Dyadic Interactions of Treatment-Resistant Schizophrenia Patients Having Followed Virtual Reality Therapy: A Content Analysis.

(1) Background: Very little is known about the inner therapeutic processes of psychotherapy interventions for patients suffering from treatment-resistant schizophrenia. Avatar therapy (AT) is one such modalities in which the patient is undergoing immersive sessions in which they interact with an Avatar representing their main persistent auditory verbal hallucination. The aim of this study is to identify the most prevalent dyadic interactions between the patient and the Avatar in AT for patient's suffering from TRS. (2) Methods: A content analysis of 256 verbatims originating from 32 patients who completed AT between 2017 and 2022 at the Institut universitaire en santé mentale de Montréal was conducted to identify dyadic interactions between the patients and their Avatar. (3) Results: Five key dyads were identified to occur on average more than 10 times for each participant during the immersive sessions across their AT: (Avatar: Reinforcement, Patient: Self-affirmation), (Avatar: Provocation, Patient: Self-affirmation), (Avatar: Coping mechanisms, Patient: Prevention), (Patient: Self-affirmation, Avatar: Reinforcement), and (Patient: Self-appraisal, Avatar: Reinforcement). (4) Conclusion: These dyads offer a first qualitative insight to the interpersonal dynamics and patient-avatar relationships taking place during AT. Future studies on the implication of such dyadic interactions with the therapeutic outcome of AT should be conducted considering the importance of dyadic relationships in psychotherapy.

French adaptation and validation of the Panic Disorder Severity Scale-self-report.

BACKGROUND: The aims of this study were to conduct a cross-cultural validation of the Panic Disorder Severity Scale - Self-Report (PDSS-SR) and to examine psychometric properties of the French-Canadian version. METHODS: A sample of 256 adults were included in the validation study based on data from the baseline interview of a clinical trial on transdiagnostic cognitive-behavioral therapy for mixed anxiety disorders. Participants completed the Anxiety and Related Disorders Interview Schedule (ADIS-5), and self-report instruments including the PDSS-SR, Beck Anxiety Inventory (BAI), Mobility Inventory for Agoraphobia (MIA), Sheehan Disability Scale (SDS), Patient Health Questionnaire (PHQ-9), Social Phobia Inventory (SPIN), Insomnia Severity Index (ISI) and Penn State Worry Questionnaire (PSWQ). The cross-cultural adaptation in French of the PDSS-SR included a rigorous back-translation process, with an expert committee review. Sensitivity to change was also examined with a subgroup of patients (n = 72) enrolled in the trial. RESULTS: The French version of the PDSS-SR demonstrated good psychometric properties. The exploratory factor analysis supported a one factor structure with an eigenvalue > 1 that explained 64.9% of the total variability. The confirmatory factor analysis (CFA) corroborated a one-factor model with a good model fit. Internal consistency analysis showed a .91 Cronbach's alpha. The convergent validity was adequate with the ADIS-5 clinical severity ratings for panic disorder (r = .56) and agoraphobia (r = .39), as well as for self-report instruments [BAI (r = .63), MIA (accompanied: r = .50; alone: r = .47) and SDS (r = .37)]. With respect to discriminant validity, lower correlations were found with the SPIN (r = .17), PSWQ (r = .11), ISI (r = .19) and PHQ-9 (r = .28). The optimal threshold for probable diagnosis was 9 for the PDSS-SR and 4 for the very brief 2-item version. The French version showed good sensitivity to change. CONCLUSIONS: The French version of the PDSS-SR has psychometric properties consistent with the original version and constitutes a valid brief scale to assess the severity of panic disorder and change in severity over time, both in research and clinical practice.

Continuous cefazolin infusion versus cefazolin plus probenecid for the ambulatory treatment of uncomplicated cellulitis: A retrospective cohort study.

Background: The preferred ambulatory IV therapy for cellulitis is often once-daily cefazolin combined with once-daily oral probenecid (C+P). However, due to a national probenecid drug shortage in 2011, our centre developed a replacement protocol for the administration of cefazolin continuous infusion (CCI) using elastomeric infusers. Our goal was to compare treatment efficacy, duration of IV therapy, and recurrence associated with CCI and C+P using retrospective data from our centre. Methods: We conducted a non-inferiority single-centre retrospective cohort study of emergency department medical records. Patients received either C+P (cefazolin 2 g IV once daily plus probenecid 1 g PO once daily) or CCI (cefazolin 2 g IV loading dose, followed by cefazolin 6 g IV via continuous infusion over 24 hours, via an elastomeric infuser). We compared treatment efficacy, duration of IV therapy, and recurrence rates. Results:  total of 203 patients were analyzed, with 107 included in the CCI arm and 96 in the C+P arm. Overall, CCI users and C+P users were comparable in their sociodemographic and clinical variables measured at admission. We observed increased odds of achieving successful treatment among the CCI group, however it did not reach statistical significance (odds ratio [OR] 2.25; 95% CI 0.84 to 6.07). Recurrence rates were similar between both groups (OR 1.91; 95% CI 0.32 to 11.31). The average duration of IV therapy was similar between groups (p = 0.6). Conclusions: ith results suggesting that CCI was non-inferior to C+P, and that both approaches required similar treatment durations, CCI could represent an acceptable alternative to C+P for the ambulatory IV treatment of cellulitis.

Historique: Le traitement intraveineux (IV) ambulatoire favorisé pour la cellulite prend souvent la forme d'une injection quotidienne de céfazoline associée à une dose quotidienne de probénécide par voie orale (PO) (C+P). Cependant, à cause d'une pénurie nationale de probénécide en 2011, le centre des auteurs a mis au point un autre protocole de perfusion continue de céfazoline (PCC) à l'aide de perfuseurs élastomériques. Les auteurs ont comparé l'efficacité du traitement, la durée du traitement IV et la récurrence associée à la PCC et aux C+P à partir des données rétrospectives du centre. Méthodologie: Les auteurs ont réalisé une étude de cohorte rétrospective monocentrique de non-infériorité à partir des dossiers médicaux du département d'urgence. Les patients ont reçu soit des C+P (2 g de céfazoline IV une fois par jour associés à 1 g de probénécide PO une fois par jour), soit une PCC (dose de charge de 2 g de céfazoline IV, suivie d'une perfusion continue de 6 g de céfazoline IV par perfuseur élastomérique sur une période de 24 heures). Ils ont comparé l'efficacité thérapeutique, la durée du traitement IV et le taux de récurrence. Résultats: Au total, les auteurs ont analysé 203 patients, dont 107 faisaient partie du volet de PCC et 96, du volet de C+P. Dans l'ensemble, les utilisateurs de la PCC et des C+P présentaient des variables sociodémographiques et cliniques semblables à l'admission. Les auteurs ont observé que le traitement du groupe sous PCC avait tendance à être plus efficace, mais cette constatation n'était pas statistiquement significative (rapport de cotes [RC] 2,25; IC à 95 %, 0,84 à 6,07). Les taux de récurrence étaient semblables entre les deux groupes (RC 1,91; IC à 95 %, 0,32 à 11,31). La durée moyenne du traitement IV était semblable entre les groupes (p = 0,6). Conclusions: Puisque, selon les résultats, la PCC n'était pas inférieure aux C+P et que la durée du traitement était semblable dans les deux cas, il serait acceptable comme traitement de rechange acceptable de C+P pour le traitement IV ambulatoire de la cellulite.