity dimensions with depression treatment outcomes, though further research attention is needed.

Impact of behavioral and medication treatment for alcohol use disorder on changes in HIV-related outcomes among patients with HIV: A longitudinal analysis.

BACKGROUND: For people with HIV (PWH) and alcohol use disorder (AUD) who initiated behavioral treatment (BAUD) we: 1) describe BAUD intensity and medication (MAUD); and 2) examine whether BAUD and MAUD were associated with changes in HIV-related outcomes (CD4 cell count, HIV-1 viral load [VL], VACS Index score 2.0, and antiretroviral [ARV] adherence) from before to one year after treatment initiation. METHODS: We used Veterans Aging Cohort Study (VACS) data to describe BAUD intensity and MAUD (acamprosate, disulfiram, and naltrexone, gabapentin or topiramate). Linear regression models estimated changes in outcomes and included BAUD, MAUD, age and race/ethnicity. RESULTS: We identified 7830 PWH who initiated BAUD from 01/2008-09/2017. Median age was 53, 60% were African-American and 28% white. BAUD intensity groups were: 1) Single Visit - 35%; 2) Minimal - 44% recieved ∼2 visits during first month; 3) Sustained Moderate - 17% recieved ∼8 visits/month initially; and 4) Intensive - 4% started out receiving ∼14-16 visits/month. Only 9% recieved MAUD, the majority of which was gabapentin. Among those with detectable VL: all HIV-related outcomes improved more among those with more intensive BAUD. Among those with undetectable VL: adherence improved more among those with greater BAUD intensity. MAUD was associated with increased CD4 among those with detectable VL and with improved adherence among both groups. CONCLUSION: Of those with >1 BAUD visit, only 21% received at least moderate BAUD and 9% received at least 6 months of MAUD. Increasing AUD treatment intensity may improve HIV-related outcomes, especially among those with detectable VL.

Longitudinal suicide ideation trajectories in a clinical trial of brief CBT for U.S. military personnel recently discharged from psychiatric hospitalization.

Research among adolescent samples has suggested patterns of change in suicidal ideation (SI) following psychiatric hospitalization discharge are heterogenous and predictive of subsequent suicide attempts. However, no studies have examined SI trajectories following discharge among adult samples or the effect of treatment on trajectories. We used growth mixture modeling to examine trajectories of SI among 152 active duty military personnel in a randomized controlled trial comparing brief cognitive-behavioral therapy (CBT) for suicide prevention to treatment as usual following discharge from inpatient psychiatric hospitalization for a suicide risk. Analyses of SI at baseline, 3-, 6-, and 12-months post-discharge among the full sample randomized to both conditions revealed two trajectories: rapid improvers (59.21%) and gradual improvers (40.79%). Gradual improvers were more than twice as likely to attempt suicide in the two years following discharge. Exploratory analyses suggested that, relative to those in the treatment as usual condition, those randomized to brief CBT in both trajectories may be less likely to make a suicide attempt during the follow-up period. Results replicate and extend prior research in identifying distinct ideation trajectories following psychiatric inpatient hospitalization for suicide risk to active-duty personnel in a treatment trial and linking these trajectories to suicide attempts during follow-up.

A prospective study of intensive in-patient treatment for obsessive-compulsive disorder.

Multimodal in-patient treatment incorporating intensive cognitive-behaviour therapy (CBT) and medication management is a promising alternative for obsessive-compulsive disorder (OCD) patients who do not respond to standard out-patient treatment. We prospectively examined the short-term outcome and predictors of outcome of intensive in-patient treatment in a largely pharmacotherapy-resistant OCD sample. Fifty eight consecutive patients, admitted for treatment of OCD were evaluated at admission, at discharge and 2 months post-discharge for psychiatric diagnosis, personality disorders, obsessive beliefs, insight into obsessions and severity of obsessive-compulsive, depressive and anxiety symptoms. All patients received comprehensive treatment consisting of a combination of pharmacotherapy and intensive CBT. The mean Y-BOCS score was 29.38(±5.72) at admission, which reduced to 16.62(±7.91) at discharge and 16.75(±8.85) at follow-up. Thirty five participants (60.3%) met the prespecified criteria for response and 19 (32.8%) for remission. There was a significant reduction in Y-BOCS scores at discharge [43.67 (23.81)%] and post-discharge follow-up [2.18 (29.32)%] as compared to baseline (p<0.01). Baseline Browns Assessment of Beleifs Scale score (insight) was the only variable that statistically differentiated responders and non-responders. In-patient treatment is an effective treatment for medication resistant, severe and chronic OCD. Poor insight is a potential predictor of non-response to in-patient treatment.

Patterns of early change in interpersonal problems and their relationship to nonverbal synchrony and multidimensional outcome.

Early change is an increasing area of investigation in psychotherapy research. In this study, we analyzed patterns of early change in interpersonal problems and their relationship to nonverbal synchrony and multiple outcome measures for the first time. We used growth mixture modeling to identify different latent classes of early change in interpersonal problems with 212 patients who underwent cognitive-behavioral treatment including interpersonal and emotion-focused elements. Furthermore, videotaped sessions were analyzed using motion energy analysis, providing values for the calculation of nonverbal synchrony to predict early change in interpersonal problems. The relationship between early change patterns and symptoms as well as overall change in interpersonal problems was also investigated. Three latent subgroups were identified: 1 class with slow improvement (n = 145), 1 class with fast improvement (n = 12), and 1 early deterioration class (n = 55). Lower levels of early nonverbal synchrony were significantly related to fast improvement in interpersonal change patterns. Furthermore, such patterns predicted treatment outcome in symptoms and interpersonal problems. The results suggest that nonverbal synchrony is associated with early change patterns in interpersonal problems, which are also predictive of treatment outcome. Limitations of the applied methods as well as possible applications in routine care are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Neuroimaging Outcomes in Studies of Cognitive Training in Mild Cognitive Impairment and Early Alzheimer's Disease: A Systematic Review.

BACKGROUND: Cognitive Training (CT) has demonstrated some benefits to cognitive and psychosocial function in Mild Cognitive Impairment (MCI) and early dementia, but the certainty related to those findings remains unclear. Therefore, understanding the mechanisms by which CT improves cognitive functioning may help to understand the relationships between CT and cognitive function. The purpose of this review was to identify the evidence for neuroimaging outcomes in studies of CT in MCI and early Alzheimer's Disease (AD). METHODS: Medline, Embase, Web of Science, PsycINFO, CINAHL, and The Cochrane Library were searched with a predefined search strategy, which yielded 1778 articles. Studies were suitable for inclusion where a CT program was used in patients with MCI or AD, with a structural or functional Magnetic Resonance Imaging (MRI) outcome. Studies were assessed for quality using the Downs and Black criteria. RESULTS: A total of 19 studies met the inclusion criteria. Quality of the included studies was variable and there was significant heterogeneity for studies included in this review. Task activation was generally increased post-training, but functional connectivity was both increased and decreased after training. Results varied by diagnosis, type of CT program, and brain networks examined. No effects were seen on hippocampal volumes post-training, but cortical thickening and increased grey matter volumes were demonstrated. CONCLUSIONS: CT resulted in variable functional and structural changes in dementia, and conclusions are limited by heterogeneity and study quality. Larger, more robust studies are required to correlate these findings with clinical benefits from CT.

Deep transcranial magnetic stimulation for obsessive-compulsive disorder is efficacious even in patients who failed multiple medications and CBT.

OCD is a chronic and disabling disease with a lifetime prevalence of 2%-3%. About 40-60% of these patients do not adequately respond to pharmacotherapy and CBT. Deep transcranial magnetic stimulation (dTMS) was shown to be safe and effective as a treatment alternative for OCD and recently received regulatory approvals. Yet it is unclear whether patients who failed numerous medications and/or CBT can still benefit from dTMS. Here, we analyzed recent data from a double-blind multicenter dTMS study and found efficacy of this novel treatment even in OCD patient cohorts who previously failed to respond to multiple medications and CBT.

Long-term effects of mindfulness-based cognitive therapy in patients with obsessive-compulsive disorder and residual symptoms after cognitive behavioral therapy: Twelve-month follow-up of a randomized controlled trial.

We examined the long-term efficacy of mindfulness-based cognitive therapy (MBCT) compared to a psychoeducation group as an active control condition in patients with obsessive-compulsive disorder (OCD) with residual symptoms of OCD after cognitive behavioral therapy. A total of 125 patients were included in a bicentric, interviewer-blind, randomized, and actively controlled trial and were assigned to either an MBCT group (n = 61) or a psychoeducation group (n = 64). Patients' demographic characteristics and the results from our previous assessments have already been reported (Külz et al., 2019). At the 12-month follow-up the completion rate was 80%. OCD symptoms were reduced from baseline to follow-up assessment with a large effect, but no difference was found between groups. Exploratory analyses showed that a composite score of time occupied by obsessive thoughts, distress associated with obsessive thoughts, and interference due to obsessive thoughts differed between groups in the per-protocol analysis, with a stronger reduction in the MBCT group. At the 12-month follow-up, the two groups showed a similar reduction of symptoms. However, preliminary evidence indicates that MBCT has a superior effect on some aspects of OCD. This should be replicated in future studies.

Long-term changes in delay discounting following a smoking cessation treatment for patients with depression.

BACKGROUND: Delay discounting (DD) has been identified as a trans-disorder process underlying addictive behaviors, including smoking. Previous studies have evaluated how different treatments for drug dependence have affected DD, showing mixed results. Furthermore, no study has examined the effects of changes in depression on DD rates. The aim of this study was to evaluate the impact of treatment type: cognitive behavioral treatment (CBT), CBT + behavioral activation (BA), or CBT + BA + contingency management (CM), and changes in smoking status and depression on DD rates in long-term follow-up among a sample of treatment-seeking smokers with depression. METHODS: Participants were 180 treatment-seeking smokers with depression who were randomly assigned to one of the following treatment conditions: CBT (n = 60), CBT + BA (n = 60), and CBT + BA + CM (n = 60). Depressive symptomatology and major depression diagnosis were evaluated through the BDI-II and the SCID-I of the DSM-IV-TR. DD rates were assessed using the DD task with hypothetical monetary rewards. Smoking status, DD, and depressive symptomatology were collected at baseline, at end-of-treatment and at one-, two-, three-, and six-month follow-ups. RESULTS: CM for smoking cessation reduces DD rates (p = .0094). Smoking abstinence (p = .0024) and reduction in depressive symptoms (p = .0437) were associated with decreases in DD rates in long-term follow-up. CONCLUSIONS: CM interventions for smoking cessation, smoking abstinence, and the improvement of depression contribute to reductions in DD over time.

Treatment and management of cognitive dysfunction in patients with multiple sclerosis.

Cognitive impairment is a common and devastating manifestation of multiple sclerosis (MS). Although disease-modifying therapies have been efficacious for reducing relapse rates in MS, such treatments are ineffective for treating cognitive dysfunction. Alternative treatment approaches for mitigating cognitive problems are greatly needed in this population. To date, cognitive rehabilitation and exercise training have been identified as possible candidates for treating MS-related cognitive impairment; however, cognitive dysfunction is still often considered to be poorly managed in patients with MS. This Review provides a comprehensive overview of recent developments in the treatment and management of cognitive impairment in people with MS. We describe the theoretical rationales, current states of the science, field-wide challenges and recent advances in cognitive rehabilitation and exercise training for treating MS-related cognitive impairment. We also discuss future directions for research into the treatment of cognitive impairment in MS that should set the stage for the inclusion of cognitive rehabilitation and exercise training into clinical practice within the next decade.