This study, to the authors' knowledge, is the first randomized controlled trial comparing the efficacy of cognitive behavior therapy (CBT), paroxetine, and a placebo (administered in a double blind ...fashion) in the treatment of hypochondriasis.
The authors randomly assigned 112 subjects with hypochondriasis according to DSM-IV criteria to 16 weeks of outpatient treatment with CBT, paroxetine, or a placebo. The main outcome measure was the Whiteley Index. The authors made pretest and posttest assessments and analyzed all outcome measures using a General Linear Model 3x2 repeated measures analysis of variance with Helmert contrasts. The authors considered subjects who scored at least one standard deviation below the mean pretest score on the Whiteley Index as responders. All analyses were conducted on intent-to-treat and completer bases.
On the Whiteley Index, Helmert contrasts on the intent-to-treat and completer cohorts revealed that pooled CBT and paroxetine were significantly superior to placebo, but did not differ significantly from each other. The responder analysis on the intent-to-treat cohort and completer cohort, respectively, revealed the following percentages of responders per group: CBT group, 45% and 54%; paroxetine group, 30% and 38%; and placebo group, 14% and 12%. In the intent-to-treat analysis, only CBT differed significantly from the placebo. In the completer analysis, both paroxetine and CBT differed significantly from the placebo.
CBT or paroxetine are effective short-term treatment options for subjects with hypochondriasis.
There is no consensus concerning the optimal casting technique for displaced distal radius fractures (DRFs) following closed reduction. This study evaluates whether a splint or a circumferential cast ...is most optimal to prevent fracture redisplacement in adult patients with a reduced DRF. Additionally, the cost-effectiveness of both cast types will be calculated.
This multicenter cluster randomized controlled trial will compare initial immobilization with a circumferential below-elbow cast versus a below-elbow plaster splint in reduced DRFs. Randomization will take place on hospital-level (cluster, n = 10) with a cross-over point halfway the inclusion of the needed number of patients per hospital. Inclusion criteria comprise adult patients (≥ 18 years) with a primary displaced DRF which is treated conservatively after closed reduction. Multiple trauma patients (Injury Severity Score ≥ 16), concomitant ulnar fractures (except styloid process fractures) and patients with concomitant injury on the ipsilateral arm or inability to complete study forms will be excluded. Primary study outcome is fracture redisplacement of the initial reduced DRF. Secondary outcomes are patient-reported outcomes assessed with the Disability Arm Shoulder Hand score (DASH) and Patient-Rated Wrist Evaluation score (PRWE), comfort of the cast, quality of life assessed with the EQ-5D-5L questionnaire, analgesics use, cost-effectiveness and (serious) adverse events occurence. In total, 560 patients will be included and followed for 1 year. The estimated time required for inclusion will be 18 months.
The CAST study will provide evidence whether the type of cast immobilization is of influence on fracture redisplacement in distal radius fractures. Extensive follow-up during one year concerning radiographic, functional and patient reported outcomes will give a broad view on DRF recovery.
Registered in the Dutch Trial Registry on January 14th 2020. Registration number: NL8311 .
We aimed to investigate whether personality characteristics predict time to remission and psychiatric status. The follow-up was at most 6 years and was performed within the scope of a randomized ...controlled trial that investigated the efficacy of cognitive behavioral therapy, paroxetine, and placebo in hypochondriasis. The Life Chart Interview was administered to investigate for each year if remission had occurred. Personality was assessed at pretest by the Abbreviated Dutch Temperament and Character Inventory. Cox's regression models for recurrent events were compared with logistic regression models. Sixteen (36.4%) of 44 patients achieved remission during the follow-up period. Cox's regression yielded approximately the same results as the logistic regression. Being less harm avoidant and more cooperative were associated with a shorter time to remission and a remitted state after the follow-up period. Personality variables seem to be relevant for describing patients with a more chronic course of hypochondriacal complaints.
Open reduction and internal fixation (ORIF) of Bennett fractures is increasingly preferred over closed reduction and percutaneous fixation (CRIF) in an attempt to prevent the development of ...post-traumatic arthrosis. The aim of this systematic review was to determine whether the preference for ORIF is justified based on the available literature regarding functional outcome and complications after surgery.
A systematic review was performed in Medline, Embase, Cochrane CENTRAL, Web of science, and Google scholar. Duplicates were removed and title and abstract were screened after which full text articles were analysed. The reference lists of selected articles were screened for additional relevant studies. Study characteristics were recorded and methodological qualities were assessed after which data was extracted from the included articles. The Eaton-Littler score for post-traumatic arthrosis (primary outcome) on follow-up X-rays was used as primary outcome. Secondary outcomes were Grip strength, Pinch strength, persistent pain, fixation failure, functional impairment, infection and surgery time.
Ten studies were included; three retrospective comparative studies and seven retrospective case series. Of the 215 patients in these studies, 138 had been treated using an open technique and 77 by a closed percutaneous technique. The pooled rate of post-traumatic arthrosis was 57.5% (26.6–85.5) in the ORIF group versus 26.1% (3.9–59.0) in the CRIF group. Mean surgical operation time was 71.9 min for ORIF and 30.2 min for percutaneous patients. Fixation failure was significantly more often seen in the ORIF patients, 8.2% (0.7–22.8) vs. 2.9% (0.8–9.1), Risk Ratio 1.132 (0.01–176.745); p = 0.048. Infection was only seen in 5 CRIF patients. Persistent pain was seen in 32.9% (0.6–83.1) in ORIF patients versus 22.3% (8.1–41.1) in the CRIF patients. The pooled means Grip strength was 48.3 kg (95% CI; 39.7–56.9) versus 43.4 kg (95% CI; 22.9–63.8) for ORIF and CRPF, respectively. Functional impairment was similar between the two groups, 1.4% (0.1–4.4) vs 1.8% (0.1–5.7) respectively.
The analysed data do not confirm ORIF to prevent post-traumatic arthrosis, secondly more fixation failure and pain was seen in the ORIF group. The pooled data show percutaneous fixation to be preferable over ORIF in the surgical treatment of Bennett fractures.
Abstract Background The present maintenance study investigated whether the reduction in hypochondriacal complaints after initial treatment with CBT or paroxetine sustained during a follow-up period ...and whether psychiatric severity at pretest predicted the course of hypochondriacal symptoms. Method A naturalistic follow-up period of 18 months after a 16-week RCT consisting of 33 patients initially allocated to a CBT condition and 29 patients to a paroxetine condition. The main outcome measure was the Whiteley Index. Results The initial treatment effect of CBT and paroxetine sustained during the follow-up period. No significant differences between CBT and paroxetine were found. Treatment course could not be predicted by psychiatric comorbidity. Conclusion CBT and paroxetine are both effective treatments for hypochondriasis in the long term.
To investigate similarities and differences between the symptom profiles of patients with hypochondriasis and those of patients with obsessive-compulsive disorder (OCD) and to compare the ...contamination/cleaning OCD subtype to other OCD subtypes.
Between January 1998 and July 2002, 76 patients diagnosed with hypochondriasis (N = 31) or OCD (N = 45) (DSM-IV criteria) and 25 subjects with no formal DSM-IV diagnosis were compared with regard to the extent of diagnosis-specific symptoms, the number and nature of physical symptoms, and whether these symptoms evoked fear. The analyses were repeated after subdividing the OCD patients into the contamination/cleaning and other OCD subgroups.
Patients with hypochondriasis and OCD differed significantly from each other on the extent of diagnosis-specific symptoms (all p < .001). Patients with hypochondriasis reported significantly more obsessive-compulsive symptoms and patients with OCD reported significantly more hypochondriacal symptoms than did the healthy control-group members (all p < .05). Neither group differed significantly from the other on the number and nature of feared physical symptoms. The contamination/cleaning OCD subtype did not differ significantly from other OCD subtypes in either the severity of hypochondriacal symptoms or the number of feared physical symptoms.
Hypochondriasis and OCD can be distinguished on the basis of diagnosis-specific symptoms, although they share a number of similarities. In addition, although patients with the contamination/cleaning OCD subtype tend to be afraid of contracting diseases, the differences between the symptom profiles of these patients and those of patients with hypochondriasis exceed the similarities. Our results confirm that the 2 conditions are separable and valid diagnoses.
Four decay modes of the B-c(+) meson into a J/psi meson and multiple charged kaons or pions are studied using proton-proton collision data, collected with the LHCb detector at centre-of-mass energies ...of 7, 8, and 13TeV and corresponding to an integrated luminosity of 9 fb(-1). The decay B-c(+) -> J/psi K+ K- pi(+)pi(+)pi(-) is observed for the first time, and evidence for the B-c(+) -> J/psi 4 pi(+)3 pi(-) decay is found. The decay B-c(+) -> J/psi 3 pi(+)2 pi(-) is observed and the previous observation of the B-c(+) -> psi(2S)pi(+)pi(+)pi(-) decay is confirmed using the psi(2S) -> J/psi pi(+)pi(-) decay mode. Ratios of the branching fractions of these four B-c(+) decay channels are measured.
The Λb0→Λc+K+K−π− decay is observed for the first time using a data sample of proton-proton collisions at centre-of-mass energies of s=7 and 8TeV collected by the LHCb detector, corresponding to an ...integrated luminosity of 3fb−1. The ratio of branching fractions between the Λb0→Λc+K+K−π− and the Λb0→Λc+Ds− decays is measured to beB(Λb0→Λc+K+K−π−)B(Λb0→Λc+Ds−)=(9.26±0.29±0.46±0.26)×10−2, where the first uncertainty is statistical, the second systematic and the third is due to the knowledge of the Ds−→K+K−π− branching fraction. No structure on the invariant mass distribution of the Λc+K+ system is found, consistent with no open-charm pentaquark signature.
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