| 1. |
- Bergström, Jan, 1976-, et al.
(författare)
-
An open study of the effectiveness of Internet treatment for panic disorder delivered in a psychiatric setting
- 2009
-
Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 63:1, s. 44-50
-
Tidskriftsartikel (refereegranskat)abstract
- Panic Disorder with or without or without agoraphobia (PD/A) is common and can be treated effectively with SSRI medication or cognitive behavior therapy (CBT). There is however a great lack of access to CBT services, which has motivated the development of self-help approaches requiring less therapist contact. A novel treatment modality in this field, showing efficacy in several randomised trials but until now not evaluated within the context of regular psychiatric care, is Internet-based treatment. The present study evaluated the effectiveness of Internet-based CBT for 20 consecutively referred PD patients in a psychiatric setting. At post-treatment, 94% of patients no longer met DSM-IV criteria for PD (82% at 6-month follow up). The within-group effect sizes (for the main outcome PDSS; Panic Disorder Severity Scale) were Cohens d=2.5 (pre- to posttreatment) and 2.8 (pre-treatment to follow up) respectively. The proportion of responders on the PDSS was 75% at posttreatment and 70% at 6-month follow up. These results indicate that Internet-based CBT can be both an effective, feasible and potentially cost-effective alternative within regular psychiatric care for patients with PD.
|
|
| 2. |
- Rück, Andreas
(författare)
-
Myocardial gene therapy and gene expression in angina pectoris
- 2006
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Angiogenesis does not fully counteract myocardial ischemia in stable angina pectoris. Refractory angina pectoris, with remaining symptoms despite medication and no possibility for bypass surgery or angioplasty, is rather common. Angiogenic gene therapy is a novel treatment strategy for these patients. Methods and results: In study I, six patients with refractory angina received intramyocardial injections of 0.25-1 mg plasmid encoding Vascular Endothelial Growth Factor (phVEGF-A165) via thoracotomy. The peak systolic velocity improved in all six patients but perioperative myocardial infarction occurred in two patients. Study II was a double-blind randomised controlled trial of the same plasmid or placebo plasmid (0.5 mg), delivered via a percutaneous catheter system in 80 patients with refractory angina. Reversible perfusion defects and wall motion improved in the phVEGF-A165-treated area compared to placebo. Nitroglycerin use tended to decrease with active treatment while symptom class and exercise capacity showed no effect beyond placebo. Five catheter-related adverse events occurred but no adverse effects were related to the plasmid. In study III, the prognosis of refractory angina was assessed in all 225 patients screened for study II. The mortality was 10.6% at three years. The baseline screening angiogram found revascularisation options in 10% of patients, although previous examinations had ruled out such possibilities. After twelve months, 36% of the trial patients had improved by at least two symptom classes and 37% had increased their exercise time by at least 60 seconds, with no difference between placebo and active groups. In study IV-V, the gene expression pattern in a reversibly ischemic myocardial area was compared to a normal area in eight patients with stable angina pectoris. Real-time polymerase chain reaction showed increased expression of ANP and BNP but not of VEGF and VEGF receptor 1 and 2 in reversibly ischemic myocardium. In microarray measurements, 15 additional known angiogenesis stimulators lacked differential expression. Instead, we found increased expression of several other genes with potential angiogenic, angiogenesis inhibiting, anti-apoptotic and muscle-related function but with yet unknown role in the myocardium. Conclusions: Intramyocardial phVEGF-A165 is safe and increases myocardial perfusion in patients with stable angina pectoris. The effect on symptoms should be tested in a larger trial. Patients with refractory angina pectoris have a rather low mortality and symptomatic improvement is common. Overexpressing VEGF (or other angiogenic factors) seems a rational strategy, as most angiogenesis stimulators not are overexpressed in ischemic myocardium in stable angina. The ischemia-related overexpression of ANP, BNP and other genes with a probable anti-angiogenic function might be a limiting factor in angiogenesis.
|
|
| 3. |
- Ruck, Christian, et al.
(författare)
-
Capsulotomy for Obsessive-Compulsive Disorder : long term follow up of 25 patients
- 2008
-
Ingår i: Archives of General Psychiatry. - : American Medical Association (AMA). - 0003-990X .- 1538-3636. ; 65:8, s. 914-922
-
Tidskriftsartikel (refereegranskat)abstract
- Abstract Context: Capsulotomy is sometimes used as a treatment of last resort in severe and treatment refractory cases of Obsessive-Compulsive Disorder (OCD). Objective: To evaluate the long-term efficacy and safety of capsulotomy in OCD. Design: Non-controlled long-term follow-up trial (mean 10.9 years after surgery). Setting: University hospital referral center. Patients: 25 consecutive OCD patients having undergone capsulotomy between the years 1988 and 2000. Intervention: Unilateral or bilateral capsulotomy. Lesions were created either by conventional heating or by gamma-radiation (radiosurgery). Main Outcome Measure: Yale-Brown Obsessive-Compulsive Rating Scale (Y-BOCS). Results: Mean Y-BOCS was 34 preoperatively and dropped to 18 at long-term follow-up (p<0.0001). Response (defined as ≥ 35 % reduction at long-term compared to baseline) was seen in 12 patients at long-term. Eight patients were in remission (Y-BOCS < 16) at long-term follow-up. Response rates did not differ between surgical method. A mean weight gain of 6 kg was reported in the first postoperative year. Ten patients were considered to sufferer from significant problems in the area of executive functioning, apathy or disinhibition. Six of these ten patients had either had high doses of radiation or multiple surgical procedures. Our MRI analysis of 11 patients suggests that the OCD symptom reduction may be increased by reducing the lateral extension of the lesions, and a reduction in the medial and posterior extension may limit the risk of side effects, that is, smaller lesions may produce better results. Conclusions: Capsulotomy is effective in reducing OCD symptoms. There is a substantial risk of side effects and the risk may vary between surgical methods. Our findings suggest that smaller lesions are safer and that high radiation doses and multiple procedures should be avoided.
|
|
