The effects of prenatal group genetic counselling on knowledge, anxiety and decisional conflict: issues for nuchal translucency screening.

This study evaluates the effects of prenatal genetic group counselling on women's anxiety, decisional conflict and levels of knowledge. Participants (N=271) were aged 35 years and older. ANOVA results indicated that pre/postcounselling scores for anxiety did not change significantly, while decisional conflict decreased significantly (P<0.001). Pre/postcounselling scores on two different knowledge measures were analysed using 2x3 mixed ANOVAs for time by highest level of education and by having discussed prenatal diagnosis with one's health care provider. No potential interactions were statistically significant; time alone had a strong significant effect for both knowledge measures (P<0.01); P<0.01, respectively), suggesting that the effects of the counselling intervention were robust. Group genetic counselling is an effective method for education and decision support in the prenatal context, and may serve as a model for other clinical populations facing genetic screening decisions.

Therapist competence ratings in relation to clinical outcome in cognitive therapy of depression.

This study reports on the relationship of therapist competence to the outcome of cognitive-behavioral treatment in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Outpatients suffering from major depressive disorder were treated by cognitive-behavioral therapists at each of 3 U.S. sites using a format of 20 sessions in 16 weeks. Findings provide some support for the relationship of therapist competence (as measured by the Cognitive Therapy Scale) to reduction of depressive symptomatology when controlling for therapist adherence and facilitative conditions. The results are, however, not as strong or consistent as expected. The component of competence that was most highly related to outcome is a factor that reflects the therapist's ability to structure the treatment.

Cognitive-behavioral group treatments in childhood anxiety disorders: the role of parental involvement.

OBJECTIVES: This study examined (1) the effect of a cognitive-behavioral group intervention on anxiety, depression, and coping strategies in school-age children (aged 7-12 years) with Axis I anxiety disorders; and (2) the effect of parental involvement on treatment outcomes. METHOD: Parents and children (N = 62) were randomly assigned to one of three 12-week treatment conditions: parent and child intervention, child-only intervention, and parent-only intervention. Child anxiety, depression, and coping strategies were assessed before and after treatment. RESULTS: All treatment groups reported fewer symptoms of anxiety and depression posttreatment and changes in their use of coping strategies. Children in the parent and child intervention used more active coping strategies posttreatment compared with children in the other 2 treatment conditions. Parents in this treatment condition reported a significantly greater improvement in their children's emotional well-being than parents in the other treatment conditions. CONCLUSIONS: Cognitive-behavioral group interventions reduced symptoms of anxiety and depression in school-age children with anxiety disorders. Concurrent parental involvement enhanced the effect on coping strategies. Further investigation is needed to corroborate the effectiveness of such short-term interventions and the maintenance of treatment effects.

The patient's motivation in seeking complementary therapies.

The motivations of cancer patients in seeking complementary therapies are, fundamentally, self-healing motivations which, when engaged appropriately, can contribute to the patient's psychological and physical well being. In this paper, we apply a theoretical model, the Risk Adaptation Model, to furthering the clinical understanding of the motivations of cancer patients in seeking complementary therapies. The model identifies six discrete cognitive processes which, in combination, are hypothesized to play a central role in therapy seeking. Emphasis in this model is placed on the patient's need to maintain positive expectancies (optimism) when faced with the risk and uncertainty of cancer. This understanding of complementary-therapy seeking is grounded in the perspective that clinicians must respect the autonomy of cancer patients in their quest for appropriate therapies, and assist rather than direct their process of therapy-seeking.

The East York Health Needs Study. I: Prevalence of DSM-III-R psychiatric disorder in a sample of Canadian women.

BACKGROUND: This study reports the prevalence of psychiatric disorder in women from a Canadian community. The GHQ and the CES-D were compared for their utility. METHOD: A thousand women over the age of 18 were mailed the GHQ and the CES-D. Our return rate was 44.4%; 24% were personally interviewed by interviews blind to screening information. The CIDI was used to establish DSM-III-R diagnoses. Four versions of the GHQ and one version of the CES-D were calibrated against the CIDI. RESULTS: The prevalence of general psychiatric disorder was estimated as between 15% and 19%, anxiety disorders between 10% and 13%, and depression occurring with anxiety between 3% and 4%. The calibrated GHQ was the most reliable instrument. CONCLUSIONS: Prevalence of DSM-III-R psychiatric disorder can be reliably determined with the calibrated GHQ. Anxiety disorders are most prevalent in this community, and were best detected using calibrated versions of the longer form GHQ.

Preemptive analgesia. Clinical evidence of neuroplasticity contributing to postoperative pain.

Recent evidence suggests that surgical incision and other noxious perioperative events may induce prolonged changes in central neural function that later contribute to postoperative pain. The present study tested the hypothesis that patients receiving epidural fentanyl before incision would have less pain and need fewer analgesics post-operatively than patients receiving the same dose of epidural fentanyl after incision. Thirty patients (ASA physical status 2) scheduled for elective thoracic surgery through a posterolateral thoracotomy incision were randomized to one of two groups of equal size and prospectively studied in a double-blind manner. Epidural catheters were placed via the L2-L3 or L3-L4 interspaces preoperatively, and the position was confirmed with lidocaine. Group 1 received epidural fentanyl (4 micrograms/kg, in 20 ml normal saline) before surgical incision, followed by epidural normal saline (20 ml) infused 15 min after incision. Group 2 received epidural normal saline (20 ml) before surgical incision, followed by epidural fentanyl (4 micrograms/kg, in 20 ml normal saline) infused 15 min after incision. No additional analgesics were used before or during the operation. Anesthesia was induced with thiopental (3-5 mg/kg) and maintained with N2O/O2 and isoflurane. Paralysis was achieved with pancuronium (0.1 mg/kg). Postoperative analgesia consisted of patient-controlled intravenous morphine. Visual analogue scale pain scores were significantly less in group 1 (2.6 +/- 0.44) than in group 2 (4.7 +/- 0.58) 6 h after surgery (P less than 0.05), by which time plasma fentanyl concentrations had decreased to subtherapeutic levels (less than 0.15 ng/ml) in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Cognitive and life stress predictors of relapse in remitted unipolar depressed patients: test of the congruency hypothesis.

Remitted depressed subjects (N = 59) were followed longitudinally to determine whether dependent or self-critical persons are more vulnerable to relapse after exposure to life events that have a bearing on interpersonal or achievement concerns. Regression analyses indicated that congruency effects, as measured by the occurrence of achievement-related adversity in the lives of self-critical subjects, accounted for a significant increment in relapse variance over each variable entered singly. When data from the 2 months just before relapse were analyzed, some evidence of congruency effects in dependent subjects experiencing interpersonal-related adversity was obtained. These findings highlight the dimensional qualities of life even impact and call for greater differentiation in modeling the activation of a diathesis and precipitation of depression after life stress.

Value of the Fear Questionnaire in differentiating agoraphobia and social phobia.

The present study examined responses on the Fear Questionnaire (FQ) of 68 patients suffering panic disorder with agoraphobia, 50 social phobics, 75 subjects with 'non-clinical' panic attacks, and 188 non-panicking controls. The FQ agoraphobia and social subscales had satisfactory internal consistency and were accurate (82%) in correctly differentiating the patients. In general, the patient and control groups differed as expected. The highest level of social fear was reported by social phobics and the highest level of agoraphobic fear was reported by patients with panic disorder and agoraphobia. Five items from these two subscales significantly differentiated social phobia from panic disorder with agoraphobia. The results support the reliability and validity of the FQ.

Cognitive-behavior therapies for major depression: current status with an emphasis on prophylaxis.

This paper reviews the major findings of studies evaluating the efficacy and secondary prevention aspects of the cognitive-behavior therapies (CBT) for depression. Currently, CBT includes well-developed systems of several psychotherapy/behavior therapy in both individual and group modalities. These approaches have been shown to be efficacious, when comparable to any standard treatment, with unipolar, non-psychotic depressions. They remain untested in bipolar disorders. The paper addresses both values of combined treatments, and the limitations of these approaches. As the Beck, Rush, Shaw and Emery (1979) approach to CBT has been shown in seven studies to lower relapse and recurrence rates, these important findings are emphasized. The paper is placed in the context of the literature of psychosocial factors in the onset, maintenance and recurrence of the depressive disorders.

Reliability of a measure of the quality of cognitive therapy.

This study investigates some of the psychometric properties of the Cognitive Therapy Scale (CTS) using a sample of experienced psychotherapists. Four raters, experienced in cognitive therapy, rated a total of 21 independent, videotaped psychotherapy sessions, and provided ratings along the dimensions of therapist competence measured by the CTS. Analyses included item intercorrelations, item-total correlations, and two assessments of inter-rater reliability. Inter-rater reliabilities showed a significant positive correlation for all items of the CTS and the internal reliability was strong. The potential of the CTS to address both the competency of cognitive therapists and trainees is discussed.

Depressive symptoms differentiating between heroin addicts and alcoholics.

The Beck Depression Inventory (BDI) was self-administered to 105 outpatient alcoholics and 211 methadone maintenance patients seeking treatment at a large community mental health center to determine whether or not specific depressive symptoms differentiated the groups. Canonical correlations were first calculated between the set of 21 BDI items and the patients' demographic characteristics of sex, race and age to ascertain if these characteristics should be controlled before making comparisons between the two types of substance abusers. Age and sex were significantly related to self-reported depressive symptomatology and were entered first into a stepwise discriminant analysis with the 21 BDI items followed by type of substance abuse. Four symptoms contributed at least 5% to the overall discrimination between the alcoholics and the heroin addicts; these were sense of failure, weight loss, somatic preoccupation, and loss of libido. The alcoholics described themselves as feeling more like failures and having more somatic preoccupation than the heroin addicts, whereas the heroin addicts reported more weight loss and loss of libido. To estimate the efficiency with which these four symptoms could differentiate between the alcoholics and heroin addicts, discriminant classification analysis was employed; 69.3% of the substance abusers were correctly assigned to their type of addiction. The results were discussed as supporting the contention that alcoholics and heroin addicts may display different depressive symptoms.