Exploring the clinical outcome of Mindfulness-Based Cognitive Therapy for bipolar and unipolar depressive patients in routine clinical practice: a pilot study

Background

Mindfulness Based Cognitive Therapy (MBCT) has been adopted as an evidence-based treatment for unipolar depressive disorder (UDD). Although MBCT has not been included in the treatment guidelines for bipolar disorder (BD), MBCT is regularly being offered to patients with BD in routine clinical practice. In this pilot study we used routine outcome monitoring (ROM) data to explore whether there are indications that patients with BD might benefit less from MBCT than patients with UDD in terms of feasibility and effectiveness.

Methods

The study population consisted of patients with BD (n = 30) or UDD (n = 501) who received MBCT at the Radboudumc Centre for Mindfulness in Nijmegen, the Netherlands. Patients completed self-report measures of depressive symptom severity, worry, well-being, mindfulness skills and self-compassion pre- and post MBCT as part of the ROM.

Results

There were significant less patients with BD who decided to start MBCT after intake than patients with UDD. No differences in dropout between groups were found. Results showed significant moderate to large improvements in both groups after MBCT, while no differences between groups were found, on all outcome measures.

Conclusions

This study demonstrates that there are no indications that MBCT, when delivered in heterogeneous patient groups in routine clinical practice, is less beneficial for patients with BD than patients with UDD in terms of feasibility and effectiveness. This lends support to conduct an adequately powered RCT to examine the (cost-)effectiveness of MBCT in BD as the next step before implementing MBCT on a larger scale in patients with BD.

Study protocol of a multicenter randomized controlled trial of mindfulness-based cognitive therapy and treatment as usual in bipolar disorder

BACKGROUND

Despite multiple pharmacological interventions, many people with bipolar disorder (BD) experience substantial residual mood symptoms, even in the absence of severe mood episodes, which have a negative impact on the course of illness and quality of life. Limited data are available on how to optimize treatment for BD, especially for those who suffer from persistent and residual depressive symptoms. Preliminary evidence suggests Mindfulness-Based Cognitive Therapy (MBCT) as a psychological treatment option for BD. This study aims to investigate whether adding MBCT to treatment as usual (TAU) will result in symptomatic and functional improvements in adults with BD compared to TAU alone.

METHODS/DESIGN

This study is a prospective, evaluator blinded, multicenter, randomized controlled trial of MBCT + TAU and TAU alone in 160 adults with bipolar type I and type II. Assessments will be conducted at baseline (T0), mid-treatment (Tmid), and at 3 (T1), 6 (T2), 9 (T3), 12 (T4), and 15 (T5) months follow-up. Primary outcome is post-treatment severity of depressive symptoms (Inventory of Depressive Symptomatology- Clinician administered). Secondary outcomes are severity of (hypo) manic symptoms, anxiety, relapse rates, overall functioning, positive mental health, and cost-effectiveness. As possible mediators will be assessed rumination of negative affect, dampening and rumination of positive affect, mindfulness skills, and self-compassion.

DISCUSSION

This study will provide valuable insight into the (cost-)effectiveness of MBCT on clinician- and self-rated symptoms of BD, relapse rates, positive mental health, and overall functioning.

TRIAL REGISTRATION

NCT03507647 . Registered 25th of April 2018.

Ruminative and dampening responses to positive affect in bipolar disorder and major depressive disorder

BACKGROUND

Although previous research has focused on distinguishing cognitive styles between Bipolar Disorder (BD) and Major Depressive Disorder (MDD), little is known about differences in positive affect regulation between these affective groups. The aim of the present study was to extend previous research by investigating such differences between BD and MDD, and between the bipolar subtypes (BD-I vs. BD-II and predominant polarities), using large, clinical, outpatient samples.

METHODS

In total, 298 participants (96 BD-I, 27 BD-II, and 175 MDD) were included. All completed the Responses to Positive Affect (RPA) questionnaire. Mood symptoms in BD patients were clinically assessed by means of the Clinical Global Impression for Bipolar Disorders (CGI-BP), while depressive symptom severity in MDD patients were assessed by means of the Inventory of Depressive Symptomatology (IDS-SR).

RESULTS

Results showed differences between affective groups and bipolar subtypes. The most salient finding was that both BD-I and BD-II patients were more likely to ruminate about positive affect than MDD patients, while MDD patients were more likely to engage in dampening responses to positive affect.

CONCLUSIONS

Differentiation of responses to positive affect between BD and MDD may have relevant clinical implications in terms of symptomatology, course, and treatment.

Low prevalence of Bartonella henselae infections in Norwegian domestic and feral cats

Bartonella henselae is the causative agent of cat scratch disease (CSD). This clinical entity is very rarely encountered in human medical practice in Norway. B. henselae infections including bacteraemia in cats have been frequently reported. The objective of the present study was to investigate the seroprevalence rate and the degree of B. henselae bacteraemia in Norwegian domestic and feral cats. One hundred cats investigated at a small animal veterinary practice in the middle of Norway were included in the study. Blood collected in Isolator blood-lysis tubes and lysates of erythrocytes after freezing and thawing were cultured. PCR analysis of whole blood was also performed. Serology was performed by indirect fluorescence assay (IFA) and enzyme immunoassay (EIA) using immobilised B. henselae Houston-1 strain as antigen. None of the 100 cats investigated was found to be bacteraemic. All 100 cats were seronegative when analysed by IFA; one cat was positive by EIA. The discrepancy between IFA and EIA of this particular cat is probably due to cross-reactive antibodies. Contrary to findings reported from several geographic regions, B. henselae infections in Norwegian cats appear to be virtually absent. This in turn may explain why CSD has not been reported in human medical practice in Norway.

Immune-mediated fever in the dog. Occurrence of antinuclear antibodies, rheumatoid factor, tumor necrosis factor and interleukin-6 in serum

Contents of antinuclear antibodies (ANA), rheumatoid factor (RF), tumor necrosis factor (TNF-alpha) and interleukin-6 (IL-6) were measured in serum from 20 dogs with immune-mediated fever. Seven out of 20 patients were ANA positive, 1 out of 20 was positive to antibodies against extractable nuclear antigens (ENA), 1 out of 20 was positive to antibodies against deoxynucleoproteins (DNP), 2 out of 13 were RF positive and none out of 20 patients had antibodies against native DNA in the serum. TNF-alpha was not detected in any serum of 15 dogs with immune-mediated fever, while 10 out of 13 presented with elevated IL-6. The results varied between patients, but the IL-6 level was high in most of them. This indicate a role for IL-6 in the pathogenesis of immune-mediated fever in most cases.

Antinuclear antibodies (ANA) in Gordon setters with symmetrical lupoid onychodystrophy and black hair follicular dysplasia

Antinuclear antibodies (ANA) were demonstrated in 3 out of 10 Gordon setters with symmetrical lupoid onychodystrophy and in 5 out of 13 Gordon setters with black hair follicular dysplasia. Two dogs showed both symmetrical lupoid onychodystrophy and black hair follicular dysplasia, and one of these was ANA positive. The results suggest that symmetrical lupoid onychodystrophy and black hair follicular dysplasia in the Gordon setter might be autoimmune diseases that are pathogenetically related, which might indicate a common genetic predisposition.

Field study on the insecticidal efficacy of Advantage against natural infestations of dogs with lice

A clinical field trial was performed to evaluate the efficacy of imidacloprid, the active ingredient of Advantage 10% Spot-On, against natural lice infestations on dogs. Imidacloprid was highly effective against both sucking (Linognathus setosus) and biting (Trichodectes canis) lice over the 6-week period of the trial. The duration of efficacy exceeded the egg-to-imago development period of both lice. Signs of remission of dermatitis and alopecia became visible to the pet owners at 2 weeks after treatment. The constant pruritus caused by the lice was seen for up to 2-4 weeks after treatment even in the absence of lice.

Hypochondroplastic dwarfism in the Irish setter

Two test matings in the irish setter were performed, and genetic, clinical, morphometric, radiographic, bone histological and plasma and urine biochemical features of dwarfism were studied. All offspring were phenotypically normal at birth and weaning, but at the age of 2.5 to 4 months the longitudinal growth of the spine and leg bones was retarded in the dwarfs compared with the normal littermates. Most dwarfs performed well, even in the field. Radiographic and histological evaluations revealed a hypochondroplasia. A morphometric diagnostic method for Irish setter dwarfism was developed. A single autosomal recessive mode of inheritance was verified.

Hip dysplasia in dogs in relation to their month of birth

German wirehaired pointers, English, Irish and Gordon setters, and labrador retrievers that were puppies during the spring and summer had a significantly lower incidence of hip dysplasia than those growing up during the autumn and winter. However, golden retrievers and German shepherd dogs did not show the same seasonal pattern of incidence of hip dysplasia.

Plasma amino acids in dogs with osteochondrosis or hip dysplasia

Radiography of the hip joints of mature dogs has shown that hip dysplasia is quite common in many middle and large size breeds in Norway. The heritability of hip dysplasia has been estimated in several studies to be between 0.2 and 0.6 (Hedhammar et al 1979). This indicates that environmental factors are important for development and severity of hip dysplasia.

Effects of different diets on viability, and gut morphology and bacteriology in captive willow ptarmigan chicks (Lagopus L. lagopus)

Young willow ptarmigan chicks were fed an artificial chick diet (ACD), and different supplements. One group got ascorbic acid supplements, another neomycin and Oxytetracyclin in the water, and a third was given ascorbic acid and sprouts of Vaccinium myrtillus. Chicks that were fed ACD only, showed low weight gain and high mortality rate. The numbers of bacteria in the gut were high and the incidence of villous epithelium erosion and bacteria colonizing the gut epithelium were high.

Admixture of ascorbic acid to the diet improved the viability of the chicks and reduced the number of coliforms in the gut.

Antibiotics in the water reduced the number of C. perfringens, enterococci and coliforms in the gut, and improved the gut epithelium conditions.

Combined supplements of ascorbic acid and Vaccinium myrtillus resulted in strongly viable chicks with healthy gut epithelium. C. perfringens was not demonstrated in the gut, and the numbers of enterococci and coliforms were low.

Physiological responses and effects on meat quality in reindeer (Rangifer tarandus) transported on lorries

Reindeer transported on lorries to the slaughterhouse showed strongly elevated plasma noradrenaline, adrenaline and Cortisol values. Plasma creatine kinase and aspartate aminotransferase activity measurements gave no evidence of muscle damage, but by cooking ammonia-like and another taint were observed in the meat from about 25 % of the transported reindeer. A control group consisting of reindeer slaughtered from the gathering corral also showed a high prevalence of these meat taints. Plasma and meat urea values were elevated in the transported reindeer, but there was no correlation between the meat urea values and the intensities of ammonia-like taint. The character of the other observed taint was not defined.

Parental nutrition and chick production in captive willow ptarmigan (Lagopus l. lagopus)

The breeding performance of captive willow ptarmigan on different diets has been studied. The nutritional factors tested were protein concentration, natural feed supplement and grass meal and flavonoid admixture, and effects on egg numbers, fertility, hatchability, chick weights at hatching and 0–14 days mortality have been recorded.

The breeding performance of ptarmigan hen in captivity showed great individual variations. Egg numbers were not statistically different in groups fed the different diets. Hens fed a 15 % crude protein died tended to produce smaller chicks with significantly lower viability than chicks from hens fed a 20 % crude protein diet. Supplement of natural feed tended to increase the number of chicks hatched through a combination of tendency to higher egg numbers and improved fertility. These tendencies were, however, statistically nonsignificant. Inclusion of 34 % grass meal to the diet also tended (non-significantly) to improve fertility and hatchability, while inclusion of flavonoids had no positive effect on reproduction.

Eggs from captive hens showed significantly lower fertility, and a tendency to lower hatchability than eggs from wild hens. The former difference was probably caused by the close cage confinements for the captive ptarmigan, while the latter condition probably was due to different start of incubation, most of the eggs from wild hens being started naturally.

Chick nutrition and mortality in captive willow ptarmigan (Lagopus l. lagopus)

Willow ptarmigan chicks were reared during 8 years on concentrates supplemented with blueberry plants. Mortality during the first 3 weeks after hatching ranged between 33 and 65 %, and was mainly caused by enteritis and digestive tract obstructions. The annual variations in chick survival seemed to be caused by the variations in plant phenology. The survival was highest when spring and blueberry plant development was late, and lowest when spring was early and warm, leading to early lignification of blueberry plant leaves.

Nephritis and uric acid diathesis in captive willow ptarmigan (Lagopus l. lagopus). Effect of feed protein concentration and grass meal admixture

Mortality due to nephritis and uric acid diathesis was observed during the fall and winter in captive willow ptarmigan. The present study examined how feed protein concentration influences feed and water consumption, plasma uric acid concentration, and mortality due to nephritis and uric acid diathesis in captive w^rillow ptarmigan. An increase in feed protein concentration from 14 to 24 % resulted in reduced feed consumption and increased plasma uric acid concentration. Mortality due to nephritis and uric acid diathesis was not influenced by variations in feed protein concentration, but an admixture of 14 % grass meal to the diet reduced the incidence markedly.

Vitamin C deficiency in growing willow ptarmigan (Lagopus lagopus lagopus)

Willow ptarmigan chicks raised on a diet containing 265 mg ascorbic acid/kg develop scury-like symptoms and die by 4 weeks of age. If blueberry plants are given as an ad libitum supplement to this diet, the malady is prevented. We have described the clinical, pathological and histological changes which accompany this malnutrition and conclude that they are in accord with the description of scurvy in guinea pig and man. Biochemical determination of ascorbic acid synthesis in the kidney of ptarmigan chicks indicated a rate of synthesis five times that found in livers of growing white rats. Blueberry plants and many other plants found in the natural diet of ptarmigan chicks contain 2,000 to 5,000 mg ascorbic acid/kg dry weight. Feeding experiments showed that the pathological signs were avoided and that already afflicted chicks recovered if the vitamin C content of the diet was raised to 750 mg/kg dry weight of food. Since the food intake of the chicks was 5 to 8 g/day the daily requirement of external vitamin C is about 150 mg/kg body weight. To our knowledge this is the first example of an animal which, while producing vitamin C itself, requires substantial amounts of external vitamin C to survive.

A comparison of the microbiological conditions in the small intestine and caeca of wild and captive willow grouse (Lagopus lagopus lagopus)

The study compares the microbiological conditions in the small intestine and caeca of captive and wild willow grouse. The small intestine of wild willow grouse scarcely contained bacteria, while the caeca, without exception, contained high numbers of microorganisms including spirochetes, small gram-negative anaerobe rods, flagellates and amoebae. In 50 % of the birds a low number of E. coli was found in the caeca. The types, numbers and distribution of intestinal microorganisms of captive willow grouse were very similar to that of the domestic fowl and thus quite unlike that of the wild grouse.

These results help to explain why captive grouse digest natural food less efficiently than wild birds. Hence captive grouse should not be used in experiments which aim to clarify digestive capacity and functions in the wild grouse.

Micromorphological studies on the small intestine and caeca in wild and captive willow grouse (Lagopus lagopus lagopus)

The present study describes the micromorphology of the small intestine and caeca of wild and captive willow grouse. The micromorphology of the small intestine was similar in wild and captive birds, while typical differences were apparent in the caeca, Wild grouse had ciliated epithelium without goblet cells in the neck part of the caeca, captive birds had strongly atrophied cilia and a high number of goblet cells. The epithelium of the body part of caeca of wild birds lodged a great number of spiral-shaped microorganisms and amoebae, which were absent in captive birds. Both the caecal villi and the longitudinal folds were much larger in wild than captive grouse. In the captive grouse the caecal lamina propria was heavily infiltrated with mono-nucleated cells and very often also with polymorphonucleated heterophilic leucocytes.

Since only first generation captives were used in this study, the differences in gut morphology of captive and wild grouse must be due to different food and environmental conditions and not to genetic selection.