SAFETY AND EFFICACY OF LSD-ASSISTED PSYCHOTHERAPY FOR ANXIETY ASSOCIATED WITH LIFE-THREATENING DISEASES. Peter Gasser, MD, Dominique Holstein, PhD, Yvonne Michel, PhD,Rick Doblin, PhD, Berra Yazar-Klosinski, PhD, Torsten Passie, MD, MA, Rudolf Brenneisen, PhD.
A double-blind, randomized, active placebo-controlled pilot study was conducted to examine safety and efficacy of LSD-assisted psychotherapy in 12 patients with anxiety associated with life-threatening diseases. Treatment included drug-free psychotherapy sessions supplemented by 2 LSD-assisted psychotherapy sessions 2-3 weeks apart. Participants received either 200µg LSD (n=8) or 20µg LSD with an open-label crossover to 200µg LSD after the initial blinded treatment was unmasked (n=4). At 2-month follow-up, positive trends were found via STAI in reductions in trait anxiety (p=0.033) with an effect size of 1.1 and state anxiety was significantly reduced (p=0.021) with an effect size of 1.2, with no acute or chronic adverse effects persisting beyond 1 day after treatment, nor treatment-related serious adverse events. STAI reductions were sustained for 12 months.
IS LIVING WITH PSYCHOSIS DEMORALIZING? INSIGHT, SELF-STIGMA AND CLINICAL OUTCOME AMONG PEOPLE WITH SCHIZOPHRENIA ACROSS ONE YEAR. Marialuisa Cavelti, PhD, Nicolas Rüsch, Professor MD, Roland Vauth, Professor MD.
This study aimed to examine the link between insight, self-stigma and demoralization as predictors of symptoms and functioning. Insight, self-stigma, depressive and psychotic symptoms, and functioning were assessed among 133 outpatients with schizophrenia at baseline and twelve months later. The data were analyzed by hierarchical multiple linear regressions. More insight at baseline and an increase in self-stigma over twelve months predicted more demoralization at follow-up. Insight at baseline was not associated with any outcome variable, but self-stigma at baseline was related to poorer functioning and more positive symptoms at follow-up. More demoralization at baseline predicted poorer functioning twelve months later. Demoralization did not mediate the relationship between self-stigma at baseline and functioning after one year.
PSYCHIATRISTS’ VIEWS OF THE GENETIC BASES OF MENTAL DISORDERS AND BEHAVIORAL TRAITS AND THEIR UTILIZATION OF GENETIC TESTS. Robert Klitzman, MD, Kristopher J. Abbate, BA, Wendy Chung, MD, PhD, Karen Marder, MD, Ruth Ottman, PhD,Katherine Johansen Taber, Cheng-Shiun Leu, PhD, Paul S. Appelbaum, MD.
We examined how 372 psychiatrists view genetic aspects of mental disorders and behaviors, and use genetic tests (GTs). Most thought the genetic contribution was moderate/high for several disorders (e.g. bipolar, schizophrenia, depression, Alzheimer’s, intelligence, creativity, anxiety, suicidality). In the past 6 months, 14.1% ordered GTs, 18.3% discussed prenatal testing with patients, 36.0% initiated discussions about other GTs, 41.6% had patients ask about GTs, and 5.3% excluded GT results from patient records. Many thought that GTs were available for schizophrenia (24.3%) and major depression (19.6%). Women were more likely to report that patients asked about GTs; and were less certain about the degree of genetic contribution to several disorders. Psychiatrists perceive strong genetic bases for numerous disorders and traits, and many have discussed and ordered tests for GTs, but have relatively little knowledge about available tests.
COMPLICATED GRIEF AND DEPRESSION IN YOUNG ADULTS: PERSONALITY AND RELATIONSHIP QUALITY. Holly B. Herberman Mash, Ph.D., Carol S. Fullerton, Ph.D., M. Katherine Shear, M.D., Robert J. Ursano, M.D.
Young adults experience problematic responses to loss more often than is commonly recognized. Few empirical studies have examined the contribution of intra- and interpersonal characteristics to grief and depression in bereaved young adults. This study investigated the association of dependency and quality of the relationship with the deceased (i.e., depth and conflict) with complicated grief (CG) and depression. Participants were 157 young adults aged 17-29 who experienced loss of a family member or close friend within the past three years (M = 1.74 years). Participants completed the Inventory of Complicated Grief, Beck Depression Inventory, Depth and Conflict subscales of the Quality of Relationships Inventory, and the Dependency subscale of the Depressive Experiences Questionnaire. Relationships among dependency and interpersonal depth and conflict and CG and depression were examined through analyses of covariance. Sixteen percent of participants met criteria for CG and 34% had mild to severe depression. Dependency and depth were independently related to CG and dependency was related to depression, but the pattern of associations was somewhat different for each outcome. Greater depth was associated with CG, at both high and low levels of dependency. High levels of dependency were related to more depressive symptoms. Although dependency is associated with both CG and depression following loss, relationships between the bereaved and deceased that are characterized by high levels of depth are particularly related to the development of CG symptoms. Interpretation of the findings is limited by the relatively small sample size and cross-sectional design.
SIMILARITIES AND DIFFERENCES IN BORDERLINE PERSONALITY DISORDER AND SCHIZOPHRENIA WITH VOICE HEARING. Stefan Tschoeke, MD, Tilman Steinert, MD, Erich Flammer, M.Sc., Carmen Uhlmann, PhD.
The aim of the study was to identify psychopathological similarities and differences in borderline personality disorder (BPD) and schizophrenia. We compared auditory verbal hallucinations (AVH), dissociation, childhood trauma and additional psychotic symptoms in 23 female patients with BPD and 21 female patients with schizophrenia . The character of AVH was similar with regard to commenting voices, location and foreign voices. Major differences were found in the prevalence of negative symptoms, bizarre delusions and formal thought disorder. These characteristics were more frequent in schizophrenia and negatively correlated with childhood traumatization. A history of childhood traumatization as well as dissociative symptoms was significantly more frequent in BPD. AVH in BPD and schizophrenia are not distinguishable in terms of the historically grown criteria in DSM-IV-TR for diagnosing schizophrenia. Other symptoms such as delusions, negative symptoms, formal thought disorder and dissociative psychopathology could help to differentiate between both groups.
PATIENTS’ PERSPECTIVES ON RESIDUAL SYMPTOMS IN BIPOLAR DISORDER: A FOCUS GROUP STUDY. Ludovic Samalina, Frank Bellivier, MD, PhD, Bruno Giordana, MD, Liova Yon, MD, Vanessa Milhiet, MD, Wissam El-Hage, MD, PhD, Philippe Courtet, MD, PhD, Evguenia Hacques, Nabil Bedira, Anne Dillenschneider, MD, Pierre Michel Llorca, MD, PhD.
Euthymic bipolar patients are often impacted by residual symptoms (RS) that increase the risk of relapse or low functioning. We aimed to identify the perceptions of RS, barriers to management, and service needs in euthymic bipolar patients recruited in France. A qualitative methodology (Focus Group) was used. The interviews were investigated using a semi-structured guide, tape-recorded, transcribed verbatim and analysed thematically. Twenty-three bipolar patients expressed concern about several RS symptoms such as emotional dysregulation, circadian rhythm disruption, cognitive impairment, low self-esteem, and physical symptoms. They reported concern about the impact of RS on their functioning and about the need for more systematic assessment of RS during inter-episode visits.
DEPRESSION STIGMA AND TREATMENT PREFERENCES AMONG ORTHODOX AND NON-ORTHODOX JEWS. David E. Baruch, MA, Jonathan W. Kanter, PhD, Steven Pirutinsky, , Joseph Murphy, and David H. Rosmain, PhD.
Anecdotal reports of increased stigma toward mental illness among Orthodox Jews seems to conflict with an existing literature describing less stigmatization toward depression among Jewish individuals. This online survey study investigated stigma toward depression and treatment preference among Orthodox and non-Orthodox Jews (N = 391). All participants were presented with a depression vignette to assess for stigma and then randomized to a vignette depicting a treatment modality (behaviorally-oriented or insight-oriented) to assess for treatment preference across several delivery options (individual, group, or internet). Results indicated elevated depression stigma among Orthodox Jews as expressed by elevated levels of secrecy, treatment seeking stigma, family/marriage stigma, and stigmatizing experiences, but not attitudinal social distancing. No group differences were found with respect to overall treatment preference, treatment modality, or manner of delivery. Overall, participants preferred individual therapy more than group and internet therapy and preferred group therapy more than internet therapy.
PERCEPTUAL PROPERTIES OF OBSESSIVE THOUGHTS ARE ASSOCIATED WITH LOW INSIGHT IN OBSESSIVE-COMPULSIVE DISORDER. Steffen Moritz, Ph.D., Marike Claussen, B.Sc., Marit Hauschildt, Ph.D. and Michael Kellner, M.D.
Preliminary evidence suggests that in a subgroup of patients with obsessive-compulsive disorder (OCD) obsessions are experienced as partially perceptual. The present study explored the prevalence of perceptually-laden obsessions and their relationship with illness insight and depression. Twenty-six patients with OCD were administered the newly developed Sensory Properties of Obsessions Questionnaire (SPOQ). Participants were asked to endorse on a 5-point Likert scale if their obsessions were associated with perceptual features. A total of 73% affirmed that their obsessions contained perceptual features. The predominant perceptual channels were visual, tactile and somatic (i.e., bodily sensations). The extent of perceptual aspects associated with obsessions was strongly correlated with lack of insight (Y-BOCS item 11) but not depression severity. The present study suggests that obsessive thoughts are frequently accompanied with perceptual sensations, which concurs with models assuming a continuum between hallucinations and intrusions. Apparently, the more “real” or authentic the obsessive thought, the less the afflicted person is able to dismiss its content as fully irrational or absurd.
Letter to the Editor. STATISTICAL ERRORS AND OMISSIONS IN A TRIAL OF COGNITIVE BEHAVIOR TECHNIQUES FOR PSYCHOSIS: COMMENTARY ON TURKINGTON ET AL. Tim Smits, PhD, Daniël Lakens, PhD, Stuart J. Ritchie, PhD, Keith R. Laws, PhD.
The article entitled “High-Yield Cognitive Behavioral Techniques for Psychosis Delivered by Case Managers to Their Clients With Persistent Psychotic Symptoms” (Turkington, Munetz, Pelton, Montesano, Sivec, Nausheen, & Kingdon, 2014; J Nerv Ment Dis 202: 30-34, 2014) addresses an important topic, fitting within a broad view on healthcare as an approach that extends to all professionals involved. Unfortunately, the paper has a number of shortcomings in methodology, statistics, and reporting that should be addressed. These problems obstruct the authors’ longer-term goal to use “this trial [...] to calculate the power required for a larger randomized controlled trial” (p.33). At present, the manuscript cannot be used as a basis for power calculations in future RCTs: Power analyses for between-subjects designs require Cohen’s dz to be reported, not Cohen’s d, and such analyses are not possible based on the reported results.
Letter to the Editor. THE REPORTING OF CONFIDENCE INTERVALS IN EXPLORATORY CLINICAL TRIALS AND PROFESSIONAL INSECURITY. Douglas Turkington, MD
The database for our exploratory trial was examined independently in line with an a priori statistical analysis plan. I can confirm that the findings have been accurately reported in our published article (Turkington et al, 2014). In Table 2 the confidence intervals are calculated around Cohen's d as indicated. The original version of our manuscript contained a table of means and standard deviations for all variables at all time points. This was viewed as being unnecessary at the time of peer review in light of the comprehensive reporting of confidence intervals and p values in the article and the table was omitted but will be provided to all interested parties from the corresponding author. We believe that we have reported with clarity that the external validity is modest and that further research is needed with a larger sample size. The labelling of the axes on Figure 5 is self evident. We believe that our exploratory article which demonstrates an encouraging new development in case manager training and practice is a useful addition to the recovery literature.