Third generation cognitive-behavioral therapies for major depressive disorder- a literature review

Introduction

Cognitive behavioral therapies (CBT) represent a heterogeneous group of psychotherapies in continuous development that share a directive, structured, collaborative approach. Due to a high degree of treatment-resistant cases of major depressive disorder (MDD), new augmentation therapies are urgently needed, in order to increase the chance of recovery in these patients.

Objectives

To analyze data that may support the indication of third wave CBT in patients with MDD.

Methods

A literature search was performed in the main electronic databases, and papers published between January 2000 and August 2020 were included.

Results

Acceptance and commitment therapy has been associated with positive results, but data are derived from low quality trials (n=2). Dialectical-behavioral therapy (DBT)-based skill group have been also associated with favorable outcome, in MDD patients (n=2). Mindfulness-based cognitive therapy (MBCT) was also proven effective in the treatment in MDD (n=4), treatment-resistant MDD included, but the difference between MBCT and active comparators was not always significant. Metacognitive therapy (MCT) has been evaluated in good quality clinical trials (n=4), and its efficacy was confirmed. Mild and moderate MDD patients may benefit from compassion-focused therapy (CFT) (n=1). Behavioral activation (BA) is dedicated to MDD patients and according to a meta-analysis (n=26 randomized controlled trials) BA is superior to other active comparators, although the quality of clinical trials was modest.

Conclusions

Third generation CBT could be useful in MDD patients as augmentative strategy, but more good-quality data are necessary before recommending them in an evidence-based treatment guideline as a distinctive intervention from classical CBT.

Psychotherapies for neurocognitive disorder due to alzheimer’s disease- the current level of evidence

Introduction

Psychosocial interventions for Alzheimer’s dementia (AD) may increase patients quality of life and overall functioning, while it decreases caregivers burden. Therefore psychotherapies represent an important component of the case management, beside pharmacological approaches.

Objectives

To review the current psychotherapeutic options available for patients diagnosed with AD, that may be added to their ongoing pharmacological treatment.

Methods

A literature review was conducted through main electronic databases, and papers published between January 2000 and August 2020 were included in the analysis.

Results

Cognitive stimulation therapy is based on general cognitive abilities training, with an accent over the social interaction, and it has been associated with significant improvement when compared to wait list or standard care. Reminiscence therapy, usually administered in a group format, focuses on past experinces, triggered by photos, newspaper fragments, music tunes etc., and according to a meta-analysis it may increase communicational, cognitive, and affective abilities. Validation therapy is based on a very empathic communication and tries to acknowledge patients perspective over the world, but the data to support its efficacy is limited for AD. Multisensorial stimulation is based on the assumption that stimuli deprivation is involved in the onset of anxiety, restlessness, insomnia etc, and may lead to short-term non-cognitive symptoms. Music therapy, art therapy, and animal-assisted therapy are also indicated, but more trials are needed to confirm their efficacy.

Conclusions

A large number of psychotherapeutic interventions are explored for AD patients, but most of them have low levels of evidence.

Studies concerning some acute biological changes after endovenous administration of 1 g l-carnitine, in elite athletes

Acute effects of l-carnitine (vials of 1 g endovenous) were recorded in a group of elite athletes (17 swimmers) by a prospective double-blind placebo-controlled trial and cross over. Significant changes were registered after l-carnitine injection, compared to placebo, for FFA, triglycerides, lactic acid after exercise, evoked muscular potential, 90 to 120 minutes after injection. The authors explain these changes by the increase of free carnitine, which permits a larger quantity of FFA to enter the mitochondria and to be more extensively used as energy source.

[Epidemiological investigations among the viral hepatitis contact in a close children collectivity]

The results of the clinico-epidemiological and laboratory (TGP, tymol and HBsAg) investigations carried out in 164 contacts of an icteric case of viral hepatitis from a creche type children collectivity are presented. A wide spread of the infection, expressed by subclinical forms of disease identified on the basis of the alterations of TGP and their dynamics (27.4%) was pointed out. The increased incidence of HBsAg carriers and the correlation with the TGP increased values allowed the conclusion that the infection was caused by the hepatitis virus type B. The epidemiological investigation established that the infection was transmitted by direct contact favoured by children's close physical contact.

Treatment of temporo-mandibular ankylosis with particular reference to the interposition of full-thickness skin autotransplant

In the treatment of the temporo-mandibular ankylosis, the maintainance of separation between the temporal and mandibular raw surfaces, after osteotomy of the bony fusion, constitutes the key to the prevention of recurrence; the great potential of bone to reform is acknowledged by all those who are experienced in this problem. Analysing 168 temporo-mandibular arthoplasties in which different methods have been used in order to maintain the newly created joint space, the causes of failures have been brought out and the difficulties studied. The conclusion is reached that the best results were obtained by the interposition of autogenous full thickness skin. The surgical technique is briefly presented as well as the records regarding the cases followed-up for a period of 2 to 19 years, illustrating the anatomical and functional conservation of the new joints. The experimental investigations concerning the behaviour and fate of the buried skin autotransplants complete the clinical studies, proving the qualities and the value of full thickness skin as an interposition material in arthroplasties.

Enteroviral etiology of some epidemic outbreaks in a zone of Romania

The authors describe three enterovirus epidemics: an outbreak of Coxsackie B1 epidemic myalgia, one of echovirus 4 meningitis and one of epidemic vomiting and diarrhea caused by Coxsackie A9 virus. Etiological diagnosis was established by virological and serological tests.

Vertical osteotomy of the ascending rami in mandibular retrognathism

The authors present their experience and conclusions regarding surgical lengthening of the mandible in retrognathism due to bone hypo-development. Thus, in hypotrophies of the ascending ramus, especially in temporo-mandibular ankylosis, they use a longitudinal osteotomy (Popescu 1949); various technical adaptations of this method, in different situations, are described, as well as their association with osteoplasty, utilizing iliac bone grafts or the hypertrophic chin prominence. In retrognathism due to hypo-development of the mandible, when the ascending rami have a good conformation, sagittal osteotomy (Obwegeser 1957, Dal Pont 1961) is preferred.