Group Acceptance and Commitment Therapy for Recovery From Psychosis: Protocol for a Single-Group Waitlist Trial

BACKGROUND

Psychological interventions, along with antipsychotic medications, are recommended for adults diagnosed with a psychotic disorder. While initially designed to mitigate positive symptoms, psychological interventions targeting personal recovery were developed and aligned with the recovery framework that many mental health services have adopted. Acceptance and Commitment Therapy (ACT) for psychosis is one such intervention that shows promise when delivered in an individual format. There is preliminary evidence that ACT for psychosis in a group format improves recovery.

OBJECTIVE

This trial aims to evaluate the effectiveness of the "Recovery ACT" group program on personal recovery among adults living with a psychotic disorder.

METHODS

Our unfunded study is a multiagency, prospective, nonrandomized, waitlist control, single-group trial of the Recovery ACT group program. The program involves 7 weekly group sessions of 90 minutes duration and a 90-minute booster session held 1 month later. We intend to recruit 160 adults living with a psychotic disorder who enroll in a group that is offered as a routine clinical service at participating public mental health services in Melbourne, Victoria, Australia. The 4 assessment time points are 4-6 weeks before the start of the group program, at the start of the group program, at the end of the group program, and at the booster session. There is an optional midgroup assessment and follow-up study. The primary outcome is personal recovery. Secondary outcomes include participants' well-being and psychological flexibility processes. Qualitative data are also collected from participants and facilitators.

RESULTS

Recruitment began in September 2019 and is ongoing until 2024, subsequent to a 24-month disruption due to the COVID-19 pandemic. As of the submission of this paper, 93 participants consented to the evaluation, 65 completed T1 measures, and 40 had a complete data set for the proposed analyses.

CONCLUSIONS

This is the first trial evaluating the effectiveness of the Recovery ACT group program on personal recovery for adults living with a psychotic disorder. Findings will contribute to knowledge about psychosocial interventions for adults living with psychosis. This trial may also serve as an example of a partnership between clinicians and academics that can facilitate the translation of research into practice.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12620000223932; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000223932.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/49849.

Pre-Multidrug-Resistant Mycobacterium tuberculosis Infection Causing Fatal Enteric Disease in a Dog from a Family with History of Human Tuberculosis

This report describes a fatal case of a pet dog with major enteric signs owned by a family that has experienced cases of pulmonary tuberculosis (TB) in the household. Clinical and epidemiological aspects, imaging data, microbiological, haematological and histopathological examinations were assessed to diagnosis of disease. gyrB-RFLP, spoligotyping and MIRU-VNTR allowed molecular detection of M. tuberculosis strain from S family. The resazurin microtiter assay indicated that all isolates were resistant to isoniazid, ethambutol, ciprofloxacin, ofloxacin, streptomycin and amikacin. The public health concerns related to canine tuberculosis and risk of the dissemination by pets of M. tuberculosis pre-multidrug-resistant (PMD) to isoniazid, ethambutol and other first-line drugs used in human therapy of TB are discussed. We believe this to be the first report of PMD M. tuberculosis infection in a dog presenting mainly enteric manifestation, confirmed as S lineage by molecular methods, owned by a family in which TB has spread in the household for generations.

Cutaneous myoepithelioma: an under-recognized cutaneous neoplasm composed of myoepithelial cells

Benign and malignant neoplasms of myoepithelial cells comprise a rare but well-characterized group of tumors, among which myoepithelioma of the salivary glands is the best known. Extrasalivary examples of myoepithelioma also have been described in the breast, larynx, and retroperitoneum. Recently, myoepithelioma of the soft tissue also has been reported. According to this description, myoepithelioma and mixed tumors arising in the skin and subcutis represent points along a clinicopathologic spectrum of cutaneous and soft-tissue tumors. To the best of our knowledge, there has been only one case report of an entirely cutaneous myoepithelioma in the literature. We report herein five additional examples of purely myoepithelial tumors located exclusively in the dermis. Histopathologically, the neoplasms were well-circumscribed dermal lesions composed of fascicles of spindle cells with eosinophilic cytoplasm and ovoid-to spindle-shaped nuclei. Focally, neoplastic aggregations of more epithelioid cells representing large round cells with abundant pale cytoplasm arranged in solid clusters, cords, or strands were also seen. Ductal differentiation was not identified in either of these solid aggregations of epithelioid cells or in the fascicles of spindle-shaped cells. Nuclear pleomorphism in epithelioid and spindle-cell areas was mild, and mitotic figures were very sparse. In some cases, small, necrotic areas were seen within the solid aggregations of spindle-shaped cells. Neoplastic stroma was scant and composed of fibrillary collagen and abundant mucin. In one case, the stroma consisted of clusters of mature adipocytes intermingled with fascicles of myoepithelial cells. Areas of chondroid or osteoid metaplasia were not seen in any of the cases. Immunohistochemically, neoplastic cells expressed positivity for muscle specific actin (HHF35), alpha smooth muscle actin (IA4), S-100 protein, glial fibrillary acidic protein (GFAP), and epithelial membrane antigen (EMA), whereas stains for pan-cytokeratin (MNF116) were focal and weak. The findings in this report expand the clinical and histopathologic spectrum of cutaneous myoepithelioma, an under-recognized cutaneous neoplasm of myoepithelial cells.

Ochratoxin A in Brazilian roasted and instant coffees

Thirty-four samples of roast and ground coffee, 14 samples of instant coffee and two samples of decaffeinated instant coffee were collected in markets and supermarkets in the city of Campinas, Brazil, and analysed for ochratoxin A using immunoaffinity columns for clean-up and HPLC with fluorescence detection for quantification. The limit of detection was 0.2 ng/g ochratoxin A. Twenty-three samples of ground and roast coffee were found to be contaminated with the toxin at levels ranging between 0.3 and 6.5 ng/g. The average concentration in all 34 samples was 0.9 ng/g. All samples of instant coffee contained ochratoxin A at levels ranging from 0.5 to 5.1 ng/g, with an average figure of 2.2 ng/g. Roast and ground coffee is the type of coffee most used by Brazilians for the preparation of the beverage. Considering that an average Brazilian adult takes five cups of coffee per day, which corresponds to 30 g of roast and ground coffee, the probable daily intake of ochratoxin A by a 70 kg adult would be 0.4 ng/kg bw, which is far below the current Provisional Tolerable Daily Intake of 14 ng/kg bw for ochratoxin A as set by the Codex Alimentarius. To study the transfer of ochratoxin A into coffee brew, the beverage was prepared by two methods: (a) the drip method and (b) the Brazilian country style method. No significant difference was observed between the two methods in terms of extraction of the toxin using five contaminated samples containing between 0.8 and 6.5 ng/g ochratoxin A. The drip method extracted 86 +/- 15% and the Brazilian country style 74 +/- 20% of the ochratoxin A initially present in the roast and ground coffee.

Fumonisins B1 and B2 in Brazilian corn-based food products

Eighty-one samples of corn products were acquired from markets and supermarkets in the city of Campinas, SP, Brazil, and were analysed for fumonsins B1 and B2 (FB1 and FB2). Forty samples (49%) were positive for FB1 (0.03-4.93 (micrograms/g) and 44 samples (54%) for FB2 (0.02-1.38 (micrograms/g). The samples, in order of decreasing contamination, were, corn meal (all contaminated, 0.56-4.93 (micrograms/g FB1), followed by degerminated corn (8/11 samples, nd-4.52 (micrograms/g FB1), corn flour (9/11 samples, nd-1.46 (micrograms/g FB1), precooked corn flour (4/6 samples, nd-1.79 (micrograms/g FB1), corn grits (2/2 samples, 0.17-1.23 (micrograms/g FB1), and popcorn (4/9 samples, nd-1.72 (micrograms/g FB1). Relatively lower incidences and levels of contamination were found in corn flakes (1/4 samples, nd-0.66 (microgram/g FB1) and corn flour baby cereal (1/2 samples, nd and 0.44 (microgram/g FB1). The samples of corn on the cob (common corn in the milky stage, 7 samples) and of the typical foods 'curau' (2 samples) and 'pamonha' (7 samples), both prepared with corn in the milky stage, did not show any detectable contamination. Canned sweet corn, also harvested in the milky stage, exhibited a very low incidence of and level of contamination (2/11 samples, nd-0.08 (microgram/g FB1). The intake of corn products is low in urban areas and in most rural areas in Brazil. In certain rural areas, however, corn products play a greater role in daily meals and the calculated intake of FB1 is higher than a proposed Tolerable Daily Intake of 800 ng/kg bw/day. This is the first report on fumonisins in Brazilian corn-based food products.

Mycotoxins and fungi in wheat harvested during 1990 in test plots in the state of São Paulo, Brazil

Wheat from two cultivars with contrasting characteristics were harvested in ten experimental plots located in wheat producing areas of the State of São Paulo, Brazil. The samples (10 of each cultivar) were analyzed by a gas-chromatographic method for deoxynivalenol (DON), nivalenol (NIV), diacetoxyscirpenol (DAS), toxins T-2 (T-2) and HT-2, T-2 tetraol, T-2 triol, and by a thin-layer chromatographic method for zearalenone (ZEN), aflatoxins B1, B2, G1, G2, ochratoxin A and sterigmatocystin. No mycotoxins were detected in 13 samples. DON was found in four samples (0.47-0.59 microgram/g), NIV in three samples (0.16-0.40 microgram/g), T-2 in two samples (0.40, 0.80 microgram/g), DAS in one sample (0.60 microgram/g), and ZEN in three samples (0.04-0.21 microgram/g). The wheat samples were also examined for the incidence of fungi. Alternaria, Drechslera, Epicoccum and Cladosporium were the prevailing genera. Among the Fusarium spp., F. semitectum was present in 19 samples and F. moniliforme in 18 samples. No F. graminearum was isolated in the samples.

Mycotoxins and fungi in wheat stored in elevators in the state of Rio Grande do Sul, Brazil

Samples of wheat harvested from 1988 to 1990 and stored in elevators in the south of Brazil (12 Brazilian, 4 Argentinian and 2 Uruguayan) were analysed in 1990 for 14 mycotoxins: deoxynivalenol (DON), nivalenol, diacetoxyscirpenol (DAS), T-2 and HT-2 toxins, T-2 triol, T-2 tetraol, aflatoxins B1, B2, G1, G2, ochratoxin A (OCHRA A), zearalenone and sterigmatocystin. One sample (1988 harvest) was contaminated with OCHRA A (0.04 microgram/g) and three other samples (1990 harvest) were contaminated with DON (0.40 microgram/g), DAS (0.30 microgram/g), T-2 (two samples, 0.35 and 0.36 gamma g/g) and T-2 tetraol (1.68 micrograms/g). Fusarium graminearum Schwabe was found in the 1990 samples with a relative incidence ranging from 1 to 22% and predominated in Argentinian and Uruguayan wheat (1990 harvest). Fusarium dimerum Penzig (8-75%) was the main Fusarium sp. in Brazilian wheat from the 1990 harvest.

Survey of aflatoxins, ochratoxin A, zearalenone, and sterigmatocystin in some Brazilian foods by using multi-toxin thin-layer chromatographic method

A previously published method for ochratoxin A was evaluated and proved appropriate for simultaneous determination of aflatoxins, ochratoxin A, sterigmatocystin, and zearalenone, with considerable savings in time and reagent costs. The detection limits were 2, 5, 15, and 55 micrograms/kg, respectively. The recoveries and coefficients of variation obtained with artificially contaminated samples were 91-101% and 0-16% for aflatoxin B1, 98-117% and 0-17% for sterigmatocystin, and 96-107% and 0-17% for zearalenone, respectively. The coefficients of variation for naturally contaminated samples (aflatoxins in rice and ochratoxin A in beans) ranged from 0 to 8%. The method was used to survey 296 samples that included 10 cultivars of dried beans, 8 types of corn products, 3 types of cassava flour, and both polished and parboiled rice between May 1985 and June 1986 in Campinas, Brazil. Only aflatoxin B1 (9 samples, 20-52 micrograms/kg), aflatoxin G1 (4 samples, 18-31 micrograms/kg), and ochratoxin A (5 samples, 32-160 micrograms/kg) were found. The average contamination percentage was 4.7%; beans showed the highest (6.6%) and rice showed the lowest (3.3%) incidence rates. Zearalenone and sterigmatocystin were not detected. Positive samples were confirmed by chemical derivatization, corroborated by development in 3 solvent systems.