Patients with problematic opioid use can be weaned from codeine without pain escalation.

BACKGROUND: Brief treatments for chronic non-malignant pain patients with problematic opioid use are warranted. The aims of the present study were to investigate (1) whether it is possible to withdraw codeine use in such patients with a brief cognitive-behavioural therapy (CBT), (2) whether this could be done without pain escalation and reduction in quality of life and (3) to explore the effects of codeine reduction on neurocognitive functioning. METHODS: Eleven patients using codeine daily corresponding to 40-100 mg morphine were included. Two specifically trained physicians treated the patients with six CBT sessions, tapering codeine gradually within 8 weeks. Codeine use, pain intensity, quality of life and neuropsychological functioning were assessed at pre-treatment to the 3-month follow-up. RESULTS: Codeine use was significantly reduced from mean 237 mg [standard deviation (SD) 65] pre-treatment to 45 mg (SD 66) post-treatment and to 48 mg (SD 65) at follow-up without significant pain escalation or reductions in quality of life. Moreover, neuropsychological functioning improved significantly on some tests, while others remained unchanged. CONCLUSION: The promising findings of codeine reduction in this weaning therapy programme for pain patients with problematic opioid use should be further evaluated in a larger randomized control trial comparing this brief CBT with both another brief treatment and attention placebo condition.

Serotonin transporter polymorphisms predict response inhibition in healthy volunteers.

Serotoninergic transmission is reliably implicated in inhibitory control processes. The aim of this study was to test the hypothesis if serotonin transporter polymorphisms mediate inhibitory control in healthy people. 141 healthy subjects, carefully screened for previous and current psychopathology, were genotyped for the 5-HTTLPR and rs25531 polymorphisms. Inhibitory control was ascertained with the Stop Signal Task (SST) from the Cambridge Neuropsychological Test Automated Battery (CANTAB). The triallelic gene model, reclassified and presented in a biallelic functional model, revealed a dose-dependent gene effect on SST performance with Individuals carrying the low expressive allele had inferior inhibitory control compared to high expressive carriers. This directly implicates serotonin transporter polymorphisms (5-HTTLPR plus rs25531) in response inhibition in healthy subjects.

Comparative effects of short-term psychodynamic psychotherapy: a meta-analysis.

In a review of 19 clinically relevant comparative outcome studies published 1978-1988, short-term psychodynamic psychotherapy (STPP) was evaluated as to overall effects, differential effects, and moderating effects vis-à-vis no-treatment controls (NT) and alternative psychotherapies (AP), respectively. Overall, STPP was superior to NT at posttreatment, inferior to AP at posttreatment, and even more so at 1-year follow-up. STPP was inferior to AP in treating depression and, in particular, to cognitive-behavioral therapy for major depression. STPP was equally successful with mixed neurotics. As research quality increased, STPP grew less superior to NT. Furthermore, STPP decreased its overall superiority over NT and increased its overall inferiority to AT on a series of clinically relevant variables. Improvement in research quality from 1978 to 1988 was noted. Evidence, although limited, supported the view that STPP approaches do seem to differ along a few major dimensions.

Predicting patient change from therapist competence and patient-therapist complementarity in short-term anxiety-provoking psychotherapy: a pilot study.

In this pilot study, therapist competence and patient-therapist complementarity measured by the Structural Analysis of Social Behavior system (SASB; Benjamin, 1974) were examined as to their interrelation and their unique, collective, and interactive contributions to patient change in 20 sessions of short-term anxiety-provoking psychotherapy (STAPP; Sifneos, 1979). Patients were 15 highly educated outpatients, mean age 30 years, with mainly anxiety diagnoses. Therapists were in postgraduate manual-guided STAPP training. Results show that competence in an early session did not relate to patient change. In contrast, patient-therapist complementarity ratings predicted patient change both alone and over and above competence. Predictions were strongest for changes in general distress and dysfunctional attitudes and for shorter term change rather than for longer term change.

Memory functioning in patients with primary fibromyalgia and major depression and healthy controls.

Memory functioning was assessed in 25 primary fibromyalgia (FM) patients by comparing them with 22 major depressed patients and 18 healthy controls. A broad range of short- and long-term memory tasks were included. Both major depressed and FM patients were significantly impaired on long-term memory tasks requiring effortful processing, compared to healthy controls. When the depressive status of the fibromyalgia patients was accounted for, only the subsample with a lifetime major depressive disorder showed memory impairment as compared with the healthy controls.

Personality profile among symptomatic and recovered patients with neck sprain injury, measured by MCMI-I acutely and 6 months after car accidents.

The relationships between personality and psychiatric symptoms and long-lasting physical symptoms were assessed in 88 neck sprain patients injured in car accidents. The Millon Clinical Multiaxial Inventory (MCMI-I) was completed at time of occurrence (intake) and 6 months after the injury. The neck sprain patients were divided into three subgroups according to symptoms 6 months after the accident. In addition, the total neck sprain group was compared with three other subject groups. The results indicated that the three neck sprain subgroups did not differ on the MCMI-I neither at intake nor 6 months later. The total neck sprain patients group was significantly different from patients with major depression on all scales of the MCMI-I, but not significantly different compared to patients with localized musculoskeletal pain. Compared to a group of health personnel, there were only a few significant differences. The study does not support the view that premorbid personality traits can predict outcome for neck sprain patients.

Acute treatment of whiplash neck sprain injuries. A randomized trial of treatment during the first 14 days after a car accident.

STUDY DESIGN: A single-blinded, randomized treatment study with a follow-up period of 6 months. OBJECTIVE: To study the long-term consequences of whiplash neck sprain injuries in patients treated with two different regimes during the first 14 days after the car accident. Patients in the first group were encouraged to act as usual, i.e., continue to engage in their normal, pre-injury activities; that group was compared with another group of patients who were given time off from work and who were immobilized using a soft neck collar. The end point of the comparison was the evaluation of subjective symptoms 6 months after the accident. SUMMARY OF BACKGROUND DATA: Few randomized treatment studies have been performed to evaluate the clinical outcome for patients with neck sprain. METHOD: Patients who participated in the study were recruited from the Emergency Clinic at the University Hospital in Trondheim, Norway. The study group included 201 patients (47% of the study group) with neck sprain that resulted from a car accident. Neck and shoulder movements and subjective symptoms, which were assessed using several different measurements, were assessed during the follow-up period. RESULTS: There was a significant reduction of symptoms from the time of intake to 24 weeks after the treatment period in both groups. There was a significantly better outcome for the act-as-usual group in terms of subjective symptoms, including pain localization, pain during daily activities, neck stiffness, memory, and concentration, and in terms of visual analog scale measurements of neck pain and headache. CONCLUSIONS: The outcome was better for patients who were encouraged to continue engaging in their normal, pre-injury activities as usual than for patients who took sick leave from work and who were immobilized during the first 14 days after the neck sprain injury.

Perceptions of parental bonding in patients with various personality disorders, lifetime depressive disorders, and healthy controls.

The aims of the present study was (a) to examine the relationship between parental bonding and various personality disorders, when the effect of a lifetime depressive disorder was statistically controlled for, and (b) to examine the relationship between parental bonding and a lifetime depressive disorder when the effects of various personality disorders were accounted for. The study included 135 psychiatric outpatients and 41 healthy controls. The patients were diagnosed according to DSM-III-R axis I and axis II. Results indicated that obsessive-compulsive personality disorder was associated with reports of lower levels of paternal care and higher levels of paternal overprotection, while cluster B personality disorder was associated with reports of high parental overprotection. Avoidant, dependent, and cluster A personality disorders were not associated with abnormal parental bonding. Lifetime depressive disorders were associated with reports of low maternal care and high maternal overprotection when the effect of a personality disorder was accounted for.

A repetition-prediction study on European parasuicide populations. Part II of the WHO/Euro Multicentre Study on Parasuicide in cooperation with the EC Concerted Action on Attempted Suicide.

One of the aims of the inter-European study on parasuicide, which was initiated by WHO/Euro in the mid-1980s, was to try and identify social and personal characteristics predictive of future suicidal behavior. A follow-up interview study (the Repetition-Prediction Study) was designed, and so far 1145 interviews have been carried out at nine research centers, representing seven European countries. The study and the instrument used (the European Parasuicide Study Interview Schedules, EPSIS I and II) are described here. Some basic characteristics of the material from the various centers are presented and compared, and the representativeness of the samples are discussed. There were differences between the centers in several respects. Results from analyses based on pooled data have to be treated with some caution because of the possible lack of representativeness.

Attentional functions in major depressive disorders with and without comorbid anxiety.

The aim of this study was to explore if the divergent results regarding attentional functions in patients with mood disorders are due to selective impairments in higher level or more basic and distinctive attentional subcomponents. We compared outpatients with current major depressive disorders (MDD; n = 37) and MDD with comorbid anxiety disorder (MDDA; n = 24) with healthy controls (n = 92) on Stroop and Attentional Network Test (ANT). The current data indicate that significant impairment in attentional functions corresponds to the presence of MDD and MDDA. MDDA displayed significantly lower performance on the Stroop variables, and MDD were significantly impaired in the alerting function in ANT. These results show impairments on different levels of attention in mood disorders. MDDA show impairments on higher level executive attention functions, whereas MDD display deficits at the basic attentional level. These findings suggest that including comorbid anxiety disorder in MDD is important for future research.

Verbal memory functions in unipolar major depression with and without co-morbid anxiety.

The aim of this study was to examine both executive control of verbal working memory and verbal learning as well as long-term storage function in outpatients with major depressive disorder (n = 61) compared to healthy controls (n = 92). A total of 37 patients had no co-morbid anxiety disorder, whereas 24 had a co-morbid anxiety disorder. Both patient groups showed impaired working memory test performance compared to healthy controls. Patients with co-morbid depression and anxiety disorder performed significantly below the depression group. Only patients with depression and co-morbid anxiety displayed deficient long-term memory function compared to healthy controls. The present results show impairments in various memory functions in patients presenting depression and depression with co-morbid anxiety disorder.

[Parasuicide in Sør-Trøndelag 1989-1992--clinical and psychological characteristics]. / Parasuicid i Sør-Trøndelag 1989-92--kliniske og psykologiske karakteristika.

The present study is based on interviews with 953 patients (572 females and 381 males) from the county of Sør-Trøndelag who came in contact with the health services after a parasuicide during the period 1 October 1988 to 31 December 1992. Almost half of the patients had a history of earlier parasuicide, and almost half reported that the intention of the last parasuicide was to kill themselves. The parasuicides were regarded as serious by the medical staff in 26% of the cases. There was a significant association between suicidal intention and seriousness. The patients often reported alcohol, drug, family and psychiatric problems, and had often been in contact with health services during the month preceding the parasuicide. 3% of the females and 23% of the males had been sentenced to jail. 24% had experienced a parasuicide and 17% a suicide among family members or friends. 33% of the females and 18% of the males reported having been physically abused, and 14% of the females and 6% of the males reported sexual abuse. The results are discussed in light of previous Norwegian studies.

Information processing in primary fibromyalgia, major depression and healthy controls.

OBJECTIVE: To assess the information processing capabilities in 25 patients with primary fibromyalgia (FM) by comparing them with 22 patients with major depression and 18 healthy controls. METHODS: A broad range of tasks related to various subcomponents of information processing were included. RESULTS: Our results indicated that patients with primary FM in general share with depressives a nonspecific deficit in information processing capacity. However, our data showed that cognitive dysfunction reflecting a presumed compromise of the right hemisphere is present in major depression, but not in primary FM. CONCLUSION: This finding would suggest that primary FM and depression are probably different conditions.

The effects of common and specific factors in short-term anxiety-provoking psychotherapy: a pilot process-outcome study.

This study attempted to identify the necessary and sufficient change factors in short-term anxiety-provoking psychotherapy (STAPP). Twenty patients were randomly assigned to either STAPP or a form of nondirective therapy almost devoid of psychodynamic elements but with common factors of psychotherapy intact. Both treatments were 20 sessions long, were manualized, and therapists in both conditions were experienced clinicians receiving manual-guided supervision. Most patients had a diagnosis of anxiety. Results showed that patients in both treatments improved greatly symptomatically and that no further gains were made after termination. Treatments were equally effective. The therapeutic alliance was a strong predictor of symptom improvement. The findings underscore the importance of common factors pertaining to the therapeutic relationship, and they may open to question, to some degree, the therapeutic effectiveness of psychodynamic technique factors in STAPP. The way in which specific and common factors can be brought together under the umbrella of the concept of affect attunement is discussed.

Effects of aerobic exercise versus stress management treatment in fibromyalgia. A 4.5 year prospective study.

To determine and compare short- and long-term effects of aerobic exercise (AE), stress management treatment (SMT), and treatment-as-usual (TAU) in fibromyalgia, 60 patients were randomized to 14 weeks of treatment by either AE, SMT or TAU. Outcome measures at baseline, midway through treatment, at treatment completion, and at 4 year follow up included a patient made drawing of pain distribution, dolorimetry of tender points, ergometer cycle test, global subjective improvement, and VAS registrations of: pain, disturbed sleep, lack of energy, and depression. Both AE and SMT showed positive short-term effects. AE was the overall most effective treatment, despite being subject to the most sceptical patient attitude prior to the study. At follow up, there were no obvious group differences in symptom severity, which for AE seemed to be due to a considerable compliance problem.

Recollections of parent-child relationships in OCD out-patients compared to depressed out-patients and healthy controls.

The present study examined the relationship between parental bonding in 26 psychiatric out-patients with obsessive-compulsive disorder (OCD) compared to 34 out-patients with major depressive disorder (MDD) and 41 healthy controls. The results indicated significantly lower levels of parental care and higher levels of maternal overprotection for the patients with a current principal diagnosis of depression, compared to healthy controls. In multiple regression analyses, the presence of depressive disorder was related to all Parental Bonding Inventory (PBI) subscales. When the presence of current depressive disorder was controlled for statistically, the diagnosis of OCD was not associated with abnormal patterns of parental bonding on the PBI.

HLA antigens in primary fibromyalgia syndrome.

HLA antigens, both class I (A,B,C) and II (DR), were determined in 60 patients with primary fibromyalgia syndrome and compared to 159 healthy controls. No significant association between primary fibromyalgia syndrome and alleles of the HLA system was detected.

Neuropsychological function in nonpsychotic unipolar major depression.

OBJECTIVE: To examine neuropsychological deficits in unmedicated patients with a nonpsychotic unipolar major depressive disorder. BACKGROUND: Although cognitive deficits in depression have been reported in several studies, most previous studies have concentrated on a few areas of cognition in more or less heterogenous groups of depressives. METHOD: Twenty-two nonhospitalized patients with a DSM-III-R defined nonpsychotic unipolar major depressive disorder were compared with 30 healthy controls. Neuropsychological tests were organized in the following functions: motor function, selective attention, mental flexibility, visuomotor tracking, working memory, short-term memory, verbal long-term memory, nonverbal long-term memory, verbal fluency, and visuospatial function. RESULTS: There emerged an overall group difference in neuropsychological test performance, with patients scoring significantly lower than controls. Bonferroni corrected univariate analyses of variance showed that patients performed significantly below controls in the following areas: selective attention, working memory, verbal long-term memory, and verbal fluency. Two functions were areas of differential deficits in the depressed group: selective attention and working memory. Impaired verbal long-term memory seemed to reflect an underlying working memory deficit. CONCLUSIONS: Nonhospitalized patients with a nonpsychotic unipolar major depressive disorder exhibited an overall neuropsychological deficit and they performed disproportionately worse in the two domains of selective attention and working memory. The neurobiological implications of the present results are in accordance with the hypothesis that there is a global-diffuse impairment of brain function with particular involvement of the frontal lobes in nonpsychotic unipolar major depressive disorder.

[Parasuicide in Sør-Trøndelag 1989-92. Rates and sociodemographic characteristics]. / Parasuicid i Sør-Trøndelag 1989-92. Rater og sosiodemografiske karakteristika.

A total of 1,740 events of parasuicide (1,329 persons; female/male ratio 1.4) were registered in the county of Sør-Trøndelag from 1 October 1988 to 31 December 1992. The information was collected by means of monitoring forms completed in hospitals, by general practitioners, and at local health centres. Person-based rates were highest amongst 25-44 year-olds (both sexes). While male rates remained relatively stable, female rates seemed to decline, owing to reduced rates amongst 25-34 year-olds and 45-54 year-olds. For both sexes rates were highest in the urban area of Trondheim. For males and females alike, the lowest rates were found in coastal municipalities. Self-poisoning was involved in 84% of the male and in 92% of the female cases. Rates for divorced and separated males and females (per 100,000) were lower than demonstrated earlier in the catchment area. The largest proportion of female parasuicides were either employed or in receipt of a disability pension; the two largest male groups were unemployed and employed. Low education was characteristic for both sexes. Almost half of each sex reported earlier attempt(s), and the annual rate of repetition varied between 10-21% for females and 11-18% for males.