Feasibility of guided cognitive behaviour therapy (CBT) self-help for childhood anxiety disorders in primary care

Anxiety disorders in childhood are common, disabling and run a chronic course. Cognitive behaviour therapy (CBT) is effective but expensive and trained therapists are scarce. Guided self-help treatments may be a means of widening access to treatment. This study aimed to examine the feasibility of guided CBT self-help in primary care for childhood anxiety disorders, specifically in terms of therapist adherence, patient and therapist satisfaction and clinical gain.Participants were children aged between five and 12 years referred to two primary child and adolescent mental health services (PCAMHSs) in Oxfordshire, UK, who met diagnostic criteria for a primary anxiety disorder. Of the 52 eligible children, 41 anxious children were assessed for anxiety severity and interference before and after receiving CBT self-help delivered via a parent (total therapy time = five hours) by primary mental health workers (PMHWs). Therapy sessions were rated for treatment adherence and parents and PMHWs completed satisfaction questionnaires after treatment completion. Over 80% of therapy sessions were rated at a high level of treatment adherence. Parents and PMHWs reported high satisfaction with the treatment. Sixty-one percent of the children assessed no longer met the criteria for their primary anxiety disorder diagnosis following treatment, and 76% were rated as 'much'/'very much' improved on the Clinical Global Impression-Improvement (CGI-I) scale. There were significant reductions on parent and child report measures of anxiety symptoms, interference and depression. Preliminary exploration indicated that parental anxiety was associated with child treatment outcome. The findings suggest that guided CBT self-help represents a promising treatment for childhood anxiety in primary care.     

水稻尾孢霉毒素

水稻尾孢霉(Cercospora oryzae)是水稻条叶枯病的致病菌。24个菌株用抑制稻种胚根生长生物测定法进行产毒筛选。大部分菌株培养滤液对胚根生长有抑制作用。6个菌株:I-16,I-26,I-28,I-38,I-42和I-49选为进一步试验的菌株。添加10％稻叶汁马铃薯蔗糖培养液适于菌株的生长和产毒。生长适宜的温度和pH范围分别是25°-30℃和pH 6—7,光线和通气可促进菌株生长,但温度、光线和通气对培养滤液的毒性无影响,pH6—7的培养滤液毒性最强。接种后3周的培养滤液表现强毒性。多数菌株生长高峰出现在第4周。对水稻尾孢霉毒素进行了初步鉴定。结果表明菌株都能产生红色色素和黄色物质,红色色素经薄层色谱,可见光谱分析和颜色反应证明与尾孢霉毒素相同。培养滤液和尾孢霉毒素提取物能抑制稻种和4种作物种子胚根生长,并能在损伤稻叶上引起褪绿和枯死。这一作用与稻秧的品种抗性和秧龄无关。     

Synthesis, structure and DFT calculation of a hexanuclear mixed-valence copper cluster supported by 2,3-disulfidobenzoate and 3-carboxybenzene-1,2-bis(thiolate)

A homoleptic hexanuclear Cu cluster, [(Cu(DSB)(CBT))₂(Cu₂Br)₂][PPh₄]₂ (1-PPh₄) [DSB = 2,3-disulfidobenzoate; CBT = 3-carboxybenzene-1,2-bis(thiolate)] was synthesized as dark green crystals by the reaction of CuCl₂ with 2,3-dimercaptobenzoic acid in acetate buffer solution. The X-ray crystal study of 1-PPh₄ revealed its unique structural features: (1) one of two types of crystallographically distinct Cu centers adopted a square planer geometry and the other center had a tetrahedral geometry, and (2) intermolecular H-bonding interactions connected between carboxylic acid group of CBT and the carboxylate group of DSB led to the construction of an unprecedented topologic architecture of a zigzag patterned infinite sheet. In addition, taking into account the total charge of the molecule, which contained 2,3-disulfidobenzoate and 3-carboxybenzene-1,2-bis(thiolate), and the diamagnetic nature of 1-PPh₄, 1-PPh₄ led to it is assignment as a mixed-valence Cu(I)/Cu(III) cluster. Such mixed valence states of Cu atoms were also examined by density functional theory calculation.     

Startle Responses in Motor Vehicle Accident Survivors: A Pilot Study

The aim of the present study was to investigate startle responses in motor vehicle accident (MVA) survivors to trauma-related, startle, and neutral sounds. Participants were 17 MVA survivors, 11 of whom participated in a controlled treatment study comparing cognitive-behavioral treatment (CBT) and supportive therapy (ST) versus a waitlist condition. Though participants differed significantly in their pretreatment clinical status and symptom severity, these differences were not reflected by group differences in EMG (at orbicularis oculi) to the stimuli at the initial assessment. Some cue-specificity was found, as all participants showed larger startle responses to trauma-related sounds, compared to startle and neutral sounds. At posttreatment, a significant reduction in EMG reactivity to all stimuli was observed in participants who received active treatment (either CBT or ST), compared to waitlist controls. The use of startle responses as a PTSD treatment outcome index is discussed.     

Comparative, clinical feasibility study of three tools for delivery of cognitive behavioural therapy for mild to moderate depression and anxiety provided on a self-help basis

Background In response to a research recommendation made by a UK healthcare policy agency (National Institute for Health and Clinical Excellence (NICE)), this study compared the effectiveness of computer‐based cognitive behavioural therapy (CBT) with other self‐help treatment options for mild to moderate depression and anxiety.Method Comparative, clinical feasibility study of three self‐help CBT tools with six‐month follow‐up. Out of an initial sample of 180 adults referred by their general practitioners, 100 met the inclusion criteria and after consenting to take part were allocated one of three self‐help CBT tools: the Beating the Blues® (BtB) computer programme;¹ workbooks on overcoming depression and anxiety; and the Livinglifetothefull free access internet website.²Results Only 50 of the 100 consented participants completed the allocated intervention protocols, however, drop‐out rates were not significantly different between the groups of participants allocated each of the three self‐help CBT tools. Adults aged over 24 years (χ² = 14.5; df = 2; P = 0.001) and with symptom duration greater than four years (χ² = 3.96; df = 1; P = 0.047) were significantly more likely to complete any of the three interventions. There was a highly significant reduction in mean Clinical Outcomes in Routine Evaluation–Outcome Measure (CORE–OM) score at week eight compared to entry in all three groups (t (49) = 9.150; P ≤0.001). Adjusting for entry scores, there was no significant difference between the three groups in CORE–OM score improvement at week eight. There was no significant association between CORE–OM score improvement at week eight and number of general practitioner (GP) consultations at six months. There was no significant association between whether participants completed the programme and number of GP consultations at six months.Conclusions The results demonstrated that within a two‐month follow‐up period, three different tools delivering self‐help CBT all produced significant clinical benefit for adults with mild to moderate depression and anxiety. The study had limited statistical power, but none of the modalities for delivering supported self‐help CBT appeared superior to another. There was no evidence to suggest that any of these interventions would be likely to reduce subsequent service uptake. Nevertheless, this pilot study has shown sufficient benefit from each of the self‐administered CBT tools to justify larger trials of their use.     

Evaluation of a primary care adult mental health service: Year 2

Aims This study aimed to examine the effectiveness of a primary care adult mental health service operating within a stepped care model of service delivery.Methods Supervised by a principal psychologist manager, psychology graduate practitioners provided one-to-one brief cognitive behavioural therapy (CBT) to service users. The Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) was used to assess service user treatment outcomes. Satisfaction questionnaires were administered to service users and referring general practitioners (GPs).Results A total of 43 individuals attended for an initial appointment, of whom 19 (44.2%) completed brief CBT treatment. Of the 13 service users who were in the clinical range pre-treatment, 11 (84.6%) achieved clinical and reliably significant improvement. Of the six service users who were in the non-clinical range pre-treatment, three (50%) achieved reliably significant improvement. Both service users and GPs indicated high levels of satisfaction with the service, although service accessibility was highlighted as needing improvement.Conclusion The service was effective in treating mild to moderate mental health problems in primary care. Stricter adherence to a stepped care model through the provision of low-intensity, high-throughput interventions would be desirable for future service provision.     

First report of computational protein–ligand docking to evaluate susceptibility to HIV integrase inhibitors in HIV-infected Iranian patients

BackgroundIran has recently included integrase (INT) inhibitors (INTIs) in the first‐line treatment regimen in human immunodeficiency virus (HIV)-infected patients. However, there is no bioinformatics data to elaborate the impact of resistance-associated mutations (RAMs) and naturally occurring polymorphisms (NOPs) on INTIs treatment outcome in Iranian patients.MethodIn this cross-sectional survey, 850 HIV-1-infected patients enrolled; of them, 78 samples had successful sequencing results for INT gene. Several analyses were performed including docking screening, genotypic resistance, secondary/tertiary structures, post-translational modification (PTM), immune epitopes, etc.ResultThe average docking energy (E value) of different samples with elvitegravir (EVG) and raltegravir (RAL) was more than other INTIs. Phylogenetic tree analysis and Stanford HIV Subtyping program revealed HIV-1 CRF35-AD was the predominant subtype (94.9%) in our cases; in any event, online subtyping tools confirmed A1 as the most frequent subtype. For the first time, CRF-01B and BF were identified as new subtypes in Iran. Decreased CD4 count was associated with several factors: poor or unstable adherence, naïve treatment, and drug user status.ConclusionAs the first bioinformatic report on HIV-integrase from Iran, this study indicates that EVG and RAL are the optimal INTIs in first-line antiretroviral therapy (ART) in Iranian patients. Some conserved motifs and specific amino acids in INT-protein binding sites have characterized that mutation(s) in them may disrupt INT-drugs interaction and cause a significant loss in susceptibility to INTIs. Good adherence, treatment of naïve patients, and monitoring injection drug users are fundamental factors to control HIV infection in Iran effectively.