1,721,058 research outputs found
Regarding "Systematic Review: Pharmacological and Behavioral Treatment for Trichotillomania"
No full textRefers to Michael H. Bloch et al. 'Systematic Review: Pharmacological and Behavioral Treatment for Trichotillomania' Biological Psychiatry, Volume 62, Issue 8, 15 October 2007, Pages 839-846<br/
Treatment of obsessive-compulsive disorder
No full textBackground: Many randomized controlled trials of the pharmacotherapy and psychotherapy of obsessive-compulsive disorder (OCD) have been undertaken. Several meta-analyses of these trials, and a number of expert consensus guidelines, have been published. This article summarizes these works, and suggests future research directions. Methods: Meta-analyses of OCD were assessed with the QUORUM statement and the Oxman and Guyatt rating scale, and consensus guidelines on the treatment of OCD were assessed with the Appraisal of Guidelines Research and Evaluation (AGREE) instrument. Current principles in the treatment of OCD, and gaps in our knowledge, were reviewed. Results: Selective serotonin reuptake inhibitors (SSRIs) and cognitive-behavioral therapy are currently viewed as the first-line treatments of choice for adult and pediatric OCD. There is also good evidence for the efficacy of atypical antipsychotics in the augmentation of patients refractory to SSRIs. Important questions remain for the field. Conclusions: There have been significant advances in both the pharmacotherapy and psychotherapy of OCD. Nevertheless, there is a paucity of longer-term trials, data on symptom remission and functional improvement, and data on treatment effectiveness in wider clinical practice. It is hoped that improved understanding of the mechanisms underlying OCD will lead to future advances
Treatment of obsessive-compulsive disorder
No full textBackground: Many randomized controlled trials of the pharmacotherapy and psychotherapy of obsessive-compulsive disorder (OCD) have been undertaken. Several meta-analyses of these trials, and a number of expert consensus guidelines, have been published. This article summarizes these works, and suggests future research directions. Methods: Meta-analyses of OCD were assessed with the QUORUM statement and the Oxman and Guyatt rating scale, and consensus guidelines on the treatment of OCD were assessed with the Appraisal of Guidelines Research and Evaluation (AGREE) instrument. Current principles in the treatment of OCD, and gaps in our knowledge, were reviewed. Results: Selective serotonin reuptake inhibitors (SSRIs) and cognitive-behavioral therapy are currently viewed as the first-line treatments of choice for adult and pediatric OCD. There is also good evidence for the efficacy of atypical antipsychotics in the augmentation of patients refractory to SSRIs. Important questions remain for the field. Conclusions: There have been significant advances in both the pharmacotherapy and psychotherapy of OCD. Nevertheless, there is a paucity of longer-term trials, data on symptom remission and functional improvement, and data on treatment effectiveness in wider clinical practice. It is hoped that improved understanding of the mechanisms underlying OCD will lead to future advances
Intrinsic functional brain connectivity in South African methamphetamine users undergoing inpatient treatment, with or without additional cognitive training
Get PDFBackground: Methamphetamine (MA) abuse is a global crisis that exacerbates sociopolitico-economic burdens in South Africa. MA use is associated with a myriad of neural abnormalities of structure and function, with associated neurocognitive deficits, particularly executive function (EF). Working memory (WM) training has been identified as a potential adjunct to treatment of substance use disorder (SUD) to improve EF in the hope of reducing relapse rates. Neuroimaging suggests MA alters intrinsic resting state functional connectivity (rsFC), and this may contribute to neuropsychological deficits observed in methamphetamine use disorder (MUD). Methods: This nested study analysed data described in Brooks et al. (2016), in which WM training was used as an adjunct to inpatient treatment of MUD. Healthy controls (HC, N = 25) were compared to two MUD groups, one receiving treatment as usual (TAU, N = 17), and one receiving additional cognitive training (CT, N = 24) in the form of a modified version of the ‘N-back' task (C-Ya). This task was also used to assess WMA in the neural scanner, using conditions of 0-back and 1-back across groups. The current research explored these data in a novel manner through examining rsFC. Hypotheses: It was predicted that: 1) HC and MUD participants would differ on measures of WMA, but WMA would improve in MA groups at follow-up compared to baseline and this would be augmented in the CT group; 2) rsFC networks of neural regions supporting WM would be predictive of ability to perform well and improve on WM tasks; and 3) MA groups would display heightened rsFC activity within and between resting state neural networks of the default mode network (DMN) and canonical cognitive control networks (CCNs). Results: Significant differences were observed between HC and MA groups in race and level of education, but not on WMA as tested in the scanner. The CT group, who completed WMA 3-back conditions, demonstrated significant improvement on this task post- intervention. Exploratory regression models showed the WM rsFC network did not demonstrate significant relationships with any clinical, demographic, or WM variables when controlling for multiple comparisons. Heightened connectivity within and between the DMN and CCNs was observed in the MUD compared to the HC group, which provided support for hypothesis 3. Exploratory multivariate regression models demonstrated race, age, education, duration of drug use, and an interaction of group and abstinence may impact rsFC in these networks. Post-hoc analyses identified pairwise network combinations affected by these variables. Conclusions: Despite limitations of this small study, it offers tentative preliminary insights into the largely unexplored field of rsFC in MA populations. This study supports limited research demonstrating hyperconnectivity within and between CCNs and DMN of MA users. This study also offers support for recent research suggesting that easier conditions of the Nback task may not reliably test all aspects of WM function. Exploratory analyses of covariates potentially affecting rsFC provide a platform for directions of future research
Cognitive therapy, working memory training, and the treatment of Methamphetamine Use Disorder - a functional MRI study
Get PDFBackground: In recent years, methamphetamine use disorder (MUD), which is associated with adverse outcomes and represents a significant public health burden, has become highly prevalent in Cape Town, South Africa. Protracted methamphetamine (MA) use has been linked with neural dysfunction and working memory deficits. Although current treatments have shown limited efficacy in addressing MUD, recent evidence indicates the potential of utilizing tailored brief cognitive therapy programs and working memory training to improve outcomes. The current study aims to investigate the potential impact of brief cognitive therapy and using working memory training as an adjunct in the treatment of MUD. Methods: Participants were recruited from an in-patient drug rehabilitation centre in Cape Town. The sample (n = 26) consists of male patients (between the ages of 18–50) diagnosed with MUD. MUD patients were randomly split into 2 groups that received 4 weeks of treatment, i.e. treatment as usual (cognitive therapy only (NT) (n= 12)) and cognitive therapy with working memory training (CT) (n = 14). Neuroimaging and psychological data were collected from participants pre- and post- intervention to assess the relative impact of said interventions. Results: Behavioural outcome measures and the n-back working memory task adapted for fMRI were measured and compared pre- and post- intervention. No significant differences were present between groups prior treatment on behavioural measures, demographic measures, and fMRI activity. The brief cognitive therapy appeared to reduce depression and impulsivity scores over the course of the intervention, with scores slightly lower in the CT group. An FDR corrected whole-brain repeated measures ANOVA on the main effect of group indicated significant activation in the left posterior cingulate, left anterior cingulate, and left lingual gyrus. Post hoc t-tests were then conducted to follow up the group main effect and significant differences under FDR correction were observed in the NT group (in contrast to the CT group) indicating significantly more activity in the left superior temporal gyrus, left insula, right posterior declive, and right lingual gyrus. Significant differences were also observed under FDR correction on a posthoc test on the CT group (in contrast to the NT group) indicating significantly less activity in the left lingual gyrus, left posterior declive, and right cuneus. 5 Conclusions: The findings tentatively suggest that the working memory training adjunct may have slightly enhanced working memory maintenance brain function relative to the treatment as usual group post-intervention. The evidence also suggests that there may have been inefficient neural functioning in the treatment as usual group during the working memory task compared to the group receiving the working memory training adjunct. The results demonstrated that brief cognitive therapy treatment did somewhat reduce depressive symptoms and impulsivity in this study, with indications of subtle treatment gains in the cognitive training group. Overall, the current study (despite numerous limitations) provides preliminary and tentative evidence of the possible benefits of brief term cognitive therapy and the potential promise of using working memory training as a treatment adjunct
Neuroimaging and neurocognitive assessment of PTSD and MDD in a South African community setting
Get PDFBackground: There is growing evidence of abnormalities in neurocognition, neuroanatomy, and functional connectivity in posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). However, there has been less work on individuals who suffer with comorbid PTSD and MDD. It is important to investigate the neurobiology of this overlap because of its prevalence, its associated morbidity, and the hope that it may shed more light on the mechanisms involved in each disorder, including the role of the prefrontal regions. This dissertation tests the hypothesis that women with PTSD and MDD display distinct patterns of neurocognitive impairment and associated brain dysfunction, relative to healthy controls, and these effects will be amplified in patients with both disorders. Methods: This dissertation was undertaken within the Drakenstein Child Health Study, a study exploring child health determinants in mother-infant dyads from the Drakenstein district, Western Cape. Mothers (between 18 and 50 years) were recruited and divided into 4 groups: PTSD, MDD, PTSD with MDD, and healthy controls. Participants were assessed using the computerised NIH Toolbox, and paper and pencil neurocognitive tests. Domains assessed included memory, learning, and processing speed, and with particular focus on executive function and attention domains. Participants underwent resting-state functional imaging as well as structural brain imaging. Functional connectivity within and between cognitive control networks (salience network, dorsal attention network, and frontoparietal networks) and a default mode network were compared across the 4 groups. Neuroanatomical indices (cortical thickness, volume, and surface area) of 10 frontal cortical regions from the Desikan-Killiany atlas in Freesurfer 6 were analysed across the 4 groups. Results: All three clinical groups demonstrated no group differences on measures of attention and executive function, diagnoses of PTSD and MDD were associated with more intrusive thoughts and delayed recall impairment, respectively. However, neurocognitive findings indicate that PTSD with comorbid MDD is not associated with greater neurocognitive dysfunction relative to mono-diagnostic groups. Abnormal resting-state connectivity was observed for the MDD group in the default mode network, and for both comorbid and MDD patient groups within frontoparietal networks. Abnormal salience network connectivity for the comorbid group was observed when examining performance on the Pattern Comparison Processing Speed test. No between-network connectivity group differences were observed. Surface area and volume reductions of prefrontal regions were evident for PTSD and MDD, however, no volumetric and surface area differences were observed for the comorbid group. Conclusion: In this sample of mothers from a low-middle income region, distinct patterns of neurocognitive dysfunction and impairment in PTSD, MDD, and PTSD with MDD were observed. However, contrary to hypotheses, comorbidity is not associated with greater dysfunction and impairment and the associations of PTSD and comorbid MDD are not amplified in this sample. These findings have implications for the development of treatment plans for patients diagnosed with PTSD, MDD, and PTSD with comorbid MDD, so that interventions are tailored in a way that is responsive to differences between these groups in the presentation of neurocognitive profile, brain function, and structure
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Frontal lobe dysfunction, as measured by the frontal systems behavioural scale, in the context of HIV infection and heavy episodic drinking
Get PDFBackground: The frontal lobe of the human brain is integral in regulating behaviour. Behavioural disturbances such as apathy, disinhibition, and dysexecutive function are well-known consequences of frontal lobe pathology, leading to significant impairment. Heavy episodic drinking (HED) and HIV are common conditions that impair the frontal lobe, with disinhibition frequently being seen in people with HED, apathy in HIV positive patients and both HIV and HED leading to executive dysfunction. There is a paucity of research on the interplay between HIV and HED and how this impacts behaviour associated with frontal lobe dysfunction. The Frontal Systems Behaviour Scale (FrSBe) is a questionnaire designed to measure problematic behaviour associated with frontal systems impairment. It has been used in a range of clinical populations. It consists of a total score and three subscale scores, namely apathy (Scale A), disinhibition (Scale D) and executive dysfunction (Scale E). This tool is easy to administer and has the potential to provide clinically useful information that could guide management of patients with these conditions. Aim: As a first step to knowing more about the complex interplay between HIV and HED and its effects on frontal lobe function, the aim of this study was to determine the relationship between HIV status, HED and frontal-systems behavioural dysfunction (impulsivity, apathy, and executive dysfunction) as measured by the FrSBe. Methods: Participants for this quantitative, cross-sectional, and analytical study were recruited from the Nolungile Clinic in Khayelitsha, Cape Town. They were grouped according to their HIV- and HED status. Relevant demographic and clinical data were obtained. Participants completed the Substance Abuse and Mental Illness Symptoms Screener (SAMISS) questionnaires and the FrSBe self-report measure that was translated into isiXhosa. Both measures were scored and the FrSBe raw scores were converted to T-scores. Results: A total of the 99 participants met the inclusion criteria, of which 25 were in the HED only group, 22 in the HIV+ only group, 26 in the dual group, and 26 were in the control group. The mean age (SD) of the sample was 37.92 (8.8) years. There was a statistical difference between groups for the total drinking score on the SAMISS (p = 65), were present on the FrSBe Total Score in 29 of the participants. On the apathy subscale score, 36 participants had clinically significant (T-score >= 65) deficits, 14 had deficits on the disinhibition subscale, and 34 had on the executive dysfunction subscale. There were no statistically significant differences in the proportion of participants with clinically significant deficits between groups for any FrSBe scores. Conclusions: This study shows that people with HED have more dysfunctional behaviour associated with frontal system impairment and are more disinhibited. HIV status does not appear to influence frontal system behaviour. These finding needs to be interpreted with caution as the study FrSBe was administered in isiXhosa, in which it has not been validated, and no normative data was available for the study population. Future studies validating the FrSBe in a South African context and deriving normative data for South African populations would be a first step into developing the FrSBe into a clinically useful tool. This could, in turn, potentially lead to improved care and treatment in these conditions by identifying specific impairments and problematic behaviours as targets for intervention
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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