Serotonin reuptake inhibitor-cognitive behavioural therapy-second generation antipsychotic combination for severe treatment-resistant obsessive-compulsive disorder. A prospective observational study.

INTRODUCTION: Six in ten patients with obsessive-compulsive disorder (OCD) do not respond to the first-line treatments with serotonin reuptake inhibitor (SRI) or cognitive behavioural therapy including exposure and response prevention (CBT/ERP), and several do not respond to second-line treatments, i.e., SRI-second generation antipsychotic (SGA) or SRI-CBT/ERP augmentation. Evidence on third-line treatments is inconsistent. OBJECTIVE: We investigated the 1-year response to SRI-CBT/ERP-SGA combination in patients with severe treatment-resistant OCD, who failed to respond to SRI and to SRI-SGA or SRI-CBT/ERP augmentation. METHODS: Twenty-eight patients were consecutively recruited and treated with SRI (drug(s) and doses previously administered), SGA (risperidone median dosage 1 mg/day in 14 cases, aripiprazole median dosage 3 mg/day in 14 cases) and CBT/ERP (median hours 32.5). Exclusion criteria: mental retardation and organic brain syndrome. RESULTS: The mean Y-BOCS total score reduction at 12 months was 28.2%, 60.7% of patients improved, 46.4% partially responded, 32.1% responded, and 28.6% remitted. Patients previously resistant to SRI-SGA and SRI-CBT/ERP did not significantly differ in the rates of improvement, partial response, response and remission. CONCLUSIONS: This study suggests that SRI-SGA-CBT/ERP combination could be useful for severe treatment-resistant OCD. Small sample size is a limitation.Key pointsUp to 6 in 10 patients with OCD do not respond to first line treatments (CBT/ERP or SRIs) and several to second-line treatments (SRI-SGA or SRI CBT/ERP augmentation).In our study, patients with OCD resistant to the first and the second line treatment improved (61%), partially responded (46%), responded (32%), or remitted (29%) combining SRI, SGA and CBT/ERP.In our patients the SRI-SGA-CBT/ERP augmentation improved working/school, social and family impairment.SRI-SGA-CBT/ERP augmentation is easier to use than other treatments for severe treatment-resistant OCD.

Dysfunctional eating behaviors, anxiety, and depression in Italian boys and girls: the role of mass media

Objective: Extensive research has implicated identification with characters in mass media in the emergence of disordered eating behavior in adolescents. We explored the possible influence of the models offered by television (TV) on adolescents' body image, body uneasiness, eating-disordered behavior, depression, and anxiety. Methods: Three hundred and one adolescents (aged 14-19) from southern Italy participated. They completed a questionnaire on media exposure and body dissatisfaction, the Eating Disorder Inventory-2, the Body Uneasiness Test, the Beck Depression Inventory, and the State-Trait Anxiety Inventory - Form Y. Results: The main factors contributing to females' eating-disordered behaviors were their own desires to be similar to TV characters, the amount of reality and entertainment TV they watched, and the discrepancy between their perceptions of their bodies and those of TV characters. Friends' desire to be similar to TV characters contributed most to depression, anxiety, body uneasiness, and eating disorders for both males and females. Conclusion: Our data confirm that extensive watching of reality and entertainment TV correlates with eating-disordered behavior among females. Moreover, the well-known negative effects of the media on adolescents' eating-disordered behaviors may also be indirectly transmitted by friends who share identification with TV characters.

Dysfunctional eating behaviors, anxiety, and depression in Italian boys and girls: the role of mass media.

OBJECTIVE: Extensive research has implicated identification with characters in mass media in the emergence of disordered eating behavior in adolescents. We explored the possible influence of the models offered by television (TV) on adolescents' body image, body uneasiness, eating-disordered behavior, depression, and anxiety. METHODS: Three hundred and one adolescents (aged 14-19) from southern Italy participated. They completed a questionnaire on media exposure and body dissatisfaction, the Eating Disorder Inventory-2, the Body Uneasiness Test, the Beck Depression Inventory, and the State-Trait Anxiety Inventory - Form Y. RESULTS: The main factors contributing to females' eating-disordered behaviors were their own desires to be similar to TV characters, the amount of reality and entertainment TV they watched, and the discrepancy between their perceptions of their bodies and those of TV characters. Friends' desire to be similar to TV characters contributed most to depression, anxiety, body uneasiness, and eating disorders for both males and females. CONCLUSION: Our data confirm that extensive watching of reality and entertainment TV correlates with eating-disordered behavior among females. Moreover, the well-known negative effects of the media on adolescents' eating-disordered behaviors may also be indirectly transmitted by friends who share identification with TV characters.

Is expressive writing effective in decreasing depression and increasing forgiveness and emotional wellbeing of preadolescents? / La escritura expresiva: ¿un método eficaz para reducir la depresión y facilitar el perdón y el bienestar de los preadolescentes?

Expressive writing (EW) can be an effective way to alter maladaptive emotional reactions to stressful life events, although little is known about how pre-adolescents may benefit from it. In this quasi-experimental study, we compared measures of depression, anger, forgiveness, positive and negative affect in pre-adolescents before and after EW in both an experimental group undergoing the EW paradigm and a control group (N=138). No significant effects between control and experimental groups were found for the considered variables, except for positive and negative affect. We suggest potential reasons accounting for these results. Given that the theorised mechanisms involved in the EW paradigm include executive functioning abilities, it is possible that preadolescents may not be able to benefit from it, due to not fully developed executive functioning skills. Our results provide useful information in order to better design future studies and prevention/intervention programmes to be implemented with preadolescents.

La Escritura Expresiva (EE) puede ser una forma efectiva de alterar reacciones emocionales maladaptativas a eventos estresantes de la vida, aunque se sabe poco sobre cómo los pre-adolescentes pueden beneficiarse de ella. En este estudio cuasi-experimental, comparamos medidas de depresión, ira, perdón, afecto positivo y negativo en pre-adolescentes antes y después de EE en un grupo experimental sometido al paradigma de EE y en un grupo de control (N=138). No se encontraron efectos significativos entre los grupos control y experimental para las variables consideradas, excepto para los afectos positivos y negativos. Sugerimos posibles razones para explicar estos resultados. Dado que los mecanismos teóricos implicados en el paradigma de la EE incluyen las capacidades de funcionamiento ejecutivo, es posible que los preadolescentes no puedan beneficiarse de ella, debido a las habilidades de funcionamiento ejecutivo no totalmente desarrolladas. Nuestros resultados proporcionan información útil para un mejor diseño de futuros estudios y programas de prevención / intervención a implementar con preadolescentes.