Psychotherapy has been shown to be an effective treatment option for depressive disorders; however, its effectiveness varies depending on patient and therapist characteristics and the individual form ...of the depressive disorder.
The aim of this article is to present the current evidence for psychotherapeutic antidepressive treatments for patients with chronic and treatment-resistant depression as well as for patients with mental and somatic comorbidities.
During the revision of the currently valid German S3- and National Disease Management Guideline (NDMG) on unipolar depression published in 2015, a comprehensive and systematic evidence search including psychotherapy for specific patient groups was conducted. The results of this search along with a systematic update are summarized.
Psychotherapy has been shown to be effective in reducing depressive symptoms in patients suffering from chronic and treatment-resistant depression and in patients with mental and somatic comorbidities. The evidence is insufficient particularly for patients with mental comorbidities.
Based on the current evidence and clinical expertise the NDMG recommends psychotherapy alone or in combination with pharmacotherapy to treat most of these depressive patient groups. Evidence gaps were identified, which highlight the need for further research.
Depressive disorders are associated with a high burden of suffering and significantly reduce the well-being and the self-esteem of affected patients. Psychotherapy is one of the main treatment ...options for depressive disorders.
The aim of this article is to present the current evidence for antidepressive psychotherapeutic treatments.
During the revision of the German S3- and National Disease Management Guideline (NDMG) on unipolar depression in 2015, a comprehensive and systematic evidence search was conducted. The results of this search along with a systematic update are summarized.
The most intensively investigated psychotherapeutic method is cognitive behavioral therapy (CBT), which proved to be effective in many trials. Evidence also exists for psychodynamic psychotherapy and interpersonal therapy (IPT), followed by systemic therapy and client-centered psychotherapy; however, the evidence is less robust.
Psychotherapy alone or in combination with pharmacotherapy was shown to be an effective treatment option. Psychotherapy represents a key element in the treatment of depressive disorders.
The shear forces between polystyrene chains end-tethered to opposing surfaces have been measured with the surface forces apparatus (SFA) in both good and near-ϑ solvents. When the shearing velocity ...was varied, the complex polymer/solvent system responded in a Newtonian-like fashion with the shear force increasing linearly with the shear velocity. The effective viscosity of the end-tethered systems in this Newtonian-like regime was found to be an order of magnitude greater than the viscosity of semidilute solutions of equivalent molecular weight free chains. At larger shear velocities or higher extents of compression, Brownian dynamics simulations suggest the interfacial width will thin, leading to a sublinear increase in the shear force with sliding velocity. Experimental limitations prevented exploration of the higher shear velocities simulated with the Brownian dynamics approach, but increasing confinement eventually did lead to sublinear behavior, in agreement with the simulation prediction.
There are 2 recognized stocks of false killer whales Pseudorca crassidens in the US Exclusive Economic Zone surrounding Hawai'i, a small demographically isolated population around the main Hawaiian ...Islands and a larger offshore ('pelagic') population. Recent evidence suggests the insular population may have declined precipitously over the last 20 yr, and one possible contributing factor is interactions with offshore longline fisheries or other hook and line fisheries. To assess movements and habitat use, satellite tags were remotely deployed on individuals in 3 groups from the insular population and one from the offshore population. Although tagged off the leeward side of the island of Hawai'i, individuals from the insular population regularly moved to the windward sides of the islands. Some insular individuals moved extensively and rapidly among islands, while other individuals remained associated with the island of Hawai'i for extended periods before moving among the other islands. Comparisons of distances between tagged individuals indicated that individuals within groups disassociated and re-associated over periods of days, occasionally moving more than 100 km apart before re-associating. The offshore individual, tagged 123.8 km offshore, approached to within 62 km of land, inshore of the longline fishery exclusion boundary. The 3 insular groups moved a maximum of 83, 87 and 96 km offshore, respectively, indicating that the distance from shore cannot be used as a strict boundary between the populations, and that individuals from the insular population may overlap with the longline fishery. When combined with photo-identification the results suggest that boundaries between these 2 stocks should be revised.
Knowledge of Cuvier’s beaked whale
Ziphius cavirostris
behavior has expanded through the utilization of animal-borne tags. However, many tag types do not record sound—thus preventing echolocation ...click detections to identify foraging—or have short deployments that sample a limited range of behaviors. As the quantity of such non-acoustic tag data grows, so too does the need for robust methods of detecting foraging from non-acoustic data. We used 692 dives from 5 sound-recording tags on Cuvier’s beaked whales in southern California, USA, to develop extreme gradient boosting tree models to detect foraging based on 1 Hz depth and 16 Hz triaxial acceleration data. We performed repeated 10-fold cross validation using classification accuracy to tune 500 models with randomly partitioned training and testing datasets. An average of 99.9 and 99.2% of training and testing dataset dives, respectively, were correctly classified across the 500 models. Dives without associated sound recordings (n = 2069 from 7 whales including 4 non-acoustic tags) were classified via a model that maximized training information using dive depth and duration, ascent and descent rates, bottom-phase average vertical speed, and roll circular variance during dive descents and bottom phases. Of all long, deep dives (conventionally assumed to include foraging), 2.4% were classified as non-foraging dives, while 0.3% of short, shallow dives were classified as foraging dives. Results confirm that conventional depth and/or duration classifiers provide reasonable estimates of longer-term foraging patterns. However, additional variables previously listed enhance foraging detections for unusual dives (notably non-foraging deep dives) for southern California Cuvier’s beaked whales.
Objective: To investigate the feasibility of switching overweight schizophrenic patients to aripiprazole and to assess the impact of 12 months of aripiprazole treatment on weight in routine ...practice.
Method: This was a non‐controlled cohort study in overweight schizophrenic patients. Data were collected before treatment with aripiprazole was started and at 12‐month follow‐up.
Results: A total of 53 patients were included; of these 55% continued using aripiprazole for 12 months. Aripiprazole treatment for 12 months (P = 0.027) and stopping clozapine or olanzapine treatment (P = 0.038) predicted weight loss (≥3 kg). Patients receiving aripiprazole monotherapy (n = 16, mean −3.0 kg) had similar weight loss than patients receiving aripiprazole in addition to another antipsychotic drug (n = 13, mean −4.4 kg).
Conclusion: In routine practice once aripiprazole treatment was started, more than half of the patients remained on aripiprazole and most of them lost weight. Adding aripiprazole to clozapine gave similar weight loss as monotherapy with aripiprazole.
“Southern Resident” killer whales (Orcinus orca) that comprise three fish-eating “pods” (J, K and L) were listed as “endangered” in the US and Canada following a 20% population decline between 1996 ...and 2001. Blubber biopsy samples from Southern Resident juveniles had statistically higher concentrations of certain persistent organic pollutants than were found for adults. Most Southern Resident killer whales, including the four juveniles, exceeded the health-effects threshold for total PCBs in marine mammal blubber. Maternal transfer of contaminants to the juveniles during rapid development of their biological systems may put these young whales at greater risk than adults for adverse health effects (e.g., immune and endocrine system dysfunction). Pollutant ratios and field observations established that two of the pods (K- and L-pod) travel to California to forage. Nitrogen stable isotope values, supported by field observations, indicated possible changes in the diet of L-pod over the last decade.
False killer whales (Pseudorca crassidens) are large delphinids typically found in deep water far offshore. However, in the Hawaiian Archipelago, there are 2 resident island-associated populations of ...false killer whales, one in the waters around the main Hawaiian Islands (MHI) and one in the waters around the Northwestern Hawaiian Islands (NWHI). We use mitochondrial DNA (mtDNA) control region sequences and genotypes from 16 nuclear DNA (nucDNA) microsatellite loci from 206 individuals to examine levels of differentiation among the 2 island-associated populations and offshore animals from the central and eastern North Pacific. Both mtDNA and nucDNA exhibit highly significant differentiation between populations, confirming limited gene flow in both sexes. The mtDNA haplotypes exhibit a strong pattern of phylogeographic concordance, with island-associated populations sharing 3 closely related haplotypes not found elsewhere in the Pacific. However, nucDNA data suggest that NWHI animals are at least as differentiated from MHI animals as they are from offshore animals. The patterns of differentiation revealed by the 2 marker types suggest that the island-associated false killer whale populations likely share a common colonization history, but have limited contemporary gene flow.
“Southern Resident” killer whales include three “pods” (J, K and L) that reside primarily in Puget Sound/Georgia Basin during the spring, summer and fall. This population was listed as “endangered” ...in the US and Canada following a 20% decline between 1996 and 2001. The current study, using blubber/epidermis biopsy samples, contributes contemporary information about potential factors (i.e., levels of pollutants or changes in diet) that could adversely affect Southern Residents. Carbon and nitrogen stable isotopes indicated J- and L-pod consumed prey from similar trophic levels in 2004/2006 and also showed no evidence for a large shift in the trophic level of prey consumed by L-pod between 1996 and 2004/2006. ∑PCBs decreased for Southern Residents biopsied in 2004/2006 compared to 1993–1995. Surprisingly, however, a three-year-old male whale (J39) had the highest concentrations of ∑PBDEs, ∑HCHs and HCB. POP ratio differences between J- and L-pod suggested that they occupy different ranges in winter.
To analyze prescribing patterns of chronic psychiatric patients living in sheltered housing facilities, to identify the extent of polypharmacy and to estimate associated risks in this patient group.
...In a retrospective cross-sectional study the prescription data of 323 chronic psychiatric patients (average age 48.5 years) living in sheltered housing facilities in Rotterdam, The Netherlands, were analyzed. Prescription data were obtained from pharmacy-dispensing records.
Patients received on average 4.6 drugs (95% CI, 4.3-4.9). The most frequently prescribed drugs were as expected antipsychotics, benzodiazepines and antimuscarinic drugs. Overall 25% (n=81) of patients received two or more antipsychotic drugs. A high proportion of patients (38%, n=124) received one benzodiazepine, and 15% (n=50) received two or more benzodiazepines.
Patients in our study received a worryingly high number of drugs, and a quarter of the population was subject to antipsychotic polypharmacy. This increases the risk that drug-drug interactions, adverse drug reactions and noncompliance occur. Our study indicates potentially low quality of prescribing and shows the need for reviewing and special monitoring of pharmacotherapy in this patient group.
PDF
